Study objective: To demonstrate how Care Need Index (CNI), a social deprivation index, may be used to allocate total primary health care resources. Design: Cross sectional survey and register data. The CNI was based on sociodemographic factors: elderly persons living alone, children under age 5, unemployed people, people with low educational status, single parents, high mobility, and foreign born people. The CNI weights were calculated from the ratings of Swedish GPs of the impact of these factors on their workload. The CNI scale was transformed into a positive scale to avoid negative values. CNI weights were calculated for each decile of the study population. The risk of poor self reported health in the CNI deciles was estimated by means of a hierarchical logistic regression in the age range 25-74 (n=27 346). The MigMed database comprising all people living in Sweden was used to calculate the CNI for Stockholm. Participants: The Swedish population and the population in Stockholm County. Main results: The means of the CNI for deciles ranged from 61 (most affluent neighbourhoods) to 140 (most deprived) in Stockholm County. The ratio between the tenth and the first decile was 1.66. There was an approximately 150% increased risk of poor self reported health for people living in the most disadvantaged neighbourhoods (OR=2.50) compared with those living in the most affluent ones (OR=1). CNI ratios for the deciles corresponded approximately to the odds ratios of poor self reported health status. Conclusions: The CNI can be used to allocate total primary health care resources.T he purpose of this study is to show how a modified Jarman score, such as the Care Need Index (CNI), 1 can be used as a direct empirical measure for the distribution of primary health care resources. Existing indices such as the Jarman score 2 allocate an additional fee, above a certain cut off, to general practitioners (GPs) who have their practices in the 5% most deprived neighbourhoods. However, the presence of negative values in the scores makes it difficult to use them for a total distribution of resources. This study shows how such an index can be transformed into a more useful scale in order to allocate total resources to primary health care.The CNI was originally developed for the purpose of measuring the potential workload of GPs in Swedish primary health care using indicators for material deprivation (unskilled, unemployed, and living in crowded households) and adding demographic factors related to family structures (elderly persons living alone, children under age 5, and single parent families), social instability (people who had moved house during the past year), and cultural needs (ethnicity) weighted by Swedish GPs.

Objective: To investigate which subgroups of the Swedish adult population use dietary supplements and natural remedies, taking into account sociodemographic and health behaviour factors. Design: A cross-sectional survey conducted in 1996=1997 by Statistics Sweden was used for the analyses. In faceto-face interviews participants reported consumption of dietary supplements and natural remedies during the previous 2 weeks. Setting: Sweden Subjects: A nationally representative sample of 11 422 adults (5596 men, 5826 women) aged 16 -84 y. The response rate was 78%. Results: Overall, 33% of Swedish women and 22% of Swedish men reported use of dietary supplements; prevalence of natural remedy users was 14 and 7%, respectively. The best predictors for use of dietary supplements and natural remedies were age, sex and subjective health. Women and older individuals were more likely to be dietary supplement and=or natural remedy users. Obese men and women were less likely to use dietary supplements than underweight ones. Among men subjective health was significantly related to use of these preparations. Men who reported excellent health ate less than men reporting poor health. This association was weaker among women. Exercise was another important factor. Both men and women (except female dietary supplement users) who reported moderate or heavy exercise were significantly more frequent users of these preparations than those who reported practically no exercise. Conclusion: Use of dietary supplements and natural remedies is associated with several sociodemographic and health behaviour factors.

Abstract

Objective: To investigate the relationship between osteoporosis and nutritional status as determined by the Mini-Nutritional Assessment (MNA). Design: A cross-sectional study. Setting: Stockholm, Sweden. Subjects: A total of 351 elderly free-living women (mean age 7372.3 years). Methods: MNA (range 0-30 points; o17 indicates malnutrition, 17.5-23.5 risk of malnutrition and X24 well nourished), measurements of bone mineral density of the left hip and lumbar spine using Hologic QDR 4500, and of the heel using Calscan DEXA-T. Results: The median MNA score was 27 (range 12.5-30). One woman was classified as malnourished and 7.4% were at risk of malnutrition. Osteoporosis of the femoral neck was observed in 22% and a fracture after the age of 50 was reported by 31% of the participants. The following items in the MNA questionnaire exhibited an increased risk of having osteoporosis in the femoral neck and/or total hip: an MNA score of o27 (odds ratio (OR) ¼ 2.09; CI ¼ 1.14-3.83); a mid-arm circumference of less than 28 cm (OR ¼ 2.97; CI ¼ 1.29-6.81); and regular use of more than 3 drugs each day (OR ¼ 2.12; CI ¼ 1.00-4.50). A body weight of more than 70 kg exhibited a decreased risk of having osteoporosis (OR ¼ 0.31; CI ¼ 0.14-0.70). Conclusions: In general, the nutritional status was good in this population of free-living elderly women. Nevertheless, half of the women who displayed an MNA score o27 points had a twofold increased risk of having osteoporosis.

Psychosocial support during the early phase of rehabilitation after orthopedic injuries may have a beneficial effect on outcome when measured as quality of life.

Study objective: This study examines whether morbidity, defined as the first psychiatric hospital admission and the first somatic hospital admission, differs among subgroups of foreign born and second generation (that is, native born with at least one parent born abroad) women compared with Swedish born women (that is, with both parents native born) after adjusting for sociodemographic factors. Design/Setting: In this follow up study the population consisted of 1 452 944 women, of whom 369 771 have an immigrant background (including second generation immigrants), aged 20-45 years. The population of 31 December 1993 was followed up to 31 December 1998. Differences in risk (hazard ratio) between different groups of immigrant women were estimated, adjusting for age, marital status, number of children, and disposable income. Main results: All four groups of foreign born women had higher age adjusted risks (HRs varied from 1.44 to 1.67) for a first psychiatric hospital admission than Swedish born women. The risk decreased only marginally when the sociodemographic factors were taken into consideration. Additionally, second generation women also had a higher age adjusted risk (HR = 1.42; CI = 1.37 to 1.48) than Swedish born women. The risk decreased only slightly in the main effect model. However, on analysing country of birth and first somatic hospital admissions, only non-European refugee women showed an increased age adjusted risk (HR = 1.26; CI = 1.24 to 1.29), which remained after adjusting for sociodemographic factors. Conclusions: Foreign born and second generation women of childbearing age had a higher risk than Swedish born women for a first psychiatric hospital admission. However, only non-European refugees were at higher risk of somatic hospital admissions.

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