Background: Given gender differences in the risk of coronary artery disease (CAD), the present study sought to investigate these dissimilarities amongst patients who underwent angiography at a major, tertiary heart hospital in Iran. Methods: Between 2005 and 2010, 44,820 patients who underwent coronary angiography were enrolled in a registry. Pre-procedural data such as demographics, CAD risk factors, presenting symptoms, and laboratory tests, as well as postprocedural data were collected. The data were, subsequently, compared between the men and women. Results: Out of the 44,820 patients (16,378 women), who underwent coronary angiography, 37,358 patients (11,995 women) had CAD. Amongst the CAD patients, the females were not only significantly older, less educated, and more overweight than were the males but also had higher levels of triglyceride, cholesterol, low-density lipoprotein, highdensity lipoprotein, and fasting blood sugar (P< 0.001). Of all the risk factors, hypertension and diabetes mellitus showed the strongest association in our female CAD patients (OR=3.45, 95%CI: 3.28-3.61 and OR=2.37, 95%CI: 2.26- 2.48, respectively). Acute coronary syndrome was more prevalent in the men (76.1% vs. 68.6%, P< 0.001), and chronic stable angina was more frequent in the females (31.4% vs. 23.9%, P< 0.001). With respect to post-procedural recommendations, the frequency of recommendations for non-invasive modalities was higher in the females (20.1% vs. 18.6%, P< 0.001). Conclusion: Hypertension and diabetes mellitus had the strongest association with CAD in our female patients. In the extensive CAD patients, medical treatment was recommended to the women more often.

Background Diverse ethnic groups may differ regarding the risk factors and severity of coronary artery disease (CAD). This study sought to assess the association between ethnicity and CAD risk and severity in six major Iranian ethnic groups.

Methods In this study, 20,165 documented coronary artery disease patients who underwent coronary angiography at a tertiary referral heart center were recruited. The demographic, laboratory, clinical, and risk factor data of all the patients were retrieved. The Gensini score (an indicator of CAD severity) was calculated for all, and the risk factors and severity of CAD were compared between the ethnical groups, using adjusted standardized residuals, Kruskal–Wallis test, and multivariable regression analysis.

Results The mean age of the participants (14,131 [70.1%] men and 6034 [29.9%] women) was 60.7 ± 10.8 years. The Fars (8.7%) and Gilak (8.6%) ethnic groups had the highest prevalence of ≥4 simultaneous risk factors. The mean Gensini score was the highest for the Gilaks (77.1 ± 55.9) and the lowest among the Lors (67.5 ± 52.8). The multivariable regression analysis showed that the Gilaks had the worst severity (β 0.056, 95% CI 0.009 to 0.102; P = 0.018), followed by the Torks (β 0.032, 95% CI 0.005 to 0.059; P = 0.020). Meanwhile, the Lors showed the lowest severity (β −0.087, 95% CI −0.146 to −0.027; P = 0.004).

Conclusions This study found that there was heterogeneity in CAD severity and a diverse distribution in its well-known traditional risk factors among major Iranian ethnic groups.

BACKGROUND: Socioeconomic status (SES) can greatly affect the clinical outcome of medical problems. We sought to assess the in-hospital mortality of patients with the acute coronary syndrome (ACS) according to their SES.

METHODS: All patients admitted to Tehran Heart Center due to 1(st)-time ACS between March 2004 and August 2011 were assessed. The patients who were illiterate/lowly educated (≤5 years attained education) and were unemployed were considered low-SES patients and those who were employed and had high educational levels (>5 years attained education) were regarded as high-SES patients. Demographic, clinical, paraclinical, and in-hospital medical progress data were recorded. Death during the course of hospitalization was considered the end point, and the impact of SES on in-hospital mortality was evaluated.

RESULTS: A total of 6246 hospitalized patients (3290 low SES and 2956 high SES) were included (mean age = 60.3 ± 12.1 years, male = 2772 [44.4%]). Among them, 79 (1.26%) patients died. Univariable analysis showed a significantly higher mortality rate in the low-SES group (1.9% vs. 0.6%; P < 0.001). After adjustment for possible cofounders, SES still showed a significant effect on the in-hospital mortality of the ACS patients in that the high-SES patients had a lower in-hospital mortality rate (odds ratio: 0.304, 95% confidence interval: 0.094-0.980; P = 0.046).

CONCLUSIONS: This study found that patients with low SES were at a higher risk of in-hospital mortality due to the ACS. Furthermore, the results suggest the need for increased availability of jobs as well as improved levels of education as preventive measures to curb the unfolding deaths owing to coronary artery syndrome.

Background

Diverse ethnic groups may differ regarding the risk factors and severity of coronary artery disease (CAD). This study sought to assess the association between ethnicity and CAD risk and severity in six major Iranian ethnic groups.

Methods

In this study, 20,165 documented coronary artery disease patients who underwent coronary angiography at a tertiary referral heart center were recruited. The demographic, laboratory, clinical, and risk factor data of all the patients were retrieved. The Gensini score (an indicator of CAD severity) was calculated for all, and the risk factors and severity of CAD were compared between the ethnical groups, using adjusted standardized residuals, Kruskal–Wallis test, and multivariable regression analysis.

Results

The mean age of the participants (14,131 [70.1%] men and 6034 [29.9%] women) was 60.7 ± 10.8 years. The Fars (8.7%) and Gilak (8.6%) ethnic groups had the highest prevalence of ≥4 simultaneous risk factors. The mean Gensini score was the highest for the Gilaks (77.1 ± 55.9) and the lowest among the Lors (67.5 ± 52.8). The multivariable regression analysis showed that the Gilaks had the worst severity (β 0.056, 95% CI 0.009 to 0.102; P = 0.018), followed by the Torks (β 0.032, 95% CI 0.005 to 0.059; P = 0.020). Meanwhile, the Lors showed the lowest severity (β −0.087, 95% CI −0.146 to −0.027; P = 0.004).

Conclusions

This study found that there was heterogeneity in CAD severity and a diverse distribution in its well-known traditional risk factors among major Iranian ethnic groups.

Background: Current evidence shows inequality in the outcomes of rural and urban patients treated at their place of residence. This study compared in-hospital mortality between rural and urban patients with acute coronary syndrome (ACS) to find whether there were differences in the outcome and received treatment. Methods: Between May 2007 and January 2018, patients admitted with ACS were included. The patients’ demographic, clinical, and laboratory data, as well as their in-hospital medical courses, were recorded. The association between place of residence (rural/ urban) and in-hospital mortality due to ACS was evaluated using logistic regression adjusted for potential confounders. Results: Of 9088 recruited patients (mean age =61.30±12.25 y; 5557 men [61.1%]), 838 were rural residents. A positive family history of coronary artery disease (P=0.003), smoking (P=0.002), and hyperlipidemia (P=0.026), as well as a higher body mass index (P=0.013), was seen more frequently in the urban patients, while the rural patients had lower education levels (P<0.001) and higher unemployment rates (P=0.009). In-hospital mortality occurred in 135 patients (1.5%): 10 rural (1.2%) and 125 urban (1.5%) patients (P=0.465). The Firth regression model, used to adjust the effects of possible confounders, showed no significant difference concerning in-hospital mortality between the rural and urban patients (OR, 1.57; 95% CI, 0.376 to 7.450; P=0.585). Conclusion: This study found no significant differences in receiving proper treatment and in-hospital mortality between ru-ral and urban patients with ACS. 

Background: Socioeconomic status (SES) can greatly affect the clinical outcome of medical problems. We sought to assess the in‑hospital mortality of patients with the acute coronarysyndrome (ACS) according to their SES.

Methods: All patients admitted to Tehran Heart Center due to 1st‑time ACS between March 2004 and August 2011 were assessed. The patients who were illiterate/lowly educated (≤5 years attained education) and were unemployed were considered low‑SES patients and those who were employed and had high educational levels (>5 years attained education) were regarded as high‑SES patients. Demographic, clinical, paraclinical, and in‑hospital medical progress data were recorded. Death during the course of hospitalization was considered the end point, and the impact of SES on in‑hospital mortality was evaluated.

Results: A total of 6246 hospitalized patients (3290 low SES and 2956 high SES) were included (mean age = 60.3 ± 12.1 years, male = 2772 [44.4%]). Among them, 79 (1.26%) patients died. Univariable analysis showed a significantly higher mortality rate in the low‑SES group (1.9% vs. 0.6%; P < 0.001). After adjustment for possible cofounders, SES still showed a significant effect on the in‑hospital mortality of the ACS patients in that the high‑SES patients had a lower in‑hospital mortality rate (odds ratio: 0.304, 95% confidence interval: 0.094–0.980; P = 0.046).

Conclusions: This study found that patients with low SES were at a higher risk of in‑hospital mortality due to the ACS. Furthermore, the results suggest the need for increased availability of jobs as well as improved levels of education as preventive measures to curb the unfolding deaths owing to coronary artery syndrome.

Background: Current evidence shows inequality in the outcomes of rural and urban patients treated at their place of residence. This study compared in-hospital mortality between rural and urban patients with acute coronary syndrome (ACS) to find whether there were differences in the outcome and received treatment.

Methods: Between May 2007 and January 2018, patients admitted with ACS were included. The patients’ demographic, clinical, and laboratory data, as well as their in-hospital medical courses, were recorded. The association between place of residence (rural/urban) and in-hospital mortality due to ACS was evaluated using logistic regression adjusted for potential confounders.

Results: Of 9088 recruited patients (mean age =61.30±12.25 y; 5557 men [61.1%]), 838 were rural residents. A positive family history of coronary artery disease (P=0.003), smoking (P=0.002), and hyperlipidemia (P=0.026), as well as a higher body mass index (P=0.013), was seen more frequently in the urban patients, while the rural patients had lower education levels (P<0.001) and higher unemployment rates (P=0.009). In-hospital mortality occurred in 135 patients (1.5%): 10 rural (1.2%) and 125 urban (1.5%) patients (P=0.465). The Firth regression model, used to adjust the effects of possible confounders, showed no significant difference concerning in-hospital mortality between the rural and urban patients (OR, 1.57; 95% CI, 0.376 to 7.450; P=0.585).

Conclusion: This study found no significant differences in receiving proper treatment and in-hospital mortality between rural and urban patients with ACS.

Background: Given gender differences in the risk of coronary artery disease (CAD), the present study sought to investigate these dissimilarities amongst patients who underwent angiography at a major, tertiary heart hospital in Iran. Methods: Between 2005 and 2010, 44,820 patients who underwent coronary angiography were enrolled in a registry. Pre-procedural data such as demographics, CAD risk factors, presenting symptoms, and laboratory tests, as well as postprocedural data were collected. The data were, subsequently, compared between the men and women. Results: Out of the 44,820 patients (16,378 women), who underwent coronary angiography, 37,358 patients (11,995 women) had CAD. Amongst the CAD patients, the females were not only significantly older, less educated, and more overweight than were the males but also had higher levels of triglyceride, cholesterol, low-density lipoprotein, highdensity lipoprotein, and fasting blood sugar (P< 0.001). Of all the risk factors, hypertension and diabetes mellitus showed the strongest association in our female CAD patients (OR=3.45, 95%CI: 3.28-3.61 and OR=2.37, 95%CI: 2.26- 2.48, respectively). Acute coronary syndrome was more prevalent in the men (76.1% vs. 68.6%, P< 0.001), and chronic stable angina was more frequent in the females (31.4% vs. 23.9%, P< 0.001). With respect to post-procedural recommendations, the frequency of recommendations for non-invasive modalities was higher in the females (20.1% vs. 18.6%, P< 0.001). Conclusion: Hypertension and diabetes mellitus had the strongest association with CAD in our female patients. In the extensive CAD patients, medical treatment was recommended to the women more often.

Purpose

Given the importance of small businesses for society, and the significance of managers’ wellbeing for employee health, leadership, and business performance, more knowledge is needed on the sources of managers’ wellbeing. This study explored factors within the small business context that were perceived by managers to hinder or enable their wellbeing.

Methods

Data were collected through qualitative semi-structured interviews with 20 managers from 12 small companies, and analysed with content analysis.

Results

The factors that these managers in small businesses experienced as enhancing or hindering their personal wellbeing covered five categories: demands and resources in the daily managerial work, achievement of results, social factors, organizational factors, and individual factors.

Conclusions

The specific context of managerial work in small companies encompasses unique factors. For instance, the small company managers’ wellbeing was affected by vulnerability due to the smallness of the business and the absence of available resources. Simultaneously, a small company context provided a strong social climate and close relationships with employees and customers that strengthened the managers’ wellbeing. The findings suggest that the availability of financial, personnel, and organizational resources varies between small companies of different size, which may have implications for small business managers’ work and wellbeing.

Purpose

Given the importance of small businesses for society, and the significance of managers’ wellbeing for employee health, leadership, and business performance, more knowledge is needed on the sources of managers’ wellbeing. This study explored factors within the small business context that were perceived by managers to hinder or enable their wellbeing.

Methods

Data were collected through qualitative semi-structured interviews with 20 managers from 12 small companies, and analysed with content analysis.

Results

The factors that these managers in small businesses experienced as enhancing or hindering their personal wellbeing covered five categories: demands and resources in the daily managerial work, achievement of results, social factors, organizational factors, and individual factors.

Conclusions

The specific context of managerial work in small companies encompasses unique factors. For instance, the small company managers’ wellbeing was affected by vulnerability due to the smallness of the business and the absence of available resources. Simultaneously, a small company context provided a strong social climate and close relationships with employees and customers that strengthened the managers’ wellbeing. The findings suggest that the availability of financial, personnel, and organizational resources varies between small companies of different size, which may have implications for small business managers’ work and wellbeing.

BACKGROUND:There is a growing interest in managers’ wellbeing due to the observed associations between their wellbeing and leadership behaviours, and between leadership behaviours and employees’ wellbeing. However, it is still unclear how managers’ wellbeing influences their practiced leadership across different workplace contexts, which specific behaviours are affected, and how this varies across time.

OBJECTIVE:The purpose of this study was therefore to explore managers’ and employees’ experiences and perceptions regarding the consequences of managers’ wellbeing for their leadership behaviours in small businesses.

METHODS:Semi-structured interviews were conducted with 37 participants (19 managers and 18 employees) working at 12 Swedish small firms, and analysed using content analysis.

RESULTS:The findings show that managers were more constructive when they felt well, and more passively destructive when unwell. Variations in managers’ wellbeing influenced their mood, energy level, and performance, as well as the company’s working climate. However, these destructive leadership variations did not have a substantial impact, because several protective factors were present.

CONCLUSION:This study shows that the wellbeing of managers in small businesses has perceptible consequences for their leadership behaviours. The study also shows that sustained leadership behaviours may coexist with temporary variations of these behaviours on a constructive-destructive continuum depending on the leader’s wellbeing. Overall, the findings contribute to a more nuanced and dynamic understanding of how the interaction between managers’ wellbeing and their behaviours unfolds in the particular context of small companies.

BACKGROUND:There is a growing interest in managers’ wellbeing due to the observed associations between their wellbeing and leadership behaviours, and between leadership behaviours and employees’ wellbeing. However, it is still unclear how managers’ wellbeing influences their practiced leadership across different workplace contexts, which specific behaviours are affected, and how this varies across time.

OBJECTIVE:The purpose of this study was therefore to explore managers’ and employees’ experiences and perceptions regarding the consequences of managers’ wellbeing for their leadership behaviours in small businesses.

METHODS:Semi-structured interviews were conducted with 37 participants (19 managers and 18 employees) working at 12 Swedish small firms, and analysed using content analysis.

RESULTS:The findings show that managers were more constructive when they felt well, and more passively destructive when unwell. Variations in managers’ wellbeing influenced their mood, energy level, and performance, as well as the company’s working climate. However, these destructive leadership variations did not have a substantial impact, because several protective factors were present.

CONCLUSION:This study shows that the wellbeing of managers in small businesses has perceptible consequences for their leadership behaviours. The study also shows that sustained leadership behaviours may coexist with temporary variations of these behaviours on a constructive-destructive continuum depending on the leader’s wellbeing. Overall, the findings contribute to a more nuanced and dynamic understanding of how the interaction between managers’ wellbeing and their behaviours unfolds in the particular context of small companies.

Purpose

In view of the importance of managers’ wellbeing for their leadership behaviour, employee health, and business effectiveness and survival, a better understanding of managers’ wellbeing and working conditions is important for creating healthy and sustainable businesses. Previous research has mostly provided a static picture of managers’ wellbeing and work in the context of small businesses, missing the variability and dynamism that is characteristic of this context. Therefore, the purpose of this study is to explore how managers in small companies perceive their working conditions and wellbeing in the context of business growth.

Methods

The study is based on qualitative semi-structured interviews with 20 managers from twelve small companies. Content and thematic analysis were applied.

Results

The findings indicate that a manager’s working environment evolves from its initial stages and through the company’s growth, leading to variations over time in the manager’s experiences of wellbeing and work–life balance as well as changes in job demands and resources. Managers’ working situation becomes less demanding and more manageable when workloads and working hours are reduced and a better work–life balance is achieved. The perceived improvement is related to changes in organizational factors (e.g. company resources), but also to individual factors (e.g. managers’ increased awareness of the importance of a sustainable work situation). However, there were differences in how the working conditions and wellbeing changed over time and how organizational and individual resources affected the studied managers’ wellbeing.

Conclusions

This study shows that, in the context of small business, managers’ working conditions and wellbeing are dynamic and are linked to growth-related changes that occur from the start of organizational activities and during periods of growth. In addition, the findings suggest that changes in managers’ working conditions and wellbeing follow different trajectories over time because of the interaction between organizational and personal factors.

We investigated managers’ work and behaviour patterns in profitable growth small- and medium-sized Swedish companies, and considered how these patterns might be associated with good health outcomes. Specifically, we looked at hours worked by managers, proportion of time spent on working activities, and leadership behaviour orientation. We used a quantitative cross-sectional design and collected data via a standardized questionnaire that was answered by 133 top managers. The data were analyzed with descriptive statistics, linear regression, and compositional data analysis. Our results indicate that the managers worked long hours, which is a health risk both for them as individuals and for their organizations, but also that they engaged in work practices and leadership behaviours that were favourable for organizational health and for their employees. The managers spent a high proportion of their time in touring, which could be beneficial to organizational health, and exercised active leadership through behaviours that contribute to both employee health and company effectiveness. Comparing our results to other studies, we can observe that patterns of managers’ time use differ between small and large companies, confirming that the size of the firm is an important determinant of managerial work.

Background

There is an increased global interest in occupational health across small businesses as they represent a large share of employers in many societies. In the model of healthy work organisations, employee health is a prerequisite for higher productivity and profitability and management practices are considered as determinants of organisational health. A better understanding of how managers in effective companies use their time can offer a better understanding of how this can affect employees’ well-being and business effect-iveness. Managers’ long working hours and share of time spent on Management by Walking Around (MBWA) are considered important characteristics of managers’ work that might have consequences for employees’ and managers’ own health outcomes, as well as for organisational effectiveness. MBWA is a management technique common for successful companies in regard to their effectiveness; providing an opportunity for a spontaneous manager-subordinate interaction that might be important for employee health and wellbeing. Studies of managerial work have to some extent not clearly placed managers’ time use in the broad context of leadership, often missing to link it with leadership behaviour theories, health and effectiveness.

Objective

The objective of this study was to explore, on the one hand, the total amount of working hours that managers spent, and on the other, their patterns of time allocation to different activities in effective SMEs. Research questions were: 1) What patterns regarding managers’ working hours can be identified across socio-demographic variables, leader-ship experience factors and leadership profiles in effective SMEs? 2) What patterns regarding proportions of total working hours spent on MBWA can be identified across socio-demographic variables, leadership experience factors and leadership profiles in effective SMEs?

Method

The study used data collected within the project, “Successful Companies in Gästrikland”. Annually the project nominates 120 companies for the award based on companies’ financial indicators. The study employed a cross-sectional design and analysed responses to questionnaires collected within the project during years 2014-2018. The inclusion criteria were small and medium sized companies (more than four and less than 250 subordinates), high-level managers having subordinates. Data analysis were carried out using descriptive statistics and regression analysis.

Results

The results section is being processed and will be reported on the conference.

Projektbeskrivning: FRAMFÖR har under 15 år bedrivits i Gästrikland i samarbete mellan utbildning och forskning vid Högskolan i Gävle, företagsutvecklare vid kommuner, företag och näringslivsorganisationer. Varje år delas utmärkelsen FRAMFÖR ut till 50 företag. Ambitionen är att uppmuntra framgångsrika företagare och visa upp intressanta exempel på hur framgång kan skapas. Processen startar med att 120 företag (>4 anställda) nomineras utifrån finansiella kriterier (ex. omsättningstillväxt, vinstmarginal). Sedan genomför studenter vid Ekonomprogrammet intervjuer med cheferna för dessa företag. Intervjuerna sker utifrån ett standardiserat frågeformulär kring arbetsmiljö, ledarskap, organisering och effektivitet. Avslutningsvis väljer en jury ut de 50 mest framgångsrika företagen utifrån såväl finansiella kriterier som studenternas intervjuresultat. Projektets trippel helixuppbyggnad (Utbildning, Forskning och, Företag) skapar nyttor för olika intressenter.

Utbildningsnyttor: Studenterna får möjlighet till interaktion med företagare i sin direkta närhet. Aktiviteterna underlättar att uppfylla utbildningsmål där flera mål kan uppfyllas med samma aktiviteter. Förståelse för näringslivets förutsättningar samt kunskaper om ett vetenskapligt angreppssätt ökar.

Forskningsnyttor: Stärker pågående forskning om hälsofrämjande och effektivt ledarskap inom arbetshälsovetenskap samt företagsutveckling inom företagsekonomi. Det stora urvalet av företag ger en bra bild av företagen i regionen och en möjlighet att följa dem över tid. Ambitionen är att få mer kunskap om hållbara och effektiva företag. Fördjupade studier av utmärkelseföretag möjliggörs och ett doktorandprojekt med inriktning på ledarskapsbeteenden, organisationsfaktorer, tidsanvändning samt chefers/medarbetares arbetsmiljö/hälsa i utmärkelseföretag är uppstartat.

Företagsnyttor: Företagare får möta studenter och förstå hur de tänker. Ställda frågor, t.ex. rörande arbetsmiljö och ledarskap, kan starta reflektionsprocesser som bidrar till fortsatt utveckling. FRAMFÖR-utmärkelsen delas ut vid en högtidlig tillställning där företagarna kan bygga nätverk. Flera företagare lyfter fram det positiva symbolvärdet av att få utmärkelsen.

Projektets framtid: Målet är att fortsätta ytterligare 15 år och fortsätta utveckla nyttorna för samtliga intressenter. Ett prioriterat område är återkoppling till företag i någon form samt ökad samverkan mellan studenter och företagare.

Observations in Nigeria have indicated polio vaccination refusal related to religion that ultimately affected child morbidity and mortality. This study assessed the role of religion in under-five (0-59 months) mortality using a cross-sectional, nationally representative sample of 7,620 women aged 15-49 years from the 2003 Nigeria Demographic and Health Survey and included 6,029 children. Results show that mother's affiliation to Traditional indigenous religion is significantly associated with increased under-five mortality. Multivariable modelling demonstrated that this association is explained by differential use of maternal and child health services, specifically attendance to prenatal care. To reduce child health inequity, these results need to be incorporated in the formulation of child health policies geared towards achieving a high degree of attendance to prenatal care, irrespective of religious affiliation.

Observations in Nigeria have indicated polio vaccination refusal related to religion that ultimately affected child morbidity and mortality. This study assessed the role of religion in under-five (0-59 months) mortality using a cross-sectional, nationally representative sample of 7,620 women aged 15-49 years from the 2003 Nigeria Demographic and Health Survey and included 6,029 children. Results show that mother's affiliation to Traditional indigenous religion is significantly associated with increased under-five mortality. Multivariable modelling demonstrated that this association is explained by differential use of maternal and child health services, specifically attendance to prenatal care. To reduce child health inequity, these results need to be incorporated in the formulation of child health policies geared towards achieving a high degree of attendance to prenatal care, irrespective of religious affiliation.

Background: Employment status has an impact on health and is a source of health inequalities. But little is known about its impact on the health of people residing in the County of Västernorrland, Sweden. The recent economic recession affected this region in a way which worsened the already existing unemployment rate.Objective of the study: This study aimed to examine the relationship between employment status, gender and self-reported health in the County of Västernorrland, Sweden in the year 2010.Setting and Design: The study used data from a cross-sectional "Health on Equal Terms" survey, carried in the County of Västernorrland in 2010. A total of 6,050 women and men aged 16-65 years were included in the analysis. Descriptive statistics and logistic regression analyses were performed, and results were expressed as odds ratio with 95% confidence intervals.Results: Women and men who were out of work had odds of poor self-reported health of 2.31 (CI 1.94-2.94) and 2.39 (CI 1.96-2.58), respectively. Controlling for other variables reduced the odds of poor health, but the relationship continued to be statistically significant.Conclusion: Results of this study found that at the pick of the most recent economic crises there were equal odds of poor self-reported health among women and men residing in Gävleborg County. The observed association was to some extent explained by demographic, socioeconomic and health-related variables. Policymakers need to pay attention to the health status of those out of work, particularly during times of economic recession and hardship.

This literature review investigated gender differentials in HIV/AIDS in Cameroon and to which extent gender was taken into account in the country’s current policy on HIV/AIDS. The review found that in Cameroon women were at increased risk of being infected with HIV/AIDS compared to men and that apart from biological vulnerability, socio-cultural as well as economic factors accounted for those differences. In addition, the review found that at the policy level, the government has drawn up plans to reduce the high prevalence of HIV/AIDS among women. However, although the current policy acknowledged the need for tackling gender differentials in HIV/AIDS transmission; little has been done at the level of implementation. The current policy needs to be implemented in a more effective manner and a multisectorial approach should be explored in order to curb the current trend of the feminization of HIV/AIDS in Cameroon.

This literature review investigated gender differentials in HIV/AIDS in Cameroon and to which extent gender was taken into account in the country’s current policy on HIV/AIDS. The review found that in Cameroon women were at increased risk of being infected with HIV/AIDS compared to men and that apart from biological vulnerability, socio-cultural as well as economic factors accounted for those differences. In addition, the review found that at the policy level, the government has drawn up plans to reduce the high prevalence of HIV/AIDS among women. However, although the current policy acknowledged the need for tackling gender differentials in HIV/AIDS transmission; little has been done at the level of implementation. The current policy needs to be implemented in a more effective manner and a multisectorial approach should be explored in order to curb the current trend of the feminization of HIV/AIDS in Cameroon.

Suicide is a leading cause of death world-wide. However, adolescent suicidal behavior is a neglected public health issue, especially in low-income countries such as Bangladesh. The study was conducted to estimate the prevalence of suicidal ideation among adolescents in a rural community and to examine factors associated with suicidal ideation. A cross-sectional survey was carried out in 2013 among 2,476 adolescents aged 14–19 years, selected randomly from a rural community of Bangladesh. An adapted version of the WHO/SUPRE-MISS questionnaire was used to collect data in the Raiganj sub-district. A two stage screening was performed to identify the suicidal ideation cases. It was found that the life-time prevalence for suicidal ideation was 5 percent among adolescents. The majority of the adolescents with suicidal ideation were females 66 (52.8%), unmarried 103 (82.4%), and students 92 (73%). Suicidal ideation was statistically significantly associated with age, education, occupation, living with parents or others, and house ownership. Respondents who were aged 18–19 years, had secondary school certificate (SSC) and secondary school certificate (HSC) or higher education, were day laborers, had own house, and do not lived with parents had odds ratios of 2.31 (CI 1.46–3.65), 2.38 (CI 1.51–3.77), 4.15 (CI 2.41–7.14), 0.28 (CI 0.13–0.60), 0.14(CI 0.05–0.35), and 1.80 (CI 1.07–3.03), respectively. Among adolescents, the prevalence of life-time suicidal ideation was moderately high. Age, education, occupation, house ownership, and living with parents were statistically significantly associated with suicidal ideation. It is important to design and implement effective community based suicide prevention programs for adolescents in Bangladesh.

Suicide is a leading cause of death world-wide. However, adolescent suicidal behavior is a neglected public health issue, especially in low-income countries such as Bangladesh. The study was conducted to estimate the prevalence of suicidal ideation among adolescents in a rural community and to examine factors associated with suicidal ideation. A cross-sectional survey was carried out in 2013 among 2,476 adolescents aged 14–19 years, selected randomly from a rural community of Bangladesh. An adapted version of the WHO/SUPRE-MISS questionnaire was used to collect data in the Raiganj sub-district. A two stage screening was performed to identify the suicidal ideation cases. It was found that the life-time prevalence for suicidal ideation was 5 percent among adolescents. The majority of the adolescents with suicidal ideation were females 66 (52.8%), unmarried 103 (82.4%), and students 92 (73%). Suicidal ideation was statistically significantly associated with age, education, occupation, living with parents or others, and house ownership. Respondents who were aged 18–19 years, had secondary school certificate (SSC) and secondary school certificate (HSC) or higher education, were day laborers, had own house, and do not lived with parents had odds ratios of 2.31 (CI 1.46–3.65), 2.38 (CI 1.51–3.77), 4.15 (CI 2.41–7.14), 0.28 (CI 0.13–0.60), 0.14(CI 0.05–0.35), and 1.80 (CI 1.07–3.03), respectively. Among adolescents, the prevalence of life-time suicidal ideation was moderately high. Age, education, occupation, house ownership, and living with parents were statistically significantly associated with suicidal ideation. It is important to design and implement effective community based suicide prevention programs for adolescents in Bangladesh.

Background:  Suicide is a leading cause of death worldwide and becoming a public health concern among adolescents. However, adolescent suicidal behaviour is a neglected public health issue, especially in low-income countries such as Bangladesh. Of great importance is the understanding of which factors might be related to this growing public problem. 

Objective: To examine the relationship between parental socio-economic position and suicide ideation among adolescents in rural Bangladesh

Methods: A cross-sectional survey was conducted in 2013 among 2,476 adolescents, aged 14-19 years, selected randomly from a rural community of Bangladesh. An adapted version of the WHO/SUPRE-MISS questionnaire was used to collect data in the Raiganj sub-district, which is a surveillance area of the Centre for Injury Prevention and Research, Bangladesh (CIPRB).

Descriptive statistics and binary logistic regression analyses were used to analyze the data. Comparisons of proportions between groups were carried out using the χ2 test. Multivariate logistic regression analysis was used to examine the relationship between parental co-variants and suicidal thoughts among adolescents. The significance level was set atp <0.05. All analyses were performed using SPSS 20.

Results: The majority of parents had education only up to primary school (mothers 58.7% and fathers 49.5%). Most of them were farmers (53.3% of fathers) and housewives (96.5% of mothers). Monthly income and expenditure of the adolescent’s parents were mainly upto 10,000 taka only. Suicidal ideation is more common among adolescents of low income group parents 104 (5.5%) and who were not living with their parents 18 (8.2%). Adolescent’s suicidal ideation was found to be significantly associated with education, marital status and house ownership of their parents. Not being able to live with their parents was also a significant factor. Parents who received education up to SSC had odds ratio of 2.10 (1.21,3.64) and 1.92 (1.15, 3.23) for mothers and fathers respectively. Parent’s income or expenditure was not associated with adolescent’s suicidal ideation. Adolescent’s suicidal ideation of single parents had higher odds (OR 3.00, CI 1.75-5.19) in comparison to adolescents who had both parents. Adolescents whose parents owned a house and who weren’t living withtheir parents had odds ratios of 0.14 (0.05,0.35), and 1.80 (1.07,3.03) respectively. After adjusting for other covariates parents’ marital status and house ownership significantly associated with the adolescent suicide ideation.

Conclusion: Parental socio-economic position was associated with suicidal ideation. Adolescent with single parents were more likely to report suicidal ideation. Low parental education and socio-economic status, marital status, house ownership, not living with parents at home as well as adolescent loneliness were the important factors for suicidal ideation.

Background: Suicide is a leading cause of death world-wide and becoming a public health concern among adolescents. However, adolescent suicidal behaviour is a neglected public health issue, especially in low-income countries such as Bangladesh. Of great importance is the understanding of which factors might be related to this growing public problem.

Objective: To examine the relationship between parental socio-economic position and suicide ideation among adolescents in rural Bangladesh

Methods: A cross-sectional survey was conducted in 2013 among 2,476 adolescents, aged 14-19 years, selected randomly from a rural community of Bangladesh. An adapted version of the WHO/SUPRE-MISS questionnaire was used to collect data in the Raiganj sub-district, which is a surveillance area of the Centre for Injury Prevention and Research, Bangladesh (CIPRB).

Descriptive statistics and binary logistic regression analyses were used to analyze the data. Comparisons of proportions between groups were carried out using the χ2 test. Multivariate logistic regression analysis was used to examine the relationship between parental co-variants and suicidal thoughts among adolescents. The significance level was set atp <0.05. All analyses were performed using SPSS 20.

Results: The majority of parents had education only up to primary school (mothers 58.7% and fathers 49.5%). Most of them were farmers (53.3% of fathers) and housewives (96.5% of mothers). Monthly income and expenditure of the adolescent’s parents were mainly upto 10,000 taka only. Suicidal ideation is more common among adolescents of low income group parents 104 (5.5%) and who were not living with their parents 18 (8.2%). Adolescent’s suicidal ideation was found to be significantly associated with education, marital status and house ownership of their parents. Not being able to live with their parents was also a significant factor. Parents who received education up to SSC had odds ratio of 2.10 (1.21,3.64) and 1.92 (1.15, 3.23) for mothers and fathers respectively. Parent’s income or expenditure was not associated with adolescent’s suicidal ideation. Adolescent’s suicidal ideation of single parents had higher odds (OR 3.00, CI 1.75-5.19) in comparison to adolescents who had both parents. Adolescents whose parents owned a house and who weren’t living withtheir parents had odds ratios of 0.14 (0.05,0.35), and 1.80 (1.07,3.03) respectively. After adjusting for other covariates parents’ marital status and house ownership significantly associated with the adolescent suicide ideation.

Conclusion: Parental socio-economic position was asso-ciated with suicidal ideation. Adolescent with single parents were more likely to report suicidal ideation. Low parental education and socio-economic status, marital status, house ownership, not living with parents at home as well as adolescent loneliness were the important factors for suicidal ideation.

Today, many of the 10 million childhood deaths each year are caused by diseases of poverty—diarrhea and pneumonia, for example, which were previously major causes of childhood death in many European countries. Specific analyses of the historical decline of child mortality may shed light on the potential equity impact of interventions to reduce child mortality.

In our study of the impact of improved water and sanitation in Stockholm from 1878 to 1925, we examined the decline in overall and diarrhea mortality among children, both in general and by socioeconomic group. We report a decline in overall mortality and of diarrhea mortality and a leveling out of socioeconomic differences in child mortality due to diarrheal diseases, but not of overall mortality. The contribution of general and targeted policies is discussed.

Today, many of the 10 million childhood deaths each year are caused by diseases of poverty—diarrhea and pneumonia, for example, which were previously major causes of childhood death in many European countries. Specific analyses of the historical decline of child mortality may shed light on the potential equity impact of interventions to reduce child mortality.

In our study of the impact of improved water and sanitation in Stockholm from 1878 to 1925, we examined the decline in overall and diarrhea mortality among children, both in general and by socioeconomic group. We report a decline in overall mortality and of diarrhea mortality and a leveling out of socioeconomic differences in child mortality due to diarrheal diseases, but not of overall mortality. The contribution of general and targeted policies is discussed.

Abstract

Background: Intimate partner violence (IPV) is a major public health problem worldwide but research on IPV in Africa remains limited. This study aims to estimate the prevalence of sexual and physical intimate partner violence against women and its associated factors, in a sample of women using prenatal care in  Nampula, province-Mozambique.

Methods: This is a cross-sectional study, carried out in six health units, from February 2013 to January 2014. One in every three pregnant women who visited primary health facilities for the first pre-natal appointment was eligible and invited to participate. After obtaining informed consent 869 pregnant answered the Conflict Tactics Scale 2. Odds ratios (OR) and respective 95% confidence intervals (95%CI) were calculated by using Logistic Regression.

Results: The prevalence of sexual abuse ever in life was 49% and of physical abuse was 46%. The past year prevalence was 46% and 44% for sexual and physical abuse, respectively. Sexual abuse and physical violence occurred in every age group. Significant associations were found between previous neonatal deaths and being physically abused, during the life-time (OR= 3.00, 95% IC: 1.67 to 5:39), and the past year (OR=3.23, 95% CI: 1.80 - 5.80).

Conclusion: This study found a high lifetime and past year violence prevalence among women using prenatal care in Mozambique. Prenatal care provides a window of opportunity for identifying women who experience violence.

Message 1

The prevalence of intimate partner violence is very high among women in Mozambique and prenatal care can be a sentinel setting

Message 2

The implementation of strategies to support women victims of violence in Mozambique is urgently needed

The aim was to estimate the prevalence of sexual and physical intimate partner violence (IPV) and its associated factors, in a sample of pregnant women using antenatal care (ANC) in Nampula province - Mozambique. This cross-sectional study was carried out in six health units in Nampula, from February 2013 to January 2014. Overall, 869 participants answered the Conflict Tactics Scale 2. The lifetime and past year prevalence of sexual abuse was 49% and 46%, and of physical abuse was 46% and 44%, respectively. Lifetime and past year sexual abuse was significantly associated with living as a couple, alcohol drinking and having a past diagnosis of gonorrhea. Lifetime and past year physical abuse increased significantly with age and was associated with living as a couple, alcohol drinking and history with syphilis. The prevalence of lifetime and previous year violence among women using ANC was high and similar showing that most women were constantly exposed to IPV. ANC provides a window of opportunity for identifying and acting on violence against women.

Purpose: The aim of the paper is to identify and categorize disclosures from the Global Reporting Initiative Sustainability Reporting Standards (GRI Standards) that have direct or indirect influence on health of external or internal stakeholders.

Methodology: GRI core and comprehensive disclosures (as part of universal standards and topic-specific standards related to economic, environmental and social topics) that can be used by businesses for CSR reporting were grouped as to have direct or indirect influence on external and internal stakeholders’ health.

Findings: The study proposes a systematic way of conceiving GRI standards in terms of direct or indirect influence on the health and well-being of internal and external stakeholders.

Originality/Value: This is the first study that provides a classification of core and comprehensive GRI disclosures that have direct or indirect influence on the health of external or internal stakeholders. This classification will allow businesses to easily report those CSR activities that might be of importance to stakeholders’ health promotion. 

Bodily complaints are widespread among the elderly; few surveys investigating bodily complaints among elder migrants exist in Germany and internationally. Our multi-centric cross section study examined bodily complaints among persons between 60 and 84 years dwelling in Stuttgart on the basis of the short version of the Giessen Complaint Questionnaire (GBB-24). In Germany 648 were explored with 13.4% (n = 87) born outside of Germany. Gender distribution was equal among migrants and non-migrants; socioeconomic status was lower among the migrants: 8.0% (n = 7) of the migrants and 2.5% (n = 14) of the non-migrants had at most four years of education; 12.6% (n = 11) of the migrants and 8.2% (n = 46) of the non-migrants held a net income of below 1000 (sic); 26.4% of the migrants and 38.1% (n = 214) of the non-migrants disposed over 2000 (sic) monthly. The incidence of somatic complaints was 65.5% (n = 57) among the migrants and 55.8% (n = 313) among the non-migrants. Women (61.8%) displayed more often somatic complaints than men (51.8%). Somatic complaints increased with age. Except of the group aged between 70-74 years no significant difference between migrants and non-migrants could be shown concerning the incidence of bodily complaints. Outlook: population based studies on bodily complaints among migrants are urgently needed.

Background Child mortality rates have been declining in most developing countries. We studied child and maternal mortality and risk factors for child mortality in Beira city in July 1993, after a decade of conflict in Mozambique.       

Methods A community-based cluster sample survey of 4609 women of childbearing age was conducted. Indirect techniques were used to estimate child mortality (‘children ever born’ method and Preceding Birth Techniques [PBT]), and maternal mortality sisterhood method). Deaths among the most recent born child, born since July 1990, were classified as cases (n = 106), and two controls, matched by age and cluster, were selected per case.                 

Results Indirect estimates of the probability of dying from birth to age 5 (deaths before age 5 years, ₅q₀ per 1000) decreased from 246 in 1977/8 to 212 in 1988/9. The PBT estimate for 1990/91 was 154 (95% confidence interval(CI): 124–184), but recent deaths may have been underreported. Lack of beds in the household (odds ratio[OR] = 2.0, 95% CI: 1.1–3.8), absence of the father (OR = 2.4, 95% CI: 1.2–4.8), low paternal educational level (OR = 2.1, 95% CI: 0.8–5.4), young maternal age (OR = 2.0, 95% CI: 1.0–3.7), self-reported maternal illness (OR = 2.4, 95% CI: 1.2–4.9), and home delivery of the child (OR = 2.3, 95% CI: 1.2–4.5) were associated with increased mortality, but the sensitivity of risk factors was low. Estimated maternal mortality was 410/100 000 live births with a reference date of 1982.                 

Conclusions Child mortality decreased slowly over the 1980s in Beira despite poor living conditions caused by the indirect effects of the war. Coverage of health services increased over this period. The appropriateness of a risk approach to maternal-child-health care needs further evaluation.

Human actions and interactions are shaped in part by our direct environment. The studies of Christopher Alexander show that objects and structures can inhibit natural properties and characteristics; this is measured in living structure. He also found that we have better connection and feeling with more natural structures, as they more closely resemble ourselves. These theories are applied in this study to analyze and compare the urban morphology within different cities. The main aim of the study is to measure the living structure in cities. By identifying the living structure within cities, comparisons can be made between different types of cities, artificial and historical, and an estimation of what kind of effect this has on our wellbeing can be made. To do this, natural cities and natural streets are identified following a bottom-up data-driven methodology based on the underlying structures present in OpenStreetMap (OSM) road data. The naturally defined city edges (natural cities) based on intersection density and naturally occurring connected roads (natural streets) based on good continuity between road segments in the road data are extracted and then analyzed together. Thereafter, historical cities are compared with artificial cities to investigate the differences in living structure; it is found that historical cities generally consist of far more living structure than artificial cities. This research finds that the current usage of concrete, steel, and glass combined with very fast development speeds is detrimental to the living structure within cities. Newer city developments should be performed in symbiosis with older city structures as a whole, and the structure of the development should inhibit scaling as well as the buildings themselves.

Objective: To classify the causes of death in Maputo City, Mozambique, using the methods of the Global Burden of Disease study, in order to provide information for health policy-makers and to obtain a baseline for future studies in Maputo City and provincial capitals.

Methods: Data were taken from the Maputo City death register and autopsy records for 1994.

Findings: A total of 9011 deaths were recorded in the death register, representing a coverage of approximately86%. Of these, 8114 deaths (92%) were classified by cause. Communicable, maternal, perinatal, and nutritionaldisorders accounted for 5319 deaths; noncommunicable diseases for 1834; and injuries for 961. The 10 leadingcauses of registered deaths were perinatal disorders (1643 deaths); malaria (928); diarrhoeal diseases (814);tuberculosis (456); lower respiratory infections (416); road-traffic accidents (371); anaemia (269); cerebrovasculardiseases (269); homicide (188); and bacterial meningitis (178).

Conclusions: Infectious diseases of all types, injuries, and cerebrovascular disease ranked as leading causes of death, according to both the autopsy records and the city death register. AIDS-related deaths were underreported.With HIV infection increasing rapidly, AIDS will add to the already high burden of infectious diseases and premature mortality in Maputo City. The results of the study indicate that cause of death is a useful outcome indicator for disease control programmes.

Objective: To classify the causes of death in Maputo City, Mozambique, using the methods of the Global Burden of Disease study, in order to provide information for health policy-makers and to obtain a baseline for future studies in Maputo City and provincial capitals.

Methods:  Data were taken from the Maputo City death register and autopsy records for 1994.

Findings: A total of 9011 deaths were recorded in the death register, representing a coverage of approximately 86%. Of these, 8114 deaths (92%) were classified by cause. Communicable, maternal, perinatal, and nutritional disorders accounted for 5319 deaths; noncommunicable diseases for 1834; and injuries for 961. The 10 leading causes of registered deaths were perinatal disorders (1643 deaths); malaria (928); diarrhoeal diseases (814); tuberculosis (456); lower respiratory infections (416); road-traffic accidents (371); anaemia (269); cerebrovascular diseases (269); homicide (188); and bacterial meningitis (178).

Conclusions: Infectious diseases of all types, injuries, and cerebrovascular disease ranked as leading causes of death, according to both the autopsy records and the city death register. AIDS-related deaths were underreported. With HIV infection increasing rapidly, AIDS will add to the already high burden of infectious diseases and premature mortality in Maputo City. The results of the study indicate that cause of death is a useful outcome indicator for disease control programmes

This study aimed to investigate the association of lifetime abuse and mental health among older persons, considering associated factors (e.g., demographics) through a cross-sectional design. We recruited 4,467 women and men ages 60–84 years from 7 European cities. Mental health was measured with the Hospital Anxiety and Depression Scale, and abuse (psychological, physical, sexual, financial, and physical injuries) based on the Revised Conflict Tactics Scale and the UK survey of abuse/neglect of older people. Multiple logistic regression analyses showed that country of residence, low educational level, and experienced financial strain increased the odds of probable cases of anxiety and depression. Female sex, white-collar profession, and financial support by social/other benefits/or partner income were associated with higher odds of anxiety, while older age and experience of lifetime injury were associated with increased odds of depressive symptoms. The findings of this study indicate that socioeconomic factors, as well as experienced lifetime severe physical abuse leading to injuries, are significant in perceived mental health of adults in later life.

This study aimed to investigate the association of lifetime abuse and mental health among older persons, considering associated factors (e.g., demographics) through a cross-sectional design. We recruited 4,467 women and men ages 60–84 years from 7 European cities. Mental health was measured with the Hospital Anxiety and Depression Scale, and abuse (psychological, physical, sexual, financial, and physical injuries) based on the Revised Conflict Tactics Scale and the UK survey of abuse/neglect of older people. Multiple logistic regression analyses showed that country of residence, low educational level, and experienced financial strain increased the odds of probable cases of anxiety and depression. Female sex, white-collar profession, and financial support by social/other benefits/or partner income were associated with higher odds of anxiety, while older age and experience of lifetime injury were associated with increased odds of depressive symptoms. The findings of this study indicate that socioeconomic factors, as well as experienced lifetime severe physical abuse leading to injuries, are significant in perceived mental health of adults in later life.

Objective The objective of this study is to compare coping strategies between adults with and without congenital heart disease and to scrutinize the associations between different available resources (e.g., social support) and adoption of certain coping strategies.

DesignThe study has a cross-sectional case-control design.

SettingThe study was conducted in two university-affilliated heart hospitals in Tehran, Iran.

Patients The participants comprised 347 persons (18–64 years) with and 353 individuals without congenital heart disease, matched by gender and age.

Outcome Measures Coping strategies, assessed with the Utrecht Coping List-short form, were compared between both groups. Block-wise multiple regression analyses were conducted to scrutinize the associations between different independent variables (e.g., demographic/socioeconomic statuses) and adoption of certain styles of coping (dependent variables) among all participants and separately for each group.

Results The styles of coping in the patients were comparable with those of the control group. Multivariate analyses revealed that congenital heart disease per se was not associated with style of coping except for palliative reaction pattern. The active problem-solving coping style was associated with never married marital status, parenthood, unemployment, higher level of anxiety/somatic symptoms, lower level of depressive symptoms, and better social support. The avoidance behavior style was associated with having a low income, whereas the expression of emotion style was associated with higher anxiety symptoms, experience of financial strain, and income. None of the adopted coping strategies was related to the heart disease variables.

Conclusions The adults with congenital heart disease coped as well as adults without congenital heart disease. Marital status, parenthood, annual income, financial strain, psychological adjustment, and perceived social support were important explanatory factors in adopting a certain style of coping among adults with congenital heart disease. However, longitudinal studies with repeated measures are warranted.

Background Life-expectancy of adults with congenital heart disease (CHD) has improved world-wide, but there are limited data on these patients' experiences of quality of life (QoL), life satisfaction (LS), and their determinants (e.g. social support), particularly among patients from developing countries.

Design Cross-sectional case-control.

Methods A total of 347 CHD patients (18-64 years, 52.2% women) and 353 non-CHD participants, matched by sex/age, were recruited from two heart hospitals in Tehran, Iran. LS and QoL served as dependent variables, and demographic/socioeconomic status, mental-somatic symptoms, social support, and clinical factors (e.g. defect category) served as independent variables in multiple regression analyses once among all participants, and once only among CHD patients.

Results The CHD patients had significantly lower scores in LS and all domains of QoL than the control group. However, having CHD was independently negatively associated only with overall QoL, physical health, and life and health satisfaction. Additionally, multivariate analyses among the CHD patients revealed that female sex, younger age, being employed, less emotional distress, and higher social support were significantly associated with higher perceived QoL in most domains, while LS was associated with female sex, being employed, less emotional distress, and better social support. Neither QoL nor LS was associated with cardiac defect severity.

Conclusions The adults with CHD had poorer QoL and LS than their non-CHD peers in our developing country. Socio-demographics, emotional health, and social support were important 'determinants' of QoL and LS among the CHD patients. Longitudinal studies are warranted to establish causal links.

Background Life-expectancy of adults with congenital heart disease (CHD) has improved world-wide, but there are limited data on these patients' experiences of quality of life (QoL), life satisfaction (LS), and their determinants (e.g. social support), particularly among patients from developing countries.

Design Cross-sectional case-control.

Methods A total of 347 CHD patients (18-64 years, 52.2% women) and 353 non-CHD participants, matched by sex/age, were recruited from two heart hospitals in Tehran, Iran. LS and QoL served as dependent variables, and demographic/socioeconomic status, mental-somatic symptoms, social support, and clinical factors (e.g. defect category) served as independent variables in multiple regression analyses once among all participants, and once only among CHD patients.

Results The CHD patients had significantly lower scores in LS and all domains of QoL than the control group. However, having CHD was independently negatively associated only with overall QoL, physical health, and life and health satisfaction. Additionally, multivariate analyses among the CHD patients revealed that female sex, younger age, being employed, less emotional distress, and higher social support were significantly associated with higher perceived QoL in most domains, while LS was associated with female sex, being employed, less emotional distress, and better social support. Neither QoL nor LS was associated with cardiac defect severity.

Conclusions The adults with CHD had poorer QoL and LS than their non-CHD peers in our developing country. Socio-demographics, emotional health, and social support were important 'determinants' of QoL and LS among the CHD patients. Longitudinal studies are warranted to establish causal links.

Objective The objective of this study is to compare coping strategies between adults with and without congenital heart disease and to scrutinize the associations between different available resources (e.g., social support) and adoption of certain coping strategies.

DesignThe study has a cross-sectional case-control design.

SettingThe study was conducted in two university-affilliated heart hospitals in Tehran, Iran.

Patients The participants comprised 347 persons (18–64 years) with and 353 individuals without congenital heart disease, matched by gender and age.

Outcome Measures Coping strategies, assessed with the Utrecht Coping List-short form, were compared between both groups. Block-wise multiple regression analyses were conducted to scrutinize the associations between different independent variables (e.g., demographic/socioeconomic statuses) and adoption of certain styles of coping (dependent variables) among all participants and separately for each group.

Results The styles of coping in the patients were comparable with those of the control group. Multivariate analyses revealed that congenital heart disease per se was not associated with style of coping except for palliative reaction pattern. The active problem-solving coping style was associated with never married marital status, parenthood, unemployment, higher level of anxiety/somatic symptoms, lower level of depressive symptoms, and better social support. The avoidance behavior style was associated with having a low income, whereas the expression of emotion style was associated with higher anxiety symptoms, experience of financial strain, and income. None of the adopted coping strategies was related to the heart disease variables.

Conclusions The adults with congenital heart disease coped as well as adults without congenital heart disease. Marital status, parenthood, annual income, financial strain, psychological adjustment, and perceived social support were important explanatory factors in adopting a certain style of coping among adults with congenital heart disease. However, longitudinal studies with repeated measures are warranted.

Background Providing appropriate care for adults with congenital heart disease requires the evaluation of their current situation. There is limited research in Iran about these patients, particularly in relation to gender differences in the demographic/socio-economic and lifestyle factors, as well as disease parameters.

Materials and methods The sample consisted of 347 congenital heart disease patients in the age group of 18–64 years, including 181 women, assessed by an analytical cross-sectional study. The patients were recruited from the two major heart hospitals in Tehran. Data were collected using questionnaires.

Results The mean age of the patients was 33.24 years. Women were more often married and more often had offspring than men (p < 0.001). Educational level and annual income were similar between women and men. Unemployment was higher among women (p < 0.001), but financial strain was higher among men (p < 0.001). Smoking, alcohol, and water-pipe use was higher among men than among women (p < 0.001). Cardiac factors, for example number of cardiac defects, were similar among women and men, except that there were more hospitalisations owing to cardiac problems, for example arrhythmia, among men. Disease was diagnosed mostly at the hospital (57.4%). Most medical care was provided by cardiologists (65.1%). Only 50.1% of patients had knowledge about their type of cardiac defect.

Conclusion Gender differences exist in the socio-economic and lifestyle characteristics of adults with congenital heart disease, in some cases related to the disease severity. Our findings also point to the need for interventions to increase patients’ knowledge about, and use of, healthier lifestyle behaviours, irrespective of gender. Furthermore, providing appropriate jobs, vocational training, and career counselling may help patients to be more productive.

Objective

Despite the improvement in life-expectancy of adults with congenital heart disease, they may experience unique medical and social challenges that could impact on their psychological functioning. The aims of this study were to address the experience of anxiety, depressive and somatic symptoms among adults with congenital heart disease in comparison with that of non-heart diseased persons considering the role of various factors (e.g. socio-economic).

Methods

In cross-sectional case–control study, the participants consisted of 347 patients with congenital heart disease (18–64 years, 52.2% female) and 353 matched (by sex/age) non-heart diseased persons. The participants completed a questionnaire. The data were analyzed with bivariate and multivariate methods.

Results

In bivariate analyses, scores in anxiety and somatic symptoms were higher among patients than the healthy controls (both at p ≤ 0.001), whereas the groups did not differ in depressive symptoms. Following multiple-linear-regression-analyses, only the association between congenital heart disease and somatic symptoms was confirmed. Among the patients, perceived financial strain was significantly related to anxiety, depressive and somatic symptoms; lower perceived social support to anxiety and depression; and low annual income to somatic symptoms. Additionally, somatic symptoms were associated with anxiety and depressive symptoms, and vice versa. And no medical variables were related to anxiety, depressive and somatic symptoms.

Conclusions

Congenital heart disease was only independently associated with somatic symptoms. Financial strain, social support and co-existence of emotional distress with somatic symptoms should be considered in developing appropriate interventions to improve the well-being of patients with congenital heart disease. However, longitudinal research is warranted to clarify causality.

Objective

Despite the improvement in life-expectancy of adults with congenital heart disease, they may experience unique medical and social challenges that could impact on their psychological functioning. The aims of this study were to address the experience of anxiety, depressive and somatic symptoms among adults with congenital heart disease in comparison with that of non-heart diseased persons considering the role of various factors (e.g. socio-economic).

Methods

In cross-sectional case–control study, the participants consisted of 347 patients with congenital heart disease (18–64 years, 52.2% female) and 353 matched (by sex/age) non-heart diseased persons. The participants completed a questionnaire. The data were analyzed with bivariate and multivariate methods.

Results

In bivariate analyses, scores in anxiety and somatic symptoms were higher among patients than the healthy controls (both at p ≤ 0.001), whereas the groups did not differ in depressive symptoms. Following multiple-linear-regression-analyses, only the association between congenital heart disease and somatic symptoms was confirmed. Among the patients, perceived financial strain was significantly related to anxiety, depressive and somatic symptoms; lower perceived social support to anxiety and depression; and low annual income to somatic symptoms. Additionally, somatic symptoms were associated with anxiety and depressive symptoms, and vice versa. And no medical variables were related to anxiety, depressive and somatic symptoms.

Conclusions

Congenital heart disease was only independently associated with somatic symptoms. Financial strain, social support and co-existence of emotional distress with somatic symptoms should be considered in developing appropriate interventions to improve the well-being of patients with congenital heart disease. However, longitudinal research is warranted to clarify causality.