bluuebunny/crossref_metadata_2025 huggingface dataset:
Changes in health beliefs after labelling with hypercholesterolaemia
Authors: Troein Margareta , RÅstam Lennart , Selander Staffan
Published: April 2008

Background: Patients' health beliefs infl uence their willingness to comply with medical advice. In an earlier study, it was found that men with a previous history of information on risk factors for ischaemic heart disease expressed more feelings of threat to their health than did men without this experience. As anxiety may have adverse effects, such as making patients avoid the desired action, this could complicate adequate patient treatment. Aims: To investigate the impact on health beliefs caused by participation in a screening programme for risk factors for ischaemic heart disease, including individualized information to patients with hypercholesterolaemia. Methods: A random sample of middle-aged, urban men participating in a health screening completed a questionnaire on socioeconomic factors, medical history, lifestyle, and health beliefs. Blood pressures and plasma cholesterol values were measured. Four months after the initial screening, hypercholesterolaemic men and controls completed the questionnaire again. Results: In a univariate analysis, no differences in health belief indices were found between cases and controls at the baseline screening. Controls achieved lower values of the indices "perceived control over illness'' and "medical motivation'' at follow-up. In a matched case-control design, the differences in "medical motivation'' increased between cases and controls because controls reported lower values. "Perceived threat to health'' did not change, and it is suggested that this is due to the supportive information to the patients. Conclusion: Individualized and supportive patient information on risk factors for cardiovascular disease does not increase patients' perceptions of threat.
Incidence of cardiovascular disease, cancer and death in postmenopausal women affirming use of hormone replacement therapy
Authors: Hedblad Bo , Merlo Juan , Manjer Jonas , Engström Gunnar , Berglund Göran , Janzon Lars
Published: April 2008

Aim: The goal of this study was to evaluate the incidence of myocardial infarction, cancer and death in relation to use of hormone replacement therapy (HRT). Methods : Nine years' follow up of an urban cohort of peri-/postmenopausal women was undertaken. Local and national registers were used for retrieval of events. Results: The incidence of myocardial infarction per 1,000 person-years in users and non-users was 0.61 (5/962) and 2.20 (92/4759) respectively, adjusted relative risk (RR) 0.37; 95% confi dence interval 0.15-0.90. Rates of mortality from cardiovascular disease and cancer were 0.36 and 1.10, p= 0.058, and 2.60 and 2.09, p=0.360, respectively. In terms of all-cause mortality the adjusted RR was 1.02; 0.69- 1.52, incidence of cancer 1.28; 1.01-1.64, breast cancer 1.52; 1.01-2.28 and endometrial cancer 3.61; 1.54-8.46 . Conclusions: Women affirming use of HRT had a lower incidence of myocardial infarction. Further studies are needed to assess whether the absence of effect on total mortality may be accounted for by an increased cancer risk.
Prevalence of subjective health complaints (SHC) in Norway
Authors: Ihlebæk Camilla , Eriksen Hege R. , Ursin Holger
Published: April 2008

Aims : As subjective health complaints are one of the major reasons for short- and long-term sickness absence it is important to know the prevalence of these conditions in the general population. Methods : In this cross-sectional study, 1,240 individuals (aged 15-84 years) from the normal population in Norway answered the Subjective Health Complaint (SHC) inventory in spring 1996. Results : The prevalence of reporting subjective health complaints was high: 80% reported musculoskeletal complaints, 65% reported ``pseudoneurological' ' complaints (tiredness, depression, dizziness), 60% gastrointestinal complaints, 34% allergic complaints, and 54% flu-like complaints. The prevalence of substantial complaints was low: 13% reported musculoskeletal complaints, 5% reported "pseudoneurological' 'complaints, 4% gastrointestinal complaints, 2% allergic complaints, and 18% flu-like complaints. Women had higher prevalence of musculoskeletal, ``pseudoneurological' ' , and allergic complaints compared with men, and reported more substantial complaints on all subscales. Individuals older than 50 years were less likely to report headache, tiredness, eczema, and fl u-like complaints compared with individuals younger than 30 years. However, they had higher risk of arm pain, shoulder pain, palpitations, and several gastrointestinal and allergic complaints. The intensity of musculoskeletal, gastrointestinal, and allergic complaints was signifi cantly higher in the oldest age group. Conclusions: Subjective health complaints are very common in the normal population; there are gender and age differences in both prevalence and degree of complaints. The intensity of subjective health complaints forms a continuum, and there are no obvious cut-off point to indicate what are ``normal' ' complaints and what is illness.
Locus of control in relation to smoking cessation during pregnancy
Authors: Lindqvist Rune , Aberg Hans
Published: April 2008

Aims : This study was carried out to investigate how the locus of control (LOC) varies between those who stop smoking in connection with pregnancy and those who do not. The LOC refl ects the extent to which a person is in control of her or his life events. Methods: One hundred and two women who were regular smokers at the time of conception and paid their fi rst visits to the antenatal clinic (ANC) on account of the current pregnancy participated. The study was quantitative and questionnaire based, covering background factors, smoking habits, and the LOC. One hundred of the women were met a second time after the delivery. Smoking habits were monitored by the content of carbon monoxide in expired air. The LOC was recorded on a VAS scale (0-10). A lower index was consistent with a more internal LOC and a higher with a more external LOC. Results : The median LOC found was 4.0 (range 1.1-7.9). The LOC was not correlated to the CO in expired air. Younger age was linked to a more internal LOC, while worse sleep was correlated to a more external LOC ( p<0.05). No differences were found between those who stopped smoking and those who did not. This was the case in both light and heavy smokers. Conclusion : The LOC does not seem to infl uence the ability to stop smoking during pregnancy.
Limiting long-term illness and the experience of financial strain in Sweden
Authors: Blank Nelson , Burström Bo
Published: April 2008

Aims: This study aims to investigate whether those individuals exposed to certain socioeconomic events (e.g. unemployment or early retirement) are more at risk of experiencing fi nancial strain if they are also exposed to some limiting long-term illness. Methods: This is a cross-sectional study using a Swedish sample of 41,497 individuals between the ages of 25 and 65 selected from the Survey of Living Conditions of Statistics Sweden. The measure of association used in the study is the prevalence odds ratio, and interaction analyses are performed in order to assess differential susceptibility to experience fi nancial strain. Results: The results show that young persons, living in poor households, unemployed or early retired, reporting a high degree of impairment, present a greater probability of experiencing fi nancial strain. Severe impairment has proved to be a component in the possible causal chain leading to the experience of fi nancial strain, which interacts with the factors studied, increasing signifi cantly the probability of certain groups experiencing fi nancial hardship. Conclusion: The results sustain the hypothesis that social consequences of illness, such as fi nancial strain, might contribute to aggravate inequalities between socioeconomic groups under certain conditions such as unemployment and poverty.
Falls among frail older people in residential care
Authors: Jensen Jane , Lundin-Olsson Lillemor , Nyberg Lars , Gustafson Yngve
Published: April 2008

Aims: A prospective study was carried out to investigate the incidence, circumstances, and injuries from falls among frail older people living in three different types of Swedish residential care settings. Methods: The settings were senior citizens' apartments, an old people's home, and a group dwelling for people with dementia. The falls were registered during the three-year study period on a semi-structured fall report, and injurious falls were categorized according to severity. Results: In total 428 falls occurred among 121 residents. The incidence rate of falls at the group dwelling was twice the rates of the old people's home and senior citizens' apartments (4282 compared with 1709 and 2114 falls per 1000 person-years respectively). Some 27% of the falls occurred during the night (2100 h to 0600 h) and 28% were related to a visit to the lavatory. The presence of acute disease at the time of a fall was diagnosed in 23% of the falls. Some type of injury occurred in 118 falls (28%) and 36 of these (8%) led to moderate or serious injuries. In total 48 fractures were diagnosed. Conclusions: In a preventive programme for falls and injuries in residential care settings, areas of particular interest should include falls after mealtimes and falls at night, conditions of acute diseases, rising up from sitting, walking, and activities in progress, especially visits to the lavatory.
Public health services use in a mountainous area, Vietnam: implications for health policy
Authors: Toan N.V. , Trong L.N. , Höjer B. , Persson L.A.
Published: April 2008

Aims : The aim of this study is to describe the use of public health services in different social and ethnic groups and to explore the implementation of user fee exemption in a mountainous area in Vietnam. Methods: A cross-sectional household survey with a structured questionnaire and a four-week diary were used to collect information on illnesses, health seeking behaviour and socioeconomic factors. Three communes in a mountainous district in Northern Vietnam were selected and a random sample of 1,452 individuals in 300 households was drawn. Results: Self-medication was most common (57%) while 30% used public health services when suffering from a health problem. Persons living far from health services attended public health services less frequently than the others (adjusted OR=0.28; 95% CI 0.15-0.51). This was especially the case for ethnic minorities who were less likely to use public health services than the others were (adjusted OR=0.47; 95% CI 0.25-0.87). Persons with mild conditions tended to use public health services less than those with more severe conditions (OR=0.19; 95% CI 0.10-0.37). Health services use was similar among women and men, but the total expenditure per visit was higher for men. Almost no patients supposed to get free attendance had been exempted from user fees. Conclusions : It was found that there was a geographical inequity in use of public health services while there was relatively equal use of these services between social, gender, and ethnic groups. Long distance in combination with failure of the fee exemption may increase inequity in use of health services in remote and isolated areas. These observations contribute to the basis for implementation of the Vietnamese health policy, emphasizing efficiency and equity.
Assessment of psychological and social current working conditions in epidemiological studies: experiences from the MUSIC-Norrtälje study
Authors: Waldenström MÅns , Theorell Töres , Ahlberg Gunnel , Josephson Malin , Nise Patrik , Waldenström Kerstin , VingÅrd Eva
Published: April 2008

Background: The aim of this study was to present, evaluate and propose a tool for the assessment of psychosocial working conditions in epidemiological studies. A referent group of the large epidemiological study, the MUSIC-Norrtälje study of musculoskeletal disorders, was used. The respondents were 950 working persons (585 female and 365 male). Method: Self-administered questionnaire and personal interview were used. The responses were subjected to factor analysis. The resulting model had components generated from the demand-control-support model and action theory. Result: The result supported the use of different aspects of psychological job demands. The interview data seemed to be more related to factual exposure and the questionnaire data more to individual perception. The usefulness of the model was supported by associations between the model and psychosomatic symptoms and sleep disturbances. Conclusion : A combination of interview and questionnaire increases the possibility of interpreting the association between working conditions and health and may provide a more effective basis for interventions.
Health inequalities by socioeconomic status among men in the Nord-Trøndelag Health Study, Norway
Authors: Krokstad Steinar , Westin Steinar
Published: April 2008

Aims: This study describes inequalities and trends in health according to socioeconomic status in the Nord-Trøndelag Health Study (HUNT I and II) and contribute to the ongoing discussion on the magnitude of inequalities in health in the Nordic welfare states. To produce data comparable to recent European studies, occupational data in the HUNT Study were reclassifi ed according to the international Erikson Goldthorpe Portocarero (EGP) social class scheme. Methods: Two cross-sectional health surveys were undertaken with a 10-year interval, HUNT I (1984-86) and HUNT II (1995-97). This was a primary healthcare, total-county population study, participants for this analysis being men aged 25-69 years. Results: A consistent pattern was found of increasing health problems with decreasing socioeconomic status for four health variables: self-perceived health, temporary disability, any long-standing health problem, and chronic conditions. The prevalence ratio between the highest and lowest status groups for ``perceived health less than good'' was 2.0 in the first survey and 2.1 in the second 10 years later. The magnitude of differences for the other health outcomes was at this level or smaller, with no signifi cant overall time trend from the mid-1980s to the mid-1990s. Conclusions: The magnitude of socioeconomic gradients in health in this study seemed somewhat smaller than results from national studies, and on the average compared to studies from other European countries; there was no detectable time trend in health differentials. International comparative studies have suggested considerably larger inequalities in health according to social class in Norway using national data.
General practitioners' perceived barriers to smoking cessation - results from four Nordic countries
Authors: Helgason Ásgeir R. , Lund Karl E.
Published: April 2008

Aims: Studies indicate that doctors may be reluctant to discuss smoking with their patients. Knowledge about how this problem might be solved is limited. The aim of this study was to identify barriers for engaging in tobacco prevention in general practice. Methods: An anonymous questionnaire was mailed to 3,167 randomly selected general practitioners (GPs) in Sweden Norway, Finland, and Iceland. The questionnaire identified practice and barriers for the discussion of smoking and smoking cessation with patients and the GPs' own smoking behaviour. Results: The overall response rate was 67%. A large majority of the GPs perceived the discussion of patients' smoking habits as part of their job. However, most GPs did not enquire about smoking unless the patient had smoking-related symptoms and few engaged in smoking cessation support. Many GPs felt that smoking cessation support was too time consuming and that the time spent was not effective because few patients quit. Shortage of smoking cessation experts to whom patients could be referred was the most common barrier for systematic involvement in smoking cessation support. On average, GPs had spent approximately one hour during the previous month on smoking cessation support. Conclusion: The main barriers identified in this study indicate that smoking cessation expertise needs to be more accessible. One alternative is to establish telephone help-lines (Quit-lines) that are easily available for all and could serve as a back-up for the GPs. Another more costly approach is to develop smoking cessation expertise at major clinics. A combination of both is probably the best solution.
Reducing social inequalities in health: evidence, policy, and practice
Authors: Krasnik Allan , Rasmussen Niels Kristian
Published: April 2008

Many policy documents have expressed concerns and intentions for action regarding inequity in health. However, the evidence on how to establish effective and acceptable interventions is rather scarce. During an international conference in Copenhagen September 2000 organised by the City of Copenhagen and the Danish Ministry of Health the present evidence was presented and possible policy measures and intervention strategies were discussed. This special issue of the Scandinavian Journal of Public Health includes selected papers and presentations from the conference. Four main arenas for interventions were outlined: the workplace; healthcare services; local communities and families; and urban development. Public health will have to move out of the present reactive position to say what its contribution is to shaping the society of the future with less inequity in health. The papers show that a number of theories, concepts, and tools are available, but also that we still have much to learn and do. At the end of the conference a fi nal declaration on reducing social inequalities was endorsed outlining important general themes that have universal relevance for action.
Tackling social inequality through the development of health policy in Lithuania
Authors: Grabauskas Vilius , Kalediene Ramune
Published: April 2008

Aims: The major aim of this study was to assess existing inequalities in health of Lithuanian population and to present the process of health policy development as a major tool for reducing inequalities. The objectives were: to present life expectancy and mortality trend analysis in comparison with other European countries; to demonstrate risk profi le of Lithuanian population to major noncommunicable diseases related to social inequalities and inequities in health; and to present the process of National health policy development as potential for effective reduction of inequalities in health of Lithuanian population.

Methods: Information about demographic, general health situation and inequalities in health was obtained from Lithuanian Department of Statistics, National Health Information Centre and research studies performed at Kaunas University of Medicine.

Results: Considerable demographic, social and territorial inequalities in health were disclosed in Lithuania. Large proportion of them might be related to social inequalities in the society. Substantial improvements in health status of Lithuanian population could be expected if due attention was paid to social determinants of health.

Conclusion: Implementation of balanced national health policy involving all sectors of the society is the solution.
Sickness leave, administrative category and gender: results from the "Casa Gran' project
Authors: Moncada Salvador , Navarro Albert , Cortès Imma , Molinero Emilia , Artazcoz Lucía
Published: April 2008

Objective: The aim of this study was to analyse the variations of sickness leave rates among the Barcelona city council civil servants by administrative category and gender Methods: The study was a retrospective cohort including all people who worked for more than six months for the City Council of Barcelona from 1 January 1984 to 31 December 1993. The cohort was composed of 11,647 men and 9,001 women who contribute to a total of 134,928.7 person/years of follow-up. The study population was classified into administrative categories. Sickness leaves were classified into short episodes (less than 11 days) and long episodes (more than 10 days). Age-specifi c rates of long and short episodes of sickness leave were computed in a gender-specifi c analysis. Results : Among men, rate ratios of long spells increased constantly from the middle technician category to the unskilled worker category for the three oldest age groups. This social pattern was not as clear for younger workers. Among women, rate ratios of long spells showed far fewer differences than among men. The social gradient was evident for the three youngest age groups, with the exception of the unskilled workers. The oldest age group showed similar differences between all categories. Short spells followed a different pattern for men and women. Conclusions: Women had generally higher rates than men did, and manual categories had higher rates than non-manual ones, which was more evident for men and long episodes. The relationship between incidence rates and gender could be due to the different contents of the jobs performed by men and women, the infl uence of gender-based work segregation, and the unequal share of the reproductive workload between men and women, information which was not available for this study.
Inequalities in urban areas: innovative approaches to complex issues
Authors: Lawrence Roderick J.
Published: April 2008

Urbanization, a characteristic of the twentieth century, is a profound transformation of human settlement processes and their outcomes, which has not been well understood in terms of both positive and negative impacts. This paper argues that the interrelations between urban planning, health, social, and environmental policies have been poorly articulated until now. Although sectoral approaches have often applied remedial and corrective measures to overcome unsatisfactory conditions in urban areas, today we know that infectious diseases stemming from insanitary conditions are not the leading cause of morbidity and mortality in Europe. Nonetheless diverse forms of ill health remain associated with place of work and residence. Therefore, in order to deal with the complexity and diversity of urban areas there is an urgent need to move from conventional, sectoral approaches based on biomedical models of health to coordinated action stemming from an ecological interpretation of health including its social determinants. This kind of approach is presented in order to promote health and social development at the local level.
Socioeconomic status and psychosocial work environment: results from a Danish national study
Authors: Kristensen Tage S. , Borg Vilhelm , Hannerz Harald
Published: April 2008

Objective: The aim of this study was to analyse the associations between socioeconomic status (SES) and a number of psychosocial work environment factors with a potential impact on inequality in health. Methods: A representative sample of 1,684 adult Danish employees fi lled in a standardized questionnaire or were interviewed by telephone. The response rate was 62%. The population was divided into four levels of SES (I to IV). The psychosocial work environment was described with 19 scales. Results: Quantitative, cognitive, and emotional job demands and a number of dimensions related to active and developmental work showed higher levels among high SES individuals. Job insecurity was highest among women with low SES. Dimensions describing interpersonal relations, social support, and leadership showed no clear associations with SES. Conclusions: Prevention aiming at improving health and reducing inequality in health should focus on the dimensions of active and developmental work: infl uence at work, possibilities for development, degrees of freedom, and meaning of work. Furthermore, job insecurity should be reduced.
The Rotterdam Local Health Information System 1987-2000: from Rebus and the health barometer to the health monitor
Authors: Swart Wim , Bleeker Jan , de Haes Willy
Published: April 2008

In this article the development of the Rotterdam Local Health Information System is sketched. Started as an offspring of the Healthy Cities Project of the WHO, the focus was very much on neighbourhoods. The data were presented by a software program, REBUS Vision. It was relatively new to gather information at the neighbourhood level, so not much consideration was given to the relative importance of data for research questions. This led to the need to condense the vast amount of data into some summary fi gure, the health barometer, which chose the 27 most important available neighbourhood indicators and divided these data into six groups leading to six scores in which a neighbourhood could be compared with the city mean, other neighbourhoods, or itself in time. Although REBUS Vision and the health barometer were reasonably successful, a frequently occurring criticism was that there was too much emphasis on the signalling of public health problems. This has led to the development of a health monitor that not only signals public health problems but also tries to identify determinants and to offer solutions on a health policy and promotion level.
Empowerment to reduce health disparities
Authors: Wallerstein Nina
Published: April 2008

This article articulates the theoretical construct of empowerment and its importance for health-enhancing strategies to reduce health disparities. Powerlessness is explored as a risk factor in the context of social determinants, such as poverty, discrimination, workplace hazards, and income inequities. Empowerment is presented and compared with social capital and community capacity as strategies to strengthen social protective factors. A case study of a youth empowerment and policy project in New Mexico illustrates the usefulness of empowerment strategies in both targeting social determinants, such as public policies which are detrimental to youth, and improving community capacities of youth to be advocates for social change. Challenges for future practice and research are articulated.
Doping among high school students in Uppsala, Sweden: A presentation of the attitudes, distribution, side effects, and extent of use
Authors: Kindlundh Anna M. S. , Isacson Dag G. L. , Berglund Lars , Nyberg Fred
Published: April 2008

The aim of this study was to determine the extent of doping drug use among adolescents in Uppsala, Sweden, and to analyse the main reasons for the use. An anonymous multiple-choice questionnaire was distributed among pupils in the first and the third grades at high school; 2,742 pupils participated in the study. The results showed that 2.7% of the male and 0.4% of the female adolescents had used doping drugs at some time in their life. However, knowledge of how to get doping drugs far exceeded use. The main reasons for using doping drugs were to improve appearance and to enhance performance in sports. Some boys self-reported side effects of AAS. Despite the still predominantly negative attitude toward doping prevention programs have to be taken.
Low birth weight in China and Finland
Authors: Baizhuang Xu  , Rantakallio Paula
Published: April 2008

Although a developing country, China has a lower occurrence of low birth weight (LBW) than many developed countries. This study of two population-based one-year birth cohorts, from Finland in 1985—86 and China in 1992, shows the occurrence of low birth weight (LBW) (1000—<2500 g) among singletons to be 2.6 percent in the Chinese cohort and 3.0 percent in the Finnish one, and that of preterm births (28—<37 weeks) 2.7 percent and 4.5 percent, respectively. The main component of LBW is term LBW (57.4 percent) in the Chinese case and preterm LBW (64.7 percent) in the Finnish case. The perinatal mortality rate (PMR) was twice as high in the Chinese cohort (13.0 vs. 5.9 per thousand). The occurrence of LBW in the Finnish cohort decreased to 2.3 percent after cross-tabulation of the Finnish mothers to conform in structure to the population of Chinese mothers in terms of maternal age, marital status and maternal smoking. The result suggests that the lower incidence of LBW in the Chinese cohort seems to be a reflection of the Chinese socio-cultural environment, which provides Chinese mothers with favourable characteristics. The Finnish excess LBW would have disappeared if the mothers had possessed those characteristics as well. The excess perinatal deaths in the Chinese series might be explained by the different levels of perinatal health care in the two countries.
Political violence, family stress and mental health of refugee children in exile
Authors: Hjern Anders , Angel Birgitta , Jeppson Olle
Published: April 2008

The mental health of 63 refugee children, with a mean age of 5,9 years, from Chile and the Middle East, were studied during the first 18 months of exile in Stockholm, Sweden. 46% of the children were rated as having poor mental health five months after resettlement in symptom interviews with parents based on the structured questionnaire developed by Cederblad, and 44% thirteen months later. Political violence in the home country and stress in the family sphere in exile were identified as the major determinants of poor mental health in this context.
Work and strain on physicians in Finland
Authors: Elovainio M. , Kivimäki M.
Published: April 2008

In this study we compared the Karasek job demand-control model with an alternative model in an attempt to explain strain on Finnish physicians ( n=91) at work. Based on previous research, job demands were studied in terms of time pressure and demands related to patients. LISREL (8) analysis was used to test the models. The three factor model, providing the most parsimonious explanation of the data, suggested that time pressure, patient-related stress and controllability all have unique predictive ability of strain on Finnish physicians.
Prevalent knee pain and sport
Authors: Hahn T. , Foldspang A.
Published: April 2008

Study objective: To estimate the prevalence of knee pain in active athletes and to investigate potential associations to type, amount and duration of sports participation.

Measurements: 339 athletes gave information about occupation, sports activity and different features of knee pain, based on a selffilled questionnaire.

Main results: The prevalence of knee pain within the preceding 12 months, constant or recurrent knee pain, absence from sport and absence from work due to knee pain, was 54%, 34%, 19% and 4%, respectively. Knee pain was positively associated with years of jogging and with weekly hours of participation in competitive gymnastics but negatively with weekly hours of tennis. Constant or recurrent knee pain was positively associated with years of swimming. Absence from sport due to knee pain was positively associated with weekly hours of soccer participation.

Conclusions: Knee pain is a common symptom in athletes. The prevalence is associated with the type, amount and duration of sports participation.
Prevalence of dementia, delirium and psychiatric symptoms in various care settings for the elderly
Authors: Sandberg Olov , Gustafson Yngve , Brännström Benny , Bucht Gustaf
Published: April 2008

A prevalence study of psychiatric symptoms was performed in parts of a hospital catchment area in Mid-Sweden. In total 717 patients, aged 75 years and above, who were receiving care in an emergency hospital, three nursing homes, five old people's homes and two home medical care districts were included. All patients were examined using the OBS-scale (Organic Brain Syndrome Scale). Anxiety (51%), psychomotor slowing (45%), delirium (44%), depressed mood (41%), irritability (40%) and dementia (33%) were the most prevalent psychiatric symptoms or diagnoses in the sample but there were wide differences between the four care settings. The present study shows that the prevalence of dementia, delirium and psychiatric symptoms is high in all types of care settings for the elderly. It also demonstrates the need for psychiatric medical and nursing competence in all types of care for the elderly.
Health promotion in school age children
Authors: Bremberg Sven
Published: April 2008

Disadvantage in school age affects health during the remaining part of life. Health promotion might alleviate this situation. It is reasonable to focus on mental health, since this is the leading cause of disability adjusted life years lost in this age group and to focus on the school, since this is the most important setting. Co-operation between the public health and the educational sector is rational, yet complicated by different perspectives on knowledge and technology used in these two sectors. It is, however, possible to carry through a dialogue. Then, the public health representatives have to clarify current scientific knowledge on health promotive characteristics of the school. Such characteristics are, enhanced health control at school, aged mixed ability grouping, class sizes of 15—20 students, a task oriented school culture and employment of skills training programmes, e.g. for tobacco deterrence.
Disability pension in Malmöhus county: Aspects on long term financial effects
Authors: MÅnsson Nils-Ove , RÅstam Lennart , Adolfsson Åke
Published: April 2008

The purpose of this study was to estimate the financial costs of disability pension in order to compare the financial burden and the numerical distribution of disability pension by main diagnostic groups. During three months all new disability pensions ( n=944) granted in Malmöhus county were registered. During a follow-up of approximately two and a half years, 40 subjects died and 15 pensions expired. The predominating diagnoses were musculoskeletal diseases, mental disorders including alcohol dependence, cardiovascular and neurological diseases. To analyse whether these proportions changed when the extent of the pension, age at pension and the retirement allowance were considered, the present value of the total retirement allowances was calculated. The ranking of the four predominating diagnosis categories was not affected by the extent of the pension or the age at which the pension was granted. Thus, musculoskeletal diseases still predominated, although the proportion decreased. Among unemployed subjects, mental disorders made the largest contribution to the total expenditure. The results gained may be used in further research where alternatives to disability pension for different groups of patients and/or diagnoses are investigated.
Perinatal determinants of adult cardiovascular disease and cancer
Authors: Signorello Lisa B. , Trichopoulos Dimitrios
Published: April 2008

Interest in perinatal factors, especially birthweight, as determinants of adult-onset diseases has been steadily growing. Low birthweight has been associated with increased risk of cardiovascular disease, and high birthweight has been linked to higher risk of breast and possibly other cancers. Most mechanistic hypotheses that have been advanced to explain the empirical evidence linking perinatal conditions to adult-life disease in humans have invoked modulation of physiological processes by exogenous factors or poorly specified ``programming'' during fetal life. A form of programming that has a strong biological foundation and has recently been suggested for further study is genomic imprinting, which involves non-permanent DNA modifications and allows for influences that span three generations. The subject of the perinatal origin of adult-onset disease has profound implications and a large and reliable body of evidence needs to be assembled for biological theories to be validly evaluated against.
Tobacco use and exposure to environmental tobacco smoke in relation to certain work characteristics
Authors: Knutsson Anders , Nilsson Tohr
Published: April 2008

This study aims to describe the prevalence of smoking, snuff use, and exposure to environmental tobacco smoke (ETS) in relation to occupation among common female and male workers in Sweden. The associations between shift work, job strain, and tobacco use and exposure to ETS are assessed. The results are based on questionnaire data of 2,584 men and 2,836 women randomly selected from 63 occupations in two counties in Sweden. The prevalence of smoking ranges from 10% (95% CI 4.5-16%, police officers) to 42% (95% CI 29-55%, packing workers) in men, and between 8% (95% CI 2-14%, dentists) and 51% (95% CI 37-65%, packing workers) in women. Snuff use is more common among men (range 11-44% in different occupations) than among women (range 0-7%). The prevalence of exposure to passive smoking in this study ranges from 0.9% to 26% in men and from 0% to 30% in women. Shiftwork is significantly associated with current smoking, and job strain is significantly related to exposure to ETS. Ages between 18 and 29 years experienced an increased risk of exposure to ETS compared to older age groups. In conclusion, this study shows that tobacco use and exposure to ETS is still a major problem in the Swedish workplace.
Differences in injury mortality between the Nordic countries - with special reference to differences in coding practices
Authors: Melinder Karin A. , Andersson Ragnar
Published: April 2008

The aims of the study are to analyse the incidence and patterns in injury mortality in the Nordic countries, and to assess the extent to which any differences found can be explained in terms of either variation in statistical validity or the existence of genuine differences. The study considers the entire injury panorama, and is performed between certain categories of injuries. Analysis is applied to all ages, and also to certain specific age categories. Finland appears as the Nordic country with the highest injury mortality. While examining potential source of errors, nothing was found to merit an adjustment of Finland's rate. All potential correction would bring the rates of the other Nordic countries closer to that of Finland. Poisoning was found to be a diagnosis that varies in application between the Nordic countries. Falling is the diagnosis with the greatest problems of sensitivity, and cannot be recommended for comparative purposes.
Prevalence of intellectual dysfunctioning and its correlates in a community-residing elderly population
Authors: Nakanishi Noriyuki , Tatara Kozo , Shinsho Fumiaki , Takatorige Toshio , Murakami Shigeki , Fukuda Hideki
Published: April 2008

To examine the prevalence of intellectual dysfunctioning and its correlates in community-residing elderly people, a randomly selected sample of 1,405 people aged 65 and over living in Settsu, Osaka, were investigated in October 1992. Data for assessing intellectual dysfunctioning were obtained from 1,364 people (97.1%), excluding 21 clinically demented people (1.5%); 17.6/100, 5.6/100, and 3.3/100 of the population showed minor, moderate, and appreciable intellectual dysfunctioning, respectively, and the prevalence of intellectual dysfunctioning increased with age. By multivariate analyses using logistic regression, age over 75, poor general health, including current medical treatment, and psychosocial conditions such as no participation in social activities, no life worth living (no Ikigai), and anxiety about the future were independent risk factors for intellectual dysfunctioning. We conclude that intellectual dysfunctioning is closely associated with health and psychosocial conditions.
Gender trends in sick-listing with musculoskeletal symptoms in a Swedish county during a period of rapid increase in sickness absence
Authors: Leijon Margareta , Hensing Gunnel , Alexanderson Kristina
Published: April 2008

Sickness absence and disability pension due to musculoskeletal diagnoses has increased in Sweden. Study objective — To study gender trends in sickness absence with musculoskeletal diagnoses and its changes in 1985—87. Design — A prospective population-based study of all new sick-leave spells exceeding seven days in 1985—87. Sickness absence with ``all diagnoses'' was compared to ``all musculoskeletal diagnoses'', the latter group was also divided into three sub-groups. Setting — The county of Östergötland, Sweden. Participants — All sick-leave insured aged 16—65; 107,000 women and 100,000 men. Results — More women than men were sick-listed in ``all diagnoses'' in 1985. There were corresponding gender differences in sickness absence with musculoskeletal diagnoses except with the diagnosis ``low back pain''. Sick-listing with musculoskeletal diagnoses increased for both women and men from 1985 to 1987, but the increase was consistently much higher for women, especially for younger women.
Trend of psychological distress in a Swedish population from 1989 to 1995
Authors: Rahmqvist Mikael , Carstensen John
Published: April 2008

The economic recession which began in Sweden in 1991 was followed by a large increase in the unemployment rate, especially in the younger labour force. The main purpose of the present study was to examine whether this recession has resulted in an increase in psychological distress in the population. Self-reported symptoms of anxiety, anguish, depression and sleeplessness have been analysed in repeated cross-sectional surveys conducted every other year from 1989 to 1995 in the County of Östergötland. The study was confined to the 20 - 39 years age group and includes 3122 male and 3440 female respondents. The analysis was restricted to symptoms reported as occurring often or constantly. There was a significant increase in the 12-month prevalence of psychological distress among both men and women. At the beginning of the period 5% of the men in the 20 - 29 years age group reported frequent symptoms of psychological distress. By 1995 this had increased to 10%. The largest increase in prevalence, however, was found in men in the 30-39 years age group and women in the 20-29 years group Interestingly, when the non-employed groups were excluded from the analysis, the increasing trends of reported distress remained statistically significant with the exception of women aged 30 - 39 years.
Sickness absence: a review of performed studies with focused on levels of exposures and theories utilized
Authors: Alexanderson Kristina
Published: April 2008

Background: Despite the major impact sickness absence has on society, companies and individuals, surprisingly little scientific knowledge has been accumulated, and the studies that have been performed vary greatly.

Aim and method: Examination of about 320 studies of sickness absence regarding structural levels of exposures studied and theories utilized.

Results: Theories concerning sickness absence were found to vary greatly. Along with exposures and factors explaining sickness absence these theories were categorized with respect to different structural levels, i.e. they were deemed national, occupational, or individual. A classification of different types of absences is presented.

Conclusion: Although most of the reviewed studies were performed within the realm of medicine, only a few of the investigators used medical explanatory models or even considered the health status of individuals. Moreover, it is known that factors at ``higher'' structural levels have a substantial effect on sickness absence, but these were seldom taken into account, or even mentioned, in the reports scrutinized.
Equity in the delivery of health care in Sweden
Authors: Gerdtham U.-G. , Sundberg G.
Published: April 2008

There is mutual agreement that health care should be delivered according to need. In this article, although we employ different specifications for need, we conclude that there is inequity in the delivery of health care in Sweden. Higher income groups visit doctors more often than lower income groups in relation to need, but lower income groups remain in hospital longer once they have been admitted. These findings may be interpreted to mean that lower income groups, for various reasons, wait too long before visiting a doctor for a specific disease, the consequence being that the disease is so serious by the time the doctor is contacted that inpatient care and a longer time in hospital are necessary. The policy implication of this situation is that lower patient fees and/or higher incomes may help to reduce the inequities in health care.
Socioeconomic differences in health indices, social networks and mortality among Swedish men. A study of men born in 1933
Authors: Rosengren Annika , Orth-Gomér Kristina , Wilhelmsen Lars
Published: April 2008

Background: In a previous survey we found large socioeconomic differences in mortality among urban Swedish men which remained unexplained after controlling for smoking and standard coronary risk factors. The present analysis was undertaken in order to investigate a broader set of possible explanatory factors in another cohort of Swedish men.

Study population and methods: Occupation was coded into five occupational classes for 717 of 776 participant men from a random population sample of 1016 men who were born in 1933. All were living in Göteborg and were 50 years old at the baseline examination. After 12 years' follow-up, 68 of the 717 men had died (9.5%).

Results: Low occupational class was associated with a higher prevalence of smoking at baseline, but no association was found with systolic blood pressure, body mass index, waist to hip ratio, serum triglycerides or serum cholesterol. Subjects from higher socioeconomic strata were taller, had higher maximum peak respiratory flow, lower plasma fibrinogen and lower body temperature. Low occupational class was associated with low social integration, low home activity levels, low levels of activity outside home and low social activity levels ( p 0.001 for all) and with low emotional support ( p0.018). There were also associations between low occupational class and poor self-perceived health, as well as with several cardiovascular symptoms. During 12 years' follow-up, there was a graded and inverse relationship between occupational class and mortality from all causes. The highest mortality was found among the men who could not be classified (23 per 1,000 person years) Of the men in the lowest occupational class, 12 per 1,000 died, compared to 3 per 1,000 in the highest class (relative risk 3.7 (1.4- 9.8)). After controlling for smoking, the relative risk decreased to 3.2 (1.2 - 8.6) and after further adjustment for emotional support, self-perceived health, activity level at home, and peak expiratory flow, the relative risk was still twofold but not significantly so (RR 2.1 (0.8-5.8)).

Conclusion: We were able to confirm earlier results as to the wide mortality differentials in urban middle-aged men in Sweden. There were also large differences in several other factors, including constitutional factors, health variables, lifestyle and social support indices, which explained important parts of the social mortality gradient, the most prominent being smoking, respiratory function, social network factors and subjective health.
Socioeconomic correlates of infant mortality in Hong Kong, 1979—93
Authors: Wong Tze-Wai , Wong Siu-Lan , Yu Tak-Sun , Liu Joseph L. Y. , Lloyd Owen L.
Published: April 2008

Although Hong Kong's infant mortality is among the lowest in the world, there may still be subgroups in the population with unusually high and possibly avoidable mortality rates. We conducted an ecological study on the relationship between socioeconomic deprivation and infant mortality in Hong Kong by using government data from three periods: 1979—83, 1984—88 and 1989—93. The study population comprised all infant births in 65 modified districts in Hong Kong in the period 1979—93. Infant, neonatal and post-neonatal mortality rates (IMRs, NMRs and PNMRs) were used as the health indicators. An F score was derived from highly correlated socioeconomic variables by factor analysis and used as a summary index of socioeconomic status. In 1979—83, socioeconomic deprivation was found to be significantly associated with high IMRs and high NMRs in both sexes, while in 1984—88 this association was observed only in baby girls. None of the observed associations were significant in 1989—93. Overall, the territory's infant mortality rates fell from 10.2 per thousand live births in 1979—83 to 5.6 per thousand live births in 1989—93. Individual-based studies are needed to ascertain whether this apparent disappearance of the socioeconomic relationship with infant and neonatal mortality is real.