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PubMed1999

The usage of veterinary antibacterial drugs for mastitis in cattle in Norway and Sweden during 1990-1997.

The prescribing patterns and annual incidence of use of antibacterial drugs for the treatment of mastitis in cattle in Norway and Sweden during the period 1990-1997 were estimated from drug wholesaler statistics. Although the drugs included in this study are also used in other species and/or other indications, mastitis in cattle is by far the most-common indication for their use. We used these sales figures to evaluate trends in the use of antibacterial drugs and changes in the incidence of treatment in bovine mastitis in Norway and Sweden. To facilitate comparisons (correcting for differences in activity and dosage) between the relative proportions of antibacterial drugs used in bovine mastitis, we introduced defined daily dose cow (DDDcow) as unit of measurement. Tentative DDDcow for the various injectable drugs were derived from doses recommended in Norway and Sweden. For intramammary drugs administered in the form of single-dose applicators, one applicator was defined as the DDDcow. The prescribing patterns of antibacterial drugs in bovine mastitis in Norway and Sweden during the study period seemed to be influenced by treatment policies, substances and formulations approved and treatment cost; length of the withdrawal period also seemed to play a role.

Animals↗
PubMed1997

Waiting for coronary revascularization: a comparison between New York State, The Netherlands and Sweden.

OBJECTIVE: To compare waiting times for percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass graft (CABG) surgery in New York State, the Netherlands and Sweden and to determine whether queuing adversely affects patients' health. METHODS: We reviewed the medical records of 4487 chronic stable angina patients who underwent PTCA or CABG in one of 15 New York State hospitals (n = 1021) or were referred for PTCA or CABG to one of ten hospitals in the Netherlands (n = 1980) or to one of seven hospitals in Sweden (n = 1486). We measured the median waiting time between coronary angiography and PTCA or CABG. RESULTS: The median waiting time for PTCA in New York was 13 days compared with 35 and 42 days, respectively, in the Netherlands and Sweden (P < 0.001). For CABG, New York patients waited 17 days, while Dutch and Swedish patients waited 72 and 59 days, respectively (P < 0.001). The Swedish and Dutch waiting list mortality rate was 0.8% for CABG candidates and 0.15% for PTCA candidates. CONCLUSIONS: There were large variations in waiting time for coronary revascularization among these three sites. Patients waiting for CABG were at greatest risk of experiencing an adverse event. In both the Netherlands and Sweden, the capacity to perform coronary revascularization has been expanded since this study began. Further international cooperation may identify other areas where quality of care can be improved.

Angina Pectoris↗
PubMed1999

Pharmaceutical expenditure in Sweden.

Recently, the responsibility for prescribed pharmaceuticals in Sweden was transferred from national level to the regional health authorities (county councils). The purpose was that a closer integration and balance between pharmaceuticals and other factors of production in health care should produce better opportunities for a cost-effective use of the total health care resources. The purpose of this paper is to present a deeper analysis of pharmaceuticals as a production factor in Sweden, mainly during the 1990s, and to discuss the future development and future policy decisions in Sweden. Pharmaceuticals have increased their share of total health care expenditure in Sweden, from about 9% in 1990 to about 14% in 1995. The Swedish pharmaceutical market can be divided into sub-markets, where the prescription sub-market accounts for the greater part of pharmaceutical expenditure. Further, a few disease categories account for a larger fraction of the cost of prescribed pharmaceuticals. The importance of pharmaceuticals as a production factor also differs between different age groups. Several factors are expected to contribute to a future increase in Swedish pharmaceutical expenditure, for instance an ageing population and the rapid introduction of expensive new pharmaceuticals.

Age Distribution↗
PubMed2001

The otter (Lutra lutra) in Sweden--population trends in relation to sigma DDT and total PCB concentrations during 1968-99.

Polychlorinated biphenyl (PCB) has been suggested as the major cause of the European otter (Lutra lutra) population decline. This study investigates temporal and geographical changes in otter numbers as well as total PCB and sigma DDT concentrations in otters and their food in different parts of Sweden with various pollution impacts during three decades. In Sweden, rare species belong to the State and carcasses of such specimens are sent to the authorities. Two-hundred and eight specimens have been used to investigate temporal and spatial variation in the otter populations during 1968 and 1999. One-hundred and twenty-five of them have been chemically analysed. The population trends in northern Sweden coincide with the temporal trends of the contaminants. When concentrations of PCBs decrease in the environment, otter population increases. Neither aldrin/dieldrin nor mercury pollution seem to explain why the Swedish otter populations decreased dramatically during the 1960s-1980s. In southern Sweden total PCB concentrations are still high and the indications of improvement of the population are weak.

Animals↗
PubMed1997

Infant mortality in Denmark and Sweden. A comparison based on data in two national registries.

OBJECTIVES: To study in detail the differences in infant mortality between Denmark and Sweden. STUDY DESIGN: Data retrieved from national health registers on infant death rates were compared for 1980-1988, supplemented with a study on the impact of socio-economic conditions in 1985-86 (Denmark) or 1986 (Sweden). RESULTS: Even after stratification for maternal age, parity, and socio-economic group, the Danish mortality rate was higher in all age-at-death intervals except for stillbirths. Maternal age-parity distribution was more favourable in Denmark, the socio-economic distribution in Sweden. The most marked country differences was seen in young women. The difference in the rate of perinatal deaths but not of later deaths is explainable by a more favourable birth weight distribution in Sweden than in Denmark. CONCLUSIONS: The studied variables do not explain the difference in mortality risk but it may be due to life style factors so far not identified.

Birth Weight↗
PubMed2001

Apheresis registry in Sweden: scope, techniques and indications for treatment. A report from the Swedish apheresis study group.

Registries of therapeutic apheresis can be used to evaluate changes in technology, clinical indications and applications over the years. This study reports data collected prospectively and voluntarily in Sweden during 1993-1999. A total number of 40 apheresis units have been performing therapeutic apheresis procedures: 16 blood centers, 20 dialysis units, two intensive care units, one hematology ward and one hemotherapy unit. The registry includes a median of 92%) of the centers for therapeutic apheresis in Sweden during the years and in 1999 there were 31 active units in 26 hospitals. The total numbers of procedures per year have remained fairly stable corresponding to a median of 46 treatments/ 100,000 inhabitants, and in 1999 4084 procedures were performed. The number of plasma exchanges has decreased, but LDL-apheresis and immunoadsorption procedures have increased over the years. 70% of the patients have been referred for 12 indications. A significant decline was found for patients with SLE and Guillain Barres syndrome. The use of extracorporeal photo-chemotherapy has increased over the years, and 3 indications include >75$ of the patients. There has been an adaptation to the experience learned by different studies. The number of collections of hematopoietic progenitor cells is about 9/100,000 inhabitants, and in 1999 821 collections were performed. The use of allogeneic donors is increasing. The extent of therapeutic apheresis in Sweden was compared to other countries on the basis of published data. In Sweden, the extent of therapy is two- to three-fold to that for Canada and France.

Blood Component Removal↗
PubMed2002

Cancer risks in Nordic immigrants and their offspring in Sweden.

Numerous migrant studies on cancer have been carried out, but little data are available on cancer incidence upon inter-European migration. We used the nationwide Swedish Family-Cancer Database to analyse cancer risk among Nordic immigrants and their offspring in Sweden. The parental population had entered Sweden in their 20s and they had become parents in Sweden. Finns were the largest immigrant group including approximately 183,000 parents and 278,000 offspring. We calculated the standardised incidence ratios (SIRs) and 90 or 95% confidence intervals (CIs) for 26 cancer sites using native Swedes as a reference. Cancers in the first generation immigrants followed the rates in the countries of origin, reaching high SIRs for tobacco-related, cervical and testicular cancer among Danes and for stomach cancer among Finns. Only a few cancers, such as cervical cancer was increased in the second generation. At many sites, particularly among the Finns, protection was observed in the first generation. At three sites, breast, ovary and urinary bladder, where plausible evidence for protection was found even among offspring, this was not reinforced among the offspring of compatriot parents, which is inconsistent with heritable effects. Protection against melanoma was strongest among the offspring of compatriots, but the contribution of cultural factors cannot be excluded. As the parents immigrated to Sweden in their 20s, their cancer pattern, including habits and life style, appeared to be set before that age because the differences to Swedes persisted even in cancers that predominate in old age. Immigrant populations would appear to be attractive subjects to study etiological factors of cancer at sites where causes remain poorly understood, such as testicular cancer.

Denmark↗
PubMed2002

Lifestyle-related characteristics of young low-meat consumers and omnivores in Sweden and Norway.

PURPOSE: To compare the lifestyle-related characteristics of low-meat consumer and omnivore adolescents in Sweden and Norway. METHODS: A total of 2041 students (578 from Umeå, Sweden; 504 from Stockholm, Sweden; and 959 from Bergen, Norway), with a mean age of 15.5 years, completed a questionnaire. Information was collected about physical characteristics, and health, family situation, social, exercise, alcohol, and tobacco habits. The response rate was 95% in Umeå, 91% in Stockholm, and 83% in Bergen. Statistical analyses included Chi-square and Mann-Whitney U tests. RESULTS: There was no reported difference between low-meat consumers and omnivores with respect to alcohol use, smoking, weight, or amount of exercise. Female low-meat consumers more frequently used smokeless tobacco, reported having more sick days during the last year, attached less importance to "being healthy," and had been depressed more often than female omnivores. Male low-meat consumers reported, to a greater extent than male omnivores, having been tired without reason, having often had headaches and having been depressed. Female low-meat consumers had parents with a higher average level of education than did female omnivores and more often spent time with friends after school. CONCLUSIONS: Vegetarianism or low-meat consumption is mainly a female phenomenon among adolescents in this study. The study indicates that the lifestyle of young low-meat consumers differs from the lifestyle found in previous studies of vegetarians with respect to the respondents' exercise habits, their perception of their own health, and their use of alcohol and tobacco. Contrary to findings from other studies, adherence to a low-meat diet may not correlate with other health promotion practices among adolescents in Sweden and Norway.

Adolescent↗
PubMed2001

Epidemiology of heart failure in Sweden--a national survey.

BACKGROUND: In Sweden heart failure is the most frequent discharge diagnosis within internal medicine. The prevalence of heart failure seems to be increasing, mainly due to an ageing population, but also because of improved survival in patients with cardiovascular diseases. AIM: To describe the epidemiology of heart failure in Sweden from a perspective based on demographic and health care data. METHODS: The national registers in Sweden provide detailed information on health care consumption in relation to different diagnoses. Pharmaceutical sales are also registered. There are national epidemiological reports, reports on health care utilization and on health economics concerning heart failure patients. RESULTS: There has been structural changes in the Swedish health care system due to financial restraints in the health care budget. Aiming at reducing hospital costs, the total amount of hospital beds has been cut down markedly during the last decade. The number of heart failure patients and the number of hospital stays have increased during the same period. Hospital stays have become shorter. The number of patients and hospital stays more than double when heart failure as both primary and secondary discharge diagnoses are included. CONCLUSION: The available national registers provide a good opportunity to study epidemiology of heart failure in Sweden. The number of hospital beds has decreased markedly within the last decade due to changes in the Swedish health care system. Nevertheless, there has been an increase in the number of patients discharged with heart failure from the hospitals, suggesting an increase in prevalence.

Ambulatory Care Facilities↗
PubMed2002

Acute intermittent porphyria in Sweden. Molecular, functional and clinical consequences of some new mutations found in the porphobilinogen deaminase gene.

Acute intermittent porphyria (AIP) is an autosomal dominant disorder caused by a partial deficit of porphobilinogen deaminase (PBGD), the third of eight enzymes in the haem biosynthetic pathway. The overt disease is characterized by neuropsychiatric symptoms that are often triggered by exogenous factors such as certain drugs, stress, and alcohol. The aim of this work has been to identify the underlying genetic defect in each AIP-affected family in order to provide early counselling to assist in the avoidance of precipitating factors. The prevalence of AIP in Sweden is in the order of 1:10 000. The major mutation in Sweden, W198X, is due to a founder effect in the northern part of the country. This mutation, together with a further 11 mutations, have been reported previously. The present communication encompasses the great majority of AIP kindreds in Sweden and includes a further 27 mutations within the PBGD gene. This includes 14 completely new mutations, as well as 11 known mutations detected for the first time in Sweden. The majority of the mutations are located in exons 10 and 12 with fewer in exon 7. The clinical and biochemical outcomes in some patients are described. We also use the three-dimensional structure of the porphobilinogen deaminase enzyme to predict the possible molecular and functional consequences of the new Swedish missense and nonsense mutations.

Codon, Nonsense↗
PubMed2001

Age-related utilisation of cataract surgery in Sweden during 1992-1999. A retrospective study of cataract surgery rate in one-year age groups based on the Swedish National Cataract Register.

PURPOSE: To study the utilisation and increase of first eye cataract surgery in one-year age groups between 60 and 90 years of age during 1992-1999. METHODS: Data was extracted from the National Swedish Cataract Register (NCR) that covers about 93.2% of all cataract extractions performed in Sweden during 1992-1999. The total number of living persons in each one-year age group was collected from the Year Book of Statistics in Sweden (1993-2000). RESULTS: The number of cataract extractions in Sweden increased by 54.8% from 1992 to 1999. The rates of first eye cataract surgery in one-year age groups between 60 and 90 years of age were different for females and males and this difference did not change during a 37% increase of the surgery volume from 1992 to 1999. The rate of first eye cataract surgery increased significantly both for females (+29.4%) and males (+27.2%) during 1992 to 1999 in Sweden. CONCLUSION: The rate of first eye cataract surgery increased significantly from 1992 to 1999 but the gender difference in age-related utilisation of surgery remained unchanged. The increase in rate was about the same in all age groups.

Age Distribution↗
PubMed2003

Pediatric spinal cord injury in Sweden: incidence, etiology and outcome.

STUDY DESIGN: Retrospective descriptive study. OBJECTIVES: To assess incidence, causes and early outcome of traumatic spinal cord injury (SCI) among children in Sweden, thereby identifying high-risk groups and situations as a basis for preventative measures and improved care. METHODS: Data from population registers, County Habilitation Centers as well as from informal sources were used to estimate the incidence of SCI in Sweden during the years 1985-1996 among children aged 0-15 years. Contacts with the treating hospitals, reviews of medical records and/or personal interviews were used to verify primary data. In total, 92 children were thus identified. RESULTS: The incidence was found to be 4.6/million children/year (95% CI 3.6-5.5). When excluding prehospital fatalities, the incidence was 2.4 (95% CI 1.8-3.1). The main cause of injury among fatalities was traffic accidents. Associated injuries occurred in 41% of the children. Among survivors (10-15 years), sports-related injuries (43%) were as common a cause as traffic accidents (39%). The survivors were treated in 18 different hospitals. CONCLUSION: Pediatric SCI in Sweden is rare, presumably because of effective primary prevention. Preventative measures should be further differentiated for each age group of children in accordance with their differing risk profiles. In contrast to the effective preventative measures that have been implemented in Sweden, care of these patients is still too fractionated and decentralized for sufficient specialization to emerge.

Accidents↗
PubMed2003

Higher prevalence of Chlamydia pneumoniae seropositivity in Finnish twins compared with co-twins living in Sweden: relationships with markers of subclinical atherosclerosis.

Mortality rates from coronary heart disease are lower in Swedish men and among Finnish migrants who have lived in Sweden for over 20 years than in men living in Finland. Sero-epidemiological studies, investigations of atheromatous plaque specimens, in vitro animal models and anti-chlamydial antibiotic trials have given support to the hypothesis that Chlamydia pneumoniae (Cpn) has a role in atherosclerosis. We investigated whether men with a similar genetic background but living permanently in Finland or Sweden have differences in the prevalence of Cpn seropositivity, and whether chronic Cpn infection is associated with markers of subclinical atherosclerosis. We measured anti-Cpn antibodies and ultrasonographic markers of subclinical atherosclerosis, including carotid intima-media thickness, carotid artery compliance and brachial artery flow-mediated dilatation, in a population of 76 migrant-discordant male twin pairs (152 men). The number of men with seropositivity to Cpn infection (defined as IgA>/=1:64 and IgG>/=1:128) was greater in Finland than in Sweden (21.5% compared with 10.5%; P =0.046). Cpn seropositivity accompanied by elevated C-reactive protein (CRP) levels (>1 mg/l) was associated with attenuated brachial artery flow-mediated dilatation (3.3+/-0.3%, compared with 5.5+/-0.4% in men with no signs of Cpn infection; P <0.001).Thus, among Finnish twin brothers discordant for migration to Sweden, the prevalence of Cpn seropositivity is higher for those living in Finland, and men with Cpn seropositivity combined with elevated CRP levels had attenuated endothelial function. These findings offer insight into the mechanism whereby chronic Cpn infection may increase the risk of coronary heart disease.

Antibodies, Fungal↗
PubMed1999

Declining prevalence of angina pectoris in middle-aged men and women. A population-based study within the Northern Sweden MONICA Project. Multinational Monitoring of Trends and Cardiovascular Disease.

OBJECTIVES: To describe trends in the prevalence of angina pectoris in northern Sweden, between 1986 and 1994. DESIGN: Cross-sectional population studies. SETTING: Northern Sweden MONICA Project in Norrbotten and Västerbotten counties, Sweden. SUBJECTS: Randomly selected men and women in the age group 35-64 years, total of 2459 men and women. MAIN OUTCOME MEASURES: Comparison of the prevalence of angina pectoris in 1986 and 1994 as measured by the Rose questionnaire. RESULTS: The proportion with a history of myocardial infarction decreased amongst the participants from 4.6% to 2.0% (P < 0.001) between 1986 and 1994. The prevalence of angina pectoris in men was essentially unchanged (3.4% in 1986 to 3.1% in 1994 (chi2 = 0.02; P = 0.87), whereas it declined significantly in women from 5. 9% to 2.8% (chi2 = 6.32; P = 0.01). In both men and women, the highest prevalence of Rose-positive persons was found in the oldest age group. In 1986 the Rose-positive subgroup had a significantly higher proportion with high cholesterol (>/=6.5 mmol L-1) as compared with the Rose-negative subgroup, 64% vs. 48% (chi2 = 5.04; P = 0.02). In both surveys high blood pressure was more common in the Rose-positive group (1986: chi2 = 13.2; P < 0.001 and 1994: chi2 = 9.8; P = 0.002). CONCLUSIONS: In women, but not in men, the prevalence of angina pectoris decreased significantly between 1986 and 1994. During the same time period the proportion of people with high cholesterol decreased in northern Sweden. In both surveys, individuals with angina pectoris had more frequent hypertension.

Adult↗
PubMed2002

Impact of smokeless tobacco use on smoking in northern Sweden.

BACKGROUND AND OBJECTIVES: For many years Swedish men have had the world's lowest rates of smoking and smoking-related mortality. Despite these facts, a thorough analysis of tobacco use patterns in Sweden has not been performed. The purpose of this study was to examine the prevalence and interaction of cigarette smoking and use of Swedish moist snuff (snus) in the population of northern Sweden. DESIGN: The study cohort of 2998 men and 3092 women aged 25-64 was derived from the northern Sweden MONICA study, consisting of population-based surveys in 1986, 1990, 1994 and 1999. Detailed information on tobacco use was used to develop prevalence data, and the prevalence ratio was used to compare rates amongst various subgroups. RESULTS: Amongst men ever-tobacco use was stable in all survey years at about 65%, but the prevalence of smoking declined from 23% in 1986 to 14% in 1999, whilst snus use increased from 22% to 30%. In women the prevalence of smoking was more stable in the first three surveys (approximately 27%) but was 22% in 1999, when snus use was 6%. In all years men showed higher prevalence of ex-smoking than women. A dominant factor was a history of snus (PR = 6.18, CI = 4.96-7.70), which was more prevalent at younger ages. CONCLUSIONS: The recent transition from smoking to snus use amongst men, and incipiently amongst women, in northern Sweden is remarkable and relevant to the global discussion on strategies to reduce smoking.

Adult↗
PubMed1997

Infant mortality in Norway and Sweden 1975-88: a cause-specific analysis of an increasing difference.

In a previous article, a high infant mortality was reported in the 1980s in Norway compared with Sweden. The aim of the present study was to assess secular trends in this difference, and to clarify whether the difference was confined to particular causes of death. Mortality rates, ratios of mortality rates and numbers of excess deaths were calculated on the basis of birth records comprising all livebirths in Norway and Sweden during the two periods 1975-79 and 1985-88. From the first to the second period, the infant mortality ratio for Norway to Sweden increased from 1.22 to 1.45 for single births, and from 1.23 to 1.54 for twin births. Increasing mortality ratios were observed for all ages at death. These were lowest in the early neonatal period (1.09 and 1.20 respectively) and highest in the postneonatal period (1.53 and 1.78 respectively). Within each cause of death category, the mortality rate in Norway was equal to or higher than the rate in Sweden. The highest mortality rate ratios were observed for sudden infant death syndrome (SIDS), 2.44 and 2.46 respectively, for the two time periods. SIDS was also the single cause of death that gave the largest contribution to the Norwegian excess mortality (45% and 53% overall, 65% and 78% for postneonatal deaths, and 65% and 79% for birthweights above 2500 g). In the second period, the excess SIDS mortality in Norway pertained mainly to infants of young mothers, infants of birth order two or more and twin births. An adverse trend for infants of young mothers in Norway was also observed in non-SIDS deaths. This suggests that in Norway, preventive health care should be improved, particularly for young mothers and their infants.

Birth Order↗
PubMed2001

Incontinence aids in Sweden: users and costs.

OBJECTIVE: To study age- and sex-specific use and costs of incontinence aids distributed free of charge in Sweden. SUBJECTS AND METHODS: The study was conducted in the county of Jämtland, Sweden (132,000 inhabitants). The use and cost of incontinence aids for people living in their homes and the total cost of incontinence aids for residents of special accommodation (e.g. nursing homes, homes for the elderly and sheltered housing) was obtained from a central database constructed for the purpose. Individual usage of incontinence aids by those in special accommodation was studied in two districts of Jämtland, representing 18% of the population. RESULTS: Free incontinence products were used by 6.4% of all women and 2.4% of all men in the county. There was a sharp increase in usage from the age of 75 years. Of the users, 21% lived in special accommodation. If the data from Jämtland are extrapolated nationally, then 274,000 women and 93,000 men in Sweden (total population 8.8 million) are using free incontinence products. The total cost of incontinence aids for Jämtland during 1999 was 15.4 million Swedish krona (SK), and those in special accommodation accounted for 46% of these costs. This corresponds to an estimated total cost in Sweden of approximately 925 million SK. Although 75% of the users were women, women only contributed 61% of the total costs. The mean annual cost of incontinence aids for an incontinent man was twice that of an incontinent woman. More than half of the costs were attributable to those aged >or=80 years. CONCLUSIONS: The estimated national costs of free incontinence aids accounts for 0.5% of the total costs of Swedish healthcare, including the care and nursing of older and disabled people, and for 0.05% of the gross national product.

Adolescent↗
PubMed1996

Bladder exstrophy in Sweden--a long-term follow-up study.

A retrospective review of all new cases of bladder exstrophy in Sweden in 1970 through 1989 is presented. The aim was to evaluate management of the malformation in Sweden and possibly identify factors that might improve the outlook. The incidence was 1:33,500 births. Records were reviewed of the 61 children (37 males and 24 females) treated at Sweden's four specialist centers of pediatric surgery. There was one perinatal death. Primary management was mainly early bladder closure (within 72 hours), late closure or perinatal urinary diversion. Subsequent measures included augmentation cystoplasty, bladder neck reconstruction, provision of continent urinary reservoir and penile reconstruction. The follow-up time was 4-19 years. In 15 cases renal scarring developed, though with impairment of total function in only three. Ten patients achieved continence, defined as 3-hour dry intervals, of whom four had urinary reservoirs with continent stoma. Urinary tract infections were recorded during follow-up in 43% of the surviving patients, though the true incidence of infection presumably was higher. To improve management of bladder exstrophy in sparsely populated Sweden, a nation-wide strategy of ongoing interhospital collaboration has been adopted. Results will be continuously presented.

Adolescent↗