Objective: We aimed to investigate the association between life-course exposure to snus and prevalence of the metabolic syndrome and its components in adulthood.

Design and method: Tobacco habits at baseline (age 16) and three follow-ups (ages 21, 30 and 43) were assessed among 880 participants in a population-based cohort in Northern Sweden. Presence of the metabolic syndrome at age 43 was ascertained using the International Diabetes Federation criteria. Odds ratios and CIs for risk of the metabolic syndrome and its components by snus use at 16, 21, 30 and 43 years were calculated using logistic regression. Cumulative snus use was defined as number of life periods (1-4) with current snus use.

Results: At age 43, 164 participants (18.6%) were current snus users. We found no association between exclusive snus use at the ages of 16, 21, 30 and 43 years and the metabolic syndrome at age 43 years. Snus use (among non-smokers) was associated with raised triglycerides and high blood pressure in crude analysis, but not in multivariable models. There was no association between cumulative snus use and risk of the metabolic syndrome. Cumulative snus use was associated with central obesity, raised triglycerides and impaired fasting glucose/diabetes mellitus type 2 in crude analyses, but not after adjustments.

Conclusions: The health consequences of snus exposure from adolescence to mid-adulthood do not seem to include increased risk of the metabolic syndrome or its components. The cardio-metabolic risk of dual exposure to snus and cigarettes may warrant further attention.

Objective: We aimed to investigate the association between life-course exposure to snus and prevalence of the metabolic syndrome and its components in adulthood.

Design and method: Tobacco habits at baseline (age 16) and three follow-ups (ages 21, 30 and 43) were assessed among 880 participants in a population-based cohort in Northern Sweden. Presence of the metabolic syndrome at age 43 was ascertained using the International Diabetes Federation criteria. Odds ratios and CIs for risk of the metabolic syndrome and its components by snus use at 16, 21, 30 and 43 years were calculated using logistic regression. Cumulative snus use was defined as number of life periods (1-4) with current snus use.

Results: At age 43, 164 participants (18.6%) were current snus users. We found no association between exclusive snus use at the ages of 16, 21, 30 and 43 years and the metabolic syndrome at age 43 years. Snus use (among non-smokers) was associated with raised triglycerides and high blood pressure in crude analysis, but not in multivariable models. There was no association between cumulative snus use and risk of the metabolic syndrome. Cumulative snus use was associated with central obesity, raised triglycerides and impaired fasting glucose/diabetes mellitus type 2 in crude analyses, but not after adjustments.

Conclusion: The health consequences of snus exposure from adolescence to mid-adulthood do not seem to include increased risk of the metabolic syndrome or its components. The cardio-metabolic risk of dual exposure to snus and cigarettes may warrant further attention.

Aims: In response to the 2009 outbreak of A/H1N1 influenza, Swedish authorities decided on a programme for universal vaccination. Over 60% of the population received at least one dose of vaccine. This study examines demographic factors and perceptions related to the decision whether or not to become vaccinated. Methods: A combined web/postal survey was conducted (n = 1587, response rate 53%) in late spring 2010. Questions reported here concerned perceptions, precautionary behaviours and vaccination decision. Results: Main reasons for becoming vaccinated were concerns about spreading the disease to relatives or in the community and confidence in the good effect of vaccination. Vaccination rates were higher among women, those with young children or belonging to a risk group. Main reasons for abstaining were belief that the flu was not a serious threat, low risk of spreading the disease, concern about side-effects and perceived uncertainties in information. Three profiles representing different patterns of thought and beliefs were identified by cluster analysis, respectively labelled as a vulnerable, a trusting and a sceptical group. Vaccination rates and precautionary behaviours were demonstrated to differ between these groups. Conclusions: Perceptions relating to the 2009 pandemic are likely to influence uptake of vaccination in the future. Authorities need to be aware of different patterns of beliefs and attitudes among the public, and that these may vary in different phases. Communication of risk needs to be dynamic and prepared to engage with the public before, during and even for some time after the acute risk period.

Aims: A study was undertaken to assess the incidence of parasuicide in Nicaragua, to identify groups at risk, and to describe the characteristics of parasuicides, such as methods used and seasonal and diurnal patterns. Method: All hospital-admitted parasuicide cases in the area of León, Nicaragua, were assessed over a three-year period using standardized instruments. Results: Two hundred and thirty-three parasuicide cases were identified in the catchment area giving a parasuicide rate of 66.3/100,000 inhabitants per year based on the population 10 years and older. Corresponding figure for 15 years and older was 71.3. A majority were females (68.8%), who were significantly younger than the males (mean 20.8 years vs. mean 24.6 years). The highest rates were found in the age group 15 - 19 years with a female rate three times higher than the male rate (302.9 vs. 98.9). Pesticides, a highly lethal substance, were used as method in 19.1% of the attempts. Consistent seasonal variation with peaks in May - June and September - October were found over the years. Among parasuicide cases, 46.5% had been in contact with the healthcare system within 6 months before attempting suicide. Conclusions: Parasuicides represent a significant health problem among young people in Nicaragua. Preventive efforts should be directed especially towards the life situation for young girls, limitation of availability of suicide means, increased awareness in schools concerning suicidal problems, as well as improved management of patients with mental health problems within primary healthcare.

Background: Many parents seek help from health professionals because of their infants' persistent crying in the early months. The aetiology of this condition, often labelled ``infantile colic'', is still unclear. Aims: To assess whether smoking during pregnancy, and/or smoking at infant age 5 weeks, is associated with infantile colic, and to describe how feeding at infant age 5 weeks and smoking are related to colic. Methods: This was a community-based study, with telephone interviews in late pregnancy, and at infant age 5 weeks, covering 1,625 mother—infant dyads, i.e. 86% of the eligible population. Results: Daily maternal smoking in pregnancy was related to subsequent colic, with an age-adjusted odds ratio (OR) of 1.74 (95% confidence interval 1.08—2.82). In the multivariate model, the OR was largely unaltered. The association between smoking at infant age 5 weeks and colic did not reach statistical significance. The subgroups based on smoking and infant feeding were small, but the results suggest that exclusive breast-feeding was protective against colic, including for infants of smoking mothers. Conclusions: This study presents yet another argument why smoking in pregnancy should be discouraged — some cases of infantile colic may be avoided. With regard to mothers who are not able to give up smoking, the results add some support for the conclusion that if a mother is worried about colic, she certainly should not refrain from breast-feeding even if she smokes. 

Background: Certain migration contexts that may help clarify immigrants’ health needs are understudied, including the order in which married individuals migrate. Research shows that men, who are healthier than women across most populations, often migrate to a host country before women. Using Danish register data, we investigate descriptive patterns in the order that married men and women arrive in Denmark, as well as whether migration order is related to overnight hospitalizations. Methods: The study base includes married immigrants who lived in Denmark between January 1, 1980 and December 31, 2014 (N = 13,680). We use event history models to examine the influence of spousal migration order on hospitalizations. Results: The order that married individuals arrive in Denmark is indeed highly gendered, with men tending to arrive first, and varies by country of origin. Risk of hospitalization after age 50 does not depend on whether an individual migrated before, after, or at the same time as their spouse among either men or women. However, among those aged 18+, men migrating before their wives are more likely to experience hospitalizations within the first 5 years of arrival. Conclusions: These findings provide the first key insights about gendered migration patterns in Denmark. Although spousal order of migration is not related to overnight hospitalization among women, our findings provide preliminary evidence that men age 18+ who are first to arrive experience more hospitalization events in the following 5 years. Future research should explore additional outcomes and whether other gendered migration contexts are related to immigrants’ health.

Background: Schools are expected to be an environment where children can reach their fullest potential and develop their talents, personality, as well as their mental and physical abilities. Children with disabilities often have restricted participation and lower achievement in school. The aim is to investigate if there are any differences in participation and achievement in school between adolescents, with and without self-reported neuropsychiatric disabilities, and to explore the relations between achievement and participation. 

Methods: A cross-sectional study was carried out based on data collected from 1520 adolescents in the sixth and seventh grade, from the south of Sweden. Multiple logistic regression was conducted to explore the relationship between having a neuropsychiatric disability, with participation and achievement, and how different factors affected this relationship. 

Results: Having a self-reported neuropsychiatric disability increases the likelihood of having restricted participation (adjusted odds ratio (AOR): 2.89; 95% confidence interval (CI): 1.99–4.23) and lower achievement in school (AOR: 2.94; 95% CI: 2.06–4.24). These adolescents were also more likely to have negative relationships to their teachers, be bullied, have poorer connectedness to their parents, come from families with less money, be trying drugs and be male, in comparison to the adolescents without a neuropsychiatric disability. The odds of having lower achievement increased with lower engagement and absenteeism from class. 

Conclusions: Adolescents with self-reported neuropsychiatric disabilities have a disadvantaged situation in school, and are exposed to factors that could have long-term negative effects. More longitudinal research is required to conclude what factors are causing restricted participation and low achievement.

Aim: To analyse how health risk behaviours (HRB) are clustered and associated with parental background and family wealth among Swedish boys and girls.

Methods: Data were collected from Health Behaviour in School-aged Children (HBSC),a global cross-sectional survey for 1997/98, 2001/02, and 2005/06. A total of 11,972 boys and girls in grades 5, 7, and 9 participated in the study. The pupils were categorised in subgroups according to parental background: Swedish (80.0%), mixed (10.6%), and foreign (9.4%). Cluster analyses were used to identify HRB profiles. Multinomial logistic regression analysis was used to estimate associations between cluster allocation, parental background, and family affluence.

Results: In total 11,232 pupils were identified and allocated to five cluster profiles, half of them in the cluster profile of low-risk behaviour. The most disadvantaged cluster was multiple HRB, which was characterised by high prevalence of smoking, drunkenness, low physical activity, and high soft-drink consumption. The cluster profile of multiple HRB was associated with both mixed background and foreign background in girls and with mixed background in boys.. The cluster profile of inadequate tooth brushing was associated with foreign background in both boys and girls. The cluster profiles of multiple HRB and inadequate tooth brushing were associated with low family affluence in girls.

Conclusions: The cluster profiles of multiple HRB and inadequate tooth brushing were associated with parental foreign extraction in boys and girls and with low family affluence in girls. Prevention programmes based on identified clusters of HRB, including consideration of impact of socio-demographic indicators, are needed.

AIM: The aim of this study was to investigate to what extent individual-based extended information given to mothers from city parts of low education can improve precautions taken by them to prevent burn and scald injuries involving young children in the home and further to compare the results with a group of mothers who had not received extended information. METHODS: This intervention study, with a comparison group, has a quasi-experimental design. Individual-based information, with an empowerment approach, was given to a group of mothers living in two separate areas of a city in southern Sweden with a low level of education. In total, 99 mothers of children under the age of 7 months participated. The mothers were selected through the local child healthcare authorities. Observations were made and bivariate analyses were established. RESULTS: The results showed that the intervention had a significant impact on improving the precautions the participating mothers introduced to protect their children against burn and scald injuries in the home and further, in relation to a comparison group. CONCLUSIONS: Through empowerment, workshops, and home visits aimed to increase their consciousness and knowledge, the participating mothers' precautions taken against child injuries in the home improved. It is of great importance that a framework for considering the problem of burn and scald injuries to children is presented from a preventive perspective which, in combination with evidence-based interventions, may enable the creation of injury prevention programmes for implementation by the community health care.

Aims: The aim of this study was to investigate the association between physical activity and mortality in post-menopausal women. In addition, the authors wanted to investigate to what extent this association could be attributed to confounding from other lifestyle factors, and to reverse causation due to a number of common health problems that may inhibit the ability to exercise. Methods: A total of 27,734 women aged 51-83 years from the Swedish Mammography Cohort were investigated. In 1997 they responded to a detailed questionnaire including questions on physical activity, diet, alcohol intake, smoking, and medical problems. During follow-up in 1999-2004, 1,232 deaths were identified by linkage to the National Population Register. Results: Women with low physical activity (<= 35 MET*h/day) had a 3.22 times increased mortality (95% confidence interval (CI)=2.35-4.43) compared with the most active women (> 50 MET*h/day). No increased risk was seen in women with moderate compared with high physical activity. Sedentary women tended to have a less healthy lifestyle and more health problems at baseline, e. g. almost 30% of them reported high blood pressure compared with less than 20% of active women. Baseline medical problems and lifestyle factors such as smoking, diet, and education accounted for 30% of the excess risk seen in sedentary women (24% and 6% respectively). Conclusions: This study indicates that even fairly small amounts of activity will reduce mortality in older women. However, sedentary women seemed to be a selected group with more medical problems and a less healthy lifestyle. The findings indicate that the association between physical inactivity and mortality will be overestimated if this is not taken into account.

Aims: In Sweden, suicides by drug poisoning have decreased in the population at large during the past two decades. However, drug poisoning suicides increased among the elderly during this period. Suicides by benzodiazepine poisoning increased in this age group despite a reduction in prescription sales of these drugs. This study aims therefore to determine the role of benzodiazepines in suicide late in life. Methods: Information concerning all definite suicides and deaths due to "undetermined" causes recorded among Swedish citizens aged 65 and above during 1992-96 was obtained from the Cause-of-Death Register. Death certificates were scrutinized to determine the type of drug employed in drug-related suicides. Results of the post mortem screening for drugs and alcohol were then examined. Results: A benzodiazepine was implicated in 216/548 (39%) of the drug poisoning suicides recorded among the elderly. Death certificates revealed that a benzodiazepine was the sole agent in 72% of these cases. Flunitrazepam or nitrazepam were implicated in 90% of the single benzodiazepine suicides. In addition to the suicides classified as drug poisonings, 82 cases were found in which a drug may have contributed to the cause of death. Benzodiazepines predominated. The terminal cause of death was drowning, often in the victim's own bathtub, in three-quarters of these cases. The annual fatality ratios for the newer benzodiazepine-like hypnotics zopiclone and zolpidem appear to be on the rise. Conclusion: Benzodiazepines, especially the hypnotics flunitrazepam and nitrazepam, are common in drug poisoning suicides in the elderly and should be prescribed with caution for this age group.

Aims: To describe trends in socioeconomic disparities in utilization of dental care. Methods: We obtained cross-sectional data from Sweden in the period 1968-2000 and from Brazil in 1986 and 2002 for 16 state capitals. The outcome was the percentage of people who reported that they had visited the dentist in the last 12 months, calculated for a higher and a lower income group and stratified by sex, age (two groups: young and adults) and dental status. Adjusted prevalence differences and prevalence ratios were produced using Poisson regression. Results: In Brazil, there was a decline in use of dental care among the 15-19 year olds in the period 1986-2002, but not among the 35-44 year olds. In Sweden, there was a decline among the young and adults between 1991 and 2000. Overall, socioeconomic disparities in use of dental services between the higher and the lower economic groups showed a decline in both countries. The reduction in disparities among young Brazilians was 1.1 percentage points per year (p < 0.01), but among the other age groups the decline was not significant (p>0.01). In the last surveys, the gap remained in both countries and age groups (p < 0.01). Conclusions: The recent decline in utilization of dental care and in the socioeconomic gap may mirror improvements in oral health. However, there are still relevant and persistent disparities in utilization of dental care in both countries, with a higher proportion of people of higher socioeconomic status visiting the dentist.

Aim: The aim of this study was to investigate whether women's adult overweight and obesity risk was associated with their childhood family structure, measured as their mothers' marital status history, during the women's first 18 years of life. Methods: Using linked register data, we analyzed 30,584 primiparous women born in Sweden in 1975 who were between 19-35 years of age when their height and pre-pregnancy weight was recorded. The outcomes were women's overweight/ obesity (body mass index (BMI) >= 25 kg/m(2)) and obesity (BMI >= 30 kg/m(2)) and the predictor was mothers' marital status history, which was summarized using sequence analysis. We carried out nested logistic regression models adjusting for women's age and maternal sociodemographic characteristics. Results: Mothers' marital status history was summarized into six clusters: stable marriage, stable cohabitation, married then divorcing, cohabiting then separating, varied transitions, and not with father. In fully adjusted models and compared with women whose mothers belonged to the stable marriage cluster: (1) women whose mothers belonged to the other marital status clusters had higher odds of overweight/obesity (odds ratio (OR) ranging 1.15-1.19; p < 0.05); and (2) women whose mothers belonged to the stable cohabitation (OR = 1.31; 95% confidence interval (CI) = 1.14-1.52), cohabiting then separating (OR = 1.23; 95% CI = 1.01-1.49), varied transitions (OR = 1.24; 95% CI = 1.11-1.39), and not with father (OR = 1.24; 95% CI = 1.00-1.54) clusters had higher odds of obesity. Conclusions: Women whose mothers were not in stable marriage relationships had higher odds of being overweight or obese in adulthood. The finding that even women raised in the context of stable cohabitation had higher odds of being overweight or obese is intriguing as these relationships are socially accepted in Sweden.

AIM: The aim of this study was to investigate whether women's adult overweight and obesity risk was associated with their childhood family structure, measured as their mothers' marital status history, during the women's first 18 years of life.

METHODS: Using linked register data, we analyzed 30,584 primiparous women born in Sweden in 1975 who were between 19-35 years of age when their height and pre-pregnancy weight was recorded. The outcomes were women's overweight/obesity (body mass index (BMI) ≥ 25 kg/m(2)) and obesity (BMI ≥ 30 kg/m(2)) and the predictor was mothers' marital status history, which was summarized using sequence analysis. We carried out nested logistic regression models adjusting for women's age and maternal sociodemographic characteristics.

RESULTS: Mothers' marital status history was summarized into six clusters: stable marriage, stable cohabitation, married then divorcing, cohabiting then separating, varied transitions, and not with father. In fully adjusted models and compared with women whose mothers belonged to the stable marriage cluster: (1) women whose mothers belonged to the other marital status clusters had higher odds of overweight/obesity (odds ratio (OR) ranging 1.15-1.19; p < 0.05); and (2) women whose mothers belonged to the stable cohabitation (OR = 1.31; 95% confidence interval (CI) = 1.14-1.52), cohabiting then separating (OR = 1.23; 95% CI = 1.01-1.49), varied transitions (OR = 1.24; 95% CI = 1.11-1.39), and not with father (OR = 1.24; 95% CI = 1.00-1.54) clusters had higher odds of obesity.

CONCLUSIONS: Women whose mothers were not in stable marriage relationships had higher odds of being overweight or obese in adulthood. The finding that even women raised in the context of stable cohabitation had higher odds of being overweight or obese is intriguing as these relationships are socially accepted in Sweden.

Aims: To investigate regional differences and time trends in women’s overweight and obesity in Sweden. Methods: Using datafrom the Swedish Medical Birth Register (women aged ⩾18 years, first pregnancy only) and the Total Population Registeraccessed through the Umeå SIMSAM Lab, age-standardized prevalence of pre-pregnancy overweight/obesity (BMI ⩾ 25 kg/m2) and obesity (BMI ⩾ 30 kg/m2) were estimated by county for the years 1992, 2000, and 2010. Maps were created usingArcMap v10.2.2 to display regional variations over time and logistic regression analyses were used to assess if the observedtrends were significant. Results: The prevalence of pre-pregnancy overweight/obesity and obesity increased significantly inall Swedish counties between 1992, and 2010. In 2010, Södermanland and Gotland exhibited the highest age-standardizedoverweight/obesity (39.7%) and obesity (15.1%) prevalence, respectively. The sharpest increases between 1992 and 2010were observed in Västerbotten for overweight/obesity (75% increase) and in Gotland for obesity (233% increase). Across theyears, Stockholm had the lowest prevalence of overweight/obesity (26.3% in 2010) and obesity (7.3% in 2010) and one ofthe least steep increases in prevalence of both between 1992 and 2010. Conclusions: Substantial regional differencesin pre-pregnancy overweight and obesity prevalence are apparent in Sweden. Further research should elucidatethe mechanisms causing these differences.

Aims: To investigate regional differences and time trends in women's overweight and obesity in Sweden. Methods: Using data from the Swedish Medical Birth Register (women aged 18 years, first pregnancy only) and the Total Population Register accessed through the Umea SIMSAM Lab, age-standardized prevalence of pre-pregnancy overweight/obesity (BMI 25 kg/m(2)) and obesity (BMI 30 kg/m(2)) were estimated by county for the years 1992, 2000, and 2010. Maps were created using ArcMap v10.2.2 to display regional variations over time and logistic regression analyses were used to assess if the observed trends were significant. Results: The prevalence of pre-pregnancy overweight/obesity and obesity increased significantly in all Swedish counties between 1992, and 2010. In 2010, Sodermanland and Gotland exhibited the highest age-standardized overweight/obesity (39.7%) and obesity (15.1%) prevalence, respectively. The sharpest increases between 1992 and 2010 were observed in Vasterbotten for overweight/obesity (75% increase) and in Gotland for obesity (233% increase). Across the years, Stockholm had the lowest prevalence of overweight/obesity (26.3% in 2010) and obesity (7.3% in 2010) and one of the least steep increases in prevalence of both between 1992 and 2010. Conclusions: Substantial regional differences in pre-pregnancy overweight and obesity prevalence are apparent in Sweden. Further research should elucidate the mechanisms causing these differences.

AIM: To examine the hypothesis that circular labour migrants who become seriously ill while living away from home return to their rural homes to convalesce and possibly to die. METHODS: Drawing on longitudinal data collected by the Agincourt health and demographic surveillance system in rural northeastern South Africa between 1995 and 2004, discrete time event history analysis is used to estimate the likelihood of dying for residents, short-term returning migrants, and long-term returning migrants controlling for sex, age, and historical period. RESULTS: The annual odds of dying for short-term returning migrants are generally 1.1 to 1.9 times (depending on period, sex, and age) higher than those of residents and long-term returning migrants, and these differences are generally highly statistically significant. Further supporting the hypothesis is the fact that the proportion of HIV/TB deaths among short-term returning migrants increases dramatically as time progresses, and short-term returning migrants account for an increasing proportion of all HIV/TB deaths. CONCLUSIONS: This evidence strongly suggests that increasing numbers of circular labour migrants of prime working age are becoming ill in the urban areas where they work and coming home to be cared for and eventually to die in the rural areas where their families live. This shifts the burden of caring for them in their terminal illness to their families and the rural healthcare system with significant consequences for the distribution and allocation of health care resources.

TB control has suffered from budget reductions in South Africa. It is critically important to develop cost-effective strategies to reduce the TB burden. Costs to public budgets can be substantially reduced while maintaining or improving case detection and treatment outcomes, by using farm-based LHWs.

AIMS: To use school nurses' knowledge and experience for a better understanding of schoolchildren's health problems and their association to socioeconomic background and gender.

METHODS: Mail questionnaires were sent to a nationally representative, random sample of Swedish school nurses (n=129). The questionnaire included structured and open-ended questions asking for school nurses' judgement of schoolchildren's health status; changes over the previous two years; estimation of schoolchildren's most common reasons for consulting the school nurse; and estimation of factors influencing schoolchildren's health.

RESULTS: Swedish school nurses judged schoolchildren's mental health to have deteriorated during the previous two years with increasing health complaints, especially among girls and in disadvantaged housing areas. Disturbed family relations were considered as one important explanatory factor. Girls were more inclined to consult school nurses with subjective health complaints. Boys more often consulted the nurses with physical injuries.

CONCLUSIONS: School nurses work closely with the children and meet them continuously during the school age period. They have a genuine knowledge of schoolchildren's health, which should be used even more, both in research and practice. The results may be applicable in other countries with similarly organized school health systems.

AIMS: To use school nurses' knowledge and experience for a better understanding of schoolchildren's health problems and their association to socioeconomic background and gender. METHODS: Mail questionnaires were sent to a nationally representative, random sample of Swedish school nurses (n=129). The questionnaire included structured and open-ended questions asking for school nurses' judgement of schoolchildren's health status; changes over the previous two years; estimation of schoolchildren's most common reasons for consulting the school nurse; and estimation of factors influencing schoolchildren's health. RESULTS: Swedish school nurses judged schoolchildren's mental health to have deteriorated during the previous two years with increasing health complaints, especially among girls and in disadvantaged housing areas. Disturbed family relations were considered as one important explanatory factor. Girls were more inclined to consult school nurses with subjective health complaints. Boys more often consulted the nurses with physical injuries. CONCLUSIONS: School nurses work closely with the children and meet them continuously during the school age period. They have a genuine knowledge of schoolchildren's health, which should be used even more, both in research and practice. The results may be applicable in other countries with similarly organized school health systems.

BACKGROUND: World population growth will be increasingly concentrated in the urban areas of the developing world; however, some scholars caution against the oversimplification of African urbanization noting that there may be "counter-urbanization" and a prevailing pattern of circular rural-urban migration. The aim of the paper is to examine the ongoing urban transition in South Africa in the post-apartheid period, and to consider the health and social policy implications of prevailing migration patterns. METHODS: Two data sets were analysed, namely the South African national census of 2001 and the Agincourt health and demographic surveillance system. A settlement-type transition matrix was constructed on the national data to show how patterns of settlement have changed in a five-year period. Using the sub-district data, permanent and temporary migration was characterized, providing migration rates by age and sex, and showing the distribution of origins and destinations. FINDINGS: The comparison of national and sub-district data highlight the following features: urban population growth, particularly in metropolitan areas, resulting from permanent and temporary migration; prevailing patterns of temporary, circular migration, and a changing gender balance in this form of migration; stepwise urbanization; and return migration from urban to rural areas. CONCLUSIONS: Policy concerns include: rural poverty exacerbated by labour migration; explosive conditions for the transmission of HIV; labour migrants returning to die in rural areas; and the challenges for health information created by chronically ill migrants returning to rural areas to convalesce. Lastly, suggestions are made on how to address the dearth of relevant population information for policy-making in the fields of migration, settlement change and health.

AIMS: The Dikgale Demographic Surveillance System (DDSS) site, established in 1995, is one of three rural surveillance sites in South Africa. This paper describes detailed mortality patterns of a rural African population in the central region of Limpopo Province. METHODS: These data were based on yearly household visits to collect data on vital events, covering 63, 873 person-years of observation over eight years. RESULTS: Crude mortality was 7.5 per 1,000 person-years (females: 6.9, males: 8.1). Under-1 year and under-5 years mortality was 15.1 and 5.8 per 1,000 person-years, respectively. Life expectancy at birth was 64.3 years (females: 68.1, males: 60.0). For the two four-year periods (1996-9 and 2000-3) under-20 years mortality risk decreased (rate ratio=0.45, 95% CI: 0.25 to 0.80) while 20-49 years mortality risk increased (rate ratio=1.55, 95% CI: 1.10 to 2.20). Multivariate mortality risk for migrants remained relatively constant (0.71, 95% CI: 0.54 to 0.94) across the two four-year periods, but has increased 2.5-fold in all DDSS +50 year-old adults across the two four-year periods. CONCLUSIONS: The DDSS mortality estimates appear to have remained relatively constant while recent mortality estimates for the Agincourt Demographic and Health Surveillance System (ADHSS) site suggest that mortality risk is higher and life expectancy is lower in ADHSS residents. Moreover, DDSS mortality estimates are substantially more favourable compared with provincial and national mortality estimates.

Aims: Historically, health research in the Arctic has focused on documenting ill-health using a narrow set of deficit-oriented epidemiologic indicators (i.e., prevalence of disease and mortality rates). While useful, this type of research does not adequately capture the breadth and complexities of community health and well-being, and fails to highlight solutions. A community’s context, strengths, and continued expressions of well-being need to guide inquiries, inform processes, and contextualize recommendations. In this paper, we present a conceptual framework developed to address the aforementioned concerns and inform community-led health and social research in the Arctic.

Methods: The proposed framework is informed by our collective collaborations with circumpolar communities, and syntheses of individual and group research undertaken throughout the Circumpolar North. Our framework encourages investigation into the contextual factors that promote circumpolar communities to thrive.

Results: Our framework centers on the visual imagery of an iceberg. There is a need to dive deeper than superficial indicators of health to examine individual, family, social, cultural, historical, linguistic, and environmental contexts that support communities in the Circumpolar North to thrive. A participatory community-based approach in conjunction with ongoing epidemiologic research is necessary in order to effectively support health and wellness.

Conclusions: The iceberg framework is a way to conceptualize circumpolar health research and encourage investigators to both monitor epidemiologic indicators and also dive below the surface using participatory methodology to investigate contextual factors that support thriving communities.

Aims: Falls are common in the elderly population, and fall-related injuries are a major health issue. We investigated the ability of simple physical tests to predict incident falls.

Methods: The Swedish Osteoporotic Fractures in Men (MrOS) study includes 3014 population-based men aged 69-81 years at the start of the study. These men performed five different physical tests at baseline: right-hand grip strength, left-hand grip strength, timed stand test, 6 m walking test (time and steps) and narrow walking test. During the first study year, we asked participants to fill out questionnaires regarding falls 4, 8 and 12 months after baseline. A total of 2969 men completed at least one questionnaire and were included in this study. We used generalised estimating equations and logarithmic regression models to estimate odds ratios for fallers and recurrent fallers (more than one fall during the one-year examination period) in each quartile of men for each physical test.

Results: The proportions of fallers and recurrent fallers were higher in the lowest quartile of the physical tests than in the other three quartiles combined for all physical tests. A reduction of one standard deviation in respective physical test resulted in a 13-21% higher risk of becoming a faller and a 13-31% higher risk of becoming a recurrent faller.

Conclusions: Low results on simple physical tests is a risk factor for incident falls in elderly Swedish men and may facilitate identification of high-risk individuals suitable for fall-intervention programs.

Background: All-cause mortality is a global indicator of the overall health of the population, and its relation to the macro economy is thus of vital interest. The main aim was to estimate the short-term and the long-term impact of macroeconomic change on all-cause mortality. Variations in the unemployment rate were used as indicator of temporary fluctuations in the economy. Methods: We used time-series data for 21 OECD countries spanning the period 1960–2018. We used four outcomes: total mortality (0+), infant mortality (<1), mortality in the age-group 20–64, and old-age mortality (65+). Data on GDP/capita were obtained from the Maddison Project. Unemployment data (% unemployed in the work force) were sourced from Eurostat. We applied error correction modelling to estimate the short-term and the long-term impact of macroeconomic change on all-cause mortality. Results: We found that increases in unemployment were statistically significantly associated with decreases in all mortality outcomes except old-age mortality. Increases in GDP were associated with significant lowering long-term effects on mortality. Conclusions: Our findings, based on data from predominantly affluent countries, suggest that an increase in unemployment leads to a decrease in all-cause mortality. However, economic growth, as indicated by increased GDP, has a long-term protective health impact as indexed by lowered mortality.

Background: All-cause mortality is a global indicator of the overall health of the population, and its relation to the macro economy is thus of vital interest. The main aim was to estimate the short-term and the long-term impact of macroeconomic change on all-cause mortality. Variations in the unemployment rate were used as indicator of temporary fluctuations in the economy. Methods: We used time-series data for 21 OECD countries spanning the period 1960–2018. We used four outcomes: total mortality (0+), infant mortality (<1), mortality in the age-group 20–64, and old-age mortality (65+). Data on GDP/capita were obtained from the Maddison Project. Unemployment data (% unemployed in the work force) were sourced from Eurostat. We applied error correction modelling to estimate the short-term and the long-term impact of macroeconomic change on all-cause mortality. Results: We found that increases in unemployment were statistically significantly associated with decreases in all mortality outcomes except old-age mortality. Increases in GDP were associated with significant lowering long-term effects on mortality. Conclusions: Our findings, based on data from predominantly affluent countries, suggest that an increase in unemployment leads to a decrease in all-cause mortality. However, economic growth, as indicated by increased GDP, has a long-term protective health impact as indexed by lowered mortality.

Background: Unemployment might affect several risk factors of cardiovascular disease (CVD), which is the leading cause of death globally. The characterisation of the relation between these two phenomena is thus of great significance from a public-health perspective. The main aim of this study was to estimate the association between the unemployment rate and mortality from CVD and from coronary heart disease (CHD). Additional aims were (a) to assess whether the associations are modified by the degree of unemployment protection; (b) to determine the impact of GDP on heart-disease mortality; and (c) to assess the impact of the Great Recession in this context. Methods: We used time-series data for 32 countries spanning the period 1960–2015. We applied two alternative modelling strategies: (a) error correction modelling, provided that the data were co-integrated; and (b) first-difference modelling in the absence of co-integration. Separate models were estimated for each of five welfare state regimes with different levels of unemployment protection. We also performed country-specific ARIMA-analyses. Results: Because the data did not prove to be co-integrated, we applied first-difference modelling. The estimated effect of unemployment and GDP on CVD as well as CHD was statistically insignificant across age and sex groups and across the various welfare state regimes. An interaction term capturing the possible excess effect of unemployment during the Great Recession was also statistically insignificant. Conclusions: Our findings, based on data from predominantly affluent countries, suggest that heart-disease mortality does not respond to economic fluctuations.

Background: Unemployment might affect several risk factors of cardiovascular disease (CVD), which is the leading cause of death globally. The characterisation of the relation between these two phenomena is thus of great significance from a public-health perspective. The main aim of this study was to estimate the association between the unemployment rate and mortality from CVD and from coronary heart disease (CHD). Additional aims were (a) to assess whether the associations are modified by the degree of unemployment protection; (b) to determine the impact of GDP on heart-disease mortality; and (c) to assess the impact of the Great Recession in this context. Methods: We used time-series data for 32 countries spanning the period 1960–2015. We applied two alternative modelling strategies: (a) error correction modelling, provided that the data were co-integrated; and (b) first-difference modelling in the absence of co-integration. Separate models were estimated for each of five welfare state regimes with different levels of unemployment protection. We also performed country-specific ARIMA-analyses. Results: Because the data did not prove to be co-integrated, we applied first-difference modelling. The estimated effect of unemployment and GDP on CVD as well as CHD was statistically insignificant across age and sex groups and across the various welfare state regimes. An interaction term capturing the possible excess effect of unemployment during the Great Recession was also statistically insignificant. Conclusions: Our findings, based on data from predominantly affluent countries, suggest that heart-disease mortality does not respond to economic fluctuations.

Aims: To investigate the confidence in primary health care, psychiatry and social services among the reindeer-herding Sami and the non-Sami population of northern Sweden. Methods: A semi-randomized, cross-sectional study design comprising 325 reindeer-herding Sami (171 men, 154 women) and a control population of 1,437 non-Sami (684 men, 753 women). A questionnaire on the confidence in primary health care, psychiatry, social services, and work colleagues was distributed to members of reindeer-herding families through the Sami communities and to the control population through the post. The relative risk for poor confidence was analyzed by calculating odds ratios with 95% confidence intervals adjusted for age and level of education. Results: The confidence in primary health care and psychiatry was significantly lower among the reindeer-herding Sami compared with the control group. No differences were found between men and women in the reindeer-herding Sami population. In both the reindeer-herding Sami and the control population, younger people (<= 48 years) reported significantly lower confidence in primary health care than older individuals (>48 years). Conclusions: A conceivable reason for the poor confidence in health care organizations reported by the reindeer-herding Sami is that they experience health care staff as poorly informed about reindeer husbandry and Sami culture, resulting in unsuitable or unrealistic treatment suggestions. The findings suggest that the poor confidence constitutes a significant obstacle of the reindeer-herding Sami to fully benefit from public health care services.

Over a million people in Sweden have difficulty hearing what is said in a conversation between several people. Almost twice as many young people today consider themselves hard of hearing than was the case 10 years ago. However, this self-reported increase has not been confirmed by studies of hearing loss.

At least 10,000 deaf and hearing-impaired people are under the age of 20. In most cases, their hearing impairments are the result of hereditary factors. People who have impaired hearing report having worse health than those with normal hearing. This is particularly true of younger, actively employed people.

Many people who are hard of hearing suffer unnecessarily because they lack the hearing-aid devices they need. Almost half the people who would benefit from a hearing aid do not have one. Only a quarter of hearing-impaired people use other assistive listening devices, such as amplified sound in telephones and doorbells.

One in every two Swedes over the age of 16 needs glasses to read plain text in a daily newspaper. One per cent of the population is unable to read text in a daily newspaper with or without glasses to help them. It is slightly less common today than 10 years ago for older women to have impaired vision. This is probably because cataracts, the most common cause of impaired vision, are operable. Most people given cataract surgery regain very good vision.

The most common cause of blindness in older people is age-related degeneration of the macula lutea. The treatment currently available is only effective with a small group of people among those who suffer from acute problems. Strabism can result in vision impairment if not treated early. Child healthcare centres and schools offer screening procedures for detecting strabism. As a result, the percentage of people in the population with this condition has declined to just under 2 per cent.

Over a million people in Sweden have difficulty hearing what is said in a conversation between several people. Almost twice as many young people today consider themselves hard of hearing than was the case 10 years ago. However, this self-reported increase has not been confirmed by studies of hearing loss.

At least 10,000 deaf and hearing-impaired people are under the age of 20. In most cases, their hearing impairments are the result of hereditary factors. People who have impaired hearing report having worse health than those with normal hearing. This is particularly true of younger, actively employed people.

Many people who are hard of hearing suffer unnecessarily because they lack the hearing-aid devices they need. Almost half the people who would benefit from a hearing aid do not have one. Only a quarter of hearing-impaired people use other assistive listening devices, such as amplified sound in telephones and doorbells.

One in every two Swedes over the age of 16 needs glasses to read plain text in a daily newspaper. One per cent of the population is unable to read text in a daily newspaper with or without glasses to help them. It is slightly less common today than 10 years ago for older women to have impaired vision. This is probably because cataracts, the most common cause of impaired vision, are operable. Most people given cataract surgery regain very good vision.

The most common cause of blindness in older people is age-related degeneration of the macula lutea. The treatment currently available is only effective with a small group of people among those who suffer from acute problems. Strabism can result in vision impairment if not treated early. Child healthcare centres and schools offer screening procedures for detecting strabism. As a result, the percentage of people in the population with this condition has declined to just under 2 per cent.

Stress can be defined as an imbalance between demands placed on us and our ability to manage them. The body’s stress system is adapted to confront sudden physical threats. Today, however, we are increasingly exposed to prolonged mental and psychosocial stress. Prolonged stress can give rise to a range of problems: poor performance, chronic fatigue, disinterest, dejection, memory disturbances, sleep problems, numbness and diffuse muscle pains. These symptoms may eventually be followed by depression, post-traumatic stress disorder and chronic fatigue syndrome, and ultimately chronic pain conditions, cardiovascular disease and diabetes. Sleep is a vital counterbalance to stress as it enables the body to recover properly. Good sleep is thus essential to our ability to cope with stress and stay healthy.

The decline in the mental wellbeing of the population since the 1980s has been accompanied by a rise in the number of pain complaints. A similar development in respect of symptoms such as anxiousness, nervousness and anxiety, constant fatigue and neck and shoulder pain and sleeping problems has been observed in the population. This increase, which continued throughout the 1990s and culminated in 2001, was followed by a slight fall. However, there was no decline among young people in the early 2000s. Rather, the number of complaints continued to increase.

Since the mid-1990s, the proportion of people suffering from stress symptoms has risen and fallen in step with employment levels. Since the beginning of the 1980s, growing numbers of people in gainful employment have experienced their work as hectic and mentally taxing. This may indicate that the balance between healthy and unhealthy factors impacting the actively employed has tilted towards less favourable conditions. Mental stress at work has increased among women and men, particularly among county council employees. Repeated organisational restructuring may explain why hectic and mentally taxing work has become more commonplace. Mental ill-health along with musculoskeletal disorders are the most frequent diagnoses in connection with newly granted disability pensions. Sickness absence trends largely reflect the trend in stress symptoms.

Aims: This study investigates the risk of small for gestational age (SGA) in relation to country of origin of the mother. The role of psychosocial resources, socioeconomic and lifestyle factors was examined in different causal models. Methods: Among all pregnant nulliparous women in the city of Malmö, Sweden, who gave birth in 1991 - 92, 872 (87.7%) women completed a questionnaire during their first antenatal visit. The study was carried out among women whose pregnancies resulted in a singleton live birth (n=826); 22% (n=182) of these women were foreign-born. Results: Fifty-five (6.7%) of the infants were classified as SGA, 37 (5.7%) of mothers of Swedish origin and 18 (9.7%) of foreign origin. SGA deliveries were much more prevalent among Middle East- and North Africa-born women (22%) and sub-Saharan-born women (15%). In all, women of foreign origin had increased odds for delivering SGA babies (OR=1.8, 95% CI=1.0,3.2). In a multivariate analysis psychosocial and socioeconomic factors explained 30% and 40%, respectively, of the increased SGA risk. Psychosocial factors seemed to be more prominent risk factors for SGA among mothers of foreign origin. A possible synergistic relation was demonstrated between foreign origin of the mother and low social anchorage. Conclusions: This study showed that psychosocial factors, most probably linked to a disadvantaged social situation, could be the theoretically most important focus for preventing SGA in immigrant women. This could also further support a hypothesis of a link between psychosocial stress and SGA in general. However, this should not exclude the need for intervention in the antenatal care system in terms of specially tailored support and education.

Aims: To investigate the importance of macro-organizational factors, i.e. organizational sociodemographic and socioeconomic preconditions, of the municipal incidence of long-term sick leave, disability pension, and prevalence of workers with long-term work ability among home care workers. Methods: In an ecological study design, data from national databases were combined by record linkage. Descriptive and analytical statistics were used to estimate and interpret macro-organizational factors (economic resources, region, unemployment, employment, occupational rehabilitation, return to work, age structures of inhabitants and home care workers). Results: The incidence of long-term sick leave among female home care workers was twice as high as that of male home care workers, and incidence of disability pension was about four times as high for the women. A great variation in municipal incidence of long-term sick leave, disability pension, and long-term work ability (101—264, 0.6—19.6, and 913—1,279 per 1,000 full-time equivalent workers and year) was also found. The strongest single factor for long-term work ability was a high proportion of part-time or hourly paid employees, which explained 35% of the municipal variation. Macro-organizational factors explained long-term work ability (47—62% explained variance) better than long-term sick leave (33% explained variance). There was a low rehabilitation activity; only 2% received occupational rehabilitation and 5% of those on sick leave longer than 2 weeks returned to work within 30 days. Conclusions: The differences in the municipal proportion of work ability incidence indicate a preventive potential, especially related to employment and return to work after sick leave.

Aims: To investigate the importance of macro-organizational factors, i.e. organizational sociodemographic and socioeconomic preconditions, of the municipal incidence of long-term sick leave, disability pension, and prevalence of workers with long-term work ability among home care workers. Methods: In an ecological study design, data from national databases were combined by record linkage. Descriptive and analytical statistics were used to estimate and interpret macroorganizational factors ( economic resources, region, unemployment, employment, occupational rehabilitation, return to work, age structures of inhabitants and home care workers). Results: The incidence of long-term sick leave among female home care workers was twice as high as that of male home care workers, and incidence of disability pension was about four times as high for the women. A great variation in municipal incidence of long-term sick leave, disability pension, and long-term work ability ( 101 - 264, 0.6 - 19.6, and 913 - 1,279 per 1,000 full-time equivalent workers and year) was also found. The strongest single factor for long-term work ability was a high proportion of part-time or hourly paid employees, which explained 35% of the municipal variation. Macro-organizational factors explained long-term work ability ( 47 - 62% explained variance) better than long-term sick leave ( 33% explained variance). There was a low rehabilitation activity; only 2% received occupational rehabilitation and 5% of those on sick leave longer than 2 weeks returned to work within 30 days. Conclusions: The differences in the municipal proportion of work ability incidence indicate a preventive potential, especially related to employment and return to work after sick leave.

Aims: The aims of the current study were to identify the prevalence of unwanted childbirth (UC), to explore the association with sociodemographic factors and to identify possible contributing factors such as psychosomatic health, contraceptive use, experiences of induced abortion and sexual violence. Methods: We used Swedish data from the randomised population-based study SRHR2017 on sexual and reproductive health and rights (SRHR), based on self-administered surveys, linked to nationwide registers. The national sample consisted of 14,537 women and men aged between 16 and 84 years. With logistic regression, we examined differences in self-reported experience of UC, stratified by sex, in relation to socio-economic factors, as well as several possible contributing factors. Results: Despite advances in SRHR and fertility control, 6% of women and men in Sweden reported UC. This experience tends to be unevenly distributed in the population according to age, country of birth and, to some extent, income and educational attainment. Previous experience of induced abortion, sexual violence and threat from a partner were significantly associated with UC, whereas self-reported good health was protective. Conclusions: Mechanisms behind unintended, unplanned, unwanted or mistimed pregnancies are complex. Current results focus on the role of individual factors and personal experiences. In addition, in line with previous understanding, there is a need for adopting a broader socio-ecological perspective on fertility intentions.

Aims: Sexual victimisation is a key public health concern because of its physical, psychological and social consequences. Nationally representative studies exploring sexual victimisation and re-victimisation are still scarce. The aim of the current study was to explore associations of sexual victimisation with sociodemographic factors including sexual orientation in Sweden.

Methods: We used Swedish data from a national population survey linked to nationwide registers. The sample consisted of 3349 individuals aged 30-44 years, (2021 women and 1328 men). With a latent class analysis we identified groups of individuals with distinctly different experiences of sexual victimisation. Multinomial logistic regression was used to explore how common characteristics could explain latent class membership classes.

Results: Experiences of sexual victimisation were common: 48% of women and 13% of men had experienced sexual harassment, 47% of women and 12% of women sexual assault, 11% of women and 1% of men attempted intercourse and 8% of women and 1% of men rape. Among women four groups were identified who had distinctly different experiences of exposure to sexual victimisation such as low victimisation, sexually harassed and assaulted several times, highly sexually victimised with low re-victimisation and finally high victimisation. Both women and men who were highly sexually victimised had to a higher extent a non-heterosexual sexual identity.

Conclusions: Non-heterosexual orientation is a robust indicator of a high level of sexual victimisation as well as re-victimisation among both male and female adults.

Aims: The study was undertaken to assess the cost-effectiveness of the Chlamydia Monday, 2007. This is a community-based intervention aimed at reducing the prevalence of chlamydia by information and increased availability of testing, treatment and contact tracing in Stockholm. The aim was to analyze the cost-effectiveness by estimating costs, savings and effects on health associated with the intervention, and to determine if cost-effectiveness varies between men and women. Methods: A societal perspective was adopted, meaning all significant costs and consequences were taken into consideration, regardless of who experienced them. A cost-effectiveness model was constructed including costs of the intervention, savings due to avoiding potential costs associated with medical sequels of chlamydia infection, and health gains measured as quality adjusted life years (QALY). Sensitivity analyses were done to explore model and result uncertainty. Results: Total costs were calculated to be (sic)66,787.21; total savings to (sic)30,370.14; and total health gains to 9.852324 QALYs (undiscounted figures). The discounted cost per QALY was (sic)8,346.05 ((sic)10,810.77/QALY for women and (sic)6,085.35/QALY for men). Sensitivity analyses included changes in effectiveness, variation of prevalence, reduced risk of sequel progression, inclusion of prevented future production loss and shortened duration for chronic conditions. The cost per QALY was consistently less than (sic)50,000, which is often regarded as cost-effective in a Swedish context. Conclusions: The Chlamydia Monday has been demonstrated by this study to be a cost-effective intervention and should be considered a wise use of society's resources.

BACKGROUND: This paper describes the methodological considerations of developing an urban Health and Demographic Surveillance System (HDSS), in the Sleman District of Yogyakarta, Indonesia.

METHODS: 1) The Sleman District was selected because it is mostly an urban area. 2) The minimum sample size was calculated to measure infant mortality as the key variable and resulted in a sample of 4942 households. A two-stage cluster sampling procedure with probability proportionate to size was applied; first, 216 Censuses Blocks (CBs) were selected, and second, 25 households in each CB were selected. 3) A baseline survey was started in 2015, and collected data on demographic and economic characteristics and verbal autopsy (VA); the 2nd cycle collected updated demographic data, VA, type of morbidity (communicable and non-communicable diseases, disability and injury) and health access. 4) The data were collected at a home visit through a Computer-Assisted Personal Interview (CAPI) on a tablet device, and the data were transferred to the server through the Internet. 5) The quality control consisted of spot-checks of 5% of interviews to control for adherence to the protocol, re-checks to ensure the validity of the interview, and computer-based data cleaning. 6) A utilization system was designed for policy-makers (government) and researchers.

RESULTS: In total, 5147 households participated in the baseline assessment in 2015, and 4996 households participated in the second cycle in 2016 (97.0% response rate).

CONCLUSIONS: Development of an urban HDSS is possible and is beneficial in providing data complementary to the existing demographic and health information system at local, national and global levels.

BACKGROUND: Several previous studies have reported on socioeconomic and sociodemographic factors associated with depression among women, but knowledge in this area remains scarce regarding women living in extreme poverty in developing countries.

OBJECTIVE: The study was aimed at examining the 12-month prevalence of depressive episodes as related to socioeconomic and sociocultural conditions of women in the reproductive age group in rural Ethiopia.

METHODS: A community-based cross-sectional study was undertaken among 3016 randomly selected women in the age group 15-49 years. Cases of depression were identified using the Amharic version of the Composite International Diagnostic Interview. A standardized World Health Organization questionnaire was used to measure the socioeconomic status of the women and their spouses. Data were analysed among all women and then separately among currently married women.

RESULTS: The 12-month prevalence of depression among all women was 4.4%. After adjusting for common sociodemographic characteristics, only marital status showed a significant association with depressive episode in terms of higher odds ratios (ORs) for divorced/separated women and widowed women than for not-married women (4.05 and 4.24, respectively). Among currently married women, after adjusting for common sociodemographic characteristics, living in rural villages (OR=3.78), a frequent khat-chewing habit (OR=1.61), having a seasonal job (OR=2.94) and being relatively better off in terms of poverty (OR=0.48) were independently associated with depression.

CONCLUSIONS: The prevalence of depression among women was in the lower range as compared to studies from high-income countries, but very poor economic conditions were associated with a higher prevalence of depression in this overall very poor setting. This further supports the notion that the relative level of poverty rather than the absolute level of poverty contributes to depression among women. Whether the association with khat chewing and depression is a causative effect or can be explained by self-medication remains unclear.

Gunnar Inghe (1910–1977) was a founding father of Scandinavian social medicine and the first editor of the Scandinavian Journal of Social Medicine. He worked as a physician for social care clients in Stockholm from 1944 to 1961 and was professor in social medicine from 1961 to 1975. We (F.D. and U.J.) were his last two PhD students. As we were recollecting the 50-year history of the Scandinavian Journal of Public Health in 2022, it became evident to us how relevant Gunnar Inghe’s work, 45 years after his death, still is for today’s social medicine, population health research and policy in Scandinavia. We shall explain why with five examples of Inghe’s work: reproductive health, health of paupers, foundation of the discipline, international solidarity and collaboration between medical and social care.

Aims: This study aimed at comparing several health outcomes in young adulthood among child refugees who settled in the different immigration and integration policy contexts of Denmark, Norway and Sweden. Methods: The study population included refugees born between 1972 and 1997 who immigrated before the age of 18 and settled in the three Nordic countries during 1986-2005. This population was followed up in national registers during 2006-2015 at ages 18-43 years and was compared with native-born majority populations in the same birth cohorts using sex-stratified and age-adjusted regression analyses. Results: Refugee men in Denmark stood out with a consistent pattern of higher risks for mortality, disability/illness pension, psychiatric care and substance misuse relative to native-born majority Danish men, with risk estimates being higher than comparable estimates observed among refugee men in Norway and Sweden. Refugee men in Sweden and Norway also demonstrated increased risks relative to native-born majority population men for inpatient psychiatric care, and in Sweden also for disability/illness pension. With the exception of increased risk for psychotic disorders, outcomes among refugee women were largely similar to or better than those of native-born majority women in all countries. Conclusions: The observed cross-country differences in health indicators among refugees, and the poorer health outcomes of refugee men in Denmark in particular, may be understood in terms of marked differences in Nordic integration policies. However, female refugees in all three countries had better relative health outcomes than refugee men did, suggesting possible sex differentials that warrant further investigation.

Aims: The aim of this study was to explore the role of self-reported non-binary gender identity in mental health problems, school adjustment, and wish to exert influence on municipal issues in a community sample of adolescents.

Methods: In a cross-sectional design, data were collected through an anonymous survey in Uppsala County, Sweden, among 8385 students (response rate 58.2%) in grades 7, 9, and 11, aged 13-17 years. The Strengths and Difficulties Questionnaire (SDQ) self-report was used to assess mental health problems. Gender identity was measured with one item and youth were categorized into those who identified as male or female (i.e. binary youth), and those who did or could not identify with either gender (i.e. non-binary youth). Logistic regressions and qualitative content analysis were used to analyse data.

Results: Youth with non-binary gender identity (n = 137; 1.6%) had higher odds of having mental problems according to the SDQ total score (OR=3.05; 1.77-5.25). The association between non-binary gender identity and mental health problems remained significant after adjusting for confounders. Additionally, compared to their binary peers, the non-binary youth reported more truancy (36.5% vs 49.6%), more often failed a subject (21.5% vs 36.5%), and were more interested in exerting influence on municipal issues such as sociopolitical development, education, municipal services, and drug and alcohol policies (25.3% vs 38.0%).

Conclusions: Youth with non-binary gender identity constitute a vulnerable population regarding mental health problems and school adjustment. The willingness to exert influence on municipal issues suggests a possible pathway to engagement.