Trends in intentional and unintentional poisonings among older adults - A national register-based study in Sweden.

BACKGROUND: Among older people intentional poisoning outnumber unintentional ones. While there are indications that time trends differ by poisoning intent, studies are scarce. We assessed how the annual prevalence of intentional and unintentional poisoning changed over time, overall and by demographic groups. METHODS: We conducted a national open cohort study of individuals aged 50-100 years, resident in Sweden during 2005-2016. Individuals were followed up in population-based registers for their demographic and health attributes from 2006-2016. Annual prevalence of hospitalization and death by poisoning intent (unintentional vs. intentional or undetermined; ICD-10 definitions) were compiled for the categories of four demographic attributes (age, sex, marital status, and birth cohort "baby boomers"). The time trends were assessed by multinomial logistic regression with year as an independent variable. RESULTS: The annual overall prevalence of hospitalization and death by intentional poisonings consistently exceeded that of unintentional poisonings. There was a significant downward trend in intentional poisonings but not in unintentional ones. This difference in trends also applied when considering men and women separately, married and unmarried people, the young-old individuals (but not the older- or oldest-old ones), and the baby boomers and non-baby boomers. The largest demographic differences within intent were found between married and unmarried people, and the smallest one between men and women. CONCLUSION: As expected, the annual prevalence of intentional poisonings considerably exceed that of unintentional ones among Swedish older people. The recent trends reveal a significant reduction of intentional poisonings, consistent across a range of demographic attributes. The scope for action regarding this preventable cause of mortality and morbidity remains considerable.

Work disability patterns before and after incident acute myocardial infarction and subsequent risk of common mental disorders: A Swedish cohort study.

This study investigated the extent to which work disability patterns including sickness absence and disability pension (SA/DP) before and after acute myocardial infarction (AMI) were associated with subsequent common mental disorders (CMDs) such as depression and anxiety in AMI patients without previous CMD. Total 11,493 patients 26-64 years with incident AMI during 2008-10 were followed up for CMD (measured as antidepressant prescription) through 2013. Four SA/DP trajectory groups during the 3-years pre-AMI and 1-year post-AMI were identified. Hazard ratios (HRs) with 95% confidence intervals for subsequent CMD were estimated in Cox models. Higher pre-AMI SA/DP annual levels (>1-12 months/year) were associated with 40-60% increased CMD rate than the majority (78%) with low increasing levels (increasing up to 1 month/year). Regarding post-AMI findings, constant high (~25-30 days/month) SA/DP levels within the first 3 months was associated with a 76% higher CMD rate, compared to constant low (0 days/month). A gradually decreasing post-AMI SA/DP pattern over a 12-month period suggested protective influences for CMD (HR = 0.80). This is the first study to demonstrate that pre- and post-AMI work disability patterns are associated with subsequent CMD risk in AMI patients. Work disability patterns should be considered as an indicator of AMI prognosis in terms of CMD risk.

Age-specific suicide mortality following non-fatal self-harm: national cohort study in Sweden.

BACKGROUND: Possible age-related differences in risk of completed suicide following non-fatal self-harm remain unexplored. We examined associations between self-harm and completed suicide across age groups of self-harming patients, and whether these associations varied by violent index method, presence of mental disorder, and repeated self-harm. METHOD: The design was a cohort study with linked national registers in Sweden. The study population comprised individuals aged ⩾10 years hospitalized during 1990-1999 due to non-fatal self-harm (n = 53 843; 58% females) who were followed for 9-19 years. We computed hazard ratios (HRs) across age groups (age at index self-harm episode), with time to completed suicide as outcome. RESULTS: The 1-year HR for suicide among younger males (10-19 years) was 14.6 [95% confidence interval (CI) 4.1-51.9] for violent method and 8.4 (95% CI 1.8-40.0) for mental disorder. By contrast, none of the three potential risk factors increased the 1-year risks in the youngest females. Among patients aged ⩾20 years, the 1-year HR for violent method was 4.6 (95% CI 3.8-5.4) for males and 10.4 (95% CI 8.3-13.0) for females. HRs for repeated self-harm during years 2-9 of follow-up were higher in 10- to 19-year-olds (males: HR 4.0, 95% CI 2.0-7.8; females: HR 3.7, 95% CI 2.1-6.5). The ⩾20 years age groups had higher HRs than the youngest, particularly for females and especially within 1 year. CONCLUSIONS: Violent method and mental disorder increase the 1-year suicide risk in young male self-harm patients. Further, violent method increases suicide risk within 1 year in all age and gender groups except the youngest females. Repeated self-harm may increase the long-term risk more in young patients. These aspects should be accounted for in clinical suicide risk assessment.

A prospective study on self-assessed mental well-being and work capacity as determinants of all-cause sickness absence.

PURPOSE: The aim of the present study was to estimate whether self-assessed mental well-being and work capacity determines future sickness absence (SA). METHODS: A questionnaire was sent to employed individuals (n = 6,140), aged 19-64 years, who were registered as sick-listed with a new sick-leave spell in 2008. The response rate was 54 %. In this study we included individuals with a single sick-leave spell in 2008 (n = 2,502). The WHO (Ten) Well-Being Index and four dimensions of self-assessed work capacity (knowledge, mental, collaborative, physical) were used as determinants. Future sickness absence was identified through national register in 2009. Outcome was defined as no sickness benefit compensated days (no SBCD) and at least one sickness benefit compensated day (SBCD). Logistic regression analyses were used to estimate odds ratios (OR) with 95 % confidence intervals (CI) for the likelihood of SBCD. RESULTS: In 2009, 28 % of the women and 22 % of the men had SBCD; the median was 59 and 66 benefit days, respectively. Individuals with low mental well-being had higher odds for SBCD with OR 1.29 (95 % CI 1.01-1.65) in the fully adjusted model. Participants reporting low work capacity in relation to knowledge (OR 1.55, 95 % CI 1.13-2.13), collaborative (OR 1.36, 95 % CI 1.03-1.79) and physical (OR 1.50, 95 % CI 1.22-1.86) demands at work had higher odds for SBCD after adjustments for all covariates; no relation was demonstrated with mental work capacity (OR 0.99, 95 % CI 0.76-1.27). CONCLUSION: Mental well-being and work capacity emerged as determinants of future SA. Screening in health care could facilitate early identification of persons in need of interventions to prevent future SA.

Injury incidence, healthcare consumption and avenues for prevention: a household survey on injury in rural Twiserkan, Iran.

OBJECTIVES: To assess the incidence rates of injuries of various levels of severity, and to document people's healthcare-seeking behaviours in case of injury and their views regarding the potential contribution of various actors for injury control and prevention. STUDY DESIGN: Community-based household survey in the Twiserkan district, Iran. METHODS: A questionnaire-based interview survey was undertaken over a 3-week period in June 2006, and a cluster sample of households (n=759) was visited by 10 pre-trained field workers. Denominator data were obtained from the Twiserkan district health centre. Gender- and age-specific injury distribution data were compiled by mechanism of injury. RESULTS: The overall estimated annual incidence rate of injuries was 91/1000 person-years (10 for hospitalization and 81 for other medical attendance). Traffic and falls were the most common mechanisms of injury (n=22 and 19, respectively); traffic injuries were more common among men and falls injuries were more common among women. Both mechanisms of injury were more common among adults (aged > or =16 years). Most people with severe injuries and nearly half of those people with moderate injuries initially sought care at hospital, whereas all people with minor injuries initially presented at their local health house. Common suggestions for injury prevention included engineering changes (authorities), safety education (local health workers) and increased cooperation (citizens). CONCLUSIONS: In the rural area studied, the incidence of injuries is high. Injuries affecting children and males are more severe, and many of these are related to traffic and falls. The rural healthcare system appears to be accessible to people for trauma care. A range of context-relevant injury counter-measures were proposed by injured and non-injured laypeople.

Car crash and injury among young drivers: contribution of social, circumstantial and car attributes.

The objective of the study was to assess the independent contribution of individual, car and circumstantial features in severe and fatal car crashes involving young drivers. A prospective longitudinal, register-based cohort study was conducted at national level (in Sweden), in which people born in the years 1970-1972 (n = 334070) were followed up for the period 1988-2000 (aged 16-18 years in 1988) for their first two-car crashes leading to severe or fatal injury. Ten variables descriptive of the driver (sociodemographics), the car (safety level) and the crash have been analysed using multiple logistic regressions for male and female drivers separately, compiling crude and adjusted odds ratios with 95% CI. When controlling for other features, none of the variables descriptive of male and female drivers' socio-demographic characteristics impacts significantly on the odds of being severely injured or dying in a car-to-car crash. After adjustment, significant excess risks are observed for speed limits higher than the lowest one, type of crash other than rear end collision and road and light conditions other than favourable (dry and daylight), for both male and female drivers. For males only, cars from all car safety levels have significantly higher odds than those from the safest category. Among male and female young drivers, class differences in the risk of being severely injured in a traffic injury are substantial. Yet, despite this imbalance, crash characteristics (for males and females) and safety level of the vehicle driven (for males) remain the most determinant factors of crash severity. Understanding the social patterning of road traffic injuries is a challenge for public health and it seems that qualitative and quantitative differences in crash exposure offer part of the explanation. Young drivers from all social groups need, however, to be sensitized to the risk factors.

First car-to-car crashes involving young adult drivers: main patterns and their relation to car and driver characteristics.

The primary objective of the study was to examine the relationship between patterns in car-to-car crashes involving young drivers and car and driver characteristics and the research design was a national register-based prospective cohort study. Individual records in a cohort born 1970-1972 are linked to road-traffic-crash data (1988-2000). Subjects' first police-registered two-car crash leading to severe or fatal injury (n = 4875) are identified. Typical crash patterns are highlighted and associations between pattern and both car and individual socio-demographic characteristics are tested. Four crash patterns are highlighted. Male drivers and those with lower educational attainment are over-represented in all patterns. Pattern-based risk levels vary considerably according to car safety level and driver's age at time of injury and socio-economic status. Crash patterns might be considered in young adult driver education systems, bearing in mind the consistent higher risks of male drivers and of drivers with lower educational attainment.

Impaired driving and motor vehicle crashes among Swedish youth: an investigation into drivers' sociodemographic characteristics.

Impaired driving is an important road safety problem, and the characteristics of drivers impaired by alcohol or drugs are relevant to targeted interventions. This study considers young drivers' sociodemographic attributes: age, sex, class of origin and educational attainment, based on a national cohort of young Swedish drivers (1988-2000) followed up in police registers for their first motor vehicle crash. Of all crashes reported for these drivers, 946 were where the driver was suspected of being under the influence of alcohol or other substances (corresponding to 6% of all first crashes). Impaired driving significantly increases the odds of severe and fatal injuries, regardless of sociodemographic attributes. Observed differences in the proportions of impaired drivers reveal significant excess risks among males, persons aged 18-19, those from households classified as "workers" and "others" (including, e.g. the long-term unemployed and those on long-term sick leave), and those with low educational attainment. Impaired driving is a risk factor in all sociodemographic strata among young people. Members of some groups are more likely to be found than others among impaired drivers on occasion of first motor vehicle crash.

Ratings of health and quality of life by young working people: are there occupational or education-based differences?

The study examines differences in self-rated health and perceived quality of life (QoL) among young working people according to occupation and education level. Subjects were extracted from a cross-sectional data set, covering questionnaire responses of people aged 20-74 years from the Swedish region of Ostergötland, and addressing individual environmental and health conditions. The emphasis was on males and females in paid employment aged 20-34 (n = 863). Differences in self-rated health items and in perceived QoL were subjected to a series of t-tests. Two measures of individual socioeconomic position were considered - occupation and education. No education-based differences were found, and there were few differences based on occupation. Among males, manual workers reported significantly higher scores with regard to pain and physical function than did non-manual workers. Male and female manual workers scored significantly lower on current perceived QoL than non-manual workers. In the case of females, the differences between manual and non-manual workers also applied to former perceived QoL. Yet, after applying the Bonferroni correction, none of the differences observed remained significant. In line with some earlier studies, it appears that -- among young working adults -- the manners in which health status and QoL are perceived are not strongly conditional on socioeconomic position.

Bicycle helmet campaigns and head injuries among children. Does poverty matter?

OBJECTIVES: To assess the impact of a community based bicycle helmet programme aimed at children aged 5-12 years (about 140,000) from poor and well off municipalities. METHODS: A quasi-experimental design, including a control group, was used. Changes in the risk of bicycle related head injuries leading to hospitalisation were measured, using rates ratios. RESULTS: Reductions in bicycle related head injuries were registered in both categories of municipalities. Compared with the pre-programme period, the protective effect of the programme during the post-programme period was as significant among children from poor municipalities (RR= 0.45 95%CI 0.26 to 0.78) as among those from richer municipalities (RR=0.55 95%CI 0.41 to 0.75). CONCLUSION: Population based educational programmes may have a favourable impact on injury risks in poor areas despite lower adoption of protective behaviours.

The share of suicide in injury deaths in the South African context: sociodemographic distribution.

This study describes the sociodemographic distribution of suicide deaths compared with other injury deaths in South Africa. Cross-sectional data for 26,354 cases were extracted from an injury surveillance database. These included all manners of injury death from 10 mortuaries for 1999-2000 (approximately 18-20% coverage of all injury deaths per year). They were used to examine the distribution of suicide across different sex, race and age groupings, and the relative involvement of alcohol across manners of death. The share of suicide as a cause of death was comparable for males and females, but varied considerably across races and age groups. It was twice as high for Whites as for Asians, and four times as high as for Coloureds and Blacks. For all races except Whites, suicides were concentrated in the younger age groups. Only among Whites was the proportion of alcohol-positive suicides higher or comparable with that for other manners of death. While homicides and unitentional injury deaths outnumbered suicides overall, the relative importance of suicide in some social groups is reason for concern. South Africa is a country undergoing profound transformations, and differences in the distribution of suicide across sociodemographic groups deserve attention.

First-year university students' health status and socio-demographic determinants of their self-rated health.

This study surveys university students' physical and psychological health status and socio-demographic determinants of their self-rated health (SRH). The study population consists of all first-year students enrolled on the three programs offered at a Swedish university in the autumn of 1998 (3,229 students). In the spring of 1999, a self-administered questionnaire (44 forced-response questions) dealing with health status, life-style and living conditions was sent to the students at their home address (response rate 70%). Associations between overall health and its physical and psychological components were measured, and ANOVAs were conducted to establish the variation in physical, psychological and overall SRH explained by a series of socio-demographic variables. Most students rated their psychological and physical health as good or very good, and restrictions on life activities - when experienced - were found to be considerably more common for physical than for psychological problems. Symptoms related to psychological problems were more frequent among female than male students. Country of birth of student was the strongest predictor of self-rated physical health, and the second strongest predictor of psychological and overall health (following sex of student). Parental educational attainment was a weak but significant predictor of psychological and physical SRH among students, but not of their overall SRH. Overall, physical and psychological SRH, though strongly inter-correlated, are not necessarily redundant measures of one and the same thing. The variation in self-ratings cannot be explained simply with reference to one set of socio-demographic variables.