Scandinavian Journal of Public Health最新文献

Aim: The aim of the paper is to analyse if alcohol consumption could explain the scarring effect of youth unemployment on later depressive symptoms.

Methods: The analyses are based on the 24-year follow-up of school leavers in a municipality in Northern Sweden (the Northern Swedish Cohort). Four-way decomposition analyses were performed to analyse if alcohol use at age 30 years could mediate and/or moderate the effect of youth unemployment (ages 18/21 years) on depressive symptoms in later adulthood (age 43 years).

Results: Excessive alcohol use at early adulthood (age 30 years) mediates 18% of the scarring effect of youth unemployment on depressive symptoms in later adulthood. The scarring effect was seen among both those with and without excessive alcohol use.

Conclusions: Youth unemployment leads to poor mental health later in life and part of these relations are explained by excessive alcohol consumption in early adulthood. Policy interventions should target the prevention of youth unemployment for reaching a lower alcohol consumption and better mental health.

Seventy years ago, the Scottish epidemiologist Jeremy Morris published his seminal papers in exercise epidemiology, providing evidence of the positive relationship between physical activity levels and reduced mortality. Today, we may remember Morris's pivotal role in establishing physical activity as a key factor in preventive medicine and public health. The roots of the role of behavioural epidemiology in modern public health lay in Morris's research on the association of coronary heart disease with physical activity at work. In consequence, a new focus for public health emerged, with an emphasis on chronic disease as well as modification of lifestyle and individual behaviour. While the immense value of his research on the health benefits of exercise is widely recognised, his influence on the teaching of social medicine is generally less well-known. Morris was involved in the pioneering course of MSc in Social Medicine at the London School of Hygiene, which was emblematic of the redefining of public health in the late 1960s. Morris gave legitimacy to a wide range of issues regarded at that time as soft and second class, including health promotion, sociology and the care of people with disability and chronic conditions. In consequence of his observation of a relationship between socioeconomic status and individual behaviour patterns in regard to exercise, nutrition and smoking, Morris urged that greater attention be paid to inequalities.

Background: The early identification of different subgroups of individuals with partial work ability is important for the development of appropriate and effective services in order to prevent exclusion from working life and prolongation of unemployment.

Aims: This study aimed to identify different main activity trajectory clusters of people with partial work ability before their participation in work ability support services and to examine sociodemographic, health, work ability and functioning features of the identified clusters.

Methods: The sample consisted of clients who had participated in the Finnish Work Ability Programme during 2020-2022. Using the main activity data spanning from 2005 to 2021, optimal matching was applied to examine the similarity between the participants' main activity trajectories. Second, using cluster analysis, participants were categorised into four main activity trajectory clusters. Finally, the sociodemographic, health, work ability and functioning features of clusters were examined.

Results: A total of 643 individuals participated in the study. Four clusters were identified: (a) early-onset retirement, (b) from studies to outside the workforce, (c) from employment to unemployment and (d) long-term employment. Individuals in the 'early-onset retirement' cluster had the best perceived work ability and functioning. Problems relating to health, work ability, functioning and well-being were highlighted in the 'from employment to unemployment' cluster.

Conclusions: Unemployed individuals with partial work ability form a heterogeneous population who often have several different underlying reasons for decreased work ability. Multiple data sources are needed to identify the special characteristics and needs of the people with partial work ability.

Aim: Platforms on social media are increasingly used for public health research. While social media provides an exceptional opportunity to explore communication about public health topics, this practice is not without ethical dilemmas. Our aim was to identify and unfold some of these dilemmas and to suggest possible solutions and ways forward for future research.

Methods: Using our own research within a closed forum for people experiencing suicidal thoughts as a case, we explored certain dilemmas and possible answers relating to whether what is to be researched falls under a public or private social media domain; we investigated avenues for obtaining access to participants in an evolving online environment; how to secure informed consent from participants; and ways of ensuring anonymity.

Results: We provide recommendations and reflections that we hope will offer inspiration for researchers embarking on similar social media public health research within and beyond suicide research.

Conclusions: The ethical framework commonly referred to in health research, based on confidentiality, anonymity, informed consent and doing no harm must be adjusted to be relevant for a social media context where technologies and regulations are constantly being altered.

Background: Atrial fibrillation and flutter (AF) is the most common sustained arrhythmia with an increasing prevalence in Western countries. However, little is known about AF among immigrants compared to non-immigrants.

Aim: To examine the incidence of hospital-diagnosed AF according to country of origin.

Method: Immigrants were defined as individuals born outside Denmark by parents born outside Denmark. AF was defined as first-time diagnosis of AF. All individuals were followed from the age of 45 years from 1998 to 2017. The analyses were adjusted for sex, age, comorbidity, contact with the general practitioner and socioeconomic variables. Adjustment was conducted using standardised morbidity ratio weights, standardised to the Danish population in a marginal structural model.

Results: The study population consisted of 3,489,730 Danish individuals free of AF and 108,914 immigrants free of AF who had emigrated from the 10 most represented countries. A total of 323,005 individuals of Danish origin had an incident hospital diagnosis of AF, among the immigrants 7,300 developed AF. Adjusted hazard rate ratios (HRRs) of AF for immigrants from Iran (0.48 [95%CI:0.35;0.64]), Turkey (0.74 [95%CI:0.67;0.82]) and Bosnia-Herzegovina (0.42 [95%CI:0.22;0.79]) were low compared with Danish individuals. Immigrants from Sweden, Germany and Norway had an adjusted HRR of 1.13 [95%CI:1.03;1.23], 1.12 [95%CI:1.05;1.18] and 1.11 [95%CI:1.03;1.21], respectively (Danish individuals as reference).

Conclusions: Substantial variation in the incidence of hospital-diagnosed AF according to country of origin was observed. The results may reflect true biological differences but could also reflect barriers to AF diagnosis for immigrants. Further efforts are warranted to determine the underlying mechanisms.

Background: Lolland-Falster Health Study (LOFUS) was a health examination survey that included self-administered questionnaires, clinical examinations, and the collection of biological samples, undertaken in 2016-2020 in a rural, socioeconomically deprived area with the lowest life expectancy in Denmark. The aim of this study was to examine the determinants of non-participation in LOFUS to evaluate the extent to which LOFUS data reflected the general population of the area.

Methods: LOFUS invited randomly selected subjects together with their entire household. As determinants of non-participation, we analyzed age, sex, municipality of residency, citizenship, residency status, socioeconomic status, invitation type, and year of invitation. Relative risk regression was used to estimate the association between determinants and non-participation rate, mutually adjusted for other determinants.

Results: In total, 53,313 subjects were invited of whom 18,949 (36%) participated. In the multivariable analysis, men had a 3% higher non-participation rate than women; subjects with citizenship other than Danish had a 3% higher non-participation rate than Danes. In-migrants had 6% higher non-participation than long-term residents. Compared with self-supported subjects aged 30-64, both publicly supported subjects of this age and younger and older subjects had higher non-participation rates: 16%, 16%, and 13%, respectively. Compared with self-supported, long-term residents, publicly supported in-migrants had 23% higher non-participation.

Conclusions: Only about one third of subjects invited to LOFUS participated. Yet, this is a relatively high participation rate compared with other recent health examination surveys in Denmark. Furthermore, there was a relatively flat social gradient in the non-participation rate across the studied determinants.

Aim: The primary aim of this cross-sectional study was to provide descriptive data about the lifetime prevalence of trauma exposure with a particular focus on sexual violence and natural disasters and to assess the prevalence of symptoms of post-traumatic stress disorder (PTSD) in the Icelandic population. In addition, the aim was to investigate whether PTSD symptoms, trauma types and prevalence differed by gender and geographical location.

Method: A representative sample of the population between the ages of 18 and 80 years was randomly selected from the Icelandic National Registrar. The study included a total of 1766 participants consisting of 930 (52.7%) women and 836 (47.3%) men, with an overall mean age of 49.9 years (standard deviation 16.1). Participants were contacted by phone and asked questions from the Lifetime Events Checklist (LEC-5) to assess lifetime exposure to traumatic events. Individuals who had experienced traumatic events completed the PTSD Checklist for DSM-5 (PCL-5) to assess PTSD symptoms.

Results: Exposure to trauma is common among the Icelandic population, with 84.3% of the participants experiencing at least one kind of trauma. Of those exposed to trauma, 10.5% fulfilled criteria indicating a higher risk of PTSD. The prevalence of sexual violence and other unwanted sexual experiences was relatively high (16.2% and 24.4%, respectively) compared with other national studies. Women were almost four times more likely than men to have been exposed to sexual violence (24.9% vs 6.4%), and were more likely to have been exposed to other unwanted sexual experience (35.1% vs 12.4%, respectively). Exposure to natural disasters is frequent but with great geographical variation.

Conclusions: This study highlights the high prevalence of trauma in Iceland, revealing significant gender disparities in sexual violence and geographical variations in natural disaster exposure.

To estimate occurrence of non-communicable diseases (NCDs) over the life-course in the Norwegian population, national health registries are a vital source of information since they fully represent the entire non-institutionalised population. However, as they are mainly established for administrative purposes, more knowledge about how NCDs are recorded in the registries is needed. To establish this, we begin by counting the number of individuals registered annually with one or more NCDs in any of the registries. The study population includes all inhabitants who lived in Norway from 2004 to 2020 (N~6.4m). The NCD outcomes are diabetes, cardiovascular diseases, chronic obstructive lung diseases, cancer and mental disorders/substance use disorders. Further, we included hip fractures in our NCD concept. The data sources used to identify individuals with NCDs, including detailed information on diagnoses in primary and secondary health care and dispensings of prescription drugs, are the Cancer Registry of Norway, The Norwegian Patient Registry, The Norwegian Control and Payment of Health Reimbursement database, and The Norwegian Prescription Database. The number of individuals registered annually with an NCD diagnosis and/or a dispensed NCD drug increased over the study period. Changes over time may reflect changes in disease incidence and prevalence, but also changes in disease-specific guidelines, reimbursement schemes and access to and use of health services. Data from more than one health registry to identify individuals with NCDs are needed since the registries reflect different levels of health care services and therefore may reflect disease severity.

Aims: Ten long-term social assistance recipients in a Norwegian municipality received a greater-than-average fixed monthly payment for 12 months. This study aimed to explore whether these recipients with reduced administrative requirements and a fixed monthly payment that was greater than the average social assistance experienced reduced poverty, increased feelings of independence, better daily living, and an improved quality of life.

Methods: The study's explorative design included 20 qualitative, in-depth, semi-structured interviews and a longitudinal electronic survey for 12 months. The 10 participants had been selected by the local labour and welfare agency based on stringent criteria and are therefore not representative of social assistance recipients in general. Individual interviews were conducted during autumn 2021 and spring 2022. The interview data were analysed using systematic text condensation, and the survey results are presented using descriptive statistics.

Results: The participants included in the project described a reduced experience of poverty. They could buy additional items and set aside money, something they had not been able to do in the past, and meant a great deal to them. They expressed experiencing freedom, gaining a stronger sense of independence, and having lessened feelings of shame. Many of the participants described health issues that were incompatible with working.

Conclusions: Being given this opportunity led to a feeling of increased dignity and greater inclusion in society among this selected group of participants. They appreciated the simplified conditions and reduced requirements for administrative matters. All expressed that spending 8 months without contact with the social welfare office was a liberation.

Aims: Immigrant women in Norway have lower cervical cancer screening participation than non-immigrant women. Our aim in this study was to assess whether the observed increase in screening participation during 2012-2017 was different between Norwegian-born women and immigrant women.

Methods: Data were collected from three national registries. The study included 1,409,561 women, categorized according to country of birth and immigrant background: (i) Norway, Norwegian parents; (ii) Norway, immigrant parent(s); (iii) Europe, excluding Norway; (iv) Africa; (v) Asia, including Turkey; and (vi) other countries. Trends and differences between groups were analyzed using Poisson regression analyses with adjustments for variables other studies have found to influence screening participation. Trends were assessed by including half-years as a continuous variable in the models and reported as prevalence ratios with 95% confidence intervals.

Results: Screening participation increased in all groups, but was not statistically significant among women from Africa in the adjusted model. The highest increase was among Norwegian women, with a 2.2% increase per year. Interaction tests showed significantly smaller increases in screening among women born in Europe (p interaction < 0.0001), Africa (p interaction < 0.0001), Asia (p interaction < 0.0001), and countries in the "Other" category (p interaction = 0.004). There was also a smaller increase among Norwegian-born women with one or more immigrant parent(s), but this was not significant (p interaction = 0.178).

Conclusions: The gap in screening participation and the increasing differences in trends suggest that healthcare services do not reach all women in Norway to the same extent. One should attempt to improve this while working toward further increasing screening participation for all.