bluuebunny/crossref_metadata_2025 huggingface dataset:
The Relationship of Coffee Consumption to Various Self-Reported Cardiovascular Events in Middle-Aged Norwegian Men and Women
Authors: Stensvold Inger , Tverdal Aage
Published: February 2009

The association between number of cups of coffee consumed per day and self-reported heart infarction, angina pectoris, or symptoms of angina pectoris was studied in 11635 men and 11785 women, aged 40-54 years, who attended two cardiovascular screenings. Questionnaire information on heart infarction has previously been found to be reliable.

Altogether 240, 201 and 241 men reported heart infarction, angina pectoris (without heart infarction) and symptoms of angina pectoris, respectively, at the last, but not at the first screening. The corresponding figures for women were 35, 102 and 395.

Univariate analysis showed a positive association between number of cups of coffee and self-reported heart infarction. The same applies to self-reported angina pectoris. After adjustment for major coronary risk factors, the associations became weaker. The relative risks of self-reported heart infarction between users of nine or more cups and users of less than one cup were 1.7 (95% CI: 1.0, 3.0) and 1.5 (0.3, 7.5) in men and women, respectively. The relative risks were smaller than those found in a previous study relating coffee consumption to coronary heart disease mortality. For self-reported angina pectoris the corresponding relative risks were 1.4 (0.8, 2.7) for men and 2.7 (1.1, 6.7) for women. The study is suggestive of a modest relationship between coffee consumption and self-reported occurrence of both heart infarction and angina pectoris.
Is moderate alcohol intake in pregnancy associated with the craniofacial features related to the fetal alcohol syndrome?
Authors: Olsen Jørn , Tuntiseranee Pitchaya
Published: February 2009

Social drinking in pregnancy is common in many countries despite the fact that alcohol in high doses has teratogenic properties. The public health implications would be appreciable if even moderate alcohol consumption were associated with embryonal or fetal maldevelopment.

A presumably sensitive marker of an alcohol effect was used in this study, namely the fetal craniofacial features included in the Fetal Alcohol Syndrome. The study was based upon self-reported alcohol intake and photographs taken at birth or at 18 months of children born to mothers with a low or moderate alcohol intake during pregnancy. These women were selected during pregnancy by a two-stage sampling from all in well defined regions. Data were available concerning 323 pregnant women and some 200 to 220 children. A short palpebral fissure, a short nose to upper-lip distance and a broad root of the nose were expected to be associated with alcohol intake in early pregnancy, but such an association was only seen between binge drinking and a short palpebral fissure. No associations proved statistically significant at the 18-month examination and any association could merely be secondary to the known association between alcohol and birth weight.
Moderate alcohol consumption in pregnancy and subsequent left-handedness. A follow-up study
Authors: Olsen Jørn
Published: February 2009

Alcohol in high doses is neurotoxic to the developing brain but it is not yet settled whether small doses give rise to more subtle effects. The aim of the study was to establish whether a moderate intake of alcohol in pregnancy would increase the frequency of left-handedness in the offspring. Such an association could indicate a possible subtle prenatal neurotoxic effect.

This was a follow-up study of a group of pregnant women who took part in a community trial in 1984 to 1987. Data on alcohol consumption were reported by consecutively sampled pregnant women in the 36th week of gestation. Hand preference for their offspring was reported by the mothers in a self-administered questionnaire when their children were 5 to 9 years old. Ninety-one percent participated in the follow-up study.

The study showed that 9.1% of the children were left-handed, with a higher prevalence among boys (11.8%). Results showed a slightly higher frequency of being left-handed among children exposed to alcohol in fetal life, but the findings were not statistically significant at a 0.05 level.
Carotid atherosclerosis in middle-aged men. Relation to conjugal circumstances and social support
Authors: Helminen Anneli , Rankinen Tuomo , Mercuri Michele , Rauramaa Rainer
Published: February 2009

The purpose of this study was to examine the association of conjugal circumstances and social support with carotid atherosclerosis. The subjects were 212 men randomly selected from those (N = 4,853) aged 50-60 years, living in Kuopio and a nearby residental area in eastern Finland. Social network and support levels were assessed with a structured 34-item questionnaire. Conjugal circumstances were constituted by cohabition or otherwise. Intima media thickness of the carotid artery (IMT) was chosen to designate atherosclerosis, and determined by quantitative B-mode ultrasonography. The analyses showed that the men living alone had greater common carotid (p = 0.008) and carotid bifurcation (p = 0.011) IMT values than their cohabiting counterparts. The differences remained significant even when the confounding factors (age, health status and education level) and potential intervening factors (saturated fat consumption and smoking) were allowed for. Of the social support subindices, strong adequacy of emotional support (p < 0.001) and of the social network subindices, strong social anchorage (p = 0.031) were correlated to increased common carotid IMT. The present data suggest that conjugal circumstances are an independent social factor predicting carotid atherosclerosis.
Sexual victimization in Norwegian children and adolescents
Authors: Pedersen Willy , Aas Henrik
Published: February 2009

A random sample of 465 Norwegian adolescents (mean age 19.3 years) from the general population answered a questionnaire related to sexual victimization. 17.2% of the girls reported being sexually assaulted, 6.8% in childhood and 10.4% during their teens. Only 0.9% of the boys reported such experiences.

Three patterns of victimization were identified:

Prepubertal girls abused by adult men, usually relatives or other trusted superiors. Adolescent girls victimized by their boyfriends, other peers and — to a lesser degree — unknown persons. A small group of girls reporting continual assaults by several offenders.

By the end of their teens, it is assumed that 2.8% of the girls have experienced ‘grave’ and prolonged sexual abuse, which invariably started during childhood. Another 7.6% have experienced ‘serious’ assaults, either in childhood or in adolescence.
Diabetes mellitus and psychological well-being. Results of the Nord-Trøndelag health survey
Authors: Néss Siri , Midthjell Kristian , Moum Torbjøm , Sørensen Tom , Tambs Kristian
Published: February 2009

The present study relies on questionnaire data from a diabetes and hypertension screening carried out on the entire adult population of a medium-sized Norwegian county (total number of participants = 74,977). Self-reported diabetic patients were compared with non-diabetics, and with patients with self-reported angina pectoris, previous cardiac infarction, and stroke. The psychological well-being of the known diabetic patients was found to be significantly poorer than that of those without diabetes, but better than that of those with angina and stroke. HbAl level was found to be significantly related to well-being, the low levels of HbAl (below 7.5%) scoring low on well-being and the high levels (above 15%) scoring high. Because of its special design, the present study allowed comparisons between diabetic patients undergoing treatment and newly detected patients who had not yet been treated. Treatment-related interpretations therefore could be rejected.
Who is a successful quitter? One-year follow-up of a National Tobacco Quit and Win Contest in Sweden
Authors: Tillgren Per , J. A. Haglund Bo , Ainetdin Tuula , Holm Lars-Erik
Published: February 2009

The first nation-wide Quit and Win Contest in Sweden was held in 1988 with 12,840 participants. This corresponds to a participant rate of 6.4 per 1,000 daily tobacco users in Sweden. In order to follow up the long-term effects of cessation and to analyse the determinants for successful cessation, a panel (n = 946) of randomized participants were followed-up at 6 and 12 months with a mailed questionnaire. This gave a complete set of data for 557 (panel) respondents. Available baseline data from the participants’ entry forms included sex, age, occupation, specific tobacco habits, quitting attempts during the previous year, and place of residence. At the 12-month follow-up 21% had been tobacco-free for the whole year. In addition 9% of the participants relapsed into tobacco-use, then quit again and were tobacco-free at the 12-month follow-up. The success rate for those participants (14%) who used smokeless tobacco (oral snuff) was similar to that of smokers. The logistic regression showed a significantly better prognosis for success among those without any earlier quitting attempts during the previous year (OR 2.35), if the subjects participated of their own volition rather than having been recruited by a non-tobacco user (OR 1.74), and if they were married/co-habiting (OR 1.92), the results were also significantly improved. The results also show that as a population-based method, Quit and Win produced many successful tobacco quitters, and one year after the contest one-fifth of the participants were still abstinent.
Organization of HIV/AIDS related attitudes and predictors of attitudes
Authors: Rise Jostein , Jakobsen Reidar
Published: February 2009

The purpose of this study was to investigate the psychological organization of attitudes towards public measures instituted to combat AIDS; secondly, to study the cognitive information about HIV transmission upon which these attitudes are based; and thirdly, to study whether education plans and gender also predicted negative attitudes. The study subjects were 229 students attending a Norwegian high-school (median age = 19), and the data were collected using a self-administered questionnaire. Confirmatory factor analysis confirmed the existence of two separate attitudinal dimensions: “Restrictive” and “Supportive”. The hypothesis was confirmed that beliefs about uncontrollable contact predicted “Restrictive” attitudes, while beliefs about controllable contacts did not. Educational plans, gender and “Uncontrolable contact” beliefs each predicted “Restrictive” attitudes. This suggests that beliefs and attitudes have instrumental as well as symbolic bases. Implications for public health strategies are discussed.
Determining the appropriate level of care. An analysis of factors affecting the staff's overall needs assessments, using data collected through the ASIM monitoring system
Authors: Lagergren Mårten
Published: February 2009

For the purpose of evaluating the validity of the staff's overall needs assessment in terms of the ‘appropriate level of care’ as a measure of resource needs — with particular emphasis on the need for institutional resources — an analysis was made concerning the relation of the assessment to various other factors. In the analysis, we used data collected in a survey undertaken in Solna municipality on November 1, 1991 according to the ASIM monitoring system. It was found by multiple regression analysis, that the ‘appropriate level of care’ was closely related to the client's degree of disability, age, and actual level of care. On the other hand, variables describing the client's social situation — marital status, single-living, informal social support, standard and accessibility of housing — bore no relation to the assessment of need for institutional care.

Chiefly because of the close relation to the actual level of care it was concluded that the staff's overall assessment of ‘appropriate level of care’ should be used with a degree of caution as measure of the need for institutional resources, since it would tend to overrate that need. A more systematic needs assessment procedure is required in order to provide the municipal authorities with unbiased estimates of institutional resource needs.
Validity of information on gynecological operations in the Swedish in-patient registry
Authors: Falkeborn Margareta , Persson Ingemar , Naessén Tord , Kressner Ulf
Published: February 2009

In order to validate information held at the Swedish Inpatient Registry on oophorectomy and/or hysterectomy procedures, the register codes were compared with data from the medical records in a random sample of 1,338 women. Only 1% of these codes were missing but 5% were erroneous, which in most cases meant that the oophorectomy had been misclassified. The positive predictive value of operation codes was high, ranging from 86 to 100% of the registered events. The actual procedures among women registered with a code for hysterectomy with or without oophorectomy comprised hysterectomy alone in 47% of the women and hysterectomy with a bilateral or unilateral oophorectomy in 30% and 20%, respectively.

The reliability of register codes for major gynecological surgical procedures is good, but when the code for hysterectomy is used, medical record data are needed to ascertain the ovarian status. Revised codes are therefore recommended.
Is left-handedness a sensitive marker of prenatal exposures or indicators of fetal growth?
Authors: Olsen Jørn
Published: February 2009

Left-handedness has been suggested as a sensitive marker of neurotoxic exposures or of the hormonal environment in fetal life.

The prevalence of left-handedness was the subject of a follow-up study in children aged 5 to 9 years and correlated to exposures recorded by their mothers during pregnancy. Altogether 965 children were studied by means of questionnaires completed by the mothers. The response rate was 91%. Smoking, head circumference, Apgar score and indicators of fetal growth retardation were found not to be associated with increased prevalence of left-handedness.
Knowledge of HIV infection and the fear of mixing socially with HIV-infected and AIDS-sick patients among STD patients in Bergen, Norway
Authors: Tveit Kåre-S. , Nyfors Allan , Nilsen Arvid , Jacobsen Reidar
Published: February 2009

This is a study of data from 599 STD (sexually transmitted disease) clinic patients in Bergen, Norway who visited the clinic in April-June 1989. We studied the patients' knowledge of modes of HIV transmission and their degree of ignorance of how HIV is not transmitted. Particular interest was focused on how misconceptions influenced the respondents' perception of HIV/AIDS sick persons and the importance of confidence in AIDS information from the health authorities. The objective of the study was to compare the data from this investigation of STD patients with data from similar studies in the general public conducted in Norway between 1986 and 1991.

HIV-infected blood (98.3%; 589/599) and unprotected vaginal intercourse (91%; 545/599) were frequently suggested as a mode of HIV transmission, while 22.4% (134/599) did not recognize anal sex as an unsafe sexual practice. There was no statistically significant difference in their knowledge of modes of HIV transmission between the following patient subgroups: homosexuals/bisexuals, intravenous drug users (IVDUs)/prostitutes, sex customers and respondents classified as ‘other heterosexuals’. Regarding ways in which HIV is not transmitted, ignorance was first and foremost related to whether the HIV virus could be passed on by oral kissing (wrong: 38.5%). Knowledge of how HIV is not transmitted was positively correlated with education ( p <0.05) and confidence in the HIV/AIDS information from health authorities ( p <0.05), and negatively correlated with age ( p <0.05). Respondents knowing how HIV is not transmitted considered social contact with HIV/AIDS sick persons to be harmless ( p <0.001). The present information campaigns on HIV/AIDS have been less effective than expected. In the future we must find new ways of informing the public by identifying the essential components that are missing from the information campaigns we have today.
Patients frequently consulting general practitioners at a primary health care centre in Sweden — A comparative study
Authors: Andersson Sven-Olof , Mattsson Bengt , Lynöe Niels
Published: February 2009

The purpose of this study was to describe the sociodemographic patterns, consultations and the nature of problems of frequent attenders (FAs) at general practitioners at a primary health care centre. The design was a comparative study of FAs (≥5 consultations during 1991) ( n = 179) and a contrast group of patients (CPs) matched by age and sex (1-4 consultations during 1991, n = 179). Data from medical records, appointment system, mortality and marital status were recorded. FAs comprised 1.7% of the inhabitants. Boys, middle-aged females, retired males and females and especially very old females were more frequent among FAs than their sections of the population would imply. FAs accounted for 15% and CPs for 4% of the consultations, 6.3 and 1.7 consultations on average, respectively. The average booked time for consultations during 1991 was 140 minutes for FAs and 35 minutes for CPs. Continuity was higher among older than younger FAs. Contacts other than medical consultations comprised a substantial part of the work with FAs, especially among middle-aged and elderly FAs. Problems arising from the musculoskeletal system, psychological and social problems were most common among FAs, often in combination, while chronic diseases such as cardiovascular diseases and diabetes were not crucial for frequent attending. Few FAs consulted as frequently in the preceding years and the following year, as in 1991, but still they accounted for more consultations than CPs during these years. More female FAs than males and CPs were divorced. The study indicates that FAs require a long-term strategy where continuity and accessibility are often important. They might also have profited by more time. However, FAs were a heterogeneous group of patients and follow-up studies and individual studies of FAs would be of interest.
Nordic children with myelomeningocele
Authors: Lie Harald R. , Lagerkvist Bengt , Rasmussen Finn , Hagelsteen Johan , Börjeson Marie-Christine , Lagergren Jan , Köhler Lennart
Published: February 2009

A study was conducted on utilization of and satisfaction with the health care and medical services among 527 Scandinavian children (aged 4-18) with myelomeningocele (MMC). Data were collected from two sources: a questionnaire distributed to parents in 1984, and patients' medical records. Comparisons were made with a control group comprised of 7,792 children. Over a period of one year, 52% of the MMC group and 6% of the controls were hospitalized. Over 3 months, children with MMC had more contact with specialist care services than had the controls, while contact with primary health care was the same for both groups. Continuity of care and satisfaction with time spent with the physician were both greater among children with MMC than in the control group. Dissatisfaction with medical services was expressed by approximately 10% of the parents of both categories. Such dissatisfaction was found significantly more frequently among Danish parents and well educated mothers. Dissatisfaction with care was not related to either the child's age or the severity of its disability. Danish children with MMC received treatment relatively more frequently from primary care physicians than from specialists. In Sweden, where satisfaction was the greatest, families with children with MMC were supported by local habilitation teams.
The Logic of Causation in Epidemiology
Authors: Karhausen L. R.
Published: February 2009

The paper attempts to model causality with logical conditionals by way of conditional probability. This provides a broad conceptualisation of causality according to which we merely observe tendencies toward sufficiency or tendencies toward necessity. Cohort studies evaluate the first tendencies, and case-control studies the latter. This conceptual approach also clarifies the logic of what unifies the two methods. Ways to measure causal tendencies are proposed. Some of the consequences of this conceptual analysis are discussed and among them, the growing role of chance instead of determinism in science and, although rarely acknowledged yet, in epidemiology.
Sex differences in sickness absence in relation to parental status
Authors: Åkerlind Ingemar , Alexanderson Kristina , Hensing Gunnel , Leijon Margareta , Bjurulf Per
Published: February 2009

The aim of this study was to analyse sex differences in medically certified sickness absence with special regard to parental status and age. All new sick-leave spells exceeding seven days and certified by a physician in a county of Sweden were registered in 1985-1987. The data-base was related to the population at risk by using data from the Swedish Official Population and Housing Census 1985. The analysis concerned the employed population in the age group from 16 to 54 with and without custody of children younger than ten years. In all ages, women with children had more sickness absence than men with children. Corresponding sex differences did not appear for persons without children, except for the oldest age-groups. Men with children had the lowest sickness absence of all groups. Young women with children had the highest. These findings remained the same when pregnancy-related sickness absence was excluded. The common finding of sex differences in sickness absence is here highly interrelated to custody of small children. The results suggest that the often reported positive health effects of multiple roles in women may be counteracted by inequality between the sexes in the responsibility as parents.
Fertility patterns according to occupational grouping in Norway, 1989
Authors: Strand Kitty , Wergeland Ebba , Bjerkedal Tor
Published: February 2009

In the early 1990s, most pregnant women in Norway were in gainful employment. This led to increased interest in the possible consequences for reproductive health, and a growing concern for the need to accommodate the pregnancy. We have therefore investigated how accurately general fertility rates predict the number of pregnancies in the workforce. Fertility rates (FR) among employed women and standardized fertility ratios (SFR) in occupational groups were estimated on the basis of information from the Labour Market Statistics and the national survey “Pregnancy and Work”, Norway, 1989.

The fertility rate among employed women was 17% higher than the general fertility rate. Two occupational groups had significantly different SFRs: technical/professional workers (SFR 118) and transport/communication workers (SFR 82). In addition, differences were found for parity-specific SFRs in administrative/executive work (SFR nullipara 80, SFR para 125) and service work (SFR nullipara 114, SFR para 80).

We suggest that work status and occupation should be included among the variables registered in the Medical Birth Registry of Norway, in order to facilitate routine presentations of fertility rates and pregnancy outcomes for women in paid work. The results further indicate that work-specific conditions influence first-birth fertility. This should be explored in demographic studies of the relation between women's fertility and participation in paid work.
Effects on birthweights of maternal education, socio-economic status, and work-related characteristics
Authors: Nordström Marie-Louise , Cnattingius Sven
Published: February 2009

Birthweights of 3,451 infants of women registered for antenatal care in Uppsala County, Sweden, were analyzed using three different maternal socio-economic indicators; education, socio-economic status and work environment exposure characteristics. Other explanatory variables were maternal age, parity, height, smoking habits, and length of gestation. Mean birthweights increase with longer education and higher socio-economic status. No general pattern was seen for work environment characteristics. When smoking habits are controlled for, social differences in birthweight decrease to non-significant values. A regression model with a socio-economic indicator alone explains only a minor part, less than 1%, of the variation in birthweight. When smoking is included, adding a socio-economic indicator does not significantly improve the model. Practically all social differences in birthweight are related to the differences in maternal age, parity, height, and smoking habits. If a socio-economic indicator is to be included in the analysis of birthweights (for other reasons like international comparisons), we recommend education.
Social inequalities in the experience of illness in Sweden
Authors: Blank Nelson , Diderichsen Finn
Published: February 2009

This paper analyses the factors involved in differences in the experience of long-term illness (severe and non-severe illness), as measured in terms of self-reported frequency and intensity of symptoms. The study has a cross-sectional design. It uses a database from the Survey of Living Conditions of Statistics Sweden, and treats a representative sample of the employed Swedish population ( n = 13,501), aged between 16 and 65, interviewed over the period 1986–89. The results show that male manual workers report more non-severe and severe illness than non-manual workers, and that manual and lower-level non-manual female workers report more severe illness, but not non-severe illness, than intermediate/higher-level non-manual working females. The observed class differences in experience of severity of illness are partly explained by the factors investigated (job demands, personal economic difficulties, smoking daily, weak social network) in the case of men, and virtually entirely in the case of women. Other ill-health dimensions, such as self-rated general health and impaired working capacity, prove to be related to severity of illness, the latter being more strongly associated with experience of severe illness than the former irrespective of social class. The results lend support to the hypothesis that manual classes are subjected to what might be called “double suffering”; they have more long-term illnesses and also experience these illnesses with greater intensity and frequency.
Health and social networks as predictors of survival in old age
Authors: Ljungquist Birgit , Sundström Gerdt
Published: February 2009

A random sample of non-institutionalised Swedish elderly ( n = 1,062; aged 67+) were interviewed in 1954. All of them are now deceased; their interview data have been completed with dates of death and causes of death. A measure of survival capacity has been used, based on the endured total mortality risk from examination until death, according to life tables from Statistics Sweden. Survival analyses were performed by gender on the whole sample and on a number of sub-samples defined by age, health-status, social class, and marital status at examination. Physical health status and activity patterns had the overall most significant effects on subsequent longevity. Among the youngest elderly mental health was, however, even more important as a predictor of survival than was physical health. The impact of most other factors like social networks, mobility, and religiosity was of less magnitude, but their importance varied among sub-samples. Most of the variation in survival, however, remains unexplained.
Who quits smoking during pregnancy?
Authors: Mås R. , Escribà V. , Colomer C.
Published: February 2009

The aim of this paper is to investigate the distribution of smoking cessation during pregnancy in relation to socio-demographic and professional characteristics. The study population are, primiparous or secundiparous women who gave birth in a large public hospital in the city of Valencia (Spain) and who have carried out paid work during pregnancy. A sample of 593 women were personally interviewed in the maternity hospital.

A simple analysis was carried out on the data subsequently adjusting a logistic regression model. Sixty-two per cent of the women smoked before pregnancy. Of them, 28% gave up smoking during pregnancy. Giving up smoking during pregnancy is more common among women of between 26–30 years of age (ORadjusted = 2.1), those with secondary level of education (ORadjusted = 2.6) and among those for whom daily cigarette intake before pregnancy was between 1–9 cigarettes (ORadjusted = 12.3) or between 10–19 (ORadjusted = 2.7).

The modification of smoking during pregnancy requires interventions prior to and throughout the course of pregnancy which should be aimed at risk groups such as younger women, those less educated and heavy smokers.
Alcohol consumption and Ischemic Heart Disease mortality in Sweden
Authors: Messner Torbjörn , Petersson Bo
Published: February 2009

Most previous studies on the relationship between alcohol consumption and mortality from ischemic heart disease (IHD) have been conducted in countries with an alcohol consumption pattern different from that in Sweden (and other countries in the “Vodka Belt”), where irregular binge drinking of distilled spirits is common. Therefore, we carried out an ecological study in Sweden where cross-sectional, longitudinal, and time series analyses (1973–1986) were performed on consumption of spirits, wine, and beer in relation to age-standardized mortality in IHD for males and females.

There was a negative correlation in both cross-sectional and longitudinal analyses between wine consumption and mortality from IHD, especially strong for women, but no consistent relationship between the consumption of total ethanol, spirits and beer versus the mortality from IHD. In the time series analysis, only wine was negatively correlated with IHD mortality for women. We conclude that, on a population level, consumption of spirits and beer in a Swedish drinking pattern does not imply any protection against death from IHD. On the other hand, wine consumption in Sweden could be associated with a reduced risk of IHD death among women.
Cancer incidence in Danish health care workers
Authors: Rix Bo A. , Lynge Elsebeth
Published: February 2009

Health care workers are exposed to various occupational hazards. In a register linkage study we investigated cancer incidence in health care personnel in Denmark. The overall cancer incidence was elevated in female general and dental practitioners. Male doctors had a risk of brain cancer twice as high as expected. Male dental practitioners, female hospital doctors and nurses had significantly high risks of melanomas of the skin. The breast cancer risk was elevated among female salaried dentists, hospital doctors, and nurses. Female cleaners had a significantly elevated risk of leukemia (31 cases, SIR 1.54). The lung cancer risk was low in several occupational groups. This indicates a change in risk behaviour related to tobacco smoking. A high risk of skin melanomas may indicate that behaviour related to sunlight exposure has not changed.
Concern about the environment among medical students
Authors: Käsmä-Ronkainen Lea , Virokannas Hannu
Published: February 2009

The aim of this study was to survey concern about the environment among medical students in Oulu in northern Finland. A questionnaire was filled in by 181 (74%) students. Most of the students were very concerned about the environment. Over half of the students were very concerned about water pollution and destruction of the rain forests. Female gender, membership in any environmental organisations and a good knowledge about the health effects of environmental factors were found to be significant independent factors to increase the concern.
The last year of lifez
Authors: Viitasalo Veikko , Nissinen Aulikki , Kivinen Paula , Takala Jorma
Published: February 2009

What will changes in the mortality patterns mean for the future? Is there any relationship between the cause of death and the assessed need for help during the last year of life? We used The Official Statistics to gain insight into the mortality patterns. We examined the independence from being reliant on other people's help, assessed from the health and social service records of 186 men in the age range 65–89 years from the Finnish cohorts of the Seven Countries Study.

The proportional risk of dying from heart disease or cancer declined with age. However the independence with regard to need of help lasted longer when men died from these diseases. There were 5–10 fold differences in the risk of needing daily help depending on the cause of death. It increased among the older men significantly just before death. These findings may have significance in the planning of health and home care with respect to changing mortality patterns.
Leading article
Authors: Weber A. , Strebl H. , Lehnert G.
Published: February 2009

The current status of scientific social medicine in the Federal Republic of Germany is presented against the background of historical development. Ideas differ when it comes to identity, academic institutionalisation, the main emphasis of work, the syllabus and future tasks. The heterogenic diversity of the subject is emphasised by the lack of any generally accepted definition. There is a current tendency to regard social medicine exclusively as population medicine rather than more generally as the interaction between disease/health, general social system and the individual. Clinical practical social medicine, epidemiology, health system research/health economy, and public health can be distinguished as important occupational fields. Acquiring the additional title in social medicine is widely recognised as the necessary further training. However, the discussion about improving the training in social medicine at German universities is still causing much controversy. Secure anchoring within the canon of medical subjects is of particular importance regarding the totality of the subject and its future in medical faculties.
The Swedish UPA score
Authors: Bajekal Madhavi , Jan Sundquist , Jarman Brian
Published: February 2009

The purpose was to construct a Swedish social deprivation index analogous to the underprivileged area (UPA) score, used in the UK to distribute resources to general practice for patients resident in the most underprivileged areas. UPA scores were calculated using 1990 Swedish census data and the 1992 unemployment and migration registers for all 8,502 SAMS (small area market statistics) areas with more than 50 inhabitants. Selection of the eight variables included in the score and weights attached to each were derived from a national survey of general practitioners in the UK representing the degree to which they considered that each factor increased their workload or pressure on services. The UPA score for each area is the sum of the eight normalised (arc sin), standardised (z scores) and weighted variables for that area. The distribution of UPA scores ranged from — 79.13, in the most affluent areas to 46.10 in the most underprivileged areas. It was found that a wide range of social deprivation exists at small area level.
Trends in diagnosis-specific mortality for the aging population in Norway, 1966–1986
Authors: Sverre Jan Marcus , Laake Petter
Published: February 2009

For the older segment of the Norwegian population, sex, age at time of death, and time-period of death are important factors to consider when describing cause-specific mortality trends. Correspondence analysis was applied to mortality and provided plots which in a conceptually simple way demonstrated the complex relations between sex, age, time-periods and causes of death. Log-linear modelling was used to confirm the findings of the correspondence analyses. During the period of observation, the elderly, regardless of sex, have experienced greater changes in the most important causes of death, than the younger segments of the population. The main intention of this article is to improve the conceptual understanding of how important parameters are associated with trends in mortality rates for the major causes of death in Norway.
Item bias in self-reported functional ability among 75-year-old men and women in three Nordic localities
Authors: Avlund Kirsten , Era Pertti , Davidsen Michael , Gause-Nilsson Ingrid
Published: February 2009

The purpose of this article is to analyse item bias in a measure of self-reported functional ability among 75-year-old people in three Nordic localities. The present item bias analysis examines whether the construction of a functional ability index from several variables results in bias in relation to geographical locality and gender. Information about self-reported functional ability was gathered from surveys on 75-year-old men and women in Glostrup (Denmark), Göteborg (Sweden) and Jyväskylä (Finland). The data were collected by structured home interviews about mobility and Physical activities of daily living (PADL) in relation to tiredness, reduced speed and dependency and combined into three tiredness-scales, three reduced speed-scales and two dependency-scales.

The analysis revealed item bias regarding geographical locality in seven out of eight of the functional ability scales, but nearly no bias in relation to gender in the combined data. The conclusion is that only one tiredness-scale (Lower Limb-T), one reduced speed-scale (Lower Limb-S) and the two dependency-scales (PADL-H and Mob-H) can be proposed for use in comparisons between the three localities (with removal of one or more items).
Assessing reliability of a measure of self-rated health
Authors: Lundberg Olle , Manderbacka Kristiina
Published: February 2009

The test-retest reliability of self-rated health is analysed and compared with the reliability of health questions phrased more as well as less precisely. Differences in reliability between men and women and between age groups are also assessed. The study is based on 204 and 409 re-interviews from the 1991 Swedish Level of Living Survey and the 1989 Survey of Living Conditions respectively. The results show that the reliability of self-rated health is as good as or even better than that of most of the more specific questions. Only an indicator of high blood pressure showed significantly higher reliability. The reliability of self-rated health is good in all subgroups studied, and is even excellent among older men. It is concluded that the good overall reliability of self-rated health found in this study is in line with previous results concerning the validity of people's assessments of their general health as well as results concerning the basis upon which they make these judgements.
Children of Psychosocial Risk-mothers
Authors: Wadsby Marie , Sydsjö Gunilla , Göran Svedin Carl
Published: February 2009

The number of stressful life events experienced as measured on the modified Swedish version of Coddington's questionnaire, and the presence of behaviour problems assessed by Achenbach's Child Behavior Check List (CBCL) were studied in 45 eight-year-old children of identified psychosocial risk-mothers. The mothers' social network was estimated using the Swedish version of Undén and Orth-Gomér's Interview Schedule for Social Interaction (ISSI). These mothers had been identified during early pregnancy. A control group of 57 children of the same age and their mothers without the presence of psychosocial risk-criteria was used as reference.

The results indicated that the index children had experienced significantly more life events, and displayed significantly more behaviour problems than the reference children. The mothers in the index group had a significantly poorer social network than the mothers in the reference group.

The study suggests that children of mothers, identified early on psychosocial risk criteria develop suboptimally. Therefore, early interventions are of great importance.
A comparative review of psychosocial and occupational environment in native Swedes and immigrants
Authors: Rosmond Roland , Lapidus Leif , Björntorp Per
Published: February 2009

The aim of the present study was to evaluate potential differences in psychosocial status and work environment between native Swedes and immigrants living in Gothenburg, Sweden. A number of psychiatric, occupational and socio-economic factors were analysed by questionnaire in 10-10 men born in 1944 out of 1302 selected. The immigrants ( n = 182) who participated in the study used psychopharmacological drugs more extensively than native Swedes. They were more dissatisfied, had traits of depression, frequent sleeping problems, dyspepsia and headaches compared with the native Swedes. The immigrants were more often out of work, and those who were gainfully employed were more dissatisfied with their current work and their colleagues, had a lower influence on the work situation, felt a lower degree of work demands, more seldom attempted to alter their work situation when having problems, and had a more frequent desire to change their type of work. Furthermore, immigrants more often than Swedes were living under poor housing standards, indicating a low socio-economic status. They felt a low degree of time pressure and had more often experienced a serious life event compared to native Swedes. It was concluded that immigrants were more affected by psychiatric, occupational and socio-economic disabilities and handicaps than native Swedes, indicating that immigrants are a vulnerable group in Swedish society.
National health insurance consumption and chronic symptoms following mild neck sprain injuries in car collisions
Authors: Borchgrevink Grethe E. , Lereim Inggard , Royneland Linn , Bjorndal Arild , Haraldseth Olav
Published: February 2009

Objective: To map the extent of sick leave and number of claims made for health insurance among persons who had suffered neck sprain (whiplash) injuries in traffic accidents, and to map subjective feeling of health and quality of life among patients several years after the injury.

Design: A retrospective study of neck sprain injuries after car accidents and a comparison to the patients' use of sick leave caused by neck pain prior to the accident.

Setting: The Emergency Clinic at The University Hospital in Trondheim, Norway.

Subjects: 426 patients with neck sprain injuries after car accidents during 1985-1990.

Main outcome measures: Information from Trondheim Social Security office about sick leave, and results from 345 patients who answered a questionnaire with respect to quality of life measures.

Results: 27% had been reported sick during the period after the car accident, and 5% had claimed health insurance. 58% reported sustained symptoms linked to the accident.

Conclusions: Many reported sustained symptoms after neck sprain injuries, 16% of them reported being in a bad state of health.
Road characteristics and bicycle accidents
Authors: Nyberg Peter , Björnstig Ulf , Bygren L-O
Published: February 2009

In Umeá, Sweden, defects in the physical road surface contributed to nearly half of the single bicycle accidents. The total social cost of these injuries to people amount to at least SEK 20 million (SEK 60,000 or about USD 8,500 per accident), which corresponds to the estimated loss of “eight life equivalents a year”. Improved winter maintenance seems to have the greatest injury prevention potential and would probably reduce the number of injuries considerably, whereas improved road quality and modification of kerbs would reduce the most severe injuries.

A local traffic safety program should try to prevent road accidents instead of handling the consequences of them. In accordance with Parliament decisions on traffic we would like to see increased investment in measures favoring bicycle traffic, where cycling is seen as a solution, not as a problem.
The art and science of targeting geriatrics programs
Authors: Wieland Darryl
Published: February 2009

“Targeting” in geriatrics is the selection from a wider screened group of frail elderly patients for specific geriatrics programs designed to meet their particular multidimensional health needs. Targeting has been advocated as a means of improving the overall cost-effectiveness of health services for elderly people, both through improvement of the measurable health outcomes in patients served, and limiting futile/inappropriate care (both in patients admitted, and in others by virtue of their exclusion) which adds cost but does not improve health or quality of life. While research supports targeting for improving health outcomes, work to improve targeting practices and criteria is somewhat underdeveloped. These issues are discussed in reference to the contribution of Karppi and Tilvis (1) and other current literature.
The impact of marital relationship on the rehabilitation process in a group of women with long-term musculoskeletal disorders
Authors: Hamberg Katarina , Johansson Eva , Lindgren Gerd , Westman Göran
Published: February 2009

This qualitative study investigated problems in the rehabilitation of women with long-term, musculoskeletal pain disorders. Data were collected by repeated semi-structured interviews and doctor-patient encounters during two years, and analysed in a gender perspective. The “marriage contract”, i.e. the pattern of division of duties and power structure within the marital relationship, was of obvious importance to the implementation of rehabilitation measures. We explored situations where the rehabilitation measures disagreed with the terms and patterns in the “marriage contract”. The participants' ways of coping with the contract in these delicate situations could be described as three type strategies; accepting the terms, negotiating for new terms, and breaking the contract. The crucial impact of the “marriage contract” and the type strategies on the rehabilitation process are exemplified.
The concept of status incongruence revisited
Authors: Faresjö Tomas , Svärdsudd Kurt , Tibblin Gösta
Published: February 2009

The purpose of this study was to analyse the relationships between status incongruency and mortality. From the concept of status incongruence two incongruent groups were defined, those with high education and low social position (socially downward drifters) and those with low education and high social position (socially upstarters).

A cohort of middle-aged men ( n = 855), all bora in 1913 and living in the city of Gothenburg, Sweden were followed during a period of 22 years. The socially downward drifters had a significantly increased risk for: non-cause specific (overall) mortality, more potential years of life lost and mortality caused by coronary heart disease. These differences were still evident after taking other risk factors into account. The socially upstarters had, on the other hand, lower mortality risks and win years. Imbalance between educational level and attained social position appears to affect survival in a long term follow-up.
Prevalence of pain combinations and overall pain
Authors: Kristjánsdóttir Gudrún
Published: February 2009

The prevalence of pain combinations among school children is addressed in view of earlier findings of high pain prevalence in this population. The study considers the prevelance of combinations of three common pains — headache, stomach pain and back pain — in a random national sample of 2173 Icelandic 11–12 and 15–16 year-old school children. According to the results from this study there is a 78.2% prevalence of monthly pain. One or more instances of weekly pain is experienced by 40.4% of the children, and 15.6% experience two or three pains weekly. Relevance of gender is greater when dealing with combinations of monthly than weekly pain. Combinations of weekly pains are more gender related than single weekly pains. Girls have significantly more frequent overall pain than boys. The distribution of pain combinations varies by age but not overall pain. The study yields important information about the extent of the overall problem of pain among school children and indicates the need to further study the correlates of different pain combinations in this age group.