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  • 1.
    Ahnquist, Johanna
    et al.
    Karolinska Inst, Dept Publ Hlth Sci, S-83140 Stockholm, Sweden.;Swedish Natl Inst Publ Hlth, Ostersund, Sweden..
    Wamala, Sarah P.
    Karolinska Inst, Dept Publ Hlth Sci, S-83140 Stockholm, Sweden.;Swedish Natl Inst Publ Hlth, Ostersund, Sweden..
    Lindstrom, Martin
    Malmo Univ Hosp, Malmo, Sweden.;Lund Univ, CED, S-22100 Lund, Sweden..
    Social determinants of health - A question of social or economic capital?: Interaction effects of socioeconomic factors on health outcomes2012Inngår i: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 74, nr 6, s. 930-939Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Social structures and socioeconomic patterns are the major determinants of population health. However, very few previous studies have simultaneously analysed the "social" and the "economic" indicators when addressing social determinants of health. We focus on the relevance of economic and social capital as health determinants by analysing various indicators. The aim of this paper was to analyse independent associations, and interactions, of lack of economic capital (economic hardships) and social capital (social participation, interpersonal and political/institutional trust) on various health outcomes. Data was derived from the 2009 Swedish National Survey of Public Health, based on a randomly selected representative sample of 23,153 men and 28,261 women aged 16-84 year, with a participation rate of 53.8%. Economic hardships were measured by a combined economic hardships measure including low household income, inability to meet expenses and lacking cash reserves. Social capital was measured by social participation, interpersonal (horizontal) trust and political (vertical/institutional trust) trust in parliament. Health outcomes included; (i) self-rated health, (i) psychological distress (GHQ-12) and (iii) musculoskeletal disorders. Results from multivariate logistic regression show that both measures of economic capital and low social capital were significantly associated with poor health status, with only a few exceptions. Significant interactive effects measured as synergy index were observed between economic hardships and all various types of social capital. The synergy indices ranged from 1.4 to 2.3. The present study adds to the evidence that both economic hardships and social capital contribute to a range of different health outcomes. Furthermore, when combined they potentiate the risk of poor health. (C) 2012 Elsevier Ltd. All rights reserved.

  • 2.
    Bogg, Lennart
    et al.
    Mälardalens högskola, Akademin för hälsa, vård och välfärd. Karolinska institutet.
    Huang, Kun
    Anhui Medical University.
    Shen, Yuan
    Xi'an Jiaotong University, China.
    Long, Qian
    Chongqing Medical University, China.
    Hemminki, Elina
    National Institute for Health and Welfare, Finland .
    Dramatic Increase of Cesarean Deliveries in the Midst of Health Reforms in Rural China2010Inngår i: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 70, nr 10, s. 1544-1549Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Cesarean delivery (CD) rates were until recently low in rural China where the population lacked healthinsurance. In July 2003 the New Cooperative Medical Scheme (NCMS) was introduced. We report findingsfrom a health systems study carried out in the EC-funded project ‘‘Structural hinders to andpromoters of good maternal care in rural China’’ in central and western China. The purpose was toanalyze how CD rates changed with the increased level of funding of the NCMS.The research design was a natural experiment. Quantitative demographic, administrative and accountsdata for 2001–2007 were collected in five counties from the county public health bureaux, the countyNCMS offices, the county statistical offices and the Maternal and Child Health (MCH) hospitals, usinga structured data collection form. We found that the CD rates increased in four of the five counties in theperiod 2004–2007 by 36%, 53%, 61% and 131% respectively. In the fifth county the CD rate remained highat 60%. The revenue from CD made up 72–85% of total delivery fee revenue. CD fee revenue increased by97%, 239% and 408% in the three counties with available data; a higher increase than in general healthcare revenue. Our conclusion is that the design of NCMS, the provider payment systems, and therevenue-related bonus systems for doctors need to be studied to rein in the unhealthy increases in ruralCD rates.

  • 3.
    Dong, Hengjin
    et al.
    Fudan University.
    Bogg, Lennart
    Mälardalens högskola, Akademin för hälsa, vård och välfärd. Karolinska institutet.
    Rehnberg, Clas
    Stockholm School of Economics.
    Diwan, Vinod
    Karolinska institutet.
    Drug policy in China: pharmaceutical distribution in rural areas.1999Inngår i: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 48, nr 6, s. 777-786Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    In 1978, China decided to reform its economy and since then has gradually opened up to the world. The economy has grown rapidly at an average of 9.8% per year from 1978 to 1994. Medical expenditure, especially for drugs, has grown even more rapidly. The increase in medical expenditure can be attributed to changing disease patterns, a higher proportion of older people in the population and fee-for-service incentives for hospitals. Due to the changing economic system and higher cost of health care, the Chinese government has reformed its health care system, including its health and drug policy. The drug policy reform has led to more comprehensive policy elements, including registration, production, distribution, utilization and administration. As a part of drug policy reform, the drug distribution network has also been changed, from a centrally controlled supply system (push system) to a market-oriented demand system (pull system). Hospitals can now purchase drugs directly from drug companies, factories and retailers, leading to increased price competition. Patients have easier access to drugs as more drugs are available on the market. At the same time, this has also entailed negative effects. The old drug administrative system is not suitable for the new drug distribution network. It is easy for people to get drugs on the market and this can lead to overuse and misuse. Marketing factors have influenced drug distribution so strongly that there is a risk of fake or low quality drugs being distributed. The government has taken some measures to fight these negative effects. This paper describes the drug policy reform in China, particularly the distribution of drugs to health care facilities.

  • 4.
    Ferlander, Sara
    et al.
    Södertörns högskola, SCOHOST (Stockholm Centre on Health of Societies in Transition).
    Mäkinen, Ilkka Henrik
    Södertörns högskola, SCOHOST (Stockholm Centre on Health of Societies in Transition).
    Social capital, gender and self-rated health. Evidence from the Moscow Health Survey 20042009Inngår i: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 69, nr 9, s. 1323-1332Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The state of public health in Russia is undoubtedly poor compared with other European countries. The health crisis that has characterised the transition period has been attributed to a number of factors, with an increasing interest being focused on the impact of social capital - or the lack of it. However, there have been relatively few studies of the relation between social capital and health in Russia, and especially in Moscow. The aim of this study is to examine the relationship between social capital and self-rated health in Greater Moscow. The study draws on data from the Moscow Health Survey 2004, where 1190 Muscovites were interviewed. Our results indicate that among women, there is no relationship between any form of social capital and self-rated health. However, an association was detected between social capital outside the family and men’s self-rated health. Men who rarely or never visit friends and acquaintances are significantly more likely to report less than good health than those who visit more often. Likewise, men who are not members of any voluntary associations have significantly higher odds of reporting poorer health than those who are, while social capital in the family does not seem to be of importance at all. We suggest that these findings might be due to the different gender roles in Russia, and the different socializing patterns and values embedded in them. In addition, different forms of social capital provide access to different forms of resources, influence, and support. They also imply different obligations. These differences are highly relevant for health outcomes, both in Moscow and elsewhere.

  • 5.
    Jukkala, Tanya
    et al.
    Uppsala universitet, Sweden.
    Mäkinen, Ilkka
    Kislitsyna, Olga
    Ferlander, Sara
    Vågerö, Denny
    Economic strain, social relations, gender, and binge drinking in Moscow.2008Inngår i: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 66, nr 3, s. 663-674Artikkel i tidsskrift (Fagfellevurdert)
  • 6.
    Mensah, Aziz
    et al.
    Mälardalens universitet, Akademin för hälsa, vård och välfärd, Hälsa och välfärd. Bielefeld Graduate School in History and Sociology (BGHS), Bielefeld University, Germany.
    Toivanen, Susanna
    Mälardalens universitet, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Diewald, Martin
    Bielefeld Graduate School in History and Sociology (BGHS), Bielefeld University, Germany.
    Ul Hassan, Mahmood
    Uppsala University, Sweden.
    Nyberg, Anna
    Uppsala Univ, Dept Publ Hlth & Caring Sci, Hlth Equ & Working Life, Uppsala, Sweden.
    Workplace gender harassment, illegitimate tasks, and poor mental health: Hypothesized associations in a Swedish cohort2022Inngår i: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 315, artikkel-id 115520Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Workers exposed to gender harassment and illegitimate tasks may experience adverse mental health outcomes such as depression and burnout. However, the longitudinal effects and the complex interrelationships between these variables remain largely unexplored. We investigated the cross-lagged relationships between gender harassment, illegitimate tasks, and mental health outcomes among working adults in Sweden over a period of two years, as well as the gender differences in the cross-lagged effects. Additionally, the study examined whether illegitimate tasks mediated the relationship between gender harassment and negative mental health outcomes over time. Data were drawn from the Swedish Longitudinal Occupational Survey of Health (SLOSH), covering 2796 working men and 4110 working women in a two-wave analysis from 2018 to 2020. We employed a structural equation model to examine the cross-lagged effects and the mediating effect between gender harassment, illegitimate tasks, and mental health outcomes over time. Furthermore, we applied a multigroup analysis to determine gender differences in the cross-lagged effects.

    The results showed statistically significant cross-lagged relationships (forward, reverse, and reciprocal) between gender harassment, illegitimate tasks, and mental ill-health. There were statistically significant gender differences in these cross-lagged relationships (burnout: 

    , p < 0.01; depression: , p < 0.01). Initial illegitimate tasks mediated the relationship between gender harassment and mental ill-health outcomes over time. The gender differences in the interrelationships between gender harassment, illegitimate tasks, and mental ill-health outcomes among workers in Sweden indicate that policies, regulations, and interventions that address these exposures in organisations must be tailored to benefit both men and women.

  • 7.
    Stjerna, M-L.
    et al.
    University of Stockholm.
    Olin Lauritzen, S.
    University of Stockholm.
    Tillgren, Per
    Mälardalens högskola, Institutionen för vård- och folkhälsovetenskap.
    ”Social thinking” and cultural images: Teenagers notions of tobacco use.2004Inngår i: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 59, nr 3, s. 573-583Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The health hazards of tobacco use are well-known, and it is considered particularly important to prevent tobacco use among teenagers. New generations of teenagers still start using tobacco. To develop a more profound understanding of tobacco use among teenagers, the purpose of this study is to explore representations of tobacco use, smoking as well as snuffing, at the age when young people often start using tobacco. Focus-group interviews were carried out with 14-15 year olds in two schools in the Stockholm area. The analysis reveals that teenagers are well informed about the health-hazards of tobacco use. At the same time they hold complex and conflicting ideas concerning the relationship between tobacco use, risk, the body and "human nature". At the most general level of "social thinking" there is a dynamic relation between the three main representations of tobacco use related to: (1) notions of risk, (2) "human nature" and; (3) society's efforts to discipline its citizens, which together can be seen as the social representation of tobacco use. These representations of tobacco use are discussed as related to the teenagers' identity-work and gender identities. 

  • 8.
    Wahlström, Emmie
    et al.
    Mälardalens universitet, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Wallander, Frida
    Mälardalens universitet, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Stier, Jonas
    Mälardalens universitet, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Vacillating between “strange” and “familiar”: representations of children in migrant families and their health in Swedish school health services2024Inngår i: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 348, artikkel-id 116809Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Representations of migrants influence how they are perceived by others. Hence, how children who have migrated or whose parents have migrated (Children in Migrant Families: CMFs) are represented in clinical practice guidelines (CPGs) for Swedish school health services (SHS) may influence how they are perceived by school nurses. Thus, this study aimed to explore representations of CMFs in school nurses’ CPGs. Data consisted of 130 CPGs from municipalities in Sweden. Documents were analyzed using the “What is the Problem Represented to be” (WPR) approach – an analytic strategy for investigating embedded assumptions of “problems”. In the analysis, Sarah Ahmed's work on “strangers” and “strangeness” was applied. In the CPGs, the CMFs and their health were repeatedly mentioned in conjunction with the need for particular or additional actions, efforts, or routines when assessing or discussing their health, to a degree beyond what is “usually” provided. This need was motivated by representing the CMFs and their health as being the same, yet different in relation to “Swedish” children in general. Thus, the children were not only represented as different, but they were “foreignized”. These representations of difference and foreignness placed the children on a continuum in relation to what is recognized as “familiar” in their health, and constructed elastic boundaries between the strange and the familiar. By illustrating how these boundaries were used for difference-making between “familiar” and “strange”, this study showed how CMFs are alternately represented as similar and different, and foreignized while provided with SHS aiming to make them “familiar”.

  • 9. Wamala, S.P
    et al.
    Mittleman, M A
    Horsten, M
    Schenck-Gustafsson, K
    Orth-Gomer, K
    Job stress and the occupational gradient in coronary heart disease risk in women - The Stockholm Female Coronary Risk Study2000Inngår i: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 51, nr 4, s. 481-489Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Recent studies of men have shown that job stress is important in understanding the occupational gradient in coronary heart disease (CHD), but these relationships have rarely been studied in women. With increasing numbers of women in the workforce it is important to have a more complete understanding of how CHD risk may be mediated by job stress as well as other biological and behavioural risk factors. The objective of this study was to examine the occupational gradient in CHD risk in relation to job stress and other traditional risk factors in currently employed women. We used data from the Stockholm Female Coronary Risk Study, a population based case-control study, comprising 292 women with CHD aged 65 years or younger and 292 age-matched healthy women (controls). An inversely graded association was observed between occupational class and CHD risk. Compared with the highest (executive/professional), women in the lowest occupational class (semi/unskilled) had a four-fold (95% CI 1.75-8.83) increased age-adjusted risk for CHD, Simultaneous adjustment for traditional risk factors and job stress attenuated this risk to 2.45 (95% CI 1.01-6.14). Neither job control nor the Karasek demand-control model of job stress substantially explained the increased CHD risk of women in the lowest occupational classes. It is likely that lower occupational class working women face multiple and sometimes interacting sources of work and non-work stress that are mediated by behavioural and biological factors that increase their CHD risk. (C) 2000 Elsevier Science Ltd. All rights reserved.

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