bluuebunny/crossref_metadata_2025 huggingface dataset:
Health promotion in South Africa
Authors: Onya Hans
Published: April 2008

Health promotion first entered the South African health system in 1990. Today, Health Promotion is a Directorate located within the Social Sector Cluster (SSC) within Primary Health Care (PHC), District and Development operations which falls under the Deputy Director General for Health Service Delivery in the National Department of Health (DoH). The first significant piece of new policy for health promotion in South Africa appeared in the African National Congress (ANC) health policy document, health care services including reproductive health care. At the moment, health promotion service delivery is the responsibility of the national, provincial and local governments with provincial and local governments mainly implementing and the National Health Promotion Directorate offering support. Funding for health promotion activities comes from the Department of Health budget allocation by the National Treasury. One major problem for Health Promotion development is infrastructure. There is significant community participation in South Africa including health promotion policy and strategy document development. Health Promotion research and evaluation is limited. The National Department of Health considers the settings approach to be crucial in driving the progress of health promotion. There are very few trained health promotion specialists either capable or in the position to inform politicians and opinion leaders about the relationship between health and social determinants, and the evidence of effectiveness of health promotion action. Mechanisms for demonstrating evidence of health promotion effectiveness in terms of health, social, economic and political impact are lacking and occupational standards for health promotion education and training are needed. ( Promotion & Education, 2007, XIV (4): pp 233-237)
South Asia's health promotion kaleidoscope
Authors: Mukhopadhyay Alok
Published: April 2008

South Asia has 22 percent of the world's population but only 1.3 percent of the global income. Consequently 40 percent of the population is living in absolute poverty. However the health transition in some of its countries including India and Sri Lanka is a testimony to the fact that there are proven solutions to the problems of health and development within the region. The countries of the region have much in common, including a democratic political system, four major religions, a vibrant and living tradition of voluntarism and an extensive health infrastructure which is operating well below par. Despite the underlying unity, South Asia enjoys enormous cultural, linguistic and ethnic diversity. In this large, complex and vibrant region, health promotion is a challenging task, but it also holds the key to a dramatic change in the global health situation. Many of these solutions lie in wider areas of socio-political action. There are much needed shifts in the health promotion and development efforts, particularly in the area of poverty and social justice; gender inequity; population stabilisation; health and environment; control of communicable and non-communicable diseases; and urban health strategies. The principle of cooperation, partnership and intersectoral collaboration for health will be explored. Developing an appropriate, sustainable and people centred health and development strategy in the coming decades is an enormous challenge. There has been an attempt to focus on the emerging needs of the region, which call for health promotion, and involvement of civil society, private sector and the governments bestowed with the increased responsibility of ensuring health security for people. Strengthening the existing health systems, allocating adequate resources for health development and ensuring community participation are all prerequisites to the success of health promotion in the region. ( Promotion & Education, 2007, XIV (4): pp 238-243)
The way forward: experiences of health promotion development in Thailand
Authors: Buasai Supakorn , Kanchanachitra Churnrurtai , Siwaraksa Parichart
Published: April 2008

A landmark in health promotion in Thailand came in 2001 with the launching of the Universal Health Coverage Scheme at the cost of approximately USD 2 billion a year. Another important event was the establishment of the Thai Health Promotion Foundation (ThaiHealth) as a health promotion funding mechanism that draws upon a 2 percent surcharge levied on alcohol and tobacco excise tax, approximately USD 50-60 million a year. The most significant institutional development is the promulgation of the National Health Act in 2007. The Act embraces the principle of human rights and key principles of the Ottawa Charter in 2005. It is a result of five years of extensive public dialogues on important health issues that enhanced public awareness and nation wide networking on health promotion. ThaiHealth regards itself as a catalyst for health promotion. The organisation collaborates with all sectors of the society, from the national to the grassroots level, and is the most notable organisation for health promotion in Thailand. ThaiHealth funds programs on health risks/issues such as alcohol, tobacco, accidents, exercise, as well as area or setting based programs, for example, school, work place, community, and programs that target specific population groups such as the youth, the elderly, Muslim community. The open grants program invites proposals from all kinds of organizations/groups interested in launching health promotion initiatives. The endeavour has started to bear fruit. Smoking and alcohol consumption rates have dropped and more people have become health conscious and do more exercise. However, much remains to be done as some population groups especially the youth have become susceptible to various kinds of health risks. This remarkable start must be sustained and reinforced by the continuation and expansion of knowledge generation and dissemination, relentless policy advocacy and creative public campaign, with a strong health promotion network as the most critical success factor. ( Promotion & Education, 2007, XIV (4): pp 250-253)
Questions et défis à l'échelle mondiale au-delà d'Ottawa : poursuivons le chemin
Authors: Scriven Angela , Speller Viv
Published: April 2008

Cet article fait le lien entre le document Déterminer l'avenir de la promotion de la santé : priorités d'action et les dix rapports de terrain régionaux à partir desquels il a été conçu. Ces éléments sont tous deux issus du projet mondial de l'UIPES et du CCRPS destiné à réaffirmer l'engagement des professionnels de la promotion de la santé envers la Charte d'Ottawa (Renewing our commitment to the Ottawa Charter “The Way Forward”). La déclaration Déterminer l'avenir de la promotion de la santé est née de ces rapports de terrain régionaux et servira de force motrice pour l'articulation future des politiques de promotion de la santé à l'échelle internationale. Il existe des liens entre les domaines clés abordés par les divers rapports mentionnés notamment en termes de politiques de promotion de la santé, de services promoteurs de santé, de financement de la promotion de la santé ainsi que de disponibilité des ressources, de participation communautaire en matière de santé, de recherche et d'information, et de recommandations telles qu'énoncées dans le document Déterminer l'avenir de la promotion de la santé : priorités d'action. Sont couverts la mise en pratique de politiques publiques favorables à la santé, le renforcement des structures et des processus pour la promotion de la santé, la recherche d'une pratique basée sur les connaissances, le développement de ressources humaines compétentes pour la promotion de la santé et l' empowerment des communautés. Plusieurs questions significatives ressortent de l'ensemble de ces rapports de terrain régionaux, et c'est à partir de celles-ci que l'on a énoncé les recommandations présentées dans la déclaration. Par exemple, l'environnement politique a fortement influencé l'évolution de la promotion de la santé. Les différents rapports délivrent un message clair selon lequel la volonté politique est un élément essentiel. Le plaidoyer au niveau politique doit donc continuer pour garantir que les objectifs politiques reflètent effectivement les principes d'Ottawa d'une manière appropriée. Des exemples tirés des rapports démontrent la quantité et la diversité des défis à relever pour la promotion de la santé pour aborder les déterminants mondiaux de la santé au 21e siècle. Il ressort également très nettement que les principes établis à Ottawa, et développés ensuite dans les différentes déclarations et chartes de l'OMS, sont fortement ancrés dans le cadre de référence des pratiques de promotion de la santé. Le document Déterminer l'avenir formule le message clé qui se dégage des rapports de terrain régionaux, et garantit ainsi que les enseignements tirés de la mise en œuvre d'Ottawa ces vingt dernières années vont être exploités et déterminer l'avenir de la promotion de la santé. ( Promotion & Education, 2007, XIV (4) : pp 255-259)
Cuestiones y retos mundiales después de Ottawa: el camino a seguir
Authors: Scriven Angela , Speller Viv
Published: April 2008

El presente artículo relaciona 10 informes de campo regionales con el documento Determinar el futuro de la promoción de la salud: Acciones prioritarias, siendo ambos fruto del proyecto mundial de la UIPES y del CCIPS, Renovar nuestro compromiso con la Carta de Ottawa: visión para el futuro. La declaración Determinar el futuro ha surgido de los informes de campo regionales y actuará como motor de la futura articulación de las políticas de promoción de la salud a escala internacional. En este artículo, se establecen relaciones entre las principales áreas que cubren dichos informes (políticas, servicios y financiación de la promoción de la salud y disponibilidad de los recursos, participación de la comunidad en el ámbito de la salud, investigación e información) y las recomendaciones formuladas en la declaración Determinar el futuro de la promoción de la salud: Acciones prioritarias. Los temas tratados son los siguientes: cómo llevar a la práctica políticas públicas favorables a la salud; el fortalecimiento de las estructuras y procesos de la promoción de la salud; fomentar prácticas basadas en los conocimientos; generar una mano de obra competente y potenciar la autonomía y la responsabilidad de las comunidades. En todos los informes de campo aparecen una serie de cuestiones importantes a partir de las cuales hemos formulado las recomendaciones de la declaración. Por ejemplo, el entorno político ha influido enormemente en la evolución de la promoción de la salud. De los informes se desprende el mensaje claro de que la voluntad política es esencial y que habrá que seguir luchando para que los objetivos de las políticas materialicen de modo apropiado los principios de Ottawa. Los ejemplos tomados de los informes demuestran los muchos y variados retos que tiene ante sí la promoción de la salud si pretende abordar los determinantes de la salud del siglo XXI a nivel mundial. También se indica claramente que los principios establecidos en Ottaway desarrollados en posteriores declaraciones y documentos de la OMS han sido integrados en el marco de la práctica de la promoción de la salud. Determinar el futuro expresa el mensaje clave de los informes regionales mencionados y asegura por lo tanto el aprovechamiento de las lecciones aprendidas de la aplicación de la Carta de Ottawa a lo largo de estos últimos veinte años lo cual modelará la promoción de la salud del futuro. ( Promotion & Education, 2007, XIV (4):pp 269-273).
Reconciling Scattered Images
Authors: Price Kristin N. , Gioia Dennis A. , Corley Kevin G.
Published: April 2008

Any organizational environment is filled with many different types of organizational images, some sent by a focal organization, some sent by outside arbiters, and others formed by interested stakeholders. As organizations attempt to communicate directly to segmented audiences by using tailored images, they also indirectly, and sometimes unwittingly, create a broader array of images of themselves. The resulting spectrum of images cumulates into a scattered images problem. That is, the many sent images (expressions) and received images (impressions) constitute a collection of potentially disparate organizational images that need to be reconciled. The authors explore this increasingly troublesome scattered images problem; the authors also propose a taxonomy of images and discuss their underlying sources of variation. Finally, the authors discuss why and how some organizations are able to mitigate the scattered images problem, arguing that organizational complexity, visibility, and image equivocality will influence an organization's ability to better control its own image.
Inequalities in life expectancy in Lithuania by level of education
Authors: Kalediene Ramune , Petrauskiene Jadvyga
Published: April 2008

The purpose of this study was to examine educational inequalities in life expectancy of the Lithuanian population. The life-tables by level of education were calculated on the basis of the individual records of the 1989 census, which were linked to the death records of males and females, aged 25 - 70 years. In comparison with the group with university education, the life expectancy of males with primary or lower education was 11.7 years shorter, and of females 4.3 years shorter. The greatest impact of educational differentials on life expectancy was the inequality found in the mortality of the population, aged 25-44 years. Sex differences in life expectancy were greatest among those with primary or lower education. External causes of death contributed most to educational differences in life expectancy of males, whereas cardiovascular diseases had a major impact to educational differences in females.
Do early unemployment and health status among young men and women affect their chances of later employment?
Authors: Hammarström Anne , Janiert Urban
Published: April 2008

The aim of this 5-year prospective study was to investigate the risk of future unemployment among young people who had experienced early unemployment, and to examine whether this risk was influenced by their health status. A total of 1,083 pupils in the final year of compulsory schooling were included in the cohort. The non-participation rate was 2%. At the time of a five-year follow-up, of those who were unemployed during the first two-year period, 71% of the men and 49% of the women were unemployed, had recent experience of unemployment, or were outside the labour market. The relative risk of being unemployed was 2.39 for men (95% CI 1.85-3.10) and 1.76 for women (95% CI 1.25-2.48) among those who had experienced early unemployment compared with those who had been in Youth Opportunities Programmes (YOP) or in work. Young women in YOP had the same risk of later unemployment as those who had experienced early unemployment, while young men in YOP did not have increased risk. Health status and health behaviour had only a minor influence on the risk of unemployment.
Stable and dynamic differences in injury mortality between the Nordic countries. What do they say about inherent national characteristics with regard to risk?
Authors: Melinder Karin A. , Andersson Ragnar
Published: April 2008

The aim of this study was to analyse long-term trends and patterns in injury mortality between the Nordic countries and to distinguish differences that are relatively temporary from those that are more durable. Both total injury mortality and special subcategories were examined. Some stable similarities and differences were found. Two kinds of injuries are distinguished: those that largely have a social genesis and those to which environmental causality applies. The general pattern is that there has been an increase in injuries with a social genesis and a decrease in those with an environment-related genesis. Finland has high rates of both types of injuries. Denmark has high rates of injuries with a social genesis, but low rates of those with an environmental genesis. By contrast, Norway has high rates of injuries with an environmental genesis and low rates of those with a social genesis. Sweden has low or medium rates of both types of injuries.
An analysis of the caregiver's burden and the "breaking-point" when home care becomes inadequate
Authors: Annerstedt Lena , ElmstÅhl Sölve , Ingvad Bengt , Samuelsson Sven-MÅrten
Published: April 2008

The burden of caregivers of patients suffering from of Alzheimer type dementia (DAT) and vascular dementia (VD) was analysed at the critical time, the "breaking-point", when home care becomes insufficient and/or inadequate and the caregiver burden has probably reached its upper limit. Primary family caregivers of 39 DAT and 40 VD patients who were being considered for relocation into group-living units were studied. Total caregiving burden and different aspects of the burden: general strain, isolation, disappointment, and emotional involvement, were correlated with the patients' diagnoses, abilities, and symptoms. Closer kinship to the patient imposed a heavier burden. The caregiver's gender, social class, and previous institutionalization of the patient did not influence the caregiver burden. There was no significant correlation between the patients' ADL ability or cognition and the burden. A higher level of disappointment was found among the VD carers. Different symptornatology in patients of the two diagnostic groups was related to special aspects of the burden. Multiple regression analysis showed that the amount of caregiving time each week and impaired sense of own identity, misidentifications, clinical fluctuations, and nocturnal deterioration in the patients predicted the breaking-point.
Association of Helicobacter pylori infection with lifestyle, chronic disease, body-indices, and age at menarche in Danish adults
Authors: Rosenstock Steffen J. , Jørgensen Torben , Andersen Leif P. , Bonnevie Olaf
Published: April 2008

This study examines the association between lifestyle factors, chronic disease, body-indices, and the seroprevalence of Helicobacter pylori infection in Danish adults. The relationship between age at menarche and H. pylori infection is also assessed. A random sample of 3,608 Danish adults completed a questionnaire about lifestyle factors (smoking habits, alcohol consumption, and coffee and tea intake), doctor diagnosed chronic diseases (heart conditions, diabetes, chronic bronchitis, and hypertension), menarche, and socio-demographic factors. A total of 2,913 participants were eligible for the present study. Electrocardiographs were recorded and blood pressure and serum lipid levels (HDL cholesterol, triglyceride, and cholesterol) were measured. Height and weight were determined and body mass index (BMI) calculated. Sera were analysed with an enzyme-linked immunosorbent assay for the presence of H. pylori specific IgG antibodies. The seroprevalence of H. pylori infection was associated with weekly alcohol intake ≥6 drinks (odds ratio 0.7, 95% confidence interval 0.6-0.9) due to a low rate of H. pylori infection among wine drinkers (odds ratio 0.6, 95% confidence interval 0.5- 0.7). No associations were found with smoking habits or serum lipids. People with upper quartile BMI (≥26.8 kg/m 2) were more likely to be seropositive for antibodies to H. pylori (odds ratio 1.6, 95% confidence interval 1.1-2.4). Chronic bronchitis (odds ratio 1.6, 95% confidence interval 1.1-2.5) and unspecified heart condition (odds ratio 2.0, 95% confidence interval 1.1-3.3) was more often seen in IgG seropositive women than in uninfected women. The likelihood of being seropositive for IgG antibodies to H. pylori increased with age at menarche (odds ratio per year 1.10, 95% confidence interval 1.02-1.19). Previously reported associations with age and socioeconomic status were confirmed. We conclude that wine drinking is associated with lower rates of H. pylori infection in Danish adults. The seroprevalence of H. pylori infection is increased in people with high BMI. H. pylori infection may relate to a history of late menarche and chronic bronchitis in Danish women.
Cost-effectiveness of an innovative four-year post-discharge programme for elderly patients
Authors: Anttila Sari K , Huhtala Heini S , Pekurinen Markku J , Pitkajarvi Time K
Published: April 2008

The cost-effectiveness of a post-discharge programme on the use of hospital care and the continuity of care was assessed in an elderly cohort ( n = 204) discharged from the city hospital. The participation rate was 97.6%, and the patients were aged 75 years or over and lived alone. The randomized controls (n = 204) received standard aftercare. During the follow-up the costs of university hospital care decreased by 52% in the intervention group and by 24% in the control group per patient year, compared with the costs in the year preceding the project. This happened despite the higher morbidity in the intervention group in terms of fractures and the use of university hospital care in the year preceding the project. There was also a tendency in the intervention group for the previous non-users of university hospital care to remain non-users during the follow-up. The costs of city hospital care increased by 16% and 5%, and of all hospital care by 1.3% and 0.2%, respectively. There were no differences in admissions to permanent care in the nursing homes. The intervention group did not make their first contact with the hospitals or permanent care in nursing homes earlier than the control group during the follow-up. The co-operation between hospital and domiciliary care and voluntary workers was well-suited to the innovative care of the elderly people.
The organizational pendulum
Authors: Axelsson Runo
Published: April 2008

In recent years, there have been a number of large-scale changes in the organization of healthcare in Sweden, as in many other countries. From a longer time perspective, however, there has been a more or less permanent oscillation between centralization and decentralization, and also between competition and co-operation, in Swedish healthcare organizations. In fact, there seems to be something like a pendulum moving all the time between opposite forms of organization. The frequency of these changes has been increasing during the last fifteen years, as different organizational models have replaced each other at shorter and shorter intervals. This development is partly due to the increasing rate of change in modern society, but partly also due to an element of fashion in the area of management. There is, however, a growing change fatigue in many healthcare organizations, and also increasing demands for empirical evidence on the efficiency and effectiveness of different organizational models before they are introduced into the healthcare system.
Changes in condom use after HIV diagnosis
Authors: Skrondal Anders , Eskild Anne , Thorvaldsen Hohannes
Published: April 2008

We investigated changes in condom use after HIV diagnosis. The study population comprised 78 asymptomatic HIVinfected subjects recruited from a clinic in Oslo, Norway, during 1988-92. In total, 240 follow-up visits were carried out. The response variable was repeated measurements of whether or not condoms were always used during anal/vaginal intercourse at follow-up. The explanatory variables were: time from HIV diagnosis to follow-up, exposure group (heterosexually infected, homosexual men, or infected through injecting drug use), time of HIV diagnosis (before 1987 or later), and history of condom use before HIV diagnosis. Random effects logistic regression analysis was used to study incremental changes in condom use, accommodating an unbalanced repeated measurement design. The use of condoms increased monotonously over time after HIV diagnosis in all exposure groups. Condom use was least likely among injecting drug users, subjects diagnosed before 1987 and subjects without a history of frequent condom use before HIV diagnosis.
Hormone replacement therapy: discrepancies between evidence and recommendations
Authors: Hemminki Elina
Published: April 2008

Postmenopausal hormone therapy is widely used to prevent diseases. This is not, however, based on the kind of evidence that is normally required of a preventive drug therapy: it is based on intermediary outcomes of trials and non-experimental studies. Many reasons can be postulated for the fact that we know little of this old and widely used therapy. To remedy the current situation, we should encourage randomised controlled trials, reveal the insufficiency of the current evidence, and challenge the drug industry's biased influence.
Back to work? Gendered experiences of rehabilitation
Authors: Ahlgren Christina , Hammarström Anne
Published: April 2008

Gendered experiences of rehabilitation were studied in a strategic sample of young people with work-related disorders. Thematic interviews were conducted with seven women and four men, and analysed from a gender perspective using grounded theory. In comparison with women, men were more likely to receive specific diagnoses, to demand actions, and to strive for full-time waged work. Women experienced more often than men that doctors distrusted them, and that social insurance officers made decisions for them. The outcome of rehabilitation was better for men, whether they adapted to the offered measures or not. Gendered structures in the rehabilitation system, the construction of gender in the meeting between the client and the doctor/social security officer, as well as the division of domestic duties within marriage, strongly influenced the outcome of the rehabilitation process in favour of men.
High demand, low control, and impaired general health: working conditions in a sample of Swedish general practitioners
Authors: Sundquist Jan , Johansson Sven-Erik
Published: April 2008

This cross-sectional survey of 1,004 Swedish general practitioners (GPs) aged 32-64 years analyses the extent to which low control, high work demand, and other work-related conditions are associated with self-rated impaired general health and impaired quality of life among Swedish GPs. The first part of the questionnaire contained "SF-36 Health Survey", from which we chose five psychosocial multi-item scales as dependent variables. The second part of the questionnaire had questions about working conditions from "The Swedish Survey of Living Conditions". Unconditional logistic regression was used. Female and male GPs with high job strain, i.e. low control and high work demand, exhibited a more than threefold increased risk of impaired general health compared with those with medium job strain. Low job strain among male GPs was associated with a low risk of impaired health. The finding of significant associations between psychosocial working conditions and impaired general health and impaired, quality of life in GPs in 1996 highlights the need to improve working conditions in Swedish primary healthcare, for example, by reducing number of inhabitants per full-time GP to 1,500.
Injuries to boys and girls in Swedish schools: different activities, different results?
Authors: Menckell Ewa , Laflamme Lucie
Published: April 2008

The study examines gender-related injury frequency by the type of school activity. Data were taken from an injury register created during the school year 1996/97 with the help of 79 Swedish public-sector schools. Injury ratios (IRs) by gender, type of municipality, and type of school were computed for injuries during all types of activities, for sports-related injuries, and for injuries sustained during recess periods. IRs were higher among boys for recess activities, and among girls for sports activities. IRs showed major variation by type of school, and minor variation by type of municipality. Schools catering for pupils aged 7-12 years had the highest IRs for all groups of injuries, both on aggregate and by gender. Gender-related injury-event occurrence at school clearly varies with kind of activity, but less so with age of pupils. The extent to which this reflects individual differences rather than varying exposure is uncertain.
Review Article: Is sitting-while-at-work associated with low back pain? A systematic, critical literature review
Authors: Hartvigsen Jan , Leboeuf-Yde Charlotte , Lings Svend , Corder Elisabeth H.
Published: April 2008

Objectives: To present a critical review and evaluate recent reports investigating sitting-while-at-work as a risk factor for low back pain (LBP). Methods: The Medline, Embase and OSH-ROM databases were searched for articles dealing with sitting at work in relation to low back pain for the years 1985-97. The studies were divided into those dealing with sitting-while-working and those dealing with sedentary occupations. Each article was systematically abstracted for core items. The quality of each article was determined based on the representativeness of the study sample, the definition of LBP, and the statistical analysis. Results: Thirty-five reports were identified, 14 dealing with sitting-while-working and 21 with sedentary occupations. Eight studies were found to have a representative sample, a clear definition of LBP and a clear statistical analysis. Regardless of quality, all but one of the studies failed to find a positive association between sitting-while-working and LBP. High quality studies found a marginally negative association for sitting compared to diverse workplace exposures, e.g. standing, driving, lifting bending, and compared to diverse occupations. One low quality study associated sitting in a poor posture with LBP. Conclusions: The extensive recent epidemiological literature does not support the popular opinion that sitting-while-at-work is associated with LBP.
Neck or shoulder pain and low back pain in Finnish adolescents
Authors: Vikat Andres , Rimpelä Matti , Salminen Jouko J. , Rimpelä Arja , Savolainen Annikki , Virtanen Suvi M.
Published: April 2008

The aim of this study was to investigate the prevalence and determinants of self-reported neck or shoulder pain (NSP) and low back pain (LBP) among 12-18-year-olds. A questionnaire was mailed to a nationally representative sample of 11,276 12-, 14-, 16- and 18-year-olds in 1991. The response rate was 77%. NSP was perceived at least once a week by 15% of 12-18-year-olds and LBP by 8%. Both symptoms were more prevalent among girls than among boys, and the prevalence increased with age. Among the determinants investigated, the number of perceived psychosomatic symptoms had the strongest association with NSP and LBP. Our study confirmed the co-morbidity of NSP and LBP, and indicated that NSP is more frequent than believed among 16-18-year-old girls. The strong association of psychosomatic symptoms with NSP and LBP suggests that the latter two pain states could be more psychosomatic than nosiceptive in character.
Visiting the cinema, concerts, museums or art exhibitions as determinant of survival: a Swedish fourteen-year cohort follow-up
Authors: Konlaan Boinkum B. , Bygren Lars O. , Johansson Sven-Erik
Published: April 2008

The aim of this study was to ascertain the possible influence of attending various kinds of cultural events or visiting cultural institutions as a determinant of survival. A cohort of individuals aged 25-74 years from a random sample were interviewed by trained non-medical interviewers in 1982 and 1983. The interviews covered standard-of-living variables. Our independent variables covered visiting cultural institutions and attendance at cultural events, reading books or periodicals, and music making. The non-response rate was about 25%. The cohort was followed with respect to survival for 14 years up to 31st December 1996. The background covariates that were used for control purposes were age, sex, cash buffer, educational standard, long-term disease, smoking, and physical exercise. Our setting was the Swedish survey of living conditions among the adult Swedish population aged 25-74 years. About 10,609 individuals were interviewed in 1982 and 1983. The outcome measure was survival until 31st December 1996. In all, 916 men and 600 women died during this period. We found a higher mortality risk for those people who rarely visited the cinema, concerts, museums, or art exhibitions compared with those visiting them most often. The significant relative risks ranging between RR 1.14 (95% CI. 1.01-1.31) of attending art exhibitions, and RR 1.42 (CI. 1.25-1.60) of attending museums, when adjusting for the nine other variables. Visits to the cinema and concerts gave significant RR in between. We could not discern any beneficial effect of attending the theatre, church service or sports event as a spectator or any effect of reading or music making. Our conclusion is that attendance at certain kinds of cultural events may have a beneficial effect on longevity
Risk of childhood injury: predictors of mothers' perceptions
Authors: Sellström Eva , Bremberg Sven , Gärling Anita , Olof Hörnquist Jan
Published: April 2008

Background and objectives: Safety education often targets parental risk perception. Predictors of risk perception, however, are not well known, thus limiting the feasibility of effective safety education. Accordingly, in this study, a range of predictors of maternal risk perception were examined. Methods: A random sample of 870 mothers in northern Sweden was included in the study. Three different questionnaires, with scenarios of a burn injury, a bicycle injury in the home environment, and a bicycle injury in traffic, were completed by the subjects. Multiple linear regression models tested the possible influence of causal attributions, normative beliefs, and sociodemographic and behaviour-related variables on mothers' risk perception. Results: Only 14-23% of the variance in mothers' risk perception could be explained by the multivariate models. Causal attribution to the child was found to be the most important predictor of maternal risk perception. Conclusion: Present theoretical models give few clues about how to design educational models that might influence risk perception. To make safety education more effective, other modifiable factors that influence parental safety behaviour, such as subjective norms and self-efficacy, might be better targets.
Socioeconomic differences in health expectancy in Denmark
Authors: Brønnum-Hansen Henrik
Published: April 2008

Background: Social differences in mortality rates reported in Denmark gave rise to the present study of health expectancy in different socioeconomic groups. Methods: Data on health status and occupation were derived from Health Interview Surveys. Information on occupation and deaths is register data. Health expectancy in each socioeconomic group was calculated using Sullivan's method. Results: Among 30-year-old men, high-level salaried employees had the longest expected lifetime in perceived good health, 41 years, which amounts to 89% of life expectancy, compared to 34 years (73%) for farmers, 32 years (73%) for unskilled workers, and 19 years (56%) for economically inactive men. Expected lifetime in perceived good health for high-level salaried female employees from age 30 was 46 years (91% of life expectancy). The lowest was found for assisting spouses, 36 years (71%) and economically inactive women, 25 years (56%). Large differences were also found when data on long-standing illness were used. Conclusion: The differences between socioeconomic groups are greater for health expectancy than for life expectancy.
Violence in an urban community: a population-based interview study
Authors: Steen Knut , Hunskaar Steinar
Published: April 2008

Background: This study aimed to estimate the proportion of an unselected population in an urban community (Bergen, Norway) that was exposed to physical violence during the preceding year, and to determine the proportion seeking medical treatment and pressing legal charges.

Method: A structured telephone interview was performed as part of monthly opinion polls.

Results: During a one-year period in 1997/1998, 3,005 residents of Bergen were interviewed. Of these, 41 (1.4%) had been exposed to physical violence during the preceding year; 10 (24%) of them had sought medical treatment, and 16 (39%) had pressed legal charges. The majority of the victims had been treated at Bergen Accident and Emergency Department. The interviewees knew about a total of 347 other people who had been assaulted during the preceding year. Of these assault victims, 224 (65%) sought medical treatment and 181 (52%) pressed legal charges, according to the respondents.

Conclusion: A high proportion of the assault victims did not seek medical treatment and did not press legal charges.
Review Article: Learning and knowledge-production for public health: a review of approaches to evidence-based public health
Authors: Eriksson Charli
Published: April 2008

Public health needs to be evidence-based if it is to be done correctly, which means that learning and knowledge-production for public health must be comprehensive and include knowledge from four different domains: distribution of health, determinants or causal web, consequences, and intervention methods. Specification of development trends in cardiovascular prevention points at four generations of preventive programs; these include a clinical, a bioepidemiological, a socioepidemiological, and an environmental and policy-oriented generation. Generations differ in focus and strategy, in knowledge base - the art of making an impact - and evaluation. Comprehensive public health programs often comprise components from different generations, leading to the need for an expanded model for research and evaluation. There is an urgent need for learning and knowledge-production using both quantitative and qualitative approaches for developing the evidence base for public health action. In addition, epidemiological knowledge is necessary for making appropriate priorities.
Variations and stability in drinking patterns in a cohort of Swedish males
Authors: Wennberg Peter , Bohman Michael , Andersson Tommy
Published: April 2008

Objective: Information on drinking patterns may make an important contribution to our understanding of the risks and consequences of alcohol consumption. The objective of the present study is to describe variations and stability of patterns of alcohol use at both the aggregate and the individual levels. Methods: The reported alcohol consumption was recorded of a normal, representative birth cohort of Swedish male (n=122) subjects followed from the age of 18 years to early middle age and more extensively scrutinized at the age of 36, using a 28 day time-line follow-back technique. Results: In young middle age a high proportion of total consumption occurred on Fridays and Saturdays (about 60%). In addition, it was possible to classify ``standard drinkers'', ``sporadic binge drinkers'', and ``frequent drinkers'' as separate clusters. Conclusion: While binge drinking was more stable than frequency of drinking from the age of 18 to the age of 36, frequent drinking showed the highest short-term stability at the age of 36 years.
Can women's network activities lead to improved health?
Authors: Gustafsson-Larsson Susanne , Hammarström Anne
Published: April 2008

The aim of our study was to focus on women's networks in the Swedish county of Jämtland, and to analyse the relationship between network activities and the perceived health among the network participants, as well as participation in the community among its residents. Questionnaires were distributed to all 68 women's networks and 60 responded. The results show that the network activities correlate with an improved perception of health, as well as with increased participation in the community among the residents. The more support, influence, self-reliance and trust in the future experienced by the networks through their work, the better the health among the participants in the network. The greater the self-reliance, trust in the future, amount of network-related unpaid work and new jobs, the better the participation among the community residents. Despite its limitations, our study suggests that women's networks could have an important role in health promotion within the framework of the new public health. The network model, with its bottom-up strategy, could be useful in public health, provided that networking is not used to fill a gap when there are cuts in the public sector.
Effects of the WHO 1985 criteria and the proposed new diagnostic criteria on the prevalence of diabetes in an elderly population
Authors: Hiltunen Liisa A. , Keinänen-Kiukaanniemi Sirkka M.
Published: April 2008

Population data suggest that a fasting blood glucose level of ≥6.1 mmol/l corresponds best to a two-hour blood glucose level of ≥11.1 mmol/l, which is associated with an increased risk of developing microvascular complications. The proposed new criteria, and the WHO 1985 criteria for diabetes, were applied in an elderly population, which underwent a two-hour oral glucose tolerance test. The prevalence of diabetes was higher when the proposed new criteria were used than when the old criteria were used. In calculating the prevalence of diabetes, the fasting blood glucose ≥6.1 mmol/l corresponded better to the combination of fasting and/or two-hour values than did fasting blood glucose ≥6.7 mmol/l. The prevalence obtained by using either of these fasting values alone or in combination with two-hour values corresponded poorly to that obtained by using mere two-hour blood glucose values.
Over-the-counter codeine use in Iceland: the impact of increased access
Authors: Almarsdóttir Anna Birna , Grímsson Almar
Published: April 2008

Background: The objective of this study was to test the assumption that liberalizing community pharmacy ownership in Iceland would lead to increased irrational use of over-the-counter pain relievers containing codeine. Methods: Based on this assumption we built and tested a model using an interrupted time series design that contrasts the monthly sales data for over-the-counter pain relievers containing codeine before and after the legislation took effect. Results: The total use of over-the-counter pain relievers containing codeine as well as those containing paracetamol and codeine has risen steadily throughout the period under study. The interrupted time series did not show a substantial effect from the legislative change on the use of all over-the-counter codeine pain relievers, paracetemol with codeine, and aspirin with codeine combinations. Conclusion: The assumption that increased access leads to irrational use of over-the-counter medicines is not substantiated in the case of over-the-counter pain relievers containing codeine.
Determinants of psychosomatic complaints in Swedish schoolchildren aged seven to twelve years
Authors: Berntsson Leeni T. , Gustafsson Jan-Eric
Published: April 2008

Objective: The aim of this study was to investigate determinants of psychosomatic complaints (PSC) in children. The model assumes that variables are working on three levels: the proximal level (the child), the intermediate level (the family), and the distal level (the society). Methods: Data were obtained from a large cross-sectional survey on children's health and well-being in the Nordic countries. A questionnaire was sent to the parents of a representative sample of 1,163 Swedish children aged seven to 12 years. The analysis included a multivariate analysis using the LISREL program. Results: The best predictors of PSC were the mother's health, the child's mental stability, contacts with peers, and long-term illness/disability. There were many other important relationships, which act via factors, such as school satisfaction, social competence, activities, the parents' sense of coherence, and family economy. Conclusion: PSC in children should be seen in the context of all three levels.
Physicians who do not take sick leave: hazardous heroes?
Authors: Rosvold Elin O. , Bjertness Espen
Published: April 2008

Background: Physicians seem to have problems in accepting their own illness, and they tend to avoid taking sick leave. This study reports the diseases that physicians bring to work, and discusses selected factors associated with the behaviour of working when ill. Methods: Of a random sample of 1,476 Norwegian physicians, 70% answered a mailed, anonymous questionnaire as a part of The Norwegian Medical Association's health survey. Results: During one year, 80% of the physicians had worked during an illness for which they would have sick-listed their patients. More than half of the physicians in the study had worked whilst having an infectious disease. Factors independently associated with the behaviour of working when ill include being in the age group 30-39 years, working as a clinician outside hospital, having received medical treatment during the last three years, and having low job satisfaction . Conclusion : A large number of physicians work whilst having infections and other diseases. This behaviour might be harmful to the physicians themselves as well as to their patients and staff members.
Health expectancy in Greenland
Authors: Iburg Kim Moesgaard , Brønnum-Hansen Henrik , Bjerregaard Peter
Published: April 2008

Background: Mortality and disease patterns in Greenland have greatly changed since the 1950s. Infectious diseases have decreased markedly; chronic diseases, suicides and violent deaths have increased. Methods: Life tables for the period 1991-95 were used and health status was derived from the 1993/94 Greenland Health Interview Survey. Health expectancy for the Inuit population of Greenland was calculated by an index suggested by Sullivan. Results: Greenland Inuit women live longer than men, but the expected lifetime in self-rated good health was shorter for women than for men. Chronic disease rates are high in Greenland, and consequently many healthy life years are lost, especially because of musculoskeletal diseases. Health expectancy decreases with age, but for this Inuit population the proportion of healthy life years increases after the age of 60, especially among men. Conclusion: The many healthy life years lost in Greenland according to self-rated poor health and chronic diseases should be a cause for concern in public health planning in Greenland. Special attention should also be paid to future investigations of regional patterns of health in Greenland, since there is great population heterogeneity according to geography and urbanization .
Self-rated health as a predictor of mortality among persons with cardiovascular disease in Sweden
Authors: Bardage Carola , Isacson Dag , Pedersen Nancy L.
Published: April 2008

Aims: This study analyses the association between cardiovascular diseases with and without drug treatment, self-rated health, and all-cause mortality during a 12-year period. Methods: Genetic and familial environmental effects were controlled for in subsets of the analyses. Data for these analyses were collected in 1984, 1987, 1990, and 1993 as part of the Swedish Adoption/Twin Study of Aging ( SATSA) , and through record linkage to mortality data from the National Cause of Death Register through 1996. Results: In multivariate analyses, both cardiovascular disease and low self-rated health were associated with higher mortality. Age, sex, lifestyle, diabetes, respiratory problems, cancer, depression, marital status, and social network were controlled for in the analyses. Furthermore, development of cardiovascular disease and/or drug use is associated with a decline in perceived health and higher mortality rates. The co-twin control analyses suggest that drug-treated cardiovascular disease has a marginal effect on survival beyond the effects of bad self-rated health and genetic liability to a certain survival time. Conclusions: This study shows that subjective health ratings are important predictors of mortality for persons with cardiovascular disease.