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PubMed1997

Use of lipid-lowering drugs from 1990 to 1994: an international comparison among Australia, Finland, Italy (Emilia Romagna Region), Norway and Sweden.

OBJECTIVE: To compare the overall utilisation pattern of lipid-lowering drugs between 1990 and 1994 in Australia, Finland, Italy, Norway and Sweden as well as the pattern of use with respect to age and gender in Italy and Sweden. METHODS: Data were retrieved from regulatory authorities in each country for the 5-year period and analysed according to the ATC/DDD methodology (Anatomical Therapeutic Chemical classification/Defined Daily Doses). Utilisation was calculated as the DDDs for 1000 inhabitants per day for all drugs of the ATC category B04 (serum lipid-reducing agents). Data from Sweden and Italy were also compared with respect to gender and age. RESULTS: In 1994, Australia demonstrated the highest degree of utilisation (11.9 DDD) and the Nordic Countries the lowest (Sweden 5.6; Norway 4.9; Finland 4.0). In all countries except Italy, a steady increase was observed; in Italy, utilisation of these drugs reached a maximum in 1992 (11.5 DDD), but then underwent a reduction which was caused by restrictions in the reimbursement status in 1993 (10.4) and 1994 (6.7). Administration of statins increased in all countries, becoming the most used group of the B04 class. In 1988, the number of different drugs listed by each national health service ranged from 4 (Norway) to 16 (Italy); in 1994 it ranged from 6 (Norway) to 9 (Sweden). Analysis with respect to gender showed the opposite pattern in Sweden (males 4.6 and females 3.3 in 1992; 6.2 and 4.5, respectively, in 1994) than in Italy (males 10.8 and females 17.8 in 1992; 6.4 and 9.2, respectively, in 1994). Exposure was highest in people aged 60-69 years in both countries, followed by age group 50-59 in Sweden and 70-79 in Italy. CONCLUSIONS: Large variations in the utilisation of lipid-lowering drugs exist between countries, with Australia and Italy much higher than others. Of the drugs in the ATC category B04, the use of statins predominates in all countries, but to varying degrees. The large difference in the degree of drug utilisation with respect to age and gender between Italy and Sweden suggests major deviations from evidence-based medicine.

Adolescent↗
PubMed2001

Health technology assessment and screening in Sweden.

OBJECTIVES: To describe health technology assessment (HTA) and policies concerning three screening procedures in Sweden. METHODS: The main source of information was reports from the Swedish Council for Technology Assessment in Health Care (SBU) and other governmental reports, supplemented by the professional literature. RESULTS: Prevention is emphasized in the healthcare services of Sweden. Specifically, screening is encouraged and supported when it is deemed beneficial. Sweden has a strong orientation toward evidence-based health care and HTA. Since its inauguration in 1987, SBU has fostered the use of HTA in making policy and clinical decisions in Sweden. Government policy in Sweden is to encourage services that are beneficial and cost-effective and discourages services that are not. Screening is no exception to this general rule. The three cases examined in this paper-mammography screening, PSA screening, and routine ultrasound screening in pregnancy-have all been formally assessed in Sweden. Assessments have been an integral part of policy making concerning these and other preventive measures. Mammography screening has been widely implemented. However, as in other countries, screening is often carried out in an opportunistic fashion, so that PSA screening, in particular, is carried out more in Sweden than can be justified by the evidence. CONCLUSIONS: Mammography screening is promoted and is completely available to the target group. PSA screening is discouraged, but not with complete success. Ultrasound in pregnancy is widely used, not because of good evidence of impact on mortality and morbidity among newborns, but because it increases the detection rate of congenitally malformed fetuses and because of evidence of positive effects on the management and planning of deliveries, as well as because of psychological and ethical implications of the technology. HTA is an important part of health policy making in Sweden.

Adult↗
PubMed1982

Comparison of infant mortality in the United States and Sweden.

This study summarizes differences between Sweden and the United States regarding certain aspects of infant mortality. Sweden has the lowest infant mortality rate (IMR) and the United States is number 16. Both the neonatal and postneonatal mortality rates of Sweden are considerably lower. Since 1960, the neonatal mortality rate of Sweden was reduced by a greater percentage. The incidence of low birth weight in Sweden is considerably lower. In the United States, no state has an IMR as low as that of Sweden. Nonwhite babies, babies born out of wedlock, and those of teenage or "old" mothers have a higher IMR. The article describes in some detail the organization and network of services in Sweden that may be playing an important role in Sweden's low IMR.

Asphyxia Neonatorum↗
PubMedDate not supplied

Nursing and health care in Sweden.

Sweden, one of the Nordic countries, has a long history of social justice and equality of access to health care. Nursing plays an important role in this and nursing education is of a high standard. The aim of this paper is to describe Sweden's health system and nursing within it, thereby giving Australian nurses information which may generate an interest in, and provide background for, collaborative work. It is part of a series initiated by the first author who visited Sweden, Iceland and England in 2000 under the auspices of a Churchill Fellowship, and who has returned to Sweden and England to continue work begun during the Fellowship. Sweden's health service is characterised by an ethic of egalitarianism and high standards; primary health care plays a large role and tertiary health care is easily accessible. Nursing in Sweden is of a high standard, with devolvement of responsibility and decision-making to those working in the wards and units. Nursing education has been influenced by the historical development of nursing in Europe and today, Swedish nurses enjoy a high standard of university education with government support readily available to make specialist education accessible. Because of the similarities in both the cultures, and nursing, in Australia and Sweden, Australian nurses would find Sweden a wonderful country in which to implement cross-cultural, collaborative work. This paper provides

Adolescent↗
PubMed1992

[Asthma and allergic diseases in Sweden].

Until recently the prevalence of asthma in Sweden was assessed to be 2-3 per cent. An increase in the prevalence of asthma and allergic rhinitis was noted among new conscripts undergoing health work-ups prior to military service with the most marked increase in northern Sweden, were 5 per cent of conscripts were reported to have asthma. In southern Sweden the prevalence remained about 2 per cent. More recent questionnaire studies in mid- and southern Sweden have reported similar rates of respiratory symptoms and use of anti-asthmatic drugs as in northern Sweden, suggesting that there may be no difference in asthma prevalence between the north and the south of the country. The exact prevalence of allergic diseases among Swedish adults is still not clear, but 40 per cent of adults in northern Sweden report that they often have wheezing in the chest, attacks of breathlessness, longstanding cough or sputum production. In questionnaire studies among children about 40 per cent of respondents have reported that they had asthma, allergic rhinitis or other type of hypersensitivity. The absence of generally accepted diagnostic criteria for asthma and allergic disorders in epidemiological studies makes comparison of prevalence difficult. It is thus not possible to be sure that the prevalence of asthma and allergic disorders in Sweden has recently increased. Risk factors for the development of asthma and allergic disorders are under study in Sweden. Several studies report an association in children between urban living and allergic disorders.

Adolescent↗
PubMed2005

Germ-cell testicular cancer in offspring of Finnish immigrants to Sweden.

Variation in testicular cancer incidence can be used to assist in identification of risks. Finland has a significantly lower germ-cell testicular cancer risk than Sweden. Finns who immigrate to Sweden maintain their lower risk irrespective of age at immigration. We investigated difference in risk between Finland and Sweden by examining germ-cell testicular cancer incidence in males born in Sweden to Finnish immigrant parents. Swedish general population registers were used to identify 11,662 males born in Sweden where both Finnish parents immigrated to Sweden from Finland from 1969 or afterward. All of these offspring were at least 15 years old by final follow-up in 2001. Some six offspring (all diagnosed between ages 20 and 24 years) had a diagnosis of germ-cell testicular cancer. Comparison with the Swedish population rate produced standardized incidence ratios [SIR (95% confidence interval)] of 0.85 (0.31-1.84) for all the men and 1.75 (0.64-3.81) for the 20- to 24-year age group. SIRs calculated using the Finnish population rates produced an overall SIR (95% confidence interval) of 1.11 (0.41-2.41) and 2.95 (1.08-6.42) for the 20- to 24-year age group. Although the substantially reduced risk of testicular cancer previously observed in Finnish immigrant to Sweden was not found, this study had insufficient statistical power to conclude that environmental exposures explain the difference in germ-cell testicular cancer risk between Finland and Sweden.

Adolescent↗
PubMed1989

Paediatric drug prescribing. A comparison of Tenerife (Canary Islands, Spain) and Sweden.

The prescribing of medicines for ambulant children below 14 years of age has been compared between Tenerife (Spain) and Sweden. Data obtained from a random sample of 1327 children in a prospective study in Tenerife were compared with data from 3901 children in a Swedish survey linking diagnosis and therapy. Upper respiratory tract infection was the main diagnosis in both countries and antibiotics was the most frequently prescribed drug group (28.2% in Tenerife and 28.8% in Sweden). Half of the children in Sweden did not receive any medication, but only 10% of those in Tenerife did not receive a prescription. Children who received a prescription on average got 1.4 drugs in Sweden and 2.3 in Spain. Amongst the ten most commonly prescribed products in Sweden there were 11 active pharmacological principles as compared to 25 in Spain. These most frequently used preparations accounted for two thirds of all the prescriptions for children in Sweden and one third in Tenerife. In conclusion, drugs were significantly more often used to treat paediatric outpatients in Tenerife than in Sweden. The prescribing physician in Spain also chose a wider variety of drugs and more commonly used fixed combination products.

Atlantic Islands↗
PubMed2006

GIS supported calculations of (137)Cs deposition in Sweden based on precipitation data.

It is of interest to know the spatial variation and the amount of (137)Cs e.g. in case of an accident with a radioactive discharge. In this study, the spatial distribution of the quarterly (137)Cs deposition over Sweden due to nuclear weapons fallout (NWF) during the period 1962-1966 was determined by relating the measured deposition density at a reference site to the amount of precipitation. Measured quarterly values of (137)Cs deposition density per unit precipitation at three reference sites and quarterly precipitation at 62 weather stations distributed over Sweden were used in the calculations. The reference sites were assumed to represent areas with different quarterly mean precipitation. The extent of these areas was determined from the distribution of the mean measured precipitation between 1961 and 1990 and varied according to seasonal variations in the mean precipitation pattern. Deposition maps were created by interpolation within a geographical information system (GIS). Both integrated (total) and cumulative (decay corrected) deposition densities were calculated. The lowest levels of NWF (137)Cs deposition density were noted in north-eastern and eastern parts of Sweden and the highest levels in the western parts of Sweden. Furthermore the deposition density of (137)Cs, resulting from the Chernobyl accident was determined for an area in western Sweden based on precipitation data. The highest levels of Chernobyl (137)Cs in western Sweden were found in the western parts of the area along the coast and the lowest in the east. The sum of the deposition densities from NWF and Chernobyl in western Sweden was then compared to the total activity measured in soil samples at 27 locations. Comparisons between the predicted values of this study show a good agreement with measured values and other studies.

Air Pollutants, Radioactive↗
PubMed1996

Prevalence of asthma in young cross-country skiers in central Scandinavia: differences between Norway and Sweden.

An increased prevalence of asthma in cross-country skiers has been reported previously. This study was conducted in order to evaluate the prevalence of asthma among young, elite cross-country skiers in Trøndelag, Norway and Jämtland, Sweden. These two regions in central Scandinavia have different climates during the winter season, with a coastal type in Trøndelag while Jämtland is characterized by a colder, drier, inland type of climate. The study population consisted of 171 skiers (118 from Norway, 53 from Sweden). The investigation included an asthma questionnaire, spirometry and methacholine provocation testing. The prevalence of self-reported asthma-related symptoms was 46% in Norway and 51% in Sweden. The prevalence of bronchial hyper-responsiveness (BHR) was significantly different between the two regions. In Norway, 14% of the skiers were hyper-responsive to methacholine compared to 43% in Sweden (P < 0.001). Moreover, the estimated prevalence of clinically diagnosed asthma was 12% in Norway and 42% in Sweden (P < 0.001). The self-reported frequency of respiratory allergy was higher in Sweden (32%) than in Norway (11%). However, on an individual basis, self-reported allergy did not predict occurrence of asthma or BHR. In conclusion, there is a high prevalence of BHR and asthma among young, elite cross-country skiers in central Scandinavia, especially in Sweden. Cross-country skiing may be a risk factor for the development of asthma. Longitudinal studies of cross-country skiers, and studies to acquire further knowledge of the mechanisms involved in the development of asthma are indicated.

Adolescent↗
PubMed2004

Postweaning multisystemic wasting syndrome--PMWS. the first year with the disease in Sweden.

Postweaning multisystemic wasting syndrome (PMWS) is causally associated with porcine circovirus type 2 (PCV2) infection of pigs. PCV2 has been present in the Swedish pig population for at least ten years. Despite this, no signs of PMWS were observed in pigs of Sweden until 2003. Since then the disease has spread slowly in Sweden. The pig population of Sweden is geographically isolated, the density of pigs and the pathogen load in the country is low and the trade of animals is organised in a restricted way. To date, there has been little information placed in the peer-reviewed literature on the study of the spread of PMWS in a country during the early phase of the disease outbreak, mainly because diagnosis of PMWS has only occurred after the disease has been recognised on a number of farms. This manuscript documents the studies to date on the PMWS outbreak in Sweden which has been closely monitored since the initial outbreak of diseases on a single farm in 2003 was diagnosed. In Sweden PMWS was officially reported for the first time at a progeny test station during December 2003. One year later sixteen herds have been diagnosed and reported to the authorities: one progeny test station, one nucleus herd, thirteen piglet producers or integrated herds and one specialised fattening herd. Fifteen suspected cases have been deemed negative for PMWS with disease scenarios associated with Lawsonia intracellularis, Brachyspira pilosicoli, Mycoplasma hyopneumoniae, shortcomings in feed composition etc. To date, one year after the index case was reported ten other herds suspected for PMWS are under observation. The PMWS cases are concentrated into the southern part of Sweden. However, the disease is spreading slowly, and in general there are no obvious physical links between affected herds. The data generated to date in Sweden suggest that introduction of a new contagious microbe into the country that is responsible for the PMWS outbreaks appears unlikely, as does the spread of PMWS via semen.

Animals↗
PubMed2002

Life expectancy in the province of Halland, Sweden, 1911-50: the progress of public health in a long-living population.

BACKGROUND: Life expectancy in Sweden is currently one of the longest in the world. The population of Halland has the longest life expectancy in Sweden. AIM: Life expectancy in the province of Halland and Sweden as a whole during 1911-50 was studied and the findings are discussed in the light of local historical data. METHOD: A trend analysis of risk ratio of death and life expectancy for Halland and Sweden was done for the period 1911-50 with regard to calendar year, age, and sex using a Poisson model. RESULTS: The risk ratio between Halland and Sweden was 0.83 for 1911 and 0.76 for 1950. The risk ratio of death for women was lower compared with men and this difference increased over time. At the start of the study period life expectancy for men and women was higher in Halland (58.5 and 60.1 years, respectively) compared with Sweden (54.7 and 56.4 years, respectively) with a difference of approximately 3.8 years. At the end of the study period this difference in life expectancy for men and women in Halland (71.3 and 72.3 years, respectively) and the nation (68.0 and 69.2 years, respectively) had decreased to approximately 3.3 years. CONCLUSION: The long life expectancy seen in Halland today can be traced back to the early twentieth century. The starting point for this development seems to be a lower infant mortality in Halland compared with Sweden as a nation during the 1880-90. The basis for this might have been a greater increase of food production during the whole nineteenth century as well as other socioeconomic characteristics of Halland compared with the rest of the country.

Aged↗
PubMed2005

Migration and smoking: an epidemiological study of Finnish twins in Sweden.

BACKGROUND: Male migrants from Finland to Sweden have been found to have a reduced risk of coronary heart disease after several years in Sweden. Changes in smoking habits may contribute to this reduced risk. AIMS: A study was undertaken to compare smoking habits in Finnish migrants to Sweden and subjects always living in Finland and to analyse whether the migration may have influenced smoking. METHODS: The study population consisted of same-sex twin pairs born in Finland younger than 76 years with at least one twin that had migrated to Sweden (n = 1,083 pairs). Smoking habits obtained by mailed questionnaire were compared in migration-discordant twin pairs to take into account early childhood and genetic factors. RESULTS: Immigrants and returnees with a history of smoking had predominantly started to smoke before the migration. Among women, immigrants to Sweden smoked more than never migrants in Finland, odds ratio (OR) 2.1 for current smokers (95% confidence interval CI 1.4-3.3) but this difference was already present before migration. In men there were essentially no differences in smoking prevalence between immigrants and never migrants but heavy smoking was less common among immigrants than among never migrant smokers, OR 0.5 (95% CI 0.2-0.9) and migration was associated with a greater propensity to cease smoking. CONCLUSIONS: Migration from Finland to Sweden does not seem to have had a strong influence on smoking among migrants. A favourable trend in smoking habits after migration may in part have contributed to reduced mortality and incidence of coronary heart disease in male Finnish migrants after several years in Sweden.

Adult↗
PubMed2006

Prevalence of low back pain and sickness absence: a "borderline" study in Norway and Sweden.

AIMS: Low back pain (LBP) is a major public health problem in both Norway and Sweden. The aim of the study was to estimate the prevalence of LBP and sickness absence due to LBP in two neighbouring regions in Norway and Sweden. The two areas have similar socioeconomic status, but differ in health benefit systems. METHODS: A representative sample of 1,988 adults in Norway and 2,006 in Sweden completed questionnaires concerning LBP during 1999 and 2000. For this study only individuals in part or full time jobs, (n = 1,158 in Norway and n = 1,129 in Sweden) were included. RESULTS: In Norway the lifetime prevalence was 60.7% and in Sweden 69.6%, the one-year prevalence was 40.5% and 47.2%, and the point prevalence 13.4% and 18.2% respectively. There was a significantly higher risk of reporting LBP in Sweden, even after controlling for gender, age, education, and physical workload. There was no difference in risk of self-certified short-term sickness absence (1-3 days), but it was a 40% lower risk of sickness absence with medical sickness certification in Sweden compared with Norway. CONCLUSION: The prevalence of LBP was higher in the Swedish area than in the Norwegian. The risk of self-certified sickness absence, however, showed no differences and the risk of medically certified sickness absence was lower in the Swedish area. This contradiction might partly be explained by the economical "disincentives" in the Swedish health compensation system.

Adult↗
PubMed2001

Body height, birth cohort and social background in Finland and Sweden.

BACKGROUND: Poor childhood living conditions are associated with short stature. Before the Second World War Finland had much lower living standards than Sweden, but this gap had largely disappeared by the 1970s. Body height differences were examined by birth cohort, economic difficulties in childhood and adult socioeconomic position in Finland and Sweden. METHODS: Two nationally representative data sets were used (n = 7,300 in Finland and n = 4,551 in Sweden). Three indicators of social background were included, i.e. economic difficulties in childhood, education and occupational class. The methods used were direct age-standardisation, index of dissimilarity and regression analysis. RESULTS: In the cohort born in 1920-1929 body height was taller in Sweden (175.8 cm among men and 163.7 cm among women) than in Finland (173.9 and 161.2 cm respectively). Body height by birth cohort increased faster in Finland, with the result that, in the cohort born in 1960-1969, the gap between the countries had narrowed to 0.8 cm among men and 0.3 cm among women. Body height differences by social background were larger in Finland than in Sweden. Socioeconomic body height differences have remained largely stable over the birth cohorts in both countries. CONCLUSIONS: The results suggest that differential economic development is partly seen in the narrowing of body height differences between Finland and Sweden. However, socioeconomic differences in body height have remained largely similar over the birth cohorts studied and between Finland and Sweden.

Adolescent↗
PubMed2005

Prevalence of IgE antibodies to morphine. Relation to the high and low incidences of NMBA anaphylaxis in Norway and Sweden, respectively.

BACKGROUND: Anaphylactic reactions to a neuromuscular blocking agent (NMBA) is more than six times as common in Norway as in Sweden, probably due to differences in preoperative sensitization. The prevalence of IgE-sensitization to morphine (MOR) and suxamethonium (SUX) in comparable populations in Bergen, Norway, and Stockholm, Sweden, was studied and related to possible sensitizing agents. METHODS: Three hundred sera of 'allergics' and 500 blood donors in Bergen and Stockholm were tested for IgE antibodies to MOR and SUX using Pharmacia Diagnostics ImmunoCAP(Uppsala, Sweden) assay and the results compared to those of 65 patients from Bergen with documented anaphylaxis to NMBA. In addition, 84 different household chemicals were tested, by IgE antibody inhibition, for SUX and MOR. RESULTS: In Norway 0.4% of blood donors, 3.7% of allergics and 38.5% of anaphylactics were IgE-sensitized to SUX, and 5.0, 10.0 and 66.7%, respectively, to MOR. No serum from Sweden was positive. The majority of those sensitized (69%) were women. Several household chemicals contained SUX and/or MOR activity, but the only difference between Norway and Sweden was cough mixtures containing pholcodine (PHO). IgE antibodies to PHO were present in 6.0% of blood donors from Norway and in no serum from Sweden. Of the anaphylactics, 65-68% were sensitized to MOR or PHO but only 39% to SUX. CONCLUSIONS: IgE-sensitization to SUX, MOR and PHO was detected in Norway but not in Sweden. One possible explanation is the unrestricted use of cough mixtures containing MOR derivatives in Norway.

Algorithms↗
PubMed1997

Cancer survival in Estonian migrants to Sweden.

OBJECTIVE: To quantify the eventual extra loss of life incurred to cancer patients in Estonia compared with those in Sweden that was possibly attributable to differences in society. DESIGN: Population based survival of cancer patients in Estonia was compared with that of Estonian immigrants to Sweden and that of all cancer patients in Sweden. The cancer sites studied were female breast and ovary, male lung and prostate, and male and female stomach and colon. SETTING: Data on incident cases of cancer were obtained from the population based Swedish and Estonian cancer registries. PARTICIPANTS: Data from Estonian patients in Sweden, Estonian patients in Estonia, and patients from the total Swedish population were included in the study. MAIN RESULTS: Differences in survival among the three populations, controlling for follow-up time and age at diagnosis, were observed in breast, colon, lung, ovarian, and prostate cancers. The survival rates of Estonians living in Sweden and the total population of Sweden were better than that of the Estonians living in Estonia. For cancers of the breast and prostate, the excess mortality in the older age group (75 and above) was much greater in Estonia than in the other populations. CONCLUSIONS: Most differences in cancer survival between Estonian and Swedish populations studied could be attributed to a longer delay in diagnosis, and also to inferior treatment (including access to treatment) in Estonia compared with Sweden. Estonia's lag in socioeconomic development, particularly in its public health organisation and funding, is probably the main source of the differences observed.

Adolescent↗
PubMed2001

The role of income differences in explaining social inequalities in self rated health in Sweden and Britain.

STUDY OBJECTIVE: To analyse to what extent differences in income, using two distinct measures-as distribution across quintiles and poverty-explain social inequalities in self rated health, for men and women, in Sweden and Britain. DESIGN: Series of cross sectional surveys, the Swedish Survey of Living Conditions (ULF) and the British General Household Survey (GHS), during the period 1992-95. PARTICIPANTS AND SETTING: Swedish and British men and women aged 25-64 years. Approximately 4000 Swedes and 12 500 Britons are interviewed each year in the cross sectional studies used. The sample contains 15 766 people in the Swedish dataset and 49 604 people in the British dataset. MAIN RESULTS: The magnitude of social inequalities in less than good self rated health was similar in Sweden and in Britain, but adjusting for income differences explained a greater part of these in Britain than in Sweden. In Britain the distribution across income quintiles explained 47% of the social inequalities in self rated health among women and 31% among men, while in Sweden it explained, for women 13% and for men 20%. Poverty explained 22% for British women and 8% for British men of the social inequalities in self rated health, while in Sweden poverty explained much less (men 2.5% and women 0%). CONCLUSIONS: The magnitude of social inequalities in self rated health was similar in Sweden and in Britain. However, the distribution of income across occupational social classes explains a larger part of these inequalities in Britain than in Sweden. One reason for this may be the differential exposure to low income and poverty in the two countries.

Adult↗
PubMed1990

Infant mortality in Sweden and Finland: implications for the United States.

Sweden had the lowest reported infant mortality rate (IMR) among countries of the world from 1920 until 1980. Since 1981, Sweden, Japan, and Finland have shared this number one ranking on a somewhat rotating basis. The United States ranks 18th. In 1985, the reported IMRs in Japan, Sweden, and Finland were 5.5, 6.8, and 6.3, respectively, while that of the United States was 10.6 per 1000 live births. This article presents detailed data on IMR in Sweden, Finland, and the United States. It also includes data on neonatal mortality, postneonatal mortality, age of death, and incidence of low birth-weight in the three countries. The paper briefly describes background information on maternal and infant care in Sweden and Finland, including prenatal care, labor and delivery, sex education, family planning, abortion, infant care, and social benefits in Sweden and Finland. The paper gives possible reasons for the achievement of the low IMR in Sweden and Finland, and considers the implications for the United States.

Birth Weight↗