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PubMed1992

Sacrococcygeal teratoma in Sweden: a 10-year national retrospective study.

Thirty-two children with sacrococcygeal teratoma have been treated during the last 10 years (1980 to 1989) in Sweden. A retrospective study was performed in four departments of pediatric surgery that treat sacrococcygeal teratomas in children from the whole of Sweden. Prenatal and perinatal histories were reviewed together with interval to diagnosis, Altman classification, histology, and serum alpha-fetoprotein. Details of surgical management +/- adjuvant chemotherapy and outcome of patients were also documented. In 8 patients the teratoma was diagnosed prenatally by ultrasonography and there was one postoperative death in this group. Multiagent chemotherapy was used in all but one of 11 patients with malignant teratomas (in 8 of them a cisplatin, bleomycin, vinblastine combination). Only one patient with a malignant tumor treated by single-agent chemotherapy died, 8 others were still alive and tumor-free after 1 to 9 years (mean time, 5.4 years). Two patients developed late relapses and were treated by surgical resection. Metastases occurred in five of the 11 malignant tumors, one at presentation and in four patients 10 to 29 months following surgery. All relapses had distant metastases as well as local disease. Serum alpha-fetoprotein was used in monitoring some of these patients.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1992

Radiocesium in muscle tissue of reindeer and pike from northern Sweden before and after the Chernobyl accident. A retrospective study on tissue samples from the Swedish Environmental Specimen Bank.

After the Chernobyl accident in April 1986, considerable deposition of radionuclides occurred regionally in eastern, central and northwestern Sweden. Locally, the fallout of radiocesium exceeded the remainder from atmospheric nuclear weapons tests by several magnitudes. Since the end of the 1960s samples of organs from various plant and animal species, annually collected at different localities, have been preserved in the Swedish Environmental Specimen Bank (ESB). In this work samples from the ESB have been used for retrospective studies of radioactive pollution. The activities of Cs-134 and Cs-137 in muscle tissues from reindeer, Rangifer tarandus, and pike, Esox lucius, preserved in the ESB, were measured. The samples were collected annually; the reindeer at three localities in northern Sweden and the pike at one of them. In material collected prior to the Chernobyl accident, the levels of Cs-137 were 57-180 Bq/kg in reindeer and 14-24 Bq/kg in pike, fresh weight basis. These levels relate to earlier nuclear bomb tests. A significant decrease was found in pike during the pre-Chernobyl period (1971-86). In post-Chernobyl samples the burden of Cs-137 varied from amounts equal to the former levels in the northernmost locality and up to 80 times higher for the maximum values in the southernmost locality. The highest value recorded was 18,425 Bq/kg in reindeer. The geographic variations in reindeer from Chernobyl fallout were in accordance with the pattern of deposition estimated by aircraft surveys performed in May 1986. The ratio between 'new' and 'old' radiocesium burdens in pike, caught in 1987, approached the corresponding ratio for reindeer grazing in the precipitation area of the lake; 33 and 19, respectively.

Accidents↗
PubMedDate not supplied

Models of midwifery care. Denmark, Sweden, and The Netherlands.

The organization of maternity services in Denmark, Sweden, and the Netherlands was studied under the sponsorship of the World Health Organization European Headquarters Office of Maternal and Child Health. Midwifery care is highly respected and is a central feature of obstetric care in each of these countries. In Denmark and Sweden, almost all births are in the hospital, and autonomous midwives are employed by national health services. About three-quarters of Dutch midwives are in independent practice, and 34% of Dutch women give birth at home. In each country midwives provide "the first line" of care for normal pregnant women and are viewed as essential to the excellent perinatal outcomes these three countries enjoy.

Birth Rate↗
PubMed1995

Return migration on the policy agenda in Sweden.

"Explicit policies on return migration are of rather recent date in most European countries, including Sweden. During the last few years a number of new policy initiatives have been taken in this field. The purpose of this paper is to examine how official Swedish policies on return migration have changed during the last 20 years. The conclusion is that Sweden has moved from a ¿non-policy' in the 1970s, much in opposition to ¿guestworker' or rotation systems, towards an active and explicit policy promoting return in the mid-1990s. The major trends in the country's immigration, emigration and return flows are also presented."

Demography↗
PubMed1986

Violence towards children in the United States and Sweden.

This paper reports the results of a cross-cultural comparison of violence towards children in the United States and Sweden. Data from the United States are based on interviews with a nationally representative sample of 1,146 households with at least one child between the ages of 3 and 17 years living at home. Data from Sweden are based on interviews with a nationally representative sample of 1,168 households with a child 3 to 17 years of age at home. Violence and abuse were measured using the Conflict Tactics Scales. In general, Swedish parents reported using less violence than did parents in the United States. There was no significant difference between the two countries in the rate of reported severe or abusive violence. The paper compares factors found associated with violence towards children in the two countries, including age, marital status, education, and parents' background. The results are analyzed by considering methodological and cultural factors that explain the similarities and differences in the use of violence towards children in the two countries.

Adolescent↗
PubMed1986

Criminal homicide in northern Sweden 1970-1981: alcohol intoxication, alcohol abuse and mental disease.

All cases of criminal homicide in northern Sweden between 1970-81 were studied, 71 cases altogether (64 offenders). Homicide was a rare event and more infrequent compared with Sweden as a whole. The offenders were predominantly males, ages 20 to 40. Half of the victims were females. Mutual intoxication was a feature in 44% of the cases and in 34% both participants were sober. The majority of the victims were related by blood or marriage to the offender. Sharp instruments, blunt instruments and use of firearms were, in this order, the most common methods of killing. Almost one-third of the offenders had no former conviction, minor trespasses excluded. Sixty-three percent of the offenders had previously been subjected to psychiatric care, 31% were considered mentally diseased at the trial and another 22% had also a coexisting abuse or personality disorder. Three-quarters of the offenders were transferred to closed psychiatric care. Alcohol abuse and alcoholism were prevalent among 30% of the offenders and another 27% were also mentally diseased or had a personality disorder. The shares of mentally diseased and abusers/alcoholics outnumbered the prevalence of these conditions in the general population as well as in many international studies. Ten subjects committed suicide before trial; these persons were relatively more often sober at the act and fewer were alcoholics. Eight had previously received psychiatric treatment. They were more prone to kill a member of their nuclear family. Only two subjects had a previous criminal record; both concerned convictions of manslaughter. Nineteen offenders were sober at the act; 15 of these were mentally diseased. The sober offenders hardly ever attacked a person outside their family. Their motives were frequently premeditated. The killings were usually by quick, certain methods, such as firearms. No sober offender attacked an intoxicated person. The sober offenders usually had no criminal records and the homicides were often considered as murder. Five of the sober offenders committed suicide while the others were surrendered for closed psychiatric care in all but one case. Of the preventive measures, restrictions in the trade of alcohol are possibly the only factors that can reduce the homicide rate to any observable degree.

Adolescent↗
PubMedDate not supplied

Experience of a 10-year use of competitive exclusion treatment as part of the Salmonella control programme in Sweden.

In Sweden, competitive exclusion (CE) treatment has been used since 1981 as a part of the national control programme for Salmonella. According to the programme all broiler flocks are tested for Salmonella before slaughter thus providing an evaluation of CE treatment. The CE culture used is mainly for the two consecutive flocks raised in a unit after a Salmonella-infected flock has been identified. During the period 1981-1990 Ce culture has been given to 179 flocks, involving 3.82 million chickens. Only one of the treated flocks was found to be Salmonella-positive. A special study during a period when Salmonella was spread by contaminated feed demonstrated that CE treatment was effective in controlling Salmonella under field conditions. A likely contributory factor is that the hatcheries in Sweden can be claimed to be Salmonella-free. In addition, the control programme and related action, have led to a very low incidence of Salmonella in broiler chickens. A nationwide study carried out in 1990 demonstrated that less than 1% of broiler chickens was contaminated with Salmonella after slaughter.

Animal Husbandry↗
PubMed1995

Control of Salmonella enteritidis in Sweden.

The Swedish control of Salmonella, with special reference to Salmonella enteritidis, in poultry is described. The control is directed at all serotypes of Salmonella and imported grandparent chickens are controlled, which is considered to be the main reason why Sweden so far is not found to be involved in the worldwide spread of different phagetypes of S. enteritidis. However, this spread has initiated a more stringent control of Salmonella in layers as earlier existed in broilers. Since 1990, 90% of the layer flocks are voluntarily tested for Salmonella before slaughter by bacteriological examination of pooled faecal samples. If S. enteritidis is isolated the flock is destroyed. This test, and in addition two similar tests during the production are mandatory as of January 1st, 1994. The voluntary Salmonella control programme has also been extended to all of the layer parents and hatcheries since 1991. Only heat-treated feed is given to all layer chickens during the rearing period and its use is becoming gradually more common also during the production period. Since 1987, four layer flocks have been found to be infected by S. enteritidis phagetype 4 and one flock with phagetype 6. During 1970-1984, 90% of all flocks of broilers were voluntarily tested bacteriologically for Salmonella before slaughter, and since 1984 such a control is mandatory to all flocks. As a result of this and other controls, S. enteritidis has not been isolated from broilers since 1972. Based on a governmental regulation from 1961, introduced as a result of a large Salmonella epidemic in 1953, Sweden runs an active, official control of Salmonella (Wierup et al., 1992).(ABSTRACT TRUNCATED AT 250 WORDS)

Abattoirs↗
PubMed1985

Building primary health care systems: a case study from Sweden.

Health policy planners have discussed for some years how to transform existing hospital-based health delivery systems into primary-care-driven systems. Although this policy goal has been adopted in a number of western European nations, the actual process of implementing such a major change has proven stubborn and complex. In particular, efforts to transfer existing resources out of the hospital sector for use in building primary care activities have proven difficult. This paper examines the effort to design and implement a primary health care strategy in Sweden. It is divided into two segments. The first section sketches the broad health system context within which the Swedish primary care effort is being conducted. The second section focuses directly on Sweden's primary care strategy, detailing both its conceptual foundation and the organizational obstacles that have impeded the policy's implementation. This discussion is punctuated with findings from a 1981 survey of county council administrators' attitudes toward this primary care strategy. The paper concludes with a short discussion of several alternative organizational approaches that might speed the development of a primary-care-driven health system.

Health Policy↗
PubMed1990

School nurses and health education for pupils with and without intellectual handicaps: a study conducted in Japan and Sweden.

The purpose of this study is to report the results from a questionnaire that was given to about 600 school nurses working in schools which have pupils with and without intellectual handicaps in Japan and Sweden, concerning their opinions on health education including sex and interpersonal relationships. The study was conducted during the spring 1987 in Sweden and during the autumn 1987 in Japan. The main results from this study concern differences between Japanese and Swedish school nurses when answering certain questions. These questions, for instance, concerned the nurses' working situation and their health education for pupils with and without intellectual handicaps. Of all the Japanese school nurses 27%, compared to 90% of the Swedish school nurses, taught about health including sex and interpersonal relationships in regular classes. Of school nurses having pupils with intellectual handicaps, only 1% of the Japanese school nurses, compared to 47% of the Swedish school nurses, taught their pupils these subjects. These differences merely seemed to be related to the educational system, including its curriculum, reflecting the general policy held within each country.

Attitude of Health Personnel↗
PubMed1994

A descriptive study of childbirth education provided by midwives in Sweden.

OBJECTIVE: to describe the content, modes of working and reaction/interaction of childbirth education provided by midwives in Sweden. DESIGN: qualitative, using non-participant observation to collect the data. Grounded theory approach was used. SETTING: antenatal classes provided in the community in Sweden. PARTICIPANTS: twelve midwives with varying lengths of experience in teaching antenatal classes, and the prospective parents who attended these classes. MEASUREMENTS AND FINDINGS: three perspectives on the content and three modes of working were found. Combinations of the differing perspectives and working modes provided differing interactions within the classes. KEY CONCLUSIONS: the confirming/mixed model resulted in dialogue in the classes. It was assumed that this model would contribute to an increased understanding of the coming experience of giving birth. IMPLICATIONS FOR PRACTICE: the findings provide midwives with a basis for reflection on their experiences as leaders in the childbirth preparation part of education for parenthood.

Curriculum↗
PubMed1984

Risks, survival and trends of malignant melanoma among white and blue collar workers in Sweden.

All persons in Sweden, classified as white or blue collar workers in the 1960 Population Census, were followed up for the period 1961-1973 with regard to the occurrence of cancer. The SMRs were calculated for 50 tumour sites and it was found that the crude classification of occupations into white or blue collar workers was particularly important for malignant melanoma risk. The number of malignant melanoma cases among blue collar workers was significantly lower than expected while it was significantly higher than expected among the white collar workers. This was true for men as well as for women. The SMRs were calculated to be 87 and 141 (men) and 79 and 117 (women), respectively. Comparing the relative survival probabilities it was found that white collar workers had a higher probability of survival than blue collar workers. This might indicate that the difference in occurrence could be dependent on early detection as well as differential risk. The incidence of malignant melanoma is increasing faster than any other kind of tumour in Sweden. For the period 1961-1970 the incidence rate increased two-fold for blue collar workers and more than two-fold for white collar workers (men). In absolute terms the white collar workers in the age group 45-64 had an appreciably faster increase in incidence over this period compared to all other groups studied.

Adult↗
PubMed1986

Class and health: comparing Britain and Sweden.

The questions addressed in this article are two, namely are class differences in health apparent in Sweden in the same manner as was shown for Britain in the Black Report? and is it possible to learn anything new about inequality patterns in different stages of life from analyses of self-reported morbidity data? By analysing data on long-standing illness by the means of logistic regression, it is shown that the risk of falling ill is distributed in very similar ways in the two countries, although the dispersion of these risk factors seems to be greater in Britain. In an analysis of acute sickness this result is not obtained, which is assumed to be an effect of differences in answering patterns. For Sweden, it is shown that social classes do not differ much in terms of health among the young. Instead, inequalities in health seem to be established at first in middle age.

Age Factors↗
PubMed1989

Studies on drug utilization: bilateral case study in Poland and Sweden.

The utilization of drugs in Poland and Sweden was compared by two means: the defined daily doses (DDD) and the price-adjusted sales figures (PASF). Obtained results imply that the total pharmaceutical consumption in the countries under study is almost equal: in Poland-US $114.47 and in Sweden-US $109.77 per inhabitant. However, in particular groups and subgroups of drugs, significant differences in prescribing exist (Tables 1 and 2). Awareness of these may help doctors to improve their prescribing of drugs, and may prompt further studies on drug utilization where irrational use of drugs is not evident but suspected.

Case-Control Studies↗
PubMed1990

Health and social inequities in Sweden.

Sweden is one of Europe's most egalitarian countries. The social inequities in living conditions have been gradually reduced to a level that is more equal than in most countries in Europe. Even if general health development has been positive during recent years, data reviewed here indicate that there may be adverse effects for some groups which may increase inequities. This article presents results on inequities in health from the Public Health Report of Sweden 1987 and discusses causal mechanisms and implications for health policy.

Adolescent↗
PubMed1996

The prevalence of pain among the oldest old in Sweden.

Although there is information available about pain in elderly persons, there have been very few studies about pain among the oldest old. In Sweden, 8% of the population is older than 74 years, and 2% is older than 84 years. It is the group over 74 which is growing fastest in proportion to the entire population. The aims of the present study are (a) to analyze if pain increases or decreases with age in the oldest age groups and (b) to study gender differences regarding pain. The present study of a random sample (n = 537) of the oldest old in Sweden shows that there is some evidence of decreased musculoskeletal pain with age. Among women, total reported pain decreases with age. Among men, there is an increase of reported severe pain with age. Including the results from another Swedish population survey of individuals aged 18-84, there is evidence that the prevalence of pain among the older elderly is comparable to the prevalence of pain among the middle-aged (45-64) and is higher than the prevalence among the younger elderly (65-75). Musculoskeletal pain is more common among old women than old men but for chest pain and abdominal pain there is no difference. The sex difference is more pronounced for multiple and severe pain complaints. The prevalence of mild or severe pain in any of the studied locations in the whole study group (77+) was 73% and for individuals over 85 years, 68%. For multiple pain, the figures were 47% for all older elderly (77+) and 46% for individuals over 85 years of age. For severe pain in at least one location, corresponding figures were 33% and 35%.

Adolescent↗
PubMed1990

Mortality and fatality of cutaneous malignant melanoma in Sweden, 1982-1986.

Among almost all cases of death from cutaneous malignant melanoma in Sweden during the 5-year observation period of 1982-86 (n = 1406), 58.5% were male. For both sexes, considered together, 80.5% were aged greater than 49 yr at the time of death; 62.9% aged greater than 59 yr, and 36.7% aged greater than 69 yr. Disease fatality, assessed as the sex and age-specific mortality between 1982 and 1986 in proportion to the age and sex-specific incidence in 1977 and 1982, increased significantly (P less than 0.001) with age in both sexes, in terms of distributional heterogeneity. Likewise, in both sexes, disease fatality was higher (P less than 0.025) in the area of Sweden north of the N 60 degrees latitude line rather than south of it. As it is a crucial measure of treatment efficacy in cutaneous malignant melanoma, case fatality deserves more attention in future epidemiologic research than it has received to-date. In this context, a revision of the criteria for histopathological "malignancy" at initial treatment against empirical data on the outcome quoad vitam is warranted.

Age Factors↗
PubMed1991

Incidence of legal abortion in Sweden after the Chernobyl accident.

The number of legal abortions in Sweden increased around the time of the Chernobyl accident, particularly in the summer and autumn of 1986. Although there was no recording of reasons for legal abortions, one might have suspected this increase to be a result of fear and anxiety after the accident. However, seen over a longer time perspective, the increase in the number of abortions started before and continued far beyond the time of the accident. There was also a simultaneous and pronounced increase in the number of births during the years subsequent to the accident. Therefore, it seems unlikely that fear of the consequences of radioactive fall-out after the Chernobyl accident resulted in any substantial increase of the number of legal abortions in Sweden.

Abortion, Legal↗