The Swedish intersectoral national public health policy: effects on child and adolescent health.

BACKGROUND: To improve health, intersectoral cooperation is often advocated. However, only few studies have reported health effects of this approach. Sweden has adopted a national public health policy (NPHP), which focuses on intersectoral primary prevention of disorders and injuries. AIM: To investigate the effects of the NPHP, on child and adolescent health in Sweden during the period 2000-19. METHODS: In the first step, the most important improvements in disorders and injuries, assessed as DALYs and incidences, were identified using the GBD Compare database. In the second step, primary prevention methods for these disorders and injuries were identified. In the third step, the relative importance of various government agents for these preventive measures was assessed using Google searches. RESULTS: Out of 24 groups of causes of disease or injury, only two groups demonstrated an incidence decrease: neoplasms and transport injuries. Leukaemia neoplasms might be prevented by reducing parental smoking, reducing outdoor air pollution and having the mother take folate supplements before getting pregnant. Transport injuries might be prevented by speed restrictions, and physically separating pedestrians from vehicle transport. Most of the primary prevention work was done by government agencies, like the Swedish Transport Agency, which worked independently of the National Institute of Public Health. CONCLUSION: Governmental agencies outside the health carried out most of the effective primary preventive efforts, almost independently of the NPHP.

Antidepressant medication might increase the risk of self-harm injuries: findings in 17 OECD countries.

Clinical trials suggest that antidepressants increase the risk of self-harm injuries (SHI). The aim was to investigate associations between antidepressants' use and the rate of change of SHI in 17 countries over the period 2000-16, with initial levels of SHI taken into account. The rate of change of SHI seems mainly (81%) determined by initial rates. The rate of SHI decreased in most countries. The decrease was slower in countries with a high level of antidepressants' use and in countries with an increase of depressive disorders. The study indicates that the use of antidepressants might increase the risk of SHI.

Suicide rates in European OECD nations converged during the period 1990-2010.

PURPOSE AND METHODS: The aim of this study was to investigate, with multiple regression analyses, the effect of selected characteristics on the rate of decrease of suicide rates in 21 OECD (Organisation for Economic Co-operation and Development) nations over the period 1990-2010, with initial levels of suicide rates taken into account. RESULTS: The rate of decrease seems mainly (83%) to be determined by the initial suicide rates in 1990. In nations with relatively high initial rates, the rates decreased faster. The suicide rates also converged. CONCLUSION: The study indicates that beta convergence alone explained most of the cross-national variations.

Mortality rates in OECD countries converged during the period 1990-2010.

AIMS: Since the scientific revolution of the 18th century, human health has gradually improved, but there is no unifying theory that explains this improvement in health. Studies of macrodeterminants have produced conflicting results. Most studies have analysed health at a given point in time as the outcome; however, the rate of improvement in health might be a more appropriate outcome. METHODS: Twenty-eight OECD member countries were selected for analysis in the period 1990-2010. The main outcomes studied, in six age groups, were the national rates of decrease in mortality in the period 1990-2010. The effects of seven potential determinants on the rates of decrease in mortality were analysed in linear multiple regression models using least squares, controlling for country-specific history constants, which represent the mortality rate in 1990. RESULTS: The multiple regression analyses started with models that only included mortality rates in 1990 as determinants. These models explained 87% of the intercountry variation in the children aged 1-4 years and 51% in adults aged 55-74 years. When added to the regression equations, the seven determinants did not seem to significantly increase the explanatory power of the equations. CONCLUSIONS: The analyses indicated a decrease in mortality in all nations and in all age groups. The development of mortality rates in the different nations demonstrated significant catch-up effects. Therefore an important objective of the national public health sector seems to be to reduce the delay between international research findings and the universal implementation of relevant innovations.

The rate of country-level improvements of the infant mortality rate is mainly determined by previous history.

BACKGROUND: Studies of country-level determinants of health have produced conflicting results even when the analyses have been restricted to high-income counties. Yet, most of these studies have not taken historical, country-specific developments into account. Thus, it is appropriate to separate the influence of current exposures from historical aspects. METHODS: Determinants of the infant mortality rate (IMR) were studied in 28 OECD countries over the period 1990-2012. Twelve determinants were selected. They refer to the level of general resources, resources that specifically address child health and characteristics that affect knowledge dissemination, including level of trust, and a health related behaviour: the rate of female smoking. RESULTS: Bivariate analyses with the IMR in year 2000 as outcome and the 12 determinants produced six statistically significant models. In multivariate analyses, the rate of decrease in the IMR was investigated as outcome and a history variable (IMR in 1990) was included in the models. The history variable alone explained 95% of the variation. None of the multivariate models, with the 12 determinants included, explained significantly more variation. CONCLUSION: Taking into account the historical development of the IMR will critically affect correlations between country-level determinants and the IMR.

Might extended education decrease inequalities in health?-a meta-analysis.

BACKGROUND: Health is substantially worse in less educated people, and extended education might potentially improve their health. A prerequisite for a beneficial health effect of education is that the effect is absolute. An absolute effect of education means that the health effect comes about independently of any effect on other persons. A relative effect, on the other hand, only contributes to individual competitiveness in relation to others. Studies of natural experiments of extended compulsory education, and other educational-policy changes, provide an option for the analysis of absolute effects of education. Published studies, however, present conflicting results. METHODS: A meta-analysis was performed of European studies where the health effects of extended compulsory or secondary level education on low-educated individuals were investigated. RESULTS: Twenty-two relevant publications were identified. The meta-analysis indicated statistically significant favourable effects of educational reforms on rates of mortality, self-reported poor health and obesity. The effects were, however, small, 1-4%. CONCLUSIONS: An educational reform that typically added one educational year in the least educated group was associated with a mean 2.1% reduction in mortality in men before age 40. This effect might be compared with the total educational gradients of mortality rates in Swedish men at ages 30-64. One extra year of education after compulsory education corresponds to a 41% reduction in mortality, which is 20 times more than the absolute effect of education found in this meta-analysis. Thus, it unlikely that extended compulsory education will substantially improve the health of the least educated individuals.

Association between labour market trends and trends in young people's mental health in ten European countries 1983-2005.

BACKGROUND: Mental health problems have become more common among young people over the last twenty years, especially in certain countries. The reasons for this have remained unclear. The hypothesis tested in this study is that national trends in young people's mental health are associated with national trends in young people's labour market. METHODS: National secular changes in the proportion of young people with mental health problems and national secular labour market changes were studied from 1983 to 2005 in Austria, Belgium, Denmark, Finland, Hungary, Norway, Spain, Sweden, Switzerland and the United Kingdom. RESULTS: The correlation between the national secular changes in the proportion of young people not in the labour force and the national secular changes in proportion of young people with mental health symptoms was 0.77 for boys and 0.92 for girls. CONCLUSION: Labour market trends may have contributed to the deteriorating trend in mental health among young people. A true relationship, should other studies confirm it, would be an important aspect to take into account when forming labour market policies or policies concerning the delivery of higher education.

Children's overweight and obesity: local and national monitoring using electronic health records.

AIM: To test the feasibility of a system for monitoring children's obesity and overweight based on data from electronic health records in the school health services. METHODS: Data on weight and height from electronic health records at school health services were collected for 10-year-olds in 2003-2004, 2004-2005 and 2005-2006. School health personnel extracted group-level data with a simple program installed on the computer containing the health records. Four Swedish municipalities were included in the study: Karlstad, Umeå, Västerås, and Ystad. RESULTS: The system achieved coverage of 92-96% of all children in 2005-2006. The overall prevalence rates were 4.2% (3.8-4.7%) obese and 22.0% (21.1-23.0%) overweight, including obesity. CONCLUSIONS: A system based on electronic health records from the school health services can successfully provide data. The system has practical, economical and ethical strengths.

Supportive and nonsupportive qualities of child health nurses' contacts with strained infant mothers.

AIMS: To examine how strained mothers perceive the support they receive from Swedish child health nurse. POPULATION AND METHODS: Twenty-four consecutive strained, infant mothers at nine child health centres were invited to participate. The mothers were interviewed when the child was 8 months of age. The mothers also reported their perceptions of their parenting competence by means of a questionnaire. RESULTS: Five components of the nurses' support were discerned: positive emotional support, positive informational support, support of the parental role which was either positive or negative, and pressure to accept social norms on child care. A third of the mothers reported strong positive support, decreasing depressive symptoms and favourable perceptions of their own parenting ability. Another third of the mothers reported negative contacts with the nurses, persisting depressive symptoms, and unfavourable perceptions of their parenting competence. The nurses' pressure for the mothers to adapt to certain social norms of child care seemed to affect the latter group of mothers negatively. CONCLUSIONS: In order to support strained mothers effectively it is necessary to clarify and resolve conflicts between different programme objectives.