Scandinavian Journal of Public Health

Aim: This study focused on the top 10 selected African countries with key interventions such as high infant mortality rate, high total fertility rate and female literacy rate. Methods: The World Bank’s 2013 data were used. Descriptive analyses were performed. Results: Findings show that Sierra Leone (107.2), Angola (102) and Central Africa Republic (96.1) reported the highest infant mortality rate per 1000 live births. The total fertility rates in Niger (7.6), Mali (6.8) and Somalia (6.6) were higher than other comparable countries. Conclusions: Health care service providers need to pay more attention during pregnancy periods, improve number of field visits, identify pregnant women and promote 100% antenatal care. If this is done practically, these countries will reduce and ultimately eliminate infant mortality.

Aims: Progress towards meeting the goal of measles elimination in the EU and the European Economic Area (EEA) by 2015 is being obstructed, as some children are either not immunized on time or never immunized. One group thought to be at increased risk of measles is migrants; however, the extent to which this is the case is poorly understood, due to a lack of data. This paper addresses this evidence gap by providing an overview of the burden of measles in migrant populations in the EU/EEA. Methods: Data were collected through a comprehensive literature review, a country survey of EU/EEA member states and information from measles experts gathered at an infectious disease workshop. Results: Our results showed incomplete data on measles in migrant populations, as national surveillance systems do not systematically record migration-specific information; however, evidence from the literature review and country survey suggested that some measles outbreaks in the EU/EEA were due to sub-optimal vaccination coverage in migrant populations. Conclusions: We conclude that it is essential that routine surveillance of measles cases and measles, mumps and rubella (MMR) vaccination coverage become strengthened, to capture migrant-specific data. These data can help to inform the provision of preventive services, which may need to reach out to vulnerable migrant populations that currently face barriers in accessing routine immunization and health services.

Aims: The present study examined the prevalence of Swedish children living with at least one parent whom has a substance use disorder (SUD), i.e. either an alcohol use disorder (AUD) or a drug use disorder (DUD). Methods: A 2013 cross-sectional survey of a nationally representative sample (n = 15,576) of the Swedish adult population 17–84 years of age was used. The response rate was 59.3%. SUDs were measured using selected parts of the Mini International Neuropsychiatric Interview (MINI), derived from the 4th edition of the diagnostic and statistical manual of mental disorders (DSM-IV). In total, 3778 parents with 7448 children under the age of 18 years participated. Results: The proportion of children whose parent had a SUD was 4.6%, implying that around 90,000 children in Sweden experience this situation. Having a parent with an AUD was most common (3.7%), while 0.7% and 0.2% had a parent with a DUD and both (AUD plus DUD), respectively. Conclusions: Our results showed that a substantial number of children in Sweden have parents with a SUD and that it is important to consider both alcohol and drugs, when estimating the size of this group. Our findings call for further strategies to support these children and their families.

Aims: Mental problems and their potential socio-demographic determinants were investigated in young schoolchildren in Sweden, a high-income country in the top of income- and gender-equality rankings. Methods: Cross-sectional study of 1465 schoolchildren in grades 3 and 6. Mental health was measured by the Child Behavior Checklist and the Youth Self Report (Total problems and 14 specific problem areas). Potential socio-demographic determinants were sex, parental education and occupation, family structure, and immigrant status. Results: Mental problems were present in 14% of the sixth graders and in 7% of the third graders. In grade 3, the mean total problem score was lower in girls than in boys, but the prevalence of problems at a subclinical/clinical level did not differ by sex. Furthermore, in nine to 13 of the 14 specific problem areas, problems were equally distributed by sex, parental education, parental occupation, immigrant status, and family structure. In grade 6, both the total mean score and the overall odds of subclinical/clinical problems were similar in girls and boys. Likewise, in all the specific problem areas, problems were evenly distributed by parental education and occupation, and only independently associated with immigrant status and family structure in one problem area. In five specific problem areas, boys had higher odds of problems than girls. Conclusions: This study shows that also in a relatively wealthy and equal country such as Sweden, mental problems are a significant child public health issue. The association between socio-demographic background and mental problems seems to be rather weak, but differ dependent on the type of mental problem in focus.

Aims: The aim was to examine experiences of bullying among Swedish adolescents and whether victims and perpetrators were also exposed to violence in the home, with particular focus on how abuse severity affected the risk of exposure to bullying. Methods: A nationally representative sample of pupils aged 14–15 responded to a questionnaire exploring exposure to corporal punishment and other types of violence. Results were analysed using Pearson’s chi-square and multiple logistic regression, adjusting for factors regarding the child, the parents and the families’ socioeconomic status. Results: Among the 3197 respondents, a significant proportion reported at least one incident of either bullying victimisation (girls 36%, boys 26%) or bullying perpetration (girls 24%, boys 36%). Physical and emotional violence in the home, including witnessed intimate partner violence, were significantly associated with both bullying victimisation and bullying perpetration. Odds ratios for exposure to bullying rose with increasing frequency and severity of abuse. Adjusted odds ratios ranged from 1.6 for any event of abuse vs. single episodes of bullying to 20.3 for multiple types of abuse vs. many episodes of bullying. The child’s gender and the presence of a chronic health condition were consistently associated with nearly all levels of abuse and bullying. Conclusions: Bullying experiences are common among youth and are clearly associated with abuse. Frequent bullying, whether as victim or perpetrator, warrants particular vigilance, as it appears to be an indicator of severe violence in the home.

Aims: Profound changes in family structure took place in many countries, during the second part of the previous century. The purpose of this paper is to analyse the association between the type of family residency and psychosomatic problems in younger and older adolescents, particularly focusing on alternate residency, and to examine the impact of child-parent relations. Methods: We used data collected in 2009 by Statistics Sweden among 172,298 Swedish students in Grade 6 and Grade 9 (approximate ages 12 and 15 years old); comprising 80% and 86%, respectively, of the entire population of students in those grades. We collected the data with a questionnaire, completed anonymously in school: We used the Psychosomatic Problems (PSP) scale as the outcome measure. Results: The type of family residency showed a weaker association with psychosomatic problems than the child-parent relationships did. Living in non-intact families increased the probability of adolescent psychosomatic problems by 0–0.05, compared to intact families. In Grade 9, there were no differences in psychosomatic problems between the students in alternate residency and those living with their two parents; and in Grade 6, these differences were relatively small. In comparison, a worse relationship with parents increased the probability of psychosomatic problems by 0.11–0.17, depending on the school grade and type of family residency. Conclusions: The structure of the family, as well as the child-parent relationships needs to be taken into account, to properly estimate the magnitude of the family situation as a determinant of adolescent psychosomatic problems. Our results justify universal intervention at the policy level.

Aim: This study aimed to investigate municipal-level variations and individual- and municipal-level predictors of high levels of depressive symptoms among Norwegian adolescents. Methods: We used data from the Norwegian cross-national Ungdata study. We included 77,424 adolescents from 171 municipalities attending junior high school (Grades 8–10; age 13–16 years) from 2011 to 2013. Multilevel (two-level) logistic regression models were applied for the data analyses. Results: The study revealed that 11% of adolescents reported high levels of depressive symptoms. The median odds ratio without adjusting for any individual- or municipal-level predictors was 1.24, indicating a small between-municipalities variability for high levels of depressive symptoms. All individual-level factors, such as gender, school grade, family income, substance use behaviours, bullying and dissatisfaction with different aspects of life, were significantly associated with high levels of depressive symptoms (p < 0.05). As to municipal-level factors, a low annual budgets for municipal health services was the sole significant predictor of high levels of depressive symptoms between municipalities. Municipal-level factors and variables related to survey characteristics explained a moderate proportion of the variation in high levels of depressive symptoms between municipalities. Conclusions: The cluster heterogeneity in high levels of depressive symptoms was small between municipalities in Norway. Further research should examine the geographic clustering of mental health problems at the school and neighbourhood level.

Aims: To investigate the development of healthy life expectancy from 65 years (HLE65) in Sweden in the period 1980 and 2010 by using two different health indicators: self-rated health and the global activity limitation indicator (GALI). Methods: Sources of data for the HLE computations were Swedish national mortality statistics and the nationwide Swedish Survey of Living Conditions (SSLC), which have been conducted biennially by Statistics Sweden since 1974. We used the Sullivan method for calculations of HLE. A decomposition into mortality and disability effect has been made in accordance with the method devised by Nusselder. Results: Life expectancy at age 65 (LE65) increased by 3.1 years for women and 4.0 years for men from 1980/85 to 2006/11. Regardless of which health measure investigated – self-rated health or GALI – HLE65 increased between the periods 1980/85 to 2006/2011 more rapidly than LE65 and as a consequence the years with bad self-rated health and years with activity limitations decreased. These increases as well as the decreases were significant (p<0.05). Conclusions: The Swedish LE65 and HLE65 development, as judged by the SSLC study, are compatible with the postponement hypothesis and there is even a clear tendency for compression. Thus, the years with bad self-rated health and years with activity limitations are postponed to a higher age and the number of those years have decreased. From this respect, the Swedish development looks positive. The need of old age care in 2010 would have been much higher if it had been expansion – not postponement – of bad self-rated health and years with activity limitations during the time period.

Introduction: We examined the socio-demographic and behavioral determinants of perceived barriers to leisure-time physical activity (LTPA) in a population-based sample of working-aged adults. Methods: Data comprised the National FINRISK 2002 Study, a population-based health examination study. Analyses were restricted to those aged 25–64 years and who perceived that their amount of LTPA did not reach sufficient levels. They reported barriers to LTPA, defined as a lack of time, motivation and lack of companionship to be active with, as well as high expenses. Age, education, household income, employment status, family type, physical activity, smoking and body mass index (BMI) were included as explanatory variables. Results: Lack of time was the most frequent barrier. Each barrier was explained by a different set of factors that also varied between genders. The strongest and most systematic associations with the barriers were found for age, employment status and family type. Lack of time was less often reported as a barrier among the unemployed, singles without children and older people. Lacking motivation as a barrier was most common among singles without children. High expenses as a barrier was more often reported by the unemployed, and less often reported in the highest income group. Conclusions: When considering actions to promote LTPA, there is not one single solution, because the perceived barriers vary by population subgroups.

Aims: Physical activity (PA) used as prevention and treatment of disease has created a need for effective tools for measuring patients’ PA level. Our aim was therefore to assess the validity of two PA questions and their three associated answer modes. Methods: Data on PA according to the PA questions and Actigraph GT3X+ accelerometers, aerobic fitness (VO₂max), cardiovascular biomarkers, and self-rated general health were collected in 365 Swedish adults (21–66 years). The PA questions ask about weekly PA via categories (Categorical), an open-ended answer (Open), or specified day by day (Table). Results: The Categorical mode, compared with the Open mode, correlated (Spearman’s rho) significantly more strongly (p<0.05) with accelerometer PA (0.31 vs. 0.18) and VO₂max (0.27 vs. 0.06), and the level of BMI (–0.20 vs. –0.02), waist circumference (–0.22 vs. –0.03), diastolic blood pressure (–0.16 vs. 0.08), glucose (–0.18 vs. 0.04), triglycerides (–0.31 vs. –0.07), and general health (0.35 vs. 0.19). The validity of the Categorical and Table modes were similar regarding VO₂max and accelerometry, but the Categorical mode exhibited more significant and stronger correlations with cardiovascular biomarkers. The capacity of the PA questions to identify insufficiently physically active individuals ranged from 0.57 to 0.76 for sensitivity and from 0.47 to 0.79 for specificity. Conclusions: The Categorical mode exhibits the strongest validity and Open mode the weakest. The PA questions may be used on a population level, or as a tool for determining patents’ appropriateness for treatment.

Background: The dietary intake in Swedish medical students has been reported for the periods 1987–1993 and 1994–2006. Objective: To analyse dietary intake in medical students between 2007 and 2012, in relation to Nordic Nutrition Recommendations, to previous surveys and to a contemporary Swedish population. Design: Nutrient intake was calculated from 3-day food records conducted by 698 medical students. The differences between surveys were evaluated using a t-test and the changes over time by linear regression. Results: The energy intake in valid female and male reporters was 8.7 and 11.9 MJ respectively. The intake of protein, fat and alcohol, as proportions of energy (E%) and dietary fibre, was within recommendations. The intake of most micronutrients was above recommendations, except for vitamin D, and in women, iron and folate. In women, E% fat increased between 2007 and 2012, while E% carbohydrate decreased. Compared to the 1994–2006 period, medical students in the present survey consumed less carbohydrates and more fat, more folate and more vitamin E. The students were more compliant with the dietary recommendations than the same age group of the Swedish population. Conclusions: Energy intake in medical students, and dietary intake with some exceptions, remained stable during 1987–2012, and close to the Nordic Nutrition Recommendations for most nutrients. Between 2007 and 2012, fat intake increased and carbohydrate intake decreased significantly in women and also tended to do so in men. Similar trends were seen in the Swedish population, possibly indicating the impact of diet trends such as the Low-Carb/High-Fat diet.

Aims: Among employees with diabetes, comorbidity may considerably deteriorate working capacity. We examined how socioeconomic status, lifestyle factors and job strain were related to work disability in individuals with diabetes with and without comorbidity. Methods: In this pooled analysis of individual-participant data from occupational cohorts from Finland (Finnish Public Sector Study FPS), UK (Whitehall II) and France (GAZEL), 1925 employees with diabetes were followed on average for 4 years. Participants were categorized into four groups, according to their baseline comorbidity status and subsequent work disability, as: non-comorbid diabetes with no/low work disability; comorbid diabetes with no/low work disability; non-comorbid diabetes with moderate/high work disability; and comorbid diabetes with moderate/high work disability. The risk of work disability was assessed with multinomial regression, using Group 1 (the first listed above) as the reference group. Results: Participants with low socioeconomic status had increased odds for higher work disability, irrespective of comorbidity (OR = 3.12; 95% CI 2.25–4.33, among participants with no comorbidity, and OR = 2.61; 95% CI 1.93–3.51 among those with comorbidity). Obesity was cross-sectionally associated with comorbidity (OR = 1.95; 95% CI 1.35–2.83 for comorbidity without disability), and this association was particularly pronounced among those whom became work disabled (OR = 2.61; 95% CI 1.89–3.60 for comorbidity with disability). Job strain was associated with high/moderate work disability, only among participants with comorbidity (OR = 1.63; 95% CI 1.14–2.34). Conclusions: Pooled data from three cohort studies showed that low socioeconomic status, obesity, and job strain are linked to both comorbidity and increased work disability in employees with diabetes.

Aims: Previous studies suggest that positive encounters with healthcare and social insurance staff may be important in promoting return to work among long-term sickness absentees. This study aimed to identify more specifically what positive encounters are important for promoting ability to return to work. Methods: A questionnaire about different types of encounters was sent to 10,042 people in Sweden on sick leave for 6–8 months (58% responded). For each positive encounter, we estimated the marginal probability difference (PD) of return to work, adjusting for age, sex, education, sick-leave diagnosis, and the sum score of all other encounters. Adjusting for the other encounters is important since of the observed variables these were the strongest confounders. Results: The positive encounters with both healthcare and social insurance staff significantly associated with promoting ability to return to work after adjusting for the other positive encounters were “Believed in my work capacity” PD=16.9 (95% CI: 12.0, 21.9) and 12.0 (6.3, 17.7), respectively; “Supported my suggestions for solutions”: 9.5 (3.1, 15.9) and 11.6 (5.7, 17.4); “Was supportive and encouraging”: 10.1 (3.6, 16.7) and 7.3 (1.7, 12.8). Additionally, the encounter with healthcare staff most strongly associated with promoting return to work was “Let me take responsibility” 14.8 (7.2, 22.3); and with social security staff: “Showed that she/he liked me” 10.4 (5.4, 15.4). Conclusions: Healthcare and social security staff being supportive, encouraging, and believing in the sickness absentee’s work capacity may be very important for increasing the probability for long-term sickness absentees’ ability to return to work.

Background: Pregnancy, delivery, and the postpartum period may imply morbidity leading to work incapacity; however, this is seldom studied. This study aimed to compare twin sisters giving or not giving birth regarding occurrence of sickness absence (SA) and disability pension (DP). Methods: This population-based cohort study included all 6323 female twins born in Sweden 1959–1990, using register data for 1994–2010 about SA and DP. Average number of SA/DP days/year was calculated in relation to the year of the first delivery, or, if not giving birth, the year when the twin sister gave birth. Twin pairs discordant for delivery were used to investigate the importance of genetic and environmental factors for occurrence of SA and DP. Results: In all, 52% had a first delivery during 1994–2010. Except for the year of delivery, the average number of SA days/year was similar when comparing women who gave birth to those who did not, while number of DP days was significantly higher in women who did not give birth. Differences between the groups seem attributable to genetic factors. Women who delivered once had higher levels of SA and DP than those who had several deliveries. DP with mental diagnoses was more common among women who had not delivered whereas DP with musculoskeletal diagnoses occurred more often among women who delivered. Conclusions: Levels of SA were similar among women who gave birth and who did not. Women not giving birth had significantly higher levels of DP, indicating health selections into childbirth.

Aims: The aim of the narrative review was to describe and analyze lower extremity musculoskeletal disorders (MSDs) in nurses and to identify factors associated with these disorders. The ultimate goal was to promote lower extremity health in nurses by recognizing factors that could improve their well-being at work. Methods: A systematic search on the Medline, CINAHL, and PsychInfo databases was conducted, producing altogether 945 citations, of which 35 were selected for this review. The studies were analyzed by content analysis. Results: Nurses have different MSDs in their lower extremities, with which the knee, foot, and ankle being most commonly affected. These problems are often correlated, and problems in the ankle can first appear as knee problems. Conclusions: Musculoskeletal disorders in lower extremities and their resulting disability are common within the nursing workforce worldwide, representing a major cause of sick leave absence and often leading to long-term absence.