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This paper presents a model for measuring the outcome of Worksite Health Promotion Programs through an application of Structural Equation Modeling with ordinal data. We model the function "being healthy" as a vector comprised of three latent or unobservable variables: Health Status, Lifestyle and Stress. Each variable can be measured only indirectly through a set of manifest or observable ordinal indicators. The objective is to derive and analyze the distributions, and changes in distributions over time, of the latent variables on an individual level. The model is analyzed empirically on data from three large Swedish manufacturing firms.

This paper examines how the unemployment rate is related to adolescent alcohol use and experience of binge drinking during a time period characterized by big societal changes. The paper uses repeated cross-sectional adolescent survey data from a Swedish region, collected in 1988, 1991, 1995, 1998, 2002 and 2005, and merges this with data on local unemployment rates for the same time periods. Individual level frequency of alcohol use as well as experience of binge drinking is connected to local level unemployment rate to estimate the relationship using multilevel modeling. The model includes municipality effects controlling for time-invariant differences between municipalities as well as year fixed effects controlling for municipality-invariant changes over time in alcohol use. The results show that the unemployment rate is negatively associated with adolescents' alcohol use and the experience of binge drinking. When the unemployment rate increases, more adolescents do not drink at all. Regular drinking (twice per month or more) is, on the other hand, unrelated to the unemployment rate. Examining gender-differences in the relationship, it is shown that the results are driven by behavior in girls, whereas drinking among boys does not show any significant relationship with changes in the unemployment rate.

This paper develops a welfare theoretic foundation for cost-effectiveness analysis (CEA) when survival is not affected. With this foundation, all costs and their corresponding utility-terms should be included. A key question, though, is whether these utility-terms are consistent with quality-adjusted life year (QALY) (utility) theory or not. The results show that health care costs and changes in the utility of health should be included. However, as QALYs do not capture the utility of changes in consumption (as this utility must be independent of health, according to QALY theory), the corresponding changes in consumption costs should be excluded. Regarding the costs for changes in absence from work, these should only be included if the utility of changes in the amount of leisure is included. As no QALY theory has been developed that includes this utility, it is unclear how to handle these costs (even if there are arguments for excluding them). For changes in productivity at work, though, there are robust arguments for the inclusion of these costs. Overall, it seems difficult to provide a clear basis for CEA in economic welfare theory when also including non-medical goods such as consumption and leisure.

Terrestrial organic carbon is exported to freshwater systems where it serves as substrate for bacterial growth. Temporal variations in the terrigenous organic carbon support for aquatic bacteria are not well understood. In this paper, we demonstrate how the combined influence of landscape characteristics and hydrology can shape such variations. Using a 13-day bioassay approach, the production and respiration of bacteria were measured in water samples from six small Swedish streams (64 degrees N, 19 degrees E), draining coniferous forests, peat mires, and mixed catchments with typical boreal proportions between forest and mire coverage. Forest drainage supported higher bacterial production and higher bacterial growth efficiency than drainage from mires. The areal export of organic carbon was several times higher from mire than from forest at low runoff, while there was no difference at high flow. As a consequence, mixed streams (catchments including both mire and forest) were dominated by mire organic carbon with low support of bacterial production at low discharge situations but dominated by forest carbon supporting higher bacterial production at high flow. The stimulation of bacterial growth during high-flow episodes was a result of higher relative export of organic carbon via forest drainage rather than increased drainage of specific "high-quality" carbon pools in mire or forest soils.

This paper is an introduction to the study "The Burden of Rheumatoid Arthritis and Patient Access to Treatment". The objective of the study is to compare patient access to new drugs in Europe, North America and a selection of other countries, and to analyse the determinants of differences between countries, as basis for a discussion on how patients' access to new and effective treatments can be improved. There were few treatments available that could affect the progression of the disease prior to the introduction of the first TNF inhibitors in the late 1990s. Since the cost per patient treated with these biological drugs is high compared to previously available treatments, reimbursement through private and public insurance is an important determinant for access to treatment.

In this paper, we analyze exits from long-term sickness spells in Sweden. Using data for more than 2,500 people, the aim is to analyze the transition to different states: return to work, full disability pension, partial disability pension, and other exits from the labor force. Given the complexity of the exit decision, which encompasses both the individual's choice, the medical evaluation and the decision of the insurance adjudicator, we consider the outcome as being the result of two aspects of the exit process: one that governs the duration of a spell prior to the decision to exit, and another that governs the type of exit. Therefore, the analysis is done in two steps: first, we analyze the duration of the sickness spells, and then we analyze the process that governs the type of exit. The results indicate that both individual characteristics and push factors, such as regional unemployment, are important for both components of the decision process.

Today there is growing awareness among spine surgeons of the advantages in using registers to facilitate the analyses and reporting of treatment outcome. The Swedish Spine register is among the first to be used on a national scale and annual reports are published in international journals. In this paper we discuss our experiences and lessons learned from a paper-based version in 1993, to an online web-based solution in 2005. We emphasise the advantages of registers being owned by the national spine society, a support function available during working hours, online feedback to participating departments and professional assistance in designing a register program for web use. Hopefully, our experiences will be of help to colleagues who are planning to start registering.