Användandet av timanställning har ökat i flera arbetsbranscher, bland annat inom äldreomsorgen. Det är vanligare med lägre självskattad hälsa inom lågavlönade kvinnodominerade yrken, exempelvis vård- och omsorg i jämförelse med mansdominerade yrken. Många studier har undersökt samband mellan olika former av osäkra anställningar och en rad hälsoutfall, men få studier har undersökt enbart timanställdas självskattade hälsa. Syftet med denna studie är således att undersöka associationen mellan självskattad hälsa och anställningsform, samt associationen mellan självskattad hälsa och föredragen anställningsform bland anställda inom äldreomsorgen. Studien är en kvantitativ metod med tvärsnittsdesign och registerdata användes från forskningsprojektet Flexibelt Arbete (Flexa-A) i Högskolan Gävle. Urvalet bestod av 302 timanställda och 110 fast anställda inom äldreomsorgen i Sverige. En ojusterad och justerad logistisk regressionsanalys genomfördes, den justerade analysen inkluderar förväxlingsvariablerna; kön, ålder, ursprung, rökvanor och fysisk aktiv på fritiden. Resultatet från den ojusterade modellen visade att timanställda hade ungefär 3 gånger  högre odds att skatta sin hälsa högre än fast anställda  (P= 0,001, OR = 3,062) och efter justering visade modellen att timanställda hade fortfarande högre självskattad hälsa än fast anställda. Däremot identifierades inget samband mellan föredragen anställning och självskattad hälsa (P=0,9). Slutsatsen var att timanställda inom äldreomsorgen hade högre självskattad hälsa än fast anställda, däremot finns det inga skillnader i självskattad hälsa mellan timanställdas föredragna anställningsform. Eftersom att användningen av timanställning ökar inom olika arbetsbranscher, är det av vikt att fortsätta studera kring timanställdas självskattade hälsa och om det finns skillnader inom olika yrkesgrupper. / The use of zero hours contracts has increased in several workplaces including elderly health care. It is more common to have lower self- rated health in low-paid female-dominated workplaces, such as in health care, compared to male-dominated workplaces. Many studies have investigated the associations between various forms of job insecurity and a range of health outcomes, but few studies have specifically examined the self-rated health of zero hours contracts. Therefore, the aim of this study is to investigate the association between self-rated health and employment type, as well as the association between self-rated health and preferred employment among employees in elderly care.  The study is a quantitative method with a cross-sectional design and uses register data collected from research project Flexible work: Opportunity and Challenge (FLOC) at the University of Gävle. The sample included 302 zero hours contract employees and 110 permanent employees in elderly care. An unadjusted and adjusted logistic regression analysis were conducted; the adjusted model included the confounding variables: gender, age, origin, smoking habits and physical activity during leisure time. The result from the unadjusted model showed that employees with zero hours contract had 3 times higher odds of rating their health as high compared to permanent employees (P= 0,001, OR = 3,062), and after adjustment the model showed that zero hours contracts still had higher self-rated health than permanent employees. While there was no association between preferred employment and self- rated health (P=0,9). The conclusion was that employees with zero hour contracts in elderly care had higher self-rated health then permanent employees, and there are no differences in self-rated health between zero hours contracts employees preferred form of employment. Since the use of zero hours contracts is increasing within different work industries, it important to continue studying zero hours contract employees’ self-rated health.

Leaders engaging in controlling leadership behaviours (CLB) has been connected to followers perceiving their basic needs thwarted. However, little research has been made in the organizational field to understand the implications of controlling leadership behaviours for employee well-being. The present study aimed to clarify this relation through understanding controlling leadership behaviours’ influence on employee health, as well as investigate the impact of both leader and employee gender on employees’ perception of  controlling leadership behaviours. A sample of 818 employees, representing the Swedish labour market, completed a questionnaire including measures of perceived controlling leadership behaviours and well-being in terms of self-rated health, burnout, self-rated job satisfaction and vigour. Results confirmed the notion that leaders’ controlling leadership behaviours, like other negative leadership behaviours, is associated with lowered well-being. Results also indicate that male employees perceive male leaders as more controlling than female employees do, while female leaders are perceived as equally controlling by both male and female employees. The gender of leaders exhibiting controlling leadership behaviours seem to have no association with employee well-being. The implications of gender on controlling leadership behaviours is still a question unanswered. Future studies should therefore continue exploring both leader and employee gender influence on CLB. / Ledare som använder sig av kontrollerande ledarskapsbeteenden har visat sig underminera basala psykologiska behov hos sina följare. Trots detta saknas det forskning på hur chefers kontrollerande ledarskapsbeteenden påverkar anställda. Denna studie syftade till att klargöra hur kontrollerande ledarskapsbeteenden påverkar anställdas hälsa, och undersöka hur såväl anställdas kön och chefens kön påverkar de anställdas uppfattning av chefens kontrollerande ledarskapsbeteenden. Ett randomiserat urval på 818 arbetstagare svarade på frågor om uppfattat kontrollerande ledarskapsbeteenden hos sin chef och självskattad hälsa i termer av självskattad hälsa, utbrändhet, arbetstillfredsställelse och arbetsenergi. Resultaten bekräftade att kontrollerande ledarskapsbeteenden hos chefer är relaterat till sämre hälsa och arbetsprestation hos de anställda, samt ökar viljan att sluta. Manliga anställda uppfattar manliga chefer som mer kontrollerande jämfört med sina kvinnliga kollegor, medan kvinnliga chefer uppfattas lika kontrollerande av både manliga som kvinnliga anställda. Den kontrollerande chefens könstillhörighet var inte associerat med anställdas mående. Hur könsaspekter påverkar kontrollerande ledarskapsbeteenden är fortfarande inte klarlagt. Framtida studier bör därför fortsätta undersöka hur både chefens och den anställdas kön influerar CLB.

Background: Cheap and effective tools for measuring patients’ physical activity (PA) level are needed. The first aim in this thesis was therefore to assess the validity of two PA -questions, and their three associated answer modes, that are used within the Swedish health care system. Sitting, light intensity PA (LIPA), and moderate and vigorous intensity PA (MVPA), are associated with health and longevity, but detailed population data assessed with objective methods is needed. The second aim was thus to assess the above with motion sensor technology, in a middle-aged Swedish sample. Low self-perceived health is a strong predictor of morbidity and mortality, but this association may vary over time with changes in the society and our lifestyle. The third aim was to assess secular trends in the interrelations between self-perceived health, physical fitness, and selected covariates. The effects of PA on prescription (PAP) on health-related quality of life (HRQoL) in overweight adults are unclear, thus the fourth aim was to explore this. Methods: All data was collected in the Swedish population. Data from the PA -questions and accelerometers, aerobic fitness, counter movement jump, and balance tests, blood samples, and self-rated general health were collected in 365 participants, 21–66 yrs. The PA pattern was assessed in 948 individuals, 50‒64 yrs, from the SCAPIS pilot study. Self-perceived physical health, and measured aerobic fitness, counter movement jump height, and balance, and demographic and lifestyle data, was assessed in three independent samples from 1990, 2000 and 2013, including 3564 adults, 20‒65 yrs. The effects of Swedish PAP on HRQoL was assessed in a randomized controlled trial including 101 men and women, 67‒68 yrs, that were inactive, overweight (BMI>25 kg/m2), and had a waist circumference ≥102 cm (men) or ≥88 cm (women), who were randomized to an intervention group or a control group. The 36-item Short Form Health Survey (SF-36) was used to assess HRQoL. Results: The multiple choice answer mode of the two PA -questions was found to have the strongest validity, compared with the two other (an open mode, and one where PA minutes is specified per weekday). The validity is in line with many other established PA-questionnaires, but the open mode has limitations. The assessment of PA pattern showed that 61% of motion sensor wear time represented sitting, 35% LIPA, and 4% MVPA. Only 7% of the sample met the PA recommendations. The odds for describing perceived health as good was found to increase by 5% per each increment of 1 ml/kg/min in VO2max. This was stable across genders and all three LIV-samples (i.e. over time). Waist circumference, chronic disease, sleep problems, and level of satisfaction with one’s life, were also important correlates. The Swedish PAP group improved significantly more, and more participants displayed clinically relevant improvements (OR 2.43), in mental aspects of HRQoL, compared to the controls. Physical aspects of HRQoL improved in the PAP group, but not in the control group. Conclusions: The multiple choice answer mode has the strongest validity and Open mode the weakest. The PA -questions may be used in populations, or in individuals to determine appropriateness for treatment. The questions’ advantages and limitations must be considered and further reliability and validity studies are needed. The results regarding sitting, LIPA, MVPA and fulfillment of PA recommendations, are of high clinical relevance. A great challenge remains to further implement methods to increase the level of PA in the Swedish population. Physical fitness is related to self-perceived health independently of changes in society and lifestyle over time, and simple questions may be useful for the clinical assessment of physical fitness. Swedish PAP has a positive effect on mental aspects of HRQoL, measured by the SF-36. This finding supports the clinical use of the Swedish PAP model. / LIV 2013

Syfte Syftet med denna studie var att undersöka samband mellan utbildning, civilstånd och inkomst gentemot upplevd fysisk och psykisk hälsa. Metod Undersökningen är en kvantitativ enkätstudie där totalt 525 individer ingick framförallt från Lidingö, Täby, Haninge, Östermalm och Solna. Åldern på individerna varierade mellan 37 och 89 år och medelåldern var 70,3 år (± 6,6), där cirka en tredjedel var män och två tredjedelar kvinnor. Samtliga har fått besvara frågor med fasta svarsalternativ kring deras upplevda fysiska (kroppslig) samt psykiska (själslig) hälsa och faktorerna inkomst, civilstånd samt utbildningsnivå. Därefter analyserades resultaten för att finna eventuella samvariationer mellan den upplevda hälsan och de specifika faktorerna. Samtliga deltagare har själva ansökt om att få vara med i ett projekt kring hälsa i Gymnastik- och idrottshögskolans regi. Resultat Signifikanta samvariationer fanns mellan upplevd fysisk och psykisk hälsa samt civilstånd där hög hälsa korrelerade med att leva i ett förhållande. I förhållande till inkomstnivå fanns tendenser till samband (dock utan signifikans) där en viss ökning av den upplevda fysiska samt psykiska hälsan noterades för varje inkomstintervall (låg, medel och hög), i synnerhet gentemot den psykiska hälsan. Utbildningsfaktorn visade inga signifikanta samband med grad av upplevd hälsa bland deltagarna. Slutsats Studiens hypotes om en positiv samvariation mellan den upplevda hälsan och samtliga tre livsfaktorer visade sig inte stämma fullt ut för denna grupp med företrädesvis äldre. Den faktor som signifikant korrelerade med upplevd hälsa var civilstånd. Även inkomst visade sig ha tendensen (dock ej signifikant) till ett visst samband med de skattade hälsoparametrarna för den undersökta gruppen. Det är möjligt, med använda arbetsmetoder, att starkare samband skulle fås fram på ett mer slumpmässigt urval av befolkningen. Studien ställer jämväl nya frågor om huruvida sambandet för undersökta faktorer i förhållande till upplevd hälsa eventuellt skiljer sig för olika åldersgrupper.

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.