Scandinavian journal of social medicine最新文献

Although a developing country, China has a lower occurrence of low birth weight (LBW) than many developed countries. This study of two population-based one-year birth cohorts, from Finland in 1985-86 and China in 1992, shows the occurrence of low birth weight (LBW) (1000- < 2500 g) among singletons to be 2.6 percent in the Chinese cohort and 3.0 percent in the Finnish one, and that of preterm births (28- < 37 weeks) 2.7 percent and 4.5 percent, respectively. The main component of LBW is term LBW (57.4 percent) in the Chinese case and preterm LBW (64.7 percent) in the Finnish case. The perinatal mortality rate (PMR) was twice as high in the Chinese cohort (13.0 vs. 5.9 per thousand). The occurrence of LBW in the Finnish cohort decreased to 2.3 percent after crosstabulation of the Finnish mothers to conform in structure to the population of Chinese mothers in terms of maternal age, marital status and maternal smoking. The result suggests that the lower incidence of LBW in the Chinese cohort seems to be a reflection of the Chinese socio-cultural environment, which provides Chinese mothers with favourable characteristics. The Finnish excess LBW would have disappeared if the mothers had possessed those characteristics as well. The excess perinatal deaths in the Chinese series might be explained by the different levels of perinatal health care in the two countries.

The mental health of 63 refugee children, with a mean age of 5.9 years, from Chile and the Middle East, were studied during the first 18 months of exile in Stockholm, Sweden. 46% of the children were rated as having poor mental health five months after resettlement in symptom interviews with parents based on the structured questionnaire developed by Cederblad, and 44% thirteen months later. Political violence in the home country and stress in the family sphere in exile were identified as the major determinants of poor mental health in this context.

This is both a retrospective and a 16 and 28 months prospective study of the association between psychiatric comorbidity and social consequences (accidents, fights, broken relationships, drunken driving arrest, and reduced employment) related to alcohol in a nation-wide sample (n = 351) of substance abusers seeking inpatient treatment. Psychiatric comorbidity was evaluated with the Diagnostic Interview Schedule, while drinking history and social consequences were assessed with a structured questionnaire. The social consequences had a high rate of re-occurrence. Controlled for alcohol consumption, polysubstance abuse predicted accidents (OR = 2.9) and fights (OR = 3.9) among men, while among pure alcoholics of both sexes phobia (OR = 4.3) and antisocial personality disorder (OR = 3.0) predicted fights. Only level of abuse predicted broken relationships. Antisocials had most drunken driving arrests. Attempts to reduce these social consequences should aim at treating polysubstance abuse, phobia, and antisocial personality disorder. However, the overriding aim should be the promotion of abstinence.

Study objective: To estimate the prevalence of knee pain in active athletes and to investigate potential associations to type, amount and duration of sports participation.

Measurements: 339 athletes gave information about occupation, sports activity and different features of knee pain, based on a self-filled questionnaire.

Main results: The prevalence of knee pain within the preceding 12 months, constant or recurrent knee pain, absence from sport and absence from work due to knee pain, was 54%, 34%, 19% and 4%, respectively. Knee pain was positively associated with years of jogging and with weekly hours of participation in competitive gymnastics but negatively with weekly hours of tennis. Constant or recurrent knee pain was positively associated with years of swimming. Absence from sport due to knee pain was positively associated with weekly hours of soccer participation.

Conclusions: Knee pain is a common symptom in athletes. The prevalence is associated with the type, amount and duration of sports participation.

Objectives: To study effects of restricting eligibility criteria for disability pension in Norway 1991.

Methods: Documents of 288 applicants from 1990 and 1993 in one county were analysed for social and medical variables as well as for the determination and its causes.

Results: Incidence of applications for disability benefits during a three-month period was 223 per 100,000 inhabitants in 1990. The focused group of 'medically imprecise' musculoskeletal diagnoses concerned 26% of all applicants, while 'precise' musculoskeletal diagnoses were given to 15%, 'imprecise' psychiatric diagnoses to 7% and 'precise' ones to 6%. The number of applicants fell by 39%, surprisingly about the same in all social and diagnostic groups. Denial rate increased from 8% to 21%. Denials mostly struck women, middle-aged, those living alone, those with short education, and applicants with 'medically imprecise' diagnoses.

Conclusions: Restriction of disability benefits affected applicants with the least resources the hardest, and seems to contribute to the on-going process of marginalizing the weaker part of the population.

The aim of this study was to determine the extent of doping drug use among adolescents in Uppsala, Sweden, and to analyse the main reasons for the use. An anonymous multiple-choice questionnaire was distributed among pupils in the first and the third grades at high school; 2,742 pupils participated in the study. The results showed that 2.7% of the male and 0.4% of the female adolescents had used doping drugs at some time in their life. However, knowledge of how to get doping drugs far exceeded use. The main reasons for using doping drugs were to improve appearance and to enhance performance in sports. Some boys self-reported side effects of AAS. Despite the still predominantly negative attitude toward doping prevention programs have to be taken.

Objective: To examine the gender differences in long-term (> 14 days) sickness absence due to musculoskeletal health problems.

Design: Analysis of data from the National Sickness Benefit Register, 1994.

Setting: The economically active population in Norway, except civil servants (n = 1,978,030).

Subjects: All persons, 16-66 years old, with long-term sickness absence episodes due to musculoskeletal health problems in 1994 (n = 141,839).

Main outcome measures: Cumulative incidence, episode frequency, and episode duration of sickness absence.

Results: Women had higher cumulative incidence of sickness absence than men-80.6 pr 1,000 vs. 64.1 pr 1,000, and longer mean duration of episodes-94 calendar days vs. 86 days counted from the first day of absence. Episode frequency did not differ between the genders. After adjustment for age and income the gender ratio (men/women) in cumulative incidence changed from 0.80 to 1.08, and in mean duration from 0.91 to 0.96.

Conclusion: Long-term sickness absence due to musculoskeletal health problems was strongly associated with gender, age, income, and diagnosis. Multivariate analysis indicated that the large gender differences in sickness absence might be overstated due to lack of adjustment for income and income-related factors.

Elderly patients (> or = 65 y) admitted to permanent institutional care in 1976 (n = 116) and 1985 (n = 193) in the city of Helsinki, Finland, were analyzed retrospectively in order to evaluate changes in the terminal care of aged patients. Patients were more demented and needed more care in 1985 than 1976. Decisions of "do not treat actively" (= NTA) increased from 16% to 39% for all patients and 18% vs 42% in patients not transferred. Laboratory examinations, parenteral treatment as well as antibiotic treatments in febrile patients during the last 7 days decreased even after controlling for dementia and functioning, but transfers to other institutions remained unchanged. The survey demonstrates that the terminal care has changed significantly as recommended in the guidelines.

In this study we compared the Karasek job demand-control model with an alternative model in an attempt to explain strain on Finnish physicians (n = 91) at work. Based on previous research, job demands were studied in terms of time pressure and demands related to patients. LISREL (8) analysis was used to test the models. The three factor model, providing the most parsimonious explanation of the data, suggested that time pressure, patient-related stress and controllability all have unique predictive ability of strain on Finnish physicians.