Bakgrund: Flertalet studier har påvisat förekomsten av skillnader i hälsa mellan olika sociala grupper i samhället. De tidigare studierna visar att det finns olika förhållanden mellan utbildningsnivå, ålder, socioekonomisk status, socialt stöd respektive kön och den självskattade hälsan. Syfte: Syftet är att undersöka den självskattade hälsan hos kvinnor med olika utbildningsnivåer i Västmanlands län, beskriva åldersskillnader samt om det finns några samband mellan självskattad hälsa och socialt stöd, ekonomisk situation och sysselsättning. Metod: Metoden utgår från en kvantitativ ansats där befintlig data från befolkningsundersökningen Hälsa på lika villkor 2012 i Västmanland har använts till analys. Resultat: Resultatet visar att det förekommer signifikanta skillnader i självskattad hälsa hos kvinnor i Västmanland med olika utbildningsnivåer, åldrar, socialt stöd, ekonomisk situation och sysselsättning. Det finns samband mellan dålig självskattad hälsa och förgymnasial- och gymnasial utbildningsnivå, ålder (50-64 år), bristande socialt stöd, ekonomiska svårigheter respektive sjukskrivning/ förtidspension samt arbetslöshet. Slutsats: Samband har identifierats mellan självskattad hälsa och utbildningsnivå samt mellan självskattad hälsa och faktorerna ålder, socialt stöd, ekonomisk situation och sysselsättning. Däremot visar studien att skillnaderna i självskattad hälsa mellan utbildningsnivåerna bland kvinnor i Västmanland med större sannolikhet beror på åldersskillnader, skillnader i socialt stöd, ekonomiska svårigheter och sysselsättning än enbart på grund av utbildningsnivån. / Background: Several studies have demonstrated the existence of differences in health between social groups. The previous studies show that there are different relationships between educational level, age, socioeconomic status, social support, sex, and self-rated health. Aims: The aim of this study is to examine differences in self-assessed health among women with different educational levels in Västmanland, describe age differences and study whether there is any associations between self-assessed health and social support, economic situation and employment. Method: This method is based on a quantitative approach where existing data from the population health survey ”Health on equal terms 2012” in Västmanland is used for analysis. Results: The results show that there are significant differences in self-rated health among women in Västmanland with different levels of education, age, social support, financial situation and employment. There is also associations between poor self-rated health and lower educational levels, age (50-64 years), lack of social support, financial hardship and sickness/ disability and unemployment. Conclusion: Correlations have been identified between self-rated health and level of education as well as between self-rated health and age, social support, financial situation and employment. However, the study shows that the differences in self-rated health between educational levels among women in Västmanland more likely due to age differences, differences in social support, financial difficulties and employment than simply because of the level of education.

A população mundial vem envelhecendo, diante dessa premissa a Organização Mundial de Saúde (OMS), bem como, o Ministério da Saúde (MS) do Brasil, vem buscando adaptar-se a esta realidade através de políticas públicas capazes de promover o envelhecimento ativo e da atenção à saúde adaptada às necessidades da população idosa. A OMS propôs a adequação da Atenção Primária à Saúde (APS) às necessidades dos idosos. O Brasil, por sua vez, segue as orientações da OMS, dentro da linha de cuidado voltada para a saúde dos idosos, na Estratégia de Saúde da Família e dentro da Política de Atenção à Saúde da Pessoa Idosa. No entanto, ainda não há evidências quanto à avaliação da adequação destas políticas e de sua relação com a forma como os idosos percebem sua saúde geral e bucal. Desta forma, esta pesquisa teve como objetivo verificar a extensão do cuidado em saúde que é acessado por idosos moradores de dois distritos de Porto Alegre/RS, em relação ao preconizado para efetividade da Atenção Primária à Saúde, e realizar um censo das unidades de saúde de APS dos mesmos distritos a fim de estabelecer uma relação entre os dados empíricos levantados e: i) Políticas de Saúde relacionadas com a Atenção Primária à Saúde voltadas às necessidades das pessoas idosas, ii) autoavaliação de saúde geral e iii) percepção de saúde bucal. A metodologia do estudo contou com um estudo teórico realizado através de um levantamento de documentos, um estudo epidemiológico de base populacional de delineamento transversal e um censo de unidades de saúde. Os resultados deste estudo apontam para uma realidade distinta entre o que as Políticas voltadas para os idosos preconizam e o que é oferecido para os idosos. Foram observadas limitações em relação ao acesso, longitudinalidade, integralidade e qualidade do cuidado. Além disso, foi possível observar que em relação à autoavaliação de saúde os resultados mostraram associações entre a avaliação positiva da saúde e fatores psicossociais (sintomatologia depressiva), características pessoais (nº de morbidades) e ambientais (orientação do serviço para a APS). Já em relação à percepção de saúde bucal, os resultados apontaram associação com determinantes primários (satisfação com último atendimento odontológico, resiliência e renda suficiente para as necessidades da família), comportamentos em saúde (hábito tabágico) e condições de saúde bucal (número de dentes e presença de restos radiculares). A conclusão que se chegou a partir de tais resultados é que há uma necessidade premente de ampliação do acesso e qualificação do cuidado para que a Atenção Primária disponibilizada para os idosos que vivem nos distritos Lomba do Pinheiro e Partenon em Porto Alegre possa ser realmente considerada adequada às necessidades dos idosos. Além disso, é necessário que se leve em consideração o papel da Atenção Primária a saúde na avaliação da sua própria saúde e na percepção de saúde bucal por parte de idosos. / The world population is aging. In response to those trends the World Health Organization (WHO), as well as the Brazilian Ministry of Health (MH), are aiming at tackling such matters through public policies that promote active aging through health care adapted to the needs of the elderly population. The WHO has proposed an Age-friendly Primary Health Care (PHC) that lies in accordance with the needs of the elderly. In Brazil, the WHO guidelines are followed within older people care provision, in the Family Health Strategy, and within the National Health Policy for the Elderly Person. However, there is still no evidence concerning the assessment of adequacy of these policies and its association with how older people perceive their general and oral health. Thus, this study aimed to verify the extension towards primary health care provided by health services accessed by older persons living in two sanitary districts of Porto Alegre/RS in relation with the recommendation in terms of effectiveness of primary health care. In addition, a census of the primary health care services of the two sanitary districts was carried out forming, along with the epidemiological survey, the basis of the empirical data that allowed establish a relationship with: i) Health Policies related to Primary Health Care and targeting on the needs of older persons, ii) self-rated health and iii) self-perceived oral health. The methodology included: theoretical study made by a documental research, a cross-sectional population-based epidemiological study and a health PHC services census. The results of this study show a distinct reality between what policies targeting older persons recommend and what is actually provided, limitations in terms of access, longitudinally, comprehensiveness and quality of care were observed. Furthermore, it was observed that positive self-rated health was associated with psychosocial factors (depressive symptomatology), personal characteristics (number of morbidities) and environmental characteristics (orientation towards PHC Attributes). Self-perceived oral health was associated with primary determinants of health (satisfaction with prior dental appointment, resilience and income that was enough to meet family needs), 17 health behaviors (smoking habit) and oral health status (number of teeth and of root remnants). Concluding, there is an urgent need to increase access and to qualify care so that Primary Health Care services made available for older people, at least for those who live in the Lomba do Pinheiro and Partenon sanitary districts of Porto Alegre/RS, reach its goals of providing adequate and resolutive care that is adequate to the needs of the elderly. Furthermore, it is necessary to take into account the role of Primary Health Care on the rate of health and perception of oral health by the elderly. Still, advances in relation to equity and quality of care in respect to primary health care professionals continued education attainment were observed.

<p>According to the salutogenic theory put forth by Antonovsky, an individual’s sense of coherence (SOC) is central for maintaining health. The present study used data from middle-aged women being part of a longitudinal research program to investigate how SOC relates to health status (in terms of self-rated health and medicine consumption) and a set of lifestyle factors (physical exercise, alcohol consumption, nicotine consumption and dietary habits). Women with a strong SOC were hypothesized to exhibit better health profiles, consume less medication, and lead a healthier lifestyle than women with a weak SOC. The findings partly confirmed the hypotheses in showing that women with a strong SOC had better self-rated overall health, better psychological well-being, fewer self-reported diseases and lower medicine consumption. Contrary to the hypothesis, women with stronger SOC had more self-reported psychological and physical symptoms. Of the lifestyle factors, only dietary habits were significantly associated with SOC. The study shows that SOC is related to differences in health and medicine consumption in a homogeneous group of middle-aged women, while the association between SOC and lifestyle was found to be less prominent.</p>

<p>The aim with this thesis was to study cardiovascular disease and hypertension, use of drugs and health from an epidemiological perspective. Various methods - self-rated health (SRH), health related quality of life (HRQL) - the 36-item short form questionnaire (SF-36) - and health utility measurements - the rating scale (RS) and the time-trade off (TTO) methods - were employed.</p><p>Data from the Swedish Adoption/Twin Study of Aging (SATSA) in 1984, 1987, 1990, and 1993 as well as a general population survey conducted in Uppsala County in 1995 were used.</p><p>Persons who have cardiovascular disease, both with and without drug treatment, were found to have a lower SRH as compared to others in the population. Longitudinal analyses showed that SRH was relatively stable over time among persons with cardiovascular disease. Both having a low SRH and having cardiovascular disease were associated with a higher mortality rate.</p><p>Hypertensives were found to have a lower HRQL than do others in the general population as measured by the SF-36. The lowest scoring was found in the general health perception scale (GH), whereas role emotional (RE) and mental health (MH) were the scales least affected by hypertension.</p><p>Nearly 20 percent of the antihypertensive drug users reported side effects.The pattern of side effects was similar to that reported in clinical trials. Both hypertension itself and the drug treatment were found to have an impact on the patient's health-state utility as measured by the RS. Comparative analyses showed that health utilities and psychometric quality-of-life instruments were only moderately correlated among hypertensives. </p><p>The results also showed that inequalities in HRQL were present with respect to several sociodemographic factors. </p><p>In summary, this thesis revealed that persons with cardiovascular disease and/or with hypertension experience poorer health than others in the population. The poor health may be caused both by the disease and/or the drug treatment. The results in this thesis also suggested that special attention and care should be directed to persons with cardiovascular disease and/or hypertension reporting ill health. This especially is important given that low HRQL can be a riskfactor for subsequent cardiovascular events or complications which in turn might result in higher mortality rate.</p>

The aim with this thesis was to study cardiovascular disease and hypertension, use of drugs and health from an epidemiological perspective. Various methods - self-rated health (SRH), health related quality of life (HRQL) - the 36-item short form questionnaire (SF-36) - and health utility measurements - the rating scale (RS) and the time-trade off (TTO) methods - were employed. Data from the Swedish Adoption/Twin Study of Aging (SATSA) in 1984, 1987, 1990, and 1993 as well as a general population survey conducted in Uppsala County in 1995 were used. Persons who have cardiovascular disease, both with and without drug treatment, were found to have a lower SRH as compared to others in the population. Longitudinal analyses showed that SRH was relatively stable over time among persons with cardiovascular disease. Both having a low SRH and having cardiovascular disease were associated with a higher mortality rate. Hypertensives were found to have a lower HRQL than do others in the general population as measured by the SF-36. The lowest scoring was found in the general health perception scale (GH), whereas role emotional (RE) and mental health (MH) were the scales least affected by hypertension. Nearly 20 percent of the antihypertensive drug users reported side effects.The pattern of side effects was similar to that reported in clinical trials. Both hypertension itself and the drug treatment were found to have an impact on the patient's health-state utility as measured by the RS. Comparative analyses showed that health utilities and psychometric quality-of-life instruments were only moderately correlated among hypertensives. The results also showed that inequalities in HRQL were present with respect to several sociodemographic factors. In summary, this thesis revealed that persons with cardiovascular disease and/or with hypertension experience poorer health than others in the population. The poor health may be caused both by the disease and/or the drug treatment. The results in this thesis also suggested that special attention and care should be directed to persons with cardiovascular disease and/or hypertension reporting ill health. This especially is important given that low HRQL can be a riskfactor for subsequent cardiovascular events or complications which in turn might result in higher mortality rate.

According to the salutogenic theory put forth by Antonovsky, an individual’s sense of coherence (SOC) is central for maintaining health. The present study used data from middle-aged women being part of a longitudinal research program to investigate how SOC relates to health status (in terms of self-rated health and medicine consumption) and a set of lifestyle factors (physical exercise, alcohol consumption, nicotine consumption and dietary habits). Women with a strong SOC were hypothesized to exhibit better health profiles, consume less medication, and lead a healthier lifestyle than women with a weak SOC. The findings partly confirmed the hypotheses in showing that women with a strong SOC had better self-rated overall health, better psychological well-being, fewer self-reported diseases and lower medicine consumption. Contrary to the hypothesis, women with stronger SOC had more self-reported psychological and physical symptoms. Of the lifestyle factors, only dietary habits were significantly associated with SOC. The study shows that SOC is related to differences in health and medicine consumption in a homogeneous group of middle-aged women, while the association between SOC and lifestyle was found to be less prominent.

Den fysiska aktiviteten i västvärlden har minskat under de senaste decennierna. Vi tillbringar mer tid inomhus framför TV, dator eller något annat medialt redskap. En av de främsta anledningarna till att vi blivit mer fysiskt inaktiva på senare tid tros vara att forskningen hela tiden går framåt, där vi uppfinner hjälpmedel som gör att vi rör på oss så lite som möjligt. Forskning visar att det finns indirekta bevis på att fysisk aktivitet är en positiv hälsofaktor som minskar risken för sjukdomar. Fysisk aktivitet har visat sig ha ett samband med högre nivåer av personligt välbefinnande, så som bättre humör, mer tillfredställelse med livet och högre livskvalitet. Vi har inte bara blivit mindre fysiskt aktiva på senare tid, den psykiska ohälsan har ökat bland befolkningen, där forskning visar att det finns samband mellan att leva ett stillasittande liv under en längre tid och klinisk definierad depression. Syftet med studien var att se om det fanns skillnader i självskattad hälsa mellan ungdomar som var fysiskt aktiva och ungdomar som inte var fysiskt aktiva. Samt att se om det fanns skillnader i självskattad hälsa mellan flickor och pojkar. Syftet innehöll en pedagogisk del där vi undersökte om omgivning och samspel mellan ungdomar påverkar den självskattade hälsan. Studien är gjord med kvantitativ metod där 187 elever från högstadiet deltog. Totalt delades 200 enkäter ut vilket gav oss en hög svarsfrekvens och ett litet bortfall. Utifrån resultatet kom vi fram till att ungdomar som är fysiskt aktiva i större utsträckning har en högre självskattad hälsa än ungdomar som inte är fysiskt aktiva. Resultatet visar att pojkar upplever i större utsträckning sin självskattade hälsa som högre än vad flickor gör. I resultatet kom vi även fram till att både samspel mellan ungdomar och stöd från omgivningen har ett har ett positivt samband med hög självskattad hälsa. / The physical activity in the western world has decreased in recent decades. We spend more time indoors watching television, computer or other media tools. One of the main reasons that we become more physically inactive in recent years that research is believed to be constantly moving forward, we invent tools that will make us move as little as possible. Research shows that there is indirect evidence that physical activity is a positive health factor that reduces the risk of disease and physical activity has been shown to be associated with higher levels of personal well-being, such as better mood, greater satisfaction with life and to have higher quality of life. We have not only become less physically active in recent years. Mental illness has increased in the population. Research shows that there is a link between living a sedentary life for a long time and clinically defined depression. The purpose of this study was to see if there were differences in self-rated health among adolescents who were physically active and young people who were not physically active. We also wanted to see if there were differences in self-rated health between girls and boys. The purpose contained an educational element in which we examined if environmental and interaction between young people affects the self-assessed health. Study was done with the quantitative method in which 187 students from junior high school participated. A total of 200 questionnaires were distributed which gave us a good response rate and a small loss. Based on these results, we concluded that young people who are physically active, have more of a higher self-rated health than young people who are not physically active. The results show that boys experience their self-rated health higher than girls do. In the results, we found that both the interaction between young people and support from the environment has a positive association with high self-rated health.

Obesity prevalences are increasing in Sweden and the US. Obesity has many health consequences and health risks are associated with small increases in weight and marked obesity. Cross-sectional and panel surveys from northern Sweden and upstate NY provide the basis for furthering understanding of body mass index (BMI) development. BMI and weight change (+/-3%) were used to evaluate obesity and weight loss, maintenance, or gain. The 1989 prevalences of obesity were 9.6% and 21.3% in Sweden and the US; 1999 prevalences were 18.4% and 32.3%. Ten-year incidences (1989-1999) of overweight and obesity were 337/1000 and 120/1000 for Sweden and 336/1000 and 173/1000 for the US. Cross-sectional data suggest obesity is a problem of older age while panel data show that the young are gaining weight most rapidly. Individual changes in BMI have similar trends for Sweden and the US; the majority of adults are gaining weight. Older age, being a woman, higher BMI, and type 2 diabetes were associated with higher odds of weight non-gain. Younger age, being a man, being married and using snuff (snus) increased the odds of weight gain. The obese were 2-7 times more likely to report self-rated poor health. Healthy behaviours explain more of the person-to-person variability in BMI than do unhealthy behaviours or chronic diseases. Encouraging trends were found among Västerbotten Intervention Programme participants: a higher proportion of adults maintained weight in more recent survey years. The proportion of weight-gaining adults with identified health risk factors is smaller than those without risk factors. Frequently weight maintenance is felt to be important only for those identified as having a problem with weight or an obesity-related health condition. The largest proportion of those gaining weight are those with a normal BMI. Obesity prevention should target those usually considered low-risk (young, without cardiovascular risk factors, normal BMI).

Work is an essential part of most people’s lives. With increasing flexibility in work life, many employees experience job insecurity – they perceive that the future of their jobs is uncertain. However, job insecurity is not just an individual experience; employees can perceive that there is a climate of job insecurity at their workplace as well, as people collectively worry about their jobs. The overall aim of this thesis was to investigate the job insecurity climate construct and how it relates to work- and health-related outcomes and to individual job insecurity. Three empirical studies were conducted to investigate this aim. Study I investigated the dimensionality of the job insecurity construct by developing and testing a measure of job insecurity climate − conceptualized as the individual’s perception of the job insecurity climate at work − in a sample of employees working in Sweden. The results indicated that individual job insecurity and job insecurity climate are separate but related constructs and that job insecurity climate was related to work- and health-related outcomes. Study II examined the effects of individual job insecurity and job insecurity climate on work- and health-related outcomes in a sample of employees working in a private sector company in Sweden. The results showed that perceiving higher levels of job insecurity climate than others in the workgroup was associated with poorer self-rated health and higher levels of burnout. Study III tested the relationship between individual job insecurity and job insecurity climate in a sample of Flemish employees. The results indicated that individual job insecurity is contagious, as individual job insecurity predicted perceptions of job insecurity climate six months later. In conclusion, by focusing on perceptions of the job insecurity climate, the present thesis introduces a new approach to job insecurity climate research, showing that employees can perceive a climate of job insecurity in addition to their own individual job insecurity and, also, that this perception of the job insecurity climate at work has negative consequences for individuals and organizations. / <p>At the time of the doctoral defense, the following papers were unpublished and had a status as follows: Paper 2: Manuscript. Paper 3: Manuscript.</p>

INTRODUCTION. Quality of life (QOL) – and individual’s perception of his or her own health – has become the subject of great interest in Lithuania. THE AIM OF THE STUDY. The aim of the study was to assess the determinants of the quality of life and self-rated health and to clarify the importance of perceived health in determining the risk of death among middle-aged Kaunas population. MAIN RESULTS. Quality of life in middle-aged Kaunas women was found to be lower than in men, except for the spirituality domain. Older age showed worse quality of life. Low income and lower educational level, manual work, living alone, unemployment, disability and retirement were associated with worse QOL in middle-aged Kaunas population. Overweight and obese men had lower probability of rating their overall QOL worse as compared to men with normal body mass. Diabetes, coronary heart disease and smoking were associated with worse QOL in men. Moderate-to-heavy alcohol consumption was associated with lower risk of having worse QOL as compared to light alcohol consumption group among men. Obesity for women increased the odds of having worse QOL as compared to women with normal body mass. Moderate-to-heavy alcohol consumption was associated with better QOL in the physical and independence domains and with worse QOL in the social relationships domain among women. Smoking and inadequate physical activity were associated with worse QOL among women. CHD increased women’s probability of scoring lower in... [to full text]