Scandinavian Journal of Public Health recent issues

Economic crisis, unemployment and public health

Janlert, U. — Wed, 28 Oct 2009 04:34:27 PDT

Readiness to change level of physical activity in leisure time among physically inactive Danish adults

Pedersen, P. V., Kjoller, M., Ekholm, O., Gronbaek, M., Curtis, T. — Wed, 28 Oct 2009 04:34:27 PDT

Aims: The study examined readiness to change the level of physical activity in leisure time among physically inactive adults, the sociodemographic, lifestyle-related and social factors associated with readiness to change, and finally the various kinds of help to become more physically active required by people who are ready to change and by those not ready to change. Materials and methods: Data were derived from the national representative Danish Health Interview Survey 2005 and included 9,160 physically inactive persons between 16 and 79 years of age. Data were analysed using multiple logistic regression and multiple correspondence analysis. Results: In all, 52 % of the physically inactive respondents stated they were ready to change their level of physical activity. Men had higher odds of being ready to change than women. Readiness to change decreased with age and increased with increasing levels of education. Those ready to change led an active and social lifestyle characterized by considerable health-oriented engagement, while the opposite characterised those not ready to change. Those ready to change wanted help to become more physically active in the form of e.g. opportunities for physical activity at work or help and support from the family. Those not ready to change wanted help from a general practitioner or did not want help at all. Conclusions: Those ready to change and those not ready to change were characterized by very different sociodemographic, lifestyle-related and social factors. This knowledge will benefit prevention initiatives and elucidates the necessity of targeting the initiatives.

Sports camp with six months of support from a local sports club as a treatment for childhood obesity

Nowicka, P., Lanke, J., Pietrobelli, A., Apitzsch, E., Flodmark, C.-E. — Wed, 28 Oct 2009 04:34:27 PDT

Aims: Although childhood obesity is becoming increasingly prevalent, treatment options are limited and the continued development of effective treatment strategies is necessary. It is equally important to explore involvement of other resources in society, such as sports associations. This study was designed to investigate the possibility of reducing the degree of obesity in obese children by focusing on physical activity as an intervention. Methods: Seventy-six children (40 boys) aged 8—12 years (mean age 10.5 years, mean body mass index (BMI) 28.9, standard deviation (SD) 3.0; mean BMI z-score 3.24, SD 0.49) were invited to participate in a one-week sports camp and six-month support system. After the camp a sports coach from a local sports club supported the child during participation in a chosen sport for six months. Weight, height, body composition (using dual energy x-ray absorptiometry and magnetic resonance imaging), and lifestyle (using a questionnaire) were measured at baseline and after 12 months. Data were pooled from two camps, one with a self-selected control group and one randomized controlled trial. Results: Twelve months after the camp the intervention group had a significant decrease in BMI z-score (baseline BMI z-score 3.22; follow up 3.10, p = 0.023). The control group also reduced their BMI z-score (baseline BMI z-score 3.27; follow up 3.18, p = 0.022). No differences were found in baseline values, follow-up values, or changes in BMI z-score between groups, nor between boys and girls. Conclusions: The focus on physical activity as an intervention had no effect on degree of obesity when compared with a waiting list control group.

Review Article: Do exercise and fitness protect against stress-induced health complaints? A review of the literature

Gerber, M., Puhse, U. — Wed, 28 Oct 2009 04:34:27 PDT

Background: Understanding how exercise influences health is important in designing public health interventions. At present, evidence suggests that there is a positive relationship between exercise and health. However, whether this relationship is partly due to the stress-moderating impact of exercise has been less frequently investigated although more and more people are taxed by stressful life circumstances. Methods: A comprehensive review of studies testing the potential of exercise as a stress-buffer was conducted (including literature from 1982 to 2008). The findings are based on a narrative review method. Specific criteria were taken into account to evaluate causality of the evidence. Results: About half of the studies reported at least partly supportive results in the sense that people with high exercise levels exhibit less health problems when they encounter stress. The causality analyses show that stress-moderation effects were consistently found in different samples and with different methodological approaches. Although more support results from cross-sectional studies, exercise-based stress-buffer effects were also found in prospective, longitudinal and quasi-experimental investigations. Conclusions: This review underscores the relevance of exercise as a public health resource. Recommendations are provided for future research. More prospective and experimental studies are needed to provide insight into how much exercise is necessary to trigger stress-buffer effects. Furthermore, more information is warranted to conclude which sort of exercise has the strongest impact on the stress-illness-relationship.

All-cause and cause-specific mortality of social assistance recipients in Norway: A register-based follow-up study

Naper, S. O. — Wed, 28 Oct 2009 04:34:27 PDT

Aims: To investigate the mortality among social assistance recipients, who are among the most marginalized people in Norway. Cause-specific mortality was analysed in an attempt to explain the excess mortality. Previous research has suggested that social disadvantage leads to higher mortality from all causes, whereas others have found substantial variation when studying separate causes. The impact of the various causes will influence policy recommendations. Methods: Data were compiled through linking between Norwegian administrative records. The entire population born between 1935 and 1974 (2,297,621 people) was followed with respect to social assistance and death from 1993 to 2003. Cause-specific, age-standardized mortality rates for social assistance recipients and the rest of the population were calculated, and both the absolute (rate difference) and relative (rate ratio) rates were measured. Results: The rate ratio for total mortality was 3.1 for men and 2.5 for women for the comparison between social assistance recipients and the general population. The mortality among social assistance recipients was higher for all causes, but the magnitude differed considerably, depending on the cause. The rate ratio for men ranged from 1.2 for non-smoking-related cancer to 18.8 for alcohol- and drug-related causes. Alcohol-and drug-related and violent causes together contributed to half of the excess mortality for men and one-third for women. Conclusions: The mortality of this socially disadvantaged group was considerably higher than that of the general population, and this difference reflected mainly drug-related causes.

Capitalists, managers, professionals and mortality: Findings from the Barcelona Social Class and All Cause Mortality Longitudinal Study

Wed, 28 Oct 2009 04:34:27 PDT

Aims: To examine the effects of Neo-Marxian social class (i.e. measured as relations of control over productive assets) and potential mediators such as labour-market position, work organization, material deprivation and health behaviours upon mortality in Barcelona, Spain. Methods: Longitudinal data from the Barcelona 2000 Health Interview Survey (n = 7526) with follow-up interviews through the municipal census in 2008 (95.97% response rate) were used. Using data on relations of property, organizational power, and education, social classes were grouped according to Wright’s scheme: capitalists, petit bourgeoisie, managers, supervisors, and skilled, semi-skilled and unskilled workers. Results: Social class, measured as relations of control over productive assets, is an important predictor of mortality among working-class positions for men but not for women. Workers (hazard ratio 1.60, 95% confidence interval 1.10—2.35), managers and small employers had a higher risk of death than capitalists. Conclusions: The extensive use of conventional gradient measures of social stratification has neglected sociological measurements of social class conceptualized as relations of control over productive assets. This concept is capable of explaining how social inequalities are generated. To confirm the protective effect of the capitalist class position and the ‘‘contradictory class location hypothesis’’, additional efforts are needed to properly measure class among low-level supervisors, capitalists, managers, and small employers.

Long-term sickness absence and social exclusion

Bryngelson, A. — Wed, 28 Oct 2009 04:34:27 PDT

Background: In previous research, ill-health and marginalization from the labour market have been pointed out as potential triggers for being marginalized from other spheres of society as well, e.g. economic, political and social, i.e. social exclusion. However, very few studies have examined the consequences of long-term sickness absence. Aim: The research question raised here is therefore to examine the relationship between long-term sickness absence (≥60 days) and social exclusion among individuals. Methods: The logistic regression analyses are based on longitudinal data (n = 3,144) from the Swedish Level of Living Survey linked to register data. Results: The results suggest that both women and men have higher odds of having no excess cash (‘‘cash margins’’) after their long-term sickness absence, compared with people with no such sickness absence. Women seem more likely to have no cash margins combined with being single/unmarried and having no close friends after long-term sickness absence, than do women without such sick-listing. The results indicate a slight mediating effect of employment status on the odds ratios for these economic and social conditions. Conclusions: The present study suggests that long-term sickness absence increases the risk of adverse economic and social conditions among individuals. That these conditions can be seen as indicators of social exclusion is more doubtful.

Drinking habits and sickness absence: The contribution of working conditions

Salonsalmi, A., Laaksonen, M., Lahelma, E., Rahkonen, O. — Wed, 28 Oct 2009 04:34:27 PDT

Aims: The main aim was to examine whether drinking habits including average, binge and problem drinking are associated with self-certified and medically confirmed sickness absence among middle-aged municipal employees. Another aim was to examine whether psychosocial and physical working conditions and work arrangements explain these associations. Methods: The data on drinking habits and working conditions of 5,119 female and 1,390 male middle-aged employees of the City of Helsinki was obtained from postal questionnaires collected in 2000—2002. The data on sickness absence (2000—2005) were derived from the employer’s registers. Poisson regression analysis with self-certified (1—3 days) and medically confirmed (over 3 days) sickness absence spells as outcomes was used in performing the analyses. Results: Heavy average, binge and problem drinking were all associated with an increase in self-certified sickness absence. Both non-drinkers and heavy drinkers had excess medically confirmed sickness absence compared to moderate drinkers. Problem drinking and among women also binge drinking were associated with medically confirmed sickness absence. Psychosocial working conditions slightly attenuated the association of drinking habits and sickness absence mainly among men. Physical working conditions and work arrangements slightly explained medically confirmed sickness absence among male problem drinkers. Conclusions: All studied drinking habits were associated with both self-certified and medically confirmed sickness absence. Thus, a decrease in unhealthy drinking habits among employees is likely to prevent sickness absence. The effects of working conditions were small but psychosocial working conditions slightly explained the associations between drinking habits and sickness absence mainly among men.

Psychometric analysis of Common Mental Disorders -- Screening Questionnaire (CMD-SQ) in long-term sickness absence

Sogaard, H. J., Bech, P. — Wed, 28 Oct 2009 04:34:27 PDT

Aims: Mental disorders often go undetected in primary care, for persons awarded disability pension, and in sick-leave certificates. No validity tests of instruments for detection and measurement of mental disorders have been performed in long-term sickness absence (LSA). This is the aim of the present study for Common Mental Disorders — Screening Questionnaire (CMD-SQ). Methods: It is validity tested in a well-defined Danish population comprising all persons on continuous sickness absence just exceeding eight weeks. CMD-SQ is composed of SCL-SOM (somatization), Whiteley-7 (illness worry and conviction), SCL-ANX4 (anxiety), SCL-DEP6 (depression), SCL-8 (emotional disorder), and CAGE (alcohol dependency). Results: Of 2,414 incident persons on long-term sickness absence within one year, 1,121 participated in the study by filling in CMD-SQ and a subsample of 337 was diagnosed by a psychiatric examination including Present State Examination. Psychometric properties such as scalability and monotonicity, construct validity, and predictive validity were analyzed. Further change over time was analyzed. SCL-SOM and Whiteley-7 showed slight psychometric and screening statistics whereas a combined scale of SC-ANX4, SCL-DEP6, and SCL-8, called SCL-8AD, showed the best and excellent psychometric and screening statistics. Conclusions: SCL-8AD, a sub-scale of CMD-SQ, is a promising candidate for screening and measurement of mental disorders in long-term sickness absence.

The effect on length of sickness absence by recognition of undetected psychiatric disorder in long-term sickness absence. A randomized controlled trial

Sogaard, H. J., Bech, P. — Wed, 28 Oct 2009 04:34:27 PDT

Background: The burden caused by psychiatric disorders on the individual and society has resulted in more studies examining interventions aimed at reducing sickness absence. Aims: To examine if detection of undetected psychiatric disorders in long-term sickness absence (LSA) would improve the rate of return to work. Methods: Over one year all 2,414 incident persons on LSA in a well-defined population were within one week after eight weeks of continuous sickness absence posted the Common Mental Disorders Screening Questionnaire (CMD-SQ) to screen for mental disorders. In a randomized controlled trial (RCT), of 1,121 responding participants, persons with a minimum level of psychiatric symptoms 420 were allocated to the intervention group and 416 to the control group. The intervention was a psychiatric examination including diagnostics with Present State Examination and feedback regarding treatment and rehabilitation to the participants themselves, general practitioners and the social service taking care of the participants’ rehabilitation back to work. Of the 420 in the intervention group 329 (78.3%) participated in the intervention. The outcomes measure was in an intention treat analysis the rate of return to work. Results: The rate of return to work was non-significantly lower for the intervention group than for the control group, except for persons without a psychiatric sick-leave diagnosis who were sick-listed from full time work, who showed a significantly higher rate of return to work in the intervention group. Conclusions: The effect of interventions for return to work depends on socio-demographic characteristics. Further studies are needed regarding interventions to improve return to work.

Choosing screening instrument and cut-point on screening instruments. A comparison of methods

Sogaard, H. J. — Wed, 28 Oct 2009 04:34:27 PDT

Aims: This study analyzes decisive measures of efficiency of a test, receiver operating characteristic (ROC) analysis and QROC analysis combined with considerations about clinical, health-economic, and ethical aspects when choosing screening instruments. Methods: Analyses of Common Mental Disorders Screening Questionnaire (CMD-SQ) and its subscales SCL-SOM, Whiteley-7, SCL-ANX4, SCL-DEP6, SCL-8, plus combinations, for early detection of psychiatric disorders, are the subject for this analysis. In all, 46.4% of 2,414 new people with continuous sickness absence for more than eight weeks over one year in a well-defined Danish population of 120,000 inhabitants participated in the study. The study was performed as a two phase study. All 1,121 persons in Phase 1 filled in the CMD-SQ. In Phase 2, a random subsample of Phase 1 on 337, the people were further examined by a psychiatrist using SCAN as gold standard. The analyses were performed as weighted analyses on Phase 2. Results: From 17 analyses it was shown that the efficiency of a test, ROC analyses, and QROC analyses resulted in different optimal scales and cut-points. The random possibility of a positive test or negative test in the population is discussed for efficiency and ROC analyses. QROC analyses correct for this by the relative -values as decisive measures. However, QROC analyses may discard tests of value, all depending on the purpose of the test. Conclusions: In supplement to test statistics the capacity of services to follow up on screening, ethics, and health economy are issues that should be considered in deciding what rating scale and cut-point should be adopted.

Sex differences in time trends for overweight and obesity in adolescents: The Young-HUNT study

Bjornelv, S., Lydersen, S., Holmen, J., Lund Nilsen, T. I., Holmen, T. L. — Wed, 28 Oct 2009 04:34:27 PDT

Aims: To investigate sex differences in the prevalence and extent of overweight and obesity in adolescents aged 14—18 years. Methods: Standardized measurements of height and weight were collected from surveys of adolescents in the same geographical area in 1966—69 (n = 8378) and in 1995—97 (n = 6673). The prevalence rates of overweight and obesity were calculated using criteria approved by the International Obesity Task Force. The extents of overweight and obesity were assessed by computing age- and sex-specific body mass index (BMI) percentiles. Results: In 1995—97, 17.2% met the criteria for either overweight or obesity, as compared with 10.7% in 1966—69. The prevalence of overweight and obesity combined was higher in girls (13.0%) than in boys (8.5%) in 1966—69 (difference 4.5%, 95% confidence interval (CI) 3.1—5.9), while no sex difference was found in 1995—97 (girls 16.9%, boys 17.5%, difference —0.6, 95% CI —2.3—1.1). The increase in overweight was greater in boys (6.2PP, 95% CI 4.7—7.6) than in girls (1.9PP, 95% CI 0.4—3.5), while the sex difference in increased obesity was smaller (boys 2.8PP, 95% CI 2.1—3.4, girls 2.0PP, 95% CI 1.3—2.6). The increase in extent of overweight and obesity was highest in boys. The values of the 85th percentile and the 95th percentile in boys increased by 1.3 and 3.0 BMI units, respectively. The corresponding increases in girls were 0.7 and 1.7 BMI units. Conclusions: A marked sex difference in time trends for both the prevalence and extent of overweight and obesity, with a more pronounced increase in boys than in girls, was demonstrated. This might have implications for preventive strategies.

News On Health Policy and Public Health

Wed, 28 Oct 2009 04:34:27 PDT

Public Health Calendar -- Public Health Events

Wed, 28 Oct 2009 04:34:27 PDT

Perinatal health in the Nordic countries -- Current challenges

Hemminki, E. — Tue, 01 Sep 2009 09:02:26 PDT

Sickness absence: Could gender divide be explained by occupation, income, mental distress and health?

Smeby, L., Bruusgaard, D., Claussen, B. — Tue, 01 Sep 2009 09:02:26 PDT

Background: Women have more spells of sickness absence than men but the reasons for this are unknown. We wanted to see if occupation, working conditions, income, health and mental distress may explain this gender difference. Methods: In a health survey in 2000—01 of all Oslo inhabitants aged 40, 45, and 59/60 years, 11,072 (48.7%) participated. Survey data were linked to the National Insurance Administration and Statistics Norway for the 8,174 eligible for sickness pay in the next four years. Occupation, working conditions, general health and mental distress were self-reported, and income was from official statistics. Long-term sickness absence (>16 days) was calculated for 2001—04 as cumulative incidence and number of days reimbursed. Results: Cumulative incidence was 50.1% for women and 34.7% for men in the four years after the survey. An age-adjusted female overweight of 48% was only reduced to 41% by adjusting for occupation, working conditions, income, self-reported health and mental distress. Duration of long-term sickness absence was 17 days more for women than for men, and was not influenced by adjustments. Conclusions: We have not explained why women have more sickness absence than men, either by work-related factors or by general health or mental distress. Factors explaining the gender divide should be sought elsewhere.

Psychiatric disorders in long-term sickness absence -- a population-based cross-sectional study

Sogaard, H. J., Bech, P. — Tue, 01 Sep 2009 09:02:26 PDT

Aims: The study estimates the incidence of psychiatric disorders in long-term sickness absence (LSA; more than eight weeks of continuous sickness absence) over one year. The study is the first accounting for everybody on LSA by linking a psychiatric assessment for all persons on LSA to public registers. Methods: In a Danish population of 120,000 inhabitants all 2,414 incident persons on LSA within one year were posted a questionnaire, of whom 1,121 (46.4%) responded. In a two phase design the 1,121 sick-listed persons were screened for psychiatric disorders. Phase 2 consisted of 844 people with predefined scores on CMD-SQ of whom 423 were randomly invited to a psychiatric examination and 329 participated. A further 11 who did not fulfil the predefined criteria were invited, of whom eight participated. The examination included a diagnostic interview by Present State Examination. Results: The 329 examined persons in Phase 2 showed by binomial tests the following frequencies: any psychiatric disorder 57%, any depression 42%, and any anxiety 18%. In Phase 1, representative for everyone on LSA, the frequencies were 48% for any psychiatric disorder, 35% for any depression, 15% for any anxiety, and 7% for any somatoform disorder. Multivariable analyses showed that female sex and unemployment were predictors of a psychiatric disorder, whereas living with children below 18 years and being a skilled worker carried a reduced risk of a psychiatric disorder. Conclusions: The high frequency of psychiatric disorders necessitates further population-based studies documenting the efficiency of screening and psychiatric examinations in LSA.

The Subjective Health Complaints Inventory: A useful instrument to identify various aspects of health and ability to cope in older people?

Thygesen, E., Lindstrom, T. C., Saevareid, H. I., Engedal, K. — Tue, 01 Sep 2009 09:02:26 PDT

Aims: The aims were to investigate the factor structure of the Subjective Health Complaints Inventory (SHC) in a population of 75 years and above and to identify whether somatic, psychosocial, and coping factors were associated with the SHC factors. Methods: Data from 242 elderly persons were analyzed. The measures were: the SHC Inventory, Sense of Coherence, Social Provision Scale, Self-Rated Health, General Health Questionnaire, Clinical Dementia Rating, Reported Illness, Barthel ADL Index, sex, age, and education. Results: The factor analysis resulted in four subgroups: musculoskeletal pain (15% of variance), gastrointestinal problems (12% of variance), respiratory/allergy complaints (11% of variance), and pseudoneurology (11% of variance). The occurrence of complaints was 76% for musculoskeletal complaints, 51% for gastrointestinal complaints, 30% for flu, 43% for allergy, and 93% for pseudoneurology. Self-rated health and reported illness were significantly associated with musculoskeletal complaints (15% of variance), impairment in activities of daily living (ADL) with gastrointestinal complaints (3% of variance), and finally sense of coherence, self-rated health, and psychological distress were associated with pseudoneurology (32% of variance). No variables were associated with respiratory/allergy complaints. Conclusions: This study supports the stability of the SHC’s factor structure. The low occurrence of health complaints could possibly be due to survival effects, or that old people to a greater extent than younger people compare themselves with aged peers. The subscales focusing on somatic symptoms were explained by reported illnesses and functional impairments to a limited degree only. The pseudoneurology subscale score was associated with psychological measures, particularly ability to cope.

Preventing evictions as a potential public health intervention: Characteristics and social medical risk factors of households at risk in Amsterdam

Van Laere, I., De Wit, M., Klazinga, N. — Tue, 01 Sep 2009 09:02:26 PDT

Aims: The public health problems precipitating evictions are understudied and no systemic data have been collected. We aim to identify the magnitude of evictions and the characteristics and social medical risk factors of households at risk in Amsterdam. This will help inform policies designed to prevent eviction. Methods: In 2003, case workers of housing associations dealing with rent arrears, and case workers of nuisance control care networks, were interviewed and completed questionnaires about households at risk of eviction. Questionnaires included the processes that resulted in eviction and the characteristics and social medical problems of the households involved. Evicted households were compared with non-evicted households. Results: In Amsterdam, over recent years 1,400 evictions, or four per 1,000 dwellings, took place annually. Of 275 households with rent arrears, 132 were evicted. Of 190 nuisance households, 136 were evicted. In both groups, the largest household group were single male tenants between 25 and 44 years. For those reporting rent arrears, social problems were reported in 71%, medical problems in 23%; independent risk factors for eviction were being of Dutch origin (OR 2.38 (1.30—4.36)) and having a drug-addiction problem (OR 3.58 (0.96—13.39)). For the nuisance households, social problems were reported in 46% and medical problems in 82%, while financial difficulties were a risk factor for eviction (OR: 8.04 (1.05—61.7)). Conclusions: In Amsterdam, households at risk of eviction consisted mainly of single (Dutch) men, aged between 25 and 44 years, often with a combination of social and medical problems. Financial difficulties and drug addiction were independent risk factors for eviction. Because of the social medical problems that were prevalent, for prevention practice evictions should be considered both a socioeconomic and a public health problem. Preventing evictions deserves full attention as a potential effective public health intervention.

Effects of leisure-time physical activity on well-being among women: a 32-year perspective

Blomstrand, A., Bjorkelund, C., Ariai, N., Lissner, L., Bengtsson, C. — Tue, 01 Sep 2009 09:02:26 PDT

Aims: To explore potential effects of physical activity on well-being in a population study. Results are from baseline and 32-year follow-ups. Methods: In a population study of 1462 women in five age strata cross-sectional and prospective analysis were carried out. Activity levels were divided into low, intermediate and high. Well-being was based on self-reported well-being using a Likert-type 7-point scale. Results: Cross-sectional analysis showed strong associations between level of physical activity and well-being. The odds ratio (OR) for poor well-being in women with low physical activity compared with physically more active women was, when studied cross-sectionally, after 12 years in 1980—81 3.94, 95% confidence interval (CI) 2.70—5.74, after 24 years in 1992—93 4.01, CI 2.61—6.17, and after 32 years in 2000—01 7.17, CI 3.56—14.44. Similar associations were observed when relating physical activity at baseline to subsequent well-being: after 12 years: OR 2.09, 95% CI 1.31—3.34, after 24 years: OR 2.74; 95% CI 1.56—4.83, and after 32 years: OR 1.49, 95% CI 0.77—2.88. There was a linear correlation between changes in the individual’s physical activity level and her simultaneous changes in experience of well-being between 1980—81 and 1992—93 and between 1992—93 and 2000—01 as well as between 1980—81 and 2000—01. Conclusions: Strong associations were observed between leisure time physical activity level and reported experience of well-being cross-sectionally and prospectively. Well-being increased with concurrent changes in physical activity. Increased physical activity in sedentary individuals appears to promote not only health but also well-being.

Stress and hazardous alcohol use: Associations with early dropout from university

Andersson, C., Johnsson, K. O, Berglund, M., Ojehagen, A. — Tue, 01 Sep 2009 09:02:26 PDT

Background: The transition to studying at university is associated with increased levels of both stress and hazardous alcohol use. The aim of this study is to investigate the influence of these factors on first-year dropout from university studies. Methods: Two complete cohorts of university freshmen at two homogeneous universities, one in the north and one in the south of Sweden, were asked to participate in an intervention study. Participants responded to a baseline questionnaire including measures of stress and alcohol use. Official university records showing dropout over 12 months were collected. Results: A multivariate analysis established that high stress and admission to the northern university were associated with dropout from university studies, while symptoms of depression and anxiety as well as hazardous drinking were not. Conclusions: There is a need to address the issue of stress associated with the start of university studies. It seems important to offer stress-reducing interventions, specifically aimed at reducing transitional stress, as soon as students start university.

The effect of early life factors on 28 day case fatality after acute myocardial infarction

Rajaleid, K., Hallqvist, J., Koupil, I. — Tue, 01 Sep 2009 09:02:26 PDT

Aims: To study the association of size at birth and social circumstances at birth with 28 day case fatality of acute myocardial infarction (AMI). Methods: Based on 1,776 first cases of AMI occurring in Uppsala Birth Cohort (men and women born 1915—1929) between 1964 and 2002. Data on circumstances at birth retrieved from archived obstetric records; data on social characteristics in adulthood, hospitalizations, and date of death obtained through linkage to Censuses, Hospital Discharge Register, and Cause of Death Register. Results: We found a U-shaped association between standardized birth weight and case fatality of AMI in men (p = 0.045 for age and period adjusted quadratic trend over quintiles of standardized birth weight) that was driven by cases of AMI occurring during the early years of follow-up. We found no association between standardized birth weight and case fatality of AMI in women. There was a statistically non-significant inverse association of AMI case fatality with social class at birth as well as with social class and household income in adulthood in the cohort. Marital status was a strong determinant of case fatality in men. Conclusions: Standardized birth weight for gestational age was associated with case fatality of AMI in men. Social class at birth was weakly inversely associated with case fatality of AMI in the cohort.

Barriers to participation in a hospital-based falls assessment clinic programme: an interview study with older people

Evron, L., Schultz-Larsen, K., Fristrup, T. — Tue, 01 Sep 2009 09:02:26 PDT

Aims: To gain new knowledge about barriers to participation in hospital-based falls assessment. Methods: Semi-structured interviews with 20 older people referred to falls assessment at a hospital-based clinic were conducted. A convenience sample of 10 refusers and 10 accepters was collected. Those who refused referral were recruited in relation to a systematic falls screening programme performed by preventive home visitors. Accepters were selected among 72 participants successively completing the falls assessment clinic programme. The time between the interviews was 12 months; different levels of knowledge were expected, owing to accepters’ participation in the programme. Interview transcriptions were thematically analysed. The analysis was directed towards identification of barriers to falls assessment. Results: Barriers to participation were categorized as being either within or outside the falls clinic, and included administration, time, communication, attitudes to fall prevention, and expected future costs. Accepters completing the programme expressed a feeling of being ‘‘met’’ in the system and maintaining authority over their own life, while the refusers expressed concern about the healthcare system taking over their life. Conclusions: This study indicates that older at-risk patients acknowledge their falls problem, but refuse to participate in hospital-based assessment programmes because they expect to lose their authority and to be caught up in the healthcare system. In order to transform the findings of this study to a public health message, we have to consider moving the focus of falls prevention strategies from disease control to the domain of health promotion in order to engage older adults in preventive healthcare.

Obesity and prevalence of risk behaviour for eating disorders among young Danish women

Waaddegaard, M., Davidsen, M., Kjoller, M. — Tue, 01 Sep 2009 09:02:26 PDT

Aims: Danish women aged 16—29 from two nationwide, representative, cross-sectional interview/questionnaire surveys from 2000 and 2005 are analyzed for trends in prevalence of risk behaviour for developing eating disorders and associations to BMI and age. Methods: Participants completed the Danish Health Interview Survey and an 8-item screen, RiBED-8, for risk behaviour for eating disorders. To analyze how the prevalence of risk behaviour depends on age, BMI, and year of survey, logistic regression analyses were applied. On acceptance of no interaction, the effect of each variable was tested and described using odds ratios with 95% confidence intervals. Results: Women aged 16—19 or with a BMI of>25 had the greatest chance of reporting risk behaviour for eating disorders. However, many women in their 20s also had risk behaviour. Prevalence of risk behaviour for eating disorders did not change from 2000 to 2005. Conclusions: The shared risk factors for obesity and eating disorders require further investigation for development of collaborative prevention and treatment strategies that should also be directed towards young women in their 20s as well as young teenagers.

To report or not report? Attitudes held by Norwegian nursing home staff on reporting inadequate care carried out by colleagues

Malmedal, W., Hammervold, R., Saveman, B.-I. — Tue, 01 Sep 2009 09:02:26 PDT

Aims: The aims of this study are, first, to describe attitudes held by nursing home staff on reporting acts of inadequate care committed by their colleagues, and second, to investigate whether nursing staff have different attitudes depending on age, education, and length of experience of working in the healthcare services. Methods: A questionnaire survey was conducted among nursing staff in 16 nursing homes in the central part of Norway. The response rate was 79% (n=616). Results: A positive attitude towards reporting acts of inadequate care committed by their colleagues was held by the participants in this study. Compared with younger staff, the older staff seemed to be more reluctant to report colleagues, to feel less brave, to be more afraid of what would happen to them if they reported, and to agree that it is best to deal with such matters internally. Regarding education, it seemed that a higher educational level was related with a more positive attitude towards a willingness to report and less fear of negative sanctions. Conclusions: Staff who observe acts of inadequate care committed by colleagues agree that it is their intention to report such incidents. Institutions need to develop and implement mechanisms for understanding and evaluating acts of inadequate care, and staff must be encouraged to speak out on behalf of residents rather than be punished for doing so.

Neonatal findings among children of substance-abusing women attending a special child welfare clinic in Norway

Hjerkinn, B., Rosvold, E. O, Lindbaek, M. — Tue, 01 Sep 2009 09:02:26 PDT

Aims: A special child welfare clinic (SCWC) in Norway provides care for pregnant women with substance abuse problems to prevent the adverse effects of substances. The SCWC aims to give treatment without replacements. This article describes neonatal findings among children of substance-abusing women at the clinic. Methods: This was a retrospective cohort study including 62 children whose mothers had attended the SCWC during pregnancy. A comparison group with children of women with no substance abuse was included. Data were collected from medical records and by means of a questionnaire concerning neonatal data, health, and living conditions. SCWC mothers were divided into short-term users (substance use stopped within first trimester) and long-term users (continued moderate substance use throughout pregnancy). Results: Average birthweight and head circumference were significantly lower in the substance-abusing groups: 3084 g and 34.0 cm in the short-term group, 3048 g and 33.9 cm in the long-term group, and 3496 g and 34.8 cm in the comparison group. There was no difference in Apgar score. Substance abuse and psychiatric illness were associated with low birthweight. Long-term users were more likely than comparisons to experience premature birth and have low-birthweight children. This difference was not found among short-term users. We found no difference in Caesarean sections and vacuum extractions. Conclusions: Substance abusers who stop their drug use early in pregnancy tend to have birth outcomes that are similar to those of mothers with no substance abuse. The study indicates that attendance at a voluntary, low-threshold initiative for pregnant substance abusers, with a focus on prenatal care and substance abuse treatment without replacements, may reduce the harmful effect of the abuse on the newborn.

The study design and characteristics of the Danish national health interview surveys

Ekholm, O., Hesse, U., Davidsen, M., Kjoller, M. — Tue, 01 Sep 2009 09:02:26 PDT

Aims: The Danish National Institute of Public Health, University of Southern Denmark has carried out national representative health interview surveys among adult Danes in 1987, 1994, 2000 and 2005. The aim of this study is to describe the characteristics of the design, including the response rates of the four surveys. Methods: The samples in 1987 and 1994 are based on simple random sampling. The samples in 2000 and 2005 are based on stratified random sampling. In addition, all invited to the survey in 1994 were re-invited in both 2000 and 2005. Data were collected via face-to-face interview at the respondent’s home. Following the interview in 1994, 2000 and 2005, all respondents were asked to complete a self-administered questionnaire. Results: The response rate for the face-to-face interview fell from 79.9% in 1987 to 66.7% in 2005 and the response rate for the self-administered questionnaire from 68.1% in 1994 to 51.5% in 2005. The decrease is particularly marked among the young. The mean interview length has increased from 33.3 minutes in 1987 to 50.2 minutes in 2005. Conclusions: The declining response rate in the surveys is a major concern and can pose problems in generalizing data from the surveys to the Danish population. However, these surveys are essential, as the information collected cannot be gathered by means of official statistical registers. Hence, efforts to increase the response rate will be important in the forthcoming surveys.

Review Article: Influence of occupational stress on mental health among Chinese off-shore oil workers

Chen, W.-Q., Wong, T.-W., Yu, T.-S. — Tue, 01 Sep 2009 09:02:26 PDT

Aim: To explore the influence of occupational stress on mental health in off-shore oil production. Methods: A cross-sectional survey was conducted among 561 Chinese off-shore oil workers. The workers were invited to fill in a self-administered questionnaire exploring their socio-demographic characteristics, occupational stress levels, and 12-item general health questionnaire. A hierarchical multiple regression procedure was used to assess the effects of occupational stress on mental health. Results: After controlling for age, educational level, marital status and years of off-shore work, poor mental health was found to have a significant positive association with seven of the nine identified sources of occupational stress. They were: conflict between job and family/social life, poor development of career and achievement at work, safety problems at work, management problems and poor relationship with others at work, poor physical environment of the work place, uncomfortable ergonomic factors at work, and poor organizational structure at work. All of these occupational stress sources together explained 19.9% of the total variance. Conclusions: The results confirmed that occupational stress was a major risk factor for poor mental health among Chinese off-shore oil workers. Reducing or eliminating occupational stressors at work would benefit workers’ mental health.

Do quitters have anything to lose? Changes in body mass index for daily, never, and former smokers over an 11-year period (1990--2001)

Reas, D. L, Nygard, J. F, Sorensen, T. — Tue, 01 Sep 2009 09:02:26 PDT

Aims: 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. Methods: 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. Results: 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 ≥ five years ago. Conclusions: Our finding that former daily smokers (≥ 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 impact of job satisfaction on the risk of disability pension. A 15-year prospective study

Labriola, M., Feveile, H., Christensen, K. B., Bultmann, U., Lund, T. — Tue, 01 Sep 2009 09:02:26 PDT

Objectives: To identify the impact of job satisfaction on the risk of disability pension. Methods: A total of 8,338 employees were sampled from the total working population in Denmark. They were interviewed regarding age, gender, job satisfaction and health behaviour. Interview data were merged with national register data on granted disability pension for up to 15 years after baseline data collection. Results: The study found a statistically significant association between low job satisfaction and disability pension for women when adjusted for age, smoking status and BMI. Conclusions: Based on the results, investing in giving workers a satisfying work environment could be a low-cost way of improving employee health and prolonging labour market participation.

News on Health Policy and Public Health

Tue, 01 Sep 2009 09:02:27 PDT

How can nature and culture promote health?

Tellnes, G. — Fri, 07 Aug 2009 04:04:04 PDT

Work life and mental wellbeing of single and non-single working mothers in Scandinavia

Bull, T., Mittelmark, M. B. — Fri, 07 Aug 2009 04:04:04 PDT

Background: This study examined levels and predictors of mental wellbeing in Scandinavian working single and non-single mothers, with a special focus on financial stress, job characteristics and work—family conflict. Methods: The European Social Survey Round 2 (2005) provided questionnaire data from 73 single and 432 non-single working mothers in Denmark, Sweden and Norway. Respondents answered questions about the outcome variables life satisfaction, happiness, and positive affect, and predictor variables financial stress, job characteristics, work—family conflict, and social support. Hierarchical multiple regression was used to assess the relationships between predictor variables and mental wellbeing outcomes. Results: Single working mothers scored significantly lower on life satisfaction and happiness, but not on positive affect, than did non-single mothers. Financial stress was higher in the single mother group. There were no significant differences in levels of enriching or stressful job characteristics, or in levels of social support. While financial stress and work—family conflict were important predictors in both groups, the relationship between financial stress and wellbeing was far stronger in the single mother group. Confidant support was a significant predictor only in the single mother group, and social participation only in the non-single mothers group. Conclusions: This study suggests that the Scandinavian welfare democracies have not yet been successful in relieving the financial pressure experienced by single working mothers. Development of efficient financial support systems should be prioritized. Ways to reduce work—family conflict in both single and non-single mothers in Scandinavia should also be given increased attention.

Impact of work, health and health beliefs on new episodes of pain-related and general absence-taking

Frost, P., Haahr, J. P., Andersen, J. H. — Fri, 07 Aug 2009 04:04:04 PDT

Objectives: To evaluate the impact of physical and psychosocial workloads, and self-reported health aspects and health beliefs, on the risk of new episodes of pain-related and general sickness absence. Methods: This was a cohort study with 2 years of follow-up of 3583 employed participants, 18—64 years of age. A questionnaire was used to obtain information about workloads, physical and mental health, fear avoidance and other health beliefs. Sickness absence data were collected from company reports, supplemented by self-report of the health problem to which absence was attributed, and by linkage to a central register of state-funded income loss compensation. Results: Sickness absence of at least 14 days and pain-related absence of at least 7 days was experienced by 24.9% and 5.2%, respectively, while 14.2% received state-funded income loss compensation. Physical work demands, working in the public sector, pain intensity, care-seeking behaviour, female gender and compensated sickness absence in the year prior to follow-up were the most important predictors of new episodes of sickness absence. Pain-related absence was associated with the same variables and also with high body mass index, but effect sizes differed. Psychosocial workloads, health anxiety and fear avoidance beliefs were unrelated to any of the absence measures used. Conclusion: Risk factors for general absence and for pain-related absence in unselected working populations are similar but of different effect sizes. A potential primary prevention area could be the provision of accommodating workplaces for employees with pain problems. The mechanisms behind the influence of care-seeking behaviour warrant further research.

Unintentional injuries in children of Danish and foreign-born mothers

Laursen, B., Moller, H. — Fri, 07 Aug 2009 04:04:04 PDT

Aims: Unintentional injuries in children of foreign-born mothers were studied and compared with those in children of Danish-born mothers. Methods: A population of 173,504 children living in 32 municipalities in Denmark was followed from 1998 to 2003. Detailed information on childhood unintentional injuries from hospital records was linked to register data on parents’ education, country of origin, income, family type, etc. Poisson regression was used to analyse differences in injury risk between children of different origins. Results: We found 133,649 injuries, of which 15,389 occurred in children of foreign-born mothers. The injury rates in children of Western and non-Western origin were 0.83 (0.70—0.98) times and 0.84 (0.79— 0.90) times that of children of Danish-born mothers, respectively. The difference was largest in children of families with unemployed parents. The injury rate in girls of non-Western origin was 29% lower than in girls of Danish origin, while the rate in boys of non-Western origin was only 5% lower than in boys of Danish origin. This gender difference was particularly pronounced for sports and traffic injuries. Children of non-Western origin had a three-fold higher rate of burns caused by hot water, tea or oil than children of Danish origin. Conclusions: Prevention of injuries in children of non-Western origin should especially focus on scalds from tea, oil, and hot water.

Cost-effectiveness in fall prevention for older women

Hektoen, L. F., Aas, E., Luras, H. — Fri, 07 Aug 2009 04:04:04 PDT

Aims: The aim of this study was to estimate the cost-effectiveness of implementing an exercise-based fall prevention programme for home-dwelling women in the !80-year age group in Norway. Methods: The impact of the home-based individual exercise programme on the number of falls is based on a New Zealand study. On the basis of the cost estimates and the estimated reduction in the number of falls obtained with the chosen programme, we calculated the incremental costs and the incremental effect of the exercise programme as compared with no prevention. The calculation of the average healthcare cost of falling was based on assumptions regarding the distribution of fall injuries reported in the literature, four constructed representative case histories, assumptions regarding healthcare provision associated with the treatment of the specified cases, and estimated unit costs from Norwegian cost data. We calculated the average healthcare costs per fall for the first year. Results: We found that the reduction in healthcare costs per individual for treating fall-related injuries was 1.85 times higher than the cost of implementing a fall prevention programme. Conclusions: The reduction in healthcare costs more than offset the cost of the prevention programme for women aged !80 years living at home, which indicates that health authorities should increase their focus on prevention. The main intention of this article is to stipulate costs connected to falls among the elderly in a transparent way and visualize the whole cost picture. Cost-effectiveness analysis is a health policy tool that makes politicians and other makers of health policy conscious of this complexity.

Disability pensioning: The gender divide can be explained by occupation, income, mental distress and health

Claussen, B., Dalgard, O. S. — Fri, 07 Aug 2009 04:04:04 PDT

Background: We aimed to test the hypothesis that gender divide in disability pensioning is attributable to differences in health, mental distress, occupation, and income. Methods: In a health survey between 2000 and 2001, a total of 11,072 (48.7%) of all Oslo inhabitants aged 40, 45, 59, and 60 years participated. Survey data were linked to data from the National Insurance Administration and Statistics Norway for 10,421 of the participants, and 9,195 of those were eligible to receive disability pension at the end of 2000. Occupation, general health, and mental distress were self-reported, while income was obtained from official statistics. Results: Approximately 5% of the eligible sample received a disability pension during the four years following the health survey. The age-adjusted odds of receiving disability pension for women was greater (odds ratio = 1.41) than for men. Self-reported health significantly contributed to the risk of receiving a pension, and seemed to reduce the imbalance in disability rates between the genders, as did adjusting for level of mental distress. Further adjustment for occupation and working conditions reduced the gender divide to an insignificant level, and the inclusion of income level (income three years prior to pensioning) completely eliminated any gender difference in risk of receiving a pension. Conclusions: Gender differences in disability pensioning in Oslo are attributable to women’s poorer self-reported health, greater levels of mental distress, lower wages, and more unfavourable working conditions such as job strain and less control over work.

Attributes of competence -- on GPs' work performance in daily practice

Landstrom, B., Mattsson, B., Rudebeck, C. E. — Fri, 07 Aug 2009 04:04:04 PDT

Aim: The core competencies of general practitioners (GP) are ordinarily formulated by professional bodies and international organisations, like the World Organization of Family Doctors (Wonca). Official documents are sometimes questioned as being too comprehensive and products of the drawing board. The aim was to explore clinically oriented GPs own description of the proficiency used in everyday practice. The study could be essential both for GPs and other professionals who work with consultations. Method: Group interviews with GPs selected by regional supervisors and with substantial clinical competence were carried out. The verbatim transcribed sessions were analyzed with a qualitative content analysis approach. Results: Two main categories emerged reflecting the competence: ‘‘Professional readiness’’ and ‘‘Working behaviour’’. Professional readiness comprises the inclination of understanding and acting based on the subcategories: medical knowledge modified by experience, knowing the patient, involvement and uncertainty. Working behaviour describes in a more concrete way the doctoring approach and is formed by the subcategories: preparation, the current problem, use of time, body attention, cooperation with other professionals, and record keeping as a work aid. Conclusions: The attributes of competence of GPs empirically have two components: professional readiness and working behaviour. Together they compose a comprehensive picture of the GP’s everyday clinical setting.

Psychiatric status among stepchildren and domestic and international adoptees in Denmark. A comparative nationwide register-based study

Laubjerg, M., Christensen, A. M., Petersson, B. — Fri, 07 Aug 2009 04:04:04 PDT

Aims: To investigate adoptees’ psychiatric contact compared with non-adoptees and to clarify the related diagnoses. Method: Observational, nationwide, register-based study, where correlations between psychiatric, demographic and socioeconomic variables were analyzed for adoptees compared with non-adoptees. The study period is 1992—2008. The setting is Denmark, encompassing seven different types of adoptees registered from 1988 to 2005 (n = 13,524). The non-adoptees (n = 839,989) are matched on sex, age and residence. Various comparison models are designed: one with delayed entries (17 years) shows a 5.0% psychiatric contact prevalence for non-adoptees and 9.2% for adoptees (adjusted odds ratio: 2.91). Another design without delayed entries (2 years) shows a 2% prevalence for non-adoptees and 3.9% for adoptees (adjusted odds ratio 2.65). p-values <0.0005. Results: Only one type of adoptee: ‘‘registered partner’s adoption of the other partner’s child’’ has a lower risk than non-adoptees (odds ratio: 0.26). Comparison within the same birth region shows a significant increased risk for most adoption types. More adoptees than non-adoptees have more than one contact. Age at adoption is an additional risk factor for4one year only. The most frequent diagnosis is ‘‘Inherent or acquired brain suffering’’ (ICD-10: F50 — F99). Conclusions: The results stress that ‘‘adoptee’’ is an independent risk factor for psychiatric contact for international as well as for Danish adoptees. Danish stepchildren have a higher risk than non-adopted Danish children, while ‘‘registered partner’s child adopted by the other partner’’ have a lower risk than non-adopted Danish children.

Self-reported faintness or dizziness -- comorbidity and use of medicines. An epidemiological study

Tamber, A.-L., Bruusgaard, D. — Fri, 07 Aug 2009 04:04:04 PDT

Aim: The aim of this study was to explore the prevalence of dizziness in a general population and the association between dizziness and socio-demographic variables, self-reported diseases and medicines used. We hypothesize that dizziness was associated with different diseases and medicines as well as the number of diseases and the number of medicines used. Materials and methods: We used data from a cross-sectional survey with 17,638 participants aged 30, 40, 45, 59/60 and 75/76 in the Oslo Health Study who had answered a self-administered questionnaire in 2000—2001. Associations were analyzed by descriptive statistics, chi-square tests, independent t-tests and logistic regression. Results: The prevalence of self-reported faintness or dizziness was 28.7%, reported more often by women than men and by age group 75/76. Participants with neck shoulder pain/stiffness, mental disorders, fibromyalgia/chronic pain syndrome, stroke/cerebral haemorrhage, angina pectoris and chronic bronchitis/emphysema, as well as use of tranquillizers, sedatives, and ‘‘other medicines on prescription,’’ had a significantly increased likelihood of being troubled by faintness or dizziness. An increasing number of reported diseases and an increasing number of medicines used gave an increasing likelihood of faintness or dizziness. In the multivariate analysis controlling for socio-demographic variables, diseases and use of medicines, the oldest did not have an increased likelihood of faintness or dizziness. Conclusions: Self-reported diseases and medicines used could explain a modest rise in the prevalence of faintness or dizziness by age. Sum of diseases and sum of medicines used were associated with reporting dizziness to a greater extent than the different diseases and medicines used.

Impact of self-reported multiple chemical sensitivity on everyday life: A qualitative study

Skovbjerg, S., Brorson, S., Rasmussen, A., Johansen, J. D., Elberling, J. — Fri, 07 Aug 2009 04:04:04 PDT

Background: Multiple chemical sensitivity (MCS) is a descriptive term covering symptoms attributed to exposure to common airborne chemicals. There are no internationally accepted criteria, but it has been suggested that MCS is a chronic and disabling condition. However, details of the impact of MCS on everyday life are limited. Objective: To describe the impact of MCS on everyday life, strategies for managing the condition, and experiences with healthcare management. Methods: A focus group study was conducted, including two interviews with a sample of six women and six men between 27 and 78 years of age, a duration of MCS of at least 1 year, and with different occupational conditions. Results: MCS may severely influence different aspects of everyday life, including lifestyle, social relations, and occupational conditions. Avoiding common airborne chemicals was the most prevalent coping strategy, which implied creating a chemical-free living space and limiting social activities. Experiences with healthcare management were overall reported as negative in terms of not receiving acknowledgement of the reported symptoms. Conclusions: MCS may have serious implications for daily functioning. Further research on individual consequences and the social and psychological factors that may be associated with MCS is needed in order to add to our understanding of this condition and to the provision of more satisfactory healthcare.

Perceived change in life satisfaction following epilepsy diagnosis

Naess, S., Eriksen, J., Tambs, K. — Fri, 07 Aug 2009 04:04:04 PDT

Aims: To study the development in perceived life satisfaction of people with epilepsy. Methods: In 2005, members of the Norwegian Epilepsy Association responded to a version of the Self-Anchoring Striving Scale (termed Cantril’s Ladder). In this article, we compare the answers given to two questions, one related to the person’s life satisfaction today, and the other related to the person’s life satisfaction 5 years ago. The same people were asked about time since epilepsy onset. Those who reported being diagnosed during the previous 5 years were compared with those who had been diagnosed earlier, with regard to reported life satisfaction, at the present and 5 years ago. The hypothesis to be tested was that people who have been diagnosed with epilepsy report their life satisfaction as being reduced in comparison to their life satisfaction before the diagnosis. Results: The hypothesis was confirmed. The respondents in our study who had been diagnosed less than 5 years ago perceived their life satisfaction to be reduced by almost a standard deviation as compared to their life satisfaction before the diagnosis. Conclusions: People diagnosed with epilepsy perceive their life satisfaction to be reduced as a consequence of the diagnosis, and should be supported in their coping with the disease. This conclusion should be drawn with caution, owing to a low response rate and difficulties related to retrospective self-reports. Prospective population-based studies are needed to explore the causal pathways.

The social and economic determinants of smoking in Moscow, Russia

Stickley, A., Carlson, P. — Fri, 07 Aug 2009 04:04:04 PDT

Background: Despite a high prevalence of smoking for decades, recent research has documented an increase in the rates of both male and female smoking in post-Soviet Russia. As yet, however, little research has taken place on smoking at the subnational level. The current study addresses this deficit by examining smoking in Moscow — the city that has been at the forefront of the entry into the Russian market of transnational tobacco corporations (TTCs) in the transition period. Methods: Data were obtained from the Moscow Health Survey 2004 — a stratified random sample of 1190 people representative of Moscow’s larger population. Information was obtained about subjects’ smoking habits and age of smoking initiation. Results: The prevalence of smoking was high among both men (55.5%) and women (26.9%), with significantly higher rates in the younger age groups. There was also a high prevalence of smoking initiation before age 15 years, especially in the youngest women (18—30 years). Logistic regression analysis showed that respondents’ age, binge drinking, locus of control and economic situation were important determinants of smoking. Conclusions: Although lifestyle factors seem to underpin the generally high levels of smoking, other things, such as its high prevalence in the younger generations and the factors associated with smoking (locus of control), nevertheless suggest that the TTCs may have played an important role in the spread of smoking in transitional Russia’s changing social environment.

C-reactive protein variations for different chronic somatic disorders

Lund Haheim, L., Nafstad, P., Olsen, I., Schwarze, P., Ronningen, K. S. — Fri, 07 Aug 2009 04:04:04 PDT

Aims: To compare the levels of C-reactive protein (CRP) in a range of chronic disorders such as osteoporosis, asthma, diabetes, chronic bronchitis/emphysema, myocardial infarction, current oral infections, stroke, angina pectoris, hay fever, and fibromyalgia/chronic pain syndrome. Methods: In all, 5,323 men took part in the first and second health screening of the Oslo Study in 1972/73 and 2000. Questionnaire information on medical history recorded at the second screening was used to identify men with relevant diseases. Serum samples collected in 2000 were stored for later analyses of CRP. In 2000 the men were aged 48—77 years. Results: Men with self-reported myocardial infarction, asthma, diabetes, chronic bronchitis/ emphysema, osteoporosis or fibromyalgia/chronic pain syndrome had significantly elevated mean levels of CRP versus non-cases. Men with osteoporosis had the highest mean values of 6.53 versus 3.55 mg/l in participants without this disease. Cases of asthma also had an increased mean CRP level of 5.01 versus 3.47 mg/l in non-cases and in chronic bronchitis/emphysema the corresponding levels were 4.42 versus 3.59 mg/l. Men with diabetes had 4.53 versus 3.53 mg/l and men with myocardial infarction had 4.27 versus 3.59 mg/l. In fibromyalgia/chronic pain syndrome the values were 4.79 mg/l and 3.60 mg/l respectively. Conclusions: Elevated CRP levels were observed in elderly men in a number of chronic diseases, indicating a persistent inflammatory response. Mean levels varied according to the disease and indicated a baseline level in the individuals with a particular disorder. This is useful knowledge when CRP is used in the clinic for infection and inflammation status.

Reimbursement for drugs -- a register study comparing economic outcome for five healthcare centres in areas with different socioeconomic conditions

Semark, B., Fredlund, K., Astrand, B., Brudin, L. — Fri, 07 Aug 2009 04:04:04 PDT

Aims: Previous studies have indicated the negative effects of socioeconomic deprivation on health status and morbidity. Nevertheless, the economic assignment systems for pharmaceutical benefits in Sweden do not take socioeconomic status (SES) into account. The aim of the study was, therefore, to compare reimbursement for subsidized drugs at primary healthcare centres (HCCs) with differing socioeconomic conditions in relation to real costs. The word reimbursement is used to denote economic compensation to the HCCs from the county council for drug benefit costs. Methods: The numbers of individuals dispensed drugs, total costs and reimbursement at five HCCs with different socioeconomic conditions were compared. A socioeconomic index was calculated for each HCC on the basis of information from the municipality registries on income (with negative sign), assistance allowance, education, foreign background, and unemployment. Register data on drug benefit costs were retrieved from the National Corporation of Pharmacies (Apoteket AB) and the Swedish Prescribed Drug Register at the National Board of Health and Welfare. Data on listed and unlisted citizens at the Kalmar County Council and on public statistics from registers at the HCC municipalities where the HCCs were situated were retrieved. Results: There was an almost inverse linear relationship between total cost compensation and the socioeconomic index (n = 5; r =-0.99; p = 0.001). The HCCs with the lowest SES received lower cost compensation. Conclusions: HCCs responsible for citizens with lower SES appeared to be disadvantaged by the prevalent reimbursement system in Sweden, thereby increasing differences in the state of health of the citizens. This, in turn, hampers health preventing programmes and lifestyle interventions. An HCC-specific standardized summary of socioeconomic burden is presented.

The prevalence of problematic gambling behaviour: A Scandinavian comparison

Bonke, J., Borregaard, K. — Fri, 07 Aug 2009 04:04:04 PDT

Aims: On the basis of a new large-scale screening for the prevalence of problematic gambling behaviour in Denmark, the aim of the study was: (a) to evaluate the effect of applying different screening tools; and (b) to compare gambling behaviour in Denmark with the prevalence of problematic gambling behaviour in other Scandinavian countries. Methods: The screening tools applied were the internationally validated SOGS-R and NODS. These were used within the same survey, thus allowing for comparison with surveys conducted in other Scandinavian countries where either the one or the other tool has been utilized. Results: The prevalence of at-risk gamblers, problematic gamblers and pathological gamblers was significantly lower in Denmark than in the other Scandinavian countries. This held true for both genders as well as for different age groups in comparisons of Denmark and Norway. Conclusions: There is a considerable variation in the prevalence of problematic gambling between the Scandinavian countries, with Denmark having the smallest number of gamblers with problematic behaviour. The variation might be due to national differences in gambling preferences, access to games, public policies concerning gambling, etc., but investigation of this would require further comparative research.

Cross-national comparisons of non-harmonized indicators may lead to more confusion than clarification

Ekholm, O., Bronnum-Hansen, H. — Fri, 07 Aug 2009 04:04:04 PDT

Aims: A newly published study showed that the life expectancy for Danes was below the European Union (EU) average. Furthermore, the study showed that healthy life years (HLYs) at 50 years of age were much higher in Denmark than in the other EU countries in 2005. However, the results of this study should be interpreted with caution. Methods: The analyses regarding HLYs were based on the global long-term activity limitation index as a measure of disability and were included in the EU Survey on Income and Living Condition (EU-SILC). In Denmark two response categories were used to asses long-term activity limitation (yes; no) compared to three levels in all other countries (severely limited; limited but not severely; none). In addition, the wording of the question in Denmark makes cross-national comparisons even more inadequate. The questions and the response categories were revised in the Danish SILC-2008. Results: A comparison of the previous and the revised indicator shows that the estimated number of HLYs at 50 years of age is approximately three years lower for both men and women in 2008 than in 2005. Furthermore, in Denmark data was collected via telephone interviews or postal questionnaires. However, in almost all other countries data was collected via face-to-face interviews. It is well known that the mode of data collection may affect response distributions. Conclusions: Results based on non-harmonized indicators should always be interpreted cautiously to avoid policy-makers and others reaching erroneous conclusions.

Lost in laterality: interpreting ''preferred side of the head during mobile phone use and risk of brain tumour'' associations

Schuz, J. — Fri, 07 Aug 2009 04:04:04 PDT

Due to the highly localized exposure from mobile phones, the preferred side of the head during their use is important information when investigating a possible link with brain tumour risk, but at the same time, error and bias hamper the assessment of this information in case-control studies. Current studies provide evidence of reporting bias insofar as cases appear to over-report the side of the head where the tumour occurred as the one that they preferred in the past when using mobile phones. More refined methods of analysis among only cases or prospective studies with an assessment of the laterality of mobile phone use before the diagnosis of disease are needed to evaluate whether associations seen in some studies are entirely due to reporting bias or a mixture of reporting bias and a causal effect.

News On Health Policy and Public Health

Fri, 07 Aug 2009 04:04:04 PDT

Public Health Calendar -- Public Health Events

Fri, 07 Aug 2009 04:04:04 PDT

Quantitative health impact assessment modelling

Bronnum-Hansen, H. — Tue, 30 Jun 2009 07:07:51 PDT

Socioeconomic inequalities in the employment impact of ischaemic heart disease: a longitudinal record linkage study in Sweden

Holland, P., Burstrom, B., Moller, I., Whitehead, M. — Tue, 30 Jun 2009 07:07:51 PDT

Aims: Low socioeconomic status is associated with increased risk of ischaemic heart disease (IHD) in many European and North American countries. We hypothesize that the adverse impact of having IHD may also be heavier in lower socioeconomic groups and may constitute a mechanism for generating or reinforcing social inequalities in health. Methods: Population registers of the 1.8 million residents of Stockholm County were used to assess the employment consequences over five years of having a diagnosis of IHD (600 cases) requiring hospital admission in 1996. We calculated annual age-standardized employment rates and age-adjusted odds of leaving employment during 1997—2001 by social class for in-patients and the general population. Results: Men and women who had an in-patient episode for IHD had lower age-standardized employment rates than the general population. Following hospital admission, the likelihood of patients with IHD leaving employment increased annually, and by 2001 their adjusted odds were almost four times greater (odds ratio 3.95, 95% confidence interval 3.23—4.83) than for the general population. The impact of IHD on employment was more severe with decreasing social class and patients employed in low-skilled manual occupations were significantly more likely to lose employment than professional workers with the same diagnosis. Within each social class patients had significantly higher odds of leaving employment than the general population. Conclusions: In spite of its progressive employment and rehabilitation policies, our study revealed considerable and socially differentiated employment consequences of IHD in Sweden. More account needs to be taken of such differential impact in health and social policy development.

Generation of a Danish TTO value set for EQ-5D health states

Wittrup-Jensen, K. U., Lauridsen, J., Gudex, C., Pedersen, K. M. — Tue, 30 Jun 2009 07:07:51 PDT

Aims: Health policy decisions should be based on national social preferences. In the absence of a set of Danish health preferences, patient outcome studies using the EQ-5D instrument have typically used UK health state valuations. This article describes the development of a Danish EQ-5D value set. Methods: Regression modelling was based on Time Trade-Off (TTO) data derived from computer-assisted interviews conducted with 1,332 respondents from the Danish general population. Using a split-sample technique, 46 health states were directly valued by the respondents. Five different model types were tested and compared on statistical and theoretical grounds. Eleven different specifications were then tested for the chosen model type to identify the most appropriate model that had high explanatory power and parameters that were both consistent (positively signed) and statistically significant. Results: An additive random effects model was found to be superior to ordinary least squares, fixed effects, random coefficient and censored Tobit modelling approaches. From the 11 model specifications tested, the TTO3 model (main effects model, without an N3 factor) performed best and was used to generate a Danish set of health state preferences. Conclusions: An additive random effects model appears to adequately generate a Danish set of EQ-5D health state preferences. The model has high explanatory power and produces consistent and significant parameters for EQ-5D dimensions and levels. It is recommended that this value set be used in Danish cost-utility studies using EQ-5D.

Danish EQ-5D population norms

Sorensen, J., Davidsen, M., Gudex, C., Pedersen, K. M., Bronnum-Hansen, H. — Tue, 30 Jun 2009 07:07:51 PDT

Background: The EQ-5D is a widely used generic health-related quality of life instrument that has been used to describe population health and health outcomes in clinical trials and health economic evaluations. Aims: To generate Danish population norms for the EQ-5D index score, stratified by age and gender. Methods: The EQ-5D data from three population health surveys were pooled, thus providing EQ-5D profile data for 15,700 individuals aged 20-79 years. The Danish TTO scoring algorithm was used to weight each respondent's profile data to derive a single index score. Mean values were computed by gender and 10-year age groups, and educational groups. Results: In a random sample from the general Danish population, the mean EQ-5D index score ranged between 0.93 for 20—29 year-olds and 0.83 for 70—79 year-olds. Men had a significantly higher score than women in all age groups. Longer education was associated with higher EQ-5D index score in most age groups. Conclusions: The calculated mean values for the EQ-5D index score may be used as reference values for comparative purposes in future Danish population health and evaluative studies.

Mortality patterns in geographical areas with a high vs. low Sami population density in Arctic Norway

Brustad, M., Pettersen, T., Melhus, M., Lund, E. — Tue, 30 Jun 2009 07:07:51 PDT

Aims: The aim of this study was to study mortality patterns in the population in different geographical locations in northern Norway on the basis of Sami population density. Methods: Mortality statistics by sex and age from 1991 to 2006 were obtained from Statistics Norway. Mortality rates, including infant mortality rates, were compared across geographical locations. The data material was divided into within and outside the the geographical areas of the Sami Development Fund (SUF) and into coastal and inland residence. Differences in mortality rates were tested by chi-quadrate tests. Results: Overall, no pronounced difference in mortality rate was found in the population between geographical areas. For men, mortality rates differed only between geographical residence in the time intervals 1991—95 and 1996—2000 for the age groups 45—59 years and 60—74 years, respectively, with outside SUF area, inland having the lowest rate. For women, there were no differences between geographical areas except for the age group 60—74 years in the time period 1991—95, where SUF coast had the highest mortality rate. For the SUF area, men had the lowest probabilities for surviving the age of 74 years and women had among the highest. No geographical difference was found in infant mortality. During the time period 1991—2006, the outside SUF area, inland had an average infant mortality rate of 1.8/1000 per year, and for SUF coast it was 6.2/1000 per year. This difference was, however, not significant (p = 0.08). Conclusions: Overall, mortality rates were similar across geographical areas with low and with high Sami population density. However, indications of geographical differences in infant mortality should be investigated further.

Lung cancer mortality: Comparing Sweden with other countries in the European Union

Rodu, B., Cole, P. — Tue, 30 Jun 2009 07:07:51 PDT

Aims: To describe how snus use has reduced smoking among men in Sweden, and to estimate how smoking-attributable lung cancer mortality would decline in other European Union countries if they had the smoking prevalence of Sweden. Methods: Lung cancer mortality rates (LCMRs) and numbers of deaths among men and women age 45+ years in 25 EU countries in 2002 were obtained from the World Health Organization mortality database, and the number of lung cancer deaths expected in each country at the LCMR of Sweden was calculated. LCMRs for EU countries were obtained during the period 1950-2004, and per capita consumption of nicotine from cigarettes and snus was estimated for men in Sweden from 1931 to 2004. Results: There were 172,000 lung cancer deaths among men in the EU in 2002. If all EU countries had the LCMR of men in Sweden, there would have been 92,000 (54%) fewer deaths. In contrast, the LCMR among Swedish women was the sixth highest in the EU; at the Swedish rate, deaths among EU women would have increased by 14,500 (26%). These LCMR patterns were in place for most of the last 50 years, and LCMRs among Swedish men can be correlated with snus and cigarette consumption. Conclusions: This study shows that snus use has had a profound effect on smoking prevalence and LCMRs among Swedish men. While it cannot be proven that snus would have the same effect in other EU countries, the potential reduction in smoking-attributable deaths is considerable.

Snuff use associated with abdominal obesity in former smokers

Sundbeck, M., Grahn, M., Lonngren, V., Mansson, N. O., Rastam, L., Lindblad, U. — Tue, 30 Jun 2009 07:07:51 PDT

Aim: To describe the consumption of snuff in a rural male population and to explore associations between snuff use and obesity. Participants and Methods: Tobacco use was explored in 834 men aged 30—75 years old who participated in a cross-sectional population survey in the municipality of Vara (participation rate was 81%). Self-reported questionnaires assessed the habits of smoking and snuff use. Anthropometric measures were obtained during a health examination. Results: Of these men 21% (n = 179) were snuff users, 13% (n = 109) current smokers, and 65% (n = 546) were non-users. Of all snuff users 65% (n = 116) were former smokers, and 35% (n = 63) were exclusive snuff users (current users who never smoked). Among non-users 65% (n = 357) were never users and 35% (n = 189) had quit smoking without nicotine substitution. These men were characterized by abdominal obesity; OR 1.84 (1.08—3.12) (p = 0.002) (WHR 41.0) and OR 1.71 (1.08—2.72) (p = 0.022) (waist circumference 4102 cm). One can/week use of snuff among ex-smokers was associated with a 1.21 cm wider (0.05—2.36) (p = 0.041) waist circumference and 0.01 (0.00—0.02) units higher (p = 0.021) WHR. There were statistically significant associations between former smoking without current nicotine substitute and both general and abdominal obesity. No similar association with abdominal obesity was seen among exclusive snuff users. Conclusions: Abdominal obesity in current snuff users is limited to former smokers. The remaining effect of previous smoking has to be considered in future studies on obesity and related disorders in snuff users. Counselling among people who substitute snuff for smoking should include measures to prevent weight gain.

Effectiveness in political--administrative decision-making in specialized healthcare

Simonen, O., Vtanen, E., Konu, A., Blom, M. — Tue, 30 Jun 2009 07:07:51 PDT

Aim: To investigate the occurrence of the word ``effectiveness'' in the political—administrative decision-making minutes in specialized healthcare as presented to board and council meetings by top management teams. Methods: The occurrence and intended use of ``effectiveness'' were identified from all council and board meeting minutes (n = 190) of five Finnish university hospital districts in 2001 and 2006. Data were collected from the Internet pages of the hospital districts. For analysis, deductive content analysis combining qualitative and quantitative methodologies was used. Results: The word ``effectiveness'' occurred in the planning, organization and evaluation of service activities and in the definitions and justifications for the goal states of research and development work. Although objectives were justified by effectiveness, the occurrence and use of the term were not grounded on proven effectiveness but rather represented an ideal being pursued. Use of the word ``effectiveness'' increased from 2001 to 2006, particularly in the political—administrative decision-making of large hospital districts. This article gives useful information regarding the benefits of effectiveness in political—administrative decision-making. Conclusions: Healthcare is under pressure to increase effectiveness, which is manifested by rhetoric presentations of the term in the political—administrative decision-making in specialized healthcare. There is a need for focused collection and systematic follow-up of easily available effectiveness information in healthcare.

Job satisfaction among hospital doctors in Norway and Germany. A comparative study on national samples

Rosta, J., Nylenna, M., Aasland, O. G. — Tue, 30 Jun 2009 07:07:51 PDT

Aims: To compare German and Norwegian hospital doctors on 10 different aspects of job satisfaction and general life satisfaction. Methods: The study population consisted of a representative sample of 1,448 German and 484 Norwegian hospital doctors aged 33—65 years (n = 1,932), selected from nationwide postal surveys in 2006. The questionnaires contained items on subjective life satisfaction and the validated 10-item Job Satisfaction Scale. Each item was scored on a seven-point Likert scale from 1 (very dissatisfied) to 7 (very satisfied). A mean sum score was calculated, ranging from 1 to 7. Regression analyses and generalized-linear-model-estimated means controlled for age and gender with 95% confidence intervals were used for comparison. Results: Norwegian hospital doctors had significantly higher life satisfaction (mean 5.31 vs. 5.15) and job satisfaction (mean 5.09 vs. 4.55) than their German colleagues. Item by item, doctors in Norway were significantly more content with seven aspects of their work: ``Freedom to choose your own methods of working'' (mean 5.00 vs. 4.72), ``opportunities to use your skills'' (mean 5.49 vs. 5.01), ``physical working conditions'' (mean 4.62 vs. 4.08), ``recognition you get for good achievements'' (mean 4.83 vs. 4.26), ``overall job situation'' (mean 5.57 vs. 4.64), ``work hours'' (mean 4.39 vs. 3.39), ``rate of pay'' (mean 4.70 vs. 3.70). General life satisfaction and age, but not gender, were positively associated with job satisfaction in both countries. Conclusions: Norwegian hospital doctors enjoy a higher level of life and job satisfaction than German hospital doctors. The most likely reasons for this are more acceptable work hours, salary and control over clinical work in Norway.

Parental attitudes and behaviour concerning adolescent alcohol consumption: do sociodemographic factors matter?

Pettersson, C., Linden-Bostrom, M., Eriksson, C. — Tue, 30 Jun 2009 07:07:51 PDT

Aims: Parental attitudes and behaviour with regard to young people and alcohol are associated with teenagers' drinking behaviour. This study examined the association between sociodemographic factors among parents and parental attitudes and behaviour with regard to alcohol and adolescents. Methods: Postal questionnaires were sent to parents of children aged 12—16 years in six Swedish municipalities. Seven hundred and ninety-five parents were included in the study. Seven sociodemographic factors and four questions identifying parental attitudes and behaviour were examined. Logistic regression was used to compute odds ratios and confidence intervals. Results: The study showed that fathers were more likely than mothers to report that children had been drinking or tasting alcohol at home. Parents who answered the questionnaire together also stated that their children had been served alcohol at home to a larger extent than mothers. Fathers, single parents and parents with older children were more likely to have non-restrictive attitudes towards adolescents and alcohol than mothers, parents living in a household with more than one adult, and parents with younger children. Factors such as age of the parents, employment status and numbers of children in the household were not associated with either parental attitudes or behaviour. Conclusions: The sex of the responding parent was the only sociodemographic factor that was associated with both parental attitudes and behaviour. Fathers were more likely than mothers to have a non-restrictive attitude. The fathers also reported to a greater extent than mothers that children had been drinking or tasting alcohol at home.

Nutritional status and self-reported and performance-based evaluation of physical function of elderly persons in rural Bangladesh

Ferdous, T., Cederholm, T., Razzaque, A., Wahlin, A., Nahar Kabir, Z. — Tue, 30 Jun 2009 07:07:51 PDT

Aim: To investigate the impact of nutritional status on self-reported as well as performance-based indicators of physical function in a rural elderly population in Bangladesh. Methods: A cross-sectional study conducted in Matlab, Bangladesh, included 457 randomly selected community-living elderly persons aged 60 years or more (60—92 years; 69 ± 7 years). Mobility, activities of daily living (ADL), performance tests, handgrip strength, the Mini Nutritional Assessment (MNA) and a structured questionnaire were used to assess physical function, nutritional status, socioeconomic status and health status, respectively. Descriptive and linear hierarchical regression analyses were applied. Results: Seven per cent of the participants reported limitations in mobility, and 8% reported limitations in ADL. However, more than half of the participants had difficulties in performing one or more items in the performance tests. According to the MNA, 26% of the participants were undernourished and 62% were at risk of malnutrition. More undernourished participants than well-nourished participants reported limited mobility, impaired ADL and difficulties in the performance tests. A corresponding reduction in grip strength was observed in the undernourished group. Accordingly, higher MNA scores, indicating better nutritional status, were significantly associated with higher mobility index, higher ADL index, higher performance tests index, and higher scores in handgrip strength. These associations remained after adjusting for demographic, socioeconomic and health status differences. Conclusions: Good nutritional status is important for the physical function of elderly people, even after controlling for possible confounders. Performance tests indicated a higher degree of functional impairment than that observed by self-reported estimation.

Salutogenesis as a framework for improving health resources of adolescent boys

Bronikowski, M., Bronikowska, M. — Tue, 30 Jun 2009 07:07:51 PDT

Background and aims: A salutogenetic approach may play an important role in developing adolescent understanding of health. On the basis of sense of coherence the study examined the relationships between self-assessed physical fitness and actual performed cardiorespiratory fitness. Methods: Data were collected from 199 boys aged 13, randomly assigned to either an experimental or a control group. Frequency of out-of-school moderate-to-vigorous physical activity (MVPA) was self-rated by pupils while cardiorespiratory fitness was measured using 20-meter Shuttle Run test (20SRT) from the battery of Eurofit. Sense of coherence was measured with a SOC-13 questionnaire. A three semesters (15 months) intervention into a physical education programme, based on the Hellison's Teaching Responsibility through Physical Activity (TRPA) model, was introduced in the experimental group. Results: In the experimental group post-test examination revealed that cardiorespiratory fitness had improved significantly as the number of minutes completed in 20SRT increased. A similar situation was observed in the case of sense of coherence. No such findings were observed in the control group, and in a post-test comparison both the average results in 20SRT and in sense of coherence were statistically (p50.05) lower than in the experimental group. Conclusions: A health-related physical education programme based on developing individual responsibility through self-planned out-of-school activity can provide pupils with substantially more physical activity during the day (and thus improve cardiorespiratory fitness) when it is based on self-determined and individualized objectives.

Factors associated with BMI change over five years in a Swedish adult population. Results from the Scania Public Health Cohort Study

Eek, F., Ostergren, P.-O. — Tue, 30 Jun 2009 07:07:51 PDT

Objectives: On account of the increasing worldwide problems associated with overweight and obesity, the aim of the present study was to examine BMI change over 5 years in relation to different lifestyle-, demographic- and psychosocial work-related factors. Methods: A cohort of 9913 persons responded to an identical survey in 2000 and 2005. BMI change over the period was examined in relation to gender, age, educational level, physical activity, job strain, and baseline BMI. Results: Mean BMI as well as prevalence of overweight and obesity increased in the cohort; most among younger persons. In all groups but younger women, BMI increase was greatest in the lowest baseline BMI quartile. Low education was associated with increased BMI at baseline, but not with BMI change over time except among young women. Exercisers had lower BMI than non-exercising persons, and exercise pattern over time was also significantly associated with BMI change. The greatest BMI increase was found among exercise drop-outs, while those who had taken up exercise during the study period were the only group who did not show a significant BMI increase over the study period. Job strain showed inconsistent associations with BMI change. Conclusions: Although socioeconomic differences in BMI were observed, these inequalities did not appear to be increasing, except among young women. Persons with a low initial BMI increased more in weight than persons with a high initial BMI. Exercise behaviour appeared to be an important factor for maintaining, or avoiding heavy increase in, BMI.

Population-wide changes in reported lifestyle are associated with redistribution of adipose tissue

Tue, 30 Jun 2009 07:07:51 PDT

Aims: The Northern Sweden MONICA project 1986—2004 demonstrated a marked increase in average body mass, an unchanged prevalence of diabetes, and a decrease in myocardial infarctions and lately also in stroke. This study estimates the relative importance of time-trends in lifestyle on average waist and hip circumference on a population level. Methods: From a series of independent cross-sectional surveys, a study population of 2,831 men and 2,976 women was formed. Associations between lifestyle factors and waist and hip circumference were estimated. Partial regression coefficients for every level of the lifestyle factors were multiplied by the differences in the proportion of the population reporting the corresponding levels of the respective lifestyle factors in 1986 and 2004. The sum of the product terms for each item represents the respective estimated impact of change in waist and hip circumference. Results: Lifestyle trends associated with changes in hip circumference were (women/men): higher education level (+4.0 mm/+2.4 mm), fewer smokers (+0.4 mm/+0.9 mm), a slight increase in alcohol consumption (+0.4 mm/+0.3 mm), and more saturated fat from meat in women (-0.9 mm) and more fibre from grains in men (+0.6 mm). Average waist circumference was influenced by increased levels of physical activity (-2.2 mm/-4.6 mm), fewer female smokers (-0.3 mm), and a higher intake of saturated fatty acids from meat among men (+1.8 mm). Conclusions: We identified physical activity and the intake of meat and whole-grain products as prime candidates for lifestyle interventions in northern Sweden.

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