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Winners and losers in flexible labor markets: the fate of women with chronic illness in contrasting policy environments--Sweden and Britain.

This study compares employment rates among men and women with and without chronic illness in the contrasting policy environments of Britain and Sweden, through analysis of household surveys for 1979-1995. Professional and managerial groups were winners in both countries, including during recession. By the 1990s, employment rates for healthy Swedish women were uniformly high across the social groups and almost comparable with those of their male counterparts; rates for women and men with a chronic illness were also comparable, albeit at a lower overall rate. The greatest losers were male and female unskilled manual workers in Britain. British women with a chronic illness in the 1990s had less than half the employment rates of healthy women. Such social inequalities were much smaller and less consistent in Sweden, where the impact of illness was softened for all social groups. In Britain, workless men tended to be classed as unemployed or permanently sick, while workless women were more likely to be classed as looking after home/family. Lesser differences were seen in Sweden. No evidence was found to support the hypothesis that women in general, and the less skilled and sick in particular, would be the winners in a more flexible, less regulated labor market-quite the reverse.

Adult↗

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

This article presents an analysis and critique of the "technocratic" view of occupational health and safety policies, which sees the values of the personnel of the "postindustrial" regulatory agencies as the most important determinant of those policies. An alternate position is put forth which explains those occupational health and safety policies as primarily the result of different degrees of political power of the two major classes (capital and labor) and the set of influences exerted on the regulatory agencies by the instruments (e.g., political parties, unions, trade organizations) of those classes. It is shown how an analysis of the historical evolution of those classes in Sweden and their conflict in both civil and political societies better explains the Swedish occupational health and safety policies than the mere analysis of the regulators' views. It is concluded that the occupational health and safety policies in Sweden are not identical to the U.S. policies--as the "technocratic" theorists assume--but rather they offer more protection to the workers than the U.S. ones. This situation is a result of labor's greater power in Sweden than in the United States. The different class formations and class behavior in both societies are compared, and the implications of this comparison for occupational health and safety policies are discussed.

Accidents, Occupational↗

Trends in care and services for elderly individuals in Denmark and Sweden.

Both Denmark and Sweden have achieved a reduction in institutionalization of elderly individuals; 23 percent nursing home care in Denmark from 1980-89 and 34 percent overall institutionalization in Sweden from 1970-1985. This was accomplished by increasing home care and housing with services and adaptations. Further increases in growth of the elderly population combined with modest economic expansion will be the forces responsible for finding additional alternatives to costly institutional care. Community-based services and care have not been demonstrated at this time to be less costly than institutional care. An illustration of an innovative model of nursing home care in Denmark is described. The medical model of care was abandoned in favor of a self-care model for the purpose of fostering independent living and decision-making as long as possible. In Sweden, a reduction in demand for beds in a long-term care hospital has been achieved through a tightly coordinated system of care and services among the various health and social service professionals.

Aged↗

The incidence of retinopathy 10 years after diagnosis in young adult people with diabetes: results from the nationwide population-based Diabetes Incidence Study in Sweden (DISS).

OBJECTIVE: To estimate the prevalence and severity of diabetic retinopathy (DR) 10 years after diagnosis in a nationwide population-based cohort study of young adult diabetic patients in Sweden. RESEARCH DESIGN AND METHODS: The Diabetes Incidence Study in Sweden (DISS) aims to register all incident cases of diabetes aged 15-34 years in Sweden. In 1987-1988, 806 cases were reported, and 627 (78%) of them were followed up with regard to retinopathy 8-10 years later. The assessment was based on retinal photographs in most cases (86%). RESULTS: Ten years after diagnosis, retinopathy was found in 247 patients (39%). The retinopathy was mild in 206 (33%), whereas 30 (4.8%) patients had moderate nonproliferative DR (NPDR) and 11 (1.8%) had proliferative DR (PDR). Patients with retinopathy had worse glycemic control during the years than patients without (HbA(1c) 8.1 +/- 1.5% and 6.8 +/- 1.2%, respectively; P < 0.001). In a Cox regression analysis, time to retinopathy was related to high HbA(1c) (P < 0.001) and high BMI (P = 0.001). Patients with type 2 diabetes had an increased prevalence of severe retinopathy (NPDR or PDR) compared with those with type 1 diabetes (14 of 93 [15%] versus no or mild 24 of 471 [5%], respectively; P < 0.001). CONCLUSIONS: Despite modern diabetes management, 39% of young adult diabetic patients developed retinopathy within the first 10 years of the disease. Nevertheless, compared with the prevalence of retinopathy (63%), after a similar duration of diabetes before the Diabetes Control and Complications Trial, this prevalence was clearly lower. Current treatment aimed to achieve strict glycemic control has reduced the risk for developing retinopathy.

Adolescent↗

Cesarean section and maternal mortality in Sweden 1973-1979.

During the years 1973-79, 704732 births took place in Sweden and 63 075 cesarean sections (CS) were performed. Within the study period there were 20 maternal deaths associated with delivery or puerperium. Thirteen of these patients were delivered by CS and 7 by the vaginal route. The hospital records of the 13 deaths associated with CS were closely analysed and it was found that 5 of the patients were critically ill before the beginning of surgery, and the CS per se was not responsible for these deaths. The 8 remaining maternal deaths gave a corrected (cesarean-attributed) maternal mortality rate of 12.7/100 000 cesarean deliveries. For vaginal deliveries the mortality rate was 1.1/100 000 deliveries. Thus, the risk of maternal death from CS in Sweden was twelve times as high as that from vaginal parturition. All maternal deaths except one, associated with CS, occurred after emergency operation. No deaths were ascribable to anesthesia complications. The most common causes of death after CS were pulmonary embolism, amniotic fluid embolism, coagulopathy and peritonitis. Time trends in the causes of maternal death in Sweden are discussed.

Adult↗

Equality in health and health care during pregnancy. A prospective population-based study from southern Sweden.

OBJECTIVE: To study health and health care during pregnancy for manual workers compared with non-manual employees. DESIGN: A prospective population-based study of all women who were registered for antenatal care during 1986 in the catchment areas of three health centers. SETTING: Three district antenatal clinics in southern Sweden. SUBJECTS: 409 pregnant women; of whom 403 with singleton pregnancies; of whom 185 were manual workers and 175 were non-manual employees. MAIN OUTCOME MEASURES: Problems encountered (registered according to the international classification of diseases) and measures taken. RESULTS: The study population resembled all women who gave birth in Sweden during the same year. Both manual workers and non-manual employees registered for antenatal care in early pregnancy (96% and 97%, respectively, before 15 completed weeks). The women in both groups made the same number of visits to the antenatal clinics (median 12 and 13, respectively). There were no differences between the two groups of women as regards the percentage figures for obstetric problems encountered during pregnancy. The manual workers had a higher frequency of diseases of the musculoskeletal system (mainly low-back pain) compared with the non-manual employees (RR = 1.89; 95% CI = 1.20-2.98), and they were sicklisted more often (RR = 1.21; 95% CI = 1.01-1.46). On the other hand, their frequency of amniocentesis was lower (RR = 0.39; 95% CI = 0.19-0.80); the reason for this was that the manual workers were younger than the non-manual employees. Otherwise, there were no differences between the two groups of women as regards the percentage figures, either for non-obstetric problems encountered, or measures taken, or regarding the outcome of pregnancy. CONCLUSION: In Sweden, both manual and non-manual working women appear to enjoy equal antenatal health and receive equal antenatal care. This conclusion is based on a small study population, meticulously monitored prospectively throughout pregnancy.

Delivery of Health Care↗

Intrapartum death of nonmalformed fetuses in Denmark and Sweden in 1991. A perinatal audit.

BACKGROUND: In 1991 the rate of intrapartum death of non-malformed fetuses was higher in Denmark than in Sweden (4.2 vs. 1.9 per 10,000, OR 2.24). However, it is not clear whether this difference reflects potentially avoidable cases and/or suboptimal care. MATERIAL AND METHODS: Short descriptions were made from medical records of all 50 intrapartum deaths in Denmark and Sweden in 1991. Ten obstetricians, two from each of the Nordic countries, reviewed the cases to determine whether (1) intra-uterine death might have occurred before admission, (2) surveillance and intervention were insufficient, (3) fetal death was potentially avoidable by improved obstetric care; and, if so, to suggest ways of improved health care. RESULTS: There was a statistically higher rate of insufficient care (surveillance and intervention) (high or less degree) in the Danish cases (66% vs. 55%). The proportion of potentially avoidable fetal deaths was also higher in Denmark (59% vs. 52%) although the difference was not statistically significant. CONCLUSION: The significantly higher rate of intrapartum death of non-malformed infants in 1991 in Denmark compared to Sweden might be reduced by improved intrapartum surveillance and interventions.

Adult↗

An estimation of dental treatment needs in two groups of refugees in Sweden.

The aim of this study was to estimate dental treatment need in groups of Chilean and Polish refugees in Sweden. Of the Nordic countries, Sweden accepts the greatest number of refugees. An average of 5000 refugees arrived annually in 1981-85, increasing to 15,000 during 1986-87. Refugees and their families now comprise 93% of non-Nordic immigration. In 1981-83 a sample of 193 Chilean and 92 Polish refugees in the county of Stockholm was selected for this study. Dental treatment needs were calculated in accordance with CPITN and the working study of Swedish dentistry, which formed the basis for the Swedish scale of dental fees for the National Dental Insurance Scheme. The estimated mean treatment time (+/- SD) in the Chilean sample was 6.9 +/- 2.3 h and in the Polish group 8.4 +/- 3.0; in comparison with estimated treatment needs in a Swedish material, both would be classified as extreme risk groups. There was no correlation between the number of months in Sweden and the estimated treatment needs. The results indicate a cumulative, unmet need for dental care in these groups. Barriers to ensuring adequate health care for immigrants persist; special outreach programmes, conducted by dental health personnel, may be an effective means of introducing immigrants to the Swedish dental care system.

Adult↗

Academic dissertations by dentists in Finland, 1891-1991, and in Finland, Norway, and Sweden, 1984-93.

Dental education in the Nordic countries was founded in the late 1800s, but the doctor's degree in dentistry (Ph.D.) was established somewhat later. Since the first dissertation in Finland in 1891, a total of 204 doctoral dentist candidates had defended their Ph.D. theses by 1991, 50% of them during the most recent 12 years. Over the 100-year period, 54% of the dentists' Ph.D. theses in Finland were defended at the University of Helsinki, 27% at Turku, 14% at Kuopio, and 5% at Oulu. Women constituted a minority of the candidates (23%) during the first 90 years but 54% from 1982 to 1991. From 1984 to 1993 a total of 374 dentist candidates in Finland, Norway, and Sweden defended their Ph.D. theses. The mean ages of the candidates ranged from 37.7 to 41.7 years for men and from 40.6 to 43.2 years for women. In the 10-year period on average 53 doctor's degrees were received per institute in Sweden, compared with 28 in Finland and 27 in Norway. In all three countries about 6 of 100 graduates in 1980s received a doctor's degree in dentistry. Almost all of these Ph.D. theses were written in English and based on collections of articles. Female candidates dominated in Finland (56%), compared with 34% in Sweden and 26% in Norway, where, however, women's contribution increased most rapidly, being tripled from early 1980s to 1990s.

Academic Dissertations as Topic↗

Underreporting of alcohol-related mortality from cirrhosis is declining in Sweden and Denmark.

Death rates for alcoholic cirrhosis ran parallel to alcohol consumption in Sweden and Denmark from 1961 to 1986, according to official statistics. Reported death rates for alcoholic cirrhosis and for non-alcoholic cirrhosis increased linearly from 1965 to 1976 in Sweden and from 1967 to 1973 in Denmark. This suggests that constant proportions of deaths from real alcoholic cirrhosis are misclassified in official statistics as due to non-alcoholic cirrhosis during these time periods. Assuming that the mortality from real non-alcoholic cirrhosis is constant (c), a statistical model for estimating both c and the misclassification rates for real alcoholic cirrhosis (p) is proposed. In the Sweden population and in Danish males c was about 5 deaths per 100,000 adults annually. The model was not applicable to Danish females because their mortality from non-alcoholic cirrhosis decreased. The misclassification rate p was about 55% in both Swedish and Danish males and 70% in Swedish females during the above time periods. Moreover, during the past decade p has decreased to 30% in Swedish and Danish males.

Data Interpretation, Statistical↗

Epidemiology of tick-borne encephalitis in Sweden 1956-1989: a study of 1116 cases.

Tick-borne encephalitis (TBE) has occurred regularly in Sweden since it was first diagnosed in 1954. In Austria, where TBE is common, vaccination has been shown to reduce the incidence considerably. Since this vaccine is now available in Sweden we analysed 1116 cases of TBE from 1956 to October 1989 in order to define a strategy for vaccination. The cases were identified in the records from all infectious disease departments in Sweden complemented with data from the virological laboratories. All diagnoses were confirmed by a positive serological result. The analysis shows TBE to be concentrated to the archipelagos and coastline areas of the Baltic and the lake Mälar around Stockholm--about 85% of all cases came from the county of Stockholm. Conspicuous clustering occurred in some areas and the geographical distribution was remarkably constant over the time studied. As can be expected with a tick-borne infection, a strong seasonal variation was found, 85% of the cases occurring July to September. The age distribution showed the highest incidence from 20-70 years; there was a male majority in all age groups. Five patients died.

Adolescent↗

Epidemiology of Q fever in Sweden.

Q fever is known to be a worldwide disease, with Sweden supposed to be one of a few exceptions. The purpose of this pilot study was to elucidate whether or not a potential risk group for obtaining Q fever in Sweden was seropositive to the causative agent Coxiella burnetii. Blood samples were collected from sheep farmers on the island of Gotland, and from members of their families. Serum samples were examined by ELISA for the presence of antibodies against C. burnetii, phases I and II. Positive reactions were confirmed with Western blot analysis. It was found that 30% of the study group were seropositive to C. burnetii, thus indicating that Q fever is endemic in this area of Sweden.

Adolescent↗

Research and development work in primary health care in Sweden.

In this report a review is given on research and development work in primary health care (PHC) in Sweden. PHC has by tradition been very weak in Sweden. As a result of the new Health Care Act of 1983, however, PHC has entered an era of rapid development. A brief historical description of primary health care research activities is given. These have initially been concentrated at a few field research stations, under the guidance of departments of social medicine during the 1970s. Since 1980, departments of general practice have also been set up in Sweden. Even though most research activities are conducted at specific research units in PHC, the results from a survey in the Autumn of 1982 show that much is happening elsewhere: 31 percent of the 712 PHC centres have ongoing projects, altogether 520. The majority (142/520) are taking place in Stockholm county. The projects are predominantly within the field of epidemiology, preventive medicine and health services research. Consequently few projects concern purely clinical questions.

Community Health Centers↗

Recent intervention trials in hypertension initiated in Sweden--HOT, CAPPP and others. Hypertension Optimal Treatment Study. Captopril Prevention Project.

In 1998 the final results were presented of two large intervention trials in hypertension, the Hypertension Optimal Treatment Study (HOT) and the Captopril Prevention Project (CAPPP). Both were initiated from Sweden although the HOT Study was conducted in 26 countries worldwide and the CAPPP Study in Finland and Sweden. The HOT and CAPPP trials and their principal results will be reviewed briefly here. In addition a brief up-date will be provided of three ongoing intervention trials in hypertension that were also initiated from Sweden: the Swedish Trial in Old Patients with Hypertension-2 (STOP-Hypertension-), the Nordic Diltiazem (NORDIL) Study and the Study on Cognition and Prognosis in Elderly Hypertensives (SCOPE).

Adrenergic beta-Antagonists↗

Serologic evidence of Puumala virus infection in wild moose in northern Sweden.

Puumala (PUU) virus is the causative agent of nephropathia epidemica, the Scandinavian form of hemorrhagic fever with renal syndrome. The infection is acquired by airborne transmission of PUU virus from its rodent reservoir, the bank vole. Besides serologic data indicating that the virus may spread also to heterologous rodents, there is little information on the susceptibility of wild living animals to PUU virus. We studied the occurrence of antibodies to PUU virus in serum samples from 427 wild-living moose, of which 260 originated from the PUU virus-endemic northern and central parts of Sweden and 167 originated from the southern, nonendemic part of Sweden. Samples from 5 animals showed reactivity in an ELISA for recombinant PUU virus nucleocapsid protein, an immunofluorescent assay, and a neutralization test. These 5 animals all originated from the PUU virus-endemic northern part of Sweden. In conclusion, 5 of 260 moose from the endemic region showed convincing serologic evidence of past PUU virus infection. The seroprevalence was low, suggesting that the moose is subjected to endstage infection rather than being part of an enzootic transmission cycle.

Age Distribution↗

Road traffic noise in southern Sweden and its relation to annoyance, disturbance of daily activities and health.

OBJECTIVES: This study investigated residential noise from road traffic and its relation to annoyance, disturbance of daily activities, and general health. METHODS: A large public health survey in southern Sweden in 1999-2000 supplied data (N=13 557; 54% participation rate) on the demography, annoyance, and disturbance of daily activities, and on general health problems regarding concentration, sleep, stress, and treatment for hypertension. Residential road noise exposure was assessed with a geographic information system. Associations with 24-hour equivalent (average) and maximum road noise level were investigated for all participants and for selected subgroups using the Cochran-Armitage trend test and Cox regression analysis. RESULTS: Annoyance from road traffic noise and the disturbance of daily activities increased markedly with road noise exposure. More than 25% reported at least occasional disturbance from traffic noise during relaxation and sleep in the highest exposure category for each noise measure. No overall pattern between road noise exposure and general health problems emerged. Among the participants that reported annoyance from road traffic noise (N=623), the average road noise level was associated with concentration problems (P for trend = 0.03) and with treatment for hypertension (P for trend = 0.02). Positive associations between average road noise exposure and health problems were found among females (hypertension), persons born outside Sweden (sleep), the unemployed (stress), and participants that reported financial problems (concentration problems). CONCLUSIONS: Exposure to road traffic noise at high levels was common and produced frequent disturbances of daily activities. Negative health effects from road traffic noise were observed in important subgroups. The findings are of concern for southern Sweden, as well as for other regions with similar or higher traffic intensity.

Activities of Daily Living↗

Prevalence of antibodies specific to Puumala virus among farmers in Sweden.

OBJECTIVES: The Puumala virus is the causative agent of nephropathia epidemica, a European form of hemorrhagic fever with a renal syndrome. From its reservoir in bank voles, the virus is spread by airborne transmission to humans. Occupational risks for the acquisition of nephropathia epidemica are not well defined. The prevalence of serum antibodies to Puumala virus was determined for Swedish farmers. From a comparison of the prevalence among farmers from various parts of the country, the assumption that Puumala virus occurs endemically only in the northern and central parts of Sweden was also tested. METHODS: Serum samples from 910 farmers and 663 referents living in various rural parts of Sweden were tested with an enzyme-linked immunosorbent assay, using a recombinant nucleocapsid protein of Puumala virus as the antigen. RESULTS: North of a latitude of 59 degrees N, the prevalence of Puumala virus antibodies was significantly higher among farmers (12.9%) than among referents (6.8%). In the southern areas, antibodies to Puumala virus were rare, and altogether only 2 of 459 persons had antibodies. Seropositive persons did not differ from seronegative ones with regard to blood pressure, and they did not comprise cases of chronic renal disease. CONCLUSIONS: Serological evidence confirmed that the exposure of humans to Puumala virus is firmly restricted to the northern and central parts of Sweden. In addition the evidence indicated that, in this region, farming is associated with an increased risk of contracting hantavirus infection.

Adult↗

Infections with Francisella tularensis biovar palaearctica in hares (Lepus timidus, Lepus europaeus) from Sweden.

The occurrence of tularemia was studied in 1,500 hares submitted to the National Veterinary Institute, Uppsala, Sweden for postmortem examination during 1973 through 1985. A total of 109 tularemia cases was recorded based on the fluorescent antibody (FA) test for Francisella tularensis and on the gross and microscopic pathology. Tularemia was diagnosed only in the varying hare (Lepus timidus) and not in the European brown hare (Lepus europaeus). The geographical distribution of the 109 cases indicates that tularemia has not spread in Sweden during the last 45 yr, with the exception of an endemic occurrence of the disease on the island of Stora Karlsö in the Baltic sea. The disease was most frequent in the autumn and only a few cases were recorded during winter. Cases were not seen in the spring. The annual prevalence varied, with several cases in 1974 and 1981, but there were no cases in 1976 and 1980. The postmortem findings in hares dying of tularemia in the autumn were characterized by focal coagulative necrosis in liver, spleen and bone marrow, with high numbers of bacteria FA-positive for F. tularensis. In hares dying during winter months, the most characteristic findings were hemorrhagic enteritis and typhlitis, although necrotic lesions could occur in liver, spleen and bone marrow. Diseased hares on the island of Stora Karlsö were demonstrated to be infected with ticks, while hares on the mainland of Sweden generally were fed upon by mosquitoes. Twenty-six of the 109 hares with tularemia were examined bacteriologically and F. tularensis biovar palaearctica was isolated from eight. The lung extract antibody test for F. tularensis was performed in 18 of the 109 hares. All were negative. In addition to the field study, an experimental study with F. tularensis biovar palaearctica was performed. Four varying hares and three European brown hares were inoculated. None of the hares died from tularemia, and generalized infection was not demonstrated.

Animals↗