Scandinavian journal of social medicine最新文献

Background: Studies of time trends in smoking prevalence provide a better understanding of the determinants of smoking. The present study analyses changes over time in the prevalence of smoking and heavy smoking in relation to sex, age, and education.

Methods: Data on smoking behaviour were collected by questionnaire in random samples of the general population in the area of Copenhagen. The database used included 71,842 measurements of smoking behaviour for 32,156 subjects aged 30 years or more, who had been examined at intervals between 1964 and 1994. In bi- and multivariate analyses the effects of sex, age, education, time period, and study group on the prevalence of smoking and of heavy smoking were assessed.

Results: Smoking was least prevalent in women, in the oldest age group (more than 70 years), and among those with 8 years or more of school education. During the study period (from 1964/74 to 1990/94), the prevalence of smoking decreased from 72% to 54% in men and from 52% to 46% in women. In both men and women this decrease was smallest in the least educated (less than 8 years of school education). Heavy smoking was also least prevalent in women, in the oldest age group, and among the well educated. During the study period, the unadjusted prevalence of heavy smoking decreased from 52% to 38% in men, while it increased from 17% to 21% in women. The multivariate analysis showed that the time trend for heavy smoking only depended on sex, while educational attainment and age had no impact on the trend.

Conclusion: During the last 30 years the prevalence of smoking has decreased in Denmark. The decrease has been smallest in women, and among the least educated, and the increasing trend in the prevalence of heavy smoking in women is a cause for concern.

Anchoring health-related quality of life (HRQOL) measures in population norms makes clinical interpretations more meaningful and is in accordance with practice in other fields of medicine. In this paper norms for the Short Form 36 (SF-36) are presented in a random sample, representative of the general Norwegian population. In addition, sociodemographic variables affecting the scale scores are explored and discussed. The response rate was 67%, being lowest among subjects aged 70 years or over. Data-completeness strongly declined with increasing age. Physical health scales were also strongly affected by age. In all scales, with the exception of general health perceptions, women reported having poorer health than men. Marital status affected the four mental health scales. Educational status affected all the scales, but the effect was smallest in the mental scales. These norms can be employed for comparison in case-control studies, or to interpret HRQOL changes in prospective studies. Differences in social status should be given special attention. Caution should be exercised when assessing subjective health or employing the norms among subjects aged 70 years or over.

Background: Despite the major impact sickness absence has on society, companies and individuals, surprisingly little scientific knowledge has been accumulated, and the studies that have been performed vary greatly.

Aim and method: Examination of about 320 studies of sickness absence regarding structural levels of exposures studied and theories utilized.

Results: Theories concerning sickness absence were found to vary greatly. Along with exposures and factors explaining sickness absence these theories were categorized with respect to different structural levels, i.e. they were deemed national, occupational, or individual. A classification of different types of absences is presented.

Conclusion: Although most of the reviewed studies were performed within the realm of medicine, only a few of the investigators used medical explanatory models or even considered the health status of individuals. Moreover, it is known that factors at "higher" structural levels have a substantial effect on sickness absence, but these were seldom taken into account, or even mentioned, in the reports scrutinized.

The aim of the present study was to examine whether selected health indicators were related to the level of social conditions in the municipalities in an affluent Danish county with a tax system aiming at narrowing income differences and with the same free health facilities for all. The 18 municipalities were separated into three groups by a sum score calculated on the basis of 10 social status variables. For each of the three groups average mortality, hospital discharge rates, cancer incidence and health services use were calculated with data from National Registers. There was a distinct gradient in all-cause, infant and cause-specific mortality, cancer incidence and use of health services related to level of social conditions. Apart from the incidence of breast cancer and melanoma, and use of general practice, all the analysed health indicators were most frequent in the group of the least affluent municipalities. It is concluded that even in an affluent county, the variation in the socioeconomic characteristics of neighbouring municipalities could be related to differences in health.

There is mutual agreement that health care should be delivered according to need. In this article, although we employ different specifications for need, we conclude that there is inequity in the delivery of health care in Sweden. Higher income groups visit doctors more often than lower income groups in relation to need, but lower income groups remain in hospital longer once they have been admitted. These findings may be interpreted to mean that lower income groups, for various reasons, wait too long before visiting a doctor for a specific disease, the consequence being that the disease is so serious by the time the doctor is contacted that inpatient care and a longer time in hospital are necessary. The policy implication of this situation is that lower patient fees and/or higher incomes may help to reduce the inequities in health care.

In this report we (i) measure the strength of the association between paediatric trauma visit rates and regional socioeconomic and demographic variables, and (ii) quantify any selective impact of user charges on service demand in socioeconomically and demographically different areas. During the period 1989-94, a total of 30,362 home and leisure injury visits were made to the Aurora City Hospital. The visit rates are analysed using a random effects model. In addition, the areas are ranked into three groups in accordance with a socioeconomic index measure, and the annual visit rates of the three groups are calculated. We found fairly minor differences in children's visit rates between unequal socioeconomic areas, and it is apparent that socioeconomic status cannot explain the change in visit rates as a result of the introduction of user charges. We speculate that these changes in emergency visit rates will not lead to long-term health problems among any segment of the city population.