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Little is known about the association between neighborhood social disorganization and coronary heart disease (CHD). This study used the theoretical frameworks of the Chicago school and the Stirling County group in order to analyze the impact of neighborhood violent crime and neighborhood unemployment on CHD in an urban setting, the capital of Sweden. The entire population of Stockholm County aged 35-64 years on January 1, 1998 was included in the study. All individuals were followed for CHD until December 31, 1998. Small area neighborhood units were used to define neighborhoods. The neighborhood-level variables were calculated as rates of violent crime or unemployment in the small area neighborhood units, categorized in quintiles. Multilevel logistic regression was used to estimate odds ratios and neighborhood-level variance in three different models. When rates of neighborhood violent crime or neighborhood unemployment increased, the risk of CHD increased among both women and men. In neighborhoods with the highest rates of violent crime (quintile 5), the odds ratios were 1.75 (CI = 1.37-2.22) and 1.39 (CI = 1.1%1.63) for women and men, respectively. In neighborhoods with the highest unemployment rates, the corresponding odds ratios were 2.05 (CI = 1.62 2.59) and 1.50 (CI = 1.28 1.75). These average neighborhood effects on CHD (fixed effects) remained almost unaltered after inclusion of the individual-level variables. The neighborhood-level variance indicated significant differences in CHD between neighborhoods, and the neighborhood-level and individual-level variables partly explained the variance between neighborhoods (random effects). Public safety and social stability in socially disorganized neighborhoods need to be improved in order to promote cardiovascular health. Keywords: Coronary heart disease: Chicago school: Neighborhood violent crime: Neighborhood unemployment; Multilevel models; Sweden

This study investigated the association between the recently minted concept of linking social capital and incidence of coronary heart disease (CHD). A follow-up study of 1,358,932 men and 1,446,747 women in Sweden aged 45-74 years was conducted between 1 January 1998 and 31 December 1999. Neighbourhood linking social capital was conceptualised as proportions of individuals voting in local government elections at neighbourhood level. The neighbourhood- and individual-level factors were analysed within a multilevel framework. Linking social capital was associated with CHD in both men and women beyond individual-level factors: in neighbourhoods with low linking social capital the odds ratios were 1.19 (CI = 1.14-1.24) and 1.29 (CI = 1.21-1.38) for men and women, respectively, after adjustment for age, country of birth, education, marital status, and housing tenure. The significant between-neighbourhood variance (i.e. the random intercept) showed significant differences in CHD incidence between neighbourhoods. Even in a relatively egalitarian society, as exemplified by the Swedish Welfare State, individual health is affected by differences between neighbourhoods in linking social capital. The use of linking social capital represents a novel conceptual advance in research on the association between CHD, one of the major causes of death in Western countries, and the multidimensional aspects of social capital. Keywords: Sweden; Linking social capital; Coronary heart disease; Incidence; Multilevel analyses

Few studies have examined the relationship between social, cultural and religious participation, political empowerment and coronary heart disease (CHD). The aim of this study was to examine whether low social participation, as described in a social participation index, predicted incidence rates of CHD. This is a follow-up study, from 1990-91 to 31 December 2000, of 6861 Swedish women and men, who were interviewed about their social participation, education, housing tenure and smoking habits. A social participation index was constructed, based on 18 variables from the survey. The outcome measure was CHD morbidity and mortality. Respondents with a CHD incident from 1986 until interview were excluded from the study. Data were analysed using Cox' regression and the results are presented as hazard ratios (HR) with 95% confidence intervals (CI). In the sex- and age-adjusted model there was a gradient between the social participation index and CHD, so that persons with low social participation had the highest risk of CHD with HR-2.15; CI= 1.57-2.94, followed by HR= 1.67; CI= 1.23-2.27 for those with middle social participation. In the full model, when education, housing tenure and smoking habits were included, the increased risk of CHD for persons with low social participation remained high, with HR 1.69, CI= 1.21 2.37. We conclude that persons with low social participation in the social participation index exhibited an increased risk of CHD that remained after adjustment for education, housing tenure and smoking habits. Keywords: Social capital; Social participation; Coronary heart disease; Sweden

There is scant knowledge of the effects of country of birth on the health of individuals in the years prior to and after retirement. The aim of this study was to consider country of birth in relation to health status, instrumental activities of daily living (IADL) and all-cause mortality when adjusted for socioeconomic status (SES). Cross-sectional data were collected between 1986 and 1991 on 8959 individuals between the ages of 55 and 74. Self-reported data were analysed using a logistic regression model while the mortality data were analysed by means of a proportional hazard model. In the present study, immigrants from Southern Europe, Eastern Europe and Finland carried significantly increased risks of poor health even after adjustment for SES. Southern Europeans, refugees from Developing countries and Finns exhibited an increased risk of impaired IADL compared to Swedes, even after adjustment for SES. In conclusion, country of birth was associated with poor health status and impaired IADL. This association remained after adjustment for SES. In accordance with pre-study expectations, mortality was predicted by impaired IADL and male gender. Country of birth was not associated with all-cause mortality. Keywords: Country of birth; Elderly; Self-rated health; IADL; Education; Mortality; Sweden

Although our knowledge of the relationship between migration and health in women is increasing, we still have a limited knowledge of the migration and health of women of reproductive age. A cross-sectional analysis of a simple random sample of 10,661 women aged 20-49 in Sweden in 1980-1985 and 9585 such women in 1992-1997 was carried out to assess their health. The risk factors for self-reported, poor health and psychosomatic complaints for female refugees and women from Finland, Southern Europe, Western countries and Sweden were examined. Country of birth was a significant risk factor for poor self-reported health and psychosomatic complaints, with women from Southern Europe, female refugees and Finnish women being at higher risk in this respect than Swedish women. The increased risk remained significant after adjustment for demographic and socio-economic factors. Swedish-born women, female refugees, and Finnish women reported poorer health and had more psychosomatic complaints (not Finns) in the 1990s than in the 1980s. Keywords: Self-reported health; Psychosomatic complaints; Migration status; Migration; Sweden

Objective: To investigate the long-term effects of the consumption of alcohol on mortality and morbidity. Method: A sample of 32,185 (50.5% female) individuals was randomly selected from the 450,000 inhabitants of Stockholm County, Sweden, in 1969. Alcohol consumption data were obtained from postal questionnaires; response rate was 87% (n = 28,001). Data on mortality and morbidity were obtained from the National Cause of Death Register, the Cancer Register and the Inpatient Register 1971-1996. Results: The reference groups were moderate consumers of alcoholic beverages. High-consumption men had increased risks of mortality from cardiovascular diseases (relative risk ratio [RR] = 1.28; 95% confidence interval [CI]: 1.12-1.46), accidents or poisoning (RR = 2.10; CI: 1.67-2.65) and gastrointestinal diseases (RR = 4.65; CI: 2.93-7.36). High-consumption women had an increased risk of mortality only from accidents or poisoning (RR = 2.95; CI: 1.82-4.78) and gastrointestinal diseases (RR = 3.60; CI: 1.40-9.24). For low-consumption women, there was an increased risk of mortality from cardiovascular diseases (RR = 1.25; CI: 1.07-1.47). Low-consumption men also had an increased mortality from cardiovascular diseases (RR = 1.23; CI: 1.05-1.44). The results with respect to morbidity almost mirrored the results for mortality, with one exception; for low-consumption men, the morbidity from cardiovascular diseases was not increased. Conclusions: The mortality and morbidity associated with different levels of alcohol consumption are associated with the same diseases, which suggests that alcohol may be one of the causative factors for these diseases. The reasons for the differences between genders, regarding responses to the negative effects of alcohol consumption, are still unknown. (d. Stud. Alcohol 62: 783-789, 2001), AN ASSOCIATION between alcohol consumption and decreased mortality rate has been demonstrated for moderate consumers of alcohol (Poikolainen, 1995; Thun et al., 1997). This effect is largely due to a [...]

This study shows the influence on self-reported health of ethnicity, operationalised as Swedes and foreign-born people from Finland, Western countries (Western Europe - except for Finland and South Europe - the United States, Canada, Australia, New Zealand and Japan), South Europe and all other countries (East Europe and non-European, non-Western countries). A simple random sample of 23,864 Swedes and foreign-born people were interviewed in 1980-1981 and 1988-1989 by Statistics Sweden. In successive models starting with only ethnicity and age, one variable at a time was included in the two main models, one with material and economic factors and another with lifestyle factors as independent variables, in order to study how the importance of ethnicity changed. The age-adjusted relations between male and female Finns and severe long-term illness were reduced from an odds ratio of 2.37 and 1.86, respectively, to 1.90 and 1.70 after including educational status, marital status, exercise, smoking, and body mass index in the final model. The high odds ratios for males and females born in South Europe or born in non-Western countries decreased with the inclusion of lifestyle factors but were still high 2.26 and 2.50 in South Europeans and 1.94 and 1.81 in non-Westerners. Males and females born in Finland, South Europe or in non-Western countries had high odds ratios for severe long-term illness when education, material standard, economic resources, leisure opportunities and social network were simultaneously controlled for. People born in Western countries showed no association to limiting long-term illness. The conclusion of the present study is that ethnicity, defined as foreign-born people, was strongly associated with limiting long-term illness when controlling for social, material and lifestyle factors. Key words - Sweden, long-term illness, ethnicity

The increasing number of immigrants in Sweden during the past four decades has brought the health of ethnic groups into focus. The purpose of this study was to analyse the influence of ethnicity, age, sex, marital status and date of immigration on suicide rates. The study population consisted of all individuals over 15 years of age, N = 6,725,274, from the Swedish census of 1985 and is based on individual data. Suicides and undetermined deaths, during the follow-up period 1986-1989, were taken from the central Cause of Death Register. Ethnicity, defined as being foreign-born, was a risk factor for suicide for both men and women with risk ratios of 1.21 (1.11-1.31) and 1.36 (1.21-1.53), respectively, with control for age and marital status. Being unmarried was also a risk factor for both males and females with risk ratios from 1.26 to 5.55 in different age groups. The highest risk ratios for suicide in Sweden, adjusted for age, were found among males born in Russia and Finland. They also showed higher suicide risks than in their countries of birth. Females born in Hungary, Russia, Finland and Poland all had high risks of committing suicide in Sweden, and they also had higher risks than in their countries of birth. Further, being of male sex, aged 45-54 or 75 and older, and born in Eastern Europe or Finland were significant risk factors for suicide. The same was true for those who had immigrated to Sweden in 1967 or earlier and were born in Finland, Eastern Europe or in non-European countries. These findings are of great importance for primary health care and psychiatric care planning. Key words - ethnicity, suicide

Seven male tank truck drivers were followed for about 3 h during ordinary work. They rated the perception of heavy work operations on Borg's CR-10 scale. The heart rates were monitored every minute. The hose was pulled out an average of 22.3 m and the corresponding mean rating was 3.2, a little above 'Moderate' on the CR-10 scale. The heart rate averaged 137 beats/min at the end of this operation. When transforming the physiological parameter heart rate to a subjective strain intensity, surprisingly high agreement was obtained between the results from the field study and the predicted ratings. By transforming ordinally scaled data from another study to a scale with ratio properties, the results could be compared with this study. Good agreement was found between the variables.

This paper discusses coefficient of dynamic friction Mu(sub k), and perceived discomfort for differently textured surfaces when touched by a normal hand, a 'sweaty' hand and a hand contaminated with glycerol, paraffin oil or lard. Fourteen male subjects applied forces of 1, 10 or 20 N using the index finger of the dominant hand while striking across a specimen of the same polycarbonate material with 100, 75, 50 or 25% skin-contact area (by ridges). Surface pressures in the range 6-288 kPa were recorded. Generally there was a very low correlation between Mu(sub k) and perceived discomfort. Wider grooves and increased normal forces were associated with discomfort but did not necessarily provide more friction. Unlike most materials, palmar skin showed sticky characteristics and Mu(sub k) frequently exceeded 1.0 when the surface loads were low. The coefficient of friction on palmar skin decreased with increasing surface loads. A considerable reduction of Mu(sub k) was noticed when the normal force increased. A 20-fold increase in normal force from 1 to 20 N (an increase in surface load from 6.3 to 81.4 kPa) resulted in only an eight-fold increase in frictional force while Mu(sub k) dropped from 2.22 to 0.85. A decrease was noticed for all tested surfaces and during all tested environmental conditions; however, increased normal force increased the perceived discomfort. A 25-50% increase in coefficient of friction could be gained under contaminated conditions using two out of four fairly similar textures. Grooves in surfaces reduced Mu(sub k) under normal and sweaty conditions, but improved Mu(sub k) when contaminants were present. Patterns with a large skin-contact area showed either a high or a low coefficient of friction depending on the environmental conditions. A plain, glossy, non-textured surface of polycarbonate under normal skin conditions yielded Mu(sub k) = 2.22 when the surface pressure was low (6 kPa). When the skin was exposed to paraffin oil, Mu(sub k) dropped drastically to 0.28. Oil and lard reduced Mu(sub k), but sweat increased it in relation to a normal hand. Wider grooves in the texture provide friction during contaminated conditions at the price of discomfort.

Background Many older adults are physically inactive and inactivity increases with age. This knowledge comes from cross-sectional studies. Cross-sectional studies may miss important trajectories within the older adults as a result of retirements, and poor health impact of promotional efforts. The aim of this study was to analyse, longitudinally, the annual effects of age group and birth cohort on self-reported regular exercise in the Swedish population aged 53-84 years during a 16-year period, for each sex separately. Methods A random sample of non-institutionalized persons was interviewed three times from 1988 to 2004 by professional interviewers. In addition to three time-related variables - year of interview, age at the time of the interview, and year of birth - we included the following explanatory variables in the analyses: educational level, body mass index, smoking, and selfreported health status. The data were analysed by a mixed model with a random intercept. Results The total prevalence of self-reported regular exercise increased between 1988/89 and 2004/05 among both men and women, from 27.1 to 43.1% and from 21.1 to 41.1%, respectively. There was a mean annual change in all age-groups in exercise of between 0.76 and 1.24% among men and between 0.86 and 1.38% among women. Low prevalence of self-reported regular exercise was associated with low educational level, obesity, smoking, and poor selfreported health, although those with poor self-reported health the greatest increase of physical activity. Conclusions There was a steady, albeit inadequate, increase in self-reported regular exercise in older adults between 1988 and 2004. Physical activity promotion in older adults should be of high priority for both primary and secondary prevention of diseases, especially among groups with known risk factors for low levels of exercise. [ABSTRACT FROM AUTHOR]

Objective. Increasing global migration has led to profound demographic changes in most industrialised countries. A growing body of research has investigated various health aspects among immigrant groups and found that some immigrant groups have poorer health than the majority population. It has been suggested that poor acculturation in the host country could lie behind the increased risk of worsened health among certain immigrant groups. The aim was to investigate the cross-sectional association between acculturation, measured as age at migration or length of residence, and self-rated health among young immigrants. Design. The simple, random samples of 7137 women and 7415 men aged 16-34 years were based on pooled, independent data collected during the period 1992-1999 obtained from the Swedish Annual Level of Living Survey (SALLS). Logistic regression was applied in the estimation of odds ratios (OR) for poor self-rated health, after accounting for age, sex, socioeconomic status (SES) and social networks. The non-response rate varied between 23.6 and 28.3% in the different immigrant groups. Results. The odds of poor self-rated health increased with increasing age at migration to Sweden among first-generation immigrants. For those who had resided in Sweden less than 15 years the odds of poor self-rated health were significantly increased. In addition, most of the immigrant groups had higher odds of poor self-rated health than the reference group. Conclusions. Health care workers and policy makers need to be aware that immigrants who arrive in the host country at higher ages and/or have lived in the host country for a shorter period of time might need special attention as they are more likely to suffer from poor self-rated health, a valid health status indicator that can be used in population health monitoring. [ABSTRACT FROM AUTHOR]

Background: Although elderly Iranian immigrants in Sweden are the largest elderly group born outside Europe, little is known about their health-related quality of life (HRQL). The aim of this study was to examine the association between migration status and HRQL in a comparison of elderly Iranians in Iran, elderly Iranian immigrants in Sweden, and elderly Swedes in Sweden. Methods: The Short Form Health Survey (SF-36) was administered to a total of 625 men and women aged 60-84 years to collect HRQL information on elderly Iranians in Sweden (n = 176) and elderly Iranians in Iran (n = 298). A Swedish control group (n = 151) was also randomly selected from the general population. Multiple linear regression procedures were applied to analyze data while adjusting for age, which was categorized into 60-69, and 70-84 years, and education. Results: Iranian women in Sweden with shorter times of residence scored lower on vitality (β-coefficient = -7.9, 95% CI = -14.3 to -1.5) compared with other women in this study. The lower vitality dimension score remained nearly unchanged in the main model (β-coefficient = -7.3, 95% CI = -13.7 to -0.9). A longer period of residence in Sweden had a positive association with social functioning (β-coefficient = 14.1, 95% CI = 3.1-25.1) and role limitation due to emotional problems (β-coefficient = 18.3, 95% CI = 1.4-35.2) among elderly Iranian women. In general, the Swedish subsample scores higher on all dimensions of the SF-36 among women and in six out of eight among men in relation to the rest of the subsamples. Conclusion: The HRQL of elderly Iranians in Sweden was more like that of their countrymen in Iran than that of Swedes, who reported a better HRQL than Iranians in this study. However, length of time since migration to Sweden is not associated with poorer HRQL among elderly Iranians. The association varied, however, with sex. Elderly Iranian women showed an increase in two of eight dimensions of the SF-36 with additional years in Sweden, whereas, among elderly Iranian men, additional years in Sweden were not associated with HRQL. [ABSTRACT FROM AUTHOR]

Aim : Research on the east–west health divide has provided extensive evidence of poorer health in Eastern Europe and the former Soviet Union than in Western Europe. This study focuses on immigrants from Eastern to Western Europe and analyses whether they have an increased risk of self-reported poor health compared with the host population and what determines that. Methods : This cross-sectional study is based on 373 immigrants from Poland, other East European countries, and the former Soviet Union, aged 25–84, who arrived in Sweden after 1944 and were interviewed during 1993–2000 along with their 35,711 Swedish counterparts. Results : Age- and sex-adjusted unconditional logistic regression showed in general a 92% higher risk of reporting poor health among immigrants than among Swedish-born respondents. The risk also persisted after adjustment for several potential confounders (living singly, having a poor social network, low socioeconomic status, and smoking) and after an additional adjustment for acculturation (language at home), and years in Sweden. Conclusions : Being born in Eastern Europe or the former Soviet Union was an independent risk factor for reporting poor health. It is therefore suggested that it is important for primary and public care services to be aware of the health status and needs of immigrants from these countries. [ABSTRACT FROM AUTHOR]

Few studies have investigated mental health among second-generation immigrants who have reached adulthood. The aim of this study was to examine whether second-generation adult immigrants have a higher risk of being hospitalised for mental disorders than the Swedish majority population after adjustment for socio-economic status. In total 1.9 million Swedish-born women and men aged 16–34 were followed from 1 January 1995 to 31 December 1998 for first hospital admissions for mental disorders, categorised in four main diagnosis groups. Second-generation immigrants comprised four groups and the Swedish majority population was used as reference group. Cox proportional hazard models were used to analyse the data. Second-generation immigrants with one parent born in Sweden and second-generation Finns had higher risks of being hospitalised for psychotic disorders, affective disorders, neurotic disorders, and personality disorders than the Swedish majority population. For second-generation Finns the age- and sex-adjusted hazard ratio for psychotic disorders was 2.42 (CI?=?2.09–2.80). No significant hazard ratios were found for second-generation labour immigrants. For second-generation refugees the risk of being hospitalised was higher than for the Swedish majority population but only for psychotic disorders. All results remained significant and decreased only slightly after adjustment for income and education. Many groups of second-generation immigrants have a higher risk of being hospitalised for mental disorder than the majority population. With increasing global migration it is crucial for all industrialised countries to take measures to improve mental health among second-generation immigrants. [ABSTRACT FROM AUTHOR]

Despite results linking shift work with ill health, only a few studies have addressed its relation with mortality. The purpose of the present study was to examine the hypothesis that shift work is a predictor of mortality. The study involved a sample of 22,411 individuals of the Swedish population. Data were obtained through annual phone interviews done between 1979 and 2000. Cox regression analysis was used to assess the association between shift work/day work as the independent variable and death/survival during the subsequent years as the dependent variable. Separate analyses were carried out for female and male white- and blue-collar workers, respectively. The results were adjusted for age, stress, physical work load, disease at the outset of the study, and smoking. Mortality was significantly increased for female white-collar workers, with a Hazard Ratio of 2.61 and a 95% confidence interval of 1.26–5.41. No other significant effects were found. It is concluded that blue-collar shift work is not related to mortality, but that risk of death is increased for women white-collar shift workers compared to women white-collar day workers. [ABSTRACT FROM AUTHOR]

Presents a study that assessed the risk of limiting long-standing illness (LLSI) among migrant women of reproductive age. Method used to determine the risk of LLSI; Comparison between the exposure of risk between immigrant women who came from first and second generation; Relationship between socio-economic status and health.

The purpose of this study was to assess how changes in the habit of attending cultural events in the community might predict self-reported health. This study made use of data based on two interviews, 8 rears apart, with 3793 adults aged 25-74 years from a simple random sample of the Swedish population. The subjects were interviewed in 1982-1983 and re-interviewed using the same questionnaire in 1990-1991. The setting was a Swedish interview survey of living conditions comprising a random sample of the adult population. Self-reported health status was the main outcome measure. The variables used for control purposes were baseline health status according to the survey of 1982-1983. age (at baseline), type of residence, geographical region of domicile, and socio-economic status (level of education). A correlation was found between perceived poor health and all the independent variables, as well as an influence in the expected direction for all of them; poor education, increasing age and a low degree of urbanization all predicted poorer perceived health, in the full model (including all nine independent variables), those who became culturally less active between the first and second occasion, or those who were culturally inactive on both occasions, ran a 65% excess risk of impaired perceived health compared with those who were culturally active on both occasions Furthermore, those who changed from being culturally less active to being more active had about the same level of perceived risk as those active on both occasions. These results could be in agreement with a causal influence of stimulation and suggest that cultural stimulation is a 'perishable commodity'. While recruiting new consumers would in that case promote health, continued frequent replenishment of the cultural stimulation may be just as important. [ABSTRACT FROM AUTHOR]