bluuebunny/crossref_metadata_2025 huggingface dataset:
Socioeconomic position and smoking behaviour in Danish adults
Authors: Osler Merete , Holstein Bjørn , Avlund Kirsten , Damsgaard Mogens Trab , Rasmussen Niels Kr
Published: April 2008

Aims: The associations between smoking and various socioeconomic indicators may have different implications and causes, which may also vary according to sex and birth cohort. This study analyses how two dimensions of socioeconomic position, an individual ( education) and a structural ( occupation) indicator, are associated with ever, current and ex-smoking. Methods: Data on smoking behaviour were collected in five cross-sectional surveys of random samples of the general Danish population aged 20 years or more at intervals between 1982 and 1994. In total, 8,054 men and 8,281 women participated. Logistic regression was used to analyse the infl uence of education and occupation on smoking behaviour controlling for sex and birth cohort. Results: In cohorts born after 1930 ever and current smoking were related to years of school education and current occupation. The prevalences of ever and current smoking were highest among the least educated, unskilled workers, unemployed persons and persons who received welfare benefits. A significant interaction between birth cohort and education indicated that the educational difference in ever and current smoking increased significantly with increasing year of birth. In multivariate analysis controlling for sex and birth cohort, ex-smoking seemed to be more strongly associated with education than occupation .Those with 12 or more years of school education had twice as high a chance of being ex-smokers as those with 7 years of school or less. Conclusion: Smoking behaviour is strongly associated with both individual and structural indicators of socioeconomic position in Danish adults in all cohorts except for those born before 1930.
Measures of prevalence: which healthcare registers are applicable?
Authors: Wigertz Annette , Westerling Ragnar
Published: April 2008

Aims: This study analyses the applicability of some of the registers used within the healthcare system for estimations of disease prevalence .The study focuses on the diagnoses of asthma, diabetes mellitus, chronic bronchitis/emphysema, hypertensive disease, and cerebrovascular disease. Methods: The study population comprised all inhabitants ( n=20,037) in the municipality of Tierp on 31 December 1996. Diagnostic information was collected from primary healthcare and occupational healthcare in the municipality of Tierp and from inpatient and outpatient units at the hospitals in Uppsala County. The proportion of registered patients in the different registers was calculated in relation to the total number of patients who had been registered during 1996 with the selected diagnoses . Results: In the primary healthcare register, between 67% ( cerebrovascular disease) and 85% ( asthma) of all patients with selected diagnoses could be identified. A search on the inpatient care register ( Hospital Discharge Register) led to the identification of between 8% ( hypertensive disease) and 53% ( cerebrovascular disease) of the patients. Conclusions: For all of the examined diagnoses, most patients could be identified in the primary healthcare register. Register data from both primary healthcare and inpatient and outpatient care at hospital are needed to make reasonable estimates of prevalence.
Changing health inequalities in the Nordic countries?
Authors: Lahelma Eero , Lundberg Olle , Manderbacka Kristiina , Roos Eva
Published: April 2008

The Nordic countries, referring here to Denmark, Finland, Norway, and Sweden, have often been viewed as a group of countries with many features in common, such as geographical location, history, culture, religion, language, and economic and political structures. It has also been habitual to refer to a ``Nordic model' ' of welfare states comprising a large public sector, active labour market policies, high costs for social welfare as well as high taxes, and a general commitment to social equality (1). Recent research suggests that much of this ``Nordicness'' appears to remain despite the fact that the Nordic countries have experienced quite different changes during the 1980s and 1990s (2). How this relates to changes in health inequalities is in the focus of this supplement.
Social differences in illness and health-related exclusion from the labour market in Denmark from 1987 to 1994
Authors: Lissau Inge , Rasmussen Niels Kristian , Hesse Nina Moss , Hesse Ulrik
Published: April 2008

Objective: The objectives were first to analyse differences in long-standing illness, limiting long-standing illness, and perceived health as below good in relation to different indicators of social class over time; and secondly to analyse the association of long-standing illness, educational level, age, and gender with employment status.

Subjects and methods : Self-reported information on illness, educational level, employment status, and occupational class was obtained in two nationally representative Danish health interview surveys in 1987 (n= 4753) and 1994 (n= 4668).

Results: There was a marked increase in long-standing illness from 1987 (33%) to 1994 (38%), especially among women with higher education (13% in 1987 to 26% in 1994). The prevalence of perceived health below good was unchanged (c. 20%) during the same period. Among employed men in 1987 the lowest prevalence of long-standing illness was seen in upper salaried employees (21%) and the highest in skilled workers (35%). In 1994, the difference had diminished and the prevalence rates for the same classes were 28% and 29%, respectively. Among employed women, a similar pattern was seen. The lowest rate in 1987 was seen among self-employed with subordinates (15%) and the highest in self-employed without subordinates (28%). In 1994, the difference was reduced with prevalence rates of 23% and 32%, respectively. In addition, substantial differences in health status between groups with different educational backgrounds were found. The proportion of the population with long-standing illnesses was clearly higher in the group with low education compared with the group with high education. A similar social gradient was found for perceived health as below good. Those with the highest odds ratio of being a disability pensioner are women with long-standing illness, only basic education, and above 55 years of age.

Conclusion: In conclusion, the study showed that the prevalence of long-standing illness increased from the mid-1980s to the mid-1990s, whereas perceived health below good was unchanged. In 1994, there was a remarkable difference in health between employed and non-employed people, indicating a health-related exclusion from the labour market. This may explain why, in 1994, smaller occupational class differences were found in the prevalence of long-standing illness among employed people compared with the findings in 1987, whereas the health differences remained in the different educational groups. Women above 54 years of age with basic education only and long-standing illness have the highest odds ratio of permanent exclusion from the labour market.
Changing health inequalities in a changing society? Sweden in the mid-1980s and mid-1990s
Authors: Lundberg Olle , Diderichsen Finn , Yngwe Monica Åberg
Published: April 2008

Whereas the end of the 1980s was characterized by an economic boom, the early 1990s saw the worst recession since the 1930s. In Sweden, the crisis that started in the fall of 1991 and culminated in 1995 meant dramatically increased unemployment rates followed by cutbacks in welfare state programs. In addition, other major changes in economic and political conditions have taken place during this period, including tax reforms and EU membership. Although public health as well as health inequalities are likely to be linked with these kinds of macro changes, it is unclear what types of changes in health and health inequalities one would expect. In this paper analyses of Swedish data on health inequalities in the periods 1986-87 and 1994-95 are undertaken on the basis of the Swedish Surveys of Living Conditions. The main finding is that overall health levels as well as differences in health between men and women, different age groups, educational groups, social classes, and employment status groups have remained constant.
Self-rated health as a predictor of disability pension and death — A prospective study of middle-aged men
Authors: MÅnsson Nils-Ove , RÅstam Lennart
Published: April 2008

Objective: Self-rated health (SRH) is increasingly attracting attention as a predictor of morbidity and mortality while its relation to impaired function has been given less momentum. The aim of this study was to assess the relation between SRH and the risk of being awarded a disability pension and premature death. Methods : Five birth-year cohorts of middle-aged men were invited to a screening programme and were followed for approximately 11 years. Of the 718 (12%) men with a disability pension granted during follow-up, 46% had perceived their health as perfect on inclusion. The corresponding figure for the remaining 5,082 men was 77%. Results: The crude relative risk (RR) of disability pension for men with SRH less than perfect was 3.7 (3.2-4.2). After adjustment for premorbidity/medication, the RR declined to 3.3 (2.8-3.8). The crude RR of death associated with SRH less than perfect was 1.6 (1.3-2.0), unchanged after adjustment. Conclusion: The results showed that SRH is a strong and independent predictor of disability and, to a lesser degree, of mortality.
Juvenile and early adulthood smoking and adult educational achievements — A 31-year follow-up of the Northern Finland 1966 Birth Cohort
Authors: Isohanni Irene , Järvelin Marjo-Riitta , Rantakallio Paula , Jokelainen Jari , Jones Peter B. , Nieminen Pentti , Croudace Tim , Isohanni Matti
Published: April 2008

Aims: To investigate the association between juvenile and early adult cigarette smoking and educational achievements up to the age of 31 years. Methods: As a part of the follow-up of the North Finland 1966 Birth Cohort ( n=10542) from 1966 to 1997, smoking was assessed at the ages of 14 and 31 by postal questionnaires. The highest level of educational attainment was obtained from the National Education Registry of Statistics Finland up to the age of 31 years. Results : Adult smoking (at age 31) and prolonged smoking (at ages 14 and 31) were both associated with an approximately two- to sixfold, adjusted odds for educational underachievement. Smoking only at age 14 showed none of these associations. Conclusion: These results are unlikely to be causal, but may be explained by other characteristics associated with smoking such as personality or lifestyle factors, as well as the effect of knowledge related to smoking gained during higher education.
Conditions during childhood and adolescence as explanations of social class differences in disability pension among young men
Authors: Upmark Marianne , Lundberg Ingvar , Sadigh Jonas , Bigert Carolina
Published: April 2008

Aims: This study investigates whether conditions present or established in youth and adolescence among young men contribute to the differences in the risk of an early disability pension (DP) among social classes. Methods: The study is based on data from a nationwide survey of the 49,285 Swedish males born between 1949 and 1951 who were conscripted into military service between 1969 and 1970. Data on socioeconomic groups were based on information of occupation and educational level reported in the census of 1975 held by Statistics Sweden. Potential psychosocial and behavioural risk factors were linked to records from the Swedish Social Insurance Board up until 1993. The analyses were based upon those 33,609 conscripts with information on all background variables who reported an occupation and who were not granted a DP in 1975. Results : The strongest social class difference in the distribution of risk indicators was found for low ranking on the psychometric tests and for having been in a remedial class. In the univariate analyses, the highest odds ratios were noted for unskilled manual workers. In the multivariate model, with all the background variables included, the increased risk ratios for lower socioeconomic groups decreased considerably for a DP irrespective of diagnosis, and diminished for a DP with an alcohol-related diagnosis. Conclusion: It is concluded that conditions present or established in youth and adolescence are of major importance to understand the strong social class gradient in disability pensions among young men. It is suggested that the increased risks for skilled and unskilled manual workers compared with non-manual employees might be interpreted according to the concept of unfavourable life careers.
Caring for relatives with dementia — Caregiver experiences of relatives of patients on the waiting list for admission to a psychogeriatric nursing home in The Netherlands
Authors: Meiland Franka J. M. , Danse Jos A. C. , Wendte Johannes F. , Klazinga Niek S. , Gunning-Schepers Louise J.
Published: April 2008

Aims: Institutionalising a relative is a difficult decision and often relatives have to feel heavily burdened before they take such a step. Then the following delay because of waiting lists can be too much. This paper examines the experiences of caregivers of demented patients at the moment of registration on the waiting list for nursing-home care. Methods: Interviews were carried out with 93 informal caregivers and analysis was made of the files of patients who were registered on the waiting list for nursing-home admission in Amsterdam in 1997 and 1998. Data collection included the Interview for Deterioration in Daily living activities in Dementia, The Revised Memory and Behaviour Problem Checklist, the Social Support List-Interaction, and three subscales of the Caregiver Reaction Assessment (CRA) scale. Results: At the moment of admission to the waiting list, half of the respondents were rather heavily burdened or worse. Less severe dementia, lower age of the patient and providing more hours of informal care especially accounted for more negative experiences of caregivers. The self-esteem derived from caregiving was higher for caregivers with lower income and for those who perceived the quality of the relationship with the demented person as better. Conclusions: The high burden levels at the moment the decision to institutionalise the patient is taken put a heavy claim on the energy needed to continue to care during the ensuing waiting period. More social support and formal home care may reduce the level of burden of caregiving.
Overutilization of antenatal care in Norway
Authors: Backe Bjørn
Published: April 2008

Background: It has long been a common belief in Norway that all pregnant women attend antenatal care, but no documentation has been provided. In 1984, official guidelines were issued recommending a reduction of the number of routine visits. However, no studies have been performed in order to monitor whether the recommendations are followed. Aims: Utilization review of antenatal care in Norway. Method: A national cross-sectional study, comprising all deliveries in all obstetrical units in the country during a two-week registration period in June 1996. Information on onset of antenatal care, the number of visits, parity and gestational age at the time of delivery was collected. The study comprised 1,557 deliveries; 45 of the 60 obstetrical units in the country participated. Results: The mean number of antenatal visits was 12.2. Only two of the 1,557 women (0.1%) delivered without any previous antenatal care. A total of 80% started antenatal care in the first trimester, 0.4% had their first antenatal visit in the third trimester. The mean number of antenatal visits was substantially higher than the recommended number. Conclusion: Antenatal care-providers do not comply with the official guidelines.
The use of analgesics and hypnotics in relation to self-rated health and disability pension — A prospective study of middle-aged men
Authors: Mansson Nils-Ove , Merlo Juan , Östergren Per-Olof
Published: April 2008

Aims: This cohort study on urban middle-aged men investigates the association between the use of analgesics and hypnotics, self-rated health (SRH) and disability pension. Methods: Five birth-year cohorts of middle-aged, urban, Swedish men were invited to a screening programme and were followed for approximately 11 years. Results: Out of all the subjects ( n=5798), 12.4% received a disability pension during follow-up, 27.0% rated their health as less than perfect, 10.6% used analgesics and 2.9% used hypnotics. Compared with non-users of analgesics and hypnotics, the adjusted hazard ratio of disability pension for the simultaneous use of both drugs was 7.0 (95% CI: 4.3, 11.6) and the adjusted odds ratio of poor SRH was 16.5 (6.3, 43.5). Thus, the use of analgesics and hypnotics was positively related to poor SRH and predicted award of a disability pension within an 11-year follow-up. This may reflect that the use of analgesics and hypnotics is a proxy of disease but an independent negative effect on health cannot be excluded. Conclusions: Information on the use of these drugs could be used to predict the award of a disability pension, such as in different geographical areas or population groups.
Prevention of cardiovascular disease in Sweden: The Norsjö community intervention programme—Motives, methods and intervention components
Authors: Weinehall L. , Hellsten G. , Boman K. , Hallmans G.
Published: April 2008

Objectives: When epidemiologic data on cardiovascular disease (CVD) mortality rates in different Swedish regions were published in the early 1980s, there was great concern about the high CVD incidence in the northernmost counties of Sweden, namely Västerbotten and Norrbotten. This paper describe the development of a Northern Sweden community intervention programme for the prevention of CVD.

Methods: As there were no Swedish prototypes, the programme was designed by drawing on experiences from other community interventions. One unique emphasis of the Norsjö intervention programme was to combine a population strategy with efforts to contact each person individually when they became 30, 40, 50, and 60 years of age (the primary care approach). Using the primary care system as part of the community intervention, systematic risk factor screening and counselling by family medicine providers were carried out at the same time as the community intervention programme invoked other efforts to raise public awareness.

Results: During the first 10 years of the programme >90% of those invited participated in the individual health screening and counselling. A new food labelling system was introduced in the grocery stores, which after a few years became the official Swedish food labelling system. Sales statistics regarding dairy products showed a significant turnover of low fat products. According to public opinion, the health screening and counselling were reported to be the most infl uential factors supporting lifestyle changes.

Conclusions: It was possible in Norsjö to create a local health promotion collaboration between healthcare providers, grocery stores, schools, municipal authorities, and the public in order to develop a Swedish model for community intervention. The different programme components were well received by the public.
Design issues in the combination of international data from two rural community cardiovascular intervention programs
Authors: Nafziger A.N. , Weinehall L. , Lewis C. , Jenkins P.L. , Erb T.A. , Pearson T.A. , Wall S.
Published: April 2008

Objectives: To compare and contrast two rural cardiovascular community intervention programs (CCIP) in northern Sweden and the US by discussing the methods used to select and combine similar data from two separately designed and implemented CCIP in order to describe and evaluate their effectiveness in reducing cardiovascular risk.

Methods: Two rural intervention populations and their reference populations were compared. A comparison was made of the intensity and duration of the intervention programs using an overall intervention intensity score. Population-based surveys were conducted at 5-year intervals in both countries. The methods used for data pooling and comparison are described. A description of statistical analyses using a mixed analysis of variance model is provided.

Results: The data were pooled, taking into consideration comparable ages. New variables were created in order to define the relationship between similar data that did not permit direct comparison.

Conclusions: Combination and comparison of international data from two programs allowed evaluation of community intervention programs that were developed independently for similar communities. The effectiveness of interventions can be compared using such methods.
The Norsjö-Cooperstown healthy heart project: A case study combining data from different studies without the use of meta-analysis
Authors: Jenkins P.L. , Weinehall L. , Erb T.A. , Lewis C. , Nafziger A.N. , Pearson T.A. , Wall S.
Published: April 2008

Objectives: This paper aims to develop and describe a method for combining, comparing, and maximizing the statistical power of two longitudinal studies of risk factors for cardiovascular disease that did not have identical data collection methodologies.

Methods: Subjects from a 1986 cross-sectional study (n= 180) were pair-matched with subjects of corresponding gender and age (+ 5 years) from a 1990 cross-sectional study. The methodology is described and results are calculated for various measures of cardiovascular risk or risk factors (e.g. cholesterol, Finnish Risk Score).

Results: Box's test of equality and symmetry of covariance matrices gave chi-square values of 223.8 and 710.0 for two cardiovascular risk factors (cholesterol and cardiac risk score, respectively); these values were highly significant (p=0.0001). For the North Karelia Risk Score, repeated measures ANOVA revealed a borderline significant interaction for treatment by time (p=0.054) and a significant interaction for treatment by time by country (p=0.035). These probabilities compared favorably with a randomized blocks model.

Conclusions: Creation of a synthetic longitudinal control group resulted in a statistically valid ANOVA model that increased the statistical power of the study.
Different outcomes for different interventions with different focus!— A cross-country comparison of community interventions in rural Swedish and US populations
Authors: Weinehall L. , Lewis C. , Nafziger A.N. , Jenkins P.L. , Erb T.A. , Pearson T.A. , Wall S.
Published: April 2008

Objectives: There is a need among healthcare providers to acquire more knowledge about small-scale and low budget community intervention programmes. This paper compares risk factor outcomes in Swedish and US intervention programmes for the prevention of cardiovascular disease (CVD). The aim was to explore how different intervention programme profiles affect outcome.

Methods: Using a quasi-experimental design, trends in risk factors and estimated CVD risk in two intervention areas (Norsjö, Sweden and Otsego- Schoharie County, New York state) are compared with those in reference areas (Northern Sweden region and Herkimer County, New York state) using serial cross-sectional studies and panel studies.

Results: The programmes were able to achieve significant changes in CVD risk factors that the local communities recognized as major concerns: changing eating habits in the Swedish population and reducing smoking in the US population. For the Swedish cross-sectional follow-up study cholesterol reduction was 12%, compared to 5% in the reference population ( p for trend differences < 0.000) . The significantly higher estimated CVD risk (as assessed by risk scores) at baseline in the intervention population was below that of the Swedish reference population after 5 years of intervention. The Swedish panel study provided the same results. In the US, both the serial cross-sectional and panel studies showed a >10% decline in smoking prevalence in the intervention population, while it increased slightly in the reference population. When pooling the serial cross-sectional studies the estimated risk reduction (using the Framingham risk equation) was significantly greater in the intervention populations compared to the reference populations.

Conclusions: The overall pattern of risk reduction is consistent and suggests that the two different models of rural county intervention can contribute to significant risk reduction. The Swedish programme had its greatest effect on reduction of serum cholesterol levels whereas the US programme had its greatest effect on smoking prevention and cessation. These outcomes are consistent with programmatic emphases. Socially less privileged groups in these rural areas benefited as much or more from the interventions as those with greater social resources.
Can a sustainable community intervention reduce the health gap? -10-Year evaluation of a Swedish community intervention program for the prevention of cardiovascular disease
Authors: Weinehall Lars , Hellsten Gideon , Boman Kurt , Hallmans Göran , Asplund Kjell , Wall Stig
Published: April 2008

Objectives: This paper evaluates the 10-year outcomes of a Northern Sweden community intervention program for the prevention of cardiovascular disease (CVD), with special reference to the social patterning of risk development.

Methods: Using a quasi-experimental design, trends in risk factors and predicted mortality in an intervention area (Norsjö municipality) are compared with those in a reference area (Northern Sweden region) by repeated independent cross-sectional surveys.

Results: There were significant differences in changes in total cholesterol level and systolic blood pressure between the intervention and reference populations. The predicted coronary heart disease mortality (based on the North Karelia risk equation), after adjustment for age and education, was reduced by 36% in the interventionarea and by 1 % in the reference area.

Conclusions: We conclude that a long-term community-based CVD prevention program which combines population and individual strategies can substantially promote a health shift in CVD risk in a high risk rural population. When evaluated for different social strata, we found no signs of an increasing health gap between socially privileged and less privileged groups. Socially less-privileged groups benefited the most from the present prevention program.
Changes in sickness absenteeism following the introduction of a qualifying day for sickness benefit - findings from Sweden Post
Authors: Voss Margaretha , Floderus Birgitta , Diderichsen Finn
Published: April 2008

Aims: In 1993, a qualifying day without sickness benefit was introduced to the Swedish sickness benefit system. The aim of the present study is to investigate sickness absenteeism before and after the introduction of the qualifying day, in the light of conditions inside and outside working life. Methods: The study was based on 1,952 female and 2,229 male employees of Sweden Post. Sickness absence was measured by sickness incidence one year before and one year after the introduction of the qualifying day (sick-leave events/person days at risk). Information about explanatory factors was collected by a postal questionnaire in 1994. Results: A decrease in sickness incidence was observed after the introduction of the qualifying day as well as an increase in the mean duration of sick-leave events. The proportion of long-term sick-leave events ( 15-365 days) increased; among men this increase was also found in absolute terms. There were no suggestions of economy being an important determinant for reduced sickness incidence. Women with long-term or serious disease did not show a reduction of sickness incidence to the same extent as those without disease, and for men a coherent result was observed. Men with heavy lifting at work more often showed an increase in incidence compared to men without heavy lifting, and the same tendency was found for women. Conclusion: The reduction in sickness incidence following the introduction of the qualifying day was fairly independent of different work-related and non-work-related factors. The impact of the qualifying day differed depending on health status and the physical workload.
Male suicide mortality in eastern Finland - urban - rural changes during a 10-year period between 1988 and 1997
Authors: Pesonen Tuula M. , Hintikka Jukka , Karkola Kari O. , Saarinen Pirjo I. , Antikainen Marja , Lehtonen Johannes
Published: April 2008

Aims: To investigate urban -rural differences in male suicide mortality between 1988 and 1997 in the province of Kuopio in eastern Finland. Methods: Male suicide mortality between 1988 and 1997 was studied in eastern Finland. The data were collected from official autopsy reports. Age, marital status, household type, place of death, method of suicide and the region within the county were analysed. Results: The age-adjusted male suicide mortality remained quite constant at 67 and 65/100,000 (>15 years of age) in 1988 and 1997, respectively. In urban areas, a decline in suicide rates was noted in all age groups of men, whereas in rural areas, after an initial decline, a marked increase took place during the last years of the study period, especially among middle-aged and elderly men. This coincided with the time of recovery from an economic recession in Finland that particularly affected rural areas. Conclusion: Male suicide mortality may be regionally diverging in Finland.
The self-perceived health status of Norwegian physicians compared with a reference population and foreign physicians
Authors: Stavem Knut , Hofoss Dag , Aasland Olaf Gjerløw , Loge Jon HÅvard
Published: April 2008

Aims: To compare the self-perceived health status of a representative sample of Norwegian physicians with a general reference population; and to investigate differences in health status among groups of physicians. Methods: A cross-sectional postal survey was carried out of 1,126 Norwegian physicians and 1,742 subjects in a general reference population, using the widely used general health status questionnaire - Short Form 36 (SF-36). Scores were adjusted for differences in age, gender and education where applicable. Results: The health status of Norwegian physicians was better than that of subjects with a lower level of education in the four dimensions of the SF-36 related to physical health. Male physicians scored better on the physical functioning scale and lower on vitality and social functioning than comparable university graduates. Older physicians scored better than younger in dimensions related to mental health and social functioning. Norwegian general practitioners reported better health status than colleagues in Sweden and the UK. Conclusions: The self-perceived health status of Norwegian physicians was as good or better than that of the general population. The cross-national differences could be caused by cultural differences, or be related to practice style or job strain.
Work ability and duration of certified sickness absence
Authors: Reiso Harald , Nygård Jan F. , Brage Sören , Gulbrandsen Pål , Tellnes Gunnar
Published: April 2008

Aims: The aim of this study was to examine the association between assessed work ability and the duration of certified sickness absence. Methods: A total of 549 patients and 52 doctors provided questionnaire data about 549 episodes of absence. The episodes were classified as new, one month, or three months according to their duration at the time of questionnaire completion. Their duration after that was used as outcome. Uni-and multivariate Cox regression analyses were performed. Results: In the multivariate analyses, a ``very much reduced' ' work ability assessed by patients was associated with a longer duration than a ``moderately reduced' ' work ability, in both one- and three-month episodes. Musculoskeletal and psychological disorders were associated with a longer duration, and respiratory disorders with a shorter duration than other disorders in new episodes. Patient age above 50 years was associated with a longer duration than lower age in new and three-month episodes. The doctors' use of referral and tests in the consultations, and the presence of non-medical factors as judged by the patients, were associated with a longer duration than the absence of those factors in new episodes. The patients' degree of job satisfaction, and non-medical factors as judged by doctors, were significantly associated with duration only in univariate Cox regression analyses in new episodes. Work demands were not significantly associated with duration in any of the analyses. Conclusions: Work ability assessed by patients may be a useful prognostic indicator of duration in prolonged episodes of certified sickness absence. Further studies using other outcomes, such as disability pensioning, would be of interest to enlighten the concepts of work ability.
Smokers who do not want to quit - Is consonant smoking related to lifestyle and socioeconomic factors?
Authors: Haukkala Ari , Laaksonen Mikko , Uutela Antti
Published: April 2008

Aims: To examine whether consonant smokers (who say they would not like to quit) differ from dissonant smokers (who would like to quit) in other forms of health-related behaviour and socioeconomic background. Methods: The participants included 2,709 male and 1,774 female smokers (aged 25-64 years old) from six annual population-based samples, examined between 1989 and 1994 via a mailed questionnaire. Results : Consonant male smokers were more likely to be heavy drinkers, use mostly butter on bread, and to not eat vegetables. Particularly in the middle educational and income groups, consonant male smokers were more likely to be heavy drinkers. Consonant female smokers were more often heavy drinkers and more sedentary than dissonant female smokers. If a male smoker belonged to the lower income group he was more likely to be a consonant smoker. Conclusions: Consonant male smokers had more adverse health behaviours compared to dissonant smokers, but nearly half of them did not have any other adverse health behaviours. However, a negative attitude towards smoking cessation was associated with other adverse health behaviours. There were no socioeconomic differences in willingness to quit smoking among female smokers and those differences between male smoker groups were small. Factors other than motivation to quit should be targeted to diminish socioeconomic differences in smoking cessation.
The health-line - a method for collecting data on self-rated health over time: a pilot study
Authors: Ringsberg Karin C. , Alexanderson Kristina A. E. , Borg Karin E. , Hensing Gunnel K. E.
Published: April 2008

Background: There is a need for an instrument to record a life-course perspective of self-rated health. Aim: To test the ``health-line'' , a simple, comprehensive method of collecting data on self-rated health over time. Method: In 1996, a questionnaire was mailed to people who in 1985 were aged between 25 and 34 years old and had a sick-leave spell >28 days with ``back diagnoses'' . They were asked to rate their global health graphically with a ``health-line'' for the years 1985- 95. Official data on sick leave and disability pension were obtained for the same period. In all, 37 out of 52 men and 60 out of 83 women answered; that is, they drew a health-line. Result: A statistically significant negative correlation between the mean number of absence days due to ill health and the health-line data was found for every year ( r = -0.35 to - 0.53; p<0.001) and for the whole period 1985- 95 ( r= -0.546; p<0.001 ) respectively. Conclusion: The method worked well and is well worth further development and testing.
A model-based analysis of professional practices in suicide prevention
Authors: Upanne Maila
Published: April 2008

Aims: The purpose of this study was to investigate what suicide prevention means in terms of practical interventions. Another purpose was to assess the feasibility of a previously developed theoretical model for analysing suicide prevention (1-3). Methods: The data consisted of plans for action provided by professionals from five fields ( n= 173) (psychologists [ n=41], clergy [ n= 37], nurses [ n= 34], social workers [ n= 32], and physicians [ n= 29]) as responses to an inquiry within the National Suicide Prevention Project in Finland. The plans were operationally described and theoretically interpreted using the model. Results: The analysis indicated that practice patterns were more or less similar irrespective of the focus of suicide prevention. Neither did clear sectoral or professional profiles of practice appear. Clinical topics, individually focused interventions and curative strategies constituted the main approach. Interventions focused mainly on risk factors, the priorities being life crises, acute risk of suicide, coping of survivors, and a suicide attempt. The bulk of the strategies were aimed at developing professional interventions and skills. Conclusions : The model proved to be a feasible tool for differentiating and theoretically interpreting suicide-prevention approaches. The paradigm adopted by the sectors was versatile and comprehensive: the activities were multifocused, all aims of prevention and locations of intervention were included, and a common set of interventions - a ``multimethod approach'' - was applied. The adoption of the idea of risk as well as of protective factors can be interpreted as refl ecting a process theory of suicide development.
The Danish National Birth Cohort - its background, structure and aim
Authors: Olsen Jørn , Melbye Mads , Olsen Sjurdur F. , Sørensen Thorkild I.A. , Aaby Peter , Nybo Andersen Anne-Marie , Taxbøl Dorthe , Hansen Kit Dynnes , Juhl Mette , Schow Tina Broby , Sørensen Henrik Toft , Andresen Jente , Mortensen Erik Lykke , Wind Olesen Annette , Søndergaard Charlotte
Published: April 2008

Background: It is well known that the time from conception to early childhood has importance for health conditions that reach into later stages of life. Recent research supports this view, and diseases such as cardiovascular morbidity, cancer, mental illnesses, asthma, and allergy may all have component causes that act early in life. Exposures in this period, which infl uence fetal growth, cell divisions, and organ functioning, may have long-lasting impact on health and disease susceptibility. Methods: To investigate these issues the Danish National Birth Cohort ( Better health for mother and child) was established . A large cohort of pregnant women with long-term follow-up of the offspring was the obvious choice because many of the exposures of interest cannot be reconstructed with sufficient validity back in time. The study needs to be large, and it is aimed to recruit 100,000 women early in pregnancy, and to continue follow-up for decades. The Nordic countries are better suited for this kind of research than most other countries because of their population-based registers on diseases, demography and social conditions, linkable at the individual level by means of the unique ID-number given to all citizens. Exposure information is mainly collected by computer-assisted telephone interviews with the women twice during pregnancy and when their children are six and 18 months old. Participants are also asked to fill in a self-administered food frequency questionnaire in mid-pregnancy. Furthermore, a biological bank has been set up with blood taken from the mother twice during pregnancy and blood from the umbilical cord taken shortly after birth. Data collection started in 1996 and the project covered all regions in Denmark in 1999. By August 2000, a total of 60,000 pregnant women had been recruited to the study. It is expected that a large number of gene-environmental hypotheses need to be based on case-control analyses within a cohort like this.
Contacts of general practitioners with illegal immigrants
Authors: Reijneveld Sijmen , Verheij Robert , van Herten Loes , de Bakker Dinny
Published: April 2008

Aims: Violence and economic hardship cause many people to go to industrialized countries, often without obtaining a residence permit. The aim of this study is to gain insight into the factors that determine the occurrence of contacts in primary health care with such illegal immigrants. Methods: Data were analysed on contacts with illegal immigrants from a national survey among Dutch general practitioners (GPs) ( n= 1,148; response: 62%). Results: GPs reported that they have on average 0.74 patient contacts with an illegal immigrant per week (95% CI: 0.56-0.92) . This probably includes some over-reporting. Contacts are more likely in practices and communities that comprise more non-Dutch-born people and more (patients with) typically urban health problems. Working experience and demography of the GP are not independently associated with the occurrence of contacts. Conclusions: Contacts of Dutch GPs with illegal immigrants mostly occur in the deprived areas of the big cities.
Early gender differences in adolescent tobacco use- The experience of a Swedish cohort
Authors: Rosaria Galanti M. , Rosendahl Ingvar , Post Ann , Gilljam Hans
Published: April 2008

Background: In Sweden, the prevalence of tobacco use in the youth population differs by product and gender, but there are no longitudinal studies of gender differences in the uptake of smoking and use of oral snuff (OS). Methods: A prospective cohort study ongoing in the County of Stockholm, encompassing 3,019 children recruited in 1997 in the fifth grade of compulsory school, of whom 96% were followed-up in the sixth grade. Results: At baseline, 22% of the boys and 15% of the girls had ever smoked, respectively 8% and 3% had ever used oral moist snuff. One year later, the overall smoking prevalence had markedly increased, as did the transition to more advanced stages of smoking, especially among girls. Among boys who at baseline had only used oral snuff, 41% had also smoked cigarettes at follow-up. Lack of a firm intention to abstain from tobacco use was strongly associated with onset of experimentation within one year, particularly among boys. Conclusions: Tobacco uptake in pre-adolescence differs between genders, with an earlier initiation among boys and a more rapid transition to regular smoking among girls. In most cases, experimentation with oral snuff among boys marks the transition to cigarette smoking.
Being a psychiatric patient in the community- reclassified as the stigmatized "other' '
Authors: Thesen Janecke
Published: April 2008

Aims: To explore the experiences of psychiatric patients living in six rural communities in Norway from a primary care perspective. Methods: A "Knowledge workshop'' (KW) was designed. It was a special kind of meeting between users of services for people with mental illness and service providers. The process and outcome were documented on fl ipcharts and audiotape and analysed by a qualitative method. Results: A main statement was constructed in order to capture the essence of meaning in the 10 main themes identified in the analysis. The statement is mainly about the process and state of being reclassified as a stigmatized "other'' , with serious consequences for both self-esteem and public esteem. The consequences include isolation and loneliness, low self-esteem, no paid work, lack of money, discrimination, and harassment. Other consequences include altered behaviour from others, lack of necessary conditions for empowerment, and the danger of becoming visible as mentally ill. Attitudinal change is called for. Conclusions: Although the stigma of mental illness is a well-known and much discussed fact, it has so far not really been included in the professional knowledge base. It is still practically absent from discussions of quality of care. In order for services to be relevant to people who need them, professionals can no longer ignore issues that are of major importance for users. Stigma must thus be included in the conceptual thinking about serving people with mental illness. The inclusion of stigma as an issue for quality of care could be a fruitful way forward.
Sociodemographic predictors of self-rated health in patients with diabetes of short duration
Authors: Jonsson Pia Maria , Nyström Lennarth , Sterky Göran , Wall Stig
Published: April 2008

Aims: To examine the impact of gender and socioeconomic factors on health-related quality of life (HRQoL) one year and eight years after diabetes diagnosis. Methods: Two national incidence cohorts who contracted diabetes between the ages of 15 and 34 years ( n= 554) and matched control groups from the general population of Sweden ( n= 1,029) were surveyed. Data on HRQoL, diabetes treatment, marital status, education, social class, and employment were collected via a questionnaire mailed to the younger cohort (aged 16-35) one year after diagnosis and to the older cohort (aged 23-42) eight years after diagnosis. Response rates were 73% among people with diabetes and 68% among the controls. Multivariable linear regression models were used to analyse the impact of gender and socioeconomic factors on HRQoL in the diabetic and control groups. The dependent variable was the ``general health perceptions'' score of the SWED-QUAL instrument, which corresponds to the ``global self-rated health'' concept. Results: A model including all the sociodemographicvariables explained 6% of the variance in self-rated health one year after diabetes diagnosis and 13% of the variance eight years after diagnosis. In the control groups, the level of explanation was 2-3%. Female gender was an independent predictor of poor self-rated health in the older diabetic cohort, but not in the younger cohort. Conclusions: Gender and socioeconomic factors were more closely associated with self-rated health eight years after diabetes diagnosis than one year after diagnosis, indicating early sociodemographic stratification in the health of the diabetic populations studied.
Immunization against Haemophilus infl uenzae type b in Sweden- A study of the introduction process
Authors: Garpenholt Örjan , Fredlund Hans , Timpka Toomas
Published: April 2008

Aims: To study the introduction of Haemophilus infl uenzae type b (Hib) vaccination in Sweden, and to identify factors promoting and inhibiting the process. Methods: The introduction of general childhood vaccination against Hib in Sweden in 1992-93 was studied using the Cultural Historical Activity Theory as a theoretical framework. Results: Five activity systems were found to be involved in the introduction process, the systems of vaccine production, government administration, news distribution, science, and disease prevention. The critical factors for introduction of the programme were found to be the vaccine product, conception of the disease, government economy and public decision-making. Conclusions: The results show that a broad range of non-biomedical aspects must be considered when a public health intervention such as a general vaccination programme is introduced.