PubMed Health⌕ Search

Biomedical subjects

Ragnar Westerling

Publications and source records attributed to Ragnar Westerling.

13 recordsLinked to original sources
PubMed2006

Health and healthcare utilization among single mothers and single fathers in Sweden.

AIMS: To analyse self-rated health and healthcare utilization with regard to whether the respondents were single or couple parents, mothers or fathers. METHODS: A postal questionnaire was distributed nationwide to 4,000 randomly chosen individuals 20-64 years of age, with a response rate of 66%. A total of 1,041 respondents had legal custody of a child (150 were single parents and 891 were couple parents), and thus met the definition of a parent used for this study. Analyses of self-rated health and health care utilization were performed according to sex, age, sociodemographic, and socioeconomic characteristics. Three different statistical methods were applied: Spearman correlation analyses, chi-square analyses and multivariate logistic regression. RESULTS: Both single fathers and single mothers reported worse health than their couple counterparts. However, single fathers had contact with a physician more frequently (OR 1.84) than couple fathers, whereas single mothers did not. Furthermore, single mothers refrained from seeing a physician despite a medical need much more often (OR 2.07) than couple mothers. CONCLUSIONS: An uneven distribution of sociodemographic and socioeconomic characteristics might help us to understand why single parents, both mothers and fathers, have worse health than parents who live together. Previously recognized gender differences with regard to healthcare utilization were present in our study as well, and it is possible that these differences are related to the unequal distribution of sociodemographic and socioeconomic assets between single fathers and single mothers found here.

Adult↗
PubMed2006

Evaluation of a sexual education intervention among Swedish high school students.

AIMS: To evaluate an intervention aimed at improving knowledge of, attitudes to, and practices regarding condoms and emergency contraception (ECP) among Swedish high school students. METHODS: An intervention study with quasi-experimental design. A strategic sample of classes from two vocational high school programs was divided into an intervention group and a comparison group. All students completed questionnaires before and after the intervention, which included sexual education lessons by a nurse-midwife and medical students, free condoms on request and access to telephone counseling. RESULTS: Of the 461 eligible students, mean age 17 years, 390 (85%) completed the pre-test and 326 (71%) the post-test. Three out of four (77%) had experienced sexual intercourse. The majority (76%) had used contraception, mostly condoms at first intercourse. The students already had good knowledge of condoms with no change after the intervention, but attitudes improved and condom use increased. Knowledge of, and attitudes towards ECP improved but use remained stable (29%). The most important source of information about ECP changed from "friends" to "school" after the intervention. More than one out of four (28%) had opted for free condoms but only 3% had requested telephone counseling. CONCLUSIONS: Condom use increased after the intervention whereas the use of ECP remained stable. Knowledge of ECP improved and the attitudes towards both condoms and ECP became more positive. Participation of nurse-midwives and medical students, skill rehearsal, and improved access to condoms may be useful elements in sexual education.

Adolescent↗
PubMed2006

Mortality in relation to employment status during different levels of unemployment.

AIMS: The aim of this study was to estimate whether the risk for total and cause-specific mortality was related to employment status, and whether mortality in different non-employed groups differed during high and low levels of unemployment. METHODS: Structured interviews were used from the Swedish Survey of Living Conditions in 1984-89 and 1992-97, including women and men aged 18 to 64, classified as unemployed (n = 2,067), retired or on temporary disability pension (n = 2,674), economically inactive for other reasons (n = 1,373), and employed (n = 38,293). Data were linked to death certificates, as registered in the Cause of Death Register. Cox proportional hazards models were performed for the mortality risk up until eight and a half years following the interview. RESULTS: Being unemployed (OR = 1.43), retired, or on temporary disability pension (OR = 2.28) or being economically inactive for other reasons (OR = 1.63) was related to a risk for total mortality, after considering the level of unemployment, sociodemographic factors and longstanding illness. The risk of death due to external causes was excessive among the unemployed and among those retired or on temporary disability pension, and resulted to a large extent from suicide. The interaction between employment status and level of unemployment was not significant. CONCLUSIONS: The level of unemployment seems to have no major influence on the mortality risk. Future interventions for the non-employed groups should focus on preventing avoidable mortality, such as injury and suicide.

Adolescent↗
PubMed2005

Health care utilization among persons who are unemployed or outside the labour force.

BACKGROUND: In Sweden, equity in health is a central aim of public health policy. To this end, the health care system is obligated to offer equal access to health care according to need. However, unemployment may hinder the fulfillment of this goal. The aim of the present study was to assess self-reported health care needs and service utilization with respect to employment status. METHODS: A questionnaire was sent to 4000 randomly chosen individuals 20-64 years of age living in different counties in Sweden (response rate 66.2%). Logistic regression analyses were carried out to estimate the influence of employment status, socio-demographic variables and health indicators on the need for and use of health care services. RESULTS: In total, 42.2% (n=35) among the unemployed, 37.4% (n=55) among persons who were on long-term sick leave (LTSD), and 22.3% (n=467) of the employed persons, abstained from consulting a physician despite reporting a perceived need to do so. The results persisted after adjusting for socio-demographic variables, social support and personal finances (unemployed: OR=1.91; LTSD: OR=1.62). The risk of foregoing care remained higher among the unemployed, but not the LTSD-group, after adjusting for long-standing illness (OR=1.94). The unemployed were more likely than the employed to perceive a need to seek care for psychological problems. The risk of abstaining from consulting a physician was related to symptoms of depression. CONCLUSIONS: Lack of employment may be related to unmet care needs, especially among unemployed who are experiencing psychological symptoms. To deal with the needs of the unemployed it may be useful to develop interventions within the health care system that focus more on psychological problems.

Adult↗
PubMed2005

Methodology of studies evaluating death certificate accuracy were flawed.

BACKGROUND AND OBJECTIVE: Statistics on causes of death are important for epidemiologic research. Studies that evaluate the source data often give conflicting results, which raise questions about comparability and validity of methods. METHODS: For 44 recent evaluation studies we examined the methods employed and assessed the reproducibility. RESULTS: Thirty studies stated who reviewed the source data. Six studies reported reliability tests. Twelve studies included all causes of death, but none specified criteria for identifying the underlying cause when several, etiologically independent conditions were present. We assessed these as not reproducible. Of 32 studies that focussed on a specific condition, 21 provided diagnostic criteria such that the verification of the focal diagnosis is reproducible. Of 16 that discussed the difference between dying "with" and "from" a condition, eight described how competing causes had been handled. For these eight, the selection of a principal cause is reproducible, but in three the selection strategy conflicts with the international instructions issued by the World Health Organization. CONCLUSION: Methods and criteria are often insufficiently described. When described, they sometimes disagree with the international standard. Explicit descriptions of methods and criteria would contribute to methodologic improvement and would allow readers to assess the generalizability of the conclusions.

Cause of Death↗
PubMed2005

Self-rated health in relation to employment status during periods of high and of low levels of unemployment.

BACKGROUND: There is a need for more research on the health impact of changes in the national unemployment rate. Therefore, the present study was carried out to compare levels of self-rated health during periods of high and low levels of unemployment. METHODS: Data included cross-sectional interviews from the Swedish Survey of Living Conditions, which were based on random samples of inhabitants between 16 and 64 years of age living in Sweden. Data were collected for the period 1983-89, when unemployment levels were low (n = 35 562; 2.5%) and for the period 1992-97 when unemployment was high (n = 24 019; 7.1%). RESULTS: After adjusting for sociodemographic variables as well as long-term disease or handicap, the differences in self-rated health between the unemployed and employed were larger when unemployment levels were high in the 1990s, than when they were low in the 1980s. More groups of the unemployed were afflicted with poor health when unemployment was high, compared with when it was low. In 1992-97, being married, living in larger cities, or not having a long-term disease or handicap no longer buffered the negative effects on health among the unemployed. CONCLUSIONS: Poorer self-rated health among the unemployed seems to be an increasing public health problem during high levels of unemployment.

Adolescent↗
PubMed2005

Different types and aspects of quality systems and their implications. A thematic comparison of seven quality systems at a university hospital.

Policy makers and managers face a difficult challenge in keeping up with the changing organisations and methods of health care. Organised systematic quality work, that is, quality systems, can make this task easier. The aim here was to study different quality systems, identify common characteristics, find types of quality systems and discuss the practical implications of the results. The study was designed as a qualitative study of seven clinics with quality systems at a large university hospital in Sweden. Purposefully selected, 19 managers or quality co-ordinators were interviewed. The interviews were audio taped, transcribed verbatim and analysed thematically. Six organisational aspects were present in the interviews: resources, administration, culture, co-operation, goal achievement and development of competence. The aspects were used to categorise the clinics' systems into three types: local, centralised and integrated systems. The responses indicated that local systems had a decentralised organisation, allowing for a high degree of adaptability. Centralised systems were reported to be more top-down orientated, allowing for a highly predictable output. Integrated systems were reported to have a management style that emphasized co-operation, allowing for both good adaptability and predictability. Policy makers and managers could use the described aspects and types of quality systems to help decide what type of quality system to implement in a specific setting, as a base line for evaluation, or as a framework for developing existing quality systems.

Hospitals, University↗
PubMed2004

Emergency contraceptive pills over-the-counter: a population-based survey of young Swedish women.

One year after emergency contraceptive pills (ECP) had become prescription-free, we sent a questionnaire to 800 randomly selected women in mid-Sweden. The aim was to investigate women's knowledge, attitudes and practices regarding the method. The response rate was 71% (n = 564). The majority of the women, 65%, would prefer to purchase ECP over-the-counter (OTC) in a pharmacy. Attitudes toward the method were predominantly positive, but one fourth (24%) had worries about side effects and one third (33%) considered ECP to be a kind of abortion. Logistic regression showed that correct knowledge of and positive attitudes toward ECP contributed to estimated future use of ECP. Although women favored the OTC option, persistent misunderstanding about ECP implies that routine information from gynecologists and health professionals as well as media campaigns is needed along with the deregulation in order to make ECP an accepted and properly used contraceptive method.

Adolescent↗
PubMed2004

A large proportion of Swedish citizens refrain from seeking medical care--lack of confidence in the medical services a plausible explanation?

Equity in health and health care is and has been a long-standing goal in Swedish health care politics. This study aims to look into how different socio-demographic variables influence unmet needs i.e. why one would refrain from seeing a doctor, despite a perceived need for medical care. A nation-wide postal questionnaire was answered by 2648 (66%) randomly chosen individuals in the ages between 20 and 64 years. The questionnaire included questions on health and health care utilisation along with data on different socio-demographic variables. The proportion of citizens that refrain from visiting a physician despite a perceived need was higher (24%) than in any previous Swedish investigation. Women, those of a non-Swedish origin and those with a low level of education refrained from going to the physician to a higher extent than men, inborn citizens and those with a higher education. Stated reasons to why the respondents refrained from medical care were associated with confidence, primarily, finite availability and economy. It appears as the Swedish health care system is not fully adapted to provide for the so far unmet needs of a large proportion of the population and that this has equitable concerns.

Adult↗
PubMed2004

Emergency contraceptive pills in Sweden: evaluation of an information campaign.

OBJECTIVE: To evaluate a community-based intervention regarding emergency contraceptive pills, including a mass media campaign and information to women visiting family planning clinics. DESIGN: Quasi-experimental. SETTING: Two counties in Sweden. POPULATION: Eight hundred randomly selected women aged 16-30 years, 400 women in the intervention group and 400 in a comparison group. METHODS: Postal questionnaires before (2002) and after (2003) the intervention. MAIN OUTCOME MEASURES: Exposure to the intervention, knowledge, attitudes, practices and intention to use emergency contraceptive pills. RESULTS: Before the intervention, the response rate was 71% (n= 564); after the intervention, the corresponding figure was 83% (n= 467); overall response rate 58%. Two-thirds (64%) of the targeted women had noticed the information campaign. One out of six who had visited a family planning clinic during the intervention year recalled being given information about emergency contraceptive pills. Specific knowledge and attitudes improved over time in both groups, but there was no difference in change between the groups. The proportion of women who had used emergency contraceptive pills increased from 27% to 31% over time. Intention to use emergency contraceptive pills in case of need was reported by 74% of the women and remained stable over time, but logistic regression showed that information during the previous year contributed to willingness to use the method in the intervention group. CONCLUSIONS: Knowledge, attitudes and practices about emergency contraceptive pills increased in both groups. Emergency contraceptive pills is gradually becoming a more widely known, accepted and used contraceptive method in Sweden, a trend that may have limited the impact of the intervention.

Adolescent↗
PubMed2003

Decreasing gender differences in "avoidable" mortality in Sweden.

AIMS: "Avoidable" mortality, that is mortality from conditions amenable to healthcare intervention, is commonly studied as an indicator of the outcome of healthcare. The objective of this study was to analyse gender equity in avoidable mortality trends in Sweden from 1971 to 1996. METHODS: The underlying cause of death was analysed for all deaths in the Swedish population in the age group 0-69 years during the period 1971-96. On the basis of those used in international studies, 18 indicators of avoidable mortality were identified. The conditions were divided into two groups: those mainly indicating an outcome of medical care and those mainly reflecting the effect of health policy. Age-standardized death rates were calculated for each indicator of avoidable mortality and for total mortality broken down by sex. Gender differences in death rates were studied. The annual trends in death rates were analysed using regression models. RESULTS: For total mortality the death rates were 80% higher for males than for females. The largest gender differences were found among those conditions mainly reflecting the effects of health policy. For most medical care indicators the gender differences were fairly small. For several avoidable causes of death the gender differences decreased considerably and for some causes of death the differences were eliminated. CONCLUSIONS: The avoidable mortality method seems to be useful in continuous epidemiological surveillance of the equity in healthcare. The comparatively low gender differences for avoidable death indicators as well as the decrease in these differences indicate decreasing gender inequity in health.

Adolescent↗
PubMed2002

'Avoidable' mortality among immigrants in Sweden.

BACKGROUND: The concept of studying 'avoidable' mortality as an indicator of the outcome of health care has been applied mainly in studies of time-trends and geographical and socio-economic variation. METHODS: In this study, indicators of 'avoidable' mortality among immigrants in Sweden have been studied. Comparisons of death rates among immigrants and those born in Sweden were made using a linkage of the Population Census and the Cause of Death Register, nationwide sources. RESULTS: For a group of health policy indicators, such as liver cirrhosis and malignant neoplasms of the trachea, bronchus and lung, death rates were about 40-100% higher among immigrants from other Nordic countries, Yugoslavia and Eastern Europe than among the Swedish born population. For causes of death considered amenable to medical care intervention there were, however, small differences. For some conditions, such as cerebrovascular disease, malignant neoplasms of colon and rectum, chronic bronchitis and emphysema, high death rates were found among immigrants from other Nordic countries. For immigrants from other countries, there were no high death rates based on medical care indicators when compared to the Swedish-born population. CONCLUSION: There were few indications of inequity reflected in the mortality outcome of medical care. The variation found in death rates from health policy indicators may reflect differences in smoking and alcohol habits.

Adult↗