Scandinavian Journal of Public Health最新文献

Background: Little is known about associations between occupational prestige, that is, the symbolic evaluation and social positioning of occupations, and sickness absence (SA) or disability pension (DP). We explored whether occupational prestige was associated with future SA or DP among women and men.

Methods: A Swedish 4-year prospective cohort study of all those in paid work and aged 25-59 in 2010 (N = 2,605,227; 47% women), using linked microdata from three nationwide registers and Standard International Occupational Prestige Scale values, categorised as 'very low', 'low', 'medium', 'high', or 'very high'. Odds ratios (ORs), 95% confidence intervals (CIs), crude and adjusted for several sociodemographic factors, were calculated for three outcomes: at least one SA spell (>14 days), >90 SA days, or DP occurrence, during follow-up (2011-2013).

Results: The mean number of SA days in 2010 varied by occupational prestige group, for example, 'very high': 3.0, 'very low': 6.5. Compared to those in occupations with 'very high' prestige, all other groups had higher adjusted ORs for all three outcomes. Among men, those with 'very low' occupational prestige had the highest OR for at least one SA spell: OR 1.51 (95% CI 1.47-1.56); among women, the 'medium' group had the highest OR: 1.30 (1.27-1.32). The results were similar for SA >90 days. OR for DP among women with 'very low' occupational prestige was 2.01 (1.84-2.19), and 3.55 (3.15-4.01) for men.

Conclusions: Working in lower occupational prestige occupations was generally associated with higher odds of future SA/DP than working in higher prestige occupations; these associations were stronger for men than for women.

Aim: High blood pressure (BP) is a key contributor to the burden of disease. This study aimed to assess: a) educational differences across the entire BP distribution, and b) educational differences in the trajectories of BP across the adult life course.

Method: Longitudinal data from the Stockholm Diabetes Prevention Program was analysed using quantile regression and linear mixed effects models. Models were adjusted for age, sex, lifestyle, and BP medication.

Results: Lower educational level was associated with higher systolic BP (SBP) at all follow-up periods. Age and sex adjusted mean SBP was 2.49 (95% confidence interval (CI) 1.10, 3.87), 3.95 (95% CI 2.45, 5.45) and 2.61 (95% CI 1.09, 4.13) mmHg higher for people with pre-secondary education compared with post-secondary at baseline, 10 years and 20 years follow-up, respectively. Quantile regressions revealed that the inequalities could be observed across the entire BP continuum. Longitudinally analysed, people with pre-secondary education had 3.01 (95% CI 1.91-4.11) mmHg higher SBP than those with post-secondary education, age and sex adjusted. No significant convergence or divergence of the educational gaps in SBP was observed. Educational differences remained even after adjusting for lifestyle and BP medication.

Conclusions: These results imply that public health interventions should aim to bring about distributional shifts in blood pressure, rather than exclusively focusing on hypertensive people, if they are to effectively minimize the educational disparities in blood pressure and its consequences.

Aims: School non-completion is a public health and educational concern in most countries. This study sought to identify the strongest predictors of the non-completion of upper secondary education based on register data.

Methods: A cross-validated elastic net regression analysis was used to predict school non-completion in a population of 2696 students in the city of Jyväskylä, Finland. The register data included data from the primary social and healthcare register and the educational register.

Results: The non-completion rate was 13.1% (13.4% for males, 12.8% for females). The non-completion of upper secondary education was best predicted by the following seven features (ordered from strongest to weakest): unauthorized absences (odds ratio (OR) = 2.27), out-of-home placement (OR = 2.23), average grade when leaving lower secondary education (OR = 0.73), an anxiety/depression diagnosis (OR = 1.43), visits to child guidance and family counselling centres (OR = 1.17), family poverty (OR = 1.11) and the grade point average in the 5th Grade (OR = 0.95).

Conclusions: Register data can be utilized to find the strongest predictors of school non-completion. Predictors support multidisciplinary actions preventing non-completion by providing both early signals to target actions more specifically and indicators for monitoring the impact of preventative actions.

Aims: To investigate 20-year trends in social participation among the oldest old (77+ years) in Sweden and assess the extent to which changes in educational attainment and functional abilities explain these trends.

Methods: Seven waves of the Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD) spanning 2002-2021 were used with a repeated cross-sectional design. To analyse the association between time and social participation we employed the Karlson-Holm-Breen method of decomposition. The study focused on informal social participation (contact with friends and family), leisure participation (public or semi-public gatherings), and formal participation (organisational engagement and study circle attendance).

Results: Both leisure and informal participation peaked in 2014 and declined in 2021, influenced by the COVID-19 pandemic, whereas formal participation showed a slight increase in 2021. Total participation increased at least until 2011. Overall, older adults have increased their levels of social participation in recent decades, disregarding the influence of the pandemic. Decomposition analysis revealed that population-level changes in educational attainment and functional abilities explained a substantial portion of the observed trends.

Conclusions: As the proportion of older adults continues to rise, it becomes increasingly important to understand the developments and drivers of behavioural change in the older population. As more people are socially active, there may be increasing differences between those participating and those not - which could lead to increased inequalities. The observed trend in increasing participation, influenced by changes in education and health, emphasises the importance of fostering age-friendly environments and addressing potential social inequalities among older adults.

Aims: A multidisciplinary group of experts and patients developed the Model for ASsessing the value of Artificial Intelligence (MAS-AI) to ensure an evidence-based and patient-centered approach to introducing artificial intelligence technologies in healthcare. In this article, we share our experiences with meaningfully involving a patient in co-creating a research project concerning complex and technically advanced topics.

Methods: The co-creation was evaluated by means of initial reflections from the research team before the project started, in a continuous logbook, and through semi-structured interviews with patients and two researchers before and after the active co-creation phase of the project.

Results: There were initial doubts about the feasibility of including patients in this type of project. Co-creation ensured relevance to patients, a holistic research approach and the debate of ethical considerations. Due to one patient dropping out, it is important to foresee and support the experienced challenges of time and energy spent by the patient in future projects. Having a multidisciplinary team helped the collaboration. A mutual reflective evaluation provided insights into the process which we would otherwise have missed.

Conclusions: We found it possible to create complex and data-intense research projects with patients. Including patients benefitted the project and gave researchers new perspectives on their own research. Mutual reflection throughout the project is key to maximise learning for all parties involved.

Aims: We aimed to investigate the association between being an immigrant and long-term prescription opioid use in Norway in 2010-2019.

Methods: Nested case-control study. The cases were all persons 18 years of age or older with long-term opioid use - that is, the use of prescription opioids longer than 3 months (N=215,642). Cases were matched to four controls who filled at least one opioid prescription, but never developed long-term opioid use in the study period (N=862,568) on sex, age and year of starting long-term/short-term opioid use. Being an immigrant was defined as being born outside of Norway to two foreign-born parents and four foreign-born grandparents. Adjusting for socioeconomic variables and clinical confounders, analyses were stratified on three age groups (18-44 years, 45-67 years and ⩾68 years).

Results: For the youngest age group, being an immigrant was inversely associated with long-term opioid use (adjusted odds ratio 0.75; 95% confidence interval [0.72-0.77]) compared with being native-born people. For this age group, the odds ratio differed between people born in Africa (0.56 [0.52-0.62]), Central or South America (0.70 [0.62-0.79]), Europe outside the European Union (EU) (0.71 [0.65-0.77]), Asia including Turkey (0.80 [0.77-0.84]) and EU/European Economic Area (EEA) (0.81 [0.77-0.85]). For the middle age group, increased odds were found for immigrants versus natives (1.05 [1.02-1.08]) in particular for those born in North America (1.26 [1.13-1.40]) and the EU/EEA (1.13 [1.09-1.18]). There was no association in the oldest group.

Conclusions: Compared with native-born people, immigrants had lower odds of long-term opioid use among younger adults, higher odds among middle-aged and similar odds among older adults.

Aims: The aim of this study was to assess the cultural validity and reliability of a Finnish version of the nine-item Shared Decision-Making Questionnaire (SDM-Q-9) in a sample of patients with different sociodemographic characteristics.

Method: The original SDM-Q-9 was translated into Finnish with the agreement of the developers of the original scale. The standardised translation procedure was followed by a pilot test of the questionnaire. The data were collected from an online questionnaire. Reliability was estimated by Cronbach's alpha. Structural validity of the questionnaire was assessed by confirmatory factor analysis.

Results: The pilot study assessing the cultural validity of the scale was a success, as it did not find any expressions needing to be revised. The Finnish version of the SDM-Q-9 - the SDM-Q-9-FIN - was tested in the study where a total of 736 patients responded to the questionnaire. The questionnaire yielded high reliability with a Cronbach's alpha of 0.92. Confirmatory factor analysis confirmed the unidimensional factor structure with Item 1 excluded.

Conclusions: The SDM-Q-9-FIN was shown to be a reliable instrument for evaluating shared decision-making among Finnish patients. Further testing and research are recommended among a greater diversity of patient groups.

Aims: Mortality influences the composition of the surviving population. Higher mortality among low-income individuals than high-income individuals may result in lower poverty rates in the surviving population. The objective of this study was to describe poverty rates for both survivors and deceased individuals in a cohort born in 1926.

Methods: We used Swedish total population data on the 1926 birth cohort (n = 83,382), calculating annual poverty rates from 1991 to 2016. We compared poverty rates for the entire cohort, those who died the next year, and those who survived for 5, 10, or 20+ years, measuring the impact of selective mortality as the differences in poverty rates between the cohort and these subgroups.

Results: Individuals who died the following year had higher poverty rates than the cohort at ages 65-90. Conversely, individuals who survived 5, 10, or 20+ years had lower poverty rates, with relatively small differences (1.1% to 6.9% lower) for survivors of 5 years or longer, and larger differences (26.4% to 32.8% lower) for those who survived 20+ years.

Conclusions: Despite differences in mortality rates by income, selective mortality had only a modest impact on poverty rates. If life expectancy rises for all, and a more diverse population reaches old age, our findings indicate a potential slight increase in poverty rates due to reduced mortality as a selective factor. These findings emphasise the need to consider mortality selection when addressing future poverty rates in older adults.

Background: Healthcare systems face escalating capacity challenges and patients with repeated acute admissions strain hospital resources disproportionately. However, studies investigating the characteristics of such patients across all public healthcare providers in a universal healthcare system are lacking.

Objective: To investigate characteristics of patients with repeated acute admissions (three or more acute admissions within a calendar year) in regard to sociodemographic characteristics, disease burden, and contact with the primary healthcare sector.

Methods: This matched register-based case-control study investigated repeated acute admissions from 1 January 2014 to 31 December 2018, among individuals, who resided in four Danish municipalities. The study included 6169 individuals with repeated acute admissions, matched 1:4 to individuals with no acute admissions and one to two acute admissions, respectively. Group comparisons were conducted using conditional logistic regression.

Results: Receiving social benefits increased the odds of repeated acute admissions 9.5-fold compared with no acute admissions (odds ratio (OR) 9.5; 95% confidence interval (CI) 8.5; 10.6) and 3.4-fold compared with one to two acute admissions (OR 3.4; 95% CI 3.1; 3.7). The odds of repeated acute admissions increased with the number of used medications and chronic diseases. Having a mental illness increased the odds of repeated acute admissions 5.8-fold when compared with no acute admissions (OR 5.7; 95% CI 5.2; 6.4) and 2.3-fold compared with one to two acute admissions (OR 2.3; 95% CI 2.1; 2.5). Also, high use of primary sector services (e.g. nursing care) increased the odds of repeated acute admissions when compared with no acute admissions and one to two acute admissions.

Conclusions: This study pinpointed key factors encompassing social status, disease burden, and healthcare utilisation as pivotal markers of risk for repeated acute admissions, thus identifying high-risk patients and facilitating targeted intervention.

Aims: To investigate whether mental health problems can be described as a latent factor indicated by nine items in the Swedish Survey of Children's Living Conditions (Barn-ULF), and to explore whether this structure varies across disability, age, gender and cohorts.

Methods: Cross-sectional survey data collected yearly from 2013 to 2019 regarding 3676 children (aged 10-18 years) was retrieved from two linked national registers: Barn-ULF (child-reported mental health problems data) and ULF/SILC (parent-reported data on child characteristics). The structural validity of the one-factor model was assessed using confirmatory factor analysis (CFA) and threshold invariance concerning disability, gender, age and cohort was tested using multigroup CFAs. The practical significance of invariance was assessed by comparing weighted scores from the single-group model and the multigroup models.

Results: A substantially modified one-factor model demonstrated adequate fit (${\chi }^2$/df = 1.94, comparative fit index = 1.00, Tucker-Lewis index = 0.99, root mean square error of approximation = 0.02). Significant measurement non-invariance was found across all groups; however, its impact on the latent variable mean was minimal (<0.03 in Cohen's d).

Conclusions: Barn-ULF might be a structurally valid tool for monitoring Swedish children's mental health problems. However, differences in model performance across child characteristics and time - even if small - indicate that group comparisons must be conducted cautiously.