bluuebunny/crossref_metadata_2025 huggingface dataset:
Estimating the Mental Illness Component of Service Need in Corrections
Authors: Magaletta Philip R. , Diamond Pamela M. , Faust Erik , Daggett Dawn M. , Camp Scott D.
Published: February 2009

From the moment of their admission to prison, offenders with mental illness represent a population with special service needs. From this services perspective, the present study draws population estimates of mental illness indicators for newly committed offenders using operational data sources available within a correctional system. In a cohort of 2,855 male and female offenders across three security levels and five regions of the United States, several indicators of mental illness (e.g., diagnosis of serious mental illness, inpatient psychiatric care) were aggregated. Findings suggest that 15.2% of newly committed offenders at low-, medium-, and high-security facilities may require some level of mental health services to address a need related to mental illness. Prevalence rates differed between gender and between lower versus medium or high security levels. Implications informing the work of clinicians, administrators, and policy makers are discussed. Future research developing additive models estimating service need among other components of corrections populations is recommended.
`I'm Just Me!'
Authors: Moinian Farzaneh
Published: February 2009

This article explores how five children born in Sweden whose parents were born in Iran talk about their own cultural and ethnic backgrounds, and the role these play in their lives. The different ways in which they do so exemplify the complexity involved in the ongoing construction and performance of identities when certain identity options seem compulsory while others are made unavailable to them. The findings show that agency and choice are crucial issues for these children, and that they resist oversimplification, reductionism and categorization based on their cultural or ethnic backgrounds. Furthermore they draw attention to the fact that their reflective choices and self-chosen identities are often challenged both at home and in their schools. This study is intended to expand knowledge of children's lives and experiences and would be useful for both teachers and other professionals working with children.
Children's Participation Rights in Research
Authors: Powell Mary Ann , Smith Anne B.
Published: February 2009

This article explores children's participation in research, from the perspectives of researchers who have conducted research with children. Researchers' reports, gained using an email interviewing method, suggest that children's participation rights are particularly compromised when the potential child participants are considered vulnerable and the topic of the research is regarded as sensitive. Such perceptions result in stringent gatekeeping procedures that prevent some children from participating in research. This article concludes that children should be viewed, not as vulnerable passive victims, but as social actors who can play a part in the decision to participate in research. Such a view would result in more careful attention to communicating effectively with children about research, and ensuring that they may have a more central role in decision-making about participation.
Dimensions and Correlates of Client Satisfaction
Authors: Spiro Shimon E. , Dekel Rachel , Peled Einat
Published: February 2009

Client satisfaction surveys give clients a voice in the planning and management of services. While their use is quite widespread, they have hardly at all been used in the evaluation of shelters for homeless youths. In this article, the authors present findings of a client satisfaction survey conducted among residents of a shelter for homeless youths in Tel Aviv, Israel, shortly after their departure from the shelter. Satisfaction was affected mainly by three aspects of life in the shelter—the staff, the food, and the other residents. Satisfaction was related to adjustment to the shelter but not to outcomes. The survey highlights the potential and limitations of client satisfaction surveys with young persons in distress.
“If You Build It, They May Not Come”
Authors: Lee Robert E.
Published: February 2009

Objective: This study attempts to uncover barriers to participation in a marital enrichment program that had been expected to be attractive to eligible couples. Method: Work products associated with a multiyear demonstration project were subjected to ethnographic analysis. Results: Eligible couples did not see congruence between the program's goals and their needs, and some were alienated from community agencies. Also, program personnel and the social systems in which they were embedded could not use feedback to change. Conclusions: Recruitment success requires shared goals, good-enough personal relationships to support work on those goals, and subsystem flexibility, throughout the intervention system.
Evaluation of a System for Injury Surveillance in Swedish Emergency Care
Authors: Jansson Bjarne , Svanström Leif
Published: February 2009

A system for continuous and periodic injury surveillance in Swedish emergency care has been evaluated based on a case study of accidental injuries on 2454 farms during a one year period. The evaluation procedure comprised registry completeness, measurement errors, trend analysis and calculation of risk. The results indicate that the structure of the registry system permits analysis of registry completeness, but further development is needed concerning the staffing and organising problem. The importance of registry inclusion criteria when one is comparing different injury surveillance systems was noted. Limitations applied to calculation of accident frequency rates per million hours work. The results show that there will be a high drop-out rate if the collection of data is not simultaneously combined with an injury control programme. The registry system could serve as a basis for periodic surveys and trend analysis. Further development of a continuous system based on reporting immediately at the injury reception centre should be considered. A coordinated system involving both continuous and periodic data seems to leave the flexibility both to identify certain risk environments or risk groups and to analyse the circumstances involved of specific accidental injuries, e.g. in agriculture.
School Health Services as Prescribed and Practised—Do They Correspond?
Authors: Rydell Ann-Margret
Published: February 2009

The purpose of this study was to elucidate the correspondence between officially prescribed objectives of the school health service and the actual practice. The health and contacts with the school health service during one school year of 383 children from two school management areas in Uppsala were studied through school health records and interviews with the school nurse. The results showed that the children's physical health and development were followed up continuously and were carefully documented. Their psychosocial status was well known by a nurse familiar with the area but documented only to a minor extent. There was a relationship between psychosocial problems, male sex and low social class. Children with psychosocial problems did not visit the school health clinic to any major extent. The official objective to promote psychosocial health did not seem to correspond to existing programmes and routines.
Epidemiology of Sickness Certification—
Authors: Tellnes Gunnar , Bjerkedal Tor
Published: February 2009

This paper is part of a broader study of doctors' “sickness certification” practice, which is correlated with, but not the same as, “sickness absence” or “sickness benefits”. In order to obtain a total picture, information on sickness certification must be related to the population at risk, i.e. the epidemiology of sickness certification in a total population defined geographically. There is no routine registration system that provides statistics of sickness certification in Norway. Neither is there current information about those of the population who at any one time are entitled to sickness benefits, i.e. the population at risk. The aim of the present paper is to discuss the problems of estimating annual incidences of sickness certification, and to describe the results according to patients' sex, age, and place of residence. The study is based on all “initial certificates” received at the National Insurance Offices in Buskerud county during a period of four weeks in 1985. The population at risk was estimated at 106019 employed persons aged 16-69 years, and the annual incidence of sickness certification at 580 per 1000 employed persons per year (females 596, males 568). The highest incidence was found in the age group 20-29 years (females 739, males 741). In the age groups 30-39 and 40-49 years, incidences were significantly higher in females than males. The standardized incidence ratio was significantly lower than average for both females and males in agricultural municipalities, while it was significantly higher than average for females 30-39 years old in urban municipalities. The basis of epidemiological studies of sickness certification used in health services planning and in community medicine is in need of improvement. This challenge is being addressed by the National Insurance Administration in association with the Central Bureau of Statistics in Norway.
Respiratory Symptoms in Danish Welders
Authors: Groth Margit , Lyngenbo Ole
Published: February 2009

In order to study the effect of welding fumes on respiratory symptoms a cross sectional study was performed in 1982 among 2660 welders, primarily shipyard welders, compared with a control group of 881 electricians. Only workers more than 34 years of age and in work at the time of the study were selected. Information about respiratory symptoms (using standardized BMRC questions) and exposure was obtained through a self-administered questionnaire. Seventy-four never-smoking welders and 31 never-smoking controls were selected for detailed clinical interviews and extended lung function tests. This article presents the results of the questionnaire study. The welders showed a significantly higher prevalence of chronic bronchitis: 21% versus 9% in the control group ( p<0.01). The difference could neither be explained by differences in age or smoking habits nor by exposure to other air polluting substances. Other symptoms from the lower and upper respiratory system were also significantly increased among the welders. A dose-response relationship was found between exposure to welding fumes and the prevalence of symptoms from both the upper and lower respiratory system.
Socio-economic Differences in Mortality and Morbidity
Authors: Fox A J
Published: February 2009

In England and Wales interest in differences in health between different sectors of the community can be traced back to analyses of vital registration records in the 1840s. Increased attention in recent years to differences between socio-economic groups, in part in response to initiatives by the World Health Organisation, has again exposed the limitations of traditional data. National data on this topic are now based on the OPCS Longitudinal Study, a record linkage study as used in a number of countries. Such studies provide more reliable measures of differences, cover a wider range of social dimensions, and also allow different explanations of differences to be investigated. Analyses of differences in mortality are complemented by longitudinal analyses of differences in health and morbidity now deriving from other studies such as the birth cohort studies which provide a basis for investigating processes. The time is ripe for more effort to be put into international comparisons of differences.
Present and Projected Consumption of Hospital Bed-days as a Function of Terminal Days Before Death
Authors: Winkel Per , Statland Bernard E. , Brammer Mogens E. , Christau Bjørn , østergaard Erik Rahbek
Published: February 2009

In 1983 the bed-day consumption per year per 1,000 inhabitants was 1,571 for all subjects in the Copenhagen County, and 774, 1,239, and 4,918 for subjects 0-19 years, 20-64 years, and above 65 years of age, respectively. Extrapolating from these data the hospital bed-day consumption per inhabitant is predicted to increase by 20.6% in Denmark by the year 2025 as compared to 1986.

The mean hospital bed-day consumption per subject during the last 150 days prior to death in hospital was 25.0 days for males and 29.7 for females. Making the conservative assumption that only subjects who die in hospital consume hospital bed-days during the last 150 days before death, the bed-day consumption during 1983 of 0-64 years old subjects being in the terminal 150-day phase was 5.87% of the total annual bed-day consumption of this age group. For subjects 65 years of age or older, it was 18.1%.
Letter to the Editor
Authors: Antti-Poika Ilkka , Pohjolainen Timo , Alaranta Hannu
Published: February 2009

In the catchment area of Helsinki University Central Hospital (in total 16 surgical hospitals) amputation was performed on 9 patients with frostbite in the upper extremities during 1984-1985. The population during the study period in this area was 1.165,000 inhabitants, corresponding to 24% of the whole population in Finland. All 9 patients were male and the mean age was 49 years (range 31-75). All amputations performed were of the fingers, the third, fourth and fifth fingers most frequently affected. Alcohol was a marked etiologic or contributing factor in most of the frostbites. Two patients were chronic schizophrenics showing no signs of alcohol abuse, but the remaining 7 were either acutely or chronically alcohol intoxicated: 5 patients were chronic alcoholics, one was an alcohol abuser without a definite diagnosis of alcoholism, and one patient with no previous history of alcohol abuse was alcohol intoxicated. Based on the present study it is clear that, in addition to the cold winters in Finland, other factors contribute to severe frostbite. These include many psychosocial factors such as alcoholism or mental disease, unbalanced marital status, occupation handicap and lack of regular residence.
Repeated Short-Term Sick-Leave and Quality of Life
Authors: Hörnquist J. O. , Hansson B. , Leijon M. , Mikaelsson B.
Published: February 2009

The primary aim of this study was to evaluate a clinical socio-medical supportive program for repeated short-term sickleavers who exhibited no evident reason for their prolonged absence. Attention was drawn to changes in the quality of life of the participants. Ninety-nine persons took part in the full program. The sex distribution was even and the mean age was 32 years. The average number of days of sick-leave during the year preceding the entrance into the program was 28. The most common self-stated diagnosis was upper respiratory infection or gastro-intestinal problems. The evaluation showed a significant change for the better in the quality of life and well-being of the patients, although more than every other patient did not explicitly attribute any personal benefit to the intervention itself. The results coincide irrespective of measuring method and, are by and large, consistent over most areas of life and components of well-being assessed. Thus the design and the results of the evalution look very promising concerning reliability, validity and especially sensitivity. A corresponding model may be applicable more generally when evaluating health- and medical care.
Peptic ulcer among urban bus drivers in Denmark
Authors: Netterstrøm Bo , Cand.stat Knud Juel
Published: February 2009

As part of a survey on the work environment of bus drivers, 2045 (83%) of 2465 male bus drivers in the three major cities in Denmark in 1978 answered a postal questionnaire on health and working conditions.

In order to evaluate the relative occurrence of peptic ulcer among the bus drivers, a follow-up study was also conducted. All hospital discharges with a peptic ulcer diagnosis among the bus drivers were registered from the Danish National Patient Register.

All Danish men were used as reference group. On the basis of the 1978-questionnaire association between occupational and psychosocial factors and subsequent hospital discharge with a peptic ulcer diagnosis was studied. The prevalence of abdominal pain alleviated by food intake was 12% among bus drivers and 6% in the reference group.

The incidence of hospital discharge with duodenal ulcer among younger bus drivers was twice the incidence among Danish men in the same age group.

The incidence of all manifestations of peptic ulcer disease among bus drivers did not differ from the incidence among Danish men.

Of occupational and psycho-social factors, wage dissatisfaction and smoking showed statistically significant association with hospital discharge with PU in a 63/4-year period. Job dissatisfaction, stress symptoms and lack of some social network factors tended to increase the risk of hospital discharge with PU.
School Absences, School Achievements and Personality Traits of the Haemophilic Child
Authors: Kvist Béatrice , Kvist Mårten , Rajantie Jukka
Published: February 2009

Cross-sectional comparisons between haemophiliacs and their healthy classmates were made in the years 1971-72 and 1987-88. The more recent set of data indicated no difference in respect to school absenteeism and school achievements between haemophiliacs and classmates in contrast to the older data, which showed such differences. In 1987-1988 the personality of the haemophilic boy was assessed both by teacher-ratings as well as by self-rating scales, and they indicated that the haemophiliacs were self-assured and independent but also less caring, less joyful, less open and more bullied than their healthy classmates. The mildly to moderately affected haemophiliacs tended to have more emotional disturbances than classmates and severely affected haemophiliacs. The latter were the least likely to avoid potentially hazardous activities. The haemophiliac's conflicts about adapting to a restricting chronic disease were elucidated.
A Quality Study of a Medical Birth Registry
Authors: Cnattingius Sven , Ericson Anders , Gunnarskog Jan , Källén Bengt
Published: February 2009

A quality control study was made of the Swedish Medical Birth Registry. This registry used one mode of data collection during 1973-1981 and another from 1982 onwards. The number of errors in the register was checked by comparing register information with a sample of the original medical records, and the variability in the use of diagnoses between hospitals was studied. Different types of errors were identified and quantified and the efficiency of the two methods of data collection evaluated.
Strategies in the Education of Humane Physicians
Authors: Riska Elianne K.
Published: February 2009

Various reforms to change the character of medical education have been implemented since the 1960s at American medical schools. The public demand for a more “humane” physician resulted in the incorporation of new sciences in the medical curriculum — behavioral sciences in the 1960s and 1970s and humantities in the 1980s. It is argued that broader structural changes in the American health care system underlie the need for these educational reforms, which in practice allow the medical profession to maintain its autonomy and control over its work. For comparison the curricular innovations in medical education in the Nordic countries are examined.
Social Conditions of Children born after Artificial Insemination by Donor
Authors: Bendvold Erik , Moe Narve , Skjáraasen Julie
Published: February 2009

Few objective data are available concerning the social conditions of children born after artificial insemination by donor (AID). We have studied 341 consecutive AID children born of 261 women during a 13-year period. Data from hospital archives were compared with information from the National Register of Norway. The parameters studied included age-relations of parents and offspring, sex- and age-relations between siblings as well as the divorce rate in AID families. Median maternal age at birth of the first AID child was 30 years. Forty-three percent of AID children were born in families that already had children or that later obtained an additional child; the majority of these siblings were conceived by AID. Mean age difference between the closest related AID siblings was three years. Six of the 261 AID families were split by divorse during the study period. The results only reflect such information as can currently be obtained with maintainance of the promise of secrecy.
Premature Deaths Among Men in a Swedish Municipality — Civil Status and Primary Health Care Utilization Prior to Death
Authors: Hallberg Hans , Mattsson Bengt
Published: February 2009

Causes of premature deaths among men in relation to civil status and primary health care utilization were studied in a Swedish municipality. Alcoholism, suicide and accidents (psycho-social deaths and accidents) were of special concern (40% of all deaths).

When principal and contributing causes of death were considered, alcoholism was registered in 21% of all men. Including information from primary health care records, the Social Services and the local outpatient alcohol clinic, the proportion of men with alcohol abuse was 40%. Half of the men with psychosocial deaths and accidents were divorced at the time of death. The time elapse between divorce and death was especially short for those who committed suicide, 1.4 years, compared to 9.5 years when death was due to alcohol. Half of the men who visited the primary health care centre six months before death were single, and the problem of the final antemortem visit anticipated the cause of death in the majority of these men.
Mortality estimates of the 1984-85 Ethiopian famine
Authors: Kidane Asmerom
Published: February 2009

A brief summary of famine and drought from a historical perspective is given. In an attempt to estimate the magnitude of deaths due to the 1984-85 famine in Ethiopia, a survey was conducted among the resettled famine victims. The results show that the expected life at birth among the male and female famine victims was 6.2 and 5.7 years, respectively. When compared with the highest mortality rates ever recorded (that is Coale-Demeny, West Model Life Table level 1), the Ethiopian famine induced rate seems to be considerably higher. Regional variations between the two famine affected regions show that mortality in Tigrai was slightly higher than that of Wello. Also prefamine socio-economic differentials between households did not seem to have an effect on mortality. The results suggest that as much as 700,000 excess deaths might have occurred during the 1984-85 famine period in Ethiopia.
Genetic epidemiology utilizing the adoption method
Authors: I. A. Sørensen Thorkild
Published: February 2009

Genetic epidemiology gives no priority to genes or environment in the search of disease causation. However, a major problem in this field is the disentangling of the effects of environment and genes. The study of subjects separated very early in life from their biologic parents and adopted by unrelated parents provide a strong tool for estimation of genetic and familial environmental influences. The degree to which the trait or disease frequency of the adoptees is similar to that seen among the biologic relatives is an indication of the strength of the genetic influence. Similarity to the adoptive relatives suggests influences of the family environment shared between them. Adoption studies of adult obesity show that it is genes, and not the family environment, that is responsible for the familial aggregation of obesity. A study of the mortality of adult adoptees and their biologic and adoptive parents indicates a genetic influence on the risk of premature death from all causes, from natural causes, infections, and cardio- and cerebrovascular conditions, and suggests familial environmental influences on death from the vascular causes and from cancer.
Contraceptive Use in Random Samples of Greenlandic and Danish Women — Changes from 1986 to 1988
Authors: Kjér Susanne K. , Svare Edith I. , Haugaard Birthe J. , Teisen Chantal , Christensen René B. , Lynge Elsebeth , Jensen Ole M.
Published: February 2009

As part of a study of risk factors for cervical cancer, the possible change was assessed in the use of condoms after AIDS campaigns. In 1986, samples of 800 women aged 20-39 years were drawn at random from Nuuk/Godthåb (Greenland) and Nykøbing Falster (Denmark). A total of 586 and 661 women were interviewed in Greenland and Denmark, respectively. In 1988, new random samples of 150 women were drawn from the same areas. Totally, 129 Greenlandic and 126 Danish women were included in the study. From 1986 to 1988 the prevalence of ever having used condoms increased significantly among Greenlandic women aged 20-29, whereas no statistically significant changes were observed in Denmark. This pattern was independent of the lifetime number of sexual partners. Neither in Greenland nor in Denmark did the mean lifetime number of sexual partners change from 1986 to 1988.
Strategies implemented but goals not attained. Some comments on an evaluation of the Swedish mental health services
Authors: Westrin Claes-Göran
Published: February 2009

Is the development of Swedish psychiatry a success or not? Available information allows different answers to this question. Valid knowledge would demand psychiatric health service research on a much larger scale and with considerably higher ambitions than hitherto. Strong arguments can be raised about the need for such research to avoid that psychiatry will remain a medical wasteland in which confused policy makers will allocate less interest and money than ever.
Risks, Benefits and Economic Consequences of Total Hip Arthroplasty in an Aged Population
Authors: Jacobsson Sven-Arne , Rehnberg Clas , Djerf Krister
Published: February 2009

An attempt was made to evaluate risks, benefits and costs of total hip replacement in patients over 80 years. Forty consecutive replacements in 37 patients were analysed and the results were compared to a younger population (36 patients) concerning complications and duration of hospitalization. The elderly group was reexamined two years postoperatively to assess the outcome. There was a significantly prolonged stay in hospital/long-term care for the octogenarians, 31.1 days compared to 13.6 for the younger group, as well as an increased risk for complications. Eleven patients had 18 different complications (11/40; 27.5%) in contrast to 2 complications in 2 patients (2/36; 5.6%) in the younger population. Quality of life was increased in terms of pain relief and there was moderate improvement in function. For the elderly, the community expenses for welfare services were not found to be reduced after the intervention. It is concluded that the observed improvement of quality of life has to be balanced against the increased risks and costs for this group.
The social consequences of insulin-treated diabetes mellitus in patients 20-50 years of age. An epidemiological case-control study
Authors: Gåfvels Catharina , Börjesson Bengt , Lithner Folke
Published: February 2009

In order to investigate the social consequencies of diabetes we sent a questionnaire to all diabetic patients aged 20-50 years and 1.125 matched non-diabetic controls living in the county of Västerbotten in Northern Sweden. The response rate was 87% and 72%, respectively. Patients more often lived alone (18 vs 13% p < 0,05) and had no children (39 vs 31% p < 0,01). They were more often the only child of their parents (14 vs 8%, p < 0,01). Thirty-seven percent of the patients and 22% of the controls ( p < 0,001) had been absent from work because of illness more than one month continuously during the last 3 years and had more often than controls prematurely retired from work (8 vs 2% p < 0,001). Patients more often had hobbies (86 vs 76%, p < 0,001) and were participating in social activities (52 vs 41%, p < 0,001), but were less satisfied with their leisure time (71 vs 80%, p < 0,001). Forty percent of the patients vs 31% of the controls ( p < 0,01) did not visit neighbours. Fifty-one percent of the patients vs 44% of the controls ( p < 0,05) never spent leisure time with their work mates. No significant differences were found in education, socioeconomic class, dwelling or household economy.

The study shows that there are social differences between diabetic patients and non-diabetic people even though they are not overwhelming.
Life events and coping patterns reported in HIV-infected hemophiliacs a year after diagnosis
Authors: Blomqvist Vanja , Jonsson Lena , Theorell Töres
Published: February 2009

A nationwide study of the psychosocial situation of HIV-infected hemophiliacs was made in Sweden. Forty-three HIV-infected hemophiliacs aged between 12 and 72 years were compared with 30 age matched non-infected hemophiliacs. A group of 17 parents of HIV-infected boys was also studied. An unexpectedly high number of residential moves was found in the infected group during the period of diagnosis. The HIV infection diagnosis was rated the most disastrous event compared to all other studied events (including death of family member), particularly among parents of HIV-infected boys. With regard to coping, subjects were asked to record their “content of life” for the past, the present and the future. The most striking findings were the pessimistic ratings of expected number of activities with other people in the future. Such activities were assumed to decrease significantly in the infected, but not in the non-infected group. Furthermore, the ratings of possibility to influence activities were lower in the infected group compared to the non-infected. The content of activities, on the other hand, differed very little between the two groups, although non-infected men reported more hobbies and leisure activities and social activities than infected men.
Long-term sick-listing, medical rehabilitation and life quality change
Authors: Hörnquist Jan Olof , Hansson Birgit
Published: February 2009

This evaluation of the health service at one of the hospitals of the National Insurance Board in Sweden is primarily based on the perspective of the patient. One interview group of 32 patients (I-group) made life quality ratings before-after their hospital stay. In responding to a postal questionnaire one year after discharge from hospital, another group of 93 former patients (Q-group) made parallel self-ratings. Due to prolonged sick-listing, the patients had been admitted to the hospital for rehabilitation/examination according to paragraph 2: 11 in the general insurance law. The basis for their sick-listing was hereby critically reviewed. Within the framework of additional examinations (interview and structured general questions), more than 40% of the respondents stated that the hospital stay was mainly satisfying and a great majority appreciated the nursing care. However, the self-ratings showed that the patients did not ascribe any particularly great significance to the hospital stay. In the short term, it even seemed to have a certain negative impact on the life quality of the patients. No obvious positive bias seems to be built into the ratings. Thus, the assessment package applied may also work well in similar evaluative settings.
The duration of breast-feeding. A longitudinal prospective study in Denmark
Authors: Vestermark Vibeke , Høgdall Claus K. , Plenov Grete , Birch Michael , Toftager-Larsen Kim
Published: February 2009

A longitudinal prospective study was performed to investigate the total duration of breast-feeding. Three hundred and sixty-six mothers were followed-up until 3 years after delivery. At 1 month 93% were breast-feeding, at 3 months 73%, at 6 months 52%, at 1 year 20% and 1% breast-fed more than 3 years. Correlations were found between duration of breast-feeding and maternal age, education and social class. Mothers who had breast-fed an older child usually breast-fed the next child for a period of similar length. Solid food was most frequently introduced when the infants were 4 months old. At 6 months 4% were still exclusively breast-fed. Breast-feeding has become popular: only 1% did not want to breast-feed at all and 89% of mothers intended to breast-feed their children for 6 months or more. Even though the mothers now breast-feed longer than earlier, only 39% succeeded in breast-feeding for as long as or longer than they had intended.
Ethical and professional aspects of the practice of alternative medicine
Authors: Lynöe Niels
Published: February 2009

Ethical and Professional Aspects of the Practice of Alternative Medicine. Lynöe, N. (Department of Social Medicine, University of Umeå, Sweden).

The question of who should provide alternative medical treatment raises a number of different problems of both an ethical and a professional nature. Providing medical treatment, including alternative medical treatment, presupposes that the physician in question possesses diagnostic competence. It is in the best interests of society that medical care is safe, and therefore society must monitor the medical profession, e.g. in order to assure itself that the treatment provided is in agreement with the tenet of science and proven experience. The democratization of the patient-doctor relationship and the liberalization of the availability of medical and alternative medical treatments means that society also has an interest in ensuring that physicians offer alternative medical treatments or cooperate with practitioners of alternative medicine. A question is whether this is also of interest to the physicians? Another question touching on professional ethics is whether the doctor has the same responsibility to respect the desire of a patient to receive alternative medical treatment as he would have to respect the patient's right to forgo ordinary medical treatment.

These questions are analysed here against the background of the perspective of the relevant interest groups and are graded with regard to the disease and treatment concerned, how far the disease has advanced, the age of the patient, and whether or not the patient is competent to make his own decisions. These considerations are relevant in a discussion of who is qualified to provide or prescribe alternative medical treatment. This study points out that the individual physician should have the possibility to compromise and improvise from case to case. In order to shed further light on these matters it is also pointed out that there is a need for empirical investigations of how patients/laymen consider the ethical dilemmas in specific situations.
Extremely low birth weight infants less than 901 g. Impact on the family during the first year
Authors: Stjernqvist Karin M.
Published: February 2009

Extremely low birth weight infants less than 901 g. Impact on the family during the first year. Stjernqvist, K. M. (Departments of Child and Youth Psychiatry and Applied Psychology, University of Lund, Lund, Sweden).

In a longterm prospective study 20 extremely low birth weight (ELBW) infants with birth weight between 500 and 900 g (mean 755 ± 109 g) and gestational age between 24 and 30 weeks (mean 26.2 ±1.8 \v) were compared with 20 fullterm infants. This part of the study focuses on the impact on the family.

Structured parental interviews were conducted in the postnatal period and at the end of the first year concerning the pregnancy, the delivery and the infant's health and behaviour during the first year of life. Questions about the parents' and siblings' reactions, physical symptoms and the strains on the husband-wife relationship were also asked. It was found that the mothers of the ELBW infants had more fertility problems, more physical symptoms during the pregnancy and the infant's first year of life.

The birth of an ELBW infant caused crisis reactions in 85% of the mothers and 65% of the fathers. Fiftyeight per cent of the ELBW parents and 21 % of the parents in the control group reported that the stress during the infant's first year had led to strains on the husband-wife relationship.

It is evident that the birth of an ELBW infant had an impact on the whole family. However, we found no relationship between permanent neurological injuries in the infant and strong reactions in the family members. On the other hand, the parental relationship in the perinatal period seems to be of significance, as does the length of time the infant was hospitalized during its first year of life.
Temporal and regional trends in fatal childhood injuries in Norway 1971–1989
Authors: Samuelsen Sven Ove , Borge Anne Inger , Magnus Per , Bakketeig Leiv S.
Published: February 2009

The paper focuses on how mortality due to injuries among Norwegian children has varied over time and throughout the country over the last two decades. The temporal trends are compared to those of the other Nordic countries. Individual data on date of birth and death, county of residence at death, sex and cause of death were obtained from the Norwegian Death Registry on all children aged 0–14 who died during the time-span 1971–1989. Denominators were the number of persons alive in the corresponding age, year, sex and county groups. There has been a decline in fatal injuries from 25 to 9 deaths per 100000 person-years in, respectively, 1971 and 1989. The decline is less distinct in the late 1980's. The rate of fatal injuries have throughout the period been lowest in the county of Oslo and highest in Northern Norway with fatal injury rates in Finnmark 3 times that of Oslo. The declining time trend was present for all types of injuries except bicyclists and passengers, but with the sharpest decline for pedestrians and drowning injuries. The regional variation was strongest for drowning and showed a different profile from the overall pattern for bicyclists, passengers and falling injuries. The incidence of fatal injuries in Norway is comparable to those of Denmark, Finland and Iceland, but considerably higher than in Sweden. In all Nordic countries the rates have declined to about one third from 1971 to 1988.
Modernization and Smoking — Regional Differences in Adolescent Smoking in Finland in 1977–1987
Authors: Karvonen J. Sakari , Rimpelä Arja H. , Rimpelä Matti K.
Published: February 2009

The purpose of the study was to test the applicability of the modernization framework to changes and regional diversity in adolescent smoking. A biannual cross-sectional survey data from the Adolescent Health and Lifestyle Survey was used. A national sample of 14, 16- and 18-year-old Finns answered a mailed questionnaire every other year from 1977. The 1977, 1979 and 1981 data were pooled as were data from 1983 and 1985 (N = 8505, 9777). The 1987 sample was weighted in accordance with the province size (N = 11 374). Modernization trends found in the literature were apparent among adolescent smokers between 1977 and 1987. The use of hand-rolled cigarettes nearly stopped when the use of manufactured cigarettes increased. The use of low-tar cigarettes increased and that of other tobacco types decreased. Regional differences in tobacco types were associated with the structural modernization level of the regions. Snuff use was most prevalent in the most modern and the most traditional regions. The modernization framework proved useful in explaining changes in smoking.
Abuse is in the eye of the beholder
Authors: Grafström Margareta , Nordberg Astrid , Winblad Bengt
Published: February 2009

In a population-based study 219 family members of cognitively impaired elderly (casegroup) and 255 family members of cognitively healthy elderly (control-group) were interviewed about their situation as a caregiver to an old person. Twenty-six family members in the case-group reported abusive behavior in the care of the elderly at home. These family members are compared with 154 family members in the control-group, reporting other coping strategies than abusive. In the abusive group most of the elderly were in a mild stage of dementia, and the family members reported more strain in the care situation. The family members were older, judged their health as deteriorated, and were mostly living together with the dependent elderiy.
Perceived functional health of frail elderly in a primary home care programme and correlation of self-perception with objective measurements
Authors: Melin Anna-Lisa , Bygren Lars Olov
Published: February 2009

This study examined the effects of a primary home care intervention programme on self-assessed functional health, and the correlation of self-perception with objective measures in frail elderly subjects.

Elderly patients about to be discharged from an acute hospital, at risk for institutionalization, were randomly assigned to physician-led primary home care or to standard care. After early post-hospital in-home intervention and assessment, ongoing medical care and treatment were monitored by a multidisciplinary team. Functional data were collected at baseline and after six months. Self-rated and objectively rated functional variables included medical factors, personal and instrumental activities of daily living, ambulation, and social activities and contacts.

From study entry to follow-up, the scores for personal activities of daily living were significantly increased in team and control subjects as were social contacts in the team subjects ( P = 0.03). No differences between team and control groups were found for self-rated functions from study entry to follow-up, except for a tentatively statistical significance in self-rated physical health in favour of the team subjects.

Positive correlations were recorded between all self-rated and objectively rated functions, but they were stronger at follow-up. Physical health and social contacts were overrated, whereas indoor ambulation and social activities were underratcd compared to objective measures at follow-up. Personal activities of daily living, were overrated at study entry, but showed substantial agreement at follow-up (0.62).

Within demographic subgroups patients over 80 showed a stronger correlation between self-ratcd and objectively measured social functions after six months than younger patients. Men and women underrated ambulation compared to objective measures at follmv-up. Women underestimated their social activities compared to objective scoring at follow-up, whereas men showed a fair correlation. Personal activities of daily living at follow-up remained unchanged within demographic subgroups.

The correlations between self-rated and objectively measured functions were not as definite as expected. Overrated physical health and social contacts, and underrated indoor ambulation and social activities probably provided a more realistic description of the patients' functions than the objective measurements could reveal.

The outcomes indicate that self-rating of functions provides a valid measure of functional health in medically stable elderly patients.
Population Based CVD Health Risk Appraisal
Authors: Gran Birger
Published: February 2009

This study used a population based screening procedure as a means for a combined strategy for targeting individuals at high risk of cardiovascular disease while aiming for a low-risk population. During a five month period 68% of the total target population (2642 out of 3880) men and women attended the screening. We found, 1) that a broad population based health risk appraisal activity, supported by a personal computer as an educational tool and as a means to speed up the handling of each test, was feasible, 2) that it was easy to identify high risk individuals, to be able to offer them further follow-up, and 3) that there is evidence supporting the view that reaching a large proportion of the population in a limited time period, a “critical mass”, will contribute to a growing health awareness not only among participants but also among the general population in the actual area.
A Comparison of the Progression Rate to Acquired Immunodeficiency Syndrome between Intravenous Drug Users and Homosexual Men
Authors: Eskild Anne , Magnus Per , Sohlberg Christian , Jensen Finn , Kittelsen Peter
Published: February 2009

In order to study differences in progression to Acquired Immunodeficiency Syndrome (AIDS) between risk groups, 205 homosexual men and 185 intravenous drug users (IVDUs) were followed from diagnosed seropositivity for Human Immunodeficiency Virus Type-1 (HIV) for a mean period of 46 months (range 1–88 months). Seven (4%) IVDUs and 55 homosexual men (27%) were diagnosed with AIDS during the follow-up period. The probability of being AIDS-free four years after diagnosed HIV positivity was 0.96 for IVDUs (SE 0.02) and 0.73 (SE 0.04) for homosexual men ( p < 0.001, log rank test). When controlling for age and gender, the relative risk of AIDS progression for homosexual men was 9.1 (3.5–24.1, 95% confidence interval) as compared with IVDUs. Even when 24 months of follow-up time without progression were added for all homosexual men, assuming that the epidemic started two years earlier in this group, the relative risk of progression was 5.4 (2.1–14.4, 95% confidence interval) for homosexual men.
Smoking or Quitting during Pregnancy
Authors: Isohanni Matti , Oja Hannu , Moilanen Irma , Koiranen Markku , Rantakallio Paula
Published: February 2009

Current and future social factors associated with smoking habits during pregnancy were assessed. Data on maternal smoking, social background and the family's development during the 21 years after delivery were gathered for a prospective longitudinal cohort study of 12068 pregnant women and their children in Northern Finland in 1966 and for a second birth cohort of 9 362 mothers in 1985–86. The prevalence of smoking before pregnancy was 22% in the 1966 cohort (29% in 1985–86). 12% (18%) of the women continued smoking throughout their pregnancy. The following background factors were mainly associated with the mother's smoking and/or continuing during pregnancy in both cohorts when mother's age, parity, place of residence and social class were standardized: mother's age under 23, parity two or more, low social class, urban dwelling, unmarried, gainful employment and heavy smoking. The follow-up responses after 14 and 21 years, respectively, were mostly more favourable among the non-smoking mothers and those who quit smoking during pregnancy — e.g. stable family structure, child's smoking and drinking habits and application for intermediate education. Smoking throughout pregnancy or quitting of smoking late in pregnancy were associated with undesirable future development of the child and family in most of these aspects.
Asthma and Allergic Rhinitis among Finnish Adolescents in 1977–1991
Authors: Rimpelä A. H. , Savonius B. , Rimpelä M. K. , Haahtela T.
Published: February 2009

Objectives — To study whether asthma and allergic rhinitis had increased from 1977 to 1991 and if so, in which subpopulations; to study if structural changes of the society or change in the genetic susceptibility of the population could explain the increase.

Design — Cross-sectional surveys with mailed questionnaires in 1977, 1979 and 1991, data from 1977 and 1979 combined; national mortality statistics.

Setting — Finland.

Subjects — A nationwide sample of 12-, 14-, 16- and 18-year-olds. Sample sizes were 4335 and 3059, response rates 88% and 77%. Mortality statistics from 1958 to 1990.

Main outcome measures — Point prevalence rate (%) of self-reported, physician-diagnosed asthma and allergic rhinitis, susceptibility of the population measured by probability of respiratory death.

Results — Prevalence of asthma was 1.0% in 1977–1979 and 2.8% in 1991, that of allergic rhinitis 5.0% and 14.9%. Logistic regression analysis showed that the increase did not differ in socio-demographic subgroups or parents' smoking groups and that changes in the distribution of socio-demographic variables did not explain the difference either. Respiratory deaths in ages 0–4 were fewer in the birth cohorts measured in 1991.

Conclusions — Physician-diagnosed asthma and allergic rhinitis increased three-fold among Finnish adolescents in 1977–1991. Factors which explain the increase affected all subgroups similarly. Such factors could be changes in diagnostic practices and indoor air quality. Increased susceptibility could explain only a small part. It is likely that a major part of this considerable increase is real.