Birgit Modén

Psychotropic drugs and falling accidents among the elderly: a nested case control study in the whole population of Scania, Sweden

Study objective The objective of this study was to investigate the associations between medication with psychotropic drugs and falling accidents in the whole population aged 65 years and older in the county of Scania, Sweden. Design A population based nested case control study was performed. Subjects Cases were persons registered in the Region Healthcare database after a falling accident during the year 2006 (n=10 482). One control was matched to each case based on age, sex, date of the falling accident, living area and propensity score (based on prevalent disease). Main results Using psychotropic drugs within 3 months before the fall was associated with a more than doubled odds for a falling accident among both men (2.14, 95% CI 1.87 to 2.44) and women (2.21, 95% CI 2.04 to 2.39). The use of psychotropic drugs during the week before the accident occurred was associated with an even higher odds for a falling accident among both men (OR=5.61; 95% CI 2.54 to 12.41) and women (OR=3.40; 95% CI 2.24 to 5.17). A similar pattern of association was seen for specific groups of psychotropic drugs: opioids, antidepressants and anxiolytics/hypnotics/sedatives. Conclusions The use of psychotropic drugs increased the odds for a falling accident among persons 65 years and older. Generally, patients using psychotropic drugs seemed to have the highest odds for falling accidents immediately after initiating therapy. Since these medications are extensively used among the elderly, the increased risk for falls associated with these kinds of drugs is an important public health problem that could be tackled by a more rational medication use.

A life course perspective on economic stress and tobacco smoking: a population based study.

AIMS To investigate the associations between economic stress in childhood and adulthood and tobacco smoking, with reference to the accumulation, critical period and social mobility hypotheses from life-course epidemiology. DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS The 2008 public health survey in Skåne, Sweden is a cross-sectional postal questionnaire study based on a random sample which yielded 28 198 participants aged 18-80 years (55% participation). Logistic regression models were used to investigate associations between economic stress in childhood and adulthood and tobacco smoking. FINDINGS A 17.4% prevalence of men and 19.1% of women reported tobacco smoking. Tobacco smoking was more prevalent among middle-aged men and young women, among those born outside Sweden, with low occupational status, low social support, low trust, economic stress in childhood and adulthood. The accumulation hypothesis was confirmed because combined childhood and adulthood exposures to economic stress were associated (P < 0.001) with tobacco smoking in a graded manner. The critical period hypothesis was not supported because the associations between economic stress in childhood as well as adulthood, respectively, and tobacco smoking were significant (P = 0.004 and P < 0.001) throughout the analyses. The social mobility hypothesis was confirmed because upward social mobility was associated significantly (P < 0.001) with lower odds of smoking, while downward social mobility was associated significantly (P < 0.001) with higher odds of smoking. CONCLUSIONS Downward social mobility and economic stress in both childhood and adulthood should be considered as risk factors for tobacco smoking over the life-course.

Sexual orientation, social capital and daily tobacco smoking: a population-based study.

BackgroundStudies have suggested poorer health in the homosexual and bisexual groups compared to heterosexuals. Tobacco smoking, which is a health-related behavior associated with psychosocial stress, may be one explanation behind such health differences. Social capital, i.e. the generalized trust in other people and social participation/social networks which decreases the costs of social interaction, has been suggested to affect health through psychosocial pathways and through norms connected with health related behaviours, The aim of this study is to investigate the association between sexual orientation and daily tobacco smoking, taking social capital into account and analyzing the attenuation of the logit after the introduction of social participation, trust and their combination in the models.MethodsIn 2008 a cross-sectional public health survey was conducted in southern Sweden with a postal questionnaire with 28,198 participants aged 18–80 (55% participation rate). This study was restricted to 24,348 participants without internally missing values on all included variables. Associations between sexual orientation and tobacco smoking were analyzed with logistic regression analysis.ResultsOverall, 11.9% of the men and 14.8% of the women were daily tobacco smokers. Higher and almost unaltered odds ratios of daily smoking compared to heterosexuals were observed for bisexual men and women, and for homosexual men throughout the analyses. The odds ratios of daily smoking among homosexual women were not significant. Only for the “other” sexual orientation group the odds ratios of daily smoking were reduced to not significant levels among both men and women, with a corresponding 54% attenuation of the logit in the “other” group among men and 31.5% among women after the inclusion of social participation and trust. In addition, only the “other” sexual orientation group had higher odds ratios of low participation than heterosexuals.ConclusionsBisexual men and women and homosexual men, but not homosexual women, are daily smokers to a higher extent than heterosexuals. Only for the “other” sexual orientation group the odds ratios of daily smoking were reduced to not significant levels after adjustments for covariates including trust and social participation.

Sexual orientation and self-rated health: the role of social capital, offence, threat of violence, and violence

Objective: To study the association between sexual orientation and self-rated health, including trust, offence, threat of violence, and violence. Design/setting/participants/measurement: The 2008 Public Health Survey in Skåne is a cross-sectional postal questionnaire study. A total of 28,198 persons aged 18–80 years responded (55%). Logistic regressions analysed the association between sexual orientation and self-rated health. Results: 27.4% of all men and 30.0% of all women rated their health as poor. Poor self-rated health was significantly more prevalent in higher age, among immigrants, people with lower education, low social support, low trust, experience of being offended, experience of threat of violence and violence, and bisexual and other orientation. Homosexual and bisexual men and women had higher age-adjusted odds ratios of having felt offended compared to heterosexual respondents. The odds ratios of low trust, threat of violence (men), and experience of violence (women) were significant for respondents with bisexual orientation but not for respondents with homosexual orientation. In the age-adjusted model, no significant association was observed between homosexual orientation and poor self-rated health among women. All other associations between sexual orientation and health were significant in the age-adjusted model but non-significant in the multiple models. Conclusions: Associations between sexual orientation and health disappear after multiple adjustments including trust and experience of offence, threat of violence, and violence. The study suggests that the group with bisexual orientation seems to be more exposed to low social capital (trust), threat of violence, and violence than the group with homosexual orientation.

Country of birth, parental background and self-rated health among adolescents: A population-based study.

Aims: The aim of this study was to investigate differences according to country of birth and parental country of birth, in relation to poor self-rated health (SRH), in Swedish adolescents. Methods: The Scania public health survey among children and adolescents, conducted in 2012, is a cross-sectional study including most pupils in grade 9 (15 years old), including in 32 of 33 municipalities. The participation rate was 83% (9,791 of 11,735). We performed logistic regressions to investigate the association between the students’ country of birth, parental country of birth and poor SRH. Results: Boys born outside Europe had an odds ratio (OR) 2.1 (1.6–2.8) of poor SRH in the unadjusted model, which was reduced to 0.7 (0.4–1.3) in the multiple model, as compared to boys born in Sweden with both or one parent born in Sweden. Boys born in Europe had an OR 0.4 (0.2–0.9) of poor SRH, after multiple adjustments. Girls born in Sweden with both parents born abroad, and girls born outside of Europe had significantly lower ORs of poor SRH in the multiple model. In particular, adjustment for socio-demographic and psychosocial factors reduced the ORs of poor SRH among boys, but did so to a lesser extent among girls. Conclusions: Differences in socio-demographic and psychosocial factors explained the higher odds of poor SRH among boys born outside of Europe. Girls born in Sweden with both parents born abroad, and girls born outside Europe, had significantly lower ORs of poor SRH. Our results indicate that there are gender differences in the factors behind poor self-rated health, according to the country-related background of adolescents in Sweden.

Risk factors for diagnosed intentional self-injury: a total population-based study

BACKGROUND Few studies investigate predictors of intentional self-injury over time in non-clinical samples. By using longitudinal data from the whole population of the county of Scania, Sweden, aged 18 years and over (N = 936 449), we aim to identify risk factors for non-fatal diagnosed intentional self-injury. Groups at risk of repeat episodes of self-injury will be identified. METHODS Information on hospital stays and outpatient specialized care visits registered as intentional self-injury was collected from the Region Skåne Healthcare database in 2007. These injuries were studied in relation to sociodemographic factors, previous disease, substance abuse and psychotropic drug treatment at baseline. RESULTS There were increased odds of diagnosed intentional self-injury during follow-up in association with being single, of young or middle age, having low income and being born in the Nordic countries. Presence of neurological or psychiatric disease, substance abuse and previous assault-related injury were also strongly associated with future intentional self-injury. The use of psychotropic drugs showed a clear dose-response relationship with intentional self-injury during follow-up. Those diagnosed with self-injury in the 3-year period before baseline had more than 10 times increased odds of a new episode of intentional self-injury. The odds of repeated episodes of self-injury among subjects born in Europe, but outside Sweden, were less than half those seen for subjects born in Sweden. CONCLUSIONS The present study, based on a total general population, expands the knowledge base regarding intentional self-injury in adults, repeat behaviour and its associations with sociodemographic variables, substance use and disease in both men and women.

Subjective health complaints and exposure to peer victimization among disabled and non-disabled adolescents: A population-based study in Sweden.

Aims: To investigate subjective health complaints (SHCs) (psychological and somatic, respectively) among disabled and non-disabled adolescents, focusing on the impact of traditional bullying and cyber harassment, and furthermore to report psychological and somatic SHCs across different types of disability. Methods: Data from the public health survey of children and adolescents in Scania, Sweden, 2012 was used. A questionnaire was answered anonymously in school by 9791 students in the 9th grade (response rate 83%), and 7533 of these with valid answers on key questions were included in this study. Associations with daily SHCs were investigated by multi-adjusted logistic regression analyses. Results: Any disability was reported by 24.1% of boys and 22.0% of girls. Disabled students were more exposed to cyber harassment (boys: 20.0%; girls: 28.2%) than non-disabled peers (boys: 11.8%; girls: 18.1%). Exposure to traditional bullying showed the same pattern but with a lower prevalence. Disabled students had around doubled odds of both daily psychological SHCs and daily somatic SHCs in the fully adjusted models. In general, the odds increased with exposure to cyber harassment or traditional bullying and the highest odds were seen among disabled students exposed to both cyber harassment and traditional bullying. Students with ADHD/ADD had the highest odds of daily psychological SHCs as well as exposure to traditional bullying across six disability types. Conclusions: Disabled adolescents report poorer health and are more exposed to both traditional bullying and cyber harassment. This public health issue needs more attention in schools and in society in general.