Gender differences in health care use among the elderly population in areas of Norway and Finland. A cross-sectional analysis based on the HUNT study and the FINRISK Senior Survey

BACKGROUND: The aim of the study was to examine gender differences in the self-reported use of health care services by the elderly in rural and metropolitan areas of two Nordic countries with slightly different health care systems: Finland and Norway. METHODS: Population based, cross-sectional surveys conducted in Nord-Tröndelag Norway (1995–97) and in rural and metropolitan areas of Finland (1997) were employed. In the Norwegian data, a total of 7,919 individuals, aged 65–74 years old were included, and the Finnish data included 1,500 individuals. The outcome variables comprised whether participants had visited a general practitioner or a specialist, or had received hospital care or physiotherapy during the past 12 months. Gender differences in the use of health care services were analysed by multiple logistic regression, controlling for health status and socio-demographic characteristics. RESULTS: In Norway, elderly women visited a specialist or were hospitalised less often than men. In Finland, elderly women used all health care services except hospital care more often than men. In Norway, less frequent use of specialist care by women was not associated with self-reported health or chronic diseases. CONCLUSION: The findings revealed differences in self-reported use of secondary care among different genders in areas of Norway and Finland

Ten-year trends in benzodiazepine use in the Dutch population

Background In the past decades knowledge on adequate treatment of affective disorders and awareness of the negative consequences of long-term benzodiazepine use increased. Therefore, a decrease in benzodiazepine use is expected, particularly in prolonged use. The aim of this study was to assess time trends in benzodiazepine use. Methods and material Data from the Longitudinal Aging Study Amsterdam (LASA) were used to investigate trends in benzodiazepine use between 1992 and 2002 in two population-based samples aged 55-64 years. Differences between the two samples with respect to benzodiazepine use and to sociodemographic, physical health and mental health characteristics were described and tested with chi- square tests and logistic regression analyses. Results Benzodiazepine use remained stable over 10 years, with 7.8% in LASA-1 (n = 874) and 7.9% in LASA-2 (n = 919) (p = 0.90) with a persisting preponderance in women and in people with low education, low income, chronic physical diseases, functional limitations, cognitive impairment, depression, anxiety complaints, sleep problems and when using antidepressants. Long-term use remained high with 70% in 1992 and 80% in 2002 of total benzodiazepine use. Conclusion In the Dutch population aged 55-64, overall benzodiazepine use remained stable from 1992 to 2002, with a high proportion of long-term users, despite the effort to reduce benzodiazepine use and the renewal of the guidelines. More effort should be made to decrease prolonged benzodiazepine use in this middle-aged group, because of the increasing risks with ageing. © The Author(s) 2011

High prevalence of benzodiazepine dependence in out-patient users, based on the DSM-III-R and ICD-10 criteria.

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Smart design rules for smart grids: analysing local smart grid development through an empirico-legal institutional lens

Background This article entails an innovative approach to smart grid technology implementation, as it connects governance research with legal analysis. We apply the empirico-legal ‘ILTIAD framework’, which combines Elinor Ostrom’s Institutional Analysis and Development (IAD) framework with institutional legal theory (ILT), to an empirical case study of a local smart grid project. Methods Empirical data were collected in an exploratory, descriptive example study of a single case, focusing on the Action Situation and interactions towards establishing a local Smart Grid. The case was chosen because of its complexity, following the ‘logic of intensity sampling’. Data triangulation took place combining participatory observation, semi-structured interviews, and document analysis. Results Through an exploratory case study, we showed how the ILTIAD framework can help reduce complexity in local decision-making processes on smart grid implementation, as it allows for analytical description and prescriptive design of local smart grid systems. In the analysis we addressed ownership arrangements and contracts and identified barriers and opportunities for realizing a local smart grid system. The design part includes a scenario which revealed the prescribed patterns of behaviour (liberties and abilities) and the consequential aspects that apply to each situation. Conclusions Analysing and designing normative alignment ex ante to the planning and implementation of a smart grid system provides clarity to stakeholders about their current opportunities. For this reason, the ILTIAD framework can be used as a design guideline for establishing new and integrated smart grid projects