This paper reports register data on a consecutive series of 141 children and teenagers hospitalized due to firearm injuries during a 21-year period in a community with restrictive firearm laws. Most of the injuries were minor and hospitalization was short. Shot by an air gun resulting in an eye injury was the most frequent reason for hospitalization. The patients hospitalized due to firearm injuries were compared with a control group composed of 141 individuals matched pair-wise for sex and age. The total morbidity during the follow-up period of on average 10 years was higher among patients compared with controls concerning both somatic diseases and injuries. All cases of severe psychopathology were found in the patient group. Criminality was higher among patients compared with controls and the former were younger at the time of the first crime compared with the latter. This study indicates that, irrespective of firearm laws, young people suffering from firearm injuries, even if the injury is classified as accidental, run a higher risk of becoming psychosocially disadvantaged and criminal as adults. This makes preventative measures highly necessary not only from a societal point of view, but also to avoid individual suffering in this high-risk group of youngsters.
OBJECTIVES: To investigate the possible influence of attendance at cultural events, reading books or periodicals, making music or singing in a choir as determinants for survival. DESIGN: A simple random sample was drawn of 15,198 individuals aged 16-74 years. Of these, 85% (12,982) were interviewed by trained non-medical interviewers between 1982 and 1983 about cultural activities. They were followed up with respect to survival until 31 December 1991. SETTING: Swedish interview survey of living conditions comprising a random sample of the adult Swedish population. SUBJECTS: 12,675 people interviewed between 1982 and 1983. MAIN OUTCOME MEASURES: Survival of subjects after controlling for eight confounding variables: age, sex, education level, income, long term disease, social network, smoking, and physical exercise. RESULTS: 6,301 men and 6,374 women were followed up; 533 men and 314 women died during this period. The control variables influenced survival in the expected directions except for social network for men; a significant negative effective was found when the analysis was made separately for men and women. We found an influence on mortality when the eight control variables were controlled for in people who rarely attended events compared with those attending most often, the relative risk being 1.57 (95% confidence interval 1.18 to 2.09). CONCLUSION: Attendance at cultural events may have a positive influence on survival. Long term follow up of large samples with confounders that are well controlled for and with the cultural stimulation more highly specified should be used to try to falsify the hypothesis before experiments start.
Between 1992 and 1996 more than one million refugees, mostly women, received asylum in the USA, Canada and Germany and about 47,000 of them sought refuge in Sweden. Little is known about their cardiovascular health. Using data from a cross-sectional study of a simple random sample of non-patients, female Bosnian refugees (n = 98) aged 18-59 and Swedish-born controls (n = 95) we examined six primary diet cardiovascular risk factors: S-triglycerides, S-cholesterol, high-density lipoprotein cholesterol, body mass index (BMI), waist circumference, and sagittal diameter of the abdomen. Bosnian women aged 42-59 y had substantially higher levels of BMI, larger waist and sagittal diameter of the abdomen measurements, higher levels of S-triglycerides, and lower HDL cholesterol indicating a more disadvantaged diet (CVD risk profile) than Swedish women. Younger Bosnian women aged 18-41 y had a higher sagittal diameter of the abdomen and lower high-density lipoprotein cholesterol than Swedish women. In conclusion this is the first study to report large differences in blood lipids, obesity and abdominal obesity after adjustment for socioeconomic status between Bosnian and Swedish women. These findings underscore the critical need to improve early detection obesity-related conditions in Bosnian women in exile.
BACKGROUND: This article examines whether the neighbourhood environment influences intermediate cardiovascular disease (CVD) risk factors, such as obesity (body mass index [BMI]), and lifestyle factors, such as no physical activity and smoking, when adjusted for the individual socioeconomic status (SES). METHODS: The study consists of face-to-face interviews from the Swedish Annual Level of Living Survey (SALLS) matched with the social status of the respondents' residential areas measured by two composite indices, the Care Need Index (CNI) and the Townsend score. The response rate was about 80%. This study was limited to the residents aged 25-74 years and consists of 9240 interviews from the years 1988-1989, when there were extended items in the SALLS about health and lifestyle. The data were analysed using a hierarchical logistic regression model. RESULTS: There was a gradient within every SES group so that respondents with a low (or intermediate or high) educational level exhibited an increasing proportion of daily smokers, physically inactive people and obese individuals with increasing neighbourhood deprivation. The multilevel model showed that respondents living in the most deprived neighbourhoods had an increased risk for being a daily smoker, engaging in no physical activity and being obese when adjusted for the individual SES. CONCLUSIONS: We showed that the area level has an important influence on risk factors for CVD which goes beyond the individual educational attainment. An increased level of living standard, more resources for primary health care and health promotion targeting the community level should be beneficial.
STUDY OBJECTIVE: To demonstrate how Care Need Index (CNI), a social deprivation index, may be used to allocate total primary health care resources. DESIGN: Cross sectional survey and register data. The CNI was based on sociodemographic factors: elderly persons living alone, children under age 5, unemployed people, people with low educational status, single parents, high mobility, and foreign born people. The CNI weights were calculated from the ratings of Swedish GPs of the impact of these factors on their workload. The CNI scale was transformed into a positive scale to avoid negative values. CNI weights were calculated for each decile of the study population. The risk of poor self reported health in the CNI deciles was estimated by means of a hierarchical logistic regression in the age range 25-74 (n=27 346). The MigMed database comprising all people living in Sweden was used to calculate the CNI for Stockholm. PARTICIPANTS: The Swedish population and the population in Stockholm County. MAIN RESULTS: The means of the CNI for deciles ranged from 61 (most affluent neighbourhoods) to 140 (most deprived) in Stockholm County. The ratio between the tenth and the first decile was 1.66. There was an approximately 150% increased risk of poor self reported health for people living in the most disadvantaged neighbourhoods (OR=2.50) compared with those living in the most affluent ones (OR=1). CNI ratios for the deciles corresponded approximately to the odds ratios of poor self reported health status. CONCLUSIONS: The CNI can be used to allocate total primary health care resources.
BACKGROUND: The purpose of this study was to analyse both cross-sectional associations and how longitudinal changes in lifestyle factors from one state in 1980-1981 to another in 1988-1989 influence self-reported health status. Another aim was to estimate the hazard ratios for all-cause mortality for the changes in lifestyle factors and self-reported hypertension during the same period of time. METHOD: The cross-sectional and the longitudinal analyses are based on the same simple random sample of 3,843 adults, aged 25-74, interviewed in 1980-1981 and 1988-1989 and is part of the Swedish Annual Level-of-Living Survey. About 85% of the respondents in the first interview participated in a second interview in 1988-1989. Cross-sectional odds ratios, based on a marginal model, were estimated using the generalized estimating equations. The transitional models were analysed using unconditional logistic regression. A proportional hazard model was applied to investigate the influence of lifestyle transitions on mortality. RESULTS: Physical inactivity, being a current or former smoker and obesity (women only) were strong risk factors for poor health either as main effects and/or combined (interactions). There was a strong interaction between physical activity and smoking, and for women, also between body mass index (BMI) and physical activity. Smoking, physically inactive and obese women had about a ten times higher risk of poor health status than non-smoking, physically active, and normal-weight women. The corresponding risk for men was about five times higher. Physically active, but smoking and obese individuals showed only moderately increased risks for poor health status. The transitional model showed that those who were physically inactive in 1980-1981, but did exercise in 1988-1989, improved their health after adjustments for sociodemographic and other lifestyle factors. Continuing to smoke or being physically inactive or having hypertension at both points in time were all associated with higher hazard ratios for all-cause mortality (1.6, 1.9 and 1.8, respectively) than those who reported that they were in good status at both points in time. CONCLUSIONS: We found that physical activity protects against poor health irrespective of an increased BMI and smoking. The major clinical implications are the long-standing benefits of physical activity and not smoking.
This study analyses the risk of self-reported diabetes mellitus among Turkish-born immigrants in Sweden. Two simple random samples were used: The Swedish National Board of Health and Welfare Immigrant Survey, and the Swedish Survey of Living Conditions, both from 1996. Totally 526 Turkish immigrants, 285 men and 241 women, were compared with 2854 Swedish controls, 1425 men and 1429 women, all in ages 27-60 years. Data were analysed by sex in an age-adjusted model, and a full model also included education, employment status, BMI and country of birth (logistic regression). Among Turkish men, age-adjusted diabetes prevalence was not higher than among Swedish men, odds ratio (OR) 1.04 (95% confidence interval (CI) 0.35-3.11). Among Turkish women, age-adjusted diabetes prevalence was higher than among Swedish women, OR 3.22 (95% CI 1.36-7.64), but when also adjusting for educational level, employment status and BMI, OR was 1.22 (95% CI 0.41-3.66). We conclude, that age-adjusted presence of known diabetes was higher among Turkish-born women than among Swedish women, but was explained by lower employment rate, lower educational status and a higher level of overweight and obesity.
OBJECTIVE: To investigate the long-term effects of the consumption of alcohol on mortality and morbidity. METHOD: A sample of 32,185 (50.5% female) individuals was randomly selected from the 450,000 inhabitants of Stockholm County, Sweden, in 1969. Alcohol consumption data were obtained from postal questionnaires; response rate was 87% (n = 28,001). Data on mortality and morbidity were obtained from the National Cause of Death Register, the Cancer Register and the Inpatient Register 1971-1996. RESULTS: The reference groups were moderate consumers of alcoholic beverages. High-consumption men had increased risks of mortality from cardiovascular diseases (relative risk ratio [RR] = 1.28; 95% confidence interval [CI]: 1.12-1.46), accidents or poisoning (RR = 2.10; CI: 1.67-2.65) and gastrointestinal diseases (RR = 4.65; CI: 2.93-7.36). High-consumption women had an increased risk of mortality only from accidents or poisoning (RR = 2.95; CI: 1.82-4.78) and gastrointestinal diseases (RR = 3.60; CI: 1.40-9.24). For low-consumption women, there was an increased risk of mortality from cardiovascular diseases (RR = 1.25; CI: 1.07-1.47). Low-consumption men also had an increased mortality from cardiovascular diseases (RR = 1.23; CI: 1.05-1.44). The results with respect to morbidity almost mirrored the results for mortality, with one exception; for low-consumption men, the morbidity from cardiovascular diseases was not increased. CONCLUSIONS: The mortality and morbidity associated with different levels of alcohol consumption are associated with the same diseases, which suggests that alcohol may be one of the causative factors for these diseases. The reasons for the differences between genders, regarding responses to the negative effects of alcohol consumption, are still unknown.
The aim of this longitudinal study was to determine the influence of ethnicity, social factors and self-reported long-term somatic and psychiatric illness on suicide in a random sample of the Swedish population. The study is based on face-to-face interviews conducted between 1979 and 1985 with a random sample of the Swedish population consisting of 47,762 Swedish-born subjects and 4407 individuals born elsewhere. The sample has been followed via register data concerning cases of suicide (suicides and undetermined deaths) until 31 December 1993. In total, 102 males and 46 females committed suicide prior to this date. Living alone and self-reported somatic illness with impaired health status were very strong risk factors for suicide, with risk ratios of 2.15 (CI, 1.51-3.05) and 1.80 (1.19-2.72), respectively. Ethnicity, defined as being born outside Sweden, had a risk ratio of 1.87 (1.18-2.97) in a model controlled for sex and age. However, this risk decreased with increasing age in the final model. Furthermore, an increased risk of suicide was found among female subjects living in rented flats and among male subjects irrespective of form of tenure, as well as among residents of large urban areas. Respondents with a self-reported long-term psychiatric illness with impaired health status also had a high risk of suicide, which decreased with increasing age. The main finding of this study is that somatic diseases and psychiatric disorders, which are known risk factors for suicide, may be revealed in surveys conducted by interviewers without medical training. Thus self-reported psychiatric and somatic illness appear to have a good potential for predicting suicide, even if the prevalence of psychiatric disorders is to some extent underestimated.
Data on the impact of functional dyspepsia on health-related quality of life in the general adult population are scarce.
To explore the impact of functional dyspepsia applying the Rome III definition on health-related quality of life in the general population.
A random sample of an adult Swedish population (n=1001, The Kalixanda study) was invited to undergo an oesophagogastroduodenoscopy. An extended abdominal symptom questionnaire and Short Form-36 (SF-36) questionnaire, which includes eight domains measuring physical, mental and social aspects of quality of life, were completed at the clinic visit just before oesophagogastroduodenoscopy.
Two hundred and two (20%) individuals reported uninvestigated dyspepsia (UID), 157 (16%) functional dyspepsia (FD), 52 (5%) epigastric pain syndrome (EPS) and 122 (12%) postprandial distress syndrome (PDS). UID, FD and PDS had a clinically meaningful (a = 5 point) and statistically significant impact (P