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PubMed1991

Health care occupations and suicide in Sweden 1961-1985.

The sex and age standardized incidence rates of suicide and undetermined deaths in Sweden were described for physicians, dentists, registered nurses, attendants in psychiatric care and auxiliary nurses for the five years following each of the censuses, 1960, 1970, 1975 and 1980. Amongst men all the occupations apart from registered nurses show increasing suicide rates from 1960, with significantly higher suicide rates during the seventies than the total male working population. A radical fall in the number of suicides amongst physicians, dentists and registered nurses took place in the period 1981-85, whilst attendants in psychiatric care and auxiliary nurses show a continuing significant excess in suicide rate. Among female physicians, there was an extremely high suicide rate in 1960, followed by a distinct fall until the period 1981-85 although the rates were significantly elevated in all periods. Female dentists show consistently high suicide rates during the seventies and eighties. Registered nurses show a reduction from a significantly high rate in the period 1961-65 and the seventies to a level equal to the total female working population. Female attendants in psychiatric care and auxiliary nurses have low rates in almost all periods. These suicide trends are compared with an increase in the proportion of women in gainful employment as well as the radical alteration in family patterns in Sweden during the seventies. Further research should emphasize the change in social roles, both in the labour market and in the family.

Cohort Studies↗
PubMed1982

Primary immunodeficiency disorders in Sweden: cases among children, 1974-1979.

A nationwide survey of symptomatic primary immunodeficiency disorders in children in Sweden during the 6-year period 1974-1979 resulted in 201 reported cases. The reported data for 174 children were analyzed. Antibody deficiencies were the most frequent (45.0%), followed by phagocytic disorders (22.0%) and combined T- and B-cell disorders (20.8%). Thirty-two children (18.4%) died, with the highest mortality for combined T- and B-cell defects. The sex ratio for all disorders was 2:1 for boys:girls. Neutropenia was significantly more common in the northern part of Sweden.

Abnormalities, Multiple↗
PubMed1977

Enterotoxigenic Escherichia coli in Sweden.

The adrenal cell test for detection of heat-labile enterotoxin-producing Escherichia coli was performed on faecal specimens collected over a period of six months from 648 patients with diarrhoea. The patients came from all parts of Sweden. A total of 72 enterotoxigenic strains were found in 27 patients. Enterotoxigenic strains do not seem to be an important cause of diarrhoea in Sweden, since 70% of the patients with enterotoxin-producing strains had been abroad. Enterotoxigenic enterobacteria were the cause of traveller's diarrhoea in 11% of the patients who had been abroad with a peak incidence in July and August when traveller's diarrhoea was associated with enterotoxigenic strains in 17% of the patients. A simplified method for screening a large number of specimens for enterotoxin production was evaluated and found to be useful.

Enterotoxins↗
PubMed1994

The work at the pharmacy: Sweden and The Netherlands compared.

At pharmacy Orden in Apeldoorn (the Netherlands) a change in the flow of filling a prescription was made, introducing the 'counter model': one person fills the prescription at the counter and is checked by another person. This change was mainly inspired by the actual working situation in Sweden. A comparison was made between pharmacy Orden and pharmacy Ekorren (Sweden) with respect to working systems, communication patterns, time spending and perceptions of the personnel. At pharmacy Orden fewer communication disturbances occurred and less advice was required to fill a prescription than at pharmacy Ekorren. The time to fill a prescription was almost two minutes shorter at pharmacy Orden. The personnel at both pharmacies was satisfied with the physical and psychological workload. The technicians at pharmacy Ekorren felt subordinate to their higher educated prescriptionist colleagues in filling a prescription.

Drug Prescriptions↗
PubMedDate not supplied

Boron neutron capture therapy for glioblastoma multiforme: clinical studies in Sweden.

A boron neutron capture therapy (BNCT) facility has been constructed at Studsvik, Sweden. It includes two filter/moderator configurations. One of the resulting neutron beams has been optimized for clinical irradiations with a filter/moderator system that allows easy variation of the neutron spectrum from the thermal to the epithermal energy range. The other beam has been designed to produce a large uniform field of thermal neutrons for radiobiological research. Scientific operations of the Studsvik BNCT project are overseen by the Scientific Advisory Board comprised of representatives of major universities in Sweden. Furthermore, special task groups for clinical and preclinical studies have been formed to facilitate collaboration with academia. The clinical Phase II trials for glioblastoma are sponsored by the Swedish National Neuro-Oncology Group and, presently, involve a protocol for BNCT treatment of glioblastoma patients who have not received any therapy other than surgery. In this protocol, p-boronophenylalanine (BPA), administered as a 6-h intravenous infusion, is used as the boron delivery agent. As of January 2002, 17 patients were treated. The 6-h infusion of 900 mg BPA/kg body weight was shown to be safe and resulted in the average blood-boron concentration of 24 microg/g (range: 15-32 microg/g) at the time of irradiation (approximately 2-3 h post-infusion). Peak and average weighted radiation doses to the brain were in the ranges of 8.0-15.5 Gy(W) and 3.3-6.1 Gy(W), respectively. So far, no severe BNCT-related acute toxicities have been observed. Due to the short follow-up time, it is too early to evaluate the efficacy of these studies.

Adult↗
PubMed1987

Carcinogenicity of radiation doses caused by the Chernobyl fall-out in Sweden, and prevention of possible tumors.

The fallout from the Chernobyl reactor resulted in radioactive fall-out in eastern Sweden leading to a ground radiation intensity of between 2 and 500 microR h-1 above the 10-15 microR h-1 background, an average external cumulative dose of about 3-4 mSv (0.3-0.4 rem) to about 1 million people, or about 3500 man-Sv (350,000 man-rem) over 50 years, or 70 man-Sv per year with a maximum dose to a few individuals of 40 mSv. The corresponding figures reported for civilians around Chernobyl is 8.6 million man-rem in 1986 and 29 million man-rem over 50 years, or 600,000 man-rem (equivalent to about 6000 man-Sv) per year. If Swedish doses are averaged over the whole population, the average is about 1 mSv or 10,000 man-Sv, or 200 man-Sv per year. The thyroid uptake of 131I is approximately 0.1-0.2 kBq (0.005 microCi) and the total body uptake of 137Cs, 1 kBq (0.03 microCi), resulting in an approximate internal dose of 0.02 mSv. If a linear dose-response curve is assumed, an increase of the normal cancer mortality incidence in the million Swedes affected by 3500 man-Sv per 50 years from 200,000 to about 200,070 can be assumed. Corresponding figures for all of Sweden are 8,000,000 inhabitants, 7000 man-Sv, 1,720,000 normal cancer deaths, and 1,720,140 expected cancer deaths. Corresponding figures reported for the population outside the 30 km evacuation zone around Chernobyl are 300,000 man-Sv, and an increase from 6,800,000 cancer deaths per 50 years to 6,806,000 cancer deaths.

Accidents↗
PubMed2002

The incidence of Type I diabetes has not increased but shifted to a younger age at diagnosis in the 0-34 years group in Sweden 1983-1998.

AIMS/HYPOTHESIS: To analyse the incidence of Type I (insulin-dependent) diabetes mellitus in the 0-34 years age group in Sweden 1983-1998. METHODS: Incidence and cumulative incidence per 100 000 and Poisson regression analysis of age-period effects was carried out using 11 751 cases from two nation-wide prospective registers. RESULTS: Incidence (95%-CI) was 21.4 (20.8-21.9) in men and 17.1 (16.6-17.5) in women between 0 and 34 years of age. In boys aged 0-14 and girls aged 0-12 years the incidence increased over time, but it tended to decrease at older age groups, especially in men. Average cumulative incidence at 35 years was 748 in men and 598 in women. Cumulative incidence in men was rather stable during four 4-year periods (736, 732, 762, 756), while in women it varied more (592, 542, 617, 631). In males aged 0-34 years, the incidence did not vary between the 4-year periods ( p=0.63), but time changes among the 3-year age groups differed ( p<0.001). In females the incidence between the periods varied ( p<0.001), being lower in 1987-1990 compared to 1983-1986, but time changes in the age groups did not differ ( p=0.08). For both sexes median age at diagnosis was higher in 1983-1986 than in 1995-1998 ( p<0.001) (15.0 and 12.5 years in males; 11.9 and 10.4 in females, respectively). CONCLUSION/INTERPRETATION: During a 16-year period the incidence of Type I diabetes did not increase in the 0-34 years age group in Sweden, while median age at diagnosis decreased. A shift to younger age at diagnosis seems to explain the increasing incidence of childhood Type I diabetes.

Adolescent↗
PubMed2004

Intervention thresholds for osteoporosis in men and women: a study based on data from Sweden.

The aim of this study was to determine the threshold of fracture probability at which interventions became cost-effective in men and women, based on data from Sweden. We modeled the effects of a treatment costing $500 per year given for 5 years that decreased the risk of all osteoporotic fractures by 35% followed by a waning of effect for a further 5 years. Sensitivity analyses included a range of effectiveness (10-50%) and a range of intervention costs ($200-500/year). Data on costs and risks were from Sweden. Costs included direct costs, but excluded indirect costs due to morbidity. A threshold for cost-effectiveness of approximately $45,000/QALY gained was used. Cost of added years was included in a sensitivity analysis. With the base case ($500 per year; 35% efficacy) treatment in women was cost-effective with a 10-year hip fracture probability that ranged from 1.2% at the age of 50 years to 7.4% at the age of 80 years. Similar results were observed in men except that the threshold for cost-effectiveness was higher at younger ages than in women (2.0 vs 1.2%, respectively, at the age of 50 years). Intervention thresholds were sensitive to the assumed effectiveness and intervention cost. The exclusion of osteoporotic fractures other than hip fracture significantly increased the cost-effectiveness ratio because of the substantial morbidity from such other fractures, particularly at younger ages. We conclude that the inclusion of all osteoporotic fractures has a marked effect on intervention thresholds, that these vary with age, and that available treatments can be targeted cost-effectively to individuals at moderately increased fracture risk.

Age Factors↗
PubMed2004

Comparative tissue distribution of metals in birds in Sweden using ICP-MS and laser ablation ICP-MS.

Cadmium, copper, lead, palladium, platinum, rhodium, and zinc profiles were investigated along feather shafts of raptor and other bird species by laser ablation inductively coupled plasma mass spectrometry (LA-ICP-MS). The distribution of external versus internal metal contamination of feathers was investigated. The species examined were peregrine falcon (Falco peregrinus), sparrowhawk ( Accipiter nisus), willow grouse (Lagopus lagopus), and house sparrow (Passer domesticus) in Sweden. For habitat comparisons, total Cu, Pb, Zn, and Cd concentrations were analyzed by ICP-MS in feathers of the examined species as well as captive peregrine falcon. For investigation of metal distribution and correlation in different biological materials of raptors, total concentrations of Cu, Pb, Cd, and Zn were also investigated by ICP-MS in feathers, eggs, blood, feces, liver, and kidney of wild peregrine falcon from southwestern Sweden. Laser ablation of feathers revealed that Pb contamination is both external and internal, Zn contamination is internal, and Cd and Cu contamination is predominantly internal, with a few externally attached particles of high concentration. Pb, Cu, and Cd signal intensities were highest in urban habitats and contamination was mainly external in feathers. The background signal intensity of Zn was also higher in birds from urban habitats. The laser ablation profile of PGE (Pt, Pd, Rh) demonstrated that PGE contamination of feathers consists almost exclusively of externally attached PGE-containing particles, with little evidence of internally deposited PGE.Generally, total metal concentrations in feathers were highest in sparrowhawk and house sparrow due to their urban habitat. Total Cu, Zn, and Cd concentrations were highest in liver and kidney due to binding to metallothionein, while the total Pb concentration was highest in feces due to the high excretion rate of Pb. A decreasing temporal trend for Pb in feathers, showing that Pb levels in feathers have decreased since the introduction of nonleaded petrol, is also discussed.

Animals↗
PubMed2002

No covariation between the geomagnetic activity and the incidence of acute myocardial infarction in the polar area of northern Sweden.

This study was undertaken to investigate whether there was any relation between the aurora borealis (measured as the geomagnetic activity) and the number of acute myocardial infarctions (AMI) in the northern, partly polar, area of Sweden. The AMI cases were collected from The Northern Sweden MONICA (multinational MONItoring of trends and determinants of CArdiovascular disease) AMI registry between 1985 and 1998, inclusive, and the information on the geomagnetic activity from continuous measurements at the Swedish Institute of Space Physics, Kiruna. In the analyses, both the relation between the individual AMI case and ambient geomagnetic activity, and the relation between the mean daily K index and the daily number of AMI cases were tested. We found no statistically significant relation between the number of fatal or non-fatal AMI cases, the number of sudden deaths or the number of patients with chest pain without myocardial damage, and geomagnetic activity. Our data do not support a relation between the geomagnetic activity and AMI.

Adult↗
PubMed2003

Molecular diversity of the coat protein-encoding region of Barley yellow dwarf virus-PAV and Barley yellow dwarf virus-MAV from Latvia and Sweden.

The sequence variability of Barley yellow dwarf virus-PAV (PAV) and Barley yellow dwarf virus-MAV (MAV) was studied by comparing 502 nucleotides from the coat protein-encoding region of six isolates from Latvia and four from Sweden. The diversity within MAV was low (>97% sequence identity), also when compared to isolates from USA and China. In contrast, the variability among PAV isolates was greater and phylogenetic analysis including isolates of a wide geographic origin detected two major clusters, of which both contained isolates from Latvia and Sweden. A new distinct variant of BYDV-PAV was discovered in Latvia, and because of the sequence difference it is proposed to belong to a new species (BYDV-OYV).

Capsid Proteins↗
PubMed2006

Increased incidence of Lyme borreliosis in southern Sweden following mild winters and during warm, humid summers.

The aim of the present study was to investigate the long-term incidence rate of Lyme borreliosis and, additionally, to determine whether a correlation exists between climatic factors and summer-season variations in the incidence of Lyme borreliosis. Climatic variability acts directly on tick population dynamics and indirectly on human exposure to Lyme borreliosis spirochetes. In this study, conducted in primary healthcare clinics in southeastern Sweden, electronic patient records from 1997-2003 were searched for those that fulfilled the criteria for erythema migrans. Using a multilevel Poisson regression model, the influence of various climatic factors on the summer-season variations in the incidence of erythema migrans were studied. The mean annual incidence rate was 464 cases of erythema migrans per 100,000 inhabitants. The incidence was significantly higher in women than in men, 505 and 423 cases per 100,000 inhabitants, respectively (p<0.001). The summer-season variations in the erythema migrans incidence rate correlated with the monthly mean summer temperatures (incidence rate ratio 1.12; p<0.001), the number of winter days with temperatures below 0 degrees C (incidence rate ratio 0.97; p<0.001), the monthly mean summer precipitation (incidence rate ratio 0.92; p<0.05), and the number of summer days with relative humidity above 86% (incidence rate ratio 1.04; p<0.05). In conclusion, Lyme borreliosis is highly endemic in southeastern Sweden. The climate in this area, which is favourable not only for human tick exposure but also for the abundance of host-seeking ticks, influences the summer-season variations in the incidence of Lyme borreliosis.

Adolescent↗
PubMed2007

Cost of breast cancer in Sweden in 2002.

Breast cancer is the most common cancer among Swedish women and an important cause of illness and death. The aim of this study was to estimate the total cost of breast cancer in Sweden in 2002, using a top-down prevalence-based cost-of-illness approach. The total cost of breast cancer in Sweden in 2002 was estimated at 3.0 billion SEK (1 euro = 9.4 SEK). The direct costs were estimated at 895 million SEK and constituted 30% of the total cost. Indirect costs were estimated at 2.1 billion SEK and constituted 70% of the total cost. The main cost driver was production losses caused by premature mortality, amounting to 52% of the indirect costs. The reason that indirect costs were the dominant cost is because most newly detected breast cancers occur in patients aged below 65, thus causing significant production losses due to sick leave, early retirement, and premature mortality.

Age Factors↗
PubMed2005

Socio-economic factors and breast cancer survival--a population-based cohort study (Sweden).

OBJECTIVE: To assess the influence of socio-economic factors on breast cancer survival in Sweden, a country with population-based mammography screening and a uniform health care system aiming to provide care to all on equal terms. METHODS: All women with a first diagnosis of invasive breast cancer in Sweden in 1993 were identified in the Swedish Cancer Register. Their sociodemographic characteristics were determined by record linkages to the 1970, 1980, 1985 and 1990 Census databases, and a nationwide Fertility Register. Information on tumor characteristics at diagnosis was obtained from five Swedish Regional Cancer Registers. Survival status on 31 December 1998, was assessed through follow-up in the Swedish Cause of Death Register. RESULTS: Of totally 4645 eligible women diagnosed with breast cancer in 1993, 772 had died from breast cancer through 1998. After adjustment for tumor characteristics and age, risk of death was 37 higher among women of low compared to high socio-economic status (HR high vs. low 0.73; 95 CI: 0.54-0.99). This difference was most pronounced in women less than 50 years at diagnosis. CONCLUSIONS: These results show that socio-economic disparities in breast cancer survival prevail even in this relatively homogenous society, offering outreach mammography and standardised treatment regimens in a tax-funded health care system.

Adult↗
PubMed2005

The trend of cardiovascular disease in immigrants in Sweden.

Little is known as to whether the declining trend in cardiovascular disease (CVD) and coronary heart disease (CHD) in the Western countries has reached the immigrant populations. Incidence rates of CVD and CHD between 1991-1993 and 1997-1999 were compared by analysing the relative risk (RR) using the Poisson regression model and the data from 1991-1993 within each group as a reference. The whole Swedish population aged 35-74 years was included and we focused on 12 different immigrant groups. The morbidity from CHD in men from Sweden, Finland and countries in the OECD decreased slightly in an age-adjusted model (RR: 0.91, 0.93, and 0.88, respectively) during the 1990s. The opposite results were observed in women from Southern Europe, Turkey and Iran, in whom CHD morbidity increased (RR: 1.35, 1.54 and 1.40, respectively). The declining trend in CVD and CHD is continuing among men from Sweden, Finland and the OECD countries, but it is unchanged for women from these countries and all other groups studied, and even with increases in some female groups. This might be a sign of a breaking trend in these diseases.

Adult↗
PubMed2005

Synchronous variation in water chemistry for 80 lakes in southern Sweden.

Variation in water chemistry was studied in 80 lakes in southern Sweden. The lakes had forest dominated catchments. The length of the time series was 14 years. Synchrony was calculated as Pearson's product moment correlation coefficients for all combinations of lakes, i.e. 3160 lake-pairs. The chemical variables studied were non-marine sulphate (SO4*), non-marine calcium (Ca*), absorbance and acid neutralising capacity (ANC). Statistically significant synchrony occurred in 93% of all lake-pairs for SO4*, and between 58 and 67% for absorbance, Ca* and ANC. In 70% of all lake-pairs, the synchrony was >0.71 for SO4*, which means that more than half of the variation in one lake could be explained by the variation in the other lake. For absorbance, Ca* and ANC, about 25% of the lake-pairs had a synchrony >0.71. The relatively high synchrony for SO4* occurred during an overall downward trend in SO4* concentration. The degree of synchrony in our study was at a level comparable to other studies in northern America and England. However, our study included lakes in a much larger area, with distances of up to 500 km between the lakes, while earlier studies were made on small lake districts with lakes located within approximately 50 km. In contrast to these earlier studies, there was no correlation between synchrony and distance, lake characteristics or catchment characteristics. However, when a small subset of 15 lakes in the southeast of Sweden was selected, such relations were found.

Calcium↗
PubMed2006

Human tissue samples and ethics--attitudes of the general public in Sweden to biobank research.

PURPOSE: To survey the attitudes of the general public in Sweden to biobank research and to discuss the findings in the light of some well-known ethical principles. METHODS: A questionnaire was used to survey the opinions of the general public in Sweden, and an ethical analysis (using the principles of autonomy, non-maleficence, beneficence and justice) was performed to discuss the possible conditions of such research. FINDINGS: Between 3 and 9% answered that they did not want their samples to be collected and stored in a biobank. Many respondents required information about the purpose of the research and wanted to be able to consent or refuse. About one third of the respondents said they would have answered differently if financial gain was involved and those who commented indicated a more negative attitude. The principle of autonomy maintains that the right to self-determination should be respected, and the principles of non-maleficence and beneficence that the probable harms and benefits resulting from a particular project by using samples from a biobank should be balanced. The general public disagree about how these principles are to be balanced. INTERPRETATION: In the light of the findings different interpretations of the situation as well as possible alternatives are discussed in this paper.

Adult↗
PubMed1986

The impact of early medical technology on maternal mortality in late 19th century Sweden.

The prevention of fatal complications of childbirth is a priority of health care in the developing countries. This historical study of maternal deaths in Sweden analyses the decline in mortality between 1751-1900 and during this years maternal mortality was reduced by 76% whereas the female mortality dropped only by 33% The decline was especially pronounced during the period 1861-1900, when maternal mortality declined from 567 to 227 per 100,000 live births. The potential impact of medical technology was analysed by epidemiological methods for the period 1861-1900. The introduction of antiseptic technique was estimated to reduce septic maternal mortality 25-fold in lying-in hospitals and 2.7-fold in rural home deliveries, implying that 49% of the septic maternal deaths were thus "prevented". In addition, licensed midwives assisting at home deliveries were estimated to reduce non-septic mortality 5-fold, thus "preventing" 46% of the non-septic maternal deaths. This could be one explanation why Sweden had a lower maternal mortality than the U.S. and the U.K. in the beginning of the 20th century.

Antisepsis↗