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7.
  • Allebeck, P, et al. (author)
  • Swedish Council on Technology Assessment in Health Care (SBU). Chapter 3. Causes of sickness absence: research approaches and explanatory models
  • 2004
  • In: Scandinavian journal of public health. Supplement. - : SAGE Publications. - 1403-4956 .- 1403-4948 .- 1651-1905. ; 3263, s. 36-43
  • Journal article (peer-reviewed)abstract
    • Research on sickness absence, emanating from different theoretical perspectives and questions, is carried out within several different scientific disciplines. Studies are often based on explanatory models addressing the causes of sickness absence. Here, a brief summary of the various approaches and explanatory models used in sickness-absence research is presented. Also explanatory models for changes over time in sickness absence are briefly discussed.
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8.
  • Allebeck, P, et al. (author)
  • Swedish Council on Technology Assessment in Health Care (SBU). Chapter 5. Risk factors for sick leave - general studies
  • 2004
  • In: Scandinavian journal of public health. Supplement. - : SAGE Publications. - 1403-4956 .- 1403-4948 .- 1651-1905. ; 3263, s. 49-108
  • Journal article (peer-reviewed)abstract
    • Extensive information is available from official statistics and descriptive studies on the association between different socio-demographic background factors and sickness absence. This information addresses age, gender, place of residence, and socio-economic status. However, few studies have thoroughly analysed these background factors, and rigorous scientific evidence on the causal relationship between these factors and sick leave is lacking. Regarding the family, we found no scientific evidence that marital status or children living at home were associated with sickness absence. However, we found limited scientific evidence for an effect of divorce. Regarding work-related factors, we found limited scientific evidence for an effect of physically stressful work, and moderate scientific evidence for low psychological control over the work situation. We found limited scientific evidence for a correlation in time between unemployment and sickness absence, but insufficient scientific evidence for the causes of the association. There was moderate scientific evidence that the amount of sickness absence is influenced by the design of the social insurance system, but insufficient evidence on the magnitude of change required to influence the level of sickness absence. Essentially the same results apply to disability pension, although the number of studies is small. However, we found moderate scientific evidence for the effects of socio-economic status, which could be explained partly by childhood experiences.
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  • Brew, Bronwyn K., et al. (author)
  • Using fathers as a negative control exposure to test the Developmental Origins of Health and Disease Hypothesis : A case study on maternal distress and offspring asthma using Swedish register data
  • 2017
  • In: Scandinavian Journal of Public Health. - Stockholm : Sage Publications. - 1403-4948 .- 1651-1905. ; 45:17, s. 36-40
  • Journal article (peer-reviewed)abstract
    • Background: Developmental Origins of Health and Disease Hypothesis (DOHaD) studies are often observational in nature and are therefore prone to biases from loss to follow-up and unmeasured confounding. Register-based studies can reduce these issues since they allow almost complete follow-up and provide information on fathers that can be used in a negative control analysis to assess the impact of unmeasured confounding.Aim: The aim of this study was to propose a causal model for testing DOHaD using paternal exposure as a negative control, and its application to maternal distress in pregnancy and offspring asthma.Methods: A causal diagram including shared and parent-specific measured and unmeasured confounders for maternal (fetal) and paternal exposures is proposed. The case study consisted of all children born in Sweden from July 2006 to December 2008 (n=254,150). Information about childhood asthma, parental distress and covariates was obtained from the Swedish national health registers. Associations between maternal and paternal distress during pregnancy and offspring asthma at age five years were assessed separately and with mutual adjustment for the other parent's distress measure, as well as for shared confounders.Results: Maternal distress during pregnancy was associated with offspring asthma risk; mutually adjusted odds ratio (OR) (OR 1.32, 95% CI 1.23, 1.43). The mutually adjusted paternal distress-offspring asthma analysis (OR 1.05, 95% CI 0.97, 1.13) indicated no evidence for unmeasured confounding shared by the mother and father.Conclusions: Using paternal exposure in a negative control model to test the robustness of fetal programming hypotheses can be a relatively simple extension of conventional observational studies but limitations need to be considered.
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11.
  • Byass, P (author)
  • Patterns of mortality in Bavi, Vietnam, 1999-2001
  • 2003
  • In: Scandinavian journal of public health. Supplement. - : SAGE Publications. - 1403-4956 .- 1403-4948 .- 1651-1905. ; 3162, s. 8-11
  • Journal article (peer-reviewed)abstract
    • Aims: Demographic data including detailed mortality patterns for Vietnam are relatively sparse, mainly coming from national census data. This paper describes detailed mortality findings from a sample drawn from the population of one district of northern Vietnam, over the three-year period 1999-2001. Methods: These data were based on quarterly household visits to collect data on vital events, covering 142,318 person-years of observation over a three-year period. Results: Crude mortality was 5.1 per 1,000 person-years (4.7 for females and 5.6 for males). Infant mortality was 21.6 per 1,000 live births and crude birth rate was 14.7 per 1,000. Life expectancy at birth was 75.2 years (78.8 year for females and 71.1 for males). Residents of mountainous and highland areas experienced lower mortality than riverside and island dwellers. Conclusions: These findings are discussed in the light of two major demographic factors: the legacy of the Vietnam War and, more recently, the effect of Vietnam's two-child policy. Although these mortality estimates seem low, there is good reason to believe that they accurately reflect the current state of this population. Vietnam as a whole enjoys low mortality in relation to its socioeconomic status compared with neighbouring countries.
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  • Eriksson, Marie, et al. (author)
  • MONICA quality assessments.
  • 2003
  • In: Scandinavian journal of public health. Supplement. - : SAGE Publications. - 1403-4956 .- 1403-4948 .- 1651-1905. ; 61, s. 25-30
  • Journal article (peer-reviewed)abstract
    • The authors give an overview of the quality assessments in the WHO MONICA project and compare the quality of the data from Northern Sweden with other reporting units. METHODS AND RESULTS: Standardized measurement procedures and routine checks were used to ensure good quality of the data. The quality has been evaluated by a scoring system. The results show that the data from Northern Sweden have good quality for all variables except total cholesterol in the initial survey. In the subsequent surveys, the quality of cholesterol data was good. CONCLUSIONS: Great effort was put in to ensure good data quality and Northern Sweden is one of the MONICA units with very good quality of data.
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14.
  • Hallmans, Göran, et al. (author)
  • Cardiovascular disease and diabetes in the Northern Sweden Health and Disease Study Cohort : evaluation of risk factors and their interactions.
  • 2003
  • In: Scandinavian Journal of Public Health. Supplement Links. - : SAGE Publications. - 1403-4956 .- 1403-4948 .- 1651-1905. ; 61, s. 18-24
  • Journal article (peer-reviewed)abstract
    • The purpose of this paper is, first, to describe the organization, sampling procedures, availability of samples/database, ethical considerations, and quality control program of the Northern Sweden Health and Disease Study Cohort. Secondly, some examples are given of studies on cardiovascular disease and diabetes with a focus on the biomarker programme. The cohort has been positioned as a national and international resource for scientific research.
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15.
  • Hang, Hoang Minh, et al. (author)
  • Community-based assessment of unintentional injuries: a pilot study in rural Vietnam
  • 2003
  • In: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905 .- 1403-4956. ; 31:Supplement 62, s. 38-44
  • Journal article (peer-reviewed)abstract
    • AIMS: Although unintentional injuries are recognised as a major public health problem globally, little is known about their patterns and rates at the community level in most low-income countries. Rapid social development, leading to increased traffic and industrialization, may be changing patterns of injury. Injuries within the home environment have not so far been recognized to the same extent as traffic and work-related injuries in Vietnam, largely because they have not been effectively counted. This study took place in northern Vietnam, in the context of a longitudinal community surveillance site called FilaBavi, as a pilot project aiming to determine the community incidence of unintentional injury and to explore appropriate methods for community-based injury surveillance. METHODS: An initial study population of 23,807 was identified and asked about their experience of injury in the preceding three months. RESULTS: Overall 450 new injuries were detected over 5,952 person-years, a rate of 76 per 1,000 person-years. Males were injured at 1.6 times the rate of females, and home and road traffic accidents were most common. Most injuries occurred during unpaid household tasks. Cutting and crushing injuries occurred most frequently. Of 221 deaths from all causes in the FilaBavi population during 1999 among 43,444 person-years, 25 were attributed to unintentional injuries and two to suicide. Unintentional injury was the third leading cause of death in this community, with a case-fatality rate of 0.8%. DISCUSSION: The findings suggest that greater attention needs to be directed toward the prevention of injuries occurring in the home in rural Vietnam. On the basis of this pilot study, a one-year study using the same approach is under way to characterize the patterns of unintentional injury in more detail, including any seasonal variation.
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16.
  • Hansson, Tommy H., 1943, et al. (author)
  • Swedish Council on Technology Assessment in Health Care (SBU). Chapter 6. Sickness absence due to back and neck disorders
  • 2004
  • In: Scand J Public Health Suppl. - : SAGE Publications. - 1403-4956 .- 1403-4948 .- 1651-1905. ; 63, s. 109-51
  • Journal article (peer-reviewed)abstract
    • The scientific evidence on the causes for sick leave attributed to back and neck disorders was reviewed. Categories were established for acute, recurring, and chronic problems based on the duration of the sick leave period. Forty-eight articles were found to be relevant, whereof two were of high quality and 26 were of medium or low quality. Quality was assessed exclusively in relation to the aim of this systematic review. The results reveal limited published research on causes for sick leave from back and neck disorders. The generalisability of the findings is also limited since most of the subjects were men and employees in manufacturing industries. Women, white-collar workers, employees in the public sector (care, social services, schools, etc) were underrepresented in the studies. Hence, these groups and areas should be studied further to verify conclusions and enhance knowledge about the causes for sick leave from back and neck disorders. The following factors were found to have consistent, but limited, support as regards their influence on the risk for sick leave due to back and neck disorders: (a) heavy physical workload, bent or twisted working position, and low work satisfaction increases the risk for short-term and long-term sick leave; (b) specific back diagnoses and previous sick leave due to back disorders increases the risk for short-term and long-term sick leave; (c) female gender, smoking, exposure to vibration, and deficient social support were not found to significantly increase the risk for short-term and long-term sick leave; (d) self-reported pain and functional impairments were associated with a high risk for long-term sick leave; (e) longer employment periods reduced the risk for short-term sick leave; (f) perceived demands at work did not influence short-term sick leave; (g) female gender and higher age increases the risk for disability pension.
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  • Hensing, Gunnel, 1956, et al. (author)
  • Swedish Council on Technology Assessment in Health Care (SBU). Chapter 7. Sickness absence and psychiatric disorders.
  • 2004
  • In: Scandinavian journal of public health. Supplement. - : SAGE Publications. - 1403-4956 .- 1403-4948 .- 1651-1905. ; 63, s. 152-80
  • Research review (peer-reviewed)abstract
    • There is limited scientific evidence that women have a higher frequency and incidence of sickness absence due to psychiatric diagnoses. Because of conflicting findings, there is insufficient evidence on gender differences in the duration of sickness absence. Because of conflicting findings, there is also insufficient evidence on the association between age and sickness absence with psychiatric diagnoses. There is insufficient evidence on the association of sickness absence due to psychiatric diagnoses with work-related factors, factors related to family and social networks outside of the job, and psychosocial factors in childhood and adolescence since none of the individual factors were investigated in more than a single study. The results were conflicting (insufficient evidence) in five studies that investigated whether individuals with psychiatric disorders were at greater risk for sickness absence and disability pension, irrespective of the diagnosis on the sickness certificate. The four studies that used alcohol diagnoses to identify alcohol problems found increased sickness absence irrespective of the diagnosis on the certificate (expressed as more sick-leave days or an increased risk for prolonged sickness absence in individuals with alcohol problems). Furthermore, two of the studies found an increased risk for disability pension in women diagnosed with alcohol problems. There is insufficient evidence because of too few studies. The results are conflicting with regard to the association between high alcohol consumption and sickness absence, irrespective of the diagnosis on the certificate (insufficient evidence).
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20.
  • Hoa, NP, et al. (author)
  • Knowledge of tuberculosis and associated health-seeking behaviour among rural Vietnamese adults with a cough for at least three weeks
  • 2003
  • In: Scandinavian journal of public health. Supplement. - : SAGE Publications. - 1403-4956 .- 1403-4948 .- 1651-1905. ; 3162, s. 59-65
  • Journal article (peer-reviewed)abstract
    • Aims: Good general lay knowledge of tuberculosis (TB), its cause and treatment is considered important for both prompt healthcare seeking and adherence to treatment. The main aim of this study was to describe the knowledge of TB among men and women with a cough for more than three weeks and to see how their health seeking related to TB knowledge. Methods: A population-based survey was carried out within a demographic surveillance site in Vietnam. The study population included 35,832 adults aged 15 years or over. Cough cases were identified at household level and structured interviews were carried out with all cases of cough in person. Results: A total of 559 people (1.6%) reported coughing with a duration of three weeks or longer (259 men and 300 women). A large proportion of individuals with a cough for more than three weeks had limited knowledge of the causes, transmission modes, symptoms, and curability of TB. Men had a significantly higher knowledge score than women (3.04 vs 2.55). Better knowledge was significantly related to seeking healthcare and seeking hospital care. More men than women did not take any health care action at all. Discussion: Health education for TB thus seems to be useful, but efforts must be made to ensure that both men and women in different socioeconomic contexts can access the information.
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  • Kahn, Kathleen, et al. (author)
  • Mortality trends in a new South Africa : hard to make a fresh start
  • 2007
  • In: Scandinavian journal of public health. Supplement. - : SAGE Publications. - 1403-4956 .- 1403-4948 .- 1651-1905. ; 35:69 Suppl., s. 26-34
  • Journal article (peer-reviewed)abstract
    • Aims: This paper examines trends in age-specific mortality in a rural South African population from 1992 to 2003, a decade spanning major sociopolitical change and emergence of the HIV/AIDS pandemic. Changing mortality patterns are discussed within a health-transition framework. Methods: Data on population size, structure, and deaths, obtained from the Agincourt health and demographic surveillance system, were used to calculate person-years at risk and death rates. Life tables were computed by age, sex and calendar year. Mortality rates for the early period 1992—93 and a decade later, 2002— 03, were compared. Results: Findings demonstrate significant increases in mortality for both sexes since the mid-1990s, with a rapid decline in life expectancy of 12 years in females and 14 years in males. The increases are most prominent in children (0—4) and young adult (20—49) age groups, in which increases of two- and fivefold respectively have been observed in the past decade. Sex differences in mortality patterns are evident with increases more marked in females in most adult age groups. Conclusions: Empirical data demonstrate a marked ``counter transition'' with mortality increasing in children and young adults, ``epidemiologic polarization'' with vulnerable subgroups experiencing a higher mortality burden, and a ``protracted transition'' with simultaneous emergence of HIV/AIDS together with increasing non-communicable disease in older adults. The health transition in rural South Africa is unlikely to predict patterns elsewhere; hence the need to examine trends in as many contexts as have the data to support such analyses.
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22.
  • Khe, ND, et al. (author)
  • Faces of poverty: sensitivity and specificity of economic classifications in rural Vietnam
  • 2003
  • In: Scandinavian journal of public health. Supplement. - : SAGE Publications. - 1403-4956 .- 1403-4948 .- 1651-1905. ; 3162, s. 70-75
  • Journal article (peer-reviewed)abstract
    • Aims: Poverty concepts and measurements have occupied philosophers for centuries and are subject to debate by researchers. A wide range of possible measures have been developed and used. Most research is country specific and different methods produce different pictures of poverty. This study aimed to compare measures of poverty within an epidemiological field laboratory in Bavi District, northern Vietnam (FilaBavi) and specifically to find out whether the official economic classification made by the local authority matched other measurements of socioeconomic status. Methods: Structured questionnaires were used to collect socioeconomic information in 11,547 households. In addition, the official classification for individual households was recorded. Five economic indicators were constructed: income, expenditure, household assets, housing conditions, and local authority's estimation. Results: Official economic classification and housing score were symmetrically distributed, while assets score and particularly income were highly skewed. Design effects were high because of high intra-cluster correlations. No indicator was closely correlated with any other. Sensitivity and positive predictive value for poverty were generally low for all indicators. Discussion: The authors' findings do not suggest that any of the indicators used is substantially better than the other or better than the Official Economic Classification made by local authority. The results also show that no indicator is particularly useful to predict the values of any other indicator and different poverty indicators may classify different socioeconomic groups as poor.
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23.
  • Larsson, K, et al. (author)
  • Chapter 8: old people's health
  • 2006
  • In: Scandinavian journal of public health. Supplement. - : SAGE Publications. - 1403-4956 .- 1403-4948 .- 1651-1905. ; 3467, s. 185-198
  • Journal article (peer-reviewed)
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24.
  • Larsson, K, et al. (author)
  • Chapter 8: old people's health
  • 2006
  • In: Scandinavian journal of public health. Supplement. - : SAGE Publications. - 1403-4956 .- 1403-4948 .- 1651-1905. ; 67, s. 185-98
  • Journal article (peer-reviewed)
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25.
  • Lindahl, Bernt, et al. (author)
  • Trends in lifestyle 1986-99 in a 25- to 64-year-old population of the Northern Sweden MONICA project.
  • 2003
  • In: Scandinavian Journal of Public Health. Supplement. - : SAGE Publications. - 1403-4956 .- 1403-4948 .- 1651-1905. ; 61, s. 31-7
  • Journal article (peer-reviewed)abstract
    • AIMS: The authors explore the time trends in lifestyle factors in the Northern Sweden MONICA population, including physical activity, intake of certain foods, coffee and alcohol consumption, smoking, and the use of smokeless tobacco. METHODS: Four health surveys during a 14-year time span were compared (1986, 1990, 1994, and 1999). The participation rate in all surveys was high. A questionnaire with similar or comparable questions about lifestyle factors was used across all health surveys. RESULTS: A large variation was demonstrated in the consumption of saturated fat in dairy products across the surveys. The use of butter on bread and of 3% fat milk clearly declined in favour of using low-fat margarine and 1-1.5% fat milk. A decline in the intake of boiled or baked potatoes together with an increase in the intake of pasta and rice was demonstrated. There were no changes in leisure-time physical activity. The proportion of the population using tobacco was unaltered. In men, smoking declined during the period but simultaneously there was an increase in the use of smokeless tobacco. The use of "boiled" or Scandinavian coffee diminished and more frequent use of alcohol was seen, especially in men. CONCLUSION: Pronounced changes were seen in food consumption with a decrease in saturated fat intake, boiled coffee, and potatoes and an increase in alcohol, rice, and pasta consumption. No clear time trends were found in physical activity or in the use of tobacco.
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26.
  • Maret-Ouda, John, et al. (author)
  • Nordic registry-based cohort studies : possibilities and pitfalls when combining Nordic registry data
  • 2017
  • In: Scandinavian Journal of Public Health. - Stockholm : Karolinska Institutet, Dept of Molecular Medicine and Surgery. - 1403-4948 .- 1651-1905.
  • Journal article (peer-reviewed)abstract
    • Aims: All five Nordic countries (Denmark, Finland, Iceland, Norway, and Sweden) have nationwide registries with similar data structure and validity, as well as personal identity numbers enabling linkage between registries. These resources provide opportunities for medical research that is based on large registry-based cohort studies with long and complete follow-up. This review describes practical aspects, opportunities, and challenges encountered when setting up all-Nordic registry-based cohort studies. Methods: Relevant articles describing registries often used for medical research in the Nordic countries were retrieved. Further, our experiences of conducting this type of study, including planning, acquiring permissions, data retrieval, and data cleaning and handling, and the possibilities and challenges we have encountered, are described. Results: Combining data from the Nordic countries makes it possible to create large and powerful cohorts. The main challenges include obtaining all permissions within each country, usually in the local language, and to retrieve the data. These challenges emphasise the importance of having experienced collaborators within each country. Following the acquisition of data, data management requires the understanding of differences between the variables to be used in the various countries. A concern is the long time required between initiation and completion. Conclusions: Nationwide Nordic registries can be combined into cohorts with high validity and statistical power, but the considerable expertise, workload, and time required to complete such cohorts should not be underestimated.
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27.
  • Nguyen, TKC, et al. (author)
  • FilaBavi, a demographic surveillance site, an epidemiological field laboratory in Vietnam
  • 2003
  • In: Scandinavian journal of public health. Supplement. - : SAGE Publications. - 1403-4956 .- 1403-4948 .- 1651-1905. ; 3162, s. 3-7
  • Journal article (peer-reviewed)abstract
    • Background: This Supplement to the Scandinavian Journal of Public Health brings together a collection of community-based studies for which the common denominator is a demographic surveillance site, FilaBavi, established in northern Vietnam in 1999. This introductory paper sets out some of the background to FilaBavi as well as setting the scene for the individual studies.
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28.
  • Perk, J, et al. (author)
  • Swedish Council on Technology Assessment in Health Care (SBU). Chapter 8. Sick leave due to coronary artery disease or stroke
  • 2004
  • In: Scandinavian journal of public health. Supplement. - : SAGE Publications. - 1403-4956 .- 1403-4948 .- 1651-1905. ; 3263, s. 181-206
  • Journal article (peer-reviewed)abstract
    • The assessment of the literature on sick-leave with cardiovascular diseases include only studies with sufficient scientific quality. These studies describe sick leave following stroke, myocardial infarction, coronary artery bypass grafting (CABG), or percutaneous coronary intervention (PCI). We found limited scientific evidence for the following results: After stroke, more than half of the patients of working age returned to work (RTW) during the first year following onset (higher rate for the younger patients). The consequences of brain damage, e.g. impaired ADL ability or cognitive capacity, play an important role in this respect. Also after myocardial infarction most patients RTW. PCI is a milder coronary artery intervention than CABG and RTW is more rapid. However, in the long run there are no differences in sick leave. People at higher ages or with physically demanding jobs return to work to a lesser degree. An international comparison shows that the duration of sick leave due to these conditions in Sweden is longer than in other countries although there is no scientific evidence to support this practice. It appears that the interest in research on sick leave in patients with cardiovascular diseases has waned in recent years. Developments in acute cardiological care should inspire renewed scientific involvement in this area of research.
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29.
  • Perk, J, et al. (author)
  • Swedish Council on Technology Assessment in Health Care (SBU). Chapter 8. Sick leave due to coronary artery disease or stroke
  • 2004
  • In: Scandinavian journal of public health. Supplement. - : SAGE Publications. - 1403-4956 .- 1403-4948 .- 1651-1905. ; 63, s. 181-206
  • Journal article (peer-reviewed)abstract
    • The assessment of the literature on sick-leave with cardiovascular diseases include only studies with sufficient scientific quality. These studies describe sick leave following stroke, myocardial infarction, coronary artery bypass grafting (CABG), or percutaneous coronary intervention (PCI). We found limited scientific evidence for the following results: After stroke, more than half of the patients of working age returned to work (RTW) during the first year following onset (higher rate for the younger patients). The consequences of brain damage, e.g. impaired ADL ability or cognitive capacity, play an important role in this respect. Also after myocardial infarction most patients RTW. PCI is a milder coronary artery intervention than CABG and RTW is more rapid. However, in the long run there are no differences in sick leave. People at higher ages or with physically demanding jobs return to work to a lesser degree. An international comparison shows that the duration of sick leave due to these conditions in Sweden is longer than in other countries although there is no scientific evidence to support this practice. It appears that the interest in research on sick leave in patients with cardiovascular diseases has waned in recent years. Developments in acute cardiological care should inspire renewed scientific involvement in this area of research.
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33.
  • Stegmayr, Birgitta, et al. (author)
  • The events registration and survey procedures in the Northern Sweden MONICA Project.
  • 2003
  • In: Scand J Public Health Suppl. - : SAGE Publications. - 1403-4956. ; 61, s. 9-17
  • Journal article (peer-reviewed)abstract
    • Introduction: The WHO MONICA Project (Multinational Monitoring of Trends and Determinants in Cardiovascular Disease) was initiated in 1982. The purpose was to evaluate to what extent mortality trends could be explained by changes over time in the population load of conventional cardiovascular risk factors. To test this hypothesis, time trends in cardiovascular event rates have been correlated with trends in levels of risk factors in 35- to 64-year-old men and women in 38 populations. In most MONICA populations, the study has covered a period of 10 years or more. Methods: All acute myocardial infarction and stroke events have been registered in a population-based setting in Norrbotten and Västerbotten counties from 1985 and onwards. The total population is approximately 510,000 inhabitants. In the frame of the WHO MONICA Project, the same strict criteria have been used in all years. Another part of the MONICA Project is population risk factor surveys. In Northern Sweden the first survey took place in 1986 and the following surveys were performed in 1990, 1994, and 1999, including the age group 25 - 74 years (the first two surveys were of the age range 25 - 64 years). Results: From 1985 to 2000, in total 18,105 suspected stroke events, aged 25 - 74 years, were scrutinized and validated at the central stroke office in Northern Sweden. Of these, 13,908 were found to fulfil the MONICA criteria of an acute stroke. During the period 1985 to 1998, in total 13,228 cases of suspected acute myocardial infarction, aged 25 - 64 years, were registered. Of these, 8,744 fulfilled the MONICA criteria for acute myocardial infarction. In the four surveys, in total 9,000 randomly selected men and women were invited for survey. Of these 6,952 (77%) participated in the surveys. Conclusion: From 1985 and onwards, the WHO MONICA project has been going on in Northern Sweden. During the whole time the same strict WHO criteria have been followed.
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34.
  • Thanh, Nguyen Xuan, et al. (author)
  • The economic burden of unintentional injuries : a community-based cost analysis in Bavi, Vietnam.
  • 2003
  • In: Scandinavian journal of public health. Supplement. - : SAGE Publications. - 1403-4956 .- 1403-4948 .- 1651-1905. ; 62, s. 45-51
  • Journal article (peer-reviewed)abstract
    • AIMS: Relatively little is known about patterns of injury at the community level in Vietnam and their economic consequences. This study sought to estimate the costs of various unintentional injuries in Bavi District during one year; to describe how costs depended on gender, age, circumstances, and severity of injury; and to describe how the economic burden of unintentional injuries was distributed between households, government, and health insurance agency. METHODS: A cohort study was undertaken, which involved four cross-sectional household surveys among sampled communities in the Bavi District during the year 2000, each asking about injuries in the preceding three months. The costing system in public healthcare in Vietnam was applied as well as information from the victims. RESULTS: The total cost of injuries over one year in Bavi District was estimated to be D3,412,539,000 (Vietnamese dong) (US$235,347), equivalent to the annual income of 1,800 people. In total, 90% of this economic burden fell on households, only 8% on government, and 2% on the health insurance agency. The cost of a severe injury to the corresponded to approximately seven months of earned income. Home and traffic injuries together accounted for more than 80% of the total cost, 45% and 38% respectively. The highest unit cost was related to traffic injuries, followed by home, "other", work-related, and school injuries in descending order. DISCUSSION: The results can be considered as an economic baseline that can be used in evaluations of future interventions aimed at preventing injuries.
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35.
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36.
  • Vingard, E, et al. (author)
  • Swedish Council on Technology Assessment in Health Care (SBU). Chapter 10. Sickness presence
  • 2004
  • In: Scandinavian journal of public health. Supplement. - : SAGE Publications. - 1403-4956 .- 1403-4948 .- 1651-1905. ; 3263, s. 216-221
  • Journal article (peer-reviewed)abstract
    • The term "sickness presence'' is used to describe situations where the ability to work is impaired due to disease, but yet the person goes to work. A problem is that the term "sickness presence'' implies that being present at work is something exceptional if a person is sick. Most people diagnosed with a disease or disorder do, however, go to work and are not sick listed. Furthermore, the term "sickness presence'' is rather diffuse, and it would be beneficial if one or several more specific terms could be used. The current body of scientific literature does not provide sufficient evidence to draw conclusions on the consequences of sickness presence.
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37.
  • Vingard, E, et al. (author)
  • Swedish Council on Technology Assessment in Health Care (SBU). Chapter 9. Consequences of being on sick leave
  • 2004
  • In: Scandinavian journal of public health. Supplement. - : SAGE Publications. - 1403-4956 .- 1403-4948 .- 1651-1905. ; 3263, s. 207-215
  • Journal article (peer-reviewed)abstract
    • The possible consequences of sick leave can be measured at different levels in society. This chapter focuses on the consequences from the perspective of the sick-listed individual. Sick leave may have both positive and negative consequences for the individual, e.g. regarding disease, health, working life, social life, lifestyle, and emotional aspects. Some of these factors have been investigated in different studies. However, scientific evidence is insufficient since there are too few studies on the consequences of sickness absence and disability pension. The lack of relevant studies is the most striking observation from the review of studies on the consequences of being sick listed.
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38.
  • Vingård, E, et al. (author)
  • Swedish Council on Technology Assessment in Health Care (SBU). Chapter 9. Consequences of being on sick leave
  • 2004
  • In: Scandinavian journal of public health. Supplement. - : SAGE Publications. - 1403-4956 .- 1403-4948 .- 1651-1905. ; 63, s. 207-15
  • Journal article (peer-reviewed)abstract
    • The possible consequences of sick leave can be measured at different levels in society. This chapter focuses on the consequences from the perspective of the sick-listed individual. Sick leave may have both positive and negative consequences for the individual, e.g. regarding disease, health, working life, social life, lifestyle, and emotional aspects. Some of these factors have been investigated in different studies. However, scientific evidence is insufficient since there are too few studies on the consequences of sickness absence and disability pension. The lack of relevant studies is the most striking observation from the review of studies on the consequences of being sick listed.
  •  
39.
  • Wahlstrom, R, et al. (author)
  • Swedish Council on Technology Assessment in Health Care (SBU). Chapter 11. Physicians' sick-listing practices
  • 2004
  • In: Scandinavian journal of public health. Supplement. - : SAGE Publications. - 1403-4956 .- 1403-4948 .- 1651-1905. ; 3263, s. 222-255
  • Journal article (peer-reviewed)abstract
    • Physicians' sick-listing practices have been studied to a very limited extent. There is limited scientific evidence that physicians perceive sick-listing duties to be difficult and problematic, regarding both the medical and the insurance-related aspects. There is limited scientific evidence also that quality is often deficient in the sickness certificates issued by physicians. This may affect case management at the local insurance office. There is insufficient scientific evidence to explain the differences in physicians' sick-listing patterns. The effects on patients are also insufficiently studied.
  •  
40.
  • Wahlström, R, et al. (author)
  • Swedish Council on Technology Assessment in Health Care (SBU). Chapter 11. Physicians' sick-listing practices
  • 2004
  • In: Scandinavian journal of public health. Supplement. - : SAGE Publications. - 1403-4956 .- 1403-4948 .- 1651-1905. ; 63, s. 222-55
  • Journal article (peer-reviewed)abstract
    • Physicians' sick-listing practices have been studied to a very limited extent. There is limited scientific evidence that physicians perceive sick-listing duties to be difficult and problematic, regarding both the medical and the insurance-related aspects. There is limited scientific evidence also that quality is often deficient in the sickness certificates issued by physicians. This may affect case management at the local insurance office. There is insufficient scientific evidence to explain the differences in physicians' sick-listing patterns. The effects on patients are also insufficiently studied.
  •  
41.
  • Persson Osowski, Christine, et al. (author)
  • Energy and nutrient intakes of Swedish children in relation to consumption of and habits associated with school lunch
  • 2017
  • In: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 45:1, s. 3-9
  • Journal article (peer-reviewed)abstract
    • Aims: School lunches are provided free in Sweden, although some children choose not to eat school lunch. The aim of this study was to analyse Swedish children's total energy and nutrient intakes on weekdays by the frequency of school lunch consumption and to analyse energy and nutrient intakes from school lunches by sex. Factors associated with children's school lunch habits were also studied. Methods: Children in grades 2 and 5 (n=1905) completed a food diary (school lunch data available for 1840 children) and the mean energy and nutrient intakes per day and per school lunch were calculated. The children also completed questions on the frequency of school lunch consumption and school lunch habits. Logistic regression was used to assess factors associated with school lunch habits. Results: Children who reported eating school lunch every day had significantly higher energy and absolute nutrient intakes than children reporting eating school lunch less than five times a week, but not standardized for energy. Boys had significantly higher energy and absolute nutrient intakes from school lunches than girls, but not standardized for energy. Younger children and children who liked school lunches had higher odds of eating school lunch every day. Children in grade 5, those with a foreign background and those disliking school lunches had higher odds of omitting the main lunch component. Conclusions: Regular school lunch consumption was associated with a higher total intake for most nutrients, but not a better nutrient density. School lunch habits were associated with age, ethnic background and liking school lunches.
  •  
42.
  • Aaro, LE, et al. (author)
  • Promoting sexual and reproductive health in early adolescence in South Africa and Tanzania: development of a theory- and evidence-based intervention programme
  • 2006
  • In: Scandinavian journal of public health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 34:2, s. 150-158
  • Journal article (peer-reviewed)abstract
    • Aims: Action to prevent the spread of HIV among young people in Sub-Saharan Africa is needed urgently. In order to be effective, such action should be theory and evidence based and carefully adapted to local cultures and contexts. The present article describes the organization, theoretical basis, and methodological approach of a project that aims at developing and evaluating school-based interventions targeting adolescents aged 12—14 years. Methods: Researchers from European and African universities have developed interventions that were conducted in three sites: Cape Town and Polokwane (South Africa) and Dar es Salaam (Tanzania). In each site the interventions were evaluated through large-scale field experiments with intervention schools and delayed intervention schools and with baseline and two follow-up data collections. Mimimum sample sizes were estimated for each site based on local data and taking into acount that the unit of allocation was schools and not individual students (the design effect). During the formative phase as well as within the field experiments, qualitative studies were also conducted. Discussion: The interventions were developed consistent with the Intervention Mapping approach, and the theoretical framework was based on a modified version of the Theory of Planned Behaviour. The limitations of Western social cognition models were recognized, and the theoretical framework has therefore been expanded in two directions: towards integrating cultural processes and towards taking societal factors and constraints into account. Conclusion: The project will throw light on the application of social cognition models as well as the usefulness of the Intervention Mapping approach to intervention development in sub-Saharan Africa.
  •  
43.
  • af Sillén, Ulrika, et al. (author)
  • Self-rated health in relation to age and gender: influence on mortality risk in the Malmö Preventive Project.
  • 2005
  • In: Scandinavian Journal of Public Health. - : SAGE Publications. - 1651-1905 .- 1403-4948. ; 33:3, s. 9-183
  • Journal article (peer-reviewed)abstract
    • Aims: A study was undertaken to examine whether poor self-rated health (SRH) can independently predict all-cause mortality during 22-year follow-up in middle-aged men and women. Subjects and methods: Data are derived from a population-based study in Malmo¨ , Sweden. This included baseline laboratory testing and a self-administered questionnaire. The question on global SRH was answered by 15,590 men (mean age 46.4 years) and 10,089 women (49.4 years). Social background characteristics (occupation, marital status) were based on data from national censuses. Mortality was retrieved from national registers. Results: At screening 4,261 (27.3%) men and 3,085 (30.6%) women reported poor SRH. Among subjects rating their SRH as low, 1,022 (24.0%) men and 228 (7.4%) women died during follow-up. Corresponding figures for subjects rating their SRH as high were 1801 (15.9%) men and 376 (5.4%) women. An analysis of survival in subjects reporting poor SRH revealed an age-adjusted hazard risk ratio (HR, 95%CI) for men HR 1.5 (1.4–1.7), and for women HR 1.4 (1.2–1.6). The corresponding HR after adjusting for possible social confounders was for men HR 1.3 (1.1–1.4), and women HR 1.1 (0.9–1.4). When additional adjustment was made for biological risk factors the association for men was still significant, HR 1.2 (1.1–1.3). Conclusion: Poor SRH predicts increased long-term mortality in healthy, middle-aged subjects. For men the association is independent of both social background and selected biological variables. The adjustment for biological variables can be questioned as they might represent mediating mechanisms in a possible causal chain of events.
  •  
44.
  • Agardh, Emilie E., et al. (author)
  • Alcohol and type 2 diabetes : The role of socioeconomic, lifestyle and psychosocial factors
  • 2019
  • In: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 47:4, s. 408-416
  • Journal article (peer-reviewed)abstract
    • AIMS: We investigate (a) alcohol consumption in association with type 2 diabetes, taking heavy episodic drinking (HED), socioeconomic, health and lifestyle, and psychosocial factors into account, and (b) whether a seemingly protective effect of moderate alcohol consumption on type 2 diabetes persists when stratified by occupational position.METHODS: This population-based longitudinal cohort study comprises 16,223 Swedes aged 18-84 years who answered questionnaires about lifestyle, including alcohol consumption in 2002, and who were followed-up for self-reported or register-based diabetes in 2003-2011. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated in a multivariable-adjusted logistic regression model for all participants and stratified by high and low occupational position. We adjusted for HED, socioeconomic (occupational position, cohabiting status and unemployment), health and lifestyle (body mass index (BMI), blood pressure, smoking, physical inactivity, poor general health, anxiety/depression and psychosocial (low job control and poor social support) characteristics one by one, and the sets of these factors.RESULTS: Moderate consumption was inversely associated with type 2 diabetes after controlling for health and lifestyle (OR=0.47; 95% CI: 0.29-0.79) and psychosocial factors (OR=0.40; 95% CI: 0.22-0.79) when compared to non-drinkers. When adjusting for socioeconomic factors, there was still an inverse but non-significant association (OR=0.59; 95% CI: 0.35-1.00). In those with high occupational position, there was no significant association between moderate consumption and type 2 diabetes after adjusting for socioeconomic (OR=0.67; 95% CI: 0.3-1.52), health and lifestyle (OR=0.70; 95% CI: 0.32-1.5), and psychosocial factors (OR=0.75; 95% CI: 0.23-2.46). On the contrary, in those with low occupational position, ORs decreased from 0.55 (95% CI: 0.28-1.1) to 0.35 (95% CI: 0.15-0.82) when adjusting for psychosocial factors, a decrease that was solely due to low job control. HED did not influence any of these associations.CONCLUSIONS: Moderate alcohol consumption is associated with a lower risk of type 2 diabetes, after adjusting for HED, health and lifestyle, and psychosocial characteristics. The association was inverse but non-significant after adjusting for socioeconomic factors. When stratified by occupational position, there was an inverse association only in those with low occupational position and after adjusting for low job control.
  •  
45.
  • Agardh, EE, et al. (author)
  • The magnitude of bias in a cross-sectional study on lifestyle factors in relation to Type 2 diabetes
  • 2006
  • In: Scandinavian journal of public health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 34:6, s. 665-668
  • Journal article (peer-reviewed)abstract
    • Aim: In cross-sectional studies it may be difficult to ascertain the temporal order of exposure and disease, which may have consequences for causal inference. The authors aimed to illustrate the possible magnitude of this potential bias using data from a cross-sectional study on coffee consumption and work stress in relation to type 2 diabetes. Methods: By a series of computer simulations the authors examined to what extent the observed negative association between type 2 diabetes and high coffee consumption and positive association between type 2 diabetes and high work stress could be due to reverse causality, by assuming that cases changed their exposures in response to development of the disease. Results: If the negative association between coffee and type 2 diabetes was a consequence of reversed causality, 30—40% of the cases would have to decrease their coffee consumption from≥5 cups of coffee per day to 3—4 cups per day and from 3—4 cups per day to≤2 cups of coffee per day. Moreover, approximately 60% of the cases would have to increase their work stress from low to medium work stress and from medium to high work stress, in order to produce the positive association with diabetes that was observed. Conclusion: Even if the type 2 diabetic patients to some extent may have changed their exposure in response to disease development, it seems unlikely that the associations observed between type 2 diabetes, coffee consumption, and work stress are due to this bias.
  •  
46.
  • Agerholm, J, et al. (author)
  • Socioeconomic differences in healthcare utilization, with and without adjustment for need: an example from Stockholm, Sweden
  • 2013
  • In: Scandinavian journal of public health. - : SAGE Publications. - 1651-1905 .- 1403-4948. ; 41:3, s. 318-325
  • Journal article (peer-reviewed)abstract
    • Aim: Previous studies have shown varying degrees of inequity of utilization of healthcare in Sweden. Studies based solely on register data cannot take into account differences in health status while studies based solely on self-reported data from surveys may potentially have biased data on healthcare utilization. The aim of this study was to investigate socioeconomic differences in utilization of outpatient healthcare services in Stockholm County, comparing analysis based on only register data, with analysis based on health survey data linked to register data. Methods: We linked data from a public health survey in Stockholm County 2006 ( n = 34,707) to register data on sociodemographic background characteristics and outpatient healthcare utilization in 2007. Negative binomial regression analysis was used to estimate income differentials in healthcare utilization adjusting for self-rated health and limiting longstanding illness. Results: Income differentials in the number of visits to doctors were found in favour of lower-income groups among people aged 25–64 years when only controlling for age. When controlling for health status, income differentials in favour of higher-income groups were observed among men (all ages) and among women aged 65+ years, with higher-income groups having 11–49% more visits than the lowest income group. Conclusions: The findings suggest that health status should be taken into account when analysing socioeconomic differences in healthcare utilization. When using only register based data there is a risk of underestimating or disregarding differences.
  •  
47.
  • Agerholm, Janne, et al. (author)
  • The organisation and responsibility for care for older people in Denmark, Finland and Sweden : outline and comparison of care systems
  • 2024
  • In: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 52:2, s. 119-122
  • Journal article (peer-reviewed)abstract
    • Aim: To outline the organisation and responsibility for health and social care provided to older people in Denmark, Finland and Sweden.Methods: Non-quantifiable data on the care systems were collated from the literature and expert consultations. The responsibilities for primary healthcare, specialised healthcare, prevention and health promotion, rehabilitation, and social care were presented in relation to policy guidance, funding and organisation.Results: In all three countries, the state issues policy and to some extent co-funds the largely decentralised systems; in Denmark and Sweden the regions and municipalities organise the provision of care services – a system that is also about to be implemented in Finland to improve care coordination and make access more equal. Care for older citizens focuses to a large extent on enabling them to live independently in their own homes.Conclusions: Decentralised care systems are challenged by considerable local variations, possibly jeopardising care equity. State-level decision and policy makers need to be aware of these challenges and monitor developments to prevent further health and social care disparities in the ageing population.
  •  
48.
  • Aglen, B., et al. (author)
  • Self-help and self-help groups for people with long-lasting health problems or mental health difficulties in a Nordic context : A review
  • 2011
  • In: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 39:8, s. 813-822
  • Research review (peer-reviewed)abstract
    • Aim: The aim of this review is to provide systematic knowledge of research from Nordic countries about the meaning of self-help and self-help groups when these are used as a concept or method addressing issues related to long-lasting health problems or mental health difficulties. Methods: Included were studies conducted in the Nordic countries that were published between January 1999 and September 2009. These studies investigated self-help and self-help groups addressing issues related to long-lasting health problems. Results: A total of 83 publications met the inclusion criteria. Four major characteristics of self-help were found to be present in the publications: self-help as an intrapsychological process, self-help as an interpsychological or group process, self-help as a coping, individual learning or empowerment process, and self-help as an alternative or complement to medical treatment. Of the 83 studies, 72 publications used a professional treatment perspective for studying self-help and 11 publications used a perspective derived from alternative or complementary therapies. Conclusions: The review shows that most of the research on self-help and self-help groups for people with long-lasting health problems or disability is conducted with an interest to improve the professional healthcare system. That is, the health-promotion strategy is mainly considered in the framework of treatment or care settings. This means that self-help in this context does not challenge the dominant biomedical health model. © 2011 the Nordic Societies of Public Health.
  •  
49.
  • Agren, G, et al. (author)
  • Mortality trends for young adults in Sweden in the years 2000-2017
  • 2022
  • In: Scandinavian journal of public health. - : SAGE Publications. - 1651-1905 .- 1403-4948. ; 50:4, s. 448-453
  • Journal article (peer-reviewed)abstract
    • Mental health problems in young people seem to be on the rise and more so in Sweden than in other locations. The aim was to compare the development of mortality rates for young adults in Sweden with Western Europe in total. Methods: Young adults were defined as individuals aged 20–34 years and the study period was 2000–2017. Mortality data were derived from the Institute of Health Metrics and Evaluation. Results: During the period 2000–2017, the mortality rate in young adults in Sweden stayed about the same, while in Western Europe as a whole the mortality rate decreased by 42%. The leading explanation for the unfavourable Swedish development was deaths due to drug use, mainly opioids, which increased by 60% during this period. The other major causes of death decreased both in Sweden and Western Europe, but decreased more slowly in Sweden. The differences in the rate of decrease between Sweden and Western Europe were for self-harm (27%), transport injuries (12%), unintentional injuries (31%) and for neoplasms (23%). The unfavourable development in Sweden resembled the development in the USA. Conclusions: The risks of four of the five leading causes of death in this age group were affected by the individuals’ social conditions. The unfavourable mortality development in young adults in Sweden was mainly due to substance use. A contributing cause might be the change in the Swedish healthcare system that introduced competition between providers, which might have encouraged providers to prescribe opioids.
  •  
50.
  • Ahlner, Johan, et al. (author)
  • Prevalence of alcohol and other drugs and the concentrations in blood of drivers killed in road traffic crashes in Sweden
  • 2014
  • In: Scandinavian Journal of Public Health. - : SAGE Publications (UK and US). - 1403-4948 .- 1651-1905. ; 42:2, s. 177-183
  • Journal article (peer-reviewed)abstract
    • Background: Drunk or drug-impaired drivers represent a major public health and societal problem worldwide. Because over 95% of drivers killed on the roads in Sweden are autopsied, reliable information is available about the use of alcohol and/or other drug before the crash. Methods: This retrospective 4-year study (2008-2011) used a forensic toxicology database (TOXBASE) to evaluate the concentrations of alcohol and other drugs in blood samples from drivers killed in road-traffic crashes. Results: The mean age of all victims (N = 895) was 48 +/- 20 years, and the majority were male (86%). In 504 drivers (56%), the results of toxicological analysis were negative and these victims were older; mean age (+/- SD) 47 +/- 20 years, than alcohol positive cases (35 +/- 14 years) and illicit drug users (34 +/- 15 years). In 21% of fatalities, blood-alcohol concentration (BAC) was above the statutory limit for driving (0.2 g/L), although the median BAC was appreciably higher (1.72 g/L). Illicit drugs (mainly amphetamine and cannabis) were identified in similar to 7% of victims, either alone (2.5%), together with alcohol (1.8%) or a prescription drug (2%). The psychoactive prescription drugs identified were mainly benzodiazepines, z-hypnotics and tramadol, which were found in the blood of 7.6% of crash victims. Conclusions: The high median BAC in fatally-injured drivers speaks strongly towards alcohol-induced impairment as being responsible for the crash. Compared with alcohol, the prevalence of illicit and psychoactive prescription drugs was fairly low despite a dramatic increase in the number of drug-impaired drivers arrested by the police after a zero-tolerance law was introduced in 1999.
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