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PubMed1982

A cross-cultural examination of use of corporal punishment on children: a focus on Sweden and the United States.

It appears that Sweden and the United States may be a study in contrasts regarding the sanction and use of corporal punishment on children. A 1979 study of American parents noted that 81% of them employed corporal punishment with children. A different study done in Sweden in 1978 noted that only 26% of parents used corporal punishment with children. What points to the differences in these parenting patterns within the two countries? In addition, a 1977 U.S. Supreme Court case entitled Ingraham vs. Wright ruled that "schools are empowered to carry out corporal punishment." This court case involved two high school boys in Florida who had been repeatedly struck with wooden paddles. In contrast, Sweden had statutes which prohibited corporal punishment of children in their secondary schools as early as the 1920s. In 1957, the country passed a law which defined corporal punishment as unacceptable for small children in the schools. Then, in 1979, the Swedish government passed a statute prohibiting corporal punishment by parents. Are there differences in the way the two countries view law and its uses? Or, do the cultures sanction violence in general or just violence against children in different ways? This article examines some of the similarities and differences found in American and Swedish treatment of children and proposes what appear to be extreme differences in the way the countries and their people approach corporal punishment.

Child↗

PubMed1996

Patient administrative system as a tool to validate the ascertainment in the diabetes incidence study in Sweden (DISS).

The aim of this study was to evaluate the degree of ascertainment in a nationwide prospective registration of incident cases of diabetes mellitus in the age group 15-34 years (The Diabetes Incidence Study in Sweden (DISS)). Incident cases of diabetes mellitus in DISS during a five year period were compared with inpatients, with the diagnosis of diabetes mellitus, registered in a routine computer-based administrative register. The Patient Administrative System-Inpatient Care (PAS-IC). To clarify this issue the two-sample capture-recapture phenomena was employed in the two southernmost counties in Sweden, Malmöhus and Kristianstad, covering 9.2% of the total of 2.3 million people aged 15-34 years in Sweden. The results showed that the ascertainment level in DISS was 0.86 for insulin dependent diabetes mellitus (IDDM). Hence, the DISS registry is a valid tool to monitor the incidence of IDDM in young (15-34 years) adult subjects.

Adolescent↗

PubMed1989

Teenage pregnancy in Sweden and Finland. Implications for the United States.

Fertility and the rates of pregnancy, live births, and abortion in teenagers in the United States are considerably higher than in most other developed countries of northern and western Europe. Fertility rates in teenagers in Sweden have declined significantly. The teaching of family life education is universal in Sweden and almost universal in Finland. Sex is openly discussed within society in both countries. Family planning and abortion services are geographically very available in both countries and both services and supplies are free. The educational level of both males and females is high in both countries. The United States has the opportunity to reduce teenage pregnancy by applying the experience of Sweden and Finland in the fields of family life education and family planning services.

Abortion, Therapeutic↗

PubMed1987

Fatal firearm accidents in Sweden.

According to Swedish law, it is prohibited to possess and use firearms without a special permission (license), which is given only after a detailed personal investigation. This restrictive legislation accounts for the fact that deaths due to firearms in Sweden are rare in an international comparison. The number of accidental firearm fatalities in Sweden is 0.074/100,000 living persons. We have previously published a series of accidental firearm fatalities during hunting, and now we present an investigation on the non-hunting fatalities. The mean age of the victims was 27 years, and males predominated. Handguns, military rifles, and shotguns caused most of the accidents. The first published case of fatal thoracic airgun wound is also included. Slightly more than half of the accidents were caused by another person and were inflicted at close range. Unsafe handling of the guns, especially "playing" with the gun or during military training caused most of the accidents. It is doubtful that one could further decrease the low number of fatal firearm accidents in Sweden by even more restrictive legislation. Instead, it is concluded that the most important factor to stress is the safer handling of weapons.

Cross-Sectional Studies↗

PubMed2005

Factors associated with an increased chance of survival among patients suffering from an out-of-hospital cardiac arrest in a national perspective in Sweden.

AIM: To describe factors associated with an increased chance of survival among patients suffering from an out-of-hospital cardiac arrest in Sweden. PATIENTS AND METHODS: All patients suffering from an out-of-hospital cardiac arrest, which were not crew witnessed, in Sweden and in whom cardiopulmonary resuscitation (CPR) was attempted and who were registered in the Swedish Cardiac Arrest Registry. This registry covers about 85% of the Swedish population and has been running since 1990. RESULTS: In all, 33,453 patients, 71% of whom had a cardiac etiology, were included in the survey. The following were independent predictors for an increased chance of survival in order of magnitude: (1) patients found in ventricular fibrillation (odds ratio [OR] 5.3, 95% confidence limits [CL] 4.2-6.8), (2) the interval between call for and arrival of the ambulance less than or equal to the median (OR 3.6, 95% CL 2.9-4.6), (3) cardiac arrest occurred outside the home (OR 2.2, 95% CL 1.9-2.7), (4) cardiac arrest was witnessed (OR 2.0, 95% CL 1.6-2.7), (5) bystanders performing CPR before the arrival of the ambulance (OR 2.0, 95% CL 1.7-2.4), and (6) age less than or equal to the median (OR 1.6, 95% CL 1.4-2.0). When none of these factors were present, survival to 1 m was 0.4%; when all factors were present, survival was 23.8%. CONCLUSION: Among patients suffering from an out-of-hospital cardiac arrest, which were not crew witnessed, in Sweden and in whom CPR was attempted, 6 factors for an increased chance of survival could be defined. These include (1) initial rhythm, (2) delay to arrival of the rescue team, (3) place of arrest, (4) witnessed status, (5) bystander CPR, and (6) age.

Age Factors↗

PubMed2006

Comparative cost-effectiveness of anticoagulation with bivalirudin or heparin with and without a glycoprotein IIb/IIIa-receptor inhibitor in patients undergoing percutaneous coronary intervention in Sweden: a decision-analytic model.

OBJECTIVE: This study modeled the comparative costs and effectiveness of anticoagulation with bivalirudin alone, heparin alone, and heparin combined with a glycoprotein IIb/IIIa-receptor inhibitor (GPI) in patients undergoing percutaneous coronary intervention (PCI) in Sweden. METHODS: GPIs are prescribed for -40% to 50% of patients undergoing PCI in Sweden. However, because treatment practices vary between hospitals, the model analyzed a cohort in which different proportions of patients (0%-100%) would receive a GPI in addition to heparin and the remaining patients would receive heparin monotherapy. This mixed cohort was compared with a cohort treated with bivalirudin. Abciximab was used as the GPI comparator, as this is the only GPI currently approved in Sweden for patients undergoing PCI. Pooled data from 3 studies (REPLACE-2 [second Randomized Evaluation of PCI Linking Angiomax to Reduced Clinical Events], ESPRIT [European/Australasian Stroke Prevention in Reversible Ischaemia Trial], and EPISTENT [Evaluation of Platelet IIb/IIIa Inhibitor for Stenting]) were used as the source for the probabilities of myocardial infarction (MI), urgent revascularization (UR), major and minor bleeding (Thrombolysis in Myocardial Infarction study definitions), and death. Treatment costs associated with these complications were obtained from 4 Swedish hospitals, and official drug prices were obtained from the Swedish Pharmacopoeia. All costs were presented in 2006 Swedish kronor (SEK). The model was evaluated over a 30-day time frame from the perspective of a Swedish hospital. The modeled patient population was 63 years old, weighed 78 kg, and was 75% male. RESULTS: Compared with a pattern in which heparin plus a GPI was used in 50% of all PCIs and heparin alone was used in the remaining 50%, bivalirudin treatment was associated with a significant reduction in all complications in the model (P < 0.05), including a mean of 18.2 fewer MIs, 1.6 fewer URs, 15.3 fewer bleeding events, and 1.3 fewer deaths per 1000 treated patients. Bivalirudin therapy also was associated with a significant reduction in total drug and health care costs per patient (SEK -1301; 95% Cl, -1367 to -1229). The benefit of bivalirudin was sensitive to the rate of GPI use: additional reductions in rates of MI, UR, and death were seen at lower rates of GPI use, and additional reductions in rates of bleeding and costs of drugs and health care utilization were seen at higher rates of GPI use. CONCLUSIONS: In this model, anticoagulation with bivalirudin in patients undergoing PCI was cost-effective compared with heparin alone and heparin plus a GPI. In a hypothetical Swedish hospital unit using equal proportions of heparin alone and heparin plus a GPI, a switch to bivalirudin would reduce the risk of both ischemic events and bleeding events, resulting in savings in total drug and health care costs.

Angioplasty, Balloon, Coronary↗

PubMed2004

Can the survival difference between breast cancer patients in Denmark and Sweden 1989 and 1994 be explained by patho-anatomical variables?--a population-based study.

Analyses of data from cancer registries have shown a 10% unit difference in 5-year relative survival between Danish and Swedish patients with breast cancer. This study investigates the effect of age and patho-anatomic variables on this survival difference. Hospital records were collected for women over 40 years of age diagnosed in 1989 or 1994 in east Denmark and south Sweden; patho-anatomical variables and survival were compared between 2289 Danish and 1715 Swedish women. Tumours were smaller, node-negative axillae more frequent and well-differentiated tumours almost 10% more frequent in Sweden. A superior 5-year relative survival in Sweden was found in the 50- to 79-year age group. The adjusted hazard rate ratio between countries was 1.7 in 1989 and 1.3 in 1994. Conditional survival after surviving the first 5 years was similar for the two countries. Adjusting for patho-anatomical variables reduced but did not eliminate the higher risk of death among the Danish patients. Higher population death rates could explain some but not all of the residual elevated risk for Danish women.

Age of Onset↗

PubMed2005

What happened to the care of older persons in Sweden? A retrospective analysis based upon simulation model calculations, 1985-2000.

There is in Sweden a lack of national data connecting public care services to needs in various sub-groups. As result of these statistical deficiencies there has been a severe lack of solid facts to guide the public debate in Sweden concerning the developments of the old age care system. Also connected to this are the similar problems of predicting future needs development in order to estimate future burdens on the systems of care. A computer model has been developed that, by combining different national and local data sources, describes the development of the Swedish public system of care for older persons in terms of service provision and costs per needs group according to age, gender, marital status and degree of disability or ill-health. The model works in 5-year steps and has a retrospective part covering the period 1985-2000 and a prospective part for the period 2005-2030. In this article is described the structure of the model, assumptions, data sources and results for the retrospective part of the model. The model calculations show that despite of a large increase in the number of older persons there has not been a very substantial increase of needs. The number of persons with severe ill-health is basically unchanged, even if there appears to have been some shift in the composition of the group towards more heavy disability. The reductions in provided services, that the municipalities have been forced to do depending on the harsher economic conditions in Sweden since the beginning of the 1990s, have almost exclusively been targeted on persons with lesser needs. Those most in need have largely been shielded.

Aged↗

PubMed2006

Do policy changes in the pharmaceutical reimbursement schedule affect drug expenditures? Interrupted time series analysis of cost, volume and cost per volume trends in Sweden 1986-2002.

The last decades increasing pharmaceutical expenditures in Sweden and other western countries have created a need for reforms to reduce the trend. The aim was to analyse if reforms concerning the pharmaceutical reimbursement scheme in Sweden during the years 1986-2002 were associated with changes in cost, volume and cost per volume of pharmaceuticals. Effects of changes in the reimbursement schedule during the study period were evaluated for all registered pharmaceuticals in Sweden and for five indicator drug groups. Five policy changes during the study period were assessed. Three concerned increased patient co-payment (January 1, 1991; January 1, 1995 and June 1, 1999), one the introduction of reference based pricing and increased co-payment (January 1, 1993) and one a new structure of the reimbursement schedule (January 1, 1997). The National Corporation of Swedish Pharmacies provided pharmaceutical delivery data for all Swedish pharmacies. Possible breaks in the trend associated with the investigated reforms were analysed with linear segmented regression analysis. This showed that increased co-payments were not associated with changed level or slope of cost and volume. The new reimbursement schedule was associated with a decreased level of cost and volume, both for all drugs combined and for several of the indicator drug groups. It was also associated with an increased slope for both volume and cost in some indicator drug groups and for all drugs. Introduction of reference based pricing was associated with a reduced slope of cost/defined daily doses (DDD) in all of the indicator drug groups and for all drugs. The analysis showed that major changes in the reimbursement system such as the introduction of a new reimbursement schedule and reference based pricing were associated with reductions in cost and volume for the new reimbursement schedule and cost per volume for reference based pricing.

Drug Costs↗

PubMed2005

Anti-inflammatory nuclear receptor superfamily in multiple sclerosis patients from Sardinia and Sweden.

Several nuclear hormone receptors have been associated with inflammatory reactions. Particularly, liver X receptors (LXRs) have recently been identified as key transcriptional regulators of genes involved in lipid homeostasis and inflammation. LXRs are negative regulators of macrophage inflammatory gene expression. Multiple sclerosis (MS), a demyelinating disease of the central nervous system of unknown cause, is characterized by recurrent inflammation involving macrophages and their inflammatory mediators. Sweden belongs to the countries with a high MS incidence. In Italy, the MS incidence is lower, except on the island of Sardinia where the incidence is even higher than in Sweden. Subjects from Sardinia are ethnically more homogeneous, and differ from Swedes also regarding genetic background and environment. We studied mRNA expression of several nuclear hormone receptors in blood mononuclear cells (MNC) from female patients with untreated relapsing-remitting MS from Sassari, Sardinia, and Stockholm, Sweden. Sex- and age-matched healthy controls (HC) were from both areas. mRNA expression was evaluated by quantitative real-time PCR. We found altered mRNA expression of LXRs, estrogen receptors (ERs), and androgen receptor (AR) in MS. mRNA expression of both LXRalpha and LXRbeta is lower in MS from Stockholm but not from Sassari. In particular, LXRalpha mRNA expression was significantly lower in MS from Stockholm as compared with all groups in the study including MS from Sassari. Low levels of ERalpha mRNA are seen in MS from both Stockholm and Sassari. The splice variant ERbetacx showed significantly higher mRNA expression in MS from Sassari and Stockholm as compared with corresponding HC. In particular, ERbetacx mRNA in MS from Sassari was remarkably higher as compared with all other groups in the study. Higher levels of AR mRNA are present in HC from Sassari. The findings indicate that the expression levels of anti-inflammatory nuclear receptor superfamily genes in MS appear to reflect both ethnic and environmental influences.

Adult↗

PubMed2004

A comparative study of the patterning of women's health by family status and employment status in Finland and Sweden.

The main aim of this study is to compare the patterning of health by family status and employment status among women in Finland and Sweden and to explore whether the patterning of health by family status is influenced by employment status and income. An additional aim was to identify which combinations of family status and employment status are especially disadvantageous for women's health . The data derived from comparable interview surveys carried out in 1994/1995. The analyses were restricted to ages 25-49; 2282 women in Finland and 2685 in Sweden. Firstly, age-adjusted prevalence percentages were presented by family status and employment status. Secondly, the patterning of health by family status and employment status, and the influence of adjusting for income, were studied by logistic regression analysis. The main results showed that women living in couples with children had the best health in both countries. Additional analyses showed that in Finland particularly poor health can be found among women who are simultaneously non-partnered and non-employed, whereas in Sweden poor health can be found among all non-employed groups of women. Income did not explain the poor health among the non-partnered and non-employed. This study confirmed that health is patterned by family status and employment status both among Finnish and Swedish women. It was found that non-employed women without a partner are likely to have poor health. In order to reduce inequalities in health among women, more efforts should be put on promoting health among these groups.

Adult↗

PubMed2005

Health inequalities by wage income in Sweden: the role of work environment.

The main aim of this study was to explore the mediating role made by work environment to health inequalities by wage income in Sweden. Gender differences were also analysed. Data from the Swedish Survey of Living Conditions for the years 1998 and 1999 were analysed. Employed 20-64-year olds with a registered wage were included (nearly 6000 respondents). Sex-specific logistic regressions in relation to global self-rated health were applied. Those in the lowest income quintile had 2.4 times (men) and 4.3 times (women) higher probability of less than good health than did those in the highest quintile (adjusted for age, family status, country of birth, education level, smoking and full-time work). The mediating contribution of work environment factors to the health gradient by income was 25 per cent (men) and 29 per cent (women), respectively. This contribution was observed mainly from ergonomic and physical exposure, decision authority and skill discretion. Psychological demands did not contribute to such inequalities because mentally demanding work tasks are more common in high income as compared with low income jobs. Using sex-specific income quintiles, instead of income quintiles for the entire sample, gave very similar results. In conclusion, work environment factors can be seen as important mediators for the association between wage income and ill health in Sweden. A larger residual effect of income on health for women as compared with men suggests that one's own income from work is a more important determinant of women's than men's ill health in Sweden.

Adult↗

PubMed2006

Population dynamics of Bordetella pertussis in Finland and Sweden, neighbouring countries with different vaccination histories.

Pertussis is an infectious disease of the respiratory tract in humans caused by Bordetella pertussis. Despite extensive vaccinations, pertussis has remained endemic and re-emerged. In Finland, a whole-cell pertussis vaccine has been used since 1952 with high coverage. In Sweden, whole-cell vaccinations were introduced in 1953 but ceased in 1979, and pertussis vaccinations with acellular vaccines were introduced in 1996. Two epidemic peaks occurred in Sweden in 1999 and 2002 and in Finland in 1999 and 2003. We compared Finnish (N=193) and Swedish (N=455) B. pertussis isolates circulating in 1998-2003 together with vaccine strains used in these neighbouring countries with different vaccination histories. The isolates were analysed by serotyping, genotyping of pertussis toxin S1 subunit and pertactin, and pulsed-field gel electrophoresis. The results suggest that the sequential epidemics were caused by clonal expansion of a certain B. pertussis strain possibly transmitted from Sweden to Finland. The roles of antigenic variation in immunity-driven evolution of B. pertussis in both countries are discussed.

Adolescent↗

PubMed2004

Seroprevalence of Dictyocaulus viviparus in first grazing season calves in Sweden.

A serological survey was carried out to determine the prevalence and geographical distribution of Dictyocaulus viviparus in calves after their first grazing season in Sweden. A total of 754 animals from 76 randomly selected herds in seven geographical regions were examined between September 24 and December 19, 2001. To get an indication about the geographical distribution of the infection 41 herds with beef-suckler calves were investigated. On each farm, blood was collected from 8 to 10 animals after an average of 26 +/- 24 days post-housing to determine specific IgG1 levels against a possible lungworm sperm antigen that is highly specific against patent infections of D. viviparus. We also investigated the seroprevalence of lungworm infection in relation to cattle management. In one region additional samples were analysed from 35 herds either with: (a) beef-suckling calves that were dewormed at housing, (b) untreated organically raised dairy calves, and finally from conventionally raised dairy calves either, (c) with or, (d) without a prophylactic anthelmintic treatment programme against gastrointestinal parasites on pasture. A questionnaire was used to obtain information about herd size and management, including measures to control nematode parasites on the farm. A total of 86 (11.8%) out of 754 animals had antibodies against D. viviparus, and at least one infected individual was detected in 30 (39.5%) of the 76 herds examined. Lungworm infected animals were found throughout the country and there was no significant differences between regions, although in southern and southwestern Sweden 70.0% of the herds were infected. Furthermore, there were no major differences in the seroprevalence in relation to management. Between 40.0 and 44.4% of the herds were infected irrespective of management, with the exception of calves from organic herds where no seropositive samples were found (0%). This result is in contrast to previous findings of lungworms in Sweden, and indicates that the parasite status on organic farms is diverse.

Animal Husbandry↗

PubMed2004

Trichinella pseudospiralis foci in Sweden.

In Sweden, the prevalence of Trichinella infection in domestic pigs has greatly decreased since the 1970s, with no reports in the past 4 years. However, infected wild animals continue to be found. The objective of the present study was to identify the species of Trichinella present in animals of Sweden, so as to contribute to the knowledge on the distribution area and hosts useful for the prevention and control of this zoonosis. In the period 1985-2003, Trichinella larvae were detected in the muscles of 81/1800 (4.5%) red foxes (Vulpes vulpes), 1/6 (16.7%) arctic fox (Alopex lagopus), 1/7 (14.3%) wolf (Canis lupus), 10/200 (5.0%) lynxes (Lynx lynx), 4/8000 (0.05%) wild boars (Sus scrofa), and 27/66 x 10(6) (0.000041%) domestic pigs. All four Trichinella species previously found in Europe were detected (Trichinella spiralis, T. nativa, T. britovi and T. pseudospiralis). The non-encapsulated species T. pseudospiralis was detected in three wild boars from Holo (Stockholm area) and in one lynx from Froso (Ostersund area), suggesting that this species is widespread in Sweden. These findings are consistent with those of a study from Finland, both for the unexpected presence of T. pseudospiralis infection and the presence of the same four Trichinella species, suggesting that this epidemiological situation is present in the entire Scandinavian region. The widespread diffusion of T. pseudospiralis in the Scandinavian region is also important in terms of it potential impact on public health, given that human infection can occur and the difficulties to detect it by the trichinelloscopic examination.

Animals↗

PubMed2000

Investigative interviews of child witnesses in Sweden.

OBJECTIVE: To evaluate the structure and informativeness of interviews with 4- to 13-year-old alleged victims of sexual abuse in Sweden. METHOD: Seventy-two alleged victims of sexual abuse were interviewed by six experienced officers from one police district in Sweden. Our evaluation focused on the structure of the interviews, the distribution and timing of the investigators' utterance types, and the quantity and quality of the information provided by the children. RESULTS: Content analysis revealed that the interviewers relied primarily on option-posing and suggestive questions--together, these comprised 53% of their utterances--when interviewing the alleged victims. As a result, most of the details (57%) obtained from the children were elicited by option-posing and suggestive utterances. Only 6% of the interviewers' utterances were open-ended invitations, and these elicited only 8% of the information obtained. CONCLUSION: The reliance on option-posing and suggestive prompts may have reduced the accuracy of the information obtained, thereby interfering with the investigations, and reducing the forensic admissibility of the children's statements. This suggests a continuing need in Sweden, as in other countries, for interview practices that enhance the quality of information provided by young victims.

Adolescent↗

PubMed1987

Epidemiology of hepatitis B in Sweden.

All the cases of clinical hepatitis B reported in Sweden since 1969 have been studied. The 10-year period 1976-1985 has been analysed intensively. For comparative purposes, the study also includes the hepatitis cases reported in 1962 and 1967. Serum hepatitis first affected young adults aged 15-24 years at the beginning of the 1960s. Cyclical outbreaks of hepatitis B due to transmission among drug abusers have been recognised since 1969. The disease was first observed in urban areas but later in rural parts of Sweden also. After 1976, a year in which outbreaks arose in various parts of Sweden, the numbers of hepatitis B cases decreased. In 1969, more than 50% of the cases reported as serum hepatitis concerned drug abusers. During the period 1976-1985, the main risk factor was drug abuse for between 20 and 52% of cases and sexual activity for between 8 and 28% of cases. Since 1969, 2-3% of cases annually have been related to blood-transfusion. In the last 5-year period, a total of 129 cases was reported among persons employed in the medical and dental fields. Of these, 59 had non-occupational exposure. During the same period, 33 patients reported contacts with infected persons, mostly household contacts. Seventy five persons had been travelling abroad.

Disease Outbreaks↗

PubMed2003

Implementation of prehospital thrombolysis in Sweden: components of delay until delivery of treatment and examination of treatment feasibility.

OBJECTIVE: To evaluate the feasibility of prehospital thrombolysis in Sweden in terms of safety and to examine the various components of the delay between onset of symptoms and start of treatment. SETTING: A total of 16 hospitals in Sweden in both urban and less populated areas and the associated ambulance organisations. DESIGN: Prospective evaluation of patients with an ST-elevation infarction treated with reteplase. An ECG was recorded and transmitted to hospital. The ambulances were staffed by a physician in 1% of cases, a nurse in 67% and a staff nurse in 32%. RESULTS: Of the 148 patients who received treatment prior to hospital admission, six (4%) had a cardiac arrest prior to hospital admission and two (1%) died prior to arrival at hospital. One patient was given treatment despite an exclusion criterion (previous stroke) and died on the 1st day in hospital due to a cerebral haemorrhage. The overall 30-day mortality was 7.1% and 1-year mortality 9.8%. Treatment was initiated within 2 h after the onset of symptoms in 53% of patients and within 1 h in 17% of patients. The median interval between the arrival of the ambulance and sending an ECG was 13 min and the median interval between sending an ECG and the start of thrombolysis was 18 min. The delay was similar regardless of ambulance staff. CONCLUSION: Implementation of prehospital thrombolysis on a national basis in Sweden appears to be safe. More than half the patients can be given treatment less than 2 h after the onset of symptoms. There is potential for reducing this time still further.

Aged↗