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We present the first 3 cases of confirmed scrub typhus imported to Scandinavia. The patients were infected in Thailand, Laos and Sri Lanka, respectively. Treatment with ciprofloxacin and doxycycline lead to rapid cure in 2 of the patients, while the third patient, who was not treated, had a prolonged convalescence. Specific antibodies against Orientia tsutsugamushi, the causative agent of scrub typhus, were detected in all 3 cases.
To describe demographics of tuberculosis (TB) in the Øresund region, southern Scandinavia, a retrospective analysis of epidemiological data from TB registers and population databases, from 1995 to 2002, was performed. A total of 2678 TB cases were reported with an overall incidence of 6.3 per 100,000 person-y of observation. There were major differences in notification rates among immigrants depending on their country of origin and their residence in the Øresund region. In the Danish part, 37% of all cases among immigrants came from the Horn of Africa compared to 28% in the Swedish areas. Older age and residence in Denmark were independent risk factors for TB. Comparisons of TB rates within the group of immigrants from the Horn of Africa showed higher rates in the Danish areas compared to the Swedish areas. The discrepancies in notification rates could be explained by different socioeconomic circumstances in the 2 countries or by a greater immigration from highly endemic countries into Denmark during the study period; however, ongoing transmission in specific population groups at high risk of tuberculosis cannot be excluded. This highlights the need for continued and improved surveillance for TB, especially among newly arrived immigrants from highly endemic countries.
In order to describe the present status in Scandinavia of evaluation and treatment of patients presenting with symptomatic benign prostatic hyperplasia (BPH), a questionnaire was mailed to 261 relevant hospitals. In total 76% of the departments answered. Several differences between hospital types in each country were revealed, as well as differences between countries. Generally, symptom scores and urodynamics were used more often in university hospitals as compared to other types of hospitals. Symptom scores were most popular in Denmark and Sweden, while uroflowmetry generally was employed in Denmark and Finland, but less frequently in Sweden and Norway. The highest frequency of prostatic surgery was noted in Denmark. Watchful waiting accounted for the handling of 30% of the BPH patients in Finland and Sweden, in contrast to only 15% in Denmark.
During the past 20 years, many immigrants from all over the world have settled in Scandinavia. Primary care physicians today are therefore meeting patients from a variety of socio-cultural, religious, and ethnic backgrounds. In addition to endemic diseases, the new immigrants are exposed to Western illness and disease patterns and psychic reactions to life events, and the on-going adaptive process may add to the dilemmas of segregation in housing and work. During consultations, doctors and patients frame this ill health by culturally determined ideas of health, illness, and treatment. This paper deals with Scandinavian studies concerning transcultural issues in primary care by exploring the Scandinavian literature. Relatively few studies were found in the databases. Many of them were small, making it difficult to generalise the findings. Descriptive explorative studies suggest problems in communication, behaviour, mental ill health, physiotherapy, and organisation of care. No studies were found concerning issues such as genital mutilation, environmental diseases, family conflicts, or chronic disorders other than pain. From action research studies or randomised-controlled trials, it can be cautiously concluded that psychiatric care may be little accepted in many immigrant groups and that immigrants with non-specific pain are best handled in primary care where dialogue about pain is to be preferred to traditional treatment. Brief advice regarding communication and organisation of care is also given. In our opinion, studies using action research methods are to be preferred, since clinical transcultural care deals with complex illness patterns, including many emotional dilemmas.
Prior to vaccinations against invasive Haemophilus influenzae type b (Hib) diseases in Scandinavia, first initiated in Finland in 1986, the incidence of cases in those five countries was 49/100,000/year in 0- to 4-year-olds and 3.5/100,000 overall. During the following decade, Hib conjugates administered to young children had approximately 95% effectiveness, regardless of which conjugate was used, whether two or three primary doses were administered, and at what age in early infancy the first vaccination was given. The herd immunity effect has extended protection to older age groups. A similar effectiveness of different conjugates in five countries despite considerable diversity in approach suggests that the same impact would occur in other regions with comparable epidemiology. The Scandinavian experience supports the view that three primary vaccine doses are not imperative, thus suggesting that reducing doses of costly Hib vaccines would be one way to facilitate their usage in regions with limited resources.
The five countries of Scandinavia (Denmark, Finland, Iceland, Norway, and Sweden) comprise 22.6 million inhabitants and rather homogeneous socioeconomic conditions. A survey of systemic Haemophilus influenzae diseases over the last decades revealed that the reported incidence of H. influenzae disease is increasing. In recent years, the overall incidence has been 3.5 cases per 100,000 people each year (800 cases annually); in children less than 5 years of age, the annual incidence has been 49 cases per 100,000. Meningitis represents only 52% of all systemic H. influenzae diseases, but lack of reliable data may obscure the importance of other entities. Few strains (less than 5%) are beta-lactamase-positive, and the case fatality rate is 3%. Analysis of seasonal variation shows peaks in June and September-October. If the efficacy of the H. influenzae conjugate vaccines were as high as that of a conjugate vaccine used in Finland during 1986-1987 (approximately 85% efficacy), then at least an 80% reduction in life-threatening H. influenzae infections would be achieved annually by routine immunization before or at the age of 6 months.
BACKGROUND: The high and increasing prevalence of childhood asthma is a major public health issue. Various risk factors have been proposed in local studies with different designs. METHODS: We have made a questionnaire study of the prevalence of childhood asthma, potential risk factors and their relations in four regions in Scandinavia (Umeå and Malmö in Sweden, Kuopio in eastern Finland and Oslo, Norway). One urban and one less urbanized area were selected in each region, and a study group of 15962 children aged 6-12 years was recruited. RESULTS: The prevalence of symptoms suggestive of asthma varied considerably between different areas (dry cough 8-19%, asthma attacks 4-8%, physician-diagnosed asthma 4-9%), as did the potential risk factors. Urban residency was generally not a risk factor. However, dry cough was common in the most traffic polluted area. Exposure to some of the risk factors. such as smoking indoors and moisture stains or moulds at home during the first 2 years of life, resulted in an increased risk. However, current exposure was associated with odds ratios less than one. CONCLUSIONS: Our findings were probably due to a combination of early impact and later avoidance of these risk factors. The effects of some risk factors were found to differ significantly between regions. No overall pattern between air pollution and asthma was seen, but air pollution differed less than expected between the areas.
The Eurasian otter, Lutra lutra, has a Palaearctic distribution and has suffered a severe decline throughout Europe during the last century. Previous studies in this and other mustelids have shown reduced levels of variability in mitochondrial DNA, although otter phylogeographic studies were restricted to central-western Europe. In this work we have sequenced 361 bp of the mtDNA control region in 73 individuals from eight countries and added our results to eight sequences available from GenBank and the literature. The range of distribution has been expanded in relation to previous works north towards Scandinavia, east to Russia and Belarus, and south to the Iberian Peninsula. We found a single dominant haplotype in 91.78% of the samples, and six more haplotypes deviating a maximum of two mutations from the dominant haplotype restricted to a single country. Variability was extremely low in western Europe but higher in eastern countries. This, together with the lack of phylogeographical structuring, supports the postglacial recolonization of Europe from a single refugium. The Eurasian otter mtDNA control region has a 220-bp variable minisatellite in Domain III that we sequenced in 29 otters. We found a total of 19 minisatellite haplotypes, but they showed no phylogenetic information.
In order to evaluate the biogeographical hypothesis that the Norwegian lemming (Lemmus lemmus) survived the last glacial period in some Scandinavian refugia, we examined variation in the nucleotide sequence of the mitochondrial control region (402 base pairs (bp)) and the cytochrome b (cyt b) region (633 bp) in Norwegian and Siberian (Lemmus sibiricus) lemmings. The phylogenetic distinction and cyt b divergence estimate of 1.8% between the Norwegian and Siberian lemmings suggest that their separation pre-dated the last glaciation and imply that the Norwegian lemming is probably a relic of the Pleistocene populations from Western Europe. The star-like control region phylogeny and low mitochondrial DNA diversity in the Norwegian lemming indicate a reduction in its historical effective size followed by population expansion. The average estimate of post-bottleneck time (19-21 kyr) is close to the last glacial maximum (18-22 kyr BP). Taking these findings and the fossil records into consideration, it seems likely that, after colonization of Scandinavia in the Late Pleistocene, the Norwegian lemming suffered a reduction in its population effective size and survived the last glacial maximum in some local Scandinavian refugia, as suggested by early biogeographical work.
Several potential environmental factors, particularly air pollutants, have been implicated as causal factors for the increased prevalence of allergic disease in western industrialized countries. However, even when combined, these factors can only partly explain the increase. Differences in prevalence of allergy are apparent between urban and rural areas of industrialized countries, with positive skin prick tests being more common in children living in urban regions. However, the prevalence of atopy is lower in children in central and Eastern Europe, where air pollution poses a major problem, than in Western Europe. Indeed, preliminary data from the International Study of Asthma and Allergy in Children (ISAAC) confirm that the prevalence of childhood atopy is lower in Eastern Europe than in Scandinavia. Although air pollution is undoubtedly associated with the development of allergic disease, other factors connected with western lifestyle, such as changes in diet and living conditions, may play an important role and provide a possible explanation for the higher prevalence of allergic disease in western industrialized countries.
This paper gives a faunistic review of mites that have been recorded in the indoor environment, particularly homes, barns, and stored products, in Norway and the other Scandinavian countries. Some preliminary results are given from unpublished investigations in Norway. Seven species of pyroglyphid mites have been recorded: Dermatophagoides pteronyssinus, D. microceras, D. farinae, D. evansi, Euroglyphus maynei, Gymnoglyphus longior, and Hirstia chelidonis. D. pteronyssinus was the predominant species, followed by D. microceras in Scandinavia and D. farinae in Denmark. D. evansi was detected in poultry houses in Norway. Lepidoglyphus destructor was the predominant species in barn dust, but large populations of Acarus, Tyrophagus, Tydeus, and Tarsonemidae also occurred. In humid homes, Glycyphagus domesticus was found in high numbers. The result of quantification of mites depends on the method for examination of dust. When one proposes limits for the concentration of mites in relation to risk of allergic sensitization and provocation of symptoms, reference should be made to a well-described method for sampling and analyzing dust. The number of mites should be given per area, not only per weight unit of dust. The number of mites per area indicates the number of mites in the home. The number of mites per weight unit of dust describes the concentration of mites in the vacuum cleaner.
The concept of "culture" figured prominently in the development of family therapy. Recent conceptualizations, however, have tended to focus primarily on the ideational dimensions of culture. While not disputing that meanings and other ideas constitute significant features of group lifeways, this article proposes a return to earlier anthropological framings that incorporate material and ideational dimensions of cultures. To illustrate how his expanded concept may serve as a guide for therapeutic work, the article describes therapy with one family at a clinic in rural Scandinavia. We especially focus on the place of key symbols as historical links between the ideational and material dimensions of cultures. The perspective developed here is one of seeing cultures as sets of interpenetrating actions and ideas shaped by as well as shaping their practitioners.
Review of studies of incidence of MS over several decades in seven geographical areas scattered over Scandinavia and Finland have shown that incidence rates fluctuate significantly with time in most of the areas but in an inconsistent pattern. The incidence appeared to the lowest in the northernmost parts of Norway indicating that the well-known north-south gradient for risk of MS does not hold true for high latitudes.
A random sample representing approx. one-third of pre-school children and approx. 95% of school children in age groups 8, 11, 13, and 15 years in a suburb of Stockholm were examined for antibodies to Toxoplasma. Antibodies were uncommon in small children. They gradually appeared throughout childhood but especially in adolescence and adult life. Antibodies were more common in females than in males. Even small girls were more often infected than boys of corresponding age. The difference becomes marked in puberty and is significant in adults. A family study revealed evidence of familial aggregation of the infection albeit with borderline significance. No correlation was found between occurrence of antibodies and the presence of cats in the families or reported consumption of raw meat. The majority of representative samples of Lapps and Skolt Lapps in northern Scandinavia lacked antibodies to Toxoplasma.
AIM: To assess the effect of vitamin supplementation on the risk of sudden infant death syndrome (SIDS). METHODS: The analyses are based on data from the Nordic Epidemiological SIDS Study, a case-control study in which parents of SIDS victims in the Scandinavian countries were invited to participate together with parents of four matched controls between 1 September 1992 and 31 August 1995. The odds ratios presented are computed by conditional logistic regression analysis. RESULTS: The crude odds ratio in Scandinavia for not giving vitamin substitution was 2.8 (95% CI (1.9, 4.3)). This effect was statistically significant in Norway and Sweden, which use A and D vitamin supplementation, but not in Denmark, where only vitamin D supplementation is given. The odds ratios remained significant in Sweden when an adjustment was made for confounding factors (OR 28.4, 95% CI (4.7, 171.3)). CONCLUSION: We found an association between increased risk of sudden infant death syndrome and infants not being given vitamin supplementation during their first year of life. This was highly significant in Sweden, and the effect is possibly connected with vitamin A deficiency. This effect persisted when an adjustment was made for potential confounders, includingsocioeconomic factors.
Data pertaining to 330 Yersinia strains isolated from wild-living mammals, birds, fish, water, and soil in Scandinavia are summarized. The strains represent a broad spectrum of antigenic and biochemical variants interconnecting the species Y. enterocolitica and Y. pseudotuberculosis. A total of 136 strains were Y. enterocolitica sensu stricto; 55 strains produced acid rhamnose (Y. frederiksenii); 49 strains did not produce acid from sucrose (Y. kristensenii); 21 strains produced acid from rhamnose and melibiose (Y. intermedia); three strains were classified as Y. pseudotuberculosis. The remaining 66 strains could not be ascribed by any presently defined species. Seven strains were antigenically related to serogroup 3. Ecologically, Y. frederiksenii and Y. intermedia were more confined to aquatic ecosystems (fish and water) than Y. enterocolitica sensu stricto which was prevalent in both terrestrial and aquatic habitats. Y. kristensenii was ecologically comparable to Y. enterocolitica biotype 1, with their highest prevalence among terrestrial vertebrates. Y. frederiksenii and Y. intermedia seemed antigenically and biochemically more similar to Y. enterocolitica sensu stricto than Y. kristensenii.
Scandinavia (Denmark, Finland, Iceland, Norway, and Sweden) comprises with mutual borders and 22.3 million inhabitants an area where the socioeconomic and cultural conditions are similar. Epidemic diseases, such as meningococcal infection, might therefore be expected to be uniformly distributed. An epidemiological study in the 10-year period 1970-9 shows, however, remarkable differences in the incidence, age, and serogroup and type distribution, as well as in the general dynamics of the disease. Three epidemics, two caused by different serotypes of group B (Norway and Iceland) and one by group A (Finland) occurred within the observation period. The annual overall incidence was generally around 3/100 000 but increased from fivefold (Finland) to eightfold (northern Norway) during epidemics. The epidemic strains caused infection in over 3000 patients and the loss of at least 250 lives. The overall case fatality rate was 8.6% (range 4.1-13.7%). Men were more susceptible and had a worse prognosis than women of the same age group. The group A epidemic in Finland was influenced by a large vaccination campaign, but this possibility was not feasible in the two other epidemics.
BACKGROUND AND PURPOSE: As a basis for comparison of differences in stroke incidence in Scandinavian countries, a community-based stroke register was established in Orebro in the centre of Sweden. METHODS: All first-ever cases of stroke were registered during a 12-month period 1999-2000. The study population was 123,503. The WHO definition of stroke was used. Cases were searched inside as well as outside hospital. Multiple overlapping sources and 'hot pursuit' technique were used in the process of case ascertainment. RESULTS: 388 cases of first-ever stroke were found, corresponding to a crude incidence rate of 314 (95% CI, 283-348) per 100,000 per year, 337 (95% CI, 294-386) for females, and 289 (95% CI, 248-336) for males. Adjusted to the European population, the corresponding rates were 254 (95% CI, 227-284) per 100,000 per year, 273 (95% CI, 238-311) for females and 232 (95% CI, 206-261) for males. The overall 28-day case-fatality rate was 19% (95% CI, 15-23). The case-fatality rates for the different subtypes of stroke were as follows: brain infarction, 10%; intracerebral haemorrhage, 20%; subarachnoidal haemorrhage 45%, and undetermined pathological type 56%. CONCLUSIONS: The present study as well as other studies in northern and middle Scandinavia show significantly higher incidence rates than studies from other regions. The crude incidence rate, reflecting the age distribution of the population, is even higher, indicating a burden to the community that is rather increasing than decreasing.