Scandinavian Journal of Public Health最新文献

{"title":"Excess mortality is not self-interpreting: Baseline choice as a governance issue in public health analytics.","authors":"Jörn Klein","doi":"10.1177/14034948261424605","DOIUrl":"10.1177/14034948261424605","url":null,"abstract":"<p><p>Interpretation of excess mortality depends critically on baseline choice. This commentary examines the recent debate on all-cause mortality in Norway in 2024 and argues that it reflects a conflation of two distinct purposes: real-time surveillance using updated baselines and assessment of whether mortality has returned to the pre-pandemic improvement trajectory. These correspond to different estimands and are not interchangeable. Baseline redefinition has predictable inferential and communicative consequences, particularly in public-facing outputs. I argue that the main risk lies not in modeling choices themselves, but in insufficiently explicit communication. Transparent reporting with clearly labeled baselines is essential to avoid interpretive drift.</p>","PeriodicalId":49568,"journal":{"name":"Scandinavian Journal of Public Health","volume":" ","pages":"429-431"},"PeriodicalIF":1.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13176472/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147327319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utilisation of primary healthcare services by patients with hypertension before, during and after the COVID-19 pandemic in Turku, Finland-are digital services creating disparity?","authors":"Jouni K Johansson, Päivi Korhonen","doi":"10.1177/14034948251392076","DOIUrl":"10.1177/14034948251392076","url":null,"abstract":"<p><strong>Aims: </strong>The objective of the study was to assess differences in the accessibility of general practitioner (GP office visits, telephone contacts and electronic communication for patients with hypertension before, during and after the COVID-19 pandemic in primary healthcare.</p><p><strong>Methods: </strong>From the primary healthcare register of the city of Turku in Southwestern Finland, subjects with the diagnosis of hypertension were identified. Data of GP office visits, telephone contacts, electronic communication, concomitant cardiometabolic diseases, low density lipoprotein and glomerular filtration rate were gathered from the hypertensive patients. The follow-up period was from 2019 to 2022.</p><p><strong>Results: </strong>The number of patients with hypertension decreased between the years 2019 and 2020 and again increased in 2021 to the 2019 level. Electronic communication increased steadily from 2019 to 2022, whereas telephone contacts decreased. A higher number of telephone contacts and higher number of electronic communication were associated with higher number of office visits. Elderly subjects used less electronic communication than younger subjects and the difference grew larger during and after the COVID-19 pandemic.</p><p><strong>Conclusions: </strong>\u0000 <b>Elderly subjects with hypertension use digital services in primary healthcare less than their younger counterparts. Digital technologies may create structural inequality in access to, and availability of, primary healthcare services.</b>\u0000 </p>","PeriodicalId":49568,"journal":{"name":"Scandinavian Journal of Public Health","volume":" ","pages":"340-347"},"PeriodicalIF":1.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13176469/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145507756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A systematic review to understand the long-term mental health effects of influenza pandemics.","authors":"Jessica L Dimka, Benjamin M Schneider, Svenn-Erik Mamelund","doi":"10.1177/14034948251391601","DOIUrl":"10.1177/14034948251391601","url":null,"abstract":"<p><strong>Aims: </strong>Health effects of pandemics extend beyond morbidity and mortality from the disease itself and may include long-term mental health consequences. However, previous studies only consider narrowly defined populations at risk or examine pandemics caused by varied pathogens that may have inconsistent effects. We examine existing literature on these long-term mental health effects following one type of pandemic (influenza).</p><p><strong>Methods: </strong>We conducted a systematic review of the long-term mental health effects of the 1889, 1918, 1957, 1968, and 2009 influenza pandemics. To our knowledge, this is the first review of studies of broad populations and multiple measures of mental health morbidity.</p><p><strong>Results: </strong>The literature search returned 8190 articles. After deduplication and title/abstract and full-text screening, 12 articles were reviewed. Seven articles focused on the 1918 pandemic and five on the 2009 pandemic. Study regions were USA or North America (<i>n</i>=5), Europe (<i>n</i>=3), and Asia (<i>n</i>=4). Long-term outcomes studied were suicide (<i>n</i>=4), admission to hospital or psychiatric facility (<i>n</i>=2), stress/anxiety/post-traumatic stress disorder (<i>n</i>=4) and schizophrenia and other/related conditions (<i>n</i>=2). The suggested mechanisms were infection (<i>n</i>=6), effects of non-pharmaceutical interventions (NPIs) (<i>n</i>=3), or other exposure pathways (<i>n</i>=3). Seven studies had a moderate risk of bias and five studies a high risk of bias.</p><p><strong>Conclusions: </strong>Mental health effects have been an outcome of pandemics. Researchers should consider a variety of possible mechanisms, and that infection and restrictive NPIs may contribute to mental health morbidity. This study highlights the need for better understanding of the broader health, social, and demographic impacts of pandemics.</p>","PeriodicalId":49568,"journal":{"name":"Scandinavian Journal of Public Health","volume":" ","pages":"409-417"},"PeriodicalIF":1.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13176476/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145649670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Framing vaccination as a collective responsibility increases intentions to vaccinate.","authors":"Sebastian B Bjørkheim, Tony Leino, Bjørn Sætrevik","doi":"10.1177/14034948261438058","DOIUrl":"10.1177/14034948261438058","url":null,"abstract":"<p><strong>Aims: </strong>The decision to vaccinate may be motivated by self-protection or community protection, and people may to varying degrees feel a personal responsibility or a collective obligation to vaccinate. In two preregistered survey experiments during the COVID-19 pandemic, we examined how a benefit framing (personal <i>vs</i>. collective) and a responsibility framing (personal <i>vs</i>. collective) influence vaccine intention.</p><p><strong>Methods: </strong>We used a 2×2 survey experiment design to manipulate vaccine promotion framing systematically. The experiments were conducted on large, overlapping representative samples of Norwegian adults. Separate survey experiments were performed before (<i>N</i>=5474) and after (<i>N</i>=1789) the COVID-19 vaccine rollout in Norway.</p><p><strong>Results: </strong>Both experiments showed that framing vaccination choice as a collective (<i>vs</i>. personal) responsibility increased vaccine intention. In the first experiment there was no effect of benefit framing, while in the second experiment emphasising personal (<i>vs</i>. collective) benefit increased vaccine intentions. There was no interaction between the factors in either experiment. We also observed a considerable increase in vaccine intention between the first and second experiment.</p><p><strong>Conclusions: </strong>\u0000 <b>These findings indicate that highlighting collective responsibility may boost vaccine uptake, whereas it is more difficult to conclude about emphasising personal versus collective benefits. Message framing may be worth considering when designing health communication strategies during infectious disease outbreaks.</b>\u0000 </p>","PeriodicalId":49568,"journal":{"name":"Scandinavian Journal of Public Health","volume":" ","pages":"377-387"},"PeriodicalIF":1.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13176484/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147724405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A debatable representation of all-cause mortality in Norway in 2024.","authors":"Ann K Skrindo Knudsen, Ingeborg Forthun, Christian Madsen, Marianne Strøm, Liv C Vestrheim Thomsen, Jesper Dahl, Preben Aavitsland, Dagfinn Mørkrid Thøgersen, Hanne Løvdal Gulseth","doi":"10.1177/14034948251393442","DOIUrl":"10.1177/14034948251393442","url":null,"abstract":"","PeriodicalId":49568,"journal":{"name":"Scandinavian Journal of Public Health","volume":" ","pages":"425-426"},"PeriodicalIF":1.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13176471/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145913604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID-19 vaccination coverage and the effect on regional disparities in morbidity and mortality among older people in Sweden, 2021-2023.","authors":"Anton Nilsson, Dominik Dietler, Carl Bonander, Malin Inghammar, Jonas Björk","doi":"10.1177/14034948261420643","DOIUrl":"10.1177/14034948261420643","url":null,"abstract":"<p><strong>Aims: </strong>The COVID-19 pandemic had substantial impacts on mortality and morbidity, even after the rollout of vaccinations. These impacts however, varied considerably across regions. We examined regional disparities in COVID-19 mortality and hospitalizations among older people in Sweden from January 2021 to August 2023 and assessed the role of vaccination coverage in shaping these disparities.</p><p><strong>Methods: </strong>Using full-population data on people in Sweden born in 1955 or earlier, we created a nested case-control study. Conditional logistic regressions with county fixed effects were estimated across three periods of vaccination rollout (Doses 1-2, 3-4, and 5-6). County fixed effects were compared across models with and without vaccination adjustment. Further, the benefits of vaccination coverage corresponding to the most successful regions were evaluated with potential impact fractions (PIFs).</p><p><strong>Results: </strong>Across counties, the final shares of vaccinated individuals ranged from 94% to 98% for Doses 1 and 2, 90% to 96% for Dose 3, 80% to 91% for Dose 4, 65% to 83% for Dose 5, and 13% to 47% for Dose 6. In models without vaccination adjustments, COVID-19 mortality ranged from -56% to +75% relative to an average county, and hospitalizations from -45% to +51%. Vaccination adjustment had little impact on the disparities. Overall PIFs were 8% to 11% for mortality and 7% to 8% for hospitalizations, with greater PIFs in urban counties.</p><p><strong>Conclusions: </strong>\u0000 <b>While higher vaccination coverage, especially in urban areas, could have prevented COVID-19 deaths and hospitalizations among older adults in Sweden, the vaccinations were not a major driver of regional disparities in these outcomes.</b>\u0000 </p>","PeriodicalId":49568,"journal":{"name":"Scandinavian Journal of Public Health","volume":" ","pages":"388-396"},"PeriodicalIF":1.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13176473/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147277430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Older people's health literacy on COVID-related health behaviours during the pandemic - Results from the SWEOLD 2021 study in Sweden.","authors":"Naima Kayser Leeoza, Josefin Wångdahl, Carin Lennartsson, Janne Agerholm","doi":"10.1177/14034948251357704","DOIUrl":"10.1177/14034948251357704","url":null,"abstract":"<p><strong>Background: </strong>Health literacy refers to an individual's ability to access, understand, and use information to promote and maintain good health. The importance of a health-literate population has been highlighted during COVID-19 when health authorities pleaded with the public to be responsible and adhere to rules and recommendations. This study investigates the relationship between health literacy levels and older people's understanding of and adherence to COVID-19 recommendations.</p><p><strong>Methods: </strong>The data for this study were obtained from the 2021 Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD), which exclusively includes individuals aged ⩾77 years. Health literacy was assessed utilising the Communicative and Critical Health Literacy (C&CHL) scale. Using logistic regression, we evaluated the association between C&CHL and vaccination coverage, as well as the comprehension of and adherence to health recommendations and the avoidance of healthcare services due to apprehension related to COVID-19.</p><p><strong>Results: </strong>The findings showed that 90% of the study population understood the COVID-19 guidelines, and 63% adhered to them to a large extent. Further, 98% got vaccinated. Although limited C&CHL was statistically associated with a lower ability to understand information (odds ratio: 2.20), it was not related to following recommendations, being vaccinated, or refraining from health or dental care.</p><p><strong>Conclusions: </strong>\u0000 <b>Regardless of individual health literacy level, most older people understood and followed COVID-19 recommendations, and nearly everyone was vaccinated. The findings indicate that the information about Swedish COVID-19 recommendations and vaccination information was tailored to meet the needs of different health literacy levels.</b>\u0000 </p>","PeriodicalId":49568,"journal":{"name":"Scandinavian Journal of Public Health","volume":" ","pages":"323-330"},"PeriodicalIF":1.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13176477/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144651057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How deaths of despair shape life expectancy across sexes and regions in Sweden.","authors":"Ali Kiadaliri, Alexis E Cullen, Oleguer Plana-Ripoll, Mohammad Hajizadeh","doi":"10.1177/14034948261450785","DOIUrl":"https://doi.org/10.1177/14034948261450785","url":null,"abstract":"<p><strong>Aim: </strong>The sim of this study was to quantify contributions of mortality from drugs, alcohol and suicide (termed as 'deaths of despair' (DoD)) to changes in life expectancy at birth across sexes and regions in Sweden.</p><p><strong>Methods: </strong>We obtained annual data on underlying causes of deaths by age, sex and region from the National Cause of Death Register. We constructed abridged life tables for two periods: 2001-2005 and 2020-2024. A continuous-change model was used to quantify the age- and cause-specific contributions of DoD to the changes in life expectancy at birth between these periods.</p><p><strong>Results: </strong>Between two periods, life expectancy at birth increased by 2.5/3.5 years for females/males. All three DoD combined had negligible but opposite contributions to the changes in life expectancy at birth among females (-0.017 years) and males (+0.101 years). In both sexes, drugs- (alcohol)-related deaths contributed to decrease (increase) in life expectancy at birth. In both sexes, deaths from suicide in the age group 10-19 years (negative contributions), drugs in the age group 30-39 years (negative contributions) and alcohol in the age groups 40-59 years (positive contributions) and 70-89 years (negative contributions) had a greater absolute contribution to the changes in life expectancy at birth than the other two DoD causes. Across regions, the changes in life expectancy at birth attributable to DoD ranged from -0.219 to +0.159 years among females and from -0.235 to +0.267 years among males.</p><p><strong>Conclusions: </strong>\u0000 <b>There were large variations in the contributions of DoD to the change in life expectancy at birth by age, sex, cause and region in Sweden, highlighting the need for targeted national and regional interventions, especially for drug-related deaths.</b>\u0000 </p>","PeriodicalId":49568,"journal":{"name":"Scandinavian Journal of Public Health","volume":" ","pages":"14034948261450785"},"PeriodicalIF":2.1,"publicationDate":"2026-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148057749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Private and public primary healthcare provider listing according to self-reported illness burden after the free choice reform: a cross-sectional study in southern Sweden.","authors":"Christine Johansson, Mirnabi Pirouzifard, Martin Lindström","doi":"10.1177/14034948261444138","DOIUrl":"https://doi.org/10.1177/14034948261444138","url":null,"abstract":"<p><strong>Aims: </strong>To investigate differences between respondents' self-reported registration with public and private primary healthcare (PHC) providers according to self-reported illness burden in the early phase of the free choice reform.</p><p><strong>Methods: </strong>The Public Health Survey undertaken in Scania, southernmost Sweden, in 2012 was a population-based study of a stratified random sample of 18-80-year olds that elicited a 51.7% participation rate. The survey included data on PHC provider type, age, sex, marital status, socioeconomic status, country of birth, and self-reported illness burden measured as poor psychological health (via the 12-item General Health Questionnaire; GHQ12), poor self-rated health, and self-reported chronic illness. Poor psychological health (GHQ12), poor self-rated health, and self-reported chronic illness were analyzed together in logistic regression models with public versus private PHC provider as the dichotomous outcome.</p><p><strong>Results: </strong>In 2012, 55.2% reported being listed with a public PHC provider, 26.1% a private PHC provider, and 18.6% did not know what type their provider was. In the final multi-adjusted logistic regression model, the odds ratios of reporting private PHC provider were 1.01 (0.91-1.13) among respondents with poor psychological health, 0.98 (0.89-1.07) among respondents with poor self-rated health, and a non-significant 1.09 (1.00-1.20) among respondents with self-reported chronic illness.</p><p><strong>Conclusions: </strong>\u0000 <b>After adjusting for relevant confounders, no statistically significant differences were found between private and public PHC providers, according to self-reported illness burden in Scania in 2012.</b>\u0000 </p>","PeriodicalId":49568,"journal":{"name":"Scandinavian Journal of Public Health","volume":" ","pages":"14034948261444138"},"PeriodicalIF":2.1,"publicationDate":"2026-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147984133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations between physical activity and sleep quality across BMI categories: a cross-sectional population-based study.","authors":"Astrid Jensen Damgaard, Louise Nørskov Nielsen, Emma Bendix Larsen, Martin Mejlby Jensen, Pernille Pedersen, Jes Bak Sørensen","doi":"10.1177/14034948261447342","DOIUrl":"https://doi.org/10.1177/14034948261447342","url":null,"abstract":"<p><strong>Aims: </strong>This study aimed to investigate the association between physical inactivity and poor sleep quality across body mass index (BMI) categories, addressing the global rise in poor sleep quality and physical inactivity.</p><p><strong>Methods: </strong>We conducted a cross-sectional study using self-reported data from the 'How are you? 2021' survey conducted in the Central Denmark Region (<i>n</i>=30,402). Logistic regression adjusted for sociodemographic factors and other covariates were employed to explore the association between physical inactivity and poor sleep quality, stratified by BMI categories.</p><p><strong>Results: </strong>Physical inactivity was associated with poor sleep quality (odds ratio (OR) 1.80; 95% confidence interval (CI) 1.62-1.99) across all BMI categories in the crude analysis. In the adjusted analysis, individuals who were physically inactive also had higher odds of poor sleep quality: OR 1.24 (95% CI 1.10; 1.39). In the stratified analyses, the OR was 1.20 (95% CI 0.98; 1.46) among individuals with a BMI less than 25 kg/m², 1.27 (95% CI 1.04; 1.55) among those with a BMI of 25-29.9 kg/m², and 1.16 (95% CI 0.94; 1.42) among those with a BMI of 30 kg/m² or greater.</p><p><strong>Conclusions: </strong>This study found an association between physical inactivity and poor sleep quality using self-reported data. While stratified analyses of the association between physical inactivity and poor sleep quality revealed lower associations among individuals with a BMI less than 25 kg/m² and over 30 kg/m², the overall pattern of the association remained. This study contributes to the understanding of the complex interplay between physical inactivity, sleep quality, and BMI. It underscores the need for public health initiatives that simultaneously address physical inactivity and sleep quality to enhance overall health outcomes.</p>","PeriodicalId":49568,"journal":{"name":"Scandinavian Journal of Public Health","volume":" ","pages":"14034948261447342"},"PeriodicalIF":2.1,"publicationDate":"2026-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147984105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}