Scandinavian Journal of Public Health最新文献

Aims: The study aimed to examine the association between adolescent friendships (ages 15 and 18 years) and self-rated health in early adulthood (age 29 years).

Methods: The study population consisted of participants from the West Jutland cohort study who reported on their close friendships at ages 15 and 18 years, and self-rated health at age 29 years. The presence of at least one close friend and self-rated health were assessed through questionnaires, and self-rated health was dichotomized as either high or low. Logistic regression analyses were adjusted for sex, family functioning, income, and parental education.

Results: Findings indicate that 89% of participants at age 15 years and 92% at age 18 years reported having close friends. The presence of close friendships at age 15 was significantly associated with higher self-rated health at age 29 years (odds ratio 1.9, 95% confidence interval 1.1-3.2). However, the association for friendships at age 18 years was not statistically significant. Experiencing close friendships at both ages 15 and 18 years showed a tendency toward an associated with self-rated health, but the association was not statistically significant (2.0, 95% confidence interval 0.6-6.6). Sensitivity analysis revealed that altering the self-rated health threshold weakened associations.

Conclusions: This study emphasizes the importance of adolescent friendships for long-term health. While the association was strongest at age 15 years, the findings underscore the need for further research into friendship quality and its lasting impact on health outcomes. The study highlights the importance of close friendships, advocating for interventions to promote social connections and reduce loneliness during this critical period.

Aims: Health effects of pandemics extend beyond morbidity and mortality from the disease itself and may include long-term mental health consequences. However, previous studies only consider narrowly defined populations at risk or examine pandemics caused by varied pathogens that may have inconsistent effects. We examine existing literature on these long-term mental health effects following one type of pandemic (influenza).

Methods: We conducted a systematic review of the long-term mental health effects of the 1889, 1918, 1957, 1968, and 2009 influenza pandemics. To our knowledge, this is the first review of studies of broad populations and multiple measures of mental health morbidity.

Results: The literature search returned 8190 articles. After deduplication and title/abstract and full-text screening, 12 articles were reviewed. Seven articles focused on the 1918 pandemic and five on the 2009 pandemic. Study regions were USA or North America (n=5), Europe (n=3), and Asia (n=4). Long-term outcomes studied were suicide (n=4), admission to hospital or psychiatric facility (n=2), stress/anxiety/post-traumatic stress disorder (n=4) and schizophrenia and other/related conditions (n=2). The suggested mechanisms were infection (n=6), effects of non-pharmaceutical interventions (NPIs) (n=3), or other exposure pathways (n=3). Seven studies had a moderate risk of bias and five studies a high risk of bias.

Conclusions: Mental health effects have been an outcome of pandemics. Researchers should consider a variety of possible mechanisms, and that infection and restrictive NPIs may contribute to mental health morbidity. This study highlights the need for better understanding of the broader health, social, and demographic impacts of pandemics.

Aim: To analyse the occurrence and significance of complaints to the Equality Ombudsman (Diskrimineringsombudsmannen (DO)) of ethnic, religious and gender discrimination in Swedish healthcare in relation to discrimination as a social phenomenon.

Methods: Through descriptive statistics and content analysis, we analysed complaints of discrimination on the grounds of ethnicity, religion and gender from 2012 to 2021 (N=431), and DO's case supervision decisions (n=23).

Results: DO has legally reviewed or initiated a supervisory process for only 23 (5%) of 431 cases and filed two lawsuits in the sample. Two-thirds of complainants were patients (n=284, 66%), one-fourth relatives (n=109, 25%), two healthcare professionals (1%) and 36 unspecified (8%). The most frequently reported healthcare sectors were primary healthcare centres (n=133, 31%), emergency care (n=50, 12%), women's healthcare (n=47, 11%) and psychiatry/psychotherapy (n=40, 9%). Perceived discrimination concerned unfulfilled expectations of equal treatment (n=158, 37%), respectful treatment (n=151, 35%), different diagnosis or treatment (n=88, 20%), faster processing (n=15, 4%) and other (n=19, 4%).

Conclusions: Complaints of ethnic, religious and gender discrimination in Swedish healthcare often report subtle discrimination or unmet expectations, and the reported discrimination is rarely legally confirmed. The results suggest that many reported cases are likely based on misunderstandings and communication problems. The unfulfilled expectations were often related to miscommunication, distrust or perceptions of being neglected. Healthcare providers should recognise these perceptions earlier and clarify any misunderstandings. The findings point to a need for further analysis of perceived discrimination in healthcare, and that more cases should be investigated.

Aims: Understanding motivators for cervical cancer screening among young women is critical for improving participation rates and reducing the incidence of cervical cancer. Young women have low participation rates in the CervicalScreen Norway. In 2022, the first cohort of school-based human papilloma virus vaccinated women entered the screening programme at the age of 25 years. This paper investigates reflections regarding cervical cancer screening and factors that influence attendance among first or second-time invitees in the CervicalScreen Norway.

Methods: The study comprises 18 qualitative semi-structured individual interviews with Norwegian women aged 25-29 years of which 14 had attended screening. We used reflexive thematic analysis with a critical approach and identified three main themes related to trust, social expectations, and perceived vulnerability.

Results: The three main themes were 'trusting health authorities but wishing for a clearer message'; 'normalisation of screening participation driven by social expectations'; and 'efforts to avoid vulnerability during the test procedure'. Trusting the authorities to provide beneficial health initiatives, the women would follow advice about screening. Social expectations led to consider screening participation as the right thing to do. These young women felt vulnerable and inexperienced with gynaecological examinations and opted for screeners that reduced their feeling of vulnerability.

Conclusions: Providing clear information on the screening procedure and expectations during gynaecological examinations is essential to reduce vulnerability and enhance participation among young women. Communication should highlight that screening is readily accessible in primary healthcare and be shared through media platforms popular with younger women.

Aim: Despite the legal obligation to possess health insurance in Germany, not all underage patients have health insurance. The exact number of people affected is uncertain. The aim of our study was to determine the care situation for children and teenagers in medical institutions that serve people without health insurance.

Methods: A systematic online search was used to identify 128 medical care institutions for uninsured people. The participating institutions received a structured questionnaire that aimed to record their paediatric care situation in 2022. In addition, the central care dataset of Malteser Hilfsdienst from 2018 to 2021 was evaluated.

Results: Sixty-eight of the 128 (53%) institutions participated. A total of 4% (371) of all patients were younger than 18 years, with a mean of 7 per institution. A total of 94% of the institutions provided care for unborn children, 59% performed deliveries and 29% provided midwives. A total of 72% of the institutions provided paediatric care, 32% provided dental care, 55% provided vaccinations, 99% were able to provide medication and 47% were able to provide glasses.

Conclusions: Charitable medical institutions for people without health insurance regularly treat underage patients. Laws have to be harmonized, and clearing centres and anonymous treatment vouchers could be established. Charitable institutions could be financed by the government, and public health services could offer care to ensure health care for children and adolescents.

Aims: Physical activity is linked to better mental health. However, the associations of physical activity and subsequent changes in mental health are poorly understood. We aimed to investigate associations between leisure-time and commuting physical activity and changes in mental health as indicated by psychological distress using the Finnish Helsinki Health Study data collected in 2017 (phase 1) and 2022 (phase 2) among young and early midlife employees (n=3135).

Methods: Leisure-time and commuting physical activity was measured with questions pertaining to four distinct levels of intensity and formed a four-class variable. We measured psychological distress using the emotional wellbeing subscale from the RAND-36 questionnaire, with scores ranging from 0 to 100 (higher scores indicate better mental health). We used a cut point of 52 to compute a four-class variable of change in psychological distress. We used multinomial regression models while adjusting for key covariates to estimate average marginal effects and odds ratios.

Results: At phase 1 the prevalence of lowest activity was 15.6% and the prevalence of highest activity was 21.3%. The prevalence of repeated psychological distress was 5.9% and 75.6% for those repeatedly without psychological distress. After adjustments, low activity was associated with a 12 percentage point lower predicted probability of being repeatedly without psychological distress (average marginal effect -0.12, 95% confidence interval -0.18 to -0.06) when comparing with very high activity. The same association was weaker for medium activity.

Conclusions: The results showed that lower activity was associated with psychological distress which indicates that higher leisure-time and commuting physical activity levels may help to maintain mental health.

Background: The Danish Nursing Home Resident Database is a comprehensive resource addressing critical gaps in understanding nursing home residents in Denmark. Maintained by the Danish Health Data Authority, it offers national coverage, integrates high-quality data sources, and enables longitudinal tracking of nursing home dynamics. The aim of this paper is to describe the content, structure, strengths, and limitations of the database to facilitate future research and policy use.

Methods: The database includes all nursing homes registered in plejehjemsoversigten.dk (PLOV), with formal data collection starting in 2019. Retrospective reconstruction using manual compilations from 2011 and 2014 extends coverage back to 2011, creating a continuous dataset spanning over a decade. Resident demographics are sourced from the Civil Personal Register (CPR), while PLOV provides data on nursing home addresses, facility capacity, and care types.

Results: The CPR is updated daily, allowing near real-time resident tracking, while PLOV undergoes quarterly updates to reflect changes in nursing home facilities. Secure access to anonymised data ensures compliance with privacy regulations. By enabling linkages to other healthcare registers via CPR numbers, the database supports analyses of comorbidities, healthcare utilisation, and mortality outcomes, offering valuable insights into geriatric care and public health policy.

Conclusions: The Danish Nursing Home Resident Database provides a comprehensive, high-quality resource that supports population-based research and evidence-based policymaking in geriatric care and public health.

Aim: This article investigates how to enhance the sustainability of the Danish healthcare sector, particularly focusing on social sustainability. While environmental and financial sustainability are well-established priorities, social sustainability - crucial for reducing readmissions and fostering cohesive care - remains underexplored. The study aims to make social sustainability actionable and inspire politicians and healthcare professionals to do sustainable healthcare to improve patient outcomes. Therefore, this article develops a circular sustainability model informed by both literature and empirical data to illustrate how sustainability is perceived and practised by healthcare professionals and patients in Denmark.

Methods: The study employs semi-structured interviews with professionals and patients from Danish community health centres. These interviews provide insights into the practical implementation of sustainability principles and highlight the intersection between theoretical frameworks and real-world practices.

Results: The findings reveal a disconnect between the theoretical understanding and the practical application of social sustainability. Although healthcare professionals rarely explicitly reference social sustainability, they inherently apply its principles through cross-sector collaboration, localised patient care, and rehabilitation efforts that prepare patients for their everyday environments. This approach aligns with broader sustainability goals by reducing hospitalisation rates and fostering patient wellbeing.

Conclusions: The study underscores the need to focus explicitly on social sustainability in healthcare. By integrating patient engagement, understanding, and community-based care, healthcare systems can achieve more cohesive and sustainable outcomes. This holistic model enhances environmental, financial, and social sustainability, reducing emissions and lowering readmission rates. The study advances the discourse on sustainable healthcare by emphasising the critical role of social factors in fostering long-term resilience and efficiency.

The use of new tobacco and nicotine products, including e-cigarettes, heated tobacco products (HTPs) and tobacco-free snus (white snus), is rising, especially among adolescents and young adults. However, evidence on their long-term health effects is limited. This review assesses current knowledge on the health risks of these products, with a focus on asthma and allergic diseases, cancer, cardiovascular disease, diabetes, lung disease and pregnancy outcomes.E-cigarettes are associated with increased risks of asthma, respiratory symptoms, chronic bronchitis and chronic obstructive pulmonary disease (COPD). Associations with cardiovascular disease, type 2 diabetes, cancer and adverse pregnancy outcomes are supported by limited epidemiological and experimental data. Less evidence is available on health risks associated with HTPs, but a few epidemiological studies indicate increased risks of asthma and COPD, with supporting data from experimental studies. Evidence on white snus is notably lacking across the different health outcomes. Given its high nicotine content - similar to or higher than in brown snus - it is plausible that white snus increases risks of diabetes, pregnancy complications and other nicotine-related health effects. Methodological limitations of existing epidemiological studies include reliance on self-reported data, inadequate adjustment for cigarette smoking, cross-sectional design and/or short follow up. Future research should prioritize large-scale, longitudinal studies assessing dose, duration and product formulation, including second-hand and prenatal exposure, as well as mechanistic studies. There is an urgent need to elucidate the health impacts of the new nicotine and tobacco products, which are growing in popularity, to inform policy, regulation and public health strategies.

Aims: The objective of the study was to assess differences in the accessibility of general practitioner (GP office visits, telephone contacts and electronic communication for patients with hypertension before, during and after the COVID-19 pandemic in primary healthcare.

Methods: From the primary healthcare register of the city of Turku in Southwestern Finland, subjects with the diagnosis of hypertension were identified. Data of GP office visits, telephone contacts, electronic communication, concomitant cardiometabolic diseases, low density lipoprotein and glomerular filtration rate were gathered from the hypertensive patients. The follow-up period was from 2019 to 2022.

Results: The number of patients with hypertension decreased between the years 2019 and 2020 and again increased in 2021 to the 2019 level. Electronic communication increased steadily from 2019 to 2022, whereas telephone contacts decreased. A higher number of telephone contacts and higher number of electronic communication were associated with higher number of office visits. Elderly subjects used less electronic communication than younger subjects and the difference grew larger during and after the COVID-19 pandemic.

Conclusions: Elderly subjects with hypertension use digital services in primary healthcare less than their younger counterparts. Digital technologies may create structural inequality in access to, and availability of, primary healthcare services.