Göran Westman

Sense of coherence--stability over time and relation to health, disease, and psychosocial changes in a general population: a longitudinal study.

Aims: To explore the stability of sense of coherence (SOC) over time in a normal population and to examine its relation to gender and psychosocial factors. Methods: The Northern Sweden MONICA Project population surveys were performed in 1994 and 1999. A cohort of 1,254 subjects participating in both surveys answered questions about experiences of disease, perceived health, marital status, psychosocial factors, and Antonovskys SOC scale with 13 items. Results: The mean SOC score showed a decrease in the five-year follow-up and those with identified disease and the oldest age group (45 - 74 years) had the largest decrease of the SOC score. People with the lowest SOC scores in 1994 had the largest decrease during the period. Men and women shared a similar pattern regarding the decrease in SOC over time. The impact of individual social changes during the study period showed that both men and women who had experienced loss of perceived good health and high social support had the largest decrease. Furthermore, women seemed to be more affected by changes than men. Conclusions: We found that SOC was only stable for those with initially high levels of SOC. For other people, individual conditions and societal changes influenced their SOC. Further longitudinal studies in normal populations are needed to investigate the stability of SOC scores.

Reduction of selection bias in primary prevention of cardiovascular disease through involvement of primary health care

OBJECTIVE To examine selection bias in social and health factors in a community intervention programme for the prevention of cardiovascular disease by comparing programme data with both census data and a random sample of the same population. DESIGN Cross sectional studies. SETTING All 35 primary health care centres in Västerbotten County, Sweden. SUBJECTS 24,870 individuals who during 1992 and 1993 became 30, 40, 50 or 60 years of age. MAIN OUTCOME MEASURES Total income, socio-economic group, employment, education, body mass index (BMI), total cholesterol, systolic and diastolic blood pressure, and daily smoking. RESULTS The differences in social characteristics between participants and non-participants were marginal, indicating that the social selection bias was small. However, unemployment, low income, and younger age tended to be associated with somewhat lower preference to participate. The overall pattern of health status, as measured by risk factors, was similar rather than dissimilar. While the participants in the intervention health survey had lower mean total cholesterol, their blood pressure was generally higher compared with the reference random sample. CONCLUSIONS The primary health care system in Sweden might serve as a useful base for educational health counselling, at least within a community intervention programme, for all levels of society.

Women with false positive screening mammograms: how do they cope?

Objectives To assess the long term psychological impact on women who were recalled for further investigation after mammography screening and to find any factors that might predict coping ability in order to identify those subjects who require additional support at an earlier stage. Setting Counties of Västerbotten and Västernorrland, Sweden. Methods A prospective design was used in which 252 recalled women completed questionnaires twice—once within a week of having received the all-clear and again at follow up six months later. A group of 1104 randomly selected, screen negative women were followed up in the same way for comparison. The questionnaire included the Psychological Consequences Questionnaire (PCQ) and basic sociodemographic data. The main outcome measure was the total score on the PCQ at six months. Results Of the 252 women, 235 (93%) completed both questionnaires. In the control group, 987 (89.4%) women responded. Six months after the all-clear, recalled women were still significantly more anxious (p<0.001) than those who had been screened but not recalled. The strongest predictor of psychological distress at six months was the PCQ score at the first measurement. Other predictors were a low level of education, living in high density urban areas, and having only one child or no children at all. Widows appeared to cope better than other women. Conclusions It is possible to define a group of women with false positive results who are already at risk of coping less effectively at the time of recall. Offering these women counselling or other types of support should be considered.

Shifting the distribution of risk : results of a community intervention in a Swedish programme for the prevention of cardiovascular disease

STUDY OBJECTIVE: To examine the impact of a systematic risk factor screening and counselling carried out by family physicians and family nurses within the larger framework of a community intervention programme for the prevention of cardiovascular disease (CVD). DESIGN: Quasi-experimental study comparing trends in an intervention area with those in a reference area. SETTING: A Northern Sweden municipality (5500 inhabitants) constituted the intervention area while the Northern Sweden region (510,000 inhabitants) served as the reference area. PARTICIPANTS: All 30, 40, 50, and 60 year old inhabitants were invited each year from 1985 to 1992. Among 2046 eligible 1893 participated (92.5%), which formed eight independent cross sections. One cross section, 1986, was re-surveyed forming a panel. MAIN RESULTS: In the cross sections, mean total cholesterol was reduced from 7.09 to 6.27 mmol/l for men (p < 0.001) and from 7.13 to 5.89 mmol/l for women (p < 0.001) and mean systolic blood pressure from 132.2 to 123.7 mm Hg for men (p < 0.05) and from 129.2 to 122.0 mm Hg for women (p < 0.001) during the eight years. Body mass index (BMI) increased from 25.6 to 26.2 for men (p < 0.05) and from 25.0 to 25.5 for women (NS). A corresponding reduction in cholesterol and blood pressure (for women) occurred in the panel, while BMI was unchanged. The risk for CVD, using the Framingham equation, was estimated to be reduced overall by 19% (p = 0.0021) when comparing early cross sections (1985/86) with the later cross sections (1990/91). CONCLUSIONS: It was concluded that a long term community based CVD prevention programme that combines population and individual strategies can substantially promote a health shift in CVD risk in a high risk rural population. The individual attention and evaluation provided by the health provider survey seem to accelerate, but not increase the amount of, risk reduction.

Experiential factors associated with childbirth-related fear in Swedish women and men: a population based study.

The aim of this study was to investigate and compare experiential factors associated with childbirth-related fear in women and in men. A questionnaire was completed by 410 women and 329 men who prior to the study had had a healthy baby at Umeå university hospital, Sweden. The level of fear was estimated, and twenty-nine statements designed to measure experiences and perceptions connected to childbirth and childbirth-related fear, were subjected to exploratory factor analysis. Factor scores were calculated and differences among women and men with intense and mild/moderate fear were estimated. Intense fear was reported by 23% of the women and 13% of the men. The factor analysis identified four factors explaining 52% of the variance in woman and 50% in men. The factors were named ‘exposedness and inferiority’, ‘communicative difficulties’, ‘norms of harmony’ and ‘insecurity and danger’. The relative order of the factors varied in relation to gender, and in the women, ‘exposedness and inferiority’ had the greatest explanatory power, while this was true for ‘communicative difficulties’ in the men. Most factors were reported to a significantly higher extent by respondents with intense fear. The results are discussed from a gender perspective.

Gender patterns in minor head and neck injuries: An analysis of casualty register data

This study was designed to determine the age- and gender-specific incidences of moderate and minor head and neck injuries from emergency room casualty registers in two cities in northern Sweden. By contrast with findings in most studies on injuries, the incidence of minor and moderate head and neck injuries was higher among women than men in the 15-17- and the 39-53-year-old age group, and the incidence of neck injuries as high among women as among men in the 15-65-year-old age group. As compared to men, women more often sustained their head and neck injuries as pedestrians and as car passengers, and in rear-end and side collisions. Men were more often injured as motor vehicle drivers, in single-vehicle accidents and head-on collisions. Sports-related impact injuries were twice as common as fall injuries among men, the reverse being true of women. The determinants of gender-specific differences, and the relatively high incidence of minor head and neck injuries among women are discussed in relation to exposure, physical differences, as well as behaviour and lifestyle. It is recommended that greater detail is required in injury registrations, and that neck injury prevention be improved taking into consideration womens greater vulnerability to such injuries.

Chronic Posttraumatic Syndrome after Whiplash Injury: A Pilot Study of 22 Patients

Chronic posttraumatic syndrome after whiplash injury presents several problems to the general practitioner, due largely to the discrepancy between the multiplicity of subjective symptoms and the poverty of objective findings. With the aim of analysing the symptoms and signs of this syndrome and of evaluating the significance of extended physical examination, 22 chronically disabled patients were investigated. The chronic syndrome is characterized by widespread symptoms, migrainous headache, and aggravation following physical activity. Extended physical examination, including an analysis of pain reaction elicited by palpation and a nerve tension test of the brachial plexus, together with negative X-ray examination, supports a common origin of symptoms in soft tissue injury and a disturbance of locomotor function. On the basis of this study we propose an alternative approach to diagnosis and care for these patients.

Medical intelligence in Sweden. Vitamin B12: oral compared with parenteral?

Background: Sweden is the only country in which oral high dose vitamin B12 has gained widespread use in the treatment of deficiency states. Objective: The aim of the study was to describe prescribing patterns and sales statistics of vitamin B12 tablets and injections in Sweden 1990–2000. Design, setting, and sources: Official statistics of cobalamin prescriptions and sales were used. Results: The use of vitamin B12 increased in Sweden 1990–2000, mainly because of an increase in the use of oral high dose vitamin B12 therapy. The experience, in statistical terms a “total investigation”, comprised 1 000 000 patient years for tablets and 750 000 patient years for injections. During 2000, 13% of residents aged 70 and over were treated with vitamin B12, two of three with the tablet preparation. Most patients in Sweden requiring vitamin B12 therapy have transferred from parenteral to oral high dose vitamin B12 since 1964, when the oral preparation was introduced. Conclusion: The findings suggest that many patients in other post-industrial societies may also be suitable for oral vitamin B12 treatment.

Eyes Wide Shut--sexuality and risk in HIV-positive youth in Sweden: a qualitative study.

Aims: This study explores the perception of sexual risk-taking behaviour in young HIV+ women and men in Sweden and their understanding of why they caught HIV. Method: In-depth interviews were conducted with 10 HIV+ women and men aged 17—24 years, 7 born in Sweden and 3 immigrants. Interviews were tape-recorded, transcribed verbatim, and analysed according to the stages of grounded theory. Results: The core category varying agency in the gendered sexual arena illustrated a spectrum of power available to these informants during sexual encounters. Two subcategories contextualized sexual practice: sociocultural blinds and from consensual to forced sex. Lack of adult supervision as a child, naïve views, being in love, alcohol and drugs, the macho ideal, and cultures of silence surrounding sexuality both individually and structurally all blinded them to the risks, making them vulnerable. Grouping narratives according to degree of consensus in sexual encounters demonstrated that sexual risks happened in a context of gendered power relations. Conclusion: This pioneering study reveals mechanisms that contribute to vulnerability and varied agency that may help in understanding why and how young people are at risk of contracting HIV. Public health strategies, which consider the role of gender and social background in the context of risky behaviours, could be developed from these findings.

Prevalence of sexualized violence among women. A population-based study in a primary healthcare district.

In order to estimate the prevalence of sexual and physical abuse, postal questionnaires were sent to a random sample of 251 adult women in a primary care district. Three yes/no-questions were asked on these topics, and a fourth inquired into effects on health. Space was left for open-ended answers in which yes-responders were invited to write about their experiences. A total of 175 women (70%) answered, and 25 (14%) of these reported abuse. Nine (5%) had experienced women battering. Thirteen (7.5%) reported sexual abuse as an adult, and 12 (7%) as a child. Many told their stories. Methodological shortcomings in this study might explain why the rates are somewhat lower than in other investigations. However, our figures verified that abuse of women is a common social phenomenon. They also confirmed abuse as a major health problem for women. One-third of respondents explicitly reported effects on health. Others, though negating such effects, described them in written narratives. In order to study this contradiction, in-depth interviews with abused women are recommended.