The Norwegian "Campaign Against Home Accidents" was launched nationwide during 1988 to 1991, with the goal of reducing the incidence of home accidents by 20%. The aim of the campaign was to urge primarily the municipal health services to form local accident prevention groups and to implement local measures for prevention of home accidents. On the basis of two surveys, after one year and at the end of the national campaign, an evaluation was carried out concerning the participation of the municipal health services in the campaign and the impact of the campaign on local accident prevention activities. The results indicate that the national campaign engaged the majority of the municipalities and stimulated local accident prevention work to some extent. Most local activities were health education measures, whereas environmental intervention were less commonly reported. Involvement in the campaign was the variable most related to level of accident prevention activities at the end of the campaign period. However, the relationship was only modest. Restricted economical resources, too little emphasis on environmental change, lack of political involvement and insufficient use of coalition partners at the community level are suggested as the major explanations for the limited effect of the campaign.
A survey conducted among all Norwegian Chief Municipal Medical Officers, provided information about their formal role and involvement in health promotion work. Of the total respondents, 71% regularly attended meetings of the Municipal Board of Health and 32% attended meetings of the Building Council; 80% had authority to forward proposals to the Board of Health on matters of environmental health. On average, the Chief Municipal Medical Officers spent one-fifth of their working time on community health promotion activities. 80% of the respondents would have liked to spend more time on these activities. These officials should have a stronger formal position in the field of health promotion, and they themselves should give higher priority to health promotion work.
The Municipal Health Services Act with amendments from 1988 defines environmental health promotion activities directed at physical, chemical, biological and social factors as mandatory for the local Norwegian health authorities. In addition, the municipal health services are responsible for health surveillance and for initiating cross-sectorial preventive measures. In 1991, we undertook a national survey among the Norwegian municipal health services to monitor planning activities, manpower resources, cross-sectorial cooperation, and project-oriented activities within the field of environmental health promotion. Less than one-third of the municipalities employed technically trained hygienic personnel. However, three of four municipalities had carried out some environmental health promotion projects within the last two years. The following factors were all independently related to level of environmental health promotion activity: the availability of technical assistance, the level of cross-sectorial cooperation and the size of the population in the municipality. We conclude that this area of health promotion should be improved by better planning, a higher level of technical hygienic competence within the municipal health services, more inter-sectorial cooperation and greater emphasis on visible projects of limited duration.
SUBJECTS AND DESIGN: The study was based on the total patient sample (n = 110) of a randomized controlled trial comparing two intervention methods advising cardiovascular high-risk men of lifestyle changes in general practice. Behaviour and risk factor changes during the one-year intervention study were analysed using multiple regression and logistic regression analyses with the above-mentioned independent variables. SETTING: Twenty-two general practice centres in the county of Hordaland, western Norway. RESULTS: Self-efficacy of increased physical exercise was the only variable significantly related to exercise change. Age and self-efficacy were statistical significant predictors of smoking cessation success. None of the independent variables was statistically significantly related to blood pressure or cholesterol change. Educational level related negatively, although statistically insignificantly, with total risk change. CONCLUSION: The study confirms the importance of self-efficacy in both human behaviour and motivation for behaviour change. OBJECTIVES: The objectives of the study were to explore the impact of possible predictors for cardiovascular risk behaviour change, predictors such as education, age, self-efficacy, doctors' interpersonal skills, and number of appointments.
OBJECTIVES: To identify the clinical and demographic factors that are associated with a poor quality of life in patients with Parkinson's disease. METHODS: 233 of a total of 245 patients identified in a community based study in a Norwegian county participated in the study. Quality of life was measured by the Nottingham Health Profile (NHP). The results were compared with those in 100 healthy elderly people. Clinical and demographic variables were determined during a semistructured interview and by clinical examination by a neurologist. Multiple regression analyses were used to determine which variables were associated with higher distress scores. RESULTS: Patients with Parkinson's disease had higher distress scores than the healthy elderly people for all the NHP dimensions. The variables that most strongly predicted a high total NHP score were depressive symptoms, self reported insomnia, and a low degree of independence, measured by the Schwab and England scale. Severity of parkinsonism contributed, but to a lesser extent. Nearly half the patients with Parkinson's disease reported lack of energy, compared with a fifth of the control group. Severity of depressive symptoms and a higher score on the UPDRS motor subscale only partly accounted for this finding. Only 30% of the variation in NHP energy score was explained by the predictive variables identified in this study. CONCLUSIONS: Parkinson's disease has a substantial impact on health related quality of life. Depressive symptoms and sleep disorders correlated strongly with high distress scores. Patients with Parkinson's disease should be examined for both conditions, which require treatment. Low energy was commonly reported and may be a separate entity of Parkinson's disease.
The objectives of this study were to: (1) study if an opportunistic screening of coronary heart disease (CHD) risk factors among male attenders in general practice (GP) influenced the overall subjective satisfaction with life of persons labelled 'high risk' compared to other screened persons; (2) compare psychological well-being and patient satisfaction in a patient centred and self-directive (PCSD) intervention with conventional care (CC); and (3) evaluate patient satisfaction and psychological well-being among subjects with high CHD risk during a one year intervention study. Effects of 'labelling' were evaluated in 115 subjects with high CHD risk in comparison with a low risk reference population. The 22 participating GP centres were randomly allocated to follow either a PCSD intervention or a CC approach. An overall satisfaction with life question was employed and psychological well-being were measured using the General Health Questionnaire (20 item version). Satisfaction measures on health care aspects were also included. No difference of change between the high risk and the reference population was found concerning satisfaction with life after screening. No significant difference of change was found within or between the PCSD and the CC group concerning emotional well-being or overall satisfaction with life during one year intervention. Satisfaction with the care received was significantly better in the CC group as compared with the PCSD group (p = 0.02). Satisfaction with own efforts for improving health was, however, more pronounced in the PCSD group (p = 0.01). A substantial number (n = 61) of the participants reported distaste of being reminded of the risk of heart disease and no more than 60 of the participants were satisfied with their own efforts for improving health. Although no significant change of satisfaction with life and emotional well-being due to screening or intervention could be detected, clinicians should be aware that encouraging patients to change life style may lead to patients' annoyance of being reminded of the risk of disease and dissatisfaction with their own efforts. Increasing patient responsibility and self-determination may improve their satisfaction with their own efforts, but reduce satisfaction with medical care.
It is necessary to involve the local population to a greater extent in the work of health promotion and prevention of disease. In the municipality of Askvoll the results of a household survey were used as an educational tool at popular meetings in the different settlements. At these meetings, the local citizens themselves chose actual health promotion projects and elected committees to carry them out. The article describes our experiences from this way of mobilizing the community. The attendance rate varied from 3% to 29% of the local population aged over 15 years. More women than men participated. A total of 17 local projects were chosen. We conclude that popular meetings can be a useful tool in local health promotion work.
This study compared multiple sclerosis (MS) patients (n=87) with the general population and with people reporting angina pectoris (n=109), asthma (n=1,353) and diabetes (n=219) regarding health-related quality of life (SF-12), working status and lifestyle factors including smoking, alcohol consumption, body mass index (BMI) and leisure physical activity. The study was cross-sectional and included the birth cohorts from 1950 to 1957 living in Hordaland County, Norway in 1997. A total of 22,312 people participated, yielding a response rate of 65%. The MS patients had a high rate of smoking and a low mean BMI, despite lower leisure physical activity compared with the rest of the study population. This suggests that it may be advisable to increase the focus on smoking, physical activity and the balance between energy intake and use.
Among 528 patients under 67 years of age discharged alive after a myocardial infarction (MI), the cumulative survival rates after 3, 5, and 7 years were 84.1%, 75.9% and 68.6%, respectively. Compared with the "normal" population, the relative mortality risk was 4.8 for the first year, 3.1 for the second, and on average 2.1 for the next 5 years. Significant age differences were not observed for relative mortality. A multivariate Cox proportional hazards model showed long-term mortality to be independently related to higher age, a reduced working activity before the MI, previous cardiovascular disease, and a higher inhospital complication score, which was computed by summing eight defined clinical events weighted for severity. The results indicate that a reasonable prediction of long-term survival after a MI can be made from routine hospital data.
The relationship between return to work (RTW) within 6 months after a myocardial infarction (MI) and selected demographic factors, characteristics of prior work situation, pre-MI health status, and clinical severity of the MI has been studied in 249 patients below 67 years of age living in urban and rural areas of Western Norway. At the follow-up 8 out of 10 urban patients and 6 out of 10 rural patients were back at work. The RTW rate for the total sample was 73%. Age below 51 years, high educational and income level, working in tertiary industries, and in a job characterized by low physical activity and little psychosocial stress were all factors associated with a favourable work resumption. Multivariate analyses showed that socioeconomic or work-related factors could not fully explain the urban-rural differences in RTW. Stepwise discriminant analysis identified the following factors as important and independent predictors for RTW: Place of residence, age, education, perceived job stress, and clinical complications during hospitalization. Failure to return to work after a MI can be explained by a number of individual and social factors and only to a limited degree by the medical status of the patient. More knowledge is needed concerning the socio-cultural differences among both patients and attending physicians in attitudes towards work resumption after a MI.