Scandinavian journal of social medicine最新文献

Sickness absence in pregnancy has been shown to be associated with strenuous working conditions and parity. So far, few studies have made adjustments for possible interaction and confounding. Such adjustments are needed to more precisely identify targets for preventive measures. We have, therefore, in a representative population of pregnant employees in Norway 1989, computed adjusted odds ratios for leaving work by sickness absence more than three (LSC > 3) and eight (LSC > 8) weeks before delivery according to working conditions identified as risk factors in earlier studies; adjusted for job control, domestic conditions and sickness absence the year prior to pregnancy. The cumulative percentage of LSC > 8 and LSC > 3 was 26.4 and 51.1. Ergonomically strenuous postures and heavy lifting increased the risk of both outcomes. In addition, shift work and hectic work pace increased the risk of LSC > 3. Influence on breaks reduced risk. Only para experienced reduced risk of LSC when working part-time. Sicklisting the year prior to pregnancy had no confounding effect, which suggest that pregnancy represents a new incompatibility with work. Preventive measures should address work postures and heavy lifting, as well as conditions influencing the woman's control with her time.

In the assessment of the effects of medical technologies, the focus is most often on the quality of the empirical data. In order to shed light on the question whether medical researchers are really so empirically oriented we conducted the following study. 600 questionnaires were sent by mail to three groups, selected at random: 1) pre-clinical researchers; 2) clinical researchers who received research grants from The Swedish Medical Research Council; and 3) general practitioners. The questionnaire was built around three cases concerning the assessment of the effects of: a) H-2-receptor antagonists, b) coronary by-pass surgery and c) the homeopathic treatment of hay fever. The results indicate that there are rather small differences in how the three groups assessed the three technologies and larger differences within one and the same group concerning different cases. The tendency is that the more one considers that empirical data should be assessed independent of theoretical considerations, the higher are the demands which are placed on the quality and quantity of the empirical documentation, and vice-versa.

Official statistics for alcohol/drug use by drivers can influence the introduction of intervention measures against impaired driving. Thus, the validity of official statistics is important. Since official statistics are based on police assessment of inebriation, the present study was aimed at investigating this issue by comparing blood analysis with the rate of police detection of alcohol/drug use by injured drivers. All injured motor vehicle drivers who were hospitalized (HD) (Umeå: n = 104) and all fatally-injured drivers (FD) who were autopsied (Umeå, Northern Sweden: n = 110; Gothenburg, Western Sweden: n = 133) from May 1991 through Dec 1993 were tested for alcohol and both licit and illicit drugs. The findings of the blood analyses were compared with police assessment of inebriation. In the HD, the police suspected inebriation in 13% (n = 13) whilst blood analyses showed drug and or alcohol in 18% (n = 19) of the drivers (sensitivity 69%; specificity 97%). In the FD, the police suspected inebriation in 7% (n = 16) of the drivers whilst blood analyses showed drug and/or alcohol in 23% (n = 57) of the drivers (sensitivity 53%; specificity 100%). The blood alcohol-positive HD who the police suspected to be inebriated had significantly higher mean blood alcohol concentrations than those not suspected. To avoid biased statistics, official statistics on inebriation of injured drivers should be based on blood analysis of drug/alcohol and not on police assessment.

Implementation of social insurance for financing health services has yielded different patterns depending on a country's economic level and its government's political ideology. By the late 19th century, thousands of small sickness funds operated in Europe, and in 1883 Germany's Chancellor Bismarck led the enactment of a law mandating enrollment by low-income workers. Other countries followed, with France completing Western European coverage in 1928. The Russian Revolution in 1917 led to a National Health Service covering everyone from general revenues by 1937. New Zealand legislated universal population coverage in 1939. After World War II, Scandinavian countries extended coverage to everyone and Britain introduced its National Health Service covering everyone with comprehensive care and financed by general revenues in 1948. Outside of Europe Japan adopted health insurance in 1922, covering everyone in 1946. Chile was the first developing country to enact statutory health insurance in 1924 for industrial workers, with extension to all low-income people with its "Servicio Nacional de Salud" in 1952. India covered 3.5 percent of its large population with the Employees' State Insurance Corporation in 1948, and China after its 1949 revolution developed four types of health insurance for designated groups of workers and dependents. Sub-Saharan African countries took limited health insurance actions in the late 1960s and 1970s. By 1980, some 85 countries had enacted social security programs to finance or deliver health services or both.

Prevention can reduce the risk of disease, but has other consequences as well. Willingness-to-pay (WTP) is one method to analyse these multi-dimensional consequences, if the stated WTP is assumed to be a function of all the expected positive and negative effects perceived. An interview study of a community-based cardiovascular disease prevention programme in northern Sweden shows that expectations regarding reduced mortality in the community and future savings in public health care spending increase the perceived value of the programme. Among personal benefits, decreased disease risk was not positively associated with WTP, while a low level of anxiety was.

The success of Finnish deinstitutionalization policy among the elderly in 1981-1991 was evaluated in terms of institutionalization rates and case-mix. Censuses of institutionalized people in all public and private residential homes and health centre hospitals (or nursing homes) were performed in 1981, 1986 and 1991. Data on demographic factors, diagnoses and dependency level were gathered. Censuses from the closest years of psychiatric patients were also used to obtain a comprehensive view of institutionalization. The eligibility criteria for the study were (1) age 65 years or more (2) currently in long-term care. In both men and women the overall relative reduction was 33%, and largest in psychiatric care, at over 67%. In residential home care the relative reduction was about 40%. In health centre hospitals a slight increase was seen, about 10%. Length of stay shortened in residential homes but increased in health centre wards. Dependency level increased among the elderly people in long-term institutional care during ten years. In conclusion, the deinstitutionalization rate was substantial among the elderly in Finland. However, because of rapid demographic change the absolute number of elderly in long-term care remained almost constant. The case-mix has become more demanding and the proportion of elderly in constant need of extensive help has risen.

The purpose of this article is to identify factors explaining why the perinatal mortality rate ceased to fall in Denmark during the 1980s, while it continued to do so in Sweden, and to study the ability of known risk factors to predict this development. My analysis is based on routinely collected published data on all births, where I have studied the levels and changes in known risk factors for perinatal deaths in the two countries. The results of the study are: The proportion of low birth weight infants and the mothers' age and parity did not differ or change in a way that explains the higher perinatal mortality rate in Denmark during the 1980s. The weight specific perinatal mortality rate was the same in the two countries, with the exception of very low birth weight babies, i.e. below 1,500 grammes, where the perinatal mortality rate was higher in Denmark; this difference increased during the 1980s. The proportion of very low birth weight infants increased in Denmark from the 1970s to the 1980s while it remained stable in Sweden. The Danish increase in the proportion of low birth weight infants can be due to changed registration practices with more very small infants being registered in the 1980s. Among the factors studied registration practices, smoking and neonatal care seemed to be able to explain part of the differences between the two countries. The relative risk of perinatal death associated with the mothers' age and parity varied depending on the size of the groups at risk: the more women in high age and parity groups the lower the relative risk, which indicates that a selection as well as a causal effect was present. A conclusion is that the changes in relative risk over time associated with age and parity should lead to a closer investigation of the characteristics actually associated with an increased risk in order not to treat all old and multiparous women as patients at risk.

Dissatisfaction with the health care system, in combination with an increasing academic status of paramedical professions, is currently inspiring the analysis of central medical terms by philosophers. One interesting result is the formulation of equilibrium theories that define health without reference to disease. It is argued here that the alleged holism of such theories is in fact weaker than the strong holism represented by the irreductive materialism inherent in traditional medicine. Strong holism resolves certain anomalies in the weakly holistic description of the Human Being, notably the claim that perfect health is compatible with having a deadly disease.

In a study of the relationship between social support and smoking behaviour, 1046 parents coming with their children for well-child control at health centres in Oslo, Norway, completed a questionnaire. The prevalence of daily smoking increased with decreasing social support. However, this association did not remain significant when adjusting for demographic and household characteristics. Among smoking parents, indoor smoking at home was related to medium (OR = 1.97; CI: 1.01-3.81) and low social support (OR = 2.35; CI: 1.19-4.63) when adjusting for demographic and household characteristics. Smoking parents smoked more cigarettes per day when they had low social support. However, this association was only seen in parents with several children. In this group, smoking 10 cigarettes per day or more was strongly related to medium (OR = 5.05; CI: 1.66-15.35) and low social support (OR = 7.81; CI: 2.44-25.01).