bluuebunny/crossref_metadata_2025 huggingface dataset:
Psychometric properties of the Swedish version of the Well-Being Questionnaire in a sample of patients with diabetes type 1
Authors: Bergh Anne-Louise , Persson Lars-Olof , Attvall Stig
Published: April 2008

Objectives: The aim of the present investigation was to further test the psychometric properties of a Swedish version of the Well-Being Questionnaire (WBQ) in order to determine whether it could be suitable for measuring health-related quality of life among type 1 diabetic patients. Methods: In total, 94 patients who fulfilled the inclusion criteria were selected for the study and of these 85% participated. Reliability was tested with Cronbach's alpha coefficient and the internal validity by means of principal component analysis and multitrait analysis. To test the external validity, comparisons were made with two other questionnaires, the Short form-36 and a Swedish Mood Adjective Check List. Results: The results show that, above all, the Swedish version of the WBQ measures psychological well-being, and thus must also be complemented with scales that measure other consequences of the illness and/or treatment, i.e. physical symptoms. The questionnaire has low discriminatory validity between subscales, which casts doubt on the appropriateness of using the four subscales as separate measures. The two scales measuring anxiety and depression are not sensitive enough for use among type 1 diabetics without complications and high or normal levels of psychological well-being. Conclusions: The Well-Being Questionnaire alone does not give any more information about subjective health status among type 1 diabetic patients than, for example, the generic SF-36.
Criterion-validity-based assessment of four scale constructs
Authors: Foldspang Anders , Montgomery Edith
Published: April 2008

Background: The aim of this study was to discuss, in general, selected crucial aspects of the appropriate methodology for the development and validation of scales indicating health status, and to illustrate this empirically by within-material comparison of the accuracy of four different scale constructs based on identical raw data. Methods: The empirical example was based on information from the parents of 99 refugee children, aged 3-15 years, from the Middle East, who participated in a structured interview on their children's mental health. Following this, they were exposed to a blinded semi-structured psychological interview. Four anxiety scales were constructed based on answers to 12 anxiety symptom questions in the structured interview: Scale 1, by cumulation of original item scores, each ranging from 0 to 3; Scale 2, by counting the number of symptoms being present; Scale 3, by counting the number of frequent or intense anxiety symptoms; Scale 4, by estimation of the multivariate probability of the child being anxious, as assessed by the psychological interview. The scales were compared for their accuracy in the identification of children assessed as anxious by psychological interview. Results: The four scales correlated mutually, and each of them was significantly associated with anxiety, as assessed by psychological interview. The weighted scale, however, performed significantly better than the unweighted scales for sensitivity but not for specificity. In the present data set the overall amount of misclassification was, however, significantly less than in the unweighted scales. Conclusion: As expected from theory, the weighted scale was found to be superior to the unweighted scales, in identifying the anxious children of the empirical example. In the presence of a blinded criterion measurement, empirical regression-based weighting of scale items thus constitutes an accessible and valid alternative to traditional methods of health and social scaling.
Amphetamine abuse during pregnancy: environmental factors and outcome after 14-15 years
Authors: Eriksson Margareta , Jonsson Björn , Steneroth Gun , Zetterström Rolf
Published: April 2008

The aim of this study was to assess the influence of social environmental factors on school performance and behavioural problems among 14-year-old children who had been exposed to amphetamine during foetal life. The study group comprised a cohort of 65 children who had suffered intrauterine exposure to amphetamine due to maternal drug abuse. This group has been followed since birth and examined at regular intervals. Information regarding the academic performance of the children was gathered from the school authorities. The psychosocial environment of the children was determined through interviews and through information obtained from the social authorities. Of the 64 children who attended a school within the state school system, 10 (15%) were a year behind for their age. The mean grades were significantly lower than those of their classmates. Behavioural problems were mentioned in the social authority documentation of one-third of the children, regardless of whether the child was placed in a foster home or was residing with the biological mother. A positive significant correlation was found between maternal age and the outcome of the children, as well as between therapy during pregnancy and outcome, whilst several environmental factors, particularly during the child's first four years, correlate negatively to outcome. Psychosocial factors early in life influence the outcome at 14 years. The positive effect of intervention during pregnancy illustrates the importance of early identification preferable during pregnancy.
Review Article: Barriers within the health care system to dealing with sexualized violence: a literature review
Authors: Rönnberg Ann-Kristin M. , Hammarström Anne
Published: April 2008

The aim of this study was to review the literature about possible barriers to recognition and intervention regarding women exposed to sexualized violence, in their interactions with the health care system. The barriers, as reported by the health care staff, were: lack of education; the stereotype of a ``typical battered woman''; too close identification with the victim/abuser; time constraints; fear of offending the victim/abuser; and feelings of hopelessness and non-responsibility. The barriers, as reported by the victims, were: negative experiences of and structural limitations within the health care system; fear of retaliation from the abusive partner; and psychological effects of the normalization process. We conclude that the barriers within the health care sector have to be dealt with on three different levels: the structural level in order to diminish male power in society; the organizational level in order to initiate screening and to allow the staff time for dealing with the victims; and on the individual level, health care staff need to acquire the knowledge and skills to enable them to address sexualized violence.
Minority status and perceived health: a comparative study of Finnish- and Swedish-speaking schoolchildren in Finland
Authors: Suominen Sakari B. , Välimaa Raili S. , Tynjälä Jorma A. , Kannas Lasse K.
Published: April 2008

Results of earlier studies suggest that the health of the Swedish-speaking minority in Finland is better than that of the sociodemographically similar Finnish-speaking population. The causes of differences are unknown. The main aim of the study referred was to investigate whether differences in perceived health according to linguistic group were present in a nation-wide representative sample (n=5,230) of schoolchildren aged 11, 13 and 15 years. A further aim was to determine whether differences could be attributed to socioeconomic background, social relationships or health behaviour. The study is part of the international Health Behaviour in School-aged children (HBSC) survey. The perceived health of Swedish-speaking children (n=1,699) proved to be better than that of Finnish-speaking children (n=3,531). In multivariate logistic regression models the differences could not be attributed to underlying associations with any variable studied. The health advantage of Swedish-speaking children essentially could not be related to known risk factors.
Socioeconomic differences in smoking cessation: the role of social participation
Authors: Lindström Martin , Hanson Bertil S. , Östergren Per-Olof , Berglund Göran
Published: April 2008

Objectives: The aim of this study was to investigate whether psychosocial resources explain socioeconomic differences in smoking cessation and its maintenance. Methods: A subpopulation of 11,837 individuals from the Malmö Diet and Cancer Study interviewed in 1992-94, age range 45-64 years, was investigated in this cross-sectional study. A multivariate logistic regression model was used to assess relative risks of having stopped smoking, adjusting for age, country of origin, previous/ current diseases, and marital status. Results: An odds ratio of 1.9 (1.4-2.5; 95% CI) for men and 2.0 (1.4-2.7; 95% CI) for women of having stopped smoking was found for higher non-manual employees when compared with unskilled manual workers. A decrease in these odds ratios was found when social participation was introduced into the model. The other three social network and social support variables were non-significant. Conclusion: High social participation is a predictor of maintenance of smoking cessation. It seems possible to interpret parts of the socioeconomic differences in smoking cessation and its maintenance as a consequence of differing social network resources and social capital between socioeconomic groups.
Sex differences in mortality in Denmark during half a century, 1943-92
Authors: Helweg-Larsen Karin , Juel Knud
Published: April 2008

Objective: The emphasis of this study is on the relative mortality of 45 - 74-year-old men and women in Denmark in 1943-92, following economic and political changes that have affected the social meaning of gender over the last 50 years, and which have diminished former sex differences in health behaviour. Methods: Sex ratios of total mortality and mortality from major non-sex-specific causes of death were calculated on computerized mortality data from the Danish National Cause of Death Register that covers all deaths in Denmark since 1943. Results: In the early 1940s the sex ratio of all-cause mortality was low, 1.0-1.1, it increased to a peak level in the late 1970s and early 1980s, but has since decreased due to an increase in female mortality and a more favourable trend in male mortality. Conclusion: Gender equality, employment, and economic autonomy may have beneficial health effects on both men and women, but the effects are inconsistent. The trend in smoking is the major explanatory factor for the more recent trends in gender differentials in mortality in Denmark.
Health and evolution
Authors: Lindahl B.I.B.
Published: April 2008

Darwinian medicine may shed new light on the notion of health and many current health problems. In this paper, health, as an ability to realize one's own welfare, is compared with health as an ability—either being developed or actually present—to perform a reproductive function of one's species. It is argued that knowledge about the conditions for health in the latter sense may enhance our efforts to promote health in the former sense.
Relation between health problems and sickness absence: gender and age differences
Authors: Sandanger Inger , Nygard Jan F. , Brage Sören , Tellnes Gunnar
Published: April 2008

Women have higher long-term sickness absence rates than men, and higher rates of most health problems. The rates vary with type of problem and diagnosis. The objectives were to examine whether equal proportions of women and men had sickness absence when they had a given health problem, and if disparities were diagnosis specific. Prevalence of low-back pain, psychiatric disorders, and injuries was assessed in random samples of two populations in Norway. Prevalence of long-term sickness absence for the same diagnostic categories was estimated for the same time period (1990). For injuries, the prevalence ratios between a health problem and a sickness absence were equal for women and men. For psychiatric health problems, there were 1.7 more women than men behind each sickness absence. Low-back pain showed an intermediate gender ratio of 1.3, indicating that also for this condition women tended to have less sickness absence. Musculoskeletal and psychiatric health problems (fluctuating, chronic) may result in more gender-biased, subjective, and random assessment of work ability than injuries (acute health problem).
Total cholesterol and HDL-cholesterol in relation to socioeconomic status in a sample of 11,645 Greek adults: the EPIC study in Greece
Authors: Benetou Vassiliki , Chloptsios Yiannis , Zavitsanos Xenofon , Karalis Dimitrios , Naska Androniki , Trichopoulou Antonia
Published: April 2008

Objective: To examine the relationship between educational level, a powerful indicator of socioeconomic status in Greece, total cholesterol and HDL-cholesterol in a large sample of Greek adults. Methods: The study sample consisted of 11,645 subjects, 4,398 men and 7,247 women, aged 23 - 86 years, who voluntarily participated in the Greek component of the EPIC study during 1994 - 98. Educational attainment was divided into low, medium, and high. Linear regression analyses were performed, in men and women separately, using total and HDL-cholesterol as dependent variables and educational level as independent, while controlling for age. Results: Total blood cholesterol values are inversely associated with educational level in both genders, a pattern contrasting with that found 20 years ago. The association is more prominent among women. HDL-cholesterol values are inversely associated with educational level in men, whereas the association is less consistent in women.
Alcohol habits in a suburban male cohort
Authors: Bohman Michael , Wennberg Peter , Andersson Tommy
Published: April 2008

Objective: Using data from a prospective birth-to-maturity project, the study presents normally occurring variations in alcohol involvement of alcohol-related problems among a representative cohort of Swedish males in young middle age, born in a Swedish metropolitan area (n=106). Methods: Description and classification were based on an analysis of self-reported information (collected at about 36 years of age) about frequency and quantity of alcohol consumption (four-week timeline), self-reported alcohol-related symptoms, and registry data. Results: According to a broad, operationally defined classification of ``harmful drinking'' (at least three alcohol-related symptoms, including alcohol-related crimes), 43 subjects (41%) had experienced a substantial drinking problem during their lifetime, to an extent that might warrant labels such as ``alcoholism'' or ``hazardous drinking''. About one-third of these misusers were currently using other drugs. Of the 106 subjects, 80 (75%) reported having had at least one alcohol-related symptom or problem at some time during their life. Taking various life events into account, including sociomedical circumstances and heavy consumption at 18 and 25 years, 23 subjects (22%) were classified as having a lifetime prevalence of alcohol abuse/dependence according to DSM-III criteria. Conclusion: Problem drinking was largely unknown to the healthcare system and only a few subjects had received treatment. The results are discussed in the light of data from other national and international epidemiological surveys.
Mortality in elderly men with low psychosocial coping resources using anxiolytic - hypnotic drugs
Authors: Merlo Juan , Östergren Per-Olof , Mansson Nils-Ove , Hanson Bertil S. , Ranstam Jonas , Blennow Göran , Isacsson Sven-Olof , Melander Arne
Published: April 2008

Objective: Insufficient coping with stress may lead to increased susceptibility for disease and death. Use of anxiolytic-hypnotic drugs has been suggested as a coping strategy, and some opinions have proposed their use as preventive medication. The aim of this study was to estimate if use of anxiolytic-hypnotic drugs counters the increased mortality observed in individuals lacking other coping strategies such as emotional support and social participation. Methods: A population based cohort study with 10-year (1982/83 - 1993) survival analysis was performed in 491 men born in 1914, living in the Swedish city of Malmö. Results: Compared with men with a high level of psychosocial coping resources who did not use anxiolytic-hypnotic drugs, men with a low level of psychosocial coping resources had a higher risk of death irrespective whether they used anxiolytic-hypnotic drugs, RR=1.7 (95% CI 1.1 - 2.6) or not (RR=1.8 (95%: 1.3 - 2.5). Conclusion: Anxiolytic-hypnotic drugs do not seem to counter increased mortality in elderly men with low psychosocial coping resources.
Does chronic illness cause adverse social and economic consequences among Swedes?
Authors: Lindholm Christina , Burström Bo , Diderichsen Finn
Published: April 2008

Background: In an international comparison, the Swedish welfare system has been known for universal coverage and high benefit levels. Perhaps this is the reason why very few studies recently have dealt with the social and economic consequences of long-term illness in Sweden. Aims: The research question raised here is therefore to examine chronic illness ( defined as limiting longstanding illness, LLSI) as a causal factor contributing adverse financial conditions, unemployment or labour market exclusion. Methods: A longitudinal design was employed with data from a sample of 27,773 people interviewed twice ( Swedish Surveys of Living Conditions performed by Statistics Sweden) , including subjects ( n=12,556) at interview I, without chronic illness or adverse socioeconomic conditions . Results: The odds ratios for labour market exclusion, unemployment, and financial difficulties among people who had acquired LLSI at interview II varied between 1.4 and 4.0 for the outcomes. The elevated OR decreased after testing for the mediating effect of social context and the labour market position for financial difficulties but remained significantly elevated. Conclusions: The results suggest that LLSI increases the risk of adverse financial conditions, unemployment, and of not being economically active.
The Otsego-Schoharie healthy heart program: prevention of cardiovascular disease in the rural US
Authors: Nafziger A.N. , Erb T.A. , Jenkins P.L. , Lewis C. , Pearson T.A.
Published: April 2008

Objectives: To describe a rural, hospital-based public health intervention program and to evaluate its effectiveness in cardiovascular disease (CVD) risk reduction using cross-sectional studies and a panel study.

Methods: A rural population of 158,000 located in New York state comprised the intervention population. A similar but separate population was used for reference. A multifaceted, multimedia 5-year program provided health promotion and education initiatives to increase physical activity, decrease smoking, improve nutrition, and identify hypercholesterolemia and hypertension. To evaluate the effectiveness of the intervention, surveys were conducted at baseline in 1989 (cross-sectional) and at follow-up in 1994- 95 (cross-sectional and panel). For cross-sectional studies, a random sample of adults was obtained using a three-stage cluster design. Self-reported and objective risk factor measurements were obtained. Comparison of pre- to post- changes in intervention versus reference populations was done using 2× 2randomized block ANOVA, 2 × 2 mixed ANOVA, and extension of the McNemar test.

Results: Smoking prevalence declined (from 27.9% to 17.6%) in the intervention population. Significant adverse trends were observed for high-density lipoprotein cholesterol and triglycerides. Systolic blood pressure was reduced while diastolic blood pressure remained stable. Body mass index increased significantly in both populations.

Conclusions: This rural, 5-year CVD community intervention program decreased smoking. The risk reduction may be attributable to tailoring of a multifaceted approach (multiple risk factors, multiple messages, and multiple population subgroups) to a target rural population. The study period was too short to identify changes in CVD morbidity and mortality.
Adolescent determinants of cardiovascular risk factors in adult men and women
Authors: Barnekow-Bergkvist Margareta , Hedberg Gudrun , Janlert Urban , Jansson Eva
Published: April 2008

Aims: To investigate how physical activity, physical performance and sociodemographic characteristics at the age of 16 are related to adult health habits (physical activity, dietary intake, smoking) and biological risk factors for cardiovascular diseases (being overweight, low aerobic fitness, unfavorable levels of serum lipids, high blood pressure). Methods: A randomly selected group of 220 male and 205 female students at 16 years of age was tested in 1974, and reinvestigated 18 years later. Results: The predictive health profiles for adult lifestyle and biological risk factors were different in men and women. Leisure sports activity along with high performance in the nine-minute run among the boys and in the two-hand lift test among the girls were significant predictors of adult physical activity. A positive attitude to aerobic exercise and high performance in the nine-minute run test among the boys and high marks in physical education among the girls decreased the risk of smoking. Leisure sports activities together with body mass index at young ages were the most powerful predictors of adult biological risk factors, but attitudes to sports and educational level were also significant determinants. Conclusion: These results contribute to the knowledge of which factors at young ages may promote adult healthy habits in particular physical activities.
A comparative analysis of different methods for obtaining estimates of alcohol consumption in a Danish population survey
Authors: Fonager Kirsten , Sabroe Svend
Published: April 2008

Aims: The aim of the present study was to compare different measures of alcohol consumption used in a Danish survey. Methods: A stratified random sample was extracted from the Civil Registration System. From January 1997 to January 1998 approximately 8 telephone interviews were conducted every day, including Sundays and holidays, ending with a total of 3,050 interviews after 1 year. Two main approaches to measure alcohol consumption were used: the quantity-frequency and the recent occasion approaches; the latter is subdivided into previous week and previous day approaches. Results: The overall estimated number of units (= 12 g of pure alcohol) per week was 6.8 (95% confidence intervals (CI ): 6.5- 7.1) , 6.7 (95% CI: 6.4-7.1 ) and 8.5 (95% CI: 7.8-9.1 ) for the quantity-frequency, previous week and previous day approaches, respectively. A total of 50% of the men and 70% of the women did not drink alcohol the previous day. Among people classified as high consumers in the previous week and previous day approaches, less than 60% and 30%, respectively, were similarly classified in the quantity-frequency approach. Conclusion: There was agreement on the level of alcohol consumption between the quantity-frequency and previous week approaches, but higher estimates when using the previous day approach. The previous day approach varied more in relation to the interview day and season compared with the quantity-frequency approach and the previous week approach. The recent occasions approach showed some difficulties in classifying the individuals. If the alcohol consumption is included in a model as a risk indicator or a confounder, the quantity-frequency approach would be more preferable than the recent occasion approach.
Boys and girls smoking within the Danish elementary school classes: a group-level analysis
Authors: Rasmussen Mette , Damsgaard Mogens T. , Due Pernille , Holstein Bjørn E.
Published: April 2008

Aims: To quantify the correlation between male and female smoking prevalence in elementary school classes by group-level analysis. Methods: This study was the Danish contribution to the cross-national study Health Behaviour in School-Aged Children (HBSC) 1998. Ninety school classes at grade nine (1,515 students) from a random sample of schools in Denmark took part. The proportion of male and female "at all '' smokers and daily smokers in the school class was calculated. Results: The mean "at all'' smoking proportion in the school classes is 39% for girls and 32% for boys. The proportion of male and female smokers within school classes does not correlate. There is high variation in male and female smoking behaviour between school classes. Conclusions: The infl uence of social classroom environment on the processes causing smoking behaviour may be different for boys and girls. This paper illustrates that group-level analysis provides valuable new knowledge.
Changes in community and individual level psychosocial coronary risk factors in the Danish MONICA population, 1982-92
Authors: Osler Merete , Jørgensen Torben , Gerdes Lars U. , Davidsen Michael , Brønnum-Hansen Henrik , Madsen Mette , Schroll Marianne
Published: April 2008

Aim: Myocardial infarction incidence declined by 3-5% per year from 1982-92 in the Danish study population of the WHO MONICA project. This study examined whether psychosocial coronary risk factors changed in the population during this period. Methods : Cross-sectional data from 6,695 Danish men and women aged 30, 40, 50, and 60 years, were examined in 1982-84, 1986-87, and 1991-92. Data from Social Registers were used to analyse trends in community social structure. Results: From 1982 to 1992 an increase in individuals' school education and social class followed an increase in the general welfare of the study area. At the same time type A behaviours increased in both men and women, while there were no changes in reported personal problems. The proportion of women living alone increased, while the proportion of emotionally distressed decreased. In men there were no changes in cohabitation status or emotional distress. The changes in the psychosocial factors were the same in different educational groups. Conclusion: The socioeconomic position of the population improved at the individual and the community level during the study period. This was concurrent with the declining incidence of myocardial infarction.
Cancer incidence and cause-specifi c mortality in male and female physicians: a cohort study in Estonia
Authors: Innos Kaire , Rahu Kaja , Baburin Aleksei , Rahu Mati
Published: April 2008

Aims: To evaluate whether the presumed knowledge of physicians about healthier lifestyle decreases their risk of cancer and mortality, a retrospective cohort study of male and female physicians was conducted in Estonia. Methods: The cancer incidence and cause-specifi c mortality of 3,673 physicians (870 M, 2,803 F ) in Estonia was compared with the rates of the general population. Information on cancer cases and deaths in the cohort between 1983 and 1998 was obtained from the Estonian Cancer Registry and the mortality database of Estonia. Results: The standardized incidence ratio (SIR) for all cancers was 1.32 (95% confi dence interval (CI) 1.15-1.48) in women and 0.92 (95% CI 0.73-1.13) in men. Female physicians had an elevated risk for breast cancer (SIR 2.03, 95% CI 1.62-2.51) and myeloid leukaemia (SIR 3.69, 95% CI 1.35-8.02). Male physicians had an excess of skin melanoma (SIR 4.88, 95% CI 1.58-11.38). A large defi cit of lung cancer was observed (SIR 0.24, 95% CI 0.11-0.48). The very low all-cause mortality in the cohort (standardized mortality ratio 0.55, 95% CI 0.50-0.61) was mainly due to large defi cits in deaths from lung cancer, cardiovascular diseases and external causes. The suicide rate in the cohort was lower than in the general population. Conclusions: No health risks were observed in the cohort that could be linked to the occupational exposures of physicians. The pattern of cancer incidence and mortality seen in physicians in Estonia is similar to the pattern seen among professional classes in other countries.
Urban development and health inequalities
Authors: McCarthy Mark
Published: April 2008

Urban development has historically been seen as both a cause and solution for social inequalities in health. However, environmental and individual gradients within urban areas occur everywhere, and are resistant to change. Environments are infl uenced by the degree and type of industrialization, quality of housing, accessibility to green space and - of increasing concern - transport. Individual behaviour, however, also contributes to social differences, both through migration and by the effects on individuals of cultural experiences through the life-course. Reduction on inequalities may be possible through larger social action, for example urban regeneration. There remains an important role for public health in addressing determinants of health at the population level.
Correlates of probable alcohol abuse among women working in nursing homes
Authors: Tómasson Kristinn , Gunnarsdóttir Hólmfríour K. , Rafnsdóttir Guobjörg L. , Helgadóttir Berglind
Published: April 2008

Aims: The purpose of this nationwide study was to assess the prevalence of probable alcohol abuse (PAA) among women working in geriatric care, and to study its demographics, medical and work-related correlates. Methods: The employees of geriatric nursing homes and geriatric hospital wards in Iceland with 10 patients or more were invited to participate in this cross-sectional study. The response rate was 80% (n=1515), with 96% being women (n=1432). Men were consequently omitted from the study. Questions were included on demographics, psychosocial factors, workplace environment, health behavior, and medical history. PAA was defined as (a) having been given such a diagnosis by a physician, (b) having missed work because of drinking, or (c) if alcohol use was considered a problem by the employee herself, her family, friends, or the employer. Results: A total of 4.8% of the employees fulfilled the criteria for PAA. These women were younger (41 vs. 45 years of age), more often single (25% vs. 15%) or divorced (13% vs. 9%), and less satisfied with work than the other women. Odds ratios for asthma, fibromyalgia, chronic fatigue, pain syndromes, mental disorders, and work-related accidents were elevated. Despite this, no differences were found concerning amount of sick leave. Their psychosocial work environment was worse but the physical work environment was the same. Conclusion: Women with probable alcohol abuse working in nursing homes have significant medical problems and psychosocial morbidity that is not reflected in more sick leave.
Social consequences of substance abuse: the impact of comorbid psychiatric disorders. A prospective study of a nation-wide sample of treatment-seeking patients
Authors: Tomasson Kristinn , Vaglum Per
Published: April 2008

This is both a retrospective and a 16 and 28 months prospective study of the association between psychiatric comorbidity and social consequences (accidents, fights, broken relationships, drunken driving arrests, and reduced employment) related to alcohol in a nation-wide sample ( n=351) of substance abusers seeking inpatient treatment. Psychiatric comorbidity was evaluated with the Diagnostic Interview Schedule, while drinking history and social consequences were assessed with a structured questionnaire. The social consequences had a high rate of re-occurrence. Controlled for alcohol consumption, polysubstance abuse predicted accidents (OR=2.9) and fights (OR=3.9) among men, while among pure alcoholics of both sexes phobia (OR=4.3) and antisocial personality disorder (OR=3.0) predicted fights. Only level of abuse predicted broken relationships. Antisocials had most drunken driving arrests. Attempts to reduce these social consequences should aim at treating polysubstance abuse, phobia, and antisocial personality disorder. However, the overriding aim should be the promotion of abstinence.
Food frequency questionnaire versus 7-day weighed dietary record information on dietary fibre and fat intake in middle-aged Swedish men
Authors: Persson Per-Gunnar , Carlsson Sofia , Grill Valdemar , Hagman Ulla , Lundgren Ann-Carolin , Östenson Claes-Göran , Perers Magdalena , Wallén Anna
Published: April 2008

To study the magnitude of agreement between a short self-administered food frequency questionnaire and a 7-day weighed dietary record regarding the consumption of fibre and fat, we collected information from 92 randomly selected middle-aged Swedish men. The participants first recorded all foods and drinks consumed over seven consecutive days by means of a digital scale. One month after the 7-day weighed record had been completed, a self-administered food frequency questionnaire on habitual consumption of foods containing fibre or fat during the preceding month was sent to the subjects. The 20 largest contributors of fibre and fat in the diet accounted for 71% and 52% of the total intake, respectively, based on the 7-day weighed record. The estimated mean consumption of fibre was 19.0 grams per day based on the 7-day weighed record and 18.3 grams per day based on the food frequency questionnaire. Corresponding estimated mean consumption of fat was 88.6 grams per day versus 46.9 grams per day. Men with high physical activity and low BMI, respectively, had higher intake of fibre and fat. These differences were seen for both dietary measurement methods but were more marked using the 7-day weighed record. The agreement between methods for each individual was also assessed. Based on five categories of fibre consumption, 61% of the respondents in the highest quintile according to the 7-day weighed record were classified in one of the two highest quintiles according to the food frequency questionnaire. The corresponding figure for fat intake was 56%. We conclude that the short self-administered food frequency questionnaire used in the present study can assess the absolute intake of fibre, but not of fat, with good precision. Also, the ranking of indiviudals in broad categories of consumption of fibre and fat was not largely misclassified based on this short questionnaire.
Restricting the influx of disability beneficiaries by means of law: experiences in Norway
Authors: Claussen Bjørgulf
Published: April 2008

Objectives: To study effects of restricting eligibility criteria for disability pension in Norway 1991.

Methods: Documents of 288 applicants from 1990 and 1993 in one county were analysed for social and medical variables as well as for the determination and its causes.

Results: Incidence of applications for disability benefits during a three-month period was 223 per 100,000 inhabitants in 1990. The focused group of `medically imprecise` musculoskeletal diagnoses concerned 26% of all applicants, while `precise` musculoskeletal diagnoses were given to 15%,`imprecise` psychiatric diagnoses to 7% and `precise` ones to 6%. The number of applicants fell by 39%, surprisingly about the same in all social and diagnostic groups. Denial rate increased from 8% to 21%. Denials mostly struck women, middle-aged, those living alone, those with short education, and applicants with `medically imprecise` diagnoses.

Conclusions: Restriction of disability benefits affected applicants with the least resources the hardest, and seems to contribute to the on-going process of marginalising the weaker part of the population.
The gender gap in musculoskeletal-related long term sickness absence in Norway
Authors: Brage Sören , Nygard Jan F. , Tellnes Gunnar
Published: April 2008

Objective — To examine the gender differences in long term (> 14 days) sickness absence due to musculoskeletal health problems.

Design — Analysis of data from the National Sickness Benefit Register, 1994.

Setting — The economically active population in Norway, except civil servants ( n = 1,978,030).

Subjects — All persons, 16—66 years old, with long term sickness absence episodes due to musculoskeletal health problems in 1994 ( n= 141,839).

Main outcome measures — Cumulative incidence, episode frequency, and episode duration of sickness absence.

Results — Women had higher cumulative incidence of sickness absence than men—80.6 pr 1,000 vs. 64.1 pr 1,000, and longer mean duration of episodes—94 calendar days vs. 86 days counted from the first day of absence. Episode frequency did not differ between the genders. After adjustment for age and income the gender ratio (men/women) in cumulative incidence changed from 0.80 to 1.08, and in mean duration from 0.91 to 0.96.

Conclusion — Long term sickness absence due to musculoskeletal health problems was strongly associated with gender, age, income, and diagnosis. Multivariate analysis indicated that the large gender differences in sickness absence might be overstated due to lack of adjustment for income and income-related factors.
Significant changes in the terminal care of aged patients in the long-term care in Helsinki
Authors: Visapää Juhani
Published: April 2008

Elderly patients (≥65 y) admitted to permanent institutional care in 1976 ( n=116) and 1985 ( n=193) in the city of Helsinki, Finland, were analyzed retrospectively in order to evaluate changes in the terminal care of aged patients. Patients were more demented and needed more care in 1985 than 1976. Decisions of ``do not treat actively'' (=NTA) increased from 16% to 39% for all patients and 18% vs 42% in patients not transferred. Laboratory examinations, parenteral treatment as well as antibiotic treatments in febrile patients during the last 7 days decreased even after controlling for dementia and functioning, but transfers to other institutions remained unchanged. The survey demonstrates that the terminal care has changed significantly as recommended in the guidelines.
How to measure sickness absence? Literature review and suggestion of five basic measures
Authors: Hensing Gunnel , Alexanderson Kristina , Allebeck Peter , Bjurulf Per
Published: April 2008

Objective — To examine different sick-leave measures used in sickness absence research, and to suggest a systematic way of assessing sickness absence.

Methods — A review and analysis of five major studies on sick-leave performed 1983—1988 with an epidemiological approach.

Results — Terminology and measures used varied in the different studies reviewed. The choice of a certain measure was seldom discussed in relation to the aim of the study. Based on the review five measures are suggested: frequency, length, incidence rate, cumulative incidence and duration. The definition of incidence rate is new and is a measure useful in studies of recurrent events within epidemiology. Conclusions — We have reviewed sick-leave measures previously used in the literature and suggested five basic measures for assessing sick-leave.
Examining what self-rated health question is understood to mean by respondents
Authors: Manderbacka Kristiina
Published: April 2008

The aim of this methodological study is to examine what self-rated health is understood to mean by survey respondents. The data are derived from semi-structured (re-)interviews with 42 middle-aged participants of the 1994 Finnish Survey on Living Conditions. When the respondents are asked to describe their present health, the results show concrete, contextual, and partly contradictory conceptions of ``health''. Health is presented primarily as absence of ill-health, but also connected to personal experience and life situation, and as a result of action. Second, when assessing self-rated health all respondents base their assessments on ill-health, modified by the severity, duration and restrictions posed by ill-health. Further analysis shows that some respondents base their assessments also on fitness and health behaviour. The results suggest that in addition to the medical model of health, adopting health promotion messages and ``healthy'' lifestyles are important factors contributing to health assessments.
Comparison of stress, job satisfaction, perception of control, and health among district nurses in Stockholm and prewar Zagreb
Authors: Tholdy Doncevic Stefanija , Romelsjö Anders , Theorell Töres
Published: April 2008

The increasing number of studies of stress among nurses in the last two decades have mainly dealt with nurses in hospitals. A few studies have included community-based nurses. However, no comparative studies of district nurses in different countries have been published. We have conducted a study to identify sources of stress, job satisfaction, perceived demands, control and health among district nurses (DNs) in Zagreb (Croatia) and Stockholm (Sweden), working in a polyvalent health care organization.

Data were obtained regarding altogether 305 district nurses by means of self- administered questionnaires using identical methods and items, with response rates between 88% and 95%. In general, district nurses reported high levels of job-related stress, satisfaction and control. Organizational sources of stress, such as ongoing changes in the primary care organization, and reorganization of tasks, were of importance for the district nurses in Stockholm.

They reported also more job satisfaction and commitment than the district nurses in Zagreb. The district nurses in Zagreb had significantly higher level of ``lack of resources''. They displayed significantly higher scores of psychological demands but also a greater feeling of control than the district nurses in Stockholm. Significant differences were also found between the groups in ranking of self-reported stressors.

Thus results show that differences in work organization and in essential resources have a substantial impact of perceived stress, job satisfaction, and on the generality both of single association and on the applications of models.
Indices of need and social deprivation for primary health care
Authors: Malmström Marianne , Sundquist Jan , Bajekal Madhavi , Johansson Sven-Erik
Published: April 2008

This study aimed to examine two indices of need, the underprivileged area (UPA) score and a Swedish Care Need Index (CNI, in Swedish vårdbehovsindex) with weightings from British and Swedish GPs respectively, and an index of material deprivation, Townsend score at SAMS (Small Area Market Statistics) level and at municipality level for the whole of Sweden. One third of primary health care physicians from the whole of Sweden received a questionnaire about their workload. CNI, UPA and Townsend scores were calculated using information from the Swedish census of 1990 and the registers of unemployment and migration for 1992. The Swedish GPs weighted some of the variables quite differently from the GPs in the UK. This may be important, especially at the SAMS level. The GPs in both countries considered that older people living alone contributed most to their workload. However, in Sweden the physicians ranked foreign-born people high compared with the English doctors, and in England the GPs ranked children under five years much higher than the doctors in Sweden. The correlation between the scores was high. Abbreviations: GP=General Practitioner, SAMS=Small Area Market Statistics, UPA=Underprivileged Area, CNI=Care Need Index.
Self-rated health among cardiovascular drug users in a study of Swedish twins
Authors: Svärdh Carola , Isacson Dag , Pedersen Nancy L.
Published: April 2008

The aim of this study was to analyse the relationship between self-perceived health and cardiovascular disease with and without drug treatment. Mental health and genetic effects were controlled for in the analyses. The data for these analyses were collected in 1984 as part of the Swedish Adoption/Twin Study of Aging (SATSA). In the first set of analyses, 1147 persons (mean age 60 years, 72% older than 50 years) were included. In the second part of the study, twin pairs discordant with respect to having a cardiovascular disease and/or drug use were included in the analyses. Cardiovascular disease was related to poor, self-rated health among both men and women. The proportion with bad health was largest among those with a drug-treated disease. In multivariate analyses, a strong relationship between cardiovascular disease, drug therapy and low self-rated health remained after controlling for mental health. The co-twin control analyses indicate that cardiovascular drugs have at most a marginal negative effect on health beyond the effects of the disease and genetic liability to self-perceived poor health.
Doctors' attitudes to fibromyalgia: a phenomenological study
Authors: Hellström Olle , Bullington Jennifer , Karlsson Gunnar , Lindqvist Per , Mattsson Bengt
Published: April 2008

Besides specific technical skills, successful encounters with patients require an understanding of the many ways in which patients may express themselves. This qualitative study reports on the clinical experiences of doctors when meeting patients with fibromyalgia (FM). Ten strategically chosen rheumatologists and 10 GPs in central Sweden were interviewed. The interviews were taped, transcribed and analysed in accordance with the empirical, phenomenological, psychological method. The analyses indicate that doctors try to comply with the wishes and demands of patients, and at the same time avoid perceptions of personal frustration. They are inclined to be objective and to act instrumentally, apparently in order to keep in touch with what gave biomedical meaning to an otherwise incomprehensible phenomenon. The meaning structures revealed by doctors' descriptions of FM and of relating to FM patients were characterized mainly by the way in which the doctors were (i) managing their clinical uncertainty, (ii) adhering to the biomedical paradigm, (iii) prioritizing diagnostics, (iv) establishing an instrumental relationship, and (v) avoiding recognizing FM as a possible biomedical anomaly.
Use of a historical register in social epidemiology: child mortality in Stockholm at the turn of the 19th century
Authors: Burström Bo , Diderichsen Finn , Bernhardt Eva , Smedman Lars
Published: April 2008

This study describes the age- and cause-specific levels and social determinants of high child mortality in Stockholm around the turn of the century. The study is based on computerized individual level sociodemographic information and the death certificates of children aged 0-15 years residing in Maria parish in Stockholm during the years 1885, 1891 and 1910 (n=36 718) from a historical register (the Roteman archives). The usefulness of such data for further studies in social epidemiology is discussed. Age-specific rates and major causes of death compared well with other studies. Low social class and being born out of wedlock increased the overall risk of death in early childhood. Data appear valid and may be useful in social epidemiology. Further analyses of data from the Roteman archives may contribute to the understanding of causes behind high levels of cause- specific child mortality and trends in mortality in relation to societal change.
Short Form 36 (SF-36) health survey: normative data from the general Norwegian population
Authors: HÅvard Loge Jon , Kaasa Stein
Published: April 2008

Anchoring health-related quality of life (HRQOL) measures in population norms makes clinical interpretations more meaningful and is in accordance with practice in other fields of medicine. In this paper norms for the Short Form 36 (SF-36) are presented in a random sample, representative of the general Norwegian population. In addition, sociodemographic variables affecting the scale scores are explored and discussed. The response rate was 67%, being lowest among subjects aged 70 years or over. Data-completeness strongly declined with increasing age. Physical health scales were also strongly affected by age. In all scales, with the exception of general health perceptions, women reported having poorer health than men. Marital status affected the four mental health scales. Educational status affected all the scales, but the effect was smallest in the mental scales. These norms can be employed for comparison in case-control studies, or to interpret HRQOL changes in prospective studies. Differences in social status should be given special attention. Caution should be exercised when assessing subjective health or employing the norms among subjects aged 70 years or over.