Well-being and mental stress in the population study of women in Gothenburg, Sweden: cohort comparisons from 1980 to 2016 of 36-year trends and socioeconomic disparities in 38-and 50-year old women

Background Women’s lives have dramatically changed in recent decades as evidenced by trends in educational attainment, employment outside the home, income, and other socioeconomic factors. Self-reported health in 18–70 year old women has been reported to be significantly lower than in men. In Sweden, the 2005 National Public Health Report showed that stressful work environments have become more common, especially for women. The purpose of the study was to monitor trends in well-being and perceived mental stress in the populations of 38- and 50-year-old women and to examine associations with socioeconomic position (SEP). Subjects In 1980, 2004, and 2017, population-based samples of 38- and 50-year old women were recruited into the Prospective Population Study of Women in Gothenburg (PPSWG), Sweden. This population-based study included participants from selected birth cohorts to participate in health examinations, at similar ages and with similar protocols on each occasion. Methods Birth cohort comparisons between three representative samples of 38- and 50-year-old women. Well-being (scale 1–7) and perceived mental stress (scale 1–6) based on questionnaires were the main outcomes studied in relation to time. Socioeconomic position (SEP) based on socio-occupational group, i.e. occupational and educational level combined, were examined as correlates of well-being and mental stress at different points in time. Results Perception of good well-being increased in generations of 50-year-old women between 1980 to 2016, but no significant time trends were seen in 38-year-old women. Perception of high mental stress increased between 1980 and 2016, for both 38-and 50-year-old women. Belonging to a low socio-occupational group was associated with lower perceived well-being in 1980 but not in 2016. Belonging to a low socio-occupational group was not associated with perceived mental stress at any examination. Conclusions Contemporary women of today have generally higher perceptions of well-being but also higher mental stress regardless of belonging to low or high socio-occupational group. Associations between poor well-being and belonging to a low socio-occupational group that were observed in 1980 and 2004 were not observed in 2016. The Prospective Population Study of Women in Gothenburg, Sweden was approved by the ethics committee of University of Gothenburg (Dnr 65–80; Ö564–03; 258–16). The studies comply with the Declaration of Helsinki and informed consent has been obtained from the subjects.

Working towards evidence-informed policy: Public health report Stockholm

Issue Public health problems and interventions are often addressed in sub-optimal ways by not prioritizing them based on the best available evidence. Description of the Problem The public health report 2019 for the Stockholm region aims to inform decision makers, politicians, and public health workers about the risk factors and diseases that account for the biggest part of the burden of disease with a clear focus on high quality evidence and communication of main messages. How did the public health report 2019 affect public health policy in the Stockholm region? Results The public health report 2019 influenced agenda setting, resource allocation and priority setting in the Stockholm region. Lessons We identified the following facilitating factors in the process, of which most also are supported in scientific literature, in chronological order: 1) understanding the policymaking context to be aware of windows of opportunity, 2) establishing relationships with relevant policymakers, engage with them routinely in the decision-making process, and being accessible for questions, 3) doing high-quality research by considering the latest scientific literature, multiple data sources and involving academic experts in the field, 4) communicating clear and relevant messages for generalists by translating research into easy-understandable texts and attractive figures, and 5) active dissemination of the report through multiple channels. In addition, the following barriers were identified: 1) the timeframe of the policymaking process was not in line with the research process, and 2) involving politicians in an early stage can potentially harm the objectivity of research in media messages. Key messages By focussing on major problems, high quality evidence and clear messages a public health report can contribute to more evidence-informed policy making. Engaging decision makers in the process of public health reporting is critical for the impact on agenda setting, resource allocation, and priority setting.

Well-being and mental stress in the Population Study of Women in Gothenburg, Sweden: Cohort comparisons from 1980 to 2016 of 36-year trends and socioeconomic disparities in 38-and 50-year old women

Background Women`s life situations has dramatically changed in recent decades. Self-reported health in women has been reported significantly lower than in men in all age groups 18-70 years. In Sweden, the National Public Health Report 2005 showed that stressful work environments have become more common especially for women. The purpose of the study was to monitor trends in well-being and mental stress in the populations of 38- and 50-year-old women and to examine associations with socioeconomic position (SEP). Subjects Population-based cohorts of 38- and 50-year-old women as a part of the Prospective Population Study of Women in Gothenburg were invited in 1980, 2004 and 2016 to health examinations, with similar protocols on each occasion Methods Cohort comparisons between three representative samples of 38- and 50-year-old women. Well-being (scale 1-7) and perceived mental stress (scale 1-6) based on questionnaires were the main outcomes studied in relation to time. Socioeconomic position (SEP) based on socio-occupational group, i.e. occupational and educational level combined were examined as correlates well-being and mental stress at different points in time. Results Perception of good well-being increased in 50-year-old women between 1980 to 2016, but no significant time trends were seen in 38-year-old women. Perception of high mental stress increased between 1980 and 2016, for both 38-and 50-year-old women. Belonging to a low socio-occupational group was associated with lower perceived well-being in 1980 but not in 2016. Belonging to a low socio-occupational group was not associated with perceived mental stress at any examination. Conclusions Contemporary women of today have generally higher perceptions of well-being and higher mental stress regardless of belonging to low or high socio-occupational group. Associations between poor well-being and belonging to a low socio-occupational group that were observed in 1980 disappeared in 2016. Trial registration The Prospective Population Study of Women in Gothenburg, Sweden was approved by the ethics committee of University of Gothenburg (Dnr 65-80; Ö564-03; 258-16). The studies comply with the Declaration of Helsinki and informed consent has been obtained from the subjects.

Transition to health democracy in France: occupational therapy for population-based interventions

Background Health promotion stands as a core value of occupational therapy, a client-centred healthcare profession that achieves this goal by enhancing individuals’ ability to engage in activities that they want to, need to, or are expected to do. Yet, occupational therapists in France have not been working in alliance with Public Health funding or programs in the community to reduce possible illnesses leading to chronic conditions and hospitalizations. There is a need to discuss how these professionals can collaborate with Public Health initiatives to move beyond individual interventions and address population-based needs. This study explores occupational therapists opportunities to develop health promotion practices in France. Methods A participatory action research was conducted with six co-participants using occupational justice-based frameworks and the French National Public Health report on Health Promotion as a ground for discussion which extended over 3 months. Qualitative content analysis and Kemmis’ practice architecture theory was used to understand how practices are shaped by discursive, economic and socio-political circumstances. Results Preliminary results show that occupational justice-based reasoning enables practitioners to shift from an individual to a population needs focus. Yet, the lack of education for this type of practices is evident. The findings highlight prerequisites that need to be fulfilled in order to apply an occupational justice-based approach within health promotion initiatives. Conclusions Working on community settings allows practitioners to comprehend the complex interactions between individuals and context. Public Health field provides an interface between society requirements and populations needs in which occupational therapist could enact health promoting interventions. The practice in this field is emerging and therefore it is relevant to discuss the competencies that should be included within occupational therapy education. Key messages A healthcare system that does not consider its population’s contextual situation is a failing system. France’s welfare transformation requires all professionals to develop community-based initiatives. The findings will support the development of the first guidelines for health promotion occupational therapy practices in France.

Frailty as the Future Core Business of Public Health: Report of the Activities of the A3 Action Group of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA)

Background: The prevalence of frailty at population-level is expected to increase in Europe, changing the focus of Public Health. Here, we report on the activities of the A3 Action Group, focusing on managing frailty and supporting healthy ageing at community level. Methods: A three-phased search strategy was used to select papers published between January 2016 and May 2018. In the third phase, the first manuscript draft was sent to all A3-Action Group members who were invited to suggest additional contributions to be included in the narrative review process. Results: A total of 56 papers were included in this report. The A3 Action Group developed three multidimensional tools predicting short–medium term adverse outcomes. Multiple factors were highlighted by the group as useful for healthcare planning: malnutrition, polypharmacy, impairment of physical function and social isolation were targeted to mitigate frailty and its consequences. Studies focused on the management of frailty highlighted that tailored interventions can improve physical performance and reduce adverse outcomes. Conclusions: This review shows the importance of taking a multifaceted approach when addressing frailty at community level. From a Public Health perspective, it is vital to identify factors that contribute to successful health and social care interventions and to the health systems sustainability.