Aim: To determine whether there are systematic differences in physical activity between residential areas after extensive control for sociodemographic factors at the individual level. Methods: Multi-level regressions of walking/bicycling, sedentary activities, household work and exercise were carried out in a representative sample of 68,303 adults in 39 residential areas in Stockholm County, first adjusting at the individual level for country of birth, sex, age, education, occupational class and income. The type of housing was then considered at the individual level or, for walking/bicycling and exercise, at both the individual and area levels (as a measure of area density). Results: After adjustment for sociodemographic factors, differences between residential areas remained in walking/bicycling, corresponding to 0.27 SD, or 50 min/week between the most and least active areas. Forty per cent of this difference could be explained by the type of housing at the area level. For sedentary activities and household work, respectively, much of the variation that remained after adjustment for sociodemographic factors was, in turn, explained by the type of housing at the individual level, leaving a difference of 0.16 SD (80 min/week) and 0.13 SD (60 min/week), respectively. For exercise, the corresponding difference was 0.11 SD (11 min/week, not sensitive to housing). Conclusions: Area level factors may influence walking/bicycling. High area density was associated with more activity. However, high density also comes with a type of housing (apartments) that is associated with less household work and, surprisingly, more sedentary activities, introducing a challenging trade-off. The differences in exercise were smaller than for all other types of activities.
Aim: The aim of this study was to test the psychometric properties of the Salutogenic Health Indicator Scale (SHIS) in an adolescent population. Methods: The investigation was performed among Swedish students aged 13–15 years (n = 817; 58% girls). The SHIS was assessed for respondent acceptability, and its psychometric properties were evaluated according to classical test theory (regarding unidimensionality, targeting, reliability, and external construct validity). Results: The adolescents found it easy to complete the questionnaire, which was completed in an average of 4 minutes. Exploratory factor analysis, which is based on polychoric correlations, identified one factor, supporting the instrument’s unidimensionality. Floor/ceiling effects were <= 3.3%. Reliability estimates yielded a Cronbach’s alpha value of 0.93; the test–retest reliability (n = 50; 2-week interval) coefficients were 0.89 for the total SHIS score and 0.52–0.79 for item scores. Spearman correlations with other variables were based on a priori expectations (self-rated general health, 0.595; depressive symptoms, –0.773; anxiety, –0.577; and sleep problems, 0.519). Conclusions: Our observations support both the acceptability and the psychometric properties of the SHIS as a brief, unidimensional assessment tool for salutogenic health in adolescents. Further studies using modern test theory are needed to better understand the measurement properties of the SHIS, including the functioning of its response categories and its comparability between adolescents and adults.
Aims: Low socioeconomic status (SES) characterizes smoking and nicotine dependence in adult samples. However, less is known about how parental SES is linked to smoking in offspring and the potential mechanisms at work. Methods: A population-based longitudinal study (n=1380) from Norway was used. Participants were followed from their mid-teens until their late 20s using survey and register data. Data were collected on parental education, parental smoking, educational aspirations and expectations, school grades and school-related conduct problems. Register data monitored education, unemployment and social welfare assistance. Risk factors for smoking and nicotine dependence were identified by means of multinomial logistic regression analyses. Mediation analyses were used to investigate the pathways between parental SES and future smoking. Results: Future smokers were recruited from families with low educational levels. Poor school grades, school dropout and low educational aspirations were also predictors. Unemployment and social welfare assistance additionally increased the risk. Parental smoking, no high school exam and welfare assistance were mediators between low parental education and high levels of nicotine dependence in young adulthood. Conclusions: Socialization to smoking reflects a multifaceted process fuelled by low parental SES. However, parental influences may be masked behind influences from schools or peers. Future research should try to capture the multiple sources of SES-related influence at work. Prevention strategies should target adolescents from low SES backgrounds, who orient towards the manual working class and who have problems entering the labour force.
Aims: To examine the associations of self-reported visual impairment and physical activity (PA) with all-cause mortality. Methods: This prospective cohort study included 65,236 Norwegians aged >=20 years who had participated in the Nord-Trøndelag Health Study (HUNT2, 1995–1997). Of these participants, 11,074 (17.0%) had self-reported visual impairment (SRVI). The participants’ data were linked to Norway’s Cause of Death Registry and followed throughout 2012. Hazard ratios and 95% confidence intervals (CI) were assessed using Cox regression analyses with age as the time-scale. The Cox models were fitted for restricted age groups (<60, 60–84, >=85 years). Results: After a mean follow-up of 14.5 years, 13,549 deaths were identified. Compared with adults with self-reported no visual impairment, the multivariable hazard ratios among adults with SRVI were 2.47 (95% CI 1.94–3.13) in those aged <60 years, 1.22 (95% CI 1.13–1.33) in those aged 60–84 years and 1.05 (95% CI 0.96–1.15) in those aged >=85 years. The strength of the associations remained similar or stronger after additionally controlling for PA. When examining the joint associations, the all-cause mortality risk of SRVI was higher for those who reported no PA than for those who reported weekly hours of PA. We found a large, positive departure from additivity in adults aged <60 years, whereas the departure from additivity was small for the other age groups. Conclusions: Adults with SRVI reporting no PA were associated with an increased all-cause mortality risk. The associations attenuated with age.
Aim: The aim of this study was to explore informal adult support experienced by children with parental alcohol problems to understand how professionals can show recognition in a similar way. Methods: We conducted a qualitative interview study with retrospective accounts from nine adults growing up with problem-drinking parents. Data were analysed with systematic text condensation. Goffman’s concept "frame" offered a lens to study how supportive situations were defined and to understand opportunities and limitations for translation of recognition acts and attitudes to professional contexts. Results: Analysis demonstrated frames of commonplace interaction where children experienced that adults recognised and responded to their needs. However, the silent support from an adult who recognised the problems without responding was an ambiguous frame. The child sometimes felt betrayed. Concentrating on frames of recognition which could be passed over to professional interactions, we noticed that participants called for a safe harbour, providing a sense of normality. Being with friends and their families, escaping difficulties at home without having to tell, was emphasised as important. Recognition was experienced when an adult with respect and dignity offered an open opportunity to address the problems, without pushing towards further communication. Conclusions: Our study indicates some specific lessons to be learnt about recognition for professional service providers from everyday situations. Frames of recognition, communicating availability and normality, and also unconditional confidentiality and safety when sharing problems may also be offered by professionals in public healthcare within their current frames of competency and time.
Aims: The globalized economy has stimulated mobility in the labour market in many countries and Denmark has one of the highest rates of mobility between workplaces among the OECD countries. This raises the question of the potential health effects of mobility and the effect of disease on mobility. Methods: This study was register-based with a longitudinal design using data on the entire Danish population in 1992–2006. The data included mobility between employers and workplaces and seven different diseases based on admissions to hospital and drug prescriptions. Results: After adjusting for relevant confounders, an exposure–response relationship was seen between mobility and the incidence of ischaemic heart disease, stroke, duodenal ulcer, anxiety/depression and, most strongly, with alcohol-related disorders. The effects were not very strong, however, with odds ratios varying from 1.2 to 1.6. As expected, no effect was seen for colorectal cancer. We also found an effect of both somatic and mental disorders on mobility, but not for the two cancer types. Mobility did not seem to prevent being out of the labour force after diagnosis. Conclusions: Frequent mobility in the labour market increases the risk of cardiovascular disease, common mental disorders and alcohol-related disorders and these diagnoses also seem to increase the risk of subsequent mobility.
Aims: School lunches are provided free in Sweden, although some children choose not to eat school lunch. The aim of this study was to analyse Swedish children’s total energy and nutrient intakes on weekdays by the frequency of school lunch consumption and to analyse energy and nutrient intakes from school lunches by sex. Factors associated with children’s school lunch habits were also studied. Methods: Children in grades 2 and 5 (n=1905) completed a food diary (school lunch data available for 1840 children) and the mean energy and nutrient intakes per day and per school lunch were calculated. The children also completed questions on the frequency of school lunch consumption and school lunch habits. Logistic regression was used to assess factors associated with school lunch habits. Results: Children who reported eating school lunch every day had significantly higher energy and absolute nutrient intakes than children reporting eating school lunch less than five times a week, but not standardized for energy. Boys had significantly higher energy and absolute nutrient intakes from school lunches than girls, but not standardized for energy. Younger children and children who liked school lunches had higher odds of eating school lunch every day. Children in grade 5, those with a foreign background and those disliking school lunches had higher odds of omitting the main lunch component. Conclusions: Regular school lunch consumption was associated with a higher total intake for most nutrients, but not a better nutrient density. School lunch habits were associated with age, ethnic background and liking school lunches.
Background: The impact of unemployment and precarious employment on the health of young people is not well understood. However, according to social causation, higher socio-economic positions and thus better working conditions are beneficial to health in general. We tried to synthesize the results of studies that test this hypothesis in the case of young people. Methods: We conducted a scoping study mapping all the academic articles published in the period 2006–2016 in Europe. The literature was searched in PubMed/Medline, Science Direct, Web of Science and Scopus. Results: We identified 1770 studies, of which only 46 met the inclusion criteria. There are more studies that focus on the relationship between unemployment and health than between precarious employment and health (28 and 16, respectively). The vast majority of the studies (44) found support for the social causation hypothesis, the most common health outcomes being mental health disorders, health risk behaviour, poor quality of life and occupational injuries. The causal mechanisms behind this association relied mainly on the life-course perspective, the breadwinner model, and the lack of social and economic benefits provided by standard employment. Conclusions: There is evidence that young people are especially vulnerable to health problems when unemployed or working in precarious conditions. Active labour market and training programmes, inclusive social security measures, improved working conditions and targeted health programmes are important for addressing this vulnerability. Further research should strive to enhance the causal model by including a gender perspective, longitudinal data, more indicators on precariousness and third factor explanations.
Aim: This study explores the association between the psychosocial work environment in school and students’ somatic health complaints. With its point of departure from the Demand–Control–Support (DCS) model, the aim was to examine how aspects of decision control and social support can moderate stress-related health implications of high psychological demands. Methods: Data come from two cross-sectional waves of the Swedish version of Health Behaviour in School-aged Children (HBSC 2005/2006 and 2009/2010), which consists of a total of 9427 11-, 13- and 15-year-old students. A two-level random intercept model was applied, with school class as the level 2 unit. Results: Findings showed significant associations between school demands and somatic health complaints for all studied age groups, with a slight increase in strength with age. Decision control as well as social support from teachers, parents and peers consistently predicted a favorable association with health. An age pattern emerged in the analyses of stress-moderating resources. For 11 year olds parental support was the only resource that displayed a significant interaction with demands in relation to somatic health complaints, whereas for 13 year olds, decision control and support from teachers and parents all demonstrated moderating effects on student health. For 15 year olds, however, it was peer support that acted as a buffering resource in the studied relationship. Conclusions: The psychosocial work environment is an important predictor of students’ health complaints. Overall, social support was a better stress-moderating resource than decision control, but some "buffers" were more important at certain ages than others.
Aims: This study explored the sex-specific associations between friendship trust and the psychological well-being of young Swedes from late adolescence to early adulthood. Methods: A random sample of native Swedes born in 1990 was surveyed at age 19 years and again at age 23 years regarding their own well-being and their relationships with a maximum of five self-named peers. The response rate was 31.3%, resulting in 782 cases to be analysed. We used sex-stratified structural equation models to explore the associations between trust and well-being. Psychological well-being was constructed as the latent variable in the measurement part. The structural part accounted for the autocorrelation of trust with respect to well-being over time and incorporated the cross-lagged effects between late adolescence and early adulthood. Results: It was found that trust increased while well-being decreased for young men and remained stable for young women from 19 to 23 years of age. The young women reported lower well-being at both time points, whereas no sex difference was found for trust. Based on model fit comparisons, a simple model without forward or reward causation was accepted for young men, whereas reversed causation from well-being to trust was suggested for young women. Subsequent analysis based on these assumptions confirmed the reversed effect for young women. Conclusions: The findings suggest that young people do not benefit from trustful social relations to the same extent as adult populations. Young women who express impaired well-being run a greater risk of being members of networks characterized by low friendship trust over time.
Aims: Ideal cardiovascular health has been defined by the American Heart Association as the absence of disease and the presence of seven key health factors and behaviours. However, little is known about the mental aspects associated with ideal cardiovascular health metrics. The objective of this study was to assess the relationships between psychosocial risk factors and ideal cardiovascular health metrics among Finnish women at municipal work units. Method: A cross-sectional study was conducted in Finland among 732 female employees (mean±SD age 48±10 years) from ten work units in 2014. Ideal cardiovascular health metrics were evaluated with a physical examination, laboratory tests, medical history and self-administrated questionnaires. Psychosocial risk factors (social isolation, stress, depressive symptoms, anxiety, hostility and type D personality) were assessed with core questions as suggested by the European Society of Cardiology. Results: The prevalence of having 5–7 ideal cardiovascular health metrics was 183 (25.0%), of whom 54.1% had at least one psychosocial risk factor. Anxiety (31.3%), work stress (30.7%) and type D personality (26.1%) were the most prevalent of the psychosocial risk factors. The prevalence of depressive symptoms (p<0.001) and type D personality (p=0.049) decreased linearly according to the sum of ideal cardiovascular health metrics after adjustment for age and years of education. Conclusions: Even women with good cardiovascular health are affected by psychosocial risk factors at municipal work units. Although the association is possibly bidirectional, screening and treating depression and dealing with type D personality might be crucial in improving cardiovascular health among women.
Aims: Tobacco is a major cause of disease and mortality in modern times. The risk of smoking in pregnancy is a serious threat to the development and future health of an unborn child. The aim of this study was to explore the epidemiological factors associated with smoking during pregnancy in a primary healthcare setting. Methods: All 856 maternity records at the Glaesibaer Health Care Centre in Reykjavik during 2006–2013 were reviewed and information on smoking habits investigated. Results: The records showed that in 108 (12.2%) pregnancies, women smoked at first visit and 63 stopped smoking in early pregnancy, leaving 45 (5.3%) mothers smoking throughout the whole gestational period. The mean age of the smoking women was 27.8 years and for the non-smokers 29.7 years. Low social status (odds ratio (OR) = 2.66; 95% confidence interval (CI): 1.19–5.96), previous mental health diagnosis (OR = 2.7; 95% CI: 1.3–5.6), and unstable relationship with a partner (OR = 3.78; 95% CI: 2.1–7.0) were associated with smoking. Smoking fewer cigarettes was associated with a 0.04-unit lower risk of smoking during pregnancy (OR = 0.04: 95% CI: 0.02–0.08). Conclusions: Our results indicated that the women who smoked during pregnancy were often heavy smokers and living without a partner. They were younger, had worse mental health, and a lower social status than those pregnant women who did not smoke. Bearing in mind the consequence of smoking in pregnancy, this subgroup should get increased assistance to quit smoking before and during early pregnancy, as well as appropriate medical and social support.
Aim: The aim of this study was to estimate the one-year health and care costs related to hip fracture for home-dwelling patients aged 70 years and older in Norway, paying specific attention to the status of the patients at the time of fracture and cost differences due to various patient pathways after fracture. Methods: Data on health and care service provision were extracted from hospital and municipal records and from national registries; data on unit costs were collected from the municipalities, hospital administrations and previously published studies. Four different patient pathways were identified and the total costs for subgroups of patients according to age, sex, fracture type and instrumental activity of daily living at fracture incidence were calculated. Descriptive statistics were used to identify cost estimates. Results: The mean total one-year costs per patient were EUR 68,376 and the costs for patients alive one year after hip fracture were EUR 71,719. The patients’ age and pre-fracture functional status contributed most to the total cost. Conclusions: On average, care costs accounted for more than 50% of the total cost; even for patients with good functional status before hip fracture, care costs accounted for 40% of the total cost compared with hospital costs of 38%. To reduce the financial costs of hip fractures in the care sector, the results point to the importance of preventive programmes to reduce the risk of hip fracture, but also to the importance of comprehensive geriatric care in the initial phase after a hip fracture.
Aims: Poverty kills children. This study assesses the relationship between poverty and child mortality rates (CMRs) in 71 societies from three world regions to determine whether some countries, relative to their region, neglect their children. Methods: Spearman rank order correlations were calculated to determine any association between the CMR and poverty data, including income inequality and gross national income. A current CMR one standard deviation (SD) above or below the regional average and a percentage change between 1988 and 2010 were used as the measures to assess the progress of nations. Results: There were positive significant correlations between higher CMRs and relative poverty measures in all three regions. In Western countries, the current CMRs in the USA, New Zealand and Canada were 1 SD below the Western mean. The narrowest income inequalities, apart from Japan, were seen in the Scandinavian nations alongside low CMRs. In Asia, the current CMRs in Pakistan, Myanmar and India were the highest in their region and were 1 SD below the regional mean. Alongside South Korea, these nations had the lowest percentage reductions in CMRs. In Sub-Saharan Africa, the current CMRs in Somalia, Burkina Faso, Sierra Leone, Chad, Democratic Republic of Congo and Angola were the highest in their region and were 1 SD below the regional mean. Conclusions: Those concerned with the pursuit of social justice need to alert their societies to the corrosive impact of poverty on child mortality. Progress in reducing CMRs provides an indication of how well nations are meeting the needs of their children. Further country-specific research is required to explain regional differences.
Aims: To follow-up hospitalization for physical diseases among homeless men and women compared with a control group from the general population. The study also investigated the changes in the difference between the homeless men and women and the general population over time by comparing two cohorts of homeless people (2000–2002 and 1996). Methods: A total of 3887 people (24% women) who were homeless during the period 2000–2002 were compared with 11,661 people from the general population with respect to hospitalization for physical diseases and injuries (2000–2010). Indirect comparisons were used to compare the relative risk (RR) of hospitalization between the cohort of people who were homeless in 2000–2002 with a cohort of those who were homeless in 1996. Results: Homeless people have an RR of being hospitalized for physical diseases twice that of the general population. The largest differences were found in skin diseases, infections, injury/poisoning and diseases of the respiratory system. Indirect comparison between people who were homeless in 2000–2002 and 1996 showed an increasing difference between young (18–35 years) homeless men and men in the control group (RR 1.32). The difference had also increased between homeless men and men in the control group for hospitalization for heart disease (RR 1.35), chronic obstructive pulmonary disease (RR 2.60) and poisoning (RR 1.89). Among women, the difference had decreased between homeless women and women in the control group for skin disease (RR 0.20) and injury/poisoning (RR 0.60). There was no significant difference between the sexes in the two homeless cohorts. Conclusions: There was no improvement in excess hospitalization among homeless people over time. The difference between young homeless men and young men in the general population increased between 1996 and 2000–2002.
Aim: The aim of this study was to analyse gender differences in wellbeing, as related to work status, among working-age people with severe impairments. Methods: This study is based on register and survey data for a sample of 7298 persons, drawn from the entire Swedish population of 15,515 working-age people 16–64 years old who, at the end of 2010, received Sweden’s unique personal assistance allowance, an allowance paid from the Swedish Social Insurance Agency (SSIA) to persons with severe impairments, enabling them to pay for assistants to support them in the functions of daily life. Logistic regression models were used to estimate the strength of relations between six measures of wellbeing, work status (not working, irregular work and regular work) and gender, together with key confounders. Results: Of the persons surveyed, 21% responded that they had regular work. Gender differences were found for all confounders, except for age. They were mostly in favour of men, which could reflect the general pattern in the labour market at large. Our results indicated there are substantial differences between non-working, irregularly working and working persons for several wellbeing aspects. Conclusions: This study analyses the contributions to wellbeing of work participation among working-age people with severe impairments, with a focus on gender differences. The analysis shows that work is an important determinant of the six measures of wellbeing examined, where the relationship between work participation and wellbeing is especially strong for peoples’ perceived standard of living. This major finding holds for both genders; however, the data show gender imbalance, in that compared with women, there was a larger percentage of men with severe impairments who have regular work. Future research should focus on finer distinctions between the types of work and the value added of personal assistants in the work context. Measures of general health not available for this study are needed to filter out a clearer picture of the interaction of work and well-being. Despite drawbacks, this study is nevertheless path-breaking in its focus on the value of work participation for the well-being of persons with severe impairments. For this reason, it provides a valuable extension of our knowledge and a clear point of departure for future studies.
Aims: This study investigated the association between literacy skills and self-reported health among Danish (n = 7284), Finnish (n = 5454), Norwegian (n = 4942) and Swedish (n = 4555) participants aged 16–65 years. Methods: Logistic regression models were used to assess the association between literacy skills and self-reported health after adjusting for sex, age and educational level. Results: Nordic participants aged 16–65 years with literacy skills at the lowest level reported sub-optimal health more often (28–37%) than those with literacy skills at the highest level (7–9%). After adjusting for sex, age and educational level, the likelihood of reporting sub-optimal health was 1.99–3.24 times as high for those with literacy skills at the lowest level as for those with literacy skills at the highest level. Conclusions: These results suggest that poor literacy skills increase the likelihood of experiencing poor health in the Nordic countries, even after controlling for educational level.
Aims: The present paper focuses on the measurement of health literacy (HL), which is an important determinant of health and health behaviours. HL starts to develop in childhood and adolescence; hence, there is a need for instruments to monitor HL among younger age groups. These instruments are still rare. The aim of the project reported here was, therefore, to develop a brief, multidimensional, theory-based instrument to measure subjective HL among school-aged children. Methods: The development of the instrument covered four phases: item generation based on a conceptual framework; a pilot study (n = 405); test–retest (n = 117); and construction of the instrument (n = 3853). All the samples were taken from Finnish 7th and 9th graders. Results: Initially, 65 items were generated, of which 32 items were selected for the pilot study. After item reduction, the instrument contained 16 items. The test–retest phase produced estimates of stability. In the final phase a 10-item instrument was constructed, referred to as Health Literacy for School-Aged Children (HLSAC). The instrument exhibited a high Cronbach alpha (0.93), and included two items from each of the five predetermined theoretical components (theoretical knowledge, practical knowledge, critical thinking, self-awareness, citizenship). Conclusions: The iterative and validity-driven development process made it possible to construct a brief multidimensional HLSAC instrument. Such instruments are suitable for large-scale studies, and for use with children and adolescents. Validation will require further testing for use in other countries.
Aims: To explore the confounding effects of early family factors shared by siblings and cardiovascular risk factors in midlife on the educational differences in mortality from cardiovascular disease (CVD). Methods: Data from national and regional health surveys in Norway (1974–2003) were linked with data from the Norwegian Family Based Life Course Study, the National Educational Registry and the Cause of Death Registry. The study population consisted of participants with at least one full sibling among the health survey participants (n=271,310). Data were available on CVD risk factors, including weight, height, blood pressure, total cholesterol and smoking. Results: The hazards ratio (HR) of CVD mortality was 3.44 (95% confidence interval (CI) 2.98–3.96) in the lowest educational group relative to the highest. The HRs were little altered in the within-sibship analyses. Adjusted for risk factors, the HR for CVD mortality in the cohort analyses was 2.05 (CI 1.77–2.37) in the lowest educational group relative to the highest. The respective HR in the within-sibship analyses was 2.46 (CI 1.48–2.24). Conclusions: Using a sibling design, we did not find that the association between education and CVD mortality was confounded by early life factors shared by siblings, but it was explained to a large extent by CVD risk factors. These results suggest that reducing levels of CVD risk factors could have the greatest effect on mortality in less well-educated people.
Aims: This study evaluated the influence of diabetes on the health-related quality of life (HRQoL) scores of adult patients with diabetes in northern Finland. Methods: A total of 3771 patients of the population of 10,264 patients aged >=15 years with the right for reimbursement of the cost of diabetes medication attended fundus photography screening for retinopathy in 2012. The 15D HRQoL scores and data on age, sex, type and duration of diabetes were gathered concurrently. The results were compared with the 15D scores reported in Finnish population studies. Results: The 15D score was obtained from 2461 patients aged 60±14 years; 20% had type 1 diabetes (T1D). The mean±SD 15D index was 0.930±0.079 in patients with T1D and their mean±SD age was 46±15 years. The mean±SD 15D index of the patients with type 2 diabetes (T2D) was 0.890±0.100 and their mean±SD age was 63±11 years. The 15D index was no lower than in the Finnish general population in either patient group or in any age group. However, the 15D score was negatively influenced by an increasing duration of diabetes in both patients with T1D and patients with T2D. No sex difference was found. Conclusions: The mean HRQoL score of patients with diabetes in this study is comparable with that of the general population of equal age. Neither the type of diabetes nor sex independently affected the HRQoL score, but a longer duration of diabetes seemed to impair the HRQoL score. Current diabetes care appears to maintain a normal HRQoL score in this diabetic population in Finland.
Aims: The aim of this study was to determine the associations between neck pain, concerns of falling and physical performance in older people. Methods: Cross-sectional study of 423 community-dwelling Danes aged 75 years and older. Measures consisted of self-reported neck pain, physical performance (Short Physical Performance Battery), self-reported psychological concerns related to falling (Falls Efficacy Scale International), depression (Major Depression Inventory), cognitive function (Mini Mental State Examination), self-reported low-back pain and self-reported history of falls. Associations between neck pain and fear of falling were determined using multivariable logistic regression modelling. Results: Bothersome neck pain that limits daily activities is significantly associated with concerns of falling (unadjusted odds ratio (OR) 3.29, 95% confidence interval (CI) 1.54–7.03) and impaired physical performance (unadjusted OR 2.26, 95% CI 1.09–4.69). However, these relationships became nonsignificant after adjusting for potential confounders. Bothersome neck pain and concerns of falling is attenuated by depression, and the relationship between bothersome neck pain and decreased physical performance is attenuated by concerns of falling, depression and previous history of falls. Conclusions: Bothersome neck pain in older people is associated with increased concerns of falling and decreased physical performance that are two known risk factors for falls in older people. However, these relationships are complicated by other variables, particularly depression.
Aim: The objective was to describe the exchange students’ health and sexual behaviour associated with their exchange studies, and examine the extent to which they had received preventive efforts against human immunodeficiency virus (HIV)/sexually transmitted infection (STI) and safer sex before departure. Methods: A cross-sectional study was conducted based on a web survey with questions about sexual behaviour, self-esteem and psychological well-being. Data were analysed using descriptive and analytical statistics. Results: A total of 136 outgoing exchange students from a Swedish University participated. Most of the exchange students rated their health as good, had psychological well-being and rated their self-esteem as being high. Approximately half of the exchange students had sex with a new partner during the exchange semester, and 87% of them had sexually risky behaviour. More than half (61%) of the exchange students had received preventive efforts before departure. No statistically significant difference regarding preventive information was found between those who reported sexually risky behaviour and those who did not. The group that had sexually risky behaviour desired free condoms and access to clinics for sexual health. Conclusions: Exchange students rated their health as good, and the majority of them participated in information sessions that addressed preventive efforts on HIV/STI and safer sex before departure. Sexually risky behaviour during exchange studies was reported and highlights the need for more effective preventive measures; for example, a recollection of reading STI information.
Aims: Unlike adults, abstaining has increased and regular use of alcohol has decreased among 12–16-year-olds over the past two decades. The paper studies whether these developments will be continued as the adolescent cohorts come of age. Methods: The Adolescent Health and Lifestyle Survey is a nationally representative monitoring system of the health habits of 12-, 14-, 16-, and 18-year-old Finns, conducted biannually between 1981 and 2013. The prevalence of alcohol use and drunkenness were measured for each 5-year cohort born in 1967–1995. Age-by-cohort trajectories and hierarchical age–period–cohort (APC) modeling were used to assess effects of age, period, and birth cohort. Results: Cohorts differentiate for underage drinking, but not at the age of 18. The younger cohorts postpone their drinking debut compared with older cohorts and thus age profiles are steeper than before. The most recent cohorts born in the 1990s, and the oldest cohorts born in 1967–71, have the highest prevalence in abstinence but drinking has been more prevalent for cohorts born in 1973–1989. APC modeling confirms significant cohort effects, but no significant decrease in drinking or drunkenness at the age of 18 years. Some of the changes can also be attributed to period effects. Conclusions: Despite the decrease in underage drinking in Finland, 18-year-olds continue to drink similarly from cohort to another. Postponing the onset of drinking has a preventive effect on alcohol-related harms, but a reduction in drinking among adult cohorts is not evident in the future.
Aims: The aim of this study was to investigate the prevalence and correlates of depression in new fathers. Methods: A population-based sample of 885 Swedish fathers and their partners completed a questionnaire, including the Edinburgh Postnatal Depression Scale at three months postpartum. Correlates of depressive symptoms were analysed with univariate and multiple variable regression models. Results: Symptoms of depression were found in 6.3% of the fathers and 12.0% of the mothers, and the point prevalence of major depression in fathers was 1.3%. The strongest correlates of depressive symptoms in fathers were problems in the partner relationship, a low educational level, previous depression, stressful life events and low partner support. The cross-sectional design could affect the magnitude of the results, and causal inferences cannot be made. Conclusions: Although the rate of depressive symptoms is lower in fathers than in mothers at three months postpartum, the associated factors are similar to those found in studies of mothers. The first visits at the child health centre could include a discussion with both parents about normal transition problems; balancing work, personal and family needs; and distress. When signs of distress or partner relationship difficulties are picked up, this should be followed up and support interventions offered.
Aims: Alcohol and illicit substance use among young adults carries the risk of adverse consequences like violence, injuries, risky sexual behaviour and, ultimately, the development of possible addiction. The nightlife arena is a high-risk setting for excessive substance use and the aims of this study were to examine prevalence rates and identify high-risk subgroups in this context. Methods: Patrons (n = 1099, response rate 76%) entering or exiting 12 popular licensed premises in downtown Oslo, Norway, completed an anonymous self-administered questionnaire and their blood alcohol concentration (BAC) levels were measured using a Breathalyzer. Results: The average BAC levels were similar (
Aims: We hypothesised that the expected increase in insulin resistance over three years’ time in individuals with impaired glucose tolerance (IGT) and/or impaired fasting glucose could be attenuated by an intervention with focus on physical activity in ordinary primary care. Methods: We conducted a randomised controlled trial with 96 participants over three years. Examination of the participants included anthropometric measures, blood pressure, body weight and height, blood samples, an oral glucose tolerance test, and questionnaires about diet and lifestyle. The study subjects were randomised to either an intense intervention with information, group sessions, referral to physical activity and a step-counter (n = 31), a less intense intervention without the group sessions (n = 35), or care as usual group (CAUG) (n = 30). Differences between the groups were analysed with general linear models adjusted for age, gender, baseline values and time in the intervention. Results: Individual insulin resistance increased in the CAUG. Due to having a similar effect, we combined the two intervention groups into a combined intervention group (CIG; n = 66) in the analyses. In individuals with IGT, the increase in the homeostatic model assessment-insulin resistance differed significantly between those in the CAUG and the CIG ( = 0.8; CI: 0.1–1.6; p = 0.034). Likewise, diastolic blood pressure decreased more in the CIG than in the CAUG ( = 5.1; CI: 0.1–10.0; p = 0.047). A total of 17 individuals developed Type 2 diabetes, 23% were in the CIG and 33% in the CAUG; so there was a 32% reduced risk in the intervention group. Conclusions: A lifestyle intervention focused on physical activity is feasible in ordinary primary care and prevents deterioration in insulin sensitivity in individuals with IGT over a three-year period.
Aims: To examine the associations between singing/playing musical instruments daily and various outcomes such as health-related quality of life and health behaviour. Methods: Data originates from the Danish Health and Morbidity Survey 2013. The survey was based on a random sample of 25,000 adult Danes (response rate: 57%). Besides standard health-related questions the survey included eight specific music questions, based on a review of the sparse literature on music and health. On the same basis, ‘daily musicking’ was defined as normally singing/playing musical instruments at least 1 h/day. Results: Both musically active men and women were more likely to report good self-rated health than individuals that were not active musically. However, the results also indicated that musically active women were less likely to report poor physical and mental health than women who were not active musically, while this pattern was not found among men. Conclusions: Gender seems to play an important role in the association between musicking and health, but more research is needed to understand these differences and the underlying mechanisms. In addition, longitudinal studies are warranted to examine the causal effects of musicking.
Aim: The aim of this study was to explore encounters with service professionals experienced in childhood and adolescence by children who grew up with parental alcohol abuse. We focused on their accounts from situations indicating children’s struggles or parental drinking problems. Methods: Semi-structured qualitative interview study was conducted with retrospective data from nine adults. Systematic text condensation was used to understand childhood experiences from encounters with professionals. Results: Participants believed that professionals rarely recognised their parents’ drinking problems. The children felt abandoned by professionals who must have noticed their struggles. Participants experienced that their appearance or behaviour was ignored and that they were not invited to talk. Professionals taking part in individual family members’ problems seemed to avoid subsequent involvement in underlying parental drinking. Even when problems were obvious, participants felt that professionals took no further action. Medical and social problems were managed within very confined perspectives. Conclusions: Specific commitment to confront cultural taboos is needed to attend to children’s unmet needs. Recognising each young person’s situation implies not only noticing that something is wrong, but also taking action. Children’s experiences of fragmented and confined approaches towards parental drinking problems may be counteracted by better collaboration between teachers, school nurses and GPs.
Aims: The aim was to assess all-cause and breast cancer mortality by income among women with incident breast cancer and the effect of cancer stage at diagnosis and comorbidity on the differences. Methods: The 43,439 women (age >=30) diagnosed with breast cancer in 1998–2008 in Finland were monitored using individual-level Cancer Registry data supplemented with data from Finnish health care registers and sociodemographic data. Results: Overall mortality was greater among breast cancer patients of the lowest income group than in the highest one; the hazard ratio (HR) for age and incidence year adjusted all-cause mortality was 1.9 (95% CI 1.8–2.1) and for breast cancer mortality 2.0 (95% CI 1.8–2.2). The women from the lowest income group were over-represented in the breast cancer stage ‘distant’ (10.1% vs. 3.5% among the highest income group). The presence of comorbidities was more common in patients with the lowest income (at least one comorbidity in 54%) than in the highest (24%). The HR adjusted with stage at presentation and comorbidities was 1.6 (95% CI 1.4–1.7) for all-cause mortality and 1.6 (95% CI 1.4–1.7) for breast cancer mortality. Conclusions: Tumour stage at diagnosis was more severe among lower income groups, and the presence of comorbidities was more common, although this only accounted for a part of the higher breast cancer mortality in these groups. More information is needed about recognition, diagnosis and treatment of breast cancer to examine whether the socioeconomic differences of breast cancer mortality are related to care.
Background: We investigated whether social adversities (parents’ receipt of income support and care placement) in adolescence were associated with the receipt of work disability pension (DP) in early adulthood. A further aim was to examine whether and to what extent individual educational attainment, labour market position and mental disorders during the period of transition to adulthood operate as underlying mechanisms in this relationship. Methods: This was a nationwide cohort study of a 60% representative sample of Finnish young adults born between 1983 and 1985 with no prior DP at entry to the study (N=116,788). Data from several nationwide registers were used with a follow-up time from 2004 to 2010. The age range of the cohort was 19–21 years at the beginning of the follow-up period. Hazards ratios (HRs) with 95% confidence intervals (CIs) were calculated using a Cox regression. Mediation analyses for educational attainment, labour market position and purchases of psychotropic drugs were performed. Results: A total of 1597 (1.37%) people were granted a DP during the follow-up period of 687,429 years at risk. After adjustment for mediators, the HR (95% CI) of DP for those whose parents had received income support was 1.36 (1.21–1.53) for men and 1.21 (1.07–1.36) for women. The corresponding figures for those with a history of care placement were 1.23 (1.00–1.51) and 1.58 (1.29–1.92), respectively. Conclusions: Social adversities in adolescence increase the risk of DP in early adulthood. The intergenerational social determination of disability could be addressed through interventions promoting mental health and improving educational and employment opportunities for young people.
Objective: The aim of the present study was threefold: (1) learn more about factors associated with teenage intimate partner violence (IPV) victimization; (2) explore aspects of digital media use in connection with teenage IPV; (3) and compare the impact IPV victimization has on boys and girls. Method: Survey data from 549 Norwegian students, mean age 15.2 years, who had experience(s) with being in intimate relationship(s), were examined. Experiences with psychological, physical, digital, and sexual violence were analyzed. Results: In total, 42.9% of the participants had experienced some form of IPV: 29.1% had experienced digital violence; 25.9% had experienced psychological violence; 18.8% had experienced sexual violence; and 12.8% had experienced physical violence. Factors significantly associated with teenage IPV victimization were female gender, older partners, domestic violence, bullying victimization, low academic achievements, and sending sexual messages via digital media. Girls reported to be significantly more negatively impacted by the victimization than boys. Conclusions: Some teenagers experience victimization in their intimate relationships, and for many digital media seems to play a central role in this violence. Teenagers who experience victimization outside their relationships or have risky lifestyles have a higher risk of experiencing IPV victimization. A focus on teenage IPV, and especially digital media’s role in this violence, is needed if this public health issue is to be combated.
Aims: The aim of this work was to study the diversity of tobacco use among Norwegian adolescent tobacco users and to investigate how different user groups compared with each other in terms of lifestyle and risk correlates. Swedish moist snuff (snus) use has increased dramatically in Norway over the last few years and is now more prevalent than smoking in younger age groups. Methods: The participants were 736 15-year-old tobacco users obtained from a large school-based cross-sectional survey (response rate 73%). Leisure time activity and risk behaviour factors were extracted by principal components analysis. Associations between tobacco use, leisure activities, risk behaviours, alcohol use and sex were studied bivariately and by logistic regression. Results: In total, 41.5% of the tobacco users were dual users (smokers and snus users). Problem behaviour and risk-taking lifestyles were associated with tobacco use frequency and high-frequency dual use, with a low risk profile for all types of occasional users (snus, cigarettes or dual users), a medium risk profile for all types of daily single-product users, including those who occasionally used the other product (i.e. dual users) and a high-risk profile for those who used both products daily (daily dual users). Conclusions: Fragmented use patterns in adolescence undermine the dichotomy often applied between smokers and snus users. For associations with lifestyle and risk correlates, use frequency and high-frequency dual use seem to be more important than the choice of product.
Aims: The aims of this study were to explore stakeholders’ expectations of municipal Healthy Life Centers (HLCs) in Norway, and to evaluate whether these expectations were compatible with current guidelines and recommendations. Methods: A multidisciplinary team of researchers arranged focus group sessions with Healthy Life Centre staff, municipality administration, county administration, general practitioners and representatives of three patient organizations. We audiotaped and transcribed the sessions verbatim. In analyses we used Systematic Text Condensation and an editing analysis style. Results: Expectations spanned from primary prevention among children to rehabilitation of adults with established disease, depending on the stakeholders’ assumptions of the role of HLCs. Healthcare providers emphasized person-centered advice based on the participant’s willingness to change, and their impressions of the participant’s presenting condition and life circumstances. Many participants represented underprivileged groups, not reached by population-based information strategies. Consistent with self-determination theory, participants who contacted the HLCs themselves more often expressed a will for lifestyle change than those referred from general practitioners, and less often dropped out. Participants with complex challenges and insufficient coping strategies often strived with follow-up. Among these, many suffered from mental health problems. Conclusions: The Norwegian HLC is still a concept in development and is trying to define its position in the public healthcare system. In accordance with national recommendations to reduce social health inequalities, the stakeholders emphasized providing effective, evidence-based HLC programs including underprivileged groups. They also expressed concern about prioritizing between an individual and population approach, and between different target groups and tasks.
Aims: The aim of this study was to investigate whether a workplace educational low back pain intervention had an effect on sick leave at the individual level and to identify possible predictors of the effect of intervention. Methods: Work units in two municipalities were cluster randomized to (a) educational meetings and peer support (45 units), (b) educational meetings, peer support and access to an outpatient clinic if needed (48 units) or (c) a control group (42 units). Both intervention groups attended educational meetings with information about back pain based on a non-injury model. A peer adviser was selected from among their colleagues. The outcome was days of sick leave at the individual level at 3, 6, 9 and 12 months, adjusting for previous sick leave at the unit level. As a result of similar effects on sick leave, the two intervention groups were merged (n=646) and compared with the control group (n=211). The predictors were different levels of belief in back pain myths, pain-related fear, helplessness/hopelessness and low back pain. Results: The intervention group had significantly less days of sick leave at the three month (4.9 days, p=0.001) and six month (4.4 days, p=0.016) follow ups compared with the control group. At three months, a low level of pain-related fear was the only predictor for the intervention effect (8.0 less days of sick leave, p<0.001). Conclusions: A workplace educational back pain intervention had an effect on sick leave for up to six months. A low score on pain-related fear was a predictor of the intervention effect.
Aims: We aimed to examine how newly diagnosed diabetes and work disability jointly predict death during working age. Methods: We used prospective population-based register data of 25–59-year-old adults who had lived in Sweden since 2002. All those with onset of diabetes recorded in 2006 were included (n=14266). A 2% random sample (n=78598) was drawn from the general population, comprising people with no indication of diabetes during 2003–2010. Net days of sickness absence and disability pension in 2005–2006 were examined; the follow-up time for mortality was 2007–2010. Cox regression models were fitted (hazard ratios, HR, 95% confidence interval, CI) adjusting for sociodemographics and time-dependent health conditions. Results: Individuals with diabetes and work disability for over 6 months were at a higher risk of premature death (HR=14.2, 95% CI 12.0–16.8) than their counterparts without diabetes and work disability. A high risk was also observed among people without diabetes but equally prolonged work disability (HR=6.4, 95% CI 5.4–7.6). Diabetes was associated with premature death even without work disability (HR=3.5, 95% CI 2.8–4.4). The associations were particularly attenuated after adjustment for health conditions assessed over the follow-up. Conclusions: Diabetes and work disability jointly increase the risk of death during working age. Diabetes with long-term work disability is associated with the highest risk of premature death, which highlights the importance of their prevention and early detection.
Aims: Studies have shown that gambling is associated with poor health and health risk-taking behaviour. However, little is known about those factors that can influence the association between gambling, health risk-taking and health. Using a population-based School Health Promotion Study of eighth- and ninth-grade Finnish boys and girls (N = 62,956), we investigated the relationships between gambling frequency, health risk-taking and poor health as well as whether social support from parents, friends and school staff could mediate these associations. Methods: Path analysis was used to discover direct and indirect effects of health, health risk-taking and gambling. Results: Social support from parents and school staff decreased gambling among boys and girls, whereas among boys support from friends increased gambling. However, the role of social support as a mediator was very weak. Overall poor health and health risk-taking were associated with increased gambling. Conclusions: Gambling should be considered an important public health issue because it clusters with other unhealthy behaviour patterns. Interventions concerning adolescent gambling should also take other simultaneous risk-taking into consideration. Also social support from parents and school should be noted when trying to decrease adolescents’ gambling.
Aims: Preterm birth is a major cause of perinatal mortality and morbidity and is strongly associated with socio-economic factors. The objective of this study was to examine the associations of maternal education, marital status and ethnicity with preterm birth and to determine the extent to which such associations can be explained by the established risk factors of maternal age, parity and smoking. Methods: This was a register-based cohort study with data from the Medical Birth Registry of Norway 1999–2009 and Statistics Norway. The sample included all singleton spontaneous births in Norway from 1999 to 2009 (n=494,073). The main outcome measure was preterm birth (gestational age <37 weeks). Results: Low maternal education and single motherhood were associated with preterm birth. After adjustment for the established risk factors, the excess risks were reduced, but remained statistically significant. The relative risk for low education was reduced from 1.50 to 1.36 and for single motherhood from 1.50 to 1.28. Women from Asia had a higher risk of preterm birth than Norwegian-born women (relative risk 1.29) with minor effects of adjustment. Conclusions: Several socio-economic risk factors are associated with preterm birth in Norway. In addition to the established risk factors, prenatal health care should focus on high-risk groups defined by maternal education, marital status and ethnicity.
Aim: The aim of the study was to investigate the incidence of human papillomavirus (HPV)-associated cancers in Denmark between 1978 and 2011, estimate the current absolute annual number (burden) of HPV-associated cancers (HPVaCa) and their precancerous lesions, and assess whether there is socioeconomic inequality in the risk of HPV-associated cancers. Methods: From four nationwide population-based registries, information was collected on HPVaCa diagnosed during 1978–2011 and age-standardised incidence rate for each site by calendar year and birth cohort was calculated. Furthermore, the current annual burden of HPVaCa and severe precancerous lesions was estimated. Incidence rate ratios and corresponding 95% confidence intervals for HPVaCa were calculated according to socioeconomic status. Results: The age-standardised incidence rate of HPV-associated cancers for the two sexes converged during the study period, and almost identical incidence rates were seen for women and men in the youngest birth cohorts. The current burden of HPV-associated lesions amounted to more than 5000 cases, the vast majority (85%) being severe precancerous lesions. The highest risk for HPV-associated cancers was associated with lower socioeconomic status. Conclusions: The burden of HPV-associated cancers among men will likely surpass that among women in the near future if the incidence trends continue. As many of these cancers and their precancerous lesions are associated with HPV type 16, a substantial proportion of cases are, in theory, preventable by the currently available vaccines.
Aims: The aims of this study were to test whether a multi-faceted intervention effective for low back pain was effective for physical capacity, work demands, maladaptive pain behaviours, work ability and sickness absence due to low back pain. Methods: A stepped wedge cluster randomised, controlled trial with 594 nurses’ aides was conducted. The intervention lasted 12 weeks and consisted of physical training (12 sessions), cognitive behavioural training (two sessions) and participatory ergonomics (five sessions). Occupational lifting, fear avoidance, physical exertion, muscle strength, support from management, work ability and sickness absence due to low back pain were measured every 3 months. Before and after the intervention we measured physical capacity, kinesiophobia and need for recovery. Linear mixed models adjusted for baseline values of the outcome were used to estimate the effect. Results: Significant reduction in occupational lifting (–0.35 (95% confidence interval –0.61 to –0.08)), and improvement in two measures of fear avoidance ((–0.75 (95% confidence interval –1.05 to –0.45) and –0.45 (95% confidence interval –0.80 to –0.11)) were found for the intervention group compared to the control. There were no significant effects on physical exertion, muscle strength, support from management, work ability or sickness absence due to low back pain. After the intervention, significant increased physical capacity and improvements in kinesiophobia were found, but no change in need for recovery. Conclusions: The intervention was significantly effective for physical work demands and maladaptive pain behaviours, but not for work ability and sickness absence due to low back pain. To improve work ability or reduce sickness absence due to low back pain more specific interventions should probably be developed.
Aim: The aim of this study was to analyse risk and binge drinking at 12-month follow-up in young women with risk drinking who received motivational interviewing compared with controls. Methods: Young women attending Swedish youth health centres were randomised into intervention or control groups. The intervention group members were asked about their alcohol consumption by a midwife/social worker using the Alcohol Use Disorders Identification Test Consumption. A score of >=5 was used as the cut-off value for risk drinking. Participants with risk drinking in the intervention group received motivational interviewing within the same visit. Participants in the control group had a regular visit with a midwife/social worker and answered the same questions about alcohol consumption in a questionnaire after their visit. A questionnaire with the same questions was administered to participants 12 months after baseline. Results: Of 1445 eligible young women, 1051 (73%) consented to randomisation and were enrolled in the study. The follow-up rate was 54%. There was a significant decrease in risk- and binge drinking, from baseline to follow-up, in both the intervention and the control groups. Generalised estimating equation analyses demonstrated no significant effect between groups. Of participants who did not have risk drinking at baseline, about 20% in both groups had developed high-risk drinking by the 12-month follow-up. Conclusions: No significant differences in risk drinking between young women who received motivational interviewing and controls were found. There was a large intra-individual mobility in young women’s risk drinking behaviour. This highlights the importance of finding reliable screening tools that can capture the mobility in drinking behaviour in youth. More research is needed before recommendations can be made.
Aim: The Global Burden of Disease (GBD) study continuously refines its estimates as new data and methods become available. In the latest iteration of the study, GBD 2013, changes were made related to the disease burden attributed to alcohol. The aim of this study was to briefly present these changes and to compare the disease burden attributed to alcohol in Swedish men and women in 2010 using previous and updated methods. Methods: In the GBD study, the contribution of alcohol to the burden of disease is estimated by theoretically assessing how much of the disease burden can be avoided by reducing the consumption of alcohol to zero. The updated methods mainly consider improved measurements of alcohol consumption, including less severe alcohol dependence, assigning the most severe injuries and removing the protective effect of drinking on cardiovascular diseases if combined with binge drinking. Results: The overall disease burden attributed to alcohol in 2010 increased by 14% when using the updated methods. Women accounted for this overall increase, mainly because the updated methods led to an overall higher alcohol consumption in women. By contrast, the overall burden decreased in men, one reason being the lower overall alcohol consumption with the new methods. In men, the inclusion of less severe alcohol dependence resulted in a large decrease in the alcohol attributed disease burden. This was, however, evened out to a great extent by the increase in cardiovascular disease and injuries. Conclusions: When using the updated GBD methods, the overall disease burden attributed to alcohol increased in women, but not in men.
To discuss the ethics dilemmas of the early detection of overweight and obesity.
Analysis of the ethical aspects of early detection.
The early detection of overweight and obesity entails a number of ethical dilemmas because it may both be helpful and harmful. It may help people to lead a healthier life and non-detection could be considered neglectful. It may, however, cause anxiety, interfere with people’s integrity, focus only on individual causes and responsibilities, cause stigmatization and have adverse effects by inducing weight gain.
Documentation of more positive than negative effects is required before early detection is introduced.
Aim: The aim of this study was to examine the screening accuracy of four brief alcohol screening instruments in a general hospital setting. Methods: Ten outpatient clinics were recruited to ensure a representative mix of demographics (e.g. sex, age and diagnosis). The staff at the reception desk handed out pre-sorted envelopes with questionnaires and information letters to the visitors. The questionnaires consisted of the 10-item Alcohol Use Disorders Identification Test (AUDIT), the Weekly Consumption Question (WCQ), the Heavy Episodic Drinking (HED) question and two questions on sex and age. Sensitivity and specificity were calculated for the AUDIT-C, AUDIT-3, WCQ and HED using the full 10-item AUDIT for comparison, with cut-off points of >=6 for women and >=8 for men. Results: In all, 898 questionnaires were included (52% women). According to the full AUDIT, 12.0% of the women and 14.8% of the men were drinking above the hazardous level. Corresponding percentages for the brief screening instruments for women and men, respectively, were as follows: AUDIT-C: 17.2% and 27.4%; the AUDIT-3: 6% and 16.2%; the WCQ: 2% and 1.6%; and the HED screener: 12.9% and 21.2%. Conclusions: The AUDIT-C may be used as a brief screener in a general hospital setting. The WCQ, as a stand-alone screening tool, may underestimate hazardous drinking habits. Screening results from the AUDIT-3 and the HED should be interpreted with caution when applied to women because of the risk of underestimation.
Aims: Like most European countries, Norway has refrained from mandatory food fortification with folic acid to reduce the number of neural tube defects. We explored the role of folic acid and multivitamin supplements in the prevention of neural tube defects among newborn infants. Methods: We used data from the Medical Birth Registry of Norway, 1999–2013. A total of 528,220 women had 880,568 pregnancies resulting in 896,674 live- and stillborn infants, of whom 270 had neural tube defects. Relative risks were estimated with log-binomial regression. Results: From 1999 to 2013, intake of folic acid supplements increased from 4.8% to 27.4%. Vitamin supplement use was more frequent in older, married or cohabiting women and those with lower parity, as well as women who did not smoke during pregnancy. The overall adjusted relative risk of infant neural tube defects associated with maternal vitamin intake before pregnancy relative to no intake was 0.76 (95% confidence interval: 0.53–1.10). When we divided our study period in two (1999–2005 and 2006–2013), we found a significantly reduced risk of neural tube defects overall by vitamin use in the second time period, but not in the first: adjusted relative risk 0.54 (95% confidence interval: 0.31–0.91) and 1.02 (95% confidence interval: 0.63–1.65), respectively. Conclusions: Over the full study period, we found no statistically significant association between vitamin use and neural tube defects overall. However, vitamin use was associated with a significantly lower risk of neural tube defects in the second half of the study period, 2006–2013.
Background:This study aimed to review Danish register-studies on seafarers’ and fishermen’s health and safety. Methods: Register-based or register-linked studies from 1970 until 2012 were identified and reviewed. Four categories of studies were included: mortality, hospitalization, specific diagnoses and conditions and accidents. Standardized risks estimates were typically calculated by comparison with the total Danish working population. Results: Elevated rates were found in all four categories. For mortality male seafarers had excess rates of accidents, cirrhosis of the liver, cancer, and suicides, and fishermen of accidents and cardiovascular disorders. Female seafarers in male-dominated occupations also had increased mortality rates. Elevated hospitalization rates for male seafarers were particularly prominent for endocrine/nutritional conditions, cervical discopathy, gastrointestinal and cardiovascular diseases, cancers, hearing impairment, and injuries, and for female seafarers cancers, circulatory and genitourinary diseases and injuries. Fishermen had increased hospitalization rates for cardiovascular diseases, bronchitis, emphysema, lung cancer, gonarthrosis, thoracolumbar discopathy, rotator cuff syndrome, carpal tunnel syndrome, injuries and hearing impairment. Specific diagnoses and conditions: There was an elevated risk of tuberculosis, hepatitis B and certain cancers for male seafarers, and of obesity and occupational accidents for both fishermen and seafarers. Conclusions: In spite of safety measures and significant structural changes in the Danish merchant and fishing fleet, the spectrum of health indicators continues to indicate considerable risk factors in the maritime environment and/or the lifestyle of seafarers and fishermen. Future monitoring of fishermen’s and seafarers’ health will remain essential for implementing appropriate preventive measures.
Background: This study aimed to explore the feasibility and effect of an intervention in clinical practice with isolated physical activity in individuals with IGT, recruited by the FINDRISC questionnaire. Methods: The questionnaire was sent to a population of 9734 individuals, 35–75 years old, in Sweden. Those with a risk score ≥15 were encouraged to perform an oral glucose tolerance test. Individuals with IGT were invited to participate in a randomized controlled trial with a focus on physical activity. The participants were allocated to one of three arms; basic intervention, intensive intervention or to care as usual. A total of 52 individuals were carefully examined and questionnaires about diet and lifestyle were completed at baseline and after one year. All analyses were adjusted for differences in age and sex, and calorie intake when relevant. Results :The prevalence of chronic diseases in the study population was high, creating considerable difficulties in conducting a standardized test for fitness. Waist circumference (p=0.020), sagittal diameter (p=0.035), body weight (p=0.038) and BMI (p=0.043) decreased significantly more in the intensive care group than in care as usual and the basic care group. However, the significance was abolished when differences in energy intake were accounted for. Conclusions: In an intention to treat, prospective lifestyle interventions with physical activity are feasible, but a high prevalence of comorbidities needs to be considered. Also, an intervention focused on isolated physical activity inevitably led to changes in diet with weight loss and significant improvement of essential risk factors in spite of the participants’ burden of chronic diseases.
The recognition of the serious health-damaging effects of tobacco smoke exposure has initiated several preventive programmes on the national and international levels worldwide. In the last decade, a considerable decrease in the prevalence of active smoking was observed in Denmark, changing the country from a poor to a favourable position in comparison to other EU countries. However, second-hand tobacco smoke exposure, especially in homes, still ranks Denmark among the problematic countries in Europe. This poorly recognised and studied discrepancy calls for further research and effective targeted interventions on population level.
Background: The aim of the study was to identify and characterize groups with poor mental health defined by the SF-12 Mental Component Summary (MCS-12) scale. Methods: The study is based on the Danish Health and Morbidity Survey 2005 and includes 10,082 participants (16 years or older). Data were analysed by means of logistic regression models. Results: Men and women with poor mental health are characterized by being single, having a long-term illness, not being able to rely on help from others in case of illness and by feeling that family and friends demand too much of them. Men with poor mental health were further characterized by being a heavy smoker, and having a BMI below 25. Women with poor mental health were further characterized by being 16–44 years old and sedentary in leisure time. Conclusions: The prevalence of poor mental health is higher among women than men, and different factors characterize men and women with poor mental health. The present findings support the notion that both socio-demographics and lifestyle factors are independently related with poor mental health. We suggest taking into account all these areas of life when planning activities to prevent poor mental health and when promoting mental health.
Background: Although Eastern Europe, including Estonia, has one of the highest morbidity and mortality rates associated with hypertension, there is little information in the literature concerning the biochemical risk factor profile or its association with hypertension in Estonia. This study examined the cross-sectional gender-stratified association between biochemical risk markers and hypertension in a population-based sample of adults in Estonia. Methods: The study was carried out in Tallinn, Estonia and consisted of 511 men and 600 women with a mean age of 46 years. Physiological measurements were taken and blood samples drawn to measure the following markers: cholesterol, high- and low-density lipoprotein cholesterol, apolipoproteins A-1 and B, lipoprotein(a), triglycerides, glucose, fibrinogen, high-sensitivity C-reactive protein and homocysteine. Results: Overall, 36% of participants had hypertension, with approximately 80% being aware of their condition. A total of 40% of participants reported taking antihypertensive medication. Multivariate binary logistic regression analysis showed that a decrease in high-density lipoprotein cholesterol and increases in age, body mass index, apolipoprotein B, triglyceride and homocysteine levels were associated with an increased probability of hypertension. Conclusions: Elevations in biochemical markers and cardiovascular risk factors are associated with hypertension. Increasing body mass index, triglyceride, apolipoprotein B and homocysteine levels with decreasing high-density lipoprotein cholesterol level should be investigated and monitored in Estonian adults.
Aims: Tobacco smoking is among the leading risk factors for chronic disease and early death in developed countries, including Denmark, where smoking causes 14% of the disease burden. In Denmark, many public health interventions, including smoking prevention, are undertaken by the municipalities, but models to estimate potential health effects of local interventions are lacking. The aim of the current study was to model the effects of decreased smoking prevalence in Copenhagen, Denmark. Methods: The DYNAMO-HIA model was applied to the population of Copenhagen, by using health survey data and data from Danish population registers. We modelled the effects of four intervention scenarios aimed at different target groups, compared to a reference scenario. The potential effects of each scenario were modelled until 2040. Results: A combined scenario affecting both initiation rates among youth, and cessation and re-initiation rates among adults, which reduced the smoking prevalence to 4% by 2025, would have large beneficial effects on incidence and prevalence of smoking-related diseases and mortality. Health benefits could also be obtained through interventions targeting only cessation or re-initiation rates, whereas an intervention targeting only initiation among youth had marginal effects on morbidity and mortality within the modelled time frame. Conclusions: By modifying the DYNAMO-HIA model, we were able to estimate the potential health effects of four interventions to reduce smoking prevalence in the population of Copenhagen. The effect of the interventions on future public health depended on population subgroup(s) targeted, duration of implementation and intervention reach.
Background: European city councils are increasingly developing interventions against health inequalities. There is little knowledge about how they are perceived. This study describes and analyses good practices and challenges for local interventions on inequalities in health through the narratives of European city managers. Methods: A qualitative study was conducted. Each participating city (Amsterdam, Barcelona, Cluj-Napoca, Helsinki, Lisbon, London, Madrid, Rotterdam) selected interventions following these criteria: at least 6 months of implementation; an evaluation performed or foreseen; the reduction of health inequalities among their objectives, and only one of the interventions selected could be based on health care. Managers of these local interventions were interviewed following an outline. Eleven individual in-depth interviews describing nine local interventions were obtained. A thematic content analysis was performed. Results: One or more local interventions against health inequalities were identified in each city. Most relied on quantitative data and were linked to national strategies. Few interventions addressed socio-economic determinants. Health care, employment and education were the main determinants addressed. With variable depth, evidence-base, participation and intersectorality were regular components of the interventions. Half of them targeted the city and half some deprived neighbourhoods. Few interventions had been evaluated. Scarcity of funding and sustainability of the projects were the main perceived barriers by the managers. Conclusions: City intervention managers were familiar with health inequalities and concepts as intersectorality, participation and evidence-based action, but others such as socioeconomic aims, gradient approach, evaluation and sustainability were not so widely applied. Managers’ capacities and political leadership in governance for health should be reinforced.
Aim: The population’s attitude towards smoking bans in public arenas is important for their passing, implementation and compliance. Smoking bans are believed to reduce the social acceptability of smoking, and once people experience them, public support increases – also among pre-ban sceptics. This study aimed to examine the temporal changes in public attitude towards smoking bans in public arenas from 2007 to 2010 and whether these changes differed across educational attainment, smoking status and intention to quit among smokers. Methods: Data from two surveys among adults (aged 25–79 years) in 2007 and 2010 in the Capital Region of Denmark (n=36,472/42,504, response rate = 52.3) was linked with data on sex, age and educational attainment from central registers. Age-standardised prevalence of supportive attitude towards smoking bans was estimated. Temporal changes in supportive attitude were explored in workplaces, restaurants and bars using logistic regression models. Results: The prevalence of supportive attitude towards smoking bans increased significantly in all arenas from 2007 to 2010. Positive temporal changes in supportive attitude towards smoking bans were seen across educational attainment, smoking status and intention to quit smoking in restaurants and across smoking status for smoking bans in workplaces and bars. Conclusions: The results of this study show that the public’s attitude towards smoking in public arenas has changed after the implementation of a comprehensive smoking ban. This change in attitude can support implementation of future legislation on smoking and may lead to positive changes in smoking norms.
Aims: The aim of this study is to follow-up on previous research indicating that the sex composition of workplaces is related to a number of health outcomes, including sickness absenteeism and mortality. We test two hypotheses. The first is Kanter’s theory of tokenism, which suggests that minority group members suffer from an increased risk of stress. Secondly, we test the hypothesis that workplaces with a higher proportion of men will have a higher incidence rate of ischaemic heart disease (IHD), as men are more likely to engage in negative health behaviours, and through peer effects this will result in a workplace culture that is detrimental to health over the long term. Methods: Large-scale, longitudinal Swedish administrative register data are used to study the risk of overnight hospitalization for IHD amongst 67,763 men over the period 1990 to 2001. Discrete-time survival analyses were estimated in the form of logistic regression models. Results: Men have an elevated risk of suffering from IHD in non-gender-balanced workplaces, but this association was only statistically significant in workplaces with 61–80% and 81–100% males. However, after adjusting for occupation no clear pattern of association could be discerned. No pattern of association was observed for women. Conclusions: This study suggests that the gender composition of workplaces is not strongly associated with the risk of suffering from IHD.
The aim of this study was to explore how functional ability, coping and health were related to work and benefit status three years after participating in a four-week inpatient interdisciplinary occupational rehabilitation program.
The cohort consisted of 338 individuals (75% females, mean age 51 years (SD=8.6)) who three years earlier had participated in a comprehensive inpatient interdisciplinary occupational rehabilitation program, due to long-term sick leave. The participants answered standardised questionnaires about subjective health complaints, functional ability, coping, and current work and benefit status. The relationships between these variables were analysed using logistic regression analyses.
At the time of the survey, 59% of the participants worked at least 50% of a full working day. Twenty-five percent received at least 50% disability pension and 16% received other benefits. Poor functional ability (OR 4.8; CI 3.0–7.6), poor general health (OR 3.8; CI 2.3–6.1), high level of subjective health complaints (OR 3.3; CI 2.1–5.2), low coping (OR 2.8; CI 1.7–4.4), poor physical fitness (OR 2.8; CI 1.7–4.6) and poor sleep quality (OR 2.4; CI 1.5–3.7) were associated with receiving allowances. In a fully adjusted model, only poor functional ability and low coping were associated with receiving allowances three years after occupational rehabilitation.
Functional ability and coping were the variables most strongly associated with not having returned to work. More attention should therefore be paid to enhance these factors in occupational rehabilitation programs. Part-time work may be a feasible way to integrate individuals with reduced workability in working life, if the alternative is complete absence from work.
Background: SOC is associated with wellbeing and health. The Lundby Study is a cohort study of an unselected population (n=3563) in whom mental health and personality traits have been assessed since 1947, with follow ups in 1957, 1972, and 1997. Aim: To describe the relationship of Antonovsky’s 29-item sense of coherence scale (SOC) and its three subscales (comprehensibility, manageability, and meaningfulness) to mental health and mortality in an unselected middle-aged and elderly community cohort, controlling for gender, age, marital status, and socioeconomic status. Another aim was to analyse the three-factor structure of the SOC. Methods: Of the 1797 surviving subjects in 1997, 1559 participated in a semistructured diagnostic interview, and 1164 subjects completed the SOC questionnaire. Psychiatrists performed diagnostic evaluations. Collateral information was obtained from case notes and registers. Dates of death from 1997–2011 were obtained from the cause of death register. Results: SOC scores showed no sex differences, but were positively correlated with age. SOC scores were higher in married relative to unmarried participants and in blue-collar workers and self-employed individuals relative to white-collar workers. Total SOC and subscale scores were negatively correlated with depressive, anxiety, organic, and psychotic disorders. Male gender was positively correlated with comprehensibility and female gender was positively correlated with manageability and meaningfulness. Higher comprehensibility scores were correlated with lower mortality. Conclusions: SOC scores increased with age, were higher for blue-collar workers, and were lower for individuals with psychiatric disorders. Higher comprehensibility scores were associated with lower mortality. However, there was only weak evidence for a three-factor structure.
Aims: Among children with separated parents, the arrangement of joint physical custody, i.e. children living equally much in both parents’ homes, has increased substantially during the last decades in Sweden. To date, empirical research on the living conditions of this group is limited. This study analyses family type differences in turning to parents for emotional support and in subjective health among adolescents. The focus of the study is adolescents in joint physical custody, who are compared with those living with two original parents in the same household; those living (only) in a single-parent household; and those living (only) in a reconstituted family. Methods: The data come from the Stockholm School Survey of 2004, a total population survey of students in grade 9 (15–16 years) in Stockholm (n=8,840). Ordinary least squares (OLS) regressions were conducted. Results: Turning to both parents about problems is most commonly reported by adolescents in intact families, followed by those in joint physical custody. Adolescents in non-traditional family types report worse subjective health than adolescents in intact families, but the difference is smaller for those in joint physical custody than for those living with a single parent. The slightly poorer health of adolescents in joint physical custody than those in intact families is not explained by their lower use of parents as a source of emotional support. Conclusions: The study suggests that joint physical custody is associated with a higher inclination to use parents as a source of emotional support and better subjective health than other post-divorce family types.
Aim: Psychosocial factors in the working environment have been shown to be associated with mobility limitations, but this has not yet been confirmed in a Danish population. We aimed to examine how psychosocial factors at work are related to developing mobility limitations in Denmark. Methods: This study is based on data from 2952 middle-aged men and women without mobility limitations in 2000. Results: We found increased risk of incident mobility limitations during 6-year follow up among men who often perceived high work pace (OR 5.45, 95% CI 1.21–24.52) vs. never, who only sometimes or/never perceived the work to be meaningful (OR 6.54, 95% CI 1.55–27.55) vs. always, and who sometimes perceived high emotional demands at work (OR 7.85, 95% CI 1.78–34.65) vs. never. Among women, lower risk of incident mobility limitations was observed among those who in 2000 perceived high work pace sometimes (OR 0.46, 95% CI 0.24–0.87) or often (OR 0.43, 95% CI 0.22–0.85) vs. never in 2000. Also, women who always or often experienced high emotional demands had an increased risk. Conclusions: The most important finding was that high work pace was strongly associated with increased risk of mobility limitations among men, but associated with lower risk of mobility limitations among women. This knowledge may be used to better target interventions among men and women in midlife from physical deterioration later in life.
Aims: The contribution of general psychological aspects, such as emotions, has received little focus in research on sickness absence. We wanted to study the relationship between shame and sickness absence, which factors that explained differences in levels of shame, and if shame predicted subsequent sickness absence. Methods: We employed a Swedish population-based cohort of current sickness absentees (19–64 years old), responding to a mailed questionnaire in 2008. Data was linked to national registries on sickness absence.Results: The young, those born outside the Nordic countries, those on lower incomes and those with higher level of education reported being more ashamed of their sickness absence. Those with more sickness absence in the past were also more likely to report higher levels of shame. Level of shame was not associated with gender or occupational class. Compared to those absent for a somatic cause, mental or co-morbid illness was associated with higher levels of shame. Those reporting high level of shame were more likely to have prolonged sickness absence the following year. Symptoms of depression at baseline only partly explained these associations. Conclusions: Our results suggest that shame might prolong sickness absence. Increased understanding of the impact of social and emotional aspects around sickness absence could be an important source for improved quality of rehabilitation.
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.
Aim: The aim of the study was to evaluate the association of death within 8–30 days after discharge home from the emergency department with a non-causative diagnosis in a prospective cohort study. Methods: The 227,097 visits to the emergency department were filed by personal identification number and included information on gender, age, admission, discharge, and diagnosis. The visits were classified by main diagnosis at discharge into those with non-causative diagnosis and those with other diagnoses. Mortality per 100,000 within 8, 15 and 30 days and the corresponding hazard ratio (HR) and 95% confidence intervals (CI) were calculated for all causes of death and for selected causes of death in a time-dependent analysis. Results: The HRs of all causes of death for patients with a non-causative diagnosis were 0.64 (95% CI 0.41–1.01) within 8 days, 0.70 (95% CI 0.50–0.99) within 15 days, and 0.82 (95% CI 0.65–1.04) within 30 days as compared to those with a causative diagnosis. The HRs within 30 days among those with a non-causative diagnosis at discharge were 1.48 (95% CI 1.03–2.13) for malignant neoplasm, 3.72 (95% CI 1.44–9.60) for suicide, and 0.50 (95% CI 0.32–0.79) for diseases of the circulatory system. Conclusion: Death within 8 days after discharge home from the ED is a rare event. Death of patients that occur shortly after discharge who had received a non-causative diagnosis as the main diagnosis may indicate a misjudgement of the patients’ condition at that time.
Aims: Incidence rates of cutaneous melanoma (CM) in light skinned people in Norway are among the highest in the world. Sunbed use has increased in Norway since 1980. We will try to elucidate whether there is any correlation between the increase in sunbed use and the CM incidence rates, whether the increase in CM risk is similar for all age groups, and whether the possible difference between young and old persons can inform future healthcare strategies. Methods: The frequency of sunbed use by different age groups in the time period 1980–2011 and incidence rates (1980–2009) of CM at different age groups in Norway were studied. Time in minutes per day spent in front of screen of computers or TVs for boys and girls was also analysed. Results: The number of sunbed sessions per year in Norway increased throughout the entire period. The number of men and women diagnosed with CM per year, all ages combined, also increased. Sunbed use increased at a similar rate for three age groups (0–19, 20–50, and >50 years old), while the age-adjusted CM incidence rate increased only for the oldest group. Time spent in front of the screen of computers or TVs increased from 1985 to 2005 and is still increasing. Conclusions: CM incidence is decreasing while sunbed use is increasing in younger age groups. The present data indicate that more work needs to be done before one can know whether the overall health effects of sunbed exposure are positive or negative.
Background: Large portion sizes have been associated with large energy intake, which can contribute to the development of overweight and obesity. Portion sizes of non-home cooked food have increased in the past 20 years, however, less is known about portion sizes of home-cooked food. Aim: The aim of the study was to assess if the portion sizes measured in calories in Danish cookbook recipes have changed throughout the past 100 years. Methods: Portion size measured in calories was determined by content-analysis of 21 classic Danish recipes in 13 editions of the famous Danish cookbook "Food" from 1909 to 2009. Calorie content of the recipes was determined in standard nutritional software, and the changes in calories were examined by simple linear regression analyses. Results: Mean portion size in calories increased significantly by 21% (β = 0.63; p < 0.01) over the past 100 years in the analyzed recipes. The mean portion size in calories from a composed homemade meal increased by 77% (β = 2.88; p < 0.01). The mean portion size in calories from meat increased by 27% (β = 0.85; p = 0.03), starchy products increased by 148% (β = 1.28; p < 0.01), vegetables increased by 37% (β = 0.21; p = 0.13) and sauce increased by 47% (β = 0.56; p = 0.02) throughout the years. Conclusions: Portion sizes measured in calories in classical Danish recipes have increased significantly in the past 100 years and can be an important factor in increased energy intake and the risk of developing overweight and obesity.
Background: The safety and pattern of use of a medicinal product cannot be fully studied prior to its marketing. In Denmark, the Danish Health and Medicines Authority (DHMA) monitors marketed drugs. An available source is the Register of Medicinal Product Statistics (RMPS), which can possibly be used for these purposes. Objective: To investigate utilisation and potential safety issues of relatively new antidepressants containing the active ingredient duloxetine (Cymbalta® and Xeristar®) by using dispensing data available in the RMPS. Methods: A retrospective study using dispensing data was designed to estimate the size and composition of the user population and patterns of use of the antidepressants Cymbalta® and Xeristar® (active ingredient: duloxetine) in the period from 1 January 2005 to 31 December 2010. Data were retrieved from Epikur, a register subset of the RMPS. Results: Both women and men in different age groups used duloxetine for depression. Some users switched to another antidepressant. Prescription of the drug for persons below the age of 18 years revealed a potential safety issue. Concomitant treatment with Cymbalta® or Xeristar® and fluvoxamine, isocarboxazid, Yentreve®, or ciprofloxacin also revealed potential safety issues. Conclusions: The present study indicated that the RMPS is applicable in monitoring the pattern of use and potential safety issues related to duloxetine when it is prescribed for depression. Switching to other antidepressants could reflect some potential safety issues. Use of duloxetine for persons below the age of 18 years and its concomitant use with contraindicated drugs also indicated potential safety issues.
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, perceptions of risk are largely formed by media communication which may influence the public’s response. Aim: The study aimed to compare the differences in how the media framed the 2009 H1N1 pandemic message and the associated public perceptions of risk as expressed through the uptake of vaccinations in Australia and Sweden. Methods: A qualitative content analysis was conducted on 81 articles from the Australian and Swedish print media: 45 and 36, respectively. Results: The risk of H1N1 was communicated similarly in Australia and Sweden. However, major differences were found in how the Australian and Swedish media framed the pandemic in terms of responsibility, self-efficacy, and uncertainty. In Australia, responsibility was predominantly reported negatively, blaming various organisations for a lack of information, compared to Sweden where responsibility was placed on the community to help protect public health. Furthermore, there was limited self-efficacy measures reported in the Australian media compared to Sweden and Sweden’s media was more transparent about the uncertainties of the pandemic. Conclusions: This study affirms the association between the framing of health messages in the media and the public’s perception of risk and related behaviour. Governments need to actively incorporate the media into pandemic communication planning.
Aims: Insomnia is a large health problem. In some prior studies, positive associations between insomnia symptoms and sickness absence have been observed. There is, however, no previous nationwide cohort study of clinically diagnosed insomnia and risk of incident sickness absence. Methods: Prospective nationwide cohort study based on Swedish population-based registers including all 4,956,358 individuals registered as living in Sweden on 31 December 2004/2005, aged 17–64 years, not on disability pension, old-age pension or on-going sickness absence. Those having insomnia inpatient or outpatient care, defined as having at least one admission/specialist visit with a main or secondary diagnosis of disorders of initiating and maintaining sleep [insomnias] (ICD-10: G47.0) during 2000/2001–2005, were compared to those with no such care. All-cause and diagnosis-specific incident sickness absence were followed during 2006–2010. Incidence rate ratios (IRRs) and 95% confidence intervals (CIs) were estimated by Cox proportional hazards regression. Results: In models adjusted for prior sickness absence, socio-demographic factors and inpatient and specialized outpatient care, associations between insomnia and increased risks of all-cause sickness absence (IRR 1.18, 95% CI 1.04–1.35) and sickness absence due to mental diagnoses (IRR 1.75, 95% CI 1.36–2.25) were observed. After further adjustment for insomnia medications these associations disappeared. No associations between insomnia and risk of sickness absence due to cancer, circulatory or musculoskeletal diagnoses, or injuries, were observed. Conclusions: In this nationwide cohort study, we observed increased risks of all-cause sickness absence and sickness absence due to mental diagnoses after adjustment for several potential confounders that disappeared after further adjustment for insomnia medications.
Aim: The purpose was to explore the possible associations between measured hearing thresholds and work related disability pension granted for other medical reasons in a Norwegian population. Method: This study included 25,537 persons from the Nord-Trøndelag Health Study (HUNT) aged 20–54 years at baseline in HUNT1 (1984–1986) who also participated in the follow-up study 11 years later, HUNT2 (1995–1997) that included a hearing examination. Logistic regression analyses of disability pension granted up to 1996 or earlier in life were conducted for men and women separately and in two age strata. Effects of low, middle and high-frequency hearing thresholds were explored, adjusting the effects of each hearing frequency for each other. Further adjustment was made for educational level, category of work (seven categories) and general health in HUNT1. Results: In all, 0.4% (16 of 4306) of the disability pensions granted up to 1996 was due to hearing related diagnoses. The risk of being granted disability pension up to 1996 with registered diagnoses not related to hearing loss increased with degree of loss of low-frequency hearing in young and middle-aged men and middle-aged women (OR 1.72, 95% CI 1.25–2.37; OR 1.16, 95% CI 1.04–1.30; OR 1.11, 95% CI 1.00–1.23). Conclusions: Hearing loss diagnoses are rarely reported as main causes in disability statistics, however, degree of hearing loss increased the risk of being granted with disability pensioning with diagnoses not related to hearing loss.
Aims: Musculoskeletal pain is a major health problem, especially in women, and is partially determined by psychosocial factors. The aim of the present study was to investigate whether gender inequality in the couple relationship was related to musculoskeletal pain. Methods: Participants (n=721; 364 women and 357 men) were all individuals living in a couple relationship in the Northern Swedish Cohort, a 26-year Swedish cohort study. Self-administered questionnaire data at age 42 years comprised perceived gender inequality in the couple relationship and musculoskeletal pain (in three locations, summarised into one score and median-split), concurrent demographic factors, psychological distress, and previous musculoskeletal pain at age 30 years. Associations were examined using logistic regression. Results: Gender inequality was positively associated with symptoms of musculoskeletal pain in the total sample, remaining significant after addition of possible confounders and of previous musculoskeletal pain. Separate adjustment for concurrent psychological distress attenuated the association but not below significance. The association was present and of comparable strength in both women and men. Conclusions: Gender inequality in the couple relationship might contribute to the experience of musculoskeletal pain in both women and men. The results highlight the potential adverse bodily consequences of living in unequal relationships.
Aims: A pro-active approach that incorporates the effective use of scientific evidence and data is a major goal in public health work. This study aimed to identify local and regional strengths and barriers to identify, translate, and use relevant evidence of "what works" in public health management. Methods: Focus group discussions were performed among 22 researchers, public health leaders and/or leaders with organisational and policy responsibilities in two municipalities, one county, and a university research centre. Results: Access to the population’s health data is insufficient for taking action. The focus group discussions clarified a need for a skills programme that specifically focuses on analysis and process expertise. Moreover, communication and collaboration among key stakeholders involved in evidence-based practices like research, policy, and practice should be enhanced in order to facilitate evidence-based policy making. Conclusions: The complex relationship between context and behaviour and the necessity of influencing systems and structures as well as individuals to promote change underlines the need for a clear national initiative to facilitate knowledge exchanges among practitioners, policy makers, and researchers.
Aim:To develop a set of assessment criteria and assess public health interventions at municipal level in Denmark using the European Community Health Promotion Indicator Development (EUHPID) model to support more effective planning and funding allocation in public health. Methods: Based on knowledge synthesis, a set of assessment criteria were developed to classify interventions into the four types of public health provided by the EUHPID model: health promotion, health protection, disease prevention, and health care. Information was then collected on all current public health interventions in Varde Municipality within a 3-month period in spring 2009. Finally, the interventions were categorised using the developed assessment criteria. Results: The knowledge synthesis process resulted in the development of a set of assessment criteria and the 154 reported public health interventions were divided into relevant types using these criteria. 57% of the interventions were based on a salutogenic health promotion approach, 33% on a pathogenic disease prevention approach, 10% on the pathogenic health protection approach, and 0% on the pathogenic health care approach. Conclusions: The assessment criteria based on the EUHPID model can be useful and have wider global significance for planning public health interventions, allocating appropriate funding to support public health interventions, and thereby encouraging and supporting more effective intersectoral working practices.
Background: Sweden has shown a decreasing tendency in the incidence of myocardial infarction (MI), except among middle-aged women. The incidence among middle-aged immigrant women is less explored. Aim: To determine if foreign-born women have a higher risk of MI as compared to women born in Sweden. Furthermore, to examine if physical activity (PA) modifies the risk of MI regardless of immigration status and smoking habits. Methods: The Malmö Diet and Cancer Study was used for analyses. A total of 16,776 women aged 45–73 years participated. The mean follow-up time was 13.8±4 years. Results: Mean age was 57.4±7.9 years. No difference was found in incidence of MI between Swedish and immigrant women (p=0.72). For current smokers among Swedish women, the relative risk (RR) with no/low PA was 2.93 (95% CI 2.07–4.14) and with moderate/high PA, the RR was 2.21 (95% CI 1.61–3.03) with no/low PA-never smoker as the reference group. Among immigrant smoking women, the RR with no/low PA was 4.56 (95% CI 1.62–12.8) and with moderate/high PA, the RR was 3.27 (95% CI 1.21–8.84) with no/low PA-never smoker as the reference group. Conclusions: PA reduces the risk of MI in non-smokers as well as in smokers, regardless of immigration status. Furthermore, PA was even more beneficial for women born outside Sweden. Against this background, immigrant women ought to get special consideration and attention from both caregivers and public health workers.
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, a random sample of persons aged 16–85 was drawn from the Swedish national register and yielded a 59% participation rate. The number of respondents analysed was 2130. A multiple logistic regression model was used to investigate the connection between the explanatory variables institutional trust and generalised trust and the outcome variable immunisation intent. The analyses included sex, age, education, self-rated health, and personal and societal concern about the 2009 A(H1N1) pandemic. Results: For institutional trust in health care, the odds ratios for intention to vaccinate against the A(H1N1) pandemic were significantly higher in the Medium trust and High trust categories as compared to the Low trust reference category. For generalised trust, the odds ratio for vaccination intention was significantly higher in the High trust category as compared to the Low trust reference category. Conclusions: 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. The effect holds also when controlling for plausible confounders, such as education, self-rated health, and personal and societal concern about the 2009 A(H1N1) pandemic.
Aims: Adverse social circumstances during one’s life course have been related to an increased risk of mortality. This article extends the literature by focusing on adversity at each phase of, and cumulatively at midlife in the Swedish population. Methods: Data on socioeconomic indicators from 1970, 1980 and 1990 were linked to death registrations from 2000 to 2009. Relative indices of inequalities were computed for socioeconomic indicators, in order to measure the cumulative impact of inequality on mortality. Results: A significant cumulative effect of being in the worst-off socioeconomic groups was found. For men, almost all indicators had a significant independent impact on risk of death. Among women, significant independent impacts were found for education in 1990 and for socioeconomic index in the 2 census years of 1970 and 1980. Conclusions: Being disadvantaged during a longer period in midlife has a significant negative impact on health. Policies targeted to reduce health inequality should focus on every stage of the midlife course.
Aims: Tobacco-smoking behaviours of young people between the age of 18 and 25 years are less understood than those of middle-aged people. The aim of this study is to contribute to improved knowledge of some of the factors that are associated with smoking and cessation among young people. Methods: We use the most recently available public health survey data from the southern region of Skåne in Sweden to analyze these factors. The survey is a cross-sectional study with a total sample size of 28,198 individuals with 2801 in the age category of interest. We apply statistical measures of association between smoking and gender and also model the relationship between smoking and smoking cessation and the role of a set of sociodemographic determinants by means of logistic regression to estimate odds ratios. Results: The findings include significant differences between the younger age group and the older group with respect to the odds of smoking and method of cessation. We also find differences between young women and men with regard to smoking prevalence, intensity and cessation methods. In particular, young women attempt to quit smoking by means of unassisted methods to a significantly higher extent than do young men. Conclusions: There are significant differences between young people and older individuals with respect to a range of smoking behaviours. There are also strong gender effects within the group of young people. Policy development and anti-smoking interventions need to take such differences into consideration for improved effectiveness.
Aim: To study the sociodemographic characteristics and attitudes associated with buying sex among Finnish men residing in different areas of Finland. Methods: A population-based questionnaire survey among 18–74-year-old Finns in 1999 with a response rate among men of 38%. The data on 575 men were analysed with descriptive statistics and logistic regression. Results: The overall proportion of men ever having bought sex was 14%. Men who at the time of the survey were in the age group 30–39, aged 50 or over, with 13–15 years of educational study, entrepreneurs, and with high income, were more likely to have ever bought sex. Being married and living with a partner at the time of the study lowered the odds of ever having bought sex. The differences between the groups were mostly the same in all residential areas, though the strength and statistical significance varied. The exception was the association with education, which occurred only in small towns. The effect of attitudes to buying sex was strong and did not differ by area of residence. Conclusions: Many men with different sociodemographic characteristics reported having bought sex. There was no noticeable variation in the sociodemographic characteristics and attitudes of men having bought sex by the area of residence. More current research is needed on the motives and health consciousness of men buying sex.
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 expenditure of 40.12 METs per day. In 2010, duration of sleep was unaltered (p = 0.1), sedentary leisure time and sedentary work time had increased by 12.6 minutes (p < 0.0001) and 13.2 minutes (p < 0.0001) per day, respectively. Time spent on MVPA had increased by 2.9 minutes per day (p < 0.0001). The 24-hour energy expenditure had decreased by 0.41 METs (p < 0.0001). Conclusions: 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. As duration of sleep is unaltered findings suggest that low intensity physical activity may be displaced in everyday life.
Background: As dispersed ethnic populations in Swedish society expand, the healthcare system need to adapt rehabilitation services according to their needs. The experiences of trauma and forced resettlement have a continuing impact on health and musculoskeletal pain, as well as the intersecting structures that prerequisite the possibilities in the new country. To understand the specific needs of women from the Iraqi diaspora in Sweden, there is a need to elucidate the effects of pain on their everyday life. Aims: To elucidate everyday life with chronic pain from the perspective of women from the Iraqi diaspora in Sweden. Methods: Qualitative interview study according to Glaser’s grounded theory. Results: The results from 11 interviews suggest that pain was associated with dependency on society as well as on family. It resulted in a struggle for sense of control, framed by faith in God, influenced by the healthcare system, and with support from family. The women’s testimony of lack of continuity of care, resulting in recollection of lived traumas in every visit, is a vital sign of the unconscious power relations within health care and how representatives from health care, instead of being the ones who help the women forward, become the ones who hold them back.Conclusions: The results show the importance of challenging the normative assumptions embedded in health care and treatment for patients with chronic pain and of including the voice of "others".
Aims: The need to combine active employment and parenthood is a reality for many parents today. Knowing more about which work place factors are associated with better or worse health could help employers to form a work environment that provides optimal conditions to maintain or increase health and work engagement in this group. The aim of this study was to explore possible associations between different subjective and objective work factors and benefits, and a range of outcome variables such as stress, symptom report, wellbeing, work-related fatigue, work engagement, and work–family conflict among working mothers and fathers with small children. Methods: Cross-sectional analyses of associations between work place factors categorised into three different dimensions; flexibility, benefits, and attitude and the outcome measures were performed, including questionnaire responses from 1562 working parents. Results: The results showed that work place factors related to flexibility and, especially among women, attitude to parenthood appear to have the strongest effect on working parents’ subjective stress and wellbeing, while benefits appear to have less impact. Except regarding factors related to attitudes at the work place, most associations were similar among men and women. Conclusions: Most likely, different factors are better suited or more important for some individuals than others depending on their total work, as well as family situation and also depending on individual factors such as personality and priorities. A positive attitude towards parenthood and a flexible work situation seem, however, beneficial for the general wellbeing and work engagement among working parents.
Aim: Poor health-related quality of life (HRQoL) is associated with increased use of healthcare services, but it remains unclear which individuals have a heightened risk in the general population. Methods: A Swedish population-based cross-sectional survey was conducted in 2008. Predefined risk characteristics including sex, age, educational level, marital status, body mass index, diseases, physical activity, and tobacco smoking were collected by a self-report questionnaire. Five aspects of the EORTC QLQ-C30 were used to assess HRQoL: physical, role, emotional, social, and cognitive function. Participants were defined as having "poor HRQoL" if they scored ≥10 points (scale 0–100) lower than the mean score of the total sample. To assess the characteristics of individuals with poor HRQoL, classification and regression tree (CART) analysis was performed. Results: A total of 4910 (70.5% participation rate) randomly selected individuals participated in the study. The CART analysis showed that for each of the five functional aspects of HRQoL, the most important covariate HRQoL was the number of reported diseases, while the second strongest covariate was physical inactivity. Conclusion: This large population-based study indicates that a higher number of diseases and physical inactivity are the most important covariates of poor HRQoL in the Swedish general population.
Aims: Sickness absence is of considerable concern in both Norway and Denmark. Labour Force Surveys indicate that absence in Norway is about twice that in Denmark and twice that of the mean reported by the Organisation for Economic Co-operation and Development. This study compares absence patterns according to age, percentage of employment, and occupation between municipal employees in the health and care sectors in two municipalities in Norway and Denmark. Methods: Data recorded in the personnel registers of the municipalities of Kristiansand, Norway and Aarhus, Denmark were extracted for the years 2004 and 2008, revealing 3498 and 7751 employee-years, respectively. We calculated absence rates together with number of sick leave episodes, and their association with the above-mentioned covariates. Gender-specific comparative descriptive statistics and negative binomial regression analysis were performed. Results: The sickness absence rate in women was 11.3% in Norway (95% confidence interval [CI] 11.2–11.4) and 7.0% in Denmark (95% CI 7.0–7.1) whereas mean number of sick leave episodes among women was 2.4 in Denmark, compared to 2.3 in Norway (p = 0.02). Young employees in Denmark had more sick leave episodes than in Norway. Proportion of absentees was higher in Denmark compared to Norway (p < 0.0001). Conclusions: The finding of that more employees in Denmark have more frequent, but shorter sick leave episodes compared to Norway, for whatever reasons, may indicate that more frequent sick leaves episodes prevent higher sick leaves rates.
Aims: Understanding the determinants of social and coping inequalities in subclinical cardiovascular disease is an important prerequisite in developing and implementing preventive strategies. The aim of this study was to investigate the association between social factors and coping status, respectively, and subclinical coronary artery disease (CAD) in middle-aged Danes. Methods: This is a DanRisk screening substudy, thus including healthy Danish males and females aged 50 or 60 years. Social measures included grade of education, employment and co-habiting status. The coping status was estimated by the general self-efficacy (GES) scale. Coronary artery calcification (CAC) was assessed by computed tomography using the Agatston score (AS). Conventional clinical risk factors included sex, family history of CAD, BMI > 25, smoking, hypercholesterolaemia and hypertension. Results: In 568 individuals the prevalence of subjects with CAC was 267 (45%). Independent predictors of CAC in males were age (OR = 1.10, 95% CI = 1.04–1.16, p < 0.001), smoking (OR = 1.75, 95% CI = 1.03–2.99, p = 0.038), and low co-habiting status (OR = 3.66, 95% CI = 1.19–11.25, p = 0.023). Independent predictors in females were age (OR = 1.67, 95% CI = 1.02–1.12, p = 0.006), and smoking (OR = 1.71, 95% CI = 1.06–2.78, p = 0.029). Higher AS was associated to lower employment level in females (p = 0.001) but not in males (p = 0.833). Conclusions: Social factors are associated to the prevalence and severity of CAC in asymptomatic middle-aged individuals with gender differences. The relative value of gender specific social versus conventional clinical risk factors in the risk assessment of subclinical CAC in middle-aged individuals needs further investigation in future prospective studies.
Background: The economic effects of waterborne outbreaks have rarely been reported. A large waterborne outbreak occurred in the town of Nokia in Finland in 2007 with half of the population in the contaminated area suffering from gastroenteritis. We studied the healthcare costs of this outbreak. Methods: Healthcare costs were studied using register data from the Nokia Health Care Centre, data collected in the regional university hospital, and data from laboratory register on stool samples. Results: Total excess healthcare costs were EUR 354,496, which is approximately EUR 10 per resident of Nokia. There were 2052 excess visits because of gastroenteritis in Nokia Health Care Centre, 403 excess episodes in the university hospital, and altogether over 2000 excess stool samples due to the outbreak. Care in the Nokia Health Care Centre accounted for 44% and care in the university hospital for 42% of the excess healthcare costs while stool samples accounted for only 10%. Conclusions: Despite the high morbidity, the total cost was low because most patients had a relatively mild illness. The situation would have been worse if the microbes involved had been more hazardous or if the financial situation of the community had been worse. Prevention of waterborne outbreaks is important, as there is a risk of severe short- and long-term health effects and substantial health-economic costs.
Background: A growing body of literature demonstrates internet-based smoking cessation interventions as a promising aid in helping people quit smoking. However, the underlying mechanisms of how these interventions influence the cessation process are still relatively unknown. Several studies have indicated blogging as a potential source in providing social support to users of internet-based smoking cessation interventions and thereby enhance their change of succeeding in quitting. Objective: The study aimed to investigate themes discussed on a blog in an internet-based smoking cessation intervention. In addition, we examined if blogging could provide social support for people in a smoking cessation process. Method: The study was based on messages posted from 1 January 2012 to 29 February 2012 on the blog of the internet-based smoking cessation programme DDSP, operated by the Danish Cancer Society. Messages were coded according to themes using Grounded Theory, and additionally data about bloggers were analyzed. Result: In total, 1663 messages were posted within the 2-month period, and we identified 16 themes. The majority of messages contained personal stories or experiences (53%), provided emotional support (34%) or congratulated other users (17%). The messages were found capable of supplying social support to members on the blog. In addition, we found that only a minority of users who viewed the blog participated actively in posting messages, and only a minority was highly active bloggers. Conclusions: The blog offers a unique platform for informal conversations about quitting smoking and is important in providing social support to people in a smoking cessation process.
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), p ≤ 0.001). In addition, having lunch, dinner and supper regularly were associated with decreased odds of mathematical difficulties. Further, a high intake of foods representing a poor diet (sugar-sweetened soft drinks, sweets, chocolate, savory snacks, pizza and hot dogs) was significantly associated with increased odds of mathematical difficulties. Conclusions: 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. The results of this study support the need for a larger study with a more representative sample.
Purpose: To describe sexual health risks in an understudied group, youth in detention, and compare these to sexual health risks among non-detained youth. In addition, variables predicting adverse sexual health outcomes are sought and compared. Methods: In 2009, a self-administered questionnaire on sexuality was conducted amongst youth in Sweden. In 2010, the same Internet-based questionnaire was applied in a study at Swedish detention centres. In this article, sexually active youth aged 15–20 years in the two groups are compared and bivariate logistic regression analyses are conducted in order to find predictors of adverse sexual health outcomes, among detainees and non-detainees respectively. Results: Major differences between the detained and the non-detained concerning a majority of risk-taking variables exist. Conclusions: Although detained youth display several risky sexual behaviors, no specific risk factors are found in a logistic regression analysis. However, this is a vulnerable group. The mere fact that an adolescent is placed at a detention centre should be an imperative for professionals to address the subject of sexual health and safer sex. Furthermore, the results will be used in a forthcoming sex education curriculum tailored especially at detained youth. This is one, but by far not the only way to minimize the health inequalities that are presented in this study.
Background and aim: Earlier research has suggested that local communities develop different sickness absence practices, expressed in variation in the absence figures. This study aimed to test the hypothesis that the work places residing in a locality share similar sickness absence practice. Methods: Register data from the major public sector employers and from private industrial employers were used to compare the absence in two localities. Results: There were significant differences by locality in both branches and both in short and in long sickness absences. Population-level statistics showed a corresponding locality difference in recipients of sickness allowance benefits and in primary healthcare visits, but not in indicators of mortality and morbidity. Social problems were more common in the locality with high rate of absence. Conclusion: Area-specific practice, or habitus, as an independent determinant of sickness absence is discussed and an explicitly sociological context is recommended for debates about "best sickness absence practices" and corresponding intervention measures.