Scandinavian journal of social medicine最新文献

Selective health-related social mobility has been suggested as one possible explanation for health inequalities. The aim of this paper is to examine the size and significance of the contribution which health-related social mobility makes to social class differences in health. We do this by examining the association between intergenerational social mobility and health among currently employed men and women in Britain and Finland. We used comparable nationally representative interview surveys from Britain and Finland. The British data is derived from the General Household Survey for 1988 and 1989, and the Finnish data from the 1986 Survey on Living Conditions. Health measures included limiting long-standing illness and self-assessed health as below good. Social mobility was measured comparing the respondent's class of origin (father's occupation) with his/her class of destination (own current occupation). Social structural changes and related social mobility have been more dramatic in Finland than in Britain during the last few decades. Downward mobility has been relatively rare, and mobility has taken place predominantly upwards. In Finland downward mobility from upper non-manual to manual worker was associated with a somewhat higher risk of limiting long-standing illness than expected among men as well as women. However, there was no statistically significant interaction effect on health between the respondent's father's occupational class and his/her own current class. In Britain, neither self-assessed health nor limiting long-standing illness were related to social mobility. Some weak evidence for health-related downward social mobility was found for currently employed Finnish men and women, but not for their British counterparts. Moreover, the evidence is weaker for self-assessed health than for limiting long-standing illness. Where social mobility may have been health-related, it concerns very rare and small groups; therefore health inequalities among the currently employed cannot be explained by intergenerational health-related social mobility.

The main objective of this study was to assess the health behavior, risk awareness and beliefs concerning the importance of positive health practices among blue-collar workers, and to examine the relationships between behavior, knowledge and beliefs. Data were gathered from 1359 workers aged 18-65 years using a postal questionnaire to 2493 randomly selected members of two labor unions. A high prevalence of negative health practices was noted among the respondents. While no relationship was found between health behaviors and awareness of risks associated with such behaviors, there was a relationship between positive health practices and strong beliefs about the importance of those practices. Awareness of the influence of a positive behavior on disease risk was associated with a stronger belief concerning the importance of that behavior. Women were characterized by having more positive health behavior, a higher level of risk awareness and stronger beliefs concerning the importance of positive health practices. It was concluded that while relationships were found between behavior and beliefs, and between beliefs and risk awareness, further research to establish the direction of the relationships is warranted.

Knowledge of hiv/aids, exposure to hiv/aids information and appreciation of given information was studied, by a questionnaire, among 326 Kenyan and 146 Swedish teenage school students in 1994. The aim of the study was to examine differences and similarities in knowledge in the two populations and to examine which sources of information about hiv and aids the respondents had been exposed to and which were most appreciated. The overall knowledge about hiv/aids was high but in specific items the knowledge and awareness of different risk behaviours for contracting hiv/aids differed for the Kenyan and Swedish teenagers. The dissemination of hard factual information about hiv/aids has thus been successful in reaching out although not in stopping the spread of hiv/aids. This calls for new strategies in disease prevention and health promotion. Those strategies should focus much more on lifestyle changes. The health care system, the school and the existing strong civil and voluntary information structures have an important role to play in that work.

In order to assess consumption of the calcium rich dairy products, intake of non alcoholic beverages and physical activity as risk factors for bone fractures among schoolage children, a case control study was undertaken in Athens, Greece. During 1995 one hundred children 7 to 14 years old (74 boys and 26 girls) with single uncomplicated fractures of the upper and lower extremities and no evidence of coexisting metabolic condition affecting bone fragility were compared with 100 age- and gender-matched controls. The analysis was undertaken by modeling the data through conditional logistic regression. Several indicators point to an increased risk of fractures among physically active children, although none of the individual variables was statistically significant. Somatometric factors were not related to fractures, although children with more advanced stage of development at Tanner's scale were apparently at increased risk. Intake of dairy products and of carbonated non cola beverages was not related to the occurrence of fractures. By contrast, intake of non carbonated beverages, mainly fruit juices, and of cola beverages were significantly associated with elevated risks of fractures [for an increase of one-half can per day, the odds ratios and associated 95% confidence intervals were 1.6 (1.2 to 2.3) and 1.7 (1.2 to 2.6) respectively]. In the absence of other common elements between cola and non carbonated beverages the positive associations of these beverages, with bone fractures probably reflect the increased rehydration needs of active children who are also at high risk for injuries.

Epidemiologists rely heavily on the relative risk in their analyses and presentations. As an index it is intelligible and intuitively appealing but can give an exaggerated impression of the strength of the association and is unreliable for comparisons. This can be shown by deriving relative risks from a normal correlation surface with an unimpressive level of correlation. Relative risks ought to be handled with caution; the underlying population risk and the relative size of exposed and reference categories should be reported. Efforts to control for additional variables, confounders, by some kind of multi-variate technique, another standard procedure, could easily give a false sense of security. From time to time it has been made clear in the literature that errors of measurement in the third variable or in the additional variables could lead to the appearance of false independent effects, but these warnings do not seem to have been heeded nearly as much as they deserve. A simulation experiment is used to bring the lesson home, with realistic numerical assumptions. A moderate degree of error contamination will produce spurious effects. This has nothing to do with sampling errors, large samples rather aggravate this danger. In meta-studies this is a source of error and conflicting results to take account of.

Greenland is a high-incidence area for certain virus-associated cancers. The long term cancer risk in a cohort of 7,761 Danish employees who had been working for some time (median 19.7 months) in Greenland during the period 1955-1978 was studied. During a total of 162,300 person-years (average 20.9 years) of follow-up ending on December 31, 1992, the number of cancers observed was 732 vs. 669 expected (relative risk (RR) = 1.09, 95% confidence interval (CI) 1.02-1.18). Whereas the men did not experience any unusual cancer incidence at any cancer site, the women were at elevated risk of developing breast cancer (RR = 1.5, 95% CI 1.2-1.8 (n = 96)); malignant melanoma (RR = 1.8, 95% CI 1.0-2.9 (n = 16)); and lymphatic and hematopoietic malignancies (RR = 1.7, 95% CI 1.0-2.8 (n = 16)). Exposure during adulthood to a high-incidence area for cervical cancer, nasopharyngeal carcinoma and tumors of the major salivary glands did not confer any measurable increase in the risk for these virus-associated cancers. Postponement of childbearing might explain part of the elevated breast cancer risk. Intensive exposure to ultraviolet light, that is likely to explain the increased risk of malignant melanoma among the women, might also be involved in the excess incidence of lymphatic and hematopoietic malignancies observed in these women. However, why the men did not experience similar alterations in the risk of melanoma and cancers of the immune system is enigmatic.

"Targeting" in geriatrics is the selection from a wider screened group of frail elderly patients for specific geriatrics programs designed to meet their particular multidimensional health needs. Targeting has been advocated as a means of improving the overall cost-effectiveness of health services for elderly people, both through improvement of the measurable health outcomes in patients served, and limiting futile/inappropriate care (both in patients admitted, and in others by virtue of their exclusion) which adds cost but does not improve health or quality of life. While research supports targeting for improving health outcomes, work to improve targeting practices and criteria is somewhat underdeveloped. These issues are discussed in reference to the contribution of Karppi and Tilvis (1) and other current literature.

The incidence and consequences of falls were investigated in three different types of Swedish geriatric care clinics: a geriatric rehabilitation clinic, a psychogeriatric clinic and a nursing home. Falls were prospectively registered by the nursing staff. The incidence rate (and 95% confidence interval) of falls per 10,000 patient days of the psychogeriatric clinic was 171 (146-196), compared with 92 (72-112) at the geriatric rehabilitation clinic, and 31 (22-41) at the nursing home. Most falls (62%) did not result in injury, while major injuries occurred in 5%. We conclude that accidental falls are a major problem in geriatric care in Sweden, but there is a considerable difference in incidence rates between different types of institutions.

This qualitative study investigated problems in the rehabilitation of women with long-term, musculoskeletal pain disorders. Data were collected by repeated semi-structured interviews and doctor-patient encounters during two years, and analysed in a gender perspective. The "marriage contract", i.e. the pattern of division of duties and power structure within the marital relationship, was of obvious importance to the implementation of rehabilitation measures. We explored situations where the rehabilitation measures disagreed with the terms and patterns in the "marriage contract". The participants' ways of coping with the contract in these delicate situations could be described as three type strategies; accepting the terms, negotiating for new terms, and breaking the contract. The crucial impact of the "marriage contract" and the type strategies on the rehabilitation process are exemplified.

The prevalence of pain combinations among school children is addressed in view of earlier findings of high pain prevalence in this population. The study considers the prevalence of combinations of three common pains headache, stomach pain and back pain-in a random national sample of 2173 Icelandic 11-12 and 15-16 year-old school children. According to the results from this study there is a 78.2% prevalence of monthly pain. One or more instances of weekly pain is experienced by 40.4% of the children, and 15.6% experience two or three pains weekly. Relevance of gender is greater when dealing with combinations of monthly than weekly pain. Combinations of weekly pains are more gender related than single weekly pains. Girls have significantly more frequent overall pain than boys. The distribution of pain combinations varies by age but not overall pain. The study yields important information about the extent of the overall problem of pain among school children and indicates the need to further study the correlates of different pain combinations in this age group.