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[Causes of cancer in Scandinavia and possible preventive measures].

The purpose of this work is to address future possibilities for avoiding cancer. We elucidate the most important known causes of cancer in the Nordic countries during the second half of this century and provide estimates of the numbers of cancer cases that might be avoided by the year 2000 if those causes were effectively eliminated. Information on the pattern of carcinogenic exposures in each of the five Nordic countries and the associated relative risk estimates from the scientific literature were obtained. The numbers of avoidable cancers were assessed on the basis of this information together with the associated population attributable risk percent, PAR%, i.e. the proportion of a given cancer that can be avoided upon elimination of the causative factor. The main causes of cancer include smoking, alcohol consumption, exposure to occupational carcinogens, radiation, obesity and infection with human papillomavirus (HPV) and Helicobacter pylori. Annually, more than 18,000 cancers in men and 11,000 in women in the Nordic populations could be avoided by eliminating exposure to known carcinogens which is equivalent to 33 percent and 20 percent of all cancers arising in men and women, respectively, around the year 2000. Smoking habits account for a little more than half of these avoidable cases. Exposure to solar radiation, HPV and Helicobacter pylori, diagnostic and therapeutic radiation and consumption of alcohol play important roles in the causation of cancer, as each of these factors is linked with 1-5 percent of all cancers in men and women. Occupational exposures are also substantial causes in men (3 percent), and obesity is important in women (1 percent). In contrast, current knowledge is insufficient to give reliable estimates of the numbers of cancers that could be avoided by well-described modifications of dietary habits. These figures indicate that the most efficient way of reducing cancer morbidity would be to reduce the prevalence of exposure of the population to cancer-causing agents.

Carcinogens↗

[How much is the workload of surgeons in Scandinavia?].

According to figures presented at the Bianniul General Meeting of the Scandinavian Surgical Society, the mean number of operations performed per surgeon at some clinics of different sizes in Denmark, Finland, Iceland, Norway and Sweden ranged from 90 to 240 in 1996. This corresponds to 2.6 to 8.5 hours actual operating time, though figures are misleading since time spent assisting at operations, or on endoscopies, minor diagnostics and outpatient procedures, and essential pre- and post-operative tasks is not included. This level of operative activity is considered barely sufficient for training surgeons or for maintaining surgical skills. Surgeons could devote more time to surgery if a greater proportion of their non-surgical workload was taken over by other hospital staff, which would also reduce the number of surgeons required.

General Surgery↗

Population structure in a critically endangered arctic fox population: does genetics matter?

The arctic fox (Alopex lagopus) in Scandinavia is classified as critically endangered after having gone through a severe decline in population size in the beginning of the 20th century, from which it has failed to recover despite more than 65 years of protection. Arctic foxes have a high dispersal rate and often disperse over long distances, suggesting that there was probably little population differentiation within Scandinavia prior to the bottleneck. It is, however, possible that the recent decline in population size has led to a decrease in dispersal and an increase in population fragmentation. To examine this, we used 10 microsatellite loci to analyse genetic variation in 150 arctic foxes from Scandinavia and Russia. The results showed that the arctic fox in Scandinavia presently is subdivided into four populations, and that the Kola Peninsula and northwest Russia together form a large fifth population. Current dispersal between the populations seemed to be very low, but genetic variation within them was relatively high. This and the relative F(ST) values among the populations are consistent with a model of recent fragmentation within Scandinavia. Since the amount of genetic variation is high within the populations, but the populations are small and isolated, demographic stochasticity seems to pose a higher threat to the populations' persistence than inbreeding depression and low genetic variation.

Alleles↗

Accumulation of heavy metals in circumpolar willow ptarmigan (Lagopus l. lagopus) populations.

A circumpolar survey of heavy metals in willow ptarmigan liver and kidney revealed considerable variations in Cd content in Canada and Scandinavia. The Cd content in central Canada was comparable with that in Scandinavia and Russia, at least for kidney. However, in both liver and kidney the median for Canada as a whole was much higher than in the other countries. Some Canadian locations had exceptionally high levels, several birds having >50 mg kg(-1) in liver and >400 mg kg(-1) in kidney. In Norway, the Cd content was highest in central mountain areas in south Norway and inland locations in the two northernmost counties. Five locations in central and north Norway showed mean Cd levels in kidney above 100 mg kg(-1). It is difficult to evaluate regional differences in Sweden, but most locations had the same Cd level as moderately contaminated locations in Norway. Cd levels in Russia were comparable to moderately contaminated locations in the other countries. Due to a high intake of willow, naturally rich in Cd, direct comparison of the Cd level in willow ptarmigan from different locations cannot reveal the effects of long-range pollution. The Pb concentration in willow ptarmigan kidney and liver varied significantly in Norway and Canada, but not in Sweden and Russia. Levels in Sweden and Russia were comparable to those in Canada and low levels in Norway. The highest median value from all locations within countries was found in Norway, both in liver and kidney. The highest Pb content was found in south Norway, indicating an effect of long-range pollution in willow ptarmigan. The level in western Canada was significantly higher than in central Canada. The Hg content in liver varied significantly from one location to another in all the countries and in kidney everywhere except Sweden. In Scandinavia, there is no distinct regional pattern. Canada had a significantly higher Hg level in central than western regions in both tissues the opposite of that found for Cd and Pb. Cu and Zn showed significant variations from one location to another in liver and kidney in Canada and Norway, but only in kidney in samples from Sweden. Comparison between western and central Canada revealed a significant difference for Cu in liver, samples from central Canada having more. There are no significant differences from one country to another, but some localities in Canada seem to have higher Cu concentrations in kidney than are found in Scandinavia and Russia.

Air Pollutants↗

Epidemiology of vaginitis.

Vaginitis is one of the most common problems in clinical medicine, and it is the reason cited most often for visits to obstetricians and gynecologists. This article reviews the epidemiology in the United States and Scandinavia for the three major causes of vaginitis: candidiasis, trichomoniasis, and bacterial vaginosis. The incidence of candidiasis has increased dramatically during the past decade, with an increase in the percentage of non-albicans Candida strains. However, in Scandinavia the incidence of candidiasis has been relatively stable, between 10% and 30%, during the past 5 years. The incidence of Trichomonas has decreased dramatically in both the United States and Scandinavia during the past 15 years, partly attributable to the advent of metronidazole. In the United States bacterial vaginosis continues to be the leading variety of vaginal infection, affecting a broader spectrum of women than gonorrhea. The prevalence of bacterial vaginosis in Scandinavia is about 30%, and this percentage increases with age according to studies of patients at sexually transmitted disease clinics.

Adolescent↗

Female genital mutilation -- an exported medical hazard.

BACKGROUND: Female circumcision (FC) has remained a common practice in the countries where it has traditionally been performed. Following increased global mobility, it has also become a common medical issue in the predominantly non-Islamic countries where an increasing number of immigrants from regions where FC is still traditional, have settled. OBJECTIVES: To investigate types of FC found in a group of immigrants from northern Africa with a current domicile in Scandinavia. To characterize these women with regard to education, socio-economic status and experienced complications and sequelae. To report attitudes to FC among the women and their husbands. METHODS: An autoquestionnaire was distributed to 220 immigrant women (16-42 years old), who belonged to an African community in Scandinavia and who had all been circumcised. Information was also gathered concerning 76 of their daughters (aged 1-13 years). Of the women's husbands, 95 were asked about their attitudes to FC. RESULTS: Of the 140 women, who had been circumcised in their home country before they migrated, 78 (35%) had been clitoridectomized, 38 (17%) had been subjected to genital excision and 24 (11%) to infibulation. The corresponding percentages in the remaining women, who had had FC when returning home for a visit, were 0%, 14% and 22%, respectively. Of the daughters, 15 (19%) had been circumcised whilst living in Scandinavia; all had been clitoridectomized. Twenty-eight (13%) women reported having experienced late complications or post-FC sequelae. A positive attitude to stopping the tradition of FC was reported twice as often by the husbands (69%) as by the circumcised women (35%). Religion (95% of the responders were Muslims and 5% Christians), cultural tradition, and increased chance of marriage or of continued health were the reasons put forward in favor of the continuation of FC by 58%, 27%, 10% and 4 %, respectively. Five per cent could not supply an opinion. CONCLUSIONS: FC is performed in immigrant women even after settling in areas where this practise is legally banned. Circumcised immigrant women experience medical and sexual problems which have to be dealt with in their new domicile country. Many African Islamic women, who have migrated to Scandinavia, seem still to be in favour of the continuation of circumcision for varying reasons.

Adolescent↗

Differences in vitamin D status between countries in young adults and the elderly.

PURPOSE: To compare vitamin D status between countries in young adults and in the elderly. MATERIALS AND METHODS: Reports on vitamin D status (as assessed by serum 25-hydroxyvitamin D) from 1971 to 1990 were reviewed. Studies were grouped according to geographic regions: North America (including Canada and the United States); Scandinavia (including Denmark, Finland, Norway, and Sweden); and Central and Western Europe (including Belgium, France, Germany, Ireland, The Netherlands, Switzerland, and the United Kingdom). RESULTS: Vitamin D status varies with the season in young adults and in the elderly, and is lower during the winter in Europe than in both North America and Scandinavia. Oral vitamin D intake is lower in Europe than in both North America and Scandinavia. Hypovitaminosis D and related abnormalities in bone chemistry are most common in elderly residents in Europe but are reported in all elderly populations. CONCLUSIONS: The vitamin D status in young adults and the elderly varies widely with the country of residence. Adequate exposure to summer sunlight is the essential means to ample supply, but oral intake augmented by both fortification and supplementation is necessary to maintain baseline stores. All countries should adopt a fortification policy. It seems likely that the elderly would benefit additionally from a daily supplement of 10 micrograms of vitamin D.

Administration, Oral↗

Living conditions in early infancy in Denmark, Norway and Sweden 1992-95: results from the Nordic Epidemiological SIDS study.

The objective was to study living conditions of infants and their families in Scandinavia in the 1990s and to assess similarities and differences among the three Scandinavian countries. The emphasis is on health and normality rather than on diseases and other deviations from well-being. The subjects are the 869 controls in the Nordic Epidemiological SIDS study carried out between 1 September 1992 and 31 August 1995 in Norway, Denmark and Sweden. The controls were matched with the 244 SIDS cases for sex, age and maternity hospital. Parents of the SIDS cases and the controls filled in the same questionnaire on family, pregnancy, delivery, the neonatal and the post-perinatal period. The most striking findings were that 99% of the mothers went to regular maternity controls, 97% to well-baby clinics and 84% breastfed exclusively. On the other hand, 11% drank alcohol more than once a month during pregnancy and 29% smoked during pregnancy. Compared to official statistics, to the extent they exist, the differences were small. The material contains valuable information on normal infant care in Scandinavia in the 1990s. Living conditions of infants in Scandinavia are similar in the three countries. Differences exist, but only to a small extent.

Alcohol Drinking↗

Scandiatransplant 20 years.

The first kidney transplant in Scandinavia was performed in 1956 by the late Professor Leif Efskind in Oslo, Norway. During the following 7-year period he did another four necro-kidney transplants. The first living related kidney transplant was performed at Ullevål Hospital in Oslo in 1963. In 1964 kidney transplantation programs were started in Helsinki, Stockholm and Aarhus, followed by Gothenburg in 1965. By the end of 1970 programs had also started in Copenhagen, Uppsala, Lund/Malmö and Odense. At present, there are 10 kidney transplant centers in Scandinavia: four in Denmark, four in Sweden, and one each in Finland and Norway. By the end of 1968 a total of 358 kidney transplants had been performed in Scandinavia. Of these, 169 (47%) were from living related donors. This new treatment modality called for closer cooperation between the Nordic countries, and during the last 20 years cooperation has been broadened through two working bodies: an expert committee and the Scandiatransplant organization.

History, 20th Century↗

An attempt to operationalize reactive delusional psychosis.

Reactive psychosis is a diagnostic concept widely used in Scandinavia but it is still a subject of discussion and controversy internationally. Inside Scandinavia the diagnosis is used according to varying criteria, which is one of the reasons for high diagnostic instability and a threat to the validity and reliability of the concept. This article presents an attempt to operationalize reactive delusional psychosis, to test its clinical utility in a pilot study, and to test the reliability of the individual items. More clinical studies based on operationalization, demarcation of the concept, and interrater reliability are needed to convince psychiatrists outside Scandinavia of the existence of reactive psychosis as a useful nosological concept in patients with good prognosis and who mainly need psychotherapy.

Adolescent↗

Different beta-casein fractions in Icelandic versus Scandinavian cow's milk may influence diabetogenicity of cow's milk in infancy and explain low incidence of insulin-dependent diabetes mellitus in Iceland.

OBJECTIVES: To compare children with insulin-dependent diabetes mellitus (IDDM) with controls in Iceland regarding their consumption of cow's milk in infancy, and to investigate the beta-casein fractions in Scandinavian and Icelandic cow's milk. The A1 variant of beta-casein has been shown to be diabetogenic in animal studies, and suggestions have been made that the B variant of beta-casein acts similarly. Differences in the relative proportions of beta-casein fractions might explain the lower incidence of IDDM in Iceland than in Scandinavia. METHODS: A retrospective case-control study on IDDM patients and matching controls was performed in Iceland to compare their diets in infancy. Fifty-five children with IDDM born in Iceland over a 16-year period and randomly collected controls (n = 165) were recruited to the study. Mothers of the children answered questions on breastfeeding habits and on when cow's milk products were introduced. Samples of cow's milk from randomly selected milk batches from the largest consumption areas in Iceland and Scandinavia were collected. The milk samples were freeze-dried and their beta-casein fractions were analyzed using capillary electrophoresis. RESULTS: No significant difference was found between IDDM patients and controls in the frequency and duration of breastfeeding or the first introduction of cow's milk products. The analyses of milk samples showed that the percentage of the A1 and B variants of beta-casein in Icelandic milk was significantly lower than in the milk from the Scandinavian countries. CONCLUSIONS: Cow's milk consumption in infancy is not related to IDDM in Iceland. The lower fraction of A1 and B beta-caseins in Icelandic cow's milk may explain why there is a lower incidence of IDDM in Iceland than in Scandinavia.

Adolescent↗

Origin of an insular population of the wood mouse based on parasitological evidence.

Parasitological data were used to test the hypothesis that the wood mouse (Apodemus sylvaticus) population of Fair Isle, Shetland, originated from the British Isles rather than Scandinavia, as is usually argued. This study was based on the assumption that the mice were likely to share most of their parasite fauna with conspecifics from their ancestral home. The ecto- and endo-parasites of wood mice on Fair Isle between 18 June to 10 July 1987 and 17 to 26 August 1991 were identified and compared with those reported from conspecifics in the two putative source areas. All eight species of metazoan parasites that infected A. sylvaticus on Fair Isle were common to mice of the British Isles, whereas just one parasite on Fair Isle, a mite, had been recorded from Scandinavia. This lends support to the hypothesis that the mice originated from Britain rather than Scandinavia.

Animals↗

[World trends in infant mortality since 1950].

Despite the considerable progress made in recent decades, and perhaps even partly because of the very uneven distribution of this progress, infant mortality is still very high in some regions, whereas in other regions it is tending, if not disappear completely, at least to become numerically negligible even though remaining a matter of social concern. Whereas in tropical Africa almost one child in five dies before its first birthday, in Japan or Scandinavia it is one child in a hundred. Infant mortality rate varies between these two extremes, but there is a substantial gulf between the "most developed" regions which are all below 30% and the "least developed" regions which fall into three categories: 65-100% (Latin America, Eastern Asia except Japan), around 140% (Northern Africa, South Asia, Melanesia), and about 200% (topical Africa). These inequalities between countries overlap with inequalities between social groupings by urbanization, social/occupational level, education and income, are all variables that are correlated with infant mortality to a greater or lesser degree. The pace of the progress achieved since 1950 seems to be independent of the starting level. Contrary to the development of mortality at other ages, it is not in the countries with high mortality that infant mortality has decreased most. The pace of reduction divides the most developed regions into three distinct groups: very rapid reduction (Japan), rapid reduction (Scandinavia, Western Europe, Southern Europe and Eastern Europe), and slower reduction (British Isles, Northern America and Australia/New Zealand). Thus Japan rapidly caught up with Western Europe and the English-speaking countries and has now reached the same level as Scandinavia. On the other hand, the English-speaking countries have fallen behind the Scandinavian countries and are now at par with Western Europe. The reduction of infant mortality mainly concerned deaths of children over one month of age or even over one week of age and otherwise is due to reduction of infectious diseases. Consequently, in the most developed regions mortality is highly concentrated in the first week of life and is mainly attributable to the "causes of perinatal mortality" and the "congenital" anomalies". In the least developed regions, on the other hand, the infectious or parasitic diseases are still of decisive importance and the risk of death remains very high throughout the first year of life and even beyond. The risk may be even higher during the second year, when weaning takes place abruptly and results in serious difficulties in feeding.

Age Factors↗

mtDNA analysis of human remains from an early Danish Christian cemetery.

One of Denmark's earliest Christian cemeteries is Kongemarken, dating to around AD 1000-1250. A feature of early Scandinavian Christian cemeteries is sex segregation, with females buried on the northern sides and males on the southern sides. However, such separation was never complete; in the few early Christian cemeteries excavated in Scandinavia, there were always a few males placed on the north side, and some females on the south side. At Kongemarken, several males with juxtaposed females were found on the north side of the cemetery. Thus, to evaluate possible kinship relationships, and more general questions of population affinity, we analyzed mitochondrial DNA extracted from nine individuals excavated in two different areas within the cemetery: one male and four females from Area 1, and one male and three females from Area 2. Using stringent laboratory protocols, each individual was unequivocally assigned to a mitochondrial haplogroup. A surprising amount of haplogroup diversity was observed (Area 1: 1 U7 (male), 1 H, 1 I, 1 J, and 1 T2; Area 2: 2 H, 1 I, and 1 T, with one H being male); even the three subjects of haplogroup H were of different subtypes. This indicates that no subjects within each area were maternally related. The observed haplogroup, U7, while common in India and in western Siberian tribes, was not previously observed among present-day ethnic Scandinavians, and haplogroup I is rare (2%) in Scandinavia. These observations suggest that the individuals living in the Roskilde region 1,000 years ago were not all members of a tightly knit local population and comprised individuals with genetic links with populations that were from much farther away.

Age Determination by Skeleton↗

International trends in prostatic cancer.

The most recent data available demonstrate a 120-fold difference between the lowest and highest incidence rates of prostatic cancer, the disease being very common in North America, particularly among Blacks, and in Scandinavia, while it is rare in Japan and other oriental countries. The highest mortality for prostatic cancer is reported from St. Vincent and Grenadines, Martinique and Bermuda, from countries where the morbidity statistics are not available; the mortality rates reported from the United States and Canada are considerably lower. The incidence of and mortality from prostatic cancer have increased in most countries, in particular in areas with an initially low frequency of this disease. The ratio of mortality to incidence for prostatic cancer varies rather widely, being low in North America, Hawaii and Scandinavia. It is suggested that the observed variation in the mortality to incidence ratio for prostatic cancer could be due to differences in diagnostic practices between countries. This could explain, at least in part, the fact that the increasing trends of prostatic cancer incidence in North America are not accompanied by an increase in mortality from this tumour. This notion, however, does not exclude advances in treatment as possible determinants of the improved survival rate from prostatic cancer in this part of the world. The available statistics on prostatic cancer are based on the sum of clinically diagnosed carcinomas and those latent tumours found unexpectedly at prostatectomy and autopsy. The proportion of latent carcinomas among all prostatic cancer cases depends on the detection rate and varies from country to country, thus casting uncertainty on the comparability of prostatic cancer statistics from different areas. To avoid confusion in the statistics of prostatic cancer, it would be useful to consider introducing latent prostatic cancer as a separate entity in the next revision of the International Classification of Diseases (ICD).

Adult↗

Frequencies of the hereditary hemochromatosis allele in different populations. Comparison of previous phenotypic methods and novel genotypic methods.

AIM: The frequencies of the hereditary hemochromatosis allele were compared for different populations assessed by previous phenotypic methods and the present genotypic methods. METHODS: From a literature survey, the calculated hemochromatosis allele frequencies from 16 studies using phenotypic biochemical markers (threshold levels for transferrin saturation [range, 46%-70%] and serum ferritin [range, 164-700 microg/L]) were compared with allele frequencies of the Cys282Tyr mutation of the hemochromatosis gene reported in 19 genotypic studies. RESULTS: Calculated phenotypic allele frequencies are high in Scandinavia: Iceland, 6.1% to 7.4%; Norway, 5.8%; central Sweden, 6.3% to 6.9%; Denmark, 6.1%. Frequencies are similarly high in Wales, Canada, Utah, South Africa, and Australia (range, 5.2%-9.8%). Frequencies are low in Finland (1.9%) and northern Italy (4.5%). Genotypic allele frequencies of the Cys282Tyr mutation are likewise high in Scandinavia. Frequencies are high in the United Kingdom and northern France and low in Finland, central Germany, northern Italy, and Greece. The phenotypic-genotypic ratios of the hemochromatosis homozygosity frequencies for the same geographic area were calculated. A ratio of 1.0 indicates that the 2 methods give similar results. In 3 studies, the ratio was above 1.0, the highest ratio of 1.67 being reported from Italy. In most studies the ratio was slightly below 1.0 (0.71-0.97). The lowest ratio was found in Finland (0.33). CONCLUSION: In most studies there was good agreement between the hemochromatosis allele frequencies determined by phenotypic and genotypic methods. A high ratio (northern Italy) may indicate that phenotypic selection criteria were too loose and/or that causes of iron overload other than the Cys282Tyr mutation are frequent in the region. A low ratio (in Finland) may indicate phenotypic selection criteria that were too stringent and/or a low penetration rate of the mutation.

Biomarkers↗

Incidence of limb fracture across Europe: results from the European Prospective Osteoporosis Study (EPOS).

The aim of this population-based prospective study was to determine the incidence of limb fracture by site and gender in different regions of Europe. Men and women aged 50-79 years were recruited from population registers in 31 European centers. Subjects were invited to attend for an interviewer-administered questionnaire and lateral spinal radiographs. Subjects were subsequently followed up using an annual postal questionnaire which included questions concerning the occurrence of new fractures. Self-reported fractures were confirmed where possible by radiograph, attending physician or subject interview. There were 6451 men and 6936 women followed for a median of 3.0 years. During this time there were 140 incident limb fractures in men and 391 in women. The age-adjusted incidence of any limb fracture was 7.3/1000 person-years [pyrs] in men and 19 per 1000 pyrs in women, equivalent to a 2.5 times excess in women. Among women, the incidence of hip, humerus and distal forearm fracture, though not 'other' limb fracture, increased with age, while in men only the incidence of hip and humerus fracture increased with age. Among women, there was evidence of significant variation in the occurrence of hip, distal forearm and humerus fractures across Europe, with incidence rates higher in Scandinavia than in other European regions, though for distal forearm fracture the incidence in east Europe was similar to that observed in Scandinavia. Among men, there was no evidence of significant geographic variation in the occurrence of these fractures. This is the first large population-based study to characterize the incidence of limb fracture in men and women over 50 years of age across Europe. There are substantial differences in the descriptive epidemiology of limb fracture by region and gender.

Age Distribution↗

Inversely density-dependent natal dispersal in brown bears Ursus arctos.

There is considerable controversy in the literature about the presence of density dependence in dispersal. In this study, we exploit a data series from a long-term study (>18 years) on radio-marked brown bears (Ursus arctos L.) in two study areas in Scandinavia to investigate how individual-based densities influence the probability of natal dispersal and natal dispersal distances. Cumulatively, 32% and 46% of the females and 81% and 92% of the males dispersed before reaching 5 years of age in the northern and southern study area, respectively. Density had a negative effect on both the probability of dispersal and dispersal distances for the dispersing animals, when controlling for study area, sex and age, making this the first study to show that natal dispersal probability and distances are inversely density dependent in a large carnivore. We suggest that female-female competition for space caused females in higher density areas to settle closer to their natal area. For males, however, merging of demes, resulting in decreased relatedness and increased heterozygosity in an expanding population, might be the reason for shorter dispersal distances in males living at higher densities. This has been hypothesised for small mammals. The high proportion of dispersing female brown bears in Scandinavian compared with North American studies might be due to lower densities in Scandinavia and recent population expansion, with unoccupied areas available at the edges of the population. The longer dispersal distances in female Scandinavian brown bears suggest less social constraints on movements than for North American females. The longer dispersal distances by Scandinavian males may be due to increased searching for potential mates in peripheral areas with lower densities of females. These results, in addition to results of other brown bear studies, suggest that brown bears might be more territorial than previously thought, and that density is regulated by social interactions.

Age Factors↗