Scandinavian Journal of Public Health

Acute admissions to anywhere other than general hospitals are uncommon in Norway, but at Hallingdal sjukestugu, a community hospital in a rural district, this has been practiced for years. This article presents experiences from this practice.

Hallingdal sjukestugu is a decentralized, specialist healthcare service, under the administration and funding of Ringerike sykehus, the nearest general hospital, which is 170 km away. General practitioners under telephone supervision of the hospital specialists run the inpatient department. Six municipalities with 20,000 inhabitants make use of the community hospital. Statistics were obtained from the patient administration systems and from manual statistics continuously registered in 2009–10.

In 2009–10 the inpatient department, an intermediate care unit with 14 beds, had an average of 605 admissions a year, with a mean length of stay of 6.3 days. There were 455 acute admissions to Hallingdal sjukestugu. Forty per cent of these patients were younger than 67 and 36% were older than 80 years of age. Half were admitted for observation and half for treatment. The main diagnostic groups were infections, injuries and palliative care. Seventeen per cent of the acute admitted patients were later transferred to the general hospital for further work-up or treatment; 70% were discharged to their homes.

The experiences from Hallingdal sjukestugu indicate that it is feasible to give a selected group of patients an alternative to acute admissions to a general hospital.

Social benefits aim to bring marginalised citizens back into the labour force. As benefits constitute a burden for tax payers, attention has been given to measure the effect. We used register data to assess the employment effect of rehabilitation benefit; the most liberal social benefit in Denmark.

We used data on rehabilitation benefits paid during 1994–2004. In the study design, special care was given to overcome selection bias. We identified municipalities with most frequent (generous) and least frequent (stingy) use of rehabilitation benefit, controlling for confounders (step 1). From the generous municipalities, population subgroups where ≥10% received rehabilitation benefit (vulnerable group) were identified based on age, sex, education, cohabitation, children, and health (step 2). Outcome measure was employment rate in 2005 for vulnerable groups in generous municipalities compared with vulnerable groups in stingy municipalities, controlled for municipality employment rate, i.e. a ratio of ratios (step 3).

Use of rehabilitation benefit varied 10-fold across the 271 Danish municipalities. The employment rate in 2005 for vulnerable groups was lower in generous than in stingy municipalities. The ratio of ratios was 0.915 (95% CI 0.888–0.945) for men and 0.919 (95% CI 0.896–0.942) for women.

No positive employment effect of generous use of rehabilitation benefit was found. Although residual confounding cannot be excluded, it is nevertheless remarkable that the possibly positive effect of rehabilitation benefit was not sufficiently large to become visible, even in a study particularly designed to eliminate selection biases and to control for confounding.

The aim of this work was to study the influence of several family dimensions on sense of coherence (SOC) in adolescence, controlling the possible effects from the demographic variables, gender and age.

The sample consisted of 7580 adolescents between the ages of 13 and 18, who had taken part in the 2010 edition of the WHO Health Behaviour in School-aged Children study in Spain.

The results showed that there were no significant gender differences in SOC levels. However, age had a significant influence on SOC. Higher levels of SOC were found in adolescents aged 13 and 14 compared to older participants. Family variables explained 18% of SOC variability, with affection, easy communication with parents, and parental knowledge as the most outstanding variables. In addition, positive relationships between parents and family affluence had a significant role in explaining SOC levels.

The results suggest that the family context plays an important role in providing meaningful experiences for the development of a strong SOC in adolescence.

In western countries out-of-hospital ischaemic heart disease (IHD) deaths account for approximately 50–70% of all IHD deaths. The objective was to examine the trends in out-of-hospital IHD deaths in the Region of Skåne in southern Sweden, in different sex- and age-groups.

All 14,347 persons (range 24–110 years) in Skåne who died out-of-hospital between 1992 and 2003 from IHD (I410–I414; I20–I25) as the underlying cause of death. Subjects with previous admission for IHD since 1970 were excluded. Data were retrieved from the Swedish National Cause of Death and Patient Register. Age-standardized IHD mortality rates and trends were calculated using Poisson regression analysis.

Age-standardized annual out-of-hospital IHD mortality rates from 1992–2003 decreased in men from 177±13 to 103±9/100,000 inhabitants (−4.7%; p<0.001) and in women from 142±11 to 96±9/100,000 (−2.7%; p<0.001). In men, the annual change in age-standardized IHD mortality rates were −5.3 % (p<0.001), −4.0 % (p<0.001) and −4.7 % (p<0.001), respectively, in the age groups 20–64 years, 65–74 years and ≥75 years. Corresponding figures in women were −4.4 % (p<0.001), −2.4 % (p=0.003) and −2.5 % (p<0.001). The proportion of IHD deaths occurring out-of-hospital was in these age groups 50%, 40% and 35% respectively.

In Skåne, out-of-hospital mortality in IHD deaths decreased significantly between 1992 and 2003. The decrease is more pronounced in men than women, and at the end of the study period in 2003, rates were almost equal. The proportion of IHD deaths occurring outside hospital was higher in younger people than in older people.

The subject of investigation is the ways in which the Danish municipalities organize prevention and health-promotion efforts for children and adolescents. The aim is to examine how health managerial ideas have been combined with health professional ideals concerning different health educational approaches.

Mixed qualitative design: survey based on telephone interviews with health managers (n=72), personal and focus group interviews with health professionals (n=84) and pupils (n=108) from 18 school classes, and comparative case studies in five selected municipalities of various size and geographical location. The theoretical framework has three positions combining a public management perspective with a pedagogical perspective on health promotion.

The municipalities give high priority to prevention and health promotion directed toward children and adolescents and face a number of challenges at the management, collaboration, and knowledge levels. Missing links is one of the main points. Health managers and health professionals are preoccupied with some educational consequences of the health interventions, but they do not focus to the same extent on explicit health educational goals, learning content, or value clarification. Health pedagogy is often a matter of retrospective rationalization rather than the starting point of planning. Health and risk behaviour approaches override health educational approaches.

Operational links between health education, health professionalism, and management strategies pose the foremost challenge. Operational links indicates cooperative levels that facilitate a creative and innovative effort across traditional professional boundaries. It is proposed that such links are supported by network structures, shared semantics, and situated pedagogical means of intervention.

To gain a deeper understanding of the conditions for and perceived benefits of regular participation in an immigrant women’s club, with special focus on the women’s wellbeing and the club’s potential for health promotion.

A qualitative research approach was applied, including semi-structured interviews, which were analysed using the constructivist Grounded Theory method. Individual interviews of 15 women aged 40–59 years and from various ethnic backgrounds were conducted in 2010/2011.

Four categories were identified during the analysis. These were labelled “Forming a place for coping with loneliness” (core category), “Learning the rules”, “Social bonding and support”, and “A space for wellbeing and health”. The categories describe how the members deal with the club’s status as a municipal association, the structure of the meetings, and the informants’ perceptions of being members of a club, as well as the effects of the membership.

Immigrant women may find support and perceive increased wellbeing from gathering in clubs with women from a similar background. In addition, the clubs may provide society an opportunity and a space for adapted health-promotion initiatives.

Precarious type of employment may have a negative impact on health, notably on low psychological wellbeing. The basis of the former relationship is constructed by definition and operationalisation of precariousness. In this research, we first experimented with a construct of work history in the operationalisation of precariousness and second studied the relationship between precariousness and health.

The research data originated from a large population-based birth cohort (NFBC 1966). The study sample consists of 3449 respondents to the postal questionnaire at the age of 31 and the information supplemented by the register data of the Finnish Centre for Pensions. Health was measured by self-reports of doctor-diagnosed/treated illnesses and HSCL-25 for mental symptoms.

Our operationalisation with a construct of discontinuous work history captured the precarious insecure relation to work. The precarious workers were found to have proportionally more mental symptoms in comparison with permanent workers. The perception of distress was stronger among precarious workers who perceived high job insecurity. However, there were no differences in doctor-diagnosed/treated illnesses between precarious and permanent workers.

The study suggests that the construct of work history is a useful element in defining precariousness. The study also illustrates the association of precariousness, perceived job insecurity, and mental distress. The study suggests further research on disadvantages experienced by precarious workers.

To analyse how health risk behaviours (HRB) are clustered and associated with parental background and family wealth among Swedish boys and girls.

Data were collected from Health Behaviour in School-aged Children (HBSC), a global cross-sectional survey for 1997/98, 2001/02, and 2005/06. A total of 11,972 boys and girls in grades 5, 7, and 9 participated in the study. The pupils were categorised in subgroups according to parental background: Swedish (80.0%), mixed (10.6%), and foreign (9.4%). Cluster analyses were used to identify HRB profiles. Multinomial logistic regression analysis was used to estimate associations between cluster allocation, parental background, and family affluence.

In total 11,232 pupils were identified and allocated to five cluster profiles, half of them in the cluster profile of low-risk behaviour. The most disadvantaged cluster was multiple HRB, which was characterised by high prevalence of smoking, drunkenness, low physical activity, and high soft-drink consumption. The cluster profile of multiple HRB was associated with both mixed background and foreign background in girls and with mixed background in boys. The cluster profile of inadequate tooth brushing was associated with foreign background in both boys and girls. The cluster profiles of multiple HRB and inadequate tooth brushing were associated with low family affluence in girls.

The cluster profiles of multiple HRB and inadequate tooth brushing were associated with parental foreign extraction in boys and girls and with low family affluence in girls. Prevention programmes based on identified clusters of HRB, including consideration of impact of socio-demographic indicators, are needed.

Various social and economic effects are associated with asthma. This quantitative study describes the effects of current asthma on work life evaluated from the number of weeks receiving transfer incomes.

The study population comprised 7,241 persons answering the ECRHS II screening questionnaire, which was sent to a random age and gender stratified sample of 10,000 persons aged 20 to 44 years. Participants with current asthma were identified by positive answers to a set of validated questions. Transfer incomes for a five-year period were registered from a study-independent national database, which collects all public administered transfer incomes in Denmark. The numbers of weeks receiving unemployment, welfare, sick-leave and disability benefits were identified for each participant and differences between asthmatics and non-asthmatics were analyzed.

Asthmatics had significantly more annual weeks receiving welfare (36.6 vs. 20.7, p=0.00), sick leave (9.2 vs. 6.6, p=0.00) and disability (19.3 vs. 11.4, p=0.00) benefits than non-asthmatics. Adult-onset asthmatics had increased prevalence rate ratios for disability of 2.40 (95% confidence interval 1.70–3.40). Blue collar work significantly increased the probability of all public transfer incomes.

Current asthma makes it harder to keep a job. Adult-onset asthmatics and blue collar workers are particularly affected.

To analyse whether gestational diabetes mellitus (GDM) was associated with increases in healthcare utilisation after delivery.

A longitudinal case–control registry-based study of 579 women with GDM delivered in 1995–2001. Two controls for each case were selected from the Swedish National Board of Health and Welfare, matched for year of birth, year of delivery, and municipality of residence. Data regarding healthcare utilisation was provided by the Patients’ Administrative System in Skåne County, Sweden, covering the period from the years of delivery up to year 2009.

Women with previous GDM had higher mean number of contacts and total cost in the years after delivery as compared to controls, also when excluding utilisation related to subsequent pregnancies and childbirth. By year 2009, 31% of women with prior GDM were diagnosed with diabetes, compared to 1% of controls. Women diagnosed with diabetes were more likely to use health care (odds ratio 14.22, 95% confidence interval 5.87–34.45) controlling for age and time since delivery, whereas cases not diagnosed with diabetes did not differ from controls. The average annual cost of healthcare utilisation was 101% higher (p<0.001) for women with diabetes 10 years after delivery compared to controls.

GDM was associated with higher healthcare utilisation postpartum for women who had a diabetes diagnosis. The results call for implementation of structured programmes to follow up women with GDM postpartum for early detection of diabetes and effective management, which may have the potential for improved health and savings in healthcare costs.

In 2010 the five Danish regions and the National Institute of Public Health at the University of Southern Denmark conducted a national representative health survey among the adult population in Denmark. This paper describes the study design and the sample and study population as well as the content of the questionnaire.

The survey was based on five regional stratified random samples and one national random sample. The samples were mutually exclusive. A total of 298,550 individuals (16 years or older) were invited to participate. Information was collected using a mixed mode approach (paper and web questionnaires). A questionnaire with a minimum of 52 core questions was used in all six subsamples. Calibrated weights were computed in order to take account of the complex survey design and reduce non-response bias.

In all, 177,639 individuals completed the questionnaire (59.5%). The response rate varied from 52.3% in the Capital Region of Denmark sample to 65.5% in the North Denmark Region sample. The response rate was particularly low among young men, unmarried people and among individuals with a different ethnic background than Danish.

The survey was a result of extensive national cooperation across sectors, which makes it unique in its field of application, e.g. health surveillance, planning and prioritizing public health initiatives and research. However, the low response rate in some subgroups of the study population can pose problems in generalizing data, and efforts to increase the response rate will be important in the forthcoming surveys.

To explore how participants taking part in a session based on a solution-focused approach to enhance self-management skills experienced the metaphor “Captain of the ship” used in the educational material.

A qualitative study with semi-structured focus group interviews with 16 participants in different self-management programmes. The educational material used the metaphor “Captain of the ship”. The material had pictures of a turtle who was “Captain of the ship” in different situations. The pictures were accompanied by solution-focused questions.

Most of the participants found the metaphor “Captain of the ship” very helpful. They reported that it was easy to remember, enhanced the learning process, and could be used as a practical tool in everyday situations. Furthermore, the metaphor helped them to become more aware of their own responsibility for self-management.

The metaphor “Captain of the ship” was experienced as strengthening the messages from the solution-focused approach.