Scandinavian journal of social medicine最新文献

In this paper, we study a nonparametric spatial pattern test statistic, the D statistic. The D statistic is an effective test statistic for testing spatial patterns in regional health data. Comparison studies of the D statistic with fixed weights and random weights are illustrated on the atlas of the Chinese cancer mortality rates and on other cancer atlas. Some social, economic and environmental reasons for statistically significant spatial autocorrelations of the Chinese cancer mortality rates were given in the discussion section. The method for calculating the mean and the variance of the randomly weighted D statistic is given in the appendix.

Sexual risk-taking can lead to serious consequences. This study addressed the question of how sexual risk-taking was influenced by unemployment. A cohort of 1060 adolescents were followed from their last term in compulsory school and five years ahead until the age of 21. Sexual risk-taking, defined as unprotected intercourse without wishing to conceive, was studied with the help of a questionnaire at the beginning and at the end of the period. For men there was a positive correlation between the length of unemployment and increase in risk-taking during the period, but for women there was a (statistically non-significant) negative correlation. In a logistic regression analysis, having children also had a significant effect on increased risk-taking among men. Unemployment thus implies increased sexual risk-taking among adolescent men.

In this paper twelve themes are pointed out as background for the increased interest for medical ethics: New medical knowledge, the democratisation of doctor-patient relationship, changes in the disease panorama, autonomy and its limits, research ethics, collegiate concern, prioritization, ethics of clinical training, immigration and cultural conflicts, changes in the view of the rationality of ethical reasoning, changes in the view of nature in relation to culture and medical students' requests for teaching in medical ethics. It is discussed whether teaching in medical ethics is a matter for social medicine or whether one should pass it on to hospital priests or philosophers.

The aim of the study was to test the impact of psychosocial resources on pregnant women, regarding continued alcohol consumption. The study is based on a one-year cohort of nulliparas followed during pregnancy. From a total of 994 invited women 872 (87.7%) agreed to participate in the study. All women who reported any alcohol consumption within the twelve months prior to the administration of the questionnaire were included in this study population (n = 692, 79.4%). 32.8% of the alcohol consumers continued to drink during pregnancy even though the alcohol intake was moderate. In spite of the official Swedish alcohol recommendation for total abstinence during pregnancy, more socially active, and more highly educated women continued drinking alcohol, with wine being the beverage of choice, maybe more as social behavior rather than to cope with stress caused by insufficient psychosocial resources. Younger women or those with fewer years of education tended to stop drinking to a higher degree, but those who continued to drink tended to drink beer or to binge.

In his article Weak and Strong Holism, Inge-Bert Tljedahl criticises some modern theories of health which define health without reference to disease. As an alternative he suggests a kind of theory called Strong holism which emphasises the lawful interrelations between all ontological layers in the human being. In this reply it is argued (1) that Täljedahl does not accurately describe the contents and intentions of the criticised theories and (2) that he does not put forward any alternative theory of health. Strong holism, as characterised by Täljedahl, is a general biological and social-biological research programme, which is very fruitful for scientific research projects, but which does not suggest any particular theory of health.

The reliability and validity of methods to assess social networks, social support and control were investigated in a population of 12,009 females and males born between 1926 and 1945 (the "Malmö Shoulder and Neck Study"). This study demonstrated an overall reliability with kappa coefficients between 0.70 and 0.47, but the reliability was more varying among females and lower in the youngest age group. The analysis of the construct validity indicated that the different indices measure different aspects of the psychosocial environment, but both theoretical and methodological problems were identified, when the validity of multidimensional concepts are to be determined. The validity of such indices can best be judged by combining quantitative and qualitative methods. Potential validity problems must be kept in mind when these indices are used in epidemiological research. The results from the reliability analysis call for repeated assessments and the sample size must be adjusted vis-a-vis the reliability.

The associations between measures assessing bereaved carers' health status and their perceptions of the quality of palliative care delivered by community nurses, general practitioners and hospital doctors to cancer patients in their last year of life are investigated in this paper. Analysis was conducted on a sub-sample from the Regional Study of Care for the Dying (RSCD), a survey in which relatives or friends of a random sample of deaths in 1990 in 20 health districts in England were interviewed some 10 months after the death. The sub-sample consisted of 1858 carers of people who died from cancer. The results showed statistically significant associations between bereaved carers' self-rating of health status, their psychological functioning, their experience of bereavement-related health problems, and their satisfaction with services delivered by the different providers. Further research is needed, however, to explore in-depth the nature of these associations.

The study focuses on adult children (n = 81) having the main responsibility for parents with dementia (study group). They were compared with children (n = 102) of non-demented parents (reference group). The children were interviewed about burden experienced. The interviews also secured information about the children's co-operation with the informal and formal network and their willingness to remain as caregivers during the progression of the disease or ageing process. The results showed that the daughters reported feeling more affection in their caregiving role than the sons. About one third of the participants in the study could not get relief from someone else. Eighty-nine per cent of the children in the study group and 76% of the children in the reference group were not willing to care for their parents in the family home during the progression of the disease, even if they were employed as caregivers.