Scandinavian Journal of Public Health

The main purpose of the present study was to assess the quality of information about occupational history obtained via retrospective interview questions. This assessment is achieved by linking interview data from the Swedish survey of Living Conditions (ULF) with occupational information about the same individuals obtained from a number of censuses. This has been done for the census years 1960, 1970, 1975 and 1980. In both ULF and the census, occupations have been classified according to the Nordic Occupational Classification (NYK). Both data sources contain errors. There are also differences in definitions and measurement procedures. Still, the survey question on occupational history gives results of good quality in terms of agreement with census data. This is especially the case for coarse levels of the classification scheme (NYK 1-digit level). The agreement is somewhat lower for the comparisons farthest back in time.

Genetic epidemiology gives no priority to genes or environment in the search of disease causation. However, a major problem in this field is the disentangling of the effects of environment and genes. The study of subjects separated very early in life from their biologic parents and adopted by unrelated parents provide a strong tool for estimation of genetic and familial environmental influences. The degree to which the trait or disease frequency of the adoptees is similar to that seen among the biologic relatives is an indication of the strength of the genetic influence. Similarity to the adoptive relatives suggests influences of the family environment shared between them. Adoption studies of adult obesity show that it is genes, and not the family environment, that is responsible for the familial aggregation of obesity. A study of the mortality of adult adoptees and their biologic and adoptive parents indicates a genetic influence on the risk of premature death from all causes, from natural causes, infections, and cardio- and cerebrovascular conditions, and suggests familial environmental influences on death from the vascular causes and from cancer.

The daily number of cases of myocardial infarctions admitted to a hospital in middle Sweden over three winter seasons 1984-87 was correlated to the weather conditions on a day-to-day basis. The study encompassed 634 days and all cases younger than 70 years, living within the catchment area, in all 382 subjects. Information on temperature, wind force, precipitation and atmospheric pressure was obtained from the Swedish Institute of Meteorology and Hydrology. A low number of myocardial infarctions was seen on Saturdays and Sundays with a mild wind chill factor and on days with moderate snowfall and high atmospheric pressure. A high number was observed for workdays, especially Mondays, as day of diagnosis. Heterogeneity of the study population and a misclassification of the time relationships between dates of diagnosis and weather changes may have caused an underestimation of the impact of weather conditions. However, weather conditions do not seem to be a major triggering factor of myocardial infarctions in Sweden.

The relationship between living in a physicial abusive relationship and adverse outcome of pregnancy was examined using a structured interview including an obstetrical history. Sixty-six women living in a physically abusive relationship, and 114 women randomly selected and not presently living in such a relationship were interviewed. The women reported 312 completed pregnancies. Five of these were twin pregnancies and one was a stillbirth without information on birth weight. Of the 306 pregnancies included in the analysis, violence had occurred in 40. The mean birth weight of births reported by women exposed to violence during pregnancy was 229 g less than the equivalent figure in non-exposed pregnancies. Adjustment for education, primiparity, and history of addiction reduced the difference in mean birth weight to 175 g.

Contraceptive practices, especially oral contraceptive and intrauterine device use, were studied in four Nordic countries by recalculating published and unpublished data from previous surveys and statistics and by collecting new data from Finland. The sales of oral contraceptives were presented in defined daily doses, and the percentages of women using oral contraceptives were estimated from them. The percentages of intrauterine device users were calculated taking into account the number of intrauterine devices sold each year and the continuation of use from previous years. The results of the surveys were reanalyzed. We found clear differences in contraceptive practices. Oral contraceptive use was most prevalent in Sweden and Denmark, and, especially at the end of the 1970s, Finnish intrauterine device use was very high. In the 1980s the differences dimished somewhat. These disparities in culturally and economically similar countries indicate that further research is needed to evaluate the factors influencing contraceptive practices.

As part of a study of risk factors for cervical cancer, the possible change was assessed in the use of condoms after AIDS campaigns. In 1986, samples of 800 women aged 20-39 years were drawn at random from Nuuk/Godthåb (Greenland) and Nykøbing Falster (Denmark). A total of 586 and 661 women were interviewed in Greenland and Denmark, respectively. In 1988, new random samples of 150 women were drawn from the same areas. Totally, 129 Greenlandic and 126 Danish women were included in the study. From 1986 to 1988 the prevalence of ever having used condoms increased significantly among Greenlandic women aged 20-29, whereas no statistically significant changes were observed in Denmark. This pattern was independent of the lifetime number of sexual partners. Neither in Greenland nor in Denmark did the mean lifetime number of sexual partners change from 1986 to 1988.

A representative sample of 286 Danish females aged 16-20 years were interviewed during the period April 1984 - February 1985. The response rate was 75%. Both use of oral contraception (OC) and smoking were common; 46.6% used OC, 34.2% smoked and 19.6% combined smoking and OC. The prevalence of smoking was significantly higher (42.0%) among OC-users than among nonusers (27.2%).

The combination of smoking and OC was especially prevalent among young women with sexual debut before 16 years (36.8%). The association between smoking and the use of OC was significant both when tested unstratified (p < 0.05) and stratified by age at sexual debut (p < 0.01). Smoking was also associated with early debut of intercourse (p < 0.001).

It has been reported that the combination of these two factors in adult women increase the risk for cardiovascular mortality. However, the health consequences later in life of combining smoking and OC at young ages have not been illuminated in the literature. These findings indicate the necessity for prospective studies of young women.

Adapting the paradigm developed by Richard Lazarus, parenting stress and coping were studied among mothers of 6-9-year-old children (n = 42) with different symptoms of Minimal Brain Dysfunction (MBD) (hyperkinesis, perceptual or motor deficits, learning disabilities or speech disorders) and among mothers of non-disabled children (n = 42) matched for age, sex, social status of the family and marital status. Mothers of children with MBD were found to experience more parenting difficulties and more negative cognitive appraisals of their stakes in parenting than their matched controls. The mothers of children with hyperkinesis and perceptual or motor deficits considered their mastery lower and experienced less positive affects than their matched controls. The mothers of children with speech disorders experienced less positive affects than their matched controls. Mothers of children with both few and several symptoms experienced more parenting difficulties in the child domain than their matched controls. Mothers of children with several symptoms considered their mastery lower and experienced less positive affects; mothers of children with few symptoms appraised their stakes in parenting more negatively than their matched controls. No significant differences were found between mothers of children with MBD with few and several symptoms.

Is the development of Swedish psychiatry a success or not? Available information allows different answers to this question. Valid knowledge would demand psychiatric health service research on a much larger scale and with considerably higher ambitions than hitherto. Strong arguments can be raised about the need for such research to avoid that psychiatry will remain a medical wasteland in which confused policy makers will allocate less interest and money than ever.

The aim of the study was to analyse the association between satisfaction with life and glycosylated haemoglobulin (MbAl). A quality of life questionnaire was administered to 247 persons with IDDM at a Diabetic Clinic in Bergen, Norway. The material was divided into two groups depending on their level of HbAl; HbAl > 0.09 was labelled poorly regulated and a level of HbAl ≥ 0.09 was labelled well regulated. The groups were compared with regard to different life domains and well-being scales. The statistical analysis showed that the well-regulated group had significantly higher average scores considering the somatic and activity/behavioural life domain ratings, the latter being only significantly different among people with higher education. The well-gegulated group had lower average scores in the psychological and social life domain ratings, but these differences were not statistically significant. Among the well-being scales we found a statistically significant difference between poor and well-regulated persons only regarding sociability and loneliness. Well-regulated persons felt on average less sociable and more lonely than poorly-regulated persons.

The aim of the study was to test the effect of a non-pharmacological weight reduction program on cardiovascular risk factors among overweight hypertensives in a primary health care setting. Forty-nine overweight hypertensive patients completed the 12-month program. The patients were randomly allocated into either intervention or control groups. The examinations included interviews by a nutritionist, pertinent laboratory tests, and a medical examination. The intervention involved an individually planned energy-restricted diet of 1000-1500 kcal per day, weekly discussions, and various leaflets on diet modification and on increase of physical activity. The mean body weight was reduced by 5 kg in the intervention group, but remained unchanged in the control group. The intervention group reduced their fat intake by 14 g/day while the control group increased it by 9 g/day on the average. In the intervention group, the total serum cholesterol decreased, HDL-cholesterol increased and triglycerides decreased significantly. The systolic blood pressure fell by 8 mm Hg and 15 mm Hg in the intervention and control groups, respectively. The diastolic blood pressure fell on average by 11 mm Hg in both groups. The results demonstrate the comprehensive weight reduction program to be effective in the control of cardiovascular risk factors.

An attempt was made to evaluate risks, benefits and costs of total hip replacement in patients over 80 years. Forty consecutive replacements in 37 patients were analysed and the results were compared to a younger population (36 patients) concerning complications and duration of hospitalization. The elderly group was reexamined two years postoperatively to assess the outcome. There was a significantly prolonged stay in hospital/long-term care for the octogenarians, 31.1 days compared to 13.6 for the younger group, as well as an increased risk for complications. Eleven patients had 18 different complications (11/40; 27.5%) in contrast to 2 complications in 2 patients (2/36; 5.6%) in the younger population. Quality of life was increased in terms of pain relief and there was moderate improvement in function. For the elderly, the community expenses for welfare services were not found to be reduced after the intervention. It is concluded that the observed improvement of quality of life has to be balanced against the increased risks and costs for this group.