Scandinavian Journal of Public Health

Women have higher long-term sickness absence rates than men, and higher rates of most health problems. The rates vary with type of problem and diagnosis. The objectives were to examine whether equal proportions of women and men had sickness absence when they had a given health problem, and if disparities were diagnosis specific. Prevalence of low-back pain, psychiatric disorders, and injuries was assessed in random samples of two populations in Norway. Prevalence of long-term sickness absence for the same diagnostic categories was estimated for the same time period (1990). For injuries, the prevalence ratios between a health problem and a sickness absence were equal for women and men. For psychiatric health problems, there were 1.7 more women than men behind each sickness absence. Low-back pain showed an intermediate gender ratio of 1.3, indicating that also for this condition women tended to have less sickness absence. Musculoskeletal and psychiatric health problems (fluctuating, chronic) may result in more gender-biased, subjective, and random assessment of work ability than injuries (acute health problem).

The aim of our study was to focus on women's networks in the Swedish county of Jämtland, and to analyse the relationship between network activities and the perceived health among the network participants, as well as participation in the community among its residents. Questionnaires were distributed to all 68 women's networks and 60 responded. The results show that the network activities correlate with an improved perception of health, as well as with increased participation in the community among the residents. The more support, influence, self-reliance and trust in the future experienced by the networks through their work, the better the health among the participants in the network. The greater the self-reliance, trust in the future, amount of network-related unpaid work and new jobs, the better the participation among the community residents. Despite its limitations, our study suggests that women's networks could have an important role in health promotion within the framework of the new public health. The network model, with its bottom-up strategy, could be useful in public health, provided that networking is not used to fill a gap when there are cuts in the public sector.

Objective: To examine the relationship between educational level, a powerful indicator of socioeconomic status in Greece, total cholesterol and HDL-cholesterol in a large sample of Greek adults. Methods: The study sample consisted of 11,645 subjects, 4,398 men and 7,247 women, aged 23 - 86 years, who voluntarily participated in the Greek component of the EPIC study during 1994 - 98. Educational attainment was divided into low, medium, and high. Linear regression analyses were performed, in men and women separately, using total and HDL-cholesterol as dependent variables and educational level as independent, while controlling for age. Results: Total blood cholesterol values are inversely associated with educational level in both genders, a pattern contrasting with that found 20 years ago. The association is more prominent among women. HDL-cholesterol values are inversely associated with educational level in men, whereas the association is less consistent in women.

Population data suggest that a fasting blood glucose level of ≥6.1 mmol/l corresponds best to a two-hour blood glucose level of ≥11.1 mmol/l, which is associated with an increased risk of developing microvascular complications. The proposed new criteria, and the WHO 1985 criteria for diabetes, were applied in an elderly population, which underwent a two-hour oral glucose tolerance test. The prevalence of diabetes was higher when the proposed new criteria were used than when the old criteria were used. In calculating the prevalence of diabetes, the fasting blood glucose ≥6.1 mmol/l corresponded better to the combination of fasting and/or two-hour values than did fasting blood glucose ≥6.7 mmol/l. The prevalence obtained by using either of these fasting values alone or in combination with two-hour values corresponded poorly to that obtained by using mere two-hour blood glucose values.

Background: The objective of this study was to test the assumption that liberalizing community pharmacy ownership in Iceland would lead to increased irrational use of over-the-counter pain relievers containing codeine. Methods: Based on this assumption we built and tested a model using an interrupted time series design that contrasts the monthly sales data for over-the-counter pain relievers containing codeine before and after the legislation took effect. Results: The total use of over-the-counter pain relievers containing codeine as well as those containing paracetamol and codeine has risen steadily throughout the period under study. The interrupted time series did not show a substantial effect from the legislative change on the use of all over-the-counter codeine pain relievers, paracetemol with codeine, and aspirin with codeine combinations. Conclusion: The assumption that increased access leads to irrational use of over-the-counter medicines is not substantiated in the case of over-the-counter pain relievers containing codeine.

Objective: Using data from a prospective birth-to-maturity project, the study presents normally occurring variations in alcohol involvement of alcohol-related problems among a representative cohort of Swedish males in young middle age, born in a Swedish metropolitan area (n=106). Methods: Description and classification were based on an analysis of self-reported information (collected at about 36 years of age) about frequency and quantity of alcohol consumption (four-week timeline), self-reported alcohol-related symptoms, and registry data. Results: According to a broad, operationally defined classification of ``harmful drinking'' (at least three alcohol-related symptoms, including alcohol-related crimes), 43 subjects (41%) had experienced a substantial drinking problem during their lifetime, to an extent that might warrant labels such as ``alcoholism'' or ``hazardous drinking''. About one-third of these misusers were currently using other drugs. Of the 106 subjects, 80 (75%) reported having had at least one alcohol-related symptom or problem at some time during their life. Taking various life events into account, including sociomedical circumstances and heavy consumption at 18 and 25 years, 23 subjects (22%) were classified as having a lifetime prevalence of alcohol abuse/dependence according to DSM-III criteria. Conclusion: Problem drinking was largely unknown to the healthcare system and only a few subjects had received treatment. The results are discussed in the light of data from other national and international epidemiological surveys.

Objective: The aim of this study was to investigate determinants of psychosomatic complaints (PSC) in children. The model assumes that variables are working on three levels: the proximal level (the child), the intermediate level (the family), and the distal level (the society). Methods: Data were obtained from a large cross-sectional survey on children's health and well-being in the Nordic countries. A questionnaire was sent to the parents of a representative sample of 1,163 Swedish children aged seven to 12 years. The analysis included a multivariate analysis using the LISREL program. Results: The best predictors of PSC were the mother's health, the child's mental stability, contacts with peers, and long-term illness/disability. There were many other important relationships, which act via factors, such as school satisfaction, social competence, activities, the parents' sense of coherence, and family economy. Conclusion: PSC in children should be seen in the context of all three levels.

Objective: Insufficient coping with stress may lead to increased susceptibility for disease and death. Use of anxiolytic-hypnotic drugs has been suggested as a coping strategy, and some opinions have proposed their use as preventive medication. The aim of this study was to estimate if use of anxiolytic-hypnotic drugs counters the increased mortality observed in individuals lacking other coping strategies such as emotional support and social participation. Methods: A population based cohort study with 10-year (1982/83 - 1993) survival analysis was performed in 491 men born in 1914, living in the Swedish city of Malmö. Results: Compared with men with a high level of psychosocial coping resources who did not use anxiolytic-hypnotic drugs, men with a low level of psychosocial coping resources had a higher risk of death irrespective whether they used anxiolytic-hypnotic drugs, RR=1.7 (95% CI 1.1 - 2.6) or not (RR=1.8 (95%: 1.3 - 2.5). Conclusion: Anxiolytic-hypnotic drugs do not seem to counter increased mortality in elderly men with low psychosocial coping resources.

Public health needs to be evidence-based if it is to be done correctly, which means that learning and knowledge-production for public health must be comprehensive and include knowledge from four different domains: distribution of health, determinants or causal web, consequences, and intervention methods. Specification of development trends in cardiovascular prevention points at four generations of preventive programs; these include a clinical, a bioepidemiological, a socioepidemiological, and an environmental and policy-oriented generation. Generations differ in focus and strategy, in knowledge base - the art of making an impact - and evaluation. Comprehensive public health programs often comprise components from different generations, leading to the need for an expanded model for research and evaluation. There is an urgent need for learning and knowledge-production using both quantitative and qualitative approaches for developing the evidence base for public health action. In addition, epidemiological knowledge is necessary for making appropriate priorities.

Darwinian medicine may shed new light on the notion of health and many current health problems. In this paper, health, as an ability to realize one's own welfare, is compared with health as an ability—either being developed or actually present—to perform a reproductive function of one's species. It is argued that knowledge about the conditions for health in the latter sense may enhance our efforts to promote health in the former sense.

Objective: Information on drinking patterns may make an important contribution to our understanding of the risks and consequences of alcohol consumption. The objective of the present study is to describe variations and stability of patterns of alcohol use at both the aggregate and the individual levels. Methods: The reported alcohol consumption was recorded of a normal, representative birth cohort of Swedish male (n=122) subjects followed from the age of 18 years to early middle age and more extensively scrutinized at the age of 36, using a 28 day time-line follow-back technique. Results: In young middle age a high proportion of total consumption occurred on Fridays and Saturdays (about 60%). In addition, it was possible to classify ``standard drinkers'', ``sporadic binge drinkers'', and ``frequent drinkers'' as separate clusters. Conclusion: While binge drinking was more stable than frequency of drinking from the age of 18 to the age of 36, frequent drinking showed the highest short-term stability at the age of 36 years.