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PubMed1999

Gender and cataract surgery in Sweden 1992-1997. A retrospective observational study based on the Swedish National Cataract Register.

PURPOSE: To study the gender difference in total utilisation of cataract surgery in Sweden during the years 1992-1997. METHODS: The study is based on data from the National Swedish Cataract Register which covers about 95% of all cataract operations performed in Sweden during the study period. RESULTS: Utilisation of cataract surgery in Sweden was significantly higher in females than in males for all age groups between 50 and 89 years of age during the period 1992-1997. This gender difference was more pronounced for second eye surgery than first eye surgery in most age groups. The gender difference varied also depending on the pre-operative visual acuity. CONCLUSION: The cataract surgery rate was significantly higher for females compared to males during the study period. Three hypotheses to explain the gender difference are discussed.

Aged↗
PubMed2002

Endophthalmitis following cataract surgery in Sweden. The 1998 national prospective survey.

PURPOSE: To investigate the morbidity of postoperative endophthalmitis (POE) following cataract surgery in Sweden in 1998. METHODS: Clinically presumed cases of POE were reported in a prospective survey in which all Swedish ophthalmic surgical units except one had agreed to participate. Data on intraocular cultures and visual outcomes at 3 months after infection were supplied. Surgical cases that became infected were identified in the Swedish National Cataract Register, thereby enabling screening for various putative risk factors. RESULTS: The nationwide incidence of POE amounted to 58 cases out of 54 666 cataract operations, or 0.1% of surgical cases. The predominant aetiology was gram-positive bacteria, which comprised 57% of the material. Acrylic intraocular lenses were found to decrease the risk of POE significantly in comparison to hydrogel and polymethylmethacrylate lenses. CONCLUSIONS: The incidence of POE after cataract surgery in Sweden is similar to that currently reported elsewhere in the developed world. We hope that continued registration of cases of POE in Sweden will shed light on the possible influences of various prophylactic measures and different intraocular lens materials on the development of postoperative infection.

Cataract↗
PubMed2001

Social inequality in oral health and use of dental care in Sweden.

OBJECTIVE: To describe oral health and use of dental care in relation to socio-economic determinants over time in Sweden. METHODS: Cross-sectional study based on interview data on two randomly sampled sequential populations consisting of 7,610 Swedish adult (25-64 years) residents and 4,315 children (3-15 years) in their households from the Survey of Living Conditions 1996-97, and 7,649 adult Swedish residents (25-64 years) from the survey of 1988-89. RESULTS: Low educational level, having no cash margin and being born outside of Sweden was associated with higher odds of problems with chewing, wearing a prosthesis and not having been treated by a dentist during the 24 months preceding the interview, in a logistic regression analysis of data from the 1996-97 survey in the adult study population (adjusted odds ratios 1.6-2.9). The same socio-economic determinants were associated with caries in children (adjusted odds ratios 1.2-1.5). The socio-economic differences in dental treatment and problems with chewing were greater in the age group 45-64 years compared to 25-44-year-olds. The prevalence of problems with chewing increased from 7.1% (95% CI 6.5-8.1) in the 1988-89 survey to 9.1% (8.4-9.8) in the 1996-97 survey. A similar increase, from 2.4% (2.2-2.6) to 4.4% (3.9-4.9) was observed for individuals not having been in dental treatment during the last 24 months. The socio-economic distribution of oral health and use of dental care in the adult population was similar in the two surveys. CONCLUSION: This study demonstrates that socio-economic differences in oral health and use of dental care are most marked in older (45-64 years) adults in Sweden, but are significant in young adults and, in terms of oral health, in children as well. A steep increase in user charges during the 1990s has been paralleled by a moderate increase in problems with chewing and the proportion of the population that has no regular dental care, which suggests a link that needs to be evaluated in further studies.

Adolescent↗
PubMed1972

A comparison between England and Wales and Sweden in the incidence and mortality of malignant skin tumours.

Although the population lives in a higher latitude, the incidence of and death rate from skin cancer is approximately the same in Sweden as it is in England and Wales. The proportion of malignant melanoma is higher in the Swedish deaths and the death rate from malignant melanoma is higher in Sweden than in England and Wales.The ratios of male to female cases and deaths from malignant melanoma are higher in Sweden than in England and Wales.These differences do not appear likely to be due to differences in the statistical or medical care systems, and suggest important genetic and occupational effects.Total skin cancer rates and rates summarizing all ages may be poor indicators of the real variations between populations in the epidemiology of malignant skin tumours.

Adult↗
PubMed2005

Health and quality of life of persons with spinal cord lesion in Australia and Sweden.

STUDY DESIGN: Cross-sectional questionnaire study. OBJECTIVES: The aim of the study was to demonstrate the value of common general health-related quality of life (HRQL) instruments, readily available for cross-cultural comparisons, in persons with spinal cord lesion (SCL) treated at spinal units in Melbourne, Australia and in Gothenburg, Sweden. Another aim was to determine as to which of the independent variables were the most powerful predictors of global QL in the two SCL groups. SETTINGS: Australia and Sweden. METHODS: Two groups consisting of 89 Australian and 71 Swedish SCL persons were surveyed. The two groups were matched according to sex, age, time since injury and level of injury. The 36-item short-form health survey (SF-36) and the Spinal Cord Injuries Quality of Life-23-item questionnaire were used to cover essential generic and specific domains of health and quality of life. Clinical and sociodemographic data were collected using questionnaires. For interpretation purpose, available general population data were used. RESULTS: The most important predictors of QL perception in the Australian group were the same as for the Swedish group; mood, physical and social functioning and problems regarding injury. In total, 61% (Australian group) and 52% (Swedish group) of the variance was explained by these variables. Despite similarities of health profiles, some areas of the SF-36 differed between the two groups. CONCLUSION: The demonstrated HRQL profiles in SCL persons have shown that valid measures can provide new information of clinical value beyond the self-evident physical and practical restrictions due to injury. Illustrative comparisons, such as those presented here between Australia and Sweden, may extend our knowledge about areas where the SCL persons themselves are the logical experts, for example, maintenance of personal roles, social interaction and emotional well-being.

Activities of Daily Living↗
PubMed2002

Dietary interventions in Finland, Norway and Sweden: nutrition policies and strategies.

AIMS: To describe the organization and implementation of nutrition policies, and examine intervention strategies for dietary change in three Scandinavian countries. METHODS: Descriptions of nutrition policies and dietary intervention strategies are based on published nutrition policy research and reports. RESULTS: All countries studied have adopted formal nutrition policies. Norway issued its first white paper in 1976, the Finnish National Nutrition Council published an action plan in 1989, and the Swedish Government issued an official action plan in 1995. Norway has a centralized National Nutrition Council with a permanent administration whereas the responsibilities and administration are more spread out between several authorities and groups in Finland and Sweden. Amongst the dietary intervention strategies employed, a Norwegian nutrition campaign, symbol labelling of foods in Sweden, the community-based North Karelia Project in Finland, and mass catering in Finland and Sweden have been selected as potentially transferable. CONCLUSIONS: Policy documents serve as guidelines for activities and assist in achieving dietary targets. A responsible administrative body with advice from a standing expert committee is valuable for implementation. Guidelines, recommendations or voluntary labelling standards can be incentives to product development and changes to food production. Regional demonstration projects may also encourage action and collaboration.

Finland↗
PubMedDate not supplied

Influence of macrostructure of society on the life situation of families with a child with intellectual disability: Sweden as an example.

BACKGROUND: Most studies on families with children with intellectual disability (ID) have been carried out in the UK or the USA, and are influenced by the societal organization, and political and economic climate of those countries. In the USA and the UK, the care and well-being of children, with or without ID, are seen almost exclusively as the individual family's responsibility. In Sweden, the care and well-being of children are seen more as a joint responsibility. Swedish society has developed many privileges for all parents in order to help them care for their children, and the support for parents of children with disabilities is provided exclusively by the Government and the community. The overall question explored in this descriptive, quantitative and qualitative study was: Are families in Sweden experiencing the stressors and life situations described in the studies of parents in more individualistic societies? METHODS: Two hundred and twenty-six families with children with ID and 234 control families with children ranging from 0 to 16 years of age answered mail surveys. RESULTS: Taken together, parents in Sweden describe most of the stressors proposed in the international literature with the exception of financial strain. Restricted social life and time restrictions seem to be the two most evident and bothersome stressors for Swedish families with children who have ID. CONCLUSIONS: As in previous research, the parents of children with ID and autism experienced more stressors and restrictions in their lives than the parents of children with DS and control families.

Adolescent↗
PubMed1999

Costs of coronary heart disease and stroke: the case of Sweden.

OBJECTIVES: To estimate the annual costs in Sweden of coronary heart disease (CHD) and stroke, and the potential cost savings if these clinical 'events' are avoided. The analysis is undertaken from a societal perspective, including both direct and indirect costs. Costs are calculated for five clinical conditions: (i) acute myocardial infarction (AMI), (ii) angina pectoris (AP), (iii) unstable angina (UA), (iv) congestive heart failure (CHF), and (v) stroke. DESIGN: A retrospective study including patients admitted to the Department of Medicine at Södertälje Hospital during the period January 1993 to March 1995 with CHD or a stroke. Each patient was followed for 1 year after admission to the hospital. To estimate potential cost savings, the patient was used as his or her own control. The potential savings in direct costs if CHD or a stroke is avoided were estimated as the difference between costs for 1 year after and 1 year before the event. The indirect costs were calculated as the difference between the values of market production of goods and services the year before the event and the year after. SETTING: The Department of Medicine at Södertälje Hospital, Södertälje, Sweden. SUBJECTS: The patients included in the study were patients at the Department of Medicine at Södertälje Hospital in Sweden. The inclusion criterion was that the patients should have been admitted for the first time for CHD or stroke during the year 1994. To obtain 25 patients for each clinical category we first had to expand the inclusion period to cover January 1993 to March 1995. Secondly, we also had to include 36 patients with an earlier established uncomplicated CHD or stroke. Despite this, no more than 22 patients with UA were found. INTERVENTIONS: Patients were followed in medical practice. MAIN OUTCOME MEASURES: Costs, direct and indirect costs, and potential savings. RESULTS: The mean direct costs during the year after a clinical event range between Swedish kronor (SEK) 41 000 for CHF and SEK 96 000 for stroke, whereas the mean potential savings in direct costs range from SEK 36 000 for CHF to SEK 91 000 for UA. The potential mean savings in indirect costs range between SEK 24 000 for CHF and SEK 102 000 for AMI. The direct costs for first-time patients are lower than those for patients with an earlier established CHD or stroke. No systematic differences have been found in potential direct cost savings and indirect costs between the two patient groups. CONCLUSIONS: CHD and stroke are associated with high costs during the year after admission to the Department of Medicine. There are also large potential cost savings from the prevention of CHD and stroke. However, further studies, including more patients and costs arising in the municipality, are needed to establish more precise and complete estimates of the costs related to CHD and stroke.

Aged↗
PubMed2003

Evolving patterns of tobacco use in northern Sweden.

BACKGROUND AND OBJECTIVES: Cross-sectional data from northern Sweden suggest that the increased use of Swedish moist snuff (snus) may have contributed to a decline in the prevalence of smoking, especially amongst men. This study describes the evolving patterns of tobacco use in this population over the period 1986-1999. DESIGN: This is a prospective follow-up study of 1651 men and 1756 women, aged 25-64 years, who were enrolled in the northern Sweden MONICA project (entry in 1986, 1990, 1994) and who were followed-up in 1999. Information on tobacco use at entry and at follow-up was used to describe the stability of tobacco use over a period of 5-13 years ending in 1999. RESULTS: Snus was the most stable form of tobacco use amongst men (75%); only 2% of users switched to cigarettes and 20% quit tobacco altogether. Smoking was less stable (54%); 27% of smokers were tobacco-free and 12% used snus at follow-up. Combined use (smoking and snus) was the least stable (39%), as 43% switched to snus and 6% switched to cigarettes. Former users of both products were much less stable than former users of either cigarettes or snus. The stability of smoking amongst women was 69%, which was higher than that amongst men (P < 0.05). CONCLUSIONS: The use of snus played a major role in the decline of smoking rates amongst men in northern Sweden. The evolution from smoking to snus use occurred in the absence of a specific public health policy encouraging such a transition and probably resulted from historical and societal influences.

Adult↗
PubMed2003

Increasing body mass index at diagnosis of diabetes in young adult people during 1983-1999 in the Diabetes Incidence Study in Sweden (DISS).

OBJECTIVE: To study trends in body mass index (BMI) at diagnosis of diabetes in all young Swedish adults in the age range of 15-34 years registered in a nation-based registry. DESIGN: The BMI was assessed at diagnosis in diabetic patients 15-34 years of age at diagnosis, for a period of 17 years (1983-1999). Islet cell antibodies (ICA) were measured during three periods (1987-1988, 1992-1993 and 1998-1999). SETTING: A nationwide study (Diabetes Incidence Study in Sweden). SUBJECTS: A total of 4727 type 1 and 1083 type 2 diabetic patients. MAIN OUTCOME MEASURES: Incidence-year specific BMI adjusted for age, gender and time of diagnosis (month). RESULTS: Body mass index at diagnosis increased significantly both in type 1 (21.4 +/- 3.6 to 22.5 +/- 4.0; P < 0.0001) and in type 2 (27.4 +/- 6.8 to 32.0 +/- 6.0; P < 0.0001) diabetic patients, also when adjusted for age, gender and month of diagnosis. A similar significant increase in BMI was found in type 1 diabetic patients and in type 2 diabetic patients in the periods 1987-1988, 1992-1993 and 1998-1999; years when ICA were assessed and considered in the classification of diabetes. Despite this increase in BMI, there was no increase in the incidence of diabetes in young-adult people in Sweden. CONCLUSION: Body mass index at diagnosis of diabetes in subjects 15-34 years of age has substantially increased during 1983-1999 in Sweden when adjusted for age, gender and month of diagnosis.

Adolescent↗
PubMed2001

Long-term survival in transfusion recipients in Sweden, 1993.

BACKGROUND: Survival and characteristics of transfusion recipients have not been studied enough, although they represent key measures in cost-effectiveness analyses of various donor screening procedures. STUDY DESIGN AND METHODS: Hospital and blood bank records were collected on all patients in Orebro County, Sweden, from March through May 1993 (1111 transfusion episodes) and a random sample from Stockholm County during April 1993 (793 transfusion episodes). All patients were then matched with the national register of deaths in Sweden during a follow-up period of 40 months. RESULTS: The median patient age was 71 years and the median transfusion total was 2 units. Only 35 percent of the patients were under the age of 65, 9 percent under 40, and 1.6 percent under 1 year. About half (56%) were women. Among the Orebro patients, 47 percent were surgical and 29 percent internal medicine patients. Of 1720 patients whose survival could be investigated, 66 percent were alive after 1 year and 51 percent after 40 months. The survival rates were rather similar in patients receiving RBCs and plasma but lower in those receiving platelets. CONCLUSION: The survival of patients transfused in Sweden in 1993 differered significantly from estimations based on studies from the 1980s. This difference has major implications for the estimations of cost-effectiveness of blood donor screening for infectious agents.

Aged↗
PubMed2000

Somalis giving birth in Sweden: a challenge to culture and gender specific values and behaviours.

OBJECTIVES: Giving birth in a foreign country implies going through a life event with little or no access to your own traditions and social support. The aim of this study was to study the childbirth experiences of Somali women and men in Sweden. DESIGN: Qualitative. Nine women and seven men were interviewed. Data collection was characterised by an openness to new ideas during the interview and the interviews were analysed according to the grounded theory technique. FINDINGS: The meeting of Somalis with Swedish antenatal and delivery care was a multicultural event. It revealed social, medical, cultural and gender factors advocating space in the arena of childbirth. The Somalis constituted a homogeneous group with regard to their cultural belonging and motives for exile. The subjects were heterogeneous in that they represented a great variety in social and demographic background as well as in experiences, feelings and modes of expression. One striking finding was the Somali man's dramatic entrance into childbirth, which seemed to have a strong impact on the Somali woman's well-being during delivery. The study showed difficulties in getting used to the Swedish model of parenthood and in finding new role divisions in the couple relationship. Some of the subjects had experienced a strengthening of their marriage and an increased understanding of each other. Others commented that various aspects of traditional womanhood and manhood were lost as a result of the unfamiliar gender structures in Sweden. CONCLUSION: The Somalis' experiences of childbirth in Sweden can be understood by using the theoretical concept of gender, rather than culture. Our own and other studies show that women and men may have different frames of reference in childbirth, where the women mainly focus on biological circumstances and the men on the social and cultural aspects of birth. The Somali couple were found to be vulnerably positioned, with the professionals having the important role of supporting and empowering Somali parents.

Culture↗
PubMed1995

Survival after the age of 80 in the United States, Sweden, France, England, and Japan.

BACKGROUND: In many developed countries, life expectancy at birth is higher than in the United States. Newly available data permit, for the first time, reliable cross-national comparisons of mortality among persons 80 years of age or older. Such comparisons are important, because in many developed countries more than half of women and a third of men now die after the age of 80. METHODS: We used extinct-cohort methods to assess mortality in Japan, Sweden, France, and England (including Wales) and among U.S. whites for cohorts born from 1880 to 1894, and used cross-sectional data for the year 1987. Extinct-cohort methods rely on continuously collected data from death certificates and do not use the less reliable data from censuses. RESULTS: In the United States, life expectancy at the age of 80 and survival from the ages of 80 to 100 significantly exceeded life expectancy in Sweden, France, England, and Japan (P < 0.01). This finding was confirmed with accurate cross-sectional data for 1987. The average life expectancy in the United States is 9.1 years for 80-year-old white women and 7.0 years for 80-year-old white men. CONCLUSIONS: For people 80 years old or older, life expectancy is greater in the United States than it is in Sweden, France, England, and Japan. This finding suggests that elderly Americans are receiving better health care than the elderly citizens of other developed countries.

Aged↗
PubMed1995

An epidemiologic study of Lyme disease in southern Sweden.

BACKGROUND: Lyme disease is the most common vector-borne infection in some temperate regions of the Northern Hemisphere. However, for most areas of endemic disease reliable epidemiologic data are sparse. METHODS: Over a one-year period, we conducted a prospective, population-based survey of cases of Lyme disease in southern Sweden. The diagnosis was made on the basis of the presence of erythema migrans at least 5 cm in diameter or characteristic clinical manifestations such as arthritis, neuroborreliosis, and carditis. RESULTS: We identified 1471 patients with Lyme disease, for an overall annual incidence of 69 cases per 100,000 inhabitants. The incidence varied markedly according to geographic region, and there were several areas where disease was widely prevalent. The incidence varied according to age, with the highest rates among people 5 to 9 and 60 to 74 years of age, but not according to sex. The most frequent clinical manifestation was erythema migrans (seen in 77 percent of all cases), followed by neuroborreliosis (16 percent) and arthritis (7 percent). Carditis was rare. A preceding tick bite was reported by 79 percent of the patients. Bites in the head and neck region were more common among children than among adults and were associated with an increased risk of neuroborreliosis. CONCLUSIONS: Lyme disease is very common in southern Sweden, with a relatively high frequency of neurologic complications and arthritis. With the exception of the low incidence of carditis, the pattern of disease we found in Sweden was similar to that reported in the United States.

Adolescent↗
PubMed2002

Cervical injuries in Sweden, a national survey of patient data from 1987 to 1999.

Neck injuries are one of the most important injuries as they have the potential to influence the spinal cord. Data from most parts of the world are not sufficient to define a comprehensive view of mortality, morbidity, disability and handicap due to neck injuries. In Sweden, there are no data on the incidence of neck injuries. The aim of this study is to define the national incidence and causes of neck injuries in Sweden. An incidence study was undertaken with data from the injury surveillance program at the Swedish National Board of Health and Welfare. The investigation includes cervical vertebral fractures reported between 1987 and 1999, and cervical soft tissue injuries over a period of three years, from 1997 to 1999. Data between 1987 and 1996 were reported in ICD 9, while data from 1997 to 1999 were reported in ICD 10. During the study period, 14,310 non-fatal and 782 fatal cervical injuries occurred. A decreasing incidence for cervical fractures can be seen for the Swedish population, except for the elderly that have a slight increase in incidence. The incidence for cervical soft tissue injuries is almost constant. Cervical fractures demand longer periods of hospitalization than the soft tissue injuries. Transportation-related cervical fractures have dropped since 1991, while soft tissue injuries increased slowly between 1997 and 1999. Fall accidents are now the largest external cause of cervical fractures, and the population above 65 years accounts for almost 50% of the fall accidents. The male population has a higher incidence of cervical fractures, disregarding age. It is concluded that safety programs for transportation-related injuries in Sweden have been successful, while fall accidents are still substantial. Much more can be done to prevent neck injuries; especially to reduce the number of transportation-related cervical soft tissue injuries and fall injuries in the elderly population.

Adolescent↗
PubMed2005

The economic cost of low back pain in Sweden in 2001.

BACKGROUND: Low back pain (LBP) is a common cause of lost work days and disability. In 2001, expenditure for back pain represented 11% of the total costs for short-term sick leave in Sweden, and about 13% of all early retirement pensions were granted for back problems, of which LBP is the most important symptom. The magnitude of LBP as a health problem justifies a closer look at its burden of illness to society. MATERIALS AND METHODS: We assessed the costs of LBP to society in Sweden in 2001. The study was conducted in a cost-of-illness framework, measuring both the direct costs of providing health care to LBP patients, and the indirect costs as the value of the production that is lost because people are too ill to work. The costs were estimated by a prevalence and top-down approach. RESULTS: The total cost of LBP was 1860 million EUR in Sweden in 2001. The indirect costs due to lost productivity accounted for 84% of the total cost. INTERPRETATION: The cost of illness due to low back pain was substantial, but does not appear to have risen during the last 10-15 years.

Adolescent↗
PubMed2003

Antibiotic resistance among Campylobacter jejuni/coli strains acquired in Sweden and abroad: a longitudinal study.

Antibiotic resistance was compared in 844 Campylobacter jejuni/coli strains acquired outside Sweden and 575 acquired in Sweden during 1990-2002. There was a clear gradual increase in ciprofloxacin and tetracycline resistance among C. jejuni/coli strains acquired outside Sweden during the 13 y period. This trend was not seen for erythromycin or in domestically acquired strains for any of the 3 antibiotics tested.

Anti-Bacterial Agents↗
PubMed2006

Seroprevalence of Toxoplasma gondii in Sweden, Estonia and Iceland.

Toxoplasmosis is a disease caused by the intracellular protozoan parasite, Toxoplasma gondii which infects up to one-third of the world human population. Toxoplasmosis in neonates and immunocompromised patients can lead to severe disease and death. We investigated the prevalence and risk factors for T. gondii infection in Iceland, Sweden and Estonia, and tested the hypothesis that T. gondii infection causes systemic inflammation and protects against atopy. Blood samples were collected from 1277 randomly selected subjects. The presence of T. gondii IgG antibodies was determined by an ELISA method and levels of Hs-CRP by immunoturbidimetric assay. The prevalence of T. gondii antibodies was 54.9% in Tartu, 23% in Uppsala and 9.8% in Reykjavik (p<0.0001). The risk of positive T. gondii antibodies increased with the number of siblings and with age in Sweden. T. gondii infection was associated with asthma related symptoms and increased Hs-CRP (p = 0.02). No association was found with IgE-sensitization and lung function. We concluded that risk factors for T. gondii infection suggested that soil exposure was 1 of the mechanisms in all 3 countries and a meat-associated infection route is a risk in Sweden.

Adult↗