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PubMed2005

Medical intelligence in Sweden. Vitamin B12: oral compared with parenteral?

BACKGROUND: Sweden is the only country in which oral high dose vitamin B12 has gained widespread use in the treatment of deficiency states. OBJECTIVE: The aim of the study was to describe prescribing patterns and sales statistics of vitamin B12 tablets and injections in Sweden 1990-2000.Design, setting, and sources: Official statistics of cobalamin prescriptions and sales were used. RESULTS: The use of vitamin B12 increased in Sweden 1990-2000, mainly because of an increase in the use of oral high dose vitamin B12 therapy. The experience, in statistical terms a "total investigation", comprised 1,000,000 patient years for tablets and 750,000 patient years for injections. During 2000, 13% of residents aged 70 and over were treated with vitamin B12, two of three with the tablet preparation. Most patients in Sweden requiring vitamin B12 therapy have transferred from parenteral to oral high dose vitamin B12 since 1964, when the oral preparation was introduced. CONCLUSION: The findings suggest that many patients in other post-industrial societies may also be suitable for oral vitamin B12 treatment.

Administration, Oral↗
PubMed2003

Effect of smokeless tobacco (snus) on smoking and public health in Sweden.

OBJECTIVE: To review the evidence on the effects of moist smokeless tobacco (snus) on smoking and ill health in Sweden. METHOD: Narrative review of published papers and other data sources (for example, conference abstracts and internet based information) on snus use, use of other tobacco products, and changes in health status in Sweden. RESULTS: Snus is manufactured and stored in a manner that causes it to deliver lower concentrations of some harmful chemicals than other tobacco products, although it can deliver high doses of nicotine. It is dependence forming, but does not appear to cause cancer or respiratory diseases. It may cause a slight increase in cardiovascular risks and is likely to be harmful to the unborn fetus, although these risks are lower than those caused by smoking. There has been a larger drop in male daily smoking (from 40% in 1976 to 15% in 2002) than female daily smoking (34% in 1976 to 20% in 2002) in Sweden, with a substantial proportion (around 30%) of male ex-smokers using snus when quitting smoking. Over the same time period, rates of lung cancer and myocardial infarction have dropped significantly faster among Swedish men than women and remain at low levels as compared with other developed countries with a long history of tobacco use. CONCLUSIONS: Snus availability in Sweden appears to have contributed to the unusually low rates of smoking among Swedish men by helping them transfer to a notably less harmful form of nicotine dependence.

Adult↗
PubMed1985

Increasing mortality from coronary heart disease among males in Sweden.

In Sweden, coronary heart disease (CHD) mortality increased by 30% among 50- to 54-year-old men and by 20% among 55- to 59-year-old men between 1968 and 1980. Among women there was no change during the same time. Two cohorts of 50-year-old men living in Gothenburg, Sweden, were examined 10 years apart (1963-1973): Levels of the 3 major CHD risk factors, blood pressure, serum cholesterol and smoking habits, were similar in these two cohorts. Men in the latest examined cohort had almost doubled the 7-year incidence of fatal and non-fatal CHD compared to men in the first examined cohort. Obesity was more prevalent among men examined in 1973 and also a significant risk factor for CHD in that cohort. Increased obesity and very slightly increased serum cholesterol levels can, however, only explain part of the increased incidence of CHD. Hypertension is being more effectively treated, the prevalence of smokers has decreased, and treatment of symptomatic CHD is similarly active in Sweden as in many other countries. Thus, several changes largely parallel those taking place in countries with decreasing CHD mortality. In spite of this, CHD mortality is increasing among males in Sweden. Possible reasons for this are discussed.

Blood Pressure↗
PubMed2004

Increasing stroke incidence in Sweden between 1989 and 2000 among persons aged 30 to 65 years: evidence from the Swedish Hospital Discharge Register.

BACKGROUND AND PURPOSE: Stroke mortality is decreasing in Sweden, as is the case in other Western European countries. However, both decreases and increases have been reported in Sweden for persons younger than age 65 years. The aim of this study was to compare the incidence of stroke in Sweden between the periods 1989 and 1991 and 1998 and 2000 in persons aged 30 to 65 years. METHODS: All first-ever stroke patients aged 30 to 65 years in the Swedish Hospital Discharge Register between 1989 and 2000 were included. RESULTS: The age-standardized, 3-year average incidence increased by 19%, from 98.9 to 118.0 per 100 000 among men, and by 33%, from 48.4 to 64.4 among women, between 1989 and 1991 and 1998 and 2000. The largest increase was seen among those younger than 60 years. On a county level, the change in age-standardized stroke incidence varied from small decreases (-3%) to large increases (82%). CONCLUSIONS: Stroke incidence increased in Sweden for both men and women between 1989 and 2000. The increase was larger among women. This calls for action when it comes to studying risk factors and planning for prevention and health promotion and indicates the need for gender-specific studies.

Adult↗
PubMed1996

Age-period-cohort effects on stroke mortality in Sweden 1969-1993 and forecasts up to the year 2003.

BACKGROUND AND PURPOSE: Variations in stroke mortality could be explained by changes in factors that act around the time of death (period effect) and by risk factors that are present in early life (cohort effect). The aim of this study was to analyze mortality rates for stroke in Sweden during the period 1969 through 1993 and to predict mortality trends until the year 2003, taking into account age, cohort, and period effects. METHODS: Age-period-cohort models were used to analyze stroke mortality in Sweden between 1969 and 1993 and to predict age-specific death rates and total number of deaths for the periods 1994 through 1998 and 1999 through 2003. RESULTS: Mortality rates in the age group 25 to 89 years decreased from 203 to 143 per 100,000 for men and from 185 to 113 per 100,000 for women over the study period (average annual decrease of 1.3% for men and 1.9% for women). The decline was present in all age groups. The full age-period-cohort model provided an acceptable fit in both sexes. Predictions based on these models gave a mortality rate of 122 and 92 per 100,000 for the period 1999-2003 in men and women, respectively. Despite an aging and increasing population, the total number of stroke deaths in Sweden is predicted to decline by approximately 10% in both men and women from 1989-1993 to 1999-2003. CONCLUSIONS: Both factors, cohort and calendar period, contain relevant information to explain the decline in stroke mortality trends in Sweden. Predictions indicate that the decline of both age-specific and total mortality will continue.

Adult↗
PubMed1984

Psychotherapy in Sweden: historical background, current status, and future projections.

From medieval times, care of the emotionally disturbed in Sweden has shifted between moralistic and enlightened approaches. In this century through the 1960s, organic methods have predominated, with emphasis on description and precise diagnosis. Psychodynamic treatment has been only reluctantly accepted until the past decade, with child psychiatrists and psychologists at the forefront. Norway has typically been most progressive in the establishment of psychoanalytic and other psychodynamic movements in Scandinavia, with Sweden following and Denmark often lagging behind. In 1970, Norway became the first Scandinavian country to require training in psychotherapy for psychiatrists. Sweden remained more conservative for years, both in adherence to the organic model at one extreme, and in supporting one of the most orthodox psychoanalytic movements in the world, at the other. During the 1970s, however, it became increasingly more common for psychiatrists in Sweden to seek training in psychotherapy through a variety of organizations, established since the early 1930s and operating independently of each other. In 1978, a uniform state program in psychotherapy was developed with theoretical and practical requirements, and is scheduled in the near future to become obligatory for psychiatrists, psychologists, and various other mental health professionals. The paramedical personnel has become increasingly more involved in mental health care during the past decade. In delivery of care, the "sectorization" principle has become central, and is likely to set the tone for the future. With the entire country divided into local catchment areas, the direction will be toward psychodynamic approaches integrated with traditional organic models, open care, decentralization, planned prophylaxis, and full collaboration of all mental health professionals and social agencies.

Child Psychiatry↗
PubMed2005

Driving forces for import of waste for energy recovery in Sweden.

Between 1996 and 2002, the Swedish import of so-called yellow waste for energy recovery increased. The import mainly consisted of separated wood waste and mixes of used wood and paper and/or plastics that was combusted in district heat production plants (DHPPs). Some mixed waste was imported to waste incineration plants for energy recovery (10% of the import of yellow waste for energy recovery in 2002). The import came primarily from Germany, the Netherlands, Norway, Denmark and Finland. We identified six underlying driving forces for this recent increase of imported waste which are outlined and their interactive issues discussed. --The energy system infrastructure, which enables high energy recovery in Sweden. --The energy taxation, where high Swedish taxes on fossil fuels make relatively expensive solid biofuels the main alternative for base load production of district heat. --The quality of the waste-derived fuels, which has been higher in the exporting countries than in Sweden. --The bans on landfilling within Europe and the shortage of waste treatment capacity. --Taxes on waste management in Europe. --Gate fee differences between exporting countries and Sweden. In the future, the overall strength of these driving forces will probably be weakened. A Swedish tax on waste incineration is being investigated. In other European countries, the ambition to reach the Kyoto targets and increase the renewable electricity production could improve the competitiveness of waste-derived fuels in comparison with fossil fuels. Swedish DHPPs using waste-derived fuels will experience higher costs after the Waste Incineration Directive is fully implemented. The uncertainty about European waste generation and treatment capacity, however, might have a large influence on the future gate fees and thus also on the yellow waste import into Sweden.

Commerce↗
PubMed2004

Cumulative risk of bovine mastitis treatments in Denmark, Finland, Norway and Sweden.

Data from the national dairy cow recording systems during 1997 were used to calculate lactation-specific cumulative risk of mastitis treatments and cumulative risk of removal from the herds in Denmark, Finland Norway and Sweden. Sweden had the lowest risk of recorded mastitis treatments during 305 days of lactation and Norway had the highest risk. The incidence risk of recorded mastitis treatments during 305 days of lactation in Denmark, Finland, Norway and Sweden was 0.177, 0.139, 0.215 and 0.127 for first parity cows and 0.228, 0.215, 0.358 and 0.204 for parities higher than three, respectively. The risk of a first parity cow being treated for mastitis was almost 3 times higher at calving in Norway than in Sweden. The period with the highest risk for mastitis treatments was from 2 days before calving until 14 days after calving and the highest risk for removal was from calving to 10 days after calving in all countries. The study clearly demonstrated differences in bovine mastitis treatment patterns among the Nordic countries. The most important findings were the differences in treatment risks during different lactations within each country, as well as differences in strategies with respect to the time during lactation mastitis was treated.

Animals↗
PubMed1990

Assessment and comparison of chest radiography techniques in the United States and Sweden.

The United States Center for Devices and Radiological Health and the Swedish National Institute of Radiation Protection started a collaborative project in 1983. The purpose of the project was to test the adequacy and practicability of the United States (US) Nationwide Evaluation of X-ray Trends (NEXT) programme in Sweden. The NEXT protocol for the postero-anterior chest projection was modified and expanded to make it both "statistical" and "investigational" (in the US, NEXT gives mainly "statistical" information). All chest X-ray units in Sweden were surveyed in 1986-87. The project showed that the NEXT programme is applicable to countries other than the United States and provides a standardized protocol that enables intercomparison of the radiological techniques. This paper presents the comparison of the radiological techniques used in Sweden and the United States. The results of the investigational modifications made to the protocol used in Sweden are discussed. Recommendations concerning expansion of the NEXT protocol to include these valuable tools for investigational surveys are presented.

Data Collection↗
PubMed1979

Exposure and accumulation of cadmium in populations from Japan, the United States, and Sweden.

Studies were carried out in Japan, United States, and Sweden regarding comparability of analytical methods for cadmium, daily intake of cadmium via food, daily amount of cadmium in feces, concentrations of cadmium in different tissues and the body burden of cadmium, urinary excretion of cadmium and cadmium concentrations in blood. It was found that the cadmium intake via food among adults is about 35 mug/day in Japan (Tokyo) and about 17 mug/day in the U.S. (Dallas) and Sweden (Stockholm). It varies with age in a way similar to calorie intake. Body burden increases rapidly with age. The half-time of cadmium is longer in muscles than in liver or kidneys. In the cross-sectional population samples studied (smokers and nonsmokers mixed) the average cadmium body burden at age 45 was about 21 mg in Japan, 9 mg in the U.S., and 6 mg in Sweden. Among nonsmokers in the U.S. and Sweden the body burden at age 45 was about 5-6 mg. The difference in average body burden for smokers and nonsmokers is explained by differences in smoking habits. Cadmium excretion in urine was closely correlated with body burden and about 0.005-0.01% of body burden is excreted daily in urine. Cadmium concentration in the blood was a good indicator of average recent intake over a 3-month period. Neither blood cadmium nor urine cadmium changed immediately after an increase of exposure level.

Adolescent↗
PubMed2003

Is the decline of the increasing incidence of non-Hodgkin lymphoma in Sweden and other countries a result of cancer preventive measures?

Is the decline of the increasing incidence of non-Hodgkin lymphoma (NHL) in Sweden and other countries a result of cancer preventive measures? The yearly age-standardized incidence of NHL increased significantly in Sweden during 1971-1990, for men an average of 3.2% and for women 3.1%. The corresponding figures for 1991-2000 were -0.8% and -0.2%, respectively. A decline of the increasing incidence has also been seen in other countries, such as the United States, Finland, and Denmark. Immunosuppression is one established risk factor for NHL, possibly with interaction with Epstein-Barr virus. Phenoxyacetic acids and chlorophenols, both pesticides, have been associated with NHL. Use of these chemicals was banned in Sweden in 1977 and 1978, respectively. Also, persistent organic pollutants such as polychlorinated biphenyls, hexachlorobenzene, chlordanes, and dioxins have been shown to increase the risk. Exposure of the whole population occurs predominantly through the food chain. Exposure to such chemicals was highest in the 1960s and 1970s. Because of regulation in the 1970s, exposure has declined substantially in the population. The change in incidence of NHL in Sweden and other countries may serve as a good example of how prohibition and limitation of exposure may be reflected in cancer statistics some decades later.

Adolescent↗
PubMed2006

Policies and practices in support of family caregivers - filial obligations redefined in Sweden.

This article provides an overview of how the expression of filial obligations has shifted over time in Sweden. Historically, and currently in many countries, the family, next of kin, and the social network are the only or major sources of help, as it was in Sweden till half a century ago. The article also explores how various aspects of solidarity-public and private-have developed and are changing in Sweden, known for its extensive welfare programs, with "from cradle to grave" security. It concludes that intergenerational solidarity has not vanished in Sweden; just the manifestations have changed.

Aged↗
PubMed2006

Evaluation of the Swedish version of Dissociation Questionnaire (DIS-Q), Dis-Q-Sweden, among adolescents.

The aim of this study was to investigate the psychometric properties of the Swedish version of the Dissociation Questionnaire in a normative adolescent population and also to investigate dissociative symptoms associated with trauma including sexual and physical abuse. A normative sample of 449 adolescents between the ages of 12 and 19 and a clinical group of 74 adolescents with known experiences of trauma, sexual and/or physical abuse was given Dis-Q-Sweden. A mixed group of 22 abused and non-abused adolescents who answered Dis-Q-Sweden was also interviewed by using the Structural Clinical Interview for DSM-IV Dissociative Disorders (SCID-D). A test-retest procedure was conducted with 90 subjects from the normative group. The results showed good reliability concerning both internal consistency and test-retest stability. Validity was tested in several ways (criterion, predictive, construct and concurrent) and found to be satisfactory. Significant differences for the total sum scores of Dis-Q-Sweden were found between the normative group and the clinical group with known sexual abuse (p < 0.001). The prevalence of dissociative symptoms (cut-off score > 2.5) was 2.3% in the normative group and 50% in the clinical group. Dis-Q-Sweden has proven to be a screening instrument with good psychometric properties and has proven to be able to capture dissociative symptoms in adolescents with self-reported trauma and known trauma (sexual abuse).

Adolescent↗
PubMed1998

The economic cost of multiple sclerosis in Sweden in 1994.

This paper investigates the economic burden of multiple sclerosis (MS) in Sweden in 1994. The cost structure was compared with costs from a similar study from 1991 and 3 studies from the UK. The cost-of-illness method, based on the human capital theory, was used to estimate the economic burden of MS in Sweden, and a prevalence approach and a top-down method were chosen. Both direct and indirect costs were estimated. The total cost (in Swedish kronor) of MS was SEK1.736 billion1 in Sweden in 1994. The indirect costs (production losses as a result of morbidity) accounted for about 80% of the total cost. While the cost of inpatient care was substantial, the drug cost was minimal by comparison. The same cost pattern was present in 1991 in Sweden; however, since the transfer of costs for long term care to the municipalities in 1992, 95% of total cost of the disease fell outside of the healthcare sector. Similar cost structures have been shown in other studies, for example, in the UK. The cost pattern shown in this study, with low costs for medical care and drugs, reflects the fact that few treatment possibilities have existed for MS. However, new relatively expensive drugs have recently been introduced, which may alter the future cost. At present, there is uncertainty regarding how many patients will be treated and the future prices of these new drugs. The cost pattern of MS may very well change dramatically in the future, and successive cost-of-illness studies is one way to assess the consequences of the introduction of new technology.

Ambulatory Care↗
PubMed1988

Dental health status in two groups of refugees in Sweden.

The aim of this study was to determine dental health status in two separate groups of Chilean and Polish refugees in Sweden. In Scandinavia, Sweden has the largest number of immigrants--1 million out of a population of 8.3 million. Since 1975, most immigrants have been refugees and their families. During 1978-82 Sweden granted residency to 20,000 refugees, the two largest groups being Chileans and Poles. In 1981-83 a sample of 193 Chilean and 92 Polish refugees in the county of Stockholm were selected for this study. The investigation consisted of a questionnaire followed by clinical examination, including roentgenograms. The average age was 34.0 years in the Chilean group and 34.8 years in the Polish group. The Chileans had been in Sweden for 17.3 months on an average and the Poles for 16.0 months. The Chileans had an average of 10.0 carious surfaces, D(s), and the Poles 11.3. Gingivitis was recorded in 87% of the total number of sites examined in the Chilean group. The corresponding figure in the Polish group was 79%. Of the Chileans 36.5% and of the Poles 32.5% had periodontal pockets measuring more than 5 mm. The results indicate that, when compared with Swedish individuals of a corresponding age, the refugee groups have a high prevalence of caries and periodontal disease.

Adolescent↗
PubMed1986

Incidence of Crohn's disease in a defined population in northern Sweden, 1974-1981.

An epidemiologic study of Crohn's disease, comprising the population of the two most northerly counties of Sweden and covering the 8-year period 1974-1981, was carried out. The basic population was about 510,000, and the area is regarded as rural, with a mean density of 3 inhabitants per km2. In all, 199 patients with a hospital discharge diagnosis of Crohn's disease were identified. A mean annual incidence of 4.9 per 10(5) inhabitants and a peak incidence of 6.7 were found. There was no sex difference and no obvious change in incidence during the time period studied. The highest incidence was observed in young adults, and ileal disease predominated. A significantly higher incidence was observed in the town of Umeå than in the rest of northern Sweden. The increase was confined to the ages between 20 and 40 years. The present study concludes that the incidence of Crohn's disease is high in northern Sweden, even though it is a sparsely populated rural area. The incidence figures are similar to those obtained for other parts of Sweden.

Adolescent↗
PubMed1996

Seroprevalence of Helicobacter pylori in south Sweden and Iceland.

BACKGROUND: Seroepidemiologic studies on the prevalence of Helicobacter pylori infection have been reported from several European countries but not from Sweden or Iceland. METHODS: Serum samples were collected from 443 persons in Sweden and 387 persons in Iceland. All the 830 sera were tested with the same enzyme immunoassay test with an acid glycine extract of H. pylori surface proteins as antigen. RESULTS: The antibody levels were low in the young age groups in both Sweden and Iceland, with increasing levels with age. CONCLUSIONS: The results are consistent with previous studies from other comparable countries, but with important differences. The prevalence was lower in Sweden than in other, previously studied, Western European countries, but, on the other hand, the prevalence was slightly higher in Iceland.

Adolescent↗
PubMed1992

Isolation of polioviruses from sewage and their characteristics: experience over two decades in Sweden.

Indigenous polio ceased in Sweden in 1962 after 5 years' use of killed polio vaccine. In 1967, it was considered of interest to investigate whether poliovirus was present in the sewage. A method for selective isolation of poliovirus from sewage was developed. The method appeared to increase the yield. The studies were carried out at intervals up to 1990. In 1989-90, the virus isolates were characterized by the use of monoclonal antibodies differentiating between vaccine-like (Sabin-like) and non-vaccine-like strains. Polioviruses of both kinds were isolated throughout the period. Two periods were of special interest. The first was in 1977, when a single, paralytic, type-2 case occurred in Sweden in an unvaccinated sect. The second was in 1984-85 when a type-3 epidemic broke out in Finland, followed by vaccinations of the whole Finnish population with live oral polio vaccine. On both occasions the implicated viruses could be traced to a high degree in sewage in Sweden. The absence of poliovirus isolations from faecal specimens of patients and the isolation of live poliovirus vaccine virus, i.e. a vaccine not used in Sweden, indicate that the virus strains are imported.

Disease Outbreaks↗