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  • 1.
    Abbasi, Seyed H
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    De Leon, AP
    Division of Social Medicine, Department of Public Health Sciences, Karolinska Intitutet, Sweden.
    Kassaian, SE
    Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
    Karimi.,, AA
    Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
    Sundin, Örjan
    Mid Sweden University, Faculty of Human Sciences, Department of Social Sciences.
    Soares, Joaquim J. F.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Macassa, Gloria
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Gender Differences in the Risk of Coronary Artery Disease in Iran2012In: Iranian Journal of Public Health, ISSN 0304-4556, Vol. 41, no 3, p. 36-47Article in journal (Refereed)
    Abstract [en]

    Background: Given gender differences in the risk of coronary artery disease (CAD), the present study sought to investigate these dissimilarities amongst patients who underwent angiography at a major, tertiary heart hospital in Iran. Methods: Between 2005 and 2010, 44,820 patients who underwent coronary angiography were enrolled in a registry. Pre-procedural data such as demographics, CAD risk factors, presenting symptoms, and laboratory tests, as well as postprocedural data were collected. The data were, subsequently, compared between the men and women. Results: Out of the 44,820 patients (16,378 women), who underwent coronary angiography, 37,358 patients (11,995 women) had CAD. Amongst the CAD patients, the females were not only significantly older, less educated, and more overweight than were the males but also had higher levels of triglyceride, cholesterol, low-density lipoprotein, highdensity lipoprotein, and fasting blood sugar (P< 0.001). Of all the risk factors, hypertension and diabetes mellitus showed the strongest association in our female CAD patients (OR=3.45, 95%CI: 3.28-3.61 and OR=2.37, 95%CI: 2.26- 2.48, respectively). Acute coronary syndrome was more prevalent in the men (76.1% vs. 68.6%, P< 0.001), and chronic stable angina was more frequent in the females (31.4% vs. 23.9%, P< 0.001). With respect to post-procedural recommendations, the frequency of recommendations for non-invasive modalities was higher in the females (20.1% vs. 18.6%, P< 0.001). Conclusion: Hypertension and diabetes mellitus had the strongest association with CAD in our female patients. In the extensive CAD patients, medical treatment was recommended to the women more often.

  • 2.
    Abbasi, Seyed H
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Tehran University of Medical Sciences, Tehran, Iran.
    Sundin, Örjan
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology.
    Jalali, Arash
    Teheran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
    Soares, Joaquim
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Macassa, Gloria
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Högskolan i Gävle.
    Ethnic differences in the risk factors and severity of coronary artery disease: a patient-based study in Iran2018In: Journal of Racial and Ethnic Health Disparities, ISSN 2197-3792, Vol. 5, no 3, p. 623-631Article in journal (Refereed)
    Abstract [en]

    Background Diverse ethnic groups may differ regarding the risk factors and severity of coronary artery disease (CAD). This study sought to assess the association between ethnicity and CAD risk and severity in six major Iranian ethnic groups.

    Methods In this study, 20,165 documented coronary artery disease patients who underwent coronary angiography at a tertiary referral heart center were recruited. The demographic, laboratory, clinical, and risk factor data of all the patients were retrieved. The Gensini score (an indicator of CAD severity) was calculated for all, and the risk factors and severity of CAD were compared between the ethnical groups, using adjusted standardized residuals, Kruskal–Wallis test, and multivariable regression analysis.

    Results The mean age of the participants (14,131 [70.1%] men and 6034 [29.9%] women) was 60.7 ± 10.8 years. The Fars (8.7%) and Gilak (8.6%) ethnic groups had the highest prevalence of ≥4 simultaneous risk factors. The mean Gensini score was the highest for the Gilaks (77.1 ± 55.9) and the lowest among the Lors (67.5 ± 52.8). The multivariable regression analysis showed that the Gilaks had the worst severity (β 0.056, 95% CI 0.009 to 0.102; P = 0.018), followed by the Torks (β 0.032, 95% CI 0.005 to 0.059; P = 0.020). Meanwhile, the Lors showed the lowest severity (β −0.087, 95% CI −0.146 to −0.027; P = 0.004).

    Conclusions This study found that there was heterogeneity in CAD severity and a diverse distribution in its well-known traditional risk factors among major Iranian ethnic groups.

  • 3.
    Abbasi, Seyed
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Ponce De Leon, Antonio
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Kassaian, Seyed Ebrahim
    Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
    Karimi, Abbasali
    Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
    Sundin, Örjan
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology.
    Jalali, Arash
    Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
    Soares, Joaquim
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden .
    Macassa, Gloria
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden .
    Socioeconomic status and in hospital mortality of acute corony syndrome: Can education and occupation serves as preventive measures?2015In: International Journal of Preventive Medicine, ISSN 2008-7802, E-ISSN 2008-8213, Vol. 6, article id Art. no. 6:36Article in journal (Refereed)
    Abstract [en]

    Background: Socioeconomic status (SES) can greatly affect the clinical outcome of medical problems. We sought to assess the in‑hospital mortality of patients with the acute coronarysyndrome (ACS) according to their SES.

    Methods: All patients admitted to Tehran Heart Center due to 1st‑time ACS between March 2004 and August 2011 were assessed. The patients who were illiterate/lowly educated (≤5 years attained education) and were unemployed were considered low‑SES patients and those who were employed and had high educational levels (>5 years attained education) were regarded as high‑SES patients. Demographic, clinical, paraclinical, and in‑hospital medical progress data were recorded. Death during the course of hospitalization was considered the end point, and the impact of SES on in‑hospital mortality was evaluated.

    Results: A total of 6246 hospitalized patients (3290 low SES and 2956 high SES) were included (mean age = 60.3 ± 12.1 years, male = 2772 [44.4%]). Among them, 79 (1.26%) patients died. Univariable analysis showed a significantly higher mortality rate in the low‑SES group (1.9% vs. 0.6%; P < 0.001). After adjustment for possible cofounders, SES still showed a significant effect on the in‑hospital mortality of the ACS patients in that the high‑SES patients had a lower in‑hospital mortality rate (odds ratio: 0.304, 95% confidence interval: 0.094–0.980; P = 0.046).

    Conclusions: This study found that patients with low SES were at a higher risk of in‑hospital mortality due to the ACS. Furthermore, the results suggest the need for increased availability of jobs as well as improved levels of education as preventive measures to curb the unfolding deaths owing to coronary artery syndrome.

  • 4.
    Abbasi, Seyed
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Sundin, Örjan
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology.
    Jalali, A
    Soares, Joaquim
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Macassa, Gloria
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Mortality by acute Coronary syndrome in Iran: Does place of residence matter?In: Article in journal (Refereed)
  • 5.
    Antai, D
    et al.
    Karolinska Institute.
    Ghilagaber, G
    Stockholm University.
    Wedrén, S
    Karolinska Institute.
    Macassa, Gloria
    Karolinska Institute.
    Moradi, T
    Karolinska Institute.
    Inequities in under-five mortality in Nigeria: differentials by ethnic affiliation of the mother2009In: Journal of religion and health, ISSN 0022-4197, E-ISSN 1573-6571, Vol. 48, no 3, p. 290-304Article in journal (Refereed)
    Abstract [en]

    Observations in Nigeria have indicated polio vaccination refusal related to religion that ultimately affected child morbidity and mortality. This study assessed the role of religion in under-five (0-59 months) mortality using a cross-sectional, nationally representative sample of 7,620 women aged 15-49 years from the 2003 Nigeria Demographic and Health Survey and included 6,029 children. Results show that mother's affiliation to Traditional indigenous religion is significantly associated with increased under-five mortality. Multivariable modelling demonstrated that this association is explained by differential use of maternal and child health services, specifically attendance to prenatal care. To reduce child health inequity, these results need to be incorporated in the formulation of child health policies geared towards achieving a high degree of attendance to prenatal care, irrespective of religious affiliation.

  • 6.
    Aspelin, Johanna
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Olofsson, Niclas
    FoU Västernorrland.
    Soares, Joaquim
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Ahmadi, Nader
    Univerfsity of Gävle.
    Walander, Anders
    Karolinska Institutet.
    Macassa, Gloria
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Gender differences in self-reported health during times of economic crises: Does employment status matter?.2015In: International Journal of Health Sciences & Research, ISSN 2249-9571, Vol. 5, no 2, p. 246-257Article in journal (Refereed)
    Abstract [en]

    Background: Employment status has an impact on health and is a source of health inequalities. But little is known about its impact on the health of people residing in the County of Västernorrland, Sweden. The recent economic recession affected this region in a way which worsened the already existing unemployment rate.Objective of the study: This study aimed to examine the relationship between employment status, gender and self-reported health in the County of Västernorrland, Sweden in the year 2010.Setting and Design: The study used data from a cross-sectional "Health on Equal Terms" survey, carried in the County of Västernorrland in 2010. A total of 6,050 women and men aged 16-65 years were included in the analysis. Descriptive statistics and logistic regression analyses were performed, and results were expressed as odds ratio with 95% confidence intervals.Results: Women and men who were out of work had odds of poor self-reported health of 2.31 (CI 1.94-2.94) and 2.39 (CI 1.96-2.58), respectively. Controlling for other variables reduced the odds of poor health, but the relationship continued to be statistically significant.Conclusion: Results of this study found that at the pick of the most recent economic crises there were equal odds of poor self-reported health among women and men residing in Gävleborg County. The observed association was to some extent explained by demographic, socioeconomic and health-related variables. Policymakers need to pay attention to the health status of those out of work, particularly during times of economic recession and hardship.

  • 7. Awuba, Jude
    et al.
    Macassa, Gloria
    HIV/AIDS in Cameroon: Rising gender issues in policy-making matters2007In: African Journal of Health Sciences, ISSN 1022-9272, E-ISSN 2306-1987, Vol. 14, no 3-4, p. 118-128Article in journal (Refereed)
    Abstract [en]

    This literature review investigated gender differentials in HIV/AIDS in Cameroon and to which extent gender was taken into account in the country’s current policy on HIV/AIDS. The review found that in Cameroon women were at increased risk of being infected with HIV/AIDS compared to men and that apart from biological vulnerability, socio-cultural as well as economic factors accounted for those differences. In addition, the review found that at the policy level, the government has drawn up plans to reduce the high prevalence of HIV/AIDS among women. However, although the current policy acknowledged the need for tackling gender differentials in HIV/AIDS transmission; little has been done at the level of implementation. The current policy needs to be implemented in a more effective manner and a multisectorial approach should be explored in order to curb the current trend of the feminization of HIV/AIDS in Cameroon.

  • 8.
    Begum, Afroza
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Rahman, A.K.M. Fazlur
    Center for Injury Prevention and Research, Dhaka, Bangladesh.
    Rahman, Aminur
    Center for Injury Prevention and Research, Dhaka, Bangladesh.
    Soares, Joaquim
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Khankeh, Hamid Rez
    Karolinska Institutet, Stockholm.
    Macassa, Gloria
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Karolinska Institute, Stockholm; University of Gävle, Gävle.
    Prevalence of suicide ideation among adolescents and young adults in Bangladesh2017In: International Journal of Mental Health, ISSN 0020-7411, E-ISSN 1557-9328, Vol. 46, no 3, p. 177-187Article in journal (Refereed)
    Abstract [en]

    Suicide is a leading cause of death world-wide. However, adolescent suicidal behavior is a neglected public health issue, especially in low-income countries such as Bangladesh. The study was conducted to estimate the prevalence of suicidal ideation among adolescents in a rural community and to examine factors associated with suicidal ideation. A cross-sectional survey was carried out in 2013 among 2,476 adolescents aged 14–19 years, selected randomly from a rural community of Bangladesh. An adapted version of the WHO/SUPRE-MISS questionnaire was used to collect data in the Raiganj sub-district. A two stage screening was performed to identify the suicidal ideation cases. It was found that the life-time prevalence for suicidal ideation was 5 percent among adolescents. The majority of the adolescents with suicidal ideation were females 66 (52.8%), unmarried 103 (82.4%), and students 92 (73%). Suicidal ideation was statistically significantly associated with age, education, occupation, living with parents or others, and house ownership. Respondents who were aged 18–19 years, had secondary school certificate (SSC) and secondary school certificate (HSC) or higher education, were day laborers, had own house, and do not lived with parents had odds ratios of 2.31 (CI 1.46–3.65), 2.38 (CI 1.51–3.77), 4.15 (CI 2.41–7.14), 0.28 (CI 0.13–0.60), 0.14(CI 0.05–0.35), and 1.80 (CI 1.07–3.03), respectively. Among adolescents, the prevalence of life-time suicidal ideation was moderately high. Age, education, occupation, house ownership, and living with parents were statistically significantly associated with suicidal ideation. It is important to design and implement effective community based suicide prevention programs for adolescents in Bangladesh.

  • 9.
    Begum, Afroza
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Viitasara, Eija
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Soares, Joaquim
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Rahman, AKM Fazlur
    Department of Epidemiology, Bangladesh University of Health Sciences, Dhaka, Bangladesh.
    Macassa, Gloria
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. University of Gävle.
    Parental socio-economic position and suicidal ideation among adolescents in Rural Bangladesh2018In: Journal of Psychiatry and Behavioral Sciences, ISSN 2637-8027, no 4, article id 1018Article in journal (Refereed)
    Abstract [en]

    Background:  Suicide is a leading cause of death worldwide and becoming a public health concern among adolescents. However, adolescent suicidal behaviour is a neglected public health issue, especially in low-income countries such as Bangladesh. Of great importance is the understanding of which factors might be related to this growing public problem. 

    Objective: To examine the relationship between parental socio-economic position and suicide ideation among adolescents in rural Bangladesh

    Methods: A cross-sectional survey was conducted in 2013 among 2,476 adolescents, aged 14-19 years, selected randomly from a rural community of Bangladesh. An adapted version of the WHO/SUPRE-MISS questionnaire was used to collect data in the Raiganj sub-district, which is a surveillance area of the Centre for Injury Prevention and Research, Bangladesh (CIPRB).

    Descriptive statistics and binary logistic regression analyses were used to analyze the data. Comparisons of proportions between groups were carried out using the χ2 test. Multivariate logistic regression analysis was used to examine the relationship between parental co-variants and suicidal thoughts among adolescents. The significance level was set atp <0.05. All analyses were performed using SPSS 20.

    Results: The majority of parents had education only up to primary school (mothers 58.7% and fathers 49.5%). Most of them were farmers (53.3% of fathers) and housewives (96.5% of mothers). Monthly income and expenditure of the adolescent’s parents were mainly upto 10,000 taka only. Suicidal ideation is more common among adolescents of low income group parents 104 (5.5%) and who were not living with their parents 18 (8.2%). Adolescent’s suicidal ideation was found to be significantly associated with education, marital status and house ownership of their parents. Not being able to live with their parents was also a significant factor. Parents who received education up to SSC had odds ratio of 2.10 (1.21,3.64) and 1.92 (1.15, 3.23) for mothers and fathers respectively. Parent’s income or expenditure was not associated with adolescent’s suicidal ideation. Adolescent’s suicidal ideation of single parents had higher odds (OR 3.00, CI 1.75-5.19) in comparison to adolescents who had both parents. Adolescents whose parents owned a house and who weren’t living withtheir parents had odds ratios of 0.14 (0.05,0.35), and 1.80 (1.07,3.03) respectively. After adjusting for other covariates parents’ marital status and house ownership significantly associated with the adolescent suicide ideation.

    Conclusion: Parental socio-economic position was associated with suicidal ideation. Adolescent with single parents were more likely to report suicidal ideation. Low parental education and socio-economic status, marital status, house ownership, not living with parents at home as well as adolescent loneliness were the important factors for suicidal ideation.

  • 10. Burström, Bo
    et al.
    Macassa, Gloria
    Öberg, Lisa
    Bernhardt, Eva
    Smedman, Lars
    Barnadödlighet, fattigdom och sanitära reformer: Stockholm 1878-19252003In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 80, no 3, p. 209-215Article in journal (Refereed)
  • 11.
    Burström, Bo
    et al.
    Stockholm University/Karolinska Institutet.
    Macassa, Gloria
    Stockholm University/Karolinska Institutet.
    Öberg, Lisa
    Stockholm University/Karolinska Institutet.
    Bernhardt, Eva
    Stockholm University/Karolinska Institutet.
    Smedman, Lars
    Stockholm University/Karolinska Institutet.
    Equitable child health interventions: the impact of improved water and sanitation oninequalities in child mortality in Stockholm at the turn of the 19th century2005In: American Journal of Public Health, ISSN 0090-0036, E-ISSN 1541-0048, Vol. 95, no 2, p. 208-216Article in journal (Refereed)
    Abstract [en]

    Today, many of the 10 million childhood deaths each year are caused by diseases of poverty—diarrhea and pneumonia, for example, which were previously major causes of childhood death in many European countries. Specific analyses of the historical decline of child mortality may shed light on the potential equity impact of interventions to reduce child mortality.

    In our study of the impact of improved water and sanitation in Stockholm from 1878 to 1925, we examined the decline in overall and diarrhea mortality among children, both in general and by socioeconomic group. We report a decline in overall mortality and of diarrhea mortality and a leveling out of socioeconomic differences in child mortality due to diarrheal diseases, but not of overall mortality. The contribution of general and targeted policies is discussed.

  • 12. Chaquisse, E
    et al.
    Fraga, S
    Macassa, Gloria
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Soares, Joaquim
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Mbufana, F
    Barros, H
    Sexual and physical intimate partner violence among women using prenatal care in Nampula, Mozambique2015Conference paper (Refereed)
    Abstract [en]

    Abstract

    Background: Intimate partner violence (IPV) is a major public health problem worldwide but research on IPV in Africa remains limited. This study aims to estimate the prevalence of sexual and physical intimate partner violence against women and its associated factors, in a sample of women using prenatal care in  Nampula, province-Mozambique.

    Methods: This is a cross-sectional study, carried out in six health units, from February 2013 to January 2014. One in every three pregnant women who visited primary health facilities for the first pre-natal appointment was eligible and invited to participate. After obtaining informed consent 869 pregnant answered the Conflict Tactics Scale 2. Odds ratios (OR) and respective 95% confidence intervals (95%CI) were calculated by using Logistic Regression.

    Results: The prevalence of sexual abuse ever in life was 49% and of physical abuse was 46%. The past year prevalence was 46% and 44% for sexual and physical abuse, respectively. Sexual abuse and physical violence occurred in every age group. Significant associations were found between previous neonatal deaths and being physically abused, during the life-time (OR= 3.00, 95% IC: 1.67 to 5:39), and the past year (OR=3.23, 95% CI: 1.80 - 5.80).

    Conclusion: This study found a high lifetime and past year violence prevalence among women using prenatal care in Mozambique. Prenatal care provides a window of opportunity for identifying women who experience violence.

    Message 1

    The prevalence of intimate partner violence is very high among women in Mozambique and prenatal care can be a sentinel setting

    Message 2

    The implementation of strategies to support women victims of violence in Mozambique is urgently needed

     

  • 13.
    Csöff, Rosina-Martha
    et al.
    Evangel Hsch Ludwigsburg, Ludwigsburg, Germany.
    Macassa, Gloria
    Karolinska Institutet, Stockholm, Sweden.
    Lindert, Jutta
    Evangel Hsch Ludwigsburg, Ludwigsburg, Germany.
    Körperliche beschwerden bei älteren migranten in Deutschland2010In: Zeitschrift für Psychiatrie, Psychologie und Psychotherapie, ISSN 1661-4747, E-ISSN 1664-2929, Vol. 58, no 3, p. 199-206Article in journal (Refereed)
  • 14. Cutts, F
    et al.
    Dos Santos, C
    Novoa, A
    David, P
    Macassa, Gloria
    Soares, AC
    Child and Maternal Mortality during a Period of Conflict in Beira City, Mozambique1996In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, no 25, p. 349-356Article in journal (Refereed)
  • 15. Dgedge, M
    et al.
    Novoa, A
    Macassa, Gloria
    Sacarlal, J
    Black, J
    Michaud, C
    Cliff, J
    The burden of disease in Maputo city, Mozambique: registered and autopsied deaths in 19942001In: Bulletin of the World Health Organization, ISSN 0042-9686, E-ISSN 1564-0604, Vol. 79, no 6, p. 546-552Article in journal (Refereed)
    Abstract [en]

    Objective: To classify the causes of death in Maputo City, Mozambique, using the methods of the Global Burden of Disease study, in order to provide information for health policy-makers and to obtain a baseline for future studies in Maputo City and provincial capitals.

    Methods: Data were taken from the Maputo City death register and autopsy records for 1994.

    Findings: A total of 9011 deaths were recorded in the death register, representing a coverage of approximately86%. Of these, 8114 deaths (92%) were classified by cause. Communicable, maternal, perinatal, and nutritionaldisorders accounted for 5319 deaths; noncommunicable diseases for 1834; and injuries for 961. The 10 leadingcauses of registered deaths were perinatal disorders (1643 deaths); malaria (928); diarrhoeal diseases (814);tuberculosis (456); lower respiratory infections (416); road-traffic accidents (371); anaemia (269); cerebrovasculardiseases (269); homicide (188); and bacterial meningitis (178).

    Conclusions: Infectious diseases of all types, injuries, and cerebrovascular disease ranked as leading causes of death, according to both the autopsy records and the city death register. AIDS-related deaths were underreported.With HIV infection increasing rapidly, AIDS will add to the already high burden of infectious diseases and premature mortality in Maputo City. The results of the study indicate that cause of death is a useful outcome indicator for disease control programmes.

  • 16.
    Eslami, Bahareh
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Macassa, Gloria
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Högskolan i Gävle.
    Melchiorre, M G
    Italian National Institute of Health and Science on Aging, INRCA, Ancona, Italy.
    Barros, H
    University of Porto Medical School, Porto, Portugal.
    Viitasara, Eija
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Lindert, J
    University of Emden, Emden, Germany.
    Stankunas, M
    Lithuanian University of Health Sciences, Kaunas, Lithuania.
    Torres-Gonzalez, F
    University of Granada, Granada, Spain.
    Ioannidi-Kapolou, E
    National School of Public Health, Athens, Greece.
    Soares, Joaquim J.F.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Life-time abuse and mental health among older persons: a European study2017In: Journal of Aggression, Maltreatment & Trauma, ISSN 1092-6771, E-ISSN 1545-083X, Vol. 26, no 6, p. 590-607Article in journal (Refereed)
    Abstract [en]

    This study aimed to investigate the association of lifetime abuse and mental health among older persons, considering associated factors (e.g., demographics) through a cross-sectional design. We recruited 4,467 women and men ages 60–84 years from 7 European cities. Mental health was measured with the Hospital Anxiety and Depression Scale, and abuse (psychological, physical, sexual, financial, and physical injuries) based on the Revised Conflict Tactics Scale and the UK survey of abuse/neglect of older people. Multiple logistic regression analyses showed that country of residence, low educational level, and experienced financial strain increased the odds of probable cases of anxiety and depression. Female sex, white-collar profession, and financial support by social/other benefits/or partner income were associated with higher odds of anxiety, while older age and experience of lifetime injury were associated with increased odds of depressive symptoms. The findings of this study indicate that socioeconomic factors, as well as experienced lifetime severe physical abuse leading to injuries, are significant in perceived mental health of adults in later life.

  • 17.
    Eslami, Bahareh
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Department of Research, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
    Macassa, Gloria
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Department of Occupational and Public Health Sciences, University of Gävle, Gävle, Sweden .
    Sundin, Örjan
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology.
    Khankeh, HR
    Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
    Soares, Joaquim J. F.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Department of Public Health Sciences, Institution of Social Medicine, Karolinska Institutet, Stockholm, Sweden .
    Quality of life and life satisfaction among adults with and without congenital heart disease in a developing country2015In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 22, no 2, p. 169-179Article in journal (Refereed)
    Abstract [en]

    Background Life-expectancy of adults with congenital heart disease (CHD) has improved world-wide, but there are limited data on these patients' experiences of quality of life (QoL), life satisfaction (LS), and their determinants (e.g. social support), particularly among patients from developing countries.

    Design Cross-sectional case-control.

    Methods A total of 347 CHD patients (18-64 years, 52.2% women) and 353 non-CHD participants, matched by sex/age, were recruited from two heart hospitals in Tehran, Iran. LS and QoL served as dependent variables, and demographic/socioeconomic status, mental-somatic symptoms, social support, and clinical factors (e.g. defect category) served as independent variables in multiple regression analyses once among all participants, and once only among CHD patients.

    Results The CHD patients had significantly lower scores in LS and all domains of QoL than the control group. However, having CHD was independently negatively associated only with overall QoL, physical health, and life and health satisfaction. Additionally, multivariate analyses among the CHD patients revealed that female sex, younger age, being employed, less emotional distress, and higher social support were significantly associated with higher perceived QoL in most domains, while LS was associated with female sex, being employed, less emotional distress, and better social support. Neither QoL nor LS was associated with cardiac defect severity.

    Conclusions The adults with CHD had poorer QoL and LS than their non-CHD peers in our developing country. Socio-demographics, emotional health, and social support were important 'determinants' of QoL and LS among the CHD patients. Longitudinal studies are warranted to establish causal links.

  • 18.
    Eslami, Bahareh
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Macassa, Gloria
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Department of Occupational and Public Health Sciences University of Gävle Gävle Sweden .
    Sundin, Örjan
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology.
    Khankeh, HR
    Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
    Soares, Joaquim J. F.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Department of Public Health Sciences Institution of Social Medicine, Karolinska Institutet Stockholm Sweden .
    Style of Coping and its Determinants in Adults with Congenital Heart Disease in a Developing Country2014In: Congenital Heart Disease, ISSN 1747-079X, E-ISSN 1747-0803, Vol. 9, no 4, p. 349-360Article in journal (Refereed)
    Abstract [en]

    Objective The objective of this study is to compare coping strategies between adults with and without congenital heart disease and to scrutinize the associations between different available resources (e.g., social support) and adoption of certain coping strategies.

    DesignThe study has a cross-sectional case-control design.

    SettingThe study was conducted in two university-affilliated heart hospitals in Tehran, Iran.

    Patients The participants comprised 347 persons (18–64 years) with and 353 individuals without congenital heart disease, matched by gender and age.

    Outcome Measures Coping strategies, assessed with the Utrecht Coping List-short form, were compared between both groups. Block-wise multiple regression analyses were conducted to scrutinize the associations between different independent variables (e.g., demographic/socioeconomic statuses) and adoption of certain styles of coping (dependent variables) among all participants and separately for each group.

    Results The styles of coping in the patients were comparable with those of the control group. Multivariate analyses revealed that congenital heart disease per se was not associated with style of coping except for palliative reaction pattern. The active problem-solving coping style was associated with never married marital status, parenthood, unemployment, higher level of anxiety/somatic symptoms, lower level of depressive symptoms, and better social support. The avoidance behavior style was associated with having a low income, whereas the expression of emotion style was associated with higher anxiety symptoms, experience of financial strain, and income. None of the adopted coping strategies was related to the heart disease variables.

    Conclusions The adults with congenital heart disease coped as well as adults without congenital heart disease. Marital status, parenthood, annual income, financial strain, psychological adjustment, and perceived social support were important explanatory factors in adopting a certain style of coping among adults with congenital heart disease. However, longitudinal studies with repeated measures are warranted.

  • 19.
    Eslami, Bahareh
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Department of Research, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran .
    Sundin, Örjan
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology.
    Macassa, Gloria
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Department of Occupational and Public Health Sciences, University of Gävle, Gävle, Sweden .
    Khankeh, Hamid Reza
    Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
    Soares, Joaquim J. F.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Division of Social Medicine, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden .
    Gender differences in health conditions and socio-economic status of adults with congenital heart disease in a developing country2013In: Cardiology in the Young, ISSN 1047-9511, E-ISSN 1467-1107, Vol. 23, no 02, p. 209-218Article in journal (Refereed)
    Abstract [en]

    Background Providing appropriate care for adults with congenital heart disease requires the evaluation of their current situation. There is limited research in Iran about these patients, particularly in relation to gender differences in the demographic/socio-economic and lifestyle factors, as well as disease parameters.

    Materials and methods The sample consisted of 347 congenital heart disease patients in the age group of 18–64 years, including 181 women, assessed by an analytical cross-sectional study. The patients were recruited from the two major heart hospitals in Tehran. Data were collected using questionnaires.

    Results The mean age of the patients was 33.24 years. Women were more often married and more often had offspring than men (p < 0.001). Educational level and annual income were similar between women and men. Unemployment was higher among women (p < 0.001), but financial strain was higher among men (p < 0.001). Smoking, alcohol, and water-pipe use was higher among men than among women (p < 0.001). Cardiac factors, for example number of cardiac defects, were similar among women and men, except that there were more hospitalisations owing to cardiac problems, for example arrhythmia, among men. Disease was diagnosed mostly at the hospital (57.4%). Most medical care was provided by cardiologists (65.1%). Only 50.1% of patients had knowledge about their type of cardiac defect.

    Conclusion Gender differences exist in the socio-economic and lifestyle characteristics of adults with congenital heart disease, in some cases related to the disease severity. Our findings also point to the need for interventions to increase patients’ knowledge about, and use of, healthier lifestyle behaviours, irrespective of gender. Furthermore, providing appropriate jobs, vocational training, and career counselling may help patients to be more productive.

  • 20.
    Eslami, Bahareh
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Sundin, Örjan
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology.
    Macassa, Gloria
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Khankeh, HR
    Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
    Soares, Joaquim J. F.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Anxiety, depressive and somatic symptoms in adults with congenital heart disease2013In: Journal of Psychosomatic Research, ISSN 0022-3999, E-ISSN 1879-1360, Vol. 74, no 1, p. 49-56Article in journal (Refereed)
    Abstract [en]

    Objective

    Despite the improvement in life-expectancy of adults with congenital heart disease, they may experience unique medical and social challenges that could impact on their psychological functioning. The aims of this study were to address the experience of anxiety, depressive and somatic symptoms among adults with congenital heart disease in comparison with that of non-heart diseased persons considering the role of various factors (e.g. socio-economic).

    Methods

    In cross-sectional case–control study, the participants consisted of 347 patients with congenital heart disease (18–64 years, 52.2% female) and 353 matched (by sex/age) non-heart diseased persons. The participants completed a questionnaire. The data were analyzed with bivariate and multivariate methods.

    Results

    In bivariate analyses, scores in anxiety and somatic symptoms were higher among patients than the healthy controls (both at p ≤ 0.001), whereas the groups did not differ in depressive symptoms. Following multiple-linear-regression-analyses, only the association between congenital heart disease and somatic symptoms was confirmed. Among the patients, perceived financial strain was significantly related to anxiety, depressive and somatic symptoms; lower perceived social support to anxiety and depression; and low annual income to somatic symptoms. Additionally, somatic symptoms were associated with anxiety and depressive symptoms, and vice versa. And no medical variables were related to anxiety, depressive and somatic symptoms.

    Conclusions

    Congenital heart disease was only independently associated with somatic symptoms. Financial strain, social support and co-existence of emotional distress with somatic symptoms should be considered in developing appropriate interventions to improve the well-being of patients with congenital heart disease. However, longitudinal research is warranted to clarify causality.

  • 21.
    Eslami, Bahareh
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Viitasara, Eija
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Macassa, Gloria
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Melchiorre, Maria Gabriella
    Italian National Institute of Health and Science on Aging.
    Lindert, Jutta
    University of Emden, Emden, Germany.
    Stankunas, Mindaugas
    Lithuanian University of Health Sciences.
    Torres-Gonzalez, Francisco
    University of Granada, Granada, Spain.
    Barros, Henrique
    University of Porto Medical School, Porto, Portugal.
    Ioannidi-Kapolou, Elisabeth
    National School of Public Health, Athens, Greece.
    Soares, Joaquim J. F.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    The prevalence of lifetime abuse among older adults in seven European countries2016In: International Journal of Public Health, ISSN 1661-8556, E-ISSN 1661-8564, Vol. 61, no 8, p. 891-901Article in journal (Refereed)
    Abstract [en]

    Objectives To investigate the lifetime prevalence rate of abuse among older persons and to scrutinize the associated factors (e.g. demographics).

    Methods This cross-sectional population-based study had 4467 participants, aged 60–84, from seven European cities. Abuse (psychological, physical, sexual, financial and injuries) was measured based on The Revised Conflict Tactics Scale, and the UK survey of abuse/neglect of older people.

    Results Over 34 % of participants reported experiencing lifetime psychological, 11.5 % physical, 18.5 % financial and 5 % sexual abuse and 4.3 % reported injuries. Lifetime psychological abuse was associated with country, younger age, education and alcohol consumption; physical abuse with country, age, not living in partnership; injuries with country, female sex, age, education, not living in partnership; financial abuse with country, age, not living in partnership, education, benefiting social/partner income, drinking alcohol; and sexual abuse with country, female sex and financial strain.

    Conclusions High lifetime prevalence rates confirm that elder abuse is a considerable public health problem warranting further longitudinal studies. Country of residence is an independent factor associated with all types of elder abuse which highlights the importance of national interventions alongside international collaborations.

    Keywords Determinant Elder abuse Financial Injuries Psychological Sexual

  • 22.
    Fraga, S
    et al.
    Universidade do Porto, Portugal.
    Soares, Joaquim J.F.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Melchiorre, MG
    Center for Socioeconomic Research on Aging, Ancona, Italy.
    Barros, H
    Universidade do Porto, Portugal.
    Eslami, Bahareh
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Ioannidi-Kapolou, E
    National School of Public Health, Athens, Greece.
    Lindert, J
    University of Emden, Emden, Germany.
    Macassa, Gloria
    Högskolan i Gävle.
    Stankunas, M
    Lithuanian University of Health Sciences; University of Griffith, Australia.
    Torres-Gonzales, F
    University of Granada, Granada, Spain.
    Viitasara, Eija
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Lifetime Abuse and Quality of Life among Older People2017In: Health & Social Work, ISSN 0360-7283, E-ISSN 1545-6854, Vol. 42, no 4, p. 215-222Article in journal (Refereed)
    Abstract [en]

    Few studies have evaluated the impact of lifetime abuse on quality of life (QoL) among older adults. By using a multinational study authors aimed to assess the subjective perception of QoL among people who have reported abuse during the course of their lifetime. The respondents (N = 4,467; 2,559 women) were between the ages of 60 and 84 years and living in seven European countries (Germany, Greece, Italy, Lithuania, Portugal, Spain, and Sweden). Lifetime abuse was assessed by using a structured questionnaire that allowed to assess lifetime experiences of abuse. QoL was assessed with the World Health Organization Quality of Life–Old module. After adjustment for potential confounders, authors found that to have had any abusive experience decreased the score of sensory abilities. Psychological abuse was associated with lower autonomy and past, present, and future activities. Physical abuse with injuries significantly decreased social participation. Intimacy was also negatively associated with psychological abuse, physical abuse with injury, and sexual abuse. The results of this study provide evidence that older people exposed to abuse during their lifetime have a significant reduction in QoL, with several QoL domains being negatively affected.

  • 23.
    Hiswåls, Anne-Sofie
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Department of Occupational and Public Health Science, University of Gävle, Sweden .
    Ghilagaber, Gebrenegus
    Department of Statistics, Stockholm University, Stockholm, Sweden .
    Walander, Anders
    Department of Occupational and Public Health Science, University of Gävle, Sweden .
    Wijk, Katarina
    Community Medicine, Gävleborg County Council, Gävle, Sweden .
    Öberg, Peter
    Department of Social Work and Psychology, University of Gävle, Sweden.
    Soares, Joaquim J. F.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Macassa, Gloria
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Department of Occupational and Public Health Science, University of Gävle, Sweden.
    Employment Status and Inequalities in Self-Reported Health2014In: Epidemiology, Biostatistics and Public Health, ISSN 2282-2305, E-ISSN 2282-0930, Vol. 11, no 4, p. 1-11Article in journal (Refereed)
    Abstract [en]

    Background: The aim of this study was to investigate the impact of employment status on self-reported health in gävleborg county.Methods: The study used data from the 2010 health in equal terms survey, a cross-sectional survey carried out in gävleborg county in sweden. a total of 4,245 individuals, aged 16–65 years were included in the analyses. descriptive and logistic regression analyses were used to assess the relationship between employment status and self-reported healthResults: Individuals outside the labour market had odds of poor health of 2.64 (cl 2.28–3.05) compared to their employed counterparts. controlling for other covariates reduced the risk slightly to 2.10 (1.69-2.60), but remained statistically significant. In addition, other variables were associated with self-reported poor health.Conclusions: This study found a statistically significant association between being outside the labour market and poor self-reported health. The relation was explained partially by socio-economic and demographic variables. More studies, in particular longitudinal, are needed to further investigate the observed relationships. Policy-makers within the gävleborg county need to pay attention to the health status of those out of work, especially during times of combined economic and labour market fluctuations.Results of the study suggest the need to pay attention to the health status of those outside the labour market, especially during times of economic hardship.

  • 24.
    Hiswåls, Anne-Sofie
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Ghilagaber, Gebrenegus
    Department of Statistics, Stockholm University, Stockholm, Sweden .
    Wijk, Katarina
    Gävleborg County Council, Gävle, Sweden .
    Öberg, Peter
    Department of Social Work and Psychology, University of Gävle, Sweden .
    Soares, Joaquim
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Macassa, Gloria
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Department of Occupational and Public Health Sciences, University of Gävle, Sweden.
    Employment status and suicidal ideation during economic recession2015In: Health Science Journal, ISSN 1791-809X, Vol. 9, no 1, p. 1-9Article in journal (Refereed)
    Abstract [en]

    Objective: Suicide is a public health problem and an important indicator of severe mental ill-health. Thus, identifying risk factors for suicidal ideation is a public health priority. The aim of this study was to examine the relationship between employment status and suicidal ideation in Gävleborg County. Method: The study used data from the 2010 Health in Equal Terms survey, a cross-sectional survey carried out in Gävleborg County in Sweden. A total of 4,245 individuals, aged 16–65 years were included in the analyses. Descriptive and logistic regression analyses were carried out to assess the relationship between employment status and suicidal ideation. Results: Individuals outside the labour market had odds of suicidal ideation of 4.21 (CI 3.14-5.64) compared to their employed counterparts. Controlling for other covariates, reduced the risk from 4.21(CI 3.14-5.64) in model I, to 1.73 (CI 1.16- 2.57) in model IV, but remained statistically significant. In addition, other variables were associated with suicidal ideation. Conclusion: There was a statistically significant association between being out of work and suicidal ideation. The association was explained partly by demographic, socio-economic and self-reported psychological variables. Results of the study suggest the need for primary prevention strategies among those out of the labour market, especially during times of economic hardship.

  • 25.
    Hiswåls, Anne-Sofie
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Department of Occupational and Public Health Science, University of Gävle, Gävle, Sweden.
    Ghilagaber, Gebrenegus
    Avdelningenför statistik, Stockholms universitet, Department of statistics, Stockholm University, Sweden.
    Wijk, Katarina
    Samhällsmedicin, Landstinget Gävleborg, Community Medicine,Gävleborg County Council, Sweden.
    Öberg, Peter
    Avdelningen för socialt arbete och psykologi, Högskolan i Gävle, Department of Social work and Psychology, University of Gävle, Sweden.
    Soares, Joaquim
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Macassa, Gloria
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Department of Occupational and Public Health Science, University of Gävle, Gävle, Sweden.
    Inequalities and Suicide Ideation during Recession Times2014In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 24, no S2, p. 361-Article in journal (Refereed)
  • 26.
    Hiswåls, Anne-Sofie
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. University of Gävle.
    Marttila, Anneli
    Karolinska Institutet, Stockholm, Sweden.
    Mälstam, Emelie
    University of Gävle.
    Macassa, Gloria
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. University of Gävle; Karolinska Institutet, Stockholm; University of Porto Medical School, Portugal.
    Experiences of unemployment and well-being after jobb loss during economic recession: results of a qualitative study in East Central Sweden2017In: Journal of Public Health Research, ISSN 2279-9028, E-ISSN 2279-9036, Vol. 6, no 3, p. 135-141Article in journal (Refereed)
    Abstract [en]

    Introduction: Several studies have revealed an association between unemployment and ill health, and shown that unemployment can affect people differently. This study aimed to provide an understanding of the experiences of unemployment and perceptions of wellbeing among persons who involuntary lost their work during the recent economic recession in Gävle Municipality. Methods: Sixteen unemployed men and women aged 28-62 were interviewed face-to-face. A purposeful sampling strategy was used in order to suit the research question and to increase the variation among informants. The interview texts were analysed using thematic analysis. Results: Six different themes emerged from the accounts: The respondents perceived work as the basis for belonging, and loss of work affected their social life and consumption patterns due to changes in their financial situation. They also expressed feelings of isolation, loss of self-esteem, and feelings of hopelessness, which affected their physical well-being. Longer duration of unemployment increased the respondents’ negative emotions. The respondents reported activities, structure, and affiliation in other contexts as part of their coping strategy against poor mental health. Conclusions: After job loss, the respondents experienced feelings of loss of dignity and belonging as a human being. They also felt worry, insecurity, and stress due to their changed financial situation, which in turn led to isolation and loss of self-esteem. Social support and having other activities gave the respondents structure and meaning.

  • 27.
    Hiswåls, Anne-Sofie
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. University of Gävle.
    Walander, Anders
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Institutionen för folkhälsovetenskap, Karolinska Institutet, Department of Public Health Science, Karolinska Institutet.
    Soares, Joaqim
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Macassa, Gloria
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. University of Gävle; Karolinska Institute.
    Employment Status, Anxiety and Depression in a Municipal Context2017In: Research in Health Science, ISSN 2470-6213, Vol. 2, no 1Article in journal (Refereed)
    Abstract [en]

    Objectives: This  study  aimed  to  investigate  the  prevalence  of  anxiety  and  depression  by  employment status among a sample of the working age population residing in Gävle Municipality in Sweden.

    Methods:  A  total  of  241  persons  completed  a  self-administered  postal  questionnaire  in  the  baseline survey  of  the  Gävle  Household,  Labour  Market  and  Health  Outcomes  (GHOLDH)  survey,  which collected  information  on  the  employment  status  and  psychological  health  (anxiety  and  depression) among persons aged 18-65 years. Descriptive and multivariate analyses were performed.

    Results:  The  prevalence  and  risk  of  anxiety  and  depression  were  high  among  people  who  were  out  of work. In the multiple regression analysis, compared to employed people, those who were not employed had a risk of anxiety of 7.76 (5.97-9.75) and 4.67 (3.60-5.74) for depression.

    Conclusion: The prevalence of anxiety and depression was higher among those who were out of labour marketas compared to those employed. Furthermore, people who were out of work had a higher risk of anxiety and depression. The odds were slightly higher for anxiety than for depression.

  • 28. Innocent, M
    et al.
    Ndonko, F
    Ngo’o, G
    Soares, Joaquim J. F.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Macassa, Gloria
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Breaking the Silence: Understanding the practice of Breast ironing in Cameroon2012In: African Journal of Health Sciences, ISSN 1022-9272, E-ISSN 2306-1987, Vol. 23, no 4, p. 232-237Article in journal (Refereed)
  • 29.
    Lindert, J
    et al.
    Protestant University of Applied Sciences Ludwigsburg, Ludwigsburg, Germany.
    de Luna, J
    Department of Medicine, University of Granada, Granada, Spain.
    Torres-Gonzalez, F
    Centro de Investigación Biomedica en Red de Salud Mental (CIBERSAM), University of Granada, Granada, Spain.
    Barros, Henrique
    Department of Hygiene and Epidemiology, University of Porto, Medical School, Porto, Portugal.
    Ioannidi-Kopolou, E
    Department of Sociology, National School of Public Health, Athens, Greece.
    Melchiore, M G
    Italian National Institute of Health and Science on Aging, INRCA, Ancona, Italy.
    Stankunas, M
    Department of Health Management, Lithuanian University of Health Sciences, Kaunas, Lithuania.
    Macassa, Gloria
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Soares, Joaquim J. F.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Abuse and neglect of older persons in 7 cities in seven countries in Europe: a cross sectional community study2013In: International Journal of Public Health, ISSN 1661-8556, E-ISSN 1661-8564, Vol. 58, no 1, p. 121-132Article in journal (Refereed)
    Abstract [en]

    Objectives

    We aimed to investigate the prevalence rate of abuse (psychological, physical, sexual, financial, neglect) of older persons (AO) in seven cities from seven countries in Europe (Germany, Greece, Italy, Lithuania, Portugal, Spain, Sweden), and to assess factors potentially associated with AO.

    Methods

    A cross-sectional study was conducted in 2009 (n = 4,467, aged 60–84). Potentially associated factors were grouped into domains (domain 1: age, gender, migration history; domain 2: education, occupation; domain 3: marital status, living situation; domain 4: habitation, income, financial strain). We calculated odds ratios (OR) with their respective 95 % confidence intervals (CI).

    Results

    Psychological AO was the most common form of AO, ranging from 10.4 % (95 % CI 8.1–13.0) in Italy to 29.7 % (95 % CI 26.2–33.5) in Sweden. Second most common form was financial AO, ranging from 1.8 % (95 % CI 0.9–3.2) in Sweden to 7.8 % (95 % CI 5.8–10.1) in Portugal. Less common was physical AO, ranging from 1.0 % (95 % CI 0.4–2.1) in Italy to 4.0 % (95 % CI 2.6–5.8 %) in Sweden. Sexual AO was least common, ranging from 0.3 (95 % CI 0.0–1.1) in Italy and Spain to 1.5 % (95 % CI 0.7–2.8) in Greece. Being from Germany (AOR 3.25, 95 % CI 2.34–4.51), Sweden (OR 3.16, 95 % CI 2.28–4.39) or Lithuania (AOR 2.45, 95 % CI 1.75–3.43) was associated with increased prevalence rates of AO.

    Conclusion

    Country of residence of older people is independent from the four assessed domains associated with AO. Life course perspectives on AO are highly needed to get better insight, and to develop and implement prevention strategies targeted at decreasing prevalence rates of AO.

  • 30. Lindert, Jutta
    et al.
    Soares, Joaquim J. F.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Csöff, RM
    Barros, H
    Torres-Gonzalez, F
    Ioannidi-Kapolou, E
    Lamura, G
    de Dios Luna, J
    Macassa, Gloria
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Melchiorre, MG
    Stankunas, M
    Gewalt und Gesundheit bei älteren Menschen in Europa2013Book (Other academic)
  • 31.
    Macassa, Gloria
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    A Matter of Faith: Unravelling the role of religion on child survival inSub-Saharan Africa2012In: African Journal of Health Sciences, ISSN 1022-9272, E-ISSN 2306-1987, no 22, p. 238-247Article in journal (Refereed)
  • 32.
    Macassa, Gloria
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Ahmadi, N
    Alfredsson, J
    Barros, H
    Soares, Joaquim
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Stankunas, M
    Employment status and differences in physical activity behavior during times of economic harship: Results of a population-based study2016In: International Journal of Medical science and Public Health, ISSN 2277-338X, Vol. 5, no 1, p. 102-108Article in journal (Refereed)
    Abstract [en]

    Background: The recent economic recession has lead to an increased unemployment in many countries worldwide. In addition, research has suggested that economic recession can have an impact on an individual's health behaviors, including engagement in physical activity. Gävleborg County in southeast Sweden, experienced massive job losses owing to the closures of large industries and small companies, which resulted in an increased unemployment rate in 2010, at the pick of the economic recession.Objective: To investigate the differences in physical activity by employment status among economically active persons living in Gävleborg County in 2010.Materials and Methods: The data were obtained from a cross-sectional survey carried out in Gävleborg County, in 2010, among the residents aged 16–65 years (n = 4,245). Data analysis was carried out using descriptive statistics and weighted logistic regression.Result: There was a statistically significant association between employment status and physical activity. People who were not employed in 2010 showed higher odds of physical inactivity when compared with their employed counterparts. The differences in physical activity behavior were explained, mainly, by health and socioeconomic and related factors.Conclusion: Being outside the labor market was associated with increased physical inactivity during a period of economic recession in Gävleborg County. From a policy perspective, our study suggests the need to promote physical activity during times of high unemployment in order to foster better health behaviors.

  • 33.
    Macassa, Gloria
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Gävle university.
    Ahmadi, N
    Hiswåls, Anne-Sofie
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Alfredsson, J
    Soares, Joaquim
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Stankunas, M
    Differences in health care-seeking behavior during economic recession2014In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 24, no supl 2Article in journal (Refereed)
  • 34.
    Macassa, Gloria
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Bergström, Helena
    Karolinska institutet.
    Malstam, Emelie
    Högskolan i Gävle.
    Hiswåls, Anne-Sofie
    Högskolan i Gävle.
    Soares, Joaquim
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Ahmadi, Nader
    Högskolan i Gävle.
    Marttila, Anneli
    Karolinska institutet.
    Experiences of employment precariousness and psychological well-being in east central Sweden2017In: Health Science Journal, ISSN 1108-7366, Vol. 11, no 2Article in journal (Refereed)
    Abstract [en]

    Background: In the past decade, temporary employment arrangements, including fixed-term and sub-contracted jobs, as well as project work, on-call work and work via temporary-help agencies have increased in developed countries, including Sweden. The objective of this study was to explore precariously employed individuals’experiences and perceptions of employment strain and its effect on their psychological well-being in Gävleborg County, Sweden.

    Methods: Semi-structured interviews were conducted with 16 respondents residing in Gävleborg County about their experiences of precarious employment and their perceptions of the relationship between their precarious employment and psychological well-being. Thematic analysis was conducted to relate the results to the employment strain framework.

    Results: The main theme to emerge in the data was managing stress. Respondent’s perceived significant stress related to keeping employment as well as having future work. In addition, they had difficulties in coping with everyday life because of economic strain, lack of work opportunities and isolation.

    Conclusions: The results of this study highlight how precariously employed individuals are unable to cope with the stress related to uncertainty in maintaining their current work or having control of their working hours. In addition, the results indicate that precariously employed workers experience economic strain related to income uncertainty, which affects their ability to cope with dailylife.

  • 35.
    Macassa, Gloria
    et al.
    Karolinska Institute.
    Burström, B
    Karolinska Institute.
    Determinants of social inequalities in child mortality in Mozambique: What do we know? What could be done?2006In: African Journal of Health Sciences, ISSN 1022-9272, E-ISSN 2306-1987, no 13, p. 139-143Article in journal (Refereed)
  • 36.
    Macassa, Gloria
    et al.
    Karolinska Institutet.
    Burström, B
    Karolinska Institutet.
    Poverty and child mortality in different contexts: can Mozambique learn from the decline in mortality at the turn of the 19th century inStockholm?2005In: African Journal of Health Sciences, ISSN 1022-9272, E-ISSN 2306-1987, no 12, p. 31-36Article in journal (Refereed)
    Abstract [en]

    Child mortality has declined in many low-income countries. However, in Sub-Saharan Africa, childhood mortality is still a major public health problem, which is worsening with some countries experiencing new increases in mortality due to HIV /AIDS. This lack of success in reducing child mortality is not only due to HIV /AIDS, but also to high numbers of deaths in other causes of death such as diarrhoea, pneumonia and neonatal causes, for which there are effective curative and preventative interventions. One problem seems to be in the access, coverage and implementation of these interventions, particularly among the poorer sections of the population. A related problem is the interventions that sometimes, when implemented, take place in environments in which they can only be expected to have limited effects. On the other hand in many developed countries infant and child mortality declined as social and economic changes of modernisation took place. However, the mechanisms that did bring about the decline are still not well understood. This paper discuss whether analyses of the historical decline of mortality in industrialised countries could contribute to knowledge in reducing the high child mortality in poor countries today, based on studies of child mortality in different social contexts in Mozambique 1973-1997 and Stockholm 1878-1925.

  • 37.
    Macassa, Gloria
    et al.
    Karolinska Institutet.
    De Leon, A P
    Karolinska Institutet .
    Burström, B
    Karolinska Institutet.
    The impact of water supply and sanitation on area differentials in the decline of diarrhoea disease mortality among infants in Stockholm 1878-19252006In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, no 34, p. 526-553Article in journal (Refereed)
    Abstract [en]

    This study analyses the impact of improved water supply and sanitation on the level and rate of decline of child diarrhoeamortality in Stockholm 1878–1925. Previous studies have failed to demonstrate an effect of improved water supply on therisk of diarrhoea mortality at the individual level. Using data on access to water and sanitation from a household survey in1895 and mortality rates and sociodemographic information from individual data 1878–1925 to analyse area differentials indiarrhoea mortality, it was found that the proportion having their own latrine in the household was associated with lowermortality risk in 1895–1900, while the proportion having water in the household was associated with lower diarrhoeamortality risk during the mortality decline until 1925. Population effects of improved water and sanitation on diarrhoeamortality may be better measured at area level than at individual level.

  • 38. Macassa, Gloria
    et al.
    Ghilagaber, G
    Bernhardt, E
    Burström, B
    Contributionof household environment factors to urban childhood mortality in Mozambique2004In: East African Medical Journal, ISSN 0012-835X, no 81, p. 408-414Article in journal (Refereed)
  • 39. Macassa, Gloria
    et al.
    Ghilagaber, G
    Bernhardt, E
    Burström, B
    Inequalities in under-five mortality in Mozambique: differentials by region of residence and ethnic affiliation of the mother2006In: East African Medical Journal, ISSN 0012-835X, no 83, p. 259-266Article in journal (Refereed)
  • 40.
    Macassa, Gloria
    et al.
    Karolinska Institutet.
    Ghilagaber, G
    Bernhardt, E
    Burström, B
    Trends in infant and child mortality in Mozambique during and after a period ofconflict2003In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 117, no 4, p. 221-227Article in journal (Refereed)
    Abstract [en]

    This study describes urban and rural trends of infant, child and under-five mortality in Mozambique (1973–1997) by mother's place of residence. A direct method of estimation was applied to the 1997 Mozambican Demographic and Health Survey data. The levels of infant, child and under-five mortality were considerably higher in rural than in urban areas. The difference in mortality between urban and rural areas increased over time until 1988–1992 and thereafter diminished. Possible causes of the different trends (e.g. the impact of civil war, drought, migration, adjustment programme and HIV/AIDS) are discussed. The increase in mortality in urban areas during the last few years before the survey may have been related to the immigration to urban areas of mothers whose children had high levels of mortality. Higher levels of infant, child and under-five mortality still prevail, particularly in rural areas. Further studies are needed to investigate the differentials of infant and child mortality by mother's place of residence.

  • 41. Macassa, Gloria
    et al.
    Ghilagaber, G
    Bernhardt, E
    Diderichsen, F
    Burström, B
    Inequalities in child mortality in Mozambique: differentials by parental socio-economic position2003In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, no 57, p. 2255-2264Article in journal (Refereed)
    Abstract [en]

    This study investigates the relation between socio-economic parental position (education and occupation) and child death in Mozambique using data from the Mozambican Demographic and Health Survey carried out between March and July 1997. The analysis included 9142 children born within 10 years before the survey. In spite of the Western system of classification used in the study, the results partly showed a parental socio-economic gradient of infant and child mortality in Mozambique. Father's education seemed to reflect the family's social standing in the Mozambique context, showing a strong statistical association with postneonatal and child mortality. However, maternal education as a measure of socio-economic position was not statistically significantly associated with child mortality. This finding may partly be explained by the extreme hardships experienced by the country (civil war and natural disasters) and the implementation of the Economic Structural Adjustment Programme that have also affected the health of women and their children during the years covered by this study. Other measures of socio-economic position applicable to the rural African setting should be investigated.

  • 42.
    Macassa, Gloria
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Ghilagaber, Gebreneus
    Stockholm university.
    Charsmar, Harry
    Stockholm university.
    Walander, A
    Sundin, Örjan
    Mid Sweden University, Faculty of Human Sciences, Department of Social Sciences.
    Soares, Joaquim
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Geographic differentials in mortality of children in Mozambique: their implications for achievement of millenium development goal 42012In: Journal of Health, Population and Nutrition, ISSN 1606-0997, E-ISSN 2072-1315, ISSN 1606-0997, Vol. 30, no 3, p. 331-345Article in journal (Refereed)
    Abstract [en]

    In the light of Mozambique's progress towards the achievement of Millennium Development Goal 4 of reducing mortality of children aged less than five years (under-five mortality) by two-thirds within 2015, this study investigated the relationship between the province of mother's residence and under-five mortality in Mozambique, using data from the 2003 Mozambican Demographic and Health Survey. The analyses included 10,326 children born within 10 years before the survey. Results of univariate and multivariate analyses showed a significant association between under-five mortality and province (region) of mother's residence. Children of mothers living in the North provinces (Niassa, Cabo Delgado, and Nampula) and the Central provinces (Zambezia, Sofala, Manica, and Tete) had higher risks of mortality than children whose mothers lived in the South provinces, especially Maputo province and Maputo city. However, controlling for the demographic, socioeconomic and environmental variables, the significance found between the place of mother's residence and under-five mortality reduced slightly. This suggests that other variables (income distribution and trade, density of population, distribution of the basic infrastructure, including healthcare services, climatic and ecologic factors), which were not included in the study, may have confounding effects. This study supports the thought that interventions aimed at reducing under-five mortality should be tailored to take into account the subnational/regional variation in economic development. However, research is warranted to further investigate the potential determinants behind the observed differences in under-five mortality.

  • 43.
    Macassa, Gloria
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Hallqvist, J
    Karolinska Institutetet.
    Lynch, JW
    McGill University, Montreal .
    Inequalities in Child Mortality in Sub-Saharan Africa: A Social Epidemiologic Framework2011In: African Journal of Health Sciences, ISSN 1022-9272, E-ISSN 2306-1987, no 18, p. 14-26Article in journal (Refereed)
    Abstract [en]

    In the past twenty years or so, the study of the determinants of child survival in low-income countries has been based on demographic conceptual frameworks. The most widely known has been the Mosley and Chen framework (1). In that framework, the key concept was a set of proximate determinants, or intermediate variables, that directly influence the risk of morbidity and mortality. It assumes that all the more distal social and economic determinants must operate through these variables to affect child survival. However the Mosley and Chen framework has failed to directly incorporate the complex social dimension of health.The objective of this paper is to link more distal causes for child health by describing a framework that conceptualises the relation between distal and proximal factors and how they operate to cause inequalities in child mortality within sub-Saharan Africa. Additionally the framework defines policy entry points needing support of empirical evidence. Furthermore the paper acknowledges that the social context plays an important role for inequalities in children’s chances of survival. However, the relative importance of the mechanisms presented in the proposed framework may vary among the different countries of sub-Saharan Africa, thus researchers should empirically adapt the framework to their specific context.

  • 44.
    Macassa, Gloria
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Hiswåls, Anne-Sofie
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Ahmadi, Nader
    Department of Social Work and Psychology, University of Gävle, Gävle, Sweden .
    Alfredsson, Johana
    Department of Community Medicine, Gävleborg County Council, Gävle, Sweden .
    Soares, Joaquim
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Stankunas, Mindaugas
    Department of Health Management, Lithuanian University of Health Sciences, Kaunas, Lithuania .
    Employment status and health care utilization in a context of economic recession: Results of a population based survey in East Central Sweden2014In: Science Journal of Public Health, ISSN 2328-7942, E-ISSN 2328-7950, Vol. 2, no 6, p. 610-616Article in journal (Refereed)
    Abstract [en]

    Introduction: The most recent economic recession left many people outside the labour market world-wide, causing widespread poverty and social exclusion. Gävleborg County in East Central Sweden experienced massive layoffs caused by closure of various industries. Objective: The objective of this study was to investigate differences in health-care use according to employment status at the pick of the recent economic recession. Methods: The study used data from a cross-sectional survey "Health in Equal Terms" carried out in Gävleborg County in 2010. The sample included 4245 persons aged 16-65 years. Descriptive and logistic regression analyses were used to assess differences in health-care seeking behaviour by employment status. Results: Employment status was statistically significantly associated with health-care use in Gävleborg County. In the bivariate analysis people who were not employed had odds ratio of 1.62 (CI 1.18-1.72) for health care use as compared to their employed counterparts. Controlling for other variables in Model II to IV removed the statistical significance and reduced the odds to 0.44(CI 0.20-1.00). Conclusions: This study found that at the pick of the most recent economic recession, people who were out of work used more often health services as compared with their employed counterparts. The observed differences in health-care use were explained by demographic, socio-economic and health-related variables. Further studies are needed to analyze trends of healthcare utilization according to employment nationally, particularly at the county level.

  • 45.
    Macassa, Gloria
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Sundin, Örjan
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology.
    Viitasara, Eija
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Barros, H
    Department of Hygiene and Epidemiology, University of Porto Medical School, Porto, Portugal.
    Torres Gonzales, F
    Departmental Section of Psychiatry and Psychological Medicine, University of Granada, Granada, Spain.
    Ioannidi-Kapolou, E
    Department of Sociology, National School of Public Health, Athens, Greece.
    Melchiorre, MG
    Italian National Institute of Health and Science on Aging (INRCA), Ancona, Italy.
    Lindert, J
    Protestant University of Applied Sciences, Ludwigsburg, Germany.
    Stankunas, M
    Department of Health Management, Lithuanian University of Health Sciences, Kaunas, Lithuania.
    Soares, Joaquim
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Psychological abuse among older persons in Europe: A cross-sectional study2013In: Journal of Aggression, Conflict and Peace Research, ISSN 1759-6599, Vol. 5, no 1, p. 16-34Article in journal (Refereed)
    Abstract [en]

    Purpose – Elder abuse is an issue of great concern world-wide, not least in Europe. Older people are increasingly vulnerable to physical, psychological, financial maltreatment and sexual coercion. However, due to complexities of measurement, psychological abuse may be underestimated. The purpose of this study is to investigate the prevalence of psychological abuse toward older persons within a 12 month period.

    Design/methodology/approach – The study design was cross-sectional and data were collected during January-July 2009 in the survey “Elder abuse: a multinational prevalence survey, ABUEL”. The participants were 4,467 randomly selected persons aged 60-84 years (2,559 women, 57.3 per cent) from seven EU countries (Germany, Greece, Italy, Lithuania, Portugal, Spain, Sweden). The sample size was adapted to each city according to their population of women and men aged 60-84 years (albeit representative and proportional to sex-age). The participants answered a structured questionnaire either through a face-to-face interview or a mix of interview/self-response. The data were analysed using descriptive statistics and regression methods.

    Findings – The prevalence of overall psychological abuse was 29.7 per cent in Sweden, followed by 27.1 per cent in Germany; 24.6 per cent in Lithuania and 21.9 per cent in Portugal. The lowest prevalence was reported in Greece, Spain and Italy with 13.2 per cent, 11.5 per cent and 10.4 per cent, respectively. Similar tendencies were observed concerning minor/severe abuse. The Northern countries (Germany, Lithuania, Sweden) compared to Southern countries (Greece, Italy, Portugal, Spain) reported a higher mean prevalence (across countries) of minor/severe abuse (26.3 per cent/11.5 per cent and 12.9 per cent/5.9 per cent, respectively). Most perpetrators (71.2 per cent) were spouses/partners and other relatives (e.g. children). The regression analysis indicated that being from Greece, Italy, Portugal and Spain was associated with less risk of psychological abuse. Low social support, living in rented housing, alcohol use, frequent health care use, and high scores in anxiety and somatic complaints were associated with increased risk of psychological abuse.

    Social implications – Psychological abuse was more prevalent in Northern than Southern countries and factors such as low social support and high anxiety levels played an important role. Further studies are warranted to investigate the prevalence of psychological abuse and risk factors among older persons in other EU countries. Particular attention should be paid to severe abuse. Such research may help policy makers and health planers/providers in tailoring interventions to tackle the ever growing problem of elder abuse.

    Originality/value – The paper reports data from the ABUEL Survey, which collected population based data on elderly abuse.

  • 46.
    Macassa, Gloria
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Walander, A
    Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Stockholm, Sweden .
    Soares, Joaquim J. F.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Violence against women in Stockholm County: Does marital status matter?2013In: Journal of Aggression, Conflict and Peace Research, ISSN 1759-6599, Vol. 5, no 2, p. 101-111Article in journal (Refereed)
    Abstract [en]

    Purpose: The purpose of this paper is to investigate differences in victimization among single and married mothers using data (n=6,388 women) from the 2006 Stockholm County Public Health Survey (SCPHS), a cross-sectional survey based on a self-administered postal questionnaire. Design/methodology/approach: Results showed higher odds of victimization among lone mothers compared to married ones. Additionally, the greatest odds of victimization were observed among those with low education, low income, and decreased social and practical support. Findings: In Sweden, particularly in Stockholm, there is a need for future population-based surveys regarding the prevalence of violence and to identify high risk groups. Furthermore, it is crucial that these surveys include items that will enable investigation of direct links between violence and health effects, and the utilization of health care for these women. Originality/value: This paper is original and it addresses for the first time violence among single mothers within a social epidemiology perspective.

  • 47.
    Macassa, Gloria
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Univ Porto, Epidemiol Unit ISPUP, Porto, Portugal.
    Winersjö, Rocio
    Swedish Board of Health and Social Welfare, Sweden.
    Wijik, Katarina
    Department of Research, Gävleborg Region, Sweden.
    Magrath, Cormac
    LIME, Karolinska Institute, Sweden.
    Ahmadi, Nader
    University of Gävle.
    Soares, Joaquim
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Fear of crime and its relationship with self-reported health and stress among men2017In: Journal of Public Health Research, ISSN 2279-9028, E-ISSN 2279-9036, Vol. 6, no 3, p. 169-174Article in journal (Refereed)
    Abstract [en]

    Background: Fear of crime is a growing social and public health problem globally, including in developed countries such as Sweden. This study investigated the impact of fear of crime on self-reported health and stress among men living in Gävleborg County.Design and Methods: The study used data collected from 2993 men through a cross sectional survey in the 2014 Health in Equal Terms survey. Descriptive and logistic regression analyses were carried out to study the relationship between fear of crime and self-reported health and stress. Results: There was a statistically significant association between fear of crime and self-reported poor health and stress among men residing in Gävleborg County. In the bivariate analysis, men who reported fear of crime had odds of 1.98 (CI 1.47- 2.66) and 2.23 (CI 1.45-3.41) respectively. Adjusting for demographic, social and economic variables in the multivariate analysis only reduced the odds ratio for self-reported poor health to 1.52 (CI 1.05-2.21) but not for self-reported stress with odds of 2.22 (1.27-3.86). Conclusions: Fear of crime among men was statistically significantly associated with self-reported poor health and stress in Gävleborg County. However, the statistically significant relationship remained even after accounting for demographic, social and economic factors, which warrants further research to better understand the role played by other variables.

  • 48.
    Macassa, Gloria
    et al.
    Karolinska Institutet.
    Öberg, Lisa
    Södertörn University College.
    Bernhardt, Eva
    Stockholm University.
    Burström, Bo
    Karolinska Institutet.
    Differentials in overall and cause-specific mortality between infants born in and out of wedlock, Stockholm 1878-19252006In: The History of the Family, ISSN 1081-602X, E-ISSN 1873-5398, Vol. 11, no 1, p. 19-26Article in journal (Refereed)
    Abstract [en]

    This study investigates differentials in the decline of cause-specific infant mortality by marital status of the mother in Stockholm (1878–1925) and factors contributing to the explanation of these differentials using computerized records of individual entries from the Roteman Archives. Included in the analysis were 120,094 children less than 1 year of age who lived in Södermalm during this period. Cause-specific mortality rates were calculated for three time periods. Cox's regression analysis was used to study the relationship between overall and cause-specific risk of infant death and of being born in and out of wedlock in relation to a set of variables. Infant mortality rates and mortality risks were higher among children born out of rather than in wedlock. The most pronounced differentials in cause-specific mortality rates between these groups of children were seen in cases of diarrhea. The socioeconomic status of the household head and number of children in the household were statistically significant with infant mortality, but explain only part of the excess mortality risk of children born out of wedlock. In Stockholm at the turn of the 19th century being born out of wedlock was strongly associated with poor health outcomes, particularly in diarrheal diseases, pneumonia/bronchitis, and immaturity/congenital causes.

  • 49.
    Melchiorre, Maria Gabriella
    et al.
    Centre of Socio-Economic Research on Ageing, Italian National Institute of Health and Science on Aging, I.N.R.C.A., Ancona, Italy.
    Chiatti, Carlos
    Italian National Institute of Health and Science on Aging, I.N.R.C.A., Ancona, Italy.
    Lamura, Giovanni
    Centre of Socio-Economic Research on Ageing, Italian National Institute of Health and Science on Aging, I.N.R.C.A., Ancona, Italy.
    Torres-Gonzales, Francisco
    Centro de Investigación Biomedica en Red de Salud Mental (CIBERSAM), University of Granada, Granada, Spain.
    Stankunas, Mindaugas
    Department of Health Management, Lithuanian University of Health Sciences, Kaunas, Lithuania.
    Lindert, Jutta
    Department of Public Health Science, Protestant University of Applied Sciences, Ludwigsburg, Germany.
    Ioannidi-Kapolou, Elisabeth
    Department of Sociology, National School of Public Health, Athens, Greece.
    Barros, Henrique
    Department of Hygiene and Epidemiology, Medical School, University of Porto, Porto, Portugal.
    Macassa, Gloria
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Soares, Joaquim
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Social Support, Socio-Economic Status, Health and Abuse among Older People in Seven European Countries: Social support and elder abuse in Europe2013In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, no 1, p. e54856-Article in journal (Refereed)
    Abstract [en]

    Background

    Social support has a strong impact on individuals, not least on older individuals with health problems. A lack of support network and poor family or social relations may be crucial in later life, and represent risk factors for elder abuse. This study focused on the associations between social support, demographics/socio-economics, health variables and elder mistreatment.

    Methods

    The cross-sectional data was collected by means of interviews or interviews/self-response during January-July 2009, among a sample of 4,467 not demented individuals aged 60–84 years living in seven European countries (Germany, Greece, Italy, Lithuania, Portugal, Spain, and Sweden).

    Results

    Multivariate analyses showed that women and persons living in large households and with a spouse/partner or other persons were more likely to experience high levels of social support. Moreover, frequent use of health care services and low scores on depression or discomfort due to physical complaints were indicators of high social support. Low levels of social support were related to older age and abuse, particularly psychological abuse.

    Conclusions

    High levels of social support may represent a protective factor in reducing both the vulnerability of older people and risk of elder mistreatment. On the basis of these results, policy makers, clinicians and researchers could act by developing intervention programmes that facilitate friendships and social activities in old age.

  • 50.
    Melchiorre, Maria Gabriella
    et al.
    INRCA Ancona, Italian Natl Inst Hlth & Sci Aging, Ctr Socioecon Res Ageing, Ancona, Italy.
    Di Rosa, Mirko
    INRCA Ancona, Italian Natl Inst Hlth & Sci Aging, Sci Direct, Ancona, Italy.
    Lamura, Giovanni
    INRCA Ancona, Italian Natl Inst Hlth & Sci Aging, Ctr Socioecon Res Ageing, Ancona, Italy.
    Torres-Gonzales, Francisco
    Univ Granada, Ctr Invest Biomed Red Salud Mental CIBERSAM, Granada, Spain.
    Lindert, Jutta
    Univ Emden, Dept Publ Hlth, Emden, Germany.
    Stankunas, Mindaugas
    Lithuanian Univ Hlth Sci, Dept Hlth Management, Kaunas, Lithuania.
    Ioannidi-Kapolou, Elisabeth
    Natl Sch Publ Hlth, Dept Sociol, Athens, Greece.
    Barros, Henrique
    Univ Porto, Sch Med, Dept Hyg & Epidemiol, Rua Campo Alegre 823, P-4100 Oporto, Portugal.
    Macassa, Gloria
    Univ Gavle, Dept Occupat & Publ Hlth Sci, Gavle, Sweden.
    Soares, Joaquim J. F.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Abuse of Older Men in Seven European Countries: a Multilevel Approach in the Framework of an Ecological Model2016In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 1, p. 1-28, article id e0146425Article in journal (Refereed)
    Abstract [en]

    BackgroundSeveral studies on elder abuse indicate that a large number of victims are women, but others report that men in later life are also significantly abused, especially when they show symptoms of disability and poor health, and require help for their daily activities as a result. This study focused on the prevalence of different types of abuse experienced by men and on a comparison of male victims and non-victims concerning demographic/socio-economic characteristics, lifestyle/health variables, social support and quality of life. Additionally, the study identified factors associated with different types of abuse experienced by men and characteristics associated with the victims.MethodsThe cross-sectional data concerning abuse in the past 12 months were collected by means of interviews and self-response during January-July 2009, from a sample of 4,467 not demented individuals aged between 60–84 years living in seven European countries (Germany, Greece, Italy, Lithuania, Portugal, Spain and Sweden). We used a multilevel approach, within the framework of an Ecological Model, to explore the phenomenon of abuse against males as the complex result of factors from multiple levels: individual, relational, community and societal.ResultsMultivariate analyses showed that older men educated to higher levels, blue-collar workers and men living in a rented accommodation were more often victims than those educated to lower levels, low-rank white-collar workers and home owners, respectively. In addition, high scores for factors such as somatic and anxiety symptoms seemed linked with an increased probability of being abused. Conversely, factors such as increased age, worries about daily expenses (financial strain) and greater social support seemed linked with a decreased probability of being abused.ConclusionsMale elder abuse is under-recognized, under-detected and under-reported, mainly due to the vulnerability of older men and to social/cultural norms supporting traditional male characteristics of stoicism and strength. Further specific research on the topic is necessary in the light of the present findings. Such research should focus, in particular, on societal/community aspects, as well as individual and family ones, as allowed by the framework of the Ecological Model, which in turn could represent a useful method also for developing prevention strategies for elder abuse.

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