Sociodemographic gender differences in patients attending a community-based alcohol treatment centre.

This study included all individuals attending a community-based treatment centre during a 4-year period. Patients were referred to the treatment centre from the primary health care (17%), social insurance office (8%), social workers (19%), employers (7%), prisons and probation administration (3%), on their own initiative (25%), and by other means (21%). The participants, 355 men and 164 women, all between 18 and 64 years of age, were compared with the total population in the municipality with regards to gender differences in sociodemographic characteristics. Adult life circumstances such as legal problems, broken relationships, unemployment and lower social class, in both men and women, were clearly associated with an alcohol dependence or at least of seeking help for this problem. The study also emphasises important social consequences of alcohol dependence in women, such as legal problems and drunk driving, normally associated with male alcohol dependence. The study revealed that living with an abusing partner was associated with a higher frequency of alcohol dependence in women. The findings are important issues to address when offering treatment to women with alcohol dependence.

How to measure sickness absence? Literature review and suggestion of five basic measures.

OBJECTIVE: To examine different sick-leave measures used in sickness absence research, and to suggest a systematic way of assessing sickness absence. METHODS: A review and analysis of five major studies on sick-leave performed 1983-1988 with an epidemiological approach. RESULTS: Terminology and measures used varied in the different studies reviewed. The choice of a certain measure was seldom discussed in relation to the aim of the study. Based on the review five measures are suggested: frequency, length, incidence rate, cumulative incidence and duration. The definition of incidence rate is new and is a measure useful in studies of recurrent events within epidemiology. CONCLUSIONS: We have reviewed sick-leave measures previously used in the literature and suggested five basic measures for assessing sick-leave.

Long-term economic effects of team-based clinical case management of patients with chronic minor disease and long-term absence from working life.

OBJECTIVES: To examine the socio-economic effects of team-based clinical case management of patients with chronic minor disease bound for early retirement. DESIGN: Marginal analysis of programme costs and benefits to society compared with no-programme baseline of costs occurring in society due to productivity loss. Prospective patient data collection on admission, discharge, and at one year and five years after discharge to determine programme effectiveness. SETTING: Out-patient clinic at the department of social medicine in tertiary care hospital. SUBJECTS: 239 patients with minor disease and long-term vocational absence consecutively admitted to the study. At the one-year evaluation, 17 patients had been readmitted to the team, 7 could not be found, 6 declined the interview and 2 were deceased. At the five-year evaluation of 49 patients who were active after one year, one was deceased and 10 were unable to be found. MAIN OUTCOME MEASURES: Vocational activity. Programme costs. Benefits to society measured by decrease in indirect costs. RESULTS: The one-year vocational rehabilitation rate from the program was 20.5% and the five-year rehabilitation rate was 11.3%. The total discounted cost for case management of the 239 patients was 7.3 MSEK (600,000 Pounds). The decrease in the indirect costs to society from the 28 patients found active after five years was 35.1 MSEK (2,500,000 Pounds). The net present value of the programme at the 1991 price level was 27.5 MSEK (2,365,000 Pounds). CONCLUSIONS: Tertiary care level team-based clinical case management for vocational rehabilitation of patients with chronic minor disease has a positive cost-benefit ratio. A cross-boundary awareness at a health policy level is needed of the societal costs involved for this group of patients who fall between the traditional services in health care and social work.

Injuries during leisure physical activity in a Swedish municipality.

The objective of this study was to provide an epidemiologic basis for planning community programmes preventing injuries during leisure physical activity, especially participation in sports. A total population survey of unintentional injuries was carried out in an area with a population of over 41,000. All sports injuries (n = 933) occurring within a 12-month period and requiring medical care were noted, giving a ratio of 22.5 per 1000 inhabitants. The majority of the injuries occurred in soccer (38.9%), followed by injuries in basketball/volleyball/handball (10.9%), and bandy/hockey (9.2%). The results correspond to previous studies in southern Scandinavia. In northern communities, the proportion of injuries in winter sports has been shown to be higher. Identification of these similarities and differences between the studies makes it possible to use the findings together in the design of general community-based sports injury prevention programmes suited to northern European conditions.

Sick-leave due to psychiatric disorder: higher incidence among women and longer duration for men.

BACKGROUND: Women take sick-leave more often than men, both in general and because of psychiatric disorders. The aim of the present study was to introduce the new dimension of sick-leave duration in the analysis of gender differences in minor psychiatric disorders. METHOD: A population-based register was used, which included all sick-leave spells exceeding seven consecutive days, 1985-1987, in a Swedish county. RESULTS: Sick-leave duration was longer for men. The greatest gender differences were found in the youngest and oldest age-groups. Women had higher incidence also in the longest spells. An increase in duration over the three years was found among women, leading to decreased gender differences. CONCLUSIONS: Contrary to other studies on minor psychiatric disorders, small gender differences were found. It is suggested that sick-leave duration can be used as a quantitative measure of health-related working capacity.

Young novice drivers: towards a model of their accident involvement.

There are two main purposes of this article. The first is to present a model of young drivers' accident involvement, including the most important processes in the development of their driving behaviour. The model describes the relations between the learning process, the individual preconditions and the social influence and how these are related to driving behaviour and accident involvement through different processes such as skill acquisition, self assessment, information processing, feedback and motivation. The second purpose is to present a state-of-the-art report for the different aspects of the model by referring to some of the literature on young drivers.

Sex differences in sickness absence in relation to parental status.

The aim of this study was to analyse sex differences in medically certified sickness absence with special regard to parental status and age. All new sick-leave spells exceeding seven days and certified by a physician in a county of Sweden were registered in 1985-1987. The data-base was related to the population at risk by using data from the Swedish Official Population and Housing Census 1985. The analysis concerned the employed population in the age group from 16 to 54 with and without custody of children younger than ten years. In all ages, women with children had more sickness absence than men with children. Corresponding sex differences did not appear for persons without children, except for the oldest age-groups. Men with children had the lowest sickness absence of all groups. Young women with children had the highest. These findings remained the same when pregnancy-related sickness absence was excluded. The common finding of sex differences in sickness absence is here highly interrelated to custody of small children. The results suggest that the often reported positive health effects of multiple roles in women may be counteracted by inequality between the sexes in the responsibility as parents.

Interrater variability and validity in subjective nutritional assessment of elderly patients.

The subjective Global Assessment technique was evaluated with regard to its reliability and validity in a Swedish elderly population. Ninety patients, 70 years of age or older, and newly admitted to the geriatric clinic, participated in the study. The nutritional state was assessed subjectively by two independent observers using the Subjective Global Assessment form, and objectively, using a combination of anthropometry and serum-protein analysis. The subjectively assessed malnutrition rate was about 20% higher than that assessed objectively. The agreement level between the two observers was 77.8%, Kappa 0.56 (< 0.001), and the levels between the subjective and objective assessments were 57.8% (Kappa = 0.17) and 73.3% (Kappa = 0.46), respectively. The experienced observer identified 85.2% of those who were defined as malnourished using the objective criteria and the less experienced observer, 66.6%. Furthermore, a regression analysis indicated weight index as the main significant objective factor influencing the subjective assessment. The subjective technique could be regarded as reliable from a clinical and preventive perspective since the agreement between the two rates was just under 80%. It seems also to be valid since the subnormalities in the selected criteria showed a similar pattern. The necessity of being well trained in order to manage nutritional status assessment, for both clinical and research purposes, is obvious.

Pregnancy-related sickness absence among employed women in a Swedish county.

OBJECTIVES: The objective of this study was to analyze the variation of pregnancy-related sickness absence among employed women according to age, occupation, and degree of male-female domination within occupations. METHODS: Data from a prospective study of all new sick-leave spells exceeding 7 d in 1985 and 1986 in the county of Ostergötland, Sweden, were related to the population at risk, through the Swedish Medical Birth Register. The subjects included in the analysis were all 7000 employed women that gave birth in 1985 and 1986, of which some 3000 were sick-listed at least once with pregnancy-related diagnoses. RESULTS: There was little difference in the pregnancy-related sickness absence between the age groups. The age-standardized rate for sick leaves involving pregnancy-related diagnoses differed substantially between occupations. Women in the metal industry had the highest rates; those employed in administration, banking, and insurance had the lowest. White-collar occupations generally had lower rates and blue-collar occupations higher rates, with some exceptions (eg, in saw mills, farming, and the chemical industry). Gender-integrated occupations had the lowest sick-leave rate, while extremely male-dominated jobs had the highest. The latter association remained after adjustment for occupational area. CONCLUSIONS: There were considerable differences between occupational groups in the rates of sick leaves involving pregnancy-related diagnoses. Some differences were related to physical load of the jobs being done, but not all. It seems important to consider also male-female domination within a job with respect to such sick leaves.

Cross-sectional assessment and subgroup comparison of functional disability in patients with rheumatoid arthritis in a Swedish health-care district.

A cross-sectional study was undertaken on 222 patients with rheumatoid arthritis (RA) within a Swedish health-care district. An exploratory analysis of functional status, according to a Swedish version of the Health Assessment Questionnaire (HAQ), was carried out in order to explore the extent and pattern of functional disability in an unselected group of individuals with RA. The mean score of functional disability according to HAQ increased with more clinical manifest disease. There were no significant differences between the mean score in men and women. Most functional disability was related to hand-grip function and the ability to take care of personal hygiene. Increased functional disability was significantly associated with increasing age and disease duration. There was no significant relation between functional status and housing condition and educational level. A strong correlation was found between pain and functional disability. Multiple regression analysis was performed and predictive functional scores were tabulated based upon sex, age at onset and duration of RA disease.

Sick-leave due to minor psychiatric morbidity: role of sex integration.

During the years 1985-1987 all sick-leave spells exceeding 7 days, together with a number of demographic variables, were registered in a Swedish county. Using this register, the 3,100 employed persons with at least one sick-leave per year due to minor psychiatric morbidity were analysed with regard to age, occupation and sex. The annual cumulative incidence was 1.7% of the employed population. In 1985 the female incidence was 2.1% and the male incidence was 1.3%. Incidence was highest in the middle-aged. The mean number of absence days per sick-listed person was 73 in 1985. For women, the corresponding figure was 63 and for men, 82. Industrial occupations had the highest incidence and with few exceptions, women had a higher incidence than men in each occupation. Occupations were categorized into five groups according to the number of women and men employed. Women in extremely male-dominated occupations had the highest incidence of all groups, 4.6%. Men in extremely female-dominated occupations had the highest incidence of all men, 2.9%. Occupations with an equal sex distribution had the lowest sick-leave incidence, 1.2%. Further studies on the influence of sex integration on sickness absence need to be done.

Pregnancy related sickness absence in a Swedish county, 1985-87.

Sickness absence during pregnancy has increased in Sweden as well as in other countries. STUDY OBJECTIVE--The study aimed to describe pregnancy related sickness absence and its increase from 1985-87; to consider if the increase were parallel to an increase in sickness absence for all diagnoses or could be explained by a higher birth rate; and to compare different ways of presenting sickness absence data. DESIGN--The data from a prospective incidence study of all new sick leave spells exceeding seven days in 1985-87 were related to the population at risk through relevant data from different registers. SETTING--The county of Ostergötland, Sweden (about 400,000 inhabitants). PARTICIPANTS--Subjects were approximately 70,000 sick leave-insured women aged 16-44 years, of whom some 15,000 had sickness absences > seven days. Some 4600 women gave birth in 1985, approximately 1300 of whom were listed as having pregnancy related diagnoses. MAIN RESULTS--The number of women with sick leave associated with pregnancy related diagnoses increased by 24% (95% confidence interval (CI) 15, 33%) during the period. This diagnosis group was one of the very few with an increasing number of people listed as sick. The corresponding increase for all diagnoses in women aged 16-44 years was < 1% (95% CI 1, 3%). The increase in the number of women who gave birth was 9% (95% CI 5, 13%). The sick leave rate associated with pregnancy related disorders increased by 14% (95% CI 7, 21%) in 1985-87, while that in all women aged 16-44 years increased by 3% (95% 1, 5%). (p < 0.0001). The number of sick leave days associated with pregnancy related disorders increased by 49% (p < 0.0001) in the period--twice the equivalent increase (p < 0.0001) in the total number of sick leave days for all diagnoses taken together. The sick leave rate and duration, like the increase in these variables, varied with age. Different ways of presenting the length of absence proved complementary to each other. CONCLUSIONS--After correcting for changes in the overall sick leave rate and in the birth rate, there is still an 11% increase in the sick leave rate associated with pregnancy related disorders that needs to be explained. Medical factors cannot explain this increase but changes in attitudes and practice in relation to sickness insurance among pregnant women and their doctors merit further study.

Treatment perspectives in rheumatoid arthritis: a descriptive study in a Swedish healthcare district.

This study analyses patterns of treatment offered to individuals with a clinical diagnosis of rheumatoid arthritis (RA). A cross-sectional investigation was carried out in 321 patients (aged greater than 16 years) fulfilling the 1958 American Rheumatism Association (ARA) criteria for RA. Medical records were scrutinised retrospectively for information about medical, surgical and other treatments during a 5-year period (1982 to 1986). All patients had received medical treatment, but a large number had discontinued drug therapy because of adverse effects or lack of efficacy. 45.9% of the individuals were receiving 1 drug at the time of the survey, 33.8% were on 2 drugs, 11.7% were on 3 or 4 drugs, and 8.6% were not receiving any medication. Nearly 50% of the patients had had various kinds of surgical procedures performed. The clinical manifestation of the disease, as measured by the number of ARA criteria fulfilled, showed a linear correlation to nearly all medical and surgical treatments. A primary healthcare physician was the basic contact person for 90% of the patients, but in addition 70% of the participants had been examined at sometime by a rheumatological specialist. The study confirms our expectations that patients with RA receive numerous pharmaceutical and other treatments. Even patients with mild and/or early disease (probable RA) had received a considerable amount of treatment. Qualified specialised care was also provided despite the distance to a university referral centre.(ABSTRACT TRUNCATED AT 250 WORDS)

Epidemiology of sickness absence in a Swedish county in 1985, 1986 and 1987. A three year longitudinal study with focus on gender, age and occupation.

In order to get a better epidemiological base for preventive intervention in the county of Ostergötland, Sweden, a comprehensive study of sickness absence was done. During the years 1985, 1986 and 1987, all new periods of sick-leave exceeding seven days were registered with demographic variables. This information was related to data about the total population of Ostergötland. Each year approx. 45,000 persons had approx. 61,000 sickness spells. These figures were stable over the years while the number of sick-leave days increased. Blue-collar occupations had the highest sick-leave rates and the female sick-leave rate was higher in general and much higher in most male-dominated occupations. The male rate was lower within female-dominated areas, except among secretaries and textile workers. Females in extremely male-dominated groups had the highest rates, while both male and female sick-leave rates were lower in more gender-integrated occupations.

Feeding dependence and nutritional status after acute stroke.

BACKGROUND AND PURPOSE: We assessed the nutritional status of patients with acute stroke and evaluated it in relation to the patients' dependence on assistance with feeding. METHODS: Fifty patients aged 70 years or older, admitted from their homes, were included. Weight index, triceps skinfold thickness, arm muscle circumference, serum proteins, delayed hypersensitivity, body composition measured by bioelectric impedance, and functional condition were determined on admission and 2 and 9 weeks after admission. Food and fluid consumption were also recorded. RESULTS: On admission, four patients were regarded as protein-energy malnourished. Those who required assistance with feeding after admission (n = 18, 36%) had lower serum albumin (P < .05), lower body cell mass (P < .01), and were more anergic than the independent patients (P < .01) on admission. The mean food consumption was 72% of the food served without significant difference between dependent and independent patients. Nine weeks after the onset of stroke symptoms, the patients who were dependent on assisted feeding showed a decrease in body cell mass. The loss of body cell mass was related to their activity and feeding dependence. CONCLUSIONS: Low serum albumin and anergy commonly occur in elderly patients with acute stroke, and they occur more prevalently among those with a severely impaired functional condition. During the recovery period, the patients use body fat to compensate for energy needs, and immobility leads to loss of body cell mass.

Perceived needs and patient satisfaction in relation to care provided in individuals with rheumatoid arthritis.

A cross-sectional study was performed upon a group of patients (N = 222) with rheumatoid arthritis (RA), from a Swedish health care district. The aim was to elucidate expectations and satisfaction with health care workers. The participants indicated that a good reception is more important than professional knowledge followed by the ability to inform about RA and the ability to show empathy. There was a trend towards increasing satisfaction with information about medical problems with severity of RA. This stands in contrast to the lack of such a systematic relation with regard to increasing functional disability as measured by the Stanford Health Assessment Questionnaire. Reasons for this could be that the physicians tend to respond more to clinical signs than to daily living restrictions. A relatively high percentage (around 80%) of the patients were satisfied with the surgical procedures offered to them. Only one third of the individuals felt that they had been involved in planning of treatment and discharge although a majority expressed this as very important. The importance of a continuous dialogue between patient and physician with regard to fulfillment of patient expectations is emphasized.

Psychological factors in the long-term prognosis of chronic low back pain patients.

This study appraised the significance of psychological factors in the long-term prognosis of patients with chronic low back pain (LBP). The MMPI ratings of 80 long-term sick-listed LBP patients were set in relation to their disability pension status 6 to 12 years later. The number of elevated scales, in combination with the level of certain scales (HS and HY), proved to be a better predictor than profile patterns, advocated in some studies. Moreover, in a review of prognostic studies, the HS and HY scales appeared most frequently as significant predictors. That result also was confirmed in this study of long-term prediction of overall functional level. The results are discussed in relation to the concepts of pain-fear and sick role.

Effects of dietary supplement on functional condition and clinical outcome measured with a modified Norton scale.

Elderly long-term care patients (n = 501) were randomly allocated to receive dietary supplementation (400 kcal/day) in addition to a normal hospital diet, or normal hospital diet only, for 26 weeks. The patients' functional condition was assessed by a modified Norton scale comprising mental condition, activity, mobility, food intake, fluid intake, incontinence and general physical state. Nutritional status was assessed by anthropometry, serum protein analysis and delayed hypersensitivity skin tests. Improvements during the first 8 weeks were seen in activity and general physical condition in the supplemented group, and in mobility and general physical condition in the control group. After 8 weeks the supplemented group showed a significantly higher level of activity (p < 0.05) compared to the control group. We conclude that in long-term geriatric care nutritional supplements help to maintain and improve the patients function.

Demographical, sociomedical and physical characteristics in relation to malnutrition in geriatric patients.

The purpose of this study was to describe and compare demographical, sociomedical and physical characteristics between protein-energy malnourished and non-malnourished geriatric patients on admission. According to the International Statistical Classification of Diseases, 104 malnourished patients were age-, gender- and diagnosis-matched with 104 non-malnourished patients. Data were collected from patients' medical records. The patient's condition was assessed by a modified Norton scale on admission. No differences were seen in marital status, type of dwelling, previous need for help service, residence before admission, and dependence on assistance with ADL function. The malnourished patients had a greater consumption of diuretics (47%; P less than 0.05) and a lower consumption of analgesics (29%; P less than 0.05) than the non-malnourished patients (33% and 42% respectively). In the malnourished group, impaired conditions in activity (83%; P less than 0.05), and general physical condition (78%; P less than 0.01) were observed compared to the non-malnourished group (69% and 60% respectively). The malnourished patients had less sufficient food intake (41% vs 21%; P less than 0.01) and fluid intake (25% vs 10%; P less than 0.01) than non-malnourished patients. This study indicates that demographical characteristics and primary ADL-functions are of minor importance for the development of protein-energy malnutrition in geriatric patients. Observation of the patients' physical condition and drug consumption seemed more important on admission.

The development and healing of pressure sores related to the nutritional state.

The aims of the study were to investigate the relationship between nutritional state and the development of pressure sores and to test the hypothesis that supplementary nutritional support might prevent pressure sore development and improve healing. Newly admitted long-term care patients hospitalised for more than 3 weeks were included and randomised into an experimental and a control group. The nutritional state was evaluated using serum protein analyses, anthropometry and the delayed hypersensitivity skin test. Further, the patients' condition was assessed weekly using a modified Norton scale. The experimental group received extra nutritional support. Significantly more patients with protein-energy malnutrition had, or developed, pressure sores. Regression analyses indicated albumin, mobility, activity and food intake as predictors for pressure sores. Patients who received extra nutritional support tended to develop fewer pressure sores and to heal existing pressure sores to a greater extent than the control group, although this did not reach statistical significance.