Background Patients who experience a stroke or transient ischemic attack (TIA) are at high risk of recurrent stroke, but little is known about temporal trends in unselected populations. Reports of low adherence to recommended treatments indicate a need for enhanced secondary preventive follow-up to achieve the full potential of evidence-based treatments. In addition, socioeconomic factors have been associated with poor health outcomes in a variety of contexts. Therefore, it is important to assess the implementation and results of secondary prevention in different socioeconomic groups. Aims The aims of this thesis were to assess temporal trends in ischemic stroke recurrence and evaluate the implementation and results of a nurse-led, telephone-based follow-up program to improve blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) levels after stroke/TIA. Methods In study I, we collected baseline data for unique patients with an ischemic stroke event between 1998 and 2009 (n=196 765) from the Swedish Stroke Register (Riksstroke). Recurrent ischemic stroke events within 1 year were collected from the Swedish National Inpatient Register (IPR) and the cumulative incidence was compared between four time periods using the Kaplan-Meier survival analysis and the logrank test. Implementation (study II) and 1-year results (study III-IV) for the secondary preventive follow-up were studied in the NAILED (Nurse-based Age-independent Intervention to Limit Evolution of Disease) study. Between 1 Jan 2010 and 31 Dec 2013, the baseline characteristics of consecutive patients admitted to Östersund Hospital for acute stroke or TIA were collected prospectively (n=1776). Consenting patients in a condition permitting telephone-based follow-up were randomized to nurse-led, telephone-based follow-up or follow-up according to usual care. Follow-up was cunducted at 1 and 12 months after discharge and the intervention included BP and LDL-C measurements, titration of medication, and lifestyle counseling. In study II, we analyzed factors associated with non-participation in the randomized phase of the NAILED study, including association with education level. In addition, we compared the 1-year prognosis in terms of cumulative survival between participants and non-participants. In study III, we compared differences in BP and LDL-C levels between the intervention and control groups during the first year of follow-up and, in study IV, in relation to level of education (low, ≤10 years; high, >10 years). Results The cumulative 1-year incidence of recurrent ischemic stroke decreased from 15.0% to 12.0%. Among surviving stroke and TIA patients, 53.1% were included for randomization, 35.7% were excluded mainly due to physical or cognitive disability, and 11.2% declined participation in the randomized phase. A low level of education was independently associated with exclusion, as well as the patient’s decision to abstain from randomization. Excluded patients had a more than 12-times higher risk of death within 1 year than patients who were randomized. After 1 year of follow-up, the mean systolic BP, diastolic BP, and LDL-C levels were 3.3 mmHg (95% CI 0.3 to 6.3), 2.3 mmHg (95% CI 0.5 to 4.2), and 0.3 mmol/L (95% CI 0.1 to 0.4) lower in the intervention group than among controls. Among participants with values above the treatment goal at baseline, the differences in systolic BP and LDL-C levels were more pronounced (8.0 mmHg, 95% CI 4.0 to 12.1; 0.6 mmol/L, 95% CI 0.4 to 0.9). In the intervention group, participants with a low level of education achieved similar or larger improvements in BP and LDL-C than participants with a high level of education. In the control group, BP remained unaltered and the LDL-C levels increased among participants with a low level of education. Conclusion The 1-year risk of ischemic stroke recurrence decreased in Sweden between 1998 and 2010. Nurse-led, telephone-based secondary preventive follow-up is feasible in just over half of the survivors of acute stroke and TIA and achieve better than usual care in terms of BP and LDL-C levels, and equality in BP improvements across groups defined by education level. However, a large proportion of stroke survivors are in a general condition precluding this form of follow-up, and their prognosis in terms of 1-year survival is poor. Patients with a low education level are over-represented within this group and among patients declining randomization for secondary preventive follow-up.

Bakgrund: Upp till 25 % av alla barn har någon gång under uppväxten någon typ av uppfödningsproblem.  Begreppet uppfödningsproblem brukar innefatta någon form av svårighet med att suga, tugga och svälja och delas ofta in i olika kategorier beroende på symtombild eller tänkt orsak. Symtomen eller den möjliga orsaken får sedan avgöra hur man väljer att behandla problemet. Spektrumet är stort vid uppfödningsproblem, alltifrån svårigheter som inte leder till några egentliga hälsorisker för barnet till allvarliga svårigheter som leder till undernäring och behov av alternativ nutrition.                                         Syfte: Beskriva gruppen barn med uppfödningsproblem vars föräldrar sökt hjälp hos Specialist Barnavårdscentral (SpecialBVC) och att jämföra föräldrarnas upplevelse av problemet före respektive efter avslutad kontakt med denna. Även att undersöka om medicinska och sociala faktorer hos barnet och föräldrar eller olika vårdprocessmått hade samband med föräldrars upplevelse av uppfödningsproblemets svårighetsgrad efter avslutad kontakt.                                                                                                                      Metod: Deskriptiv, komparativ longitudinell studie på redan insamlat material.         Resultat: Det fanns en skillnad i upplevelsen av uppfödningsproblemets svårighetsgrad hos föräldrar efter avslutad kontakt med SpecialBVC. Analysen visade en signifikant positiv förändring av föräldrarnas upplevelse av problemets svårighetsgrad vid jämförelse före respektive efter avslutad kontakt med SpecialBVC. I populationen för den deskriptiva analysen hade 13  % av mödrarna depression och 17  % annan psykisk ohälsa. Många familjer (32 %) hade ett sviktande nätverk. Förekomst av dessa faktorer hos föräldrar vid uppfödningsproblem hos barn stöds i annan forskning.                                            Slutsats: Föräldrarna upplevde att uppfödningsproblemets svårighetsgrad minskade både för barnet och för familjen efter kontakt med SpecialBVC. En förklaring kan vara SpecialBVCs arbetssätt. För att kunna förstå patienten rätt och därmed kunna hjälpa behöver enligt Joyce Travelbee (1971) en relation uppstå mellan patient och behandlare. SpecialBVCs arbetssätt att genom hembesök med noggrann anamnesupptagning, planering av behandling utifrån familjens resurser samt uppföljning på det sätt som passar familjen ligger väl i linje med Joyce Travelbees Interaktionsteori. / Background: Up to 25 % of all children have at some time during childhood some type of eating difficulties. The concept of eating difficulties usually include some form of difficulty with sucking, chewing and swallowing. Eating difficulties are often divided into different categories depending on symptoms or the supposed cause. The symptoms or the possible cause to, decides how to treat the child. The spectrum is wide for eating difficulties, ranging from difficulties that do not lead to any real health risk, to severe difficulties leading to malnutrition and the need for alternative nutrition.                                                 Purpose: To describe the group of children with food problems whose parents sought help from specialist Child health (SpecialBVC) and comparing the parent's perception of food problems before and after completion of contact with SpecialBVC. Also see if the medical and social factors in the child and parent, and various health care processes measures related with the parent's perception of the difficulty of the food problem after finishing the contact. Method: Descriptive, comparative longitudinal study on the already collected material. Results: There was a difference in the experience of the severity of the food problem of parents after completing contact with SpecialBVC. This difference was significant. The study population had a high percentage of maternal depression or other mental illnesses. Many families had a failing network. These factors among parents supports the already done research on breeding problems in children.                                                        Conclusion: Parents perception of the severity of the food problem for both the child and family decreased after contact with SpecialBVC. One explanation may be SpecialBVCs approach that can be transferred in Joycee Travelbees interaction theory. To properly understand the patient seeking care, and thus able to help must first be a relationship-interaction occur. The result is a mutual contact and understanding that health care is based on forward.

Background Most environmental epidemiological studies are conducted in high income settings. The association between ambient temperature and mortality has been studied worldwide, especially in developed countries. However, more research on the topic is necessary, particularly in India, given the limited evidence on the relationship between temperature and health in this country. The average global temperature is increasing, and it is estimated that it will go up further. The factors affecting vulnerability to heat-related mortality are not well studied. Therefore, identifying high-risk population subgroups is of particular importance given the rising temperature in India. Objectives This research aimed to investigate the association of daily mean temperature and rainfall with daily deaths (Paper I), examine the relationship of hot and cold days with total and cause-specific mortality (Paper II), assess the effects of heat and cold on daily mortality among different socio-demographic groups (Paper III) and estimate the effect of maximum temperature on years of life lost (Paper IV). Methods The Vadu Health and Demographic Surveillance System (HDSS) monitors daily deaths, births, in-out migration and other demographic trends in 22 villages from two administrative blocks in the rural Pune district of Maharashtra state, in western India. Daily deaths from Vadu HDSS and daily weather data (temperature and rainfall) from the Indian Meteorological Department were collected from 2003 through 2013. Verbal autopsy data were used to define causes of death and classified into four groups: non-infectious diseases, infectious diseases, external causes and unspecified causes of death. Socio-demographic groups were based on education, occupation, house type and land ownership. In all papers, time series regression models were applied as the basic approach; additionally, in Paper III, a case-crossover design and, in Paper IV, a distributed lag non-linear model (DLNM) were used. Results There was a significant association between daily temperature and mortality. Younger age groups (0-4 years) reported higher risk of mortality due to high and low temperature and heavy rainfall. In the working age group (20-59 years), mortality was significantly associated only with high temperature. Mortality due to non-infectious diseases was higher on hot days (>39°C), while mortality from infectious diseases and from external causes were not associated with hot or cold days. A higher heat-related total mortality was observed among men than in women. Mortality among residents with low education and those whose occupation was farming was associated with high temperature. We found a significant impact of high temperature on years of life lost, which confirms our results from the previous research (Papers I-III). Conclusion The study findings broadened our knowledge of the health impacts of environmental exposure by providing evidence on the risks related to ambient temperature in a rural population in India. More specifically, the study identified vulnerable population groups (working age groups, those of low education and farmers) in relation to high temperature. The adverse effect of heat on population is preventable if local human and technical capacities for risk communication and promoting adaptive behavior are built. Furthermore, it is necessary to increase residents’ awareness and prevention measures to tackle this public health challenge in rural populations.

In accordance with structural theory and distributive justice theory, this study investigates if Americans' personal encounters with the opportunity structure and their existing reward conditions will influence their perceptions toward distribution outcomes in the U.S. I argue that higher-status individuals possessing various "attributes of structural privilege" will exhibit less support for regulating income inequality in society than lower-status individuals. Upward mobility should also be negatively related to support for restoring greater equality in allocation outcomes. However, the effect of mobility on justice perceptions should vary by class status, since class has been known to be a reliable predictor of these attitudes. The study employed a sample of 438 American adults from the GSS 2000 dataset, and ordinary least squares (OLS) regression was applied in the analyses of the data. Two of the three above hypotheses received partial confirmation, that is, there were class, race, and gender differences in distributive justice perceptions. Class also interacted significantly with occupational mobility in altering distributive justice perceptions.

This study examined a segment of the homeless population who participated in a jobs training program. The research investigated the effect of socioeconomic status, self-esteem, and locus of control on the clients in getting and keeping jobs. The training was a comprehensive 36-day treatment dealing with three major areas: (a) how to get a job, (b) how to keep a job, and (c) how to develop life-coping skills. A quasi-experimental research design was used for testing by t-tests, two-by-two repeated-measured anova, chi-square tests, and regression analysis. The findings showed that high socioeconomic status clients demonstrated higher self-esteem and internal locus of control than low socioeconomic status clients at the start of the treatment. The treatment had a significant effect on both groups with an increase in self-esteem and internal locus of control and a decrease in both external locus of control dimensions of powerful others and chance. The treatment had a greater effect on the low socioeconomic status clients than on the high socioeconomic status clients on increases in self-esteem and locus of control—internal. Both groups were successful in finding jobs, with 79% for high socioeconomic status clients and 74% for low socioeconomic status clients having jobs at the end of the treatment. Both high self-esteem and high socioeconomic status had a positive effect on the length of time over a sixmonth period following treatment that clients were able to maintain employment (job retention). This study must be considered largely as exploratory in its findings. Restrictions in the selection process prevented the results from being generalized. It does, however, provide a very important profile of a segment of the homeless population that can be useful in the research for new and improved methods of dealing with the problems of the homeless unemployed.

In the United States and many other countries, obesity is viewed as a public health crisis that must be handled. Many social and individual solutions to the problem are proposed in research and policy. On an individual level, many Americans try to get rid of their fat with a multitude of weight loss practices as part of a healthy lifestyle. Obesity rates, feelings towards fatness, and weight control behaviors are significantly affected by a number of sociocultural factors. In this project I explore the relationship between the desire to lose weight and weight control practices with income. Using data from the National Health and Nutritional Examination Survey (NHANES) 2009-2010 (N=4,341), I explore how income is associated with body satisfaction and weight control behaviors. I then examine if specific weight loss strategies differ by SES among those who have tried to lose weight (N=1,512). Results indicate that income impacts the desire to lose weight, weight loss attempts (OR=.778, CI=.663-.913), and some weight control strategies such as exercise (OR=1.392, CI=1.055-1.836), switching to lower calorie foods (OR=1.364, CI=1.027-1.813), and eating less fat to lose weight (OR=1.449, CI=1.094-1.919). However, other sociodemographic characteristics, such as education, gender, and race, played very important roles in predicting these behaviors. Overall, these findings suggest that an individual’s socioeconomic status influences feelings about one’s weight and what one does to change it, but it is only one piece of the puzzle. This study has several implications; most notably that one-size-fits-all obesity solution policy platform cannot be created if real changes are expected. Tailoring interventions to specific groups based on education and income are important to creating lasting change.

Background: The current adherence to colorectal cancer screening (CRCS) guidelines is suboptimal. How neighborhood characteristics, e.g., racial residential segregation (RRS), area-level socioeconomic status (SES) and physician composition, affect CRCS adherence are not fully understood. We assessed associations between facility proximity to RRS areas, area-level SES, physician composition, and CRCS adherence. Methods: Data sources included 2013 Minnesota Community Measurement, 2009-2013 American Community Survey, 2012 U.S. and 2012-2013 Washington State Behavioral Risk Factor Surveillance System data, and 2013-2014 Area Health Resource File. Logistic regressions and weighted multilevel logistic regressions were used to assess the association between facility proximity to RRS areas and CRCS adherence, and association between area-level SES, physician composition and CRCS adherence, respectively. Results: Facility proximity to RRS areas was positively associated with low CRCS performance, e.g., facilities located < 2 miles away from Hispanic-segregated areas were 3 times more likely to have low CRCS performance than those at ≥5 miles away (odds ratio (OR): 2.83, 95% confidence interval (CI): 1.29, 6.24). Most area-level SES measures showed negative bivariate associations between deprivation and colonoscopy/overall adherence, and measures such as education had relatively strong associations, although few of fully-adjusted associations remained statistically significant. Further, a one-unit increase in the percentage of gastroenterologists among physicians was associated with 3% increase in the odds of colonoscopy (OR: 1.03, 95% CI: 1.01-1.04) and overall adherence (OR: 1.03, 95% CI: 1.01-1.04) in the rural-metropolitan areas. Conclusions: Developing culturally tailored CRCS programs, increasing percentage of gastroenterologists, and targeting deprived communities may improve CRCS adherence.

Title: Socio-economic aspects of physical activities for seniors in Prague Objectives: The aim of study was to find out what are the socioeconomic aspects of walking and other physical activities Prague's population of seniors. Specifically find answers to questions, whether regular walk in this population affect the quality of life in old age, if those people bring motion standard from earlier stages of life, what are their motives for periodic walking, if they operate other physical activities than walking and whether is there a coherent categories of pedestrians. Methods: In this thesis were used quantitative and qualitative research methods. The source of quantitative analysis was the questionnaire WHOQOL OLD with a complementary inquiry on walking. The sample consisted of 156 respondents and was divided equally between pedestrians and non-pedestrians. There were used methods of descriptive statistics and statistical hypothesis testing. For qualitative analysis was with a part-respondents (pedestrians) made an interview, investigating their socioeconomic status, the motives for carrying out walking and other activities, and also was made their segmentation. Results: Statistically significantly higher quality of life (at 95% confidence level) in the domains of Independence, Filling, Nearby...

The study aims to identify the influence of socioeconomic factors on the prevalence of type 2 diabetes for individuals aged 27 and older in the Republic of Belarus. We analyze data from the Diabetes Survey conducted by the Endocrinology Medical Center in Minsk and the Ministry of Health of the Republic of Belarus from 2011 to 2015. The association between socioeconomic factors and the prevalence of type 2 diabetes is examined using logistic regression with sequential adjustments for clinical and behavioral predictors. Our findings indicate that individuals with lower income and educational levels are more likely to suffer from type 2 diabetes than those in higher income and education groups. Moreover, the prevalence of type 2 diabetes decreases as income and educational level go up. Furthermore, this association remains significant even after further adjusting for various behavioral and clinical factors. In addition, we confirm that type 2 diabetes is more prevalent among overweight / obese, physically inactive and older individuals. These findings suggest that strategies for preventive diabetes programs should be focused on socioeconomic environment rather than on individual risky behavior only.

This correlational study investigates traditional gender roles, self-efficacy for career and parenting, and socioeconomic status (SES), as they relate to university undergraduates’ planning for career and family and anticipation of work-family conflict regarding their future families. Unmarried, undergraduate women and men of varying socioeconomic status will complete an online survey consisting of several scales. Proposed results predict that women must often choose between career goals and family care, whereas men usually do not. Expectedly, women will show higher self-efficacy for parenting and increased anticipation of work-family conflict and planning for career and family compared to men. It is proposed that men will exhibit greater self-efficacy for career. Women of lower SES and women who aspire to obtain leadership positions at work will likely report higher anticipated work-family conflict. Those of lower SES will likely hold more traditional gender beliefs than the middle and upper SES groups, and men whose fathers helped in the home will likely have higher self-efficacy for their own parenting. The anticipated results indicate a discrepancy between men’s and women’s and those of differing SES’s planning for work and family. Women will tend to undertake an increased burden; however, a switch to more family-friendly workplace policies for men and women would likely help couples become more egalitarian in their division of family and career labor and planning.