Locked in Permanent Employment-Longitudinal Associations With Depressive and Functional Somatic Symptoms

OBJECTIVE: To study mental health as a precedent and an outcome of not being in the preferred job ("locked-in situation"). METHODS: Longitudinal data from age 16 to 43 were derived from surveys of the Northern Swedish Cohort. Changes in mental health were studied with analyses of variance for repeated measures. RESULTS: Getting out of locked-in situation was associated with improving and getting into locked-in with worsening mental health between age 30 and age 43. The worsening was more pronounced and the improvement less pronounced in white-collar than in blue-collar employees. Poor mental health at age 16 predicted locked-in situation in early middle age. CONCLUSIONS: The findings clarify the bidirectional nature of the associations between locked-in situation and poor mental health, as well as the importance of social class in assessing these associations.acceptedVersionPeer reviewe

Children of boom and recession and the scars to the mental health – a comparative study on the long term effects of youth unemployment

BACKGROUND: Earlier research shows that there is an association between unemployment and poor mental health, and that recovery from the damages to mental health obtained during unemployment remains incomplete over a long period of time. The present study relates this 'mental health scarring' to the trade cycle, exploring if those exposed to youth unemployment during boom differ from those exposed during recession with respect to mental health in the middle age. METHODS: The sample consists of two cohorts from the same industrial town in Northern Sweden: the cohort born in 1965 and the cohort born in 1973 included all pupils attending the last grade of compulsory school, respectively, in 1981 and in 1989. Their depressiveness and anxiousness were assessed by questionnaires at age 21 and again at age 43/39. Mental health at follow-up was related to exposure to unemployment during age years 21-25. Statistical significance of the cohort*exposure interactions from binary logistic regression analyses were used to assess the cohort differences in the mental health between Cohort65 and Cohort73, entering the labour market, respectively, during a boom and a recession. RESULTS: Compared to the unexposed, high exposure to unemployment at the age from 21 to 25 was associated to increased probability of poor mental health in the middle age in both in Cohort65 (odds ratio 2.19 [1.46-3.30] for anxiousness and 1.85 [1.25-2.74]for depressiveness) and in Cohort73 (odds ratio 2.13 [1.33-3.39] for anxiousness and 1.38 [0.89-2.14] for depressiveness). The differences between the cohorts also turned out as statistically non-significant. CONCLUSIONS: The scars of unemployment exposure onto future health seem to be rather insensitive to economic trades. Thus, at the population level this would mean that the long-term health costs that can be attributed to youth unemployment are more widespread in the generation that suffers of recession around the entry to the work life.BioMed Central open acces

Можливості розвитку інноваційної діяльності малого та середнього бізнесу в Україні та за кордоном

Objectives The unemployed are assumed to adopt unhealthy behaviours, including harmful use of alcohol. This study sought to elucidate the relations between unemployment before age 21years and consumption of alcohol from 21 to 42years. The design was based on the conception of youth as a sensitive period for obtaining drinking scars' that are visible up to middle age. Setting The Northern Swedish Cohort Study has followed up a population sample from 1981 to 2007 with five surveys. Participants All pupils (n=1083) attending the last year of compulsory school in Lulea participated in the baseline survey in classrooms, and 1010 of them (522 men and 488 women) participated in the last follow-up survey that was conducted at classmate reunions or by post or by phone. Outcome measure The trajectory of alcohol consumption from 21 to 43years, obtained with latent class growth analyses, was scaled. Results Men were assigned to five and women to three consumption trajectories. The trajectory membership was regressed on accumulation of unemployment from 16 to 21years, with multinomial logistic regression analyses. The trajectory of moderate consumption was preceded by lowest exposure to unemployment in men and in women. With reference to this, the relative risk ratios for high-level trajectory groups were 3.49 (1.25 to 9.79) in men and 1.41 (0.74 to 2.72) in women, but also the trajectories of low-level consumption were more probable (relative risk ratio 3.18 (1.12 to 9.02) in men and 2.41 (1.24 to 4.67) in women). Conclusions High-level alcohol consumption throughout adulthood is, particularly among men, partly due to scars' from youth unemployment, particularly in men, but there are also groups of men and women where unemployment in the teens predicts a trajectory of low consumption

A cross-sectional and semantic investigation of self-rated health in the northern Sweden MONICA-study

A cross-sectional and semantic investigation of self-rated health in the northern Sweden MONICA-study. Methodology, 12: 154 http://dx.doi. org/10.1186/1471-2288-12-154 Access to the published version may require subscription. N.B. When citing this work, cite the original published paper. BMC Medical Research Permanent link to this version: http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-64328 R E S E A R C H A R T I C L E Open Access A cross-sectional and semantic investigation of self-rated health in the northern Sweden MONICA-study The aim of this paper is to examine the meaning of two questions on self-rated health, the statistical distribution of the answers, and whether the context of the question in a questionnaire affects the answers. Methods: Statistical and semantic methodologies were used to analyse the answers of two different SRH questions in a cross-sectional survey, the MONICA-project of northern Sweden. Results: The answers from 3504 persons were analysed. The statistical distributions of answers differed. The most common answer to the General SRH was "good", while the most common answer to the Comparative SRH was "similar". The semantic analysis showed that what is assessed in SRH is not health in a medical and lexical sense but fields of association connected to health, for example health behaviour, functional ability, youth, looks, way of life. The meaning and function of the two questions differ -mainly due to the comparing reference in Comparative SRH. The context in the questionnaire may have affected the statistics. Conclusions: Health is primarily assessed in terms of its sense-relations (associations) and Comparative SRH and General SRH contain different information on SRH. Comparative SRH is semantically more distinct. The context of the questions in a questionnaire may affect the way self-rated health questions are answered. Comparative SRH should not be eliminated from use in questionnaires. Its usefulness in clinical encounters should be investigated

Household out-of-pocket payments for illness: Evidence from Vietnam

BACKGROUND: In Vietnam, illnesses create high out-of-pocket health care expenditures for households. In this study, the burden of illness in the Bavi district, Vietnam is measured based upon individual household health expenditures for communicable and non-communicable illnesses. The focus of the paper is on the relative effect of different illnesses on the total economic burden of health care on households in general and on households that have catastrophic health care spending in particular. METHODS: The study was performed by twelve monthly follow-up interviews of 621 randomly selected households. The households are part of the FilaBavi project sample – Health System Research Project. The heads of household were interviewed at monthly intervals from July 2001 to June 2002. RESULTS: For the population in the Bavi district, communicable illnesses predominate among the episodes of illness and are the reason for most household health care expenditure. This is the case for almost all groups within the study and for the study population as a whole. However, communicable illnesses are more dominant in the poor population compared to the rich population, and are more dominant in households that have very large, or catastrophic, health care expenditure, compared to those without such expenditures. CONCLUSION: The main findings indicate that catastrophic health care spending for a household is not usually the result of one single disastrous event, but rather a series of events and is related more to "every-day illnesses" in a developing country context than to more spectacular events such as injuries or heart illnesses

Is body size at birth related to circadian salivary cortisol levels in adulthood? Results from a longitudinal cohort study

<p>Abstract</p> <p>Background</p> <p>The hypothesis of fetal origins of adult disease has during the last decades received interest as an explanation of chronic, e.g. cardiovascular, disease in adulthood stemming from fetal environmental conditions. Early programming and enduring dysregulations of the hypothalamic-pituitary-adrenal (HPA axis), with cortisol as its end product, has been proposed as a possible mechanism by which birth weight influence later health status. However, the fetal origin of the adult cortisol regulation has been insufficiently studied. The present study aims to examine if body size at birth is related to circadian cortisol levels at 43 years.</p> <p>Methods</p> <p>Participants were drawn from a prospective cohort study (n = 752, 74.5%). Salivary cortisol samples were collected at four times during one day at 43 years, and information on birth size was collected retrospectively from delivery records. Information on body mass during adolescence and adulthood and on health behavior, medication and medical conditions at 43 years was collected prospectively by questionnaire and examined as potential confounders. Participants born preterm or < 2500 g were excluded from the main analyses.</p> <p>Results</p> <p>Across the normal spectrum, size at birth (birth weight and ponderal index) was positively related to total (area under the curve, AUC) and bedtime cortisol levels in the total sample. Results were more consistent in men than in women. Descriptively, participants born preterm or < 2500 g also seemed to display elevated evening and total cortisol levels. No associations were found for birth length or for the cortisol awakening response (CAR).</p> <p>Conclusions</p> <p>These results are contradictory to previously reported negative associations between birth weight and adult cortisol levels, and thus tentatively question the assumption that only low birth weight predicts future physiological dysregulations.</p

Socialmedicinens väg till specialitet

Specialistbegreppet och specialistkompetensen var ursprungligen en facklig fråga som reglerades av Svenska läkarförbundet. I takt med att behörighetskraven för läkare successivt skärptes kom även kompetensen i fokus. Relativt sent kom denna behörighet att formaliseras i termer av ”specialitet”. Den första mer genomgripande regleringen av medicinska specialiteter inom den offentligrättsliga sfären ägde rum 1960. År 1974 kom socialmedicinen att inkluderas i behörighetsämnena, sedermera specialiteterna. Vid en utredning i början av 2003 föreslogs att socialmedicinen skulle avföras från specialitetsförteckningen. Efter ett väl genomfört utredningsarbete av Bernhard Grewin, där det klart fastslogs att socialmedicinen var en viktig del av hälso- och sjukvården beslöt regeringen att behålla socialmedicinen som medicinsk specialitet, och ge den status av basspecialitet.The concept of a medical speciality was from the beginning a trade union matter which was handled by the Swedish Medical Association. As competence requirements gradually were increased, the medical qualification also came into focus. The formalisation of this authority was made into terms of “specialities”. The more thorough regulation of the medical specialities within the public sphere came about in 1960. In 1974 social medicine was included in the medical specialities. In a report in 2003 there was a proposal to remove social medicine from the list of medical specialities. After a thorough work by Bernhard Grewin, where it was brought about that social medicine was an important part of public health and medical care, the government decided to keep social medicine as a medical speciality and also gave it the standing of a base medical speciality