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      Health Care Utilisation and Attitudes towards Health Care in Subjects Reporting Environmental Annoyance from Electricity and Chemicals

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          Abstract

          Environmentally intolerant persons report decreased self-rated health and daily functioning. However, it remains unclear whether this condition also results in increased health care costs. The aim of this study was to describe the health care consumption and attitudes towards health care in subjects presenting subjective environmental annoyance in relation to the general population, as well as to a group with a well-known disorder as treated hypertension (HT). Methods. Postal questionnaire ( n = 13 604) and record linkage with population-based register on health care costs. Results. Despite significantly lower subjective well being and health than both the general population and HT group, the environmentally annoyed subjects had lower health care costs than the hypertension group. In contrast to the hypertension group, the environmentally annoyed subjects expressed more negative attitudes toward the health care than the general population. Conclusions. Despite their impaired subjective health and functional capacity, health care utilisation costs were not much increased for the environmentally annoyed group. This may partly depend on negative attitudes towards the health care in this group.

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          Self-rated health. Comparisons between three different measures. Results from a population study.

          Self-rating of health is among the most frequently assessed health perceptions in epidemiological research. The aim of this study was to compare different measures of global self-rated health (SRH) with respect to differences in age and sex groups and relations to hypothesized determinants. Three single-question measures of SRH were included in a health questionnaire administered to 8200 randomly chosen men and women. Two SRH measures were non-comparative, one with seven (SRH-7) and one with five response options (SRH-5), while the third measure included a comparison with others of the same age (SRH-age). SRH-7 had specified response options only at the ends of the scale, while the other two measures gave specified statements for each option. Comparisons between the SRH assessments were studied with respect to response frequencies, frequency distributions, age and gender differences and differences in associations with hypothesized determinants. The differences between the SRH measures were in most cases marginal. Some diversities may, however, be worth considering: a high drop-out rate for the SRH-7 measure in the oldest age group; a trend that SRH-7 correlated most strongly with the independent variables; SRH-age showed improved health ratings with increasing age but a less skewed frequency distribution compared to the non-comparative measures. The results imply that non-comparative measures are more appropriate in longitudinal studies and that measures without specified response options might be less suitable for an older study group. The overall impression is, however, that the different measures represents parallel assessments of subjective health.
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            'I just want permission to be ill': towards a sociology of medically unexplained symptoms.

            A significant proportion of symptoms are medically unexplained. People experience illness but no pathological basis for the symptoms can be discerned by the medical profession. Living without a clinical diagnosis or medical explanation has consequences for such patients. This paper reports on a small qualitative interview-based study of 18 neurology outpatients in England who live with such medically unexplained symptoms (MUS). The findings broadly concur with those identified in the related literatures on medically unexplained syndromes and unexplained pain: the difficulties of living with uncertainty; dealing with legitimacy; and a resistance to psychological explanations of their suffering. From a thematic analysis of the interview data we identify and elaborate on three related issues, which we refer to as: 'morality'; 'chaos'; and 'ambivalence'. Although this article presents empirical data its aim is primarily conceptual; it integrates the findings of the empirical analysis with the existing literature in order to try to make some sociological sense of the emergent themes by drawing on sociological and cultural analyses of risk and the body. We draw on Bauman's concept of ambivalence to suggest that the very processes associated with more precise 'problem solving' and 'classification' do, in fact, generate even more uncertainty and anxiety. On the one hand, we seek closure and certainty and yet this leaves no means of living with uncertainty. Indeed, society does not readily grant permission to be ill in the absence of disease. We conclude by suggesting that an appreciation of the experience of such embodied doubt articulated by people who live with MUS may have a more general applicability to the analysis of social life under conditions of late modernity.
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              A review of the evidence for overlap among unexplained clinical conditions.

              Unexplained clinical conditions share features, including symptoms (fatigue, pain), disability out of proportion to physical examination findings, inconsistent demonstration of laboratory abnormalities, and an association with "stress" and psychosocial factors. This literature review examines the nature and extent of the overlap among these unexplained clinical conditions and the limitations of previous research. English-language articles were identified by a search of the MEDLINE database from 1966 to January 2001 by using individual syndromes and their hallmark symptoms as search terms. Studies that assessed patients with at least one unexplained clinical condition and that included information on symptoms, overlap with other unexplained clinical conditions, or physiologic markers. Conditions examined were the chronic fatigue syndrome, fibromyalgia, the irritable bowel syndrome, multiple chemical sensitivity, temporomandibular disorder, tension headache, interstitial cystitis, and the postconcussion syndrome. Information on authorship, patient and control groups, eligibility criteria, case definitions, study methods, and major findings. Many similarities were apparent in case definition and symptoms, and the proportion of patients with one unexplained clinical condition meeting criteria for a second unexplained condition was striking. Tender points on physical examination and decreased pain threshold and tolerance were the most frequent and consistent objective findings. A major shortcoming of all proposed explanatory models is their inability to account for the occurrence of unexplained clinical conditions in many affected patients. Overlap between unexplained clinical conditions is substantial. Most studies are limited by methodologic problems, such as case definition and the selection and recruitment of case-patients and controls.
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                Author and article information

                Journal
                J Environ Public Health
                JEPH
                Journal of Environmental and Public Health
                Hindawi Publishing Corporation
                1687-9805
                1687-9813
                2009
                14 April 2009
                : 2009
                : 106389
                Affiliations
                1Department of Occupational and Environmental Medicine, Lund University, SE 221 85 Lund, Sweden
                2Department of Social Medicine, Lund University, SE 205 02 Malmö, Sweden
                3Department of Health, The Health Centre of The County Council, Scania Region, SE 221 00 Lund, Sweden
                Author notes

                Recommended by Jill Pell

                Article
                10.1155/2009/106389
                2778839
                19936124
                48f718f5-0c02-4fe5-b403-0caee5e28205
                Copyright © 2009 Frida Eek et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 1 December 2008
                : 16 February 2009
                : 24 February 2009
                Categories
                Research Article

                Public health
                Public health

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