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In this study we investigated the importance of social network and social support systems outside the workplace and workload and psyshological job strain in former work for the prevalence of daily neck and low back pain. The study population (n= 621) comprised a random half of all male residents in Malmö, Sweden, born in 1914, of whom 500 (80.5%) participated.Two of the social network and social support indices (social anchorage and availability of material and informational support) were independent of life-style factors (leisure time physical activity, smoking and alcohol consumption) related to daily neck and back pain after retirement (OR = 2.0, 95% CI 1.2–3.4 and OR = 1.7, 95% CI 1.0–2.7, respectively), while the psycho-social and physical factors in former work were not. As no conclusion about the direction of the association can be drawn, prospective studies are needed to further explore these findings.

In a five-year follow-up of a random sample of men aged 55 the association between risk factors and premature death was analysed. The overall mortality in five years was 5.8%. The mortality among the smokers was 8%; among non-smokers 2%. Of 16 cancer deaths all were smokers except one who was an ex-smoker. In spite of treatment of hypertension (>165/110 mmHg) there was an association between high blood pressure and premature death, particularly when cause of death was cardiovascular disease. There was no association between premature death and serum cholesterol, serum triglycerides or physical activity. The study is based on 703 men, of whom 41 died. The autopsy frequency was 93%. Only 3 men (0.4%) were lost to follow-up.

All men born in even-numbered months in 1914 and domiciled in Malmö were invited in 1969 to participate in an investigation regarding risk factors for cardiovascular disease. Individuals with a blood pressure of 165/110 and over were treated and a sub-sample of heavy smokers were later invited to take part in a quit-smoking project. During the following five year period total and cause-specific mortality in the examined group was compared with corresponding data for men born in uneven months in 1914. Mortality in the examined cohort was lower than among controls and differed significantly from that in the control group with regard to cardiovascular mortality.

Results of a quit-smoking research project in a randomly selected population.Isacsson, S.-O. and Janzon, L. (Departments of Clinical Physiology, Social and Preventive Medicine, and Surgery, Allmänna Sjukhuset, S-21401 Malmö, Sweden).In the spring of 1973, 58 strictly randomized heavy smokers from a defined population of men born in 1914 were asked to quit smoking, at least for 8–9 weeks, as a part of a research project focused upon the relationship between smoking and peripheral blood flow, fibrinolysis, and lung function. Eighty-eight per cent of the smokers were willing to try to quit smoking. Seven (12%) refused at the outset, as they regarded quitting as impossible. Of the remaining 51 it was possible to keep 31 (60%) free from smoking for 8–9 weeks with the aid of an intense anti-smoking program lasting 6 weeks. Checks of continued smoking abstention were made by questionnaire and COHb-determination. After 6 weeks, no further information was given to the subjects. A follow-up after 8–9 months revealed that 33% of the 51 participants (i.e. 29% of the original 58) were still non-smokers.The long-lasting effect of our quit-smoking method was equal to the best reported by others and 30% is probably the highest rate of long-term success to be achieved in smoking cessation.

Results of a quit-smoking research project in a randomly selected population.Isacsson, S.-O. and Janzon, L. (Departments of Clinical Physiology, Social and Preventive Medicine, and Surgery, Allmänna Sjukhuset, S-21401 Malmö, Sweden).In the spring of 1973, 58 strictly randomized heavy smokers from a defined population of men born in 1914 were asked to quit smoking, at least for 8–9 weeks, as a part of a research project focused upon the relationship between smoking and peripheral blood flow, fibrinolysis, and lung function. Eighty-eight per cent of the smokers were willing to try to quit smoking. Seven (12%) refused at the outset, as they regarded quitting as impossible. Of the remaining 51 it was possible to keep 31 (60%) free from smoking for 8–9 weeks with the aid of an intense anti-smoking program lasting 6 weeks. Checks of continued smoking abstention were made by questionnaire and COHb-determination. After 6 weeks, no further information was given to the subjects. A follow-up after 8–9 months revealed that 33% of the 51 participants (i.e. 29% of the original 58) were still non-smokers.The long-lasting effect of our quit-smoking method was equal to the best reported by others and 30% is probably the highest rate of long-term success to be achieved in smoking cessation.

In connection with a population study including 703 randomly selected 55-year-old men, 20 men with the highest blood pressure were selected for a careful follow-up and treatment for 1 year. Controls without hypertension were randomly selected from the remainder of the same population. Electrocardiogram at rest and in connection with an exercise test, changes in fundus oculi, orthostatic tests, peripheral arterial blood flow, chemical analyses and other variables were recorded on three occasions during the observation year. Drug treatment was standardized. Basic treatment was induced with polythiazide, which normalized the blood pressure in the majority of the hypertensive cases. The most striking findings in the hypertensive group before treatment were, besides the high blood pressure at rest, high blood pressure during exercise, an increased peripheral blood-flow through the calves, and an increased heart-rate. During treatment, the blood pressure were selected for a careful follow-up and blood-flow were almost “normalized”; the heart-rate remained elevated. The investigation shows that it is quite easy to achieve adequate reduction of blood pressure in hypertension among middle-aged men, as found in the “real world” outside the hospital. The main problem today is not to normalize the blood pressure but rather to detect hypertension and to maintain the therapy for several years. Hypertension is considered to be the cardiovascular risk factor that is probably most amenable to preventive approaches to public health.

The reliability and validity of methods to assess social networks, social support and control were investigated in a population of 12,009 females and males born between 1926 and 1945 (the “Malmö Shoulder and Neck Study”). This study demonstrated an overall reliability with kappa coefficients between 0.70 and 0.47, but the reliability was more varying among females and lower in the youngest age group. The analysis of the construct validity indicated that the different indices measure different aspects of the psychosocial environment, but both theoretical and methodological problems were identified, when the validity of multidimensional concepts are to be determined. The validity of such indices can best be judged by combining quantitative and qualitative methods. Potential validity problems must be kept in mind when these indices are used in epidemiological research. The results from the reliability analysis call for repeated assessments and the sample size must be adjusted vis-à-vis the reliability.

Knowledge of hiv/aids, exposure to hiv/aids information and appreciation of given information was studied, by a questionnaire, among 326 Kenyan and 146 Swedish teenage school students in 1994. The aim of the study was to examine differences and similarities in knowledge in the two populations and to examine which sources of information about hiv and aids the respondents had been exposed to and which were most appreciated.The overall knowledge about hiv/aids was high but in specific items the knowledge and awareness of different risk behaviours for contracting hiv/aids differed for the Kenyan and Swedish teenagers. The dissemination of hard factual information about hiv/aids has thus been successful in reaching out although not in stopping the spread of hiv/aids. This calls for new strategies in disease prevention and health promotion. Those strategies should focus much more on lifestyle changes. The health care system, the school and the existing strong civil and voluntary information structures have an important role to play in that work.

In this study foreign- and Swedish-born individuals with diabetes mellitus were compared regarding prevalence and characteristics. In a Swedish county 1,568 patients aged 20-64 years were identified, of whom 97.4% were included (143 foreign- and 1,384 Swedish-born) in the study of medical records. There was no difference in prevalence of diabetes (1.4% (95% CI 1.2-1.7%) vs 1.5% (95% CI 1.4-1.6%)) but diagnosis at or after the age of 30 years was more common in foreign-born patients (p<0.001). They were also less often treated with insulin (p<0.001), had shorter duration of diabetes (p<0.001), were more often classified as having a low social position in Sweden (p<0.001) and less often controlled in specialized diabetes care departments (p<0.001, 18% vs 43%). There was a higher occurrence of albuminuria among foreign-born women (p<0.05). No differences were found in glycaemic control, but low social position was related to poor glycaemic control independent of being foreign- or Swedish-born, and it seems to be more important than place of birth.

Twenty-five in-depth interviews were made with middle-aged persons of both sexes, who had suffered a first myocardial infarction (MI) two months previously. The purpose was to assess the layman's understanding of concepts such as social network, social supportand controlwhich are exposures commonly used or suggested for use in quantitative research in the area of social epidemiology. The validity of the instruments and the underlying concepts in assessing such exposures has important implications for the interpretation of the association between psychosocial factors and health or health behavior.The layman's understanding of social network and social support concepts seemed unproblematic, but the concept of control was understood in rather disparate ways among those interviewed. The experience of control/decision latitude in the work environment, seemed to form a model for the overall understanding of control among several of those interviewed and there also seemed to be important differences based on gender. Another impression, was that the individual's level of aspiration might be an important confounder in the assessment of control in population studies. It is therefore suggested that epidemiologcal data should be stratifyed by basic demographic variables like age, sex and social class in analyses including the control variable, to improve the valid use of this type of measure.

We have compared the use of primary health care and the diagnoses at visits to doctors in the Spili Health Centre (SHC) in Crete and the Dalby Health Centre (DHC) in Sweden. In DHC more patients per 1000 population visited the doctors than in SHC. This was so regardless of age-group and sex, in fact more or less regardless of diagnosis. Other differences between the populations were: The diagnosis acute otitis media was more frequent in the Dalby children than in the Spili ones. The opposite was true of “head injuries” which were more frequent in the Spili boys. Visits to doctors for bronchitis was more frequent in the Spili men, maybe because of the extensive smoking habits of Cretan men. Visits for diseases of the musculoskeletal system were more frequent in DHC than in SHC. A hypothesis worth testing is that this was influenced by differences in the health insurance and sick benefit systems. Angina pectoris was fairly frequent in both areas but cardiosclerosis (including healed myocardial infarction) was more common in DHC than in SHC. Use of primary health care may be influenced by the need for health care in the population, the accessibility of the health care facilities, the costs for the patients, the quality of care as perceived by the patients and by other sociocultural factors. Comparative studies, even though fairly uncommon today, may be of use in generating hypotheses about the impact of different factors on the use of health care.

The epidemiology of sick leave in an urban population in Malmö, Sweden. 1Isacsson, A., 1Hanson, B. S., 1Janzon, L. and 2Kugelberg, G. (1Department of Community Health Sciences, Lund University, and 2Social Insurance Board, Malmö, SwedenThe epidemiology of sick leave was studied in the city of Malmö, Sweden, (230000 inhabitants). Every current and completed sick-leave episode during the year of 1985 was collected for 124411 persons aged 16 to 65, who were registered with the National Health insurance scheme in 1985. Absence rate, absence incidence, absence prevalence and absence duration were analyzed in relation to age, sex, marital status, nationality, income and place of residence. Absence rate (mean value) in the total population was 25.5 days with a median of three days. The absence rate increased by age. High absence rates were seen for females, single people and some immigrant groups. This was even true for residential areas characterized by a higher proportion of single-person households and households on social welfare, of unemployed and people with a low income and a foreign background. The absence rate gives limited information as to the epidemiology of sick leave. Through adding absence incidence, absence prevalence and absence duration it was possible to get a more comprehensive picture of the phenonemon. Sex-differences in absence rate for instance were mainly explained by differences in absence incidence and prevalence, while differences in absence rate regarding nationality were explained by differences in absence duration. This is an important step towards a better understanding of the factors behind sick leave.

A cohort of 50 patients under 70 years of age who had suffered their first myocardial infarction (MI) entered an exercise-based rehabilitation programme. An extensive personal interview concerning psychosocial factors, including social network and social support, as well as an assessment of an array of clinical and laboratory variables was made before the patients were discharged from the hospital. A follow-up 6 months later of the 40 patients that completed the programme showed that material social supportand social anchorageat baseline predicted improvement in physical working capacity, independently from age, gender and important clinical variables. The authors conclude that psychosocial factors could be predictors of equal importance as many of the standard risk factors and clinical assessments in the rehabilitation of a majority of post-MI patients. It is suggested that training programmes should provide opportunities for involvement of the patients' social network, in order to benefit from optimal social support during the rehabilitation process.

Recurrent ear infection in children during pre-school years is an important public health problem. Common advice given to parents is to minimize exposure of susceptible children to crowding and air pollution. This study aimed at investigating what changes parents undertake to improve the health of an otitis-prone child. Parents of children with 5 events before age thirty months (index children; n = 198) and a matched control group (n = 396) were asked to fill in a questionnaire. Results show that 22.3% of indexfamilies and 9.5% (p< 0.001) of control families had changed one or more of the following conditions: working hours, child day-care, housing and smoking habits. In summary, index families and control families were remarkably similar given the striking difference in otitis media, a finding that rises concern.