The experiencing of positive consequences of drinking in four Scandinavian countries1

Based on data from a comparative survey of drinking in four Scandinavian countries (Finland, Iceland, Norway and Sweden), the experiencing of positive consequences of drinking was studied in relation to alcohol consumption, intoxication frequency and the experiencing of negative consequences of drinking. In all four countries a substantial portion–both of the men and of the women–reported having experienced various positive effects of drinking during the last 12 months. The positive consequences clearly correlated with yearly alcohol consumption and even more with intoxication frequency. A strong link between the experiencing of positive and negative consequences of drinking was also found. The study also indicates that there are national differences in the experiencing of positive consequences of drinking which do not reflect the national differences in total alcohol consumption.     

IQ and personality traits assessed in childhood as predictors of drinking and smoking behaviour in middle-aged adults: a 24-year follow-up study

Aims . The identification of childhood personality predictors of drinking and smoking behaviour in adults.
Design . A 24-year follow-up study.
Setting . Prague, the Czech Republic.
Participants . Combined cohorts of 220 males and females born of unwanted pregnancies, and 220 control subjects, examined with low attrition rates at ages 9-10, 21-23, 28-31 and 32-35.
Measurements . In childhood IQ was assessed by the Wechsler Intelligence Scale, Children (WISC), and personality characteristics were rated by teachers, mothers and classmates. In adulthood questionnaires and face-to-face interviews were used to assess drinking and smoking.
Findings . Unwanted pregnancy was not related to adult drinking and smoking. The ratings of childhood personality characteristics were condensed into three personality dimensions, i.e. conscientiousness, extroversion and neuroticism, interpreted as three of the Big Five personality dimensions, and found to show some stability into adulthood. Gender, IQ and the three childhood personality traits were used as predictors of adult drinking and smoking behaviour. Adult drinking behaviour was significantly predicted by the block of the three childhood personality traits, low conscientiousness predicting high drinking quantity per occasion (and heavy episodic drinking) whereas extroversion predicted subjects' average daily consumption. Smoking in adulthood was predicted by low IQ and low conscientiousness.
Conclusions . IQ and personality traits in children explain to some degree the drinking and smoking behaviour of adult men and women, but the roles of the different components vary according to the form of substance use.     

Alcohol and Suicide in Scandinavia

Several individual level studies suggest that heavy drinking is a risk factor with regard to suicide. At the aggregate level we should thus expect a relationship between the suicide rate and the prevalence of heavy drinking (as measured by per capita consumption of alcohol). To test this hypothesis, time series data far Denmark (1931–80), Finland (1932–80), Norway (1931–80) and Sweden (1922–49, 1950–70) was analysed. It was expected that the relationship between alcohol and suicide would be contingent on characteristics of the drinking culture. More specifically, it was thought that the relationship would be strongest in Finland, with its more explosive drinking practice, weakest in Denmark due to its more continental drinking patterns, and with Sweden and Norway in between. The results show that the relationship is statistically significant in the two latter countries only. Some methodological problems that should be considered when interpreting the findings are discussed in the final section.     

Age,Alcohol Consumption and the Experiencing of Negative Consequences of Drinking in Four Scandinavian Countries1

Based on data from a comparative survey of drinking in four Scandinavian countries (Finland, Iceland, Norway and Sweden), use of alcohol and negative consequences of drinking were studied in relation W age. Clear differences were found between age-groups as regards experiencing such negative consequences in respect of both men and women. These differences were to a large extent a reflection of similar differences between the age-groups in regard to alcohol consumption and intoxication frequency. However, it was also found that when both alcohol consumption and intoxication frequency were maintained at a constant level, age in itself seemed to influence the experiencing of negative consequences. The study also indicates that in all age-groups there are national differences in drinking patterns and thus in the experiencing of negative consequences of drinking which do not reflect the national differences in total alcohol consumption.     

Alcohol use,heavy episodic drinking and subsequent problems among adolescents in 23 European countries: does the prevention paradox apply?

Aims According to the prevention paradox, a majority of alcohol‐related problems in a population can be attributed to low to moderate drinkers simply because they are more numerous than heavy drinkers, who have a higher individual risk of adverse outcomes. We examined the prevention paradox in annual alcohol consumption, heavy episodic drinking (HED) and alcohol‐related problems among adolescents in 23 European countries. Design and setting Survey data from the 2007 European School Survey Project on Alcohol and Drugs (ESPAD) among 16‐year‐old students were analysed. Participants A total of 38 370 alcohol‐consuming adolescents (19 936 boys and 18 434 girls) from 23 European countries were included. Measurements The upper 10% and the bottom 90% of drinkers by annual alcohol intake, with or without HED, and frequency of HED, were compared for the distribution of 10 different alcohol‐related problems. Findings Although the mean levels of consumption and alcohol‐related problems varied largely between genders and countries, in almost all countries the heavy episodic drinkers in the bottom 90% of consumers by volume accounted for most alcohol‐related problems, irrespective of severity of problem. However, adolescents with three or more occasions of HED a month accounted for a majority of problems. Conclusions The prevention paradox, based on measures of annual consumption and heavy episodic drinking, seems valid for adolescent European boys and girls. However, a minority with frequent heavy episodic drinking accounted for a large proportion of all problems, illustrating limitations of the concept. As heavy episodic drinking is common among adolescents, our results support general prevention initiatives combined with targeted interventions.     

The Relationship Between Alcohol Consumption,Alcohol Intoxication and Negative Consequences of Drinking in Four Scandinavian Countries★

In February 1979 identical questionnaires were mailed w representative samples totalling 3000 persons between 20 and 69 years of age in the populations of each of four Scandinavian countries, (Finland, Iceland, Norway and Sweden), in order to study-among other things-the relationship between alcohol consumption, alcohol intoxication and negative consequences of drinking in various cultural settings. The results indicate that it is not possible on the basis of the total consumption of a country to make a reliable prediction of the negative consequences of alcohol consumption that the study considers. In a country with a high total consumption, the scale of negative consequences could be much lower than in a country with a lota total consumption. However, the likelihood of having experienced the types of negative consequences inquired about in the questionnaire was approximately the same in all four countries, when intoxication frequency was maintained at a constant level. The national differences in the experience of negative consequences therefore mainly seems to correlate with differences between the countries in intoxication frequency.     

Immunisation of healthcare workers in the Nordic countries: Variation in recommendations and practices and a lack of assessment

Healthcare workers (HCWs) are at increased risk of both exposure and transmission of infectious disease. Two European Union (EU) directives state that health services are responsible for assessing their employees’ potential exposure to infectious diseases and offering immunisation free of charge. We assessed current policy for immunisation of HCWs and the availability of vaccine coverage data in the Nordic countries by surveying national vaccination experts in Denmark, Finland, Iceland, Norway and Sweden, as well as Swedish county medical officers (CMOs). All national experts and 17 of 21 Swedish CMOs responded. All EU countries had transposed the European directives into national law, while Norway and Iceland had similar national legislation. Recommendations or guidelines were issued in Denmark, Finland, Iceland, Norway and 15 of 17 responding Swedish counties. The range of diseases covered differed by countries and Swedish counties. HCW vaccine coverage data were not systematically collected; incomplete estimates were only available for Finland and two Swedish counties. In conclusion, recommendations or guidelines exist in the Nordic countries, but their impact cannot be assessed, as vaccine uptake among HCWs is not currently measured. Systematic collection of data is a necessary step towards improving HCW immunisation policy and practice in the Nordic countries.     

Epidemiological trends in oesophageal cancer in the Nordic countries

Objective. The incidence rates of oesophageal cancer vary more than those of any other cancer, world-wide. The aim of this study was to examine the epidemiological features of oesophageal cancer in the Nordic countries. Material and methods. Epidemiological data from the Nordic Cancer Registry (NORDCAN Database, http://www.ancr.nu/nordcan.asp) were used for the study analysis. Results. From 1971 to 2000 in the Nordic countries, 18,034 oesophageal cancers were detected in males and 8216 in females. In males, the incidence rates (world age standardized incidence per 100,000) of oesophageal cancer in 1971–75 and 1996–2000 were 2.7 and 6.0 in Denmark, 4.2 and 3.2 in Finland, 3.4 and 5.6 in Iceland, 2.6 and 3.3 in Norway, and 2.9 and 3.3 in Sweden, respectively. In females, the corresponding figures were: Denmark 1.1 and 1.8, Finland 3.1 and 1.3, Iceland 2.5 and 1.3, Norway 0.7 and 0.9, and Sweden 1.1 and 1.0. Each Nordic country showed a significant geographical variation in the incidence of oesophageal cancer. In both males and females the incidence curves began rising after 40 years of age, but significantly more steeply in males than in females. Over the study period, oesophageal cancer mortality increased from 2.97 to 3.68 per 100,000 in males but decreased from 1.30 to 1.08 in females. The incidence rates of oesophageal adenocarcinoma increased in males in all Nordic countries, and the increase was most marked in Denmark. The incidence of oesophageal adenocarcinoma also increased among Danish females, but compared with males, the incidence rate remained significantly lower. Conclusions. The time trends in incidence of oesophageal cancer differ between the Nordic countries, and there has also been geographical variation within them. On a global comparison, the incidence rates of oesophageal cancer are low in the Nordic region. Oesophageal cancer is a male-predominant disease in all Nordic countries, and the incidence rates of oesophageal adenocarcinoma have increased in males and Danish females.     

International Review Series: Alcohol and Alcohol Problems Research 3. Nordic Countries

This paper describes the development of alcohol research in Denmark, Finland, Iceland, Norway, and Sweden. Different organizational structures have developed. In Finland and Norway, separate research institutes carry the main research responsibility. Sweden, with its several university chairs for alcohol research, has chosen an internationally unique organizational solution. The orientation, content, and recent trends in social alcohol research are dealt with on the basis of data from the 1970s and recent research reports; the main differences between the countries are discussed. Existing Nordic cooperation is also described.     

Diffusion of knowledge of Helicobacter pylori and its practical application by Nordic clinicians

BACKGROUND: The knowledge uptake by physicians in five Nordic countries about Helicobacter pylori and gastrointestinal disease was studied. METHODS: Questionnaires were sent to 1832 general practitioners (GP) and gastroenterologists (GE), and central persons were interviewed in Norway, Sweden, Denmark, Finland, and Iceland. RESULTS: Half the GEs had heard of H. pylori by 1987 and had begun eradication treatment before 1991, and half the GPs had by 1989 and 1992, respectively. By 1996 this applied to more than 90% of both groups. The most important information sources were national journals for GPs and international journals and conferences for GEs. More than 80% of respondents considered H. pylori causative for peptic ulcer, less than 50% for stomach cancer, and 10% for non-ulcer dyspepsia. Variations between countries were mostly small. CONCLUSIONS: GPs and GEs in the Nordic countries have knowledge of H. pylori, and there is broad agreement on diagnosis and treatment, although some differences exist.     

Do morphology and stage explain the inferior lung cancer survival in Denmark?

Danish lung cancer patients diagnosed during 1983-1987 experienced 5-yr relative survival rates 2-7% inferior to patients in the other Nordic countries, despite the similarity of cancer registration and healthcare systems in the Nordic countries. Is the inferior relative survival in Denmark due to differences in morphology or stage of lung cancers? The present study compared in detail the survival of 92,719 patients diagnosed with lung cancer during 1978-1992 in Denmark, Finland, and Norway. In particular, differences in morphology and extent of disease were studied. A poor survival rate for small cell anaplastic lung carcinoma compared with all other morphologies was confirmed. However, this could not explain the relative survival differences observed between countries. Extent of disease was the most important predictor of survival. Part of the observed survival differences could be explained by a less favourable stage distribution in Denmark, combined with a slightly lower relative survival rate for those with metastatic disease. Differences in treatment are unlikely to explain the findings, although delays in diagnosing and treating patients in Denmark compared with neighbouring countries could partially explain the lower patient survival in Denmark. In conclusion, the main factor in the lower survival rate in Denmark is unfavourable stage distribution.     

Exploring the relationship between alcohol consumption and non-fatal or fatal stroke: a systematic review

Objective. Alcohol consumption has been reported to have both beneficial and harmful effects on stroke occurrence. Several studies have demonstrated a significant association with heavy drinking, but the evidence linking light-to-moderate alcohol consumption still remains unclear. This study, using a systematic review of the published literature, aimed to explore the dose-response relationship between alcohol and stroke, the effect of irregular drinking and the effect of beverage types on the risk of stroke.
Methods. A structured search for English-language published literature since 1966 was made using several electronic databases. This was supplemented using a hand search of references in review articles and additional searches on key authors. From the 153 eligible articles, 41 studies were selected according to study design, categorization of the exposure and outcome measures.
Findings. An association between recent alcohol use and stroke was consistently reported. There was also some evidence for a linear positive association for haemorrhagic stroke and alcohol consumption. Inconsistent results emerged on the J -shaped relationship between alcohol and ischaemic stroke, and the association between alcohol and non-fatal or fatal stroke combined. The importance of the pattern of drinking was also demonstrated, indicating a higher risk for irregular drinkers.
Conclusions. There is insufficient evidence to conclude that light-to-moderate alcohol drinking and wine intake have beneficial effects on stroke occurrence. On the contrary, findings from this review suggest the opportunity for a primary prevention regarding heavy drinking and binge drinking. More information regarding the risk of stroke associated with irregular alcohol drinking, and the joint effects of alcohol with other risk factors, would clarify the complex interaction between alcohol and stroke.     

The relationship between alcohol use and mortality rates from injuries: a comparison of measures.

Per capita consumption of alcohol has traditionally been considered to be the leading indicator of population levels of alcohol problems. However, some recent research suggests that this relationship may be weakening, and that drinking pattern measures may be preferable to per capita consumption as problem-level indicators. We compared the ability of per capita alcohol consumption and survey-based measures of alcohol use to predict deaths from injuries in Ontario, Canada, for the period 1977-1996. Per capita consumption and percentage of daily drinkers were significantly related to injury mortality, but percentage of drinkers and percentage of episodic heavy drinkers (those who drank five or more drinks on a drinking occasion) were not. Of the measures we examined, per capita consumption was the strongest indicator of mortality rates from injuries. However, the survey-derived measure of percentage of daily drinkers was similar to per capita consumption in ability to predict problem levels.     

Hostility, drinking pattern and mortality

AIMS: This study examined the association of hostility to drinking pattern and whether this association mediated the relation of hostility to mortality. PARTICIPANTS AND DESIGN: Subjects were 3326 current drinkers from the Vietnam Experience Study cohort who were followed for vital status. SETTING: United States. MEASUREMENTS: Hostility was measured by an abbreviated version of the Cook-Medley Hostility Scale (ACM). The alcohol variables were total monthly intake of alcohol, drinking frequency, drinks per drinking day and drinking > or = 5 drinks on at least one occasion in the past month (i.e. heavy episodic drinking). FINDINGS: Regression analyses showed associations between the ACM and total monthly intake of alcohol (P < 0.0001), drinks per drinking day (P < 0.0001) and heavy episodic drinking (P < 0.0001), but not with frequency of drinking days. Hostility, drinks per drinking day, heavy episodic drinking and total monthly alcohol intake were also associated with all-cause mortality (all Ps < 0.0001). Further analyses showed that drinking pattern, particularly drinks per drinking day, may account partially for the relation of hostility to mortality. CONCLUSIONS: High hostility is associated with elevated mortality and a deleterious drinking pattern characterized by relatively high intake per drinking occasion. Drinking pattern could help explain the relationships between hostility and health.     

Does the Association Between Alcohol Consumption and Depression Depend on How They Are Measured?

BACKGROUND: Inconsistent findings regarding the relationship between alcohol consumption and depression, including whether the relationship is J-shaped or U-shaped, may be at least partly due to the types of measures used for both alcohol consumption and depression. METHODS: We conducted a general population survey using random digit dialing (RDD) and computer-assisted telephone interviewing (CATI) with 6,009 males and 8,054 females aged 18 to 76 years. The survey included 4 types of alcohol measures (frequency, usual and maximum quantity per occasion, volume, and heavy episodic drinking) covering both the past week and the past year, and 2 types of depression measures (meeting DSM criteria for a clinical diagnosis of major depression, recent depressed affect). RESULTS: The overall relationship between depression and alcohol consumption did not vary by gender or type of depression measure but did vary significantly by type of alcohol measure, with the strongest relationship found for heavy episodic drinking and high quantity per occasion. There were also significant gender interactions with both depression and alcohol measures, with females showing a stronger relationship than males when depression was measured as meeting the criteria for major depression and when alcohol consumption was measured as quantity per occasion or heavy episodic drinking. There was some evidence of a J-shaped relationship, that is, greater depression among abstainers compared with those who usually drank 1 drink and never drank as much as 5 drinks for both former drinkers and lifetime abstainers when depression was measured as recent symptoms of depression but the J shape was found only for former drinkers when depression was measured as meeting the criteria for major depression and did not reach statistical significance in some analyses. CONCLUSIONS: The results of the present study suggest that measurement and gender are key issues in interpreting findings on the relationship between alcohol and depression. First, depression is primarily related to drinking larger quantities per occasion, less related to volume, and unrelated to drinking frequency, and this effect is stronger for women than for men. Second, the overall relationship between depression and alcohol consumption is stronger for women than for men only when depression is measured as meeting a clinical diagnosis of major depression and not when measured as recent depressed affect. Finally, while there was some evidence that former drinkers had slightly higher rates of major depression and higher scores on recent depressed affect compared with light drinkers, there was no evidence that light drinking was protective for major depression when compared with lifetime abstainers, although light drinkers did report fewer recent symptoms of depressed affect.     

Effects of Assessment Frequency on Subjective Intoxication Ratings After Alcohol Consumption

BACKGROUND: It is common for subjective intoxication measures to be administered frequently throughout an experimental session. It is unclear, however, whether repeated assessments affect the experience of intoxication. This study examined the effect of assessing subjective intoxication levels during alcohol consumption on subsequent perceptions of intoxication after drinking. METHODS: Forty-two participants consumed a moderate dose of alcohol (men, 82 g/kg; women, 0.74 g/kg) during a 30-min period. Participants either reported or did not report subjective intoxication levels at 10-min intervals during the drinking period. After the drink, all participants rated their level of subjective intoxication on several occasions. RESULTS: Individuals who reported their intoxication during the drinking period reported higher levels after consumption than did those who did not rate their intoxication during drinking. CONCLUSIONS: These data suggest the potential for reactivity effects when conducting repeated assessments of perceived subjective intoxication.     

Changes in volume of drinking after changes in alcohol taxes and travellers' allowances: results from a panel study

AIMS: The aim of this paper is to study short-term changes in alcohol consumption by subgroups of the population in Denmark, Finland and southern Sweden following large-scale decreases in alcohol taxation in Denmark and Finland and large increases in travellers' allowances in Finland and Sweden. DESIGN: General population random samples surveyed before and after the changes, using northern Sweden as a control site. SETTING: Denmark, Finland, southern Sweden and northern Sweden. PARTICIPANTS: Respondents aged 16-69 years. MEASUREMENTS: Volume of drinking is the main measure reported. Changes are examined by gender, age, income and year 2003 consumption level. RESULTS: Consumption decreased or remained the same among women and men in all three study sites. Relative changes were similar across subgroups of age, gender and income in all countries. In absolute terms, there was a consistent differential change by age in Denmark, Finland and Southern Sweden, with the higher level of the young and lower level of the old converging. Women's and men's consumption converged in Finland and southern Sweden. The changes did not differ systematically by income. Changes were not larger among heavier drinkers. CONCLUSIONS: The results did not confirm expectations: an increase in consumption larger than that in the control site could not be shown in any of the countries or subgroups of the population. If there has been an effect -- as shown in aggregate data in Finland -- it seems to have been stronger among the old than the young and, in Finland and southern Sweden, among women rather than men.     

A social exclusion perspective on loneliness in older adults in the Nordic countries

Several factors associated with loneliness are also considered indicators of social exclusion. While loneliness has been proposed as an outcome of social exclusion, there is limited empirical evidence of a link. This study examines the associations between social exclusion indicators and loneliness in older adults (60+ years) in four Nordic countries. Data from four waves of the European Social Survey were pooled, providing a total of 7755 respondents (Denmark n = 1647; Finland n = 2501, Norway n = 1540; Sweden n = 2067). Measures of loneliness, demographic characteristics, health, and eight indicators of social exclusion were selected from the survey for analysis. Country-specific and total sample hierarchical logistic regression models of loneliness were developed. Significant model improvement occurred for all models after social exclusion indicators were added to models containing only demographic and health variables. Country models explained between 15.1 (Finland) and 21.5% (Sweden) of the variance in loneliness. Lower frequency of social contacts and living alone compared to in a two-person household was associated with a higher probability of loneliness in all countries, while other indicators were associated with loneliness in specific countries: lower neighbourhood safety (Sweden and Denmark); income concern (Sweden and Finland); and no emotional support (Denmark, Finland, and Sweden). A robust relationship was apparent between indicators of social exclusion and loneliness with the direction of associations being highly consistent across countries, even if their strength and statistical significance varied. Social exclusion has considerable potential for understanding and addressing risk factors for loneliness.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10433-022-00692-4.     

Variations in pediatric asthma hospitalization rates and costs between and within Nordic countries

BACKGROUND: We assessed variations in hospitalization parameters and costs among asthmatic children in four Nordic countries by geographic location and age groups. METHODS: Cross-sectional, county-level aggregate data on asthma-related hospitalizations in 1999, obtained from public national databases for children < 15 years old from Denmark, Sweden, Norway, and Finland, together with country-specific asthma management cost were used to estimate the incidence of first hospital admission (per 1,000), length of hospital stay (LOS), and hospitalization cost. Longitudinal patient-specific data from 1998/1999 were used to calculate the relative hazard of readmission (RHR) using a multivariate Cox proportional hazards model. RESULTS: Nordic incidence of first hospital admission in 1999 was 2.17 per 1,000 children, readmission was noted in 16% of the patients, mean LOS was 2.64 days, and total hospitalization cost was almost 14 million dollars. Hospitalization incidence, RHR, and costs were significantly higher in children < 5 years old compared with school children 6 to 14 years old. Hospital LOS, incidence of first hospital admission, and cost per child were the highest in Denmark, though RHR did not differ significantly from Sweden. CONCLUSIONS: Large variations in all parameters were observed between and within countries. Given the similarities among the four countries studied, these results may, among other reasons, indicate different efficiencies of the various asthma management plans between and within them. The presented measures of hospitalization patterns could prove to be valuable quality-of-care measures to guide further improvements in asthma management.     

Helping the female partners of men abusing alcohol: a comparison of three treatments

Aim . To evaluate the effectiveness of three approaches to assisting the female partners of male problem drinkers with the stress imposed by the male's drinking.
Design . Participants were assigned randomly via random number tables to one of three treatment conditions: supportive counselling, stress management or alcohol-focused couples therapy.
Setting . The intervention took place at the Behaviour Research and Therapy Centre (BRTC), The University of Queensland. This research and training centre offers outpatient psychology services to the community.
Participants . Sixty-one married women whose husbands drank heavily. Participants reported protracted alcohol problems, severe impact of alcohol on social functioning and severe marital distress.
Measurement . The women's stress, alcohol consumption by the male, and relationship functioning were assessed at pre- and post-treatment and at 6-month follow-up.
Interventions . All three treatments involved 15 1-hour sessions with the woman. In the alcohol-focused couple therapy, attempts were made to engage the man in these sessions.
Results . Contrary to our predictions, there were few differences between the treatments. All three treatments were associated with reductions in the women's reported stress, with trends for somewhat greater reduction in the women's stress in the stress management and alcohol-focused couples therapy conditions than for supportive counselling. None of the treatments produced clinically significant reductions in men's drinking or relationship distress.
Conclusion . The treatments ease stresses and burden but do not improve drinking or relationships. Limited power in the design restricted the capacity to detect differential treatment effects.