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High serum insulin, insulin resistance and their associations with cardiovascular risk factors. The northern Sweden MONICA population study.

OBJECTIVES: To estimate the prevalence of insulin resistance and high serum insulin levels and to investigate their relationship to other cardiovascular risk factors. DESIGN: Cross-sectional cardiovascular risk factor survey. SETTING: Northern Sweden. SUBJECTS: A subsample of the population-based Northern Sweden MONICA Study. This subsample underwent an oral glucose tolerance test after an overnight fast, and consisted of 354 men and 404 women in the 25-64-year age range. MAIN OUTCOME MEASURES: Delineation of low insulin sensitivity and high serum insulin by the diagnostic test technique, prevalence of these variables and their associations with cardiovascular risk factors. RESULTS: The participants were classified into four subgroups by an insulin sensitivity index and fasting serum insulin. The combination of low insulin sensitivity and high serum insulin was present in 17% of the male and in 18% of the female 25-64-year-old population. In both sexes this combination was closely associated (P < 0.001) with body mass index, waist-hip ratio, blood pressure and serum triglycerides, and correlated inversely with serum HDL cholesterol (P < 0.001). When high serum insulin was present as an isolated entity it was as closely associated with other cardiovascular risk factors such as isolated low insulin sensitivity, except that impaired glucose tolerance occurred exclusively in the group with isolated low insulin sensitivity. CONCLUSIONS: The combination of insulin resistance and high insulin levels is associated with a marked clustering of cardiovascular risk factors and is present in one-sixth of the middle-aged population in the north of Sweden.

Adult↗

The incidence and survival of acute de novo leukaemias in Estonia and in a well-defined region of western Sweden during 1982-1996: a survey of patients aged > or =65 years.

OBJECTIVES: To compare the incidence and survival of acute de novo leukaemias with particular reference to political/socio-economic and environmental factors in two neighbouring countries over the three 5-year periods (1982-1996). PATIENTS: The present report covers only patients diagnosed when aged > or =65 years. SETTING: A well-defined area of Sweden, the so-called Western Swedish Health Care Region and Estonia. Population-wise, the western Swedish Region and Estonia are very similar; area-wise they are also well comparable. RESULTS: The number of acute de novo leukaemias was quite dissimilar in the two countries (Estonia, n = 137, Sweden, n = 354). The age standardized incidence rates regarding the total number of acute de novo leukaemias was 5.31 per 100,000 inhabitants/year for Estonia and 7.99 for Sweden, this difference being statistically significant. However, the difference was merely attributable to incidence rates as regards acute myeloblastic leukaemias (AML); on the contrary, differences as regards acute lymphoblastic leukaemias (ALL) and non-classifiable, undifferentiated or biphenotypic acute leukaemias (uAL) were negligible. The relative survival for the total material of patients was significantly higher for Swedish when compared with Estonian patients (P < 0.001). Thus, the relative survival for the total material of patients aged > or =65 years in Estonia at 1 year was 8.5% and at 3 years 3.5% respectively. The corresponding figures for the Swedish patients were considerably higher, 22.7 and 7.7% respectively. This difference, however, applied only for patients with AML (P < 0.001), whereas the results for patients with ALL and uAL were equally dismal. CONCLUSION: The results clearly reflect how political and socio-economic factors may influence the survival of acute leukemia patients in two neighbouring countries.

Aged↗

Overwintering of Culex mosquitoes in Sweden and their potential as reservoirs of human pathogens.

1. Culex pipiens L. and Cx torrentium Martini are suspected enzootic vectors in Sweden of Sindbis virus causing Ockelbo disease in man. To estimate their potential as virus reservoirs over the winter, mosquitoes were collected from August to May from a cellar in a rural area, central Sweden. The mosquitoes were dissected and examined for blood content, gonotrophic stage, parity and insemination, and tested for fructose. 2. Cx pipiens, Cx torrentium and Cx territans Walker constituted 94% of 887 females caught. A few Culiseta annulata (Schrank), Cs. alaskaensis (Ludlow) and An. maculipennis Meigen s.l. were also collected. 3. Data suggested that all blood-fed, parous Culex females disappeared during the winter and that only non-bloodfed, nulliparous females survived. 4. Fructose, detected in some of these females, and other plant sugars may be the main energy sources for winter survival. 5. Unless transovarially or venerally infected, Culex females are presumably of no or very limited importance in rural, central Sweden as winter reservoirs for blood-borne pathogens of vertebrates.

Animals↗

Comparison of clinical significance and allergenic cross-reactivity of storage mites Blomia kulagini and Lepidoglyphus destructor in Sweden and Brazil.

Comparison of the clinical significance and allergenic cross-reactivity of Blomia kulagini (B. kulagini) and Lepidoglyphus destructor (L. destructor) was made on sera from Sweden and Brazil using the radio-allergo-sorbent test (RAST) and the RAST inhibition technique. RAST-positive sera were obtained from 53 allergic Swedish farmers and 31 allergic subjects from Brazil who were positive to B. kulagini and/or L. destructor. B. kulagini was shown to be a common cause of sensitization especially in Brazil. There was a fairly high correlation between positive RAST results to L. destructor and B. kulagini based on sera from both Sweden and Brazil. The highest RAST scores were found against L. destructor in Swedish sera and against B. kulagini in Brazilian sera. The RAST inhibition studies showed that the L. destructor extract was able to inhibit the B. kulagini system (a positive RAST to B. kulagini allergen disc) in Swedish but not in Brazilian sera. In contrast, the B. kulagini extract was only able to inhibit the L. destructor system in sera from Brazil and not in sera from Sweden. This study shows that results obtained with RAST inhibition are not entirely dependent on the overall specificity of the IgE antibodies in the patient's sera, since the more subtle specificity of the primarily sensitizing allergen will dominate. Thus, conclusions drawn regarding allergenic cross-reactivity are dependent on the populations tested, and conclusions on the existence or absence of cross-reactivity, e.g. between two species of mites may be contradictory.

Adolescent↗

High prevalence of IgE antibodies among blood donors in Sweden and Norway.

BACKGROUND: Reactions after a blood transfusion could be allergic because of passive transfer of immunoglobulin E (IgE) antibodies from allergic donors. AIMS OF THE STUDY: To compare spectrum and prevalence of IgE antibodies in blood donors from Sweden and Norway. METHODS: Using the ImmunoCAP method, serum samples from 1002 blood donors from Sweden and 500 from Norway were analysed for IgE antibodies to common inhalant and food allergens and allergens common in a hospital environment, such as penicilloyl G and latex. RESULTS: As many as 23.6-27.3% of the donors had IgE antibodies to at least one of the 14 allergens tested. Of these 6.8-16.7% had extremely high concentrations, i.e. >35 kU(A)/l corresponding to 100 times the cut-off for a positive allergy test. Most donors were sensitized to pollens, dander and mite but several had very high levels of IgE antibodies to penicilloyl G, latex and peanut. The pattern of sensitizing allergens differed between Sweden and Norway. CONCLUSIONS: High serum levels of IgE antibodies to various allergens are common among blood donors and the degree of sensitization and spectrum of involved allergen varies between geographical regions. Present routines to identify IgE sensitized, potential risk, donors are not satisfactory; the sensitivity of selection procedures is about 25%.

Allergens↗

Sjögren-Larsson syndrome in Sweden. A clinical, genetic and epidemiological study.

Sjögren-Larsson syndrome (SLS), originally described in Sweden, has been studied in a countrywide survey. A total of 58 SLS patients in 41 families were traced, 35 of them still alive. Thirty patients, 23 alive and seven deceased, have not been reported earlier. The mean incidences per 100,000 in the years 1901-1977 were 0.6 in the whole of Sweden, 10.2 in the county of Västerbotten and 2.7 per 100,000 in the county of Norrbotten. In the above-mentioned areas, the prevalence figures of SLS on 31st December 1978 were estimated to be 0.4, 8.3 and 2.6 per 100,000 persons, the frequencies of SLS gene carriers 0.5, 2.0 and 1.0%, and the gene frequencies 0.002, 0.010 and 0.005, respectively. Of the 58 identified Swedish SLS patients, 45 were born in a restricted area in the northeast of Sweden.

Adolescent↗

Qualitative study of pregnancy and childbirth experiences in Somalian women resident in Sweden.

OBJECTIVE: To explore the attitudes, strategies and habits of Somalian immigrant women related to pregnancy and childbirth, in order to gain an understanding as to how cultural factors might affect perinatal outcome. METHODS: Interpreter assisted qualitative in depth interviews around topics such as attitudes and strategies regarding childbirth. PARTICIPANTS: Fifteen women from the Somalian community in a city in Sweden, between the ages of 20 and 55 years with delivery experience in Somalia and Sweden. RESULTS: The interviews describe how the women themselves perceived their experiences of childbirth in the migrant situation. Many voluntarily decreased food intake in order to have a smaller fetus, an easier delivery and to avoid caesarean section. The participants considered a safe delivery to be the same as a normal vaginal delivery They reduced food intake in order to diminish the growth of the fetus, thereby avoiding caesarean section and mortality. The practice of food intake reduction, while rational for the participants when in Somalia, was found less rational in Sweden and may lead to suboptimal obstetric surveillance. CONCLUSIONS: Somalian women have childbirth strategies that differ from those of Swedish women. These strategies should be seen as 'survival behaviours' related to their background in an environment with high maternal mortality. The hypothesis generated is that there is a relationship between the strategies during pregnancy and adverse perinatal outcome among Somalian immigrants. Considering the strong association of the habits to safe birth, it seems doubtful whether the women will change their habits as long as health care providers are unaware of their motives. We suggest a more culturally sensitive perinatal surveillance.

Adult↗

Further considerations on the distribution of multiple sclerosis in Sweden.

OBJECTIVES: The geographic distribution of multiple sclerosis (MS) in Sweden over time was compared in order to analyze homogeneity. METHODS: The distribution of MS was compared among three nationwide resources: 1301 hospital cases 1925-1934; 5425 deaths 1952-1992; and 11,371 disability pension recipients 1971-1994. RESULTS: Distributions by county (lan) were markedly non-homogenous, with greatest variations in the early prevalence series (16-232% of the national mean), less within the death data (75-170%), and least for the disability series (87-128%). Maximal rates for MS in the early prevalence series were found for the cluster of seven counties surrounding the two major lakes of south central Sweden, as well as for one region on the northern shore of the Bay of Bothnia, and another also off the Bay north of Stockholm. CONCLUSION: Though the epidemiologic sources are quite different, they are internally consistent and thus provide three consecutive cross-sectional views of the distribution over time. When considered together the data may be compatible with a thesis of the origin and spread of MS within Sweden from the south-central inland lake regions of the country. Such spread within a half century is too rapid for a genetic cause, including HLA patterns.

Adolescent↗

Management of postmenopausal bleeding in Sweden: a need for increased use of hydrosonography and hysteroscopy.

BACKGROUND: The objective was to determine how postmenopausal bleeding (PMB) is managed in Sweden today, and to relate the findings to a new evidence-based algorithm for the management of PMB. METHODS: A questionnaire regarding the role of ultrasound and the use of different endometrial biopsy methods in the management of PMB was sent to all 61 gynecologic departments in Sweden. RESULTS: Fifty-nine of the 61 departments (97%) satisfactorily answered the questionnaire. Ultrasound was either always (n = 54, 92%) or most commonly (n = 5, 8%) used in the diagnostic work-up of PMB. In women with endometrial thickness < or =4 mm, 18 of the departments (31%) routinely sampled the endometrium; 12 (15%) followed the women with ultrasound; three (5%) did both sampling and follow-up with ultrasound; and the remaining 29 (49%) used expectant management (i.e. no biopsy or routine follow-up). In women with endometrium > or =5 mm, hydrosonography was performed routinely in two departments (3%), occasionally in 37 departments (63%), and never in 20 departments (34%). In women with endometrium > or =5 mm, endometrial biopsy was obtained routinely by Endorette/Pipelle in 39 departments (66%), while in 26 departments (44%) operative hysteroscopy was never performed. CONCLUSION: More than one-third of the gynecologic departments in Sweden never perform hydrosonography to rule out focal lesions or operative hysteroscopy for the removal of such lesions. Hydrosonography and hysteroscopy have a central role in the new guidelines for the management of PMB. Therefore, a need exists to broaden the use of hydrosonography and hysteroscopy.

Biopsy↗

Evidence of Rickettsia spp. infection in Sweden: a clinical, ultrastructural and serological study.

Sweden is an area potentially endemic for spotted fever rickettsioses. Rickettsia helvetica has been isolated from its tick vector Ixodes ricinus, and in a handful of cases linked to human disease. This study demonstrates for the first time in Sweden the transmission of rickettsial infection after a tick bite and the attack rate in an endemic area. We present three cases of documented rickettsial infection and a prospective serological study of Swedish recruits who were trained in the area where the patients lived and showed seroconversion to spotted fever rickettsiae. All patients showed a four-fold increase in antibody titer to the spotted fever rickettsia, R. helvetica, and immunohistochemical examination revealed rickettsia-like organisms in the walls of skin capillaries and veins. Electron microscopy showed organisms resembling R. helvetica and immunogold labeling with two anti-rickettsial antibodies demonstrated specific labeling of the rickettsial organisms in the skin biopsy specimens. Eight of the thirty-five recruits showed a four-fold increase in IgG titer reflecting a high rate of exposure. The results of this study demonstrate that spotted fever rickettsioses should be taken into consideration in the diagnosis of tick-transmitted infections in Sweden.

Aged↗

A longitudinal study of oral health in immigrant children in Sweden.

Children immigrating into Sweden from Finland and Southern Europe (Greece, Yugoslavia and Turkey) were subjected to a longitudinal study on caries activity and gingival condition. For each immigrant child a Swedish "twin" of the same sex and age was used as a control. Out of 124 pairs originally examined, 75 were reexamined after a 2 1/2-year stay in Sweden. The study showed that on arrival in Sweden the Finnish children had more caries and a higher Gingival Index (GI) than the controls and that they acquired more carious lesions during their stay in this country. Their GI, however, did not develop less favorably than that of the Swedish controls. The South-European children did not seem to have more carious lesions than the Swedish controls on arriving, nor did they seem to acquire more carious lesions during the period of observation. Their GI was higher at the first examination but the change in this index ran parallel with that of the controls. It was concluded that the children immigrating from Finland should be considered a risk group with regard to oral health.

Adolescent↗

Social background and dental care habits and attitudes of Finnish immigrants in Sweden.

Foreign citizens today constitute 5% of the Swedish population. While several epidemiological investigations have dealt with dental care habits in the Swedish population, very little is known about the dental care habits of immigrants. This constitutes a factor of uncertainty in the planning of dental care. A random sample of 170 Finnish immigrants, 20-80 years old, in the community of Huddinge was selected. They were summoned to the Faculty Clinics for interview and clinical and radiographic examination. 143 persons appeared for examination. The interview showed that 46.6% of the subjects had never visited a dentist in Sweden though 80% of them intended to remain in Sweden. 19.8% still made more or less regular use of dental services in Finland. The low frequency of utilization of dental services is mainly due to the difficulty in obtaining dental care, lack of knowledge of Swedish, lack of interest and fear of pain. According to the present study Finns in Sweden utilize dental services to a smaller extent than Swedes. The decision of principle adopted by the Swedish parliament in 1968 that immigrants shall be able to live under the same conditions as the Swedes seems not to be fully achieved with regard to the dental care of Finnish immigrants.

Adult↗

Treatment of caries and periodontitis in Sweden in 1974-77.

During 1974 and 1975 a sample of individuals in Sweden between 20 and 60 years were interviewed about dental care habits. 938 of them were then clinically examined. An estimation of the time needed for treatment of dental caries and periodontitis was based upon the clinical examination. Dental status and the estimated treatment time were then related to the dental care carried out during one period of 18 months and one of 48 months after the clinical examination. For these calculations, information on dental care was acquired from the patient register of the National Social Insurance Board. The results derived from the analyses showed that the requisite time for treating caries related well to the treatment executed. On the other hand the time for treating periodontal disease showed a poorer agreement with what could have been expected from the clinical periodontal status. The treatment time devoted to periodontal disease was considerably higher in the metropolitan areas, with their higher density of dentists, than in other parts of Sweden. Thus, dental care in Sweden between 1974 and 1978 concentrated primarily on restorative procedures while a progression of periodontal disease was largely ignored by dental practitioners.

Adult↗

Congenital hypothyroidism in Sweden. Incidence and age at diagnosis.

A total number of 112 children with congenital hypothyroidism were diagnosed in all Children's Hospitals and Pediatric Wards in Sweden during the 7-year period 1969-1975. Since it may be assumed that all cases of congenital hypothyroidism, which were diagnosed during that period were seen in one of these hospitals, the incidence of congenital hypothyroidism in Sweden can be calculated to be 1:6900 live births. In spite of an efficient National Health Care Program for infants the diagnosis was delayed until after an age of three months in 52% of the cases. This fact supports the view that mass screening of newborns for congenital hypothyroidism has to be introduced in Sweden. However, the beneficial effects of such a program cannot be fully elucidated until it has been considered whether earlier instituted treatment would have improved the outcome of children in whom a diagnosis was made after 3 months of age.

Age Factors↗

The incidence of coeliac disease in children in south-east Sweden.

Among children born between 1969 and 1977 in two areas of south-east Sweden an initial flat small intestinal mucosa was found in 84 cases, 64 of whom were considered to have coeliac disease (CD) diagnosed mostly according to the criteria formulated by the European Society for Paediatric Gastroenterology and Nutrition. The incidence of CD was 1/859, which is in agreement with that of a recent report from south Sweden. This suggests that the incidence of CD is the same in the whole of Sweden. In the present study all patients with an initial flat mucosa improved clinically and histologically after 1 year or more on a gluten-free diet. When challenged with gluten, 19% did not relapse within 2 years, thus fulfilling the criteria for so-called transient gluten intolerance. These patients had a lower mean age of symptom debut and for first biopsy, compared with the patients with CD.

Celiac Disease↗

Incidence and survival curves of cystic fibrosis in Sweden.

A registry of all patients with cystic fibrosis (CF) in Sweden has been kept since 1968. During the 10-year period 1968-1977 the number of CF patients in Sweden increased by about 8-9 per year, i.e. from 116 to 200, the median age of patients increased from 5 to 11 years, the percentage of patients above 18 years of age increased from 3 to 9 of the total CF population, and the median survival age increased from 7.5 to 16 years. For CF patients born without meconium ileus the median survival age in 1973-1977 was 17.8 years. From these figures the incidence of CF in Sweden is estimated to be 1 : 2200 to 1 : 4500. Several factors may have contributed to the improved outcome for CF patients, such as better medical treatment with more intensive physical therapy, the use of inhalation therapy and new antibiotics, improved social care and intensified information.

Adolescent↗

Sudden infant death syndrome in Sweden in 1973-1977 and 1979.

The aim of the investigation has been to describe Sudden Infant Death Syndrome, SIDS, in Sweden, its background, true incidence and epidemiological characteristics, and finally to offer possibilities of prophylaxis. The method used has entailed a retrospective survey of all 1,873 post-perinatal (1-51 weeks) deaths from six birth cohorts in 1973-1977 and 1979. Through comprehensive documentation, 334 deaths have been isolated as SIDS. The result was an incidence of 0.54/1000 live births. Internationally, this incidence is low, but the study could establish that SIDS increased during 1973-1977 and 1979 in Sweden. The epidemiological characteristics shown by the study agree to an extent with American and British investigations, but reported Swedish incidence is lower. An assessment of the total post-perinatal mortality has also been made to demonstrate that there is no communication between SIDS with a uniform diagnosis and other causes of death. Analysis has been binary: in relation to factors in society, and on an individual basis. Geographical or social bases did not affect incidence of SIDS in Sweden, which is remarkable when comparing these findings with other reports on the subject. In regards to individuals, the analysis has been based upon the place where the infant died. Deaths in the infant's own bed showed a clear rise on Saturdays, but the incidence here remained constant over the period studied. Deaths in bed with one/two adults showed epidemiological findings which indicated disadvantageous family and social factors in many cases; this group increased from year to year. Deaths outdoors were common in winter; a certain increase towards the end of the week as well as from year to year was indicated. No social strain was shown. Deaths during car rides clearly increased from year to year, but showed no particular socio-familial profile nor weekday variation. Findings analyzing location of death have indicated that the different places have their own epidemiological characteristics distribution. Analyses of this sort are scarce. There were no certain indications of SIDS occurring more often in socially disadvantageous circumstances: 4/5 of the SIDS families had no social strain. The study has also included medico-historical notes, e.g. 'over-laying' and a description of epidemiological/pathological and forensic aspects of sudden infant death from Stockholm during the 1840s. SIDS means that neither anamnesis nor a thorough autopsy can explain the death. SIDS may be considered a dysfunction syndrome, in which endogenous and exogenous factors act together and silently lead to death.(ABSTRACT TRUNCATED AT 400 WORDS)

Female↗

First information and support provided to parents of children with Down syndrome in Sweden: clinical goals and parental experiences.

UNLABELLED: When parents are informed that their newborn child has Down syndrome (DS), they often respond with a traumatic crisis reaction. The aims of this study were to assess the clinical goals regarding the first information and support provided to parents of newborn children with DS at the Swedish paediatric departments, and to analyse the parents' experiences of how they were first informed and treated. Data were collected during 1992-1993 from all of the 51 departments of paediatrics in Sweden. Information on the parents' experiences, collected retrospectively in 1996, was based on recollection by 165 parents of 86 children with DS born between 1989 and 1993 at 10 of the paediatric departments considered representative for Sweden. Seventy-five percent of the families were informed about the diagnosis within 24 h post partum. Some parents felt they were informed too late, and a few parents that they were told too soon. Half of the parents were satisfied with the timing. About 70% of the parents considered the information insufficient and 60% felt that they had been unsupported. Seventy percent would have liked more frequent information. Parental criticisms concerning the way in which the information was provided were that they received too much negative information about DS and that both the communication skills and the basic knowledge of DS on the part of the professionals could have been better. CONCLUSION: The Swedish paediatric departments fall short of their reported strong clinical goals regarding the initial information in Sweden, and improvements in this area are desirable.

Adaptation, Psychological↗