Search

Purpose: The incidence of gestational diabetes among Chinese women is 4.3%. No study has previously been conducted about beliefs and health-related behavior among urban Chinese women with this disease. This article aims to explore beliefs about health and illness and health-related behavior among women in this group in a Chinese sociocultural context. Design: A qualitative exploratory study was conducted and semistructured individual interviews (n = 15) were processed by content analysis. Results: Beliefs about health and illness among these women were foremost attributed to the individual, social, and natural worlds. They feared the negative influence of gestational diabetes, but some of them believed in “letting nature take its course” and “living in the present.” Their care-seeking behavior varied between the professional, popular, and folk sectors. They sought a balance between following professionals’ advice and avoiding practical difficulties. Conclusion: The beliefs and health-related behavior among them were influenced by Chinese culture, which can sometimes but not always reduce the effect of the disease.

Introduction: health-care seeking behaviour is important as it determines acceptance of health care and outcomes of chronic conditions but it has been investigated to a limited extent among persons with diabetes in developing countries. The purpose of the study was to describe health-care seeking behaviour and understand reasons for using therapies offered by traditional healers. Methods: descriptive study using focus-group interviews. Three purposive focus-groups were conducted in 2011 of 10 women and 7 men aged 39–72 years in Uganda. Data were collected through semi-structured interviews and qualitatively analysed according to a method described for focus-groups. Results: reasons for seeking help from traditional healers were symptoms related to diabetes such as polydipsia, fatigue and decreased sensitivity in lower limbs. Failure of effect from western medicine was also reported. Treatment was described to be unknown extracts, of locally made products taken as herbs or food, and participants had sought help from different health facilities with the help of relatives and friends. Conclusion: the pattern of seeking care was inconsistent, with a switch between different health care providers under the influence of the popular and folk sectors. Despite beliefs in using different healthcare providers seeking complementary and alternative medicine, participants still experienced many physical health problems related to diabetes complications. Health professionals need to be aware of the risk of switches between different health care providers, and develop strategies to initiate health promotion interventions to include in the care actors of significance to the patient from the popular, folk and professional sectors, to maintain continuity of effective diabetes care.

Our premise for this literature review is the global demographic change caused by the world’s population living longer and becoming older, and extensive international migration leading to multicultural societies. Increasing age leads to health problems, often long-term or chronic, requiring investments in health care. Worse health and dissimilarities in pattern of morbidity/ mortality have been found in foreign-compared to Swedish-born persons, so it is reasonable to assume that this affects use of health care. The exploratory review focuses on elderly migrants’ (>65 years) use of healthcare. The databases Pub Med, EBSCO, CINAHL and ERIC were searched in 2000-2013. A limited number of studies were found; few had a comparative approach, most were from the USA, and focused on migrants from the former Soviet Union or countries in South-East Asia. A range of factors were identified that influence patterns of health care use: language fluency, ability to communicate, self-reported health status, prevalence of chronic disease, physical distance from care provision, availability of transport to reach care, cost of care, the health insurance system, cultural norms and values regarding different forms of care, level of education, and length of residence in the host country. Most studies treated health care from a general perspective and collected data from community and hospital settings, without analysing usage separately. Some studies indicated elderly migrants making use of health care less than other groups but the pattern is not unambiguous: other studies show that there is an overuse of health care. It is therefore difficult to show any particular pattern, or possible differences in use, regarding community versus in-patient care. Studies focusing on migrants’ actual use of health care are few and further research is needed, especially because elderly people form the largest group of users of health care and will be even larger in the future.

BACKGROUND: Good communication is an important prerequisite for equal treatment in a healthcare encounter. One way to overcome language barriers when patients and healthcare staff do not share the same language is to use a professional interpreter. Few previous studies have been found investigating the use of interpreters, and just one previous study from the perspective of European migrants, which showed that they perceived interpreters as a communication aid and a guide in the healthcare system as regards information and practical matters. No previous study has gathered quantitative information to focus on non-European migrants' attitudes to the use of interpreters in healthcare encounters. Thus, the aim of this study was to investigate Arabic-speaking individuals' attitudes, opinions, preferences and past experiences concerning the use of interpreters in healthcare in order to: (i) understand how persons' expectations and concerns regarding interpreters may vary, both within and across cultural/linguistic populations; (ii) understand the consequences of diverse opinions/expectations for planning responsive services; and (iii) confirm findings from previous qualitative studies. METHOD: A postal cross-sectional study using a structured self-administered 51-item questionnaire was used to describe and document aspects of Arabic-speaking individuals' attitudes to the use of interpreters in healthcare. The sample of 53 Arabic-speaking migrants was recruited from three different places. Participants were mostly born in Iraq and had a high level of education and were almost equally divided between genders. Data were analysed with descriptive statistics. RESULTS: The main findings were that most of the participants perceived the interpreter's role as being a communication aid and a practical aid, interpreting literally and objectively. Trust in the professional interpreter was related to qualification as an interpreter and personal contact with face-to-face interaction. T

Aim The aim was to explore adults’ experiences of their family members’ use of interpreters in health-care encounters. Background Language barriers are a major hindrance for migrants to receive appropriate healthcare. In a foreign country, family members often need support in care of migrant patients. No previous studies focusing on adult family members’ experiences of the use of interpreters in healthcare have been found. Method A purposive sample of 10 adult family members with experiences of the use of interpreters in health-care encounters. Data were collected between May and September 2009 by focus-group interviews and analysed with qualitative analysis according to a method described for focus groups. Findings Three categories emerged from the analysis: (1) Experiences of the use of professional interpreters, (2) Experiences of being used as an interpreter and (3) Experiences of what needs to be improved when using interpreters. The main findings showed no agreement in family members’ experiences; interpretation should be individually and situationally adapted. However, when family members acted as interpreters, their role was to give both practical and emotional support, and this led to both positive and negative emotions. Use of simple language, better collaboration in the health-care organization and developing the interpreters’ professional attitude could improve the use of professional interpreters. The type of interpreter, mode of interpretation and patient's preferences should be considered in the interpretation situation. In order to achieve high-quality healthcare, health-care professionals need to organize a good interpretation situation case-by-case, choose the appropriate interpreters with the patient in focus and cooperate with members of the patient's social network.

Aim To describe conceptions of daily life in women living with a man suffering from chronic obstructive pulmonary disease (COPD) in different stages. Background The spouse is often the primary caregiver to someone with COPD, and thus also affected by the consequences of the disease. No previous studies have been found focusing on conceptions of daily life in women living with a man suffering from COPD in different stages. Methods A phenomenographic study was conducted. Data were collected in 2008–2009 through semi-structured interviews with 21 women living with men suffering from COPD in different stages. Findings Four main descriptive categories were found: unchanged life situation where no support was needed; socially restricted life and changed roles; changes in health; and changes in the couple's relationship where support was needed. The categories are described in relation to the woman herself, in relation to the man, and in relation to others. No support was needed from society or health care when the men had mild COPD and the women experienced no change in their daily life. As the disease progressed, the women's responsibilities increased and their role changed from being a spouse to being an informal carer. Social contacts became limited, and they began to feel isolated. The women prioritized their spouse's health and well-being and compromised their own health. They experienced lack of support from health professionals and from the municipality.

【Abstract】Objective To investigate and analyze the Chinese medicine constitution types of pregnant metaphase women in Fuzhou of China. Methods Cross-sectional study and stratified sampling were used. A scale, , was as a tool for investigation. 1000 scale copies were handed out. 989 scale copies were got after excluding the scale copies with logic error. Constitution types were described by constituent ratio. Results In Fuzhou, the Chinese medicine constitution types of pregnant metaphase women were as following: Yang-deficiency type was 28.5%, damp-heat type was 25.5%, Yin-deficiency type was 25.2%, Qi-depression type and Qi-deficiency type were 23.1% respectively, gentleness type was 20.2%, stasis type was 19.1%, phlegm type was 10.9%, and special intrinsic type was 7.0%. The front three constitution types in different age groups: 20 years old～group: Qi-deficiency type was 29.4%, gentleness type was 24.8%, Yin-deficiency type and yang-deficiency type were 24.2% respectively; 25 years old～group: Yang-deficiency type was 27.6%, Yin-deficiency type and damp-heat type were 23.3% respectively; 30 years old～group: damp-heat type was 34.4%, Yang-deficiency type was 33.9%, Yin-deficiency type was 30.8%. The distribution of constitution types in different education background groups was similar as that of total constitution types of pregnant metaphase women. Conclusions The constitution type’s characteristics of pregnant metaphase women in Fuzhou were inclined to deficiency, heat and damp, and Qi-depression. Guided by the theory of “Preventive Treatment of Disease”, the staff working on antepartum care may provide targeted care according to different body constitution types of pregnant women.

AIM: To describe conceptions of daily life in men living with a woman suffering from chronic obstructive pulmonary disease (COPD) in different stages of the disease. BACKGROUND: A chronic disease like COPD affects not only the person living with the illness, but also the spouse. Significant tasks and demands are placed on husbands. COPD has for a long time been considered more a man's disease than a woman's disease, but according to new evidence COPD is a vast problem in women, which requires support from their spouses. The literature review did not reveal any previous studies concerning conceptions of daily life in men living with women suffering from COPD in different stages. METHODS: A phenomenographic study was conducted. Data were collected from October 2008 to October 2009 through semi-structured interviews with 19 men living with a woman suffering from COPD. FINDINGS: Two main descriptive categories were found: (1) unchanged life situation where no support was needed; (2) changed life situation related to severity of COPD, where support was needed. The categories were described from the perspective 'ME and my spouse'. Even in their caregiving situation, the men continued with their own life and activities and did not put themselves in second place. No support was needed from healthcare or municipality when the women had mild COPD, but this changed when the COPD progressed. The men felt that daily life was burdened, restricted and the partner relationship was affected, even if the disease had not reached the final stage. The COPD forced them gradually into a caregiving role, and their daily life changed. They become more of a caregiver than a spouse. The men experienced lack of knowledge and support, and they felt that health professionals and municipality did not care about them.

Purpose - An increasing number of people are migrating within the borders of China. Some migrants have to leave their children behind, and 58,000,000 children are estimated to be living as left-behind children. Earlier studies have found severe mental problems in left-behind children, but different factors could influence their mental health. The aim of this study was to investigate the mental health of these left-behind children and to determine possible influencing factors. Design/methodology/approach - Data for this study were collected in one province of the P R of China with a validated instrument, the Strengths and Difficulties Questionnaire (SDQ) to investigate behavior in 13- to 15-year old children. Findings - No significant difference was found in total difficulty score and in any subscale score of SDQ when we compared left-behind children with children who were not left behind. A significant difference in emotional difficulty subscale score was found between girls who were left behind and girls who were not. Some socio-economic factors such as poor family economy and living with relatives, friends or grandparents, were identified as risk factors. Originality/value - When strategies for support of the mental health in left-behind children are developed, they will need to be individualized according to the gender, social and economic situation and focused on emotional and conduct problems.

Aim The aim was to explore adults’ experiences of their family members’ use of interpreters in health-care encounters. Background Language barriers are a major hindrance for migrants to receive appropriate healthcare. In a foreign country, family members often need support in care of migrant patients. No previous studies focusing on adult family members’ experiences of the use of interpreters in healthcare have been found. Method A purposive sample of 10 adult family members with experiences of the use of interpreters in health-care encounters. Data were collected between May and September 2009 by focus-group interviews and analysed with qualitative analysis according to a method described for focus groups. Findings Three categories emerged from the analysis: (1) Experiences of the use of professional interpreters, (2) Experiences of being used as an interpreter and (3) Experiences of what needs to be improved when using interpreters. The main findings showed no agreement in family members’ experiences; interpretation should be individually and situationally adapted. However, when family members acted as interpreters, their role was to give both practical and emotional support, and this led to both positive and negative emotions. Use of simple language, better collaboration in the health-care organization and developing the interpreters’ professional attitude could improve the use of professional interpreters. The type of interpreter, mode of interpretation and patient's preferences should be considered in the interpretation situation. In order to achieve high-quality healthcare, health-care professionals need to organize a good interpretation situation case-by-case, choose the appropriate interpreters with the patient in focus and cooperate with members of the patient's social network.

INTRODUCTION: A previous study of beliefs about health and illness in Zimbabweans with diabetes mellitus indicated limited knowledge about diabetes and the body, affecting self-care and health-care seeking behaviour. The aim of this study was to assess the level of diabetes knowledge in Zimbabwean adults with diabetes mellitus, to determine the main gaps in knowledge and identify the socio-demographic and diabetes-related determinants that predict diabetes awareness and self-care practices. METHODS: A cross-sectional descriptive study was performed using a standardized self-report Diabetes Knowledge Test questionnaire (DKT) of 58 respondents, 32 women and 26 men. Results were analysed with descriptive and analytic statistical methods. RESULTS: The majority of the respondents scored average knowledge on all three sub-scales: general knowledge, insulin use and total knowledge, with an overall score of 63.1 ± 14, 2%. Major knowledge gaps were in areas related to diet, insulin use and glycaemic control. No significant differences in mean scores were detected in the diabetes knowledge sub-scales when comparisons were made of mean knowledge scores in relation to socio-demographic and diabetes-related characteristics. However, diabetes-related complications were significantly associated with lower total and general diabetes knowledge, and female gender was an independent determinant of low general knowledge. CONCLUSION: Knowledge gaps were evident in areas regarding insulin use, diet and glycaemic control. Low diabetes knowledge was associated with female gender and could be a risk factor for development of diabetes-related complications. Knowledge gaps need to be addressed in diabetes education to prevent development of diabetes-related complications.

Background. Regional variations in mortality and morbidity have been shown in Europe and USA. Longitudinal studies have found increased mortality, dissimilarities in mortality pattern, and differences in utilization of healthcare between foreign- and native-born Swedes. No study has been found comparing mortality among foreign-born and native-born Swedes in relation to catchment areas/counties. Methods. The aim was to describe and compare mortality among foreign-born persons and native Swedes during 1970-1999 in 24 counties in Sweden. Data from the Statistics Sweden and the National Board of Health and Welfare was used, and the database consisted of 723,948 persons, 361,974 foreign-born living in Sweden in 1970 and aged 16 years and above and 361,974 matched Swedish controls. Results. Latest county of residence independently explained higher mortality among foreign-born persons in all but four counties; OR varied from 1.01 to 1.29. Counties with a more rural structure showed the highest differences between foreign-born persons and native controls. Foreign-born persons had a lower mean age (1.0-4.3 years) at time of death. Conclusion. County of residence influences mortality; higher mortality is indicated among migrants than native Swedes in counties with a more rural structure. Further studies are needed to explore possible explanations.

This study explored beliefs about health and illness that might affect self-care and health-seeking behaviours in Zimbabwean men and women with diabetes. Gender differences were indicated in a previous study but their extent has not been studied. The present study used a qualitative descriptive design with semi-structured interviews to gain a deeper understanding of the phenomena. The sample consisted of 21 participants, 11 females aged 19-61 years (Median 44 years) and 10 males aged 22-65 years (Median 52 years). Qualitative content analysis was used. Health was described as freedom from diseases and enjoying well-being. Both males and females displayed limited knowledge about diabetes and dissimilarities in health-seeking behaviours. Women, in contrast to men, were more active in self-care and used various measures besides drugs as they related to a higher extent the cause of diabetes to supernatural factors like gods and witches. They sought information from self-help groups and help from outside the professional health sector like healers in the folk sector. Prolonged economic disruption also had negative effects towards maintenance of healthy life-styles as both men and women struggled to get money for food and drugs. Thus, the study highlighted that knowledge about diabetes and its management are important for self-care. There is therefore need to develop acceptable and affordable gender- sensitive diabetes care programmes that enhance patient participation, empowerment and promotion of health.

In previous longitudinal studies of mortality and morbidity among foreign-born and native-born Swedes, increased mortality and dissimilarities in mortality pattern were found. The aim of this study is to describe, compare, and analyse the utilization of in-hospital care among deceased foreign- and Swedish-born persons during the years 1987-1999 with focus on four diagnostic categories. The study population consisted of 361,974 foreign-born persons aged 16 years and upward who were registered as living in Sweden in 1970, together with 361,974 matched Swedish controls for each person. Data from Statistics Sweden (SCB) and the National Board of Health and Welfare Centre for Epidemiology, covering the period 1970-1999, was used. Persons were selected if they were admitted to hospital during 1987-1999 and the cause of death was in one of four ICD groups. The results indicate a tendency towards less health care utilization among migrants, especially men, as regards Symptoms, signs, and ill-defined conditions and Injury and poisoning. Further studies are needed to explore the possible explanations and the pattern of other diseases to see whether migrants, and especially migrant men, are a risk group with less utilization of health care.

A previous study of beliefs about health and illness in Zimbabweans with diabetes mellitus indicated limited knowledge about DM affecting self-management and care seeking behaviour. The aim of this study was to assess the level of diabetes knowledge in Zimbabwean adults with DM, to determine the main gaps in knowledge and identify the socio-demographic and DM-related determinants predict DM awareness and self-management. Methods: A cross-sectional descriptive study was performed using a standardized self-report Diabetes Knowledge Test questionnaire (DKT) of 58 respondents. Results were analysed with statistical methods.The majority of the respondents scored average knowledge on the sub-scales: general knowledge, insulin use and total knowledge, with an overall score of 63.1± 14, 2%. Major knowledge gaps were found concerning diet, insulin use and glycaemic control. No significant differences in mean scores were detected in the DM knowledge sub-scales when comparingb mean knowledge scores in relation to socio-demographic and DM characteristics. However, DM -related complications were significantly associated with lower total and general DM knowledge, and female gender was an independent determinant of low general knowledge. In conclusion, knowledge gaps were evident regarding insulin use, diet and glycaemic control. Low DM knowledge was associated with being a female and could be a risk factor for development of DM-related complications. Knowledge gaps need to be addressed in diabetes education to prevent development of complications., article in fulltext

Aim: to analyze the pattern of mortality in deceased foreign-born persons living in Sweden during the years 1970-1999 in relation to distance mobility. MEthods: Data from Statistics Sweden and the National Board of Health and Welfare was used, and the study population consisted of 281,412 foreign-born persons aged 16 years and over who were registered as living in Sweden in 1970. Results: Distance mobility did not have a negative effect on health. Total mortality was lower (OR 0.71; 95% CI 0.69-0.73) in foreign-born persons in Sweden who had changed their county of residence during the period 1970-1990. Higher death rates were observed, after adjustment for age, in three ICD diagnosis groups "Injury and poisoning", "External causes of injury and poisoning", and "Diseases of the digestive system" among persons who had changed county of residence.

Aim: To describe how healthcare professionals experience and perceive the use of interpreters in their contacts with patients with whom they do not share a common language. Methods: An explorative descriptive study. The study was conducted in different healthcare settings in Sweden and included 24 healthcare staff, of whom 11 were physicians, 9 nurses, 2 physiotherapists and 2 assistant nurses. Data were generated through written descriptions of the use of interpreters in healthcare and analysed using qualitative content analysis. Findings: Two main categories emerged: 1) aspects related to the interpreter and 2) organizational aspects. It was shown that having a face-to-face, professional, trained interpreter, with a good knowledge of both languages and of medical terminology, translating literally and objectively, was perceived positively. The organizational aspects that affected the perception were functioning or non-functioning technical equipment, calm in the interpretation environment, documentation of the patients’ language ability, respect for the appointed time, and the level of availability and service provided by the interpreter agency. Conclusion: It is important to develop a well-functioning interpreter organization that offers trained interpreters with a professional attitude to improve and ensure cost-effective and high-quality encounters and care.

BACKGROUND: This is the first longitudinal study with a 22-year follow-up, based on a national and complete sample, to determine whether the prevalence of hip fracture and the age when it occurs are influenced by migration and by being foreign-born. Cultural background and environmental factors such as UV-radiation and lifestyle during childhood and adolescence may influence the risk of a hip fracture event later in life. Differences in prevalence might occur between the indigenous population and those who have migrated to a country. METHODS: The study was based on national population data. The study population consisted of 321,407 Swedish-born and 307,174 foreign-born persons living in Sweden during the period 1987-1999. RESULTS: Foreign-born individuals had a reduced risk of hip fracture, with odds ratios (ORs) of 0.47-0.77 for men and 0.42-0.88 for women. Foreign-born women had the hip fracture event at a higher age on average, but a longer time spent in Sweden was associated with a small but significant increase in risk. CONCLUSIONS: We found that there was a reduced risk of hip fracture in all foreign-born individuals, and that the hip fracture event generally happened at a higher age in foreign-born women. Migration must therefore be considered in relation to the prevalence and risk of hip fracture. Migration can therefore have a positive effect on one aspect of the health of a population, and can influence and lower the total cost of healthcare due to reduced risk and prevalence of hip fracture.

BACKGROUND: Sharing knowledge and experience internationally can provide valuable information, and comparative research can make an important contribution to knowledge about health care and cost-effective use of resources. Descriptions of the organisation of health care in different countries can be found, but no studies have specifically compared the legal and formal organisational systems in Sweden and China. AIM: To describe and compare health care in Sweden and China with regard to legislation, organisation, and finance. METHODS: Literature reviews were carried out in Sweden and China to identify literature published from 1985 to 2008 using the same keywords. References in recent studies were scrutinized, national legislation and regulations and government reports were searched, and textbooks were searched manually. RESULTS: The health care systems in Sweden and China show dissimilarities in legislation, organisation, and finance. In Sweden there is one national law concerning health care while in China the law includes the "Hygienic Common Law" and the "Fundamental Health Law" which is under development. There is a tendency towards market-orientated solutions in both countries. Sweden has a well-developed primary health care system while the primary health care system in China is still under development and relies predominantly on hospital-based care concentrated in cities. CONCLUSION: Despite dissimilarities in health care systems, Sweden and China have similar basic assumptions, i.e. to combine managerial-organisational efficiency with the humanitarian-egalitarian goals of health care, and both strive to provide better care for all.

Due to social transformation in China, more than 100,000,000 people are migrating within the country. Many parents are forced to leave their children behind when they migrate. In 2008, 58,000,000 children were living as left-behind children, mainly in the rural parts of China (Zhang, 2009). Migration and its accompanying stressors may affect the mental health of the left-behind children. This unique literature review of Chinese literature summarises the present state of knowledge and reviews the influential factors. Possible approaches to intervention and system reforms are discussed. A literature review was performed of published studies between 2001 and 2008. Databases used were Fujian Medical University Library Interface, Chinese National Knowledge Infrastructure, Wanfang Data, and VIP Information. The Chinese word for 'left-behind' was used as a key word. Books, book chapters, monographs and studies on caring were searched electronically and by hand. Altogether, 53 items were found, discussed and grouped together. Migration affected the mental health of the left-behind children in a passive way, especially their emotions and social behaviour. There is still controversy over how serious mental health problems are among children who have been left behind. Life events, personality, coping strategies and social support can be regarded as four main factors that are predictive of mental health, which provides theoretical guidance for intervention. Support and prevention of mental health problems in schools, in families and in primary care should be developed and studied.

In most societies informal care of the elderly (often given by a relative) plays an important role, this article describes the situation and support for carers that exist in Sweden. The description is partly based on the results from the evaluation of a project (“Anhörig 300”) aimed to develop support for carers in the County of Kronoberg as well as from information and documents. Four different typical situations for carers are identified and is an indication of how different situations for carers can be. In the future the support for carers must be paid attention to and further developed. The National Development Plan for the Nursing and Care for elderly in Sweden suggest increased support for carers as a supplement to the public sector elderly care. It is important to involve voluntary organizations to break isolation and loneliness among carers.

Migration är idag en internationell process och en internationell fråga som påverkar nästan varje land på jorden. Internationella beräkningar uppskattar att antalet migranter har, under perioden 1970 till år 2000, stigit från 82 till 175 millioner. Sambandet mellan migration och hälsa har diskuterats i tidigare studier och att migration kan påverka hälsan både i negativ riktning eller i positiv riktning. Under 2002-2006 genomfördes fyra olika delstudier av med inriktning på hälsa och hälsoutveckling bland migranter i Sverige. Samtliga studier baserades på data från SCB och Socialstyrelsens Epidemiologiska centrum (EpC) och i databasen ingick samtliga utrikes födda personer, 16 år och äldre, som var bosatta i Sverige 1970.. Till varje utrikes född person fanns en matchad infödd svensk person, en kontrollperson. Databasen som användes för analyser kom att omfatta 723 948 personer där hälften var utrikes födda och hälften svenska kontrollpersoner. De fyra olika delstudierna beskrev och analyserade skillnaderna mellan utrikes födda och personer födda i Sverige vad gäller, dödlighet, sjukdomsmönster, konsumtion av vård och regionala skillnader i dödlighet. Resultaten, visade en högre dödlighet med regionala skillnader, annorlunda sjukdomsmönster och en tendens till lägre konsumtion av vård bland utrikes födda än bland svenskfödda personer under perioden 1970-1999. Det går inte att påvisa och förklara de återfunna skillnaderna i hälsa med ett fåtal enkla faktorer. Flera faktorer, så som ekonomisk situation, arbete, arbetsmiljö, arbetslöshet, sociala nätverk och situationen före migrationen kan ha påverkat de utrikes föddas sämre hälsoläge. Den fysiska och sociala miljön och eventuella ojämlikheter i sjukvårdsresurser och tillgång till vård spelar också en viktig roll. Migrationen har haft en negativ inverkan på de utrikes föddas hälsa och är en viktig faktor att ta hänsyn till vid studier av hälsa och hälsoutveckling bland befolkningen i ett land.

Doktorsexamen Medicinsk Vetenskap

BACKGROUND: Mortality in a population is regarded as an accurate and valid measure of the population's health. There are a few international studies, predominantly cross-sectional, of mortality among all foreign-born compared with an indigenous population, and the results have varied. No Swedish longitudinal study describing and analysing mortality data was found in a literature review. METHODS: This study describes and analyses the differences in mortality between foreign-born persons and native Swedes during the period 1970-1999, based on data from Statistics Sweden and the National Board of Health and Welfare. The database consisted of 723,948 persons, 361 974 foreign-born living in Sweden in 1970, aged > or = 16 years, and 361 974 Swedish controls matched for age, sex, occupation and type of employment, living in the same county in 1970. RESULTS: The results showed increased mortality for foreign-born persons compared with the Swedish controls [odds ratio (OR) 1.08; 95% confidence interval (CI) 1.07-1.08]. Persons who had migrated 'late' (1941-1970) to Sweden were 2.5 years younger at time of death than controls. In relation to country of birth, the highest risk odds were for men born in Finland (OR 1.21), Denmark (OR 1.11) and Norway/Iceland (OR 1.074). Age cohorts of foreign-born persons born between 1901 and 1920 had higher mortality at age 55-69 years than cohorts born between 1921 and 1944. CONCLUSIONS: Migrants had higher mortality than the native population, and migration may be a risk factor for health; therefore, this seems to be an important factor to consider when studying mortality and health.

Due to migration, an increasing number of the elderly in Sweden will be foreign-born, ‘old migrants’. Old migrants will need help from society with health care and social service. Migration may influence people's health and thus also their consumption of health care and social service. The aim of the present study was to discuss migration and health with the focus on old migrants by a review of literature, and to describe the pattern of health care and social service consumption among old migrants living in Sweden, studying whether there were any differences compared with old people born in Sweden. The results showed that there is a lack of data describing old migrants' health. Available data indicate poorer self-rated health, more chronic illness and impaired mobility capacity. There are some Swedish studies describing morbidity and mortality among migrants in Sweden. These are consistent: migrants have more health problems in general and migrants from the Nordic countries have a higher mortality rate. There are no public statistics about old migrants' consumption of health care and social service in Sweden. Some studies show that old migrants consume less than native Swedes. Other studies indicate the same or higher consumption of health care, but lower consumption of social service among migrants. In conclusion, few studies concern health and consumption of health care and social care among old migrants; the results are divergent and there could be several different explanations for dissimilarities, such as migrational background, cultural distance, time of residence, socioeconomic position and adaptation in the new society. Thus, further studies are needed.