Artikkel som viser at samisktalende er mindre fornøyd med legetjenester. ; OBJECTIVES: the government's Action Plan for Health and Social Services states as a goal that the Sami population's encounter with health and social services should be just as good as what the rest of the population experiences. The goal of this study is to investigate patient satisfaction with the municipal GP service in areas with both a Sami and Norwegian population. STUDY DESIGN: a cross-sectional population study using questionnaires. METHODS: the data were taken from the population based study of health and living conditions in areas with both Sami and Norwegian populations (SAMINOR) in which respondents were asked about their satisfaction with GP services in their municipalities. This population survey was carried out in the period 2002-2004. The analyses include 15,612 men and women aged 36-79. RESULTS: the Sami-speaking patients were less satisfied with the municipal GP service as a whole than were the Norwegian speakers; RR 2.4 (95% CI 2.1-2.7). They were less satisfied with the physicians' language skills; RR 5.8 (95% CI 4.8-7.0); and they felt that misunderstandings between physician and patient due to language problems were more frequent; RR 3.8 (95% CI 3.3-4.3). One-third expressed that they did not wish to use an interpreter. CONCLUSIONS: the results indicate that it is necessary to place greater emphasis on the physicians' language competency when hiring GPs in municipalities within the Administrative Area for the Sami Language. This could improve satisfaction with the physicians' services.
Background: This is a population-based study that explores and describes a set of personal values in indigenous Sami and non-Sami adults in Norway. Norway ratified the ILO convention no. 169 concerning indigenous and tribal peoples in independent countries in 1990. In accordance with the convention the integrity of the indigenous culture and values shall be respected. Our aim is to describe and explore value patterns among Sami and Norwegian populations. Method: Cross-sectional questionnaire. From 24 local authorities, a total of 12,623 subjects between the ages of 36 and 79 were included in the analysis. The survey instrument consisted of a 19-item questionnaire of personal values and the analysis was based on responses from 10,268 ethnic Norwegian (just 6 questions were asked to them) and 2,355 Sami participants (1,531 Sami and 824 mixed Sami/ethnic Norwegian participants). Results: From the 19 values, Sami respondents held the following five personal values in the highest regard: being in touch with nature; harnessing nature through fishing, hunting and berry-picking; preserving ancestral and family traditions; preserving traditional Sami industries and preserving and developing the Sami language. On the other hand, Sami respondents' least important values included modern Sami art and the Sami Parliament (Sametinget). The ethnic Norwegians also held being in touch with nature as a very important value. Sami reported significantly higher scores for experience of ethnic discrimination and fear of losing their work/trade than ethnic Norwegians. The last 13 questions were just asked to Sami and mixed-Sami respondents. According to those questions four dimensions associated with personal values were identified among the indigenous Sami population: "Traditional Sami Values," "Modern Sami Values," "Contact with Nature" and "Feeling of Marginalisation." Traditional and modern Sami values were both characterised by significantly higher scores among females, the lowest age bracket and those who considered themselves Sami. Within the Traditional Sami Values dimension, higher scores were also recorded in participants who were married or cohabiting, living in majority Sami areas, satisfied with "way of life" and members of the Læstadian Church. The Modern Sami Values dimension showed higher scores among participants with high household incomes. The Contact with Nature dimension had significantly higher proportions of Sami, married or cohabitants, and participants content with their way of life; age, geographical area and household income were found to be insignificant variables within this dimension. Feeling of Marginalisation was characterised by significantly greater proportions of males, individuals of working age, residence in Norwegian-dominated areas, self-perceived Sami ethnicity, low household income, poorer self-reported health and dissatisfaction with way of life. Conclusion: Four distinct value patterns and relationships to well-being and self-reported health were identified in the indigenous Sami population. The four dimensions reflect important aspects of present-day Sami society.
Background: Several countries are discussing new legislation on the ban of smoking in public places, and on the acceptable levels of traffic-related air pollutants. It is therefore useful to estimate the burden of disease associated with indoor and outdoor air pollution. Methods: We have estimated exposure to Environmental Tobacco Smoke (ETS) and to air pollution in never smokers and ex-smokers in a large prospective study in 10 European countries (European Prospective Investigation into Cancer and Nutrition)(N = 520,000). We report estimates of the proportion of lung cancers attributable to ETS and air pollution in this population. Results: The proportion of lung cancers in never- and ex-smokers attributable to ETS was estimated as between 16 and 24%, mainly due to the contribution of work-related exposure. We have also estimated that 5–7% of lung cancers in European never smokers and ex-smokers are attributable to high levels of air pollution, as expressed by NO2 or proximity to heavy traffic roads. NO2 is the expression of a mixture of combustion (traffic-related) particles and gases, and is also related to power plants and waste incinerator emissions. Discussion: We have estimated risks of lung cancer attributable to ETS and traffic-related air pollution in a large prospective study in Europe. Information bias can be ruled out due to the prospective design, and we have thoroughly controlled for potential confounders, including restriction to never smokers and long-term ex-smokers. Concerning traffic-related air pollution, the thresholds for indicators of exposure we have used are rather strict, i.e. they correspond to the high levels of exposure that characterize mainly Southern European countries (levels of NO2 in Denmark and Sweden are closer to 10–20 ug/m3, whereas levels in Italy are around 30 or 40, or higher). Therefore, further reduction in exposure levels below 30 ug/m3 would correspond to additional lung cancer cases prevented, and our estimate of 5–7% is likely to be an underestimate. Overall, our prospective study draws attention to the need for strict legislation concerning the quality of air in Europe.
BACKGROUND: Life expectancy is increasing in Europe, yet a substantial proportion of adults still die prematurely before the age of 70 years. We sought to estimate the joint and relative contributions of tobacco smoking, hypertension, obesity, physical inactivity, alcohol and poor diet towards risk of premature death. METHODS: We analysed data from 264,906 European adults from the EPIC prospective cohort study, aged between 40 and 70 years at the time of recruitment. Flexible parametric survival models were used to model risk of death conditional on risk factors, and survival functions and attributable fractions (AF) for deaths prior to age 70 years were calculated based on the fitted models. RESULTS: We identified 11,930 deaths which occurred before the age of 70. The AF for premature mortality for smoking was 31 % (95 % confidence interval (CI), 31–32 %) and 14 % (95 % CI, 12–16 %) for poor diet. Important contributions were also observed for overweight and obesity measured by waist-hip ratio (10 %; 95 % CI, 8–12 %) and high blood pressure (9 %; 95 % CI, 7–11 %). AFs for physical inactivity and excessive alcohol intake were 7 % and 4 %, respectively. Collectively, the AF for all six risk factors was 57 % (95 % CI, 55–59 %), being 35 % (95 % CI, 32–37 %) among never smokers and 74 % (95 % CI, 73–75 %) among current smokers. CONCLUSIONS: While smoking remains the predominant risk factor for premature death in Europe, poor diet, overweight and obesity, hypertension, physical inactivity, and excessive alcohol consumption also contribute substantially. Any attempt to minimise premature deaths will ultimately require all six factors to be addressed. ; This work was supported by the French Social Affairs & Health Ministry, Department of Health (Direction Générale de la Santé). The work undertaken by David C Muller for this project was performed during the tenure of an IARC-Australia fellowship supported by Cancer Council Australia. Elio Riboli was supported by the Imperial College Biomedical Research Centre funded by the National Institute of Health Research of UK. The coordination of EPIC is financially supported by the European Commission (DG-SANCO) and the International Agency for Research on Cancer. The national cohorts are supported by Danish Cancer Society (Denmark); Ligue Contre le Cancer, Institut Gustave Roussy, Mutuelle Générale de l'Education Nationale, Institut National de la Santé et de la Recherche Médicale (INSERM) (France); Deutsche Krebshilfe, Deutsches Krebsforschungszentrum and Federal Ministry of Education and Research (Germany); the Hellenic Health Foundation (Greece); Associazione Italiana per la Ricerca sul Cancro-AIRC-Italy and National Research Council (Italy); Dutch Ministry of Public Health, Welfare and Sports (VWS), Netherlands Cancer Registry (NKR), LK Research Funds, Dutch Prevention Funds, Dutch ZON (Zorg Onderzoek Nederland), World Cancer Research Fund (WCRF), Statistics Netherlands (The Netherlands); Nordic Centre of Excellence programme on Food, Nutrition and Health. (Norway); Health Research Fund (FIS), PI13/00061 to Granada, Regional Governments of Andalucía, Asturias, Basque Country, Murcia (no. 6236) and Navarra, ISCIII RETIC (RD06/0020) (Spain); Swedish Cancer Society, Swedish Scientific Council and County Councils of Skåne and Västerbotten (Sweden); Cancer Research UK (14136 to EPIC-Norfolk; C570/A16491 to EPIC-Oxford), Medical Research Council (1000143 to EPIC-Norfolk) (United Kingdom).
