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PubMed2003

Characterisation of human tick-borne encephalitis virus from Sweden.

Viruses of the tick-borne encephalitis (TBE) antigenic complex, within the family Flaviviridae, cause a variety of diseases including uncomplicated febrile illness, meningo-encephalitis and haemorrhagic fever. Different wildlife species act as reservoir hosts with ixodid tick species as vectors. TBE virus (TBEV) causes 40-130 cases confirmed serologically in Sweden each year. Characteristics of TBEV strains circulating in Sweden have not been investigated previously and no viral sequence data has been reported. In the present study, virus strains were isolated from serum of patients with clinical symptoms consistent with acute TBEV infection. Serologic characterisation, using a panel of E-specific monoclonal antibodies and cross-neutralisation tests, indicated that the Swedish strains of TBEV, isolated 1958-1994, all belonged to the Western TBEV subtype, which includes the Austrian vaccine strain Neudoerfl. Genetic analysis of a partial E-sequence confirmed this close relationship: all Swedish TBEV strains belonged to the European lineage of the Western TBEV subtype, which includes the previously characterised strains Neudoerfl, Hypr, and Kumlinge. Further, three Swedish strains showed partial E-sequences identical to that of the Finnish Kumlinge strain, ten Swedish strains formed a well-supported separate cluster, whereas four others did not show any real clustering. No apparent correlation was observed in comparison of clinical parameters with genetic data or geographic origin of the strains.

Adolescent↗
PubMed2006

Epidemiology of Kaposi's Sarcoma herpesvirus (HHV8) in Västerbotten County, Sweden.

A population-based serosurvey of Human Herpesvirus type 8 (HHV8) in Västerbotten County, an area of Northern Sweden with high incidence of Kaposi's Sarcoma, was conducted. Serum samples from an age- and sex-stratified random sample of 520 subjects (260 men and 260 women) participating in a population-based biobanking project were tested for antibodies against HHV8, using a sensitive indirect immunofluorescence assay to latent and lytic HHV8 antigens. Buffy coat DNA was also analyzed for viral DNA using real time PCR assay. HHV8 DNA was not detectable in any one of the buffy coat samples. Eighty-four subjects (16.2%) were HHV8 seropositive, 14.4% for the lytic HHV8 antigen, and 1.7% for the latent HHV8 antigen. HHV8 seroprevalences were not associated significantly with sex or age. HHV8 seropositivity was more common among smokers (OR: 1.95, 95% CI: 1.02-3.75), but was less common among consumers of wine and spirits (OR: 0.44, 95% CI: 0.25-0.77 and OR: 0.50, 95% CI: 0.26-0.95, respectively). In summary, HHV8 has an intermediate high and stable seroprevalence rate in Northern Sweden, but environmental determinants that can explain the viral distribution were not found.

Adult↗
PubMed2007

Spontaneously reported fatal suspected adverse drug reactions: a 10-year survey from Sweden.

PURPOSE: One of the main methods for monitoring the safety of marketed drugs is spontaneously reporting of suspected adverse drug reactions (ADRs). The objective of this study was to describe the pattern of spontaneously reported fatal adverse drug reactions (FADRs) by analysing data from the national spontaneous reporting system in Sweden. METHODS: In Sweden it is compulsory to report all new or serious suspected ADRs to the Medical Products Agency. The information in these reports is stored in the national database SWEDIS (Swedish Drug Information System). All suspected FADRs reported to SWEDIS between 1 January 1995 and 31 December 2004 were reviewed and analysed. RESULTS: During the study period 990 reports of FADRs were found. The main distribution of suspected FADRs was: haemorrhages (n = 603; 60.9%), blood and bone marrow dysfunction (n = 71; 7.2%), sudden death (n = 38; 3.8%) and pulmonary embolism (n = 30; 3.0%). Antithrombotic agents were the drugs most frequently implicated in the FADRs (n = 605; 61.1%). Vitamin K antagonists were reported in 453 cases (45.8%) and acetylsalicylic acid in 82 cases (8.3%). Among the fatalities with blood and bone marrow dysfunction methotrexate was the most frequently reported drug. For sudden death and pulmonary embolism, antipsychotics and oestrogen containing drugs, respectively, were most commonly reported. CONCLUSIONS: Bleeding complications amounted more than half of all reports of FADRs and vitamin K antagonists were implicated in most of these reports. However, as spontaneous reporting systems are primarily set up for signalling purposes, the data must be interpreted with utmost care.

Adolescent↗
PubMedDate not supplied

Antidepressant medication and suicide in Sweden.

OBJECTIVE: To explore a possible temporal association between changes in antidepressant sales and suicide rates in different age groups. METHODS: A time series analysis using a two-slope model to compare suicide rates in Sweden before and after introduction of the selective serotonin reuptake inhibitors, SSRIs. RESULTS: Antidepressant sales increased between 1977-1979 and 1995-1997 in men from 4.2 defined daily doses per 1000 inhabitants and day (DDD/t.i.d) to 21.8 and in women from 8.8 to 42.4. Antidepressant sales were twice as high in the elderly as in the 25-44-year-olds and eight times that in the 15-24-year-olds. During the same time period suicide rates decreased in men from 48.2 to 33.3 per 10(5) inhabitants/year and in women from 20.3 to 13.4. There was significant change in the slope in suicide rates after the introduction of the SSRI, for both men and women, which corresponds to approximately 348 fewer suicides during 1990-1997. Half of these 'saved lives' occurred among young adults. CONCLUSION: We demonstrate a statistically significant change in slope in suicide rates in men and women that coincided with the introduction of the SSRI antidepressants in Sweden. This change preceded the exponential increase in antidepressant sales.

Adolescent↗
PubMed2004

Under-reporting of serious adverse drug reactions in Sweden.

INTRODUCTION: Adverse drug reactions (ADR) constitute a major problem, both from a medical point of view and as an economical burden. Spontaneous reporting of ADRs is one of the methods for post marketing surveillance of drug safety. Under-reporting can also provide an important obstacle to rapid and relevant signal detection. AIM: To investigate the rate of under-reporting serious ADRs of selected ICD 10 diagnoses. METHOD: In order to investigate the under-reporting rate we investigated at five hospitals within the county of Norrbotten in Sweden the total number of diagnosed cases during a period of 5 years (1996-2000) with the following diagnoses: cerebral haemorrhage (I 61.0-I 61.9), pulmonary embolism (I 26.0 and I 26.9), embolism or thrombosis (I 74.0-I 74.9), phlebititis, thrombophlebitits or venous thrombosis (I 80.0-I 80.3, I 80.8 and I 80.9) and portal vein thrombosis and other thrombosis or emboli (I 82.0-I 82.3, I 82.8 and I 82.9). The identity of these patients was obtained through a database search. The patients' case records were then scrutinized by a specially trained nurse and the drugs used at the time of the event were noted. An assessment of the possibility of an ADR was performed using standard WHO causality criteria. Later, database search in the Swedish ADR registry was performed in order to investigate whether these suspected ADRs had been reported to the national authority in Sweden or not. RESULTS: In total 1349 case records were found and scrutinized. Of these, 107 patients had received drugs that could have been a probable or possible cause to the diagnoses. Of these 92 cases had not been reported and only 15 patients were found in the database, giving an overall under-reporting rate of all ADRs of 86%. The most commonly occurring diagnoses were cerebral haemorrhage followed by venous thrombosis, 545 and 468 respectively. Among those cases that should have been reported according to the existing rules for spontaneous reporting of suspected ADRs the most frequently occurring diagnosis was cerebral haemorrhage (I 61.0) in connection to treatment with anticoagulants. CONCLUSION: The rate of spontaneous ADR reporting is very low, also for serious and fatal reactions.

Adverse Drug Reaction Reporting Systems↗
PubMedDate not supplied

Patients' satisfaction ratings and their desire for care improvement across oncology settings from France, Italy, Poland and Sweden.

There has been an increasing interest in patient satisfaction assessment across nations recently. This paper reports on a cross-cultural comparison of the comprehensive assessment of satisfaction with care (CASC) response scales. We investigated what proportion of patients wanted care improvement for the same level of satisfaction across samples from oncology settings in France, Italy, Poland and Sweden, and whether age, gender, education level and type of items affected the relationships found. The CASC addresses patient's satisfaction with the care received in oncology hospitals. Patients are invited to rate aspects of care and to mention for each of these aspects, whether they would want improvement.One hundred and forty, 395, 186 and 133 consecutive patients were approached in oncology settings from France, Italy, Poland and Sweden, respectively. Across country settings, an increasing percentage of patients wanted care improvement for decreasing levels of satisfaction. However, in France a higher percentage of patients wanted care improvement for high-satisfaction ratings whereas in Poland a lower percentage of patients wanted care improvement for low-satisfaction ratings. Age and education level had a similar effect across countries. Confronting levels of satisfaction with desire for care improvement appeared useful in comprehending the meaning of response choice labels for the CASC across oncology settings from different linguistic and cultural background. Linguistic or socio-cultural differences were suggested for explaining discrepancies between countries.

Adult↗
PubMed1994

Pregnancy outcome in Sweden after the Chernobyl accident.

OBJECTIVE: To study pregnancy outcome including development of childhood cancer in areas within Sweden with the highest radioactive fallout after the Chernobyl accident in 1986. METHODS: Various Swedish health registries were used in order to identify all pregnancies and their outcome in Sweden according to the measured radioactive fallout. RESULTS: A reduction in conception rate occurred after the accident, as well as possible increase in induced abortion rate during the fall after the accident. No changes in the rate of spontaneous abortions or congenital malformations occurred in pregnancies exposed at the time of the accident. There was a temporary increase in low birth weight which could well be random. Among infants conceived after the accident, a slight excess of Down syndrome infants was found in the most exposed areas but this observation is based on small numbers. No certain excess of childhood cancer was seen in the most exposed areas, but three infants, in utero at the time of the accident, developed leukemia. CONCLUSIONS: No major effects on pregnancy outcome were seen but the indicated increase in Down syndrome and childhood leukemia--if not random--could be a result of radioactive exposure.

Abortion, Spontaneous↗
PubMed1998

No obvious spatial clustering of twin births in Sweden between 1973 and 1990.

The aim of this work was to ascertain whether spatial clustering of twin deliveries occurred in Sweden between 1973 and 1990. Since 1973, the Medical Birth Registry (MBR) has gathered information on all births in Sweden. Between 1973 and 1990, there were 17,067 twin deliveries. The MBR records data on pregnancies, deliveries, and the neonatal period, including parturients' domicile. To test the hypothesis that atmospheric pollution from refuse incinerators increases the incidence of twin deliveries, the periods before and after the commissioning of 14 such plants were compared. There was no apparent increase in the number of parishes or municipalities having a relative excess of twin deliveries. In the vicinity of one plant, there was a significantly increased number of twin deliveries, whereas in another, there was a significant decrease. There was no spatial clustering when the incidences of twin delivery were compared among parishes, municipalities, and areas near incinerators.

Birth Rate↗
PubMed1978

The use of food additives in Sweden.

Recently it was demonstrated that the levels of some added colours in food sold in Sweden were such that the recommended daily intake (ADI) could easily be exceeded by the consumer (Ahlborg et al. Vår Föda, 26, 1974, 194-217). New regulations concerning the use of food colours in Sweden came into force on July 1st, 1975. The collection of information on the use of food additives in products sold on the Swedish market has not been extended to cover other food additives such as preservatives and antioxidants. This study is based upon details of about 10,000 food products containing food additives. The material is being computerised and work on the evaluation is in progress. The new investigation demonstrates that the use of food colours has decreased and that very few products now contain high levels of food colours. Data will be presented concerning the levels and total amounts of preservatives, antioxidants and other food additives used in different groups of food products.

Food Additives↗
PubMed1993

A survey of Q-fever in Sweden.

Coxiella burnetii, the etiological agent of Q-fever has recently been isolated from sheep in southern Sweden. In this region 24-30% of sheep farmers have been exposed to the organism as shown by serological measurements. In veterinarians, another group with high risk of exposure to C. burnetii, about 12% have antibodies to the bacteria. The seropositive veterinarians are scattered all over the country. In two non-risk groups, draftees and hospital employees, 5-7% were found to be positive. This survey showed that Q-fever is a domestic disease which is spread throughout Sweden.

Adolescent↗
PubMed1996

Women's labor force transitions in connection with childbirth: a panel data comparison between Germany, Sweden and Great Britain.

"In this paper we make use of the panel aspects of the German GSOEP, the Swedish HUS and the British BHPS data...[to analyze] labor force transitions triggered by child births of different birth orders.... We find that German and British women have even higher full-time labor force participation than Swedish women 12 months before the birth of the first child. The difference is more pronounced for second and third births than for first births. We suggest that these differences are caused by different family policy regimes where Germany can be characterized as a breadwinner regime and Sweden a regime oriented towards equal role sharing of father and mother. Our results on determinants of being in the labor force both after and before the birth of a child as well as determinants of the tempo of entering the labor force after birth show that women's own human capital is important both in Germany and Great Britain, whereas in Sweden also less educated women have entered the labor force by the time the child is 2 years old."

Birth Order↗
PubMed1977

Lethal intoxications with morphine in Sweden 1966-1974.

Fatal intoxications with morphine derivatives have become increasingly common in Sweden. Toxicologic data and pathologic findings in 34 cases of morphine intoxications from 1966 to 1974 in Sweden are presented. From 1972 on when morphine the black market, lethal intoxications with centrally stimulation amines.

Adolescent↗
PubMed1975

Lethal intoxications with centrally stimulating amines in Sweden 1966-1973.

Fatal intoxications with centrally stimulating amines (CSA) have become increasingly common in Sweden. Toxicological data and pathological findings of 32 cases of amphetamine and phenmetrazine intoxications which occurred from 1966-1973 in Sweden are described. Furthermore, 13 cases where these drugs were not the cause of death, but found in urine and organs, are reported.

Accidents↗
PubMed1988

The panorama of psychiatric emergencies in three different parts of Sweden.

A total of 1226 psychiatric emergencies from three socially different catchment areas in Sweden were analyzed. Data were obtained over 28 consecutive days at the beginning of 1985. Very small differences were found between urban and rural catchment areas, which is probably due to a high degree of equality for both social and medical services throughout Sweden. The largest diagnostic subgroup was patients with an alcohol problem (33%). A measure of the patients network of close relatives, yielded small differences between the diagnostic subgroups.

Adult↗
PubMed1997

Injury panorama and medical consequences for 1158 persons assaulted in the central part of Stockholm, Sweden.

This retrospective study describes assaults, type of trauma, injury panorama, the abbreviated injury scale score and medical consequences for 1158 assaulted persons. All patients were examined by surgeons at the Emergency Department, Sabbatsberg's Hospital, Stockholm, Sweden, which is open around the clock. The police were not notified. The study group included all assaulted patients who attended and were examined at the Emergency Department from 1 April 1992 to 31 March 1993: 84% men and 16% women. Their median age was 25 years (range 13-86 years). Sixty-eight percent arrived at the Emergency Department between 11 p.m. and 4 a.m. In 44% the hospital staff registered in the case notes that the victims were drunk. Blunt trauma of low-energy type predominated, 44% were hit by fists and 30% by kicks. Penetrating trauma occurred in 10% of the assaults (knife 8%), and a combination of blunt and/or cutting trauma (bottle/ glass) in 10%. Eighty-two percent of the victims suffered an injury to the head, resulting in concussion in 116 cases, 4 skull fractures, 1 intracerebral contusion, 74 fractures of nose bones, 17 fractures of other face bones, and 6 mandible fractures. Two persons died because of knifestab wounds. Eighty-two percent of the victims had minor injuries, and 16% had moderate injuries according to the score on the Abbreviated Injury Scale (AIS). The present study shows that assault in the central part of Stockholm, Sweden, is mainly a problem involving young men, especially late in the evening, and that many of the victims are drunk. Injuries to the head due to low-energy trauma are the most common (hit by fists and kicks), but severe injuries seldom occur.

Adolescent↗
PubMed1986

Therapeutic traditions in Northern Ireland, Norway and Sweden: I. Diabetes. WHO Drug Utilization Research Group (DURG).

A questionnaire survey was carried out to explore differences in the approach to treatment of patients with Type II diabetes between physicians in Northern Ireland, Norway and Sweden, and to discover to what extent it could account for the three-fold difference in drug use between the countries. A representative sample of 400 physicians in each country was asked to give their opinions on the choice of therapy for three model cases designed to cover the spectrum of treatment - from diet alone to insulin. Significantly more Swedish (65%) than Northern Irish (51%) and Norwegian (52%) doctors suggested diet alone for uncomplicated diabetes recently discovered in a middle aged, overweight man. For symptomatic diabetes in a 76 year old over-weight woman with few retinal microaneurysms, the majority of physicians in all three countries suggested treatment with sulphonylureas. Biguanides were here a more common alternative in Northern Ireland than in Scandinavia. For suspected secondary treatment failure in a 63 year old woman with no signs of complications, insulin was suggested by 71% of the Norwegian doctors but only by 44 and 49% of those in Northern Ireland and Sweden, respectively. General practitioners tended to suggest oral treatment earlier and to maintain it longer than hospital physicians. The study has demonstrated significant differences in the approach to treatment of Type II diabetes mellitus between physicians in the three countries. However, the differences were more prominent in the choice of drugs than in the threshold of drug treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Diabetes Mellitus↗
PubMed1977

Recording of drug prescriptions in the county of Jämtland, Sweden. I. Methodological aspects.

Prescribed drugs dispensed to 13% (17000) of the inhabitants in the county of Jämtland, Sweden, have been continuously recorded since 1970. Individual patients in the investigation are fully identifiable by their identity number as used in Sweden, so patients exposed to a particular drug or group of drugs can be reached subsequently, e. g. for studies of the incidence and nature of side effects. The following information is coded at the local pharmacies: prescribing physician, dispensing pharmacy, year and week of dispensation, name, amount and price of drug, dosage, type of prescription record. In a five year period the drop-out rate has decreased from 9% in 1970 to 4% in 1974. Every year at least one drug is prescribed for approximately 60% of the population. During the five year period 74% of the male and 80% of the female population purchased prescription drugs. The representative nature of the data is discussed, as well as their value in detection of irrational drug usage and ascertaining any particular patient's drug history.

Drug Information Services↗
PubMed1987

Continuous recording of drug prescribing in Sweden 1974-1983. Methods and examples of utilization of data.

Drug prescribing in Sweden under the National Insurance Act has been continuously recorded since 1974. A random sample of 1 in 288 is drawn from the about 24 million prescriptions issued yearly and the following data are recorded: dispensing pharmacy, type of prescription, year and month of dispensing, year of birth and sex of the patient, trade name, quantity, dosage, and price of the drug. The numbers of prescriptions of drugs free of charge increased by 32% between 1974 and 1983, while that of price deducted drugs decreased by 7%. The national cost of drugs rose sharply during the period. The per capita cost of drugs to persons aged greater than or equal to 75 years was more than eight-fold higher than for persons aged less than or equal to 14 years. A two-fold difference in the number of prescription items was found between women and men, and there were nine- to ten-fold differences between age-groups. Total prescribing varied modestly over time, as did the prescribing to most patient groups and for most groups of drugs. Exceptions to this were prescribing to children, particularly of antiallergic drugs for which a 50% increase was observed between 1974 and 1975, mainly due to increased prescribing of phenylpropanolamine. The recording of prescriptions as described is useful for early identification of new patterns of drug use and for mapping drug utilization and drug dosages in different age groups. The system is particularly powerful as a complement to other methods for recording drug use in Sweden, e.g. wholesale sales statistics and individual prescription monitoring in the county of Jämtland.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗