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  • 1.
    Abassi, Seyed Hesamedin
    et al.
    Department of Health Sciences, Section of Public Health Sciences, Mid Sweden University, Sundsvall, Sweden; Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Heart, Family Health Research Center, Iranian Petroleum Health Research Institute, Tehran, Iran.
    Ponce De Leon, Antonio
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Department o de Epidemiologia, Instituto de Medicina Social, Universidade do Estado de Rio de Janeiro, Brazil.
    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
    Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
    Jalali, Arash
    Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
    Soares, Joaquim
    Department of Health Sciences, Section of Public Health Sciences, Mid Sweden University, Sundsvall, Sweden; Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Macassa, Gloria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science. Department of Health Sciences, Section of Public Health Sciences, Mid Sweden University, Sundsvall, Sweden; Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Socioeconomic Status and in-hospital Mortality of Acute Coronary Syndrome: Can Education and Occupation Serve as Preventive Measures?2015In: International Journal of Preventive Medicine, ISSN 2008-7802, E-ISSN 2008-8213, Vol. 6, no 1, 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 coronary syndrome (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.

  • 2.
    Abbasi, Seyed Hesameddin
    et al.
    Mid Sweden University, Sundsvall, Sweden; Tehran University of Medical Sciences, Tehran, Iran; Iranian Petroleum Health Research Institute, Tehran, Iran .
    De Leon, Antonio Ponce
    Karolinska Institutet, Stockholm, Sweden; Universidade do Estado de Rio de Janeiro, Brazil.
    Kassaian, Seyed Ebrahim
    Tehran University of Medical Sciences, Tehran, Iran.
    Karimi, Abbasali
    Tehran University of Medical Sciences, Tehran, Iran.
    Sundin, Örjan
    Department of Psychology, Mid-Sweden University, Östersund, Sweden.
    Jalali, Arash
    Tehran University of Medical Sciences, Tehran, Iran.
    Soares, Joaquim
    Mid Sweden University, Sundsvall, Sweden; Karolinska Institutet, Stockholm, Sweden.
    Macassa, Gloria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences. Mid Sweden University, Sundsvall, Sweden; Karolinska Institutet, Stockholm, Sweden.
    Socioeconomic status and in‑hospital mortality of acute coronary syndrome: can education and occupation serve as preventive measures?2015In: International Journal of Preventive Medicine, ISSN 2008-7802, E-ISSN 2008-8213, Vol. 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 coronary syndrome (ACS) according to their SES.

    METHODS: All patients admitted to Tehran Heart Center due to 1(st)-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.

  • 3.
    Abbasi, Seyed Hesameddin
    et al.
    Department of Health Sciences, Section of Public Health Sciences, Mid Sweden University, Sundsvall, Sweden; Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
    Sundin, Örjan
    Department of Psychology, Mid Sweden University, Östersund, Sweden.
    Jalali, Arash
    Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
    Soares, Joaquim
    Department of Health Sciences, Section of Public Health Sciences, Mid Sweden University, Sundsvall, Sweden.
    Macassa, Gloria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science. Department of Health Sciences, Section of Public Health Sciences, Mid Sweden University, Sundsvall, Sweden.
    Ethnic Differences in the Risk Factors and Severity of Coronary Artery Disease: a Patient-Based Study in Iran2017In: Journal of Racial and Ethnic Health Disparities, ISSN 2197-3792Article 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.

  • 4.
    Abbasi, SH
    et al.
    Mittuniversitetet, Institutionen för hälsovetenskap.
    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, Ö
    Mittuniversitetet, Institutionen för samhällsvetenskap.
    Soares, J
    Mittuniversitetet, Institutionen för hälsovetenskap.
    Macassa, Gloria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences. Mittuniversitetet, Institutionen för hälsovetenskap.
    Gender Differences in the Risk of Coronary Artery Disease in Iran2012In: Iranian Journal of Public Health, ISSN 0304-4556, Vol. 41, no 3, 36-47 p.Article 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.

  • 5.
    Ahmadi, Elena
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Vilhelmson, Pär
    University of Gävle, Faculty of Education and Business Studies, Department of Business and Economic Studies, Business administration.
    Macassa, Gloria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science.
    Larsson, Johan
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    FRAMFÖR (Framgångsrika företag i Gästrikland): ett longitudinellt projekt om ledarskap, arbetsmiljö och effektivitet – fördel för både forskning, utbildning och ett hållbart arbetsliv?2016In: Inkluderande och hållbart arbetsliv: Book of abstracts - FALF 2016, Östersund: Mittuniversitetet , 2016, 48-48 p.Conference paper (Refereed)
    Abstract [sv]

    Projektbeskrivning: FRAMFÖR har under 15 år bedrivits i Gästrikland i samarbete mellan utbildning och forskning vid Högskolan i Gävle, företagsutvecklare vid kommuner, företag och näringslivsorganisationer. Varje år delas utmärkelsen FRAMFÖR ut till 50 företag. Ambitionen är att uppmuntra framgångsrika företagare och visa upp intressanta exempel på hur framgång kan skapas. Processen startar med att 120 företag (>4 anställda) nomineras utifrån finansiella kriterier (ex. omsättningstillväxt, vinstmarginal). Sedan genomför studenter vid Ekonomprogrammet intervjuer med cheferna för dessa företag. Intervjuerna sker utifrån ett standardiserat frågeformulär kring arbetsmiljö, ledarskap, organisering och effektivitet. Avslutningsvis väljer en jury ut de 50 mest framgångsrika företagen utifrån såväl finansiella kriterier som studenternas intervjuresultat. Projektets trippel helixuppbyggnad (Utbildning, Forskning och, Företag) skapar nyttor för olika intressenter.

    Utbildningsnyttor: Studenterna får möjlighet till interaktion med företagare i sin direkta närhet. Aktiviteterna underlättar att uppfylla utbildningsmål där flera mål kan uppfyllas med samma aktiviteter. Förståelse för näringslivets förutsättningar samt kunskaper om ett vetenskapligt angreppssätt ökar.

    Forskningsnyttor: Stärker pågående forskning om hälsofrämjande och effektivt ledarskap inom arbetshälsovetenskap samt företagsutveckling inom företagsekonomi. Det stora urvalet av företag ger en bra bild av företagen i regionen och en möjlighet att följa dem över tid. Ambitionen är att få mer kunskap om hållbara och effektiva företag. Fördjupade studier av utmärkelseföretag möjliggörs och ett doktorandprojekt med inriktning på ledarskapsbeteenden, organisationsfaktorer, tidsanvändning samt chefers/medarbetares arbetsmiljö/hälsa i utmärkelseföretag är uppstartat.

    Företagsnyttor: Företagare får möta studenter och förstå hur de tänker. Ställda frågor, t.ex. rörande arbetsmiljö och ledarskap, kan starta reflektionsprocesser som bidrar till fortsatt utveckling. FRAMFÖR-utmärkelsen delas ut vid en högtidlig tillställning där företagarna kan bygga nätverk. Flera företagare lyfter fram det positiva symbolvärdet av att få utmärkelsen.

    Projektets framtid: Målet är att fortsätta ytterligare 15 år och fortsätta utveckla nyttorna för samtliga intressenter. Ett prioriterat område är återkoppling till företag i någon form samt ökad samverkan mellan studenter och företagare.

  • 6.
    Antai, Diddy
    et al.
    Karolinska Inst, Stockholm, Sweden..
    Ghilagaber, Gebrenegus
    Stockholm Univ, Stockholm, Sweden.
    Wedrén, Sara
    Karolinska Inst, Stockholm, Sweden.
    Macassa, Gloria
    Karolinska Inst, Stockholm, Sweden.
    Moradi, Tahereh
    Karolinska Inst, Stockholm, Sweden.
    Inequities in Under-Five Mortality in Nigeria: Differentials by Religious Affiliation of the Mother2009In: Journal of religion and health, ISSN 0022-4197, E-ISSN 1573-6571, Vol. 48, no 3, 290-304 p.Article 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.

  • 7.
    Awuba, Jude
    et al.
    Karolinska Inst, Stockholm, Sweden.
    Macassa, Gloria
    Karolinska Inst, Stockholm, Sweden.
    HIV/AIDS in Cameroon: Rising gender issues in policy-making matters2007In: African Journal of Health Sciences, ISSN 1022-9272, Vol. 14, no 3-4, 118-128 p.Article 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, Sundsvall, Sweden.
    Rahman, A. F.
    Center for Injury Prevention and Research, Dhaka, Bangladesh; Department of Epidemiology, Bangladesh University of Health Sciences, Dhaka, Bangladesh.
    Rahman, A.
    Center for Injury Prevention and Research, Dhaka, Bangladesh.
    Soares, Joaquim
    Mid-Sweden University, Sundsvall, Sweden.
    Reza Khankeh, H.
    Department of Clinical Science and Education, Karolinska Institute, Stockholm, Sweden.
    Macassa, Gloria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science. Department of Health Sciences, Section of Public Health Sciences, Mid-Sweden University, Sundsvall, Sweden; Department of Clinical Science and Education, Karolinska Institute, Stockholm, Sweden.
    Prevalence of suicide ideation among adolescents and young adults in rural Bangladesh2017In: International Journal of Mental Health, ISSN 0020-7411, E-ISSN 1557-9328, Vol. 46, no 3, 177-187 p.Article 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.
    Burström, Bo
    et al.
    Karolinska Institutet.
    Macassa, Gloria
    Karolinska Institutet.
    Öberg, Lisa
    Södertörns högskola.
    Bernhardt, Eva
    Stockholm universitet.
    Smedman, Lars
    Karolinska Institutet.
    Barnadödlighet, fattigdom och sanitära reformer2003In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 80, no 3, 209-215 p.Article in journal (Refereed)
  • 10.
    Burström, Bo
    et al.
    Centre of Health Equity Studies, Stockholm University/Karolinska Institutet, Sweden.
    Macassa, Gloria
    Centre of Health Equity Studies, Stockholm University/Karolinska Institutet, Sweden.
    Öberg, Lisa
    Centre of Health Equity Studies, Stockholm University/Karolinska Institutet, Sweden.
    Bernhardt, Eva
    Centre of Health Equity Studies, Stockholm University/Karolinska Institutet, Sweden.
    Smedman, Lars
    Centre of Health Equity Studies, Stockholm University/Karolinska Institutet, Sweden.
    Equitable Child Health Interventions: The Impact of Improved Water and Sanitation on Inequalities in Child Mortality in Stockholm, 1878 to 19252005In: American Journal of Public Health, ISSN 0090-0036, E-ISSN 1541-0048, Vol. 95, no 2, 208-216 p.Article 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.

     

  • 11.
    Chaquisse, Eusebio
    et al.
    University of Porto, Porto, Portugal.
    Fraga, Silvia
    University of Porto, Porto, Portugal.
    Merieles, Paula
    University of Porto, Porto, Portugal.
    Macassa, Gloria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science.
    Soares, Joaquim
    Mittuniversitet.
    Nbofana, Francisco
    Universidade Liria, Mozambique.
    Barros, Henrique
    University of Porto, Porto, Portugal.
    Sexual and physical intimate partner violence among women using antenatal care in Nampula, Mozambique2017In: Journal of Public Health in Africa, ISSN 2038-9922, E-ISSN 2038-9930Article in journal (Refereed)
  • 12.
    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 Deutschland [Somatic Complaints among Elderly Migrants in Germany]2010In: Zeitschrift für Psychiatrie, Psychologie und Psychotherapie, ISSN 1661-4747, E-ISSN 1664-2929, Vol. 58, no 3, 199-206 p.Article in journal (Refereed)
    Abstract [en]

    Bodily complaints are widespread among the elderly; few surveys investigating bodily complaints among elder migrants exist in Germany and internationally. Our multi-centric cross section study examined bodily complaints among persons between 60 and 84 years dwelling in Stuttgart on the basis of the short version of the Giessen Complaint Questionnaire (GBB-24). In Germany 648 were explored with 13.4% (n = 87) born outside of Germany. Gender distribution was equal among migrants and non-migrants; socioeconomic status was lower among the migrants: 8.0% (n = 7) of the migrants and 2.5% (n = 14) of the non-migrants had at most four years of education; 12.6% (n = 11) of the migrants and 8.2% (n = 46) of the non-migrants held a net income of below 1000 (sic); 26.4% of the migrants and 38.1% (n = 214) of the non-migrants disposed over 2000 (sic) monthly. The incidence of somatic complaints was 65.5% (n = 57) among the migrants and 55.8% (n = 313) among the non-migrants. Women (61.8%) displayed more often somatic complaints than men (51.8%). Somatic complaints increased with age. Except of the group aged between 70-74 years no significant difference between migrants and non-migrants could be shown concerning the incidence of bodily complaints. Outlook: population based studies on bodily complaints among migrants are urgently needed.

  • 13.
    Cutts, F T
    et al.
    London School of Hygiene and Tropical Medicine Keppel St.
    Dos Santos, C
    Ministry of Health Mozambique.
    Novoa, A
    Eduardo Mondlane Faculty of Medicine Mozambique.
    David, P
    London School of Hygiene and Tropical Medicine Keppel St.
    Macassa, Gloria
    Eduardo Mondlane Faculty of Medicine Mozambique.
    Soares, A C
    Eduardo Mondlane Faculty of Medicine Mozambique.
    Child and Maternal Mortality during a Period of Conflict in Beira City, Mozambique1996In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 25, no 2, 349-356 p.Article in journal (Refereed)
    Abstract [en]

    Background Child mortality rates have been declining in most developing countries. We studied child and maternal mortality and risk factors for child mortality in Beira city in July 1993, after a decade of conflict in Mozambique.       

    Methods A community-based cluster sample survey of 4609 women of childbearing age was conducted. Indirect techniques were used to estimate child mortality (‘children ever born’ method and Preceding Birth Techniques [PBT]), and maternal mortality sisterhood method). Deaths among the most recent born child, born since July 1990, were classified as cases (n = 106), and two controls, matched by age and cluster, were selected per case.                 

    Results Indirect estimates of the probability of dying from birth to age 5 (deaths before age 5 years, 5q0 per 1000) decreased from 246 in 1977/8 to 212 in 1988/9. The PBT estimate for 1990/91 was 154 (95% confidence interval(CI): 124–184), but recent deaths may have been underreported. Lack of beds in the household (odds ratio[OR] = 2.0, 95% CI: 1.1–3.8), absence of the father (OR = 2.4, 95% CI: 1.2–4.8), low paternal educational level (OR = 2.1, 95% CI: 0.8–5.4), young maternal age (OR = 2.0, 95% CI: 1.0–3.7), self-reported maternal illness (OR = 2.4, 95% CI: 1.2–4.9), and home delivery of the child (OR = 2.3, 95% CI: 1.2–4.5) were associated with increased mortality, but the sensitivity of risk factors was low. Estimated maternal mortality was 410/100 000 live births with a reference date of 1982.                 

    Conclusions Child mortality decreased slowly over the 1980s in Beira despite poor living conditions caused by the indirect effects of the war. Coverage of health services increased over this period. The appropriateness of a risk approach to maternal-child-health care needs further evaluation.

  • 14.
    Dgedge, Martinho
    et al.
    Universidade Eduardo Mondlane, Maputo, Mozambique..
    Novoa, Ana
    Universidade Eduardo Mondlane, Maputo, Mozambique.
    Macassa, Gloria
    Universidade Eduardo Mondlane, Maputo, Mozambique.
    Sacarlal, Jahit
    Universidade Eduardo Mondlane, Maputo, Mozambique.
    Black, James
    Epidemiologista, Direcc¸a˜ o Provincial de Sau´ de, Manica, Mozambique..
    Michaud, Catherine
    Harvard Center for Population and Development Studies, Cambridge MA, USA..
    Cliff, Julie
    Universidade Eduardo Mondlane, Maputo, Mozambique.
    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, 546-552 p.Article 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 approximately 86%. Of these, 8114 deaths (92%) were classified by cause. Communicable, maternal, perinatal, and nutritional disorders accounted for 5319 deaths; noncommunicable diseases for 1834; and injuries for 961. The 10 leading causes 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); cerebrovascular diseases (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

  • 15.
    Eslami, Bahareh
    et al.
    Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
    Macassa, Gloria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science. Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
    Melchiorre, Maria Gabriella
    Centre for Socio- Economic Research on Ageing, Italian National Institute of Health and Science on Aging, INRCA, Ancona, Italy.
    Barros, Henrique
    Department of Hygiene and Epidemiology, University of Porto Medical School, Porto, Portugal.
    Viitasara, Eija
    Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
    Lindert, Jutta
    Department of Public Health, University of Emden, Emden, Germany; Women ’ s Studies Research Center, Brandeis University, Waltham, MA, USA.
    Stankunas, Mindaugas
    Department of Health Management, Lithuanian University of Health Sciences, Kaunas, Lithuania; Health Service Management Department, Centre for Health Innovation, School of Medicine, University of Griffith, Gold Coast, Queensland, Australia.
    Torres-Gonzalez, Francisco
    Centro de Investigacion Biomedica en Red de Salud Mental (CIBERSAM), University of Granada, Granada, Spain.
    Ioannidi-Kapolou, Elisabeth
    Department of Sociology, National School of Public Health, Athens, Greece.
    Soares, Joaquim J. F.
    Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
    Life-timeabuse 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, 590-607 p.Article 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.

  • 16.
    Eslami, Bahareh
    et al.
    Mittuniversitetet, Avdelningen för hälsovetenskap.
    Macassa, Gloria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences. Mittuniversitetet; Karolinska Institutet.
    Sundin, Örjan
    Mittuniversitetet, Avdelningen för psykologi.
    Khankeh, Hamid Reza
    Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
    Soares, Joaquim
    Mittuniversitetet, Avdelningen för hälsovetenskap.
    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, 349-360 p.Article 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.

  • 17.
    Eslami, Bahareh
    et al.
    Mittuniversitetet, Avdelningen för hälsovetenskap och Tehran Heart Center, Tehran University of Medical Sciences.
    Macassa, Gloria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences. Mittuniversitetet, Institutionen för hälsovetenskap och Karolinska institutet.
    Sundin, Örjan
    Mittuniversitetet, Avdelningen för psykologi.
    Khankeh, Hamid Reza
    Karolinska Institutet; University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
    Soares, Joaquim J.F.
    Mittuniversitetet, Avdelningen för hälsovetenskap och Karolinska Institutet.
    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, 169-179 p.Article 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.
    Department of Public Health Sciences, Mid Sweden University, Sundsvall, Sweden.
    Sundin, Örjan
    Department of Psychology, Mid Sweden University, Östersund, Sweden.
    Macassa, Gloria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences. Department of Public Health Sciences, Mid Sweden University, Sundsvall, Sweden.
    Khankeh, Hamid Reza
    Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
    Soares, Joaquim JF
    Department of Public Health Sciences, Mid Sweden University, Sundsvall, Sweden.
    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, 49-56 p.Article 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.

  • 19.
    Eslami, Bahareh
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences. Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
    Viitasara, Eija
    Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
    Macassa, Gloria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences. Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
    Melchiorre, Maria Gabriella
    Centre for Socio-Economic Research on Ageing, Italian National Institute of Health and Science on Aging, I.N.R.C.A, Ancona, Italy.
    Lindert, Jutta
    Department of Public Health, University of Emden, Emden, Germany; Brandeis University, Waltham, USA .
    Stankunas, Mindaugas
    Department of Health Management, Lithuanian University of Health Sciences, Kaunas, Lithuania; Health Service Management Department, Centre for Health Innovation, School of Medicine, University of Griffith, Gold Coast, QLD, Australia.
    Torres-Gonzalez, Francisco
    Centro de Investigacion 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-Kapolou, Elisabeth
    Department of Sociology, National School of Public Health, Athens, Greece.
    Soares, Joaquim J. F.
    Section of Public Health Science, Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
    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, 891-901 p.Article 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.

  • 20.
    Eslami, Bahareh
    et al.
    Mid Sweden University, Sundsvall, Sweden.
    Örjan, Sundin
    Mid Sweden University, Sundsvall, Sweden.
    Macassa, Gloria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences. Mid Sweden University, Sundsvall, Sweden.
    Khankeh, Hamid Reza
    Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
    Soares, Joaquim J. F.
    Mid Sweden University, Sundsvall, 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 2, 209-218 p.Article 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.

  • 21.
    Fraga, Silvia
    et al.
    University of Porto.
    Soares, Joaquim
    Soares, Joaquim J.F. Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för hälsovetenskap.
    Melchiorre, Maria Gabriella
    Eslami, Bahareh
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för hälsovetenskap.
    Ioannidi-Kapolou, E.
    Lindert, Jutta
    Macassa, Gloria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science. Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för hälsovetenskap.
    Stankunas, M.
    Torres-Gonzales, F.
    Viitasara, Eija
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för hälsovetenskap.
    Lifetime Abuse and Quality of Life among Older Persons2017In: Health & Social Work, ISSN 0360-7283, E-ISSN 1545-6854Article in journal (Refereed)
  • 22.
    Hiswåls, Anne-Sofie
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences. Mittuniversitetet, Avdelningen för hälsovetenskap.
    Ghilagaber, Gebrenegus
    Avdelningen för statistikvetenskap, Stockholms Universitet, Department of Statistics, University of Stockholm.
    Walander, Anders
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences. Center for Epidemiology and Community Medicine, Stockholm County Council, Stockholm Sweden.
    Wijk, Katarina
    Samhällsmedicin, Landstinget Gävleborg, Community Medicine, County Council of Gävleborg.
    Öberg, Peter
    University of Gävle, Faculty of Health and Occupational Studies, Department of Social Work and Psychology.
    Soares, Joaquim
    Mittuniversitetet, Avdelningen för hälsovetenskap, Mid Sweden University, Department of Health Science.
    Macassa, Gloria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences. Mittuniversitetet, Avdelningen för hälsovetenskap.
    Employment Status and Inequalities in Self-Reported Health2014In: Epidemiology, Biostatistics and Public Health, ISSN 2282-2305, E-ISSN 2282-0930, Vol. 11, no 4, 1-11 p.Article 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 health

    Results: 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.

  • 23.
    Hiswåls, Anne-Sofie
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences. Mittuniversitetet, Avdelningen för hälsovetenskap.
    Ghilagaber, Gebrenegus
    Stockholms universitet, Statistiska institutionen.
    Wijk, Katarina
    Öberg, Peter
    University of Gävle, Faculty of Health and Occupational Studies, Department of Social Work and Psychology.
    Soares, Joaquim
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för omvårdnad.
    Macassa, Gloria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences. Mittuniversitetet, Institutionen för hälsovetenskap; Karolinska Institutet.
    Employment status and suicidal ideation during economic recession2015In: Health Science Journal, ISSN 1791-809X, Vol. 9, no 1, 13Article 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.

  • 24.
    Hiswåls, Anne-Sofie
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences. Mittuniversitetet, Avdelningen för hälsovetenskap.
    Ghilagaber, Gebrenegus
    Avdelningen för statistik, Stockholms universitet, Department of statistics, Stockholm University.
    Wijk, Katarina
    Samhällsmedicin, Landstinget Gävleborg, Community Medicine,Gävleborg County Council .
    Öberg, Peter
    University of Gävle, Faculty of Health and Occupational Studies, Department of Social Work and Psychology.
    Soares, Joaquim
    Mittuniversitetet, Avdelningen för hälsovetenskap, Mid Sweden University, Department of Health Science .
    Macassa, Gloria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences. Mittuniversitetet, Avdelningen för hälsovetenskap, Mid Sweden University, Department of Health Science .
    Inequalities and Suicide Ideation during Recession Times2014In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 24, no Suppl. 2, 361- p.Article in journal (Other academic)
    Abstract [en]

    Background

    Suicide behaviour is a serious public health problem as it imposes economic and human costs to individuals, families and communities. Available evidence from some European countries indicates a significant rise in suicides related to economic recession. However, the debate continues regarding the role of unemployment in the reported suicide rates. In Sweden, very few studies have investigated the relationship between suicide behaviours and employment status in the context of the recent economic crisis although unemployment increased nationally and across different counties.

    The aim of this study was to examine the relationship between employment status and suicide ideation in Gävleborg, Sweden.

    Methods

    The study used data from a cross-sectional survey, Health in Equal terms, carried out in Gävleborg County in Sweden, 2010. A total of 4245 individuals, aged 16–65 years were included in the analysis. The relationship between employment status and suicide ideation was assessed using descriptive and logistic regression analyses.

    Results

    People who were not working had odds of suicide ideation of 4.21 (95% Cl 3.14–5.64) as compared to those employed. Controlling for other covariates reduced the risk to 1.73 (95% CI 1.16-2.57) but remained statistically significant. In addition variables like anxiety, self-reported stress and young age were also associated with suicide ideation. However among the covariates, people who reported anxiety had the highest odds of suicide ideation.

    Conclusions

    This study found a statistically significant association between being out of work and suicide ideation. The association was largely explained by self-reported stress, anxiety, socioeconomic and demographic variables.

    Policy-makers within the County need to pay attention to the health status of those out of work, especially during times of combined economic and labour market fluctuations.

    Key messages

    • Suicide ideation was more common among people out of labor force in Gävleborg County, Sweden.

    • Further studies are needed to investigate suicide ideation among unemployed persons during times of economic and labor market insecurity.

  • 25.
    Hiswåls, Anne-Sofie
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science.
    Marttila, Anneli
    Karolinska Institutet, Stockholm, Sweden.
    Mälstam, Emelie
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science.
    Macassa, Gloria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science.
    Experiences of Unemployment  and Well-Being  After Job Loss During Economic Recession: Results of a Qualitative Study in East Central Sweden2017In: Journal of Public Health Research, ISSN 2279-9028, E-ISSN 2279-9036Article in journal (Refereed)
  • 26.
    Hiswåls, Anne-Sofie
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of health sciences, Mid-Sweden University, Sweden.
    Walander, Anders
    Department of health sciences, Mid-Sweden University, Sweden; Department of public health, Karolinska institute, Stockholm, Sweden.
    Soares, Joaquim F J
    Department of health sciences, Mid-Sweden University, Sweden.
    Macassa, Gloria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of health sciences, Mid-Sweden University, Sweden; Department of public health, Karolinska institute, Stockholm, Sweden.
    Employment Status, Anxiety and Depression in a Municipal Context2017In: Research in Health Science, ISSN 2470-6213, Vol. 2, no 1, 12-23 p.Article 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.

  • 27. Innocent, M
    et al.
    Ndonko, F
    Ngo’o, G
    Soares, Joaquim J. F.
    Mid Sweden University, Sundsvall, Sweden.
    Macassa, Gloria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences. Mid Sweden University, Sundsvall, Sweden.
    Breaking the Silence: Understanding the practice of Breast ironing in Cameroon2012In: African Journal of Health Sciences, ISSN 1022-9272, Vol. 23, no 4, 232-237 p.Article in journal (Refereed)
  • 28.
    Lindert, Jutta
    et al.
    Protestant University of Applied Sciences Ludwigsburg, Ludwigsburg, Germany, and Department of Psychology and Sociology, University of Leipzig, Leipzig, Germany.
    de Luna, Juan
    Department of Medicine, University of Granada, Granada, Spain .
    Torres- Gonzales, Francisco
    University of Granada, Granada, Spain.
    Barros, Henrique
    Department of Hygiene and Epidemiology, University of Porto Medical School, Porto, Portugal .
    Loannidi- Kopolou, Elisabeth
    Department of Sociology, National School of Public Health, Athens, Greece .
    Melchiorre, Maria Gabriella
    Italian National Institute of Health and Science on Aging, INRCA, Ancona, Italy .
    Stankunas, Mindaugas
    School of Public Health, Griffith University, Gold Coast, QLD, Australia, and Lithuanian University of Health Sciences, Kaunas, Lithuania .
    Macassa, Gloria
    Institution for Health Sciences, Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden .
    Soares, Joaquim F J
    Institution for Health Sciences, Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden, and Division of Social Medicine, Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden.
    Abuse and neglect of older persons in seven cities in seven countries in Europe: a cross-sectional community study2013In: International Journal of Public Health, ISSN 1661-8556, Vol. 58, no 1, 121-132 p.Article 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

  • 29. Lindert, Jutta
    et al.
    Soares, Joaquim JF
    Mittuniversitetet, Avdelningen för hälsovetenskap.
    Csöff, RM
    Barros, H
    Torres-Gonzalez, F
    Ioannidi-Kapolou, E
    Lamura, G
    de Dios Luna, J
    Macassa, G
    Mittuniversitetet, Institutionen för hälsovetenskap.
    Melchiorre, MG
    Stankunas, M
    Gewalt und Gesundheit bei älteren Menschen in Europa2013Book (Other academic)
  • 30.
    Macassa, G.
    Stockholms universitet, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Poverty and health in different contexts. Social inequalities in child mortality in Mozambique and 19th centrury Stockholm2004Doctoral thesis, monograph (Other academic)
  • 31.
    Macassa, Gloria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences.
    A Matter of Faith: Unravelling the role of religion on child survival in sub-Saharan Africa2012In: African Journal of Health Sciences, ISSN 1022-9272, Vol. 22, no 3, 238-247 p.Article in journal (Refereed)
    Abstract [en]

    This study has reviewed the role of religion on child mortality in subSaharan Africa using searches of electronic Databases. The review found only one study, which investigated the relationship between religion and child mortality in subSaharan Africa using religion as the “main” independent variable. In addition the review identified several areas (definition of religion, measurement and types of studies), which should be further addressed towards a better understanding of the role of religion on child health outcomes, especially child mortality.

  • 32.
    Macassa, Gloria
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences.
    Ahmadi, Nader
    University of Gävle, Faculty of Health and Occupational Studies, Department of Social Work and Psychology.
    Hiswåls, Anne-Sofie
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences.
    Alfredsson, J
    Samhällsmedicin, Landstinget Gävleborg.
    Soares, J
    Mittuniversitetet, Avdelningen för hälsovetenskap.
    Stankunas, M
    Department of Health Management, Lithuanian University of Health Sciences, Kaunas, Lithuania.
    Differences in health care-seeking behavior during economic recession2014In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 24, no Suppl. 2Article in journal (Other academic)
    Abstract [en]

    Background

    In Europe, equitable access to high-quality healthcare constitutes a key challenge for health systems across the continent. However, the recent economic recession left many outside the labour market, causing many to fall in poverty and social exclusion. Unemployment is probably the main factor leading to social exclusion. Studies which analysed health seeking behaviour among unemployed people have reported a variety of results, from low to high utilization of health services. However, some researchers argue that during stressful economic and social circumstances can cause high utilization of the health care system due to increased psychological disorders masked by physical complaints. This study examined differences in health seeking behaviour in Gävleborg County, which at the pick of the economic recession had high levels of unemployment as compared to the national average.

    Methods

    The data for the study come from the 2010 Survey of Health in Equal terms carried out in Gävleborg County, Sweden. The sample included 4245 persons aged 16-65 years. Descriptive and binary logistic analysis was used to assess differences in health seeking behavior by employment status.

    Results

    There was a statistical significant relationship between employment status and health-seeking behavior. Compared to employed persons, people who were out of the labor market had odds ratio of 1.42 (1.12-1.62) for contact with health care services; of 1.30 (1.12-1.50) for contact with a doctor in a health care facility and 1.67 (1.42-1.97) for contact with a doctor in a hospital. Controlling for age, sex, marital status, education, income, smoking habits, physical activity, self-rated health, and long standing illness removed the statistical significance of the observed relationships. Thus, the odds for contact with health care services went from.

    Conclusions

    At the pic of the recent economic recession, people who were outside the labor market had more contact with health care services, with doctor in hospitals as well as primary health care services as compared to employed counterparts. The differences in health seeking behavior were explained by demographic, socioeconomic and health variables.

    Key Words: Employment status, Health care, Gävleborg, economic recession.

    Key messages

    • People who were out of labor market in Gävleborg County in 2010 had more contact with health care services, with a doctor in hospital and primary health care respectively.

    • Future studies are warranted that can assess trends in health-seeking behavior among people outside Gävleborgs labor market.

  • 33.
    Macassa, Gloria
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science. Department of Health Sciences, Mid-Sweden University, Sweden; Epidemiology Unit-ISPUP, University of Porto Medical School, Portugal.
    Bergström, Helena
    Department of Public Health Sciences, Karolinska Institute, Sweden.
    Malstam, Emelie
    Hiswåls, Anne Sofie
    Soares, Joaquim
    Department of Health Sciences, Mid-Sweden University, Sweden.
    Ahmadi, Nader
    University of Gävle, Faculty of Health and Occupational Studies, Department of Social Work and Psychology, Social work.
    Marttila, Anneli
    Department of Public Health Sciences, Karolinska Institute, Sweden.
    Experiences of employment precariousness and psychological well-being in East Central Sweden2017In: Health Science Journal, ISSN 1791-809X, no 2, 491Article 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 daily life.

  • 34.
    Macassa, Gloria
    et al.
    Karolinska Institutet.
    Burström, Bo
    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, Vol. 13, no 1-2, 139-143 p.Article in journal (Refereed)
    Abstract [en]

    Health inequalities are no longer an issue only for developed countries. In recent years there is agreement that all countries present health inequalities regardless of their level of wealth. In low-income countries and especially in sub-Saharan Africa where the majority of the poor people live as well as their children, research on child health inequalities is still scarce. This review of evidence suggests that if Mozambique is to achieve the millennium development goals (MDGs) by 2015 further research on important determinants of disparities in child mortality is urgently needed.

  • 35.
    Macassa, Gloria
    et al.
    Karolinska Institutet.
    Burström, Bo
    Poverty and child mortality in different contexts: Can Mozambique Learn from the Decline in Mortality at the Turn of the 19th Century in Stockholm?2005In: African Journal of Health Sciences, ISSN 1022-9272, Vol. 12, no 1-2, 31-36 p.Article 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.

  • 36.
    Macassa, Gloria
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Ghilagaber, Gebrenegus
    Stockholms universitet, Stockholm, Sweden.
    Bernhardt, Eva
    Stockholms universitet, Stockholm, Sweden.
    Burström, Bo
    Karolinska Institutet, Stockholm, Sweden.
    Contribution of household environment factors to urban childhood mortality in Mozambique2004In: East African Medical Journal, ISSN 0012-835X, Vol. 81, no 8, 408-414 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Household environment factors are known to be associated with child mortality in urban and rural areas of many developing countries. In Mozambique, no study to date has addressed this relationship. This study is aimed to access the contribution of household environment factors to urban childhood mortality in Mozambique.DESIGN: Retrospective follow-up study.SETTING: Urban Mozambique.SUBJECTS: One thousand and forty eight children born in urban areas of Monzambique within five years of the 1997 Demographic and Health Survey.METHODS: Cox regression analysis was performed on a sample of 1048 children born in urban areas of Mozambique within five years of the 1997 Demographic and Health Survey.RESULTS: Children of mother's who lived in households with no toilet facility or with well as a source of drinking water had a high risk of dying compared to children who lived in households with flush toilet and piped water.CONCLUSION: Type of toilet facility and source of drinking water play an important role in the risk of childhood mortality in urban areas of Mozambique and the relationship seems to be mediated partly by demographic and socioeconomic factors.

  • 37.
    Macassa, Gloria
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Ghilagaber, Gebrenegus
    Stockholms universitet, Statistiska institutionen.
    Bernhardt, Eva
    Burström, Bo
    Karolinska Institutet, Stockholm, Sweden.
    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, Vol. 83, no 5, 259-266 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To explore regional and ethnic differentials in under-five mortality in Mozambique in relation to other determinants.DESIGN: Retrospective follow-up study.SETTING: Mozambique.RESULTS: Compared to children of Xitsonga mother's, children of Emakua and Cisena mother's had a mortality risk of 1.47 (CI = 1.06-1.90) and 1.21 (CI = 1.00-1.62) respectively. The excess mortality risks were partly explained by demographic, household environment, socioeconomic factors including region of residence.CONCLUSION: Ethnic affiliation of the mother (measured by the first language the mother spoke) was statistically associated with under-five mortality in Mozambique. Children of mothers of Emakua and Cisena ethnic affiliations and living in the North and Central regions had the worst survival chances. The relation between mother's ethnicity and under-five mortality was largely explained by demographic, socioeconomic and environmental factors.

  • 38.
    Macassa, Gloria
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Ghilagaber, Gebrenegus
    Stockholms universitet, Stockholm, Sweden.
    Bernhardt, Eva
    Stockholms universitet, Stockholm, Sweden.
    Burström, Bo
    Karolinska Institutet, Stockholm, Sweden.
    Trends in infant and child mortality in Mozambique during and after a period of conflict2003In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 117, no 4, 221-227 p.Article 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. (C) 2003 The Royal Institute of Public Health. Published by Elsevier Science Ltd. All rights reserved.

  • 39.
    Macassa, Gloria
    et al.
    Karolinska Institutet.
    Ghilagaber, Gebrenegus
    Stockholm University, Stockholm, Sweden.
    Bernhardt, Eva
    Stockholm University, Stockholm, Sweden.
    Diderichsen, Finn
    Stockholm University, Stockholm, Sweden.
    Burström, Bo
    Stockholm University, Stockholm, Sweden.
    Inequalities in child mortality in Mozambique: differentials by parental socio-economic position2003In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 57, no 12, 2255-2264 p.Article 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. (C) 2003 Published by Elsevier Science Ltd.

  • 40.
    Macassa, Gloria
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences. Mittuniversitetet, Institutionen för hälsovetenskap.
    Ghilagaber, Gebreneus
    Stockholm university.
    Charsmar, Harry
    Stockholm university.
    Walander, A
    Sundin, Örjan
    Mittuniversitetet, Institutionen för samhällsvetenskap.
    Soares, Joaquim
    Mittuniversitetet, Institutionen för hälsovetenskap.
    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, Vol. 30, no 3, 331-345 p.Article 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.

  • 41.
    Macassa, Gloria
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences. Division of Social Medicine, Department of Public Health Sciences, Karolinska Institutetet, Stockholm, Sweden.
    Hallqvist, Johan
    Division of Social Medicine, Department of Public Health Sciences, Karolinska Institutetet, Stockholm, Sweden.
    Lynch, John William
    Department of Epidemiology, Biostatistics and Occupational Health, McGill University.
    Inequalities in Child Mortality in Sub-Saharan Africa: a Social Epidemiologic Framework2011In: African Journal of Health Sciences, ISSN 1022-9272, Vol. 18, no 1-2, 14-26 p.Article 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.

  • 42.
    Macassa, Gloria
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences. Department of Health Science, Section of Public Sci ence, Mid-Sweden University, Sundsvall, Sweden; Department of Public Health Sciences, Karolinska In stitute, Stockholm, Sweden .
    Hiswåls, Anne-Sofie
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences.
    Ahmadi, Nader
    University of Gävle, Faculty of Health and Occupational Studies, Department of Social Work and Psychology.
    Alfredsson, Johanna
    Department of Community Medicine, Gävleborg County Council, Gävle, Sweden .
    Soares, Joaquim F. J.
    Mittuniversitetet, Avdelningen för Folkhälsovetenskap.
    Stankunas, Mindaugas
    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 ISSN 2328-7942, EISSN 2328-7950, Vol. 2, no 6, 610-616 p.Article 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.

  • 43.
    Macassa, Gloria
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science. Epidemiology Unit - ISPUP, University of Porto Medical School, Porto, Portugal.
    Hiswåls, Anne-Sofie
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science.
    Ahmadi, Nader
    University of Gävle, Faculty of Health and Occupational Studies, Department of Social Work and Psychology, Social work.
    McGrath, Cormac
    Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
    Educating Public Health Professionals for an Unknown Future: Insight from a New Bachelor Programme Linking Health Promotion and Sustainable Development2017In: Research in Health Science, ISSN 2470-6205, Vol. 2, no 2, 70-78 p.Article in journal (Refereed)
    Abstract [en]

    This paper aims to provide a description of the new bachelor programme “Health Promotion through Sustainable Development”, which started in autumn 2016 at the University of Gävle, Faculty of Health and Working Life. The programme was built integrating public health and biology through a thread of health promotion and sustainable development across the three years of study. In the era of sustainable development and more complex health threats, future public health professionals need to be equipped with the right knowledge and skills that will enable them to promote a sustainable population health.

  • 44.
    Macassa, Gloria
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science. Department of Health Science, Section of Public Health, Mid-Sweden University, Sundsvall, Sweden.
    Olofsson, Niclas
    3Center for Public Health, Västernorrland County Council, Härnösand, Sweden.
    Soares, Joaquim J.F.
    Department of Health Science, Section of Public Health, Mid-Sweden University, Sundsvall, Sweden.
    Ahmadi, Nader
    University of Gävle, Faculty of Health and Occupational Studies, Department of Social Work and Psychology, Social work.
    Socio-economicposition and suicidal education: Beyond education, occupation and income2016In: Mid-Sweden Journal of Public Health, Vol. 1, no 1Article in journal (Refereed)
    Abstract [en]

    Objective: Suicidal ideation have been found to be a strong predictor of suicide attempt as well as completed suicide. Currently, there is  an on-going debate on the impact of the recent economic recession on mental health outcomes, including suicide behaviours. Northern Sweden continues to bear the consequences of the recent recession which started in 2008.Thus, this study investigates differentials in twelve months suicidal ideation by socio-economic position (SEP) among economically active persons residing in Västernorland County. In addition, the study discusses the importance of employment status as a fourth measure of socio-economic position in the context of economic hardship.

     Method: The study uses cross-sectional data from the 2010 Västernorrland in 2010 “Health on Equal Terms Survey”, which consisted of 5,050 in economically active persons aged 16-65 years. Descriptive and weighted regression analyses were performed and results are presented as OR´s (with 95% confidence intervals).

    Results: Suicidal ideation was statistically significantly associated with SEP as measured by education, occupation, income and employment status. Respondents who had primary education, were manual workers, or had lower income and  were out of work had odds ratios of 2.19 (CI 1.51-3.16); 2.95 (CI 2.04-4.27); 3.40 (CI 2.41-4.79) and 3.24 (CI 2.84-4.21), respectively. Controlling for demographic, socio-economic and health-related variables only eliminated the statistical significance for education and income.

    Conclusion: SEP as measured by education, occupation, income and employment was associated with suicide ideation in Västernorrland County. Also, employment status was found to be an important measure of SEP within the context of economic recession. There is a need for social protective policies for the less privileged in the population at all times, but especially during times of economic crises.

  • 45.
    Macassa, Gloria
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Ponce de Leon, Antonio
    Karolinska Institutet, Stockholm, Sweden.
    Burström, Bo
    Karolinska Institutet, Stockholm, Sweden.
    The impact of water supply and sanitation on area differentials in the decline of diarrhoeal disease mortality among infants in Stockholm 1878—19252006In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 34, no 5, 526-533 p.Article 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 diarrhoea mortality in Stockholm 1878—1925. Previous studies have failed to demonstrate an effect of improved water supply on the risk of diarrhoea mortality at the individual level. Using data on access to water and sanitation from a household survey in 1895 and mortality rates and sociodemographic information from individual data 1878—1925 to analyse area differentials in diarrhoea mortality, it was found that the proportion having their own latrine in the household was associated with lower mortality risk in 1895—1900, while the proportion having water in the household was associated with lower diarrhoea mortality risk during the mortality decline until 1925. Population effects of improved water and sanitation on diarrhoea mortality may be better measured at area level than at individual level.

  • 46.
    Macassa, Gloria
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences. Mittuniversitetet, Institutionen för hälsovetenskap.
    Sundin, Örjan
    Mittuniversitetet, Avdelningen för psykologi.
    Viitasara, Eija
    Mittuniversitetet, Avdelningen för hälsovetenskap.
    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
    Mittuniversitetet, Avdelningen för hälsovetenskap.
    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, 16-34 p.Article 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.

  • 47.
    Macassa, Gloria
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences. Mittuniversitetet, Institutionen för hälsovetenskap.
    Walander, A
    Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Stockholm, Sweden .
    Soares, Joaquim JF
    Mittuniversitetet, Avdelningen för hälsovetenskap.
    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, 101-111 p.Article 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.

  • 48.
    Macassa, Gloria
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences.
    Walander, Anders
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences.
    Hiswåls, Anne-Sofie
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences.
    Living in the Municipality of Gävle: Report on the Gävle Household, Labour Market Dynamics and Health Outcomes Survey - Wave 12013Report (Other academic)
    Abstract [en]

    In many industrialized countries including those in Europe, there is an established relationship between work conditions and health. For instance employment status and conditions have been reported to influence physical health (self-assessed health, pain and various somatic conditions), as well as mental health outcomes such as anxiety and depression, even if debate is still ongoing. Employment conditions have been suggested to be a key determinant of health inequalities, although this factor has been less researched than have education and income. Therefore, a study of the role played by employment status/conditions in a small geographical area such as Gävle Municipality (with its pattern of industries, plant and services closures, and high levels of unemployment) could contribute to knowledge on ways to reduce ill health related to labour market. 

     The overall aim of this study was to examine the relationship between employment status, household income and physical and psychological health outcomes among economically active people residing in Gävle Municipality, using data from Wave 1 of the Gävle Household, Labour Market Dynamics and Health Outcomes (GHOLDH) survey, a household panel survey carried out between April and June 2012. Data analysis was conducted using descriptive statistics and mixed multivariate models.

    There were differences in physical and psychological health by employment status. Individuals who were outside the labour market were more likely to report poor health, body pain and exhaustion than were individuals who were employed. In addition, those individuals who were outside work had a higher prevalence and risk of anxiety and depression. Data on household income also showed associations with physical and psychological health, with a concentration of poor self-reported health, somatic complaints, anxiety and depression in lower income households.

    Interestingly, the study findings revealed that anxiety was also prevalent among employed people, suggesting that people with insecure jobs might also be at risk of poor mental health. This finding requires further research to discern the role of precarious employment conditions on inequalities in physical and mental health outcomes. In addition, studies on the impact of gender on the relationship between employment status/conditions and physical and psychological health outcomes are warranted. To this end, the follow-up survey to be carried out in 2014 might provide additional knowledge pertaining to ways to reduce employment-related health inequalities within the municipality.

  • 49.
    Macassa, Gloria
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Öberg, Lisa
    Södertörn University College, Huddinge, Sweden.
    Bernhardt, Eva
    Stockholms Universitet, Stockholm, Sweden.
    Burström, Bo
    Karolinska Institutet, Stockholm, Sweden.
    Differentials in overall and cause-specific mortality among infants born in and out of wedlock, Stockholm 1878–19252006In: The History of the Family, ISSN 1081-602X, Vol. 11, no 1, 19-26 p.Article 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.

  • 50.
    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 and Karolinska Institute.
    Soares, Joaquim
    Mittuniversitetet, Avdelningen för hälsovetenskap.
    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, Vol. 8, no 1, e54856- p.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.

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