Scandinavian journal of social medicine最新文献

Besides specific technical skills, successful encounters with patients require an understanding of the many ways in which patients may express themselves. This qualitative study reports on the clinical experiences of doctors when meeting patients with fibromyalgia (FM). Ten strategically chosen rheumatologists and 10 GPs in central Sweden were interviewed. The interviews were taped, transcribed and analysed in accordance with the empirical, phenomenological, psychological method. The analyses indicate that doctors try to comply with the wishes and demands of patients, and at the same time avoid perceptions of personal frustration. They are inclined to be objective and to act instrumentally, apparently in order to keep in touch with what gave biomedical meaning to an otherwise incomprehensible phenomenon. The meaning structures revealed by doctors' descriptions of FM and of relating to FM patients were characterized mainly by the way in which the doctors were (i) managing their clinical uncertainty, (ii) adhering to the biomedical paradigm, (iii) prioritizing diagnostics, (iv) establishing an instrumental relationship, and (v) avoiding recognizing FM as a possible biomedical anomaly.

The economic recession which began in Sweden in 1991 was followed by a large increase in the unemployment rate, especially in the younger labour force. The main purpose of the present study was to examine whether this recession has resulted in an increase in psychological distress in the population. Self-reported symptoms of anxiety, anguish, depression and sleeplessness have been analysed in repeated cross-sectional surveys conducted every other year from 1989 to 1995 in the County of Ostergötland. The study was confined to the 20-39 years age group and includes 3122 male and 3440 female respondents. The analysis was restricted to symptoms reported as occurring often or constantly. There was a significant increase in the 12-month prevalence of psychological distress among both men and women. At the beginning of the period 5% of the men in the 20-29 years age group reported frequent symptoms of psychological distress. By 1995 this had increased to 10%. The largest increase in prevalence, however, was found in men in the 30-39 years age group and women in the 20-29 years group Interestingly, when the non-employed groups were excluded from the analysis, the increasing trends of reported distress remained statistically significant with the exception of women aged 30-39 years.

The purpose of this study was to estimate the financial costs of disability pension in order to compare the financial burden and the numerical distribution of disability pension by main diagnostic groups. During three months all new disability pensions (n = 944) granted in Malmöhus county were registered. During a follow-up of approximately two and a half years, 40 subjects died and 15 pensions expired. The predominating diagnoses were musculoskeletal diseases, mental disorders including alcohol dependence, cardiovascular and neurological diseases. To analyse whether these proportions changed when the extent of the pension, age at pension and the retirement allowance were considered, the present value of the total retirement allowances was calculated. The ranking of the four predominating diagnosis categories was not affected by the extent of the pension or the age at which the pension was granted. Thus, musculoskeletal diseases still predominated, although the proportion decreased. Among unemployed subjects, mental disorders made the largest contribution to the total expenditure. The results gained may be used in further research where alternatives to disability pension for different groups of patients and/or diagnoses are investigated.

The increasing number of studies of stress among nurses in the last two decades have mainly dealt with nurses in hospitals. A few studies have included community-based nurses. However, no comparative studies of district nurses in different countries have been published. We have conducted a study to identify sources of stress, job satisfaction, perceived demands, control and health among district nurses (DNs) in Zagreb (Croatia) and Stockholm (Sweden), working in a polyvalent health care organization. Data were obtained regarding altogether 305 district nurses by means of self-administered questionnaires using identical methods and items, with response rates between 88% and 95%. In general, district nurses reported high levels of job-related stress, satisfaction and control. Organizational sources of stress, such as ongoing changes in the primary care organization, and reorganization of tasks, were of importance for the district nurses in Stockholm. They reported also more job satisfaction and commitment than the district nurses in Zagreb. The district nurses in Zagreb had significantly higher level of "lack of resources". They displayed significantly higher scores of psychological demands but also a greater feeling of control than the district nurses in Stockholm. Significant differences were also found between the groups in ranking of self-reported stressors. Thus results show that differences in work organization and in essential resources have a substantial impact of perceived stress, job satisfaction, and on the generality both of single association and on the applications of models.

The aim of this methodological study is to examine what self-rated health is understood to mean by survey respondents. The data are derived from semi-structured (re-)interviews with 42 middle-aged participants of the 1994 Finnish Survey on Living Conditions. When the respondents are asked to describe their present health, the results show concrete, contextual, and partly contradictory conceptions of "health". Health is presented primarily as absence of ill-health, but also connected to personal experience and life situation, and as a result of action. Second, when assessing self-rated health all respondents base their assessments on ill-health, modified by the severity, duration and restrictions posed by ill-health. Further analysis shows that some respondents base their assessments also on fitness and health behaviour. The results suggest that in addition to the medical model of health, adopting health promotion messages and "healthy" lifestyles are important factors contributing to health assessments.

Catastrophes in the health area are frequent. A template for conduct and reporting of research in disaster responses has recently been published. The WHO Rehabilitation of War Victims Project basically followed these principles in former Yugoslavia to estimate defined needs, prioritise and evaluate methods used. Around 30% of war victims reported to be wounded were found to be in need of physical rehabilitation. Priority was given to the 5% with severe disabilities caused by amputations, spinal cord injuries and traumatic brain injuries. Most of the infrastructure was destroyed and WHO supported a community based rehabilitation approach (CBR). Evaluating this type of service delivery became extremely difficult under present circumstances. Waves of refugees rolled both within the republics and over the borders demonstrating both the needs and problems listed in the template referred to. The CBR service delivery worked out satisfactorily with high patient satisfaction. Limited medical training greatly improved the situation for the personnel. Even in a disaster situation research is needed for proper decision-making and to gain experiences for future aid.

The purpose of this study was to investigate how response rates to a postal questionnaire are affected by title and length of the survey instrument. Five questionnaires, which differed according to title and length, were designed. Each questionnaire was mailed to a random sample of one thousand Norwegian women aged, 35-49 years. A total of 3,106 questionnaires were returned (62.1%). The highest response rate (70.2%) was achieved by a two-page questionnaire entitled "Women and Cancer". An otherwise identical questionnaire entitled "Oral Contraceptives and Cancer" had a response rate of 60.7%. Questionnaires entitled "Women and Cancer" with a length of four and six pages had a response rate of 62.8% and 63.3%, respectively. The four page questionnaire entitled "Women, Lifestyle and Health" had the lowest response rate of 57.1%. This study shows that in a general population of Norwegian women the title of a postal questionnaire influences the response rate. The results indicate that although the shortest questionnaire had the highest response rate, the most extensive survey instrument did not have the lowest response rate. The distribution of risk factors for breast cancer did not vary according to response rate or design of questionnaire. The overall findings of this study suggest that the benefits from the increased information obtained from extensive postal questionnaires out-weighs a potential non-response bias due to a somewhat lower response rate.