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Mattelin E, Paidar K, Söderlind N, Fröberg F, Korhonen L. A systematic review of studies on resilience and risk and protective factors for health among refugee children in Nordic countries. Eur Child Adolesc Psychiatry 2024; 33:667-700. [PMID: 35445318 PMCID: PMC10894096 DOI: 10.1007/s00787-022-01975-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 03/09/2022] [Indexed: 11/03/2022]
Abstract
The Nordic welfare model is often used as an example for the promotion of health and wellbeing, even in vulnerable groups of children, such as refugees. Nonetheless, there are no published reviews on resilience and/or risk and protective factors for physical and mental health among refugee children living in Nordic countries. In this systematic review, we identified 5181 studies on the topic, screened titles, and abstracts, viewed 632, and finally included 26 studies. These studies described 18 samples with a total of 34,080 individuals ranging in ages 0-18 years. Overall, the studies were of good quality. Nearly all studies assessed adversity. Six studies reported physical health outcomes and all studies mental health outcomes, most often post-traumatic stress disorder and anxiety. None explicitly studied resilience. While we found that age and sex are the most frequently studied risk- and protective factors, findings are inconclusive, since the direction of the associations was different in the different studies. This systematic review indicates that there is still a need for well-designed and -powered studies using clear definitions of key study concepts to examine health outcomes and resilience among refugee children in Nordic countries.
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Affiliation(s)
- Erica Mattelin
- Barnafrid and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Center for Social and Affective Neuroscience and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Kristina Paidar
- Department of Child and Adolescent Psychiatry, Region Halland, Kungsbacka, Sweden
| | - Natalie Söderlind
- Barnafrid and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Frida Fröberg
- Barnafrid and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Laura Korhonen
- Barnafrid and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
- Center for Social and Affective Neuroscience and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
- Department of Child and Adolescent Psychiatry and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
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Agerholm J, Pulkki J, Jensen NK, Keskimäki I, Andersen I, Burström B, Jämsen E, Tynkkynen LK, Schön P, Liljas AE. The organisation and responsibility for care for older people in Denmark, Finland and Sweden: outline and comparison of care systems. Scand J Public Health 2024; 52:119-122. [PMID: 36691975 PMCID: PMC10913333 DOI: 10.1177/14034948221137128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/26/2022] [Accepted: 10/14/2022] [Indexed: 01/25/2023]
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.
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Affiliation(s)
- Janne Agerholm
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Jutta Pulkki
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Natasja K. Jensen
- Department of Public Health, Copenhagen University, Copenhagen, Denmark
| | - Ilmo Keskimäki
- Faculty of Social Sciences, Tampere University, Tampere, Finland
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Ingelise Andersen
- Department of Public Health, Copenhagen University, Copenhagen, Denmark
| | - Bo Burström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Esa Jämsen
- Gerontology Research Center (GEREC), Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Centre of Geriatrics, Tampere University Hospital, Tampere, Finland
| | | | - Pär Schön
- Ageing Research Center, Stockholm Sweden
| | - Ann E.M. Liljas
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Raitasalo K, Rossow I, Moan IS, Bye EK, Svensson J, Thor S, Ekholm O, Pisinger V, Arnarsson Á, Bloomfield K. Changes in co-use of alcohol and cannabis among Nordic adolescents in the 21st century: Results from the European School Survey Project on Alcohol and Other Drugs study. Drug Alcohol Rev 2024; 43:616-624. [PMID: 37095643 DOI: 10.1111/dar.13672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 04/26/2023]
Abstract
INTRODUCTION In the 21st century, there has been a decline in alcohol use among adolescents in most Nordic countries, while trends of cannabis use have diverged. We explore how alcohol and cannabis use, respectively, and co-use of the two substances, have changed among Nordic adolescents. Three hypotheses are used to frame the study: (i) cannabis use has substituted alcohol use; (ii) there has been a parallel decline in both substances; and/or (iii) there has been a 'hardening' of users, implying that alcohol users increasingly use cannabis. METHODS Data from the European School Survey Project on Alcohol and Other Drugs, conducted among 15- to 16-year-olds in Denmark, Finland, Iceland, Norway and Sweden (N = 74,700, 49% boys), were used to explore trends of past-year alcohol and cannabis use in the period 2003-2019. RESULTS The proportion of adolescents reporting alcohol use decreased significantly in all Nordic countries except Denmark. The proportion of those using cannabis only was low (0.0%-0.7%) and stable in all countries. The total number of substance use occasions declined among all adolescents in all countries but Denmark. Among alcohol users, cannabis use became increasingly prevalent in all countries but Denmark. DISCUSSION AND CONCLUSIONS We found no support for the 'parallel decline hypothesis' in alcohol and cannabis use among Nordic adolescents. Partially in line with the 'substitution hypothesis', cannabis use accounted for an increasing proportion of all substance use occasions. Our results suggests that the co-use of alcohol and cannabis has become more common, thus also providing support to the 'hardening' hypothesis.
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Affiliation(s)
- Kirsimarja Raitasalo
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | | | - Elin K Bye
- Norwegian Institute of Public Health, Oslo, Norway
| | - Johan Svensson
- Karolinska Institutet, Stockholm University, Stockholm, Sweden
| | - Siri Thor
- Karolinska Institutet, Stockholm University, Stockholm, Sweden
| | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Veronica Pisinger
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | | | - Kim Bloomfield
- Centre for Alcohol and Drug Research, Aarhus University, Copenhagen, Denmark
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Bliksvær T, Andrews T, Lindholst AC, Rauhala A, Wolmesjö M, Sinervo TS, Fagerström LM, Hansen MB. Health care services for older people in COVID-19 pandemic times - A Nordic comparison. Scand J Prim Health Care 2024; 42:144-155. [PMID: 38145400 PMCID: PMC10851817 DOI: 10.1080/02813432.2023.2296119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 12/12/2023] [Indexed: 12/26/2023] Open
Abstract
OBJECTIVE To explore the Nordic municipal health and care services' ability to promote principal goals within care for older people during the COVID-19 pandemic. DESIGN AND SETTING Two surveys were conducted among managers of municipal health care services for older people in Denmark, Finland, Norway and Sweden; the first around 6 months into the pandemic (survey 1), and the second around 12 months later (survey 2). Data were analysed through descriptive statistics, and multiple regression (OLS). SUBJECTS 1470 (survey 1, 2020) and 745 (survey 2, 2021) managers. 32% in home care, 51% in nursing homes, 17% combined. RESULTS In all countries the pandemic seems to have had more negative impact on eldercare services' ability to promote an active and social life, than on the ability to promote or enhance older people's mental and physical health. The regression analysis indicates that different factors influence the ability to promote these goals. Managers within nursing homes reported reduced ability to promote mental and physical health and an active social life to a significantly lower degree than managers of home care. The effect of three prevention strategies (lock down, testing, and/or organisational change), were explored. Organisational change (reorganize staff and practice, restrict use of substitutes) tended to impact the units' ability to promote a social life in a positive direction, while lock down (areas, buffets etc) tended to impact both the ability to promote mental/physical health and a social life in a negative direction. CONCLUSION Measures that can improve opportunities for an active and social life during a pandemic should have high priority, particularily within home care.
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Affiliation(s)
| | | | | | - Auvo Rauhala
- Faculty of Education and Welfare Studies, Åbo Akademi University, Vaasa, Finland
| | - Maria Wolmesjö
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Boras, Sweden
| | | | | | - Morten Balle Hansen
- Department of Applied Welfare Research, UCL University College, Odense, Denmark
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Varpula R, Äyräs O, Aabakke AJM, Klungsøyr K, Svanvik T, Kanerva J, Jonasdottir E, Mentzoni CT, Thurn L, Jones E, Fredriksson L, Pettersson K, Nyfløt LT, Vangen S, Røe K, Júlíusson PB, Källén K, Gissler M, Pyykönen A, Jakobsson M, Krebs L, Engjom HM. Early suppression policies protected pregnant women from COVID-19 in 2020: A population-based surveillance from the Nordic countries. Acta Obstet Gynecol Scand 2024. [PMID: 38382894 DOI: 10.1111/aogs.14808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/03/2024] [Accepted: 01/17/2024] [Indexed: 02/23/2024]
Abstract
INTRODUCTION The Coronavirus 2019 Disease (COVID-19) pandemic reached the Nordic countries in March 2020. Public health interventions to limit viral transmission varied across different countries both in timing and in magnitude. Interventions indicated by an Oxford Stringency Index ≥50 were implemented early (March 13-17, 2020) in Denmark, Finland, Norway and Iceland, and on March 26, 2020 in Sweden. The aim of the current study was to assess the incidence of COVID-19-related admissions of pregnant women in the Nordic countries in relation to the different national public health strategies during the first year of the pandemic. MATERIAL AND METHODS This is a meta-analysis of population-based cohort studies in the five Nordic countries with national or regional surveillance in the Nordic Obstetric Surveillance System (NOSS) collaboration: national data from Denmark, Finland, Iceland and Norway, and regional data covering 31% of births in Sweden. The source population consisted of women giving birth in the included areas March 1-December 31, 2020. Pregnant women with a positive SARS-CoV-2 PCR test ≤14 days before hospital admission were included, and admissions were stratified as either COVID-19-related or non-COVID (other obstetric healthcare). Information about public health policies was retrieved retrospectively. RESULTS In total, 392 382 maternities were considered. Of these, 600 women were diagnosed with SARS-CoV-2 infection and 137 (22.8%) were admitted for COVID-19 symptoms. The pooled incidence of COVID-19 admissions per 1000 maternities was 0.5 (95% confidence interval [CI] 0.2 to 1.2, I2 = 77.6, tau2 = 0.68, P = 0.0), ranging from no admissions in Iceland to 1.9 admissions in the Swedish regions. Interventions to restrict viral transmission were less stringent in Sweden than in the other Nordic countries. CONCLUSIONS There was a clear variation in pregnant women's risk of COVID-19 admission across countries with similar healthcare systems but different public health interventions to limit viral transmission. The meta-analysis indicates that early suppression policies protected pregnant women from severe COVID-19 disease prior to the availability of individual protection with vaccines.
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Affiliation(s)
- Reetta Varpula
- Department of Obstetrics and Gynecology, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Outi Äyräs
- Department of Obstetrics and Gynecology, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Anna J M Aabakke
- Department of Obstetrics and Gynecology, Copenhagen University Hospital-Holbaek, Holbaek, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kari Klungsøyr
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department for Health Promotion, Norwegian Institute of Public Health, Bergen, Norway
| | - Teresia Svanvik
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Julia Kanerva
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Eva Jonasdottir
- Department of Obstetrics and Gynecology, Landspitali University Hospital, Reykjavik, Iceland
| | | | - Lars Thurn
- Department of Obstetrics and Gynecology, Skåne University Hospital, Lund, Sweden
| | - Elin Jones
- Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
| | - Lisa Fredriksson
- Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
| | - Karin Pettersson
- Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
| | - Lill Trine Nyfløt
- Norwegian Research Center for Women's Health, Oslo University Hospital, Oslo, Norway
| | - Siri Vangen
- Norwegian Research Center for Women's Health, Oslo University Hospital, Oslo, Norway
| | - Kjerstine Røe
- Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway
| | - Pétur B Júlíusson
- Department for Health Registry Research and Development, Norwegian Institute of Public Health, Bergen, Norway
| | - Karin Källén
- Department of Obstetrics and Gynecology, Institution of Clinical Sciences, Lund University, Lund, Sweden
| | - Mika Gissler
- Department of Knowledge Brokers, THL Finnish Institute of Health and Welfare, Helsinki, Finland
- Academic Primary Health Care Center, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | | | - Maija Jakobsson
- Department of Obstetrics and Gynecology, HUS Hyvinkää Hospital, Helsinki University, Helsinki, Finland
| | - Lone Krebs
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Obstetrics and Gynecology, Copenhagen University Hospital-Amager and Hvidovre Hospital, Copenhagen, Denmark
| | - Hilde Marie Engjom
- Department for Health Promotion, Norwegian Institute of Public Health, Bergen, Norway
- Department for Health Registry Research and Development, Norwegian Institute of Public Health, Bergen, Norway
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Corell M, Friberg P, Petzold M, Löfstedt P. Socioeconomic inequalities in adolescent mental health in the Nordic countries in the 2000s - A study using cross-sectional data from the Health Behaviour in School-aged Children study. Arch Public Health 2024; 82:20. [PMID: 38326845 PMCID: PMC10848422 DOI: 10.1186/s13690-024-01240-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 01/13/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Adolescents in Sweden experience more mental health problems and lower mental well-being than adolescents in other Nordic countries. According to the literature, one possible explanation may be differences in income inequality. The at-risk-of-poverty rate varies significantly across the Nordic countries, and the highest rate is found in Sweden. The aims of the study were to examine socioeconomic inequalities in subjective health complaints and life satisfaction among adolescents in the Nordic countries during 2002 - 2018 and to explore whether subjective health complaints and life satisfaction were related to income inequality in terms of the at-risk-of-poverty rate at the country level. METHODS Data regarding 15-year-olds from the Health Behaviour in School-aged Children study from five survey rounds (2002 - 2018) were used (n = 41,148). The HBSC Symptoms Checklist and Cantril's ladder were used as measures of subjective health complaints and life satisfaction, respectively. The Family Affluence Scale, the Perceived Family Wealth item and the at-risk-of-poverty rate in each country were used as measures of individual-level socioeconomic conditions and country-level income inequality. Statistical methods involved ANOVA, multiple linear regressions and multilevel regression analyses. RESULTS Absolute and relative socioeconomic inequalities in both subjective health complaints and life satisfaction were found in all countries. Sweden showed average socioeconomic inequalities, Iceland the largest and Denmark the smallest. Country-level income inequality in terms of the at-risk-of-poverty rate was associated with a higher prevalence of subjective health complaints and lower levels of life satisfaction in all countries. CONCLUSION Socioeconomic inequalities in adolescent mental health and well-being persisted in Nordic countries in the 2000s. Increasing income inequality may have contributed to higher levels of SHC and lower LS in Sweden compared to the other Nordic countries. Policies improving families' socioeconomic conditions and reducing income inequality at the country level are needed to improve and reduce inequalities in mental health and well-being among adolescents.
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Affiliation(s)
- Maria Corell
- School of Public Health and Community Medicine, Institute of Medicine, Gothenburg University, 405 30, Göteborg, Box 428, Sweden.
- Public Health Agency of Sweden, 171 82, Solna, Sweden.
| | - Peter Friberg
- School of Public Health and Community Medicine, Institute of Medicine, Gothenburg University, 405 30, Göteborg, Box 428, Sweden
| | - Max Petzold
- School of Public Health and Community Medicine, Institute of Medicine, Gothenburg University, 405 30, Göteborg, Box 428, Sweden
| | - Petra Löfstedt
- School of Public Health and Community Medicine, Institute of Medicine, Gothenburg University, 405 30, Göteborg, Box 428, Sweden
- Public Health Agency of Sweden, 171 82, Solna, Sweden
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Forsby M, Hulander E, Amberntsson A, Brembeck P, Winkvist A, Bärebring L, Augustin H. Nutritional intake and determinants of nutritional quality changes from pregnancy to postpartum-a longitudinal study. Food Sci Nutr 2024; 12:1245-1256. [PMID: 38370042 PMCID: PMC10867539 DOI: 10.1002/fsn3.3838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 10/27/2023] [Accepted: 11/03/2023] [Indexed: 02/20/2024] Open
Abstract
Nutrient requirements vary across the reproductive cycle, but research on changes in nutritional intake and quality from pregnancy to beyond the lactation period is limited. Thus, we aimed to study nutritional intake and quality changes, among Swedish pregnant participants from late pregnancy to 18 months postpartum and to study the determinants of nutritional quality changes. Participants (n = 72) were studied longitudinally from the third trimester of pregnancy and postpartum (2 weeks 4, 12, and 18 months postpartum). At each visit, participant characteristics and 4-day food diaries were collected. Nutritional quality was assessed by energy adjusted Nutrient Rich Food Index 11.3. Linear mixed models were used to analyze the determinants of change in nutritional quality. Intakes of carbohydrate energy percentage (E%), fiber, vitamin A, vitamin C, and potassium were higher in the third trimester compared to postpartum, whereas intakes of E% protein and monounsaturated fat were lower. Adherence to recommended intakes was low at all study visits for saturated fat (4%-11%), fiber (15%-39%), vitamin D (8%-14%), folate (0%-2%), and iron (6%-21%). Overall, nutritional quality did not differ significantly from third trimester to postpartum. Shorter duration (<4 months) of lactation was negatively related to nutritional quality changes, whereas higher age was positively related to changes. In conclusion, nutritional intake from pregnancy to postpartum changed, whereas quality remained relatively stable, with age and lactation duration as determinants. Identification of people at risk of adverse dietary changes from pregnancy to the postpartum period should be further addressed in future larger and more diverse study populations.
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Affiliation(s)
- Mathilda Forsby
- Institute of Medicine, University of GothenburgGothenburgSweden
| | - Erik Hulander
- Institute of Medicine, University of GothenburgGothenburgSweden
| | | | - Petra Brembeck
- Institute of Health and Care Sciences, University of GothenburgGothenburgSweden
| | - Anna Winkvist
- Institute of Medicine, University of GothenburgGothenburgSweden
| | | | - Hanna Augustin
- Institute of Medicine, University of GothenburgGothenburgSweden
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Gunnerlind O, Lundqvist R, Ott M, Werneke U. Alcohol consumption under lockdown measures during the COVID-19 pandemic in three Nordic countries. Int J Soc Psychiatry 2024; 70:48-58. [PMID: 37650471 DOI: 10.1177/00207640231194486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
BACKGROUND At the beginning of the COVID-19 pandemic, concerns arose about a possible rise in alcohol consumption. Early surveys, however, more commonly pointed towards a decrease of alcohol use. But studies based on self-reports may underestimate alcohol use. They also depend on the population sampled. Because of border closures and gastronomy restrictions, countries with centralised alcohol sales provided a unique opportunity to study total domestic consumption during the pandemic without influence of private import or reliance on self-reports. AIMS We examined the correlation between alcohol sales and national COVID-19 restrictions in three such countries, Finland, Norway and Sweden. METHOD We conducted this study as a mirror image study, comparing alcohol sales during the first 2 years of the COVID-19 pandemic with the two preceding years. We explored hours of daylight/season as potential confounders. RESULTS We found no relevant change in alcohol sales during the pandemic years for Finland or Sweden. For Norway, there was a level-change in sales, which could be explained by decreased imports. Sales followed a seasonal pattern. In all three countries, the initial pandemic increase in alcohol sales coincided with an underlying annually recurring seasonal variation. CONCLUSIONS The COVID-19 pandemic had less of an impact on alcohol consumption in the three Nordic countries than could intuitively be expected. The increase of alcohol sales at the beginning of the COVID-19 pandemic coincided with a seasonal rise following a pre-pandemic pattern. Therefore, caution should be exercised with drawing conclusions from data with a short time perspective to avoid attribution bias.
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Affiliation(s)
- Oscar Gunnerlind
- Department of Clinical Sciences, Division of Psychiatry, Sunderby Research Unit, Umeå University, Umeå, Sweden
| | - Robert Lundqvist
- Department of Public Health and Clinical Medicine, Sunderby Research Unit, Umeå University, Luleå, Sweden
| | - Michael Ott
- Department of Public Health and Clinical Medicine - Medicine, Umeå University, Umeå, Sweden
| | - Ursula Werneke
- Department of Clinical Sciences, Division of Psychiatry, Sunderby Research Unit, Umeå University, Umeå, Sweden
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Hopp P, Rolandsen CM, Korpenfelt SL, Våge J, Sörén K, Solberg EJ, Averhed G, Pusenius J, Rosendal T, Ericsson G, Bakka HC, Mysterud A, Gavier-Widén D, Hautaniemi M, Ågren E, Isomursu M, Madslien K, Benestad SL, Nöremark M. Sporadic cases of chronic wasting disease in old moose - an epidemiological study. J Gen Virol 2024; 105. [PMID: 38265285 DOI: 10.1099/jgv.0.001952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024] Open
Abstract
Transmissible spongiform encephalopathies or prion diseases comprise diseases with different levels of contagiousness under natural conditions. The hypothesis has been raised that the chronic wasting disease (CWD) cases detected in Nordic moose (Alces alces) may be less contagious, or not contagious between live animals under field conditions. This study aims to investigate the epidemiology of CWD cases detected in moose in Norway, Sweden and Finland using surveillance data from 2016 to 2022.In total, 18 CWD cases were detected in Nordic moose. All moose were positive for prion (PrPres) detection in the brain, but negative in lymph nodes, all were old (mean 16 years; range 12-20) and all except one, were female. Age appeared to be a strong risk factor, and the sex difference may be explained by few males reaching high age due to hunting targeting calves, yearlings and males.The cases were geographically scattered, distributed over 15 municipalities. However, three cases were detected in each of two areas, Selbu in Norway and Arjeplog-Arvidsjaur in Sweden. A Monte Carlo simulation approach was applied to investigate the likelihood of such clustering occurring by chance, given the assumption of a non-contagious disease. The empirical P-value for obtaining three cases in one Norwegian municipality was less than 0.05, indicating clustering. However, the moose in Selbu were affected by different CWD strains, and over a 6 year period with intensive surveillance, the apparent prevalence decreased, which would not be expected for an ongoing outbreak of CWD. Likewise, the three cases in Arjeplog-Arvidsjaur could also indicate clustering, but management practices promotes a larger proportion of old females and the detection of the first CWD case contributed to increased awareness and sampling.The results of our study show that the CWD cases detected so far in Nordic moose have a different epidemiology compared to CWD cases reported from North America and in Norwegian reindeer (Rangifer tarandus tarandus). The results support the hypothesis that these cases are less contagious or not contagious between live animals under field conditions. To enable differentiation from other types of CWD, we support the use of sporadic CWD (sCWD) among the names already in use.
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Affiliation(s)
- Petter Hopp
- Norwegian Veterinary Institute, P.O. Box 64, NO-1431 Ås, Norway
| | - Christer Moe Rolandsen
- Norwegian Institute for Nature Research (NINA), P.O. Box 5685 Torgarden, NO-7485 Trondheim, Norway
| | | | - Jørn Våge
- Norwegian Veterinary Institute, P.O. Box 64, NO-1431 Ås, Norway
| | - Kaisa Sörén
- National Veterinary Institute (SVA), Uppsala, Sweden
| | - Erling Johan Solberg
- Norwegian Institute for Nature Research (NINA), P.O. Box 5685 Torgarden, NO-7485 Trondheim, Norway
| | | | - Jyrki Pusenius
- Natural Resources Institute Finland (LUKE), Yliopistokatu 6, FI-80100 Joensuu, Finland
| | | | - Göran Ericsson
- Department of Wildlife, Fish and Environmental Studies, Swedish University of Agricultural Sciences (SLU), Umeå, Sweden
| | - Haakon Christopher Bakka
- Norwegian Veterinary Institute, P.O. Box 64, NO-1431 Ås, Norway
- Present address: Kontali, Fred Olsens gate 1, NO-0152 Oslo, Norway
| | - Atle Mysterud
- Centre for Ecological and Evolutionary Synthesis (CEES), Department of Biosciences, University of Oslo, P.O. Box 1066 Blindern, NO-0316 Oslo, Norway
| | | | | | - Erik Ågren
- National Veterinary Institute (SVA), Uppsala, Sweden
| | | | - Knut Madslien
- Norwegian Veterinary Institute, P.O. Box 64, NO-1431 Ås, Norway
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Sarnola K, Koskinen H, Klintrup K, Astrup C, Kurko T. Uptake and availability of new outpatient cancer medicines in 2010-2021 in Nordic countries - survey of competent authorities. BMC Health Serv Res 2023; 23:1437. [PMID: 38110924 PMCID: PMC10729379 DOI: 10.1186/s12913-023-10421-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 12/01/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Nordic countries excel in cancer care, but studies on uptake, costs, or managed entry agreements of cancer medicines have not been conducted recently. The aim of this study was to examine the uptake and availability of orally administered new cancer medicines in Nordic countries. Orally administered cancer medicines enable and are used in the community as part of outpatient care. Firstly, we studied the distribution, costs and adoption of managed entry agreements of these medicines, and secondly, uptake of and managed entry agreements for cancer medicines used in outpatient care that were granted marketing authorization in Europe in 2010-2021. METHODS An E-mail survey of competent authorities, meaning pharmaceutical service organizers, payers or other government or non-government actors developing pharmaceutical service operations, in Denmark, Finland, Iceland, Norway, and Sweden in April-June 2022. The data were analysed using frequencies and percentages for descriptive analysis. RESULTS The distribution of cancer medicines has similarities in Finland, Iceland, Norway, and Sweden, where cancer medicines can be distributed both via hospitals or hospital pharmacies for inpatient use, and via community pharmacies for outpatient use. In Denmark, cancer medicines are predominantly distributed via publicly funded hospitals. In all countries that provided data on the costs, the costs of cancer medicines had notably gone up from 2010 to 2021. The number of reimbursable medicines out of new cancer medicines varied from 36 products in Denmark and Iceland to 51 products in Sweden, out of 67 studied products. Managed entry agreements, often with confidential discounts, were in use in all Nordic countries. The number of agreements and the cancer types for which agreements were most often made varied from three agreements made in Iceland to 35 agreements made in Finland, out of 67 studied products. Average days from authorization to reimbursement of new cancer medicines varied from an average of 416 to 895 days. CONCLUSIONS Nordic countries share similar characteristics but also differ in terms of the details in distribution, adopted managed entry agreements, market entry, and availability of new orally administered cancer medicines used in the outpatient care. The costs of cancer medicines have increased in all Nordic countries during the last decade. Due to differences in health care and because orally administered cancer medicines can be dispensed at community and hospital pharmacies in all studied countries other than Denmark, the number of reimbursable medicines and managed entry agreements vary between countries. However, Nordic countries show good agreement for 2010 to 2021 in entry and reimbursement decisions of novel cancer medicines.
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Affiliation(s)
- Kati Sarnola
- Research Unit, Social Insurance Institution of Finland (Kela), P.O. Box 450, Helsinki, 00056 KELA, Finland.
| | - Hanna Koskinen
- Research Unit, Social Insurance Institution of Finland (Kela), P.O. Box 450, Helsinki, 00056 KELA, Finland
| | - Katariina Klintrup
- Medical Advisory Centre, Social Insurance Institution of Finland (Kela), Helsinki, Finland
| | - Cecilie Astrup
- Business Intelligence and Health Economy, Amgros I/S, Copenhagen, Denmark
| | - Terhi Kurko
- Research Unit, Social Insurance Institution of Finland (Kela), P.O. Box 450, Helsinki, 00056 KELA, Finland
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Freese R, Aarsland TE, Bjørkevoll M. Pantothenic acid - a scoping review for Nordic Nutrition Recommendations 2023. Food Nutr Res 2023; 67:10255. [PMID: 38187802 PMCID: PMC10770646 DOI: 10.29219/fnr.v67.10255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 06/15/2022] [Accepted: 09/27/2023] [Indexed: 01/09/2024] Open
Abstract
Pantothenic acid, also referred to as vitamin B5, is a water-soluble vitamin that has essential functions in the body as a component of coenzyme A (CoA) and acyl carrier protein (ACP). It is widely distributed in animal and plant-source foods. Nutritional deficiency of pantothenic acid is rare and toxicity negligible. Information on pantothenic acid intakes in the Nordic countries is limited and biomarker data from Nordic and Baltic populations is missing. Due to a lack of data, no dietary reference values (DRVs) were given for pantothenic acid in the Nordic Nutrition Recommendations (NNR) since 2012. The aim of this scoping review was to examine recent evidence relevant for updating the DRVs for NNR2023. Scientific literature since 2012 on associations of pantothenic acid with health-related issues in Nordic and Baltic countries was searched. No health concerns related to pantothenic acid were identified.
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Affiliation(s)
- Riitta Freese
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
| | - Tonje E. Aarsland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Maja Bjørkevoll
- Centre for International Health, University of Bergen, Bergen, Norway
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12
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Freese R, Lysne V. Niacin - a scoping review for Nordic Nutrition Recommendations 2023. Food Nutr Res 2023; 67:10299. [PMID: 38187785 PMCID: PMC10770643 DOI: 10.29219/fnr.v67.10299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 02/09/2022] [Accepted: 10/16/2023] [Indexed: 01/09/2024] Open
Abstract
Niacin is the precursor to pyridine nucleotides NAD (nicotinamide adenine dinucleotide) and NADP (nicotinamide adenine dinucleotide phosphate). Niacin (vitamin B3) is the common term for nicotinic acid, nicotinamide and derivatives that exhibit the biological activity of nicotinamide. Furthermore, the indispensable amino acid tryptophan is the substrate for de novo synthesis of NAD. Thus, the requirements and intake of niacin are expressed as niacin equivalents (NE). The focus of interest for niacin over the last decade has primarily been on pharmacological doses of nicotinic acid as a lipid-lowering agent and other NAD precursors as potential enhancers of cellular NAD+ concentrations. None of these studies, however, makes a useful contribution to understanding dietary requirements in healthy populations. The requirement for niacin is estimated based on the relationship between intake and biochemical indices of niacin status, primarily urinary excretion of nicotinamide metabolites.
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Affiliation(s)
- Riitta Freese
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
| | - Vegard Lysne
- Norwegian Institute of Public Health, Oslo, Norway
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13
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Geisler J, Karihtala P, Tuxen M, Valachis A, Holm B. Current treatment landscape of HR+/HER2- advanced breast cancer in the Nordics: a modified Delphi study. Acta Oncol 2023; 62:1680-1688. [PMID: 37713138 DOI: 10.1080/0284186x.2023.2254475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 08/06/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND This Delphi study aimed to assess current perspectives on hormone receptor-positive/human epidermal growth factor receptor 2-negative(HR+/HER2-) advanced breast cancer (aBC) treatment strategies across the Nordics, and to establish where consensus exists across the Nordics on HR+/HER2- aBC treatment. MATERIAL AND METHODS A modified, three-round Delphi method was followed. A steering committee was appointed for study coordination, panellist selection, and questionnaire development. The questionnaires covered relevant topics on HR+/HER2- aBC treatment: treatment patterns in different lines of therapy (first [1L], second [2L], and third [3L]), oligometastatic disease, de novo aBC, brain metastases, age as influential factor, visceral crisis, radiotherapy, diagnostics, and clinical guidelines. Both open and closed-ended questions were included. Consensus was defined as at least 70% agreement. RESULTS In total, 28 experienced BC oncologists participated in the study from all five Nordic countries. Overall, topics reaching consensus included: preferred treatment approach in 1L and 2L therapy, treatment of oligometastatic disease, visceral crisis, brain metastases, and age-related treatment considerations. No consensus was reached for 3L therapy and local treatment for primary tumour in de novo aBC. Endocrine therapy (ET) combined with a cyclin-dependent kinase (CDK)4/6 inhibitor was the treatment of choice for 1L and 2L therapy. Treatment patterns in clinical practice did not always follow recommendations in current Nordic guidelines, as seen in the case of recently approved treatments. DISCUSSION ET in combination with a CDK4/6 inhibitor is the preferred frontline treatment for HR+/HER2- aBC in the Nordics. The observed discrepancy between current guidelines and clinical practice could be due to differences in the reimbursement of novel treatments in the Nordics. Collaborative research efforts are warranted for topics that lack consensus.
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Affiliation(s)
- Jürgen Geisler
- Department of Oncology, University of Oslo and Akershus University Hospital, Akershus, Norway
| | - Peeter Karihtala
- Department of Oncology, Helsinki University Hospital Comprehensive Cancer Centre and University of Helsinki, Helsinki, Finland
| | - Malgorzata Tuxen
- Department of Oncology, University of Copenhagen Herlev Hospital, Copenhagen, Denmark
| | - Antonis Valachis
- Department of Oncology, Örebro University Hospital, Örebro, Sweden
| | - Barbro Holm
- Department of Oncology, Novartis, Stockholm, Sweden
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14
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Vangsted A, Thinggaard BS, Nissen AHK, Hajari JN, Klefter ON, Krogh Nielsen M, Sørensen TL, Grauslund J, Subhi Y. Prevalence of geographic atrophy in Nordic countries and number of patients potentially eligible for intravitreal complement inhibitor treatment: A systematic review with meta-analyses and forecasting study. Acta Ophthalmol 2023; 101:857-868. [PMID: 37680141 DOI: 10.1111/aos.15768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 08/30/2023] [Indexed: 09/09/2023]
Abstract
We systematically reviewed the literature on the prevalence of geographic atrophy (GA) in Nordic populations, conducted meta-analyses on age-stratified estimates, and calculated current and future number of patients and those potentially eligible for intravitreal complement inhibitor treatment. We followed the PRISMA guidelines, and our protocol was registered in PROSPERO. Ten databases were searched on 22 April 2023 for population-based studies of GA prevalence. Based on clinical descriptive analyses of GA and eligibility criteria of the phase III studies for intravitreal pegcetacoplan (complement C3 and C3b inhibitor), we were able to calculate the proportion of patients with GA potentially eligible for therapy. Finally, we extracted population data for Nordic countries (Denmark, Finland, Iceland, Norway, and Sweden) from Eurostat, applied prevalence statistics to the extracted census and forecasting data to estimate the number of patients with GA, and then applied the proportion eligible for intravitreal pegcetacoplan therapy. We identified six studies with a total of 10 159 individuals. Prevalence of GA was estimated to 0.4% (95% confidence intervals [CI]: 0.2%-0.8%), 1.5% (95% CI: 0.7%-2.6%), and 7.6% (95% CI: 4.6%-11.3%) for individuals aged 60-69, 70-79, and 80+ years, respectively. In Nordic countries, we estimate a total of 166 307 individuals with GA in 2023, increasing to 277 893 in 2050. Of these, 90 803 individuals in 2023, increasing to 151 730 in 2050, are potentially eligible for intravitreal complement inhibitor treatment. Considering these large numbers, our study highlights the importance of this topic in the coming years and its potential to significantly impact our clinical practice, organization, and staffing.
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Affiliation(s)
- Andreas Vangsted
- Department of Ophthalmology, Rigshospitalet, Copenhagen, Denmark
| | - Benjamin S Thinggaard
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Anne H K Nissen
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark
| | - Javad N Hajari
- Department of Ophthalmology, Rigshospitalet, Copenhagen, Denmark
| | - Oliver N Klefter
- Department of Ophthalmology, Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Torben L Sørensen
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Ophthalmology, Zealand University Hospital, Roskilde, Denmark
| | - Jakob Grauslund
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Ophthalmology, Vestfold Hospital Trust, Tønsberg, Norway
| | - Yousif Subhi
- Department of Ophthalmology, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Ophthalmology, Zealand University Hospital, Roskilde, Denmark
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15
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Rönkä AR, Sailo A, Hirvonen N. Six decades of longitudinal health knowledge production: a systematic review on Nordic birth cohort studies. Int J Circumpolar Health 2023; 82:2278815. [PMID: 38010742 PMCID: PMC10997306 DOI: 10.1080/22423982.2023.2278815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/30/2023] [Indexed: 11/29/2023] Open
Abstract
This systematic review (a) identifies birth cohort studies (BCSs) established in the Nordic countries, (b) describes their basic characteristics, and (c) explores how these characteristics have evolved over time, discussing their implications to knowledge production. To identify Nordic BCSs, cohort databases and relevant scientific articles were systematically searched and screened.The review shows that since 1959, more than 600,000 index children have participated in the 79 Nordic BCSs (22 Danish, 20 Finnish, 12 Norwegian, 24 Swedish, one Icelandic), over half of them still ongoing. The Nordic BCSs cover a wide geographical area including the Nordic Arctic. The topics of BCSs have varied over time but most have focused on examining the developmental origins of diseases. A quarter of them had a general scope, while the rest started with a specific focus, commonly atopic diseases. All BCSs collected questionnaire and/or interview data and over 60% of the BCSs announced exclusion criteria for participants, typically insufficient language proficiency.NBCSs have produced crucial scientific knowledge for over six decades, but there are underutilised opportunities including systematic interdisciplinary collaboration, inclusion of children's own views of their health and well-being, intergenerational data collection, and specific knowledge of Arctic indigenous peoples and other minorities.
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Affiliation(s)
- Anna Reetta Rönkä
- Faculty of Education and Psychology and History of Sciences and Ideas, Faculty of Humanities, University of Oulu, Oulu, Finland
| | - Annukka Sailo
- History of Sciences and Ideas, Faculty of Humanities, University of Oulu, Oulu, Finland
| | - Noora Hirvonen
- Information Studies, Faculty of Humanities, University of Oulu, Oulu, Finland
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16
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Hellman M. Evidence for improving welfare services. Nordisk Alkohol Nark 2023; 40:421-423. [PMID: 37969898 PMCID: PMC10634384 DOI: 10.1177/14550725231205802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 09/20/2023] [Indexed: 11/17/2023] Open
Affiliation(s)
- Matilda Hellman
- Faculty of Social Sciences, Helsingin Yliopisto, Helsinki, Finland
- Department of Sociology, Uppsala University
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17
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Højstrup S, Thomsen JH, Prescott E. Disparities in cardiovascular disease and treatment in the Nordic countries. Lancet Reg Health Eur 2023; 33:100699. [PMID: 37953994 PMCID: PMC10636266 DOI: 10.1016/j.lanepe.2023.100699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/27/2023] [Accepted: 07/10/2023] [Indexed: 11/14/2023]
Abstract
The Nordic countries, including Denmark, Finland, Iceland, Norway, and Sweden have seen a steep decline in cardiovascular mortality in recent decades. They are among the most egalitarian countries by several measures, and all have universal, publicly funded welfare systems providing healthcare for all citizens. However, despite these seemingly ideal conditions, disparities in access to cardiovascular care and outcomes persist. To address this challenge, The Lancet Region Health-Europe convened experts from a broad range of countries to summarize the current state of knowledge on cardiovascular disease disparities across Europe. This Series Paper presents the main challenges in Nordic countries based on evidence from high-quality nationwide registries. Focusing on major cardiovascular health determinants, areas in need of improvement were identified. There is a need for addressing structural causes underlying these disparities, such as poverty and discrimination, but also to improve access to healthcare in deprived neighborhoods and to address underlying social determinants of health that may mitigate disparities in cardiovascular outcomes. Overall, while the Nordic countries have made great strides in promoting egalitarianism and providing universal healthcare, there is still much work to be done to ensure equitable access to care and improved cardiovascular outcomes for all members of society.
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Affiliation(s)
- Signe Højstrup
- Department of Cardiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Jakob Hartvig Thomsen
- Department of Cardiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Eva Prescott
- Department of Cardiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
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18
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Laakso L, Jokelainen P, Houe H, Skjerve E, Hansen J, Lynge E, Martinsen JI, Mehlum IS, Selander J, Torfadóttir JE, Weiderpass E, Heikkinen S, Pukkala E. No Excess Cancer Risk among Veterinarians in Denmark, Finland, Iceland, Norway, and Sweden after the 1980s. Cancers (Basel) 2023; 15:4079. [PMID: 37627107 PMCID: PMC10452372 DOI: 10.3390/cancers15164079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/09/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
The cancer profile of veterinarians has received little research attention, despite the profession potentially being exposed to a wide range of known and suspected carcinogens. In this large-scale cohort study, we assessed cancer incidence in veterinarians in Denmark, Finland, Iceland, Norway, and Sweden, across more than 40 years (1961-2005). The cohort comprised 4708 veterinarians and 119,503 person-years at follow-up. The overall cancer incidence in veterinarians was close to the incidence in the total population in all countries and in all age groups. In male veterinarians, the standardized incidence ratios (SIR) in 1961-1990 were elevated for colon cancer (1.86, 95% confidence interval (CI) 1.39-2.44), prostate cancer (1.35, 95% CI 1.07-1.67), and especially skin melanoma (3.62, 95% CI 2.78-2.84), while there was no longer any statistically significant excess in the more recent follow-up period. Decreased SIRs were observed for lip cancer (0.11, 95% CI 0.00-0.62), laryngeal cancer (0.38, 95% CI 0.12-0.89), lung cancer (0.59, 95% CI 0.47-0.74), and stomach cancer (0.58, 95% CI 0.38-0.86), without a marked change in SIR over time. Non-significant excesses among male veterinarians were also observed in Hodgkin lymphoma (1961-1990 only), and leukaemia. This multi-country study indicates that there was an elevated incidence of several cancer types among male veterinarians before the 1990s but not after that. Some of the findings might rather be attributed to lifestyle factors and not directly to work conditions, but the excess risk of cancers of kidney and bladder, for example, might be related to work exposures.
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Affiliation(s)
- Laura Laakso
- Animal Clinic of Paippinen, 04170 Paippinen, Finland;
| | - Pikka Jokelainen
- Infectious Disease Preparedness, Statens Serum Institut, 2300 Copenhagen, Denmark
- Faculty of Veterinary Medicine, University of Helsinki, 00014 Helsinki, Finland
| | - Hans Houe
- Department of Veterinary and Animal Sciences, University of Copenhagen, 1870 Frederiksberg, Denmark;
| | - Eystein Skjerve
- The Faculty of Veterinary Medicine, Norwegian University of Life Sciences, 1433 Ås, Norway;
| | - Johnni Hansen
- Danish Cancer Society Research Center, Danish Cancer Society, 2100 Copenhagen, Denmark;
| | - Elsebeth Lynge
- Nykøbing Falster Hospital and Department of Public Health, University of Copenhagen, 1014 Copenhagen, Denmark;
| | | | - Ingrid Sivesind Mehlum
- Department of Occupational Medicine and Epidemiology, National Institute of Occupational Health (STAMI), 0304 Oslo, Norway;
| | - Jenny Selander
- Unit of Occupational Medicine, Institute of Environmental Medicine, 171 77 Stockholm, Sweden;
| | - Jóhanna Eyrún Torfadóttir
- Department of Education & Prevention, The Icelandic Cancer Society, 105 Reykjavik, Iceland;
- Centre for Public Health Sciences, University of Iceland, 102 Reykjavik, Iceland
| | - Elisabete Weiderpass
- International Agency for Research on Cancer (IARC), World Health Organization, 69372 Lyon, France;
| | - Sanna Heikkinen
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, 00130 Helsinki, Finland;
| | - Eero Pukkala
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, 00130 Helsinki, Finland;
- Health Sciences Unit, Faculty of Social Sciences, Tampere University, 33520 Tampere, Finland
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19
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Satokangas M, Arffman M, Agerholm J, Thielen K, Hougaard CØ, Andersen I, Burström B, Keskimäki I. Performing up to Nordic principles? Geographic and socioeconomic equity in ambulatory care sensitive conditions among older adults in capital areas of Denmark, Finland and Sweden in 2000-2015. BMC Health Serv Res 2023; 23:835. [PMID: 37550672 PMCID: PMC10405465 DOI: 10.1186/s12913-023-09855-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 07/27/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Denmark, Finland and Sweden pursue equity in health for their citizens through universal health care. However, it is unclear if these services reach the older adult population equally across different socioeconomic positions or living areas. Thus, we assessed geographic and socioeconomic equity in primary health care (PHC) performance among the older adults in the capital areas of Denmark (Copenhagen), Finland (Helsinki) and Sweden (Stockholm) in 2000-2015. Hospitalisations for ambulatory care sensitive conditions (ACSC) were applied as a proxy for PHC performance. METHODS We acquired individual level ACSCs for those aged ≥ 45 in 2000-2015 from national hospitalisation registers. To identify whether the disparities varied by age, we applied three age groups (those aged 45-64, 65-75 and ≥ 75). Socioeconomic disparities in ACSCs were described with incidence rate ratios (IRR) and annual rates by education, income and living-alone; and then analysed with biennial concentration indices by income. Geographic disparities were described with biennial ACSC rates by small areas and analysed with two-level Poisson multilevel models. These models provided small area estimates of IRRs of ACSCs in 2000 and their slopes for development over time, between which Pearson correlations were calculated within each capital area. Finally, these models were adjusted for income to distinguish between geographic and socioeconomic disparities. RESULTS Copenhagen had the highest IRR of ACSCs among those aged 45-64, and Helsinki among those aged ≥ 75. Over time IRRs decreased among those aged ≥ 45, but only in Helsinki among those aged ≥ 75. All concentration indices slightly favoured the affluent population but in Stockholm were mainly non-significant. Among those aged ≥ 75, Pearson correlations were low in Copenhagen (-0.14; p = 0.424) but high in both Helsinki (-0.74; < 0.001) and Stockholm (-0.62; < 0.001) - with only little change when adjusted for income. Among those aged ≥ 45 the respective correlations were rather similar, except for a strong correlation in Copenhagen (-0.51, 0.001) after income adjustment. CONCLUSIONS While socioeconomic disparities in PHC performance persisted among older adults in the three Nordic capital areas, geographic disparities narrowed in both Helsinki and Stockholm but persisted in Copenhagen. Our findings suggest that the Danish PHC incorporated the negative effects of socio-economic segregation to a lesser degree.
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Affiliation(s)
- Markku Satokangas
- Health Economics and Equity in Health Care, Finnish Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland.
- Network of Academic Health Centres and Department of General Practice and Primary Health Care, University of Helsinki, P.O. Box 20, 00014, Helsinki, Finland.
| | - Martti Arffman
- Health Economics and Equity in Health Care, Finnish Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland
| | - Janne Agerholm
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Karsten Thielen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Ørsted Hougaard
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ingelise Andersen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Bo Burström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Ilmo Keskimäki
- Health Economics and Equity in Health Care, Finnish Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland
- Faculty of Social Sciences, Tampere University, 33014, Tampere, Finland
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20
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Kyrönlahti A, Erdmann F, Feychting M, Frederiksen LE, Hirvonen E, Korhonen LM, Krøyer A, Mader L, Malila N, Mogensen H, Pedersen C, Talbäck M, Taskinen M, Winther JF, Madanat‐Harjuoja L, Pitkäniemi J. Income disparities between adult childhood cancer survivors and their peers-A register-based cohort study from the SALiCCS research programme. Cancer Med 2023; 12:16455-16468. [PMID: 37305982 PMCID: PMC10469706 DOI: 10.1002/cam4.6218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 04/20/2023] [Accepted: 05/30/2023] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND Childhood cancer survivors face various adverse consequences. This Nordic register-based cohort study aimed to assess whether survivors of childhood cancer are more likely to have low income than their peers. METHODS We identified 17,392 childhood cancer survivors diagnosed at ages 0 to 19 between 1971 and 2009 with 83,221 age-, sex-, and country-matched population comparisons. Annual disposable income at ages 20 to 50 years was retrieved from statistical offices (for 1990-2017) and categorized into low income and middle/high income. The number of transitions between income categories were assessed using binomial regression analyses. RESULTS The prevalence of annual low income among childhood cancer survivors was 18.1% and 15.6% among population comparisons (risk ratio [RR] 1.17; 95% confidence interval [CI] 1.16-1.18). Compared to population comparisons, childhood cancer survivors were 10% (95% CI 8%-11%) less likely to transition from low to middle/high income and 12% (10%-15%) more likely to transition from middle/high to low income during follow-up. Among those initially in the low income category, survivors were 7% (95% CI 3%-11%) more likely to remain in the low income category. If the initial category was middle/high income, childhood cancer survivors were 10% (95% CI 8%-11%) less likely to remain in the middle/high income and 45% (37%-53%) more likely to transition to the low income category permanently. CONCLUSIONS Childhood cancer survivors are at higher risk for low income in adulthood than their peers. These disparities might be reduced by continued career counseling along with support in managing within the social security system.
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Affiliation(s)
- Anniina Kyrönlahti
- Finnish Cancer RegistryHelsinkiFinland
- Children and AdolescentsHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Friederike Erdmann
- Childhood Cancer Research GroupDanish Cancer Society Research CenterCopenhagenDenmark
- Division of Childhood Cancer EpidemiologyInstitute of Medical Biostatistics, Epidemiology, and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University MainzGermany
- Department of Prevention and EvaluationLeibniz Institute for Prevention Research and Epidemiology – BIPSBremenGermany
| | - Maria Feychting
- Unit of EpidemiologyInstitute of Environmental Medicine, Karolinska InstitutetStockholmSweden
| | | | | | - Liisa Maria Korhonen
- Finnish Cancer RegistryHelsinkiFinland
- Children and AdolescentsHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Anja Krøyer
- Childhood Cancer Research GroupDanish Cancer Society Research CenterCopenhagenDenmark
| | - Luzius Mader
- Childhood Cancer Research GroupDanish Cancer Society Research CenterCopenhagenDenmark
- Childhood Cancer Research GroupInstitute of Social and Preventive Medicine, University of BernBernSwitzerland
- Cancer Registry Bern‐SolothurnUniversity of BernBernSwitzerland
| | | | - Hanna Mogensen
- Unit of EpidemiologyInstitute of Environmental Medicine, Karolinska InstitutetStockholmSweden
| | - Camilla Pedersen
- Childhood Cancer Research GroupDanish Cancer Society Research CenterCopenhagenDenmark
| | - Mats Talbäck
- Unit of EpidemiologyInstitute of Environmental Medicine, Karolinska InstitutetStockholmSweden
| | - Mervi Taskinen
- Children and AdolescentsHelsinki University Hospital and University of HelsinkiHelsinkiFinland
- Division of Pediatric Hematology, Oncology, and Stem Cell TransplantationHelsinki University HospitalHelsinkiFinland
| | | | - Laura Madanat‐Harjuoja
- Finnish Cancer RegistryHelsinkiFinland
- Dana Farber/Boston Children's Cancer and Blood Disorders ClinicBostonMassachusettsUSA
| | - Janne Pitkäniemi
- Finnish Cancer RegistryHelsinkiFinland
- Health Sciences Unit, Faculty of Social SciencesTampere UniversityTampereFinland
- Department of Public Health, Faculty of MedicineUniversity of HelsinkiHelsinkiFinland
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21
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Thualagant N, Simonsen N, Sarvimäki A, Stenbock-Hult B, Olafsdottir HS, Fosse E, Torp S, Ringsberg KC, Forrinder U, Tillgren P. Nordic responses to covid-19 from a health promotion perspective. Health Promot Int 2023; 38:daab211. [PMID: 35022714 PMCID: PMC8807276 DOI: 10.1093/heapro/daab211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
On 30 January 2020, the disease covid-19 was declared by the World Health Organization to be an international threat to human health and on 11 March 2020, the outbreak was declared a pandemic. The aim of this study was to analyse policy strategies developed by the five Nordic countries during the first 3 months of the pandemic from a health promotion perspective in order to identify Nordic responses to the crisis. Although the Nordic countries have a long tradition of co-operation as well as similar social welfare policies and legislation, each country developed their own strategies towards the crisis. The strategies identified were analysed from a health promotion perspective emanating from five principles: intersectorality, sustainability, equity, empowerment and a lifecourse perspective. Denmark, Finland and Norway had lockdowns to varying degrees, whereas Sweden and Iceland had no lockdowns. Iceland implemented a test and tracking strategy from the very beginning. All countries based their recommendations and restrictions on appeals to solidarity and trust in institutions and fellow citizens. The analysis showed that the strategies in all countries could be related to health promotion principles with some differences between the countries especially regarding equity and sustainability. The Nordic governments took responsibility for protecting their citizens by developing policy strategies based on restrictions and recommendations congruent with the principles of health promotion. The findings also identified issues that will pose challenges for future pandemic strategies.
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Affiliation(s)
- Nicole Thualagant
- Research Centre in Health Promotion. Department of People and Technology, Roskilde University, Roskilde, Denmark
| | - Nina Simonsen
- Folkhälsan Research Center, Public Health Research Program & University of Helsinki, Department of Public Health P.O. Box 211, FI-00251 Helsinki, Finland
| | | | | | | | - Elisabeth Fosse
- Department of Health Promotion and Development, Faculty of Psychology, University of Bergen, Norway
| | - Steffen Torp
- Department of Health, Social and Welfare Studies, Faculty of Health and Social Sciences, Campus Vestfold, University of South-Eastern Norway
| | - Karin C Ringsberg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ulla Forrinder
- Department of Social Work and Psychology, University of Gävle, Sweden
| | - Per Tillgren
- School of Health, Care and Social Welfare, Mälardalen University, Sweden
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22
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Bergsmark T, Engesæter LK, Rasmussen A, Bennet W, Nordin A, Pall V, Line PD, Ericzon BG, Melum E. Long-term survival after liver transplantation for alcohol-related liver disease in the Nordic countries. Scand J Gastroenterol 2023; 58:923-930. [PMID: 36872559 DOI: 10.1080/00365521.2023.2184193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 03/07/2023]
Abstract
OBJECTIVES Alcohol-related liver disease (ALD) is among the most common indications for liver transplantation (LTX) in Europe and North America, with good five-year survival rates post-LTX. Here we evaluated survival up to and beyond 20 years after LTX for patients with ALD compared to a comparison group. METHODS Patients with ALD and a comparison group transplanted in the Nordic countries between 1982 and 2020 were included. Data were analyzed using descriptive statistics, Kaplan-Meier curves and predictors of survival were assessed with Cox-regressions. RESULTS 831 patients with ALD and 2979 patients in the comparison group were included in the study. Patients with ALD were older at the time of LTX (p < .001) and more likely to be male (p < .001). The estimated median follow-up time was 9.1 years for the ALD-group and 11.1 years for the comparison group. 333 (40.1%) patients with ALD and 1010 (33.9%) patients in the comparison group died during follow-up. The overall survival was impaired for patients with ALD compared to the comparison group (p < .001) and was evident for male and female patients, patients transplanted before and after 2005, and observed in all age-groups except patients over 60 years. Age at transplant, waiting time, year of LTX and country of LTX were associated with decreased survival after LTX for patients with ALD. CONCLUSIONS Patients with ALD have a decreased long-term survival following LTX. This difference was evident in most sub-groups of patients and warrants close follow-up of liver transplanted patients with ALD with focus on risk reduction.
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Affiliation(s)
- Thomas Bergsmark
- Section of Gastroenterology, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Lise Katrine Engesæter
- Section of Gastroenterology, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Norwegian PSC Research Center, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Oslo, Norway
- Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
| | - Allan Rasmussen
- Department of Surgical Gastroenterology and Liver Transplantation, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - William Bennet
- Transplant Institute, Sahlgrenska University Hospital, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Arno Nordin
- Department of Transplantation and Liver Surgery, University Hospital, Helsinki, Finland
| | - Virge Pall
- Transplantation Centre, Tartu University Hospital, Tartu, Estonia
| | - Pål-Dag Line
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Section of Transplantation Surgery, Department of Transplantation Medicine, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Oslo, Norway
| | - Bo-Göran Ericzon
- Division of Transplantation Surgery, Karolinska Institutet, CLINTEC, Stockholm, Sweden
| | - Espen Melum
- Section of Gastroenterology, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Norwegian PSC Research Center, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Oslo, Norway
- Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
- Hybrid Technology Hub-Centre of Excellence, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
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23
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Björnsson HM, Bjørnsen LP, Skjærbæk CB, Hruska K, Palomäki A. Current postgraduate training in emergency medicine in the Nordic countries. BMC Med Educ 2023; 23:469. [PMID: 37349721 DOI: 10.1186/s12909-023-04430-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 06/06/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Emergency Medicine (EM) is an independent specialty in all five Nordic countries. This study aims to evaluate the structure of post-graduate EM training in the area. METHODS A leading hospital or hospitals in EM training in each country were identified. An e-survey was sent to each hospital to gather data on patient volume and physician staffing, curriculum, trainee supervision, and monitoring of progression in training. RESULTS Data were collected from one center in Iceland and Norway, two in Finland and Sweden, and four centers in Denmark. The data from each country in Denmark, Finland, and Sweden, were pooled to represent that country. The percentage of consultants with EM specialist recognition ranged from 49-100% of all consultants working in the participating departments. The number of patients seen annually per each full time EM consultant was almost three times higher in Finland than in Sweden. In Iceland, Denmark, and Sweden a consultant was present 24/7 in the ED but not in all centers in the other countries. The level of trainee autonomy in clinical practice varied between countries. Requirements for completing standardized courses, completing final exams, scientific and quality improvement projects, and evaluation of trainee progression, varied between the countries. CONCLUSIONS All Nordic countries have established EM training programs. Despite cultural similarities, there are significant differences in how the EM training is structured between the countries. Writing and implementing a standardized training curriculum and assessment system for EM training in the Nordic countries should be considered.
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Affiliation(s)
- Hjalti Már Björnsson
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland.
- Department of Emergency Medicine, Landspitali-The National University Hospital of Iceland, Fossvogur, 108, Reykjavík, Iceland.
| | - Lars Petter Bjørnsen
- St. Olav's University Hospital, St. Olav's University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | | | | | - Ari Palomäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Emergency Department, Kanta-Häme Central Hospital, Hämeenlinna, Finland
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24
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Nouf F, Ineland J. Epistemic citizenship under structural siege: a meta-analysis drawing on 544 voices of service user experiences in Nordic mental health services. Front Psychiatry 2023; 14:1156835. [PMID: 37333919 PMCID: PMC10272743 DOI: 10.3389/fpsyt.2023.1156835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/02/2023] [Indexed: 06/20/2023] Open
Abstract
This paper presents a meta-analysis, drawing exclusively on qualitative research (n = 38), which contributes to findings on mental health service user experiences of received provisions and/or encounters in contemporary social and mental health services in the Nordic countries. The main objective is to identify facilitators of, and barriers to, various notions of service user involvement. Our findings provide empirical evidence regarding service users' experiences of participation in their encounters with mental health services. We identified two overarching themes, professional relations and the regulative framework and current rule and norm system, in the reviewed literature concerning facilitators and hindrances of user involvement in mental health services. By including the interrelated policy concept of 'active citizenship' and theoretical concept of 'epistemic (in)justice' in the analyses, the results provide foundations for broader exploration and problematization of the policy ideals of what we call 'epistemic citizenship' and contemporary practices in Nordic mental health organizations. Our conclusions include suggestions that linking micro-level experiences to organizational macro-level circumstances opens up avenues for further research on service user involvement.
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Affiliation(s)
- Faten Nouf
- Department of Social Work, Umeå University, Umeå, Sweden
| | - Jens Ineland
- Department of Social Work, Faculty of Social Sciences, Umeå University, Umeå, Sweden
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25
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Kepp KP, Björk J, Emilsson L, Lallukka T. The contribution of population age-sex structure to the excess mortality estimates of 2020-2021 in Denmark, Finland, Iceland, Norway, and Sweden. SSM Popul Health 2023; 22:101377. [PMID: 36919136 DOI: 10.1016/j.ssmph.2023.101377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 03/07/2023] Open
Abstract
The Nordic countries offer an ideal case study of the COVID-19 pandemic due to their comparability, high data quality, and variable mitigations. We investigated the age- and sex-specific mortality patterns during 2020-2021 for the five Nordic countries and analysed the total age- and sex-adjusted excess deaths, ratios of actual to expected death rates, and age-standardized excess death estimates. We assessed excess deaths using several time periods and sensitivity tests, and 42 sex and age groups. Declining pre-pandemic age-specific death rates reflected improving health demographics. These affect the expected death estimates and should be accounted for in excess mortality models. Denmark had the highest death rates both before and during the pandemic, whereas in 2020 Sweden had the largest mortality increase. The age-standardized mortality of Denmark, Iceland and Norway was lowest in 2020. 2021 was one of the lowest mortality years for all Nordic countries. The total excess deaths in 2020-2021 were dominated by 70-89-year-olds, were not identified in children, and were more pronounced among men than women. Sweden had more excess deaths in 2020 than in 2021, whereas Finland, Norway and Denmark had the opposite. Our study provides new details on Nordic sex- and age-specific mortality during the first two years of the pandemic and shows that several metrics are important to enable a full understanding and comparison of the pandemic mortality.
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26
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Olsen SH, Reynstind D, Hallgrímsson H, Kesmodel US. Birthweight and gestational age in the Faroe Islands: A comparison between birthweight and gestational age in the Faroe Islands and other Nordic countries. Acta Obstet Gynecol Scand 2023; 102:506-515. [PMID: 36789586 PMCID: PMC10008297 DOI: 10.1111/aogs.14527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 01/15/2023] [Accepted: 01/23/2023] [Indexed: 02/16/2023]
Abstract
INTRODUCTION This study aimed to examine Faroese infants' birthweight and gestational age in 2010-2019 and compare these findings with other Nordic countries. Risk factors for high birthweight among Faroese infants were also investigated in this study. MATERIAL AND METHODS All singleton liveborn infants registered in the Faroese Birth Registry in 2010-2019 were included in the study (n = 6121). A comparison was made with data on birthweight and gestational age from Denmark, Iceland, Norway, and Sweden. RESULTS The mean birthweight increased significantly from 3652 g (95% confidence interval [CI]: 3505-3699 g) in 2010 to 3745 g (95% CI: 3700-3790 g) in 2019, a mean increase in birthweight of 93 g (95% CI: 28-158 g) (p < 0.05). The birthweight increased 186 g (95% CI: 179-193 g) for each gestational week and 11 g (95% CI: 7-15 g) for each year. Changes in gestational age explained 31% of the change in birthweight. The proportion of infants weighing 4500 g or more increased significantly from 6.1% in 2010 to 9.6% in 2019 (p < 0.05). The risk of giving birth to an infant weighing 4000 g or more was consistently associated with previously giving birth (OR 1.98 (95% CI: 1.71-2.30)) and gestational age (OR 1.28 (95% CI: 1.23-1.33) per week increase in gestational age). Infants born in gestational weeks 40 and 42 in 2019 had a higher birthweight z-score than infants born in gestational weeks 40 and 42 in 2010. Compared to other Nordic countries, Faroese infants' mean birthweight was high, the Faroe Islands had a higher number of infants born with a weight of 4000 g or more and a higher proportion of infants born in gestational week 41 or later (31.5%). CONCLUSIONS Our results showed that the mean birthweight and the proportion of infants with high birthweight significantly increased during 2010-2019 in the Faroe Islands. The mean birthweight, the proportion of infants with high birthweight and the gestational age at birth for Faroese infants was higher than all other Nordic countries. The reasons for this require further investigation.
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Affiliation(s)
- Sunnvá Hanusardóttir Olsen
- Department of Obstetrics and Gynecology, National Hospital of the Faroe Islands, Tórshavn, Faroe Islands
| | - Diana Reynstind
- Department of Obstetrics and Gynecology, National Hospital of the Faroe Islands, Tórshavn, Faroe Islands
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27
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Dukovska-Popovska I, Kjellsdotter Ivert L, Jónsdóttir H, Carin Dreyer H, Kaipia R. The supply and demand balance of recyclable textiles in the Nordic countries. Waste Manag 2023; 159:154-162. [PMID: 36764240 DOI: 10.1016/j.wasman.2023.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 12/28/2022] [Accepted: 01/17/2023] [Indexed: 06/18/2023]
Abstract
The textile industry is on its early steps towards circular economy. Being a highly resource-intensive and waste-generating industry, it is essential to embrace fiber-to-fiber recycling in addressing the increasing textile waste problem. Several innovative initiatives are happening within this area, not least in the Nordic countries, where automated sorting and fiber-to-fiber recycling technologies and capacities are developing. These large investments require economy of scale; however, this is challenged by the fractioned supply due to the specific fiber requirements of the recycling facilities. To ensure economy of scale and support strategic planning, it is important to investigate the balance of the demand of those capacities with the supply of recyclables generated in the region. Local and regional perspectives are needed in order to avoid unnecessary transportation of low value materials. Based on a synthetises of existing textile flow studies and interviews with relevant actors in four Nordic countries, this study investigates the balance between the supply of recyclable textiles and the sorting and recycling capacity. This is accomplished by estimating the volumes of recyclables and their fiber composition (based on developed weighting average method) and comparing these with the current and upcoming capacities in each country and in the Nordics as a whole. The findings indicate that the upcoming automatic sorting and recycling capacity will be sufficient to deal with the total recyclable fraction in the Nordic region, except for some of the synthetic fibers. However, there are imbalances between supply and demand within individual countries, highlighting opportunities for collaboration.
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Affiliation(s)
| | | | | | - Heidi Carin Dreyer
- Department of Industrial Economics and Technology Management, NTNU, 7491 Trondheim, Norway.
| | - Riikka Kaipia
- Industrial Engineering and Management, Aalto University School of Science, and School of Economics, University of Turku, 20500 Turku, Finland.
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28
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Badache AC, Mäki-Torkko E, Widen S, Fors S. Why Are Old-Age Disabilities Decreasing in Sweden and Denmark? Evidence on the Contribution of Cognition, Education, and Sensory Functions. J Gerontol B Psychol Sci Soc Sci 2023; 78:483-495. [PMID: 36112366 PMCID: PMC9985323 DOI: 10.1093/geronb/gbac118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Improvements in educational attainment, cognitive and sensory functions, and a decline in the prevalence of disabilities have been observed in older adults in Sweden and Denmark. In the present study, it was investigated whether better cognition, higher educational attainment, and improved sensory function among older adults aged 60 and older in these countries have contributed to decreasing rates of old-age disabilities. METHODS The analyses were based on repeated cross-sectional data from the Survey of Health, Ageing, and Retirement in Europe for the 2004-2017 period. Descriptive data were used to benchmark the declining prevalence of disabilities, improving cognitive and sensory functions, and increased educational level. The association between time and disabilities was analyzed with logistic regression models, and the contribution of the improved cognitive function, education, and sensory function to the declining prevalence of old-age disabilities was estimated using the Karlson-Holm-Breen method for mediation analysis. RESULTS The analysis suggests that the declining prevalence of old-age disabilities in Sweden and Denmark between 2004 and 2017 can largely be attributed to improved cognitive function and vision and to a lesser extent by education and hearing ability. DISCUSSION These findings raise important questions about the causal mechanisms producing the associations between cognition, education, and sensory functions and disability in older age. Future studies should explore the causal nature of the associations between these mediators and old-age disabilities. In addition, they should explore whether these findings differ across regional and cultural contexts and over different time periods.
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Affiliation(s)
- Andreea C Badache
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,Swedish Institute for Disability Research, Örebro University, Örebro, Sweden
| | - Elina Mäki-Torkko
- School of Medical Sciences, Örebro University, Sweden.,Audiological Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Stephen Widen
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Stefan Fors
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Stockholm, Sweden
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29
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Depren Ö, Kartal MT, Ayhan F, Kılıç Depren S. Heterogeneous impact of environmental taxes on environmental quality: Tax domain based evidence from the nordic countries by nonparametric quantile approaches. J Environ Manage 2023; 329:117031. [PMID: 36528942 DOI: 10.1016/j.jenvman.2022.117031] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/25/2022] [Accepted: 12/11/2022] [Indexed: 06/17/2023]
Abstract
This study aims to examine the heterogeneous causality and impact of environmental taxes at both aggregated and disaggregated levels on environmental quality. In this context, the study focuses on Nordic countries as green economies; handles carbon dioxide (CO2) emissions as an environmental quality indicator; includes aggregated and disaggregated levels of environmental taxes as explanatory variables; uses quarterly data for the period 1994/Q1-2020/Q4 as the most recent available data; applies novel nonparametric Granger causality-in-quantiles (GCQ) and quantile-on-quantile regression (QQR) approaches as the main models while using quantile regression (QR) for robustness check. The results present that (i) causal impacts of environmental taxes on CO2 emissions exist in most quantiles at disaggregated levels excluding some lower, middle, and higher quantiles, whereas indicator-, country-, and quantile-based results vary; (ii) environmental tax on energy (ETE) has a mainly decreasing impact in Iceland, a mixed impact in Denmark, Finland, Norway, and Sweden based on quantiles; (iii) environmental tax on pollution (ETP) has the highest decreasing impact in most quantiles in Denmark, Iceland, and Norway; (iv) environmental tax in transport (ETT) has a decreasing impact in Norway and Sweden, whereas it has a reverse impact in Denmark, Finland, and Iceland; (v) impact of total environmental tax (TET) has a decreasing impact in Denmark and Norway at some quantiles, whereas an increasing impact in Finland, Iceland, and Sweden; (vi) the robustness of the QQR results are confirmed by the QR approach. Hence, the results underline the importance of country and quantile-based disaggregated analyses and Nordic countries should re-adjust environmental taxes to increase environmental quality.
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Affiliation(s)
- Özer Depren
- Yapı Kredi Bank Customer Experience Research Lab., İstanbul, Turkey.
| | - Mustafa Tevfik Kartal
- Borsa İstanbul Strategic Planning, Financial Reporting, and Investor Relations Directorate, İstanbul, Turkey.
| | - Fatih Ayhan
- Bandırma Onyedi Eylül University, Faculty of Economics and Administrative Sciences, Department of Economics, Balıkesir, Turkey.
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30
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Jones AW. Highly cited forensic practitioners in the Nordic countries and their composite citation scores based on six different citation metrics. Med Leg J 2023:258172221145109. [PMID: 36752031 DOI: 10.1177/00258172221145109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Forensic science is a multidisciplinary field that involves the use of various scientific methods and techniques for the investigation of crimes. Forensic scientists are often required to testify in court as expert witnesses and explain the meaning of chemical, physical, and/or medical evidence to a judge and jury. This article took advantage of a citation database to identify the most highly cited forensic practitioners in four Nordic countries within the discipline of legal and forensic medicine. The starting point was 7 million scientists indexed in the SCOPUS database, each of whom had their name on at least five entries. Six different citation metrics were used to calculate a person's composite citation score. Those within the top 2% of their primary research discipline were considered highly cited.
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Affiliation(s)
- Alan W Jones
- Department of Biomedical and Clinical Sciences, Division of Clinical Chemistry and Pharmacology, University of Linköping, Sweden
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31
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Karttunen E, Hervonen P, Hosseini Aliabad A, Oldenburg J, Pappot H, Sairanen J, Støvring H, Vásquez JL, Bergman S, Magnussen G, Norremark P, Thoresen S, Ullén A. Incidence, mortality and relative survival of patients with cancer of the bladder and upper urothelial tract in the Nordic countries between 1990 and 2019. Scand J Urol 2023; 57:15-21. [PMID: 36416403 DOI: 10.1080/21681805.2022.2138965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE To understand the potential impact of new treatment options for urinary tract cancer, recent population trends in incidence, mortality and survival should be elucidated. This study estimated changes in the incidence, mortality and relative survival of urinary tract cancer in the Nordic countries (Denmark, Finland, Iceland, Norway and Sweden) between 1990 and 2019. METHODS Annual counts of incident cases and deaths due to urinary tract cancer (International Classification of Diseases, Tenth Revision, Clinical Modification codes C65-C68, D09.0-D09.1, D30.1-D30.9 and D41.1-D41.9) in Nordic countries were retrieved in 5-year age categories by sex during the study period. Country-specific time trends (annual rate ratios [RRs]) were estimated using Poisson regression, and RRs were compared between sexes. RESULTS The incidence rate of bladder and upper urothelial tract cancer was >3-times lower in women than men in all countries across all age groups (incidence RR for women to men ranging from 0.219 [95% CI = 0.213-0.224] in Finland to 0.291 [95% CI = 0.286-0.296] in Denmark). Incidence rates were lowest in Finland and highest in Norway and Denmark. Age-adjusted mortality decreased in Finland, Denmark and Norway and in Swedish men, with the greatest decrease seen in Danish men (annual RR = 0.976; 95% CI = 0.975-0.978). In all countries and age groups, women had a lower relative survival rate than men. CONCLUSION Between 1990 and 2019, the incidence of urinary tract cancer was stable in the Nordic countries, while mortality rates declined and relative survival increased. This could be due to earlier diagnosis and better treatment.
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Affiliation(s)
| | - Petteri Hervonen
- Department of Urology, Helsinki University Hospital, Finland.,Comprehensive Cancer Center, Helsinki University Hospital, Finland
| | | | - Jan Oldenburg
- Department of Oncology, Akershus University Hospital, Oslo, Norway
| | - Helle Pappot
- Department of Oncology, Rigshospitalet, University Hospital of Copenhagen, Denmark
| | - Jukka Sairanen
- Department of Urology, Helsinki University Hospital, Finland
| | - Henrik Støvring
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Juan Luis Vásquez
- Department of Urology, Zealand University Hospital Roskilde, Denmark
| | | | - Gry Magnussen
- Merck AB NUF, Oslo, Norway, an affiliate of Merck KGaA
| | | | | | - Anders Ullén
- Department of Oncology, Karolinska University Hospital, Solna, Sweden
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Kourantidou M, Verbrugge LNH, Haubrock PJ, Cuthbert RN, Angulo E, Ahonen I, Cleary M, Falk-Andersson J, Granhag L, Gíslason S, Kaiser B, Kosenius AK, Lange H, Lehtiniemi M, Magnussen K, Navrud S, Nummi P, Oficialdegui FJ, Ramula S, Ryttäri T, von Schmalensee M, Stefansson RA, Diagne C, Courchamp F. The economic costs, management and regulation of biological invasions in the Nordic countries. J Environ Manage 2022; 324:116374. [PMID: 36352726 DOI: 10.1016/j.jenvman.2022.116374] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 09/11/2022] [Accepted: 09/23/2022] [Indexed: 06/16/2023]
Abstract
A collective understanding of economic impacts and in particular of monetary costs of biological invasions is lacking for the Nordic region. This paper synthesizes findings from the literature on costs of invasions in the Nordic countries together with expert elicitation. The analysis of cost data has been made possible through the InvaCost database, a globally open repository of monetary costs that allows for the use of temporal, spatial, and taxonomic descriptors facilitating a better understanding of how costs are distributed. The total reported costs of invasive species across the Nordic countries were estimated at $8.35 billion (in 2017 US$ values) with damage costs significantly outweighing management costs. Norway incurred the highest costs ($3.23 billion), followed by Denmark ($2.20 billion), Sweden ($1.45 billion), Finland ($1.11 billion) and Iceland ($25.45 million). Costs from invasions in the Nordics appear to be largely underestimated. We conclude by highlighting such knowledge gaps, including gaps in policies and regulation stemming from expert judgment as well as avenues for an improved understanding of invasion costs and needs for future research.
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Affiliation(s)
- Melina Kourantidou
- University of Southern Denmark, Department of Sociology, Environmental and Business Economics, Esbjerg Ø, Denmark; Institute of Marine Biological Resources and Inland Waters, Hellenic Center for Marine Research, Athens, Greece.
| | - Laura N H Verbrugge
- Aalto University, Department of Built Environment, Water & Development Research Group, Aalto, Finland; University of Helsinki, Department of Forest Sciences, Helsinki, Finland
| | - Phillip J Haubrock
- Senckenberg Research Institute and Natural History Museum Frankfurt, Department of River Ecology and Conservation, Gelnhausen, Germany; University of South Bohemia in České Budějovice, South Bohemian Research Center of Aquaculture and Biodiversity of Hydrocenoses, Vodňany, Czech Republic
| | - Ross N Cuthbert
- School of Biological Sciences, Queen's University Belfast, Belfast, BT9 5DL, Northern Ireland
| | - Elena Angulo
- Université Paris-Saclay, CNRS, AgroParisTech, Ecologie Systématique Evolution, Orsay, France; Estación Biológica de Doñana (CSIC), Seville, Spain
| | - Inkeri Ahonen
- Swedish Environmental Protection Agency, Stockholm, Sweden
| | - Michelle Cleary
- Swedish University of Agricultural Sciences, Southern Swedish Forest Research Centre, Alnarp, Sweden
| | | | - Lena Granhag
- Chalmers University of Technology, Göteborg, Sweden
| | - Sindri Gíslason
- Southwest Iceland Nature Research Centre, Suðurnesjabær, Iceland
| | - Brooks Kaiser
- University of Southern Denmark, Department of Sociology, Environmental and Business Economics, Esbjerg Ø, Denmark
| | - Anna-Kaisa Kosenius
- University of Helsinki, Department of Economics and Management, P.O. Box 27, 00014 Helsinki, Finland
| | - Henrik Lange
- Swedish Environmental Protection Agency, Stockholm, Sweden
| | | | | | - Ståle Navrud
- School of Economics and Business, Norwegian University of Life Sciences, Ås, Norway
| | - Petri Nummi
- University of Helsinki, Department of Forest Sciences, Helsinki, Finland
| | | | - Satu Ramula
- Department of Biology, University of Turku, Turku, Finland
| | | | | | | | - Christophe Diagne
- Université Paris-Saclay, CNRS, AgroParisTech, Ecologie Systématique Evolution, Orsay, France
| | - Franck Courchamp
- Université Paris-Saclay, CNRS, AgroParisTech, Ecologie Systématique Evolution, Orsay, France
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Kepp KP, Björk J, Kontis V, Parks RM, Bæk KT, Emilsson L, Lallukka T. Estimates of excess mortality for the five Nordic countries during the COVID-19 pandemic 2020-2021. Int J Epidemiol 2022; 51:1722-1732. [PMID: 36331437 PMCID: PMC9960481 DOI: 10.1093/ije/dyac204] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Excess mortality during the COVID-19 pandemic is of major scientific and political interest. METHODS We critically reviewed different estimates of all-cause excess mortality for the five Nordic countries (Denmark, Finland, Iceland, Norway and Sweden), which have been much studied during the COVID-19 pandemic, using the latest register data to discuss uncertainties and implications. RESULTS We show using back-calculation of expected deaths from Nordic all-cause deaths that the Institute for Health Metrics and Evaluation model is a clear outlier in the compared estimates and likely substantially overestimates excess mortality of Finland and Denmark, and probably Sweden. Our review suggests a range of total Nordic excess deaths of perhaps 15 000-20 000, but results are sensitive to assumptions in the models as shown. CONCLUSIONS We document substantial heterogeneity and uncertainty in estimates of excess mortality. All estimates should be taken with caution in their interpretation as they miss detailed account of demographics, such as changes in the age group populations over the study period.
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Affiliation(s)
- Kasper P Kepp
- Section of Biophysical and Biomedicinal Chemistry, DTU Chemistry, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Jonas Björk
- Clinical Studies Sweden, Forum South, Skåne University Hospital, Lund, Sweden
- Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Vasilis Kontis
- Faculty of Medicine, School of Public Health, Imperial College London, London, UK
| | - Robbie M Parks
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York City, USA
| | - Kristoffer T Bæk
- Section of Biophysical and Biomedicinal Chemistry, DTU Chemistry, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Louise Emilsson
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
- Vårdcentralen Värmlands Nysäter and Centre for Clinical Research, County Council of Värmland, Värmlands Nysäter, Sweden
| | - Tea Lallukka
- Department of Public Health, University of Helsinki, Helsinki, Finland
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Baluszek JB, Wiig S, Myrnes-Hansen KV, Brønnick KK. Specialized healthcare practitioners' challenges in performing video consultations to patients in Nordic Countries - a systematic review and narrative synthesis. BMC Health Serv Res 2022; 22:1432. [PMID: 36443770 PMCID: PMC9706945 DOI: 10.1186/s12913-022-08837-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 11/15/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Video consultations are becoming an important telemedicine service in Nordic countries. Its use in specialized healthcare increased significantly during COVID-19 pandemic. Despite advantages video consultations have, it may also produce challenges for practitioners. Identifying and understanding these challenges may contribute to how managers can support these practitioners and thereby improve work related wellbeing and quality of care. METHODS We designed this study as systematic review of the literature with narrative synthesis and conducted a thematic analysis. We conducted review about the use of video consultations in specialized healthcare in Nordic countries to identify and categorize challenges experienced and/or perceived by practitioners. We searched Ovid MEDLINE(R), EMBASE, APA PsycINFO, and CINAH, from 2011 to 2021. Eligibility criteria were population - practitioners in specialized healthcare with experience in video consultations to patients, interest - challenges experienced and/or perceived by practitioners and, context - outpatient clinics in Nordic countries. RESULTS We included four qualitative and one mixed method studies, published between 2018 and 2021 in Norway, Denmark, and Sweden. By thematic analysis we identified three main themes: challenges related to video consultation, challenges related to practitioner and, challenges related to patient. These themes are composed of 8 categories: technology uncertainties, environment and surroundings, preparation for requirements, clinical judgment, time management, practitioners' idiosyncrasies, patients' idiosyncrasies and patients' suitability and appropriateness. Challenges from technology uncertainties category were most frequent (dominant) across all clinical specializations. CONCLUSION Findings indicate the scarcity of the research and provide rationale for further research addressing challenges in providing video consultations in the Nordic context. We suggest updating this review when the amount of available research increases.
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Affiliation(s)
- Joanna Barbara Baluszek
- Faculty of Health Sciences, Department of Quality and Health Technology, University of Stavanger, Stavanger, Norway. .,Cognitive Lab: Cognitive and Behavioral Neuroscience Lab, University of Stavanger, Stavanger, Norway. .,SHARE - Centre for Resilience in Healthcare, University of Stavanger, Stavanger, Norway.
| | - Siri Wiig
- Faculty of Health Sciences, Department of Quality and Health Technology, University of Stavanger, Stavanger, Norway.,SHARE - Centre for Resilience in Healthcare, University of Stavanger, Stavanger, Norway
| | - Kai Victor Myrnes-Hansen
- Norwegian School of Hotel Management, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Kolbjørn Kallesten Brønnick
- Faculty of Health Sciences, Department of Quality and Health Technology, University of Stavanger, Stavanger, Norway.,Cognitive Lab: Cognitive and Behavioral Neuroscience Lab, University of Stavanger, Stavanger, Norway.,SHARE - Centre for Resilience in Healthcare, University of Stavanger, Stavanger, Norway.,SESAM, Stavanger University Hospital, Stavanger, Norway
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Aradhya S, Tegunimataka A, Kravdal Ø, Martikainen P, Myrskylä M, Barclay K, Goisis A. Maternal age and the risk of low birthweight and pre-term delivery: a pan-Nordic comparison. Int J Epidemiol 2022; 52:156-164. [PMID: 36350574 PMCID: PMC9908063 DOI: 10.1093/ije/dyac211] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 10/20/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Advanced maternal age at birth is considered a risk factor for adverse birth outcomes. A recent study applying a sibling design has shown, however, that the association might be confounded by unobserved maternal characteristics. METHODS Using total population register data on all live singleton births during the period 1999-2012 in Denmark (N = 580 133; 90% population coverage), Norway (N = 540 890) and Sweden (N = 941 403) and from 2001-2014 in Finland (N = 568 026), we test whether advanced maternal age at birth independently increases the risk of low birthweight (LBW) (<2500 g) and pre-term birth (<37 weeks gestation). We estimated within-family models to reduce confounding by unobserved maternal characteristics shared by siblings using three model specifications: Model 0 examines the bivariate association; Model 1 adjusts for parity and sex; Model 2 for parity, sex and birth year. RESULTS The main results (Model 1) show an increased risk in LBW and pre-term delivery with increasing maternal ages. For example, compared with maternal ages of 26-27 years, maternal ages of 38-39 years display a 2.2, 0.9, 2.1 and 2.4 percentage point increase in the risk of LBW in Denmark, Finland, Norway and Sweden, respectively. The same patterns hold for pre-term delivery. CONCLUSIONS Advanced maternal age is independently associated with higher risk of poor perinatal health outcomes even after adjusting for all observed and unobserved factors shared between siblings.
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Affiliation(s)
- Siddartha Aradhya
- Demography Unit and Department of Sociology, Stockholm University, Stockholm, Sweden,Centre for Economic Demography, Lund University, Lund, Sweden
| | | | - Øystein Kravdal
- Department of Economics, University of Oslo, Oslo, Norway,Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Pekka Martikainen
- Max Planck Institute for Demographic Research, Rostock, Germany,Population Research Unit and Department of Social Research, University of Helsinki, Helsinki, Finland
| | - Mikko Myrskylä
- Max Planck Institute for Demographic Research, Rostock, Germany,Population Research Unit and Department of Social Research, University of Helsinki, Helsinki, Finland
| | - Kieron Barclay
- Corresponding author. Department of Sociology, Stockholm University, 106 91 Stockholm, Sweden. E-mail:
| | - Alice Goisis
- Social Research Institute, University College London, London, UK
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Bozkaya Ş, Onifade ST, Duran MS, Kaya MG. Does environmentally friendly energy consumption spur economic progress: empirical evidence from the Nordic countries? Environ Sci Pollut Res Int 2022; 29:82600-82610. [PMID: 36215009 DOI: 10.1007/s11356-022-23452-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/30/2022] [Indexed: 06/16/2023]
Abstract
Exploring energy use-growth nexus can proffer valuable clues to policymakers and stakeholders on both economic and environmental sustainability targets. Unlike extant studies, this study focuses on the effects of renewable energy consumption on the economic progress of the Nordic countries including Denmark, Sweden, Norway, Finland, and Iceland. The empirical analysis encompasses two distinctive renewable energy consumption indicators while accounting for influential factors like research and development (R&D) expenditures, and both human and physical capital components within the traditional growth model framework. The DCCE estimator was deployed for the empirical analysis covering the available sample data between 1995 and 2020. From the results, the estimated impact of renewable energy consumption on economic progress varies according to its measurement vis-à-vis the utilized indicator 1 (renewable as % of total energy use) and indicator 2 (distinctive renewable power sources and biofuels). In the case of the former indicator, the impacts were insignificant while a positive significant impact on growth was seen across all model evaluations using both the GDP and per capita income levels of the Nordic countries in the latter indicator. Furthermore, both R&D expenditures and human capital component are essential significant long-run drivers of both economic growth and income levels in the bloc while physical capital formation produced contrary evidence on economic progress in the bloc. As such, policy implications and recommendations to enhance economic progress were suggested in the main text for the Nordic countries in view of renewable energy development and the bloc's environmental sustainability drive. Notably, strategic policy implementation should be geared towards encouraging more R&D expenditures, especially in renewable energy developments to facilitate economic growth and income levels while further positioning the Nordic bloc on environmental sustainability path.
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Affiliation(s)
- Şeyma Bozkaya
- Institute of Social Sciences, Nevşehir Hacı Bektaş Veli University, Nevşehir, Turkey
| | - Stephen Taiwo Onifade
- Department of International Trade and Logistics, Faculty of Economics and Administrative Sciences, KTO Karatay University, Konya, Turkey.
| | - Mahmut Sami Duran
- Department of Finance, Banking and Insurance, Selcuk University, Konya, Turkey
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Kumar BN, Diaz E, Castaneda AE, Ahrne M, NØrredam ML, Puthoopparambil SJ. Migration health research in the Nordic countries: Priorities and implications for public health. Scand J Public Health 2022; 50:1039-1046. [PMID: 36245405 DOI: 10.1177/14034948221125037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The past 50 years have witnessed an increase in immigration to the Nordic countries from and beyond neighbouring countries in Europe. Diversity implies variations and differences in health status and health outcomes both within and across populations. Migrant health research has not been prioritized and health policies and practice, especially long-term national plans, often exclude migrants. In this article, we briefly trace the history, the groups, reasons for migration and the road to migrant health research in Norway, Sweden, Finland and Denmark. We discuss the case for data and research including needs, basis for data collection and the methodological challenges. We provide a brief snapshot of migrant health research, identify current gaps and discuss the implications for research. We recommend a regional Nordic strategy to promote intercountry exchange, sharing and learning. Finally, we reflect on the larger picture, implications for policy and practice that could enable societal conditions to reduce avoidable health inequalities.
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Affiliation(s)
| | | | | | - Malin Ahrne
- Public Health Agency of Sweden, Solna, Sweden
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38
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Torkki P, Leskelä RL, Bugge C, Torfadottir JE, Karjalainen S. Cancer-related costs should be allocated in a comparable way-benchmarking costs of cancer in Nordic countries 2012-2017. Acta Oncol 2022; 61:1216-1222. [PMID: 36151990 DOI: 10.1080/0284186x.2022.2124883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND High costs of cancer, and especially the increase in treatment costs, have raised concerns about the financial sustainability of publicly funded health care systems around the world. As cancers get more prevalent with age, treatment costs are expected to keep rising with aging populations. The objective of the study is to analyze the changes in cost of cancer care broken down into separate cost components and outcomes of cancer treatment in the Nordic countries 2012-2017. MATERIALS AND METHODS We estimated direct costs of cancer based on retrospective data from national registers: outpatient care and inpatient care in primary care and specialized care as well as medicine costs. The number of cancer cases and survival data was obtained from NORDCAN. Cancer was defined as ICD-10 codes C00-C97. RESULTS Healthcare costs of cancer in real terms increased in all countries: CAGR was between 1 and 6% depending on the country. Medicine costs have increased rapidly (37-125%) in all countries during the observation period. In Finland and Denmark, inpatient care costs have decreased, whereas in Iceland, Norway, and Sweden, they have increased, although the number of inpatient days has decreased everywhere. The age-standardized cancer mortality has decreased constantly over time. CONCLUSION Cancer care in Nordic countries has significant differences in both cost structures and in the development of cost drivers, indicating differences in the organization of care and different focus in health policy. It is important to compare the cancer care costs internationally on a detailed level to understand the reasons for cost development. The registration of cost data, especially medicine costs, should be more standardized to enable better cost and outcomes comparisons between countries in the future.
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Affiliation(s)
- Paulus Torkki
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Riikka-Leena Leskelä
- Department of Public Health, University of Helsinki, Helsinki, Finland.,NHG Finland Ltd., Helsinki, Finland
| | - Christoffer Bugge
- Oslo Economics AS, Oslo, Norway.,Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
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Hellström L, Gren Voldby K, Eplov LF. Stigma towards people with mental illness in the Nordic countries - a scoping review. Nord J Psychiatry 2022; 77:319-328. [PMID: 35930387 DOI: 10.1080/08039488.2022.2105946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
INTRODUCTION Stigma affects people with mental illness globally, however, it is proposed that stigma is less prevalent in wealthier countries and that people hold more positive attitudes in Northern and Western Europe. Even so, accounts from surveys in Denmark and Sweden reveal that stigma is very much prevalent. AIM This scoping review aims to shed light on the body of literature regarding mental-health-related stigma in the Nordic Countries and identify knowledge gaps. METHODS We searched four electronic databases in December 2017 and again in June 2020. All types of empirical studies (qualitative, quantitative, and mix-methods) examining the stigma of people with mental illness were included. RESULTS In total, 61 studies were included. Overall, findings from the Nordic countries resemble global findings. Studies are primarily descriptive, and mostly survey studies of attitudes toward people with mental illness in the general population. Few studies focus on discrimination, and those who do, measure intended behavior in hypothetical situations rather than actual acts of discrimination in real-life situations. Studies were mostly conducted on a community or organizational level; no studies were identified on a system level. Experienced stigma and discrimination by patients, but also relatives, were a focus in one-third of the studies. Very few studies of interventions to reduce stigma and discrimination were identified. CONCLUSION More studies into stigma on a system or institutional level are needed. Ways to measure acts of discrimination should be invented. Furthermore, interventions to reduce stigma and discrimination should be developed, targeting all levels of society.
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Affiliation(s)
- Lone Hellström
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Hellerup, Denmark
| | - Katrine Gren Voldby
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Hellerup, Denmark
| | - Lene Falgaard Eplov
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Hellerup, Denmark
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40
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Karalexi MA, Eberhard-Gran M, Valdimarsdóttir UA, Karlsson H, Munk-Olsen T, Skalkidou A. Perinatal mental health: how nordic data sources have contributed to existing evidence and future avenues to explore. Nord J Psychiatry 2022; 76:423-432. [PMID: 35057712 DOI: 10.1080/08039488.2021.1998616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Perinatal mental health disorders affect a significant number of women with debilitating and potentially life-threatening consequences. Researchers in Nordic countries have access to high quality, population-based data sources and the possibility to link data, and are thus uniquely positioned to fill current evidence gaps. We aimed to review how Nordic studies have contributed to existing evidence on perinatal mental health. METHODS We summarized examples of published evidence on perinatal mental health derived from large population-based longitudinal and register-based data from Denmark, Finland, Iceland, Norway and Sweden. RESULTS Nordic datasets, such as the Danish National Birth Cohort, the FinnBrain Birth Cohort Study, the Icelandic SAGA cohort, the Norwegian MoBa and ABC studies, as well as the Swedish BASIC and Mom2B studies facilitate the study of prevalence of perinatal mental disorders, and further provide opportunity to prospectively test etiological hypotheses, yielding comprehensive suggestions about the underlying causal mechanisms. The large sample size, extensive follow-up, multiple measurement points, large geographic coverage, biological sampling and the possibility to link data to national registries renders them unique. The use of novel approaches, such as the digital phenotyping data in the novel application-based Mom2B cohort recording even voice qualities and digital phenotyping, or the Danish study design paralleling a natural experiment are considered strengths of such research. CONCLUSIONS Nordic data sources have contributed substantially to the existing evidence, and can guide future work focused on the study of background, genetic and environmental factors to ultimately define vulnerable groups at risk for psychiatric disorders following childbirth.
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Affiliation(s)
- Maria A Karalexi
- Department for Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Malin Eberhard-Gran
- Norwegian Research Centre for Women's Health, Women and Children's Division, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Unnur Anna Valdimarsdóttir
- Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Epidemiology, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Hasse Karlsson
- Department of Psychiatry and Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Trine Munk-Olsen
- The National Centre for Register-based Research, Aarhus University, Aarhus, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Alkistis Skalkidou
- Department for Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Corbin S, Togawa K, Schüz J, Le Cornet C, Fervers B, Feychting M, Wiebert P, Hansen J, Dalton SO, Kjærheim K, Nordby KC, Østrem RS, Skakkebæk NE, Uuksulainen S, Pukkala E, Olsson A. Parental occupational exposures in wood-related jobs and risk of testicular germ cell tumours in offspring in NORD-TEST a registry-based case-control study in Finland, Norway, and Sweden. Int Arch Occup Environ Health 2022; 95:1243-1253. [PMID: 34853884 PMCID: PMC9273544 DOI: 10.1007/s00420-021-01818-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/12/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We assessed the association between parental prenatal exposures in wood-related jobs and risk of testicular germ cell tumours (TGCT) in offspring. METHODS NORD-TEST, a registry-based case-control study in Sweden, Finland and Norway, included 8112 TGCT cases diagnosed at ages 14-49 years between 1978 and 2012 with no history of prior cancer, and up to four controls matched to each case on year and country of birth. Parents of cases and controls were identified via linkages with the population registries and their occupational information was retrieved from censuses. The Nordic Occupational Cancer Study Job-Exposure Matrix was used to assign occupational exposures to each parent. Logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI). RESULTS Maternal wood-related job was not associated with the risk of TGCT in offspring (OR 1.08, CI 0.55-2.14), while paternal wood-related job was associated with a decreased risk of TGCT in offspring (OR 0.85, CI 0.75-0.96). None of the specific wood-related jobs, such as upholsterers, sawyers, or construction carpenters, were significantly associated with a risk of TGCT. Only exception was observed in a sensitivity analysis which showed an increased risk in the small group of sons of fathers working as 'cabinetmakers and joiners' the year before conception (OR of 2.06, CI 1.00-4.25). CONCLUSION This large-scale NORD-TEST analysis provided no evidence of an association between parental prenatal exposures in wood-related jobs and TGCT in sons.
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Affiliation(s)
- Sara Corbin
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer (IARC/WHO), 150 cours Albert Thomas, 69372, Lyon Cedex 08, France
| | - Kayo Togawa
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer (IARC/WHO), 150 cours Albert Thomas, 69372, Lyon Cedex 08, France
| | - Joachim Schüz
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer (IARC/WHO), 150 cours Albert Thomas, 69372, Lyon Cedex 08, France
| | - Charlotte Le Cornet
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer (IARC/WHO), 150 cours Albert Thomas, 69372, Lyon Cedex 08, France
- Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Germany
| | - Beatrice Fervers
- Prevention Cancer Environment Department, Centre Léon Bérard, University of Lyon, Lyon, France
- Inserm UMR 1296 Radiations: Defence, Health, Environment, Lyon, France
| | - Maria Feychting
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Pernilla Wiebert
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Johnni Hansen
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | | | | | | | | | - Niels E Skakkebæk
- Department of Growth and Reproduction and International Center for Research and Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), University of Copenhagen, Copenhagen, Denmark
| | | | - Eero Pukkala
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
- Finland School of Health Sciences, University of Tampere, Tampere, Finland
| | - Ann Olsson
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer (IARC/WHO), 150 cours Albert Thomas, 69372, Lyon Cedex 08, France.
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Eklund Karlsson L, Balkfors A, Gunnarsdottir H, Povlsen L, Regber S, Buch Mejsner S, Leena Ikonen A, Fosse E. Are universal measures sufficient in reducing child poverty in the Nordic countries? An analysis of policies and political commitments. Scand J Public Health 2022; 50:892-902. [PMID: 35815562 DOI: 10.1177/14034948221109694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The five Nordic countries (Denmark, Finland, Iceland, Norway and Sweden) have long traditions of social welfare policies that have eradicated poverty as part of their goals. The purpose of this study was to increase our understanding of why child poverty is still significant in the Nordic countries despite existing strategies. METHODS A qualitative analysis of Nordic government documents and reports between 2007 and 2019 was carried out to track changes in public health priorities and political measures and to determine the similarities and differences between the five countries. RESULTS In all countries, most of the measures were universal, such as benefits during pregnancy, paid parental leave before and after the child was born, paid parental leave related to children's sickness, child allowances, day care, free health care for children and support for disabled children. National policies aimed to reduce social inequalities and child poverty exist in all five countries, but unaffordable housing, unequal disposable family income distribution and unequal income distribution at local municipality levels seem to be obstacles to reaching national policy goals. CONCLUSIONS Despite comprehensive universal measures to eradicate child poverty, inequalities are significant and increasing in some of the Nordic countries. This might be due to a lack of proportional universalism, where universal measures are in place in all Nordic countries, but with a lack of scale and intensity proportional to the children and families at risk. The significance of eliminating social inequalities needs to be emphasised at the local level.
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Affiliation(s)
- Leena Eklund Karlsson
- Unit for Health Promotion Research, Public Health Institute, University of Southern Denmark, Denmark
| | | | | | - Lene Povlsen
- Unit for Health Promotion Research, Public Health Institute, University of Southern Denmark, Denmark
| | - Susann Regber
- School of Health and Welfare, Halmstad University, Sweden
| | - Sofie Buch Mejsner
- Unit for Health Promotion Research, Public Health Institute, University of Southern Denmark, Denmark
| | - Anne Leena Ikonen
- Faculty of Education and Psychology, University of Jyväskylä, Finland
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Jones AW. How Nordic Countries Enforce Impaired Driving Legislation. Forensic Sci Rev 2022; 34:131-143. [PMID: 35932486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This article reviews how the Nordic countries of Denmark, Finland, Norway, and Sweden enforce their legislation pertaining to driving under the influence of alcohol and/or other impairing drugs. The evidence necessary for a successful prosecution of traffic offenders has undergone radical changes over the past 50 years. The once widely used clinical tests of impairment are no longer a major element of the prosecution case and a physician is more seldom required to examine apprehended drivers and document any clinical signs and symptoms of alcohol and/or drug influence. These clinical tests have been superseded by results derived from a comprehensive toxicological analysis of psychoactive substances in samples of the driver's blood. The current statutory limits of blood-alcohol concentration (BAC) are among the lowest in the world: Norway and Sweden (0.20 g/kg) and Denmark and Finland (0.50 g/kg). Results from using evidential quality breath-alcohol instruments are accepted as evidence in drunk-driving cases and this has necessitated setting statutory breath-alcohol concentration (BrAC) limits. Laws dealing with driving under the influence of drugs (DUID) other than alcohol have also been updated and made more pragmatic for prosecution of traffic offenders. In Finland and Sweden zero-tolerance laws exist, making it illegal to drive with any quantifiable amount of a scheduled drug in the driver's blood. Prescription drugs are exempt from this zero-tolerance mandate provided the medication was used in accordance with a physician's ordination. Lacking a valid prescription or if there is a supratherapeutic concentration of the drug in blood, this will lead to a prosecution for DUID. In Denmark and Norway threshold concentration limits have been established for many psychoactive drugs, both licit and illicit. After these stricter laws for DUID were introduced, the number of suspects apprehended by the police per year increased by as much as tenfold in some Nordic countries. There is increasing evidence that many traffic delinquents in the Nordic countries suffer from a substance-use disorder, because repeat-offending is a common occurrence. This suggests that some type of treatment and rehabilitation program might be more beneficial compared with conventional penalties for people arrested for DUI and/or DUID.
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Affiliation(s)
- A W Jones
- Division of Clinical Chemistry and Pharmacology, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Östergötland, Sweden
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Aarø LE, Fismen AS, Wold B, Skogen JC, Torsheim T, Arnarsson ÁM, Lyyra N, Löfstedt P, Eriksson C. Nordic adolescents responding to demanding survey scales in boring contexts: Examining straightlining. J Adolesc 2022; 94:829-843. [PMID: 35719057 DOI: 10.1002/jad.12066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/06/2022] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Straightlining, or identical responses across all items within a multi-item scale, is often taken as an indication that responses to all items in a questionnaire are of poor quality. The purpose of this study was to examine straightlining on two scales: The Sense of Unity Scale (SUS) and the short version of the Warwick-Edinburgh Mental Well-being Scale (SWEMWBS). METHODS Data stem from the 2017-2018 data collections in four Nordic countries of the Health Behaviour in School-children study (HBSC) (15-year-old students only; 50.9% girls; n = 5928). Data were weighted to adjust for oversampling of Swedish-speaking Finnish students and to equalize sample size across countries. The main analyses were done with general linear modeling with adjustments for cluster effects (school classes). RESULTS The proportion with straightlining on SUS was 22.8%, varying from 5.8% among Swedish girls to 46.4% among Finnish boys. The proportion with straightlining on SWEMWBS was 18.4%, varying from 5.2% among Norwegian girls to 46.0% among Finnish boys. Straightlining on one of the scales correlated with straightlining on the other one. Straightlining tended to inflate Cronbach's α values and reduce number of factors in factor analyses. Associations between the two scales and external variables tended to be lower among straightlining students. Associations between external variables (other than SUS/SWEMWBS) are on average slightly weaker among straightliners. Straightlining students obtained more favorable scores on several resource-related variables. CONCLUSION Although some problems have been identified, straightlining does not serve well as a general indicator of poor data quality.
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Affiliation(s)
- Leif Edvard Aarø
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway.,Department of Health Promotion and Development, University of Bergen, Bergen, Norway
| | - Anne-Siri Fismen
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway.,Centre for Evaluation of Public Health Measures, Norwegian Institute of Public Health, Oslo, Norway
| | - Bente Wold
- Department of Health Promotion and Development, University of Bergen, Bergen, Norway
| | - Jens Christoffer Skogen
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway.,Centre for Evaluation of Public Health Measures, Norwegian Institute of Public Health, Oslo, Norway.,Alcohol and Drug Research Western Norway, Stavanger University Hospital, Stavanger, Norway
| | - Torbjørn Torsheim
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Ársaell Már Arnarsson
- Faculty of Health Promotion, Sport and Leisure Studies, University of Iceland, Reykjavík, Iceland
| | - Nelli Lyyra
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Petra Löfstedt
- Department of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Charli Eriksson
- Department of Learning, Informatics, Management, and Ethics, Karolinska Institute, Stockholm, Sweden
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45
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Hamina A, Muller AE, Clausen T, Skurtveit S, Hesse M, Tjagvad C, Thylstrup B, Odsbu I, Zoega H, Jónsdóttir HL, Taipale H. Prescription opioids among older adults: ten years of data across five countries. BMC Geriatr 2022; 22:429. [PMID: 35578167 PMCID: PMC9112605 DOI: 10.1186/s12877-022-03125-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 05/09/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Opioid use has increased globally in the recent decade. Although pain remains a significant problem among older adults, susceptibility to opioid-related harms highlights the importance of careful opioid therapy monitoring on individual and societal levels. We aimed to describe the trends of prescription opioid utilisation among residents aged ≥65 in all Nordic countries during 2009-2018. METHODS We conducted cross-sectional measurements of opioid utilisation in 2009-2018 from nationwide registers of dispensed drugs in Denmark, Finland, Iceland, Norway, and Sweden. The measures included annual opioid prevalence, defined daily doses (DDDs) per 1000 inhabitants per day (DIDs), and morphine milligram equivalents (MMEs) per user per day. RESULTS From 2009 to 2018, an average of 808,584 of adults aged ≥65 used opioids yearly in all five countries; an average annual prevalence of 17.0%. During this time period, the prevalence decreased in Denmark, Norway, and Sweden due to declining codeine and/or tramadol use. Iceland had the highest opioid prevalence in 2009 (30.2%), increasing to 31.7% in 2018. In the same period, DIDs decreased in all five countries, and ranged from 28.3 in Finland to 58.5 in Denmark in 2009, and from 23.0 in Finland to 54.6 in Iceland in 2018. MMEs/user/day ranged from 4.4 in Iceland to 19.6 in Denmark in 2009, and from 4.6 in Iceland to 18.8 in Denmark in 2018. In Finland, Norway, and Sweden, MMEs/user/day increased from 2009 to 2018, mainly due to increasing oxycodone utilisation. CONCLUSIONS The stable or decreasing opioid utilisation prevalence among a majority of older adults across the Nordic countries coincides with an increase in treatment intensity in 2009-2018. We found large cross-national differences despite similarities across the countries' cultures and healthcare systems. For the aged population, national efforts should be placed on improving pain management and monitoring future trends of especially oxycodone utilisation.
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Affiliation(s)
- A. Hamina
- grid.5510.10000 0004 1936 8921Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, University of Oslo, PO Box 1171, 0218 Oslo, Norway ,grid.9668.10000 0001 0726 2490School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - A. E. Muller
- grid.418193.60000 0001 1541 4204Division of Reviews and Health Technology Assessments, Norwegian Institute of Public Health, Oslo, Norway
| | - T. Clausen
- grid.5510.10000 0004 1936 8921Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, University of Oslo, PO Box 1171, 0218 Oslo, Norway
| | - S. Skurtveit
- grid.5510.10000 0004 1936 8921Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, University of Oslo, PO Box 1171, 0218 Oslo, Norway ,grid.418193.60000 0001 1541 4204Department of Mental Disorders, Division of Mental and Physical Health, the Norwegian Institute of Public Health, Oslo, Norway
| | - M. Hesse
- grid.7048.b0000 0001 1956 2722Center for Alcohol and Drug Research, Aarhus University, Aarhus, Denmark
| | - C. Tjagvad
- grid.5510.10000 0004 1936 8921Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, University of Oslo, PO Box 1171, 0218 Oslo, Norway
| | - B. Thylstrup
- grid.7048.b0000 0001 1956 2722Center for Alcohol and Drug Research, Aarhus University, Aarhus, Denmark
| | - I. Odsbu
- grid.418193.60000 0001 1541 4204Department of Mental Disorders, Division of Mental and Physical Health, the Norwegian Institute of Public Health, Oslo, Norway
| | - H. Zoega
- grid.1005.40000 0004 4902 0432Centre for Big Data Research in Health, Faculty of Medicine & Health, UNSW Sydney, Sydney, Australia ,grid.14013.370000 0004 0640 0021Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - H. L. Jónsdóttir
- grid.14013.370000 0004 0640 0021Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland ,grid.14013.370000 0004 0640 0021Faculty of Psychology, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - H. Taipale
- grid.9668.10000 0001 0726 2490School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland ,grid.4714.60000 0004 1937 0626Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden ,grid.466951.90000 0004 0391 2072Niuvanniemi Hospital, Kuopio, Finland
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Laaksonen N, Bengtström M, Axelin A, Blomster J, Scheinin M, Huupponen R. Success and failure factors of patient recruitment for industry-sponsored clinical trials and the role of the electronic health records-a qualitative interview study in the Nordic countries. Trials 2022; 23:385. [PMID: 35550003 PMCID: PMC9097356 DOI: 10.1186/s13063-022-06144-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 03/04/2022] [Indexed: 11/27/2022] Open
Abstract
Background Patient recruitment for clinical trials is challenging—only approximately one third of all trials recruit their participants as planned. The pharmaceutical industry’s views on recruitment success have not been comprehensively investigated, although the industry globally conducts almost one third of all clinical drug trials. This study explored patient recruitment success and failure factors and the role of electronic health records (EHR) in the recruitment of trial participants in the Nordic countries. Methods A descriptive qualitative interview study was conducted with 21 representatives of the pharmaceutical industry or contract research organizations operating in Finland, Sweden, Denmark, and Norway. The interviews covered 34 clinical pre-market drug trials. Qualitative data were analyzed using inductive content analysis. Results Four main categories were derived to represent both success and failure factors, whereas a fifth category represented only failure factors: (1) sponsor-related (protocol and trial preparation and feasibility evaluations), (2) site/investigator-related (access to patients, motivation, commitment and resources), (3) patient-related recruitment factors (medical need, patients’ role in their care and attitudes towards trials), (4) Sponsor—sites—patients collaboration factors, and (5) start-up related factors. EHR was the most important source of recruitment, utilized in 29 out of 34 trials discussed. Revision of the legislation regulating the secondary use of EHR was highlighted as the most effective measure to facilitate the use of EHR in recruitment of trial participants. Conclusions The industry representatives recognized quite well their own role in contributing to the success or failure of the recruitment: to facilitate recruitment of trial participants, many obstacles can be avoided with better trial preparation and proper feasibility evaluations. As access to patients represents one of the key success or failure factors of recruitment, and as the EHR is regarded the main source of searching for and finding patients, the development of EHR utilization appears to represent a powerful tool to improve patient recruitment. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06144-9.
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Affiliation(s)
- Niina Laaksonen
- Institute of Biomedicine, University of Turku, Turku, Finland.
| | - Mia Bengtström
- Pharma Industry Finland, Helsinki, Finland.,Pharmaceutical Sciences Laboratory, Åbo Akademi University, Turku, Finland
| | - Anna Axelin
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Juuso Blomster
- Department of Cardiology, University of Turku and Turku University Hospital, Turku, Finland
| | - Mika Scheinin
- Institute of Biomedicine, University of Turku, Turku, Finland.,Clinical Pharmacology Unit, Turku University Hospital, Turku, Finland
| | - Risto Huupponen
- Institute of Biomedicine, University of Turku, Turku, Finland.,Clinical Pharmacology Unit, Turku University Hospital, Turku, Finland
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47
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Gehrt L, Laake I, Englund H, Nieminen H, Benn CS, Feiring B, Trogstad L, Palmu AA, Sørup S. Hospital Contacts for Infectious Diseases Among Children in Denmark, Finland, Norway, and Sweden, 2008-2017. Clin Epidemiol 2022; 14:609-621. [PMID: 35520276 PMCID: PMC9063804 DOI: 10.2147/clep.s355193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/21/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Comparing rates of childhood infectious disease hospitalisations across countries may uncover areas for improvement in the prevention of severe childhood infections. We compared rates of childhood infectious disease hospital contacts across Denmark, Finland, Norway, and Sweden with the overall objective to elucidate potential differences in burden of disease and in organisational and registration practices. Methods Using national registries, we estimated incidence rates for infectious disease hospital contacts between 2008 and 2017 among children aged 0–14 years. We investigated the rates for different types of contacts (inpatient or outpatient including emergency room), duration of admission, and by sex. Results During the study period, the rate of all hospital contacts per 1000 person-years was highest in Sweden (125.2) followed by Finland (87.1), Denmark (79.0), and Norway (62.1). The rates aligned for inpatient contacts with overnight stays; 19.3 (Denmark), 16.6 (Finland), 16.3 (Norway), and 13.0 (Sweden); these were highest in early infancy in all countries. A peak around 1 year of age was seen in all countries except in Sweden. The rates were higher among boys compared with girls in early childhood, after 13 years of age the rates among girls surpassed the boys. Conclusion Large cross-country differences were observed for outpatient and short-term hospital contacts for infectious diseases, affected by differences in organisational structures and coding practices across and within countries over time. Inpatient contacts requiring overnight stays reflected more comparable levels of severe infections across countries. Childhood infectious disease morbidity was greatest among boys and before 2 years of age.
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Affiliation(s)
- Lise Gehrt
- Bandim Health Project, Research Unit Open, Department of Clinical Research, University of Southern Denmark, Odense C, Denmark.,Research Center for Vitamins and Vaccines, Statens Serum Institut, Copenhagen, Denmark
| | - Ida Laake
- Division of Infection Control, Norwegian Institute of Public Health, Oslo, Norway
| | - Hélène Englund
- Unit for Vaccination Programmes, Public Health Agency of Sweden, Solna, Sweden
| | - Heta Nieminen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Tampere, Finland
| | - Christine Stabell Benn
- Bandim Health Project, Research Unit Open, Department of Clinical Research, University of Southern Denmark, Odense C, Denmark.,Research Center for Vitamins and Vaccines, Statens Serum Institut, Copenhagen, Denmark.,Danish Institute for Advanced Study, University of Southern Denmark, Odense C, Denmark
| | - Berit Feiring
- Division of Infection Control, Norwegian Institute of Public Health, Oslo, Norway
| | - Lill Trogstad
- Division of Infection Control, Norwegian Institute of Public Health, Oslo, Norway
| | - Arto A Palmu
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Tampere, Finland
| | - Signe Sørup
- Research Center for Vitamins and Vaccines, Statens Serum Institut, Copenhagen, Denmark.,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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Abstract
With the extensive long-term care services for older people, the Nordic countries have been labelled 'caring states' as reported (Leira, Welfare state and working mothers: the Scandinavian experience, Cambridge University Press, Cambridge, 1992). The emphasis on services and not cash benefits ensures the Nordics a central place in the public service model (Anttonen and Sipilä, J Eur Soc Policy 6:87-100, 1996). The main feature of this ideal model is public social care services, such as home care and residential care services, which can cover the need for personal and medical care, as well as assistance with household chores. These services are provided within a formally and professionally based long-term care system, where the main responsibility for the organization, provision and financing of care traditionally lays with the public sector. According to the principle of universalism (in: Antonnen et al. (eds), Welfare state, universalism and diversity, Elgar, Cheltenham, 2013), access to benefits such as home care and residential care is based on citizenship and need, not contributions nor merit. Also, care services should be made available for all and generally be used by all, with no stigma associated. Vabø and Szebehely (in: Anttonen (ed), Welfare State, universalism and diversity, Edward Elgar Publishing, London, 2012)) further argue that the Nordic service universalism is more than merely issues of eligibility and accessibility, in that it also encompasses whether services are attractive, affordable and flexible in order to meet a diversity of needs and preferences. However, recent decades have seen a continuous tendency towards prioritization of care for the most frail, contributing to unmet need, informalization of care and privatization in the use of topping up with market-based services. These changes have raised questions about increasing inequalities within Nordic long-term care systems. We investigate in the article what effect changes have for equality across social class and gender, for users and informal carers. The article is based on analysis of comparable national and international statistics and a review of national research literature and policy documents.
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Affiliation(s)
- Tine Rostgaard
- Roskilde University, Roskilde, Denmark ,Stockholm University, Stockholm, Sweden
| | - Frode Jacobsen
- Western Norway University of Applied Science, Bergen, Norway
| | - Teppo Kröger
- Western Norway University of Applied Science, Bergen, Norway ,University of Jyväskylä, Jyvaskyla, Finland
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Pizzato M, Martinsen JI, Heikkinen S, Vignat J, Lynge E, Sparén P, La Vecchia C, Pukkala E, Vaccarella S. Socioeconomic status and risk of lung cancer by histological subtype in the Nordic countries. Cancer Med 2022; 11:1850-1859. [PMID: 35166068 PMCID: PMC9041078 DOI: 10.1002/cam4.4548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 12/10/2021] [Accepted: 12/10/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND While the excess in lung cancer risk among lower socioeconomic status individuals has been widely described, the magnitude of this association across lung cancer subtypes, as well as histotype-related long-term incidence trends, are inconclusively reported. AIMS We explored the variation in the incidence of the three main lung cancer histotypes (i.e. squamous cell carcinoma, small cell carcinoma and adenocarcinoma) by socioeconomic status (SES, i.e. upper and lower white collar, upper and lower blue collar, and farming/forestry/fishing) in the adult population of four Nordic countries (i.e. Sweden, Norway, Finland and Denmark). MATERIALS & METHODS We have used data from the Nordic Occupational Cancer Study (NOCCA), computing age-standardized incidence rates per 100,000 person-years truncated at ages 50-69 years, by sex, histotype, country and SES, for the period 1971-2005. We estimated relative risks and the corresponding 95% confidence intervals through Poisson regression models, including terms for SES, age, sex and country, as indicated. RESULTS A clear socioeconomic gradient, with a progressive increase in lung cancer risk as SES level decreases, was observed in all subtypes and in both sexes. Favourable lung cancer incidence trends were seen among men for squamous cell and small cell carcinomas, although for adenocarcinomas rates were increasing everywhere except for Finland. Among women, upward temporal trends were seen in all SES groups and for all subtypes, although rates increased to a greater extent for low, compared to high, SES, especially in Denmark and Norway. Farmers showed comparatively lower risks compared to other SES categories. DISCUSSION This prospective cohort study shows that substantial socioeconomic inequalities in the incidence of the most important lung cancer histotypes exist in the Nordic Countries, and that these inequalities are on the rise, especially among women. CONCLUSION Smoking habits are likely to largely explain the observed social gradient for lung cancer histotypes in both sexes.
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Affiliation(s)
- Margherita Pizzato
- Department of Clinical Sciences and Community HealthUniversità degli Studi di MilanoMilanItaly
| | | | | | - Jerome Vignat
- International Agency for Research on CancerLyonFrance
| | - Elsebeth Lynge
- Nykøbing Falster HospitalUniversity of CopenhagenDenmark
| | - Pär Sparén
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholm
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community HealthUniversità degli Studi di MilanoMilanItaly
| | - Eero Pukkala
- Finnish Cancer RegistryInstitute for Statistical and Epidemiological Cancer ResearchHelsinkiFinland
- Faculty of Social Sciences, Tampere UniversityTampereFinland
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50
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Raitasalo K, Bye EK, Pisinger C, Scheffels J, Tokle R, Kinnunen JM, Ollila H, Rimpelä A. Single, Dual, and Triple Use of Cigarettes, e-Cigarettes, and Snus among Adolescents in the Nordic Countries. Int J Environ Res Public Health 2022; 19:683. [PMID: 35055504 PMCID: PMC8775390 DOI: 10.3390/ijerph19020683] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/04/2022] [Accepted: 01/05/2022] [Indexed: 12/04/2022]
Abstract
New tobacco and nicotine products have emerged on the market in recent years. Most research has concerned only one product at a time, usually e-cigarettes, while little is known about the multiple use of tobacco and nicotine products among adolescents. We examined single, dual, and triple use of cigarettes, e-cigarettes, and snus among Nordic adolescents, using data of 15-16-year-olds (n = 16,125) from the European School Survey Project on Alcohol and other Drugs (ESPAD) collected in 2015 and 2019 from Denmark, Finland, Iceland, Norway, Sweden, and the Faroe Islands. Country-specific lifetime use of any of these products ranged between 40% and 50%, and current use between 17% and 31%. Cigarettes were the most common product in all countries except for Iceland, where e-cigarettes were remarkably more common. The proportion of dual and triple users was unexpectedly high among both experimental (24%-49%) and current users (31-42%). Triple use was less common than dual use. The users' patterns varied somewhat between the countries, and Iceland differed substantially from the other countries, with a high proportion of single e-cigarette users. More knowledge on the patterns of multiple use of tobacco and nicotine products and on the potential risk and protective factors is needed for targeted intervention and prevention efforts.
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Affiliation(s)
- Kirsimarja Raitasalo
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, 00271 Helsinki, Finland;
| | - Elin K. Bye
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, 0213 Oslo, Norway; (E.K.B.); (J.S.); (R.T.)
| | - Charlotta Pisinger
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, 2000 Frederiksberg, Denmark;
- Department of Public Health, University of Copenhagen, 1353 Copenhagen, Denmark
- Danish Heart Foundation, 1120 Copenhagen, Denmark
| | - Janne Scheffels
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, 0213 Oslo, Norway; (E.K.B.); (J.S.); (R.T.)
| | - Rikke Tokle
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, 0213 Oslo, Norway; (E.K.B.); (J.S.); (R.T.)
- Norwegian Social Research, Oslo Metropolitan University, 0170 Oslo, Norway
| | - Jaana M. Kinnunen
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, 33014 Tampere, Finland; (J.M.K.); (A.R.)
| | - Hanna Ollila
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, 00271 Helsinki, Finland;
| | - Arja Rimpelä
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, 33014 Tampere, Finland; (J.M.K.); (A.R.)
- Department of Adolescent Psychiatry, Tampere University Hospital, 33521 Tampere, Finland
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