Physical activity,exercise and self-rated health: a population-based study from Sweden

Background  

In order to screen for the most inactive individuals in the population and target health-related interventions where they are most needed it is important to assess different forms of physical activity in population-based studies. The aims were (1) to identify the most inactive individuals in the population by assessing two dimensions of physical activity, (2) to investigate the correlation between exercise and total physical activity and (3) to investigate the association between exercise, total physical activity and good self-rated health.     

Ethnic differences in anticipated discrimination, generalised trust in other people and self-rated health: a population-based study in Sweden

This paper investigates the relationship between anticipation that employers may discriminate against certain people (not specified, but not specifically the respondent) according to race, colour of skin, religion or cultural background, and self-rated health, adjusting for social capital in the form of generalised (horizontal) trust in other people. It also investigates ethnic differences in anticipated discrimination in relation to self-rated health. The 2004 Public Health Survey in the Scania region of Sweden is a cross-sectional study. Twenty-seven thousand nine hundred and sixty-three respondents aged 18-80 years answered a postal questionnaire, which represents 59% of the random sample. A logistic regression model was used to assess the association between anticipated discrimination and self-rated health. Multivariate analyses of self-rated health were performed in order to investigate the importance of possible confounders (age, country of origin, education, economic stress, and generalised trust) on this association. Of the men and the women, 28.7 and 33.2%, respectively, rated their health as poor. Of the respondents, 16.0 and 28.7% reported that they anticipated that 'most employers' or 'approximately 50% of employers' would discriminate, respectively. Respondents with high age, born outside Sweden, with low/medium education, economic stress, low horizontal trust, and with anticipation that most or approximately 50% of employers (among men born in Sweden and all women) would discriminate had significantly higher odds ratios of poor self-rated health. Multiple adjustments had a slight effect on the significant relationship between anticipated discrimination and poor self-rated health for both men and women. The introduction of generalised trust in the models reduced the odds ratios to a limited extent. In conclusion, the anticipation that employers may discriminate against certain people (not the respondent) according to race, colour of skin, religion or cultural background is associated with poor self-rated health. However, this is a cross-sectional exploratory study and causality may go in both directions.     

Building primary health care systems: a case study from Sweden.

Health policy planners have discussed for some years how to transform existing hospital-based health delivery systems into primary-care-driven systems. Although this policy goal has been adopted in a number of western European nations, the actual process of implementing such a major change has proven stubborn and complex. In particular, efforts to transfer existing resources out of the hospital sector for use in building primary care activities have proven difficult. This paper examines the effort to design and implement a primary health care strategy in Sweden. It is divided into two segments. The first section sketches the broad health system context within which the Swedish primary care effort is being conducted. The second section focuses directly on Sweden's primary care strategy, detailing both its conceptual foundation and the organizational obstacles that have impeded the policy's implementation. This discussion is punctuated with findings from a 1981 survey of county council administrators' attitudes toward this primary care strategy. The paper concludes with a short discussion of several alternative organizational approaches that might speed the development of a primary-care-driven health system.     

The routine use of health risk appraisals: results from a national study of physician organizations

PURPOSE: To document use of health risk appraisals (HRAs) by U.S. physician organizations as part of their overall approach to health promotion and to identify associated organizational characteristics. METHODS: Telephone survey of 1590 physician organizations in the United States; surveys were conducted in organizations comprising 20 or more physicians and were conducted between September 2000 and September 2001 (70% response rate). Chi-square tests and logistic regression analysis were used to examine the association between organizational characteristics and routine administration of HRAs. RESULTS: Only 22.5% of physician organizations in the United States routinely administer HRAs. External quality incentives, information technology capabilities, and status as a medical group vs. an independent practice association are associated with greater odds of the routine use of HRA. DISCUSSION: Increased use of external quality incentives and information technology in physician organizations may be important in supporting the use of HRAs.     

Cross-border utilization of health care: evidence from a population-based study in south Texas

Objective. To assess the prevalence of health care utilization in Mexico by Texas border residents and to identify the main contributing factors to their cross‐border utilization of health care services. Data and Methods. This study used primary data from a population‐based telephone survey that was conducted in the whole Texas border area in 2008. The survey included responses from 1,405 adults. Multivariate logistic regression models were estimated to determine predictors of utilizing a wide range of health care services in Mexico. Principal Findings. Forty‐nine percent of the sample reported having ever purchased medications in Mexico, followed by 41 percent for dentist visits, 37.3 percent for doctor visits, and 6.7 percent for inpatient care. The most significant predictors of health care utilization in Mexico were lack of U.S. health insurance coverage, dissatisfaction with the quality of U.S. health care, and poor self‐rated health status. Conclusions. The high prevalence of use of health care services in Mexico by Texas border residents is suggestive of unmet needs in health care on the U.S. side of the border. Addressing these unmet needs calls for a binational approach to improve the affordability, accessibility, and quality of health care in the U.S.–Mexico border region.     

Undue influence of weight on self-evaluation: a population-based twin study of gender differences

OBJECTIVE: To explore the extent to which genetic and environmental factors contribute to liability to placing undue importance on weight as an indicator of self-evaluation and to determine whether differences exist across genders in the nature and magnitude of these effects. METHOD: Self-report data were collected on 8,045 same-sex and opposite-sex twins, aged 18-31 years, from a population-based registry of Norwegian twins. Structural equation modeling was utilized to estimate the relative contribution of genetic and environmental factors to liability for undue influence of weight on self-evaluation, allowing for gender-specific effects. RESULTS: Individual variation in undue influence of weight on self-evaluation was best explained by shared and individual environmental influences. No significant gender differences were found. Shared environmental factors accounted for 31% of the variance. DISCUSSION: These results raise the possibility that there may be distinct sources of familial resemblance for different symptoms of bulimia nervosa as codified in the 4th ed. of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994).     

Male gender and low education with poor mental health literacy: a population-based study

BACKGROUND: Both male gender and low socioeconomic status have been related to depression and suicide, but their possible relationship to mental health literacy remains uncertain. The objectives of this study were to assess the level of mental health literacy in rural communities in Japan and to examine related factors. METHODS: A population-based cross-sectional study using a questionnaire was conducted. Response rate was 88.2% from 8163 residents aged 30-69 years. The relationships between mental health literacy (including cognition of depression, attitude toward depression, and acceptance of suicide) and demographics, socioeconomic status, and the severity of depression were assessed by logistic regression analysis. RESULTS: Of the respondents, 25.2% showed an inadequate cognition of depression, 12.5% showed an inadequate attitude toward depression, and 13.1% showed an acceptance of suicide. Of the complete respondents (65.5%), an inadequate cognition of depression was associated with being male (adjusted odds ratio=1.93, 95% confidence interval: 1.68-2.22), advanced age (2.18, 1.58-3.00), and a lower level of education (1.95, 1.34-2.86); an inadequate attitude toward depression was associated with being male (2.18, 1.82-2.61), a lower education (2.34, 1.38-3.97), and the severity of depression (2.26, 1.54-3.32); and an acceptance of suicide was associated with being male (1.33, 1.13-1.58) and the severity of depression (5.77, 4.20-7.93). CONCLUSIONS: Poor mental health literacy related strongly to male gender and a low level of education. According to our results, poor mental health literacy may possibly be a factor contributing to male vulnerability to suicide.     

Sickness absence and self-reported health a population-based study of 43,600 individuals in central Sweden

Background  

Sickness absence is very high in Sweden. The reasons for this phenomenon are not well known. The aim of this study was to investigate the association between degree of self-reported sickness absence and health. The hypothesis was that individuals with long-term sickness absence would report more symptoms and lower self-rated health. Another hypothesis was that women are more likely to self-rate psychiatric diagnoses compared to men, who are more likely to self-rate musculoskeletal diagnoses.     

Factors associated with colorectal cancer screening in a population-based study: the impact of gender, health care source, and time

INTRODUCTION: The effectiveness of colorectal cancer screening in reducing incident colorectal cancer and the risk of death has been shown. Despite campaigns to promote the benefits of and use of colorectal cancer screening, most people are not participating in screening. In this paper, we examine factors associated with screening behavior over time, by health care provider, and by gender and report associations between screening and development of colorectal cancer after adjusting for diet and lifestyle factors. METHODS: Data from two population-based case-control studies of colorectal cancer were used to examine risk associations with nonparticipation in colorectal cancer screening. Study participants were identified for the first study between 1991 and 1994 (N = 1,346 cases and 1,544 controls) and for the second between 1997 and 2001 (N = 952 cases and 1,205 controls) and were asked to complete a detailed in-person interviewer-administered diet and lifestyle questionnaire. The control population is used to examine changes in screening behavior and associations with screening over time. RESULTS: Significantly, fewer people reported fecal occult blood test (FOBT) in 1997-2001 than in 1991-1994 (62.5% in 1991-1994 vs. 47.2% in 1997-2001); a slight nonsignificant increase in sigmoidoscopy screening was reported for these periods among controls (33.9% vs. 36.6%). In the control population, during these periods, there was a statistically significant increase in the number of people who reported having had a sigmoidoscopy for screening rather than for problems (72.6% in 1997-2001 vs. 63.8% in 1991-1994). There were differences in factors associated with screening behavior by time, by sex, and by health care provider, although having a family history of colorectal cancer, having more education, and being male was associated with more screening in all settings. After adjusting for diet and lifestyle factors, we observed that non-sigmoidoscopy screening significantly influenced risk of incident cancer (rectal OR: 2.9; 95% CI, 2.3-3.7; distal tumor OR: 1.8; 95% CI, 1.4-2.3); proximal tumor: 1.4; 95% CI, 1.1-1.8). Nonuse of FOBT also was associated significantly with tumors in the rectal (OR: 1.6; 95% CI, 1.3-1.9) and distal (OR: 1.4; 95% CI, 1.1-1.8) sites. SUMMARY: These data reinforce the importance of screening to reduce risk of colorectal cancer development. However, flexible sigmoidoscopy screening is increasing only modestly over time, and primarily in settings where a significant investment in screening has been made. FOBT screening, which is effective for rectal cancer prevention, is actually decreasing.     

A population-based study of age and gender differences in patterns of health-related behaviors

Purpose: Most research on preventive health behaviors has focused on individual rather than groups of behaviors. This study examined interrelationships among multiple preventive health behaviors in different age and gender groups.Methods: From 1990 to 1992, Maryland residents were surveyed by telephone through the Behavioral Risk Factor Surveillance System. The study sample of 4455 was divided into 8 groups based on age (18–24, 25–39, 40–54, and 55+) and gender. Correlation and oblique rotated factor analyses were used to examine patterns of 8 to 11 preventive health behaviors in each age-gender group.Results: Medical checkup and cholesterol test formed one behavioral cluster in the four male age groups. Breast and cervical cancer screening (mammogram, clinical breast examination [CBE], and Pap Smear) did not form one cluster until age 55 or older; Pap smear, CBE formed one cluster for women of all ages. Risk-taking behaviors were only prominent in the youngest age group: Seatbelt non-use, smoking, and drinking formed one cluster in younger males, and drinking and driving after drinking clustered in younger females.Conclusion: Screening and risk-taking behaviors form distinct groups, and behavioral patterns differ by age and gender. Public health programs should consider multi-behavioral approaches, and be sensitive to the gender and age of the target population.     

Intergenerational differences in workloads among primary care physicians: a ten-year, population-based study

Analyses of population-based services and surveys in Canada from the early 1990s and early 2000s indicate that younger and middle-aged family physicians carried smaller workloads in 2003 than their same-age peers did ten years earlier and that older family physicians carried larger workloads in 2003 than their same-age peers did ten years earlier. Yet family physicians in all age groups worked similar numbers of hours in 2003. Intergenerational effects are similar for male and female physicians, although feminization of the workforce will affect supply, as a result of the falling service volumes delivered by women.     

Parental age and risk of childhood cancers: a population-based cohort study from Sweden

BACKGROUND: Frequent germ line cells mutations were previously demonstrated to be associated with aging. This suggests a higher incidence of childhood cancer among children of older parents. A population-based cohort study of parental ages and other prenatal risk factors for five main childhood cancers was performed with the use of a linkage between several national-based registries. METHODS: In total, about 4.3 million children with their parents, born between 1961 and 2000, were included in the study. Multivariate Poisson regression was used to obtain the incidence rate ratios (IRR) and 95% confidence interval (CI). Children <5 years of age and children 5-14 years of age were analysed independently. RESULTS: There was no significant result for children 5-14 years of age. For children <5 years of age, maternal age were associated with elevated risk of retinoblastoma (oldest age group's IRR = 2.39, 95%CI = 1.17-4.85) and leukaemia (oldest age group's IRR = 1.44, 95%CI = 1.01-2.05). Paternal age was significantly associated with leukaemia (oldest age group's IRR = 1.31, 95%CI = 1.04-1.66). For central nervous system cancer, the effect of paternal age was found to be significant (oldest age group's IRR = 1.69, 95%CI = 1.21-2.35) when maternal age was included in the analysis. CONCLUSION: Our findings indicate that advanced parental age might be associated with an increased risk of early childhood cancers.     

Experience of physical violence and mental health among young men and women: a population-based study in Sweden

Background

In Sweden mental ill-health has increased among the young, especially among young women. Our aim was to investigate the association between experience of physical violence during the past year and self rated psychological health among young men and women.

Methods

The study population consisted of men (n?=?2,624) and women (n?=?3,569) aged 18–34 years who participated in the 2008 public health survey study in Skåne. The survey was a cross-sectional stratified random sample postal questionnaire study with a 54.1% participation rate. Associations were investigated by logistic regression models.

Results

The prevalence of poor psychological health was 18.9% among men and 27.7% among women. One in ten men and one in twenty women had experienced physical violence during the past year. Most men were violated in public places, while women were most often violated at home. Women who had experienced violence during the past year showed more than doubled odds of poor psychological health, odds ratio (OR): 2.66 (95% confidence interval (CI): 2.00, 3.53). Such an association could not be seen in men OR: 1.12 (95% CI: 0.85, 1.47). Adjustment for covariates (i.e. age, country of birth, socioeconomic status, economic stress, alcohol risk consumption, emotional support, instrumental support and generalized trust in other people) did not change the association found among women.

Conclusion

Violated women, but not men, showed nearly doubled odds of poor psychological health after multiple adjustments. There was also a gender difference regarding location of violence. Awareness of gender differences regarding context and mental impact of violence may assist public health workers in reducing the consequences of violence and to design preventive strategies.     

Pharmacological treatment after acute coronary syndrome: Baseline clinical characteristics and gender differences in a population-based cohort study

ObjectiveTo describe baseline socio-demographic and clinical characteristics and drugs prescribed for secondary prevention after a first episode of ACS and to assess differences between men and women.SettingPHC in Catalonia. Data source: SIDIAP (Information System for Research in Primary Care).ParticipantsPatients who suffered an ACS during 2009–2016 and followed-up in PHC centres of the Catalan Health Institute in Catalonia.InterventionsNot applicable.Main measuresSocio-demographic and clinical characteristics at baseline: sex, age, socioeconomic index, toxic habits, comorbidities, study drugs (prescribed for cardiovascular secondary prevention: antiplatelets, betablockers, statins, drugs acting on the renin–angiotensin system) and comedications.Results8071 patients included, 71.3% of them were men and 80.2% had an acute myocardial infarction. Their mean age was 65.3 and women were older than men. The most frequent comorbidities were hypertension, dyslipidaemia and diabetes and they were more common in women. Antiplatelets (91.3%) and statins (85.7%) were the study drugs most prescribed. The uses of all comedications were significantly higher in women, except for nitrates. The combination of four study groups was initially prescribed in 47.7% of patients and combination of beta-blockers, statins and antiplatelets was prescribed in 18.4%. More men than women received all recommended pharmacological groups.ConclusionWomen were older, had more comorbidities and received more comedications. Most patients were treated with a combination of four or three study drugs for secondary prevention. Men initiated more drug treatments for secondary prevention and dual antiplatelet therapy than women.EUPAS RegisterEUPAS19017.     

Childbearing and the risk of scleroderma: a population-based study in Sweden

This study examined associations between childbearing and risk of scleroderma by using national population-based registry data from Sweden. Women with a discharge diagnosis of scleroderma from 1964 to 1999 (n = 2,149) were identified in the Swedish Inpatient Register. These cases were matched by year and month of birth and region of residence to as many as five controls obtained from the Multi-Generation Register. Pregnancy history (number of births, age at each birth) was restricted to births before the first scleroderma-related hospitalization for cases and the corresponding age for their matched controls. Risk estimates, measured by the odds ratio and 95% confidence interval, were obtained by using conditional logistic regression. Nulliparity was associated with an increased risk of scleroderma (odds ratio = 1.37, 95% confidence interval: 1.22, 1.55). Risk decreased with increasing number of births. Similar results were found when analyses were limited to births up to 2 years or up to 5 years before hospitalization. Among parous women, younger age at first birth was associated with an increased risk of scleroderma. The association between lower parity and increased risk of scleroderma could reflect subfecundity caused by scleroderma before disease became clinically evident, possible common causes of infertility and scleroderma, or a protective effect of pregnancy through an unknown mechanism.     

Risk factors and predictors of induced abortion: a population-based study

This study aimed to identify key risk factors and predictors of induced abortion. A cross-sectional population-based study was conducted with a representative sample of 3,002 women 15 to 49 years of age in southern Brazil, randomly assigned to answer questions on induced abortion using either the ballot-box method or the indirect questioning method. Socioeconomic, demographic, and reproductive data were obtained through a pre-coded questionnaire. Data analysis used epidemiological statistical inferences and Bayes' theorem to calculate a posteriori probability. Induced abortion was strongly associated with fetal loss for all age groups. In adolescents, the main predictors were low socioeconomic level, low schooling, elevated school drop-out, and knowledge of a large number of contraceptive methods. For all other women, socioeconomic characteristics and skin color were not associated with abortion. For women aged 20 to 49 years, marital status and reproductive characteristics, including knowledge of contraceptive methods, were the most frequent risk factors and predictors of induced abortion.     

The use of quantile regression in health care research: a case study examining gender differences in the timeliness of thrombolytic therapy

Investigators are frequently interested in determining patient and system characteristics associated with delays in the provision of essential medical treatment. Investigators have typically used either multiple linear regression or Cox proportional hazards models to assess the impact of patient and system characteristics on the timeliness of medical treatment. A drawback to the use of these two methods is that they allow, at best, a partial exploration of how a distribution of delays in treatment or of waiting times changes with patient characteristics. In contrast, quantile regression models allow one to assess how any quantile of a conditional distribution changes with patient characteristics. We illustrate the utility of quantile regression by examining gender differences in the delivery of thrombolysis in patients with an acute myocardial infarction. We demonstrate that richer inferences can be drawn through the use of quantile regression. Females were more likely to experience delays in treatment compared to males. Furthermore, gender had a greater impact upon those patients who had the greatest delays in treatment. Investigators who want to determine how a distribution of delays in treatment or of waiting times changes with patient or system characteristics should consider complementing their analyses with the use of quantile regression.