Självskattad hälsa beskriver personens subjektiva uppfattning av sin hälsa. En lågt självskattad hälsa har samband med ökad framtida dödlighet. Ett starkt välbefinnande är enligt Katie Erikssons dimensioner av hälsa, förutsättningen för att hälsan ska skattas som bra. Syftet med denna studie var att beskriva eventuella skillnader i självskattad hälsa sett till olika levnadsvanor hos 40-åriga kvinnor och män. Metod: Enkätsvar från totalt 1144 40-åriga kvinnor och män har använts. Enkäterna genomfördes under 2014 på 55 vårdcentraler i två regioner i södra Sverige. Levnadsvanor som valdes till denna studie var fysisk aktivitet, grönsaks- och frukostvanor, alkoholintag, rökning, sysselsättning, sömn och stress. Självskattad hälsa kategoriserades som bra (”mycket bra” och ”bra”) och dålig (”någorlunda”, ”dålig” och ”mycket dålig”). För att studera skillnader användes Student T-test på parametrisk data och Chi-två på icke parametrisk data. Resultat: De levnadsvanor som var vanligare förekommande hos de med bra självskattad hälsa var ansträngande/hård motion, låg nivå av stress och att vara i arbete (p<.001). Att inte röka hos män och att äta frukost och grönsaker hos kvinnor var också vanligare förekommande hos de med bra självskattad hälsa. Lågt intag av alkohol visade inte på några skillnader.  Slutsats: För att minska risken för framtida sjuklighet är det viktigt för distriktssköterskor, samt flera andra samhällsinsatser, att försöka påverka och uppmuntra hög fysisk aktivitet och minskad stress. / Self-rated health describes a person's subjective perception of their health. A low self-rated health has been associated with increased mortality risk. A strong well-being is, according to Katie Eriksson’s health dimensions, a pre-condition for estimating health as well. The aim of this study was to describe eventual differences in self-rated health in terms of different life-style habits of 40-year old woman and men. Method: Survey responses from a total of 1144 40-year old woman and men have been used. The surveys were conducted in 2014 at 55 health centers in two regions in southern Sweden. The living habits chosen for this study were physical activity, vegetable- and breakfast habits, alcohol consumption, smoking, employment, sleep and stress. Self-rated health was categorized as good ("very good" and "good") and poor ("reasonably", "poor" and "very poor"). To study the differences Student T-test was made on the parametric data and Chi-square on the non-parametric data. Results: The living habits that were more common in those with good self-rated health were high physical activity, low level of stress and to have an employment (p<.001). Not smoking in men and to eat breakfast and vegetables in woman were also more common in those with good self-rated health. Low intake of alcohol showed no differences. Conclusion: To reduce the risk of future illness, it is important for district nurses, as well as several community actions, to try to influence and encourage physical activity and reduced stress.

Musculoskeletal complaints are one of the most common reasons for visits to medical and chiropractic professionals in the United States, and spine-related symptoms in particular comprise the largest share of these complaints. Spine-related conditions increase as people age, having implications for rising disability and consequent spending by Medicare and Medicaid on increased health services use and long-term services and support. Chiropractic is one type of treatment used by older adults with these types of health problems. Covered by Medicare since 1972, chiropractic spinal manipulation is allowed for the express purpose to arrest the progression of functional decline or restore and possibly improve patient function. No studies, however, have examined whether chiropractic use by Medicare beneficiaries has indeed arrested functional decline, delayed disability, or restored health. The purpose of this dissertation research is to examine the comparative effectiveness of chiropractic use relative to no treatment and alternative medical care on the health and functional trajectories of community-dwelling older adults. I also examine the comparative effect of chiropractic on satisfaction with care. This is accomplished through the use of two longitudinal surveys with representative Medicare populations linked to Medicare provider claims. The first analysis examines the long-term comparative effect of chiropractic relative to no use and alternative care on functional decline, self-rated health decline, and the onset of additional depressive symptoms in a cohort of older Medicare beneficiaries, both with and without back conditions. The second study examines the effect of chiropractic compared to medical only episodes of care on health and functional decline in an older adult population with uncomplicated back conditions over a two-year period. The third and final study examines the comparative effect of chiropractic relative to medical care only on one-year changes in function, self-rated health, and satisfaction with care in a nationally representative age-eligible Medicare population with spine-related musculoskeletal conditions. Study results suggest that chiropractic has a consistently protective effect when compared to routine alternative medical care against decline in function among older adults with spine-related conditions, both over the long-term and the short-term. Chiropractic also has a comparative protective effect against decline in self-rated health in the short-term, but has no differential effect on the onset of depressive symptoms either in the short-term or long-term . Medicare beneficiaries using chiropractic for spine-related health conditions are relatively more satisfied than those using medical care only with the information provided to them about their condition, and with follow-up care provided after the initial visit. This research is the first of its kind to examine the comparative effectiveness of chiropractic relative to other usual sources of care for Medicare beneficiaries, in general and specifically among those with spine-related conditions, finding that chiropractic use has a comparatively beneficial effect on function, health, and satisfaction with care. The results have important policy implications for clinicians, patients, and Medicare because of the potential to shift clinical practice away from technologically intense and expensive treatments toward therapies like chiropractic spinal manipulation that demonstrate a comparative advantage in preserving health and function among older adults.

There is still a debate concerning the evidence base for community interventions. The randomised clinical trial design (RCT) is increasingly challenged as a gold standard for their evaluation. This thesis takes the Norsjö health programme in Västerbotten as the starting point for a discussion about the ethical platform of community interventions and for exploring the role of self-rated health. The specific objectives are: 1) to better understand barriers to community participation and to assess the role of ethical premises among decision-makers, 2) to explore how health related norms and attitudes interact with self-rated health and the risk factor outcome of an intervention and 3) to analyse the gender and socio-cultural interplay of self-rated health with biomedical risk factors for cardiovascular disease. The participation and views of different actors in the planning and implementation phases of the intervention were studied by contrasting information between official documents, interviews with decision makers and professionals and questionnaires to community members. The role of basic values in setting priorities and choosing intervention strategies utilised a questionnaire design with hypothetical scenarios sent to a representative sample of Swedish health care politicians. Qualitative research interviews were used to explore health related norms and attitudes. Health examination measurements and questionnaire data formed the basis for analysis of the development of self-rated health and risk factor load during a 10-year follow-up of the intervention. Access to a stroke registry enabled a case-referent approach for studying the interaction between bio-medical risk factors, socio-demographic factors and self-rated health. Data from the Västerbotten Intervention Programme (VIP) could be utilised for a cross-country comparison with a “sister project” in Otsego, U.S.A. The results point to both strengths and limitations of the efforts made to involve people in the intervention. The problem definition mainly remained with the professionals and participation as a goal in itself, strengthening local democracy was felt to be an exaggerated ambition. However, there was an overall agreement about the seriousness of the health problem, the need to intervene and about the implementation mode. Self-rated health and reported behavioural change were important indicators of participation and young men with bad health seemed to have been least involved. Among Swedish health care politicians there was an overall agreement to allocate resources for prevention directed towards communities when there are serious health problems. The majority preferred an intervention strategy that involved primary health care. The risk of harm by creating some degree of anxiety or stigma was for many considered an acceptable drawback of a successful intervention. The follow-up study revealed a positive risk factor reduction accompanied by a positive development of self-rated health, especially for men. Additional support for an intervention effect was given through a comparison with a reference area. The interaction pattern between risk reduction and self-rated health was more polarised for men than for women, with a corresponding pattern for the lower compared to the higher educated. These results could be linked to a transition in the health related norm system and to “ideal types” representing attitudinal sets towards the intervention. The case-referent analysis suggested an interaction effect between self-rated health and bio-medical risk factor load in predicting stroke that was greater for men than for women. The cross-country comparison revealed a stronger influence of education in the U.S.A. The lower educated, with a high risk load, had a greater risk of self-rated poor health than their Swedish counterparts. The thesis suggests that self-rated health is an unexplored indicator, potentially important for understanding the complexity of community interventions. Self-rated health may predict disease development as well as modify the impact of established risk factors.

This dissertation aims to describe social inequalities in self-rated health in an integrated framework of gender, social class and immigration, and to identify the main intermediary factors and health problems that contribute to these inequalities. Three cross-sectional studies were performed with data from surveys of the general population residing in Catalonia and Spain in 2006. Migration from poor regions of Spain to Catalonia emerged as a health inequality dimension in addition to and interaction with gender and social class, highlighting the transitory nature of the ‘healthy immigrant effect’ partially observed in foreign immigrants. Material and economic resources made major contributions to all three types of health inequalities: individual income made the greatest contribution to gender inequalities; household material assets and financial difficulties to migration-related inequalities; and both to social class inequalities. Poorer self-rated health of women was showed to be not an issue of perception but a precise reflection of the higher burden of chronic conditions they suffered compared to men, such as musculoskeletal, mental and other pain disorders, which could be targets for a health system responsive to gender inequalities. Intersections between axes of inequality created complex social locations with unique consequences on health.

Fysisk aktivitet har positiv effekt på den självskattade hälsan, där motivationsgraden har stor betydelse till att utöva fysisk aktivitet. Syftet med föreliggande uppsats är att studera hur fysiskt aktiva personer skattar sin hälsa. Vidare undersöks sambandet mellan skattad hälsa och motivation samt skattad hälsa och antalet träningstillfällen. Dessutom undersöks sambandet mellan skattad hälsa och hinder till träning samt känsla inför, under och efter träningspass. En enkätundersökning genomfördes på ett gym i västra Sverige och totalt besvarade 244 fysisk aktiva individer enkäten. Data analyserades statistiskt med hjälp av dataprogrammet SPSS. Resultaten visade att alla deltagarna som tillhörde gruppen ”över fyra träningstillfällen per vecka” hade en självskattad hälsa på nivån ”God”, ”Mycket god” eller ”Utmärkt”.   Faktorn ”Antalet träningstillfällen” var positivt relaterat till självskattad hälsa. Deltagarna i studien som kategoriserades till ”Sämre självskattad hälsa” instämde i högre grad till påståendena i enkäten som handlade om ”Hinder till träning” jämfört med de som kategoriserades till hinder som finns för de individer som är fysisk inaktiva. Även att undersöka varför somliga människor påverkas av vissa motivationsfaktorer och varför en del inte påverkas av dem alls. Genom att inspirera och motivera fysisk inaktiva personer med tillfredställande hälsofrämjande insatser kan hälsotillståndet förbättras och på lång sikt kan folkhälsan i landet öka. / Physical activity has a positive effect on self-rated health, where motivation level may be important to physical activity. The purpose of this paper is to study how physically active people rate their health. Further investigated the relationship between the assessed health and motivation, and assessed health and number of training sessions. In addition, examined the relationship between the assessed health and barriers to exercise and feel before, during and after workouts. A survey was carried out at a gym in western Sweden and a total of 244 physical active individuals answered the questionnaire. Data were    analyzed statistically using the computer program SPSS. The       results of this study showed that all of the participants who belonged to the group “Over four times per week” expressed a self-rated health at the level of “Good”, “Very good” or “Excellent”. The factor “Number of training sessions” was positive related self-rated health. Study participants with “Poor self-rated health” agreed in a greater extent to the allegations contained in the survey which focused on “Barriers to exercise” compared to those who had a “Better self-rated health”. Further research should examine what barriers exist for those individuals who are physically inactive. Further research should also study why some people are affected by some motivators and why some people are not affected by them at all. By inspiring and motivating physical inactive persons with satisfactory health promotion interventions can improve health status and long- term health of the country increase.

Tyrimo tikslas – nustatyti reabilitacijos ligoninėje po širdies ir kraujagyslių ligų gydomų pacientų subjektyvios sveikatos sąsajas su gyvenimo prasme ir socialiniu palaikymu sociodemografinių veiksnių kontekste. Eiga. Tyrime dalyvavo 172 tiriamieji (vyrai: n=91 (52,9 %), moterys: n=81 (47,1 %), amžiaus intervalas: 40 – 88 metai (vidurkis 67,9, st.n. 10,954)), LSMUL KK filialo Viršužiglio reabilitacijos ligoninės pacientų, besigydančių šioje ligoninėje po širdies ar kraujagyslių ligų. Tyrimo rezultatai parodė, kad subjektyvi sveikata statistiškai reikšmingai susijusi su psichologiniais veiksniais: gyvenimo prasmingumo turėjimu (p(0,000) < 0,05), sociodemografiniais veiksniais: socialiniu palaikymu (p(0,038) < 0,05), darbiniu statusu (p(0,011) < 0,05). Subjektyvios sveikatos ryšys su kitais veiksniais (gyvenimo prasmės ieškojimu, lytimi, amžiumi, gyvenama vieta, šeimynine padėtimi, išsilavinimu, turimų vaikų skaičiumi, ligos pobūdžiu) statistikai nereikšmingas (p > 0,05). Nustatyta, kad geresnę subjektyvią sveikatą gali lemti tai, jog tiriamasis yra dirbantis, mažiau ieško gyvenimo prasmės ir daugiau jos jau turi (p < 0,05). / The aim of the study was to establish rehabilitation hospital cardiovascular recovery patients subjective health links to the meaning of life and social support in the context of socio-demographic factors. The subjects of the study were 172 rehabilitation hospital cardiovascular recovery patients (men: n=91 (52,9 %), women: n=81 (47,1 %), age: 40 – 88 years (mean 67,9, st.d. 10,954)). Study was carried out in Hospital of Lithuanian University of Health Sciences Kaunas Clinics Virsuziglis Hospital of Rehabilitation. The results of the study showed that the subjective health significantly associated with psychological factors: the meaning of life presence (p (0,000) < 0,05), and sociodemographic factors: social support (p (0,038) < 0,05), working status (p (0,011 ) < 0,05). Subjective health link with other factors (meaning of life searching, gender, age, place of residence, marital status, education, number of children, the nature of the disease) is statistical insignificant (p > 0,05). It was found that better subjective health may lead to the fact that the patients are working, less searching the meaning of life and the more they already have (p < 0,05).

Made available in DSpace on 2014-07-29T15:04:46Z (GMT). No. of bitstreams: 1 dissertacao valeria pagotto.pdf: 851386 bytes, checksum: b69b53b1c7c85fd7e5c4a211e5bef9ef (MD5) Previous issue date: 2009-12-15 / Self-rated health is one of the most widely used indicators in studies of the elderly population. There is evidence of its reliability and its potential in predicting mortality and functional decline. The perception of health is a multidimensional and subjective individual, who usually consider a number of factors when considering their own health. The aim of this study was to estimate the prevalence of self-rated poor health and associated factors in elderly users of the Unified System of Health, Goiânia-GO. This is a cross-sectional population-based, with individuals 60 years or more. Data were collected from December 2008 to March 2009. Applied a standardized questionnaire including socioeconomic, demographic, health and lifestyle. Self-rated health was dichotomized in self-rated good health (very good / good / fair) and bad (poor / very poor). Analysis was descriptive of the study variables and the relationship between self-rated poor health and the covariates were explored through the prevalence ratio (PR) and respectives CI 95%. Multivariate analysis was performed using Poisson regression with hierarchical analysis. Were included in this analysis the variables with value p <0.20. The tests were performed in STATA 9.0. We interviewed 403 elderly and 66% were female, 29.8% aged 65 to 69, 28.8% with less than 1 year of study and 56.1% of elderly living with a partner. Self-rated poor health was reported by 27.5% of the elderly, with higher prevalence among women (29.7%) and aged 60-64 years (29.1%). In the bivariate analysis the factors associated with self-rated poor health were: living without a partner, have 3 or more conditions, have Diabetes Mellitus and Musculoskeletal Disease, was hospitalized last year, making use of 5 or more drugs and no physical activity or sport. Observing the estimates of effect, the highest prevalence ratios were: no physical activity (RP= 2.17, 95% CI 1.44-3.66), musculoskeletal diseases (RP = 1.84, 95% CI 1.26-2.68), hospitalization in the last year (RP = 1.62, 95% CI 1.10 - 2.41), diabetes (RP = 1.52, 95% CI 1.02 to 2.27).The results of this study confirm that several factors are associated with poor self-rated health. However, among elderly users of SUS in Goiania, self-evaluation is strongly associated with health conditions. Starting from the assumption that this indicator can help in objective assessment of the health status of older people, this knowledge can help steer the formulation of policies to promote health and quality of life. / A auto-avaliação do estado de saúde é um dos indicadores mais empregados em estudos com a população idosa. Existem evidências de sua confiabilidade e de seu potencial na predição da mortalidade e do declínio funcional. A percepção da saúde representa uma visão multidimensional e subjetiva do individuo, que costuma considerar uma série de fatores quando analisam sua própria saúde. O objetivo deste estudo foi estimar a prevalência da auto-avaliação do estado de saúde ruim e seus fatores associados em idosos usuários do Sistema Único de Saúde de Goiânia-GO. Trata-se de um estudo transversal, de base populacional, com idosos de 60 anos ou mais. Os dados foram coletados no período de dezembro de 2008 a março de 2009. Aplicou-se questionário padronizado incluindo variáveis socioeconômicas, demográficas, condições de saúde e estilo de vida. A auto-avaliação de saúde foi dicotomizada em auto-avaliação de saúde boa (muito boa/boa/regular) e ruim (fraca/péssima). Realizou-se análise descritiva das variáveis do estudo e as associações entre auto-avaliação do estado de saúde ruim e as co-variáveis foram exploradas através da Razão de Prevalência (RP) e respectivos IC 95%. A análise multivariada foi realizada por meio da Regressão de Poisson hierarquizada. Foram inseridas nesta análise as variáveis com p<0,20. As análises foram realizadas no STATA 8.0. Foram entrevistados 403 idosos sendo 66% do sexo feminino, 29,8% na faixa etária de 65 a 69 anos, 28,8% com menos de 1 ano de estudo e 56,1% de idosos vivendo com companheiro. A auto-avaliação do estado de saúde ruim foi referida por 27,5% dos idosos, com maior prevalência entre as mulheres (29,7%) e na faixa etária de 60-64 anos (29,1%). Na análise bivariada a os fatores associados à auto-avaliação do estado de saúde ruim foram: viver sem companheiro, ter 3 ou mais morbidades, ter Diabetes Mellitus e Doenças Osteomusculares, ter sido internado no último ano, fazer uso de 5 ou mais medicamentos e não praticar atividade física. Observando as estimativas de efeito, as maiores Razões de Prevalência foram: não praticar atividade física (RP=2,17; IC95% 1,44 3,66), doenças osteomusculares (RP=1,84; IC95% 1,26 2,68), internação no último ano (RP=1,62; IC95% 1,10 2,41) e Diabetes Mellitus (RP=1,52; IC95% 1,02 2,27). Os resultados deste estudo mostram que vários fatores estão associados à auto-avaliação ruim da saúde. No entanto, entre os idosos usuários do SUS em Goiânia, a auto-avaliação de saúde ruim está fortemente associada com as condições de saúde. Partindo-se do pressuposto que este indicador pode auxiliar na avaliação objetiva do estado de saúde dos idosos, este conhecimento pode contribuir para a orientação e formulação de políticas que visem promover a saúde e a qualidade de vida dos idosos.

Made available in DSpace on 2014-08-20T13:57:56Z (GMT). No. of bitstreams: 1 Dissertacao_Giovanny_Vinicius_Araujo_de_Franca.pdf: 1350290 bytes, checksum: f64656537fb2ed84aef7bef88c09c3df (MD5) Previous issue date: 2010-11-05 / Objective: To estimate the prevalence of episodes of Binge Eating (BE) and to assess potential associations with nutritional status, satisfaction with current body weight, selfrated health status (SRHS) and body weight. Method: A cross-sectional populationbased study was carried out in the city of Pelotas, southern Brazil, with a sample of 2,097 individuals aged 20-59 years. BE was assessed through a questionnaire and defined as binging one or more times over the last three months before the interview. Results: The prevalence of BE and recurrent BE was 7.9% and 2.7%, respectively. In the adjusted analysis, obesity, fair/poor SRHS and body dissatisfaction remained strongly associated with BE. Discussion: This study showed a high prevalence of BE among adults in Pelotas, and its higher among younger women, fat and those who desire to weigh less. The current results are informative, but longitudinal studies would be needed to demonstrate the causal relationship between these events. / Objetivo: estimar a prevalência de episódios de compulsão alimentar (BE) e para avaliar as possíveis associações com estado nutricional, satisfação com o peso corporal atual, o estado de saúde autoavaliados (SRHS) e peso corporal. Método: Estudo transversal populacional realizado na cidade de Pelotas, sul do Brasil, com uma amostra de 2.097 indivíduos com idade entre 20-59 anos. BE foi avaliada através de um questionário e definido como compulsão uma ou mais vezes nos últimos três meses anteriores à entrevista. Resultados: A prevalência da BE e recorrente BE foi de 7,9% e 2,7%, respectivamente. Na análise ajustada, obesidade, SRHS justas / pobres e a insatisfação corporal permaneceu fortemente associada com a BE. Discussão: Este estudo mostrou uma elevada prevalência de CA entre adultos em Pelotas, e sua maior entre as mulheres mais jovens, gordura e aqueles que desejam pesar menos. Os resultados atuais são de caráter informativo, mas estudos longitudinais seriam necessários para demonstrar a relação causal entre esses eventos.

This thesis examines two aspects of social inequalities in health with three empirical studies that are based on the Swedish Level of Living survey (LNU): The relationship between accumulated occupational class positions during adulthood and health and the class-specific nature of gender differences in health. Previous research continuously finds that there are health differences by class and gender, but less is known about the extent to which accumulated class experiences in adulthood are related to health or how gender differences vary by class. The overall conclusion in this thesis is that occupational class experiences matters for health, both as historical and current experiences. Furthermore, the results highlight the importance of taking class into consideration when examining health differences between men and women, as the mechanisms that underlie the gender gaps in health are not necessarily the same for all classes. The studies can be outlined as: Study I: Class differences in working conditions is a mechanism that underlies class inequalities in health. The working class is generally more exposed to adverse working environments than non-manual employees, and when the wear and tear of these conditions accumulate over time, the length of this exposure may contribute to class inequalities in health. Thereby, accumulated time in the working class is studied as a partial explanation for class differences in health. The results suggest that the duration of time in the working class is related to a higher probability of less than good self-rated general health (SRH), given current class position. This association was also found among individuals who were no longer in working class positions and thus show that duration of experience matters, both as current and past experience. Study II: The study addresses the research gap of class-specificity in gender health inequality and seeks to further disentangle class and gender by studying gender gaps separately by class. The results show that there are class-specific gender gaps for both SRH and musculoskeletal pain, while the gender gap in psychiatric distress appears to be more general across class. Working conditions do not explain the between-class differences in gender gaps but contribute to specific gender differences in health within classes. Study III: The labour market has changed over time and has “upgraded” the class structure while at the same time the share of women in paid employment has increased. Therefore, female health may be increasingly influenced by occupational factors, such as working conditions. This study explores the class-specific nature of gender differences and investigates musculoskeletal pain and working conditions among employed men and women within classes during a time-period that spanned more than 30 years. There were class-specific gender gaps in health throughout the period. The gender gap has increased more, and is wider, among non-manual employees compared to the working classes. This development could not be explained by changes in working conditions. / <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>

This thesis deals with self-rated health and consumption of fruits and vegetables in the Czech part of the HAPIEE study. The recommended amount of 400 g of fruit and vegetable consumption was met at 49,2% of men and 70,1% of women participating in the study. In the case of a higher 600 g recommendation it was 23,3% men and 42,6% women. The relationship between self-rated health and fruit and vegetable consumption was analyzed using the logistic regression method. Health was better assessed by those who consumed fruits and vegetables in the interval of 258-549g (2nd and 3rd quintiles of fruit and vegetable consumption). Those who consumed less or more fruits and vegetables rated their health worse. There were no differences in the relationship between self-rated health and consumption of fruits and vegetables among the sexes, although men had a higher chance of rating their health as bad than women. Key words: self rated health, fruit and vegetable intake, fruit, vegetable, regression