Aims: Observed changes in subcategories of injury death were used to test the hypothesis that a sizeable proportion of "injury deaths of undetermined intent" (Y10–Y34 in ICD 10) in the Baltic and Slavic countries after the USSR dissolved in 1991 were hidden suicides. Methods: Using male age-adjusted suicide rates for two distinctly different periods, 1981–90 and 1992–2005, changes, ratios and correlations were calculated. The data were compared with the EU average. Results: After the USSR broke up, the obligation to make a definitive diagnosis became less strict. A massive increase in "injury deaths of undetermined intent" resulted. The mean rate for the second period reached 52.8 per 100,000 males in Russia (the highest rate) and 12.9 in Lithuania (the lowest), against 3.2 in EU-15. The rise from the first to the second period was highest in Belarus (56%) and Russia (44%). The number of injury deaths of undetermined intent was almost equal to that of suicides in Russia in 2005 (ratio 1.0) and Ukraine in 2002 (1.1). In all the countries, especially the Slavic ones, prevalence trends of injury-death subcategories were uniform, i.e. strongly correlated over time. No direct substitution of one diagnosis for another was evident. Conclusions: There is no evidence that the category of "injury deaths of undetermined intent" in the Baltic and Slavic countries hides suicides alone. Aggregate level analysis indicates that accidents and homicides could sometimes be diagnosed as undetermined.

Aim: This article compares adolescent alcohol and illicit drug use among first- and second-generation immigrants from Nordic, non-Nordic European and non-European countries with that of the native Swedish majority population. Methods: Using data from a 2005 survey, multilevel logistic regression analysis was performed on a sample of 13,070 adolescents. The survey was conducted in three Swedish regions containing 24 municipalities. Results: Second-generation immigrants from Nordic countries were more likely to use alcohol and to binge drink, while first generation immigrants from non-European countries were less likely to; this difference is mainly explained by the relatively low use by girls from non-European countries. All immigrant groups were more likely to use illicit drugs than were the majority population. The highest drug use was found among first-generation Nordic immigrants and non-European immigrants. Consumption patterns among second-generation immigrants were more similar to those of the Swedish majority population, implying more alcohol use and less illicit drug use. Conclusions: Preventive policy for alcohol use should target Nordic immigrants in Sweden (second generation), while preventive policy for drug use, which is a more general immigrant phenomena, should mostly target both Nordic and non-European immigrants.

Aims: Asylum seekers are screened for tuberculosis at entry to Norway. We aimed to assess follow-up of screening results at different healthcare levels in relation to demographics, screening results and organizational factors, and how this influenced treatment of latent tuberculosis. Methods: All asylum seekers ≥18 years with a Mantoux test ≥6 mm or positive x-ray findings who arrived at the National Reception Centre from January 2005 to June 2006, were included. Data were collected from public health authorities in the municipality where the asylum seekers had moved, and from internists in case they had been referred to a specialist. Specialists are responsible for treating latent tuberculosis. Individual subjects were matched with the National Tuberculosis Register to which everybody who had started treatment for latent tuberculosis was reported. Results: Of 4,643 asylum seekers, 2,237 fulfilled the inclusion criteria. By May 2008, 30 persons had started treatment for latent TB, a median of 17 months (range 3–36) after arrival. A Mantoux test ≥15 mm on arrival was significantly associated with treatment. Demographic factors influenced follow-up in primary healthcare while screening results did not. Referral to specialist was related to screening results. Several specialists were reluctant to diagnose and treat latent tuberculosis and to treat persons without a permanent visa in particular. Conclusions: Just 1% of the study group received treatment for latent tuberculosis and with a long time delay. The reason for this may be organizational factors affecting follow-up and referral and specialists not following current guidelines.

Aims: To ascertain the attitudes towards the use of existing diagnostic and research samples, the setting up of a national biobank, and different types of informed consent among Finns. Method: A population survey of 2,400 randomly selected Finns aged 24–65 was conducted at the beginning of 2007. Results: A total of 1,195 responses (50%) were received after one reminder. Of the respondents, 83% said that they had little or no knowledge of what biobanks were. Despite this, 77% regarded the setting up of a national biobank in a positive light. One third (34%) would not attach any conditions on their consent, while 42% said that it was important to regain consent when the new study contains diverging steps. One third (30%) wanted consent to be regained for every new research project, and 44% would like to decide what type of research their samples would be used for if they were included in a national biobank. One third of both men and women approved of the use of their samples in research involving private enterprises. Conclusions: In general, Finns were positive toward the setting up of a national biobank, as well as public–private partnerships, even though they considered their knowledge of biobanking to be limited. This, however, did not mean that they were indifferent to the use of their samples, but most wanted the ability to control how their samples are used.

Aims: In this paper, we examine income- and education-related inequality in small-for-gestational age (SGA) and preterm birth in Denmark and Finland from 1987 to 2003 using concentration indexes (CIXs). Methods: From the national medical birth registries we gathered information on all births from 1987 to 2003. Information on highest completed maternal education and household income in the year preceding birth of the offspring was obtained for 1,012,400 births in Denmark and 499,390 in Finland. We then calculated CIXs for income- and education-related inequality in SGA and preterm birth. Results: The mean household income-related inequality in SGA was -0.04 (95% confidence interval: -0.05, -0.04) in Denmark and -0.03 (-0.04, -0.02) in Finland. The maternal education-related inequality in SGA was -0.08 (-0.10, -0.06) in Denmark and -0.07 (-0.08, -0.06) in Finland. The income-related inequality in preterm birth was -0.03 (-0.03, -0.02) in Denmark and -0.03 (-0.04, -0.02) in Finland. The education-related inequality in preterm birth was -0.05 (-0.07, -0.04) in Denmark and -0.04 (-0.05, -0.03) in Finland. In Denmark, the income-related and education-related inequity in SGA increased over time. In Finland, the income-related inequality in SGA birth increased slightly, while education-related inequalities remained stable. Inequalities in preterm birth decreased over time in both countries. Conclusions: Denmark and Finland are examples of nations with free prenatal care and publicly financed obstetric care of high quality. During the period of study there were macroeconomic shocks affecting both countries. However, only small income- and education-related inequalities in SGA and preterm births during the period were observed.

Aims: To investigate psychosocial characteristics and problems of a representative sample of Swedish drunk drivers with special consideration of the gender of the driver; analyze criminal records of the drivers before and after enrolment in the study; identify psychosocial predictors of relapse to drunk driving. Methods: Psychosocial characteristics were assessed by the Addiction Severity Index (ASI). Alcohol problems were additionally assessed by the Alcohol Use Disorders Identification Test (AUDIT). Criminal records were collected for the five year period before the enrolment, and for the subsequent two years, from Sweden’s official crime statistics. Results: About half of the investigated drivers had other psychosocial problems besides the drink driving offence. Female drivers had more alcohol, drug, psychiatric and relational problems, including with parents when growing up, than male drivers, but less previous and subsequent criminality. Heavily drunk drivers (blood alcohol concentration ≥0.1%) had more problems with alcohol, legal status and employment and support than the other drunk drivers. Problems with legal status, family and social relations and alcohol use increased the risk of relapse in drunk driving, while medical problems seemed to be a protective factor. Different ASI risk factors were identified for relapse in either traffic offences or other crimes. Conclusions: As well as the drunk driving offence, drunk drivers often have other psychosocial problems, female drivers in particular. Already the blood alcohol concentration per se gives some indication of the psychosocial problem profile of a drunk driver and the ASI profile has some prognostic value for relapse in drunk driving.

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

Aims: To estimate the prevalence, time trends and factors associated with paid sex among men. Methods: Norwegian Sex Surveys using similar questions in 1992, 1997 and 2002 were analyzed using a cohort analysis and logistic regression. The questionnaires included demographic background, and several aspects of sexual behaviour. The following questions on paid sex were included: "Have you ever paid for sexual services?" "If yes, how many times?", "How old were you the first time?", "How old were you the last time?", and "Did you use a condom the last time?" Results: Of the 4,545 men who answered this question, 585 (12.9%) reported ever having paid for sex. There was a marked decline overall in reporting from 26.2% in the cohort born in 1927–34, to 5.9% in the cohort born in 1975–84 (p < 0.001). However, there was an increase in the last cohort after the age of around 23 years (p = 0.1). Having paid for sex was significantly associated with being single, being on a disability pension, early sexual debut and having multiple other sex partners; these men were less likely to use condoms when having sex with a cohabiting partner (p < 0.01) and more likely to have had a sexually transmitted infection (p < 0.001). Conclusions: Having paid for sex is associated with high risk sexual behaviour and represents a public health problem. Preventive measures should address men’s behaviour across social groups and marital status and explore the trend among younger men.

Aims: To examine the development of self-assessed and parent proxy-assessed health related quality of life (HRQL) in pre-adolescent schoolchildren. Methods: The population (n = 1,346) consisted of the total cohort of children starting 4th grade (age 10) in 2004 in primary schools in a Finnish city of 175,000 inhabitants. HRQL was assessed using the Pediatric Quality of Life Inventory^TM 4.0 (PedsQL ^TM 4.0). The baseline study was conducted in 2004 (child age 10) and follow-up in a panel setting in 2006 (child age 12). The response rate for the children was 80% (n = 1,094) in 2004 and 85% (n = 1,139) in 2006. The response rate for children having responded both in 2004 and 2006 was 73% (n = 986). For parents of the children, one parent participated in the parents’ survey (n = 999 in 2004, n = 888 in 2006). Results: HRQL scores increased significantly in the two-year follow up (child t = 10.16–5.95, p < 0.0001, parent-proxy t = 6.35–2.76, p < 0.0001–0.006). Correlation between baseline and follow-up assessments was significant (child r = 0.4–0.5, p < 0.0001, parent r = 0.47–0.57, p < 0.0001). The correlation between baseline HRQL and change was negative (child r = -0.67 to -0.56, p < 0.0001, parent r = -0.62 to -0.46, p < 0.0001). Correlation between child and parent assessments increased from baseline (r = 0.20–0.39, p < 0.0001) to follow up (r = 0.3–0.42, p < 0.0001). Conclusions: Child-assessed and parent proxy-assessed HRQL scores increase, suggesting HRQL improves, when children grow from age 10 to age 12. Baseline HRQL may not strongly predict future HRQL in early adolescence. The correlation between child self-assessment and parent proxy-assessment is fragile.

Aims: The overall goal of this paper is to highlight the epidemiology of injury in Lithuania between 1998 and 2006. Such a situation analysis will inform the important dialogue happening in Lithuania with respect to renewal of the trauma programme and help to profile the burden of injury in the country. Methods: Review of the literature, and secondary analysis of data from the Lithuanian Health Information Center and the European Detailed Mortality database. Results: Sixteen articles were identified as population-based studies; only incidence of burn injuries was reported as 240 per 100,000 per year. According to our analysis, the overall incidence of injury increased from 76 cases per 1,000 individuals in 1998 to 121 cases per 1,000 individuals in 2006. The total number of deaths from external causes remained similar with an average of 5,301 per year, as did the age-standardized mortality rates of 152 in 1998 and 150 per 100,000 in 2006. The mortality rate in men was four times higher than in women. Suicide was the most frequent cause of death (34% in 2006); while road traffic injuries were the second most frequent accounting for 17–19% of deaths. There were 429 deaths due to exposure to natural cold in 2006, which constituted 8% of all deaths due to injury. Conclusions: Injury incidence and mortality from external causes in Lithuania has not declined over an eight year time frame. New efforts should be launched in the health sector to address this major cause of deaths.

Aims: The aim is to highlight adoptees’ and stepchildren’s psychiatric contact and diagnoses compared with non-adoptees. Methods: The setting is Greenland and the methodology is a comparative in-ward patient register-based study. The background is the Greenlandic tradition for adoption and community child care and international research stressing that adoptees demonstrate adverse health outcomes. The cohort is in-ward patients (>24 hours), born between 1973 and 2005. Correlation between various dependent and independent variables are analyzed. The research makes different comparative statements of psychiatric admissions and diagnoses related to adoptees and stepchildren compared to non-adoptees with respect to demographic and socioeconomic indicators. The psychiatric data material is collected from 1992 to 2008 and the socioeconomic indicators are included from 1996. Results: The findings show, contrary to findings related to adoptees in Western societies, that being an adoptee in Greenland does not increase the risk for psychiatric admission, but being a "female stepchild" does. The adjusted risk for adoptees is "non-significant" at 1.1 (95% confidence interval (95% CI) 0.6–1.9) but the adjusted risk for female stepchildren is "significant" at 3.4 (95% CI 1.8–6.6). The most frequent diagnosis is "Inherent or acquired brain suffering". The findings open up possibilities for new hypotheses as to reasons for adoptees’ adverse health outcomes in the Western world. Conclusions: Epidemiological and medical contact recording do not exist outside central hospital level in Greenland, therefore, in order to put psychiatric contact patterns into perspective, in-depth field studies are required in close collaboration with the local Greenlandic population.

Aims: Screening instruments for detection of common mental disorders have not been validity tested in long term sickness absence (LSA), which is the aim of this study for the Common Mental Disorders Screening Questionnaire (CMD-SQ). Methods: Of all 2,414 incident persons on continuous sick-leave for more than eight weeks in a Danish population of 120,000 inhabitants 1,121 participated in a two-phased study by being screened for mental disorders by CMD-SQ in Phase 1. A subgroup of 337 was examined by a psychiatrist and diagnosed with Present State Examination in Phase 2. Results performed on Phase 2 were weighted up to Phase 1. Test performance was analyzed by ROC-analyses, and the fraction with a positive screening test, Q, the sensitivity SE, and 1 minus the specificity, SP, were plotted against decreasing cut-point in the tested scales for specific diagnostic groups. Results: A sub-scale in CMD-SQ, SCL-8AD, compiled of SCL-ANX4, SCL-8, and SCL-DEP6, showed the best psychometric properties in detection of any mental disorder (AUC 0.80). Other scales were tested as well. The psychometric properties were dependent on sex and age. The plots of Q, SE, and 1-SP against decreasing cut-point gave a comprehensive view of the performance of the scales, which could be of significance in addressing the ethical aspects of screening. Conclusions: SCL-8AD is a promising candidate for the screening of mental disorders in LSA. It is intended to be administered by the social services because in Denmark there is not a legal requirement that sick-listed persons are certified as sick by a physician.

The article discusses and describes how healthcare reform from 2007 in Denmark has influenced the health sector. This reform has been labelled the most radical reform of the political administrative system since the first democratic constitution in 1849. Local government reform is the latest step in a process of reforming the welfare state and the health sector. In more concrete terms this article analyzes two key issues that have had top priority in the first period of reform implementation – the new planning of hospital structure and the first generation of health agreements.

Background: Most studies on sick building syndrome (SBS) are cross-sectional and have dealt with symptoms among office workers. There are very few longitudinal cohort studies and few studies on SBS in relation to domestic exposures. The aim of this study was to investigate changes in SBS symptoms during the follow-up period and also to investigate changes in different types of indoor exposures at home and relate them to SBS symptoms in a population sample of adults from Sweden. We also wanted to investigate if there was any seasonal or regional variation in associations between exposure and SBS. Methods: A random sample of 1,000 people of the general population in Sweden (1991) was sent a self administered questionnaire. A follow-up questionnaire was sent in 2001. Results: An increased risk for onset of any skin symptoms (risk ratio (RR) 2.32, 1.37–3.93), mucosal symptoms (RR 3.17, 1.69–5.95) or general symptoms (RR 2.18, 1.29–3.70) was found for those who had dampness or moulds in the dwelling during follow-up. In addition people living in damp dwellings had a lower remission of general symptoms and skin symptoms. Conclusions: Dampness in the dwelling is a risk factor for new onset of SBS symptoms. Focus on indoor environment improvements in dwellings can be beneficial both for the inhabitants and the general population. Reducing dampness in buildings is an important factor for reducing SBS symptoms in the general population.

Aims: School is one of the key settings for health education (HE). The objectives of this study are to assess primary school teachers’ self-reported teaching practices in HE and to describe their representation concerning their role in HE. Methods: A quantitative study was conducted on a sample of primary school teachers (n = 626) in two French regions in order to analyze their practices and representations in HE. A hierarchical clustering dendogram was performed on questions exploring representations of HE. Multiple linear regression analysis helped explain the motivation and self-perceived competency score. Results: Three quarters of the teachers declare they work in HE. Only one third of them declare they work in a comprehensive HE perspective. The HE approach is often considered in terms of specific unique curriculum intervention. Two thirds of the teachers say they work alone in HE, the other third associate other partners and choose mainly school health services. Parents are rarely (12%) involved in HE initiatives. It is essentially the practice of HE, teacher training and teachers’ representation of HE that condition their motivation to develop HE. Conclusions: Teachers can take different approaches to HE. Teachers’ representation of HE plays an important role in the development of HE activities: some teachers consider that HE is the mission of the health professionals and the parents. Our expectations of teacher involvement should be realistic, should take into account the representations of their role, the difficulties they encounter, and should be sustained by specific training.

Background: Antonovsky’s concept of "sense of coherence" (SOC) has been shown to be related to health. The aim of this study was to describe the distribution of SOC scores and their components in an adult Swedish population aged 20–80 years. Methods: A random sample of 910 individuals from Jönköping, Sweden, aged 20, 30, 40, 50, 60, 70 and 80 years, of which 589 agreed to participate in an oral health examination. The participants answered Antonovsky’s 13-item version of "the life orientation questionnaire scale". The response to the items and the distribution of the three components of comprehensibility, manageability and meaningfulness were analyzed for different age groups and genders using mean values and standard deviations, Student’s t-test and ANOVA. Results: A total of 526 individuals, 263 men and 263 women, answered all 13 questions and constituted the final material for the study (response rate 89%). The individual SOC score increased with age. The 20 year olds had a statistically significantly lower SOC score compared with the other age groups and 55% of them had a low SOC (≤66 points) compared with 17% of the 80 year olds. Men in the 60 and 70 year age groups had a statistically significantly higher SOC score compared with women of the same age. Conclusions: The individual distribution of SOC varied with age and gender. Twenty year olds had a significantly lower SOC score compared with elderly age groups. Elderly men had a statistically significantly higher SOC score compared with women of the same age.

Background: The eldercare sector is characterized by a shortage of labour and a high turnover rate, which constitutes a major challenge for the ageing societies of western Europe. The aim of the present study was to investigate if a low level of psychological well-being at the time of graduation predicts dropout among eldercare workers two years later. Methods: We included 4,968 female eldercare trainees in this prospective study, recruited from 27 of the 28 Danish colleges for eldercare. Psychological well-being in 2004 was measured with the five-item Mental Health Inventory (MHI-5) of the 36-item Short-Form Health Survey (SF-36). We linked the survey data with national register data to obtain information about labour market attachment two years after qualification. Results: In 2006, 37% of all participants had left the eldercare sector. Compared to participants with high psychological well-being at baseline, participants with medium and low psychological well-being were more likely to dropout to sectors unrelated to health and welfare (odds ratio (OR) 1.40 (95% confidence interval (95% CI) = 1.06–1.85) and 1.66 (95% CI = 1.27–2.19), respectively). They were also more likely to drop out of the labour market (OR 1.48 (95% CI = 1.08–2.04) and 1.60 (95% CI = 1.12–2.20), respectively). Psychological well-being was not related to dropout to other health- and welfare sectors or dropout to further education. Conclusions: The fact that more than one third of all participants had left the eldercare sector two years after qualification demonstrates the importance of retention initiatives early in working life. In addition a focus on psychological well-being among eldercare workers should be considered.

Background: Multidisciplinary teamwork is recommended for various disorders and it has been suggested that it is a way to meet the new challenges and demands facing general practitioners (GPs) in modern society. Attempts to introduce the method in primary care have failed partly due to GPs’ unwillingness to participate. The aim of this study was to measure attitudes towards collaboration among GPs and district nurses (DN) and to investigate whether there is a correlation between a positive attitude toward collaboration and high self-esteem in the professional role. Methods: The Jefferson Scale of Attitudes toward Physician Nurse Collaboration and the Professional Self-Description Form (PSDF) was used to study a cohort of 600 GPs and DNs in Västra Götaland region. The purpose was to map differences and correlations of attitude between DNs and GPs, between male and female GPs, and between older and younger DNs and GPs. Results: Four hundred and one answers were received. DNs (mean 51.7) were significantly more positive about collaboration than GPs (mean 49.4). There was no difference between younger and older, male and female GPs. DNs scored higher on the PSDF-scale than GPs. Conclusions: DNs were slightly more positive about collaboration than GPs. A positive attitude towards collaboration did not seem to be a part of the GPs’ professional role to the same extent as it is for DNs. Professional norms seem to have more influence on attitudes than do gender roles. DNs seem more confident in their profession than GPs.

Background: The objective of this study was to find out the number of publications (in Danish) and research projects (including grey literature) either carried out or ongoing within the field of public health in Denmark, using the same criteria as the SPHERE project, but looking at Danish research databases. Methods: The Danish research database served as the main resource for the study supported by national reserach reports. Results: There is an increasing trend in the number of public health research projects and publications. Compared with public health research projects published in English there are differences in some categories. Overall, public health research in Denmark seems to contribute around 4.8%–6.5% of the total amount of health research. Conclusions: Public health research has a relatively low share of overall health research in Denmark.

Aims: The aim of the work presented here was to explore differences between pet owners and non-pet-owners concerning aspects of health, physical/leisure activities, work and socio-demographics. Methods: The study was based on nationally representative data from the Swedish population (n = 43,589). Associations between pet ownership and background variables were investigated using logistic regression analysis. Results: A total of 39,995 respondents were included in the analysis (non-pet-owners = 25,006; pet owners = 14,989). Pet ownership was associated with both positive and negative aspects of health, physical/leisure activities and socio-demographics. Pet owners had better general health but suffered more from mental health problems than non-pet-owners. Their leisure activities involved a greater interest in nature life and/or gardening than those of non-pet-owners. The logistic regression analysis showed that people who were self-employed, in the age range 35 to 49, of female sex, and suffering from pain in the head, neck and shoulders were more likely to own a pet than others. People physically active at a level sufficient to have a positive effect on their health more often owned a pet than people who were less active. Conclusions: Pet owners differ from non-pet-owners in aspects of socio-demographics, health, physical/leisure activities and work situation. This study, based on a general regional population in Sweden, showed differences of both a positive and a negative kind between non-pet-owners and pet owners concerning aspects of health, physical and leisure activities, and work situation.