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PubMed1989

Antibiotic consumption in Sweden 1975 to 1987: changes in prescription patterns.

The antibiotic consumption in Sweden was evaluated during the period 1975 to 1987. Consumption was measured in terms of defined daily doses (DDDs), that is, the normally prescribed daily adult doses. During the study period the total consumption varied between 49 and 51 million DDD, indicating a considerable over-use of antibiotics in Sweden. In the various groups of antibiotics, considerable fluctuations were seen. The cephalosporin use increased from 477000 DDDs 1975 to 1795000 DDDs in 1987, which can be explained by an increased use of cefaclor for treatment of respiratory tract infections and by the fact that cefuroxime is the dominant injectable antibiotic in Sweden. Markedly increased usage during the study period was also seen for erythromycin and penicillinase resistant penicillins. There were no obvious medical reasons for those increases. Among the folate inhibitors, sulphonamide usage has been almost completely abandoned during the period and the sulphonamides have been replaced by pivmecillinam, trimethoprim and, lately, norfloxacin for the treatment of urinary tract infections. Reduced usage was also seen for sulphonamide/trimethoprim combinations, probably due to an increased awareness of the risk for side effects to these antibiotics. During the entire period the use of tetracyclines, and especially doxycycline, was extensive--almost 10 million DDDs in 1987. The reason for that remains unclear but there are reasons to assume that these antibiotics are prescribed too frequently.

Anti-Bacterial Agents↗
PubMed1988

Thyroid uptake of iodine-131 and iodine-133 from Chernobyl in the population of southern Sweden.

The accident at the nuclear power plant of Chernobyl on April 26, 1986 led to radioactive contamination of many countries including Sweden. The population was exposed to released radionuclides, both by inhalation and from contaminated food. We have studied the content of gamma-emitting radioisotopes in the thyroid glands of a normal population from southern Sweden using measurements of samples taken at autopsy. The first samples are from a person who died on April 27, 1986. This report contains results for 131I and 133I. The time-activity curve for 131I shows an immediate uptake with a maximum 18-26 days after the accident. No measurable levels were observed after 93 days. We have found that the increase in dose equivalent to the thyroid for the population of southern Sweden due to the released 131I and 133I will be less than 0.1 mSv. This may lead to an increase in the incidence of thyroid cancer of 0.1% during a period of 25 yr.

Accidents↗
PubMed1988

Changing mortality patterns that led life expectancy in Japan to surpass Sweden's: 1972-1982.

Between 1972 and 1982, Japan caught up to and then surpassed Sweden as the country with the longest life expectancy. The contributions of different causes of death and age groups to life expectancy changes in males during this time period are examined in detail for these two countries. Even though cerebrovascular disease mortality rates remained lower in Sweden over the entire interval, the rapid gain made by Japan relative to Sweden for this cause of death was a prime factor in Japan's ending the period with a higher life expectancy. Important contributions to life expectancy improvement in Japan came from declining mortality rates in those aged 55 and older.

Adolescent↗
PubMed1987

The vascular registry--a responsibility for all vascular surgeons? Vascular Registry in Southern Sweden (VRISS).

The value of a medical technique or a surgical method is demonstrated when it is applied in everyday, community practice. Peripheral vascular surgery has become an increasingly common mode of treatment in non-university, community hospitals in Sweden during the last decade. Most reports on the outcome of vascular surgery, however, emanate from University hospitals, presumably with better facilities and perhaps selected patients. In an attempt to explore the value and application of peripheral vascular surgery, a registry in southern Sweden (VRISS) has been organized. In this communication some aspects on starting the registry and results from a pilot period are presented. This registry will be of particular interest because it covers all vascular operations within a defined population from a geographic area in Sweden.

Humans↗
PubMed1986

Regulation of animal experimentation in Sweden.

The Swedish regulations in force on animal protection matters - regulations on destination breeding, experimental animal housing and ethical pre-testing - are a solid base for controlled and adopted experimental animal use in relation to the political attitudes prevailing towards these questions in Sweden. Certain and by no means small or unsignificant groups of the population are, however, still very critical of the structure of our regulations as well as the application thereof, and of the experimental animal use on the whole. This is something that Sweden has in common with several other countries. In an international comparison, however, the situation for the experimental animals in Sweden is likely to be quite good.

Animal Testing Alternatives↗
PubMed1980

Demographic responses and demographic transitions: a case study of Sweden.

An important study by Friedlander investigated some of the effects of different demographic responses on national demographic transitions. England and Sweden were advanced as cases that approximated the suggested hypothetical models of transitions. His argument implied that the rural population of a country (in this case Sweden) experiencing mortality decline but little industrialization would reduce its fertility rates if our-migration from agricultural areas were not possible. This present study, using more complete data and better measures, concludes that this did not occur in Sweden--it did not conform to Friedlander's hypothesized model. Because the potential implications of these findings could be profound and wide-ranging, there is a need for more studies of individual countries using better data and giving more careful attention to Davis's theory on which the Friedlander hypothesis is based.

Birth Rate↗
PubMed1995

Salmonella isolated from animals and feedstuffs in Sweden during 1988-1992.

The present paper surveys the number of Salmonella isolations in animals and feedstuffs in Sweden during 1988-1992. It is the eighth in a series of reports published by the National Veterinary Institute (NVI) since 1949. During the period referred to, 602 outbreaks of Salmonella were reported in animals, both domestic and wild. Compared with the previous 5-year period there was a 20% reduction in the number of outbreaks (760). Fifty-six different serotypes were reported, 19 of which had never been isolated in any animal in Sweden previously. A temporary increase in the number of outbreaks in poultry was seen in 1991 following an extended sampling before slaughter of layers. A remarkably high prevalence (38%) of Salmonella was observed in snakes in the wild. In 1990, the end-point testing of feeds was replaced by an approach based on HACCP (Hazard Analysis Critical Control Point) principles for the monitoring of feed mills. Significantly higher number of Salmonella positive samples were found by using this technique compared with the previous analysis of finished feed. It is concluded that the adopted Salmonella control program has contributed to a reduced number of Salmonella outbreaks in animals in Sweden.

Animal Feed↗
PubMed1995

Lyme arthritis--a common manifestation in a highly endemic area in Sweden.

OBJECTIVE: To study the prevalence and the clinical features of Lyme arthritis in a Swedish area highly endemic for Lyme borreliosis. METHODS: Sera from 480 of 540 individuals living in a tick endemic area on an island in southern Sweden were tested by ELISA for IgG antibodies against Borrelia burgdorferi. A questionnaire was completed at the time serum was obtained. Antibody positive individuals who reported joint pain were examined by the authors one year later. RESULTS: Of 90 seropositive individuals, 34 (38%) reported symptoms of chronic or recurrent arthralgia. Of seronegative individuals from the same area 48/390 (12%) reported such complaints (p < 0.001). One year later one of the 34 seropositive patients with arthralgia had died and, of the remaining, 32 still had arthralgia. Lyme arthritis was diagnosed in 11/32 (35%) of these individuals corresponding to a prevalence of 2.3% (95% confidence interval: 1.0-3.6) in the population. The prevalence of other rheumatic disorders did not differ from that found in other areas in South Sweden. Clinical and laboratory findings were in agreement with previous reports of Lyme arthritis. Other manifestations of Lyme borreliosis were found in 6 of the 11 patients with Lyme arthritis. After antibiotic treatment 9/11 (82%) remain free of complaints followed for 6 months or more. CONCLUSION: Our results indicate that arthritis and musculoskeletal symptoms of Lyme borreliosis are as common in highly endemic areas for Lyme borreliosis in Sweden as in similar areas in North America.

Adult↗
PubMed1994

Age patterns of mortality and cause-of-death structures in Sweden, Japan, and the United States.

This paper uses a new standard model of adult mortality to compare the mortality patterns of Swedes, Japanese, and U.S. whites between 1950 and 1985. It examines changes in the age patterns of mortality and the cause-of-death structures within the populations, and the relationships between those two factors. As Japan has reached a level of mortality similar to that in Sweden, the age patterns of mortality in the two populations have become more similar despite distinct differences in causes of death. The United States has a cause-of-death structure similar to that of Sweden, but the age pattern of mortality is very different. High mortality in the middle age range in the United States results in approximately a one-year loss of life expectancy at age 45 in comparison with Sweden.

Accidents↗
PubMed1994

Maternal mortality in Sweden, 1980-1988.

OBJECTIVE: To assess recent maternal mortality in Sweden according to the different definitions of the eighth, ninth, and tenth editions of the International Classification of Diseases (ICD). METHODS: All maternal deaths in Sweden during 1980-1988 were sought in the Medical Birth Registry and in the Registers of Births and Deaths. Hospital records and autopsy reports were requisitioned. RESULTS: According to ICD-9, the maternal mortality ratio in Sweden for 1980-1988 was 7.4 per 100,000 live births. Of the 58 deaths, 36 were direct maternal deaths. Embolism, hemorrhage, preeclampsia, and infection were the predominant causes in the direct cases. Advanced age was the most pronounced risk factor. Suboptimal standard of care was a contributing cause in almost one-third of the direct maternal deaths. Accidental or incidental deaths, including suicide, accidents, and pregnancy-related deaths, added six cases. There were 76 late maternal deaths, occurring 43-365 days postpartum. Malignancy, stroke, and heart disease were the predominant causes. After malignant disease, suicide constituted the leading cause of pregnancy-related deaths within 1 year of delivery. CONCLUSIONS: Regular reviews of maternal mortality are still important in a country with a low rate of maternal deaths. The new classification of maternal deaths allows a better international comparison of mortality risks. Continuous surveillance of maternal deaths and pregnancy-related deaths requires record linkage of birth and death registrations.

Adult↗
PubMedDate not supplied

Survey on the allergic status in a Turkish population in Sweden.

A limited survey on the allergic status and total IgE was performed on 205 persons of Turkish origin aged between 16 and 76 years living in Stockholm, Uppsala, Sweden in 1990. A questionnaire was mailed to 205 persons and was returned by 92%. 71 persons were randomly selected among those who returned the questionnaire, and were examined after an interview, skin-prick test (SPT) and total IgE levels were also measured. The atopy prevalence of the randomly selected group of Turks was found 32.4%. Clinical symptoms were significantly associated with positive SPT reactivity. IgE levels in the atopic group were significantly higher than those of non atopic group (78.2 ku/l vs 28.4 ku/l respectively). However, the difference in IgE levels were significant between non atopic and atopic groups residing in Sweden longer than 10.5 years, but not significant between those who resided less than 4.5 years. The allergic spectrum changed with residence time spent in Sweden in Turks. Skin test positivity to birch, cat, and dog increased with time. This increase may be related to the change in life styles and habits, such as indoor contact with pets, and intensive environmental birch pollen exposure. In conclusion, our data indicate that immunologic status of persons is influenced by a new millieu. Within a few years the allergic status of Turkish immigrants adapted to the new environment.

Adolescent↗
PubMed1996

Radiotherapy practices in Sweden compared to the scientific evidence.

Comparing the scientific literature to practices in Sweden reveals that radiotherapy is given to less than 34% of all patients with tumor diseases. This figure is lower than rates reported in other countries. For most tumor types, curative radiotherapy in Sweden is generally similar to practices supported in the literature. Hyperfractionated radiotherapy and interstitial brachytherapy are used much too sparingly. Palliative radiotherapy is underutilized in Sweden. The need for radiotherapy can be expected to increase until the year 2010.

Humans↗
PubMed1997

[Changing life expectancy in the 1980's. Why was Denmark different from Sweden?].

The aim of the present study was to identify the contribution from specific causes of death to the changes in life expectancy at birth in Denmark relative to Sweden in different age groups during the 1980s and to compare the difference in life expectancy between the two countries in 1990. Mortality data from WHO mortality tapes grouped in smaller series of clinically meaningful categories were used to calculate the contribution of each of these categories at each ten year age group to the difference in life expectancy at birth in each country between 1979 and 1990 and between the two countries. During the period from 1979 to 1990 life expectancy increased in both Denmark and Sweden. However, Sweden experienced the greatest increase in life expectancy (more than two years) while it increased less than one year in Denmark. In both countries a decrease in cardiovascular disease mortality contributed most to the increase in life expectancy among males as well as females. Both among males and females the less favourable development in Denmark was mainly caused by differences in mortality trends related to cardio-vascular diseases, respiratory and non-respiratory cancer. Over a short period of time two Nordic countries experienced remarkable, but different changes in mortality. These findings suggest that mortality rates are sensitive to even minor differences in social and cultural factors across countries and over short time periods.

Adolescent↗
PubMed1997

Bordetella pertussis serotype of clinical isolates in Sweden during 1970-1995 and influence of vaccine efficacy studies.

During the years 1970 to 1995, the serotypes of collected clinical isolates from the different regions of Sweden were examined. Vaccination using whole-cell pertussis vaccine decreased during the year preceding cessation of general vaccination of children in 1979. Although the total number of clinical isolates examined was limited up to 1978 compared to later years, serotype 1, 2, 3 clinical isolates generally predominated. During periodical pertussis outbreaks, serotype 1, 3 strains were isolated, the proportion of which was about equal to that of serotype 1, 2, 3 isolates. Following cessation of general vaccination in 1979, the proportion of both serotypes 1, 2, 3 and 1, 3 isolates gradually diminished, together contributing about 20 percent of the total number of isolates in 1995. Clinical isolates of serotype 1, 2 were identified in the year 1977, just before cessation of general vaccination in Sweden using whole-cell vaccine. Since then, this serotype has gradually increased to over 80 percent of total isolates in 1995, possibly indicating that the use of whole-cell pertussis vaccine was effective against this serotype or that the vaccine influenced serotype expression. Vaccine efficacy studies conducted in Sweden during 1986-87 using one and two-component vaccines (BIKEN) and in 1994-95 using two-component (SmithKline Beecham Pharmaceuticals) and five-component (Connaught Laboratories, Ltd.) vaccines are examined with the object of studying whether the vaccines showed any influence on the different serotypes of B. pertussis causing disease.

Animals↗
PubMed1997

[Potentially avoidable perinatal deaths in Denmark and Sweden 1991].

In 1991 the perinatal mortality rate in Denmark was 8.0/1000 deliveries compared to 6.5/1000 in Sweden. An international audit was designed to investigate whether the perinatal death rates in the two countries to some extent could reflect differences in the quality of care. Medical records of 97% of all perinatal deaths in 1991 in the two countries were analyzed. A new classification focusing on potential avoidability from a health services perspective was elaborated at a Nordic-Baltic workshop, using the variables: time of death in relation to admission and delivery, fetal malformation, gestational age, growth-retardation and Apgar score at 5 min. Rates of perinatal deaths of malformed infants (0.00195 and 0.00145) and intrapartum deaths of non-malformed infants (0.00042 and 0.00019) were significantly higher in Denmark than in Sweden. The study raised the following questions: why is the rate of perinatal death of malformed infants higher in Denmark than in Sweden and could intrapartum care in Denmark be improved?

Apgar Score↗
PubMed1998

Potential exposure to SV40 in polio vaccines used in Sweden during 1957: no impact on cancer incidence rates 1960 to 1993.

U.S. polio vaccines produced during the 1950s were potentially contaminated by simian virus 40 (SV40). Recently DNA from SV40 has been detected in brain ependymoma, pleural mesothelioma and osteosarcoma. In 1957, when national polio vaccination was started in Sweden, vaccine potentially contaminated with SV40 was given to approximately 700,000 individuals, mainly pre-school and school children born between 1946 and 1953. From 1958, a Swedish inactivated polio vaccine was exclusively used, which has been claimed to be free of SV40. We explored cancer incidence rates in the cohorts exposed to the potentially contaminated polio vaccines in Sweden. The Swedish Cancer Registry provided annual cancer incidence rates in five-year age groups for the years 1960-93. Cancer incidence in cohorts maximally exposed was followed during this period, and the incidence when these cohorts reached a specific age was compared to the incidence when unexposed cohorts reached the same age. For osteosarcoma and brain ependymoma overall age-standardised incidence rates were essentially unchanged between 1960 and 1993, and age specific rates were similar in the exposed and unexposed male and female cohorts. During the same period, overall age standardised incidence rates in males of brain cancers increased from 9.0 to 13.1 and of pleural mesotheliomas from 0.2 to 2.1 per 100,000. None of these increased rates was associated with the exposed cohorts. The use of potentially SV40 contaminated inactivated polio vaccines in Sweden has not been shown to be associated with increased cancer incidence. However, the exposed cohorts have not yet reached the age of increased risk of brain cancer or mesothelioma.

Adolescent↗
PubMed2002

Pricing and reimbursement of drugs in Sweden.

The Swedish public health care system is financed mainly by taxes. The major part of drug costs is paid by the drug reimbursement system. Sweden has, as most other countries, seen a large increase in the expenditures on drugs in recent years. The responsibility for the cost of drugs in Sweden has recently been decentralized to the county council level. The reimbursement system of drugs currently covers all drugs with a price approved by the National Social Insurance Board, unless the government specifically decides against such coverage. Two groups of drugs were recently excluded from coverage: drugs for obesity and impotence. The price level of drugs in Sweden is close to the average of the European countries. Economic evaluations are currently not mandatory in Swedish price and reimbursement negotiations but are nonetheless important, particularly in negotiations for drugs expected to command large price premiums. The Swedish pricing and reimbursement system has recently been under investigation, and new reforms are expected in the near future.

Journal Article↗
PubMed1985

Subsidizing pharmaceutical prescriptions: the experience of Denmark, Finland, Norway and Sweden.

In 1980, drug consumption per capita was 455 Swedish crowns (SEK) in Sweden, SEK 452 in Denmark, SEK 384 in Finland and SEK 382 in Norway; actual figures for Denmark, Finland and Norway being converted into Swedish crowns using the mean 1980 exchange rates. To what extent can these differences be explained by differences in the drug reimbursement programmes of these four Nordic countries? For instance, is it the greater generosity of the Swedish system--in Sweden, the share of drug reimbursement expenditures to total drug consumption is 57%, as against 33% in Norway, 38% in Finland and 34% in Denmark--that makes drug consumption per capita so much higher in Sweden? If the demand for drugs were elastic and if all other influencing factors, besides the reimbursement system, were the same in all the four Nordic countries, then a definite conclusion would, obviously, be fairly easy to reach. However, a number of factors do differ: for instance, income per capita, physician remuneration schemes (and, hence, maybe, physician behaviour) and consumer charges for inpatient and outpatient care; and other factors such as morbidity and patterns of illness may differ. A complete analysis has to take all these factors into account. Too many factors seem to vary to make the sole use of cross-section data meaningful in this case. Time-series data are available and will be used in future analyses.

Cost Control↗