Showing papers in "Scandinavian Journal of Public Health in 2006"

Burnout among employees in human service work: design and baseline findings of the PUMA study.

Abstract: Aim: To present the theoretical framework, design, methods, and baseline findings of the first Danish study on determinants and consequences of burnout, and the impact of workplace interventions in...

The significance of neighbourhood context to child and adolescent health and well-being: a systematic review of multilevel studies.

Abstract: Growing up in a poor neighbourhood has negative effects on children and adolescents. In the literature it has been concluded that the risk of low birth weight, childhood injury and abuse, and teenage pregnancy or criminality double in poor areas. However, the validity of such studies has been questioned, as they have been associated with ecological or individualistic fallacies. Studies using multilevel technique might thus contribute important knowledge in this field. The present review clarifies the importance of neighbourhood contextual factors in child and adolescent health outcomes, through considering only studies using multilevel technique. Keyword searching of the Medline, ERIC, PsycInfo, Sociological Abstracts, and Social Citation Index databases was performed. Original studies using multilevel technique to examine the effect of neighbourhood characteristics on child and adolescent health outcomes, and focusing on populations in high-income countries were included. Neighbourhood socioeconomic status and social climate were shown to have small to moderate effects on child health outcomes, i.e. birth weight, injuries, behavioural problems, and child maltreatment. On average, 10% of variation in health outcomes was explained by neighbourhood determinants, after controlling for important individual and family variables. This review demonstrates that interventions in underprivileged neighbourhoods can reduce health risks to children, especially in families that lack resources. An analysis of methodological fallacies indicates that observed effects and effect sizes can be underestimated, and that interventions may well have greater impact than this review was able to establish.

Neighborhood deprivation and cardiovascular disease risk factors : Protective and harmful effects

Abstract: Aims: To determine whether neighborhood-level deprivation is independently associated with cardiovascular disease (CVD) health behaviors/risk factors in the Swedish population. Methods: Pooled cross-sectional data, Swedish Annual Level of Living Survey (1996—2000) linked with indicators of neighborhood-level (i.e. Small Area Market Statistics areas) deprivation (1997), to examine the association between neighborhood-level deprivation and individual-level smoking, physical inactivity, obesity, diabetes, and hypertension among women and men, aged 25—64 (n=18,081). Data were analyzed with a series of logistic regression models that adjusted for individual-level age, gender, marital status, immigration status, urbanization, and a comprehensive measure of socioeconomic status (SES). Interactions were tested to determine whether neighborhood effects varied by SES or length of neighborhood exposure. Results: Living in a neighborhood with low deprivation was protective (i.e. lower odds) for smoking, while living ...

A randomized trial of lifestyle intervention in primary healthcare for the modification of cardiovascular risk factors The Björknäs study

Abstract: AIMS: To evaluate the effects of a lifestyle intervention programme in primary healthcare, targeted to patients with moderate to high risk of cardiovascular disease in terms of cardiovascular risk ...

Representativeness in population-based studies: a detailed description of non-response in a Danish cohort study.

Abstract: Background: Decreasing rates of participation in population-based studies increasingly challenge the interpretation of study results, in both analytic and descriptive epidemiology. Consequently, es...

Health in Sweden – The National Public Health Report 2005 : Scandinavian Journal of Public Health

Abstract: Health in Sweden – The National Public Health Report 2005 : Scandinavian Journal of Public Health

Rural-urban differences in health and health behaviour: a baseline description of a community health-promotion programme for the elderly.

Abstract: Study objective: To (1) describe the setting and design of the Good Ageing in Lahti Region (GOAL) programme; (2) by using the baseline results of the GOAL cohort study, to examine whether living in urban, semi-urban, or rural communities is related to risk factors for chronic diseases and functional disability in ageing individuals. Design: The baseline data of a cohort study of ageing individuals living in three community types (urban, semi-urban, rural). Data were collected by two questionnaires and laboratory assessments. Setting: Fourteen municipalities in the Lahti region (Paijat-Hame County) in Finland. Participants: A regionally and locally stratified random sample of men and women born in 1946—50, 1936—40, and 1926—30. A total of 4,272 were invited and 2,815 (66%) participated. Main results: Elevated serum cholesterol, obesity, disability, sedentary lifestyle (<2 times/week walking), and high fat intake were more prevalent in rural vs. urban and semi-urban communities. After adjustment for sex, ag...

Representativity of a postal public health questionnaire survey in Sweden, with special reference to ethnic differences in participation

Abstract: AIM: Non-participation in health surveys is a common phenomenon. When differences between participants and non-participants are considerable, the external validity of the sample survey may decrease and false conclusions might be drawn about the health status of the population. For this reason, the authors aimed to investigate the representativity of a postal questionnaire survey performed in the county of Scania, Sweden, in 1999-2000. The survey, which was based on an 18- to 80-year-old population sample, had a 58% response rate (n = 13 604).METHODS: For some variables, the information obtained using the questionnaire was compared with information obtained from a population register that covers all the population in the county (for the 18- to 80-year-old group, n = 850 476). The population register includes, among other data, information on age, gender, educational level, country of birth, and healthcare expenditure.RESULTS: Men, individuals with a low level of education, and immigrants were under-represented in the survey. However, except for immigrants, the under-representation was not large. Among immigrants, particularly those born in former Yugoslavia, the Arabic-speaking countries, and Poland were very significantly under-represented in the study. By contrast, immigrants born in other Nordic countries had responded to almost the same extent as respondents born in Sweden. The survey sample had about the same healthcare utilization costs as did the general population.CONCLUSIONS: In summary, the "Health Survey for Scania, 2000" seems largely representative of the total Scanian population. A major concern, however, is the under-representation of the immigrant population. (Less)

Promoting sexual and reproductive health in early adolescence in South Africa and Tanzania : Development of a theory- and evidence- based intervention programme

Abstract: Aims: Action to prevent the spread of HIV among young people in Sub-Saharan Africa is needed urgently. In order to be effective, such action should be theory and evidence based and carefully adapted to local cultures and contexts. The present article describes the organization, theoretical basis, and methodological approach of a project that aims at developing and evaluating school-based interventions targeting adolescents aged 12–14 years. Methods: Researchers from European and African universities have developed interventions that were conducted in three sites: Cape Town and Polokwane (South Africa) and Dar es Salaam (Tanzania). In each site the interventions were evaluated through large-scale field experiments with intervention schools and delayed intervention schools and with baseline and two follow-up data collections. Mimimum sample sizes were estimated for each site based on local data and taking into acount that the unit of allocation was schools and not individual students (the design effect). During the formative phase as well as within the field experiments, qualitative studies were also conducted. Discussion: The interventions were developed consistent with the Intervention Mapping approach, and the theoretical framework was based on a modified version of the Theory of Planned Behaviour. The limitations of Western social cognition models were recognized, and the theoretical framework has therefore been expanded in two directions: towards integrating cultural processes and towards taking societal factors and constraints into account. Conclusion: The project will throw light on the application of social cognition models as well as the usefulness of the Intervention Mapping approach to intervention development in sub-Saharan Africa.

Refining a probabilistic model for interpreting verbal autopsy data

Abstract: Objective: To build on the previously reported development of a Bayesian probabilistic model for interpreting verbal autopsy (VA) data, attempting to improve the model's performance in determining cause of death and to reassess it.

Health behaviour among adolescents in Denmark: Influence of school class and individual risk factors

Abstract: Aims: The aim of this study was to assess the relative influence of school class on health behaviour among adolescents versus that of the family's socioeconomic status and individual factors among adolescents. Methods: The material comprised 3,458 students in grades 8 and 9 in 244 school classes. Data were collected through questionnaires completed by the students and by their class teacher and information from the school physician. Multilevel analysis was used to indicate the relative significance of individual and school class characteristics. Results: We find no consistent pattern between the mother's socioeconomic status and the included health behaviour measurements; however, adolescents from the lower socioeconomic groups had a higher risk of unhealthy dietary habits and adolescents whose mothers were unemployed had a significantly lower risk of drinking alcohol weekly versus all other adolescents. Not living with both biological parents, focusing on friends, and not being very academically proficient were associated with an increased risk of harmful health behaviour. Health behaviour varied substantially between school classes, especially for daily smoking, weekly alcohol consumption, and use of hashish and other euphoriants. Circumstances in the school class more profoundly influenced risk behaviour among adolescents (smoking, alcohol consumption, and use of hashish or other euphoriants) than their dietary habits (eating breakfast, frequent intake of fruit and vegetables, and frequent intake of soft drinks). Conclusions: The school class had the relatively strongest influence on adolescents' risk behaviour (smoking, alcohol intake, and use of hashish or other euphoriants), whereas family circumstances comprised the strongest influence on dietary habits.

Health in Sweden: the National Public Health Report 2005.

Abstract: Health in Sweden – The National Public Health Report 2005 : Scandinavian Journal of Public Health

Prevalence of low back pain and sickness absence: A ``borderline'' study in Norway and Sweden

Abstract: Aims: Low back pain (LBP) is a major public health problem in both Norway and Sweden. The aim of the study was to estimate the prevalence of LBP and sickness absence due to LBP in two neighbouring regions in Norway and Sweden. The two areas have similar socioeconomic status, but differ in health benefit systems. Methods: A representative sample of 1,988 adults in Norway and 2,006 in Sweden completed questionnaires concerning LBP during 1999 and 2000. For this study only individuals in part or full time jobs, (n=1,158 in Norway and n=1,129 in Sweden) were included. Results: In Norway the lifetime prevalence was 60.7% and in Sweden 69.6%, the one-year prevalence was 40.5% and 47.2%, and the point prevalence 13.4% and 18.2% respectively. There was a significantly higher risk of reporting LBP in Sweden, even after controlling for gender, age, education, and physical workload. There was no difference in risk of self-certificated short-term sickness absence (1—3 days), but it was a 40% lower risk of sickness ab...

Association between fruit and vegetable consumption and birth weight: A prospective study among 43,585 Danish women:

Abstract: Objective: To examine whether fruit and vegetable consumption in pregnancy is associated with birth weight in a Western population. Design: Prospective cohort study based on telephone interviews, a...

Self-reported and test-based mobility limitations in a representative sample of Finns aged 30+:

Abstract: Aims: The object of the present study was to acquire a comprehensive and accurate picture of mobility limitations in the Finnish adult population. Methods: A nationally representative sample of 8,0...

Contribution of Swedish moist snuff to the metabolic syndrome : A wolf in sheep's clothing?

Abstract: AIM: Combined effects of genetic and environmental factors underlie the clustering of cardiovascular risk factors in the metabolic syndrome (MetSy). The aim was to investigate associations between ...

Cost-effectiveness of healthcare-based interventions aimed at improving physical activity.

Abstract: Aim: This article aims to review current knowledge concerning the cost-effectiveness of healthcare-based interventions aimed at improving physical activity. Method: A search was performed for economic evaluations containing the terms ``physical activity'', ``exercise'', or ``fitness''. Cost-effectiveness for the articles found was described based on a model for evaluating interventions intended to promote physical activity. Results: A total of 26 articles were found in the search. Nine of them concern a general population, 7 evaluated older people, and 10 studied disease-specific populations. A preventive perspective is most common, but some have a treatment perspective. Around 20 of the interventions studied were cost-effective according to their authors, but all analyses had some shortcomings in their evaluation methods. Conclusion: This review found many examples of cost-effective interventions. There is a lack of evidence for the cost-effectiveness of interventions aimed at those whose only risk facto...

Effects of body fatness and physical activity on cardiovascular risk: Risk prediction using the bioelectrical impedance method:

Abstract: Aims: To explore the effects of body fat percentage (BF%) on incidence of and mortality from cardiovascular disease (CVD) and to study the cardio-protective effect of physical activity in relation to BF%. Methods: A total of 26,942 men and women, aged 45-73 years, without history of CVD were followed up for incidence of coronary events (CE), ischaemic stroke, and CVD mortality over seven years in relation to sex-specific quartiles (Q1-Q4) of BF%. The cardio-protective effect of leisure-time physical activity was studied in relation to BF%. Results: In men, the relative risk (RR) for CE and CVD mortality increased progressively with BF%. RR for CE in Q4 was 1.37 (95% confidence interval: 1.07-1.74), adjusted for age, height, smoking, high alcohol intake, and physical activity, compared with Q1. In women, BF% was significantly associated with incidence of CE and stroke. BF% was more strongly correlated to body mass index (BMI) (r=50.83) and waist circumference (r=0.76) in women than in men (r=0.59 and r=50.66, respectively). BF% was a stronger risk factor than BMI in women, and equally strong as waist circumference. A significant interaction (p=0.013 for incidence of CE, p=0.026 for ischaemic stroke) was found between BF% and sex. The raised cardiovascular risk was reduced by physical activity in subjects with high BF%. Conclusions: BF% is a risk factor for CE, ischaemic stroke, and CVD mortality. An interaction between BF% and sex suggests that BF% is a stronger CVD risk factor in women. The raised cardiovascular risk associated with high BF% is reduced by physical activity. (Less)

Combining risk factors and demographic surveillance: Potentials of WHO STEPS and INDEPTH methodologies for assessing epidemiological transition:

Abstract: AIMS: Demographic surveillance systems (DSSs) create platforms to monitor population dynamics. This paper discusses the potential of combining the WHO STEPwise approach to Surveillance (STEPS) with ...

Socioeconomic aspects of fractures within universal public healthcare: a nationwide case-control study from Denmark.

Abstract: AIMS: To investigate the effects of income and other socioeconomic variables on fracture risk adjusted for disease-related confounders as fractures are a major public health problem. METHODS: Case-control study where all subjects in Denmark with a fracture during the year 2000 (n = 124,655) served as cases. From the general population three age- and gender-matched subjects were selected as controls (n = 373,962). Adjustment were made for income, living with someone vs. living alone, having a job vs. being out of work, education, comorbidity (Charlson index), number of bed days in hospital, number of contacts with general practitioner, use of corticosteroids, prior fracture, and alcoholism. RESULTS: Income was not associated with fracture risk on adjustment for the other covariates. Living with someone was associated with a decreased risk of any fracture in all ages. A higher level of education was associated with a decreased fracture risk in the age groupsor=60 years. Being at work was associated with a decreased hip fracture risk among subjects>or=40 years. Alcoholism and a prior fracture were significant predictors of fracture in all age groups. CONCLUSIONS: Income does not predict fracture risk in Denmark after adjustment for other social and comorbidity variables. This may signal neutralization of the effect by socioeconomic compensation or that income was the product of underlying socioeconomic variables. Language: en

Chapter 5.5: major public health problems - mental ill-health.

Abstract: N An estimated 20% to 40% of the population today suffer from mental ill-health – everything from more serious disease states such as psychoses to milder mental problems such as worry, anxiety or anguish and disturbed sleep. Of these, 10–15% are reckoned to have serious complaints that may need psychiatric treatment. N Only about 3–4% of the population seek psychiatric care in any one year. Fewer than 1% (0.7%) of the adult population are reckoned to have mental disabilities that require contact with the

Mortality in relation to employment status during different levels of unemployment.

Abstract: Aims: The aim of this study was to estimate whether the risk for total and cause-specific mortality was related to employment status, and whether mortality in different non-employed groups differed during high and low levels of unemployment. Methods: Structured interviews were used from the Swedish Survey of Living Conditions in 1984-89 and 1992-97, including women and men aged 18 to 64, classified as unemployed (n = 2,067), retired or on temporary disability pension (n = 2,674), economically inactive for other reasons (n = 1,373), and employed (n = 38,293). Data were linked to death certificates, as registered in the Cause of Death Register. Cox proportional hazards models were performed for the mortality risk up until eight and a half years following the interview. Results: Being unemployed (OR = 1.43), retired, or on temporary disability pension (OR = 2.28) or being economically inactive for other reasons (OR = 1.63) was related to a risk for total mortality, after considering the level of unemployment, sociodemographic factors and longstanding illness. The risk of death due to external causes was excessive among the unemployed and among those retired or on temporary disability pension, and resulted to a large extent from suicide. The interaction between employment status and level of unemployment was not significant. Conclusions: The level of unemployment seems to have no major influence on the mortality risk. Future interventions for the non-employed groups should focus on preventing avoidable mortality, such as injury and suicide. Language: en

The need for a European strategy on global health.

Abstract: International health has as a rule been considered as the involvement of countries in the work of international organizations such as the World Health Organization, usually through small departments of ‘‘international health’’ in the Ministries of Health and as development aid and humanitarian assistance, more often than not handled by bilateral aid agencies linked (in most cases) to the Ministries of Foreign Affairs or to Ministries of Development. But even in these long-established areas of action there has not been enough cooperation between European countries to speak with one voice, support similar priorities, harmonize aid and cooperate at recipient country level. This division has also held back joint European action on global health. Global health refers to those health issues that transcend national boundaries and governments and call for actions on the global forces that determine the health of people [1]. It requires new forms of governance at national and international level that seek to include a wide range of actors. As in international health, in many countries as well as in the European Commission three strands of global health action generally run in parallel with little coordination or even in competition:

Sense of coherence and its determinants: a comparative study of the Finnish-speaking majority and the Swedish-speaking minority in Finland.

Abstract: Background: Despite similar living conditions among the Finnish-speaking majority and the Swedish-speaking minority in Finland, the latter is a more advantaged group e.g. in terms of socioeconomic ...

Psychosocial work conditions, unemployment, and leisure-time physical activity: a population-based study.

Abstract: Objective: To investigate the association between psychosocial work conditions and unemployment, and low leisure-time physical activity. Design/setting/participants/measurements: The 2000 public health survey in Scania is a cross-sectional postal questionnaire study with a 59% participation rate. A total of 5,180 persons aged 18—64 years who belonged to the workforce and the unemployed were included in this study. Logistic regression models were used to investigate the associations between psychosocial factors at work and unemployment, and low leisure-time physical activity. Psychosocial conditions at work were defined according to the Karasek—Theorell demand—control/decision latitudes into relaxed, active, passive, and job strain categories. The multivariate analyses included age, country of birth, education, economic stress, and social participation. Results: In total, 16.1% of men and 14.8% of women had low leisure-time physical activity. The job strain (high demands/low control) and unemployed categor...

The impact of immunization on the association between poverty and child survival: evidence from Kassena-Nankana District of northern Ghana.

Abstract: Background: Research conducted in Africa has consistently demonstrated that parental poverty and low educational attainment adversely affect child survival. Research conducted elsewhere has demonstrated that low-cost vaccines against preventable diseases reduce childhood mortality. Therefore, the extension of vaccination to impoverished populations is widely assumed to diminish equity effects. Recent evidence that childhood mortality is increasing in many countries where vaccination programmes are active challenges this assumption. Data and methods: This paper marshals data from accurate and complete immunization records and survival histories for 18,368 children younger than five years in a rural northern Ghanaian population that is generally impoverished, but where family wealth and parental educational differentials exist nonetheless. Time-conditional Weibull hazard models are estimated to test the hypothesis that childhood immunization offsets the detrimental effects of poverty and low educational att...

HIV/AIDS knowledge and condom use among Somali and Sudanese immigrants in Denmark.

Abstract: Aims: This study explores the knowledge, attitudes and practices among Somali and Sudanese immigrants in Denmark with regard to HIV/AIDS and condom use. Material and methods: A 78-item questionnaire, divided into five thematic sections, was given to 192 purposively selected Sudanese and Somalis of both sexes, aged 18-49, who had lived in Denmark for one or more years. It was administered in Arabic and Somali in four locations and supplemented by 13 semi-structured interviews. Results: Education, sex, and nationality, but not length of residence in Denmark, were positively associated with knowledge about HIV/AIDS. Less than half of both men and women scored more than 70% on the knowledge portion of the questionnaire, while Sudanese knew more than Somalis. Men had a more negative attitude towards condoms than women, but greater knowledge about them. One-third of the women reported never having seen or heard of a condom, and almost half had never received information about condoms. Both sexes preferred receiving such information from the TV or friends instead of family doctors or HIV-positive individuals. Conclusions: This study suggests that knowledge about HIV/AIDS is low in these two Danish immigrant groups, both of which are characterized by reported incidence rates that are higher than the national average. The groups receive little information, while condom knowledge is particularly low among poorly educated women, and men have a negative attitude to condom use. The findings indicate a need for targeted, culturally sensitive HIV/AIDS information and advice.

Low physical activity and mortality in women: Baseline lifestyle and health as alternative explanations:

Abstract: Aims: The aim of this study was to investigate the association between physical activity and mortality in post-menopausal women. In addition, the authors wanted to investigate to what extent this association could be attributed to confounding from other lifestyle factors, and to reverse causation due to a number of common health problems that may inhibit the ability to exercise. Methods: A total of 27,734 women aged 51—83 years from the Swedish Mammography Cohort were investigated. In 1997 they responded to a detailed questionnaire including questions on physical activity, diet, alcohol intake, smoking, and medical problems. During follow-up in 1999—2004, 1,232 deaths were identified by linkage to the National Population Register. Results: Women with low physical activity (≤35 MET*h/day) had a 3.22 times increased mortality (95% confidence interval (CI)=2.35—4.43) compared with the most active women (>50 MET*h/day). No increased risk was seen in women with moderate compared with high physical activity. Se...

Road traffic injuries in India: a review of the literature.

Abstract: Aims: India is the largest country in the South Asian region with all the problems faced by rapidly developing nations, especially increasing motorization. In spite of such developments, there are limited data in the literature addressing the problem of road traffic injuries. This article is an attempt to estimate the magnitude of the problem through published literature. Methods: This article is a systematic review of the literature on road traffic injuries in India, conducted using three electronic databases and hand-searching of the selected articles. Final analyses were conducted with 22 studies. Results: Road traffic injuries are a significant burden on the health care system in India. The most commonly affected group is young males. Pedestrians constitute a large majority of the victims and there is high early mortality in most cases. Conclusions: There is lack of population-based data on road traffic injuries in India and there is large heterogeneity in the published data. This is an important research agenda for the country. Immediate steps are required to curb this problem to limit the loss of life and resources.

Workload, work stress, and sickness absence in Swedish male and female white-collar employees.

Abstract: Aims: This study aimed to analyse, in a homogeneous population of highly educated men and women, gender differences in self‐reported sickness absence as related to paid and unpaid work and combinat ...