Status inconsistency and return to work among foreign-born and native Swedes

We investigated potential differences in status inconsistency and time to return to work (RTW) from sickness absence between foreign-born and native Swedes, whether inconsistency was associated with RTW, and if this association was stronger for foreign-borns than natives. Significantly fewer native than foreign-born Swedes reported negative status inconsistency, but RTW did not differ between the groups and inconsistency was not associated with RTW. A positive selection of individuals to the Swedish labour market might help explain the findings. This first study of status inconcistency and RTW requires follow-ups in different settings of labour markets and insurance regulations

Alcohol environment, gender and nonfatal injuries in young people. An ecological study of fourteen Swedish municipalities (2000–2005)

BACKGROUND: Sweden has had a restrictive alcohol policy, but there are gender and geographical differences in alcohol consumption and injury rates within the country. Whether and how the Swedish alcohol environment influences gender differences in injuries in young people is still unclear. Thus, the aim of this study was to analyse the associations between the local alcohol environment and age- and gender-specific nonfatal injury rates in people up to 24 years in Sweden. METHODS: The local alcohol environment from 14 municipalities was studied using indicators of alcohol access, alcohol consumption and alcohol-related crimes. A comprehensive health care register of nonfatal injuries was used to estimate mean annual rates of nonfatal injuries by gender and age group (2000–2005). Pearson’s correlation coefficients were used to analyse linear associations. RESULTS: Associations were shown for both alcohol access and alcohol consumption with injury rates in boys aged 13–17 years; no other associations were observed between alcohol access or per capita alcohol consumption and nonfatal childhood injuries. The prevalence of crimes against alcohol laws was associated with injury rates in children of both genders aged 6–17 years. CONCLUSIONS: This study found no strong area-level associations between alcohol and age and gender specific nonfatal injuries in young people. Further, the strength of the area-level associations varied by age, gender and type of indicator used to study the local alcohol environment

Validity of the Capacity to Work Index:Development of an Instrument to Measure Work Capacity in Relation to Depression and Anxiety in the General Working Population

Purpose To develop an index to assess capacity to work in relation to common mental disorders (CMDs) in the generalworking population and field test its psychometric properties.Methods Content analysis of three qualitative studies on people (n = 49) with their own experiences of working with CMDguided the items selected for the index. Face and content validity and test-retest reliability were performed. The index wasfield tested in two versions with 26 and 17 items, respectively, among health care professionals regarding internal reliability,component structure and concurrent validity.Results The final version of the Capacity to Work Index (C2WI; 17 items) was normally distributed in the field test withhigh internal reliability (Cronbach’s alpha, 0.84). Missing responses were randomly distributed and nonspecific. Principalcomponent analysis showed one clear component with negatively framed items. Concurrent validity showed high correlationwith the WHO-5 Well-Being Scale (Pearson’s r, 0.68), but lower correlation for the general health question (r, − 0.44), oneitem of the Work Ability Index (r, − 0.33), and the Stress of Conscience constructs (r, 0.44).Conclusion The C2WI showed promising psychometric qualities. Low and negative correlation with the item from WorkAbility Index suggests that the C2WI measures additional dimensions, but further testing in larger and more diverse samplesis required

Harmful alcohol habits did not explain the social gradient of sickness absence in Swedish women and men

Background: the aim of this study was to examine the prevalence and socioeconomic distribution of harmful alcohol habits in sick-listed women and men, and whether the social gradient in sickness absence could be explained by the socioeconomic distribution of harmful alcohol habits. Methods: this cross-sectional questionnaire study included newly sick-listed individuals (n=2 798, 19-64 years, 66% women) from Sweden. The outcome variable, self-reported harmful alcohol habits, was measured with the Alcohol Use Disorder Identification Test. Registered socioeconomic variables (education, income, occupational class) were explanatory variables with age as confounder and selfreported health, symptoms, mental wellbeing, and self-efficacy as mediators. Chi2-tests and logistic regression models were applied. Results: 9% of sick-listed women and 22% of men had harmful alcohol habits. Women with a low annual income (≤149 000 SEK) had higher odds ratios (OR=2.47; 95% CI=1.43-4.27) of harmful alcohol habits than those with ≥300 000 SEK/year. The significance of low income remained when mediators were introduced into the logistic regression model (OR=2.03, 95% CI=1.13-3.65). In the model including age, income was no longer significant. Men with low income were more likely to have harmful alcohol habits than men with high income (OR=2.59; 95% CI=1.45-4.62). When mediators were included low income remained significant (OR=2.88; 95% CI=1.56-5.31). Income was no longer significant when age was introduced. Education and occupational status were not significant. Conclusions: harmful alcohol habits were common among sick-listed women and men. The socioeconomic differences in harmful alcohol habits did not explain the social gradient in sickness absence

Psychosocial resources predict frequent pain differently for men and women: A prospective cohort study

Introduction Psychosocial resources, psychological and social factors like self-efficacy and social support have been suggested as important assets for individuals with chronic pain, but the importance of psychosocial resources for the development of pain is sparsely examined, especially sex and gender differences. The aim of this study was to investigate associations between psychosocial resources and sex on the development of frequent pain in a general population sample, and to deepen the knowledge about sex and gender patterns. Methods A sample from the Swedish Health Assets Project, a longitudinal cohort study, included self-reported data from 2263 participants, 53% women, with no frequent pain at baseline. The outcome variable was frequent pain at 18–months follow-up. Psychosocial resources studied were general self-efficacy, instrumental and emotional social support. Log binomial regressions in a generalised linear model were used to calculate risk ratios (RRs), comparing all combinations of men with high psychosocial resources, men with low psychosocial resources, women with high psychosocial resources and women with low psychosocial resources. Results Women with low psychosocial resources had higher risk of frequent pain at follow-up compared to men with high resources: general self-efficacy RR 1.82, instrumental social support RR 2.33 and emotional social support RR 1.94. Instrumental social support was the most important protective resource for women, emotional social support was the most important one for men. Results were discussed in terms of gender norms. Conclusions The psychosocial resources general self-efficacy, instrumental and emotional support predicted the risk of developing frequent pain differently among and between men and women in a general population sample. The results showed the importance of studying sex and gender differences in psychological and not least social predictors for pain.publishedVersio

“Brave Men” and “Emotional Women”: A Theory-Guided Literature Review on Gender Bias in Health Care and Gendered Norms towards Patients with Chronic Pain

Background. Despite the large body of research on sex differences in pain, there is a lack of knowledge about the influence of gender in the patient-provider encounter. The purpose of this study was to review literature on gendered norms about men and women with pain and gender bias in the treatment of pain. The second aim was to analyze the results guided by the theoretical concepts of hegemonic masculinity and andronormativity. Methods. A literature search of databases was conducted. A total of 77 articles met the inclusion criteria. The included articles were analyzed qualitatively, with an integrative approach. Results. The included studies demonstrated a variety of gendered norms about men\u27s and women\u27s experience and expression of pain, their identity, lifestyle, and coping style. Gender bias in pain treatment was identified, as part of the patient-provider encounter and the professional\u27s treatment decisions. It was discussed how gendered norms are consolidated by hegemonic masculinity and andronormativity. Conclusions. Awareness about gendered norms is important, both in research and clinical practice, in order to counteract gender bias in health care and to support health-care professionals in providing more equitable care that is more capable to meet the need of all patients, men and women

Income security during periods of ill health: A scoping review of policies, practice and coverage in low-income and middle-income countries

The COVID-19 pandemic is a reminder that insufficient income security in periods of ill health leads to economic hardship for individuals and hampers disease control efforts as people struggle to stay home when sick or advised to observe quarantine. Evidence on income security during periods of ill health is growing but has not previously been reviewed as a full body of work concerning low-income and middle-income countries (LMICs). We performed a scoping review to map the range, features, coverage, protective effects and equity of policies that aim to provide income security for adults whose ill health prevents them from participating in gainful work. A total of 134 studies were included, providing data from 95% of LMICs. However, data across the majority of these countries were severely limited. Collectively the included studies demonstrate that coverage of contributory incomesecurity schemes is low, especially for informal and lowincome workers. Meanwhile, non-contributory schemes targeting low-income groups are often not explicitly designed to provide income support in periods of ill health, they can be difficult to access and rarely provide sufficient income support to cover the needs of eligible recipients. While identifying an urgent need for more research on illness-related income security in LMICs, this review concludes that scaling up and diversifying the range of income security interventions is crucial for improving coverage and equity. To achieve these outcomes, illnessrelated income protection must receive greater recognition in health policy and health financing circles, expanding our understanding of financial hardship beyond direct medical costs.Funding for this research was received from the Swedish Research Council (2018–05174)

Domestic Workload and Multiple Roles. Epidemiological findings on health and sickness absence in women

Aim: The objective of this thesis was to analyse the importance of specific exposures in women’s lives to health and sickness absence; more precisely to study the association between domestic work, multiple roles and the experience of being sick-listed, and self-rated health, psychiatric disorders and sickness absence. Method: The thesis was based on two datasets. ‘Women’s health and living conditions’ (WHL) is a cross-sectional study on 1 417 employed women aged 17 to 64 years old. Data was collected with a questionnaire, and register and employee data on sickness absence. ‘Women and alcohol in Göteborg’ (WAG) is a prospective cohort study on 1 799 women in eight age cohorts born from 1925 to 1980. Data was collected with a screening questionnaire, interviews and register-based sickness absence. Several aspects of domestic work, multiple roles and experience of sickness absence were analysed in relation to self-rated health (SF-36), psychiatric disorders (DSM-III and IV) and sickness absence. The study on multiple roles emanated from the role strain and role enhancement hypotheses and roles were analysed as single roles and as combinations of roles. Changes in self-rated physical health were assessed in relation to experience of sickness absence over five year. Cross-sectional and longitudinal analyses were conducted using multivariate regressions analyses. Results: Domestic job strain and a lack of domestic work equity and marital satisfaction were associated with lower self-rated health particularly vitality and mental health. The former was not associated to sickness absence, but the latter was. Women with domestic workload due to children and adults with special needs had higher odds for medium-long sick-leave spells, while parental responsibility gave lower odds for any sick-leave spell. Occupation was related to lower odds for poor self-rated physical health and sickness absence, while the parental role was associated with higher odds for sickness absence. Compared with women who had all three roles women with occupation and partner role had lower odds for negative health outcomes. Support was found for the role strain hypothesis in the cross-sectional analyses of role combinations while neither of the hypotheses was supported in the five year follow up. A lower proportion of those who had experience of being sick-listed reported good health at both baseline and follow up. Women with psychiatric disorders had higher odds for a change from poor to good self-rated physical health over the five years if they had been sick-listed. Conclusion: Domestic workload was associated to health and sickness absence in women, but there were inconsistencies in the findings on children and being a parent and on multiple roles. From a public health perspective, deeper knowledge on the importance of women’s engagement domestic work and its different dimensions is important for promoting women’s health. A multidimensional assessment of domestic work is important and the content and complexity of domestic work and of different roles needs to be further explored in relation to health and sickness absence in women