Mid Sweden University

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.

Aim: To analyse how health risk behaviours (HRB) are clustered and associated with parental background and family wealth among Swedish boys and girls.

Methods: Data were collected from Health Behaviour in School-aged Children (HBSC),a global cross-sectional survey for 1997/98, 2001/02, and 2005/06. A total of 11,972 boys and girls in grades 5, 7, and 9 participated in the study. The pupils were categorised in subgroups according to parental background: Swedish (80.0%), mixed (10.6%), and foreign (9.4%). Cluster analyses were used to identify HRB profiles. Multinomial logistic regression analysis was used to estimate associations between cluster allocation, parental background, and family affluence.

Results: In total 11,232 pupils were identified and allocated to five cluster profiles, half of them in the cluster profile of low-risk behaviour. The most disadvantaged cluster was multiple HRB, which was characterised by high prevalence of smoking, drunkenness, low physical activity, and high soft-drink consumption. The cluster profile of multiple HRB was associated with both mixed background and foreign background in girls and with mixed background in boys.. The cluster profile of inadequate tooth brushing was associated with foreign background in both boys and girls. The cluster profiles of multiple HRB and inadequate tooth brushing were associated with low family affluence in girls.

Conclusions: The cluster profiles of multiple HRB and inadequate tooth brushing were associated with parental foreign extraction in boys and girls and with low family affluence in girls. Prevention programmes based on identified clusters of HRB, including consideration of impact of socio-demographic indicators, are needed.

This study aimed to analyze how bullying involvement is associated with the distribution of parental background and with subjective health complaints (SHC) among Swedish boys and girls. Data were collected from the World Health Organization, Health Behavior in School-aged Children (WHO/HBSC) survey, measurement years 1997/1998, 2001/2002 and 2005/2006. A total of 11,972 boys (50.6 %) and girls (49.4 %) in grades five, seven and nine participated in the study. The adolescents were categorized in subgroups according to parental background: Swedish (80.1 %), mixed (10.5 %) and foreign(9.7 %). Multivariate logistic regressions were used to estimate remaining risk of SHC in the categories of bullying involvement. The frequencies of bullying involvement once or more were: none involved (74.8 %), victims (10.6 %), bullies (10.3 %) and bully/victims (4.4 %). Six out of ten involved in bullying were boys. Boys of foreign background were more involved as bullies compared to boys of mixed or Swedish background. Girls of foreign background were more involved in all three categories of bullying than girls of mixed or Swedish background. Increased risk of SHC was estimated among all adolescents involved in bullying, with highest OR in the category of bully/victims, OR 3.95 (CI 3.13–4.97) for the boys and OR 4.51 (CI 4.51–6.40) for the girls. The multivariate models were stable even after adjustment for socio-demographics. There are some associations between bullying involvement and parental background. Regardless of parental background, family affluence, family structure and gender, all adolescents involved in bullying are at increased risk of SHC.

Background: Negative impact on health from school disturbance due to asymmetric power relations such as discrimination and offensive treatment are frequent problems among students. This study sought to analyze associations between occurrence of discrimination at school, participation and psychosomatic problems. Methods: Pupils in grades 6–9 in ten schools in a northern Swedish municipality participated in the study. The frequency of discrimination at school was measured by six items: sex; culture or ethnicity; disability; religion beliefs; sexual preferences; and any other form of discrimination. The Social and Civic Objectives Scale (SCOS) was used for an estimation of the level of participation. The pupils’ health was measured by the PsychoSomatic Problem (PSP) scale. Multivariate logistic regression models were used for estimation of increased risk of PSP. The formula Z=d/s (d)was used to test mediation. Results: Two thirds of the boys and three fourths of the girls reported occurrences of discrimination at schools (p = 0.001). Discrimination was a mediating factor between participation and PSP among boys and girls as the mediating formula Z=d/s (d) was > + 2 SD, –2.59 for boys and –39.27 for girls. Independent of each other, low participation and discrimination were associated with increased risk of PSP. Conclusion: Discrimination was a mediating factor between participation and PSP. The mediating effectwas stronger in girls than in boys. There is a need for school health promotion programsfocusing on participation in terms of democratic processes, communication and cooperation in the classroom.

Objective: The general aim of this study was to explore the associations between foreign extraction and subjective health complaints (SHC) among school-aged children in Sweden. Methods: Data were obtained from the global cross-sectional survey Health Behaviour in School-aged Children (HBSC), 1997/1998, 2001/2002, and 2005/2006. A total of 11,972 pupils in grades 5, 7 and 9 participated in the survey. Logistic regression analyses were used to estimate remaining risk of SHC among the subgroups of pupils. The analyses were adjusted for socio-demographic indicators, grade and measurement year. Results: Parental background: Swedish n = 9,585, mixed n = 1,263, and foreign n = 1,124. The results showed an increased risk of SHC among girls with a foreign background OR 1.27 (95% CI 1.04-1.55) compared with girls with a Swedish background and among girls in single-adult households OR 1.42 (95% CI 1.20-1.67) compared with girls in two-adult households. No such differences were shown among boys. Conclusions: A significantly increased risk of ill health remained in girls of foreign background after adjustment for socio-demographic indicators, grade and measurement year. © 2011 Swiss School of Public Health.

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.

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

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.

Background: Our aim in this survey was to explore descriptive epidemiology of injuries in Tehran in 2012 and to report the recalled estimates of injury incidence rates.

Methods: A population survey was conducted in Tehran during 2012, within which a total of 8626 participants were enrolled. The cluster sampling was used to draw samples in 100 clusters with a pre-specified cluster size of 25 households per cluster. Data were collected on demographic features, accident and injury characteristics based on the International Classification of Diseases (ICD10).

Results: A total of 618 injuries per 3 months were reported, within which 597 cases (96.6%)were unintentional injuries. More than 82% of all injuries were those caused by exposure to inanimate mechanical forces, traffic accidents, falls and burns. Above 80% of the traffic injuries happened among men (P<0.001). About 43% of the unintentional injuries were mild injuries.After the age of 40, women, unlike men, had higher risks for being injured. The estimated annual incidence rate for all types of injuries was 284.8 per 1000 (95% CI: 275.4-294.4) and for unintentional injuries was 275.2 per 1000.

Conclusion: Injuries are major health problems in Tehran with a highly reported incidence. The status is not substantially improved over the recent years which urges the need to be adequately and emergently addressed. As the incidence rate was estimated based on participant recalls, the real incidence rate may even be higher than those reported in the current study.

Globally, ocular morbidity and disability among children are major public health concerns.This study was designed to explore the health-seeking behaviours of parents in Bangladesh whose children have ocular problems. A cross-sectional mixed method was followed for this study. The method was designed to measure the eye health care-seeking practices of caregivers/parents with children with ocular morbidity in three unions (the lowest administrative geographical area comprising 30,000–50,000 population) of the Raiganj Upazila under the Sirajganj District of Bangladesh. The study period was from January to April 2017. Face-to face interviews using a semi-structured quantitative questionnaire with the caregivers and KI were conducted among the health service providers during the study period. This was the first community-based study conducted in Bangladesh to find out caregivers’ health-seeking behaviour with identified ocular morbidity. Among 198 confirmed cases of childhood ocular problems, only 87 (43.9%) parents sought health care for their children’s ocular morbidities. Better health-seeking behavior was found among the wealthier families. Proportions were 55.3% and 36% among wealthy and low-income families, respectively. Affluent families sought care from qualified service providers. Educated household heads chose qualified service providers for their children at a higher rate than illiterate household heads. Lack of knowledge, lack of awareness and financial constraints are significant barriers to seeking proper health care. More than half of the caregivers did not seek any eye care services for their children. Socio-demographic factors, and financial constraints play an essential role in the health-seeking behaviour of the parents.

Introduction: Childhood eye morbidity is a great public health problem, especially in low-income countries. This study aimed to determine the economic burden of childhood ocular morbidity on attending tertiary hospitals in Bangladesh. This study also assessed the catastrophic health expenditure (CHE) for childhood ocular morbidity in Bangladesh. Methods: A cross-sectional mixed method was used for this study from April to October 2023 at two tertiary hospitals in Bangladesh, one government-funded and one private. Face-to-face interviews using a semi-structured quantitative questionnaire with the caregivers/parents and in-depth interviews (IDIs) were conducted among the same respondents of these two hospitals, and a workshop was conducted with the stakeholders during the study period. Results: This was the first study in Bangladesh to determine the cost of pediatric ocular morbidity. Among 335 patients, the total median direct cost at a single time was 3740 ± 18,285 BDT (34 ± 166.2 USD) at the government hospital and 7300 ± 40,630 BDT (66.36 ± 369.36 USD) at the private hospital. The disease-specific median overall cost from diagnosis of the disease was 65,000 BDT (591 USD) for squint, 50,000 BDT (454.54 USD) for cataract, and 30,000 BDT (272.72 USD) for eye injury. Almost 90% of the caregivers/parents faced CHE due to different pediatric ocular morbidity. Conclusions: These cost estimates can be used as an initial basis for financial decisions that aim to enhance access to care, management, and follow-up of children with ocular morbidity. These cost estimates also offer helpful information for organizational and financial sustainability initiatives. Policymakers can consider serious immediate interventions for securing ocular health services in Bangladesh and prevent families from CHE. 

Risk factors and consequences of exposure to violence at work were examinedthrough a systematic review of longitudinal studies of workplace violence.Literature in different databases was screened and the articles were selected onthe basis of a set of inclusion criteria. Sixteen studies were included into thereview and they were evaluated according to a number of criteriarecommended for use in systematic reviews. Of the reviewed studies, 12 metmore than half of the evaluation criteria. The studies identified individual,situational, and structural risk factors of workplace violence. Five studiesdemonstrated that being subjected to violence at work have both acute andlong-term consequences for the exposed staff and the workplace. Two studiesalso found symptoms of Posttraumatic Stress Disorder in victims. In view ofthe detrimental effects of violence, it is important that preventive measures aretaken and evaluated in future longitudinal studies.

Introduction The majority of childhood, adolescent and young adult (AYA) cancer survivors suffer from long-term and late effects such as fatigue, psychological distress or comorbid diseases. Effective health promotion strategies are needed to support the health of this vulnerable group. This protocol provides a methodological description of a study that aims to examine the feasibility and safety of performing a randomised clinical trial (RCT) on a wilderness programme that is developed to support the health of AYA cancer survivors.Methods and analysis The pilot RCT study has a mixedmethod design, including quantitative and qualitative evaluations. Participants are AYAs, aged 16–39 years, that have been diagnosed with cancer during childhood, adolescence or young adulthood. A total of 40 participants will be randomly assigned to a wilderness programme (n=20) or a holiday programme (n=20). Both arms include participation in an 8-day summer programme, followed by a 4-day programme 3 months later. Primary outcomes are feasibility and safety parameters such as time to recruitment, willingness to be randomised, programme adherence and adverse effects. Secondary outcomes include self-reported health such as self-esteem, quality of life, self-efficacy and lived experiences. Descriptive statistics will be used to analyse outcomes and explore indications of differences between the programmes. Interviews are analysed by directed content analysis and hermeneutic phenomenology. A convergent parallel mixed-method analysis design will be applied to integrate quantitative and qualitative data. Results of this feasibility study will inform the preparation for a larger RCT with AYA cancer survivors.

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.

OBJECTIVE: Violent and disruptive acts committed by persons with developmental disabilities are a potential work environment problem for caregivers. This study developed and tested an instrument for describing and analyzing violence among persons with developmental disabilities. METHODS: Personnel from four units of one facility recorded daily on a simple form all violent and disruptive acts occurring in a limited range of situations. RESULTS: Acts of violence were associated with a small minority of individuals, but grossly underreported and unrecognized in formal reporting systems. None of the nearly 3000 incidents recorded during the six-week study required sick leave. Violent and disruptive acts occurred most often when an individual was requested to do something he or she did not want to do, when the individual was denied the opportunity to do something they did want to do and when waiting or under-stimulated. Personnel used the data in discussing countermeasures that could be integrated with the care and treatment of the individual. CONCLUSION: Hitting, kicking, pinching etc. of personnel are a work environment problem due to their high frequency and effects upon employee morale. The instrument and procedures can be used to reduce incidents of violence, which would improve the working environment of employees and assist persons with developmental disabilities as they move from institutional environments.

The problem of threats and violence at work has received increasing attention in Sweden in recent years. Exposure is especially high among health-care personnel in social services. A nationwide survey of prevalence, work environment and risk situations was conducted. A questionnaire was sent to a stratified sample of 2800 local government employees in the care and welfare sector, working mainly with the elderly or persons with developmental impairments. Seven occupational groups, including supervisors, specialists and other categories of carers, were included, and represented a population of more than 170 000 employees. The response rate was 85%. The results indicated that as many as 51% of the population had been affected by threats/violence, either verbally or physically, over the previous year. Moreover, the results suggest that over 9% of the employees in the care sector experienced acts of violence or threats on a daily basis, and several times a month by 67%. The most vulnerable groups were assistant nurses and direct carers. Verbal threats appear more common (79%), but 66% appear to have experienced physical assaults. Stratified estimates suggest that feelings of anger (41%) and helplessness (31%), but also minor physical injuries (18%), are frequent reactions. Organizational change in the workplace and high workload entailed increased risk. Threats and violence in health-care settings are a major work-environment issue. Greater knowledge of consequences for organization, work situation and health of personnel is needed.

BACKGROUND: Improving access to optimal quality of care is a core priority and ambitious health policy goal in spite of impediments, threats and challenges in Palestine. Understanding the factors that may impede quality of care is essential in developing an effective healthcare intervention for patient with non-communicable disease (NCD) or war-injured survivors. METHODS: Qualitative interviews were performed using a purposive sampling strategy of 18 political-key informants, 10 patients with NCD and 7 war-injured survivors from different health facilities in Gaza Strip. A semi-structured interview guide was developed for data collection. The interviews were audio recorded and transcribed verbatim. Important field notes of the individual interviews were also reported. Thematic-driven analytic approach was used to identify key themes and patterns. RESULTS: From the policy maker's perspective, the following important barriers to accessing optimal healthcare for patients with NCD or war-injured survivors' treatment were identified; 1) organizational/structural 2) availability 3) communication 4) personnel/lack of staff 5) financial and political barriers. Patient with NCD or war-injury had similar experiences of barriers as the policy makers. In addition, they also identified socioeconomic, physical and psychological barriers for accessing optimal healthcare and treatment. CONCLUSIONS: The main perceived barriers explored through this study will be very interesting and useful if they are considered seriously and handled carefully, in order to ensure efficient, productive, cost-effective intervention and delivery of a high-standard quality of care and better disease management.

BACKGROUND: War-related injury is a growing clinical and public health concern in occupied Palestinian territory, especially in the Gaza Strip. However, little research has been done into the quality of care and management of war injuries in public hospitals. We explored the perceptions of health-care workers about these factors in Palestinian health-care facilities in Gaza. METHODS: This was a qualitative descriptive study. Data were obtained in four focus group discussions attended at public health facilities by 30 purposively selected health-care providers, comprising 14 head surgeons, and 16 head nurses, aged 38-55 years. A semi-structured topic guide was developed by the authors for the study based on earliest literature, and was critically reviewed by a panel of experts to ensure the trustworthiness of the qualitative guide and to minimise complexity and enhance clarity of the questions for participants. Audio recordings of discussions were transcribed verbatim, translated, and analysed with a thematic analysis approach. The study was approved by the Palestinian Health Research Council and facilitated by the Ministry of Health. FINDINGS: A consensus was expressed that, despite some positive aspects in the system, fundamental changes and essential improvements were needed to advance the care and facilitation of war injury management. Some respondents had serious concerns about the health-care system, suggesting that it needs to be comprehensively rebuilt. Unanimous views were expressed about the important barriers to effective management and quality of care: shortages of resources, medicines, and funding; underuse or absence of specific and unified clinical practice guidelines; no official commitment by the Ministry of Health to adopt updated clinical guidelines; few incentives and poor motivation, poor communications; blockade and siege; division of health systems in the country; overcrowding of patients with war injuries in hospitals with limited capacity; spreading of infection due to poor cleanliness; shortages in fuel and power supply; and low wages, which negatively affected staff motivation. Respondents also reported inadequate sharing of care and cooperation between different health-care facilities. INTERPRETATION: The perceptions about barriers to management of war injuries and the quality of care provided were similar across Palestinian health-care facilities in the Gaza strip. Our findings suggest that fundamental changes and comprehensive reform of the health-care system are needed to make the care of patients with war injuries more effective and efficient. One of the important strengths of this study is that it addressed the perspective and opinions of different key health professionals, which made it possible gain deeper and better understanding of how war injuries are managed in the Palestinian health system. In addition, the outcomes of the study were based on diverse information. However, the analysis of the qualitative data may represent challenges, and be more complicated and time consuming than a quantitative approach.None. 

Background: Palestine, like other low-income countries, is confronting an increasing epidemic of non-communicable disease (NCD) and trend of war injury. The management of health problems often presents a critical challenge to the Palestinian health system (PHS). Understanding the perceptions of healthcare providers is essential in exploring the gaps in the health system to develop an effective healthcare intervention. Unfortunately, health research on management of NCD and war injury has largely been neglected and received little attention. Therefore, the study aimed to explore the perspectives of healthcare providers regarding NCD and war injury management in the PHS in the Gaza Strip. Methods: A qualitative study approach was used, based on four focus group discussions (FGDs) involving a purposive sampling strategy of 30 healthcare providers from three main public hospitals in Gaza Strip. A semi-structured topic guide was used, and the focus group interviews data were analyzed using manifest content analysis. The study was approved by the Palestinian Health Research Council (PHRC) for ethics approval. Results: From the healthcare providers perspective, four main themes and several subthemes have emerged from the descriptive manifest content analysis: functioning of healthcare system; system-related challenges; patients-related challenges; strategies and actions to navigating the challenges and improving care. Informants frequently discussed that despite some positive aspects in the system, fundamental changes and significant improvements are needed. Some expressed serious concerns that the healthcare system needs complete rebuilding to facilitate the management of NCD and war-related injury. They perceived important barriers to effective management of NCD and war injury such as poor hospital infrastructure and logistics, shortage of micro and sub-specialities and essential resources. Participants also expressed a dilemma and troubles in communication and interactions, especially during emergencies or crises. The informants stressed the unused of updated clinical management guidelines. There was a consensus regarding poor shared-care/task sharing, partnership, and cooperation among healthcare facilities. Conclusion: Our findings suggest that fundamental changes and significant reforms are needed in the health system to make healthcare services more effective, timely, and efficient. The study disclosed the non-use of clinical guidelines as well as suboptimal sectorial task-sharing among different stakeholders and healthcare providers. A clear and comprehensive healthcare policy considering the gaps in the system must be adopted for the improvement and development of care in the PHS.

To promote equity in health is complex and requires not only multidisciplinary methods but also interdisciplinary studies to get a better insight and under-standing of today’s health problems. Distance learning makes it possible for students to be room-and-time-independent as well as local independent. In this article we present, a public health education leading to a Bachelor’s degree. The programme is a collaboration between two universities in Sweden, Halmstad University and Mid Sweden University in Sundsvall. The training is at it-distance and begins with basic courses at Halmstad Univer-sity with a specialization in health and lifestyle. Further, the students starts at the Mid Sweden University in Sundsvall with focus on project planning and project management to implement strategic actions for better health at the organizational and societal level. The programme ends with a Bachelor’s degree in Public Health.

Objective:

To explore how community-living people with perceived cognitive impairment or dementia and their next-of-kin perceive functioning and disability in major life domains.

Methods:

Individual interviews guided by the World Health Organization Disability Assessment Schedule (WHODAS 2.0) were  conducted with 26 people with perceived cognitive impairment or dementia (age range 38–87 years) and 26 next-of-kin. Qualitative content analysis- and International Classification of Functioning, Disability, and Health (ICF-) linking methods were used to analyse the transcripts. The perceived degree of disability in daily functioning was calculated and compared between people with perceived cognitive impairment or dementia and next-of-kin, using a Mann–Whitney U test.

Results:

A total of 38 of 47 (81%) established ICF categories corresponding to WHODAS items and 38 additional International Classification of Functioning, Disability, and Health (ICF) categories describing participants perceived cognitive and physical impairments, activity limitations and participation restrictions in interaction with the environmental factors were confirmed from the transcripts. The perceived disability of people with perceived cognitive impairment or dementia was scored higher by next-of-kin (48%) than by people with perceived cognitive impairment or dementia (16%, p < 0.0001).

Conclusion:

Interviews provided a comprehensive picture of participants’ perceived activity limitations and participation restrictions in the life domains cognition, mobility, self-care, getting along, life activities, and participation. For a better understanding of the impact of cognitive impairment on people’s daily lives, inclusion of the perspective of the next-of-kin and the factors that hinder or facilitate daily living in the community setting is necessary.

Aim: The aim of this study was to analyse discourses of parenting training in official inquires in Sweden that explicitly deal with the bringing up of children and parental education and how the representations of the problems and their solutions affect parental subject positions in the early welfare state and at the onset of the 21st century. Method: We carried out a discourse analysis of two public inquiries of 1947 and 2008, drawing on theories about governmentality and power regimes. Tools from political discourse analysis were used to investigate the objectives of political discourse practices. Results: Both inquiries referred to a context of change and new life demands as a problem. Concerning suggestions for solutions, there were discrepancies in parents’ estimated need of expert knowledge and in descriptions of parental capacity. In a discourse of trust and doubt, the parents in 1947 were positioned as trusted welfare partners and secure raisers of future generations, and in 2008, as doubted adults, feared to be faltering in their child-rearing tasks. Conclusions: The analysis revealed how governmental problem descriptions, reasoning about causes and suggestions of solutions influenced parents’ subject positions in a discourse of trust and doubt, and made way for governmental interventions with universal parenting training in the 21st century. 

Purpose: The purpose of this paper is to investigate chronicity (frequency) in different abuse types (e.g. psychological) and overall abuse (all abuse types) by severity (minor, severe, total) in seven European cities, and scrutinize factors associated with high chronicity levels (frequency on the median and higher) in psychological and overall abuse by severity. Design/methodology/approach: The study design was cross-sectional. The sample consisted of 4,467 randomly selected women/men (2,559 women) aged 60-84 years from seven European cities, and data were analysed with bivariate and multivariate methods. Findings: Chronicity varied across country and by abuse type. For instance, Germany had the highest chronicity means in physical and sexual abuse; Greece in physical, injury, sexual and overall abuse; Lithuania in physical, injury, financial and overall abuse; Portugal in physical abuse; Spain in physical, sexual and financial abuse; and Sweden in psychological, injury, financial and overall abuse. In general, Italy had the lowest chronicity means. The main perpetrators were people close to the respondents and women (in some cases). Research limitations/implications: The independent relationship (regressions) between chronicity/severity of abuse, country and other variables (e.g. depression) was examined only for psychological and overall abuse. More research into this issue with other types of abuse (e.g. sexual) is warranted. Originality/value: The paper reports data from the ABUEL survey, which gathered population-based data on elderly abuse.

Background: Elder abuse and its effects are a serious public health issue. However, little is known about therelation between psychological abuse, other factors (e.g. social support) and quality of life (QoL) by domain. This studyaddressed differences in QoL by domain between psychologically abused and non-abused. While considering otherfactors such as social support.

Methods: The respondents were 4,467 (2,559 women) randomly selected persons aged 60-84 years living in7 European cities. The mean response across countries was 45.2%. The cross-sectional data were analyzed withbivariate/multivariate methods.

Results: Abused respondents contrasted to non-abused scored lower in QoL (autonomy, 67.42 ± 21.26 vs. 72.39± 19.58; intimacy, 55.31 ± 31.15 vs. 67.21 ± 28.55; past/present/future activities, 62.79 ± 19.62 vs. 68.05 ± 18.09;social participation, 65.03 ± 19.84 vs. 68.21 ± 19.77). Regressions showed that abuse was negatively associated withautonomy, intimacy and past/present/future activities, and positively with the social participation. All QoL dimensionswere negatively associated with country and depressive/anxiety symptoms, and positively with social support. Further,variables such as age, sex and somatic symptoms were negatively associated with some of the QoL dimensions andothers such as family structure, education, health care use and drinking positively. The regression model “explained”32.8% of the variation in autonomy, 45.6% in intimacy, 44.8% in past/present/future activities and 41.5% in socialparticipation.

Conclusions: Abuse was linked to lower QoL in most domains, but other factors such as depressive symptomsalso carried a negative impact. Social support and to some extent family structure had a “protective” effect on QoL.Abuse, health indicators (e.g. depressive symptoms) and social support should be considered in addressing the QoL ofolder persons. However, QoL was influenced by many factors, which could not be firmly disentangled due to the crosssectionalapproach, calling for longitudinal research to address causality.

Quality of life was compared for lifetime victimized (n = 353) and nonvictimized men (n = 167) for demographic and quality of life variables by a cross-sectional design. The univariate analyses showed that victims compared to nonvictims had a lower quality of life, were younger, more often had upper secondary school education, and were more often blue-collar/low white-collar workers, on student allowances, on unemployment, financially strained, and smokers. The regressions revealed that unemployment, financial strain, smoking, depression, and home/public abuse were associated with reduced quality of life among victimized men. Being a blue-collar/low/intermediate white-collar worker and social support were related to increased quality of life. This study may have provided new insights into the experiences of quality of life of victimized men.

The abuse and mental health of older persons are sources of great concern. However, there are limited data on the relation between the chronicity (frequency of abuse) by severity (minor, severe) of abuse (e.g. psychological, physical) and mental health (e.g. depression). Women/men aged 60–84 years from seven European cities (n=4,467) participated in this study, and data were analysed with bivariate/multivariate methods. High chronicity (frequency, median/above) of psychological and physical abuse independently of severity was related to depression and anxiety; financial and overall abuse to anxiety; and minor financial abuse and overall abuse to depression. Regressions showed that some factors (e.g. being from Greece) were associated with a lower depression/anxiety “risk” and others (e.g. low social support) with high risk. Low chronicity (frequency, below median) of psychological abuse was associated with a lower anxiety risk. The management of depression/anxiety, particularly anxiety, among elders should also consider the roles of abuse and social support.

Purpose– The purpose of this paper is to examine differences in the experience of somatic symptoms by domain (exhaustion, musculoskeletal, gastrointestinal, heart distress) between psychologically abused and non-abused older persons, and to scrutinize associations between abuse and somatic symptoms while considering other factors (e.g. social support).Design/methodology/approach– The design was cross-sectional. The participants were 4,467 women/men aged 60-84 years living in seven European cities. The data were analysed using bivariate/multivariate methods.Findings– Psychologically abused participants scored higher on all somatic symptom domains than non-abused, and thus were more affected by the symptoms. The regressions confirmed a positive association between psychological abuse and most somatic symptom domains, but other factors (e.g. depression, anxiety) were more salient. Demographics/socio-economics were positively (e.g. marriage/cohabitation) or negatively (e.g. education) associated with somatic symptoms depending on the domain. Social support and family structure "protected" the experience of somatic symptoms.Research limitations/implications– The research focused on psychological abuse. It did not incorporate other abuse types calling for further research on the effects of other abuse types on somatic symptoms. Nevertheless, the findings indicate that psychological abuse is linked to somatic symptoms, but the role of other factors (e.g. depression, anxiety, social support) is also important.Practical implications– Improvements in the older person's situation regarding somatic symptoms need to consider psychological abuse, co-morbidities, social support and living conditions.Originality/value– The paper reports data from the ABUEL Survey, which collected population-based data on elder abuse.

Objectives. We examined differences in demographics/socio-economics, lifestyles and mental/ physical health between victimized/non-victimized men, and identified/quantified factors associated with mental/physical health.

Study design. The study design was cross-sectional.

Methods. The men were assessed in various areas (e.g., depression) by means of a questionnaire.

Results. The univariate analyses showed that victims compared with non-victims were younger. They also had higher intermediate education levels, were more often blue-collar/low white-collar workers, were on student allowances and financially strained, smoked more, had a lower BMI, and reported headaches, depression, tension and cognitive difficulties more frequently. The regression analyses showed that financial strain rather than violence was a more important factor for illhealth. Only headaches and cognitive difficulties were associated with violence.

Conclusions. Quite an number of men were in a poor physical/mental state, but there were few differences between victims/non-victims. Financial strain was determined to be a more important factor for ill-health than violence. Our data indicate that violence had little effect on men’s health. Our findings do not generally support a relationship between poor health and the abuse of men.

Introduction Falls among older adults are a significant cause of disability, injury, and death worldwide. The high incidence of falls in older adults, combined with the increased susceptibility to injury of the older adult population, leads to severe global health issues. Further studies are needed to comprehensively evaluate the typical personal and environmental risk factors of falls in the Iranian elderly population. Future preventive strategies and intervention programs will be based on these findings. The study determined the risk factors associated with unintentional falls among a representative sample of older adults living in Tehran, the capital city of Iran.Methods The study design was cross-sectional. The target population was men/women aged 65 years and over from the general population living in 22 different districts of Tehran who were selected by stratified random sampling. The researchers gathered the data using validated questionnaires and observations. The informed consent was obtained from all participants before starting the interview. Multivariate logistic regression analysis examined the association between falls occurring during the past 12 months with demographics/ socioeconomics and fall-related predictor factors.Results The risk of falls was higher in women (47.0%) and those aged≥75 years (44.1%). Older adults who were married had their fall risk reduced by 36.4% compared with other types of marital status. Older adults who were illiterate (48.1%), housewives (47.0%), and always had concerns about living expenses (53.9%) tended significantly to have a higher risk of falls. Moreover, participants who live with their family were less likely to fall than those who live alone (36.5% vs. 40.4%). Persons with safe homes were less likely to experience falls than persons with unsafe homes (30.9% vs. 41.4%). The logistic regression analysis showed that the female gender, being worried about living expenses, home safety, functional behavior, and function factors, were independently associated with the risk of falls during the past 12 months.Conclusions Our findings revealed that a wide range of intrinsic and extrinsic risk factors contributed to injurious falls; based on the literature, some are preventable. The present data may be helpful as a starting point and guide future efforts for health providers and policymakers to allocate additional resources and develop proper falls prevention or intervention programs at the community level.

Background and aim

Falling threatens the health, independence and quality of life of older adults. Information about characteristics and predisposing factors of falls is essential to develop and implement effective preventing measure. The aim of this study was to examine the prevalence, circumstances and consequences of falls among community-dwelling older adults in Tehran, Iran, and scrutinize factors (e.g. demographics) associated with falls.

Methods

A cross-sectional study was conducted in Tehran. A total of 653 individuals aged 65 years and over were selected by a stratified random sampling as representing older adults in Tehran. All required data were collected through face-to-face interviews using questionnaires.

Results

The prevalence of falls was 39.7% and higher in women than in men. For both sexes, most of the falls occurred in the afternoon (n = 135, 52.1%) and at home (n = 209, 80.7%). One-fourth of the falls (23.2%) occurred in a forward direction, mostly among women (60%). For both sexes, one-third of the causes of falls were loss of balance, mostly among women and the oldest persons. Two-hundred and twelve of the fallers reported injuries. The logistic regression showed that female gender, low education and constant worries about living expenses were significantly associated with falls.

Conclusions

This study may have provided new insights into the characteristics/ circumstances/ consequences of injurious falls and their relation with age, gender and injury severity in Iran. It may be useful for health policy makers and health providers when designing falls intervention and prevention programs at the community level.

Aim

To evaluate the associations between refraining from buying prescribed medications and selected factors among older persons.

Methods

A total of 4467 people aged 60–84 years from seven European countries answered a questionnaire (response rate 45.2%). Refraining from buying prescribed medications was measured with the question: ‘Have you ever refrained from buying prescribed medication and care?’

Results

About 11.9% of older people refrained from buying prescribed medications. The multiple regression analysis showed that ages 60–64 (odds ratio (OR) = 2.08; 95% confidence interval (95%CI): 1.38–3.13) and 65–69 (OR = 1.73; 95%CI: 1.16–2.57) years, experience of financial strain (OR = 1.59; 95%CI: 1.27–2.01), as well as exposure to abuse (OR = 1.64; 95%CI: 1.31–2.06) when taking into account country of participant were independently associated with refraining from buying medications, while an opposite association was observed for being male (OR = 0.72; 95%CI: 0.58–0.91).

Conclusions

The study has revealed that refraining from buying prescription medications is a problem among older people and it has identified a number of factors associated with this.

Background and objective: Abuse and pain complaints are common among older persons. However, little is known about relationships between abuse (e.g. psychological) and pain complaints (e.g. backache) among older persons while considering other factors (e.g. depression).Therefore, the aim of this study was to determine these relationships.Materials and methods: The design was cross-sectional. A total of 4467 women and men aged 60-84 years from Germany, Greece, Italy, Lithuania, Portugal, Spain, and Sweden answered questionnaires regarding various areas such as abuse, mental health (e.g. anxiety) and pain complaints (e.g. backache). The data were examined with bivariate (analyses ofvariance) and multivariate methods (linear regressions).Results: The bivariate analyses showed that psychological abuse was connected with all pain complaints; physical with headache and head pressure; sexual with neck or shoulder pain and headache; injury with all complaints (except pain in joints or limbs); financial with pain in joints or limbs and head pressure; and overall abuse (one or more types) with all complaints (except headache). The regressions showed that psychological abuse increased the likelihood of being affected by head pressure and heaviness or tiredness in the legs; physical abuse of being affected by headache and head pressure; financial abuse of being affected by head pressure; and overall abuse of being affected by headache and head pressure. In general, respondents from Sweden and younger (60-64 years) were less affected by the complaints than those from other counties (e.g. Germany) and older (e.g. 70-74 years), respectively. Respondents on medication (e.g. pain killers) were less affected by all pain complaints and those with high social support by pain in joints or limbs. High scores on anxiety and depression and having many diseases increased the likelihood of being affect by all pain complaints.Conclusions: Abuse was related with certain pain complaints (e.g.headache), but other factors and in particular mental health and physical diseases impacted on all pain complaints. Medication and partly social support had a positive effect on the pain experience, i.e. the complaints interfered less with for instance the daily-life of the respondents.

For newly arrived migrants, integration is important in promoting health and decreasing health inequities. In a Swedish context, civic orientation is a program to promote integration and increase the chance of employment for newly arrived migrants. The aim of this project was to explore how civic communicators view and approach health promotion in their work with newly arrived migrants in the civic orientation program in Sweden. Data were collected through interviews with eight civic communicators working with newly arrived migrants in civic orientation in the north of Sweden. The interviews followed a semi-structured interview guide and were transcribed verbatim and analyzed using thematic analysis. The analysis resulted in the main theme “To dress the participants for a (healthy) life in Sweden,” with two sub-themes “Knowledge—a key to health” and “Being a guide for participants in a new context.” In their work with civic orientation for newly arrived migrants, civic communicators are involved in health promotion by preparing their participants for a life in Sweden. They work to empower their participants to be able to make informed decisions and live healthy lives by both providing information to enhance knowledge and skills. They also work to guide them through the complexity of being in a new situation and country. 

As a group, newly arrived migrants in Sweden face inequities in health compared to the general population. Successful promotion of population health requires awareness of and focus on health from several sectors of society. In light of this, the aim was to study the views of local authority officials on collaboration in health promotion activities for newly arrived migrants. Data was collected through five focus group interviews with 23 local authority officials working with the integration of newly arrived migrants in the Establishment Program in a municipality or at the Employment Services in northern Sweden. An inductive qualitative latent content analysis was performed, and the analysis showed that the participating officials considered health promotion as desirable in the Establishment Program, but it also raised complex issues within the existing organisations. The officials described unclear roles, but also possible changes to the organisation that would improve the possibility of working to promote health. The present study adds to the relatively limited knowledge of health promotion in integration activities and offers clinical relevance for policymakers through the officials’ suggestions for improvements in the Establishment Program. It also raises important questions for further research. 

Background and aim: Early action is important for promoting newly arrived migrants’ health. Politicians are major actors in decision-making that affects health outcomes in the population. Therefore, the aim of this study was to explore local and regional politicians’ considerations of newly arrived migrants’ health in political decision-making: whether politicians reflect on or discuss the effects of decision-making specifically on newly arrived migrants’ health, whether considerations differ between municipality and regional politicians, and how knowledge and attitudes are associated with such considerations. Subject and methods: A cross-sectional quantitative study was conducted. A total of 667 municipality and regional politicians from northern Sweden responded to a questionnaire developed based on interviews with politicians. Bivariate analyses were performed using χ2 tests, the independent samples t-test, and the Wilcoxon signed-rank test. Multivariate analysis was performed using binary logistic regression. Results: Politicians considered the effects on newly arrived migrants’ health significantly less frequently than those on the total population’s health. Regional politicians discussed such effects more often than municipality politicians. Knowledge (odds ratio [OR] = 1.343), attitude (OR = 5.962), previous experience working on public health issues (OR = 1.784), and female gender (OR = 1.787) were positively associated with considering effects on newly arrived migrants’ health in decision-making. Conclusion: Politicians play important roles in health promotion, and most consider health-related effects in their decision-making. However, about a third do not consider such effects. General health-related knowledge and attitude are important factors that could be affected or changed during political assignments. 

Newly arrived migrants in Sweden risk facing ill health. Politicians at the local and regional levels are involved in many decisions regarding the social determinants of health. The aim of this study was to explore politicians’ views on different societal actors’ responsibility and possibility to promote newly arrived migrants’ health. Data were collected through online questionnaires completed by 667 politicians from municipality and regional councils in northern Sweden. Bivariate analysis was performed using the Wilcoxon signed-rank test. Multivariate analyses were performed using cluster analysis and binary logistic regression analysis. The results show that politicians generally rate societal actors’ responsibility and possibility to promote the general population’s health higher than newly arrived migrants’ health. Moreover, they consider societal actors’ responsibility to be greater than their possibility to promote health. Factors significantly contributing to politicians’ high ratings of societal responsibility and possibility are attitude (odds ratio [OR] = 2.156, 95% confidence interval [CI]: 1.306–3.558), specific knowledge of newly arrived migrants’ health status (OR = 1.528, 95% CI: 1.005–2.323), personal interest in public health (OR = 2.452, 95% CI: 1.460–4.119), being a municipality politician (OR = 1.659, 95% CI: 1.031–2.670) and being female (OR = 1.934, 95% CI: 1.333–2.806). This study shows that politicians generally rate societal responsibility and possibility to promote newly arrived migrants’ health rather high. Personal characteristics are important for politicians’ high or low ratings of responsibility and possibility, suggesting insufficient structural support for politicians in health promotion.

Aims: Describing alcohol use by abuse type (e.g. psychological) and considering other factors (e.g. depression).

Methods: The respondents were 4467 (2559 women, 57.3%) randomly selected elders (60–84 years) from seven European cities. The cross-sectional data were collected with scales covering various areas and examined with bivariate/multivariate methods.

Findings: Psychologically abused elders were more often alcohol users than non-users (21.7% vs. 16.3%) and the opposite regarding financially abused elders (4.8% vs. 3.5%). Psychologically abused elders also had more often three or more drinks containing alcohol in a drinking day (21.1% vs. 16.1%) and six or more drinks on one occasion (24.5% vs. 18.3%). Psychological abuse, demographics/socio-economics (e.g. education), smoking and leisure activities were positively associated alcohol use, and being from certain countries (e.g. Italy), age (e.g. 80–84 years), depression and financial abuse negatively.

Conclusions: Across countries, 64.2% of the elders were drinkers. Some variables (e.g. psychological abuse) were positively related to alcohol use and others (e.g. depression) negatively. Many of the elders were exposed to abuse. Our findings may be useful to prevent/manage drinking and abuse among elders. However, alcohol use was influenced by various factors that need to be further elucidated, particularly the relation between abuse and drinking.

The problem of violence at work has received considerable attention in recent years. According to Swedish statistics, personnel in the health-care sector are the most affected. The purpose of this paper is to present a framework or model for studies of workplace violence, and to demonstrate its application to the analysis of violence in health-care settings. The model treats violence as a process comprising of several stages/sub-events, and shows how this process is influenced by underlying structural (rather permanent) and situational (generally temporary) risk factors. Understanding the diversity in the process provides a basis for analysis of connections between interacting factors at different stages. Risk management (hazard identification, risk analysis, and preventive counter-measures) should be integrated into the work situation and operations of an organization.

Violence towards health-care personnel represent an in-creasing problem, but little is known in terms of how differentoccupational groups are affected. A questionnaire was sent to astratified sample of 2,800 of 173,000 employees in the Swedishmunicipal health and welfare sector. Seven major groups workingwith the elderly or persons with developmental disabilities wereconsidered: administrators, nursing specialists, supervisors, directcarers, nursing auxiliaries, assistant nurses, and personal assist-ants. The response rate was 85 percent. Fifty-one percent ofrespondents reported exposure to violence or threats of violenceover one year. The most vulnerable groups were assistant nursesand direct carers (usually of the developmentally disabled). Indi-vidual characteristics, such as age and organizational tenure, wererelated to exposure. Work-related characteristics, such as type ofworkplace, working full-time with clients, organizationaldownsizing, and high workload, were also associated with risk.Greater knowledge of impacts on different professional groups andrelevant prevention are required.