Showing papers in "Scandinavian journal of social medicine in 1982"

The concept of quality of life.

Abstract: Despite the fact that, in the current debate, quality of life is depicted as something very desirable, its concept is seldom specified. With regard to previous research into welfare and quality of life, a model of an overall concept of quality of life is presented here. The theoretical analysis ends in and is woven into an empirical application. The application consists of a prospective longitudinal investigation of alcoholics who receive disability pensions. This report is the first in a planned series from the research project "Abuse of alcohol--Disability pension--Quality of life".

Mortality among the widowed in Sweden

Abstract: This study consists of three parts In the first part the risk of death for widowed persons is studied as a function of time interval since the day of bereavement The effects of bereavement on mortality are investigated in all widowed people in Sweden (about 360 000) from 1968 to 1978 Among widowers above 65 years of age there are nine deaths per 1000 in excess compared with married men during the first 3 months after bereavement In comparison with married people in the age group 70-74 it is found that among widows there is an increased mortality by 22% and among widowers by 48% during the first 3 months after bereavement Further observation, during a period of altogether 11 years, showed that excess mortality continues, though at a lower level In the second part, causes of death in the age group 70-74, divided according to marital status, are studied on the basis of data from the National Central Bureau of Statistics The excess in mortality is due mainly to cancer and cardiovascular deaths, but also accidents, suicides and cirrhosis of the liver The third part deals with differences between marital status groups with respect to tobacco smoking and alcohol abuse by using data from the population study of "70-year-olds in Goteborg" (H 70) By using data from central registers together with data from the population study it is possible to show that life style factors have an impact on the difference in mortality pattern between married and widowed people in Sweden

Assessment of Sodium Intake by a Short Dietary Questionnaire

Abstract: The aim of the study was to develop a short questionnaire for classifying persons according to their use of salt in public health work. After pretesting the questionnaire it was modified to measure the saltiness of diet. It consisted of five questions concerning certain salting habits and self-rating of salt use, and the frequency of use of seven salty food items. The questionnaire was completed by 1471 persons aged 14 to 65 who also collected one 24-hour urine sample. A sum index of all the questions was formed and called the Salt Index (SI). The correlation between the 24-hour urinary sodium excretion and SI was 0.18 in men and 0.20 in women (both significant at p less than 0.001). Men and women were classified into three groups according to their SI: low representing the lowest quintile, high representing the highest and medium containing all the other quintiles. The mean 24-hour urinary sodium excretion was lowest in the low SI-category and highest in the high SI-category in both men and women. The subjects were further divided into light and heavy workers on the basis of their occupation. In this analysis the effect of both energy intake and the saltiness of the diet indicated by SI were clearly distinguished. Women doing light work and having a low SI had the lowest sodium excretion value, 148 mmol/day, and men doing heavy work and having a high SI had the highest, 260 mmol/day.

The influence of repeated health examinations on mortality in a prospective cohort study, with a comment on the autopsy frequency. The study of men born in 1913.

Abstract: In the Study of Men Born in 1913 it was possible to investigate the influence of repeated health examinations on mortality in a prospective cohort study. On January 1, 1963, 1010 men in the experimental group and 1956 in the control group were alive. The experimental group took part in repeated examinations in 1963, 1967, 1973 and 1980. Overt diseases were treated accordingly. Newly detected hypertension was also treated. By the end of a 15-year-long observation period, the cumulative mortality in the experimental group (14.5%) was not significantly lower than that in the control group (15.7%). In the experimental group, 855 took part. The mortality was significantly higher in the non-participating group. The autopsy frequency decreased for in-hospital deaths but increased for deaths outside hospital during the study period.

The Prevalence of Bronchial Asthma and Chronic Bronchitis in an Industrialized Community in Northern Sweden

Abstract: The population living within a small area around a sulphite pulp factory in Northern Sweden was studied with regard to chronic obstructive lung disease. In persons in the age group 20-64 years the prevalence of bronchial asthma was found to be 3.0% for males and 3.2% for females. These figures correspond closely with previous studies in the Central and Southern Sweden. In the same age group the prevalence of chronic bronchitis was 2.8% for males and 1.0% for females, i.e. not differing much from that of other parts of Sweden. These findings, however, were far removed from the high prevalence of chronic bronchitis reported from Northern Finland, viz. 28.2% in males and 5.8% in females. The difference is probably attributable to differences in diagnostic criteria. In this study, those sulphite pulp factory workers who smoke seemed to constitute a population running a high risk of contracting chronic bronchitis.

Occurrence of atopic diseases in three generations.

Abstract: The incidence of asthma, hay fever and atopic dermatitis was assessed in three generations in 2820 families by a questionnaire. 35% of the families were atopic when the histories of parents and grandparents were included. 64% of atopic children had atopy in probands and the corresponding figure for non-atopic individuals was 31%. The highest prevalence of atopy was found in the parents' generation (13.5%) but it did not differ significantly from that of children (10.8%) when compared with grandparents (7.6%). The results suggested an increasing prevalence of children's atopic dermatitis in Finland since the 1950s. The influence of heredity was apparent. Few geographical differences were observed.

Survival experience of semi-skilled disability pensioners in Denmark.

Abstract: The purpose of this study was to estimate the survival prognosis of semi-skilled disability pensioners. The survival experience of 1353 invalid male members of the Danish Semiskilled Workers Union (SID) awarded disability pensions in 1975 was compared with a control group of members of the same union, matched geographically and by age. The two groups were followed until Nov. 30, 1978. For the follow-up period as a whole, the mortality risk among disability pensioners was estimated to be 6.8 times as high as that of controls. The relative risk of mortality was higher at the period's inception than at the end. A very high mortality level was found among disability pensioners awarded the highest level of disability pension, but no differences in mortality were found between disability pensioners awarded the lower levels of disability pension and the corresponding control group. The significance of medical and social factors in reducing the ability to work is discussed, as it relates to grounds for the awarding of disability pensions. The prognosis of one category of disability pensioners is very poor, while the survival prognosis of another is not significantly worsened, despite a considerable deterioration in the ability to work.

Injuries sustained in junior league handball. A prospective study of validity in the registration of sports injuries.

Abstract: In a study of injuries sustained in junior league handball, all injuries during 685 hours of play sustained by 7 320 players have been registered in a cup tournament. Junior handball appears generally to have a very low injury risk, but with a clearly indicated tendency towards more injuries in the higher age group and fewer injuries in the lower age group and among girls. The more serious injuries sustained during a junior handball tournament are carefully registered by the tournament doctor, but the less serious injuries must, if so wished, be registered by other means, for example by telephone call or postal report after the tournament games.

Unemployment and hospitalization among bricklayers.

Abstract: 677 active members of the bricklayers' trade union in Aarhus have been investigated with regard to unemployment and hospitalization during the period April 1, 1972-March 31, 1978. Information concerning unemployment was obtained through the bricklayers' trade union, and information about hospitalization from the hospital administration registry of three counties of Northern Jutland and from the Danish Central Psychiatric Register. Using logit analysis it was found that admission to a hospital increased the risk of unemployment, and that unemployment increased the risk of hospitalization. Admission to a psychiatric department appeared within a latency period of 0-1 years. A latency period of 1/2-11/2 years was observed before admission to a medical department. Admission to a surgical department occurred 1/2-21/2 years after accumulated unemployment. The risk of admission to a psychiatric department was seven times as high for bricklayers who have been unemployed more than 50% of the time compared with those who have been unemployed less of the time, although the calculation was based on relatively few individuals. The risk of admission to medical wards was twice as high, and the risk of admission to surgical wards was almost twice as high among those with much unemployment.

Abuse of alcohol and disability pension. The effect of the liberalization in Sweden in 1977.

Abstract: Social reforms are often introduced solely on the basis of theoretical considerations without any empirical research. Thus, it is often an urgent matter to evaluate the real effects of a reform. In this investigation, the increased possibilities for abusers to obtain disability pensions that came into force in Sweden 1977-01-01 have been examined. A representative sample of 15 percent of all applications in the county of Ostergotland in 1975 has been compared with a corresponding one in 1978. As expected, the number of abusers of alcohol among the applicants increased. The proportion of male abusers rose from 13.5 in 1975 to 22 percent in 1978. Despite a levelling off of differences in the civil status in 1978, the abusers were still in a substantially weaker social position than the other applicants. In contrast to the other applicants, no traces of increased efforts towards vocational rehabilitation can be noted among the abusers in 1978. This is quite remarkable since, according to the preceding official report, liberalization was not meant to replace meaningful efforts of rehabilitation. In 1978, the whole group of applicants were younger and they lived more frequently in large, densely populated areas. Furthermore, the number of women increased so that they were in a majority among the applicants in 1978. These changes probably reflect structural changes in society, especially in the labour market. This is the final report of an independent study in the research project "Abuse of alcohol - Disability pension - Quality of life".

The role of socio-economic status and place of residence in total hip replacement.

Abstract: The influence of socio-economic status and place of residence on walking ability, performance of daily activities and the aid required in these activities were evaluated among 539 total hip replacement (THR) patients. The walking ability of patients of higher socioeconomic status and of urban origin was better than that of patients of lower socio-economic status and of rural origin, both before and after THR. There were no significant interclass differences in the improvement in walking ability. The same pattern was valid as regards preoperative and postoperative performance of daily activities and the need for assistance. Neither socio-economic status nor place of residence had any significant influence on the improvement in the performance of daily activities or on the decrease in use of an aid. Earlier total hip replacement is recommended for patients of lower socio-economic status and for those living in rural areas.

The incidence of disability pensions and mortality among semi-skilled construction workers in Copenhagen. A retrospective cohort study with two control groups.

Abstract: The aim of the present study was to discover whether the incidence of disability pensions and mortality was higher amongst semi-skilled construction workers (SCW) in Copenhagen than in two control groups from the same geographic area. The population investigated consisted of a fixed cohort of 3537 SCW from Copenhagen as per 1/5/1975. The two control groups comprised 3818 Copenhagen members of the Warehouse Workers' union and a group of Copenhagen members of the Semi-skilled Worker's Union age-matched to the SCW cohort, both as per 1/5/75. Up to 31/12/79, a total of 102 SCW were granted disability pensions, compared with 89 and 77 in the two control groups respectively, i.e. a significantly higher frequency of award of disability pension among SCW than among warehouse workers (p less than 0.05). This was due especially to a higher frequency of disability pensions granted because of musculoskeletal diseases and cancer in SCW. The number of deaths was recorded from 1/5/75 to 30/11/78. No differences in overall mortality were found among the three groups, although slightly fewer deaths from lung cancer and ischaemic heart diseases and more suicides were observed among the construction workers. Selection bias and the effect of the working environment are discussed against the background of a concurrent investigation of the state of health and working conditions of SCW. Language: en

Menopausal Age and Spontaneous Abortion in a Group of Women Working in a Swedish Steel Works

Abstract: Female workers in a Swedish Steel works had a higher parity than clerical day workers. Mean menopausal age was 48 +/- 1 years in shift workers, compared with 49 +/- 1 in industrial day workers and 50 +/- 1 years in clerical day workers. Menstrual irregularity was not found to any higher degree in the industrially exposed groups. A tendency to increased frequency of spontaneous abortion among workers in the metallurgical areas was found, but can probably be explained by factors such as age and smoking habits.

Social factors and life events as predictors for children's health. A one-year prospective study after discharge from hospital.

Abstract: During a period of one year information concerning social background, life events and diseases of children (aged 1-14) admitted to a paediatric department had been obtained. One year after this index hospitalization, information concerning the children's present state of health was obtained. Forty (13%) had been readmitted to hospital during the follow-up year, and the parents of 72 children (23%) reported that their child's present state of health was poor. A multivariate predictor analysis was performed. The associations discovered suggest 1) that the selected social or psycho-social factors do not appear to be of considerable importance for prediction of readmission to hospital, 2) that "poor health" in the children has a very complex prediction pattern, partly due to disease variables, partly due to indices of unfavourable family background.

Incidence of disability pensions among slaughterhouse workers in Denmark. With special regard to diagnosis of the musculo-skeletal system

Abstract: The objective of this study was to examine whether slaughterhouse workers (SW) in Denmark have a higher incidence of disability than expected in comparison with the general population and the sub-group of the population that is gainfully employed, especially with regard to pensions awarded for incapacity related to the musculo-skeletal system. There were 122 male SW who were awarded disability pensions (medium or high level of compensation) in the 3-year period 1977–79 as compared with the expected figure, 152.3 (p<0.05) and 40 disability pensions awarded to female SW as compared with 30.7 (0.05 p<0.10). In men the Standardized Disability Ratio (SDR) increases with age. High SDRs are observed for diagnosis in the musculo-skeletal system for both sexes. The difference between observed and expected values does not change appreciably when the expected values are calculated on the basis of age-specific incidence rates among all actively employed people. Problems of the study design and selection bias are disc...

Variations between and within countries in hospital care for peptic ulcer. A comparison between Denmark and Sweden.

Abstract: The present study tries to examine variations in utilization rates for hospital care for ulcer disease between and within Denmark and Sweden. The focus is on how utilization rates differ but an attempt is also made to explain why regional differences occur. Hospital patient statistics from both countries show that ulcer disease accounts for 35% more bed-days per 100000 inhabitants in Denmark than in Sweden. The main source for this difference is duodenal ulcer, where the number of bed-days is 63% higher in Denmark. The differences in length of stay are negligible and the numbers of surgical operations are about the same in the two countries. The greater utilization of hospital resources in Denmark is explained mainly by the fact that more medical cases are treated as in-patients in Denmark than in Sweden. Neither mortality rates nor other data support the hypothesis that the incidence of duodenal ulcer is higher in Denmark than in Sweden. The difference between Denmark and Sweden widens when utilization rates are adjusted for differences in the age structure of the population in the two countries. There are wide variations in utilization rates between regions within both countries. The findings support the hypothesis that the intertemporal change in the technology for management of ulcer disease is one of the main reasons for variations between and within countries.

Comment on Sune Nyström. Relation of prevention of social problems to virtues and morality.

Abstract: Sune Nystrom (I) calls attention to the important relation 'that exists between personal vulnerability, unhappy social events, dysfunction, and disease. He also points out that of these risk factors for all kinds of disorders and premature death, not all belong to the medical domain or to the sociomedical concepts of disease and treatment. His emphasis on the distinction between the need for protection in situations of social stress and increased vulnerability as differing both from the need for treatment and for rehabilitation, and from being a patient or a client, represents a challenge to sociomedical thinking and practice. It turns our attention to prevention rather than to treatment and aid, and also to critical reappraisal of the concepts of causation the many disease models of social problems rely upon. This shift of emphasis from reparative to preventive types of action is no easy change for our profession. Recent experience from the field of alcohol-related problems has taught us that in order to change strategy in sociomedical work, you also have to change all the governing images you have built up about the social problems you are confronted with. In my opinion this is what Sune Nystrom is trying to do with his paper-but he is more cautious than he need be. Concluding longitudinal studies of personality risk factors for middle-age disease and death, Vaillant (1979) (2) points out that types of personal defence mechanisms seem to playa dominant role for adult health and social adaptation. He distinguishes between vulnerable, immature personalities with psychotic, psychopathic and neurotic types of defence reactions, and invulnerable personalities which consist of t'mature mechanisms including humor, altruism, sublimation and suppression, which still distort and alter feelings, conscience, relationsship and reality. But they perform this task gracefully and flexibly\". Changing to common language he states: \"Indeed, just as the

Confounding as a Result of Differential Diagnosis

Abstract: Confounding occurs when a competing cause of illness is associated with one or more of the factors being examined under the study hypothesis Factors that influence the likelihood of diagnosis and are associated with exposure will also have confounding properties in registry-based follow-up studies without ad hoc diagnosis, and in case-control studies where cases are ascertained from medical settings Such confounders can be controlled in the same manner as other confounders if the necessary information has been collected in the study Oftentimes sufficient control of confounders will not be possible, especially in registry-based studies This article gives guidelines for estimating the direction and magnitude for both forms of confounding The formulas may be needed for the interpretation of positive or negative results in studies where control for confounding has been incomplete

Mortality studies in unskilled and semi-skilled workers in Denmark. A comparative analysis.

Abstract: Results from two Danish studies on mortality among male unskilled and semi-skilled workers are compared. The first study is based on union data, the second study on census data. Apparently conflicting results are found to be identical after making adjustment for differences in the study populations and standard populations. The male unskilled and semi-skilled workers have an excess mortality in the younger age groups which decreases with increasing age.