Scandinavian journal of social medicine最新文献

The purpose of this study was to identify predictors of mortality and institutionalization in aged patients receiving Finnish supervised home care. The study was carried out in Central Finland, whose area and population is 5% of the total of the country. The subjects consisted of a sample of 312 patients (65 years or more). They were originally assembled to assess the effectiveness of a geriatric inpatient unit, the results of which have been published previously. Deaths were ascertained over at least three years and long-term care institutionalization over two years. The most powerful predictor of mortality was impaired ADL functioning. Predictors of long-term institutional care were impaired ADL functioning, impaired cognition and depression. These data may be helpful in resource allocation and targeting patients for the supervised home care programmes.

The purpose of this study was to analyse the relationships between status incongruency and mortality. From the concept of status incongruence two incongruent groups were defined, those with high education and low social position (socially downward drifters) and those with low education and high social position (socially upstarters). A cohort of middle-aged men (n = 855), all born in 1913 and living in the city of Gothenburg, Sweden were followed during a period of 22 years. The socially downward drifters had a significantly increased risk for: non-cause specific (overall) mortality, more potential years of life lost and mortality caused by coronary heart disease. These differences were still evident after taking other risk factors into account. The socially upstarters had, on the other hand, lower mortality risks and win years. Imbalance between educational level and attained social position appears to affect survival in a long term follow-up.

The three main objectives of this study were to estimate the proportion of the Norwegian population with experience of homosexual behaviour, to study the degree of change in sexual practices among homosexual men during a 5-year period and to study the degree of change in sexual practices reported by HIV positive homosexual men from before to after awareness of HIV-positivity. The data comes from two questionnaire surveys (in 1987 and 1992) of sexual behaviour in the general population of Norway and a questionnaire study of sexual behaviour before and after awareness of HIV-positivity among HIV-positive homosexual men taking part in a cohort study starting in 1988 (the Oslo HIV cohort study). Estimation of the proportion of subjects with homosexual experience was made as well as a trend analysis of the number of male sexual partners per year, number of intercourses per month, condom use and anal sex. Among men aged 18 to 60 from the general population, 3.8% reported homosexual practice during lifetime and 1.2% during the past 3 years. Among women, the same percentages were 3.1 and 1.0. In the surveys, the number of male partners per year decreased significantly for men with current homosexual experience from a yearly median of 1.0 in 1987 to 0.3 in 1992 (p = 0.02). Among HIV-positives, the number of male partners decreased from a yearly median of 4.3 before to 1.6 after awareness of HIV-seropositivity (p < 0.01). Among HIV-positives, a significant increase in the use of condoms, a decrease in the number of intercourses and a decrease in the frequency of anal sex was found. The results show that some changes in sexual practice may have occurred among homosexual men in general in the period from 1987 to 1992, and that more significant changes may have occurred for HIV-positive men. The present data do not support other findings of a relapse to more unsafe sex, but suggest that there is still a need to keep modifying behaviour in order to stop the spread of HIV among men who have sex with other men.

The present study relies on data for the years 1988 and 1989 from the Swedish continuous Surveys of Living Conditions (SLC), which are based on random samples from the population among individuals aged 16 through 84 years. We compared the rates of self-reported mental health for subjects reporting diabetes (n = 361), a musculoskeletal condition but without diabetes (n = 2187), hypertension but without diabetes (n = 980), and healthy free from any medical condition (n = 6664). Comparisons are based on age- and gender-standardized rates, using the diabetes group as standard. The results show that more diabetic respondents had psychic symptoms and long-standing psychiatric disorders than the healthy respondents, with otherwise no differences compared to the other chronic conditions. The diabetic respondents had lower mean disposable income, and a higher rate of disability pension than the respondents with hypertension, and than the healthy. They also reported more sick leave days than the healthy respondents.

The aim of this study was to investigate the occupation-specific prevalence of musculoskeletal disease in Norway. A cross-sectional interview survey of a representative sample of households in Norway in 1985, including 6,681 persons, 16 to 66 years old was carried out. Age-standardised, occupation-specific prevalence ratios for musculoskeletal disease were calculated. Musculoskeletal diseases were more frequent in women (20.6%) than men (17.3%), and increased markedly with age. In men, the prevalence was highest for construction carpenters; in women, for manufacturing/construction workers. In both male and female occupations, the highest prevalence of musculoskeletal diseases was approximately two-fold that of the lowest. Health-related exits from the labour force, and mobility between occupations influenced the results. It is suggested that the high disability pensioning and sickness absence rates observed in some occupations are related to occupation-specific consequences of disease in addition to higher morbidity.

In an earlier study made in Uppsala, it was found that in 17% of suicide cases there was a correlation between the suicidal act and serious physical disease. To obtain a deeper knowledge of this, an interview study among relatives and/or friends of 21 patients who had committed suicide was performed. Variables studied were: demographic data, somatic diagnoses, psychiatric diagnoses, contact with the medical sector, earlier suicidal signals, and the correlation between the suicidal act and the physical disease. The provision of inadequate medical treatment was sought. The persons who had committed suicide were allocated to one of three groups according to the degree of correlation between suicidal act and physical disease. "Very strong" correlation was found for five persons, "rather strong" for nine persons, and "weak" for five persons. We found that physical disease was seldom decisive for the suicidal act. Medical treatment was experienced as inadequate in nine cases. Since there is reason to believe that physical disease is an important complicating risk factor for suicide, it is important to be aware of anxiety in patients and their relatives, give plenty of time for information, show empathy and give the care-providers a sense of security to avoid suffering and reduce suicidal acts.

The number of stressful life events experienced as measured on the modified Swedish version of Coddington's questionnaire, and the presence of behaviour problems assessed by Achenbach's Child Behavior Check List (CBCL) were studied in 45 eight-year-old children of identified psychosocial risk-mothers. The mothers' social network was estimated using the Swedish version of Undén and Orth-Gomér's Interview Schedule for Social Interaction (ISSI). These mothers had been identified during early pregnancy. A control group of 57 children of the same age and their mothers without the presence of psychosocial risk-criteria was used as reference. The results indicated that the index children had experienced significantly more life events, and displayed significantly more behaviour problems than the reference children. The mothers in the index group had a significantly poorer social network than the mothers in the reference group. The study suggests that children of mothers, identified early on psychosocial risk criteria develop suboptimally. Therefore, early interventions are of great importance.

Objective: To map the extent of sick leave and number of claims made for health insurance among persons who had suffered neck sprain (whiplash) injuries in traffic accidents, and to map subjective feeling of health and quality of life among patients several years after the injury.

Design: A retrospective study of neck sprain injuries after car accidents and a comparison to the patients' use of sick leave caused by neck pain prior to the accident.

Setting: The Emergency Clinic at The University Hospital in Trondheim, Norway.

Subjects: 426 patients with neck sprain injuries after car accidents during 1985-1990.

Main outcome measures: Information from Trondheim Social Security office about sick leave, and results from 345 patients who answered a questionnaire with respect to quality of life measures.

Results: 27% had been reported sick during the period after the car accident, and 5% had claimed health insurance, 58% reported sustained symptoms linked to the accident.

Conclusions: Many reported sustained symptoms after neck sprain injuries, 16% of them reported being in a bad state of health.