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Aim: The study aimed to critically review and synthesize the best available evidence about the effectiveness of therapist-guided internet-delivered cognitive behavioral therapy (iCBT) in terms of reducing sickness absence (SA). Methods: We searched Medline (PubMed), Embase, PsycInfo, CINAHL, and Cochrane Central (up to November 2020) for English language peer-reviewed papers that described randomized controlled trials of therapist-guided iCBT compared with usual treatment for SA in adults with common mental disorders. Eligible studies were assessed with the Cochrane Risk of Bias 1 tool, meta-analysis was conducted using a random-effects model, and standardized mean differences (SMD) with 95% confidence intervals (CI) were reported. A subgroup analysis investigated potential moderating variables (diagnosis, SA at baseline, and estimated accuracy of self-report). Results: We identified 2788 references, of which 68 remained after the completion of the systematic screening process. A hand search of reference lists yielded no additional studies. The full texts of these 68 studies were appraised critically, and 11 were deemed to be suitable for a meta-analysis. SA was similar for iCBT and usual treatment groups (SMD: 0.02, 95% CI, –0.08 to 0.11), and remained similar even after the removal of two studies in which the recall time was over 3 months (SMD: 0.00, –0.11 to 0.12). Similar SA levels in intervention and control groups at 6-month and 12-month follow-up were observed in studies of participants with depression symptoms. Conclusions: iCBT did not appear to be effective in terms of reducing (largely self-assessed) SA in adults with common mental disorders. There is a need to improve the method and consistency of assessing SA. [ABSTRACT FROM AUTHOR]

Background: The association between belonging to a disadvantaged socio-economic status or social class and health outcomes has been consistently documented during recent decades. However, a meta-analysis quantifying the association between belonging to a lower social class and the risk of dementia has yet to be performed. In the present work, we sought to summarise the results of prospective, longitudinal studies on this topic. Methods: We conducted a systematic review and meta-analysis of prospective, longitudinal studies measuring the association between indicators of social class and the risk of all-cause/Alzheimer's dementia. The search was conducted in four databases (Medline, Embase, Web of Science and PsychInfo). Inclusion criteria for this systematic review and meta-analysis were: (a) longitudinal prospective study, (b) aged ⩾60 years at baseline, (c) issued from the general population, (d) no dementia at baseline and (e) mention of social class as exposure. Exclusion criteria were: (a) study of rare dementia types (e.g. frontotemporal dementia), (b) abstract-only papers and (c) articles without full text available. The Newcastle–Ottawa scale was used to assess the risk of bias in individual studies. We calculated the overall pooled relative risk of dementia for different social class indicators, both crude and adjusted for sex, age and the year of the cohort start. Results: Out of 4548 screened abstracts, 15 were included in the final analysis (76,561 participants, mean follow-up 6.7 years (2.4–25 years), mean age at baseline 75.1 years (70.6–82.1 years), mean percentage of women 58%). Social class was operationalised as levels of education, occupational class, income level, neighbourhood disadvantage and wealth. Education (relative risk (RR)=2.48; confidence interval (CI) 1.71–3.59) and occupational class (RR=2.09; CI 1.18–3.69) but not income (RR=1.28; CI 0.81–2.04) were significantly associated with the risk of dementia in the adjusted model. Some of the limitations of this study are the inclusion of studies predominantly conducted in high-income countries and the exclusion of social mobility in our analysis. Conclusions: We conclude that there is a significant association between belonging to a social class and the risk of dementia, with education and occupation being the most relevant indicators of social class regarding this risk. Studying the relationship between belonging to a disadvantaged social class and dementia risk might be a fruitful path to diminishing the incidence of dementia over time. However, a narrow operationalisation of social class that only includes education, occupation and income may reduce the potential for such studies to inform social policies. [ABSTRACT FROM AUTHOR]

Aim: Joint physical custody, children spending equal time in each parents' respective home after a parental divorce, is particularly common in Nordic compared with other Western countries. Older children have been shown to fare well in this practice but for young children there are few existing studies. The aim of this paper is to study psychological problems in 2- to 9-year-old Nordic children in different family forms. Methods: Total symptom score according to the Strengths and Difficulties Questionnaire as well as scores showing externalizing problems were compared among 152 children in joint physical custody, 303 in single care and 3207 in nuclear families through multiple linear regression analyses. Results: Children in single care had more psychological symptoms than those in joint physical custody (B = 1.08; 95% CI 0.48 to 1.67) and those in nuclear families had the least reported symptoms (B = −0.53; 95% CI −0.89 to −0.17). Externalizing problems were also lower in nuclear families (B = −0.28, 95% CI −0.52 to −0.04) compared with joint physical custody after adjusting for covariates. Conclusions: Young children with non-cohabiting parents suffered from more psychological problems than those in intact families. Children in joint physical custody had a lower total problem score than those in single care after adjusting for covariates. Longitudinal studies with information on family factors before the separation are needed to inform policy of young children's post-separation living arrangements. [ABSTRACT FROM AUTHOR]

Aims: Labour force activity and marriage share some pathways through which they potentially influence health. In this paper, we examine whether marriage and labour force participation interact in the way they influence mortality in the USA and six European countries. Methods: We used data from the US National Health Interview Survey linked to the National Death Index, and national mortality registry data for Austria, England/Wales, Finland, Hungary, Norway and Spain (specifically, the Basque country) during 1999–2007, for men and women aged 30–59 years at baseline. We used Poisson regression to estimate both the additive (relative excess risk due to interaction) and multiplicative interactions between marriage and labour force activity on mortality. Results: Labour force inactivity was associated with higher mortality, but this association was stronger for unmarried, rather than married, individuals. Likewise, being unmarried was associated with higher mortality, but this association was stronger for inactive than for active individuals. To illustrate, among US women out of the labour force, being unmarried was associated with a 3.98 times (95%CI 3.28–4.82) higher risk of dying than being married; whereas the relative risk (RR) was 2.49 (95%CI 2.10–2.94), for women who were active in the labour market. Although this interaction between marriage and labour force activity was only significant for women on a multiplicative scale, there was a significant additive interaction for both men and women. The pattern was similar across all countries. Conclusions: Marriage attenuated the increased mortality risk associated with labour force inactivity; while labour force activity attenuated the mortality risk associated with being unmarried. Our study emphasizes the importance of public health and social policies that improve the health and well-being of unmarried and inactive men and women. [ABSTRACT FROM AUTHOR]

Aim: The overall aim of this paper is to examine sexually active young people’s behavioral expectations of condom use. Methods: We collected data at nine youth clinics and one sexually transmitted infections (STI) clinic in Sweden. We included participants whom had been sexually active during the past 12 months: A total of 1022 participants between the ages of 15 and 31 were included. We analyzed the data separately, for different types of sexual practices and types of sexual partners. Multinomial logistic regression was used to analyze age and gender differences for discrepancies. Results: The behavioral expectation of condom use differed, depending on the type of sexual practice and the type of partner. For all types of sex, the overall pattern showed that the participants were most likely to use a condom with a casual unknown partner, followed by a casual known partner, regular partner and lastly, a main partner. Our results also demonstrated that there is a discrepancy between the behavioral expectation of condom use and the self-reported condom use. The lowest discrepancy was for oral sex, especially with a main partner, and the largest discrepancy was for anal sex and vaginal sex with a casual partner. Conclusions: Our results imply that the participants had a greater expectation of condom use than actually occurs, especially for casual unknown partners. There is a lack of knowledge about the risks associated with oral sex, which is evident in the results of the participants’ behavioral expectations of condom use under those conditions. [ABSTRACT FROM PUBLISHER]

Aims: Parental education and childhood adversities are associated with long-term work disability but their contribution to sickness absence is largely unknown. We aimed to examine the associations between parental education, childhood adversities and self-certified and medically-certified sickness absence among midlife employees. Methods: The Helsinki Health Study baseline survey data (2000–2002) of 40-to-60-year-old municipal employees were linked with sickness absence data from the employer's register. Self-certified (1–3 days) and medically-certified (>3 days) sickness absence spells were followed from 2003 until the end of 2008. The study included 5728 employees. The analyses were made by Poisson regression and the results are presented as rate ratios (RRs) and their 95% confidence intervals (CIs). Results: Low maternal education was associated with self-certified sickness absence (RR 1.32, 95% CI 1.13–1.55) among women only whereas both low maternal (1.49, 1.26–1.77) and low paternal education (1.48, 1.32–1.67) were associated with medically-certified sickness absence. Adjustment for own occupational class mainly abolished these associations. Having experienced any childhood adversity was associated with self-certified (1.18, 1.12–1.25) and medically-certified (1.22, 1.15–1.30) sickness absence. In addition, childhood economic difficulties, childhood illness, parental divorce, parental mental illness, parental alcohol problems and bullying were each associated both with self-certified and with medically-certified sickness absence. The associations mainly remained after adjustments for occupational class, marital status, working condition, body mass index and health behaviours. Conclusions: Low parental education and childhood adversities contributed to midlife sickness absence. Promoting well-being of families with children might help sustain adult work ability and prevent sickness absence still in midlife. [ABSTRACT FROM AUTHOR]

Aims: Prolonged screen time (ST) is a potential concern for poor wellbeing. This study aimed to examine the associations of different types of ST with life satisfaction among adolescents. Methods: Data were from 380,446 adolescents (aged 11–15 years, 51% girls) across 37 European and North American countries who completed the 2010 and 2014 Health Behaviour in School-Aged Children surveys. Participants reported h/day during free time spent on television, electronic games, and computer/other devices. Life satisfaction was assessed using a 10-point scale (low life satisfaction ⩽5). Results: Generalized additive modelling showed non-linear associations for each ST type, with low life satisfaction increasing monotonically for >1 h/day of electronic gaming or computer/other device and >2 h/day of watching television. Multilevel multivariable modelling showed that >4 h/day of watching television was associated with 26% higher odds for boys (OR 1.26; 95% CI:1.21–1.32) and 52% higher odds for girls (1.52; 1.46–1.59) of low life satisfaction than for ⩽1 h/day of television. Electronic gaming >4 h/day was associated with low life satisfaction with odds 42% higher in boys (1.42, 1.36–1.48) and 69% higher in girls (1.69, 1.61–1.76). A similar association was found for >4 h/day of computer/other device for boys (1.43, 1.37–1.49) and girls (1.71, 1.65–1.77). Conclusions: Low levels of ST may be beneficial; however, prolonged periods are associated with low life satisfaction among adolescents, in particular among girls. Results support ⩽2 h/day restriction of ST and highlight research is needed to understand underlying mechanisms of ST and wellbeing, which may not reflect active versus passive content. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to investigate associations between psychosocial work exposure and the presence of biological and imaging biomarkers of cardiovascular disease. Methods: This cross-sectional study was conducted in a sub-cohort of the Swedish CArdioPulmonary bioImage Study (SCAPIS). Psychosocial exposure was evaluated with the job demand–control model, and analysed according to the standard categorization: high strain, active, passive and low strain (reference). Biomarkers (blood pressure, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol, coronary artery calcification (CAC) and metabolic syndrome) were measured, or derived through measurements, from clinical examinations. Gender-specific prevalence ratios (PRs) and 95% confidence intervals (CIs) were calculated with regression models and adjusted for age, education, smoking, physical activity, general life stress and body mass index (BMI). Results: The analyses included 3882 participants (52.5% women). High strain (high demands–low control) was linked to increased PR for low HDL cholesterol in women, adjusted for all covariates (PR 1.76; 95% CI 1.25–2.48). High strain was also related to moderately increased PR for metabolic syndrome in men, after adjustments for all covariates except BMI (PR 1.25; 95% CI 1.02–1.52). In addition, passive work (low demands–low control) was associated with diastolic hypertension in women (fully adjusted: PR 1.29; 95% CI 1.05–1.59). All relationships between psychosocial factors and LDL cholesterol or CAC (both genders), or hypertension (men), were non-significant. Conclusions: Poor psychosocial job conditions was associated with the presence of low HDL cholesterol and diastolic hypertension in women, and metabolic syndrome in men. These findings contribute to the knowledge of potential pathways between stressful work and coronary heart disease. [ABSTRACT FROM AUTHOR]

Aims: Sexual victimisation is a key public health concern because of its physical, psychological and social consequences. Nationally representative studies exploring sexual victimisation and re-victimisation are still scarce. The aim of the current study was to explore associations of sexual victimisation with sociodemographic factors including sexual orientation in Sweden. Methods: We used Swedish data from a national population survey linked to nationwide registers. The sample consisted of 3349 individuals aged 30–44 years, (2021 women and 1328 men). With a latent class analysis we identified groups of individuals with distinctly different experiences of sexual victimisation. Multinomial logistic regression was used to explore how common characteristics could explain latent class membership classes. Results: Experiences of sexual victimisation were common: 48% of women and 13% of men had experienced sexual harassment, 47% of women and 12% of women sexual assault, 11% of women and 1% of men attempted intercourse and 8% of women and 1% of men rape. Among women four groups were identified who had distinctly different experiences of exposure to sexual victimisation such as low victimisation, sexually harassed and assaulted several times, highly sexually victimised with low re-victimisation and finally high victimisation. Both women and men who were highly sexually victimised had to a higher extent a non-heterosexual sexual identity. Conclusions: Non-heterosexual orientation is a robust indicator of a high level of sexual victimisation as well as re-victimisation among both male and female adults. [ABSTRACT FROM AUTHOR]

Aims: To examine the associations between undocumented pregnant migrant women and the risk of experiencing stillbirth or preterm birth. Methods: A retrospective case–control study based on nationwide registers from Statistics Denmark and hospital journals from the seven largest hospital wards in Denmark from 1 January 2011 to 31 December 2018. A total of 882 undocumented pregnant migrant women and 3528 matched controls (both documented migrant and non-migrant women) were included. Logistic regression models were used to estimate the risk of undocumented pregnant migrant women experiencing (a) stillbirth and (b) preterm birth compared with the control group. Results: Of the undocumented pregnant migrant women, 33.3% were EU citizens, 16.2% were applicants for residence and 50.5% had an unknown basis for residence. The mean age of the undocumented pregnant migrant women was 28.4 years, whereas the mean age of women in the control group was 30.9 years. Higher adjusted odds of experiencing stillbirth (aOR 3.50; 95% CI 1.31–9.38) and preterm birth (aOR 1.41; 95% CI 1.04–1.93) were observed among the undocumented pregnant migrant women compared with the control group. The basis of residence was not associated with higher odds of experiencing stillbirth or preterm birth. Conclusions: We found a higher risk of stillbirth and preterm birth among the undocumented pregnant migrant women than in the control group. Our findings suggest a need to increase the focus on providing access to antenatal care among those women currently excluded from this care. [ABSTRACT FROM AUTHOR]

Aims: The purpose of this study is systematically to review and synthesise available prevalence data of major chronic diseases in international immigrants. Methods: Four electronic databases were searched to retrieve peer-reviewed original articles published in English between January 2000 and December 2020. Cross-sectional, cohort, or longitudinal studies that reported the prevalence of cardiovascular disease, any type of cancer, chronic obstructive pulmonary disease, and type 2 diabetes among immigrant adults were included. We calculated pooled prevalence using random-effects meta-analyses. Results: Of 13,363 articles retrieved, 24 met the eligibility criteria. The pooled prevalence of diabetes was 9.0% (95% confidence interval (CI) 7.6–10.4) with a higher prevalence in North American countries 11.1% (95% CI 8.0–14.1) than in the other destination countries: 6.6% (95% CI 5.1–8.1) including Italy, Sweden, The Netherlands, Australia, and Israel. The pooled prevalence of cardiovascular diseases and respiratory diseases was 7.7% (95% CI 5.7–9.6) and 6.5% (95% CI 2.3–10.7), respectively. Only two articles reported the prevalence of cancers (2.7% and 3.8%). We found high heterogeneity among all studies regardless of the disease. Conclusions: The prevalence of diabetes was higher than other chronic diseases in international immigrants. There is a strong need to enhance health information systems to understand the magnitude of chronic diseases among different immigrant subgroups. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to compare the self-rated health status of the Roma and of the general population by gender and educational level in six Central and Eastern European countries. Methods: We analysed the United Nations Development Program Regional Roma Survey and EUROSTAT's European Union Statistics on Income and Living Conditions surveys from 2011 for Bulgaria, Croatia, Czechia, Hungary, Romania and Slovakia. Using logistic regression, predicted probabilities of good or very good self-rated health were estimated for the Roma (n =11,401), Roma neighbours (n =5857) and the general population (n =101,579) stratified by gender, and adjusted by age, country and educational level. Results: There was a distinctive social gradient in self-rated health between the groups among both men and women, and a gap between primary versus secondary or tertiary education among all three groups, but Roma (men) and their neighbours with secondary or higher education had significantly worse predicted self-rated health compared to the general population with similar qualifications. Conclusions: These results strongly suggest that ethnicity and gender should be considered as fundamental causes that explain structural health inequalities. Consequently, future research and policy initiatives to reduce health inequities should acknowledge the impact of ethnic minorities and how these fundamental causes extend the general population's social gradient in health. Study designs enabling direct comparisons between ethnic groups and the general population should be applied. More and better data about ethnic minorities are needed to document and monitor existing health inequalities. [ABSTRACT FROM AUTHOR]

Aim: To investigate the effect of screening for anxiety and depression (AD) in patients with ischaemic heart disease (IHD) on the likelihood of receiving treatment for AD. Methods: We used a nationwide dataset of all Danish patients with an incident IHD diagnosis in the period 2015–2018 (N = 80,701) of which 20,461 (25%) were exposed to screening for AD as part of cardiac rehabilitation. A binary composite indicator for the use of any AD treatment (prescriptions of AD drugs, general practitioner (GP) counselling or referral to a psychologist), was modelled as the dependent variable. The probability of receiving AD treatment was estimated using linear probability and instrumental variable regression models. Results: Exposure to AD screening was lower for patients with low income (change in probability −0.67, 95% CI −0.76; −0.59), low education (change in probability −0.16, 95% CI −0.20; −0.13), and a high comorbidity burden (change in probability −0.09, 95% CI −0.10; −0.07). Screened patients had a lower conditional probability of AD treatment (change in probability −0.0061, p < 0.001) than non-screened patients. The patient's GP also had an impact on the probability of being referred for AD treatment. Using an instrumental variable approach did not affect the results. Conclusions: Screening for AD was subject to selection at the patient level; patients at lower risk of AD had a higher probability of being screened. Hence, extending systematic screening to cover a larger population may not achieve a noticeable increase in the uptake of AD treatment if it is not supported by appropriate measures to reduce reverse selection into screening. [ABSTRACT FROM AUTHOR]

Aim: to assess whether participation in cardiac rehabilitation affects the probability of returning to work after ischaemic heart disease. Methods: the study population consisted of 24,509 patients (18–70 years of age) discharged from an inpatient admission at a Danish hospital during 2014–2018 and who were working before their admission. Only patients with a percutaneous coronary intervention or coronary artery bypass grafting surgery procedure and ICD-10 codes I20–I25 as their main diagnosis or ICD-10 codes I21, I240, I248 or I249 as secondary diagnosis during an emergency admission were included. Exposure was defined as participation in cardiac rehabilitation (N = 15,742), and binary indicator of being at work in the last week of a given month were used as primary outcomes. Coarsened exact matching (CEM) of exposed and unexposed patients was used to reduce selection bias. Logistic regression models were applied on the matched population (N = 15,762). Results: Less deprived and less comorbid patients were more likely to receive cardiac rehabilitation. CEM succeeded in arriving at a population where this selection was reduced and in this population we found that patients who received cardiac rehabilitation had a lower probability of returning to work after 3 months (OR 0.81, 95%CI: 0.77–0.84), a higher but insignificant probability after 6 (OR 1.02, 95%CI: 0.97–1.08), and a higher probability after 9 (OR 1.08, 95%CI: 1.02–1.15) and 12 months (OR 1.20, 95%CI: 1.13–1.28). Conclusions: Deprived and comorbid patients have lower use of cardiac rehabilitation. In a matched population where this bias is reduced, cardiac rehabilitation will increase the probability of returning to work. [ABSTRACT FROM AUTHOR]

Background and aim: It is generally accepted that functional somatic disorders (FSDs) are a product of biological, psychological, and social factors. Social position might be part of this complex, but the literature on this issue is currently heterogeneous and inconsistent. The aim of the present study was – in a population-based cohort – to test the hypothesis that lower social position would be associated with higher a risk of FSD. Method: The association between social position and FSD was examined in a cross-sectional study with various measures of social position (education as measured by vocational training; employment; cohabitation; subjective social status) and delimitations of FSD (irritable bowel syndrome, chronic fatigue syndrome, fibromyalgia, bodily distress syndrome, and symptom profiles). The associations were analyzed using logistic regressions to calculate odds ratios and 95% confidence intervals. Each social measure was analyzed independently and was adjusted for age and sex. Results: Lower levels of vocational training, being unemployed, and living alone were associated with higher risk of FSD, regardless of the FSD delimitation. There was also a significant negative association between subjective evaluated social status and FSD. The associations remained after multiple adjustments, and seemed to be strongest for the more severe FSD-types. Conclusions: Lower social position is associated with higher risk of FSD, especially the more severe FSD delimitations, which might constitute an especially vulnerable group. However, the mechanisms behind the relations remain unknown. [ABSTRACT FROM AUTHOR]

Aims: To evaluate the validity of recorded chronic disease diagnoses in Icelandic healthcare registries. Methods: Eight different chronic diseases from multiple sub-specialties of medicine were validated with respect to accuracy, but not to timeliness. For each disease, 30 patients with a recorded diagnosis and 30 patients without the same diagnosis were randomly selected from >80,000 participants in the iStopMM trial, which includes 54% of the Icelandic population born before 1976. Each case was validated by chart review by physicians using predefined criteria. Results: The overall accuracy of the chronic disease diagnoses was 96% (95% CI 94–97%), ranging from 92 to 98% for individual diseases. After weighting for disease prevalence, the accuracy was estimated to be 98.5%. The overall positive predictive value (PPV) of chronic disease diagnosis was 93% (95% CI 89–96%) and the overall negative predictive value (NPV) was 99% (95% CI 96–100%). There were disease-specific differences in validity, most notably multiple sclerosis, where the PPV was 83%. Other disorders had PPVs between 93 and 97%. The NPV of most disorders was 100%, except for hypertension and heart failure, where it was 97 and 93%, respectively. Those who had the registered chronic disease had objective findings of disease in 96% of cases. Conclusions: When determining the presence of chronic disease, diagnosis data from the Icelandic healthcare registries has a high PPV, NPV and accuracy. Furthermore, most diagnoses can be confirmed by objective findings such as imaging or blood testing. These findings can inform the interpretation of studies using diagnostic data from the Icelandic healthcare registries. [ABSTRACT FROM AUTHOR]

Aims: It is becoming increasingly possible to obtain additional information about health survey participants, though not usually non-participants, via record linkage. We aimed to assess the validity of an assumption underpinning a method developed to mitigate non-participation bias. We use a survey in Finland where it is possible to link both participants and non-participants to administrative registers. Survey-derived alcohol consumption is used as the exemplar outcome. Methods: Data on participants (85.5%) and true non-participants of the Finnish Health 2000 survey (invited survey sample N =7167 aged 30-79 years) and a contemporaneous register-based population sample (N =496,079) were individually linked to alcohol-related hospitalisation and death records. Applying the methodology to create synthetic observations on non-participants, we created 'inferred samples' (participants and inferred non-participants). Relative differences (RDs) between the inferred sample and the invited survey sample were estimated overall and by education. Five per cent limits were used to define acceptable RDs. Results: Average weekly consumption estimates for men were 129 g and 131 g of alcohol in inferred and invited survey samples, respectively (RD –1.6%; 95% confidence interval (CI) –2.2 to –0.04%) and 35 g for women in both samples (RD –1.1%; 95% CI –2.4 to –0.8%). Estimates for men with secondary levels of education had the greatest RD (–2.4%; 95% CI –3.7 to –1.1%). Conclusions: The sufficiently small RDs between inferred and invited survey samples support the assumption validity and use of our methodology for adjusting for non-participation. However, the presence of some significant differences means caution is required. [ABSTRACT FROM AUTHOR]

Aims: Polypharmacy and potentially inappropriate medications (PIM) are risk factors for negative health outcomes among older people. This study aimed to investigate socio-demographic differences in polypharmacy and PIM use among older people with different care needs in a standard versus an integrated care setting. Methods: Population-based register data on residents aged ⩾65 years in Stockholm County based on socio-demographic background and social care use in 2014 was linked to prescription drug use in 2015. A logistic regression analysis was used to estimate socio-demographic differences in polypharmacy and PIM, adjusting for education, age group, sex, country of birth, living alone, morbidity and dementia by care setting based on area and by care need (i.e. independent, home help or institutionalised). Results: The prevalence of polypharmacy and PIM was greater among home-help users (60.4% and 11.5% respectively) and institutional residents (74.4% and 11.9%, respectively). However, there were greater socio-demographic differences among the independent, with those with lower education, older age and females having higher odds of polypharmacy and PIM. Morbidity was a driver of polypharmacy (odds ratio (OR)=1.19, confidence interval (CI) 1.16–1.22) among home-help users. Dementia diagnosis was associated with reduced odds of polypharmacy and PIM among those in institutions (OR=0.78, CI 0.71–0.87 and OR 0.52, CI 0.45–0.59, respectively) and of PIM among home-help users (OR=0.53, 95% CI 0.42–0.67). Conclusions: Polypharmacy and PIM were associated with care needs, most prevalent among home-help users and institutional residents, but socio-demographic differences were most prominent among those living independently, suggesting that municipal care might reduce differences between socio-demographic groups. Care setting had little effect on inappropriate drug use, indicating that national guidelines are followed. [ABSTRACT FROM AUTHOR]

Aims: The child restraint system (CRS) for vehicles is designed to provide specialized protection for children in the event of a crash. The aim of the study was to investigate the rate of CRS use and analyze the factors associated with CRS use among children aged under six years in China, and to provide further insight into developing strategies for promoting public health education. Methods: This is a cross-sectional study. The study sites were 36 primary healthcare institutions in 12 provinces across China, and the participants were 34,503 guardians of children aged 0–6 years. Guardians who owned private cars were included and completed surveys about their experience using CRS. Odds ratios and 95% confidence intervals were calculated using multivariate logistic regression models. Results: The overall rate of CRS use among children aged under six years in China was 17.3%. Multivariate logistic regression analysis revealed that living in an urban area, low age of the child, guardians having higher education and being looked after by parents had a significant positive association with CRS use among children aged under six years. Conclusions: This study confirms that there is a low rate of CRS use among children aged under six years in China, highlighting the considerable need for CRS use education, advocacy and promotion of increasing use. [ABSTRACT FROM AUTHOR]

Background: The success of vaccination campaigns against COVID-19 infection is vital for moving from a COVID-19 pandemic to an endemic scenario. We aimed to unravel the influence of the risk perception of epidemics along with individual and contextual factors on adherence to COVID-19 vaccination campaigns in Italy and Sweden. Methods: We compared the results of two nationwide surveys carried out in August 2021 across four domains of epidemic risk perception: perceived likelihood, perceived impact on the individual and perceived individual and authority knowledge. The roles of individual and contextual determinants were also explored. Results: The survey included 2144 participants in Sweden (52.3% women) and 2010 in Italy (52.6% women). In both countries, we found that trust in authorities was one of the main drivers of this process, with two-fold increased odds of being vaccinated. Being highly educated and having a higher relative income were associated with a higher adherence to the vaccination campaign (for relative income OR = 1.44, 95% CI 1.23–1.67 in Sweden and OR = 1.18, 95% CI 1.04–1.34 in Italy; for education OR = 1.90, 95% CI 1.30–2.77 in Sweden and OR = 1.47, 95% CI 1.09–1.97 in Italy), whereas a right and centre-right compared with a left and centre-left political orientation was negatively related to vaccination adherence (OR = 0.41, 95% CI 0.25–0.67 in Sweden and OR = 0.47, 95% CI 0.33–0.68 in Italy). Conclusions: Increasing trust in authorities, along with an equal global distribution of vaccine doses, can contribute to accelerating vaccination campaigns around the world and, in turn, to move towards an endemic scenario. [ABSTRACT FROM AUTHOR]

Background: Life expectancy has increased markedly in the past decades. Thus, it is of great importance to understand how people are ageing and if the trajectories of health and disability are changing over time. This study aimed to examine trends in functional abilities and health in independent cohorts of people aged 75–95 over three decades. Methods: This Helsinki Ageing Study consists of repeated cross-sectional postal surveys examining independent cohorts of old people (75, 80, 85 and 90+ years old). This study combined data from four waves (1989, 1999, 2009 and 2019). Results: In the most recent wave, there was an increase in the portion of participants who were able to walk outdoors easily (75-year-olds p =0.03, 80-year-olds p =0.002, 85-year-olds p <0.001; p for linearity for the study year effect, all adjusted for sex). Fewer people in the youngest age group (75-year-olds) needed daily help from another person in 2019 compared to the earlier waves (p =0.02 for linearity for the study year). Over the past three decades, the proportions of self-reported good mobility have risen 8.7% (95% confidence interval (CI) 2.3–15.1) in 75-year-olds, 11.7% (95% CI 3.9–19.6) in 80-year-olds and 20.1% (95% CI 10.7–29.4) in 85-year-olds, after adjusting for sex. Furthermore, in 2019, more people rated their health as good and scored better in psychological well-being than in the previous waves among 75-, 80- and 85-year-olds. However, no improvements were found among 90+-year-olds in any of these variables. Conclusions: People between 75 and 85 years old are presently feeling and functioning better than their predecessors. This may be an important objective for both economics and health policy. [ABSTRACT FROM AUTHOR]

Aims: To develop a questionnaire to examine attitudes among employees and managers to include people with various health problems into their work group, and to test the questionnaire in one relevant population within the labour market. Methods: A questionnaire was developed through a process involving discussions in a scientific forum and pilot testing with group discussions. The final questionnaire, which was tested in a survey study of managers and employees in 33 Norwegian kindergartens (N =485), contained 10 short case stories followed by questions concerning workplace inclusion. The case stories described individuals with musculoskeletal and mental disorders, as well as individuals with potentially stigmatising behavioural history and lifestyle, and control cases. Risk ratios with 95% confidence intervals (CIs) were used to compare the case stories. Cases with high risk ratios had an increased risk of not being included compared to a control case. Results: Attitudes for workplace inclusion varied between the different case stories. Cases portraying mental illness had the highest risk ratios, indicating that employees and managers are less likely to include people with mental illness than people with musculoskeletal illness. Furthermore, unspecific or chronic illness had higher risk ratios than specific and acute illness. The most important barriers also varied between case stories. Conclusions: The workplace inclusion questionnaire fulfills the need for a quantitative measure of attitudes to include individuals with various health problems into the workplace. Comparison of risk ratios showed clear differences between case stories, indicating that the workplace inclusion questionnaire is a valuable tool to measure the variance in workplace inclusion. [ABSTRACT FROM AUTHOR]

Aims: Chronic pain is increasingly considered to be an international public health issue, yet gender differences in chronic pain in Europe are under-examined. This work aimed to examine gender inequalities in pain across Europe. Methods: Data for 27,552 men and women aged 25–74 years in 19 European countries were taken from the social determinants of health module of the European Social Survey (2014). Inequalities in reporting pain were measured by means of adjusted rate differences (ARD) and relative adjusted rate risks (ARR). Results: At the pooled pan-European level, a greater proportion of women (62.3%) reported pain than men (55.5%) (ARD 5.5% (95% confidence intervals (CI) 4.1, 6.9), ARR 1.10 (95% CI 1.08, 1.13)). These inequalities were greatest for back/neck pain (ARD 5.8% (95% CI 4.4, 7.1), ARR 1.15 (95% CI 1.12, 1.19)), but were also significant for hand/arm pain (ARD 4.6% (95% CI 3.5, 5.7), ARR 1.24 (95% CI 1.17, 1.30)) and foot/leg pain (ARD 2.6% (95% CI 1.5, 3.8), ARR 1.12 (95% CI 1.07, 1.18)). There was considerable cross-national variation in gender pain inequalities across European countries. Conclusions: Significant gender pain inequalities exist across Europe whereby women experience more pain than men. The extent of the gender pain gap varies by country. The gender pain gap is a public health concern and should be considered in future prevention and management strategies. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to describe the prevalence and socio-demographic and lifestyle-related correlates of muscle-strengthening activity (MSA; strength/resistance training, sit-ups/push-ups, etc.) among a large sample of European adolescents. Methods: Data were drawn from the European Health Interview Survey Wave 2 (2013–2014), including 8818 adolescents (15–17 years) from 28 European countries. Self-reported MSA was assessed using a previously validated survey item. Population-weighted prevalence ratios were calculated for (a) 'none' (0 days/week), (b) 'insufficient MSA' (1–2 days/week) or (c) 'sufficient MSA' (⩾3 days/week). Generalised linear models using Poisson regression with robust error variance were used to calculate the prevalence ratios for adolescents reporting sufficient MSA by socio-demographic/lifestyle characteristics and by European region. Results: Overall, 19.4% (95% confidence interval (CI) 18.3–20.7) reported sufficient (⩾3 days/week) MSA and 57.9% (95% CI 56.4–59.6) reported none. Females, adolescents from Southern and Eastern European regions, those not meeting the aerobic guideline and adolescents classified as overweight were significantly associated with a lower likelihood of reporting sufficient MSA, independent of other characteristics. Conclusions: The majority of European adolescents do not meet the MSA guidelines. Future large-scale MSA public-health interventions should target female and currently inactive adolescents, as well as those from Southern and Eastern European regions. [ABSTRACT FROM AUTHOR]

Aims : This study aimed to compare the prevalence in different gambling types as well as problem gambling in the Nordic countries, examining gambling, leisure activities, school truancy, parental relations and consumption of alcohol and other substances as covariates for problem gambling. Methods : Cross-country data were provided by the European Survey Project on Alcohol and Other Drugs (ESPAD) 2015. Prevalence of gambling and potential covariates were analysed for Denmark, Finland, Iceland Norway and Sweden (N =13,172 respondents aged 16 years), while analyses regarding problem gambling only included countries that participated in the optional questions on gambling problems (Denmark, Finland and Sweden; N =8108). We tested variables for problem gambling by bivariate logistic regression and multivariate logistic regression. Results : Cross-country differences were found in gambling and problem gambling, as well as differences in covariates for problem gambling. Sweden had the lowest rate of problem gambling. No significant difference was found between Denmark and Finland. Reports of too much gaming, inhalants, slots, betting and online gambling were positively associated with problem gambling, while parental monitoring and parental caring had a negative association. The relevance of the covariates varied across countries. Conclusions : Results indicate that although gambling regulation and its implementation have an important impact on gambling behaviour, we need more research on social, economic and cultural factors and how youth understand and interact with them. Contexts and regulations in other related fields should inform gambling research, policies and interventions. [ABSTRACT FROM AUTHOR]

Introduction: Objective sales data have indicated that the Norwegian indoor smoke-free regime implemented in June 2004 did not affect the hospitality business negatively. This paper investigates whether self-reports on the economic impact of the smoking ban from employees in the hospitality sector gave similar results, and whether post-ban self-reports on the economic impact of the ban were influenced by pre-ban attitudes towards smoke-free policies. Methods: A random sample of 516 employees in bars and restaurants stated their attitudes towards smoke-free policies shortly before the ban became effective. One year later, the same respondents gave their perceptions of changes in patronage for their workplace. Data were collected using self-administered questionnaires and telephone interviews. Results: 56.4% of the hospitality workers stated that the ban on smoking had led to a large reduction (28.2%) or some reduction (28.2%) in the number of patrons, a result inconsistent with analysis of sales data. After adjusting for demographic and smoking-related variables, a negative pre-ban attitude significantly increased the odds for reporting a negative economic impact post ban (odds ratio 2.48, confidence interval 1.48—4.14). Conclusions: Subjective reports of the economic impact from an indoor ban on smoking are influenced by attitudes towards smoke-free policies and should not be considered as a valid measure of the economic effect. [ABSTRACT FROM PUBLISHER]

Our research group recently reported that symptom levels of depression, anxiety, and stress among Swedish university students were relatively stable during the first three months of COVID-19 and decreased slightly during the following three summer months. Since then, Sweden has faced a second and third wave of COVID-19. Aims: This study aims to describe the mean trajectories of depression, anxiety and stress symptoms among Swedish university students before and during the second and third waves of the COVID-19 pandemic. Methods: We recruited 1835 participants in September 2020, of whom 81% provided follow-ups in December 2020–January 2021 and 77% provided follow-ups in March–April 2021. The short-form Depression, Anxiety and Stress Scale was used to measure mental health symptoms. Generalized estimating equations were used to estimate the mean differences in symptom levels over the three time periods. Results: Compared with September, mean depression was 0.91 points of 21 higher (95% confidence interval (CI) 0.70–1.13) in December 2020–January 2021 and 0.66 points higher (95% CI 0.43–.88) in March–April 2021. Anxiety levels were 0.20 points higher (95% CI 0.05–0.34) in December 2020–January 2021 and 0.17 points higher (95% CI 0.02–0.33) in March–April 2021. Stress levels were 0.21 points higher (95% CI 0.00–0.41) in December 2020–January 2021 and 0.16 points lower (95% CI −0.38 to 0.05) in March–April 2021. Conclusions: Our results indicate relatively stable levels of mental health among Swedish university students during the second and third waves of COVID-19 compared with before the second wave. Mean depression symptom scores increased slightly, but the importance of this small increase is uncertain. [ABSTRACT FROM AUTHOR]

Background: Female educational advantage is evident from elementary school and throughout the education system. Understanding the gender differences that precede school entry might provide important insight as to why girls outperform boys later in their educational careers. Aims: The aim of this study was to explore gender differences in early literacy and numeracy skills, as well as a range of neurodevelopmental and behavioral domains between the age of five and six years. Methods: We used questionnaire data from preschool teachers in the Norwegian Mother, Father and Child Cohort Study reported for 7467 children attending the final year in preschool, to explore gender differences and age patterns by fitting flexible regression models predicting pre-academic, behavioral and neurodevelopmental outcomes. Results: We found gender differences favoring girls for all outcomes except internalizing behavior. For neurodevelopment and behavior, differences in adjusted standardized scores ranged from 46% of a standard deviation (95% confidence interval (CI) 0.41, 0.50) in overall school readiness to 31% of a standard deviation difference in externalizing behavior problems (CI 0.21, 0.41). We found gender differences for all literacy skills in favor of girls. The gender gap in naming and adding numbers was small, but in favor of girls. Increasing age was associated with improved pre-academic skills and school readiness, as well as reduction of attention problems and language difficulties, the latter especially for boys. Conclusions: We conclude that gender differences favoring girls exist prior to school entry for a broad range of pre-academic, behavioral and neurodevelopmental skills relevant to school functioning. [ABSTRACT FROM AUTHOR]

Aims: We aimed to investigate (a) the association between body mass index (BMI) and self-rated health (SRH) and (b) BMI's predicted value for SRH within a representative population in the Skaraborg Project. Methods: This was a longitudinal observational study. A random population of 2816 individuals were included in the study between 2002 and 2005, and a representative sample of these individuals were invited consecutively for a follow-up visit between 2012 and 2014. At follow-up, data from 1327 participants were collected concerning anthropometric variables, blood samples and validated questionnaires regarding lifestyle factors. Results: A significant inverse association was observed between BMI and SRH both at baseline and at follow-up, with all p -values for trend being ⩽0.001 in both men and women. This association was observed even after adjusting for confounders such as co-morbidity, age, sex, education, marital status and lifestyle factors. In addition, the longitudinal analyses showed that BMI at baseline was inversely associated with SRH at follow-up in both sexes (odds ratio (OR)=1.1, confidence interval (CI) 1.02–1.16, p =0.017 in men; and OR=1.1, CI 1.04–1.14, p =0.001 in women). These findings remained in participants whose weight increased (p =0.022) or was stable (p =0.004), while it was not seen in individuals who lost weight over the years (p =0.340). Conclusions: SRH is inversely associated with BMI in Swedish men and women. High BMI predicted low SRH from a longitudinal perspective, independent of co-morbidities, except for individuals who lost weight over the years. This knowledge emphasises the importance of an understanding and empathetic attitude towards these individuals. [ABSTRACT FROM AUTHOR]

Aim: The objective of this study was to investigate if grip strength or the short physical performance battery could predict the rate of receiving two different types of home care services: (a) personal care and (b) home nursing care for community-dwelling older adults aged 75+ years. Methods: A secondary data analysis of a prospective cohort study including 323 community-dwelling older adults. Measures of grip strength and the short physical performance battery were incorporated in a nationally regulated preventive home visit programme. Referral to personal and home nursing care were obtained from an administrative database with an average follow-up of 4.1 years. The rate of receiving the individual home care services and the study measures were determined using multivariable Cox proportional hazards models controlling for a priori selected covariates (age, sex, living status, obesity, smoking and prior use of home care). Results: The mean age was 81.7 years with 58.8% being women. The rate of receiving personal care differed between the short physical performance battery groups but not between the grip strength groups after adjusting for all covariates with hazard ratios (95% confidence intervals) of 1.90 (1.29–2.81) and 1.41 (0.95–2.08), respectively. The rate of receiving home nursing care differed between both the short physical performance battery and grip strength groups after adjusting for all covariates with hazard ratios of 2.03 (1.41–2.94) and 1.48 (1.01–2.16), respectively. Conclusions: The short physical performance battery was associated with the rate of receiving both personal care and home nursing care. The short physical performance battery can be used to predict home care needs of community-dwelling older adults aged 75+ years. [ABSTRACT FROM AUTHOR]

Aims: This cross-sectional, population-based study aimed to investigate the prevalence of violence polyvictimization during childhood and sexual violence in adulthood among women, and how childhood violence exposure and sociodemographic factors associate with women's risk of experiencing sexual violence in adulthood. Methods: A survey regarding lifetime experiences of sexual, physical and psychological violence was sent to a national sample of 10,000 women aged 18–74 years, of which 56% participated. Data were analysed using Chi-square analyses and logistic regression. Results: Sexual violence before 18 years of age was reported by 16.3% and rape/attempted rape in adulthood by 10.2% of the women. In univariate analyses, sexual, physical, and psychological violence during childhood was associated with rape/attempted rape in adulthood (odds ratio 4.5, confidence interval 3.2–6.2; odds ratio 2.5, confidence interval 1.3–4.6; and odds ratio 2.5, confidence interval 1.8–3.2, respectively). Associations were stronger for combined exposure to sexual and physical (odds ratio 5.5, confidence interval 2.5–12.3), sexual and psychological (odds ratio 9.2, confidence interval 6.7–12.8) or sexual, physical, and psychological violence (odds ratio 14.1, confidence interval 10.4–19.2) during childhood. Rape/attempted rape after 18 years of age was more common among women who were single, those with college-level education and those who had been unemployed or had received social welfare payments. Most associations remained relatively unchanged when including all exposure and background variables in multivariate analyses. Conclusions: Although several of the sociodemographic factors studied showed significant associations, multiple exposure to violence during childhood was found to be the most potent risk factor for sexual violence in adulthood among adult women. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to test the hypothesis that heavy alcohol consumption and problem drinking is associated with a higher risk of becoming unemployed and a lower chance of entering the job market across socioeconomic positions. Methods: A sample of 84,474 men and women aged 18–60 years from the Danish National Health Survey 2010 participated in the study. Information on alcohol consumption and problem drinking was obtained by questionnaire. The primary outcomes were becoming unemployed and entering the job market. The follow-up period was five years. Information on labour market transitions and socioeconomic position (educational level) was obtained through nationwide registers. Multiplicative analyses were performed. Results: Heavy alcohol consumption and problem drinking were associated with a higher risk of unemployment among low-educated (hazard ratio (HR)=1.5; 95% confidence interval (CI) 1.3–1.9) and medium-educated (HR=1.3; 95% CI 1.1–1.5) individuals in comparison to individuals with a similar educational level drinking one to seven drinks per week. Excessive alcohol consumption and problem drinking were associated with a lower chance of entering the job market for individuals with a medium or high level of education: medium-educated individuals drinking >28 drinks per week had a HR of 0.82 (95% CI 0.69–0.98) when compared to medium-educated individuals drinking one to seven drinks per week. The corresponding HR among high-educated individuals was 0.71 (95% CI 0.49–1.0). Conclusions: Heavy alcohol consumption and problem drinking are associated with a higher risk of unemployment in some social strata, whereas excessive alcohol consumption and problem drinking are associated with a lower chance of entering the job market in other social strata. [ABSTRACT FROM AUTHOR]

Background: Pneumonia and influenza are major health concerns and constitute a high economic burden. However, few data are available on the associated risk of pneumonia and influenza and work exposure on a large population scale. Aim: This study aimed to examine the associated risk of pneumonia and influenza by type of work exposure. Methods: By cross-linking administrative Danish registries, we classified people in 10 different profession types. The main outcome was hospitalisation with pneumonia or influenza. A multivariable Poisson regression analysis was used to assess the associated incidence rate ratio (IRR) of being hospitalised with pneumonia or influenza by type of profession. Results: A total of 1,327,606 people added risk time to the analyses. In a multivariable model, work in day care, public transportation, sewers and nursing home care was associated with an increased risk of hospitalisation with pneumonia compared to work within public administration: IRR=1.20 (95% confidence interval (CI) 1.12–1.28), IRR=1.21 (95% CI 1.09–1.34), IRR=1.61 (95% CI 1.19–2.19) and IRR=1.10 (95% CI 1.03–1.18), respectively. In a multivariable analysis, people working within public transportation were associated with an increased risk of hospitalisation with influenza compared to people working within public administration: IRR=2.54 (95% CI 1.79–3.58). Conclusions: Working in day care, public transportation, sewers and nursing home care increased the associated risk of hospitalisation with pneumonia, and working within public transportation increased the associated risk of being hospitalised with influenza compared to working within public administration. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to investigate the relationship between diabetes stigma as experienced by adults with type 1 diabetes and diabetes outcomes using the novel, validated measure of the Type 1 Diabetes Stigma Assessment Scale. Methods: A total of 1594 adults with type 1 diabetes completed a questionnaire on socio-economic factors, psychosocial health, and diabetes stigma and these self-reported data were linked with data from electronic clinical records on glycaemic control, diabetes duration, age, and diabetes-related complications. Bivariate analyses and multivariate linear regressions were performed to assess the relationship between diabetes stigma as measured by three subscales, Identity concern, Blame and judgement, and Treated differently on the one hand, and patient characteristics and diabetes outcomes on the other. Results: Endorsement of the stigma statements ranged from 3.6–78.3% of respondents. Higher stigma scores in relation to Identity concern and Blame and judgement were significantly associated with being female, of lower age, lower diabetes duration, and having at least one complication. Those who reported higher levels of perceived stigma reported significantly higher levels of diabetes distress (β = 0.37 (95% CI: 0.33–0.40), 0.35 (95% CI: 0.30–0.39), 0.41 (95% CI: 0.35–0.46)), and HbA1c levels (β = 0.11 (95% CI: 0.02–0.21), 0.28 (95% CI: 0.16–0.40), 0.26 (95% CI: 0.14–0.42) for Identity concern, Blame and judgement, and Treated differently, respectively). Conclusions: The findings demonstrated that diabetes stigma is negatively associated with both diabetes distress and glycaemic control and should be considered part of the psychosocial burden of adults with type 1 diabetes. [ABSTRACT FROM AUTHOR]

Aims: This study investigated mortality in disability pensions due to common mental disorder, and variation over time after first receiving disability pension. Methods : Objectives were explored in 301,863 construction workers (97.2% men) recruited through healthcare examinations from 1971–1993. By linking with the Swedish National Insurance Agency registers, disability pensions until 2014 were identified. Common mental disorder was defined as disability pension diagnosis due to anxiety, stress-related disorders or moderate depression. Mortality was calculated in all-psychiatric diagnosis and diagnostic sub-groups, and compared to persons without disability pensions, using Poisson regression. Additional analyses were stratified by age at follow-up. Results : In total 6030 subjects received disability pensions based on psychiatric diagnoses, and 2624 constituted common mental disorder. Analyses in an all-psychiatric diagnosis displayed increased mortality risks in men (relative risk 3.6; 95% confidence interval 3.3–3.9) and women (relative risk 2.1; 95% confidence interval 1.6–2.6). Common mental disorder was associated with mortality, especially in men (relative risk 2.5; 95% confidence interval 2.2–2.8). Increased relative risks in alcohol and substance abuse were also observed. Results in analyses stratified by age at follow-up displayed persistent high relative risks for mortality in older ages (75–89 years) in men in all-psychiatric disability pensions diagnosis (relative risk 2.8; 95% confidence interval 2.1–3.7) and common mental disorder diagnosis (relative risk 2.6; 95% confidence interval 1.8–3.6), compared to men without disability pensions. Similar results were found in women, but few cases lowered the precision of estimates. Conclusions : This study shows that disability pension based on common mental disorders, often regarded as a 'lighter' psychiatric diagnosis, is a risk for early mortality in construction workers, even several years after first receiving disability pension. [ABSTRACT FROM AUTHOR]

Aims: Research on the effect of unmet health-care needs on mortality at follow-up is scarce. This study investigated whether unmet health-care needs in 2008 were associated with a higher risk of mortality during a five-year follow-up period in a population in southern Sweden, and whether the association was stronger for particular subgroups of cause of death. Methods: The 2008 public-health survey in Skåne was used as baseline. The survey included variables such as unmet health-care needs, risk behaviours and social and socio-economic variables, and had 28,198 respondents aged 18–80 years. The study was longitudinal. Mortality data for the period 27 August 2008 (start of the survey) to 31 December 2013 were provided by the National Board on Health and Welfare. Analyses were run using Cox proportional hazard models. Mortality was analysed as the total and in subgroups: cardiovascular disease (CVD), cancer and other causes. Results: In the time period studied, 946 (3.4%) people had died. Unmet health-care needs increased the hazard ratios (HRs) of total mortality after adjusting for age, particularly for people aged 65–80 years (HR=1.53; confidence interval 1.24–1.88). Unmet health-care needs were associated with death due to cancer and other causes but not with CVD. Adjusting for self-rated health attenuated the HRs. For the age group 18–64 years, there was no significant association between unmet health-care needs and mortality. Conclusions: Having unmet health-care needs at baseline was significantly associated with increased mortality for all causes, except CVD, in the following five year-period, particularly for people aged 65–80 years. [ABSTRACT FROM AUTHOR]

Aims: Scientific knowledge about risk factors for work disability in terms of long-term sickness absence and disability pension following lumbar spine decompression surgery remains insufficient. This study aimed to investigate the associations between socio-demographic, work-related, and medical characteristics with subsequent long-term sickness absence (>90 days) and disability pension for individuals who underwent lumbar spine decompression surgery. Methods: A prospective cohort study of all individuals aged 19–60 years with diagnosed dorsopathies, who underwent lumbar spine decompression surgery 2008–10 in Sweden (n =7373) was performed. Univariate and multivariate hazard ratios with 95% confidence intervals regarding long-term sickness absence and disability pension with a 3-year follow-up period were estimated by Cox proportional regression. Results: Low educational level, being a non-European immigrant and preoperative sickness absence were risk factors for both long-term sickness absence and disability pension (hazard ratios: 1.2–3.8). Female sex was a risk factor for long-term sickness absence (hazard ratios: 1.3) whereas age >44 years and being a Nordic immigrant were risk factors for disability pension (hazard ratios: 1.9–2.6). Medical factors as common mental disorders, other mental disorders, prescribed psychiatric medication and somatic comorbidity were risk factors for both long-term sickness absence and disability pension (hazard ratios: 1.2–3.4). A simultaneous lumbar fusion surgery and high preoperative pain severity were risk factors for long-term sickness absence (hazard ratios 1.2–1.8). Conclusions: To prevent long-term work disability after lumbar spine decompression surgery, specific focus is required on older and female patients, those with mental or somatic comorbidities, high levels of preoperative pain or sickness absence, with a simultaneous lumbar fusion surgery, a low educational level or a non-European immigrant background. [ABSTRACT FROM AUTHOR]

Aims: Police have a high prevalence of musculoskeletal disorders. While physical factors contributing to this have been explored, little is known regarding the contribution of the psychosocial work environment. This study explores the association between elements of the JDC model, social support and multi-site musculoskeletal pain among Swedish police. Methods: In this cross-sectional study, responses from 4185 police were collected using a self-administered online survey. The survey included questions on the psychosocial work environment and musculoskeletal pain, as well as several potential confounding factors. Logistic regression analyses were performed to explore the degree of association between 1) the indices for job demands, job control, social support and multi-site musculoskeletal pain and 2) the four categories of the JDC model, social support and multi-site musculoskeletal pain. Results: The overall psychosocial work environment of Swedish police was characterised by low control and high social support. Police who reported active and high strain jobs were found to have an increase in the odds ratio for multi-site musculoskeletal pain (OR 1.45 (95% CI 1.08–1.94) and 1.84 (1.51–2.24), respectively). High demands, which is a component in the categories for active and high strain jobs, was also found to be associated with an increase in the odds ratio for multi-site musculoskeletal pain (OR 1.66 (1.45–1.91)). High social support was associated with a decrease in the odds ratio for multi-site musculoskeletal pain (OR 0.72 (0.57–0.86)). Conclusions: The psychosocial work environment should be considered when investigating factors related to the health and wellbeing of police. [ABSTRACT FROM AUTHOR]

Aim: Volcanic eruptions and other natural disasters may affect survivor's physical and mental health. The aim of this study was to examine the mental health effects of the 2010 Eyjafjallajökull volcanic eruption in Iceland on nearby residents, by exposure level and experience. Methods: This population-based study included 1615 residents living in an area close to the Eyjafjallajökull volcano at the time of the eruption and a sample of 697 residents from a non-exposed area. All participants received a questionnaire 6–9 months after the eruption assessing mental health (GHQ-12, PSS-4 and PC-PTSD). The exposed group also received questions related to the experience of the eruption. Results: Replies were received from 1146 participants in the exposed group (71%) and 510 participants in the non-exposed group (73%). Compared to the non-exposed group, participants living in the high-exposed area were at increased risk of experiencing mental distress (GHQ) 6–9 months following the eruption (odds ratio (OR) 1.45%; 95% confidence interval (CI) 1.11–1.90). High-exposed participants were furthermore at increased risk of experiencing symptoms of post-traumatic stress disorder (PTSD) compared to those living in the low-exposed area (OR 3.71; 95% CI 1.34–15.41). We further found that those who had direct experience of the eruption were more likely to suffer from symptoms of mental distress, PTSD symptoms and perceived stress, compared to those less exposed. Conclusions: The findings indicate that screening for these factors (e.g. experience of the event) could potentially aid in identifying those most vulnerable to developing psychological morbidity after this unique type of disaster. [ABSTRACT FROM AUTHOR]

Aims: Self-rated health (SRH) is a predictor of future health. However, the association between SRH in adolescence and health problems and health care utilization in adulthood has rarely been investigated. The aim of this study was to examine adolescent SRH as a predictor of general practitioner consultations in adulthood. Methods: SRH was registered in the Young-HUNT1 survey in 1995–1997 (N=8828, mean age 16 years, 88% participation rate). General practitioner consultations during 2006–2014 were obtained from a national claims database. The predictive value of adolescent SRH on general practitioner consultations in adulthood was analysed by regression models estimating the relative risks (RR) for the total number of consultations and consultations for psychological, gastrointestinal, musculoskeletal or respiratory problems. Age, sex and baseline measures of chronic disease and health care attendance were used as the adjusting variables. Results: SRH was reported as 'very good' by 28.4%, 'good' by 60.6% and 'not good' by 11.0% of the respondents. The increases in consultation rates were 21% (RR 1.21, 95% CI 1.15–1.27) and 52% (RR 1.52, 95% CI 1.40–1.64) when comparing respondents with 'very good' SRH to those with 'good' and 'not good' SRH, respectively. We also demonstrated a dose–response association between adolescent SRH and general practitioner consultations for psychological, gastrointestinal, musculoskeletal or respiratory problems. Conclusions: SRH in adolescence is a predictor for general practitioner consultations in adult life. Previous research shows that SRH is influenced by factors such as well-being, health behaviour, functional status and body satisfaction. Intervention studies are needed to evaluate whether population-based and clinical interventions can improve SRH by improving these factors among adolescents. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this study was to evaluate a two-step screening method for hypertension in dentistry regarding the number needed to screen (NNS) and positive predictive value (PPV) and to risk-classify those with newly diagnosed hypertension. Methods: In connection with their regular dental care check-up, 2025 subjects aged 40–75 years were screened for high blood pressure. Via a health questionnaire, data were collected concerning risk factors. Blood pressure was screened comprehensively in two steps, which included screening in a dental clinic and home measurements for one week. Recently discovered hypertensive participants were assessed for 10-year risk of cardiovascular mortality according to the guidelines of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC). Results: A total of 170 new hypertensive participants were found (NNS = 12; 95% confidence interval (CI): 11–13). The method yielded a PPV of 0.73 (95% CI: 0.68–0.78) and eliminated 84.8% of the false-positive participants. The results also showed that based on ESH/ESC risk estimation, 76.5% of those newly diagnosed hypertensive participants had a moderate or high risk of cardiovascular mortality within 10 years. Conclusions: The study shows that a two-step method for blood pressure screening in a dental setting including home measurement resulted in a high PPV and eliminated most of those with a false high blood pressure reading. The findings also show that two-step screening for hypertension is feasible in a larger population with more screening providers involved. [ABSTRACT FROM AUTHOR]

Aims: Overweight and obesity are clinical public-health concerns worldwide. Amongst older adults, the prevalence of overweight and obesity is considered high. The purpose of this study was to provide current data regarding the prevalence and trends of overweight and obesity of adults from 2005 to 2013 in 10 European countries. Methods: The data used in the present study were derived from the first, second, fourth and fifth waves of the Survey of Health, Ageing and Retirement in Europe. The present study includes individuals aged ⩾50 years from 10 European countries. Body mass index (BMI) was calculated from self-reported height and weight (kg/m2). Results: The general prevalence of overweight (BMI ⩾25 kg/m2) was slightly above 60% and remained stable between 2005 (60.1%, 95% confidence interval (CI): 59.3–60.9%) and 2013 (60.3%, 95% CI: 59.7–60.9%). On the other hand, the prevalence of obesity (BMI ⩾30 kg/m2) increased significantly (1.6 points, 95% CI: 0.7–2.6) from 17.5% in 2005 to 19.2% in 2013. Although the prevalence of obesity increased in most countries, the only significant increase was observed in Germany (5.8 points, 95% CI: 1.8–9.9). Spain was the only country where the prevalence of obesity decreased significantly (−4.7 points, 95% CI: −8.8 to −0.5). Sex and age differences are reported. Conclusions: Although the prevalence of overweight was stable, the prevalence of obesity rose. Based on the data currently available for Europe, the prevalence of obesity in European older adults has already reached epidemic proportions, which reinforces the need for the development of effective healthy lifestyle programs. [ABSTRACT FROM AUTHOR]

Background: In Norway, snus use among women has increased substantially over the last decade, particularly in younger age groups. Snus use is associated with increased morbidity among men, but few studies have addressed health consequences of snus use among women. Aim: To investigate the associations between body mass index (BMI) and female snus use, and between self-rated general health and female snus use. Methods: A nationally representative net sample of 13,756 women in Norway, aged 18–45 years, participated in a survey on lifestyle and health. Ordinal logistic regression was applied to address associations between snus use and BMI/general health, adjusting for age and lifestyle factors. Results: Compared to never users of snus, daily snus users had a lower likelihood of high BMI (OR: 0.83, 95% CI: 0.68–1.00), a higher likelihood of low BMI (OR: 1.63, 95% CI: 1.14–2.33), and a higher likelihood of poor/fair health (OR: 1.43, 95% CI: 1.08–1.90). Former and occasional snus users did not differ from never users in terms of BMI or general health in multiply adjusted models. Daily smokers had the highest likelihood of reporting poor/fair health (OR: 2.18, 95% CI: 1.8–2.63) relative to never smokers. Conclusions: Daily female snus use was associated with a lower likelihood of being overweight, and a higher likelihood of being underweight. Moreover, daily snus use was associated with a higher likelihood of worse general health. Former and occasional female snus use was not associated with BMI or general health. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to investigate the associations between problem gambling and health-related quality of life, stress, pain or discomfort and the use of analgesics and sleeping pills. Methods: Data derives from the Danish Health and Morbidity Survey 2010. The survey was based on a random sample of 25,000 adult Danes (response rate: 61%), and data were collected via a self-administered questionnaire. The Lie/Bet Questionnaire was used as the screening instrument for problem gambling. Respondents were categorised as current, previous or non-problem gamblers. The questionnaire also included topics such as health-related quality of life (Short Form-12), perceived stress, pain and discomforts within the past two weeks, as well as the use of medication within the past two weeks. Results: Current problem gambling was strongly associated with negative outcomes such as poor mental health, high perception of stress, headache, fatigue and sleeping problems. Furthermore, previous problem gambling was generally associated with poorer health outcomes. Thus, current and previous problem gamblers had 2.36 times (95% confidence interval [CI] 1.44–3.87) and 1.66 times (95% CI 1.07–2.55) higher odds than non-problem gamblers of reporting fair or poor health, respectively. The data revealed no clear association between problem gambling and the use of analgesics. Conclusions: Both current and previous problem gambling were negatively associated with physical and mental-health problems. Health professionals should be alert to any signs of these complicating factors when planning the treatment of problem gamblers. [ABSTRACT FROM AUTHOR]

Aim: In this study, our aim was to assess the prevalence of sedentariness and overweight/obesity, two modifiable risk factors for non-communicable diseases (NCDs), and to investigate the geographic variability in their association with socio-economic status (SES) and family characteristics in Italian adults. Methods: The Multipurpose Survey on Health Conditions and the Recourse to Health Services (MSHC), 2012/2013 edition, conducted by the National Institute of Statistics was used as data source. The sample for this study included 99,479 interviewed people aged 18 and over, which are representative of about 50 million persons. For the scope of this analysis, data were considered as individuals nested within families within regions and analysed through multilevel models. Results: It was estimated that 39.8% of Italian adults are sedentary, 38.1% are partially active and 22.1% are physically active; 11.3% of Italian adults are obese and the 34.5% are overweight. There was evidence of inverse socio-economic gradient for both sedentariness and body mass index (BMI). There was higher risk of sedentariness for one-parent (odds ratio (OR) = 1.10; 95% confidence interval (CI) = (1.02; 1.20)) and other family types (OR = 1.34; 95% CI = (1.20; 1.48 )) compared with couples with children. Also, the relative variation of BMI was statistically significant for one-parent, one-person and other families (p < 0.05). An increasing north–south gradient was suggested for BMI, but not for sedentariness. Conclusions: Policy interventions could be addressed to reduce BMI levels in the southern area and to encourage physical activity in regions with high sedentariness. The Italian family is the key driver to promote virtuous healthy behaviours. [ABSTRACT FROM AUTHOR]

Aims: The main aim of the present study was to investigate the clustering of risk factors for cardiovascular diseases and metabolic syndrome in a large, healthy representative Norwegian child population. Methods: From a population of 2817, parents of 2297 children agreed to participate. Values of waist circumference (WC), total cholesterol (TC), high-density lipoprotein (HDL), systolic blood pressure (sysBP), haemoglobin-A1c (HbA1c) and Andersen aerobic fitness test were used to test clustering of cardiometabolic risk factors in this sample. Expected distributions of probability for zero to five risk factors are, respectively, 23.7%, 39.6%, 26.4%, 8.8%, 1.5% and 0.1%. A cardiometabolic risk score from zero to five for each individual was derived by adding the number of variables in the least desirable quartile (highest for WC, sysBP, TC and HbA1c; lowest for aerobic fitness and HDL). Results: A risk ratio of 5.8 (95% confidence interval 0.7–46.9) was found for five risk factors, though the small sample size rendered the results non-significant. An explorative analysis combining children with four and five risk factors did not reveal any significant clustering either. Conclusions: No clustering of risk factors was found among Norwegian children aged 6–12 years. [ABSTRACT FROM AUTHOR]

Aim: Relatively little is known about the effectiveness of return-to-work interventions for employees sick-listed with mental disorders, and the results of the literature are contradictory. This study evaluated the return-to-work effect of a multidisciplinary health assessment for persons sick-listed with mental disorders. Methods: The study population consisted of 244 persons who were allocated to the treatment and control groups based on their birth year. In addition to the usual case management, the treatment group (n = 83) was assessed by a team consisting of a case manager, a psychiatrist, and a job coach. The control group (n = 99) received the usual case management. We used unique register data to code outcome variables (sick-leave duration and return-to-work duration). Results: The multidisciplinary treatment had no statistically significant effect on the sick-leave duration (HR = 1.05; 95% CI 0.74-1.43) or the return-to-work duration (HR = 0.94; 95% CI 0.65-1.35). Subgroup analyses showed that the treatment effect did not systematically depend on age, education or severity of the mental disorder. We found no signs of systematic dropout from the study population or of imbalanced data. We found an insignificant tendency indicating that control-group case managers may have learned about the intervention from treatment case managers (p = 0.31). Conclusions: This study showed no return-to-work effect of a multidisciplinary assessment of sick-listed individuals with mental disorders. Together with the sparse and inconclusive findings of the literature, this finding suggests that further research is needed for disentangling the elements that constitute an effective intervention. [ABSTRACT FROM AUTHOR]

Aims: Most previous prospective studies have examined workplace social capital as a resource of the individual. However, literature suggests that social capital is a collective good. In the present study we examined whether a high level of workplace aggregated social capital (WASC) predicts a decreased risk of individual-level long-term sickness absence (ltSA) in Danish private sector employees. Methods: A sample of 2043 employees (aged 18-64 years, 38.5% women) from 260 Danish private-sector companies filled in a questionnaire on workplace social capital and covariates. WASC was calculated by assigning the company-averaged social capital score to all employees of each company. We derived ltSA, defined as sickness absence of more than three weeks, from a national register. We examined if WASC predicted employee ltSA using multilevel survival analyses, while excluding participants with ltSA in the three months preceding baseline. Results: We found no statistically significant association in any of the analyses. the hazard ratio for ltSA in the fully adjusted model was 0.93 (95% CI 0.77-1.13) per one standard deviation increase in WASC. When using WASC as a categorical exposure we found a statistically non-significant tendency towards a decreased risk of ltSA in employees with medium WASC (fully adjusted model: HR 0.78 (95% CI 0.48-1.27)). Post hoc analyses with workplace social capital as a resource of the individual showed similar results. Conclusions: WASC did not predict LTSA in this sample of Danish private-sector employees. [ABSTRACT FROM AUTHOR]

Aims: Are potentially traumatic events associated with subsequent disability pension? Traumatic exposure and post-traumatic stress disorder (PTSD) may represent a disabling state with both personal and professional consequences for the affected individual. Despite this, there is a scarcity of research studying the effects of traumatic exposure on disability pension. This study examined the differences in risk for disability pension among unexposed, exposed to trauma and PTSD cases. Methods: An ambidirectional Norwegian cohort study, consisting of 1238 individuals aged 18--66 years who were at risk of disability pension, were interviewed using the Composite International Diagnostic Interview, and linked with registry data on disability pension. Registry follow-up in the Norwegian Insurance Database lasted ten years following interview in 2000-- 01. The risk of disability pension after traumatic exposure, divided into accidental and premeditated, was assessed by Cox proportional hazards regression analysis. Results: In 10 years, 9.5% of the cohort had been granted disability pension. Overall exposure to traumatic events did not alter the risk of disability pension. However, among women, exposure to premeditated traumas did increase the risk (HR 2.96 (95% CI 1.54-5.68)), and was an independent risk factor. Fulfilling criteria for PTSD caseness further increased the risk (HR 4.69 (95% CI 1.78--12.40)). There was no increased risk found between traumatic exposure and disability pension for men. Conclusions: Exposure to trauma, particularly premeditated trauma, seems to be an independent risk factor for disability pension in women. [ABSTRACT FROM AUTHOR]

Aims: The aims of this study were to describe the perceived work ability of unemployed individuals and to explore the association between perceived good work ability and sociodemographic, work-related and well-being factors. Methods: The data were derived from the Finnish Regional Health and Well-being Study (ATH) collected by postal and Internet-based questionnaires in 2014-2015. The random sample was selected from the Finnish national Population Register. The present study includes data from unemployed or laid-off respondents (n=1975) aged 20-65 years. logistic regression was used in the statistical analysis. Perceived work ability was measured with the Work Ability Score. Results: Factors significantly associated with good work ability were having young children living in the household, short-term unemployment, low or moderate physical strain in most recent job, moderate mental strain in most recent job, satisfaction with most recent job, good self-rated health and good quality of life. Good self-rated health (odds ratio=10.53, 95% confidence interval 5.90- 18.80) was the most substantial factor in the multivariate model. Conclusions: The findings provide further evidence on the factors related to good work ability of the unemployed. These factors should be considered when designing interventions for promoting work ability and to minimise the harmful effects of long-term unemployment. [ABSTRACT FROM AUTHOR]