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PubMed2002

Validation and calibration of food-frequency questionnaire measurements in the Northern Sweden Health and Disease cohort.

OBJECTIVES: To evaluate the reproducibility of, and to compare and calibrate, diet measures by the Northern Sweden 84-item food-frequency questionnaire (FFQ) with measures from 24-hour diet recalls (24-HDR). DESIGN: Randomly selected respondents from the EPIC (diet-cancer) and MONICA (diet-cardiovascular disease) study cohort in Northern Sweden were invited to answer the FFQ twice over a one-year interval (FFQ1 and FFQ2), and to complete ten 24-hour recalls (reference method) in the months between. Plasma beta-carotene concentrations were determined from a subset of 47 participants. SETTING: Västerbotten and Norrbotten, Northern Sweden. PARTICIPANTS: Ninety-six men and 99 women, who completed the study. RESULTS: The reproducibility of the FFQ was high in terms of both mean energy and nutrient intakes and relative ranking of participants by intake levels (median Pearson correlation of 0.68). Moderately higher food intake frequencies were recorded by FFQ1 compared with 24-hour recalls for dairy products, bread/cereals, vegetables, fruits and potato/rice/pasta, whereas meat, fish, sweet snacks and alcoholic beverage intakes were lower. The median Spearman coefficient of correlation between FFQ1 and the average of ten 24-HDR measurements was 0.50. Daily energy and nutrient intakes were similar for FFQ1 and 24-HDR measurements, except for fibre, vitamin C, beta-carotene and retinol (FFQ1>24-HDR) and sucrose and cholesterol Pearson coefficients of correlation between FFQ1 and 24-HDR corrected for attenuation due to residual day-to-day variation in the 24-HDR measurements ranged from 0.36 to 0.79 (median 0.54). Adjustment for energy had only very moderate effects on the correlation estimates. Calibration coefficients estimated by linear regression of the 24-HDR on the FFQ1 measurements varied between 0.30 and 0.59 for all nutrients except alcohol, which had calibration coefficients close to 1.0. These low calibration coefficients indicate that relative risk estimates corresponding to an absolute difference in dietary intake levels measured by the FFQ will generally be biased towards 1.0. Plasma beta-carotene levels had a Pearson coefficient of correlation of 0.47 with the 24-HDR measurements, and of 0.23 with FFQ1 measurements. CONCLUSIONS: The Northern Sweden FFQ measurements have good reproducibility and an estimated level of validity similar to that of FFQ measurements in other prospective cohort studies. The results from this study will form the basis for the correction of attenuation and regression dilution biases in relative risk estimates, in future studies relating FFQ measurements to disease outcomes.

Adult↗

PubMed1999

Chronic hepatitis B in children in Gothenburg, Sweden.

Sweden is a low prevalence area for hepatitis B, but the number of chronic carriers has increased during the last decade due to immigration. Out of a total of 120 children with identified chronic hepatitis B in Gothenburg, Sweden, 93 were investigated during the 2-year period 1994-95. The children had a mean age of 10.9 years and originated from 21 different countries. Most infections were discovered during various screening programmes after arrival in Sweden. A total of 90 of the 93 children were HBV-DNA positive by Amplicor HBV Monitor (Roche Diagnostics) and 58% (54/93) were HBeAg positive. All children either originated from areas with a high or medium prevalence of HBV infection (81/93, 87%) or were born in Sweden to mothers originating from high or medium prevalence countries (12/93, 13%). Three of these 12 children were vertically infected in spite of adequate immunoprophylaxis and 8 were born to mothers with undiscovered chronic HBV infection. In all, 34 children had mothers who were HBsAg positive. No overt case of transmission was notified in day-care centres or schools, or from a child to a non-immune parent. None of the children reported any symptoms of liver disease, but 38% (35/93) had elevated aminotransferases. Therefore, screening programmes are essential to identify chronic HBV infection in children in order to prevent transmission and to find individuals at risk of progressive liver damage who should be considered for treatment.

Acute Disease↗

PubMed2005

The National Prostate Cancer Register in Sweden 1998-2002: trends in incidence, treatment and survival.

OBJECTIVES: To provide a descriptive review of the establishment of the National Prostate Cancer Register (NPCR) in Sweden, to present clinical characteristics at diagnosis and to calculate the relative survival of different risk groups after 5 years. MATERIAL AND METHODS: Since 1998, data on all newly diagnosed prostate cancers, including TNM classification, grade of malignancy, prostate-specific antigen (PSA) level and treatment, have been prospectively collected. For the 35,223 patients diagnosed between 1998 and 2002, relative survival in different risk groups has been calculated. RESULTS: Between 1998 and 2002, 96% of all prostate cancer cases diagnosed in Sweden were registered in the NPCR. The number of new cases increased from 6137 in 1998 to 7385 in 2002. The age-standardized rate rose in those aged < 70 years, while it was stable, or possibly declining from 1999, in the older age groups. The proportion of T1c tumours increased from 14% to 28% of all recorded cases. The age-adjusted incidence of advanced tumours (M1 or PSA > 100 ng/ml) decreased by 17%. The proportion of patients receiving curative treatment doubled. Patients with N1 or M1 disease or poorly differentiated tumours (G3 or Gleason score 8-10) had a markedly reduced relative 5-year survival rate. CONCLUSIONS: It is possible to establish a nationwide prostate cancer register including basic data for assessment of the disease in the whole of Sweden. The introduction of PSA screening has increased the detection of early prostate cancer in younger men and, to a lesser extent, decreased the incidence of advanced disease. The effect of these changes on mortality is obscure but the NPCR in Sweden will serve as an important tool in such evaluation.

Age Distribution↗

PubMed2003

The cost of treating pancreatic cancer--a cohort study based on patients' records from four hospitals in Sweden.

An estimate of the average cost of treatment (COT) was assessed for 53 patients with pancreatic cancer treated between 1997 and 1999 in four hospitals in southern Sweden. Average COT was estimated to Euro18 947, 55% of which was attributable to hospitalization (including surgical procedures), 20% to long-term care and 11% to chemotherapy. Diagnostics and radiotherapy accounted for 9% and 4%, respectively. Median survival was 5.6 months (mean 6.3 months). Treatment costs per patient were negatively correlated with age but were higher for patients receiving chemo/radiotherapy and surgical treatment than for patients receiving only standard supportive care. Disease stage and type of hospital (university versus regional/local hospitals) were not significant predictors of COT per se. Assuming that our estimate of the average cost is representative for Sweden, the total healthcare cost for pancreatic cancer was Euro16 million (dollar14 million), i.e about 2-3% of the COT for all cancer diseases in Sweden. In the USA the cost of pancreatic cancer accounted for the same proportion. However, our estimated cost per patient was about half the amount of the US estimate. The distribution of costs between the different types of treatment services did not differ greatly between Sweden and the USA.

Adult↗

PubMed2003

Radiotherapy and cancer care in Sweden.

A systematic assessment of radiotherapy for cancer was conducted by The Swedish Council on Technology Assessment in Health Care (SBU) in 2001. It included an overview of the organisation of radiotherapy and cancer care in Sweden and education of staff. It further included an update of cancer statistics for Sweden and an estimate of the need for radiotherapy resources by the year 2010. The following conclusions were drawn: Compared with a similar assessment in 1992, the number of departments of oncology at the county hospital level has increased by one, and one more department was scheduled to start radiotherapy during 2002. The speciality of oncology in Sweden includes all types of non-surgical cancer treatment, in contrast to the situation in most countries, where radiation oncology and medical oncology are independent specialities. Gynaecologic oncology is a unique speciality for Sweden. The number of new cancer cases increased by 13% between 1990 and 2000, and continues to increase by more than 1.0% per year. The projections of cancer incidence stated in the previous report were checked against observed data for the year 2000 and found to be an underestimation. To maintain the current capacity for radiotherapy in relation to number of new cancer cases by the year 2010, a total of 65 accelerators would be needed.

Cancer Care Facilities↗

PubMed2003

The Swedish Council on Technology Assessment in Health Care (SBU) systematic overview of radiotherapy for cancer including a prospective survey of radiotherapy practice in Sweden 2001--summary and conclusions.

A systematic assessment of radiotherapy for cancer was conducted by The Swedish Council on Technology Assessment in Health Care (SBU) and published in 1996. The assessment reviewed the scientific literature up to 1993 on the use of radiotherapy in the treatment of solid tumours, and estimated the costs associated with radiotherapy. It also described the current practise of radiotherapy in Sweden 1992 and compared practise with scientific knowledge. The SBU has now conducted a follow-up study on radiotherapy for cancer, including a review of the scientific literature from 1994 and a prospective survey of radiotherapy practise in Sweden 2001. The following conclusions were drawn: The role of radiotherapy as an important form of treatment for cancer with both curative and palliative intent has been further confirmed. The use of radiotherapy in Sweden has increased and is now at the internationally recommended level. Radiotherapy in Sweden is mostly given in accordance with the scientific evidence but may still be underutilized in certain situations. The resources for radiotherapy are being utilized more efficiently. The costs of radiotherapy are still 5% of the total cost of cancer care, while the cost of an individual treatment (fraction) has decreased. The need for radiotherapy capacity will increase. In addition, half of the treatment equipment will have to be replaced in the next few years.

Female↗

PubMed2004

Does stage at diagnosis explain the difference in survival after breast cancer in Denmark and Sweden?

Breast cancer survival differs 9 percentage points between the neighbouring countries of Denmark and Sweden. The authors' aim was to analyse whether this was caused by early detection in Sweden. The extent of disease and outcome was compared in two population-based breast cancer cohorts in 1983-1989. Breast cancer management was decentralized in Denmark without mammography screening whereas treatment in Sweden was centralized and the population partly screened. Ten- and 15-year relative survival was 15% and 6% higher in Sweden (p<0.001) with corresponding differences in crude and disease-specific survival. Stage distribution was significantly more favourable in the Swedish cohort. In multivariate analysis age, tumour size, extent of axillary surgery, and spread affected survival; however, the impact of region persisted (p<0.001). Reanalysis without screening-detected patients only slightly affected the impact of region. It was concluded that early detection had significant impact on survival but other regional differences might be of importance.

Adult↗

PubMed2006

Head circumference from birth to age 48 months for infants in Sweden.

AIM: To describe the development of head circumference, from birth to age 48 mo, of infants in Sweden. METHODS: Every infant born on the 15th of any month in the 1981 birth cohort, living in Sweden as of 31 December 1989, was studied from birth to age 48 mo (n=3158). By collecting data from child healthcare records and then analysing these data using piecewise linear regression, means and other statistics were produced for every age. Data were analysed for all and with exclusions for low birthweight and those born outside Sweden. RESULTS: From the sample of 3158, data for 3107 infants were collected, making the percentage of missing individuals 1.6%; thus, non-response bias is minimized and high national representativeness is achieved. Summary statistics for head circumference are presented. Comparisons are made to international reference materials, and to previous and current Swedish reference curves. CONCLUSION: For the first time in Sweden, and without selection bias, means and distribution of head circumference measurements are documented longitudinally for a nationally representative sample of infants.

Child, Preschool↗

PubMed2004

Traumatic experiences and dissociative symptoms among Swedish adolescents. A pilot study using Dis-Q-Sweden.

The aim of this study was to explore the occurrence of dissociative symptoms in relation to reported traumatic experiences among adolescents. A normative sample of 216 adolescents and a clinical sample of 30 cases with a history of traumatization were given the Swedish translation of Dissociation Questionnaire, DIS-Q. The results showed that 8.8% of the adolescents reported scores above the cut-off score of 2.5 on the Dis-Q-Sweden, with a female-male ratio of 2.6:1. In the normative sample, 53 (24.5%) of the adolescents reported one or more trauma experiences. The adolescents who self-reported trauma experiences in the normative sample scored higher on the total Dis-Q-Sweden scores and on three of the four subscales compared to the adolescents with no such experiences. The clinical group exhibited significantly higher Dis-Q-Sweden scores than the normative sample on every scale, with 60% above the cut-off score. The study confirms the results from earlier studies that adolescents with a history of trauma exhibit more dissociative symptoms in this study according to Dis-Q-Sweden. The impact of trauma qualities and background factors on the development of dissociative symptoms need to be studied further.

Adolescent↗

PubMed2004

The incidence and survival of acute de novo leukaemias in Estonia and in a well defined region of Western Sweden during 1982-1996: a survey of patients aged 16-64 years.

In the present work the incidence and survival of acute de novo leukaemias in two neighbouring countries, were studied retrospectively over three 5-year periods, 1982-1996. The aim was to compare the above variables, particularly with respect to political/socio-economic and environmental factors, in a well defined area of Sweden, the so-called Western Swedish Health Care Region, with Estonia. Population-wise the Western Swedish Region and Estonia are very similar; area-wise they are also well comparable. The present report covers only patients diagnosed between the ages of 16-64 years. The number of acute de novo leukaemias in the two regions was quite similar (Western Sweden n = 282 and Estonia n = 237). The age standardized incidence rate regarding total acute de novo leukaemias was slightly lower in Estonia than in Western Sweden (1.49/100,000 inhabitants/year for Estonia and 1.76 for Sweden, respectively), the difference being not statistically significant. However, the survival data for the two countries were highly different (P < 0.001). Thus, the relative survival for the total group of patients aged 16-64 years in Estonia at 1 year was 20.7% and at 5 years 3.6%, respectively. The corresponding figures for the Swedish patients were considerably higher, 65.2 and 29.4%, respectively. Further, the 5 year survival significantly (P < 0.05) increased for the Swedish patients over the 3 consecutive 5-year periods. No such improvement was recorded for the Estonian patients.

Acute Disease↗

PubMed2000

Management of minor head injuries in emergency departments in Sweden. Time for a new strategy?

OBJECTIVE: To study how patients with minor head injuries are currently managed. DESIGN: Questionnaire to senior residents in emergency departments and data from registers covering all in-hospital care in Sweden. SETTING: All 92 emergency departments in Sweden. RESULTS: The response rate to the questionnaire was 100%. In Sweden, 75 emergency departments treat patients with minor head injuries. Four departments are paediatric. General surgeons are the main providers (87%) of care for patients with minor head injuries. All hospitals admit patients with a history of unconsciousness or amnesia. Skull radiography is not used routinely. The estimated use of computed tomography (CT) varies between 2% and 80%, the mean being 22%. The need for CT, or the result thereof, is not the deciding factor for admission. In 1996, 16877 patients were treated as inpatients for minor head injuries, (191/100000 inhabitants). The admission rates varied widely among departments, and the total figures have been constant since 1987. The mean hospital stay was 1.6 days, so a large number of hospital days are consumed. The resources more than cover routine CT investigations for those seeking care, and hospital care for those with abnormal findings or special needs. CONCLUSION: In Sweden, patients with minor head injuries are routinely admitted to hospital for observation. The estimated use of CT varies considerably. No clinics report using CT to triage patients for admission, a strategy that would be consistent with effectiveness and economic arguments.

Adolescent↗

PubMed2006

Cardiovascular risk factor burden has a stronger association with self-rated poor health in adults in the US than in Sweden, especially for the lower educated.

BACKGROUND: There is an ongoing debate about the importance of biomedical and sociodemographic risk factors in the prediction of self-rated health. OBJECTIVES: To compare the association of sociodemographic and cardiovascular risk factors and self-rated health in Sweden and the US. DESIGN: Data from two population-based cross-sectional health surveys, one in Sweden and one in the US. SUBJECTS: The surveys included questionnaire and measured data from 5,461 adults in Sweden and 7,643 in the US. Participants were between 35 and 65 years of age. RESULTS: The odds ratios for poor self-rated health for the included cardiovascular risk factors were greater in the US. Low education was significantly more prevalent among those with self-rated poor health in the US, but not in Sweden. Using Swedes with high education as reference group (OR = 1), adults in the US with low education and 2+ risk factors had a greater than threefold risk (OR = 6.3) of self-rated poor health compared with Swedish low-educated adults with the same risk factor burden (OR = 1.9). The better-educated US adults with 2+ risk factors were significantly more likely to report poor health (OR = 3.4) compared with their Swedish counterparts (OR = 2.4). CONCLUSIONS: The interaction between risk factors, education, and self-rated health suggests a frightening picture, especially for the US. Public health interventions for reducing cardiovascular risk factors need to include both population and individual measures. Taking people's overall evaluation of their health into account when assessing total health risk is important.

Adult↗

PubMed2006

Socioeconomic factors, country of birth, and years in Sweden are associated with first birth fertility trends during the 1990s: a national cohort study.

AIMS: Decreasing fertility rates and postponement of first birth are of considerable public health concern in many industrialized countries. Previous studies suggest that this will increase involuntary childlessness in the population. The general aim was to examine the association between sociodemographic factors and first birth fertility trends in Sweden during the 1990s. METHODS: This Swedish national study examined changes in first birth rates and mean age at first birth between 1991 and 1992 (n = 452,000) and 1997-98 (n = 495,756). The impact of socioeconomic factors and years in Sweden on first birth fertility was examined among Swedish-born and 19 subgroups of foreign-born women aged 20-41 years. Poisson regression was used in the analysis. RESULTS: First birth rates decreased and mean age at first birth increased between the two periods among the Swedish-born and most foreign-born women. Non-employment and low income were associated with decreased first birth fertility, and low educational status was associated with slightly increased first birth fertility. Interaction tests revealed that, in contrast to Swedish-born women, several groups of foreign-born women increased their first birth fertility even if they were non-employed or had a low income. Among foreign-born women fewer years in Sweden was significantly associated with increased first birth fertility. CONCLUSION: Public health information should emphasize that postponement of first birth could lead to involuntary childlessness. Health care workers need to consider the woman's socioeconomic characteristics, country of birth, and years in Sweden when such information is given.

Adult↗

PubMed2003

Stroke in Northern Sweden.

BACKGROUND: Stroke is one of the most common causes of death and long-term disability worldwide. Although stroke mortality has decreased in most industrialized countries, there are populations, particularly in East Europe, in which the mortality has increased. The WHO initiated, 20 years ago, the MONICA Project. The aim of the study was to measure trends in coronary heart disease and stroke and to assess the extent to which these were related to changes in known risk factors. DESIGN: The Northern Sweden MONICA stroke study started in 1985 and is still ongoing. All individuals with an acute stroke in the age group 25-74 years have been included in the stroke register. Death certificates, discharge records, and GPs' records are screened and validated using strict MONICA criteria. RESULTS: Stroke event rates (first ever and recurrent stroke) per 100000 and year in the age group 25-74 years varied little over the years. Between 1985 and 1998 the annual incidence varied between 318 and 372 in men and between 195 and 240 in women, with no secular trends at all. The 28-day case fatality decreased in both men and women, from 19% to 11%. Logistic regression analyses showed a risk reduction in dying from stroke to 0.55 (p<0.0001) the last year compared with the first, with an absolute annual reduction in case fatality of 3%, in both men and women. In international comparison Northern Sweden shows an intermediately high incidence and one of the lowest case fatality rates of all participating populations. The incidence in subarachnoid haemorrhage was among the highest. CONCLUSION: The ongoing decline in stroke mortality in Sweden is driven exclusively by declining case fatality, whereas event rates (first ever and recurrent stroke) have remained the same since 1985. This, together with more people entering advanced, stroke-prone age groups, implies that the burden of stroke will continue to increase in Sweden.

Adult↗

PubMed2000

Newspaper reporting of hazards in the UK and Sweden.

Public understanding of risks is likely to be informed by the media. We report a cross-national study looking at how newspapers in Sweden and the United Kingdom characterize a variety of risks, focusing on two months around the 10th anniversary of the Chernobyl accident. Approximately four times as many reports about risks were found in Sweden as in the U.K., possibly reflecting a Swedish safety culture. The Bovine Spongiform Encephalopathy (BSE) crisis dominated reporting in both countries, especially in the U.K. The proportion and pattern of reports on Chernobyl was similar across countries. However, in Sweden, there was an increase in reports about other nuclear hazards after the anniversary, suggesting that generalization of media concern may have occurred. Generally, BSE was discussed using a greater number of characterizations in the U.K., while Chernobyl was reported using more characterizations in Sweden. Reports about hazards tended to be alarmist rather than reassuring, and rarely used statistics to express degrees of risk.

Animals↗

PubMed2001

Socioeconomic differences in use of medical care and antibiotics among schoolchildren in Sweden.

BACKGROUND: Studies of mortality among children and adults in Sweden have demonstrated considerable socioeconomic differences. This paper describes socioeconomic patterns of physical morbidity and use of medical care and antibiotics in schoolchildren in Sweden. METHODS: A cross-sectional study based on parent interviews from the Swedish Survey of Living Conditions in 1996-1997 was used. The study population consisted of 3,557 children aged 6-15 years. RESULTS: Forty-five percent of the schoolchildren in the study were reported to have been absent from school because of illness at least once during the previous three months, 8% were taking regular medication and 10% had ever suffered from a chronic disorder. There were no indications of socioeconomic differences according to the education of the responding parent in morbidity or use of consultations with a physician. However, children in families where the responding parents had primary education only consumed antibiotics less often (OR 0.7 and CI: 0.5-0.9) when compared to children in families with post-secondary education. Children in rural areas used consultations with a physician less often and consumed less antibiotics (adjusted OR 0.7 and CI: 0.4-0.9 and 0.7 and CI: 0.5-0.9 respectively). CONCLUSION: No obvious patterns of socioeconomic inequality in physical morbidity or use of medical care were identified among schoolchildren in Sweden. Further studies are needed in order to explain the social inequality in consumption of antibiotics among schoolchildren in Sweden and to describe social and regional patterns of psychiatric, behavioural and psychosomatic morbidity.

Adolescent↗

PubMed2003

Legal access to needles and syringes/needle exchange programmes versus HIV counselling and testing to prevent transmission of HIV among intravenous drug users: a comparative study of Denmark, Norway and Sweden.

BACKGROUND: Countries have adopted different strategies to prevent the transmission of HIV among intravenous drug users. Legal access to needles and syringes/needle exchange programmes as part of such a strategy has been heavily debated. HIV counselling and testing has also been part of prevention strategies. The objective of this study was to discuss the effectiveness of legal access to needles and syringes/ needle exchange programmes versus HIV counselling and testing among intravenous drug users (IDUs) as part of HIV prevention strategies. METHODS: Differences in HIV prevention strategies in Denmark, Norway and Sweden among IDUs are described. Outcome variables of effectiveness were HIV incidence rates over time. These were estimated by back calculation methods from 1980 through 1996, using data from the national HIV and AIDS registers. RESULTS: A comparison of HIV prevention strategies in Denmark, Norway and Sweden suggests that a high level of HIV counselling and testing might be more effective than legal access to needles and syringes/needle exchange programmes. Sweden and Norway, with higher levels of HIV counselling and testing, have had significantly lower incidence rates of HIV among IDUs than Denmark where there was legal access to needles and syringes and a lower level of HIV counselling and testing. In Sweden there was no legal access to drug injection equipment. CONCLUSION: Promotion and accessibility of HIV counselling and testing among intravenous drug users should be considered in countries where such a strategy is not adopted or has low priority.

AIDS Serodiagnosis↗

PubMed1997

Trends in occupational mortality among middle-aged men in Sweden 1961-1990.

BACKGROUND: Many European countries have in recent decades reported growing socioeconomic differentials in mortality. While these trends have usually paralleled high unemployment and increasing income disparities, Sweden had low unemployment and narrowing income differences. This study describes trends, 1961-1990, in total and cardiovascular mortality among men, 45-69 years of age, in major occupational classes in Sweden. METHODS: From census data four cohorts were created from those enumerated in 1960, 1970, 1980 and 1985. Through record linkage with the Swedish cause of death registry the mortality in each cohort was followed for 5-10 years. Age-standardized mortality trends 1961-1990 were calculated for occupational groups, categorized according to sector of the economy. RESULTS: The increase in mortality among middle-aged men in Sweden 1965-1980 was mainly a result of increasing cardiovascular mortality among industrial workers and farmers. In the 1980s the trend for these groups changed into a last decrease in mortality similar to that for non-manual occupations for the whole period. Consequently the rate ratio for industrial workers in comparison with men having a professional/managerial type of occupation increased from 0.98 to 1.43. The slowest decrease is now found among unqualified occupations in services and transportation. CONCLUSIONS: While Sweden, during the period studied, had narrowing income differentials and low unemployment this result points to the importance of working conditions in understanding trends and distribution of male adult mortality.

Aged↗