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Biomedical subjects

F Diderichsen

Publications and source records attributed to F Diderichsen.

67 records · Page 4Linked to original sources
PubMed1992

Effects of economic change on male morbidity in neighbouring industrial and rural municipalities in northern Sweden.

STUDY OBJECTIVE: The aim was to investigate the health effects of economic changes in a rural and industrial community. DESIGN: This was a historical cohort study with retrospective information on exposure and information on health outcome from a mailed questionnaire (response rate 82.5%). SETTING: An industrial and a rural community in northern Sweden. PARTICIPANTS: Participants included all men born in a rural community and a random sample of men born in a neighbouring industrial community 1915-1924 and alive in 1984 (N = 1989). MAIN RESULTS: Morbidity was higher in the cohort born in the rural municipality in which more profound changes in the socioeconomic structure had occurred. Even when taking such factors as childhood deprivation, migration, socioeconomic status, early retirement, unemployment, and single living into consideration, most of the differences in morbidity in the two municipalities still remained. However, the changes in employment conditions alone do not appear to explain the differences in morbidity that were found. CONCLUSION: The higher morbidity in the rural community indicates a health effect of the profound economic changes in that community but this difference cannot be explained by crude indicators of exposure to migration, unemployment, and other indicators of economic change.

Aged↗
PubMed1992

[Swedish public health report 1991. Increasing social consequences of illness?].

According to the Swedish Public Health Report of 1991, health has improved in the 45-64-year-old age group of the gainfully employed population during the 1980s. Cardiopulmonary and gastrointestinal diseases have become less common, whereas certain types of cancer, allergy, and locomotor pain are on the increase. The prevalence of locomotor pain among young working women has doubled. The number of those on early pensions is increasing, which may be due to increasing demands in the working environment as well as to organisational re-structuring. The report points out that the chronically ill and those on disability pensions are finding it harder to compete in the housing market. A medical class distinction is made: those with long-term mental illness have a much worse standard of living than those with somatic diseases.

Adolescent↗
PubMed1990

Health and social inequities in Sweden.

Sweden is one of Europe's most egalitarian countries. The social inequities in living conditions have been gradually reduced to a level that is more equal than in most countries in Europe. Even if general health development has been positive during recent years, data reviewed here indicate that there may be adverse effects for some groups which may increase inequities. This article presents results on inequities in health from the Public Health Report of Sweden 1987 and discusses causal mechanisms and implications for health policy.

Adolescent↗
PubMed1990

Clinical symptoms of sleep apnea syndrome and automobile accidents.

Patients with clinical features of sleep apnea syndrome (SAS) and self-reported sleep spells at the wheel do poorly in simulated monotonous driving. To evaluate whether drivers with defined symptoms of SAS (heavy snoring, sleep disturbances and daytime sleepiness) compensate in real traffic by careful driving or not, the rate of car accidents over a 5-year period was investigated. A questionnaire was addressed to 140 patients with and 142 controls without symptoms associated to SAS. Seventy-three of the patients had a complete triad of SAS-associated symptoms. Fifty-two percent of these patients reported habitual sleep spells at the wheel, as opposed to less than one percent by the controls. The ratio of drivers being involved in one or more combined-car accident was similar for patients and control drivers, but for single-car accidents the ratio was about 7 times higher for patients with a complete triad of symptoms of SAS compared to controls (p less than 0.001). When corrected for mileage driven, the total number of single-car accidents was almost 12 times higher among patients with sleep spells whilst driving, compared to controls (p less than 0.001). It is concluded that drivers with the clinical features of SAS are at increased risk especially for single-car accidents and that the risk seems to vary with the severity of symptoms.

Accidents, Traffic↗
PubMed1989

Changes in alcohol-related inpatient care in Stockholm County in relation to socioeconomic status during a period of decline in alcohol consumption.

Alcohol sales in Stockholm County decreased by 18 per cent from 1976 to 1981. The socioeconomic status of inpatients treated for alcohol psychosis, alcoholism, alcohol intoxication, liver cirrhosis, and pancreatitis was studied by linking data from the National Housing and Population Censuses in 1975 and 1980 with the inpatient care registers for 1976 and 1981. In both years, all rates were highest for people outside the labor market and lowest among white collar employees. The employment rate for those aged 25-44 years and treated in 1981 for alcohol psychosis, alcoholism, and alcohol intoxication--already low in 1975--had drifted further downward by 1980. Total rates of inpatient treatment for alcohol-related diagnoses generally declined but the gap between blue collar workers and white collar workers widened. We conclude that the goal for national alcohol policy, suggested by the WHO--a reduction of per capita consumption--should be combined with additional measures that will reach all social groups.

Adolescent↗
PubMed1989

Better health--but not for all: the Swedish Public Health Report, 1987.

This article is a summary of the Public Health Report submitted to the Swedish Parliament in 1987. Health development, especially that of underprivileged groups, is regarded as an indicator of the quality of social and economic development of the country. Sweden is a very egalitarian country, but in spite of decreasing inequalities in living standards, the Report shows increasing inequalities in health. At the same time, the state has put restraints on health care spending, and the shift in the health care budget toward more primary care has stopped. This development seriously impairs the ability of the health and medical services to cope with inequities described in this Report.

Adolescent↗
PubMed1988

Participation of primary health care personnel in the Stockholm Health of the Population Study--a preliminary report.

The 1984/85 Stockholm Health of the Population Study (HPS) was a cross sectional study including a questionnaire and a health examination. It was conducted through the ordinary health personnel of four Primary Health Care (PHC) districts in the Stockholm County. The main objective was to broaden the scope for planning health care. One of the goals of the study was to involve those working in PHC in planning their activities after local needs and to use more time for prevention work. The main effort to reach this objective was through involvement of the PHC personal from the early planning phase. This strategy was very time consuming but, on the other hand experiences from the HPS have led to both new screening activities of e.g high consumers of alcohol and the elderly, and preventive work aimed at those with smoking and overweight problems in the local PHC area. In the implementation process and through education the scientific approach level and interest in primary health care increased. A keen interest of survey data for local planning is obvious.

Attitude of Health Personnel↗
PubMed1986

Strategies for equity in health: report from Sweden.

In recent years the Swedish debate on health policy has been focusing on resource allocation between primary care versus secondary care, private care versus public care, and prevention versus care. The National Commission on the "Swedish Health Services in the 1990s" brought attention to the prevailing inequalities in health. The Health Policy Bill of 1985 defines the reduction of inequalities in health as a major target of national health policy. The health policy measures discussed are mainly outside the health care sector.

Adolescent↗
PubMed1982

Ideologies in the Swedish health sector today: the crisis of the social democracy.

Sweden has a long tradition of social democracy and corporate cooperation. Social problems are treated as technological questions that always should be solved through rational and neutral means. Today Sweden faces a crisis of economy as well as a crisis of medicine. In the spirit of consensus, the state has proposed a new health reform emphasizing the responsibility of the public health service to prevent disease and provide equal access to care. It is claimed that improved health planning, based on epidemiological knowledge on inequalities, can solve the crisis in medicine within an improved system of primary care and prevention. However, in the context of the current economic crisis, the struggle against health hazards and cuts in public spending has intensified and the gap between the ideology of technological rationalism and reality has widened.

Adult↗
PubMedDate not supplied

Market reforms in health care and sustainability of the welfare state: lessons from Sweden.

Reforming health care systems which are predominantly publicly provided and financed has usually been motivated as a way of increasing efficiency even if it seldom is explicit whether it is in the official sense related to individual utility or in the unofficial sense related to health outcomes. In the case of Sweden the welfare state has been made politically sustainable through a construction where cash benefits and service provision are tailored to satisfy not only the basic needs but even the more discriminating needs of the middle classes. Their loyalty with the taxes is politically crucial and therefore their evaluation of the services in the welfarist sense equally important. That loyalty was however threatened in a situation where cost-containment policies were applied while equity principles were still a strong priority. Health care utilization was increasing among the very old and chronically ill while it was decreasing for other groups. The reforms introduced in some counties during the 1990s have been focussing on a purchaser-provider split and fee-for-service payment of providers. They have increased productivity sharply, increased utilization even among the groups that previously were 'pressed out' and reduced waiting lists. Increased efficiency however, threatens equity in some specific aspects. Fee-for-service payment means increased production and so far even increased costs. If they are to be met with increased private financing, rather than with present tax financing, it will bring the risk of inequities. Payment of hospitals through DRG systems means payment to providers for medical interventions with no incentives to deal with social consequences of illness. Inequities in health care can be related to the way health care deals with inequalities in health due to inequalities in living conditions or inequalities in living conditions due to ill health. In the short perspective the reforms may threaten equity in the second aspect, in the longer perspective the problems of cost control and the pressure it raises for alternative financial sources may be a more serious risk even for the former.

Efficiency, Organizational↗
PubMedDate not supplied

Do episodes of anger trigger myocardial infarction? A case-crossover analysis in the Stockholm Heart Epidemiology Program (SHEEP).

OBJECTIVE: Our objectives were to study anger as a trigger of acute myocardial infarction (MI) and to explore potential effect modification by usual behavioral patterns related to hostility. METHODS: This study was a case-crossover study within the Stockholm Heart Epidemiology Program. Exposure in the period immediately preceding MI was compared with exposure during a control period for each case. From April 1993 to December 1994, 699 patients admitted to coronary care units in Stockholm County were interviewed. RESULTS: During a period of 1 hour after an episode of anger, with an intensity of at least "very angry," the relative risk of MI was 9.0 (95% CI, 4.4-18.2). In patients with premonitory symptoms, the time of disease initiation may be misclassified. When restricting the analyses to those without such symptoms, the trigger risk was 15.7 (95% CI, 7.6-32.4). The possibility of examining effect modification was limited by a lack of statistical power (eight exposed cases). Results of the analyses suggested, however, an increased trigger effect among subjects reporting nonhostile usual behavior patterns, nonovert strategies of coping with aggressive situations (not protesting when being treated unfairly), and nonuse of beta-blockers. CONCLUSIONS: The hypothesis that anger may trigger MI is further supported, with an increased risk lasting for approximately 1 hour after an outburst of anger. It is suggested that the trigger risk may be modified by personal behavior patterns.

Adult↗