Socioeconomic outcome and access to care in adults with epilepsy in Sweden: A nationwide cohort study.

PURPOSE: Epilepsy has well-documented associations with low income and low education levels, but the impact of a patient's socioeconomic standing (SES) on the effects of epilepsy have been less studied. METHOD: We performed a register-based cross-sectional study and asked if SES was associated with more severe epilepsy or limited access to care in Sweden, where health care is universal, and if socioeconomic outcomes (employment and income) differed for persons with epilepsy (PWE) with different levels of educational attainment. The study cohort consisted of all adult patients with an epilepsy diagnosis in the Swedish patient register in 2000-2015 (n = 126,406) and controls (n = 379,131) matched for age, gender, and place of birth. RESULTS: Somatic and psychiatric comorbidities were more common in PWE, while education and income levels were lower. Among PWE, hospitalizations were more common in persons with lower income or education. Having at least one prescription written by a neurologist in the study period was more common in the high-income and high-education groups. Finally, although low educational attainment was associated with low levels of income and inversely associated with employment in both persons with epilepsy and controls, regression analyses demonstrated that these associations were much more noticeable in cases than controls. CONCLUSIONS: We conclude that both the severity and consequences of epilepsy are greater in persons of low SES, even in a country with universal health care. This indicates that universal access may not be sufficient to mitigate socioeconomic inequity in epilepsy.

Adolescents' presentation of food in social media: An explorative study.

The study aimed to explore how adolescents communicate food images in a widely used social media image-sharing application. We examined how and in what context food was presented and the type of food items that were frequently portrayed by following a youth related hashtag on Instagram. The hashtag #14år ("14 years") was used to find adolescent users on Instagram: these users public photo streams were then searched for food items they had shared with others. Food items were identified and categorized based on type of food and how the food items were presented. Most of the adolescent users (85%) shared images containing food items. A majority of the images (67.7%) depicted foods high in calories but low in nutrients. Almost half of these images were arranged as a still life with food brand names clearly exposed. Many of these images were influenced by major food marketing campaigns. Fruits and vegetables occurred in 21.8% of all images. This food group was frequently portrayed zoomed in with focus solely on the food, with a hashtag or caption expressing palatability. These images were often presented in the style of a cook book. Food was thus presented in varied ways. Adolescents themselves produced images copying food advertisements. This has clear health promotion implications since it becomes more challenging to monitor and tackle young people's exposure to marketing of unhealthy foods in these popular online networks because images are part of a lifestyle that the young people want to promote. Shared images contain personal recommendations, which mean that they may have a more powerful effect than commercial advertising.