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Basic gait parameters: a comparison of reference data for normal subjects 20 to 29 years of age from Kuwait and Scandinavia.

This study obtained measurements of the spatiotemporal gait parameters of healthy young adult Kuwaiti subjects from both genders and compared the data to those collected in a similar study performed in Sweden. Thirty healthy subjects volunteered to participate in the study (which included being asked to walk at their "free," "slow," and "fast" self-selected speeds). We collected the spatiotemporal gait data using an automated system. Descriptive statistics were calculated for each variable measured at each walking condition. The data were then compared to those from the Swedish study. The results indicate several significant differences between Kuwaiti and Swedish subjects in their manner of walking. These results suggest a need to include data from subjects with diverse cultural backgrounds when a database on normal gait is developed or a need to limit the results of the database to a specified ethnic population.

Adult↗

Contribution of known and unknown susceptibility genes to early-onset diabetes in scandinavia: evidence for heterogeneity.

In an attempt to identify novel susceptibility genes predisposing to early-onset diabetes (EOD), we performed a genome-wide scan using 433 markers in 222 individuals (119 with diabetes) from 29 Scandinavian families with > or =2 members with onset of diabetes < or =45 years. The highest nonparametric linkage (NPL) score, 2.7 (P < 0.01), was observed on chromosome 1p (D1S473/D1S438). Six other regions on chromosomes 3p, 7q, 11q, 18q, 20q, and 21q showed a nominal P value <0.05. Of the EOD subjects in these 29 families, 20% were GAD antibody positive and 68% displayed type 1 diabetes HLA risk alleles (DQB*02 or 0302). Mutations in maturity-onset diabetes of the young (MODY) 1-5 genes and the A3243G mitochondrial DNA mutation were detected by single-strand conformation polymorphism and direct sequencing. To increase homogeneity, we analyzed a subsample of five families with autosomal dominant inheritance of EOD (greater than or equal to two members with age at diagnosis < or =35 years). The highest NPL scores were found on chromosome 1p (D1S438-D1S1665; NPL 3.0; P < 0.01) and 16q (D16S419; NPL 2.9; P < 0.01). After exclusion of three families with MODY1, MODY3, and mitochondrial mutations, the highest NPL scores were observed on chromosomes 1p (D1S438; NPL 2.6; P < 0.01), 3p (D3S1620; NPL 2.2; P < 0.03), 5q (D5S1465; NPL 2.1; P < 0.03), 7q (D7S820; NPL 2.0; P < 0.03), 18q (D18S535; NPL 1.9; P < 0.04), 20q (D20S195; NPL 2.5; P < 0.02), and 21q (D21S1446; NPL 2.2; P < 0.03). We conclude that considerable heterogeneity exists in Scandinavian subjects with EOD; 24% had MODY or maternally inherited diabetes and deafness, and approximately 60% were GAD antibody positive or had type 1 diabetes-associated HLA genotypes. Our data also point at putative chromosomal regions, which could harbor novel genes that contribute to EOD.

Adult↗

The development of gynecological oncology in Scandinavia during the last 50 years.

The last 50 years of development in gynecological oncology has changed the methods for the diagnosis of cancer and for treatment of cancer, both to give better treatment results. From the beginning the gynecologist could only inspect or palpate. Later on roentgen examination was introduced and later still microscopic diagnosis, more advanced diagnostic methods, e.g. endoscopy, ultrasound, isotope examination and advanced microscopic diagnosis and computerized tomography. Today we are waiting for the break-through in computerized tomography using nuclear spin resonance for the study of tumors and the spread of tumors. Parallel with the development in diagnosis, treatment has developed. Originally surgery was the only method available. Later on low energy radiation, endocrine therapy, chemotherapy and then high voltage energy treatment became available along with some experimental therapies. Today we have a broad range of therapeutic tools to use. In the future we might use prophylaxis more than we do today to prevent cancer and when cancer is present we might enhance the immune defense or introduce specific immuno-therapy with clonal antibodies, specially made for the actual tumor, and surgery, radiotherapy and chemotherapy will be used less.

Female↗

Pre-pregnancy risk factors of small-for-gestational age births among parous women in Scandinavia.

To study the etiology and consequences of intrauterine growth retardation (IUGR), a prospective study was organized by the National Institute of Child Health and Human Development, NIH, with the Universities of Trondheim and Bergen in Norway, Uppsala in Sweden, and Alabama in the United States. This paper reports on the Scandinavian portion of the study. 6,354 women were referred to the study and 5,722 women, who were expecting their second or third child between January 1986 and March 1988, were eligible and made their first appointment for the study. Of these, 1,945 women and their births were selected for follow-up at four prenatal visits, delivery, and during the first year of life. This report analyzes the relative impact of various maternal pre-pregnancy risk factors associated with SGA birth. For example, mothers who smoked cigarettes around the time of conception, but who had none of the other major risk factors, nearly doubled their risk of SGA birth. A previous low birth weight (LBW) delivery increased the risk nearly two and a half times among non-smokers. If a mother both smoked and had a previous LBW, the relative risk rose to nearly five and a half. Low maternal pre-pregnancy weight (< 50 kg) increased the risk of SGA birth almost twofold among non-smokers, while low pre-pregnancy weight and smoking together increased the risk of SGA birth fourfold. A low weight mother who smoked and also had a previous LBW delivery, had a risk of SGA birth that was nearly six times that of a mother without those characteristics.

Adult↗

Proficiency survey of serum protein analyses in Scandinavia.

A lyophilized human pool serum was distributed to Scandinavian clinical chemical laboratories for routine quantitation of different serum proteins. The analytical repertoir of the laboratories, and the methods and reference materials used, were registered. For almost all proteins the results varied considerably between the laboratories (CV 8--29%). The reasons for this variation are discussed together with possible recommendations to improve the accuracy of protein measurements.

Analysis of Variance↗

Renal blood flow in acute epidemic nephritis (nephropathia epidemica of Scandinavia).

Different haemodynamic and functional parameters were studied in 5 cases of acute epidemic nephritis with uraemia using nephroangiography and dye-dilution measurements combined with determination of extraction ratio and clearance for 51Cr-EDTA and PAH. In the acute phase, with greatly reduced renal function, increased vascular resistance was noted in spite of the vasodilatation observed in the renal artery out to and including the interlobular arteries. Moreover, angiography revealed enlarged kidneys with an increase in the thickness of the cortex and reduced cortical contrast accumulation. The renal blood flow, which was normal or slightly reduced initially, increased during convalescence, and renal function returned to normal. The investigation indicated that a primary vascular lesion in glomerular to postglomerular capillaries gives rise to pronounced interstitial oedema, which, probably as a result of secondary tubular compression, may be the cause of the rapidly developing renal failure.

Acute Disease↗

A comparison of primary care systems in the USA, Denmark, Finland and Sweden: lessons for Scandinavia?

In the United States large corporately owned health care delivery institutions, some of which are known as health maintenance organizations (HMOs), are assuming an increased prominence in the provision of primary care (PC). These private organizations are similar in many ways to the public-sector providers that have functioned for decades within the Scandinavian systems. This article explores the similarities and differences between these two PC approaches. This is accomplished by contrasting the governance, organization, financing and staffing of the PC systems of three Nordic countries (Denmark, Finland, and Sweden) to that of the US. Also provided is a critical analysis of the extent to which each model attains the ideal attributes of PC including; 1) accessibility, 2) comprehensiveness, 3) coordination and continuity, and 4) sensitivity to the patient's social milieu. For each facet of PC assessed, the American models offer approaches that are worthy of consideration by Scandinavian clinicians and planners. These include innovations in the areas of coordination between primary and secondary care, preventive care for adults and incentives for financial efficiency. Also, although successful in attaining many attributes of PC, this article discusses some perceived weaknesses of the Scandinavian systems.

Continuity of Patient Care↗

Management of non-Hodgkin lymphoma in adults in Scandinavia, United Kingdom, and The Netherlands. Report from the European School of Oncology intercity meeting at Huddinge Hospital, 3rd June, 1988.

Current treatment strategies in northern Europe of non-Hodgkin lymphoma are presented. High-grade malignant lymphomas have been treated with doxorubicin-containing polychemotherapy in various modes. The advantage of six-drug regimens over CHOP-like therapy is as yet not proven. Patients with the ability to tolerate the calculated dose have good prognosis. High-dose therapy and bone marrow transplantation should be considered in poor-risk patients with lymphoblastic lymphomas in first remission, patients with all high-grade histologies in partial remission after first-line therapy and patients with relapse that are still responsive to therapy. Preliminary results from autologous bone marrow transplantation in follicular lymphoma are also encouraging. Chlorambucil induces multiple remissions in follicular lymphoma, with a median duration of the 1st, 2nd and 3rd remission being the same. The watch and wait strategy seems justified initially in most asymptomatic generalized low-grade malignant lymphomas. Systemic therapy is required in aggressive stage II-IV lymphomas. A meticulous investigation is needed for stage I patients before giving local treatment only. Immune phenotyping is of great value for diagnosis and staging. Liver, but not bone marrow involvement seems to be an adverse prognostic factor. Follicular lymphoma is an example of a dynamic tumour with gradual cellular changes associated with new and more malignant clinical signs.

Antineoplastic Combined Chemotherapy Protocols↗

A century with hyperthermic oncology in Scandinavia.

The hyperthermic research during the last 100 years is reviewed with the aim to describe a research activity which has been performed in parallel to and associated with the development of radiation oncology. Basic and clinical research in several Scandinavian centres has made major international contributions to the establishment of a rationale for and implementation of hyperthermia as a combined modality treatment with chemotherapy or radiation in oncology. At the same time it has been demonstrated that collaboration and integration easily could be performed within the Scandinavian centres. Hyperthermic oncology is therefore a typical example of how research involving both biological, physical/engineering, and clinical skills in a proper environment can create valuable results.

History, 20th Century↗

Thromboembolic complications following scoliosis surgery in Scandinavia.

Out of 1229 patients operated on according to Harrington there were eight with clinical deep venous thrombosis (DVT) confirmed by phlebography or at autopsy. One patient died from massive pulmonary embolism. All eight DVT were located proximally on the left side. In two cases the first symptom was abdominal pain. At follow-up two patients had slight complaints. One had edema in hot weather and one swelling of the left leg. Another patient had no complaints but venography showed pathological collateral veins. There may be a considerable risk of development of a postthrombotic syndrome.

Adolescent↗

Trends in aging care in Scotland and Scandinavia.

The proportion of older adults in Western European countries, as in the United States, continues to increase rapidly. Faced with geriatric care dilemmas decades earlier, however, these countries have had more experience on which to base the development of community-based, integrated care systems for the elderly. This article provides observations from a 1993 World Health Organization Fellowship study of long-term care facilities in four European countries: Scotland, Sweden, Norway and Denmark. Several emerging trends in geriatric care documented in the literature were confirmed. These included: moratoria on institutional long-term care, emphasis on informal care and support, provision of 24-hour assistance in the home, care management to individualize care, and an expanded set of providers within integrated delivery systems.

Aged↗

Low birthweight, congenital malformations, and spontaneous abortions among dry-cleaning workers in Scandinavia.

With a common study protocol, case-referent studies within cohorts were performed in Denmark, Norway, Sweden, and Finland to study reproductive hazards of women doing dry-cleaning work. Due to national differences not all of the studies could follow exactly the same procedures in data collection, but they were all based on the linkage of cohorts of dry-cleaning and laundry workers to national registers of births and reproductive failures. Summary measures from each study were combined without the data being pooled. The most significant finding was an increased risk of spontaneous abortion among the most exposed women in the Finnish data. This finding was only supported by the results of the other studies to a minor degree, and the combined odds ratio had confidence limits which included unity.

Abortion, Spontaneous↗