bluuebunny/crossref_metadata_2025 huggingface dataset:
Predictive factors for disability pension — An 11-year follow up of young persons on sick leave due to neck, shoulder, or back diagnoses
Authors: Borg Karin , Hensing Gunnel , Alexanderson Kristina
Published: April 2008

Aims: Although back diagnoses are recurrent and the main diagnoses behind sickness absence and disability pension surprisingly few longitudinal studies have been performed. This study identifies predictive factors for disability pension among young persons initially sick-listed with back diagnoses. Methods: An 11-year prospective cohort study was conducted, including all individuals in a Swedish city who, in 1985, were aged 25-34 and sick-listed ≥ 28 days owing to neck, shoulder, or back diagnoses (n=213). The following data was obtained: disability pension, emigration, and death for 1985-96, sickness absence for 1982-84, and demographics in 1985 regarding sex, income, occupation, marital status, diagnosis, socioeconomic group, and citizenship. Cox regression and life tables were used in the analyses. Results: In 1996, i.e. within 11 years, 22% of the individuals (27% of the women and 14% of the men) had been granted disability pension. The relative risk for disability pension was higher for women (2.4; p=0.010), persons with foreign citizenship (3.6; p=0.009), and those who had had > 14 sick-leave days per spell during the three years before inclusion, compared to those with < 7days/spell (3.1; p = 0.003). Conclusions: This cohort of young persons proved to be a high-risk group for disability pension. Some of the factors known to predict long-time sickness absence also predict disability pension in a cohort of already sick-listed persons.
Shifts in B12 opinions in primary health care of Sweden
Authors: Loökk Johan , Nilsson Mats , Norberg Bo , Hultdin Johan , Sandström Herbert , Westman Göran
Published: April 2008

Aims: The diagnosis and management of vitamin B12 deficiency varies between countries and within countries. The aim of the study was to map current attitudes and values behind clinical decision-making in Swedish primary health care, which has a unique B12 tradition: two patients out of three are treated with oral high-dose cyanocobalamin. Most patients with B12-associated problems are managed in primary health care by general practitioners (GPs). Methods: The study was designed to elucidate possible opinion shifts among GPs during the period 1996- 1998. GPs ( n=499), stratified and randomized, received a questionnaire with 24 statements on B12-associated clinical and laboratory problems, to be evaluated by a visuo-analogue scale. Results: The majority of GPs in primary health care in Sweden accepted homocysteine and methylmalonic acid (MMA) as markers for functional deficiency of vitamin B12. The evaluation of classical markers of B12 deficiency was wary and balanced. There was a consensus of the need for B12 therapy to risk groups such as patients with atrophic gastritis or previous gastric surgery. The answers also appeared to refl ect an improvement of professional knowledge and competence concerning B 12-associated problems among Swedish GPs between 1996 and 1998. Conclusions: The overriding conclusion was that B12-associated opinions of Swedish GPs were stable within the period studied, with marginal improvements of knowledge and competence.
Mental health problems as a cause of long-term sick leave in the Norwegian workforce
Authors: Nystuen Pal , Hagen Kare B. , Herrin Jeph
Published: April 2008

Aims: There has been a growing concern about the proportion and socioeconomic consequences of work incapacity due to mental health problems. The aim of the present study was to describe the incidence and duration of different categories of mental health problems with at least two weeks of compensated absence from work in the general working population in Norway. Methods: Cases were identified from files of the national medical insurance system, covering 90% of all employees, while census data were used for the denominators. Based on the International Classification of Primary Care, a total of 101,512 individuals with one or more long-term sick leaves (>2 weeks) due to psychological problems were identified in 1997 and 1998. Results: Employees absent for psychological problems accounted for 16.8% of all incidences and 31.5% of all refunded sick days. The average one-year incidence was 2.47%, and was significantly higher for women (3.53%) than for men (1.66%). The incidence increased with increasing age, and more so for women than for men. The median duration of absence for all claimants was 79 days. Approximately 25% were back to work after one month, 52% after three months, while 8.5% had not returned to work after 12 months and were transferred to other forms of compensation. The length of sick leave varied considerably with diagnostic category, age, and gender. Conclusion : Mental health problems constitute a major health problem in the Norwegian workforce today. There is an urgent need for more knowledge about the effectiveness of interventions.
Gendered health resources and coping - A study from general practice
Authors: Malterud Kirsti , Hollnagel Hanne , Witt Klaus
Published: April 2008

Aim: The aim of this study was to explore gender and coping in primary health care patients, by comparing self-assessed health resources in men and women. Methods: Female and male patients' self-assessed health resources were identified by mean of key questions, developed separately for men and women. Patients' answers were audiotaped and analyzed qualitatively. An explorative gender comparative analysis was done. The setting comprised two women GPs and their consultations. The subjects were 37 consecutive female patients and 39 consecutive male patients aged 19-85 years. Results: The analysis indicated notable differences in spite of apparent similarities in self-assessed personal health resources in men and women. In men, personal strength was part of a proud identity, while women reported that they were able to manage because they just had to. Work was often mentioned as a health resource, but while men emphasized their well-being at work and a capacity to relax at home, women handled stressful tensions by diving into household activities. While men spoke of gaining health from being with others, women talked about social relations as contexts for gaining as well as giving health. Conclusion : None of the phenomena described by the respondents can be reasonably categorized as respectively problem-focused, emotion-focused or avoidance coping strategies. Asking people about their own ideas regarding health resources may provide more complex understandings of coping and gender. In a clinical setting skilful listening can prevent gender essentialism, where all men are regarded as different from all women.
Occurrence of Cryptosporidium oocysts and Giardia cysts in raw waters in Norway
Authors: Robertson Lucy J. , Gjerde Bjørn
Published: April 2008

Aims: This paper reports the first investigation into the occurrence of Cryptosporidium and Giardia in Norwegian raw water sources. Methods: Between June 1998 and October 1999, 408 raw water samples, collected from 147 different sites across Norway, were analysed for these parasites. Analysis was based upon US EPA Method 1623. Results: In 305 samples (75%), parasites were not detected. In 55 samples (13.5%), Cryptosporidium only was detected. In 38 samples (9%), Giardia only was detected. In 10 samples (2.5%) both Cryptosporidium and Giardia were detected. Of the sites sampled, parasites were not detected at 100 (68%) of them, Cryptosporidium only was detected at 20 (13.5%), Giardia only was detected at 11 (7.5%), and both Cryptosporidium and Giardia were detected at 16 (11%). Concentrations of parasites were low; usually one cyst/ oocyst detected per 10 litres of water. Conclusions: Significant associations were demonstrated for these samples between the detection of these parasites and (a) turbidity ≥2.0 NTU, and (b) high numbers of domestic animals within the catchment area. No association between seasonality and the occurrence of these parasites could be detected. The results are discussed in relation to other studies and the potential public health implications for Norway.
Intentional childhood injuries in Greece 1996-97 - Data from a population-based Emergency Department Injury Surveillance System (EDISS)
Authors: Petridou Eleni , Moustaki Maria , Gemanaki Efi , Djeddah Carol , Trichopoulos Dimitrios
Published: April 2008

Aim: It has been gradually recognized that intentional injuries among children represent a largely hidden problem in modern societies. With the exception of mortality, population-based data from Greece have not been previously reported. To assess the magnitude and the characteristics of intentional injuries among children aged 0-14 years old, data from the population-based Emergency Department Injury Surveillance System (EDISS) database during the period 1996-97 were used. Methods: EDISS relies on personal interviews with children and their escorts who contact the emergency departments of three hospitals. Two of these hospitals are district hospitals of the county of Magnesia and the island of Corfu, whereas the other is a university children's hospital that covers the Greater Athens area on alternative days. Results: Among 46,807 children recorded in EDISS, 108 injuries (0.23%) were attributed to acts of violence. Among the 108 intentional injuries, only 11 were caused by firearms or other weapons and only 4 concerned infants. In comparison to unintentional home and leisure injuries, intentional childhood injuries increase significantly with age and they are more common among migrant children. They occur more frequently during late night and early morning hours, they are more serious, and they are more often multiple and concentrated on the head. Conclusions : In Greece, a problem of violence directed against children does exist. The actual magnitude of this problem is difficult to estimate, but its size appears to be smaller in comparison with that reported in other populations.
``It was really nice to have someone'' - Lay people with musculoskeletal disorders request supportive relationships in rehabilitation
Authors: Östlund Gunnel , Cedersund Elisabet , Alexanderson Kristina , Hensing Gunnel
Published: April 2008

Aims: To explore the lay person's perspective on the rehabilitation process. Methods: A total of 20 interviews were conducted with women and men who had recent or more distant experience of sickness absence with musculoskeletal diagnoses. Grounded theory was used, which includes an inductive approach and theoretical sampling. The interviews focused on the individuals' own stories and experiences of factors that promoted or hindered the rehabilitation process. Results : The interviewees emphasized how and by whom they had been treated rather than what type of rehabilitation programmes they had attended. They focused on the importance of supportive relationships from the private, occupational, and health care arenas. The relationship with rehabilitation agents (professionals who implemented rehabilitation) was described as having either supportive or non-supportive qualities. Based on the interviewees' descriptions, a model was developed on the socioemotional qualities of the rehabilitation agent. The most promoting factor in the rehabilitation process was to have a professional mentor that is a rehabilitation agent who combines a supportive approach with individually chosen rehabilitation measures and goals. Conclusions: The lay person's perspective gave additional knowledge regarding rehabilitation and recovery from musculoskeletal disorders. The socioemotional qualities of the rehabilitation agents were emphasized by the interviewees and a model regarding these qualities was developed. This model needs to be tested further. A clinical implication of the present study is the need for rehabilitation agents to develop their communication skills further.
The effect of respiratory tract infections on reported asthma symptoms
Authors: Nystad Wenche , Nafstad Per , Jaakkola Jouni J. K.
Published: April 2008

Background: Wheezing and chest tightness is associated with respiratory tract infections. Thus the occurrence of respiratory tract infections may infl uence the prevalence of asthma. Aims: To assess the strength of relation between two main symptoms of asthma and the prevalence of respiratory tract infections in children with and without asthma. Methods: The study population was 3,796 children, four years of age, whose parents had answered a questionnaire on respiratory symptoms and asthma. The prevalence of wheezing and chest tightness in the last 12 months and four weeks was estimated according to the occurrence of respiratory tract infections during the corresponding time periods; 95% confi dence intervals of the prevalence and the statistical signifi cance of the differences in the prevalence by using chi-square test were calculated. Results: The prevalence of wheezing and chest tightness was higher in children who had experienced respiratory tract infections than in those who had not. The prevalence of wheezing was 17.5% among children who had experienced bronchitis and 3.0% among children whom had not ( p<0.001). The prevalence of chest tightness in the last 12 months was 3.7% (95% CI 3.1- 4.1) among children without asthma and 59.3% (95% CI 53.4- 65.2) among children with asthma ( p<0.001). The prevalence of wheezing and chest tightness increased with increasing number of different types of respiratory tract infections among children without asthma ( p<0.001) and tended to be so among children with asthma. Conclusions: These findings have implications for the interpretation of results from epidemiological studies using respiratory symptoms as a health-related outcome of asthma.
Predicting the effect of prevention of ischaemic heart disease
Authors: Brønnum-Hansen Henrik
Published: April 2008

Background: Priority setting in public health policy must be based on information on the effectiveness of alternative preventive and therapeutic interventions. The purpose of this study is to predict the effect on mortality from ischaemic heart disease (IHD) in Denmark of reduced exposure to the risk factors hypertension, hypercholesterolaemia, cigarette smoking, and physical inactivity. Methods: The simulation model, "Prevent'', was used. The input data for the model were population size, death rates, prevalence of cardiovascular risk factors, and relative risks. Scenarios of the impact of reduced exposure to risk factors on mortality from IHD were studied, including the health benefi ts of successful implementation of some of the targets in the Danish Government programme for public health and health promotion, 1999-2008. Results: The greatest reduction in mortality from IHD would be achieved by interventions against cigarette smoking. If the proportion of cigarette smokers could be reduced by one-third within 10 years, the number of deaths due to IHD among people under 65 would be 10% lower for men and 15% lower for women. If the proportion of heavy smokers or the proportion of people with hypertension were reduced by 25%, the rate of mortality from IHD would be 5% lower for men and 6-7% lower for women. Reducing the number of cases of severe hypercholesterolaemia by 25% would lower the IHD mortality rate before age 65 by 3% for men and 6% for women after 15 years, similar to the effect of easy exercise for at least 4 hours a week among physically inactive people.
Lifestyle factors and choice of hormone replacement therapy among Danish nurses
Authors: Hundrup Yrsa A. , Thoning Henrik , Obel Erik B. , Rasmussen Niels K. , Philip John
Published: April 2008

Background: Studies have found that women who use hormone replacement therapy (HRT) are healthier or report better health than non-users. This study examines the association between lifestyle factors, self-reported health and the use of HRT in Danish female nurses above the age of 50 years. Methods: Postal questionnaires were used for data collection. Two cohorts were examined, a younger including women between 50 and 59 years and an older including women of 60 years and above. Results: Of the 14,071 nurses included, 5,528 (39%) reported ever using HRT. In both cohorts, ever using HRT was positively associated (odds ratio >1) with intake of vitamin supplements, alcohol consumption at weekends, consulting a physician, use of medicine, and previous use of oral contraceptives. Only a few differences were found between former and current users of HRT. A highly signifi cant association was found between ever using HRT and self-reported poor health. Conclusions: In this study use of HRT was not found to be associated with a particularly healthy lifestyle or better health. Therefore, these factors should be specifi cally considered in studies evaluating the effect of HRT.
Invitation to a population-based cohort study: differences between subjects recruited using various strategies
Authors: Manjer Jonas , Elmstahl Sölve , Janzon Lars , Berglund Göran
Published: April 2008

Aim: The present study compares subjects recruited to a population-based prospective cohort study by community versus personal invitation, and subjects responding late versus early to personal invitation. Subjects were compared with respect to sociodemographic characteristics, selected lifestyle factors, cancer incidence and mortality. Methods: The Malmö Diet and Cancer Study recruited a total of 28,098 subjects between 1991 and 1996. Entire birth-year cohorts, born 1923-50, were recruited using community directed (passive) invitation, and a personal letter of invitation (active recruitment). Information on sociodemography and lifestyle was obtained using a self-administered questionnaire. Anthropometric measurements were assessed at a physical examination. Cancer incidence and cause of death were retrieved using record linkage with national registries. Results: Subjects responding to community directed invitation were older, and more often females, than participants recruited using personal invitation. Furthermore, participants recruited through passive invitation had a comparably more favourable situation with regard to sociodemographic and lifestyle factors. They also had a lower frequency of prevalent disease, lower incidence of cancer and lower mortality. Contrary to this, men were more likely to respond late to a personal letter of invitation and late responders were also older, as compared with subjects responding early to personal invitation. Furthermore, those who responded late had a comparatively unfavourable socioeconomic situation and were characterized by a high prevalence of current smoking, obesity, weight change, and prevalent disease. Conclusions: Subjects who are recruited using different strategies in population-based cohort studies may have different sociodemographic and lifestyle characteristics, and may vary with regard to prevalent disease, cancer incidence and subsequent mortality.
Review Article: A review of studies of sexual behaviour of school students in sub-Saharan Africa
Authors: Kaaya Sylvia F. , Flisher Alan J. , Mbwambo Jessie K. , Schaalma Herman , Aarø Leif Edvard , Klepp Knut-Inge
Published: April 2008

Aims: This is a review of articles on sexual behaviour of school students in sub-Saharan Africa published between 1987 and 1999. The objective was to describe what is known in this regard and identify gaps in knowledge. Methods: Literature search using electronic databases and a thumb search of relevant journals identified 47 articles reporting sexual behaviours of school-based young persons aged between 14 and 24 years. Results: The fi ndings indicate a relatively low number of articles when one considers the scope of the problems related to adolescent sexual behaviour in the region; high prevalence rates of sexual intercourse; infrequent use of condoms and other contraceptives; and signifi cant proportions of adolescents who have two or more lifetime sexual partners. More data are needed on the extent to which adolescents engage in non-penetrative sexual behaviour and penetrative sex other than heterosexual vaginal intercourse; characteristics of the sexual partners of adolescents; and proximal psychosocial antecedents of sexual behaviour and consistent risk-reduction behaviours. Conclusions: Cultural infl uences on sexual behaviour, the sensitivity of such research in adolescent populations, and the opportunity afforded by school systems for intervention suggest a need for additional exploratory and methodological studies. Placing such information fi rmly within sociocultural contexts in which young people are raised will better inform effective interventions that both delay the onset of sexual intercourse and encourage use of risk reduction strategies.
National policies for reducing social inequalities in health in Europe
Authors: Zöllner Herbert
Published: April 2008

Gaps in health between poor and rich countries, and between social groups within countries, are unacceptably large and may be widening. WHO has made the fi ght against inequities in health a priority in the European region, as part of the policy framework for health for all in the twenty-fi rst century (HEALTH21), aimed at allowing all people to participate in social and economic life. It proposes a number of concrete steps, in order to promote access to health and reduce inequalities in health status. Equity should be everybody's concern, because inequities in health are everybody's loss. They harm many people, operate on a socioeconomic gradient, and put a strain on economic development and social cohesion. Equity is not something that is achieved once for all. A three-pronged approach to action includes: provision to all people of a "decent minimum' ' of assets and resources for creating and maintaining health and living; targeted additional support for disadvantaged groups in ways that respect their dignity and human rights; and appropriate policies, actions, and investments to secure opportunities and support at all levels of society. Genuine progress can be achieved by:

•securing a champion and making action understood and attractive;

•identifying and acting on needs;

•working in partnership and at different levels - community, subnational, national, and international;

•mobilizing investment for health;

•building in accountability for health;

•agreeing on policy choices, and reallocating resources and responsibilities accordingly;

•learning and developing knowledge, and looking around and ahead.
Generating evidence on interventions to reduce inequalities in health: the Dutch case
Authors: Stronks Karien
Published: April 2008

The aim of this paper is to refl ect on the type of evidence that is required to design policy measures and interventions to reduce inequalities in health. This issue will be discussed in the context of the Dutch national research programmes on inequalities in health. The fi rst type of evidence relates to the background of socioeconomic inequalities in health. From a very simple conceptual scheme, four policy options can be derived: (1) reducing inequalities in socioeconomic goods; (2) changing the distribution of specifi c risk factors across socioeconomic groups; (3) diminishing the effect of health on socioeconomic status; (4) offering extra healthcare for people in lower socioeconomic groups. Whereas the evidence on the background of socioeconomic inequalities in health has increased enormously, there is clearly a lack of evidence on the effectiveness of interventions to tackle inequalities in health, which is the second type of evidence that is required. The Dutch fi ve-year programme, including 12 (quasi) experimental studies on specifi c interventions in different policy fi elds, showed that this second type of evidence is more difficult to collect, partly because of the methodological complexity of these studies. The third type of evidence relates to the political feasibility of policy measures. It is not enough to know that a specifi c determinant of socioeconomic inequalities in health might be effectively addressed by a specifi c intervention. The political will to implement that intervention is obviously a necessary prerequisite for actually reducing inequalities in health. Within the Dutch research programme, the political feasibility of policy measures was explored during a number of conferences, for several policy fi elds. The lack of evidence on, in particular, the effectiveness of interventions to reduce inequalities in health is clearly an obstacle to tackling inequalities in health. On the other hand, it should be ensured that the lack of evidence is not used as an excuse for not taking policy measures at all.
Reducing social inequalities in health: work-related strategies
Authors: Siegrist Johannes
Published: April 2008

Despite reduced health risks in terms of physical and chemical hazards current trends in occupational life continue to contribute to ill health and disease among economically active people. Stress at work plays a crucial role in this respect, as evidenced by recent scientifi c progress. This paper discusses two leading theoretical models of work-related stress, the demand-control model and the model of effort-reward imbalance, and it summarizes available evidence on adverse health effects. As work stress in terms of these models is more prevalent among lower socioeconomic status groups, these conditions contribute to the explanation of socially graded risks of morbidity and mortality in midlife. Implications of this new knowledge for the design and implementation of worksite health-promotion measures are elaborated. In conclusion, it is argued that workplace strategies deserve high priority on any agenda that aims at reducing social inequalities in health.
What can health services contribute to the reduction of inequalities in health?
Authors: McKee Martin
Published: April 2008

Policies to reduce inequalities in health are needed in many different settings, one of which is the healthcare setting. This paper, drawing on the conclusions of the Copenhagen conference, explores the contribution that such policies can make within the healthcare system. In doing so it examines four themes. It begins by exploring the contribution that healthcare makes to health. It challenges the widely held view that this contribution is small, arguing that there have been major advances in the effectiveness of medical care and the use of evidence-based healthcare, so that interventions of proven effectiveness are increasingly delivered to those who will benefi t. Unfortunately, there is growing evidence that the benefi ts of modern healthcare do not benefi t all groups equally. Thus, there is an unfi nished agenda in many countries to enhance the equitable distribution of access to effective healthcare. Second, it explores the dynamic relationship between illness and poverty and, specifi cally, the impoverishing nature of illness in the absence of effective mechanisms to ensure solidarity and to provide social safety nets. It identifi es how all elements within a healthcare system have a part to play. Those responsible for healthcare fi nancing should ensure that funds are obtained in an equitable manner. Those who provide healthcare can do much to promote access for the disadvantaged and to use their facilities to promote health as well as cure disease. Third, it considers the specifi c needs of disadvantaged populations, and especially those whose needs are least visible, such as illegal migrants. It concludes by reviewing the need for better information to document the scale of inequalities, to evaluate interventions designed to reduce them, and to disseminate evidence of good practice.
Decreasing gender differences in ``avoidable'' mortality in Sweden
Authors: Westerling Ragnar
Published: April 2008

Aims: ``Avoidable'' mortality, that is mortality from conditions amenable to healthcare intervention, is commonly studied as an indicator of the outcome of healthcare. The objective of this study was to analyse gender equity in avoidable mortality trends in Sweden from 1971 to 1996. Methods: The underlying cause of death was analysed for all deaths in the Swedish population in the age group 0 - 69 years during the period 1971-96. On the basis of those used in international studies, 18 indicators of avoidable mortality were identified. The conditions were divided into two groups: those mainly indicating an outcome of medical care and those mainly reflecting the effect of health policy. Age-standardized death rates were calculated for each indicator of avoidable mortality and for total mortality broken down by sex. Gender differences in death rates were studied. The annual trends in death rates were analysed using regression models. Results: For total mortality the death rates were 80% higher for males than for females. The largest gender differences were found among those conditions mainly reflecting the effects of health policy. For most medical care indicators the gender differences were fairly small. For several avoidable causes of death the gender differences decreased considerably and for some causes of death the differences were eliminated. Conclusions: The avoidable mortality method seems to be useful in continuous epidemiological surveillance of the equity in healthcare. The comparatively low gender differences for avoidable death indicators as well as the decrease in these differences indicate decreasing gender inequity in health.
Response rate according to title and length of questionnaire
Authors: Lund Eiliv , Gram Inger Torhild
Published: April 2008

The purpose of this study was to investigate how response rates to a postal questionnaire are affected by title and length of the survey instrument. Five questionnaires, which differed according to title and length, were designed. Each questionnaire was mailed to a random sample of one thousand Norwegian women aged, 35—49 years. A total of 3,106 questionnaires were returned (62.1%). The highest response rate (70.2%) was achieved by a two-page questionnaire entitled ``Women and Cancer''. An otherwise identical questionnaire entitled ``Oral Contraceptives and Cancer'' had a response rate of 60.7%. Questionnaires entitled ``Women and Cancer'' with a length of four and six pages had a response rate of 62.8% and 63.3%, respectively. The four page questionnaire entitled ``Women, Lifestyle and Health'' had the lowest response rate of 57.1%. This study shows that in a general population of Norwegian women the title of a postal questionnaire influences the response rate. The results indicate that although the shortest questionnaire had the highest response rate, the most extensive survey instrument did not have the lowest response rate. The distribution of risk factors for breast cancer did not vary according to response rate or design of questionnaire. The overall findings of this study suggest that the benefits from the increased information obtained from extensive postal questionnaires out-weighs a potential non-response bias due to a somewhat lower response rate.
Social support, social disability and their role as predictors of depression among patients with congestive heart failure
Authors: Murberg Terje A. , Bru Edvin , Aarsland Torbjørn , Svebak Sven
Published: April 2008

The purpose of this study was to assess the effect of social support variables, personality, clinical variables (New York Heart Associations classification), and social disability upon depression. The sample consisted of 119 clinically stable patients (34 females, 85 males) with symptomatic heart failure, recruited from an outpatient hospital practice. The patients underwent a brief physical examination and completed a set of questionnaires. Descriptive statistics were used to characterise the patients' informal functional network. The analysis revealed that the intimate social network support (spouses) and primary social network support (close family) were rated as most supportive. Results from the path analysis showed that social disability was explained by the two personality factors, neuroticism and extraversion, and by the severity of disease (NYHA). No significant effects of the social support variables upon social disability were detected. Moreover, path-analyses showed that poor intimate network support, social disability and neuroticism were significantly positively associated with depression.
Work disability and health-affecting psychosocial problems among patients in general practice
Authors: Gulbrandsen Pål , Hjortdahl Per , Fugelli Per
Published: April 2008

Psychosocial problems are often ignored among patients in general practice. By identifying high risk groups this situation could possibly be altered. This study aimed to explore if patients in general practice perceiving themselves as work-disabled by at least 50% more often have health-affecting psychosocial problems than those not work-disabled. In a geographically defined population, 1,058 consecutive adult patients consulting 89 general practitioners were approached during one regular working day in March 1995. They completed a questionnaire at home, returning it directly to the department of general practice. Male patients considered themselves work-disabled more often than female patients. All psychosocial problems except having a demanding care-giving task were more common among the work-disabled. The doctors should bear in mind that work-disabled patients more often than other patients have concomitant healthaffecting psychosocial problems. Granting long-term sick leaves or a disability pension may not be the only management needed.
Children's residential exposure to environmental tobacco smoke varies greatly between the Nordic countries
Authors: Lund Karl E. , Skrondal Anders , Vertio Harri , Helgason Ásgeir R.
Published: April 2008

Objective: To assess similarities and differences in the Nordic countries regarding ETS (environmental tobacco smoke) exposure in young children.

Design: A population-based cross-sectional study comprising a randomly selected sample of 5,500 households which included a child born in 1992. Data were collected using a mailed anonymous questionnaire.

Results: While the prevalence of household smoking was similar in all countries, there was a great difference between the countries with regard to child ETS exposure. Finnish parents were more likely than all other Nordic parents to protect their children from ETS and the situation was worst in Denmark and Iceland, where almost half of all households, and nine out of ten households containing daily smokers, exposed their children. Approximately eight out of ten current and former smokers in all countries stated that they had made efforts to change their smoking habits because of their children.
Validity of two questions on alcohol use in a health survey questionnaire
Authors: Theobald Holger , Olov Bygren Lars , Carstensen John , Engfeldt Peter
Published: April 2008

The aim of this study was to investigate whether consumers of high and low levels of alcohol could be identified by two questions about alcohol use in a postal questionnaire survey. A sample of 2,300 persons aged 18 - 64 years from Stockholm county were sent a masked postal questionnaire comprising 30 questions about their health and functioning. Two questions concerned their alcohol consumption. One year later the subjects underwent a psychiatric health examination, which included an assessment of their alcohol use. The two questions about alcohol consumption identified high alcohol consumers with a relatively high sensitivity and specificity, of 64% and 87%, respectively, and thus are useful for identifying high alcohol consumers in health surveys using questionnaires.
Drinking problems load health centre hospitals in Finland
Authors: Vehviläinen Arto T. , Kumpusalo Esko A. , Takala Jorma K.
Published: April 2008

This study examined the reasons for referral of patients from general practice to health centre hospitals in central and northern Finland during one week in 1994. Participants were 806 general practitioners (GPs) from public health centres. Outcome measures were reasons for referral by ICPC codes, with respect to characteristics of patients, GPs, and practices. A total of 723 patients (1.4%) were referred from 53,633 consultations. Most referrals (532, 74%) were from out of hours consultations. The most commonly reported reasons for referral in the age group under 65 years were alcohol abuse for males and vertigo for females. For patients aged 65 or over, angina pectoris was the most common reason for referral for both male and female patients. Our results will be useful in developing primary healthcare and the training of GPs. Future research should focus on alcohol-related diseases in those patients referred to health centre hospitals.
Functional status and need of help among people aged 90 or over: a mailed survey with a total home-dwelling population
Authors: Jylhä Marja , Hervonen Antti
Published: April 2008

The aims of this study were to test the feasibility of a mailed survey in a population aged 90 years and over and to establish whether self-reported indicators of functioning and need of help predict mortality and institutionalization. A self-administered survey was mailed to the total home-dwelling people aged 90 years or over in the city of Tampere (n=448). The response rate was 81%. Confirmation of place of residence was carried out after 12 months and a mortality follow-up was conducted after 18 months. Seventy-one percent of the home-dwelling respondents lived alone, 49% went out of doors regularly and 32% received help on a daily basis. Mortality was higher among the institutionalized people than among those living at home. Being bed-ridden, not doing one's own shopping, not reading newspapers and regular need of help were significant predictors of mortality. Regular need of help also predicted institutionalization. We conclude that the population aged 90+ is very heterogeneous. In good conditions a mailed survey can be a feasible method of collecting data even among the oldest-old.
Variation in referring newborns to special care in Finland
Authors: Hemminki Elina , Gissler Mika , Saarikoski Hanna
Published: April 2008

We studied the frequency of referring newborns to special care in Finland and its variation between hospitals. Data was obtained from the nationwide Finnish Birth Register for 1991 and 1994. Newborns who during their first week of life had been in special care, in another hospital, in a respirator, or who had received a blood exchange were defined as having been in special care. This applied to 7% of newborns in 1991 and to 8% in 1994. The proportions of newborns in special care varied notably between hospitals of the same level. The differences could be explained by varying patient mixtures and different thresholds for referral to care. The indications for referring newborns into special care, especially in hospitals with high rates of referral, requires scrutiny.
Effects of maternal education on infant mortality and stillbirths in Denmark
Authors: Olsen Ole , Madsen Mette
Published: April 2008

This study examined inequalities in infant mortality in Denmark in relation to maternal educational level, and compared the inequalities to those observed in a similar study 10 years earlier. It was a register-based study of all singleton births in Denmark 1991-92, a study population of 113,814 births. When adjusted for mother's age, parity, and smoking, the stillbirth rate was independent of mother's educational level, but a clear social gradient in infant mortality was observed. Compared with a similar study in 1982-83, infant mortality has decreased most in the highest educational group and has increased in the lowest educational group. In conclusion, social inequality in infant mortality in Denmark is pronounced and cannot be explained by differences in smoking habits. The social gap between different educational groups has widened during the last decade, but may partly be explained by the decreasing number of women in the lowest educational group.
Teaching social inequalities in health: barriers and opportunities
Authors: Muntaner Carles
Published: April 2008

This article examines some of the main threats and new opportunities encountered by teachers of social inequalities in health in contemporary academia. Focusing mostly on the recent US and European experiences, I suggest that lay world views legitimating social inequalities are often in conflict with explanations arising from social epidemiology and medical sociology. The dominance of medicine in public health, through its often implicit assumptions about the biological determinants of human behaviour, is also identified as a barrier to teaching social inequalities in health. Educational elitism, which restricts higher education to members of the upper middle class, is identified as another barrier to teaching social inequalities in health. On the other hand, teachers in this field can benefit from a recent growth of empirical studies during the last decade aimed at understanding the social determinants of health inequalities. Finally, I suggest that familiarity with current critical scholarship within public health, as well as the use of techniques developed by sociologists to teach social stratification, can be valuable resources for teaching social inequalities in health.
The link between socioeconomic status and breast cancer-a possible explanation
Authors: Lawson James S.
Published: April 2008

The aim of this ecological study was to explore possible associations between childhood nutrition and breast cancer. The study compared heights and weights of children of different socioeconomic status and subsequent breast cancer risk in Queensland, Australia. In 1950 12-year-old girls from families of high socioeconomic status were 3 cm taller and 6.6 kg heavier than girls of the same age of lower socioeconomic status. Approximately 35 years later, age standardized mortality rates for breast cancer among all Queensland women were approximately 10% higher for women of high compared with low socioeconomic status. Taking into account the limitations of ecological studies and risk factors other than nutrition, these results are compatible with the hypothesis that there is an association between childhood nutritional experiences and subsequent risk of breast cancer.
Trends in tobacco use among Estonian and Russian youth in Tallinn
Authors: Nurk Eha , Mittelmark Maurice B. , Suurorg Lagle , Tur Inna , Luiga Ester
Published: April 2008

Smoking behaviour and exposure to environmental tobacco smoke (ETS) were examined in three cross-sectional surveys from 1991/92, 1993/94, and 1995/96. The study population comprised 3,185 Estonian and Russian adolescents from 17 schools in Tallinn, Estonia. Prevalence of ever-smoking girls increased by 13 percentage points versus 2% among boys during the study period. Mean ages of the first experimentation with tobacco and exposure to ETS did not change significantly. Regular smoking increased significantly from 1991/92 to 1995/96. Detailed analyses for the 1995/96 survey showed that among ethnic Estonians, compared with ethnic Russians, the prevalence of ever-smokers and regular smoking were higher, mean age for the first experimentation was younger, and on average, Estonians smoked more cigarettes per week. The smoking trend among adolescents in Estonia is worsening; especially among Estonian youth. This study identifies a compelling need for national and community-wide efforts to deter adolescents from smoking and to reduce the exposure to ETS.
Gender and the capacity of women with NIDDM to implement medical advice
Authors: Hepworth Julie
Published: April 2008

This qualitative study of women with non-insulin dependent diabetes mellitus (NIDDM) examined constructions of their diabetes management and socio-familial relationships as potential sources of support. Semi-structured interview data was collected from 16 women. The transcripts were analysed with the aim of examining the ways in which gender relations structured women's accounts of health-related behaviours. Women talked about themselves as wives, mothers, being pregnant and parenting, and friends of other women in ways that demonstrated how caring for others impeded their capacity to care for themselves. Meeting the food preferences of husbands and dietary requirements of diabetic husbands were dominant themes in women's accounts of marriage, and in various ways women justified their husbands' lack of support. Furthermore, the care of others during pregnancy and parenting was also an obstacle to women caring for themselves. An awareness of the gender politics inherent within social and family contexts is crucial to improving the effectiveness of medical advice for diabetes management.
Are women disfavoured in the estimation of Disability Adjusted Life Years and the Global Burden of Disease?
Authors: Sundby Johanne
Published: April 2008

Addressing women's health goes beyond merely producing gender-disaggregated data. A women's perspective on health issues involves an analysis based on knowledge of broader gender differences than those that can be attributed to biology alone. Women and men live different lives. It is therefore important to evaluate whether women's health issues are disfavoured by known health burden estimators in general use. The Global Burden of Disease and Disability Adjusted Life Years framework was presented to the public health community by the World Bank in 1993. The data presented are applied for the year 1990. The estimators have been criticized for not being able to address social inequity within populations, and for failure to predict how serious the HIV/AIDS epidemic would be. Some of the critical voices have also centred around how the methodology will affect the way women's health priorities are incorporated; however, the debate is still in its infancy. This paper examines this new concept of measuring health burdens from a women's health perspective.
Public Service Media Online? Regulating Public Broadcasters' Internet Services—A Comparative Analysis
Authors: Moe Hallvard
Published: April 2008

Facing a digital media system, European public service broadcasters have encountered increasing scrutiny from both competitors and regulators. As these institutions have ventured onto media platforms very unlike traditional broadcast radio and television, discussions about the scope of their activities have flourished. The case of the internet clearly illustrates the emerging challenges. How have public service broadcasters approached the internet? How do regulatory frameworks relate to the wider remits? Is it public service media online? This article presents a comparative study of three Western European mainly publicly funded broadcasters' activities on the internet, their arguments in support of them, the role of competitors, and actual regulatory frameworks they relate to. It scrutinizes how different forms of regulations affect the developments. Based on the findings, the article outlines remaining problematic issues for national regulation of public broadcasters' online services and suggests how researches might get a better grasp of public service media online.
Development of the Warp Knitted Spacer Fabrics for Cushion Applications
Authors: Xiaohua Ye  , Hong Hu  , Xunwei Feng
Published: April 2008

Polyurethane (PU) foam is a common material used in seats, sofas and mattresses, etc. However, the use of PU foam presents some problems concerning comfort and recycling. Compared with PU foam, warp knitted spacer fabrics can solve these problems. This paper presents work in the development of the warp knitted spacer fabrics for cushion application. Three kinds of the properties, i.e., pressure distribution, air permeability, and heat resistance of the fabrics developed are evaluated and compared with those of the PU foam. The results show that the warp knitted spacer fabrics have better pressure relief properties, higher air permeability, and lower heat resistance than PU foam, and thus could be used to substitute PU foam, especially in the case where the comfort and recycle are highly required.