Showing papers in "Scandinavian Journal of Public Health in 2013"
TL;DR: The decreasing attendance rate calls for new recruitment strategies and optimisation of the study organisation to facilitate attendance.
Abstract: Aims: To provide a synopsis of the sixth survey of the Tromso Study, Tromso 6, objectives and new target areas, study design, follow-up studies, data collection, attendance, and participant characteristics. Methods: The Tromso Study, initiated in 1974, is an epidemiological, prospective study of health conditions and chronic diseases, and a resource for the surveillance of disease risk factors. The purpose of Tromso 6 (2007–08) was to collect novel and repeated measurements of exposure data and to assess levels of disease risk factors. Tromso 6 included a main study that comprised two screening visits and several follow-up studies. Main study data collection: First visit (n=12,984): questionnaires, interviews, measurements of height, weight, hip and waist circumference, heart rate, blood pressure, forearm bone density, grip strength, pain sensitivity measurements, and blood and hair samples and nose and throat swab cultures. Second visit (n=7307): sampling of biological specimens (blood, urine, nose and t...
139 citations
TL;DR: The review shows that youth sports clubs have plentiful opportunities to be or become health-promoting settings; however this is not something that happens automatically, and the club needs to take a comprehensive approach to its activities, aims, and purposes.
Abstract: Aims: The aims of this review is to compile and identify key issues in international research about youth sports clubs as health-promoting settings, and then discuss the results of the review in terms of a framework for the youth sports club as a health-promoting setting. Methods: The framework guiding this review of research is the health-promoting settings approach introduced by the World Health Organization (WHO). The method used is the integrated review. Inclusion criteria were, first, that the studies concerned sports clubs for young people, not professional clubs; second, that it be a question of voluntary participation in some sort of ongoing organized athletics outside of the regular school curricula; third, that the studies consider issues about youth sports clubs in terms of health-promoting settings as described by WHO. The final sample for the review consists of 44 publications. Results: The review shows that youth sports clubs have plentiful opportunities to be or become health-promoting settings; however this is not something that happens automatically. To do so, the club needs to include an emphasis on certain important elements in its strategies and daily practices. The youth sports club needs to be a supportive and healthy environment with activities designed for and adapted to the specific age-group or stage of development of the youth. Conclusions: To become a health-promoting setting, a youth sports club needs to take a comprehensive approach to its activities, aims, and purposes.
127 citations
TL;DR: This article describes national level development towards a Health in All Policies approach in Finland over the past four decades, from tackling single health problems, through large-scale programmes, further to systematic work based on legislation and permanent structures.
Abstract: This article describes national level development towards a Health in All Policies approach in Finland over the past four decades. In the early 1970s, improving public health became a political priority, and the need to influence key determinants of health through sectors beyond the health sector became evident. The work began with policy on nutrition, smoking and accident prevention. Intersectoral health policy was developed together with the World Health Organization (WHO). When Finland joined the European Union in 1995, some competencies were delegated to the EU which complicated national intersectoral work. The priority in the EU is economy, but the Constitution's requirement to protect health in all policies gives legal backing for including health consideration in the EU-level work. To promote that, Finland adopted 'Health in All Policies' (HiAP) as the health theme for its EU Presidency in 2006. The intersectoral work on health has developed from tackling single health problems, through large-scale programmes, further to systematic work based on legislation and permanent structures. In the 2000s, work at local level was strengthened by introducing more focused and tighter legislation and by providing expert support for implementation. Recently, emphasis has been on broad objectives and Governmental intersectoral programmes, and actors outside the administrative machinery. Great improvements in the population health have been gained over the past few decades. However, health inequalities across social groups have remained unacceptably large. Major decisions on economic policy with varying impacts by the social groups have been made without health impact assessment, or ignoring assessments conducted.
82 citations
TL;DR: The findings suggest that health status should be taken into account when analysing socioeconomic differences in healthcare utilization, when using only register based data there is a risk of underestimating or disregarding differences.
Abstract: Aim: Previous studies have shown varying degrees of inequity of utilization of healthcare in Sweden. Studies based solely on register data cannot take into account differences in health status while studies based solely on self-reported data from surveys may potentially have biased data on healthcare utilization. The aim of this study was to investigate socioeconomic differences in utilization of outpatient healthcare services in Stockholm County, comparing analysis based on only register data, with analysis based on health survey data linked to register data. Methods: We linked data from a public health survey in Stockholm County 2006 (n = 34,707) to register data on sociodemographic background characteristics and outpatient healthcare utilization in 2007. Negative binomial regression analysis was used to estimate income differentials in healthcare utilization adjusting for self-rated health and limiting longstanding illness. Results: Income differentials in the number of visits to doctors were found in ...
79 citations
TL;DR: It is suggested that preventing ill-health and improving working conditions, especially among the lower socioeconomic classes, would help reduce socioeconomic differences in disability retirement.
Abstract: Aims: Socioeconomic differences in disability retirement are large. In this study, the main interest was to find out the contribution of diseases, self-rated health, health behaviours and working conditions to socioeconomic differences in disability retirement. Methods: The data are from the nationally-representative Health 2000 Survey to which register-based retirement data have been linked. These data include 3674 persons aged 30–62 years who were employed at baseline. Of the participants, 363 ended up in disability retirement during the follow-up period 2000–2009. Cox regression analysis was used to calculate hazard ratios and their 95% confidence intervals. Results: The risk of all-cause disability retirement was higher among manual workers (HR for men 2.44, 95% CI 1.64–3.63, women 2.33, 1.57–3.44) than upper-grade non-manual employees. Ill-health and physical working conditions contributed to the socioeconomic differences in disability retirement. The importance of physical working conditions was see...
63 citations
TL;DR: Two important social capital indicators – institutional trust in health care and generalised trust – seem to be independently associated with intention to accept vaccination against the 2009 A(H1N1) pandemic.
Abstract: Aim: To investigate the connection between social capital indicators and immunisation. Method: The national Society Opinion & Media (SOM) survey is an annual cross-sectional postal survey. In 2009,...
61 citations
TL;DR: Adult Danish men and women spend an increased amount of time sitting down at work and during leisure time, but also on leisure time MVPA, suggesting that low intensity physical activity may be displaced in everyday life.
Abstract: Background: Prevalence of sedentary behaviour is high in many countries, but little is known about temporal trends in sitting time. Objective: To examine temporal changes in sleep and domain-specific sedentary behaviour and moderate to vigorous leisure time physical activity (MVPA). Methods: Two cross-sectional population-based surveys of 25–79-year-old inhabitants were conducted in The Capital Region of Denmark in 2007 (N = 69.800, response rate 52.3%) and 2010 (N = 77.517, response rate 54.8%). Information on sedentary behaviour and physical activity was obtained from self-report questionnaire and sociodemographic information from central registers. Data were weighted for survey design and for non-response and were analysed by multiple regression analyses. Results: In 2007, the entire survey population reported a mean daily sleeping duration of 7.4 hours, leisure time sitting of 3.4 hours per day, occupational sitting of 4.4 hours per day, MVPA of 0.87 hours per day and a total 24-hour energy expenditur...
58 citations
TL;DR: Having a less-frequent intake of unhealthy foods and not skipping meals are associated with decreased odds of self-reported learning difficulties in Norwegian adolescents in this study.
Abstract: Aim: The academic performance of children impacts future educational attainment which may increase socioeconomic status which again influences their health. One of several factors that might affect academic performance is the diet. The aim of this study was to investigate the cross sectional relation between diet and self-reported reading-, writing-, and mathematical difficulties in Norwegian adolescents. Methods: In total, 475 ninth- and tenth-grade students out of 625 eligible ones from four different secondary schools in three different municipalities in Vest-Agder County, Norway, participated, giving a participation rate of 77%. The students filled in a questionnaire with food frequency questions of selected healthy and unhealthy food items, questions of meal frequency and different learning difficulties. Results: Regular breakfast was significantly associated with decreased odds of both writing and reading difficulties (OR: 0.44 (0.2–0.8), p = 0.01) and mathematical difficulties (OR: 0.33 (0.2–0.6), ...
58 citations
TL;DR: Identifying problems in early parenthood could help predict later problems exhibited by the preschool child, which might be prevented by supportive programmes.
Abstract: Aims: To examine whether there was any association between mothers’ and fathers’ post-partum depressive symptoms and sense of coherence and perception of their child’s temperament. The hypotheses were that parents with depressive symptoms: 1) have more often a poor sense of coherence, and 2) perceive their child’s temperament to be more difficult than parents without depressive symptoms. Methods: A total of 401 Swedish-speaking couples, who were the parents of children born through the years 2004–2006 in the northern part of the county of Vastmanland, Sweden, were invited to participate in the study. The parents answered 3 questionnaires including: at inclusion of the study: demographic data (n = 393 couples); at 3 months: the Edinburgh Postnatal Depression Scale and the Sense of Coherence Scale (n = 308 couples); and at 18 months: the Infant Characteristics Questionnaire (n = 272 couples). Results: Depressive symptoms measured at 3 months, were reported by 17.7% of mothers and 8.7% of fathers, and correl...
48 citations
TL;DR: The Danish Deprivation Index can be used to identify Danish parishes by their levels of deprivation and it provides municipalities with a tool to allocate resources to the geographic areas where they are most needed.
Abstract: Aims: To describe the development of a deprivation index for Danish parishes and to investigate its association with all-cause mortality compared with the Townsend index and individual-level factors. Methods: Nine socioeconomic factors were aggregated to the parish level from individual-level register data comprising the entire Danish population in 2005. A principal component analysis was conducted to reduce the number of factors and to apply weights. An ecological analysis investigated the association between the Danish Deprivation Index (DANDEX) and standardised mortality ratios in Danish parishes. Results were compared with the Townsend index and a possible modifying effect of population density was investigated. Sensitivity of the index was investigated with multilevel survival analyses evaluating the association between all-cause mortality and DANDEX, the Townsend Index, individual-level socioeconomic factors, and population density. Results: DANDEX consists of two components measuring socioeconomic ...
47 citations
TL;DR: The association between the framing of health messages in the media and the public’s perception of risk and related behaviour is affirmed and governments need to actively incorporate the media into pandemic communication planning.
Abstract: Background: Australia and Sweden have similar immunisation rates. However, during the 2009 H1N1 pandemic the uptake of immunisation was 60% in Sweden and 18% in Australia. During pandemics, percept...
TL;DR: The findings suggest that the majority of cases could have been available for preventive measures through their contacts with health and social services, and the heterogeneity among cases indicates that such measures need to be multifaceted.
Abstract: Aims: To assess demographic characteristics, treatment utilization and circumstances of death among those who died from drug-induced deaths in an urban setting and to identify possible subpopulations that should be targeted specifically to further develop preventive public health policies. Methods: Subjects (N = 231) who died, from drug-induced deaths, in the Norwegian capital Oslo (2006–2008) were identified through the National Cause of Death Registry. Data on toxicology, prison release and contact with health and social services in Oslo were collected. Results: Majority of cases were men (78%) and the mean age was 37 years. Nearly all cases (90%) were polydrug intoxications. Heroin was implicated in 67%. Residential address was the most common place of death (67%). Most cases (82%) had been in contact with health and social services in the year before death. Women were 4 years older, more often Oslo residents (82% vs. 64%) and fewer died from heroin intoxication. Non-Oslo residents were younger and more likely to have been found outdoors with heroin as the main intoxicant. Other identified subpopulations were those who died after prison release and those discharged from drug treatment. Conclusions: The findings suggest that the majority of cases could have been available for preventive measures through their contacts with health and social services. Yet, the heterogeneity among cases indicates that such measures need to be multifaceted. Finally, it is important for policymakers and health and social workers in various countries to consider subpopulations such as women and non-city residents when developing public health interventions to prevent overdose deaths.
TL;DR: The comparison of the different disability benefit systems shows that there are relatively large national differences in terms of rules and regulations, the handling of disability benefit cases, and offered rehabilitation activities and other measures to support young adults on disability benefits to strengthen their working capability, and hence enable them to approach the labour market in the future.
Abstract: Background: This article, based on a study by the Swedish Social Insurance Inspectorate, describes the development of young adults receiving disability benefits due to reduced working capability, and the disability benefit systems in seven European countries; Denmark, Finland, Iceland, Norway, the Netherlands, Sweden, and the UK. This comparative study mainly uses Sweden as a benchmark. Methods: Apart from a documentary and legal data collection and analysis, 26 semi-structured interviews were conducted with representatives of the responsible ministries and authorities in the studied countries. In addition, national and European data was collected. Results: There is an increasing trend of young adults, aged 19–29, on disability benefits in all studied countries. The most common diagnosis group among young adults on disability benefits is mental and behavioural disorders, ranging from 58% in the UK to 80% in Denmark. Conclusions: The comparison of the different disability benefit systems shows that there a...
TL;DR: The hypothesis of an association between job stress and lipid disturbances and lifestyle variables in 91,593 workers undergoing periodic checkups is supported.
Abstract: Aims: To investigate whether there is an association between job stress, lipid profile and dyslipidemia diagnosis. Methods: This study used a questionnaire to evaluate job stress and lifestyle vari...
TL;DR: It is found that poor availability of forest and recreational facilities in the neighbourhood is associated with more sedentary leisure time, and intervention efforts may benefit from emphasising the importance of having recreations options in residential areas to provide alternatives to sedentary activities.
Abstract: AIM: Sedentary behaviour is a risk factor for diabetes, cardiovascular disease etc., independently of level of physical activity. Availability of recreational green space is associated with physical activity, but is unknown in relation to sedentary behaviour. The aim of this study is to examine the association between availability of green space and sedentary leisure time in a Danish population. METHODS: The study was based on a random sample of 49,806 adults aged 16 + who answered a questionnaire in 2010, including sedentary leisure time. Objective measures of density green were calculated for each respondent using Geographical Information System (GIS). A multilevel regression analysis, taking neighbourhood and individual factors into account, was performed. RESULTS: 65% of the respondents were sedentary in leisure time for more than 3h/day. We found that poor availability of forest and recreational facilities in the neighbourhood is associated with more sedentary leisure time; OR: 1.11 (95% CL: 1.04-1.19), after adjusting for individual, and neighbourhood, level characteristics. CONCLUSIONS: Among adult inhabitants, sedentary leisure time of more than 3h/day was more frequent in neighbourhoods with less green surroundings. Intervention efforts may benefit from emphasising the importance of having recreations options in residential areas to provide alternatives to sedentary activities. Language: en
TL;DR: The results indicate that factors related to the individual in terms of low school performance, low health status, and high vulnerability predict future success in the educational system.
Abstract: Aims: Getting a secondary education is essential in preventing future inequalities in health and socioeconomic status. We investigated to what degree personal predictors like low school performance, high vulnerability, and poor health status are associated with not completing a secondary education in a Danish youth cohort. Methods: This prospective study used data from a questionnaire in 2004 and register data in 2010. The study population consisted of 3053 adolescents born in 1989. Information on educational attainment from Statistics Denmark was divided into four categories: completed, still studying, dropped out, or never attained a secondary education. Data was analysed using multinomial logistic regression. Results: Low grades when completing compulsory school predicted not having completed a secondary education by age 20/21 (odds ratios (OR) between 1.7 and 2.5). Low sense of coherence in childhood was associated with dropping out from a vocational education (OR 2.0). Low general health status was a...
TL;DR: The results suggest primacy of the effects of insomnia symptoms over sleep duration on sickness absence and suggest that both sleep duration and insomnia symptoms need to be considered to promote work ability.
Abstract: Aims: We aimed to examine the joint associations of sleep duration and insomnia symptoms with subsequent sickness absence of various lengths while considering several covariates. Methods: Baseline ...
TL;DR: Understanding how the QoL changes in relation with the selected treatment option can be important to the urologist and individual patient to have realistic expectations as well as to optimise treatment decisions for the prostate cancer patient.
Abstract: Background: The lack of consensus amongst experts delineate how important it is for patients diagnosed with prostate cancer (PCa) to make an informed decision on available treatment options through an objective discussion of the risks and benefits. One of important benefits could be seen as patient’s quality of life (QoL) after treatment. We aimed to assess QoL differences in prostate cancer patients by stage and treatment for a population-based sample. Methods: The cross-sectional PCa patient population-based national level study for a prostate cancer patient population was performed. QoL was investigated with EORTC QLQ-C30. The analysis includes descriptive statistics and evaluation of differences in functional and symptom scales by stage and treatment group by predictors in the model. Results: Response rate was 79.1% (N=514). The highest QoL scores were observed in localised PCa, active surveillance treatment group. The lowest scores were observed in advanced stages, chemotherapy treatment group. Betwe...
TL;DR: The study underlined that the magnitude of educational differences in SRH varied according to gender and country.
Abstract: Aims: The aim of this study was to examine educational differences in self-reported health (SRH) among men and women in Europe. Methods: The study was based on a sample of 15,362 men and 20,272 wom...
TL;DR: Although smoking is the main modifiable risk factor for COPD, the disease was significantly related to manual workers and non-manual assistant employees, i.e. socioeconomic groups reflecting occupation.
Abstract: Objectives: Chronic obstructive pulmonary disease (COPD) is globally a major, but often undiagnosed, cause of morbidity and mortality. The aims of this study were to assess the prevalence of COPD in Helsinki, Finland, with international diagnostic criteria and to analyse risk factors including socioeconomic status, and disease severity. Methods: A general population sample of 628 adults (368 women) completed flow-volume spirometry with bronchodilation test and a structured interview. Postbronchodilation spirometry was assessed both using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria and relative to the fifth percentile of the reference value (lower limit of normal, LLN). Results: According to GOLD criteria, 37 (5.9%), and by using the LLN criteria, 43 subjects (6.8%) had airway obstruction consistent with COPD. Using the GOLD criteria, four subjects or 0.6% of the population had severe, 3.0% moderate, and 2.2% mild COPD. Of those with post-bronchodilator obstruction, 49% had no previous diagnosis of obstructive airways disease and did not use medication for any respiratory disease. The prevalence of undiagnosed COPD defined by GOLD was 2.9% (LLN 3.3%). In addition to age, smoking history, and prior history of asthma, socioeconomic status based on occupation was significantly related to COPD in the population. Manual workers in industry (GOLD 10.0%, LLN 11.7%) and non-manual assistant employees (10.2%, 10.2%) had a significantly higher prevalence of COPD than professionals (2.8%, 2.3%). Conclusions: Although smoking is the main modifiable risk factor for COPD, the disease was significantly related to manual workers and non-manual assistant employees, i.e. socioeconomic groups reflecting occupation.
TL;DR: The official death certificates should be used with caution to evaluate CVD in small community intervention programmes, and restricted to the chapter level and total populations.
Abstract: Aim: The aim was to investigate the possibility to evaluate the mortality pattern in a community intervention programme against cardiovascular disease by official death certificates.Methods: For al ...
TL;DR: BMI – measured or self-reported – is a valid anthropometric indicator of body weight and predictor of obesity-associated health-risks and its use is feasible for research purposes as well as for the assessment of weight-related risks to work ability.
Abstract: Aims: Excessive weight is associated with increased sickness absence from work due to obesity-linked health problems. However, it is not known which obesity measure best predicts sickness absence. ...
TL;DR: Prevention efforts to prevent drowning in the future should focus on preventing alcohol use by young bathers; better fencing around swimming sites; improved coverage of swimming lessons to all children in Sweden, especially children from immigrant families; more education on drowning risks for single parents; and better awareness by adults on the need for constant supervision of children and adolescents in and near water.
Abstract: Aims: The goal of this research project was to explore circumstances surrounding each drowning death occurring to children and adolescents ages 0-17 in Sweden during the years 1998-2007. Methods: R ...
TL;DR: These results underscore the urgency in efforts to reduce testing delay among especially young MSM and point to the need for additional public health resources and prevention marketing efforts to be directed towards increasing awareness of HIV testing.
Abstract: Background: HIV testing among persons at risk of infection has become a cornerstone in prevention and control of the HIV/AIDS epidemic. Understanding factors related to HIV testing is thus fundamental for informing prevention and testing initiatives. Aims: This study aims to identify prevalence of, and factors that are associated with, HIV testing. Methods: This study analysed data from 2011 HIV-negative and untested MSM collected in a national, online survey. Results: More than a third (35.3%) of MSM had never received an HIV test result. Multivariate logistic regression results showed that compared with men ever tested, untested men were younger (odds ratio, OR 0.95), closeted about same sex attractions (OR 3.84), had low educational level (OR 0.47), low HIV transmission and testing knowledge (OR 0.98), did not believe that HIV testing is free (OR 0.27), had never taken a test for sexually transmitted infection (OR 0.08), and had not engaged in sex abroad in the past year (OR 0.69). Conclusions: These r...
TL;DR: The group process during patient education might be more important for improving coping skills than the content of the programme, and future patient education programmes should focus on group processes and improving participants’ activity.
Abstract: Aims: Studies investigating the effect of patient education usually evaluate whole educational programmes. The aim of this study was to describe the content of several locally developed educational programmes and investigate which parts predicted improved coping skills in the participants. Method: A prospective observational study investigating the content of several educational programmes and the participants’ coping skills 4 months afterwards. Results: The content of 35 different educational programmes was described. The programmes lasted on average 12 hours. The main focus was increased knowledge about the disease and improved coping skills. Programmes developed locally and tailored to the specific participant group in collaboration between services users and health professionals led to improved coping skills. The participants’ level of activity was the strongest predictor for improved coping skills (adjOR = 4.1 (95% CI 1.5–11.2) p = 0.007). Conclusions: The group process during patient education might...
TL;DR: Both average number of patients on GPs’ lists and lack of free capacity in nursing and care institutions in the hospital catchment area was found to be negatively associated with perceived referral quality.
Abstract: Aims: It has been shown that referral letters from GPs often are of poor quality, but research in this field is scarce, and few efforts have been made to investigate the factors that may help explain the variation in referral quality. Methods: Combining a survey among 1298 Norwegian hospital physicians (response rate: 52%) with information on the hospitals and the communities they are serving, this study investigates how they view the general quality of patient referrals received from GPs, and the extent to which insufficient information in referrals and inappropriate referrals is considered a problem for cooperation with GPs. Results: Only 15.6% of the hospital physicians perceived the quality of the referrals to be “usually good”, and both lack of information in referrals and inappropriate referrals are seen as important barriers to cooperation with GPs. Of the individual factors, former GP practice is associated with a positive view on referral quality, while regular meetings between hospital physician...
TL;DR: A more than nine-fold variation in annual hospitalization rates among the nursing homes in one municipality suggests the presence of unwarranted variation and demands for political action to improve the premises for a more uniform practice in nursing homes.
Abstract: Background: The geriatric nursing home population is frail and vulnerable to sudden changes in their health condition. Very often, these incidents lead to hospitalization, in which many cases repre...
TL;DR: Investigating differences in socio-economic characteristics between CAM users and CAM non- users among people with MS in Denmark found that CAM users differed from CAN non-users in relation to socio- economic factors as well as treatment characteristics.
Abstract: Aims: The aim of this study was to investigate differences in socio-economic characteristics between CAM users and CAM non-users among people with MS in Denmark as well as differences in characteristics related to the use of CAM among CAM users and the use of conventional treatments among CAM non-users. Methods: An internet-based questionnaire was used to collect data from 3361 patient members of the Danish MS society. A letter with a personal code was sent to all respondents, asking them to fill out the questionnaire online. Reminders to non-respondents were sent twice and the final response rate was 55.5%. Statistical associations were presented as odds ratios and with respective 95% confidence intervals. Results: People with MS in Denmark use a wide range of CAM treatments for a variety of reasons. CAM users were more likely to be of female gender, 18–40 years of age, educated at bachelor level or above, and have a high income compared to CAM non-users (p < 0.05). CAM users more often addressed non-spe...
TL;DR: SOC in first-time parents decreased at 4 years, especially in mothers, and social support can be of significance for parents of young children to be able to experience health.
Abstract: Background: Antonovsky’s idea of sense of coherence (SOC) is related to wellbeing and is of importance for individuals in public health care. SOC in parents with healthy children has not previously...
TL;DR: Findings demonstrate for the first time C. difficile contamination of a tap water distribution system and waterborne transmission of toxigenic C.difficile seems possible.
Abstract: Aims: In November through December 2007, the drinking water distribution system in the town of Nokia, Finland, was contaminated with treated sewage effluent that resulted in a large gastroenteritis...