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PubMed1991

Health professionals' opinions regarding abortions and the abortion law in samples from Italy and Sweden.

The present study was undertaken to investigate the opinions of health professionals working in family planning clinics in Italy and Sweden. The comparison of two such different countries seemed of interest both to describe differences and/or similarities between the samples as well as to analyze factors that could influence professionals' opinions regarding abortion. A questionnaire was distributed to doctors, nurses and social workers in family planning clinics in Rome, Italy and in Gothenburg, Sweden. The opinions of the health professionals in the two countries investigated were similar in many respects, both regarding their attitudes to abortion as well as their considerations concerning the care offered to the woman/couple undergoing an abortion. Fifty-nine percent of the Italian sample and 68% of the Swedish sample considered abortion justifiable on the same indications as those laid down in the laws, while 36% of the Italian and 32% of the Swedish professionals considered it justifiable only on medical grounds and 5% in the Italian sample did not justify abortion at all. In both Italy and Sweden, doctors as well as nurses suggest that the preventive work should be increased and that the psychological care for women undergoing abortion has to be improved.

Abortion, Legal↗
PubMed2005

Historical reflections on mental health care in Sweden: the welfare state and cultural diversity.

This article discusses historical reflections on the response of Swedish mental health care to cultural diversity and immigration and our views regarding future directions for clinical care, research and training. Sweden has become increasingly multicultural through immigration. Mental health care in Sweden faces the challenges of encountering cultural diversity and the mental health consequences of forced immigration, acculturation, and refugee trauma. In our view, Swedish mental health care is at a crossroads: either it takes up the challenge raised by immigration of an increasing cultural diversity or it satisfies itself with rhetoric, thus leaving reality at the margins. Equity regarding access to mental health care in Sweden today must include an acceptance of, and interest for, the diversity of the population.

Acculturation↗
PubMed1982

The prevalence of bronchial asthma and chronic bronchitis in an industrialized community in Northern Sweden.

The population living within a small area around a sulphite pulp factory in Northern Sweden was studied with regard to chronic obstructive lung disease. In persons in the age group 20-64 years the prevalence of bronchial asthma was found to be 3.0% for males and 3.2% for females. These figures correspond closely with previous studies in the Central and Southern Sweden. In the same age group the prevalence of chronic bronchitis was 2.8% for males and 1.0% for females, i.e. not differing much from that of other parts of Sweden. These findings, however, were far removed from the high prevalence of chronic bronchitis reported from Northern Finland, viz. 28.2% in males and 5.8% in females. The difference is probably attributable to differences in diagnostic criteria. In this study, those sulphite pulp factory workers who smoke seemed to constitute a population running a high risk of contracting chronic bronchitis.

Adult↗
PubMed1996

Alcohol consumption and ischemic heart disease mortality in Sweden.

Most previous studies on the relationship between alcohol consumption and mortality from ischemic heart disease (IHD) have been conducted in countries with an alcohol consumption pattern different from that in Sweden (and other countries in the "Vodka Belt"), where irregular binge drinking of distilled spirits is common. Therefore, we carried out an ecological study in Sweden where cross-sectional, longitudinal, and time series analyses (1973-1986) were performed on consumption of spirits, wine and beer in relation to age-standardized mortality in IHD for males and females. There was a negative correlation in both cross-sectional and longitudinal analyses between wine consumption and mortality from IHD, especially strong for women, but no consistent relationship between the consumption of total ethanol, spirits and beer versus the mortality from IHD. In the time series analysis, only wine was negatively correlated with IHD mortality for women. We conclude that, on a population level, consumption of spirits and beer in a Swedish drinking pattern does not imply any protection against death from IHD. On the other hand, wine consumption in Sweden could be associated with a reduced risk of IHD death among women.

Adolescent↗
PubMed2003

Salmonella isolated from animals and feed production in Sweden between 1993 and 1997.

This paper presents Salmonella data from animals, feedstuffs and feed mills in Sweden between 1993 and 1997. During that period, 555 isolates were recorded from animals, representing 87 serotypes. Ofthose, 30 serotypes were found in animals in Sweden for the first time. The majority of all isolates from animals were S. Typhimurium (n = 91), followed by S. Dublin (n = 82). There were 115 isolates from cattle, 21 from broilers, 56 from layers and 18 from swine. The majority of these isolates were from outbreaks, although some were isolated at the surveillance at slaughterhouses. The number of isolates from the feed industry was similar to that of the previous 5-year period. Most of those findings were from dust and scrapings from feed mills, in accordance with the HACCP programme in the feed control programme. It can be concluded that the occurrence of Salmonella in animals and in the feed production in Sweden remained favourable during 1993-97.

Animal Feed↗
PubMed1984

The determinants of health policy, a case study: regulating safety and health at the workplace in Sweden.

This article analyzes and criticizes the " technocratic " view of occupational health and safety policies, which sees the values of the personnel in "post-industrial" regulatory agencies as the most important determinant of those policies. It takes an alternate position, which explains occupational health and safety policies as primarily resulting from the different degrees of political power of the two major classes (capital and labor), and from the set of influences exerted on the regulatory agencies by the instruments (e.g., parties, unions, trade organizations) of those classes. It shows how an analysis of the historical evolution of those classes in Sweden and their conflict in both civil and political societies explains Swedish occupational health and safety policies better than a mere analysis of the regulators' views. And it concludes that the occupational health and safety policies in Sweden are not identical to those in the U.S.--as the " technocratic " theorists assume--but rather offer more protection to the workers than U.S. policies do. This situation is a result of labor having more power in Sweden than it has in the U.S. The different class formations and class behavior in the two societies are compared, and the implications of this comparison for occupational health and safety policies are discussed.

Accidents, Occupational↗
PubMed2003

Activity levels and body mass index of children in the United States, Sweden, and Australia.

PURPOSE: Assess the physical activity and body mass index (BMI) levels of children in the United States, Sweden, and Australia. METHODS: A total of 1954 children, 6-12 yr old (711 American, 563 Australian, and 680 Swedish) wore sealed pedometers for four consecutive days. Height and weight measures were obtained. RESULTS: Descriptive data for step counts and BMI by sex, age, and country were calculated to determine activity levels and BMI. Three-way multivariate ANOVA for step counts and BMI between countries at each age and sex found that, in general, the Swedish children were significantly more active than the Australian and American children, and the American children were significantly heavier than the Australian and Swedish children. For boys, the mean step counts ranged from 15673 to 18346 for Sweden, 13864 to 15023 for Australia, and 12554 to 13872 for America. For girls, the mean step counts ranged from 12041 to 14825 for Sweden, 11221 to 12322 for Australia, and 10661 to 11383 for America. The activity curve is somewhat level during the preadolescent years. The rate of increase in BMI with age is much greater in the American children than in the Swedish or Australian children. The percent of American, Swedish, and Australian boys classified as overweight/obese was 33.5, 16.6, and 15.8, respectively. The percent of American, Swedish, and Australian girls classified as overweight/obese was 35.6, 16.8, and 14.4, respectively. Correlation analysis found few significant negative relationships between step counts and BMI. CONCLUSIONS: American children tend to be the least active and heaviest with the greatest rate of increase in BMI. The Swedish children are the most active group followed by Australia. Swedish and Australian children maintain lower BMI throughout their prepubescent years than do the American children who have a greater percentage who are classified as overweight.

Age Distribution↗
PubMed1999

Telemedicine in Sweden--a diffusion study.

A survey of telemedicine use in Sweden was carried out. The response rate by hospital management was high at almost 90%. Sixty per cent of hospitals were involved in some kind of telemedicine activity in Sweden, with a further 15% planning telemedicine implementation. In rural areas of north Sweden good links exist between primary and secondary care. In the more populated southern region good links exist between the county hospitals and specialist university hospitals. Fifty-four per cent of telemedicine applications were used for specialist consultations, 13% for consultation between paramedics and hospitals and 10% for rounds. Teleradiology was the most frequent service.

Diffusion of Innovation↗
PubMed1977

Emissions of arsenic in Sweden and their reduction.

The role of arsenic in Sweden is generally described, including raw materials, exports/imports, products, consumption, etc. An attempt was also made to estimate the transport of arsenic in Sweden. The quantities of arsenic in raw materials, the emissions of arsenic from such processes as copper smelters and chemical industries, and the amounts of products containing arsenic were calculated. The studies show that a copper smelter is the main user of arsenical materials, the very largest emitting source and also the plant which manufacturers most arsenic products. A summary of measurements of arsenic in air, water and soil in Sweden has also been made. The concentrations near a smelter, in the Baltic, in cities and in "clean-air areas" are given. The efforts made to date to reduce the emissions of arsenic and the measures planned for the next few years are described. A reduction has already been achieved and a further rather large decrease will come, especially in arsenic levels in water. The possibilities of minimizing the use of materials and products containing arsenic is also discussed.

Air↗
PubMed2006

Pharmaceutical care in community pharmacies: practice and research in Sweden.

OBJECTIVE: To describe the organization and delivery of community pharmacy and medical care, as well as pharmaceutical care practice and research, in Sweden. FINDINGS: The Swedish retail pharmacy system of 800 community pharmacies and nearly 80 hospital pharmacies is unique in that it is organized into one single, government-owned chain, known as Apoteket AB. The pharmacy staff consists of pharmacists, prescriptionists, and pharmacy technicians. Some activities related to pharmaceutical care have been directed toward specific patient groups during annual theme campaigns. In the past few years, there has been a growing emphasis on the identification, resolution, and documentation of drug-related problems (DRPs) in Swedish pharmacy practice. A classification system for documenting DRPs and pharmacy interventions was developed in 1995 and incorporated into the software of all community pharmacies in 2001. A national DRP database (SWE-DRP) was established in 2004 to collect and analyze DRPs and interventions on a nationwide basis. Recently, a new counseling technique composed of key questions to facilitate the detection of DRPs has been tested successfully. Patient medication profiles are kept in 160 pharmacies, and a new national register of drugs dispensed to patients became available in 2006. Most pharmaceutical care studies in Sweden have focused on DRPs and resulting pharmacy interventions. DISCUSSION: Swedish community pharmacy DRP work is in the international forefront but there is a potential for further developing cognitive services, given the beneficial organization of the country's pharmacies into one single pharmacy chain. The introduction of patient medication profiles has been both late and slow and has only had a marginal effect on pharmaceutical care practice so far. The universities do not appear to have any desire to influence the practice of pharmacy and could potentially take on a more active role in preparing pharmacy students for patient-oriented services. Current threats to pharmaceutical care practice and research include organizational changes, budget cuts, and reduced manpower of Apoteket AB. CONCLUSIONS: The identification, resolution, and documentation of DRPs are central to community pharmacy practice in Sweden, resulting in a number of research studies. A national DRP database, patient medication profiles, and a new national register of drugs dispensed to patients provide opportunities for growth in pharmaceutical care practice and research in the country.

Delivery of Health Care↗
PubMed2003

Temporal differences in the regional twinning rates in Sweden after 1750.

When twinning rates are studied, maternal age and parity should be considered. Data on parity are seldom available. We studied information about the mean parity, using the gross reproduction rate, the total fertility rate and the crude birth rate. These are strongly correlated with the mean parity. The crude birth rate is more readily available than the gross reproduction rate or the total fertility rate. Earlier studies have shown that it is difficult to model variations in the twinning rate with data for the macrolevel. In this study these findings are explained by theoretical analyses and illustrated by empirical data. Sweden, having the oldest continuous population statistics and high twinning rates, offers excellent possibilities for analyses of the twinning rate. We considered data for the counties of Gotland, Alvsborg and Stockholm and the city of Stockholm from 1749 to 1960 and for Sweden until 1996. For Alvsborg, the twinning rate was low for the whole period, showing no statistically significant decreasing trend. It is mainly about 11-14 per thousand, which is only 50-60% of the twinning rate in Gotland in the 18th century. In Gotland, in the county of Stockholm, in the city of Stockholm and in Sweden as a whole, the decreasing trends in the twinning rate were statistically significant. The decreasing twinning rates converge towards the low twinning rate of Alvsborg. After standardization of the twinning rate, the differences remained and the low rate in Alvsborg could not be explained by maternal age.

Birth Rate↗
PubMed2005

The convergence of the regional twinning rates in Sweden, 1751-1960.

Sweden has, as a whole nation, the oldest continuous population register of births, including twin and higher multiple maternities, starting in the 17th century. Until the 1920s, the rates of multiple maternities in Sweden were among the highest known among Europeans. Strong secular and regional fluctuations were noted. Some of the eastern counties showed especially marked decreasing trends. The twinning rate had no clear associations with the anthropometric and serological data. In this paper we study the temporal and regional variations of the twinning rate in the 25 counties of Sweden from 1751 to 1960. Different statistical methods were applied in order to test the hypothesis that, irrespective of the initial levels, the twinning rates for the counties converge towards a common low level. We present and interpret a geometrical model for the trends of the regional twinning rates. We also analyze the regional heterogeneity using the ranges and the coefficients of variation of the regional twinning rates. All the methods gave consistent results, supporting our convergence hypothesis that the regional differences in the twinning rate are gradually disappearing. In addition, this study supports our earlier findings that the regional heterogeneity cannot be explained by differences in the distribution of maternal age and parity. We suggest that the convergence may be caused by increased urbanization and industrialization and by the increased interregional migration of citizens as a consequence of better communications, which lead to the breaking up of isolates and decreased endogamy.

Birth Rate↗
PubMed2002

Costs of COPD in Sweden according to disease severity.

OBJECTIVES: COPD is a common and disabling disease that entails high costs for society. The objectives of this study were to measure the societal costs of COPD in Sweden, and to examine the relationship between severity of illness and costs. METHODS: The costs of COPD were examined using a well-defined and representative cohort of subjects with mild, moderate, and severe COPD. Regular telephone interviews regarding resource utilization were made to a cohort of 212 subjects with COPD derived from studies of the general population in Northern Sweden. RESULTS: The annual per capita cost for COPD in Swedish crowns (SEK) was estimated at SEK 13,418 (1,284 US dollars (USD); 1,448 euros (EUR). The direct and indirect costs were SEK 5,592 (42%) and SEK 7,828 (58%), respectively. A highly significant relationship was found between severity of disease and costs. Costs for severe disease were 3 times as high as costs for moderate disease and > 10 times as high as for mild disease. Large individual variations in the level of costs were found. CONCLUSION: Assuming that the prevalence and treatment patterns are representative of Sweden as a whole, the total costs of COPD to society in 1999 were estimated at SEK 9.1 billion (USD 871 million; EUR 982 million). Subjects with mild disease (83%) accounted for 29%, while subjects with moderate disease (13%) accounted for 41% of the total costs. The subjects with severe disease (4%) accounted for the remainder (30%). Prevention, early diagnosis, and postponement of disease progression should have large monetary and policy implications.

Adult↗
PubMed2000

Large differences in laboratory utilisation between hospitals in Sweden.

There are large differences in the use of laboratory tests between hospitals in Sweden. These differences are not only due to differences between the patients treated but also to differences in practice. Use of laboratory test seems to reflect local traditions to a large extent. These large variations in practice are not compatible with the objective of providing care on equal terms and reduce the cost-effectiveness of clinical chemistry. Recently, several intervention studies have been performed in Sweden with the aim to optimise the use of clinical chemistry tests in primary care. The results show that it is possible to reduce the cost in primary care by SEK 100 million per year while increasing the clinical usefulness. This constitutes approximately 10% of the total cost for clinical chemistry tests in primary care. It should also be possible to reduce the cost for clinical chemistry tests in secondary and tertiary care. Hospitals order more tests than primary care and the potential savings are thus greater. We have studied the ordering habits for eleven Swedish hospitals. The comparison was made in the form of ratios between related laboratory tests to reduce the effects of differences in size between the studied laboratories. The large variation between hospitals indicates that a continuous discussion between the clinicians and the laboratories could reduce the cost. We have used the figures from the comparison and calculated the potential savings for seven frequently used tests. The potential yearly saving in Sweden for these tests is approximately SEK 150 million.

Clinical Chemistry Tests↗
PubMed2000

Alcohol and unnatural deaths in Sweden: a medico-legal autopsy study.

OBJECTIVE: To investigate alcohol involvement in all types of unnatural deaths in Sweden. METHOD: All cases of unnatural death that underwent medico-legal autopsies (1992-1996) in Sweden were analyzed (N = 15,630; i.e., 68% of all unnatural deaths). Alcohol was regarded as contributing to the death if: (1) there was any indication that the deceased was a "known alcoholic"; (2) the underlying or contributing causes of death were alcohol-related; (3) the deceased had alcohol-related inpatient diagnosis during a period of 3 years prior to death; or (4) the case tested positive for blood alcohol. RESULTS: Thirty-nine percent of the blood-tested cases (n = 13,099) were positive for alcohol. Almost 40% of the unnatural deaths were associated with alcohol. Alcohol involvement was most common in the intoxication group (84%), followed by the "undetermined" (65%), homicide (55%), fall (48%), fire (44%), asphyxia (41%), suicide (35%) and traffic (22%) groups. More than half (52%) of the deaths in the age group 30-60 years, 35% of those aged 0-29 years and 25% of those aged 60 and over were associated with alcohol. CONCLUSIONS: In Sweden, two of five unnatural deaths are associated with alcohol; this is a conservative estimate. Alcohol-associated mortality varies considerably between different groups of external causes of death, between men and women, and with age.

Accidents↗
PubMed1986

Goitre epidemiology: thyroid volume, iodine excretion, thyroglobulin and thyrotropin in Germany and Sweden.

Thyroid volume of 1397 German and 303 Swedish adults were estimated by sonography. Thyroid size of 6-16 year old Germans (n = 619) was determined and compared with findings on palpation. Thyroid volume was more than twice as great in German (21.4 +/- 15.6 ml, mean +/- SD) than in Swedish adults (10.1 +/- 4.9 ml). The echopattern was abnormal in 16% of the Germans and in 3.6% of the Swedes. German children have a thyroid volume ranging from 1.8 +/- 0.4 ml at 6 years to 10.8 +/- 6.0 ml at 16 years of age. Palpation is by comparison an unreliable method for determining thyroid size. In Germany, the iodine excretion was less in children (n = 619, 39.5 +/- 30.5, 34.1 micrograms I/g creatinine, mean +/- SD, median) than in adults (n = 1193, 83.7 +/- 94.4, 62.6), (P less than 0.001) and much lower than that observed in Sweden (adults n = 98, 170.2 +/- 93.3, 141.4; 13 year olds n = 113, 172.9 +/- 224.1, 124), (P less than 0.0001). Serum thyrotropin concentration was significantly higher (P less than 0.001) in Sweden (n = 62, 1.49 +/- 0.82 mU/ml), than in Germany (n = 91, 0.97 +/- 0.52 mU/ml), while serum thyroglobulin was increased in Germany (n = 91, 72.6 +/- 50.6 micrograms/l) as compared to Sweden (n = 62, 23.5 +/- 17.4), (P less than 0.0001). These results indicate the goitrogenic effect of iodine deficiency and the continuing need for an effective iodine prophylaxis in the FRG.

Adolescent↗
PubMed2002

Assessment of Health Economics in Alzheimer's Disease (AHEAD): treatment with galantamine in Sweden.

BACKGROUND: Like other developed countries with aging populations, Sweden is expecting large increases in the prevalence of Alzheimer's disease and corresponding escalations in the cost of care for patients with this disease. Galantamine, a new acetylcholinesterase inhibitor and nicotinic modulator, has proved effective in managing patients with Alzheimer's disease in clinical trials. OBJECTIVE: To estimate the long-term health and economic impact of galantamine from the perspective of the public health payer in Sweden. DESIGN AND SETTING: The Assessment of Health Economics in Alzheimer's Disease (AHEAD) model compares galantamine treatment with no pharmacologic treatment. It consists of a module based on trial data followed by a projection module that uses the trial results to predict the time until patients require full-time care (FTC) or until their death. Forecasts were made for up to 10 years. The model was customised to Sweden by using Swedish resource use profiles obtained from the literature. RESULTS: Galantamine is predicted to reduce the time patients require FTC by almost 10%. Approximately 5.6 patients with mild-to-moderate disease would need to be treated to avoid one year of FTC. This would result in savings averaging 27 436 Swedish kronas (SEK) [3131 euros (EUR)] per patient over 10 years (1998 values). To avoid one year of FTC, 3.9 patients with moderate disease would need to be treated, with savings averaging SEK49 019 (EUR 5594) per patient over 10.5 years. Sensitivity analyses of key parameters, such as proportion of patients needing FTC treated in the community, cost of care in an institution, cost of FTC care in the community, the price of galantamine, and the discount rate, found savings with galantamine would occur under most circumstances. CONCLUSION: Galantamine can increase the time before patients require FTC, and may also lead to savings as treatment costs are offset by reductions in other healthcare expenditures and the costs associated with FTC.

Aged↗
PubMed2006

Studying social policy and resilience to adversity in different welfare states: Britain and Sweden.

Is poverty more damaging to health in Britain than in Sweden, and if so, why? Following previous research by the authors that suggested such an effect, a new comparative study is examining whether there are aspects of the social and policy context in Britain that add to and reinforce the health-damaging experience of being poor. Conversely, are there other aspects of living in Sweden that are supportive for people in poverty, which make the experience of poverty less stressful and health-damaging? Stemming from this ongoing study, the aim of this article is to present a framework for understanding the context in which social welfare policies are formed and operate in Britain and Sweden. It then uses the framework to consider the "upstream" influences of ideology, culture, and values on policy development in the two countries and what these developments might mean for the health and well-being of people facing financial adversity in the two societies.

Employment↗