Scandinavian journal of social medicine最新文献

{"title":"Long-term economic effects of team-based clinical case management of patients with chronic minor disease and long-term absence from working life.","authors":"T Timpka,&nbsp;M Leijon,&nbsp;G Karlsson,&nbsp;L Svensson,&nbsp;P Bjurulf","doi":"10.1177/140349489702500402","DOIUrl":"https://doi.org/10.1177/140349489702500402","url":null,"abstract":"<p><strong>Objectives: </strong>To examine the socio-economic effects of team-based clinical case management of patients with chronic minor disease bound for early retirement.</p><p><strong>Design: </strong>Marginal analysis of programme costs and benefits to society compared with no-programme baseline of costs occurring in society due to productivity loss. Prospective patient data collection on admission, discharge, and at one year and five years after discharge to determine programme effectiveness.</p><p><strong>Setting: </strong>Out-patient clinic at the department of social medicine in tertiary care hospital.</p><p><strong>Subjects: </strong>239 patients with minor disease and long-term vocational absence consecutively admitted to the study. At the one-year evaluation, 17 patients had been readmitted to the team, 7 could not be found, 6 declined the interview and 2 were deceased. At the five-year evaluation of 49 patients who were active after one year, one was deceased and 10 were unable to be found.</p><p><strong>Main outcome measures: </strong>Vocational activity. Programme costs. Benefits to society measured by decrease in indirect costs.</p><p><strong>Results: </strong>The one-year vocational rehabilitation rate from the program was 20.5% and the five-year rehabilitation rate was 11.3%. The total discounted cost for case management of the 239 patients was 7.3 MSEK (600,000 Pounds). The decrease in the indirect costs to society from the 28 patients found active after five years was 35.1 MSEK (2,500,000 Pounds). The net present value of the programme at the 1991 price level was 27.5 MSEK (2,365,000 Pounds).</p><p><strong>Conclusions: </strong>Tertiary care level team-based clinical case management for vocational rehabilitation of patients with chronic minor disease has a positive cost-benefit ratio. A cross-boundary awareness at a health policy level is needed of the societal costs involved for this group of patients who fall between the traditional services in health care and social work.</p>","PeriodicalId":76525,"journal":{"name":"Scandinavian journal of social medicine","volume":"25 4","pages":"229-37"},"PeriodicalIF":0.0,"publicationDate":"1997-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/140349489702500402","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20386244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypertension and years of driving in transit vehicle operators.","authors":"D R Ragland,&nbsp;B A Greiner,&nbsp;B L Holman,&nbsp;J M Fisher","doi":"10.1177/140349489702500410","DOIUrl":"https://doi.org/10.1177/140349489702500410","url":null,"abstract":"<p><p>In this study, data from transit vehicle operators of the San Francisco Municipal Railway (Muni), and a control group of individuals newly hired but not yet working as operators, were used to investigate prevalence of hypertension as a function of exposure to bus driving (years of driving), controlling for alcohol consumption and body mass index. Data were collected from transit vehicle operators in the course of their regular biennial examination during the period November 1983 to October 1985. Groups working as operators fewer than 10 years (n = 1137), from 10 to 20 years (n = 493), and more than 20 years (n = 196) were compared to each other and to a group of individuals with no prior exposure, but who were given a medical examination just before beginning their jobs as transit vehicle operators (n = 226). For hypertension (defined as systolic blood pressure > or = 140, or diastolic blood pressure > or = 90, or taking hypertension medication), the prevalence, adjusted for age, race, and gender, increased in a stepwise fashion from 28.8 percent in the group with no exposure to 38.9 percent in the group of drivers with more than 20 years on the job. A similar pattern was found for moderate to severe hypertension (systolic blood pressure > or = 160, or diastolic blood pressure > or = 95, or hypertension medication). These patterns were diminished, but not eliminated, when body mass index and alcohol consumption were considered. Higher rates of separation from employment for hypertensive operators suggested that the effect of years of employment may be underestimated by this cross-sectional comparison. Prolonged exposure to operating a transit vehicle may be associated with increased hypertension; increased alcohol consumption and body mass index with increased years of driving may account for at least some of the increased hypertension.</p>","PeriodicalId":76525,"journal":{"name":"Scandinavian journal of social medicine","volume":"25 4","pages":"271-9"},"PeriodicalIF":0.0,"publicationDate":"1997-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/140349489702500410","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20387516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health examinations and health services for asylum seekers in Sweden.","authors":"A Hjern,&nbsp;P Allebeck","doi":"10.1177/140349489702500310","DOIUrl":"https://doi.org/10.1177/140349489702500310","url":null,"abstract":"With an influx of several hundred thousand refugees during the last two decades, care for asylum seekers and refugees has become an important part of health and medical care in Sweden. The Swedish government spent 377 million Swedish crowns (SEK) on medical expenses for asylum seekers and refugees in 1990–91, 427 million SEK in 1991–92 and 804 million in 1992–93 (1 US$ is approximately 6 SEK). The annual cost per asylum seeker was 11,387 SEK in 1992, to be compared with the average cost of health and medical care for Swedish residents in the age 0–49 years which was around 8,000 SEK at that time (1). Despite the large amounts of money and the large number of patients involved in the medical reception programme for refugees in Sweden in recent years, there has been little research about the quality and adequacy of this programme. The Swedish reception programme for asylum seekers is centered around state-run refugee camps in different parts of the country. To be able to describe the structure and content of the health care service offered to asylum seekers, a semi-structured questionnaire was sent to all health units in refugee camps in Sweden in May 1995. Health units in 30 of the 33 refugee camps in Sweden responded to the questions about the health care service offered to asylum seekers (2).","PeriodicalId":76525,"journal":{"name":"Scandinavian journal of social medicine","volume":"25 3","pages":"207-9"},"PeriodicalIF":0.0,"publicationDate":"1997-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/140349489702500310","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20291373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"War victims in need of physical rehabilitation in Croatia.","authors":"N Henigsberg,&nbsp;B Lagerkvist,&nbsp;Z Matek,&nbsp;I Kostovic","doi":"10.1177/140349489702500309","DOIUrl":"https://doi.org/10.1177/140349489702500309","url":null,"abstract":"<p><p>A Rehabilitation Information System was created in July 1993 in order to register war victims in need of physical rehabilitation all over Croatia. The system is currently operating and presented data covers the period from July 1991 to July 1995. Approximately 15,000 questionnaires had been completed and returned from medical institutions on in total 8589 disabled war victims in need of rehabilitation. People with severe disabilities comprised about 20% of all in need of rehabilitation. Those reported injured were 3.5 times more than those in need of physical rehabilitation. Most common types of injuries were fractures with a permanent disabling condition (3109 persons), peripheral nerve injuries (1213 persons) and amputations (956 persons). Traumatic brain injuries were registered for 594 and spinal cord injuries for 262 persons. Causes of injuries were explosive devices (such as mines, mortar shell shrapnel, etc.) in 37% of cases, bullets in 22%, accidents in 7%, other (such as fire, blast injuries, etc.) and unknown causes in 34%.</p>","PeriodicalId":76525,"journal":{"name":"Scandinavian journal of social medicine","volume":"25 3","pages":"202-6"},"PeriodicalIF":0.0,"publicationDate":"1997-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/140349489702500309","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20291372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Why is prevention so difficult and slow?","authors":"E Allander,&nbsp;B I Lindahl","doi":"10.1177/140349489702500301","DOIUrl":"https://doi.org/10.1177/140349489702500301","url":null,"abstract":"<p><p>The abundance of perceived 'possibilities' for prevention contrasts sharply with the difficulties that face preventive programmes. We argue that this situation has emerged from an incomplete understanding of the process of prevention, involving a mixture of biological factors, human decision making and time perspectives. Based on examples, an analysis of the factors in the prevention process is presented.</p>","PeriodicalId":76525,"journal":{"name":"Scandinavian journal of social medicine","volume":"25 3","pages":"145-8"},"PeriodicalIF":0.0,"publicationDate":"1997-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/140349489702500301","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20290275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lifestyle as regards physical exercise, smoking and drinking, of adult insulin-treated diabetic people compared with non-diabetic controls.","authors":"C Gåfvels,&nbsp;F Lithner","doi":"10.1177/140349489702500304","DOIUrl":"https://doi.org/10.1177/140349489702500304","url":null,"abstract":"<p><p>Chronic complications in diabetes are sometimes associated with living habits. To investigate whether diabetic people's habits of smoking, drinking alcohol and taking physical exercise differed from those of the general population, a questionnaire was sent to 561 insulin-treated diabetic people and to 1,125 controls, matched for age, sex and domicile. Diabetic people were current smokers as often as controls (21% vs 23%; ns), but they drank less alcohol and more of them were non-drinkers (22% vs 13%; p < 0.001). Diabetic people more often took physical exercise than did controls (40% vs 28%; p < 0.001). Diabetic women were more seldom smokers (18% vs 26%; p < 0.05), more often non-drinkers (26% vs 14%; p < 0.001) and exercised regularly more (44% vs 28%; p < 0.001) than female controls. Diabetic men were more similar to male controls in their habits. Young diabetic people drank less alcohol and were more often non-drinkers (22% vs 9%; p < 0.001) compared with their controls. Comparison within the diabetic group showed that men drank alcohol more frequently and in greater amounts, and that more women were non-drinkers (26% vs 18%; p < 0.05). People with chronic complications drank less frequently and exercised less regularly (34% vs 44%; p < 0.05) than those without complications. These findings suggest that diabetic people's smoking, drinking and exercise habits are rather similar to general people's. However, diabetic women seem to take risk factors for developing complications into consideration more than men, which could reflect a true gender pattern and/or be an effect of worrying more about diabetes.</p>","PeriodicalId":76525,"journal":{"name":"Scandinavian journal of social medicine","volume":"25 3","pages":"168-75"},"PeriodicalIF":0.0,"publicationDate":"1997-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/140349489702500304","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20290278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence of long-term sick-listing in an urban area of Sweden and its relationship with demographic data of the population.","authors":"M Lurie,&nbsp;M Gustafsson,&nbsp;M Lindh,&nbsp;H Sanne","doi":"10.1177/140349489702500306","DOIUrl":"https://doi.org/10.1177/140349489702500306","url":null,"abstract":"<p><p>By checking the card indexes of seven out of twelve Social Insurance Offices covering 66% of the total wage-earning population in the city of Göteborg the patients recorded for 90 days of continuous sick-listing were classified into four diagnostic categories according to the doctor's certificate: \"non-specific pain\" and \"specific pain\" of the musculoskeletal system, \"other pain\" and \"non-pain\" diagnoses. The overall yearly incidence of 90 days' sick-listing averaged 5.4%. A significant correlation was found between the incidence of 90 days' sick-listing due to \"non-pain\" and musculoskeletal pain diagnoses and the proportion of demographic characteristics of the areas. The hypothesis of presuming the highest association between non-specific pain diagnoses and demographic factors was rejected.</p>","PeriodicalId":76525,"journal":{"name":"Scandinavian journal of social medicine","volume":"25 3","pages":"180-4"},"PeriodicalIF":0.0,"publicationDate":"1997-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/140349489702500306","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20291369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sick-leave among women and the role of psychiatric disorder.","authors":"G Hensing,&nbsp;F Spak,&nbsp;K Alexanderson,&nbsp;P Allebeck","doi":"10.1177/140349489702500307","DOIUrl":"https://doi.org/10.1177/140349489702500307","url":null,"abstract":"<p><p>The aim was to assess sick-leave among women in relation to psychiatric disorder. A stratified population-based sample of women in Gothenburg were interviewed and diagnoses were made according to DSM-III-R. Sick-leave data was obtained for a ten year period. Women with psychiatric disorder had higher rates of sick-leave, compared to women without such disorders, in analyses taking into account age, socio-economic status, physical health, marital status and motherhood. Presence of psychiatric and physical illness were both independently associated with higher sick-leave. Highest sick-leave was found among those with a combination of psychiatric and physical morbidity. Psychiatric disorder is an important factor in sick-leave among women, especially regarding length of absence.</p>","PeriodicalId":76525,"journal":{"name":"Scandinavian journal of social medicine","volume":"25 3","pages":"185-92"},"PeriodicalIF":0.0,"publicationDate":"1997-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/140349489702500307","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20291370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations of health-related behaviors, school type and health status to physical activity patterns in 16 year old boys and girls.","authors":"M Aarnio,&nbsp;U M Kujala,&nbsp;J Kaprio","doi":"10.1177/140349489702500303","DOIUrl":"https://doi.org/10.1177/140349489702500303","url":null,"abstract":"<p><p>Sedentary behavior often begins in childhood and is associated with the development of risk factors for many chronic diseases in adulthood. Physical activity is considered important in the prevention of unfavorable changes in the risk factors. We investigated whether health-related behaviors, school type and health status are associated to physical activity among adolescents. A questionnaire was sent to all Finnish 16-year-old twins in 1991-93. A total of 3,254 twins responded. The response rate was 88%. Physical activity was classified into five categories (very active, active, moderately active, hardly active, inactive) based on self-reported frequency and intensity of physical activity. The analysis considered all subjects as individuals. Smoking was strongly associated with physical activity among girls and boys. Those who smoked regularly were less active. The type of school was also associated with physical activity. In general, those who attended comprehensive school or high school were physically more active, while those in vocational schools, particularly boys, were less active. Girls in lower physical activity groups reported more psychosomatic symptoms. Associations of self-reported health-related behaviors, school type and health status to physical activity seem to be the same among boys and girls. However, as the more active students are in comprehensive school or high school and the less active in vocational school, and physical inactivity is related to smoking and use of alcohol, health education should be tailored by school type.</p>","PeriodicalId":76525,"journal":{"name":"Scandinavian journal of social medicine","volume":"25 3","pages":"156-67"},"PeriodicalIF":0.0,"publicationDate":"1997-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/140349489702500303","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20290277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Work load, job control and risk of leaving work by sickness certification before delivery, Norway 1989.","authors":"K Strand,&nbsp;E Wergeland,&nbsp;T Bjerkedal","doi":"10.1177/140349489702500308","DOIUrl":"https://doi.org/10.1177/140349489702500308","url":null,"abstract":"<p><p>Sickness absence in pregnancy has been shown to be associated with strenuous working conditions and parity. So far, few studies have made adjustments for possible interaction and confounding. Such adjustments are needed to more precisely identify targets for preventive measures. We have, therefore, in a representative population of pregnant employees in Norway 1989, computed adjusted odds ratios for leaving work by sickness absence more than three (LSC > 3) and eight (LSC > 8) weeks before delivery according to working conditions identified as risk factors in earlier studies; adjusted for job control, domestic conditions and sickness absence the year prior to pregnancy. The cumulative percentage of LSC > 8 and LSC > 3 was 26.4 and 51.1. Ergonomically strenuous postures and heavy lifting increased the risk of both outcomes. In addition, shift work and hectic work pace increased the risk of LSC > 3. Influence on breaks reduced risk. Only para experienced reduced risk of LSC when working part-time. Sicklisting the year prior to pregnancy had no confounding effect, which suggest that pregnancy represents a new incompatibility with work. Preventive measures should address work postures and heavy lifting, as well as conditions influencing the woman's control with her time.</p>","PeriodicalId":76525,"journal":{"name":"Scandinavian journal of social medicine","volume":"25 3","pages":"193-201"},"PeriodicalIF":0.0,"publicationDate":"1997-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/140349489702500308","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20291371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}