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  • 1.
    Audulv, Åsa
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    The over time development of chronic illness self-management patterns: a longitudinal qualitative study2013In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 13, p. Art. no. 452-Article in journal (Refereed)
    Abstract [en]

    Background: There currently exists a vast amount of literature concerning chronic illness self-management, however the developmental patterns and sustainability of self-management over time remain largely unknown. This paper aims to describe the patterns by which different chronic illness self-management behaviors develop and are maintained over time.

    Method: Twenty-one individuals newly diagnosed with chronic illnesses (e.g., diabetes, rheumatism, ischemic heart disease, multiple sclerosis, chronic renal disease, inflammatory bowel disease) were repeatedly interviewed over two-and-a-half years. The interviews were conducted in Sweden from 2006 to 2008. A total of 81 narrative interviews were analyzed with an interpretive description approach.

    Results: The participants’ self-management behaviors could be described in four different developmental patterns: consistent, episodic, on demand, and transitional. The developmental patterns were related to specific self-management behaviors. Most participants took long-term medications in a consistent pattern, whereas exercise was often performed according to an episodic pattern. Participants managed health crises (e.g., angina, pain episodes) according to an on demand pattern and everyday changes due to illness (e.g., adaptation of work and household activities) according to a transitional pattern. All of the participants used more than one self-management pattern.

    Conclusion: The findings show that self-management does not develop as one uniform pattern. Instead different self-management behaviors are enacted in different patterns. Therefore, it is likely that self-management activities require support strategies tailored to each behavior’s developmental pattern.

  • 2.
    Bergqvist, Kersti
    et al.
    Centre for Health Equity Studies, Stockholm University, Karolinska Institutet, Stockholm, Sweden .
    Åberg Yngwe, Monica
    Centre for Health Equity Studies, Stockholm University, Karolinska Institutet, Stockholm, Sweden .
    Lundberg, Olle
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Centre for Health Equity Studies, Stockholm University, Karolinska Institutet, Stockholm, Sweden .
    Understanding the role of welfare state characteristics for health and inequalities - an analytical review2013In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 13, p. Art. no. 1234-Article, review/survey (Refereed)
    Abstract [en]

    Background: The past decade has witnessed a growing body of research on welfare state characteristics and health inequalities but the picture is, despite this, inconsistent. We aim to review this research by focusing on theoretical and methodological differences between studies that at least in part may lead to these mixed findings. Methods: Three reviews and relevant bibliographies were manually explored in order to find studies for the review. Related articles were searched for in PubMed, Web of Science and Google Scholar. Database searches were done in PubMed and Web of Science. The search period was restricted to 2005-01-01 to 2013-02-28. Fifty-four studies met the inclusion criteria. Results: Three main approaches to comparative welfare state research are identified; the Regime approach, the Institutional approach, and the Expenditure approach. The Regime approach is the most common and regardless of the empirical regime theory employed and the amendments made to these, results are diverse and contradictory. When stratifying studies according to other features, not much added clarity is achieved. The Institutional approach shows more consistent results; generous policies and benefits seem to be associated with health in a positive way for all people in a population, not only those who are directly affected or targeted. The Expenditure approach finds that social and health spending is associated with increased levels of health and smaller health inequalities in one way or another but the studies are few in numbers making it somewhat difficult to get coherent results. Conclusions: Based on earlier reviews and our results we suggest that future research should focus less on welfare regimes and health inequalities and more on a multitude of different types of studies, including larger analyses of social spending and social rights in various policy areas and how these are linked to health in different social strata. But, we also need more detailed evaluation of specific programmes or interventions, as well as more qualitative analyses of the experiences of different types of policies among the people and families that need to draw on the collective resources.

  • 3.
    Deville, Walter
    et al.
    NIVEL Netherlands Inst Hlth Serv Res, NL-3500 BN Utrecht, Netherlands. .
    Greacen, Tim
    Etab Publ Sante Maison Blanche, F-75019 Paris, France. .
    Bogic, Marija
    Queen Mary Univ London, Unit Social & Community Psychiat, Newham Ctr Mental Hlth, London E13 8SP, England. .
    Dauvrin, Marie
    Catholic Univ Louvain, Inst Hlth & Soc, B-1200 Brussels, Belgium. .
    Dias, Sonia
    Univ Nova Lisboa, Inst Higiene & Med Trop, P-1349008 Lisbon, Portugal.
    Gaddini, Andrea
    Laziosanita ASP Publ Hlth Agcy Lazio Reg, I-00198 Rome, Italy. .
    Jensen, Natasja Koitzsch
    Univ Copenhagen, Dept Publ Hlth, Sect Hlth Serv Res, Danish Res Ctr Migrat Ethn & Hlth MESU, DK-1014 Copenhagen, Denmark. .
    Karamanidou, Christina
    Natl Sch Publ Hlth, Dept Sociol, Athens 11521, Greece. .
    Kluge, Ulrike
    Charite, CCM, Clin Psychiat & Psychotherapy, D-10117 Berlin, Germany. .
    Mertaniemi, Ritva
    Natl Inst Hlth & Welf THL, Dept Mental Hlth & Subst Abuse Serv, FIN-00271 Helsinki, Finland. .
    Puigpinos i Riera, Rosa
    Agcy Publ Hlth Barcelona, Barcelona 08023, Spain. .
    Sarvary, Attila
    Univ Debrecen, Fac Hlth Sci Nyiregyhaza, H-4400 Nyiregyhaza, Hungary. .
    Soares, Joaquim J. F.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Stankunas, Mindaugas
    Lithuanian Univ Hlth Sci, Dept Hlth Management, LT-44307 Kaunas, Lithuania. .
    Strassmayr, Christa
    Ludwig Boltzmann Inst Social Psychiat, A-1090 Vienna, Austria. .
    Welbel, Marta
    Inst Psychiat & Neurol, PL-02957 Warsaw, Poland..
    Priebe, Stefan
    Queen Mary Univ London, Unit Social & Community Psychiat, Newham Ctr Mental Hlth, London E13 8SP, England..
    Health care for immigrants in Europe: Is there still consensus among country experts about principles of good practice? A Delphi study2011In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 11, p. Art. no. 699-Article in journal (Refereed)
    Abstract [en]

    Background: European Member States are facing a challenge to provide accessible and effective health care services for immigrants. It remains unclear how best to achieve this and what characterises good practice in increasingly multicultural societies across Europe. This study assessed the views and values of professionals working in different health care contexts and in different European countries as to what constitutes good practice in health care for immigrants. Methods: A total of 134 experts in 16 EU Member States participated in a three-round Delphi process. The experts represented four different fields: academia, Non-Governmental Organisations, policy-making and health care practice. For each country, the process aimed to produce a national consensus list of the most important factors characterising good practice in health care for migrants. Results: The scoring procedures resulted in 10 to 16 factors being identified as the most important for each participating country. All 186 factors were aggregated into 9 themes: (1) easy and equal access to health care, (2) empowerment of migrants, (3) culturally sensitive health care services, (4) quality of care, (5) patient/health care provider communication, (6) respect towards migrants, (7) networking in and outside health services, (8) targeted outreach activities, and (9) availability of data about specificities in migrant health care and prevention. Although local political debate, level of immigration and the nature of local health care systems influenced the selection and rating of factors within each country, there was a broad European consensus on most factors. Yet, discordance remained both within countries, e. g. on the need for prioritising cultural differences, and between countries, e. g. on the need for more consistent governance of health care services for immigrants. Conclusions: Experts across Europe asserted the right to culturally sensitive health care for all immigrants. There is a broad consensus among experts about the major principles of good practice that need to be implemented across Europe. However, there also is some disagreement both within and between countries on specific issues that require further research and debate.

  • 4.
    Engqvist, Ulf
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Social Work.
    Rydelius, Per-Anders
    Child and adolescent psychiatric patients and later criminality2007In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 7, no 147, p. 221-Article in journal (Refereed)
    Abstract [en]

    Background Sweden has an extensive child and adolescent psychiatric (CAP) research tradition in which longitudinal methods are used to study juvenile delinquency. Up to the 1980s, results from descriptions and follow-ups of cohorts of CAP patients showed that children´s behavioural disturbances or disorders and school problems, together with dysfunctional family situations, were the main reasons for families, children, and youth to seek help from CAP units. Such factors were also related to registered criminality and registered alcohol and drug abuse in former CAP patients as adults. This study investigated the risk for patients treated 1975-1990 to be registered as criminals until the end of 2003. Methods A regional sample of 1,400 former CAP patients, whose treatment occurred between 1975 and 1990, was followed to 2003, using database-record links to the Register of Persons Convicted of Offences at the National Council for Crime Prevention (NCCP). Results Every third CAP patient treated between 1975 and 1990 (every second man and every fifth woman) had entered the Register of Persons Convicted of Offences during the observation period, which is a significantly higher rate than the general population. Conclusions Results were compared to published results for CAP patients who were treated between 1953 and 1955 and followed over 20 years. Compared to the group of CAP patients from the 1950s, the results indicate that the risk for boys to enter the register for criminality has doubled and for girls, the risk seems to have increased sevenfold. The reasons for this change are discussed. Although hypothetical and perhaps speculative this higher risk of later criminality may be the result of lack of social control due to (1) rising consumption of alcohol, (2) changes in organisation of child social welfare work, (3) the school system, and (4) CAP methods that were implemented since 1970.

  • 5.
    Fransson, E.I.
    et al.
    Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE-171 77 Stockholm, Sweden.
    Nyberg, S
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Heikkilä, K
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Alfredsson, L
    Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE-171 77 Stockholm, Sweden.
    Bacquer, D
    Department of Public Health, Ghent University, Ghent, Belgium.
    Batty, G
    Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Bonenfant, S
    Versailles-Saint Quentin University, Versailles, France.
    Casini, A
    School of Public Health, Université Libre de Bruxelles, Brussels, Belgium.
    Clays, E
    Department of Public Health, Ghent University, Ghent, Belgium.
    Goldberg, M
    Versailles-Saint Quentin University, Versailles, France.
    Kittel, F
    School of Public Health, Université Libre de Bruxelles, Brussels, Belgium.
    Koskenvuo, M
    Department of Public Health, University of Helsinki, Helsinki, Finland.
    Knutsson, Anders
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Leineweber, C
    Stress Research Institute, Stockholm University, Stockholm, Sweden.
    Magnusson Hanson, L
    Stress Research Institute, Stockholm University, Stockholm, Sweden.
    Nordin, M
    Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden.
    Singh-Manoux, A
    Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Suominen, S
    Department of Public Health, University of Turku, Turku, Finland.
    Vahtera, J
    Department of Public Health, University of Turku, Turku, Finland.
    Westerholm, P
    Finnish Institute of Occupational Health, Turku, Finland.
    Westerlund, H
    Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Zins, M
    Versailles-Saint Quentin University, Versailles, France.
    Theorell, T
    Stress Research Institute, Stockholm University, Stockholm, Sweden.
    Kivimäki, M
    Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Comparison of alternative versions of the job demand-control scales in 17 European cohort studies: The IPD-Work consortium2012In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 12, no 1, p. Art. no. 62-Article in journal (Refereed)
    Abstract [en]

    Background: Job strain (i.e., high job demands combined with low job control) is a frequently used indicator of harmful work stress, but studies have often used partial versions of the complete multi-item job demands and control scales. Understanding whether the different instruments assess the same underlying concepts has crucial implications for the interpretation of findings across studies, harmonisation of multi-cohort data for pooled analyses, and design of future studies. As part of the ’IPD-Work’ (Individual-participant-data meta-analysis in working populations) consortium, we compared different versions of the demands and control scales available in 17 European cohort studies. Methods. Six of the 17 studies had information on the complete scales and 11 on partial scales. Here, we analyse individual level data from 70 751 participants of the studies which had complete scales (5 demand items, 6 job control items). Results. We found high Pearson correlation coefficients between complete scales of job demands and control relative to scales with at least three items (r > 0.90) and for partial scales with two items only (r = 0.76-0.88). In comparison with scores from the complete scales, the agreement between job strain definitions was very good when only one item was missing in either the demands or the control scale (kappa > 0.80); good for job strain assessed with three demand items and all six control items (kappa > 0.68) and moderate to good when items were missing from both scales (kappa = 0.54-0.76). The sensitivity was > 0.80 when only one item was missing from either scale, decreasing when several items were missing in one or both job strain subscales. Conclusions. Partial job demand and job control scales with at least half of the items of the complete scales, and job strain indices based on one complete and one partial scale, seemed to assess the same underlying concepts as the complete survey instruments. 

  • 6.
    Hansen, Elisabeth
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Norwegian Univ Sci & Technol, Fac Med, Dept Publ Hlth & Gen Practice, HUNT Res Ctr, N-7600 Levanger, Norway.
    Sund, Erik
    Norwegian Univ Sci & Technol, Fac Med, Dept Publ Hlth & Gen Practice, HUNT Res Ctr, N-7600 Levanger, Norway.
    Knudtsen, Margunn Skjei
    Nord Trondelag Cty Council, Dept Hlth Promot, N-7735 Steinkjer, Norway.
    Krokstad, Steinar
    Norwegian Univ Sci & Technol, Fac Med, Dept Publ Hlth & Gen Practice, HUNT Res Ctr, N-7600 Levanger, Norway.
    Holmen, Turid Lingaas
    Norwegian Univ Sci & Technol, Fac Med, Dept Publ Hlth & Gen Practice, HUNT Res Ctr, N-7600 Levanger, Norway.
    Cultural activity participation and associations with self-perceived health, life-satisfaction and mental health: the Young HUNT Study, Norway2015In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 15, article id 544Article in journal (Refereed)
    Abstract [en]

    Background: Leisure time activities and culture participation may have health effects and be important in pulic health promotion. More knowledge on how cultural activity participation may influence self-perceived health, life-satisfaction, self-esteem and mental health is needed. Methods: This article use data from the general population-based Norwegian HUNT Study, using the cross-sectional Young-HUNT3 (2006-08) Survey including 8200 adolescents. Data on cultural activity participation, self-perceived health, life-satisfaction, self-esteem, anxiety and depression were collected by self-reported questionnaires. Results: Both attending meetings or training in an organisation or club, and attending sports events were positively associated with each of the health parameters good self-percieved health, good life-satisfaction, good self-esteem, and low anxiety and depression symptoms. We found differences according to gender and age (13-15 years versus 16-19 years old) for several culture activities, where girls aged 16-19 years seemed to benefit most from being culturally active. The extent of participation seemed to matter. Those who had frequent participation in cultural activities reported better health outcomes compared to inactive adolecents. Conclusions: The results from this study indicate that participation in cultural activities may be positively associated with health, life-satisfaction and self-esteem in adolescents and thus important in public health promotion. Possible sex and age differences should be taken into account.

  • 7.
    Hauck, Yvonne
    et al.
    Curtin University, Perth, Australia; King Edward Memorial Hospital, Subiaco, Australia.
    Blixt, Ingrid
    Uppsala University, Uppsala .
    Hildingsson, Ingegerd
    Uppsala University, Uppsala.
    Gallagher, Louise
    Trinity College Dublin, Dublin, Ireland.
    Rubertsson, Christine
    Uppsala University, Uppsala.
    Thomson, Brooke
    Curtin University, Perth, Australia.
    Lucy, Lewis
    Curtin University, Perth, Australia; King Edward Memorial Hospital, Subiaco, Australia.
    Australian, Irish and Swedish women's perceptions of what assisted them to breastfeed for six months: exploratory design using critical incidence technique2016In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 16, no 1, article id 1067Article in journal (Refereed)
    Abstract [en]

    Background: Breastfeeding initiation rates in some developed countries are high (98 % in Sweden and 96 % inAustralia) whereas in others, they are not as favourable (46 % to 55 % in Ireland). Although the World Health Organization recommends exclusively breastfeeding for six months, 15 % of Australian women, 11 % of Swedish women and less than 7 % of Irish women achieve this goal. Awareness of what women in different countries perceive as essential breastfeeding support is a gap in our knowledge.

    Methods: Our aim was to explore Australian, Irish and Swedish women’s perceptions of what assisted them tocontinue breastfeeding for six months. An exploratory design using critical incident techniques was used. Recruitment occurred through advertisements in local newspapers and on social networking platforms. Initial sampling was purposive, followed by snowball sampling. Telephone interviews were conducted with 64 Irish, 139 Swedish and 153 Australian women who responded to one question “what has assisted you to continue breastfeeding for at least six months?” Content analysis was conducted and common categories determined toallow comparison of frequencies and priority ranking.

    Results: Categories reflected the individual mother, her inner social network, her outer social network (informal support either face to face or online), and societal support (health professionals, work environment and breastfeeding being regarded as the cultural norm). Categories ranked in the top five across the three countries were ‘informal face to face support’ and ‘maternal determination’. Swedish and Australian women ranked “health professional support” higher (first and third respectively) than Irish women who ranked ‘informal online support’ as second compared to ninth and tenth for Swedish and Australian women.

    Conclusions: The support required to assist breastfeeding women is complex and multi-faceted. Although common international categories were revealed, the ranking of these supportive categories varied. We must recognize how the cultural context of breastfeeding support can vary for women in differing countries and acknowledge the resourcefulness of women who embrace innovations such as social media where face to face formal and informal support are not as accessible.

  • 8.
    Månsdotter, Anna
    et al.
    Karolinska institutet.
    Nordenmark, Mikael
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Hammarström, Anne
    Umeå universitet.
    The importance of childhood and adulthood aspects of gendered life for adult mental ill-health symptoms – a 27-year follow-up of the Northern Swedish Cohort2012In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 12, p. Art. no. 493-Article in journal (Refereed)
    Abstract [en]

    Background: The increasing gender equality during the 20th century, mainly in the Nordic countries, represents a major social change. A well-established theory is that this may affect the mental health patterns of women and men. This study aimed at examining associations between childhood and adulthood gendered life on mental ill-health symptoms.

    Methods: A follow-up study of a cohort of all school leavers in a medium-sized industrial town in northern Sweden was performed from age 16 to age 42. Of those still alive of the original cohort, 94% (n = 1007) participated during the whole period. Gendered life was divided into three stages according to whether they were traditional or non-traditional (the latter includes equal): childhood (mother’s paid work position), adulthood at age 30 (ideology and childcare), and adulthood at age 42 (partnership and childcare). Mental ill-health was measured by self-reported anxious symptoms (“frequent nervousness”) and depressive symptoms (“frequent sadness”) at age 42. The statistical method was logistic regression analysis, finally adjusted for earlier mental ill-health symptoms and social confounding factors.

    Results: Generally, parents’gendered life was not decisive for a person’s own gendered life, and adulthood gender position ruled out the impact of childhood gender experience on self-reported mental ill-health. For women, non-traditional gender ideology at age 30 was associated with decreased risk of anxious symptoms (76% for traditional childhood, 78% for non-traditional childhood). For men, non-traditional childcare at age 42 was associated with decreased risk of depressive symptoms (84% for traditional childhood, 78% for non-traditional childhood). A contradictory indication was that non-traditional women in childcare at age 30 had a threefold increased risk of anxious symptoms at age 42, but only when having experienced a traditional childhood.

    Conclusion: Adulthood gender equality is generally good for self-reported mental health regardless of whether one opposes or continues one’s gendered history. However, the childcare findings indicate a differentiated picture; men seem to benefit in depressive symptoms from embracing this traditionally female duty, while women suffer anxious symptoms from departing from it, if their mother did not.

  • 9. Priebe, S
    et al.
    Sandhu, S
    Dias, S
    Gaddini, A
    Greacen, T
    Ioannidis, E
    Kluge, U
    Krasnik, A
    Lamkaddem, M
    Lorant, L
    Puigpinós i Riera, R
    Sarvary, A
    Soares, Joaquim
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Stankunas, M
    Straßmayr, C
    Wahlbeck, K
    Welbel, M
    Bogic, M
    Good practice in health care for migrants: views and experiences of care professionals in 16 European countries2011In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 11, p. 187-Article in journal (Refereed)
    Abstract [en]

    Background

    Health services across Europe provide health care for migrant patients every day. However, little systematic research has explored the views and experiences of health care professionals in different European countries. The aim of this study was to assess the difficulties professionals experience in their service when providing such care and what they consider constitutes good practice to overcome these problems or limit their negative impact on the quality of care.

    Methods

    Structured interviews with open questions and case vignettes were conducted with health care professionals working in areas with high proportion of migrant populations in 16 countries. In each country, professionals in nine primary care practices, three accident and emergency hospital departments, and three community mental health services (total sample = 240) were interviewed about their views and experiences in providing care for migrant patients, i.e. from first generation immigrant populations. Answers were analysed using thematic content analysis.

    Results

    Eight types of problems and seven components of good practice were identified representing all statements in the interviews. The eight problems were: language barriers, difficulties in arranging care for migrants without health care coverage, social deprivation and traumatic experiences, lack of familiarity with the health care system, cultural differences, different understandings of illness and treatment, negative attitudes among staff and patients, and lack of access to medical history. The components of good practice to overcome these problems or limit their impact were: organisational flexibility with sufficient time and resources, good interpreting services, working with families and social services, cultural awareness of staff, educational programmes and information material for migrants, positive and stable relationships with staff, and clear guidelines on the care entitlements of different migrant groups. Problems and good care components were similar across the three types of services.

    Conclusions

    Health care professionals in different services experience similar difficulties when providing care to migrants. They also have relatively consistent views on what constitutes good practice. The degree to which these components already are part of routine practice varies. Implementing good practice requires sufficient resources and organisational flexibility, positive attitudes, training for staff and the provision of information.

  • 10.
    Priebe, Stefan
    et al.
    Queen Mary University of London, London, UK .
    Matanov, Alexandra
    Queen Mary University of London, London, UK .
    Holcnerova, Petra
    Charles University, Prague, Czech Republic .
    Kluge, U
    University Medicine Berlin, Berlin, Germany .
    Lorant, V
    Université Catholique de Louvain, Bruxelles, Belgium.
    Moskalewicz, J
    Institute of Psychiatry and Neurology, Warsaw, Poland .
    Schene, AH
    University of Amsterdam, Amsterdam, The Netherlands .
    Macassa, Gloria
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Karolinska Institute, Stockholm, Sweden .
    Gaddini, A
    Public Health Agency, Lazio Region, Rome, Italy .
    Schor, Ruth
    Queen Mary University of London, London, UK .
    Straßmayr, Christa
    Ludwig Boltzmann Institute for Social Psychiatry, Vienna, Austria.
    Barros, Henrique
    University of Porto Medical School, Porto, Portugal.
    Barry, Margaret M
    National University of Ireland Galway, Galway, Ireland .
    Díaz-Olalla, José Manuel
    Madrid Salud, Madrid, Spain .
    Gabor, Edina
    National Institute for Health Development, Budapest, Hungary .
    Greacen, Tim
    Laboratoire de recherche, Etablissement Public de Santé Maison Blanche, Paris, France .
    Good practice in mental health care for socially marginalized groups in Europe: a qualitative study in 14 countries2012In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, no 12, p. 248-Article in journal (Refereed)
    Abstract [en]

    Background:Socially marginalised groups tend to have higher rates of mental disorders than the general populationand can be difficult to engage in health care. Providing mental health care for these groups represents a particularchallenge, and evidence on good practice is required. Thisstudy explored the experiences and views of experts in 14European countries regarding mental health care for six socially marginalised groups: long-term unemployed; street sexworkers; homeless; refugees/asylum seekers; irregular migrants and members of the travelling communities.Methods:Two highly deprived areas were selected in the capital cities of 14 countries, and experts were interviewed foreach of the six marginalised groups. Semi-structured interviews with case vignettes were conducted to exploreexperiences of good practice and analysed using thematic analysis.Results:In a total of 154 interviews, four components of good practice were identified across all six groups: a) establishingoutreach programmes to identify and engage with individuals with mental disorders; b) facilitating access to services thatprovide different aspects of health care, including mental health care, and thus reducing the need for further referrals; c)strengthening the collaboration and co-ordination betweendifferent services; and d) disseminating information onservices both to marginalised groups and to practitioners in the area.Conclusions:Experts across Europe hold similar views on what constitutes good practice in mental health care formarginalised groups. Care may be improved through better service organisation, coordination and information.

  • 11.
    Rising Holmström, Malin
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Olofsson, Niclas
    Folkhälsocentrum, Landstinget Västernorrland, Härnösand, Sweden.
    Asplund, Kenneth
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Kristiansen, Lisbeth
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Transitions in the Swedish school system and the impact on student's positive self-reported-health2014In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 14, p. Art. no. 1045-Article in journal (Refereed)
    Abstract [en]

    Background: To explore three school based transitions and their impact on positive self-reported-health (SRH), pre-school to elementary school (6-10 y), elementary school to junior high school (10-13y), and junior high school to upper secondary school/high school (13-16y), in a long-term longitudinal population based study. Methods: The study followed three cohorts through one school transition each. A longitudinal study with data from 6693 Health Dialogue questionnaires were used. Data were collected in the middle of Sweden during 2007-2012 with school children age 6-16 years old. Results: Several significant factors were identified with an impact for a positive self-reported-health among children age 6-16y; not feeling sad or depressed, afraid or worried, positive school environment (schoolyard and restrooms), not bullied, good sleep, daily physical activity and ability to concentrate. There was no single factor identified, the factors differed according to gender and age. Conclusion: The study have identified several gender and age specific factors for successful school transitions relevant for a positive SRH. This is valuable information for school staff, parents and school children and provides a possibility to provide support and assistance when needed.

  • 12.
    Rodriguez, Alina
    et al.
    Uppsala universitet, Institutionen för psykologi.
    Järvelin, Marjo-Riitta
    Obel, Carsten
    Taanila, Anja
    Pietilainen, Katri
    Moilanen, Irma
    Henriksen, Tine
    Ebeling, Hanna
    Kotimaa, Arto
    Linnet, Karen
    Olson, Jorn
    Do inattention and hyperactivity symptoms equal scholastic impairment? evidence from three European cohorts2007In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 7, p. 327-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Attention Deficit/ Hyperactivity Disorder (ADHD) affects many children, adolescents, and adults and is associated with a number of impairments. Poor academic performance is related to ADHD in clinical samples. However, it is unclear to what extent core ADHD symptoms and scholastic impairment are related in non-referred school-aged children. METHODS: Data come from three population-based cohorts from Sweden, Denmark, and Finland, which are part of the Nordic Network on ADHD. The combined sample size was 13,087 children who were studied at ages 7-8 or 10-12 years. Teachers rated children on inattention and hyperactivity symptoms and reported children's scholastic performance on basic skills. RESULTS: There was a significant association in all cohorts between core ADHD symptoms and scholastic impairment in reading, writing, and mathematics. Particularly, inattention was related to a two to tenfold increase in scholastic impairment. Prevalence of hyperactivity symptoms was similar across the three cohorts, but inattention was lowest among children from the Finnish cohort, after stratification on living conditions. CONCLUSIONS: These results extend previous reports of scholastic impairment among children with clinically diagnosed ADHD to non-referred population samples from three European countries. Surveillance policies should be implemented in school systems to catch children in need of behavioral or scholastic support early.

  • 13.
    Sellström, Eva
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Hjern, A
    Arnoldsson, G
    Bremberg, S
    Are there differences in birth weight between neighbourhoods in a Nordic welfare state: a 10 year cohort study2007In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 7, p. 267-Article in journal (Refereed)
    Abstract [en]

    Background. The objective of this cohort study was to examine the effect on birth weight of living in a disadvantaged neighbourhood in a Nordic welfare state. Birth weight is a health indicator known to be sensitive to political and welfare state conditions. No former studies on urban neighbourhood differences regarding mean birth weight have been carried out in a Nordic country. Methods. A register based on individual data on children�s birth weight and maternal risk factors was used. Neighbourhood characteristics, i.e. aggregated measures on ethnicity and income, were also included. Connections between individual- and neighbourhood-level determinants and the outcome were analysed using multi-level regression technique. The study covered six hundred and ninety-six neighbourhoods in the three major cities of Sweden, Stockholm, Göteborg and Malmö, during 1992-2001. The majority of neighbourhoods had a population of 4 000�10 000 inhabitants. An average of 500 births per neighbourhood were analysed in this study. Results. Living in a deprived neighbourhood in Sweden did not add to the more proximal risk of giving birth to lower weight infants connected to individual socioeconomic status. Infants born in homogenous ethnic neighbourhoods weighed 69 g less than did infants born in homogeneous Swedish neighbourhoods. No independent effect of neighbourhood income was observed. ICC was less than 1 per cent indicating that most variability in birth weight was on the individual level. Conclusions. Social policies in Sweden, including universal social benefits, gender equality seen in high female labour market participation, and a general and free maternal health care, could possibly explain the non-existent differences in mean birth weight in Swedish urban neighbourhoods.

  • 14.
    Strassmayr, C
    et al.
    Ludwig Boltzmann Institute for Social Psychiatry, Lazarettgasse 14A-912, 1090 Vienna, Austria.
    Matanov, A
    Unit for Social and Community Psychiatry, Queen Mary University of London, Mile End Road, London E13 8SP, United Kingdom.
    Priebe, S
    Unit for Social and Community Psychiatry, Queen Mary University of London, Mile End Road, London E13 8SP, United Kingdom.
    Barros, H
    Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto, Medical School, Al Prof Hernani Monteiro, 4200-319, Porto, Portugal.
    Canavan, R
    Health Promotion Research Centre, National University of Ireland Galway, University Road, Galway, Ireland.
    Díaz-Olalla, J.M
    Madrid Salud, Calle Juan Esplandiú no 13, 28007 Madrid, Spain.
    Gabor, E
    National Institute for Health Development, Nagyvárad tér 2, 1096 Budapest, Hungary.
    Gaddini, A
    Laziosanità ASP, Public Health Agency, Lazio Region, Via di S. Costanza 53, 00198 Rome, Italy.
    Greacen, T
    Laboratoire de Recherche, Etablissement Public de Ssanté Maison Blanche, 18 rue Rémy de Gourmont, 75019 Paris, France.
    Holcnerová, P
    Department of Psychiatry, 1st Faculty of Medicine, Charles University, Ke Karlovu 11/12000, Prague, Czech Republic.
    Kluge, U
    Clinic for Psychiatry and Psychotherapy, Charité, University Medicine Berlin, CCM, Charitéplatz 1, 10117 Berlin, Germany.
    Welbel, M
    Institute of Psychiatry and Neurology, ul. Sobieskiego 9, 02-957 Warsaw, Poland.
    Nicaise, P
    Institute of Health and Society (IRSS), Université Catholique de Louvain, Clos Chapelle- aux-Champs, 30.05, B-1200 Bruxelles, Belgium.
    Schene, AH
    Academic Medical Center, University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, Netherlands.
    Soares, Joaquim J. F.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Katschnig, H
    Ludwig Boltzmann Institute for Social Psychiatry, Lazarettgasse 14A-912, 1090 Vienna, Austria.
    Mental health care for irregular migrants in Europe: Barriers and how they are overcome2012In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 12, no 367, p. Art. no. 367-Article in journal (Refereed)
    Abstract [en]

    Background

    Irregular migrants (IMs) are exposed to a wide range of risk factors for developing mental health problems. However, little is known about whether and how they receive mental health care across European countries. The aims of this study were (1) to identify barriers to mental health care for IMs, and (2) to explore ways by which these barriers are overcome in practice.

    Methods

    Data from semi-structured interviews with 25 experts in the field of mental health care for IMs in the capital cities of 14 European countries were analysed using thematic analysis.

    Results

    Experts reported a range of barriers to mental health care for IMs. These include the absence of legal entitlements to health care in some countries or a lack of awareness of such entitlements, administrative obstacles, a shortage of culturally sensitive care, the complexity of the social needs of IMs, and their fear of being reported and deported. These barriers can be partly overcome by networks of committed professionals and supportive services. NGOs have become important initial points of contact for IMs, providing mental health care themselves or referring IMs to other suitable services. However, these services are often confronted with the ethical dilemma of either acting according to the legislation and institutional rules or providing care for humanitarian reasons, which involves the risk of acting illegally and providing care without authorisation.

    Conclusions

    Even in countries where access to health care is legally possible for IMs, various other barriers remain. Some of these are common to all migrants, whilst others are specific for IMs. Attempts at improving mental health care for IMs should consider barriers beyond legal entitlement, including communicating information about entitlement to mental health care professionals and patients, providing culturally sensitive care and ensuring sufficient resources.

  • 15.
    Svensson, Jessika
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Romild, Ulla
    Swedish Natl Inst Publ Hlth, Ostersund, Sweden.
    Shepherdson, Emma
    Swedish Natl Inst Publ Hlth, Ostersund, Sweden.
    The concerned significant others of people with gambling problems in a national representative sample in Sweden - a 1 year follow-up study2013In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 13, p. Art. no. 1087-Article in journal (Refereed)
    Abstract [en]

    Background: Research into the impact of problem gambling on close social networks is scarce with the majority of studies only including help-seeking populations. To date only one study has examined concerned significant others (CSOs) from an epidemiological perspective and it did not consider gender. The aim of this study is to examine the health, social support, and financial situations of CSOs in a Swedish representative sample and to examine gender differences. Methods: A population study was conducted in Sweden in 2008/09 (n = 15,000, response rate 63%). Respondents were defined as CSOs if they reported that someone close to them currently or previously had problems with gambling. The group of CSOs was further examined in a 1-year follow up (weighted response rate 74% from the 8,165 respondents in the original sample). Comparisons were also made between those defined as CSOs only at baseline (47.7%, n = 554) and those defined as CSOs at both time points. Results: In total, 18.2% of the population were considered CSOs, with no difference between women and men. Male and female CSOs experienced, to a large extent, similar problems including poor mental health, risky alcohol consumption, economic hardship, and arguments with those closest to them. Female CSOs reported less social support than other women and male CSOs had more legal problems and were more afraid of losing their jobs than other men. One year on, several problems remained even if some improvements were found. Both male and female CSOs reported more negative life events in the 1 year follow-up. Conclusions: Although some relationships are unknown, including between the CSOs and the individuals with gambling problems and the causal relationships between being a CSO and the range of associated problems, the results of this study indicate that gambling problems not only affect the gambling individual and their immediate close family but also the wider social network. A large proportion of the population can be defined as a CSO, half of whom are men. While male and female CSOs share many common problems, there are gender differences which need to be considered in prevention and treatment.

  • 16.
    Wahlgren, Lina
    et al.
    School of Health and Medical Sciences, Örebro university, Örebro, Sweden.
    Schantz, Peter
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Exploring bikeability in a metropolitan setting: stimulating and hindering factors in commuting route environments2012In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 12, no 168, p. Art. no. 168-Article in journal (Refereed)
    Abstract [en]

    Background

    Route environments may influence people's active commuting positively and thereby contribute to public health. Assessments of route environments are, however, needed in order to better understand the possible relationship between active commuting and the route environment. The aim of this study was, therefore, to assess the potential associations between perceptions of whether the route environment on the whole hinders or stimulates bicycle commuting and perceptions of environmental factors.

    Methods

    The Active Commuting Route Environment Scale (ACRES) was used for the assessment of bicycle commuters' perceptions of their route environments in the inner urban parts of Greater Stockholm, Sweden. Bicycle commuters (n = 827) were recruited by advertisements in newspapers. Simultaneous multiple regression analyses were used to assess the relation between predictor variables (such as levels of exhaust fumes, noise, traffic speed, traffic congestion and greenery) and the outcome variable (hindering – stimulating route environments). Two models were run, (Model 1) without and (Model 2) with the item traffic: unsafe or safe included as a predictor.

    Results

    Overall, about 40% of the variance of hindering – stimulating route environments was explained by the environmental predictors in our models (Model 1, R² = 0.415, and Model 2, R² = 0.435). The regression equation for Model 1 was: y = 8.53 + 0.33 ugly or beautiful + 0.14 greenery + (−0.14) course of the route + (−0.13) exhaust fumes + (−0.09) congestion: all types of vehicles (p ≤ 0.019). The regression equation for Model 2 was y = 6.55 + 0.31 ugly or beautiful + 0.16 traffic: unsafe or safe + (−0.13) exhaust fumes + 0.12 greenery + (−0.12) course of the route (p ≤ 0.001).

    Conclusions

    The main results indicate that beautiful, green and safe route environments seem to be, independently of each other, stimulating factors for bicycle commuting in inner urban areas. On the other hand, exhaust fumes, traffic congestion and low 'directness' of the route seem to be hindering factors. Furthermore, the overall results illustrate the complexity of a research area at the beginning of exploration.

  • 17.
    Wallmann-Sperlich, B.
    et al.
    Institute of Health Promotion and Clinical Movement Science, German Sports University, Köln, D-50933, Germany .
    Bucksch, J.
    WHO Collaborating Centre for Child and Adolescent Health Promotion, School of Public Health, Bielefeld University, Bielefeld, D-33615, Germany.
    Hansen, S.
    Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, 6229 ER, Netherlands .
    Schantz, Peter
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Froboese, I.
    Institute of Health Promotion and Clinical Movement Science, German Sports University, Köln, D-50933, Germany .
    Sitting time in Germany: An analysis of socio-demographic and environmental correlates2013In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 13, no 1, p. Art. no. 196-Article in journal (Refereed)
    Abstract [en]

    Background: Sedentary behaviour in general and sitting time in particular is an emerging global health concern. The aim of this study was to provide data on the prevalence of sitting time in German adults and to examine socio-demographic and environmental correlates of sitting time. Methods. A representative sample of German adults (n = 2000; 967 men, 1033 women; 49.3 ±17.6 years of age) filled in the Global Physical Activity Questionnaire, including one question on overall sitting time and answered questions about the neighbourhood environment, as well as concerning demographics. Daily sitting time was stratified by gender, age group, BMI, educational and income level, as well as physical activity (PA). To identify socio-demographic and environmental correlates of sitting time, we used a series of linear regressions. Results: The overall median was 5 hours (299 minutes) of sitting time/day and men sat longer than women (5 vs. 4 hours/day; p < 0.05). In both genders age and PA were negatively and the educational level positively associated with sitting time. The level of income was not a correlate of sitting time in multivariate analyses. Sitting time was significantly positively associated with higher neighbourhood safety for women. The variance of the multivariate model ranged from 16.5% for men to 8.9% for women. Conclusions: The overall sitting time was unequally distributed in the German adult population. Our findings suggest implementing specific interventions to reduce sitting time for subgroups such as men, younger aged adults and adults with a higher education and lower PA. Future studies should enhance our understanding of the specific correlates of different types and domains of sitting in order to guide the development of effective public health strategies.

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