Tuberculosis (TB) is among the top ten causes of global mortality. Sudan is among the countries with high TB prevalence; with an estimated incidence of 90/100,000 smear-positive cases. In 1993, the Khartoum State tuberculosis control programme was established. Since its establishment, however, the programme has never been adequately assessed.
To evaluate and describe the tuberculosis control programme in Khartoum State, Sudan in 2006; to find out if the programme achieved its global targeted goals; and to identify the challenges and needs for performing a good standard tuberculosis control programme.
A descriptive cross-sectional and retrospective study design was used. The study population was tuberculosis control departments at the levels of the state (n = 1), localities (n = 7), health areas (n = 19) and health facilities (n = 42). Records review and group interviews were used to collect the required data.
The study found that the TB control programme in Khartoum State achieved a 77.2% case detection rate of the smear-postive cases, and 73.5% treatment success rate, and a case fatality rate of 2.2%, treatment failure rate of 2.2%, and default rate of 14.1%. There was no system to detect the prevalence of MDR-TB (multi-drug resistant TB) or HIV (human immunodeficiency virus) among the TB cases. The programme was not well implemented at locality or health area levels. Conversely, drugs and laboratory supply systems were functioning well.
The tuberculosis control programme in Khartoum State is centralized, not updated, and does not achieve the targeted goals.
To examine the trends over five years for patients' seeking online additional health information about their disease/health problem to what the doctor has been giving, and investigate any differences in information-seeking behaviour according to age, gender, self-perceived health status, living area, and type of medical encounter.
Data from three independent surveys conducted in 2000, 2002, and 2005 of a population with a recent experience of outpatient care[n]typesetter: please remove blue shading here and elsewhere[/n], including 24,800 respondents aged between 20 and 95, were analysed in a trend analysis and a logistic regression regarding background factors that may influence the seeking behaviour.
During the study period, there was a significant increase in Internet use in most age groups. The total use among men 20-95 years old increased from 7% in 2000 to 18% in 2005 and from 9% to 25% for women respectively. The predictors for using the Internet as a source of information were: age, gender, self-perceived health status, living area, and the type of medical encounter (first or repeated). In 2005, women aged 20-49 used the Internet as a source to a significantly greater extent than men, even when all background factors were controlled for (OR 1.46 and CI 1.21-1.77).
Swedish patients, especially the young and middle-aged, are to a substantial degree using the Internet to gather additional information on their disease. The benefits of this increase include more informed patients; however, there are inherent quality issues that require strategies for ensuring public access to high-quality health information online.
To provide a synopsis of the sixth survey of the Tromsø Study, Tromsø 6, objectives and new target areas, study design, follow-up studies, data collection, attendance, and participant characteristics.
The Tromsø Study, initiated in 1974, is an epidemiological, prospective study of health conditions and chronic diseases, and a resource for the surveillance of disease risk factors. The purpose of Tromsø 6 (2007-08) was to collect novel and repeated measurements of exposure data and to assess levels of disease risk factors. Tromsø 6 included a main study that comprised two screening visits and several follow-up studies. Main study data collection: First visit (n=12,984): questionnaires, interviews, measurements of height, weight, hip and waist circumference, heart rate, blood pressure, forearm bone density, grip strength, pain sensitivity measurements, and blood and hair samples and nose and throat swab cultures. Second visit (n=7307): sampling of biological specimens (blood, urine, nose and throat swab cultures) and clinical examinations (12-lead electrocardiography, cognitive tests, visual acuity test, retinal photography, carotid ultrasound, spirometry, dual-energy X-ray absorptiometry, and echocardiography.
A total of 12,984 participants aged 30-87 years were examined. The attendance rate was 66%, lower than in previous Tromsø Study surveys. The attendance was lowest in the youngest and oldest, those invited for the first time, and lower in men than women.
The completion of the survey with this comprehensive data collection went satisfactorily. The decreasing attendance rate calls for new recruitment strategies and optimisation of the study organisation to facilitate attendance.
The aim of this study was to explore and describe self-rated health in middle-aged and elderly Danes using both a cross-sectional and a longitudinal design. Global and (age) comparative self-rated health are examined and compared.
This study is interview based and comprises data on 11,294 Danes aged 45-102 with more than 1,900 participants aged 90 years and older.
As expected, global self-rated health declines with age in both cross-sectional and longitudinal analyses. In contrast, comparative self-rated health either increases or remains stable with age in cross-sectional analyses while in longitudinal analyses there is a slight decline in comparative self-rated health.
The age-trajectory of global self-rated health is similar in individuals and populations. For comparative self-rated health, however, the individual on average experiences a slight decline, whereas on the population level comparative self-rated health either increases or remains stable. The explanation for this is likely to be higher mortality and higher non-response among the participants with the poorest self-rated health.
The present study compares subjects recruited to a population-based prospective cohort study by community versus personal invitation, and subjects responding late versus early to personal invitation. Subjects were compared with respect to sociodemographic characteristics, selected lifestyle factors, cancer incidence and mortality.
The Malmö Diet and Cancer Study recruited a total of 28,098 subjects between 1991 and 1996. Entire birth-year cohorts, born 1923-50, were recruited using community directed (passive) invitation, and a personal letter of invitation (active recruitment). Information on sociodemography and lifestyle was obtained using a self-administered questionnaire. Anthropometric measurements were assessed at a physical examination. Cancer incidence and cause of death were retrieved using record linkage with national registries.
Subjects responding to community directed invitation were older, and more often females, than participants recruited using personal invitation. Furthermore, participants recruited through passive invitation had a comparably more favourable situation with regard to sociodemographic and lifestyle factors. They also had a lower frequency of prevalent disease, lower incidence of cancer and lower mortality. Contrary to this, men were more likely to respond late to a personal letter of invitation and late responders were also older, as compared with subjects responding early to personal invitation. Furthermore, those who responded late had a comparatively unfavourable socioeconomic situation and were characterized by a high prevalence of current smoking, obesity, weight change, and prevalent disease.
Subjects who are recruited using different strategies in population-based cohort studies may have different sociodemographic and lifestyle characteristics, and may vary with regard to prevalent disease, cancer incidence and subsequent mortality.
The aim of this study was to describe the prevalence of and investigate the association between mental health problems, asthma, allergy and eczema in Norwegian and immigrant youths.
A cross-sectional study was performed of all 10th-grade students in Oslo, Norway, in two school years; 1999-2000 and 2000-2001. Of the 8316 eligible students, 7345 (88.3%) participated. Internalized mental problems were measured using the Hopkins Symptom Check List 10-version, and two subscales of the Strength and Difficulties Questionnaire were used to study externalizing mental health problems. All questions are based on self-report, and 25% of the sample had an immigrant background.
Immigrant boys had higher scores on internalizing problems than Norwegian boys. First-generation immigrants reported less asthma and eczema than Norwegians. The strongest association between mental health problems and inflammatory conditions was for allergy and internalizing problems for boys (odds ratio (OR)=2.5 for immigrants and OR=1.8 for Norwegians). For girls, it was allergy in Norwegians (OR=1.6) and asthma for immigrants (OR=2.2). For externalizing problems, the association was strongest for asthma in boys and eczema in girls. Immigrant boys had stronger associations between number of inflammatory conditions and internalizing mental health problems than Norwegians (OR=3.2 vs. OR=2.4). Among girls, the figures were 1.7 for Norwegians and 1.8 for immigrants.
There is a strong association between number of inflammatory conditions and internalizing mental health problems, especially among boys with an immigrant background. The association with externalizing mental health problems was less prominent.
The lack of effective school-based interventions for preventing obesity in children has caused a call for longer duration of interventions and better reporting on design and evaluation methodology. The purpose of this paper is to present the development of the intervention, the design of the effectiveness study, and the test-retest reliability of the main outcome measures in the HEalth In Adolescents (HEIA) study.
The HEIA intervention programme was developed based on literature reviews, a social ecological framework, and focus groups. The intervention aimed to increase total physical activity (PA) and consumption of fruit and vegetables and to decrease screen time and consumption of sugar-sweetened beverages. The intervention programme consisted of a classroom component, including dietary behaviour lessons, computer tailoring, fruit/vegetable and PA breaks, and posters, and an environmental component including active transport campaigns, equipment, suggestions for easy improvements of schoolyards, inspirational courses for teachers (all with regards to PA), and fact sheets to parents. The effect of the intervention programme is evaluated in a cluster randomised controlled trial design (intervention = 12 schools, control = 25 schools) including process evaluation. Main outcomes include anthropometry, PA, screen time, and consumption of fruit, vegetables, and sugar-sweetened beverages. A 2-week test- retest study was conducted among 114 pupils. Determinants of the behaviours were assessed. Similar data were collected from parents. Children's PA was measured objectively by accelerometers.
The HEIA study represents a theoretically informed randomised trial comprising a comprehensive set of multilevel intervention components with a thorough evaluation using reliable outcome measures. The study will contribute to a better understanding of determinants of healthy weight development among young people and how such determinants can be modified.
This cross-sectional study had two aims: firstly, to study the associations of parental influence in the form of encouragement, father and mother modelling and involvement on children's physical activity (PA), and secondly, to study the mediation effect of encouragement, father and mother modelling and involvement on children's PA through children's perceived competence and attraction to PA.
A total of 1278 children (response rate 79%), aged 10-11 years, participated in the study in the autumn of 2006. Of these children, 883 children completed all the data in a questionnaire assessing their self-reported PA, perceived competence, attraction to PA, and perceived parental influence. The associations were examined by multiple mediator analyses with bootstrapping method. All the models were adjusted with gender and grade.
The analyses pointed out that father modelling had a direct effect on children's physical activity, whereas encouragement, mother modelling, and involvement had an indirect effect through perceived competence and attraction to physical activity on children's physical activity. The strongest indirect association was formed from encouragement through attraction to physical activity to children's physical activity.
The results show that parents influence on children's physical activity in a variety of ways. Parents influence their children's physical activity in direct and indirect manners through their encouragement, involvement and modelling. Furthermore, mother and father influence their children's physical activity in different ways. This versatility should be taken into consideration in future interventions.
The aim of this paper is to investigate anthropometric characteristics in 11-year-old Norwegian by gender and parental education, and to study associations between adolescents' overweight and waist circumference (WC) and maternal and paternal overweight and WC.
A total of 1483 adolescents, 1156 mothers, and 1016 fathers participated in the baseline survey of the HEalth In Adolescents (HEIA) study (September 2007). Anthropometric measures of the adolescents were assessed by project staff according to standard procedures. Self-reported data about pubertal status were collected through questionnaires. Parental education and anthropometric measures of parents were collected by self-report.
The prevalence of overweight (including obesity) determined by the cut-offs for body mass index (BMI) suggested by the International Obesity Task Force was 14.6% among girls and 13.6% among boys. The highest prevalence of overweight was observed among adolescents with parents who had less than 12 years of education (18.8%). Overweight and WC in girls was strongly associated with maternal overweight and WC. For boys, overweight and WC was strongly associated with both maternal and paternal overweight and WC.
There was a social gradient in anthropometric characteristics and overweight rates among Norwegian 11-year-old adolescents. Maternal overweight and WC was associated with overweight and WC in girls and boys, while paternal overweight and WC were associated with overweight and WC in boys. The results indicate that mothers are key persons in prevention of overweight among adolescents, despite gender. Fathers are important as role models for their sons. Targeting parental overweight/ obesity could be a strategy in future interventions.
The purpose of the present study was to examine whether body mass index (BMI) trajectories differed between daily smokers, never smokers, and former daily smokers among a population-based sample over an 11-year period.
A cohort of 1,166 adults (n = 579 men; n = 587 women) self-reported BMI during a general health interview twice administered in two regions in Norway. Of the participants, 37.5% were never smokers, 31.6% current smokers, and 31% were former smokers.
Those who had quit smoking within the past five years had the highest age-adjusted BMI increase, gaining 3 kg and 5 kg more weight on average than current smokers (women and men, respectively). No significant differences in weight gain over the 11-year period existed between never smokers and former smokers who had quit > or = five years ago.
Our finding that former daily smokers (> or = five years since quitting) demonstrated equivalent BMI increases to never smokers (1990-2001) is in line with evidence suggesting that the average body weight of quitters tends to stabilize over time to levels of never smokers. As post-cessation weight gain often represents a barrier to successful quitting, improved knowledge about the temporal and variable effects of smoking cessation on long-term weight outcome may strengthen motivational enhancement and relapse prevention efforts.
The aim of the study is to investigate the influence of the school food environment on the dietary behaviours of 11-year-old Norwegian children in elementary schools.
Baseline data from a school-based intervention study: the Health In Adolescents study was used. A total of 1425 11-year-old children from 35 schools from the eastern part of Norway were included. School administrators provided information on the physical, political, and sociocultural school food environment and students reported their intake of fruits, vegetables, sugar-sweetened beverages (SSB), and snacks. Multilevel modelling was used to assess the school-level variance in dietary behaviours and to investigate the association of school food environmental factors with these dietary behaviours.
After adjustment for student characteristics, the school level accounted for a small proportion (1.1%-3.0%) of the variance in the dietary behaviours investigated. None of the investigated school food environmental factors were found to be related to the children's reported intake of fruits, vegetables, snacks or SSB.
Most of the variance in the dietary behaviours investigated was at the personal level. Thus in this sample, the investigated school-level factors do not appear to exert a strong influence on the dietary behaviours of children. Longitudinal studies using validated measures of the school food environment are needed.
Although back diagnoses are recurrent and the main diagnoses behind sickness absence and disability pension surprisingly few longitudinal studies have been performed. This study identifies predictive factors for disability pension among young persons initially sick-listed with back diagnoses.
An 11-year prospective cohort study was conducted, including all individuals in a Swedish city who, in 1985, were aged 25-34 and sick-listed > or =28 days owing to neck, shoulder, or back diagnoses (n = 213). The following data was obtained: disability pension, emigration, and death for 1985-96, sickness absence for 1982-84, and demographics in 1985 regarding sex, income, occupation, marital status, diagnosis, socioeconomic group, and citizenship. Cox regression and life tables were used in the analyses.
In 1996, i.e. within 11 years, 22% of the individuals (27% of the women and 14% of the men) had been granted disability pension. The relative risk for disability pension was higher for women (2.4; p = 0.010), persons with foreign citizenship (3.6; p=0.009), and those who had had >14 sick-leave days per spell during the three years before inclusion, compared to those with <7 days/spell (3.1; p=0.003).
This cohort of young persons proved to be a high-risk group for disability pension. Some of the factors known to predict long-time sickness absence also predict disability pension in a cohort of already sick-listed persons.
A study was undertaken to ascertain whether the differences in risk in relation to gender and citizenship observed in a previous study of the same cohort would remain if more recent data on sickness absence were used.
This was an 11-year prospective population-based cohort study. The dataset includes all individuals in a Swedish city who, in 1985, were aged 25-34 and had a sick-leave spell > or = 28 days with neck, shoulder, or back diagnoses (n=213). The data covered the following: for 1985-96, disability pension, emigration, and death; for 1982-96, sickness absence; for 1985, sex and citizenship. The data were subjected to Cox regression analyses with a time-dependent covariate.
Disability pension was granted to 22% (n=46) of the cohort. The relative risk for disability pension increased by 9.3 with each sick-leave spell > or = 90 days during the two previous years. The risk was higher for women than men, and also higher for foreign citizens than Swedes.
Many studies have revealed a gender difference in the risk of being on disability pension, and it was found that this difference was still apparent when sick leave during the follow-up period is taken into account. Thus, the reason for the gender differences ought to be found among other factors than prior levels of sickness absence.
To describe the self-reported medicine use for common health complaints among 11-15-year-olds in Denmark during a ten year period, 1988-1998. The paper focuses on medicine for headache, stomach ache, cough, cold, nervousness, and difficulties in getting to sleep.
Four cross-sectional surveys of 11-15-year-old students in random samples of schools in Denmark, conducted in 1988 (n=1671), 1991 (n=1860), 1994 (n=4046) and 1998 (n=5205). The surveys were similar with regard to sampling and data collection. Data were collected by self-administered questionnaires in the classroom.
A large proportion of 11-15-year-olds reported medicine use during the past month. It was most common to take medicines for headache (used by 55% of 15-year-old girls and 36% of 15-year-old boys in 1998) and stomach ache (33% among 15-year-old girls in 1998). Pain reliever use was higher among girls than boys and this sex difference increased with age. There was an upward trend in reported medicine use from 1988 to 1998, in particular regarding medicine for stomach-ache among 13- and 15-year-old girls. A large proportion of girls were frequent users of medicine for headache, stomach-ache, and sleeping difficulties.
A high proportion of 11-15-year-old girls and boys reported medicine use in relation to common health complaints. The proportion of users increased during the past decade. It is suggested that more information about medicine be built into health education programs in the future.
Recorded sales of alcohol increased at the end of the 1990s and peaked in 2004. Total consumption is obtained by adding unrecorded consumption (legal and illegal) to recorded sales. In 2010, the total consumption was 9.1 litres per person versus 8.0 litres1 in 1996. Consumption of wine and strong beer has risen, while consumption of spirits has declined. Self-reported data also shows that consumption rose between 1990 and 2004 and has subsequently declined. Alcohol consumption in 2010 was 2.3 litres for women.and 5.0 litres for men. However, the figures for self-reported consumption are lower than actual consumption, which was estimated at 5.8 litres for women and 12.5 for men respectively in 2010. Although alcohol consumption has increased over the past 20 years, Sweden is among the countries in Europe with the lowest consumption rates. However, whereas young people in Sweden drink roughly the same amount of alcohol as young people in the rest of the EU, consumption among middle-aged people is lower than in the rest of the EU. Obtaining data on the extent to which risky alcohol consumption has also increased in the 1990s, and decreased in more recent years, is more difficult. The percentage of men who drink the equivalent of two or more glasses of wine per day - regarded as a relatively high level of consumption - increased from 6 to 8 per cent between 1990 and 2002. The percentage of women who drink a corresponding amount - 1.5 or more glasses of wine per day - has risen from 2 to 5 per cent. Reported comsumption of at least one bottle of wine (or its equivalent) on a single occasion, at least once a week in the previous month could be classified as binge drinking has decreased between 2004 and 2010 (13 to 9 per cent among men and 4 to 3 per cent among women). People's alcohol consumption changes throughout their lives. In all age groups, women drink significantly less alcohol than men. Men aged 20-24 drink the most: an estimated average of 20 litres of pure alcohol consumed in 2010, equivalent to twenty tins of beer per week. The older women and men become the less alcohol they consume. However, women and men aged 30-39 consume less than in the 50-64 age group. This coincides with the age at which many are responsible for small children. What may be regarded as risky alcohol habits are also most frequently found among young people. Alcohol consumption among girls and boys in the 9th grade of compulsory school also increased at the end of the 1990s, according to self-reported data. Consumption peaked in 2000 but has subsequently declined. Meanwhile, the percentage of pupils in the 9 th grade who do not drink at all has increased; in 2010, it stands at 39 per cent of boys and 32 per cent of girls. As in the case of adult men and women, boys drink more than girls. More men than women die of an alcohol-related disease, i.e. as a direct result of the harmful effects to the body of alcohol dependence. The percentage of women over the age of 65 who die of an alcoholrelated disease has grown since the beginning of the 1990s. Among women aged 45-64, the percentage of those who die of alcohol abuse has remained the same, with perhaps a slight increase in recent years. Alcohol mortality among men is increasing in people over the age of 65 and declining across the entire 25-64 age range. The percentage of men and women who were hospitalised for alcohol poisoning rose in all age groups between 2000 and 2005, and has remained relatively constant since. Alcohol is a major public health concern for a number of reasons. Its consumption is the underlying cause of a large proportion of accidents, injuries and violence. In Sweden, approximately 3,000 people die each year as result of injuries, a third of which are estimated to be alcohol-related. Every year, approximately 125 people under the influence of alcohol die in traffic accidents. This is equivalent to approximately 20 per cent of all traffic deaths. However, the number of motorists, cyclists, and pedestrians who have died in alcohol-related traffic accidents has remained relatively constant between 1997 and 2007. Depression is two to three times as frequent among women and men with alcohol problems as in the population at large. Alcohol dependence can of course have social repercussions as well, which in turn affect the health of alcohol abusers and those close to them. The positive health effects of alcohol apply mainly to cardiovascular diseases, diabetes and cognitive functions, where the risk of morbidity can be lowered through the consumption of alcohol in small doses: for example one glass of wine per day. However, no positive effects of moderate alcohol consumption have been demonstrated in the case of young people, and excessive drinking (drinking to the point of intoxication) generally entails a higher health risk. Preventive programs chiefly target alcohol consumption among young people and women, despite the fact that men drink considerably more. Preventive programs based on knowldege of the causes of these significant gender disparities are important both for women's and men's health. Illicit drug use increased among 9 th grade pupils in the 1990s. The trend peaked in 2001 and then declined. However, it is now once again on the rise. In 2010, 9 per cent of boys and 7 per cent of girls reported having tried drugs at some point. Two per cent of girls and 3 per cent of boys in the 9th grade have used illicit drugs in the past month, a measure regarded as a better indicator of regular use. The number of deaths from drug overdose has risen dramatically since 1971. Deaths resulting from illegal drug use are three times higher among men than women.
Work disability and sickness absence increase following partner's retirement, which similarities in spouses' health could explain. We therefore studied the risk of work disability within couples, taking account of baseline health, lifestyle and socioeconomic factors.
A cohort of 12,511 couples from the HUNT Study (aged 20-67 years in HUNT2, 1995-1997) was linked to national registries, identifying all new cases of disability pension up until December 2007. Data were analysed with discrete time multilevel logistic regression and Cox regression models. Partners' disability pension was included as a time-varying covariate. Follow-up time was split to examine the association dependent of time. Analyses were adjusted for age only, adjusted for health, and for lifestyle and education along with health.
About 15% of an individual's propensity to receive a disability pension could be attributed couple similarity. There was an increased risk of work disability following the spouse's disability retirement [HR (hazard ratio) 1.43 (95% confidence interval 1.20-1.71) for men, HR 1.49 (95% confidence interval 1.28-1.74) for women]. The association was somewhat attenuated after adjustments for health, lifestyle and education.
There was a substantial clustering of disability pensions within couples, which cannot be explained by similarities in health, lifestyle and education. This suggests partners influence each other's work ability. From a clinical perspective, the family situation needs to be taken into account when addressing health promotion and work participation.
Cardiovascular disease (CVD) originates during childhood and adolescence. Schools are potentially effective settings for early public health prevention strategies. The aim of this study was to evaluate the effect of six physical education (PE) lessons on children's CVD risk.
This longitudinal study in 10 public schools (1218 children, aged 6-13 years), 6 intervention and 4 control schools evaluates a natural experiment, where intervention schools tripled PE to six lessons per week compared to the mandatory two PE lessons in the control schools. Baseline (2008) and 2-year follow-up measures were anthropometrics, cardiorespiratory fitness, blood pressure and blood samples providing lipids and measures for insulin resistance. Based on these variables, a composite risk score was calculated and used for further analysis. Multivariate multilevel mixed effect regression models were used to estimate effect of intervention taking the hierarchical structure of data into account. Individual, class and school were considered random effects. Intra class correlation (ICC) was calculated.
Intervention significantly lowered mean of composite risk score with 0.17 SD (95% CI: -0.34 to -0.01). Six PE lessons per week had a beneficial effect on triglycerides (TG) levels (-0.18 SD, 95% CI: -0.36 to 0.00), systolic blood pressure (SBP) (-0.22 SD, 95% CI: -0.42 to -0.02) and insulin resistance (HOMA-IR) (-0.17 SD, 95% CI: -0.34 to 0.01).
Six PE lessons at school can reduce children's CVD risk measured as a composite risk score. The changes in risk score are considered substantial in the perspective of public health strategy for preventing CVD in later life.
To increase knowledge of self-rated health and lifestyle in relation to overweight/obesity among 13-15 year olds in northern Sweden.
All 6768 13-15 year olds in nine out of 15 municipalities in Västerbotten County were asked to complete a cross-sectional school-based on-line survey in 2007. Eighty-two per cent participated in the study. Responses were considered reliable for 74% of the participants (2517 boys/2470 girls). The survey addressed demography, self-rated health, self-reported weight, height, and lifestyle characteristics. Simple and multiple logistic regression analyses were used.
Overweight/obesity (ISO body mass index ≥25 kg/m(2)) was more prevalent among boys (20%) than girls (11%), but more girls (19%) than boys (9%) reported fair or bad health. Overweight/obese boys and girls were more often physically inactive. For the boys, overweight/obesity was also associated with skipping breakfast, insufficient tooth brushing, and using snuff. For the girls, overweight/obesity was also associated with living with one parent and more television watching. Boys reported healthier habits concerning sleep duration, physical activity, eating breakfast, and smoking compared to the girls. On the other hand, girls reported better dietary and tooth brushing habits.
This study uncovered two alarming findings: a fifth of the boys were overweight/obese and a fifth of the girls reported fair or bad health. Girls living with a single parent and boys and girls with unhealthy lifestyles were more likely to be overweight. Our findings emphasise the need for developing and implementing effective health promotion strategies for school-aged children to prevent an overweight and obesity epidemic that could continue into adulthood.
To examine whether four modifiable physical performance-based measurements predicted 13.5-year mortality in 300 elderly women.
This prospective observational cohort study followed 300 randomly-selected community-dwelling women, with a mean age of 80.9 years at baseline, for 13.5 years. Baseline physical performance measurements were: comfortable walking speed, Timed Up and Go (TUG), functional reach, and one-leg stance. Demographic and health measurements were recorded. Date of death was recorded from the national population registry. Cox proportional hazard models were fitted, with time from baseline assessment to death or censored date as the dependent variable.
At follow-up, 71% of the participants had died. All performance-based measurements except one-leg stance were significantly associated with 13.5-year mortality. Only walking speed remained significantly independently associated with mortality when the three significant performance measurements were included in the same multiple proportional hazard Cox model.
Comfortable walking speed, TUG and functional reach predicted 13.5-year mortality, and walking speed was the strongest predictor of mortality. Screening elderly women with performance measurements may aid in identifying those at risk and thus targeted interventions may be applied.
This study attempted to investigate the nature and risk factors of injury hospitalization among Finnish conscripts in 1998-2002.
Altogether 135,987 military conscripts, including 2,044 (1.5%) women, were followed during their 6- to 12-month service in 1998-2002. Data on injury hospitalizations were obtained from the National Hospital Discharge Register. Outcome variables were injury hospitalization, multiple injury hospitalization, and hospitalization due to lower limb injury. Background variables consisted of conscripts' service and physical fitness data.
Injury hospitalization occurred among 6,059 (4.5%) conscripts, in 530 (0.4%) of them more than once. The total number of hospitalizations was 7,187, of which 50% were due to lower limb injuries. Most injuries (57%) were dislocations and sprains of joints and ligaments. The strongest risk factors for injury hospitalization in the multivariate logistic regression models were female sex (OR 2.3, 95% CI 1.9-2.7), and overweight (OR 1.4, 95% CI 1.2-1.7). These odds ratios increased when multiple injuries were investigated separately. Excellent aerobic fitness was a specific risk factor for lower limb injury (OR 1.3; 95% CI 1.1-1.5).
Women were markedly more likely than men to be hospitalized for injury. Moreover, overweight predicted an increased injury risk. Generalizable to the young adult population, the findings should be considered when identifying targets for injury prevention measures.
The preventive effect of physical activity on risk of cancer in general remains controversial. This study aimed at assessment of the associations between leisure- time physical activity and incidence of cancer in the general population of adult men and women.
13,216 women and 18,718 men aged 20-93 years selected from the general population participated in a health examination including a questionnaire with information on physical activity, smoking, alcohol intake, postmenopausal hormones, and socioeconomic status. Incident cases of cancers where recorded during a follow-up period of 14 years. The six most frequent cancer cases in both sexes were included in this analysis.
A highly significant inverse association was seen between vigorous physical activity in leisure time and cancer of the ovary, adjusted rate ratio being 0.33 (95% CI 0.16-0.67; p = 0.001) for the most physical active women. In men there was a highly significant increase for non-melanoma skin cancer, with adjusted rate ratio of 1.72 (95% CI 1.23-2.40; p = 0.001), for the most active men and vigorous activity was associated with a non-significant lower risk of colon cancer, the adjusted rate ratio being 0.72 (95% CI 0.47-1.11; p = 0.06).
Generally, there were no, or only weakly, inverse associations between physical activity in leisure time and incidence of cancer, except for cancer of the ovary.
To analyse predictors among pupils leaving compulsory school for smoking and high alcohol consumption as adults.
A prospective cohort study in which all pupils (N = 1083) in the last year of compulsory school were followed for 14 years. The data were collected through repeated comprehensive self-administered questionnaires.
Smoking was better predicted than alcohol intake. The best predictors were earlier high alcohol intake and earlier smoking. Among other predictors, low grades, poor teachers' prognoses and early unemployment pointed to unfavourable health habits, mainly smoking.
It is possible already at school to identify risk groups for future smoking and high alcohol consumption.
The aim of this study was to assess the influence of social environmental factors on school performance and behavioural problems among 14-year-old children who had been exposed to amphetamine during foetal life. The study group comprised a cohort of 65 children who had suffered intrauterine exposure to amphetamine due to maternal drug abuse. This group has been followed since birth and examined at regular intervals. Information regarding the academic performance of the children was gathered from the school authorities. The psychosocial environment of the children was determined through interviews and through information obtained from the social authorities. Of the 64 children who attended a school within the state school system, 10 (15%) were a year behind for their age. The mean grades were significantly lower than those of their classmates. Behavioural problems were mentioned in the social authority documentation of one-third of the children, regardless of whether the child was placed in a foster home or was residing with the biological mother. A positive significant correlation was found between maternal age and the outcome of the children, as well as between therapy during pregnancy and outcome, whilst several environmental factors, particularly during the child's first four years, correlate negatively to outcome. Psychosocial factors early in life influence the outcome at 14 years. The positive effect of intervention during pregnancy illustrates the importance of early identification preferable during pregnancy.
Environmental settings seem to influence the activity patterns of children in neighbourhoods and schoolyards, the latter being an important arena to promote physical activity (PA) in school children. New technology has made it possible to describe free-living PA in interaction with the environment. Aims of study: This study focused on how schoolyard environments influenced the activity patterns and intensity levels in 14-year-old children and whether PA levels in adolescents complied with official recommendations. Another objective was to introduce methodology of using a mobile global positioning system (GPS) device with synchronous heart rate (HR) recordings as a proxy for PA level and a geographical information system (GIS) for spatial analyses.
The sample constituted of 81 children (aged 14 years) from two schools. Movement patterns and activity levels were recorded during lunch break applying a GPS Garmin Forerunner 305 with combined HR monitoring and analysed in a GIS by an overlaid grid and kriging interpolation.
Spatial data from GPS recordings showed particular movement patterns in the schoolyards. Low activity levels (mean HR < 120 bpm) dominated in both schools with no gender differences. Activities located to a handball goal area showed the highest monitored HR (>160 bpm) with higher intensity in girls than in boys.
Movement patterns and PA generated in GIS for visualisation and analysis enabled direct and realistic description of utilising of schoolyard facilities and activity levels. Linking GPS data and PA levels to spatial structures made it possible to visualise the environmental interaction with PA and which environments promoted low or high PA.
Asthma, hay fever and eczema became a public health problem following a marked increase in the prevalence of these conditions in the second half of the 20th century. However, the rise in the incidence of allergies and asthma now appears to have halted, at least in children. Before puberty, asthma and hay fever occur most frequently in boys. However, this ratio is reversed after puberty. Allergic diseases, especially hay fever, were mainly an upper-class disease in the 1800s. However this is no longer the case; today, asthma is a more common condition, and its symptoms are most severe, in lower-income social groups. An important reason for this is that smoking is now more widespread in these groups. The origins of this rise in the prevalence of asthma and allergies are still unclear, but they seem to be linked to changing contact with microbes1, mainly bacteria and parasites, in early life. Various cost factors can also be significant. It is important to distinguish between factors that contribute to the pathogenesis of the condition and those that exacerbate allergic reactions. Air pollutants, pollen and animal hair contribute to an increase of symptoms in people with asthma and allergies but seldom lead to the development of these diseases in people who are healthy. The socioeconomic costs of air pollutants, for example, can nonetheless be significant since a large proportion of the population is exposed to them and asthma and allergies are common in the population. Additional factors such as tobacco smoke can contribute to the onset of asthma in healthy people and to the aggravation of allergic problems in sufferers.
The aim was to evaluate total and cardiovascular disease (CVD) mortality in relation to use of oral contraceptives (OC) in a cohort of women with a relatively high prevalence of smoking and high serum lipid levels.
In all 29,053 women aged 20-49 years were invited to a health survey in 1985-88. Of the total 82% attended and 20,282 women free of known CVD were included in this analysis. The relative risk (RR) of mortality during 14 years of follow-up was compared between OC users and non-users by means of proportional hazards regression.
About 50% of 827 OC users were daily cigarette smokers, and the mean total cholesterol level in the cohort was 5.9 mmol/l. There were 518 deaths, of which 10 occurred among the women taking OC at baseline. Of three deaths from CVD among OC users, two occurred in the first year of follow-up. Among non-smokers using OC three women died during the follow-up; none of the deaths was due to CVD. Women using OC of any type had no different adjusted total mortality (RR 0.87; 95% CI 0.46-1.65) or CVD mortality (RR 1.41; 95% CI 0.44-4.56) compared with non-users.
The results were consistent with previous evidence which does not indicate that mortality from all causes or CVD is elevated in women using OC.
There is a lack of empirical studies assessing the possible impact of active labour market programmes (ALMP) on health. The aim of this study was to analyze whether participation in ALMP, in contrast to being unemployed and not participating in ALMP (UNALMP), was related to mental health at different ages.
The study was carried out in a medium-sized industrial town in the north of Sweden. The cohort, consisting of all 1,083 pupils who attended or should have attended the last year of compulsory school in 1981, was followed up at the ages of 16, 18, 21 and 30. Data on 381 individuals at age 21, and 281 at age 30 were used in the study. The main health measurement was psychological symptoms among participants of ALMP in contrast to UNALMP at ages 21 and 30, and was analyzed by propensity score matching method (PSM) and multivariate logistic regression.
Generally, ALMP had higher scores of psychological symptoms than UNALMP. Nevertheless, participation in ALMP was not related to mental health. Due to methodological shortages our results have to be interpreted with caution. Adjustment for either all background selection variables or the propensity score in multivariate logistic regression showed similar associations, suggesting that propensity score could be used to adjust for background selection variables.
There is a need for more well-designed studies, using a theoretical framework, within the field, that are based on larger samples.
A hip fracture is commonly regarded as the most devastating fragility fracture, as regards both morbidity and mortality, while a vertebral fracture is usually regarded as having lower general morbidity. The purpose of this study was to investigate whether hospitalized patients with a hip or a vertebral fracture experience similar functional deterioration following the fracture as regards activity of daily living (ADL) and experienced quality of life (QOL).
Eighty-seven women and 22 men, mean age 81 (range 66-96), with a hip fracture and 34 women and 8 men, mean age 81 (range 68-92), with a vertebral fracture were followed up for 12 months. ADL before fracture and at 4 and 12 months after the fracture were evaluated as well as QOL at 4 and 12 months after the fracture, by questionnaires.
A hip and a vertebral fracture in community dwellers within the same age range confers a similar decrease in ADL during the four months following the fracture. No restoration was seen in ADL or total QOL during the year following the fracture. Patients with a vertebral fracture had a lower QOL than patients with a hip fracture 4 and 12 months after the fracture.
The need for external community assistance for patients with a vertebral fracture that forces them to have hospital treatment may be similar to the need following a hip fracture.
To reach the Millennium Development Goals for health, influential international bodies advocate for more resources to be directed to the health sector, in particular medical treatment. Yet, health has many determinants beyond the health sector that are less evident than proximate predictors.
To assess the relative importance of major socioeconomic determinants of population health, measured as infant mortality rate (IMR), at country level.
National-level data from 152 countries based on World Development Indicators 2003 were used for multivariate linear regression analyses of five socioeconomic predictors of IMR: public spending on health, GNI/capita, poverty rate, income equality (Gini index), and young female illiteracy rate. Analyses were performed on a global level and stratified for low-, middle-, and high-income countries.
In order of importance, GNI/capita, young female illiteracy, and income equality predicted 92% of the variation in national IMR whereas public spending on health and poverty rate were non-significant determinants when adjusted for confounding. In low-income countries, female illiteracy was more important than GNI/capita. Income equality (Gini index) was an independent predictor of IMR in middle-income countries only. In high-income countries none of these predictors was significant.
The relative importance of major health determinants varies between income levels, thus extrapolating health policies from high- to low-income countries is problematic. Since the size, per se, of public health spending does not independently predict health outcomes, functioning health systems are necessary to make health investments efficient. Potential health gains from improved female education and economic growth should be considered in low- and middle-income countries.
There is a large difference in the prevalence of cervical cancer between European countries. Between European Union countries, cervical cancer is the most prevalent in Lithuania. Currently we have available vaccines for different types of human papillomavirus virus (HPV), but we lack evidence on how the vaccination would be cost-effective in low-resource Eastern European countries like Lithuania.
To create a simulation model for the Lithuanian population; to estimate epidemiological benefits and cost-effectiveness for a HPV16/18 vaccination programme in Lithuania. Study design: For the cost-effectiveness analysis, we used Lithuanian population mathematical simulation and epidemiological data modelling. We performed comparative analysis of annual vaccination programmes of 12-year-old or 15-year-old girls at different vaccine penetration levels. Population: Lithuanian female population at all age groups.
A vaccination programme in Lithuania would gain an average of 35.6 life years per death avoided. Vaccinated girls would experience up to 76.9% overall reduction in incidence of cervical cancers, 80.8% reduction in morbidity and 77.9% reduction in mortality over their lifetime. Cost per life year gained with different vaccine penetration levels would range from 2167.41 Euros to 2999.74 Euros.
HPV vaccination in Lithuania would have a very positive impact on the epidemiological situation and it would be cost-effective at all ranges of vaccine penetration. Vaccination in Lithuania in the long term potentially could be more cost-effective due to avoiding early disease onset and lower accumulation of period costs.
To explore inequalities in total mortality between small areas of 16 European cities for men and women, as well as to analyse the relationship between these geographical inequalities and their socioeconomic indicators.
A cross-sectional ecological design was used to analyse small areas in 16 European cities (26,229,104 inhabitants). Most cities had mortality data for a period between 2000 and 2008 and population size data for the same period. Socioeconomic indicators included an index of socioeconomic deprivation, unemployment, and educational level. We estimated standardised mortality ratios and controlled for their variability using Bayesian models. We estimated relative risk of mortality and excess number of deaths according to socioeconomic indicators.
We observed a consistent pattern of inequality in mortality in almost all cities, with mortality increasing in parallel with socioeconomic deprivation. Socioeconomic inequalities in mortality were more pronounced for men than women, and relative inequalities were greater in Eastern and Northern European cities, and lower in some Western (men) and Southern (women) European cities. The pattern of excess number of deaths was slightly different, with greater inequality in some Western and Northern European cities and also in Budapest, and lower among women in Madrid and Barcelona.
In this study, we report a consistent pattern of socioeconomic inequalities in mortality in 16 European cities. Future studies should further explore specific causes of death, in order to determine whether the general pattern observed is consistent for each cause of death.
Danish registers contain information on many important health and social issues. Because all Danish citizens have a unique personal identification number, linkage at the individual level between these nationwide registers and other data sources is possible and feasible. In this paper we briefly introduce selected Danish registers and the data structure and requirements forgetting access to data at Statistics Denmark, which is the main provider of register data. We introduce the Danish Data Archive and briefly present the Act on Processing of Personal Data, which is the legal foundation for analyses of register-based data in Denmark.
To study the relationship between mental distress and later use of anxiolytic drugs, taking into account potential confounders such as lifestyle and socioeconomic factors.
In a prospective cohort study, data from population-based health surveys from three Norwegian counties (2000-01) were linked to data from the Norwegian Prescription Database (NorPD) (2004-07). In the surveys, 9,386 men (43.1% of those invited) and 11,244 women (52.4%) participated. The two age cohorts were 40 and 45 years old (cohort 1) and 60 years old (cohort 2). Participants in each age group were divided into quartiles (Q1-Q4) separately for men and women according to the degree of mental distress, measured by increasing Hopkins Symptom Checklist-10 score (HSCL-10 score) at baseline. Multivariate logistic regression was performed to assess predictors of anxiolytic drug use.
At baseline: Increasing HSCL-10 score was associated with: increasing use of specified prescribed drugs, poor health, ever having sought help because of mental distress, musculoskeletal pain, being married or in partnership, low educational level, receiving disability pension and current smoking (except for women 60 years old). Predictors found: There was a graded positive relationship between HSCL-10 score at baseline (2000-01) and the chance of a prescription of anxiolytics during follow-up (2004-07) in the 40 and 45 year olds. Predictors, regardless of age, were: female gender, reported use of hypnotics, having previously sought help because of mental distress and current smoking.
HSCL-10 score was related to later use of anxiolytic drugs in a dose response manner.
This study was undertaken to estimate the effect of hip protectors on the incidence of hip fracture when introduced into nursing homes as a regular part of the healthcare for all residents.
A pre-test/test design was used. The pre-intervention period lasted 18 months from May 1996. The intervention period lasted 18 months from May 1998. During the intervention period all residents (965 beds) in nursing homes in two municipalities in Norway were offered free use of hip protectors. The project manager provided motivational activities in the nursing homes during the whole period, aimed at increasing the participation rate.
The intervention period showed a 39% reduction in the hip fracture incidence when compared with the pre-intervention period (p = 0.003). The percentage of daily users of the protector varied from 35% during the first months to 22% at the end of the period. Among the 61 persons who suffered a hip fracture 31 were registered as daily users. Fourteen of the 31 users were not wearing the protector when the hip fracture occurred, while five of the 31 had the protector on their knees. Twelve of the 31 suffered a hip fracture while properly wearing the protector.
This non-randomized study showed that hip protectors introduced to all residents in nursing homes considerably reduced the incidence of hip fracture. It may be possible to achieve higher compliance and a further reduction in the incidence of hip fractures if the producers of hip protectors increase the comfort of the protector without reducing its effect. In addition, it is important that health workers encourage more individuals at high risk to use the protector.
Deliberate self-harm (DSH) in young people is an important public health issue. To prevent DSH, more knowledge is needed about its prevalence and associated contextual factors in community samples of adolescents.
To determine the prevalence of deliberate self-harm in 17-year-old Swedish students and to explore the association of demographic variables, psychological distress, experiences of violence, and school-related factors with DSH.
Data were derived from a cross-sectional study in which 17-year-old students completed questionnaires during school hours (n = 1,663; 78.3%). The variables used in this analysis are as follows: deliberate self-harm, demographic variables, psychological distress, experiences of violence, and school-related factors. Data were analysed using chi-squared statistics and logistic regression.
The lifetime prevalence of DSH was 17%, and it was more common among girls (23.3%) than boys (10.5%). There were considerable socioeconomic differences in reports of DSH. Psychological distress was strongly associated with DSH in both boys and girls, as were experiences of bullying, sexual harassment, physical violence and sexual assault. Social support, safety and academic factors in school were related to reports of DSH in both girls and boys. There were some gender differences with respect to which factors were associated with DSH.
Deliberate self-harm is common and more frequently reported by girls than boys. Psychological distress, experiences of different types of violence, and school-related factors (academic, social and safety-related), should be considered risk factors for DSH in young people. Findings can be applied to health-promotion policy and interventions in various contexts, for example schools.
Over a million people in Sweden have difficulty hearing what is said in a conversation between several people. Almost twice as many young people today consider themselves hard of hearing than was the case 10 years ago. However, this self-reported increase has not been confirmed by studies of hearing loss. At least 10,000 deaf and hearing-impaired people are under the age of 20. In most cases, their hearing impairments are the result of hereditary factors. People who have impaired hearing report having worse health than those with normal hearing. This is particularly true of younger, actively employed people. Many people who are hard of hearing suffer unnecessarily because they lack the hearing-aid devices they need. Almost half the people who would benefit from a hearing aid do not have one. Only a quarter of hearing-impaired people use other assistive listening devices, such as amplified sound in telephones and doorbells. One in every two Swedes over the age of 16 needs glasses to read plain text in a daily newspaper. One per cent of the population is unable to read text in a daily newspaper with or without glasses to help them. It is slightly less common today than 10 years ago for older women to have impaired vision. This is probably because cataracts, the most common cause of impaired vision, are operable. Most people given cataract surgery regain very good vision. The most common cause of blindness in older people is age-related degeneration of the macula lutea. The treatment currently available is only effective with a small group of people among those who suffer from acute problems. Strabism can result in vision impairment if not treated early. Child healthcare centres and schools offer screening procedures for detecting strabism. As a result, the percentage of people in the population with this condition has declined to just under 2 per cent.
To (a) describe the prevalence, trend, and amount of hypnotic drug use, (b) determine the prevalence of chronic diseases among hypnotic drug users, and (c) determine levels of recurrent hypnotic drug use (2007-2011), among 0-17 year old Norwegians.
Data were obtained from the nationwide Norwegian Prescription Database (NorPD) in the period 2004-2011.
Hypnotic drug use in 0-17 year olds increased during the period, from 8.9 to 12.3 per 1000, mainly owing to doubling of melatonin use. Hypnotic drug use peaked at 15 per 1000 among those aged 1-2 years. Melatonin use increased steadily from 6 to 12 years of age, most pronounced in males. Among females, hypnotic drug use increased threefold from 13 to17 years of age. Melatonin was dispensed in the highest annual amount of all hypnotic drugs; accounting up to a median of 360 defined daily doses in 9-13 year old boys. A total of 62% and 52% of all male and female hypnotic drug users were co-medicated with reimbursable drugs for chronic diseases. Levels of recurrent use (2007-2011) were 12% in boys and 8% in girls, of whom 76-77% were co-medicated with drugs reimbursed for chronic diseases.
There is a trend of increasing use of hypnotic drugs among 0-17 year olds, mainly owing to increasing use of melatonin, used in high amounts. Still, melatonin is not recommended in Norway for use in this age group because of insufficient data on safety and efficacy. A threefold increase in hypnotic drugs among females from 13 to 17 years of age warrants attention.
The aim of this study was to describe and analyse the prevalence of sexual problems in Norway.
The results are based on two samples from 2008, one of which was taken from 1671 web interviews in December among persons ranging from 18-67 years of age, and the other being a survey on sexual behaviour among a random sample of 12,000 Norwegians between the ages of 18 and 59, taken in April. Main outcome measures: The prevalence of sexual problems during the past 12 months.
Generalised linear model analyses showed that the highest expected prevalence of manifest problems was found in the following groups: reduced sexual desire problems in 60-67-year-old women with university education (52%); orgasm problems in 18-29-year-old women with less than university education (32%); genital pain in 18-29-year-old women with less than university education (19%); premature ejaculation problems in 18-29-year-old men with less than university education (27%); delayed ejaculation problems in men with less than university education (12%); erectile dysfunction in 60-67-year-old men (34%); and lubrication problems in 60-67-year-old women living in southeast Norway (29%). Sexual problems correlated negatively with sexual wellbeing.
This research indicates that sexual problems represent a public health problem.
The policy of population-wide human papillomavirus (HPV) vaccination has been debated as the introduction of such a programme in a low-resource country faces the risk of insufficient cost-effectiveness.
To assess the potential healthcare spending changes after the introduction of a HPV16/18 population-wide vaccination programme in Lithuania.
For a cost-effectiveness analysis, we used mathematical simulation and epidemiological data modelling based on a Lithuanian female population. We performed comparative analysis of an annual 12-year-old girls population-wide vaccination programme combined with cervical cancer screening programme compared to the screening programme strategy only.
HPV vaccination would gain an average of 35.6 life years per death avoided or up to 284.8 thousand life years would be gained over 90 years in total. The programme costs would be 2932.58 EUR per life year gained. All costs associated with the introduction of the vaccination programme could be recovered in 48 years. The HPV vaccination programme in Lithuania has the potential to generate up to 40.07 million EUR of economic returns annually compared with the current practice of the cervical screening alone.
In Lithuania the HPV16/18 vaccination programme would be economically effective only in the long term. The investment costs of HPV16/18 vaccination have the potential to be recovered.
The aim of this study was to investigate the occurrence, nature, and severity of violence and violence-related injuries, and the occurrence of alcohol-related violence among Finnish adolescents.
A 12-page questionnaire was mailed to a nationwide representative sample of 12-, 14-, 16-, and 18-year-olds (n = 10,883). The response rate was 75%.
Of the 8,135 respondents, 7.9% (646) reported violence occurrence and 1.7% violence-related injury during the past month. The male-female ratio for violence occurrence was 1.9 (95% CI 1.6-2.2) and for violence-related injury occurrence 0.8 (95% CI 0.6-1.2). Sixteen-year-old girls reported the highest injury rate (23/1,000). Most typically, the violent persons were individuals known by the victim before the incident. Girls were significantly (p < 0.001) more often (43%) in a fight with, or assailed by, a family member than boys (8%). Although boys' violent actions were related to leisure-time activities (64%), violence rarely took place during sports activities. Alcohol-related violence increased with age. Some 13% of 14-year-olds reported being under the influence of alcohol at the time of violence. The corresponding figures for 16- and 18-year-olds were 41% and 62%, respectively. Moreover, alcohol was closely associated with violence-related injuries.
Violence is common among Finnish adolescents. While violence does not always lead to injury, related injuries are an important cause of adolescent morbidity. Alcohol seems to be strongly associated with adolescent violence and related injuries.
To investigate the associations between work environment indicators and health- related work disability.
A health survey of 5,749 working 40-42-year-old Norwegians from Nordland County were linked to a national register for disability pension during a follow-up of over 18 years. The risk for disability pension following various self-reported physical and psychosocial work environmental exposures (individual and cumulative) were estimated using Cox regression analysis.
Both cumulative physical and psychosocial work environmental exposures were associated with an increased risk for disability pension, although this association was attenuated for most variables after adjusting for health and education. An increase in five poor psychosocial work environmental exposures was associated with a 22% increased risk for disability (adjusted hazard ratio, aHR, 1.22, 95% CI 1.04-1.44), whereas a similar increase in five poor physical work environmental exposures was associated with a 29% increased risk (aHR, 1.29, 95% CI 1.16-1.44). There were no indications of statistical interaction between either sex or education and work exposures.
People who report a poor work environment are at a higher risk for subsequent work disability. This finding suggests that improving working conditions may be an area of intervention in order to reduce the number of people who leave the labour market with a disability pension.
Traditionally, the child health services have laid emphasis on first-time mothers. Some researchers have argued that the needs of multiparous mothers must be considered equally important. The aim of this paper was to analyse parity-related characteristics in pairs of mothers and 18-month-old children.
The study was population-based and cross-sectional. 586 primiparous mothers and 821 mothers with at least one previous child completed a questionnaire. Additional information was extracted from the child health records by the nurses. Data were collected in 2002-2003 and 2004-2005.
Compared to multiparous mothers, primiparous mothers had a higher utilization of child health services. Multiparous mothers scored higher on parental incompetence stress and felt that their work load was more demanding. Multiparous mothers reported less social support, particularly in practical respects such as baby-sitting. They considered their interaction with the child as less satisfactory than did primiparous mothers; their children participated less in shared reading and had a more restricted vocabulary. Fewer multiparous mothers assessed their own and their child's total situation as very good.
The child health services should develop competence and methods to support multiparous mothers and alleviate their workload when caring for several children.
To study the hearing of 18-year-old men by using screening audiograms obtained at military conscription.
The study group comprised 301,873 Swedish men belonging to six age cohorts born from 1953 to 1977 who had been screened at age 18 years from 1971 to 1995. The prevalence of mild to moderate hearing loss was investigated.
Of the entire study group, 13.1% had elevation of one or more pure tone thresholds. In most cases, 11.9%, the elevation was situated in the high-frequency region. High-frequency hearing loss was more common in the left ear (7.5%) than in the right ear (6.2%). The prevalence of hearing loss decreased during the period 1971 to 1981 from 15.7% to 8.3%. During the last part of the study period, 1986 to 1995, the prevalence increased from 9.8% to 16.3%. The increase included mild to moderate degrees of hearing loss with thresholds below 35 dB HL. The prevalence of threshold elevations was highest in sparsely populated areas of Sweden and lowest in large, metropolitan areas of Sweden from 1971 to 1986. During the last part of the study period the geographical differences decreased or disappeared.
The total prevalence of hearing loss was in accordance with other reports. The frequency 6 kHz was most affected by threshold elevations. The prevalence of hearing loss decreased in the first part of the study period, and increased at the end of the study period. Hearing loss was most commonly seen in rural areas.
One of the most common medical actions performed by a doctor is to prescribe medicine for a patient . In 2007, two in every three Swedes purchased at least one prescription drug at a pharmacy. The volume of drugs dispensed by pharmacies increases by 3-4 per cent every year. Recent years have seen the addition of a number of new and more effective drugs. The cost of prescription drugs rose by about 10 per cent annually in the period 1986-2002. However, the rate of increase has since slowed due to changes in the rules on pharmaceutical benefits, primarily those governing generic substitution. The combined cost of all medicines, i.e. prescription drugs, prescription- free drugs and drugs administered during hospital care, accounted for 11.6 per cent of total health and medical care costs in 2006. Pharmaceutical drug use patterns among women and men differ, as does drug use within social groups. Although these disparities are partly accounted for by variation in the disease burden across population groups, there are also gender and social disparities that cannot readily be attributed to differences in the needs of those who use prescription drugs. Examples include drugs for treating dementia and post-heart attack patients, which long-term follow-ups show are used more extensively by the highly educated than by the less well educated. People born outside the EU are less likely to use recommended medicines for heart attacks, heart failure, stroke and chronic obstructive pulmonary disease (COPD). The elderly are using prescription drugs to an increasing extent, a pattern that entails risks as well as benefits. A major proportion of the most frequently used drugs have a proven effect in treating many of the diseases and conditions common among the elderly. At the same time, use of multiple drugs, or polypharmacy, carries the risk of side effects and drug-drug interactions as different medications affect one another. The elderly are particularly vulnerable. Sensitive to drugs owing to dementia or multiple morbidity, they are among those most often exposed to polypharmacy. As a result, drug treatment is not always entirely appropriate. The Swedish National Board of Health and Welfare has accordingly developed quality indicators  and assessed and discussed the quality of drug treatments for the elderly in a number of reports [3-5]. According to the World Health Organization (WHO), deficiencies in drug prescribing are a principal cause of inadequate clinical treatment .
In recent years, there have been a number of large-scale changes in the organization of healthcare in Sweden, as in many other countries. From a longer time perspective, however, there has been a more or less permanent oscillation between centralization and decentralization, and also between competition and co-operation, in Swedish healthcare organizations. In fact, there seems to be something like a pendulum moving all the time between opposite forms of organization. The frequency of these changes has been increasing during the last fifteen years, as different organizational models have replaced each other at shorter and shorter intervals. This development is partly due to the increasing rate of change in modern society, but partly also due to an element of fashion in the area of management. There is, however, a growing change fatigue in many healthcare organizations, and also increasing demands for empirical evidence on the efficiency and effectiveness of different organizational models before they are introduced into the healthcare system.
This study analyses the impact of improved water supply and sanitation on the level and rate of decline of child diarrhoea mortality in Stockholm 1878-1925. Previous studies have failed to demonstrate an effect of improved water supply on the risk of diarrhoea mortality at the individual level. Using data on access to water and sanitation from a household survey in 1895 and mortality rates and sociodemographic information from individual data 1878-1925 to analyse area differentials in diarrhoea mortality, it was found that the proportion having their own latrine in the household was associated with lower mortality risk in 1895-1900, while the proportion having water in the household was associated with lower diarrhoea mortality risk during the mortality decline until 1925. Population effects of improved water and sanitation on diarrhoea mortality may be better measured at area level than at individual level.