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Biomedical subjects

A Hjern

Publications and source records attributed to A Hjern.

At least 37 records · Page 2Linked to original sources
PubMed2001

Socio-demographic risk factors for home-type injuries in Swedish infants and toddlers.

UNLABELLED: In this paper we use data from Swedish national registers to study socio-demographic patterns of hospital admissions as a result of injuries sustained at home (poisoning, falls, scalding and ingestion/intrusion of foreign objects) in children 0-3 y. The study population comprised 546 336 children born in Sweden during the period 1987-91. The different injury mechanisms peaked at different ages: ingestion of foreign objects at 10-12 mo, scald injuries at 13-15 mo, non-drug poisoning at 16-18 mo and drug poisoning at 24-30 mo. In a multivariate analysis it was demonstrated that children of young mothers (<24 y) were more likely to have been admitted to hospital because of fall injuries and poisonings, while children with more than two siblings had a slightly increased risk for all injuries. Children of mothers born in a non-western country were more likely to have been admitted to hospital because of scald injuries; odds ratio (OR) 1.7 (95% CI: 1.4-2.1), while they were less likely to have been admitted because of fall injuries; OR 0.8 (0.7-0.8) and non-drug poisoning; OR 0.5 (0.4-0.6). Children in families who received social welfare benefits were more likely to have been admitted to hospital because of fall injuries; OR 1.3 (1.2-1.4), drug poisoning; OR 1.8 (1.7-2.0), non-drug poisoning; OR 1.4 (1.3-15) and scald injuries; OR 1.1 (1.1-1.5), while injuries with ingestion/intrusion of foreign objects tended to vary little with socio-economic indicators. CONCLUSION: Infants and toddlers in families with young mothers and in families on social welfare are at particular risk for home injuries in Sweden. The knowledge that the risk of poisoning, scalding and ingestion of foreign objects is related to specific ages can be used in timing of parent counselling.

Accidental Falls↗
PubMed2001

High use of sedatives and hypnotics in ethnic minorities in Sweden.

OBJECTIVE: To study use of analgesics, and psychotropic drugs in relation to health indicators in four ethnic minorities in Sweden in comparison with Swedish-born. DESIGN: Cross-sectional study based on data from the Survey of Living Conditions and Immigrant Survey of Living Conditions in Sweden in 1996. STUDY POPULATION: Random samples of 1890 Swedish residents, in the age range 27-60 years, born in Chile, Poland, Turkey and Iran and 2452 age-matched Swedish-born residents. RESULTS: A two fold higher use of prescribed analgesics and antidepressants and a five to sixfold higher use of hypnotic and sedative drugs was demonstrated in members of ethnic minorities in Sweden in comparison with Swedish-born. In a multivariate analysis the higher use of prescribed analgesics and antidepressants was explained almost entirely by a higher morbidity in the minority study groups. A twofold higher use of sedatives and hypnotics was demonstrated in the minority study populations compared to the Swedish-born sample even after adjustment for extensive indicators of psychiatric and physical health in the multivariate analysis. CONCLUSIONS: The higher use of sedatives and hypnotics in relation to health in the minority samples in the present study indicates a differential treatment of minor psychiatric disorders of members of ethnic minorities in Swedish health services. Further studies that yield more qualitative data regarding the interaction of Swedish physicians with migrant patients are needed to explain these differences and to create a basis for intervention.

Adult↗
PubMed2001

Is there equity in access to health services for ethnic minorities in Sweden?

BACKGROUND: This paper addresses the extent to which equity of treatment according to need, as defined by self-reported health status, is received by members of ethnic minorities in Swedish health services. METHODS: The study was based on a multivariate analysis of cross-sectional data from the Swedish Survey of Living Conditions and Immigrant Survey of Living Conditions in 1996 on use of health services, morbidity and socioeconomic indicators. The study population consisted of 1,890 Swedish residents aged 27-60 years born in Chile, Poland, Turkey and Iran and 2,452 age-matched, Swedish-born residents. MAIN RESULTS: Residents born in Chile, Iran and Turkey were more likely to have consulted a physician during the 3 months prior to the interview compared to Swedish-born residents; odds ratios (ORs) 1.4 (95% CI: 1.2-1.7), 1.3 (95% CI: 1.1-1.7) and 1.5 (95% CI: 1.3-1.9) respectively. The higher consultation rate in these ethnic minorities was primarily explained by a less satisfactory, self-reported health status compared to Swedish-born residents. Thirty-eight percent of the minority study groups reported exposure to organised violence in their country of origin, which was associated with a higher level of use of consultations with a physician (OR 1.3, 95% CI: 1.1-1.6). CONCLUSIONS: This study did not indicate any gross pattern of inequity in access to care for ethnic minorities in Sweden. Systems for allocating resources to health authorities need to consider the possibility that ethnic minorities in Sweden and in particular victims of organised violence, use health services more than is suggested by socioeconomic indicators only.

Adolescent↗
PubMed2001

Socioeconomic differences in use of medical care and antibiotics among schoolchildren in Sweden.

BACKGROUND: Studies of mortality among children and adults in Sweden have demonstrated considerable socioeconomic differences. This paper describes socioeconomic patterns of physical morbidity and use of medical care and antibiotics in schoolchildren in Sweden. METHODS: A cross-sectional study based on parent interviews from the Swedish Survey of Living Conditions in 1996-1997 was used. The study population consisted of 3,557 children aged 6-15 years. RESULTS: Forty-five percent of the schoolchildren in the study were reported to have been absent from school because of illness at least once during the previous three months, 8% were taking regular medication and 10% had ever suffered from a chronic disorder. There were no indications of socioeconomic differences according to the education of the responding parent in morbidity or use of consultations with a physician. However, children in families where the responding parents had primary education only consumed antibiotics less often (OR 0.7 and CI: 0.5-0.9) when compared to children in families with post-secondary education. Children in rural areas used consultations with a physician less often and consumed less antibiotics (adjusted OR 0.7 and CI: 0.4-0.9 and 0.7 and CI: 0.5-0.9 respectively). CONCLUSION: No obvious patterns of socioeconomic inequality in physical morbidity or use of medical care were identified among schoolchildren in Sweden. Further studies are needed in order to explain the social inequality in consumption of antibiotics among schoolchildren in Sweden and to describe social and regional patterns of psychiatric, behavioural and psychosomatic morbidity.

Adolescent↗
PubMed2000

Ethnicity, childhood environment and atopic disorder.

BACKGROUND: The International Study of Asthma and Allergies in Childhood (ISAAC) has demonstrated large differences in the prevalence of atopic disorders in children between different regions in the world. Populations with a higher standard of living and a more westernized lifestyle tend to have higher rates of atopy and asthma. Many hypotheses regarding environmental causes of atopic disorder focus on the early childhood environment. OBJECTIVE: To study the influence of ethnicity and country of birth for the prevalence of atopic disorders. METHODS: The prevalence of atopic disorders in Swedish residents born in Turkey and Chile, who settled in Sweden as adults in the 1980s, was compared with their own Swedish-born children and a sample of Swedish-born parents and their children in interview data from the Survey of Living Conditions in 1996. The study group included 1734 adults 27-60 years of age and their 2964 children aged 3-15. RESULTS: The Chilean-born parents and their children had the highest risk for allergic asthma; adjusted odds ratios (ORs) 2.2 (1.2-4.0) and 2.7 (1.6-4.5), respectively, and allergic rhino-conjunctivitis; OR 1.6 (1.1-3) and 1.6 (1.1-2.5) in both groups, when compared with the Swedish-born parents and their children. The Turkish-born parents and their children had the lowest risk for allergic rhino-conjunctivitis; both groups had OR 0.6 (0. 4-0.9) and the children in this group also had the lowest risk for eczema; OR; 0.4 (0.3-0.7). The risk for all atopic disorders was lower in the Turkish group compared with the Chileans. CONCLUSION: This study demonstrates that ethnicity is an important determinant of atopic disorder independent of the external childhood environment. The value of international comparisons of environment and risk for atopic disorders can be questioned until more is known about factors related to ethnicity, such as genetic susceptibility and diet, for the development of atopy.

Adult↗
PubMed2000

Lower respiratory tract infections in an ethnic and social context.

Family size and smoking during pregnancy were studied as mediating factors for social and ethnic variation of lower respiratory tract infection (LRI) in hospital discharge data. The study population consisted of all children aged 0-4 years in the three largest metropolitan areas of Sweden during 1990-94. Maternal smoking during pregnancy increased the risk of children being admitted to hospital for LRI during their first 3 years of life, with an adjusted odds ratio (OR) of 1.3 for the age-group 0-1 years. The risk attributed to smoking during pregnancy was the same in children of mothers in ethnic groups in which smoking during pregnancy was related to social adversity as in those in which it was not. Having at least one sibling increased the risk of being admitted to hospital for LRI in the age group 0-1 years (adjusted OR 2.2). This risk was lower in children in families in which the mother was born in southern Europe, Africa, Asia or Latin America, suggesting a contextual relation to ethnicity for this risk factor. It is concluded that family size and smoking during pregnancy are important mediators of the risk for LRI related to social adversity and ethnicity in Swedish children below 2 years of age.

Child, Preschool↗
PubMed2000

Socio-economic differences in daycare arrangements and use of medical care and antibiotics in Swedish preschool children.

UNLABELLED: In this study we describe socio-economic patterns of daycare enrolment, medical care and antibiotics in children, 0-5 y, whose parents participated in the Swedish Survey of Living Conditions 1996-97. Children in families with low socio-economic status and unemployed parents were less often enrolled in out-of-home care. Multivariate analyses (adjusted for various sociodemographic indicators, type of daycare and chronic morbidity) demonstrated that children 1-5 y in families with low social status (low parental education and/or low SES) were less likely to have paid a visit to a physician because of an acute infection during the previous 3 mo [odds ratio (OR) 0.6 (0.4-0.8)] or to have consumed antibiotics during the previous 12 mo [OR 0.8 (0.6-1.0)] compared to children with a higher social status. Children in out-of-home care more often had paid a visit to a physician because of an acute infection during the previous 3 mo [OR 1.5 (1.2-1.9)] and more often had consumed antibiotics during the previous 12 mo [OR 1.7 (1.3-2.1)] than children in home care. The effect of out-of-home care on use of medical care and antibiotics decreased with increasing age of the child, and deviated from the null hypothesis in children 1-3 y only. CONCLUSION: Preschool children in families with a low social status consume less medical care and are less likely to attend out-of-home care compared to children with a higher social status in Swedish society. This inequity needs to be addressed in social and health policy.

Adolescent↗
PubMed2000

Organized violence and mental health of refugee children in exile: a six-year follow-up.

UNLABELLED: In an earlier study we described a high rate of poor mental health in 63 refugee children from Chile and the Middle East during the first 18 mo of exile. In this follow-up study the mental health of 49 of these children is described in parent, teacher and child interviews 6-7 y after settlement in Sweden. The level of poor mental health in parent interviews has improved from 47% 18 mo after settlement to 22% (p < 0.01 in paired t-test) at follow-up. CONCLUSIONS: Eighteen percent of 34 children still in primary school were judged by their teachers to show deviant behaviour in the classroom. Three children were found to suffer from either reexperience or avoidance of painful memories, whereas only one neurologically impaired child fulfilled the criteria of PTSD according to DSM-IV. Recent stress in the family sphere and exposure to acts of organized violence in the country of origin are identified as the major determinants of poor mental health.

Child↗
PubMed2000

Dental health and access to dental care for ethnic minorities in Sweden.

OBJECTIVE: To describe access to dental care in a population-based sample of foreign-born Swedish residents in relation to dental health. DESIGN: The study was based on data from the Immigrant Survey of Living Conditions in four minority study groups consisting of a total of 1,898 Swedish residents born in Poland, Chile, Turkey and Iran aged 27-60. An age-matched study group of 2,477 Swedish-born residents from the Survey of Living Conditions of 1996 was added as a comparison group. The study also included 2,228 children aged 3-15 years in the minority households and 2,892 children in the households of the Swedish-born study group. RESULTS: The risk of poor dental health was higher in all four minority study groups than for the Swedish-born study group after adjusting for socio-economic variables. In the adult minority study groups the adjusted odds ratios (ORs) for having prostheses and problems with chewing was 6.3 (4.3-9.1) and 2.7 (1.8-4.3), respectively, for the Polish-born, 4.8 (3.3-7.1) and 3.2 (2.1-4.9) for the Chilean-born, 4.6 (3.1-6.9) and 4.8 (3.6-7.2) for the Turkish-born, and 2.7 (1.5-4.8) and 6.5 (4.1-10.3) for the Iranian-born compared with the Swedish-born. In the child study group all four minority groups had an increased risk of caries ranging from OR 1.6 (1.3-2.1) in the Chilean group to 2.5 (2.0-3.0) in the Turkish group compared with the children with Swedish-born parents. The adults in all four minority study groups more often lacked regular treatment by a dentist than Swedish-born residents. The OR for not having been treated by a dentist during the 2 years preceding the interview ranged from 1.9 (1.4-2.6) in the Polish-born study group to 3.0 (2.3-4.0) in the Chilean-born study group after adjustment for socio-economic factors and general health. CONCLUSION: This study demonstrates that adults in minority populations in Sweden use less dental care despite having greater needs of dental treatment than the majority population. This inequity calls for action in health policy and preventive dental health programmes.

Adolescent↗
PubMed1999

Migration and atopic disorder in Swedish conscripts.

We have studied asthma and allergic rhinitis prevalence in Swedish conscripts born 1973-1977 according to the military service conscription register in relation to the socio-economic status and country of birth of the conscripts and their parents, and age when granted residency in Sweden. There was an increase in prevalence of asthma and allergic rhinitis over time in all groups irrespective of country of birth or ethnic origin. Conscripts who themselves were born in Africa, Asia, Latin America and the Mediterranean had a significantly lower risk for asthma and allergic rhinitis than Swedish-born conscripts. The risk of atopic disorder among the foreign-born conscripts increased with time of residency in Sweden. Conscripts with mothers from Latin America, Asia and Africa were identified as having the highest risk for atopic disorder among Swedish-born conscripts with high socio-economic status; the adjusted risk ratio (RR) for asthma was 2.6 (95% CI 1.7-4.0) and that for allergic rhinitis was 2.0 (1.5-2.6). The conscripts with mothers from the Mediterranean had the lowest risk for atopic disorders of the Swedish-born conscripts with low socio-economic status; the RR for asthma was 0.43 (0.34-0.56) and that for allergic rhinitis was 0.84 (0.76-0.93). This study demonstrates that factors related to migration and ethnicity are important determinants of atopic disorder among Swedish conscripts.

Adolescent↗
PubMed1999

Age at adoption, ethnicity and atopic disorder: a study of internationally adopted young men in Sweden.

Epidemiological and laboratory studies have implied that the environment during early childhood is important for the risk of developing atopic disorders. In this study we analyzed the prevalence of asthma, hayfever and eczema among 1901 internationally adopted young men at the military-induction medical examination in relation to indicators of their early childhood environment. The adopted young men who came to Sweden before 2 years of age suffered from asthma, hayfever and eczema significantly more often than those who came to Sweden between 2 and 6 years of age; the risk ratios (RR) were 1.6, 2.5 and 2.1, respectively. The young men who were born in the Far East were identified as being particularly susceptible to the development of hayfever and eczema, with RRs of 1.3 and 1.7. This study demonstrates that the environment during the first 6 years of life has a profound influence on the risk of suffering from atopic disorders as young adults.

Adolescent↗
PubMed1999

Vernal keratoconjunctivitis in a Stockholm ophthalmic centre--epidemiological, functional, and immunologic investigations.

PURPOSE: To classify a cohort of 62 patients with vernal keratoconjunctivitis (VKC) in immunologic, functional, and epidemiological terms. METHODS: A retrospective chart review was conducted to establish the patients' ethnic origin and to ascertain the results of standard in vitro and in vivo testing for atopic allergy. The latter data were compared with tear Phadiatop, an allergy screening test, in 31 subjects. Further subgroup analyses included methacholine bronchial provocations, serum screening for chlamydial antibodies and epidemiological calculations of the observed prevalence of VKC in the Stockholm area in 1994. RESULTS: Thirty-seven subjects (59.7%) were sensitised to common allergens. No additional allergic subjects were diagnosed with the tear Phadiatop test. The serology for ocular chlamydial disease was negative. Only 6 out of 17 subjects displayed bronchial reactivity to methacholine of whom 4 had a history of asthma. VKC was clearly more common in individuals with an Asian and African origin. CONCLUSIONS: Sensitivity to allergens is a strong determinant for the disease but in a large proportion of the subjects this immunologic abnormality is absent. The varying prevalence of the condition in different ethnic groups indicates a genetic predisposing factor.

Adolescent↗
PubMed1999

Social adversity, migration and hospital admissions for childhood asthma in Sweden.

The number of children admitted to hospitals because of asthma has been reported to decrease in Sweden in recent decades despite an increasing prevalence of childhood asthma. This decrease has been explained by improved maintenance therapy of children with severe asthma. In this study we used data on hospital admissions for asthma from the Swedish National Patient Discharge Registers in Stockholm, Malmö and Gothenburg 1990-1994 to identify social and ethnic characteristics of children 2-18-y-old in need of improvement in disease management. Children in families on social welfare (adjusted odds ratios (OR): 1.3 and 1.5) and children in single-parent households (adjusted OR: 1.3 and 1.4) were more often admitted to hospital because of asthma at least once during a calendar year in the 2-6- and 7-18-y-old groups. Children in families on social welfare had a particularly high risk of being admitted more than once during a calendar year (adjusted OR: 1.6 in the younger age group and 2.9 in the older group). Exposure to smoking during pregnancy was more common in socially disadvantaged families and increased the risk of hospital admission in children below 3 y of age. Children born outside Western Europe, the USA and Australia were less commonly admitted to hospital because of asthma than other children in the population (adjusted OR: 0.1-0.5). Swedish-born children with mothers who were born in Eastern and Southern Europe were also at lower risk for admission to hospital with a diagnosis of asthma (adjusted OR: 0.2-0.6). This probably indicates a lower prevalence of asthma in these ethnic groups. Further studies are needed to identify factors that can explain these ethnic differences in childhood asthma.

Adolescent↗
PubMed1999

Mortality statistics in immigrant research: method for adjusting underestimation of mortality.

BACKGROUND: It is difficult to carry out fair comparisons of the mortality of different ethnic groups in a population in register-based studies because sizeable numbers of immigrants who subsequently leave their new homeland fail to register this fact with the national registration authorities. In this article we present a method which attempts to address these problems. METHODS: Age-standardized mortality rates for native Swedes and immigrants in the age group 20-64 years were calculated for all individuals who either were included in the Swedish Population Censuses for 1985 or 1990, or who moved to Sweden during the period November 1990-1994. In order to define the population under scrutiny different sources of income are used as indicators of residence in the country. RESULTS: When an analysis is made of all nationally registered individuals, significantly reduced death rates are found among immigrants outside the north-east of Europe compared to those for Swedish-born people. Extremely low death rates are found for those born in Turkey, Southern Europe, Latin America, Asia, and Africa and for those who are younger and without any income. When the income criterion is introduced, there is a change so that the earlier significantly reduced relative death risks for immigrants born outside the north-east of Europe for some subgroups are no longer significantly lowered. CONCLUSION: This study has important implications for the interpretation of every study of mortality among immigrants based on official mortality statistics. Using information about income as an indicator of residence in the country appears to be a method which can be pursued further in order to achieve a more accurate understanding of mortality among immigrant groups.

Adult↗
PubMed1998

Political violence, family stress and mental health of refugee children in exile.

The mental health of 63 refugee children, with a mean age of 5.9 years, from Chile and the Middle East, were studied during the first 18 months of exile in Stockholm, Sweden. 46% of the children were rated as having poor mental health five months after resettlement in symptom interviews with parents based on the structured questionnaire developed by Cederblad, and 44% thirteen months later. Political violence in the home country and stress in the family sphere in exile were identified as the major determinants of poor mental health in this context.

Acculturation↗
PubMed1991

Persecution and behavior: a report of refugee children from Chile.

A Swedish study of 50 newly resettled refugee children from Chile describes the children's experiences of persecution in their home country and coping patterns in the receiving country. Thirty-six children had experiences directly related to persecution, and seven of these had been victims of physical assault for political reasons. Sleep disturbances and dependency were behaviors significantly associated with experiences of persecution. Resettled refugee families need to be approached by concerned professionals as symptoms of trauma in refugee children are often recognized only in the family sphere.

Acculturation↗