Scandinavian Journal of Public Health

Aims: To explore the relation between employment status, type of unemployment and pregnancy outcomes. Methods: A cohort study of 7,282 pregnancies of unemployed women and 56,014 pregnancies among women in paid jobs was performed within the Danish National Birth Cohort. Pregnancy outcomes were ascertained and information about lifestyle, occupational, medical, and obstetric factors was obtained. Logistic regression was used to calculate odds ratios (OR) for fetal loss, congenital anomalies, multiple births, sex ratio, preterm and very preterm birth and small for gestational age status, adjusting for lifestyle, medical and obstetric factors. Results: There were no differences in pregnancy outcomes between employed and unemployed women but women receiving unemployment benefit had an increased risk of preterm birth (adjusted OR (aOR) 1.16, 95% confidence interval (95% CI) 1.03—1.31) and having a small for gestational age child (aOR 1.08, 95% CI 1.00—1.19) compared with employed women. Women receiving sickness or maternity benefit had an increased risk of multiple birth (aOR 1.70, 95% CI 1.43—2.04), preterm (aOR 1.47, 95% CI 1.22—1.77) and very preterm birth (aOR 1.88, 95% CI 1.22—2.89), while those receiving an unreported type of support had an increased risk of preterm birth (aOR 1.40, 95% CI 1.02—1.93). Conclusions: We found no indication that being unemployed during pregnancy benefits or endangers the health of the child. Within the subgroups of unemployed women, we observed that women receiving unemployment and sickness or maternity benefits were at higher risk for some adverse pregnancy outcomes.

Aim: To assess the impact of hospital episiotomy policy on obstetric and anal sphincter rupture (OASR, n = 2448) rates and risks among singleton vaginal deliveries in Finland between 1997 and 2007. Methods: An observational, retrospective, population-based register study. All 424,297 women in hospitals with more than 1000 deliveries annually, were divided into three groups based on the episiotomy rate quartiles for 11 years and separated on the basis of whether the women were primiparous or multiparous. The lowest and the highest quartiles were compared against the hospitals with intermediate episiotomy rates, comprising the two quartiles around the median. Stepwise logistic regression analysis was used to adjust significant risk factors. Results: The annual range of episiotomy varied from 11 to 94% in primiparous women, and from 1 to 46% in multiparous women. After adjustment the risk of OASR appears to be 39% lower (OR 0.61, 95% CI 0.52—0.90) in primiparous and 45% lower (OR 0.55, 95% CI 0.42—0.72) in multiparous women delivered in the highest quartile hospitals. At an individual level, episiotomy was a protective factor (OR 0.82, 95% CI 0.75—0.91) in primiparous women, but increased the risk by 2.36-fold in multiparous women (OR 2.36, 95% CI 1.86—2.84). Conclusions: The results suggest that high episiotomy rate provided protection from OASR among both groups of women. Among the multiparous women, the 2.4-fold risk of OASR related to episiotomy at an individual level might be explained by confounding by indication, since episiotomy was performed more often to women at a high risk of OASR.

Aim: To investigate cytomegalovirus, rubella, varicella, toxoplasma, and hepatitis B immune status and factors associated with susceptibility for infections among Pakistani pregnant women in Norway. Methods: A total of 206 pregnant Pakistani women living in Norway participated in the evaluation. Blood samples were collected during pregnancy and tested for IgG antibodies against cytomegalovirus, rubella virus, varicella-zoster virus, Toxoplasma gondii, and hepatitis B (HB) virus. Results: All women had IgG antibodies against cytomegalovirus. Positivity for rubella IgG was 92%, 93% had varicella IgG antibodies, while 17% had toxoplasma IgG. Eleven per cent were anti-HBc positive, one of whom was HBsAg positive, which means that blood and cervix secretions are infectious with risk of virus transmission to the baby at the time of birth. Six women were only anti-HBc positive, they may have low-level HB infection, and risk of transmission cannot be excluded. Age younger than 25 years, having less than two children, and having lived less than 5 years in Norway were factors significantly associated with varicella-seronegative status, and thus susceptible for primary infection. Conclusions: To decrease the incidence of neonatal and maternal morbidity related to rubella, varicella, toxoplasma, and hepatitis B in our Pakistani immigrant population, we should intensify our rubella antenatal screening programme and focus upon rubella vaccination postpartum. We should offer varicella-seronegative women immunisation, advise toxoplasma-seronegative women to avoid visit to their home country during pregnancy, and give hepatitis B vaccine to all newborns regardless of maternal HBsAg status.

Aim: The aim of this study was to investigate to what extent individual-based extended information given to mothers from city parts of low education can improve precautions taken by them to prevent burn and scald injuries involving young children in the home and further to compare the results with a group of mothers who had not received extended information. Methods: This intervention study, with a comparison group, has a quasi-experimental design. Individual-based information, with an empowerment approach, was given to a group of mothers living in two separate areas of a city in southern Sweden with a low level of education. In total, 99 mothers of children under the age of 7 months participated. The mothers were selected through the local child healthcare authorities. Observations were made and bivariate analyses were established. Results: The results showed that the intervention had a significant impact on improving the precautions the participating mothers introduced to protect their children against burn and scald injuries in the home and further, in relation to a comparison group. Conclusions: Through empowerment, workshops, and home visits aimed to increase their consciousness and knowledge, the participating mothers’ precautions taken against child injuries in the home improved. It is of great importance that a framework for considering the problem of burn and scald injuries to children is presented from a preventive perspective which, in combination with evidence-based interventions, may enable the creation of injury prevention programmes for implementation by the community health care.

Background: In 2007, the Danish Cancer Society and the Tryg Fonden launched a campaign to prevent skin cancer and melanoma. As a part of this intervention programme, the Danish Cancer Society prepared a ‘‘sun policy’’, which recommends how children in Danish kindergartens can be protected from the sun. Aims: The aim of this study was to determine the factors that influence a decision to implement the sun policy in Danish kindergartens. Methods: We conducted a comparative qualitative study. Data were collected at semi-structured interviews with the principals of five kindergartens with a sun policy and five without. Results: The key factor in making a decision is the priority given to the sun policy by the principal, which in turn depends on the principal’s perception of his or her resources. Further factors are the principal’s attitude toward parental responsibility and media focus on sun protection. Conclusions: Principals must be convinced of the importance of a written sun policy. A mailed reminder containing arguments about its importance to accompany the draft sun policy might reinforce the formulation and implementation of sun policies nationwide.

Aim: We surveyed Lithuanian general practitioners’ (GPs) views on the importance of confidentiality for adolescents and on their practices in informing parents about sexual and reproductive health consultations with this age group. Methods: In this cross-sectional study, a 41-item questionnaire was sent to a random sample of 607 Lithuanian GPs. The purpose of this questionnaire was to gain knowledge about current practices of GPs in informing parents on the importance of confidentiality as well as in protecting the privacy of minors. GPs’ knowledge of the current legal age limit of confidentiality protection in patient-provider settings was also assessed. Results: Although 67.5% of the responding GPs (response rate 73.5%) stated that they inform the parents or guardians of adolescent patients about the importance of confidentiality, 82.9% of them only did so if the opportunity arose. When consulting on general sexual issues, more than 70% stated that they would guarantee their minor patients confidentiality. However, when cases involved sexually transmitted infections or pregnancy, nearly the same percentage said they would inform the parents. 62.3% of GPs incorrectly believed that the law only protects the right to confidentiality for patients who are 18 or older. Conclusions: Our findings indicate that Lithuanian GPs frequently violate adolescents’ right to confidential health services. The study highlights the need for a comprehensive strategy to strengthen the confidentiality of sexual and reproductive health services for this group in Lithuanian primary care.

Introduction: A decrease in physical activity amongst adolescents has been observed and it is well documented that low levels of activity are associated with poor health. In an attempt to understand factors that influence physical activity (PA) in young people research was undertaken with high school students in New Zealand to identify preferred places for PA and establish factors that they felt influenced levels of PA. Methods: One hundred males and 73 females in year nine (aged 12—13) in health and physical education classes completed mapping exercises in which they delineated favourite and least favourite places for PA, where they went on a particular Sunday, how they got there and what they did, and chosen after-school activities and how they got there. Results: Open public spaces were the most favoured places for PA with a nearby beach and park most frequently cited. Specific physical activities, having fun, and having friends to do an activity with were the most frequently cited reasons for liking these places. An industrial harbour area, other schools, and cemeteries were the least favoured places. Less than 2% biked somewhere on the Sunday surveyed and only 23% walked somewhere. The majority were driven to activities by car and a similar reliance on cars was observed for after-school activities. Conclusions: A combination of environmental and social factors is important in both encouraging and discouraging PA and should be taken into account when seeking to enhance PA of young people.

Hearing difficulties is a growing public health problem and more knowledge of consequences of those difficulties in working life is warranted. Aims: To study the future risk of being granted a disability pension (DP) among people with sickness absence with an otoaudiological diagnoses (OAD) compared to other sickness absentees. Methods: A population-based prospective cohort study of all 40,786 people in a Swedish county who in 1985 were aged 16—64 and had a new sick-leave spell >7 days. Those were followed for 12 years with regard to DP. Hazard ratios (HR) + 95% confidence intervals (CI) of being granted DP was calculated among those with sick leave due to OAD compared to people with sickness absence with other diagnoses. Results: In 1985, 515 people had a new sick-leave spell with an OAD. Twelve years later, 36% of those had been granted DP, compared to 24% of all other sickness absentees. Their HR for DP was 1.42 (95% CI 1.23—1.64) adjusting for gender and age. Compared to men, women with an OAD had a HR of DP of 1.24 (95% CI 0.90—1.71), when adjusted for age. The HR for DP regarding those aged>45 years and sickness absent with OAD was 2.63 (95% CI 1.95—3.55) compared to the sickness absentees with OAD below 45 years of age, adjusted for gender. Conclusions: The risk for future DP was more than 40% higher among those initially on sickness absence due to OAD than among other sickness absentees.

Aims: Sickness certificates are to provide information on a disease and its consequences on the patient’s functioning. This information has implications for the patient’s rights to sickness benefits and return-to-work measures. The objective of this study was to investigate the description of functioning in sickness certificates according to WHO’s International Classification of Functioning, Disability, and Health (ICF), and to describe the influence of patients’ age, gender, diagnostic group, and affiliation of certifying physician. Method: A content analysis of written statements regarding how the disease limits the patient’s functioning with ICF as a framework was performed in 475 sickness certificates, consecutively collected in Östergötland County, Sweden. Results: Musculoskeletal diseases (MSD) were the largest diagnostic group, followed by mental disorders (MD). Certificates were mainly issued from physicians at hospitals and in primary health care (PHC). ICF was applicable for classifying statements regarding functioning in 311 certificates (65%). The distribution of components was 58% body functions, 26% activity, and 7% participation. The descriptions were primarily restricted to the use of at least one component; namely, body functions. Subgroup analysis showed that descriptions of activity and participation were more common in certificates for MD and MSD, or those issued by PHC physicians. A multiple regression analysis with the activity component as dependent variable confirmed the results by showing that activity was related to both diagnosis and affiliation. Conclusions: In a consecutive sample of sickness certificates, it was shown that information on functioning is scarce. When functioning was described, it was mainly body oriented.

Aims: Cardiac rehabilitation should safeguard that socioeconomic factors or other differences that affect people’s cardiovascular health are not further aggravated after healthcare treatment. The study examines whether socioeconomic status, emotional problems, or the severity of disease affect people’s ability to continue to work after heart disease. We also examined if these effects can be explained by differences in motivational factors. Methods: 217 patients (41 women) from the Krokeide Rehabilitation Centre in Bergen participated. Multiple linear regression analysis was used to examine motivational differences, and logistic regression analysis was used to examine whether socioeconomic factors or other differences affected people’s ability to continue to work after heart disease. Results: Self-efficacy for future work strongly impacted the likelihood of being incapacitated for work during the 2-year follow-up. The household’s total income and emotional problems were statistically significant related to patients dropping out from work in the course of the observation. The association between emotional problems and future work was mediated by motivational problems. The relation between income and future incapacity for work could not be explained by motivational factors. Conclusions: The study shows a clear Matthew effect on people’s ability to continue to work after heart disease as low-income groups and people with emotional problems are more at risk of dropping out of work. This Matthew effect was, however, only explained by the motivational difficulties for the association between emotional distress and dropping out of work and not for the impact of household income on the likelihood of leaving work.

Aims: In Finland, 91% of employer-arranged occupational health services (OHS) include primary care for employees. Occupational health (OH) physicians and OH nurses carry the main responsibility for primary care in OHS. This study analyses work- and health-related factors associated with primary care visits to OH physicians and OH nurses. Methods: This population-based cross-sectional survey encompassed 1636 randomly selected working employees aged 25—64 covered by OHS which included primary care. The associations between factors and visits during the previous 6 months were tested by Poisson regression analysis. Results: The proportion of employees who visited OH physicians or OH nurses was 57%. Men visited OH nurses more often than women, but the number of visits to OH physicians was similar. Long-standing illnesses impairing work ability, work-related symptoms, and type of OHS provision were associated with visits to both OH physicians and nurses. Moderate psychological stress was associated with visits to OH physicians. Among men, the requirement of obtaining a sick-leave certificate on the first day of absence was associated with visits. Less possibilities to influence one’s work was associated with visits to OH nurses, and among women also to OH physicians. Poor support from supervisors and co-workers had non-significant or inverse associations. Conclusions: The wide use of OHS and both the type and similarities between factors associated with visits may signify that both OH physicians and OH nurses are likely to encounter work-related health problems through primary care in OHS.

Aims: The aim of this study was to investigate whether temporary employment was related to non-optimal self-rated health and psychological distress at age 42 after adjustment for the same indicators at age 30, and to analyze the effects of job insecurity, low cash margin and high job strain on this relationship. Methods: A subcohort of the Northern Swedish Cohort that was employed at the 2007 follow-up survey (n = 907, response rate of 94%) was analyzed using data from 1995 and 2007 questionnaires. Results: Temporary employees had a higher risk of both non-optimal self-rated health and psychological distress. After adjustment for non-optimal self-rated health at age 30 and psychological distress at age 30 as well as for sociodemographic variables, the odds ratios decreased but remained significant. However, after adjustment for job insecurity, high job strain and low cash margin the odds ratio dropped for non-optimal self-rated health but remained significant for psychological distress. Conclusions: Temporary employment may have adverse effects on self-rated health and psychological health after adjustment for previous health status and sociodemographic variables. Our findings indicate that low cash margin and job insecurity may partially mediate the association between temporary employment and health status.

Aim: The aim of this study was to analyse hospitalisation trends of obese people in Poland in the period of 1985—2007. Methods: The data comes from a nationwide database created in 1979 in the framework of General Hospital Morbidity Study by the Centre for Monitoring and Analyses of Population Health in The National Institute of Public Health — National Institute of Hygiene in Warsaw. The analysis took into account age, gender, and place of residence (urban/rural) of hospitalised persons. For this analysis hospitalisation rates have been used (number of people hospitalised due to obesity during the year per unit of analysed population). Results: Analysis has shown a systematic increase in the number of people hospitalised due to obesity. The majority of all admitted patients were women of whom those between the ages of 10—19 were treated most frequently. Because of obesity urban inhabitants were more often hospitalised than those coming from rural areas. In the analysed period of 23 years the hospitalisation span has been reduced by about 50%; it may be due to the trend of shortening treatment time, as well as to high costs of treating obese patients. Conclusions: Systematic increase in the prevalence of overweight and obesity in the Polish population reflects a problem growing for decades, manifested in the increase in the number of people hospitalised due to obesity.

Background: We studied ability of serum cotinine and detailed history of smoking to predict bronchial obstruction. Methods: The baseline study was done during the Mini-Finland Health Survey in 1980 and the follow-up study during the Health 2000 Survey in 2000 for a total of 662 persons free from bronchial obstruction at baseline. Spirometric values of the ratio of forced expiratory volume in one second to forced vital capacity (FEV%) <80% were defined as moderate and <70% as severe bronchial obstruction at follow-up. Cotinine was determined from frozen serum samples collected at baseline. Results: For those who reported at baseline not to smoke currently but whose serum cotinine (≥100 μg/l) indicated active smoking, the age- and sex-adjusted odds ratio of bronchial obstruction at follow-up was 2.55 (95% CI 1.26—5.19) compared with the ‘‘true non-smokers’’ (<100 μg/l). Among current smokers, after adjustment for age, sex, pack years, daily consumption of cigarettes, and inhalation of smoke, the odds ratio of moderate and severe bronchial obstruction was 1.61 (95% CI 1.12— 2.32) and 1.97 (95% CI 1.10—3.54) per an increment of one standard deviation (367 μg/l) in serum cotinine. The predictive value of all the interview measures of past or current smoking was clearly lower. Conclusions: Serum cotinine concentration is a useful predictor for development of obstruction. Smoking history alone may be insufficient in risk factor studies focusing on smoking-related diseases.