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Abstract: Objective: The objective of this study was to assess expectations of effect when using statins in a treatment population. Further the aim was to examine factors, including history and concurrent risk of coronary heart disease, associated with a higher and lower treatment belief. Methods: Eight hundred and twenty-nine (829) Swedish patients using statins completed postal questionnaires about their health, life style, cardiovascular risk factors and expectation of the treatment. Expected treatment benefit was used as outcome measurement. Results: A medical history of coronary heart disease did not affect treatment expectations. Patients with a high risk of cardiovascular disease reported a slightly lower expectation of the treatment effect at a 10-year perspective (p <0.01) but not at shorter time perspectives. Low satisfaction with the explanation of the purpose of the treatment and a poor perceived control of own health was associated with a more negative view on treatment benefit. Conclusion: The rationale applied by physicians prescribing statins does not seem to relate to the patients’ expectations, whereas factors relating to the patient–physician relationship, the social situation and the perceived control of health seem to affect patient belief. Practice implications: The association between patients’ poor satisfaction of treatment explanation and a low belief in treatment benefits emphasizes the importance of the patient–physician communication. It is suggested that clinical tools are developed in order to identify patients with poor belief in treatment benefit since tailored education for this group might reduce the risk of non-compliance and subsequently reduce the risk of coronary heart disease. [Copyright &y& Elsevier]

Abstract: Background and Objective: Statistics on causes of death are important for epidemio-logic research. Studies that evaluate the source data often give conflicting results, which raise questions about comparability and validity of methods. Methods: For 44 recent evaluation studies we examined the methods employed and assessed the reproducibility. Results: Thirty studies stated who reviewed the source data. Six studies reported reliability tests. Twelve studies included all causes of death, but none specified criteria for identifying the underlying cause when several, etiologically independent conditions were present. We assessed these as not reproducible. Of 32 studies that focussed on a specific condition, 21 provided diagnostic criteria such that the verification of the focal diagnosis is reproducible. Of 16 that discussed the difference between dying “with” and “from” a condition, eight described how competing causes had been handled. For these eight, the selection of a principal cause is reproducible, but in three the selection strategy conflicts with the international instructions issued by the World Health Organization. Conclusion: Methods and criteria are often insufficiently described. When described, they sometimes disagree with the international standard. Explicit descriptions of methods and criteria would contribute to methodologic improvement and would allow readers to assess the generalizability of the conclusions [Copyright &y& Elsevier]

Abstract: Objective: This study attempts to identify a structure among patient-related factors that could predict treatment adherence in statin patients, especially with regards to the necessity-concern framework. Methods: 414 Swedish patients using statins completed a questionnaire about their health, treatment, locus of control, perception of necessity-concern and adherence. The data were handled using a structural equation modeling approach. Results: Patients that reported high perceptions of necessity to treatment seemed to adhere well, and side effects appear to affect adherence negatively. Disease burden, cardiovascular disease experience and high locus of control seem to have mediating effects on adherence. Conclusion: This study provides support for the hypothesis that health- and treatment-related factors, as well as locus of control factors, are indirectly associated with treatment adherence via their association with mediating factor necessity. Practice implications: This study highlights the importance of considering patients’ beliefs about medications, disease burden, experience of cardiovascular events and locus of control as these factors are associated with adherence behavior to statin treatment. This study also emphasizes more generally the importance of an approach targeting necessity and concern when communicating with and treating patients with lipid-lowering medication. [Copyright &y& Elsevier]

Abstract: Objective: Mortality statistics are important for epidemiological research. We examine if discrepancies between death certificate (DC) and hospital discharge condition (HDC) indicate certification errors. Study Design and Setting: From 39,872 hospital deaths in Sweden in 1995, we randomly selected 600 “cases,” where DC and HDC were incompatible, and 600 compatible “controls,” matched on sex, age, and underlying cause of death. We obtained case summaries for 1,094 (91%) of these. Using a structured protocol, we assessed the accuracy of DCs. Results: Regression analysis indicated diagnostic group and “case” or “control” as the variables that most affected the accuracy. Malignant neoplasm “controls” had the highest accuracy (92%), and benign and unspecified tumor “cases,” the lowest (20%). For all diagnostic groups except one, compatible “controls” had better accuracy than incompatible “cases.” The exception, chronic obstructive lung disease, had low accuracy for both “cases” (54%) and “controls” (52%). Conclusion: Incompatibility between DC and HDC indicates a greater risk of certification errors. For some diagnostic groups, however, DCs are often inaccurate even when DC and HDC are compatible. By requesting additional information on incompatible cases and all deaths in high-risk diagnostic groups, producers of mortality statistics could improve the accuracy of the statistics. [Copyright &y& Elsevier]

One year after emergency contraceptive pills (ECP) had become prescription-free, we sent a questionnaire to 800 randomly selected women in mid-Sweden. The aim was to investigate women''s knowledge, attitudes and practices regarding the method. The response rate was 71% (n = 564). The majority of the women, 65%, would prefer to purchase ECP over-the-counter (OTC) in a pharmacy. Attitudes toward the method were predominantly positive, but one fourth (24%) had worries about side effects and one third (33%) considered ECP to be a kind of abortion. Logistic regression showed that correct knowledge of and positive attitudes toward ECP contributed to estimated future use of ECP. Although women favored the OTC option, persistent misunderstanding about ECP implies that routine information from gynecologists and health professionals as well as media campaigns is needed along with the deregulation in order to make ECP an accepted and properly used contraceptive method. [Copyright &y& Elsevier]

Companies need to ensure a functioning occupational health and safety management (OHSM) system to protect human health and safety during work, but generally there are differences in how successful they are in this endeavor. Earlier research has indicated that factors like company size, safety culture, and different measures of financial performance may be related to the quality of OHSM practices in companies. Therefore, the aim of this study was to investigate whether these factors are associated with OHSM practices in companies. A postal questionnaire was used to collect data from a sample of Swedish manufacturing companies, and complementary data regarding the companies were retrieved from a credit bureau database. The statistical analysis was performed with ordinal regression analysis using generalized estimating equations. Different predictor variables were modeled with OHSM practices as the outcome variable, in order to calculate p -values and to estimate odds ratios. Company size, safety culture, and creditworthiness were found to be associated with better, as well as worse, OHSM practices in companies (depending on directionality). Practical implications for industry and future research are discussed. [ABSTRACT FROM AUTHOR]

Workers in the steel-manufacturing industry face many safety risks due to the nature of the job. How well safety procedures and regulations are followed within an organization is considered to be influenced by the reigning culture of the organization. The aim of this study was to investigate and describe safety culture and risk-taking at a large steel-manufacturing company in Sweden by exploring workers’ experiences and perceptions of safety and risks. Ten focus group interviews were conducted with a total of 66 workers. In the interviews, the situation of safety at work was discussed in a semi-structured manner. The material was analyzed inductively using qualitative content analysis. The analysis resulted in a thorough description of safety culture and risk-taking at the company, based on the following five main categories: 1. Acceptance of risks , one simply has to accept the safety risks of the work environment, 2. Individual responsibility for safety , the responsibility for safe procedures rests to the largest extent on the individual, 3. Trade-off between productivity and safety , these are conflicting entities, wanting to produce as well as wanting to work safely, 4. Importance of communication , it is needed for safety actions to be effective, and 5. State-of-the-day and external conditions , an interplay between these factors affect risk-taking. In sociotechnical systems theory it is acknowledged that there are interactions between social and technical factors in organizations. The findings of this study are interpreted to be in line with a sociotechnical understanding of safety culture and risk-taking. [ABSTRACT FROM AUTHOR]