Biomedical subjects

C H Lyttkens

Publications and source records attributed to C H Lyttkens.

9 recordsLinked to original sources

PubMed2004

Parental economic stress: evidence of an overlooked public health risk among Swedish families.

BACKGROUND: Studies have demonstrated that when parents shoulder considerable financial responsibilities, adverse health outcomes may occur. The present study assesses the association between economic stress and self-rated health in a sample of Swedish parents, and especially how this relation is affected by foreign origin and employment status. METHODS: A questionnaire was sent to a random sample of 5,600 individuals between the ages of 21 and 81 in Malmö, Sweden. The total response rate was 69%. Among the respondents, 824 were parents having at least one child living at home. The main exposures were such sociodemographic variables as country of origin and employment status, and economic stress. The outcome variable was self-rated health. RESULTS: Of the parents in the study, the 34.7% coded as exposed to economic stress showed a significantly increased odds ratio for poor self-rated health (OR=3.12, 95% CI: 2.01-4.84) adjusted for age and sex. After controlling for foreign origin and unemployment, the odds ratio remained statistically significant regarding exposure to economic stress (OR=1.94; 1.16-3.23). In the multivariate model, foreign origin and unemployment were also strongly associated with poor self-rated health (OR=1.78, 95% CI: 1.12-2.88; OR=1.67, 95% CI: 1.01-2.75, respectively). The adjusted population-attributable risk for poor self-rated health was estimated to be 27.4% for economic stress, 26.6% for foreign origin, and 16.7% for unemployment. CONCLUSIONS: Parental economic stress was associated with low self-rated health to a statistically significant degree, even when accounting for employment status and foreign origin. It, therefore, deserves to be seriously considered as an potential public health risk factor among Swedish families.

Adult↗

PubMed2002

Discounting and clinical decision making: physicians, patients, the general public, and the management of asymptomatic abdominal aortic aneurysms.

Clinical decisions often entail in intertemporal trade-off. Moreover, they often involve physicians of different specialities. In an experiment dealing with the management of small asymptomatic abdominal aortic aneurysms (a clinically relevant problem) we find that specialists in internal medicine exhibit higher implicit discount rates than vascular surgeons, general practitioners, and actual and prospective patients. Several personal characteristics expected to be directly related to pure time-preference and risk aversion (gender, smoking habits, age, place of employment) have the hypothesised effects. Additionally, financial incentives appear to affect the estimated implicit discount rates of physicians, but are unlikely to have caused the inter-group differences. Differences in discount rates could lead to variations in clinical practice, which may conflict with equality of treatment or equal access to health care.

Aged↗

PubMed1999

Preferences for equity in health behind a veil of ignorance.

Individual attitudes to distributions of life years between two groups in a society are explored by means of an experiment. Subjects are asked to place themselves behind a veil of ignorance which is specified in terms of risk (known probabilities) for some subjects and in terms of uncertainty (unknown probabilities) for some subjects. The latter is argued to be the appropriate interpretation of Rawls' notion. It is found that subjects exhibit convex preferences over life years for the two groups, and that preferences do not differ between the risk and the uncertainty specifications.

Attitude to Health↗

PubMed1998

Equity is out of fashion? An essay on autonomy and health policy in the individualized society.

It is widely recognized that there is a discrepancy between principle and practice with respect to the health equity aim of public policy. This discrepancy is analyzed from two theoretical perspectives: the individualization of society and the fact that individual beliefs and values are connected to one's position in the social structure. These mechanisms influence both the choice of health policy measures and the normative judgements of preventive efforts, both of which tend to be consonant with the views of dominant social groups. In particular, we focus on the treatment of the ethical principle of autonomy and how this is reflected in health policy aimed at influencing health-related behaviour. We examine the current trend towards targeting health information campaigns on certain socio-economic groups and argue that it entails an ethical dilemma. The dominant discourse of the welfare state is contemplated as a means to understand why there tend to be a lack of emphasis on measures that are targeted at socio-economic inequalities. It is argued that there is no substantive basis in the individualized society for perceiving health equity as an independent moral principle and that the driving force behind the professed health equity goal may be in essence utilitarian.

Ethics, Medical↗

PubMed1997

Decisions about treatment of aortoiliac claudication: the current practice among Swedish vascular surgeons.

OBJECTIVE: To find out what information vascular surgeons consider before they decide on treatments for intermittent claudication. SUBJECTS: 25 randomly selected vascular surgeons who participate in the Swedish Vascular Registry. METHOD: Interviews about what information and investigations the surgeons would need before they make recommendations for treatment of 6 test cases. MAIN OUTCOME MEASURES: The pattern of numbers and types of questions and of recommendations for treatment. RESULTS: Surgeons asked a median of five questions (range 0-13) before they came to a decision. Only 9% of those questions concerned the patients' preferences. Open surgery was recommended in 59 of the 150 consultations (39.3%), for some by none and for others by up to 80% of surgeons. CONCLUSIONS: Vascular surgeons primarily consider the patient's history and physical findings when treating claudication. They pay little attention to the preferences of the patients. Vascular surgeons in Sweden differ considerably in their patterns of questioning and do not agree about the treatment of intermittent claudication in individual patients.

Aged↗

PubMed1996

An economic and sociological interpretation of social differences in health-related behaviour: an encounter as a guide to social epidemiology.

We argue that the group-centred analyses of social epidemiology should follow from theoretical considerations that take the situation of the individual as their natural starting point. In a tentative dialogue between economics and sociology, we develop a framework for the analysis of health-related behaviour. Such behaviour is modelled as a process of decision-making at the individual level. Within economics, we draw specifically on the demand-for-health literature and the new institutional economics. Within sociology, Bourdieu's habitus theory is presented in combination with a macro-structural approach where the focus is on the process of individualization. The relationship between these different approaches to health-related behaviour and their implications is discussed. We find that the encounter between different sciences provides valuable insights for future work in the socio-epidemiological tradition.

Decision Making↗

PubMed1993

Monitoring health in Sweden: on the rationale for working environment regulations.

The quality of the working environment affects the health status of a population. In the absence of government intervention this quality would be determined by market forces, but the market outcome is generally not accepted. Instead public policy attempts to carefully monitor the level of occupational hazards, which are invariably subject to regulation in industrialized countries. However, this study demonstrates that the welfare implications of this monitoring of health are not self-evident. In the presence of a tax on labour and, for example, a tax-financed social insurance system, it is shown that market forces may lead either to excessive or to sub-optimal investments in injury prevention. Both private and (local) public safety goods are considered.

Environmental Monitoring↗

PubMedDate not supplied

QALY league tables.

Explore the source record for details and available documents.

Cost-Benefit Analysis↗

PubMedDate not supplied

Implicit discount rates of vascular surgeons in the management of abdominal aortic aneurysms.

A growing empirical literature has investigated attitudes towards discounting of health benefits with regard to social choices of life-saving and health-improving measures and individuals' time preferences for the management of their own health. In this study, the authors elicited the time preferences of vascular surgeons in the context of management of small abdominal aortic aneurysms, for which the choice between early elective surgery and watchful waiting is not straightforward. They interviewed 25 of a random sample of 30 Swedish vascular surgeons. Considerable variation in the time preferences was found in the choices between watchful waiting and surgical intervention among the otherwise very homogeneous group of surgeons. The discount rates derived ranged from 5.3% to 19.4%. The median discount rate (10.4%) is similar to those usually reported for social choices concerning life-saving measures. The surgeons who were employed in university hospitals had higher discount rates than did their colleagues in county and district hospitals.

Adult↗