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This study aimed at analysing associations among housing type, neighbourhood safety behaviour, self-rated health (SRH), psychological well-being and unhealthy days in the general population. From 2004 to 2013, 90,845 Swedes completed a questionnaire about their health, number of days with poor health, psychological well-being, housing type, and whether they refrained from going out based on perception of neighbourhood safety. People not living in private housing and those who did not go out for safety reasons reported lower SRH and psychological well-being and higher frequency of recent unhealthy days and days without work capacity due to poor health. [ABSTRACT FROM PUBLISHER]

Background Social inequities are considered to affect healthcare utilization, whereas less is known about the factors associated with refraining from seeking dental care. This study aimed to investigate whether people with no social support, long-term illness, caregiver burden and low socioeconomic status (SES) refrained from seeking dental care in higher proportion than the general Swedish population. Methods This study used cross-sectional questionnaire data from repeated nationwide health surveys during 2004-2013 of a total of 90 845 people. The questionnaire included questions on demographic characteristics, social support, long-term illness, caregiving burden, SES and dental care-seeking behaviour. Descriptive statistics, chi-square tests, correlation analyses and logistic regressions were used to investigate associations between independent variables and dental care-seeking behaviour. Results In the total sample, 15.1% of respondents reported refraining from seeking dental care. Having no emotional social support or having no instrumental social support was separately associated with reporting refraining from seeking dental care in adjusted multivariate models (odds ratio [ OR] 1.26, 95% confidence interval [ CI] 1.18-1.34 and OR: 1.89, 95% CI: 1.67-2.13, respectively). Having a long-term illness was associated with refraining from seeking dental care in adjusted models (adjusted OR: 1.43, 95% CI: 1.35-1.51). Furthermore, being an informal caregiver was associated with refraining from seeking dental care (adjusted OR: 1.15, 95% CI: 1.07-1.23). Low SES was associated with higher refraining from seeking dental care; the strongest association was with having financial problems (adjusted OR: 3.57, 95% CI: 3.19-4.00). Interaction effects were found between education level and SES, and between social support and long-term illness, and the outcome. Conclusions The findings in this study imply that having no social support, having long-term illness, being informal caregiver or having financial problems are factors associated with reporting refraining from seeking dental care, on a population basis. [ABSTRACT FROM AUTHOR]

This study explores factors influencing condom use among Swedish women and men who visited a sexual health clinic after unprotected sex during international travel. Semi-structured interviews were conducted with 25 women and 25 men. The data were analyzed using conventional content analysis. The informants' narratives were categorized as strategies and barriers. Strategies found were: risk assessment, testing, and treatment for sexually transmitted infections. The barriers were characterized as technical and personal or emotional. The findings indicate that sexual behavior may be different while traveling internationally, and that a release of social constraints and increased alcohol consumption were risk factors for practicing unprotected sex. Some of the strategies may be appropriate for the prevention of sexually transmitted infections, but several strategies and most barriers were used to explain why unprotected sex was practiced. Thus, people need the opportunity to reconsider strategies and strengthen confidence in their ability to use condoms. An individual-based approach employed within routine health care may support the practice of safer sex and prevent further transmission of sexually transmitted infections. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to investigate patients' willingness to initiate a preventive treatment and compared two established effect measures to the newly developed Delay of Events (DoE) measure that expresses treatment effect as a gain in event-free time.Methods: In this cross-sectional, randomized survey experiment in the general Swedish population,1079 respondents (response rate 60.9%) were asked to consider a preventive cardiovascular treatment. Respondents were randomly allocated to one of three effect descriptions: DoE, relative risk reduction (RRR), or absolute risk reduction (ARR). Univariate and multivariate analyses were performed investigating willingness to initiate treatment, views on treatment benefit, motivation and importance to adhere and willingness to pay for treatment.Results: Eighty-one percent were willing to take the medication when the effect was described as DoE, 83.0% when it was described as RRR and 62.8% when it was described as ARR. DoE and RRR was further associated with positive views on treatment benefit, motivation, importance to adhere and WTP.Conclusions: Presenting treatment effect as DoE or RRR was associated with a high willingness to initiate treatment.Practice Implications: An approach based on the novel time-based measure DoE may be of value in clinical communication and shared decision making. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives Differences in the performance of medical care may be due to variation in the introduction and diffusion of medical innovations. The objective of this paper is to compare seven European countries ( United Kingdom, the Netherlands, West Germany, France, Spain, Estonia and Sweden) with regard to the year of introduction of six specific pharmaceutical innovations (antiretroviral drugs, cimetidine, tamoxifen, cisplatin, oxalaplatin and cyclosporin) that may have had important population health impacts. Methods We collected information on introduction and further diffusion of drugs using searches in the national and international literature, and questionnaires to national informants. We combined various sources of information, both official years of registration and other indicators of introduction (clinical trials, guidelines, evaluation reports, sales statistics). Results and conclusions The total length of the period between first and last introduction varied between 8 years for antiretroviral drugs and 22 years for cisplatin. Introduction in Estonia was generally delayed until the 1990s. The average time lags were smallest in France (2.2 years), United Kingdom (2.8 years) and the Netherlands (3.5 years). Similar rank orders were seen for year of registration suggesting that introduction lags are not only explained by differences in the process of registration. We discuss possible reasons for these between-country differences and implications for the evaluation of medical care. [ABSTRACT FROM AUTHOR]

Aims: Modifiable risk factors for cardiovascular disease include overweight, which is prevented by healthy diet and physical activity. Recently settled migrants may have varying levels of exposure to health information. Therefore, the objectives of this study were to explore the associations between self-reported information on healthy diet and on physical activity and overweight and the possible modification of this association by educational level among recently settled Iraqi migrants in Sweden. Methods: Cross-sectional data were collected through a postal questionnaire in Arabic and analysed by means of logistic regression. Dummy variables were created in order to assess the possible modification by educational level on the association between health information and overweight. Results: After adjustments for potential confounders, associations were found between overweight and not having received information on healthy diet (OR 1.56, 95% CI 1.07—2.27) and physical exercise (OR 1.58, 95% CI 1.07—2.32). Educational level modified these associations, so that the impact on overweight by information was much more evident among those with a high level of education. Conclusions: The findings showed that overweight was associated to perceived lack of health information among recently settled Iraqi migrants. It may be easier for migrants with high education to seek, receive, and understand health-related information. Migrants with low education may be more traditional in, for example, their diet and therefore less likely to be overweight. Culturally adapted information may therefore not be relevant for them. The broader context of the social determinants of health needs to be considered when planning interventions for migrants. [ABSTRACT FROM PUBLISHER]

Aims: To study whether social capital is associated with health among parents and if so, whether existing inequalities in health between single and couple parents could be better understood by introducing social capital as a possible mechanism for how health is distributed. Material and methods: At total of 2,500 parents with children in the age range of 4-16 years were randomized from existing national registers and asked to participate in a nationally distributed postal questionnaire; 1,589 parents participated (277 single and 1,312 couple), giving a response rate of 64%. The questionnaire contained questions regarding sociodemographic and socioeconomic characteristics, self-rated health, emotional and instrumental social support, civic and social participation, and trust. Social capital was measured by different levels of civic and social participation and trust. A multivariate analysis was used in order to find possible associations between social capital and health, when adjusted for social support, sociodemographic and socioeconomic characteristics. Results: A low level of social capital (both social participation and trust), when adjusted for social support, socioeconomic and sociodemographic variables, was clearly and positively associated with less than good self-rated health. Social capital was unevenly distributed between single and couple mothers. Conclusions: Social capital is positively associated with self-rated health, at an individual level. The uneven distribution of social capital between single and couple mothers may be of some importance when trying to further understand and possibly alter the inequality in health that exists between single and couple parents. [ABSTRACT FROM AUTHOR]

Several international studies point at the efficacy of bicycle helmets in reducing head injuries. In Sweden, observational studies show that from 1988 to 1996 helmet use increased in all categories of cyclists. The objectives of this study were to analyse the trends of bicycle-related head injuries based on their main diagnosis and external cause of injury by different age groups. Our study area was the whole population of Sweden from 1987 to 1996. Outcome evaluation was based on data from the Swedish National Hospital Discharge Register concerning all bicycle-related injuries from 1987 to 1996, which presented 49 758 reported in-patient care. The trends in incidence rates (IRs) were studied with regression analyses. The results show that children under 15 years had the highest IRs. For these children, the IR decreased by 46%. The head injuries in children decreased both in collisions with motor vehicles and in other accidents. Similarly, the IR of concussion and skull fracture decreased. For non-head injuries, there were no significant changes for children. On the other hand, the incidence of both head and other injuries for adults aged 16-50 years increased. Ages above that showed no significant changes. Our conclusions are that the decrease in IR for bicycle-related head injuries refers to children in ages for whom bicycle helmet use during the period increased. This could not be explained by any general decrease in bicycle-related accidents or by any changes in the distribution of injuries after collision with motor vehicles. The increasing helmet use among younger schoolchildren probably contributed to the decrease in head injuries. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The objective of this study was to assess expectations of effect when using statins in a treatment population. Further the aim was to examine factors, including history and concurrent risk of coronary heart disease, associated with a higher and lower treatment belief. Methods: Eight hundred and twenty-nine (829) Swedish patients using statins completed postal questionnaires about their health, life style, cardiovascular risk factors and expectation of the treatment. Expected treatment benefit was used as outcome measurement. Results: A medical history of coronary heart disease did not affect treatment expectations. Patients with a high risk of cardiovascular disease reported a slightly lower expectation of the treatment effect at a 10-year perspective (p <0.01) but not at shorter time perspectives. Low satisfaction with the explanation of the purpose of the treatment and a poor perceived control of own health was associated with a more negative view on treatment benefit. Conclusion: The rationale applied by physicians prescribing statins does not seem to relate to the patients’ expectations, whereas factors relating to the patient–physician relationship, the social situation and the perceived control of health seem to affect patient belief. Practice implications: The association between patients’ poor satisfaction of treatment explanation and a low belief in treatment benefits emphasizes the importance of the patient–physician communication. It is suggested that clinical tools are developed in order to identify patients with poor belief in treatment benefit since tailored education for this group might reduce the risk of non-compliance and subsequently reduce the risk of coronary heart disease. [Copyright &y& Elsevier]

Background: There is a need for more research on the health impact of changes in the national unemployment rate. Therefore, the present study was carried out to compare levels of self-rated health during periods of high and low levels of unemployment. Methods: Data included cross-sectional interviews from the Swedish Survey of Living Conditions, which were based on random samples of inhabitants between 16 and 64 years of age living in Sweden. Data were collected for the period 1983-89, when unemployment levels were low (n = 35 562; 2.5%) and for the period 1992-97 when unemployment was high (n = 24 019; 7.1%). Results: After adjusting for sociodemographic variables as well as long-term disease or handicap, the differences in self-rated health between the unemployed and employed were larger when unemployment levels were high in the 1990s, than when they were low in the 1980s. More groups of the unemployed were afflicted with poor health when unemployment was high, compared with when it was low. In 1992-97, being married, living in larger cities, or not having a long-term disease or handicap no longer buffered the negative effects on health among the unemployed. Conclusions: Poorer self-rated health among the unemployed seems to be an increasing public health problem during high levels of unemployment. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to estimate whether the risk for total and cause-specific mortality was related to employment status, and whether mortality in different non-employed groups differed during high and low levels of unemployment. Methods: Structured interviews were used from the Swedish Survey of Living Conditions in 1984–89 and 1992–97, including women and men aged 18 to 64, classified as unemployed ( n = 2,067), retired or on temporary disability pension ( n = 2,674), economically inactive for other reasons ( n = 1,373), and employed ( n = 38,293). Data were linked to death certificates, as registered in the Cause of Death Register. Cox proportional hazards models were performed for the mortality risk up until eight and a half years following the interview. Results: Being unemployed (OR = 1.43), retired, or on temporary disability pension (OR = 2.28) or being economically inactive for other reasons (OR = 1.63) was related to a risk for total mortality, after considering the level of unemployment, sociodemographic factors and longstanding illness. The risk of death due to external causes was excessive among the unemployed and among those retired or on temporary disability pension, and resulted to a large extent from suicide. The interaction between employment status and level of unemployment was not significant. Conclusions: The level of unemployment seems to have no major influence on the mortality risk. Future interventions for the non-employed groups should focus on preventing avoidable mortality, such as injury and suicide. [ABSTRACT FROM AUTHOR]

Aims : To analyse self-rated health and healthcare utilization with regard to whether the respondents were single or couple parents, mothers or fathers. Methods : A postal questionnaire was distributed nationwide to 4,000 randomly chosen individuals 20–64 years of age, with a response rate of 66%. A total of 1,041 respondents had legal custody of a child (150 were single parents and 891 were couple parents), and thus met the definition of a parent used for this study. Analyses of self-rated health and health care utilization were performed according to sex, age, sociodemographic, and socioeconomic characteristics. Three different statistical methods were applied: Spearman correlation analyses, chi-square analyses and multivariate logistic regression. Results : Both single fathers and single mothers reported worse health than their couple counterparts. However, single fathers had contact with a physician more frequently (OR 1.84) than couple fathers, whereas single mothers did not. Furthermore, single mothers refrained from seeing a physician despite a medical need much more often (OR 2.07) than couple mothers. Conclusions : An uneven distribution of sociodemographic and socioeconomic characteristics might help us to understand why single parents, both mothers and fathers, have worse health than parents who live together. Previously recognized gender differences with regard to healthcare utilization were present in our study as well, and it is possible that these differences are related to the unequal distribution of sociodemographic and socioeconomic assets between single fathers and single mothers found here. [ABSTRACT FROM AUTHOR]

Abstract: Background and Objective: Statistics on causes of death are important for epidemio-logic research. Studies that evaluate the source data often give conflicting results, which raise questions about comparability and validity of methods. Methods: For 44 recent evaluation studies we examined the methods employed and assessed the reproducibility. Results: Thirty studies stated who reviewed the source data. Six studies reported reliability tests. Twelve studies included all causes of death, but none specified criteria for identifying the underlying cause when several, etiologically independent conditions were present. We assessed these as not reproducible. Of 32 studies that focussed on a specific condition, 21 provided diagnostic criteria such that the verification of the focal diagnosis is reproducible. Of 16 that discussed the difference between dying “with” and “from” a condition, eight described how competing causes had been handled. For these eight, the selection of a principal cause is reproducible, but in three the selection strategy conflicts with the international instructions issued by the World Health Organization. Conclusion: Methods and criteria are often insufficiently described. When described, they sometimes disagree with the international standard. Explicit descriptions of methods and criteria would contribute to methodologic improvement and would allow readers to assess the generalizability of the conclusions [Copyright &y& Elsevier]

Aims : "Avoidable" mortality, that is mortality from conditions amenable to healthcare intervention, is commonly studied as an indicator of the outcome of healthcare. The objective of this study was to analyse gender equity in avoidable mortality trends in Sweden from 1971 to 1996. Methods : The underlying cause of death was analysed for all deaths in the Swedish population in the age group 0-69 years during the period 1971-96. On the basis of those used in international studies, 18 indicators of avoidable mortality were identified. The conditions were divided into two groups: those mainly indicating an outcome of medical care and those mainly reflecting the effect of health policy. Age-standardized death rates were calculated for each indicator of avoidable mortality and for total mortality broken down by sex. Gender differences in death rates were studied. The annual trends in death rates were analysed using regression models. Results : For total mortality the death rates were 80% higher for males than for females. The largest gender differences were found among those conditions mainly reflecting the effects of health policy. For most medical care indicators the gender differences were fairly small. For several avoidable causes of death the gender differences decreased considerably and for some causes of death the differences were eliminated. Conclusions : The avoidable mortality method seems to be useful in continuous epidemiological surveillance of the equity in healthcare. The comparatively low gender differences for avoidable death indicators as well as the decrease in these differences indicate decreasing gender inequity in health. [ABSTRACT FROM AUTHOR]

Presents a study that investigated the differences in avoidable mortality among immigrants in Sweden. Calculation of the standardized mortality ratios for avoidable causes of death; Comparison of the mortality of immigrants and Swedish nationals; Methodology.

Aims: This study analyses the applicability of some of the registers used within the healthcare system for estimations of disease prevalence. The study focuses on the diagnoses of asthma, diabetes mellitus, chronic bronchitis/emphysema, hypertensive disease, and cerebrovascular disease. Methods: The study population comprised all inhabitants (n=20,037) in the municipality of Tierp on 31 December 1996. Diagnostic information was collected from primary healthcare and occupational healthcare in the municipality of Tierp and from inpatient and outpatient units at the hospitals in Uppsala County. The proportion of registered patients in the different registers was calculated in relation to the total number of patients who had been registered during 1996 with the selected diagnoses. Results: In the primary healthcare register, between 67% (cerebrovascular disease) and 85% (asthma) of all patients with selected diagnoses could be identified. A search on the inpatient care register (Hospital Discharge Register) led to the identification of between 8% (hypertensive disease) and 53% (cerebrovascular disease) of the patients. Conclusions: For all of the examined diagnoses, most patients could be identified in the primary healthcare register. Register data from both primary healthcare and inpatient and outpatient care at hospital are needed to make reasonable estimates of prevalence. [ABSTRACT FROM AUTHOR]

In this article, the author discusses the process and objectives in the harmonization of the speciality in Public Health in the European Union (EU) countries. He is critical on the need to promote high quality education and training for medical specialists and in Public Health Medicine that should be participated in by the specialist profession. The author also mentions the objectives of a public health specialist and the European Union of Medical Specialists (UEMS) list of competencies.

Background: Asylum seekers coming to most countries are offered a specific health examination. A previous study concluded that a considerable proportion of those taking part of it in Sweden had poor experiences of the communication in and the usefulness of this examination and had poor health literacy. The aim of this study was to explore in greater depth the experiences of the health examination for asylum seekers among Arabic- and Somali-speaking participants in Sweden. A secondary aim was to examine experiences and discuss findings using a health literacy framework.Methods: Seven focus group discussions were conducted with 28 Arabic and Somali speaking men and women that participated in a health examination for asylum seekers. Data were analyzed by latent content analysis.Results: One overarching theme - beneficial and detrimental - was found to represent the participants' experiences of the health examination for asylum seekers. Three categories were identified that deal with those experiences. The category of "gives some good" describes the examination as something that "gives support and relief" and "cares on a personal level." The category of "causes feelings of insecurity" describes the examination as something that "lacks clarity" and that "does not give protection." The category "causes feelings of disappointment" views the examination as something that "does not fulfil the image of a health examination" and "does not focus on the individual level."Conclusion: The health examination for asylum seekers was experienced as beneficial and detrimental at the same time. The feelings were influenced by the experiences of information and communication before, during and after the examination and on how health literate the organizations providing the HEA are. To achieve more satisfied participants, it is crucial that all organizations providing the HEA become health literate and person-centered. [ABSTRACT FROM AUTHOR]

Background: Common measures used to describe preventive treatment effects today are proportional, i.e. they compare the proportions of events in relative or absolute terms, however they are not easily interpreted from the patient's perspective and different magnitudes do not seem to clearly discriminate between levels of effect presented to people.Methods: In this randomised cross-sectional survey experiment, performed in a Swedish population-based sample (n = 1041, response rate 58.6%), the respondents, aged between 40 and 75 years were given information on a hypothetical preventive cardiovascular treatment. Respondents were randomised into groups in which the treatment was described as having the effect of delaying a heart attack for different periods of time (Delay of Event, DoE): 1 month, 6 months or 18 months. Respondents were thereafter asked about their willingness to initiate such therapy, as well as questions about how they valued the proposed therapy.Results: Longer DoE:s were associated with comparatively greater willingness to initiate treatment. The proportions accepting treatment were 81, 71 and 46% when postponement was 18 months, 6 months and 1 month respectively. In adjusted binary logistic regression models the odds ratio for being willing to take therapy was 4.45 (95% CI 2.72-7.30) for a DoE of 6 months, and 6.08 (95% CI 3.61-10.23) for a DoE of 18 months compared with a DoE of 1 month. Greater belief in the necessity of medical treatment increased the odds of being willing to initiate therapy.Conclusions: Lay people's willingness to initiate preventive therapy was sensitive to the magnitude of the effect presented as DoE. The results indicate that DoE is a comprehensible effect measure, of potential value in shared clinical decision-making. [ABSTRACT FROM AUTHOR]

Despite the well‐known associations between local environment and health, few studies have focused on environment and healthcare utilisation, for instance healthcare seeking behaviour or adherence. This study was aimed at analysing housing type, behaviour based on perceived local outdoor safety, social support, informal caregiving, demographics, socioeconomics, and long‐term illness, and associations with health‐seeking and adherence behaviours at a population level. This study used data from the Swedish National Public Health Survey 2004–2014, an annually repeated, large sample, cross‐sectional, population‐based survey study. In all, questionnaires from 100,433 individuals were returned by post, making the response rate 52.9% (100,433/190,000). Descriptive statistics and multiple logistic regressions were used to investigate associations between explanatory variables and the outcomes of refraining from seeking care and non‐adherence behaviour. Living in rented apartment, lodger, a dorm or other was associated with reporting refraining from seeking care (adjusted OR 1.16, 95% CI 1.00–1.22), and non‐adherence (adjusted OR 1.22; 95% CI 1.13–1.31). Refraining from going out due to a perceived unsafe neighbourhood was associated with refraining from seeking care (adjusted OR 1.59, 95% CI 1.51–1.67) and non‐adherence (adjusted OR 1.26, 95% CI 1.17–1.36). Social support and status as an informal caregiver was associated with higher odds of refraining from seeking medical care and non‐adherence. This study suggests that living in rental housing, refraining from going out due to neighbourhood safety concerns, lack of social support or informal caregiver status are associated with lower health‐seeking behaviour and non‐adherence to prescribed medication. [ABSTRACT FROM AUTHOR]

Thailand is one of the most common countries of origin among immigrants in Sweden and Thai immigrants comprise the immigrant group most frequently diagnosed with HIV. Little is known about their healthcare-seeking behaviour and views on HIV prevention. This study explored Thai women’s healthcare-seeking behaviour in relation to sexual and reproductive health and their views on HIV prevention. Nineteen in-depth interviews were conducted with Thai-born women in the Stockholm area. Three themes were identified: (1) poor access to healthcare in Sweden, preferring to seek care in Thailand; (2) partners playing a key role in women’s access to healthcare; (3) no perceived risk of HIV, but a positive attitude towards prevention. Despite expressing sexual and reproductive healthcare needs, most women had not sought this type of care, except for the cervical cancer screening programme to which they had been invited. Identified barriers for poor access to healthcare were lack of knowledge about the healthcare system and language difficulties. To achieve ‘healthcare on equal terms’, programmes and interventions must meet Thai women’s healthcare needs and consider what factors influence their care-seeking behaviour. Integrating HIV prevention and contraceptive counselling into the cervical screening programme might be one way to improve access. [ABSTRACT FROM PUBLISHER]

ABSTRACT BACKGROUND Parents' beliefs about human papillomavirus ( HPV) vaccination influence whether they allow their daughters to be vaccinated. We examined the association between parents' refusal and sociodemographic background, knowledge and beliefs about HPV, and the HPV vaccination in relation to the Health Belief Model. METHODS The sample consisted of 200 (55%) parents of children aged 11-12 years in the Swedish national vaccination program. Data were collected using a self-reported questionnaire. Most parents (N = 186) agreed to the vaccination. Pearson's chi-square, Fisher's exact test, and the Mann-Whitney U test were used to analyze data. RESULTS Declining parents saw more risks and fewer benefits of HPV vaccination but no differences in beliefs regarding the severity or young girls' susceptibility to HPV were found. There was an association between refusing the HPV vaccine and lower acceptance of previous childhood vaccinations, and their main source of information was the Internet. Parents who declined the vaccine believed it could adversely affect condom use, the age of their daughter's sexual debut, and the number of sexual partners. CONCLUSION Parents should have the possibility to discuss HPV and HPV vaccine with a school nurse or other health care professionals, and should have access to evidence-based information on the Internet. [ABSTRACT FROM AUTHOR]

Poor mental health is common among migrants. This has been explained by migration-related and socio-economic factors. Weak social capital has also been related to poor mental health. Few studies have explored factors that protect mental health of migrants in the post-migration phase. Such knowledge could be useful for health promotion purposes. Therefore, this study aimed to analyse associations between financial difficulties, housing problems and experience of discrimination and poor mental health; and to detect possible effect modification by social capital, among recently settled Iraqi migrants in Sweden. A postal questionnaire in Arabic was sent to recently settled Iraqi citizens. The response rate was 51% (n = 617). Mental health was measured by the GHQ-12 instrument and social capital was defined as social participation and trust in others. Data were analysed by means of logistic regression. Poor mental health was associated with experience of discrimination (OR 2.88, 95% CI 1.73-1.79), housing problems (OR 2.79, 95% CI 1.84-4.22), and financial difficulties (OR 2.14, 95% CI 1.44-3.19), after adjustments. Trust in others seemed to have a protective effect for mental health when exposed to these factors. Social participation had a protective effect when exposed to experience of discrimination. Social determinants and social capital in the host country play important roles in the mental health of migrants. Social capital modifies the effect of risk factors and might be a fruitful way to promote resilience to factors harmful to mental health among migrants, but must be combined with policy efforts to reduce social inequities. [ABSTRACT FROM AUTHOR]

Background: Informal caregiving by relatives is a great resource for individuals as well as for society, but the caregiving role is associated with health problems for the caregiver. This study aimed to compare caregivers' self-rated health, number of recent days with poor health and psychological wellbeing with that of non-caregivers in a general Swedish population. Methods: From 2004 to 2013, 90,845 Swedish people completed a postal questionnaire about their health, number of recent days with poor health during last month, psychological wellbeing and if they were performing caregiving or not. Descriptive statistics, chi-square analysis, ANOVA, logistic regressions and negative binomial regression models were used to investigate associations between being a caregiver or not and health and wellbeing. Negative binomial regression was used to assess the relation between caregiver status and recent days with poor health or functioning. Results: Eleven percent reported having a caregiving role. Caregivers reported poorer self-rated health compered to non-caregivers, also in adjusted models; odds ratio (OR): 1.07 with a 95 % confidence interval (CI): 1.01-1.13. Caregivers also reported lower psychological wellbeing compared to non-caregivers; OR: 1.22, CI: 1.15-1.30. Caregiving status was associated with more recent days with poor physical health and more recent days with poor mental health. Conclusions: This study suggests that caregivers have worse perceptions in self-rated health and psychological wellbeing compared with non-caregivers, indicating that the role of caregiver is adversely associated with health. This association also appears in terms of reporting days of poor health in the last month. The underlying mechanism of these associations, including the potential detrimental health effects of being a caregiver, needs to be investigated in longitudinal studies. [ABSTRACT FROM AUTHOR]

Background: Informal caregiving by relatives is a great resource for individuals as well as for society, but the caregiving role is associated with health problems for the caregiver. This study aimed to compare caregivers' self-rated health, number of recent days with poor health and psychological wellbeing with that of non-caregivers in a general Swedish population. Methods: From 2004 to 2013, 90,845 Swedish people completed a postal questionnaire about their health, number of recent days with poor health during last month, psychological wellbeing and if they were performing caregiving or not. Descriptive statistics, chi-square analysis, ANOVA, logistic regressions and negative binomial regression models were used to investigate associations between being a caregiver or not and health and wellbeing. Negative binomial regression was used to assess the relation between caregiver status and recent days with poor health or functioning. Results: Eleven percent reported having a caregiving role. Caregivers reported poorer self-rated health compered to non-caregivers, also in adjusted models; odds ratio (OR): 1.07 with a 95 % confidence interval (CI): 1.01-1.13. Caregivers also reported lower psychological wellbeing compared to non-caregivers; OR: 1.22, CI: 1.15-1.30. Caregiving status was associated with more recent days with poor physical health and more recent days with poor mental health. Conclusions: This study suggests that caregivers have worse perceptions in self-rated health and psychological wellbeing compared with non-caregivers, indicating that the role of caregiver is adversely associated with health. This association also appears in terms of reporting days of poor health in the last month. The underlying mechanism of these associations, including the potential detrimental health effects of being a caregiver, needs to be investigated in longitudinal studies. [ABSTRACT FROM AUTHOR]

Background: Informal caregiving by relatives is a great resource for individuals as well as for society, but the caregiving role is associated with health problems for the caregiver. This study aimed to compare caregivers’ self-rated health, number of recent days with poor health and psychological wellbeing with that of non-caregivers in a general Swedish population. Methods: From 2004 to 2013, 90,845 Swedish people completed a postal questionnaire about their health, number of recent days with poor health during last month, psychological wellbeing and if they were performing caregiving or not. Descriptive statistics, chi-square analysis, ANOVA, logistic regressions and negative binomial regression models were used to investigate associations between being a caregiver or not and health and wellbeing. Negative binomial regression was used to assess the relation between caregiver status and recent days with poor health or functioning. Results: Eleven percent reported having a caregiving role. Caregivers reported poorer self-rated health compered to non-caregivers, also in adjusted models; odds ratio (OR): 1.07 with a 95 % confidence interval (CI): 1.01-1.13. Caregivers also reported lower psychological wellbeing compared to non-caregivers; OR: 1.22, CI: 1.15-1.30. Caregiving status was associated with more recent days with poor physical health and more recent days with poor mental health. Conclusions: This study suggests that caregivers have worse perceptions in self-rated health and psychological wellbeing compared with non-caregivers, indicating that the role of caregiver is adversely associated with health. This association also appears in terms of reporting days of poor health in the last month. The underlying mechanism of these associations, including the potential detrimental health effects of being a caregiver, needs to be investigated in longitudinal studies. [ABSTRACT FROM AUTHOR]

Background Self-rated health is a robust predictor of several health outcomes, such as functional ability, health care utilization, morbidity and mortality. The purpose of this study is to investigate and explore how health locus of control and disease burden relate to self-rated health among patients at risk for cardiovascular disease. Methods In 2009, 414 Swedish patients who were using statins completed a questionnaire about their health, diseases and their views on the three-dimensional health locus of control scale. The scale determines which category of health locus of control - internal, chance or powerful others - a patient most identifies with. The data was analyzed using logistic regression and a structural equation modeling approach. Results The analyses showed positive associations between internal health locus of control and self-rated health, and a negative association between health locus of control in chance and powerful others and self-rated health. High internal health locus of control was negatively associated with the cumulative burden of diseases, while health locus of control in chance and powerful others were positively associated with burden of diseases. In addition, age and education level had indirect associations with self-rated health through health locus of control. Conclusions This study suggests that self-rated health is positively correlated with internal locus of control and negatively associated with high locus of control in chance and powerful others in patients at high risk for cardiovascular disease. Furthermore, disease burden seems to be negatively associated with self-rated health. [ABSTRACT FROM AUTHOR]

Background: The risk of heart failure is disproportionately high among the socioeconomically disadvantaged. Furthermore, socioeconomically deprived patients are at risk of inequitable access to heart failure treatment and poor outcomes. Non-employment as a risk factor in this respect has not previously been studied at the level of the individual. The aim of this register-based cohort study was to analyse equity in access to renin-angiotensin system blockers and mortality, by employment status and educational level. Methods: The study population consisted of Swedish patients aged 20–64 years hospitalised for heart failure in July 2006–December 2010, without a heart failure hospitalisation within one year or more before index hospitalisation and without renin-angiotensin system blocker dispensation in the 6 months preceding index hospitalisation. Non-access to renin-angiotensin system blockers, measured as drug dispensations, was investigated by employment status and educational level through logistic regression. Cox regression models were used to obtain hazard ratios for all-cause death by educational level and employment status. Interaction analysis was used to test whether associations between access to treatment and mortality differed by employment status. Results: Among the 3874 patients, 1239 (32%) were women. The median age was 57 years. Fifty-three percent were employed. The non-employed patients had more comorbidity and lower access (68%) to renin-angiotensin system blockers compared with the employed (82%). The adjusted odds ratio for non-access to renin-angiotensin system blockers among the non-employed was 1.76. Non-employment was associated with an adjusted hazard ratio of 1.76 for death. Low educational level was associated with a higher death risk. Mortality was highest among the non-employed without access to renin-angiotensin system blockers and the association between access to renin-angiotensin system blockers and survival was slightly weaker in this group. Conclusions: Non-employment and low educational level were associated with elevated mortality in heart failure. Non-employment was a risk factor for lower access to evidence-based treatment, and among the non-employed access to treatment was associated with a slightly smaller risk reduction than among the employed. The results underscore that clinicians need to be aware of the importance of socioeconomic factors in heart failure care. [ABSTRACT FROM AUTHOR]

Abstract: Objective: This study attempts to identify a structure among patient-related factors that could predict treatment adherence in statin patients, especially with regards to the necessity-concern framework. Methods: 414 Swedish patients using statins completed a questionnaire about their health, treatment, locus of control, perception of necessity-concern and adherence. The data were handled using a structural equation modeling approach. Results: Patients that reported high perceptions of necessity to treatment seemed to adhere well, and side effects appear to affect adherence negatively. Disease burden, cardiovascular disease experience and high locus of control seem to have mediating effects on adherence. Conclusion: This study provides support for the hypothesis that health- and treatment-related factors, as well as locus of control factors, are indirectly associated with treatment adherence via their association with mediating factor necessity. Practice implications: This study highlights the importance of considering patients’ beliefs about medications, disease burden, experience of cardiovascular events and locus of control as these factors are associated with adherence behavior to statin treatment. This study also emphasizes more generally the importance of an approach targeting necessity and concern when communicating with and treating patients with lipid-lowering medication. [Copyright &y& Elsevier]

Background: The perception of cardiovascular risk factors is believed to be associated with a person's willingness to carry out lifestyle changes as well as their willingness to adhere to prescribed preventive medications. Little is known about whether these perceptions differ between statin users and those not using statins, including how these factors relate to health behaviours. Purpose: The objective was to investigate and compare the perceptions of known modifiable risk factors for cardiovascular disease in patients using statins with those of a non-treated population. One further objective was to investigate if statin use was associated with favourable health behaviours. Method: Data about health, perception of the importance of cardiovascular risk factors and health behaviours were collected through questionnaires from 829 statin users and 629 non-statin users. Beliefs about risk factors were compared in univariate analyses, and four health behaviours were compared in multivariate regression models. Results: Statin users had better health behaviours in univariate analyses compared to non-statin users. Statin users rated lifestyle-related risk factors as more important contributors for the development of cardiovascular disease than non-statin users. In a multivariate model, statin use was associated with having better eating habits. Conclusion: People using statins are more concerned about cardiovascular risk factors compared to non-statin users. The behaviour of taking statins seems to be associated with favourable eating habits. [ABSTRACT FROM AUTHOR]

Background: International research shows that there is a higher use of care among the unemployed than among the employed, although the findings on the association between unemployment and healthcare use are not conclusive. Purpose: To examine the association between healthcare use and employment status and the factors influencing this relationship. Method: During 2002, a questionnaire was sent to 1,000 persons who had recently registered as unemployed (participation rate: n = 570) and to a sample of 1,000 persons representing the Swedish population (participation rate: n = 641). The study design was cross-sectional. Persons still unemployed or otherwise not employed ( n = 416) were compared with the employed ( n = 414) using logistic regression analyses. Results: About half of those in the unemployed group had contacted a physician. The unemployed were also more likely to have needed but not sought care. Being in the unemployed group was a statistically significant risk factor for reporting unmet care needs, after adjusting for sociodemographic factors (OR = 1.53). The risk of abstaining from seeking care did not persist when considering economy and social network. Among those with unmet care needs, there was still a higher risk in the unemployed group of reporting: a small social network (OR = 2.73), economic hardship (OR = 2.87) and symptoms of depression (OR = 2.04). Conclusions: Unemployment is a risk factor for both contacting a physician and for unmet care needs. A low social network and economic hardship are more present among persons who abstain from seeking healthcare and seem to be more common among the unemployed. The healthcare system should also be aware of the fact that some unemployed people with symptoms of depression abstain from seeking care. [ABSTRACT FROM AUTHOR]

Background: Many researchers have examined the effect that mental health has on reemployment opportunities amongst the unemployed, but the results are inconclusive. Our aim in this study is to investigate the effects that different aspects of mental and physical health, as well as socio-demographic, social, and economic factors, have on reemployment. Methods: A questionnaire was administered to 1,000 and answered by 502 newly registered unemployed Swedes, who were followed for one year using data from the Swedish National Labour Market Board. The differences between those reemployed and those not reemployed was analysed using stepwise logistic regression. Results: General mental ill health amongst unemployed individuals measured by the General Health Questionnaire scale was associated with lower levels of reemployment after one year. This effect could not be explained by any of the scales measuring specific aspects of mental disease such as health-related level of function, rate of depression, burnout, or alcohol misuse. Instead being above 45, low control over one's financial situation, being an immigrant, and visiting a physician during the last three months were better predictors of failure to be reemployed. Conclusion: There are theoretical reasons to assume that psychological distress leads to a decreased reemployment rate amongst the unemployed. The results of this study partly endorse this hypothesis empirically, showing that general subjective mental distress decreases the rate of reemployment amongst newly unemployed individuals, although this effect was mediated by social and economic factors. Indicators of psychiatric disease had no significant effect on reemployment. The results of this study lead us to suggest the early introduction of financial counselling, psychological support, and other interventions for groups with lower reemployment rates. [ABSTRACT FROM AUTHOR]

Statins are a lipid-lowering treatment, prescribed frequently to prevent cardiovascular events. The objective of this study was to explore how doctors anticipate the effect of statins and what factors are associated with their willingness to initiate treatment. A total of 330 Swedish cardiologists, internists and general practitioners were asked to consider two hypothetical patient cases, one with and one without previous coronary heart disease. Based on these cases, the respondents answered questions about their willingness to initiate treatment and what effects they might expect. The expectation of effect was assessed in two ways: (1) the absolute risk reduction of myocardial infarction in 1000 patients treated with statins for 5 years; and (2) statins' average effect on increased life expectancy. The doctors' beliefs about absolute risk reduction were compared with results from clinical trials. Most doctors had a suboptimal expectation about absolute risk reduction; only about one-third had expectations in the range supported by evidence-based data. There were different views about statins' ability to prolong life: that is, average gain in life expectancy due to treatment was believed to be 2 years in the primary patient case, and 3 years in the second patient case. The doctors' beliefs about statins' ability to prolong life were associated significantly with their willingness to initiate treatment. The overall results imply that doctors have varying and suboptimal understanding of the effect of statins. This may inhibit the goal of integrating clinical research into clinical practice. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Mortality statistics are important for epidemiological research. We examine if discrepancies between death certificate (DC) and hospital discharge condition (HDC) indicate certification errors. Study Design and Setting: From 39,872 hospital deaths in Sweden in 1995, we randomly selected 600 “cases,” where DC and HDC were incompatible, and 600 compatible “controls,” matched on sex, age, and underlying cause of death. We obtained case summaries for 1,094 (91%) of these. Using a structured protocol, we assessed the accuracy of DCs. Results: Regression analysis indicated diagnostic group and “case” or “control” as the variables that most affected the accuracy. Malignant neoplasm “controls” had the highest accuracy (92%), and benign and unspecified tumor “cases,” the lowest (20%). For all diagnostic groups except one, compatible “controls” had better accuracy than incompatible “cases.” The exception, chronic obstructive lung disease, had low accuracy for both “cases” (54%) and “controls” (52%). Conclusion: Incompatibility between DC and HDC indicates a greater risk of certification errors. For some diagnostic groups, however, DCs are often inaccurate even when DC and HDC are compatible. By requesting additional information on incompatible cases and all deaths in high-risk diagnostic groups, producers of mortality statistics could improve the accuracy of the statistics. [Copyright &y& Elsevier]

Background: Clinicians, nurses, and managers in hospitals are continuously confronted by new technologies and methods that require changes to working practice. Quality systems can help to manage change while maintaining a high quality of care. A new model of quality systems inspired by the works of Donabedian has three factors: structure (resources and administration), process (culture and professional co-operation), and outcome (competence development and goal achievement). The objectives of this study were to analyse whether structure, process, and outcome can be used to describe quality systems, to analyse whether these components are related, and to discuss implications. Methods: A questionnaire was developed and sent to a random sample of 600 hospital departments in Sweden. The adjusted response rate was 75%. The data were analysed with confirmatory factor analysis and structural equation modeling in LISREL. This is to our knowledge the first large quantitative study that applies Donabedian's model to quality systems. Results: The model with relationships between structure, process, and outcome was found to be a reasonable representation of quality systems at hospital departments (p = 0.095, indicating no significant differences between the model and the data set). Structure correlated strongly with process (0.72) and outcome (0.60). Given structure, process also correlated with outcome (0.20). Conclusion: The model could be used to describe and evaluate single quality systems or to compare different quality systems. It could also be an aid to implement a systematic and evidencebased system for working with quality improvements in hospital departments. [ABSTRACT FROM AUTHOR]

Aims: To evaluate an intervention aimed at improving knowledge of, attitudes to, and practices regarding condoms and emergency contraception (ECP) among Swedish high school students. Methods: An intervention study with quasi-experimental design. A strategic sample of classes from two vocational high school programs was divided into an intervention group and a comparison group. All students completed questionnaires before and after the intervention, which included sexual education lessons by a nurse-midwife and medical students, free condoms on request and access to telephone counseling. Results: Of the 461 eligible students, mean age 17 years, 390 (85%) completed the pre-test and 326 (71%) the post-test. Three out of four (77%) had experienced sexual intercourse. The majority (76%) had used contraception, mostly condoms at first intercourse. The students already had good knowledge of condoms with no change after the intervention, but attitudes improved and condom use increased. Knowledge of, and attitudes towards ECP improved but use remained stable (29%). The most important source of information about ECP changed from “friends” to “school” after the intervention. More than one out of four (28%) had opted for free condoms but only 3% had requested telephone counseling. Conclusions: Condom use increased after the intervention whereas the use of ECP remained stable. Knowledge of ECP improved and the attitudes towards both condoms and ECP became more positive. Participation of nurse-midwives and medical students, skill rehearsal, and improved access to condoms may be useful elements in sexual education. [ABSTRACT FROM AUTHOR]

To evaluate a community-based intervention regarding emergency contraceptive pills, including a mass media campaign and information to women visiting family planning clinics.Quasi-experimental.Two counties in Sweden.Eight hundred randomly selected women aged 16–30 years, 400 women in the intervention group and 400 in a comparison group.Postal questionnaires before (2002) and after (2003) the intervention.Exposure to the intervention, knowledge, attitudes, practices and intention to use emergency contraceptive pills.Before the intervention, the response rate was 71% (n= 564); after the intervention, the corresponding figure was 83% (n= 467); overall response rate 58%. Two-thirds (64%) of the targeted women had noticed the information campaign. One out of six who had visited a family planning clinic during the intervention year recalled being given information about emergency contraceptive pills. Specific knowledge and attitudes improved over time in both groups, but there was no difference in change between the groups. The proportion of women who had used emergency contraceptive pills increased from 27% to 31% over time. Intention to use emergency contraceptive pills in case of need was reported by 74% of the women and remained stable over time, but logistic regression showed that information during the previous year contributed to willingness to use the method in the intervention group.Knowledge, attitudes and practices about emergency contraceptive pills increased in both groups. Emergency contraceptive pills is gradually becoming a more widely known, accepted and used contraceptive method in Sweden, a trend that may have limited the impact of the intervention. [ABSTRACT FROM AUTHOR]

One year after emergency contraceptive pills (ECP) had become prescription-free, we sent a questionnaire to 800 randomly selected women in mid-Sweden. The aim was to investigate women''s knowledge, attitudes and practices regarding the method. The response rate was 71% (n = 564). The majority of the women, 65%, would prefer to purchase ECP over-the-counter (OTC) in a pharmacy. Attitudes toward the method were predominantly positive, but one fourth (24%) had worries about side effects and one third (33%) considered ECP to be a kind of abortion. Logistic regression showed that correct knowledge of and positive attitudes toward ECP contributed to estimated future use of ECP. Although women favored the OTC option, persistent misunderstanding about ECP implies that routine information from gynecologists and health professionals as well as media campaigns is needed along with the deregulation in order to make ECP an accepted and properly used contraceptive method. [Copyright &y& Elsevier]

Background: The risk of heart failure is disproportionately high among the socioeconomically disadvantaged. Furthermore, socioeconomically deprived patients are at risk of inequitable access to heart failure treatment and poor outcomes. Non-employment as a risk factor in this respect has not previously been studied at the level of the individual. The aim of this register-based cohort study was to analyse equity in access to renin-angiotensin system blockers and mortality, by employment status and educational level.Methods: The study population consisted of Swedish patients aged 20-64 years hospitalised for heart failure in July 2006-December 2010, without a heart failure hospitalisation within one year or more before index hospitalisation and without renin-angiotensin system blocker dispensation in the 6 months preceding index hospitalisation. Non-access to renin-angiotensin system blockers, measured as drug dispensations, was investigated by employment status and educational level through logistic regression. Cox regression models were used to obtain hazard ratios for all-cause death by educational level and employment status. Interaction analysis was used to test whether associations between access to treatment and mortality differed by employment status.Results: Among the 3874 patients, 1239 (32%) were women. The median age was 57 years. Fifty-three percent were employed. The non-employed patients had more comorbidity and lower access (68%) to renin-angiotensin system blockers compared with the employed (82%). The adjusted odds ratio for non-access to renin-angiotensin system blockers among the non-employed was 1.76. Non-employment was associated with an adjusted hazard ratio of 1.76 for death. Low educational level was associated with a higher death risk. Mortality was highest among the non-employed without access to renin-angiotensin system blockers and the association between access to renin-angiotensin system blockers and survival was slightly weaker in this group.Conclusions: Non-employment and low educational level were associated with elevated mortality in heart failure. Non-employment was a risk factor for lower access to evidence-based treatment, and among the non-employed access to treatment was associated with a slightly smaller risk reduction than among the employed. The results underscore that clinicians need to be aware of the importance of socioeconomic factors in heart failure care. [ABSTRACT FROM AUTHOR]

Aims: Health-related behaviours are associated with social relationships. Adolescence is a time when healthy and unhealthy behaviours are established. There is a need to investigate adolescents' views on how social relationships are related to health-related behaviours of adolescents in the Scandinavian welfare system. This study aimed to explore Swedish adolescents' experiences and thoughts of how social relationships in different social environments are related to health-related behaviours. Methods : A total of 36 adolescents aged 15–16 years were interviewed in seven focus-group sessions. Qualitative content analysis was used for analysis of the transcribed interviews. Results : Two themes – social context and personal management – emerged. Swedish adolescents describe that their health-related behaviours as being partly shaped by their own personal management but mainly by the social contexts that surround them. Social contexts were expressed as playing a role in the adolescents' health-related behaviours, as they provide fellowship, pressure, dependability and engagement. Fellowship with friends and family was expressed as providing healthy behaviours and high levels of well-being. Fellowship with friends was particularly important for physical activity. Close relationships were stated to influence health-related behaviours. Pressure from friends, teachers and social media were described as mainly influencing unhealthy behaviours and, to some extent, low levels of well-being. However, adolescents' personal ability illustrated how adolescents shaped their own health-related behaviours. Conclusions : The study results contribute to the understanding of Swedish adolescents' views on how social relationships can shape their health-related behaviours. The findings may be useful to school professionals in supporting adolescents to improve well-being and healthy behaviours. [ABSTRACT FROM AUTHOR]

In 2012, human papillomavirus (HPV) vaccination was introduced free of charge in the Swedish national school-based vaccination programme for 10-12-year-old girls, and as catch-up vaccination for young women. In Sweden, there is an ongoing discussion about including boys in the national vaccination programme. Few studies are undertaken about adolescents’ knowledge, beliefs and HPV vaccination status in relation to socioeconomic status and sexual experience. Thus, the aim was to examine HPV catch-up vaccination status in adolescents in relation to 1) socioeconomic factors, 2) beliefs and knowledge about HPV prevention, and 3) sexual behaviour. The Health Belief Model was used as a theoretical framework. Upper secondary school students (n = 832) aged 16, randomly chosen from a larger sample, were invited to participate in conjunction with the general health interview with the school nurse. A total of 751/832 (90.3%), girls (n = 391, 52%) and boys (n = 360, 48%) completed the questionnaire. HPV vaccination was associated with ethnicity and the mothers’ education level; i.e. girls with a non-European background and girls with a less educated mother were less likely to have received the vaccine (p<0.01 and p = 0.04 respectively). Vaccinated girls perceived HPV infection as more severe (p = 0.01), had more insight into women’s susceptibility to the infection (p = 0.02), perceived more benefits of the vaccine as protection against cervical cancer (p<0.01) and had a higher intention to engage in HPV-preventive behaviour (p = 0.01). Furthermore, boys and girls were almost equally sexually experienced, although fewer girls had used condom during first intercourse with their latest partner (p = 0.03). Finally, HPV vaccinated girls were less likely to have unprotected sex (p<0.01). In summary, catch-up HPV vaccination among young girls was associated with a European background and high maternal education level, as well as more favourable beliefs towards HPV prevention and less sexual risk-taking. Further preventive measures should therefore be directed at the migrant population. [ABSTRACT FROM AUTHOR]

Companies need to ensure a functioning occupational health and safety management (OHSM) system to protect human health and safety during work, but generally there are differences in how successful they are in this endeavor. Earlier research has indicated that factors like company size, safety culture, and different measures of financial performance may be related to the quality of OHSM practices in companies. Therefore, the aim of this study was to investigate whether these factors are associated with OHSM practices in companies. A postal questionnaire was used to collect data from a sample of Swedish manufacturing companies, and complementary data regarding the companies were retrieved from a credit bureau database. The statistical analysis was performed with ordinal regression analysis using generalized estimating equations. Different predictor variables were modeled with OHSM practices as the outcome variable, in order to calculate p -values and to estimate odds ratios. Company size, safety culture, and creditworthiness were found to be associated with better, as well as worse, OHSM practices in companies (depending on directionality). Practical implications for industry and future research are discussed. [ABSTRACT FROM AUTHOR]

Background: Several interventions have been carried out to tackle health inequalities between migrant groups, especially refugees, and native-born European populations. These initiatives are often address language or cultural barriers. One of them is the International Health Advisors (IHA) in Sweden; a peer education intervention aimed at providing health information for recently settled migrants. It is known that social determinants, such as educational level and access to social capital, affect health. Social determinants may also affect how health information is received and transformed into practice. The aims of this study was to a) assess the impact of the IHA on recently settled migrants' self-reported health status, and received health information; b) determine the moderating role of educational level and social capital; and c) critically discuss the outcomes and suggest implications for health promotion practice.Methods: The study was designed as a prospective cohort study. A postal questionnaire translated to Arabic was sent to recently settled Iraqi migrants in eight counties in Sweden, in May 2008 and May 2010. Two of the counties were exposed to the intervention, and six were used as references.Results: The proportion of individuals who reported that they had received information on healthy diet and physical exercise was higher in the intervention group than in the non-intervention group (OR 2.31, 95% CI 1.02-5.22), after adjustments. Low social participation was negatively associated with deteriorated or unchanged health needs (OR 0.47, 95% CI 0.24-0.92). No other statistically significant differences in health outcomes could be observed between the groups. No signs of effect modification on this association by social capital or educational level could be found.Conclusions: Health information provided by the IHA increased self-reported level of knowledge on healthy diet and physical exercise. The interpretation of the observed negative association between low social participation and deteriorated or unchanged health needs is that participation was limited to one's own social group, and therefore had limited positive influence on health seeking behaviour. The lack of measurable improvements in health status could be explained by limitations in the study, in the theoretical assumptions underlying the intervention, and in the implementation of the intervention. Further research is needed to understand success factors in health promoting interventions among recently settled migrants better. [ABSTRACT FROM AUTHOR]

Background: Migration from Thailand to Sweden has increased threefold over the last 10 years. Today Thailand is one of the most common countries of origin among immigrants in Sweden. Since the year 2000, new HIV cases are also more prevalent among Thai immigrants compared to other immigrant nationalities in Sweden. The purpose of this study was to investigate the association between knowledge and utilization of sexual and reproductive healthcare services, contraceptive knowledge and socio-demographic characteristics and social capital among Thai immigrant women in Sweden. Methods: This is a cross-sectional study using a postal questionnaire to all Thai women (18-64) in two Swedish regions, who immigrated to the country between 2006 and 2011. The questionnaire was answered by 804 women (response rate 62.3 %). Bivariate and multivariate logistic regression analyses were used. Results: The majority (52.1 %) of Thai women had poor knowledge of where they should turn when they need sexual and reproductive healthcare services. After controlling for potential confounders, living without a partner (OR = 2.02, CI: 1.16-3.54), having low trust in others (OR= 1.61, CI: 1.10-2.35), having predominantly bonding social capital (OR = 1.50, CI: 1.02-2.23) and belonging to the oldest age group (OR = 2.65, CI: 1.32-5.29) were identified as risk factors for having poor knowledge. The majority (56.7 %) had never been in contact with healthcare services to get advice on contraception, and about 75 % had never been HIV/STI tested in Sweden. Low utilization of healthcare was associated with poor knowledge about healthcare services (OR = 6.07, CI: 3.94-9.34) and living without a partner (OR = 2.53, CI: 1.30-4.90). Most Thai women had knowledge of how to prevent an unwanted pregnancy (91.6 %) and infection with HIV/STI (91.1 %). Conclusions: The findings indicate that social capital factors such as high trust in others and predominantly bridging social capital promote access to knowledge about healthcare services. However, only one-fourth of the women had been HIV/STI tested, and due to the HIV prevalence among Thai immigrants in Sweden, policy makers and health professionals need to include Thai immigrants in planning health promotion efforts and healthcare interventions. [ABSTRACT FROM AUTHOR]

Background Several international studies suggest inequity in access to evidence-based heart failure (HF) care. Specifically, studies of ACE inhibitors (ACEIs) point to reduced ACEI access related to female sex, old age and socioeconomic position. Thus far, most studies have either been rather small, lacking diagnostic data, or lacking the possibility to account for several individual- based sociodemographic factors. Our aim was to investigate differences, which could reflect inequity in access to ACEIs based on sex, age, socioeconomic status or immigration status in Swedish patients with HF. Methods Individually linked register data for all Swedish adults hospitalised for HF in 2005-2010 (n=93 258) were analysed by multivariate regression models to assess the independent risk of female sex, high age, low employment status, low income level, low educational level or foreign country of birth, associated with lack of an ACEI dispensation within 1 year of hospitalisation. Adjustment for possible confounding was made for age, comorbidity, Angiotensin receptor blocker therapy, period and follow-up time. Results Analysis revealed an adjusted OR for no ACEI dispensation for women of 1.31 (95% CI 1.27 to 1.35); for the oldest patients of 2.71 (95% CI 2.53 to 2.91); and for unemployed patients of 1.59 (95% CI 1.46 to 1.73). Conclusions Access to ACEI treatment was reduced in women, older patients and unemployed patients. We conclude that access to ACEIs is inequitable among Swedish patients with HF. Future studies should include clinical data, as well as mortality outcomes in different groups. [ABSTRACT FROM AUTHOR]

Background: The purpose of the health examination for asylum seekers in most countries is to identify poor health in order to secure the well-being of seekers of asylum and to guarantee the safety of the population in the host country. Functional health literacy is an individual's ability to read information and instructions about health and to function effectively as a patient in the health system, and comprehensive health literacy is an individual's competence in accessing, understanding, appraising and applying health information. Little is known about refugees' health literacy and their experiences of the health examination for asylum seekers. The purposes of the study were to investigate refugees' experiences of communication during their health examination for asylum seekers and the usefulness of that examination, and whether health literacy is associated with those experiences.Methods: A cross-sectional study was made among 360 adult refugees speaking Arabic, Dari, Somali or English. Health literacy was measured using the Swedish Functional Health Literacy Scale and the short European Health Literacy Questionnaire. Experiences of communication and the usefulness of the health examination were measured in several questions. Associations were sought using univariate and multivariate statistical models.Results: In the health examination for asylum seekers, a poor quality of communication was experienced by 36 %, receiving little information about health care by 55 %, and receiving little new knowledge by 41 % and/or help by 26 %. Having inadequate as compared to sufficient comprehensive health literacy was associated with the experience of a poorer quality of communication (OR: 9.64, CI 95 %: 3.25-28.58) and the experience of receiving little valuable health care information (OR: 6.54, CI 95 %: 2.45-17.47). Furthermore, having inadequate as compared to sufficient comprehensive health literacy was associated with the experience of not receiving new knowledge (OR: 7.94, CI 95 %: 3.00-21.06) or receiving help with health problems (OR: 8.07, 95 % CI: 2.50-26.07. Functional healthy literacy was not associated with experiences of HEA.Conclusion: Refugees' experiences indicate that a low level of comprehensive health literacy can act as a barrier to fulfilling the purposes of the health examination for asylum seekers. Comprehensive health literacy seems to be of greater importance in that context than functional health literacy. [ABSTRACT FROM AUTHOR]

Background Many Western countries have cervical cancer screening programmes and have implemented nation-wide human papillomavirus ( HPV) vaccination programmes for preventing cervical cancer. Objective To explore immigrant women's experiences and views on the prevention of cervical cancer, screening, HPV vaccination and condom use. Design An exploratory qualitative study. The Health Belief Model ( HBM) was used as a theoretical framework. Setting and participants Eight focus group interviews, 5-8 women in each group (average number 6,5), were conducted with 50 women aged 18-54, who studied Swedish for immigrants. Data were analysed by latent content analysis. Results Four themes emerged: (i) deprioritization of women's health in home countries, (ii) positive attitude towards the availability of women's health care in Sweden, (iii) positive and negative attitudes towards HPV vaccination, and (iv) communication barriers limit health care access. Even though the women were positive to the prevention of cervical cancer, several barriers were identified: difficulties in contacting health care due to language problems, limited knowledge regarding the relation between sexual transmission of HPV and cervical cancer, culturally determined gender roles and the fact that many of the women were not used to regular health check-ups. Conclusion The women wanted to participate in cervical cancer prevention programmes and would accept HPV vaccination for their daughters, but expressed difficulties in understanding information from health-care providers. Therefore, information needs to be in different languages and provided through different sources. Health-care professionals should also consider immigrant women's difficulties concerning cultural norms and pay attention to their experiences. [ABSTRACT FROM AUTHOR]

Workers in the steel-manufacturing industry face many safety risks due to the nature of the job. How well safety procedures and regulations are followed within an organization is considered to be influenced by the reigning culture of the organization. The aim of this study was to investigate and describe safety culture and risk-taking at a large steel-manufacturing company in Sweden by exploring workers’ experiences and perceptions of safety and risks. Ten focus group interviews were conducted with a total of 66 workers. In the interviews, the situation of safety at work was discussed in a semi-structured manner. The material was analyzed inductively using qualitative content analysis. The analysis resulted in a thorough description of safety culture and risk-taking at the company, based on the following five main categories: 1. Acceptance of risks , one simply has to accept the safety risks of the work environment, 2. Individual responsibility for safety , the responsibility for safe procedures rests to the largest extent on the individual, 3. Trade-off between productivity and safety , these are conflicting entities, wanting to produce as well as wanting to work safely, 4. Importance of communication , it is needed for safety actions to be effective, and 5. State-of-the-day and external conditions , an interplay between these factors affect risk-taking. In sociotechnical systems theory it is acknowledged that there are interactions between social and technical factors in organizations. The findings of this study are interpreted to be in line with a sociotechnical understanding of safety culture and risk-taking. [ABSTRACT FROM AUTHOR]

Background: Refugees have poorer health compared to indigenous populations, which may be explained by lower health literacy, i.e. not being able to access, understand, appraise or apply health information. This study aims to determine levels of functional and comprehensive health literacy, and factors associated with inadequate health literacy, in refugees coming to Sweden. Method: A cross-sectional study was performed among 455 adult refugees speaking Arabic, Dari, Somali or English. Participants in 16 strategically selected language schools for immigrants responded to a questionnaire. Health literacy was measured using the Swedish Functional Health Literacy Scale and the HLS-EU-Q16 questionnaire. Uni- and multivariate statistical methods were used to investigate group differences. Results: The majority of the participating refugees had inadequate or limited functional health literacy and comprehensive health literacy. About 60% of them had inadequate functional health literacy and 27% had inadequate comprehensive health literacy. Low education and/or being born in Somalia were factors associated with an increased risk of having inadequate functional health literacy. Having inadequate functional health literacy was associated with an increased risk of having inadequate comprehensive health literacy. Conclusions: The majority of refugees in the language schools had limited or poor health literacy. Health literacy should be taken into consideration in contexts and in activities addressing migrants. More research is needed to better understand health literacy among refugees and to develop strategies and methods to increase health literacy and make life easier for those with low health literacy. [ABSTRACT FROM AUTHOR]

Background: Self-rated health is a robust predictor of several health outcomes, such as functional ability, health care utilization, morbidity and mortality. The purpose of this study is to investigate and explore how health locus of control and disease burden relate to self-rated health among patients at risk for cardiovascular disease.Methods: In 2009, 414 Swedish patients who were using statins completed a questionnaire about their health, diseases and their views on the three-dimensional health locus of control scale. The scale determines which category of health locus of control - internal, chance or powerful others - a patient most identifies with. The data was analyzed using logistic regression and a structural equation modeling approach.Results: The analyses showed positive associations between internal health locus of control and self-rated health, and a negative association between health locus of control in chance and powerful others and self-rated health. High internal health locus of control was negatively associated with the cumulative burden of diseases, while health locus of control in chance and powerful others were positively associated with burden of diseases. In addition, age and education level had indirect associations with self-rated health through health locus of control.Conclusions: This study suggests that self-rated health is positively correlated with internal locus of control and negatively associated with high locus of control in chance and powerful others in patients at high risk for cardiovascular disease. Furthermore, disease burden seems to be negatively associated with self-rated health. [ABSTRACT FROM AUTHOR]