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PubMed1994

Cohort approach in tuberculosis surveillance: comparison of the situation in Sweden and Finland.

SETTING: Finland and Sweden. OBJECTIVE: To present and compare the long-term trends of the tuberculosis situation and especially the experiences of different birth-year cohorts. DESIGN: Analysis of morbidity and mortality statistics since the early 1950s. The grouped birth-year cohorts are followed at 5-year intervals. RESULTS: In both countries the morbidity and mortality rates have diminished in a similar fashion. The Finnish situation follows the Swedish one by a delay of about 15 years. The incidences in the younger age groups have diminished markedly, but in the older ones the progress has been much less rapid. The median age of new cases has increased continuously. In Sweden, obviously due to the great number of immigrants, this trend has ceased in recent years. In each cohort born this century, the highest morbidity rates have been experienced at the age of around 20-30 years. After this they diminish exponentially at about the same speed, at least in recent times. CONCLUSION: The high prevalence of tuberculosis infection reached in early life seems to introduce a high lifelong incidence of the disease. In the older age cohorts the relatively high rates at present still reflect the circumstances in the 1940s or earlier. Age-oriented long-term surveillance can give useful information on the dynamics of the tuberculosis epidemic.

Adolescent↗
PubMed1995

Malignant oral tumours in Sweden 1960-1989--an epidemiological study.

Epidemiological data from the Swedish Cancer Registry of new cases of malignant oral tumours in Sweden 1960-1989 are presented, including the total number and the age-standardised incidence rate per 1 million population, by site and sex, (I(s)). An analysis of the various histopathological types of malignant oral tumours in the different sublocations is also given. A comparison is made between the three 10-year periods 1960-1969, 1970-1979 and 1980-1989 regarding total number and I(s). The total number of cases, 17,158, represented 1.8% of all newly diagnosed cancers in Sweden. The following relative frequencies were noted for the respective sites: intra-oral region 0.7%, lip 0.6% and pharynx 0.5%. The results indicated an increase in total number and a statistically significant increase of I(s) for malignant lip tumours in females over the whole period. A corresponding increase in total number during the periods 1960-1969 and 1980-1989 and a decrease in I(s) during the periods 1970-1979 and 1980-1989 in lip tumours for males was observed. For males there was an increase in total number and a statistically significant increase in I(s) for malignant tongue tumours, while the corresponding figures for females remained constant. For malignant floor of the mouth tumours there was an increase in total number and a statistically significant increase in I(s) for both men and women. In the intra-oral region, including the sublocations oral cavity-other sites, tongue and floor of the mouth, the male:female ratio was 1.8:1 and I(s) changed from 22.8 (1960-1969) to 29.6 (1980-1989).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2005

A survey of teenager unnatural deaths in northern Sweden 1981-2000.

OBJECTIVE: To survey unnatural deaths among teenagers in northern Sweden and to suggest preventive measures. SETTING: The four northernmost counties (908,000 inhabitants, 1991), forming 55% of the area of Sweden. MATERIAL AND METHODS: All unnatural teenager deaths from 1981 through 2000 were identified in the databases of the Department of Forensic Medicine in Umea, National Board of Forensic Medicine. Police reports and autopsy findings were always studied, social and hospital records if present. RESULTS: Three hundred and fifty-five deaths were found, of which 267 (75%) were males and 88 (25%) females. Ninety out of 327 (28%) tested positive for alcohol. Two hundred and forty-eight (70%) were unintentional and 102 (30%) were intentional deaths, and five (1%) were categorized as undetermined manner of death. Unintentional deaths decreased while the incidence of intentional deaths remained unaffected by time. CONCLUSIONS: Injury-reducing measures have been effective concerning unintentional deaths and the fall in young licensed drivers due to the economical recess have probably also contributed to the decrease. However, there were no signs of decreasing numbers of suicides during the study period, which calls for resources to be allocated to suicide prevention.

Adolescent↗
PubMed2005

Under what circumstances are nurses willing to engage in brief alcohol interventions? A qualitative study from primary care in Sweden.

To improve alcohol prevention in primary health care, it has been suggested that primary care nurses are an under-utilised resource. The aim of this study was to identify under what circumstances primary care nurses in Sweden are willing to engage in alcohol prevention. All nurses at three primary health care centres in Ostergötland, Sweden were invited to participate in focus group interviews; 26 nurses participated. The nurses considered primary health care to be just one among other sectors within the community with responsibility for alcohol prevention. The role of health care in alcohol prevention was perceived to be important but mainly secondary preventive. The nurses felt justified screening all patients' alcohol habits only when they could refer to an obligation or a time-limited project. Otherwise, they mainly wanted to engage in screening patients with alcohol-related symptoms or diagnoses and other risk groups. Reasons for refraining from alcohol screening and intervention included lack of self-efficacy, time consumption and fear of harming their relationship with the patient. New strategies for alcohol prevention in primary care are discussed.

Alcohol Drinking↗
PubMed2006

Characteristics of women giving birth at home in Sweden: a national register study.

OBJECTIVE: The objective of the study was to estimate the proportion of planned home births in Sweden and to identify maternal characteristics of women giving birth at home. STUDY DESIGN: This case-control study included register data of births from 1992 to 2001 in 352 women giving birth at home and 1760 women giving birth in a hospital. RESULTS: Four hundred thirty-nine out-of-hospital births were found during the study period, and the proportion of planned home births was less than 0.5/1000. Women with home birth were more likely to have 4 children or more (odds ratio 3.7 [1.4 to 9.9]), be born in a European country outside Sweden (odds ratio 3.5 [1.8 to 6.8]), have a family income below the median (odds ratio 2.9 [2.0 to 4.1]), not work outside the home (odds ratio 2.4 [1.7 to 3.5]), have a high level of education (odds ratio 2.1 [1.5 to 3.0]), and be older than 35 years (odds ratio 1.7 [1.1 to 2.5]). CONCLUSION: Women with planned home births appear to be a group having a different lifestyle, compared with Swedish women in general.

Adult↗
PubMed2005

Cost-effectiveness of memantine for moderate to severe Alzheimer's disease in Sweden.

BACKGROUND: Alzheimer's disease entails enormous costs for society and impairs quality of life for patients and caregivers. OBJECTIVE: This study estimated the cost-effectiveness of memantine in the treatment of patients with moderately severe to severe cognitive impairment from Alzheimer's disease in Sweden. METHODS: The study was based on published data from several sources, including a randomized controlled trial of memantine versus placebo and a longitudinal observational study of Alzheimer's disease patients in Sweden. Costs were estimated from the public payer's perspective, including direct costs but excluding costs of informal care, and resource utilization data were taken from the observational study. Cost-effectiveness was quantified as quality-adjusted life-years (QALYs) gained from treatment with the use of previously published utility weights. A Markov simulation model was constructed, incorporating the effect of treatment on cognitive function, physical dependence related to activities of daily living, and institutionalization. Costs and effects for treated and untreated patients were estimated for 5 years (10 cycles). In the base-case analysis, treatment costs were added for 2 years, but the effect on transition probabilities was applied only for the first year of treatment. RESULTS: Compared with no treatment, memantine treatment was predicted to be associated with lower costs of care, longer time to dependence and institutionalization, and gains in QALYs. Treatment was estimated to decrease formal care costs by 123,600 Swedish kronor (SEK) and, after taking into account the cost of memantine, to lead to net cost savings of 100,528 SEK per patient. Treated patients gained 0.148 QALY over the 5-year simulation. CONCLUSIONS: From a public payer's perspective, the observed effect of memantine on cognitive and physical function is predicted to translate into economic benefits that offset the added treatment cost. Treatment is also predicted to delay institutionalization, improve independence, and increase QALYs.

Activities of Daily Living↗
PubMed2004

Cost effectiveness of alendronate for the treatment of male osteoporosis in Sweden.

BACKGROUND: One third of all the hip fractures occur in men. The risk for mortality following hip fracture is higher for men compared to women. The Fracture Intervention Trial (FIT) showed that the bisphosphonate alendronate reduces the risk of fractures and increases bone mineral density (BMD) in osteoporotic women. Similar effects of alendronate were observed in men in some other trials. There are also results demonstrating alendronate to be cost-effective in the treatment of osteoporosis in women. OBJECTIVE: To investigate the cost effectiveness of alendronate for male osteoporosis in Sweden by assuming the same relative risk reduction of fractures in men as for women, based on the FIT trial. DESIGN: A Markov model earlier used to analyze cost effectiveness of alendronate in treatment of postmenopausal osteoporosis in Sweden was adapted to fit a cohort of Swedish men. Cost effectiveness of alendronate vs. no treatment was assessed by transitioning men in the model over time between different health states. TIME HORIZON: The patients were followed from start of intervention until 100 years of age or death. In the base-case alendronate was assumed to have a fracture-risk-reducing effect for 10 years; a treatment duration period of 5 years followed by a 5-year period where the effect declined linearly to zero. RESULTS: Taking a societal perspective treating a 71-year-old man (mean age in the FIT) with low BMD and prior vertebral fracture (VFA) with alendronate was found to be associated with a cost of 14,843 per quality adjusted life year (QALY) gained. CONCLUSIONS: The results in this study indicate that treating osteoporotic men with alendronate was projected to be cost-effective, under the assumption of the same fracture-risk-reducing effect of alendronate for men as for women.

Aged↗
PubMed2007

Burns in Sweden: an analysis of 24,538 cases during the period 1987-2004.

Burn care is always progressing, but there is little epidemiological information giving a clear picture of the current number of treated burns in Sweden. This study was conducted to provide an update of patients admitted to hospital with burns in Sweden. Data were obtained for all patients who were admitted to hospitals with a primary or secondary diagnosis of burns (ICD-9/10 codes) from 1 January 1987 to 31 December 2004; 24,538 patients were found. Most of the patients were male (69%), giving a male:female ratio of 2.23:1. Children in the age-group 0-4 years old predominated, and accounted for 27% of the study material. The median length of stay was 3 days. Throughout the period 740 patients (3%) died of their burns. Significant reductions in mortality, incidence, and length of stay were seen during the study, which correlates well with other studies. However, most of the reductions were in the younger age-groups. Men accounted for the improved mortality, as female mortality did not change significantly. We think that the improvement in results among patients admitted to hospital after burns is a combination of preventive measures, improved treatment protocols, and an expanding strategy by which burned patients are treated as outpatients.

Adolescent↗
PubMed2005

Clinical characteristics at onset of Type 1 diabetes in children diagnosed between 1977 and 2001 in the south-east region of Sweden.

To survey clinical characteristics at diagnosis for children diagnosed with Type 1 diabetes during 25 years in the south-east part of Sweden we included all 1903 children < 16 years of age and who had been diagnosed between 1977 and 2001 in the south-east region of Sweden. A nurse or doctor in the diabetes team obtained information from medical records. Over the 25 years the mean duration of symptoms prior to diagnosis was 17.8 +/- 26.4 days and the mean glucose level at diagnosis was 23.6 +/- 9.7 mmol/l. Three percent of the children (n = 50) had a pH value < or = 7.1. The youngest children (0-5 years) had shorter duration of symptoms, lower blood-glucose levels and less often had ketonuria than the oldest children (11-15 years) but more often suffered from infections prior to diagnosis. The proportion of children diagnosed in the group 0-5 years of age increased over the study-period, apart from the last 5 years, while children with pH value < or = 7.3 decreased significantly as did the proportion of children with ketonuria or infection. The clinical characteristics at diagnosis of diabetes are heterogeneous, especially in the oldest age group. Some characteristics varied with time.

Adolescent↗
PubMed2026

Surveilled subjectivation: narratives of drug policing among people who use prohibited drugs in Sweden.

In Sweden, possession and personal use of drugs are criminalized since 1988, resulting in police work being directed towards minor drug offenses. Despite this, police and other authorities are encouraged to protect the health and wellbeing of people who use prohibited drugs (PWUPD). Knowledge is scarce on how this drug policy plays out in practice. This study therefore analyzes interviews with 20 PWUPD who visited harm reduction services and interacted with policing agents in Stockholm, Sweden. The analysis is based on the participants' narratives of drug policing, and it concerns how they produced themselves as subjects through relations between materiality and discourse. We utilize the concept of surveilled subjectivation to elucidate what the participants could do, what they knew and who they could be or become under drug policing. Four themes were identified illustrating the link between discourse and materiality in PWUPD's surveilled subjectivation: "Material aspects of surveillance"; "Resisting the 'drug abuser' identity"; "Fighting power with power"; and "Crossing boundaries and becoming-other". The participants described nonstop efforts to prevent their bodies, activities, belongings and environments from being enfolded by drug law enforcement, which otherwise would fuel even more surveillance. They therefore disassociated themselves from the "drug abuser" identity, and managed encounters with policing agents by keeping a low profile or acting compliantly. While the study highlights the skills and knowledges the participants deployed to navigate omnipresent drug policing, we conclude that their production of autonomous and empowered subjectivities would be facilitated if possession and use of drugs were no longer criminalized.

Humans↗
PubMed2005

Improved survival in cancer of the colon and rectum in Sweden.

AIMS: To analyse time-trends in survival of patients with colon and rectal cancer in Sweden. PATIENTS AND METHODS: Data including all patients diagnosed with adenocarcinoma of the colon and rectum between 1960 and 1999, from the Swedish Cancer Registry, were analysed. The observed and relative survival rates were calculated according to the Hakulinen cohort method. RESULTS: Five-year relative survival rate for cancer of the colon improved significantly from 39.6% in 1960--1964 to 57.2% in 1995--1999 and for rectal cancer from 36.1 to 57.6%, respectively. Corresponding observed survival improved from 31.2 to 44.3% for colon cancer and from 28.4 to 45.4% for rectal cancer. The largest improvement of survival were seen during the later part of the period observed. CONCLUSION: The survival of patients with colon and rectal cancer in Sweden continues to improve, especially in rectal cancer, which now has a 5-year observed and relative survival rate comparable to that for colon cancer. The survival improvement in rectal cancer is probably a result of the implementation of total mesorectal excision and pre-operative radiotherapy.

Adenocarcinoma↗
PubMed2005

Survival of brown trout during spring flood in DOC-rich streams in northern Sweden: the effect of present acid deposition and modelled pre-industrial water quality.

Mortality and physiological responses in brown trout (Salmo trutta) were studied during spring snow melt in six streams in northern Sweden that differed in concentrations of dissolved organic carbon (DOC) and pH declines. Data from these streams were used to create an empirical model for predicting fish responses (mortality and physiological disturbances) in DOC-rich streams using readily accessible water chemistry parameters. The results suggest that fish in these systems can tolerate higher acidity and inorganic aluminium levels than fish in low DOC streams. But even with the relatively low contemporary deposition load, anthropogenic deposition can cause fish mortality in the most acid-sensitive surface waters in northern Sweden during spring flood. However, the results suggests that it is only in streams with high levels of organically complexed aluminium in combination with a natural pH decline to below 5.0 during the spring where current sulphur deposition can cause irreversible damage to brown trout in the region. This study support earlier studies suggesting that DOC has an ameliorating effect on physiological disturbances in humic waters but the study also shows that surviving fish recover physiologically when the water quality returns to less toxic conditions following a toxic high flow period. The physiological response under natural, pre-industrial conditions was also estimated.

Adaptation, Physiological↗
PubMed2005

Time trends in burdens of cadmium, lead, and mercury in the population of northern Sweden.

The time trends of exposure to heavy metals are not adequately known. This is a worldwide problem with regard to the basis for preventive actions and evaluation of their effects. This study addresses time trends for the three toxic elements cadmium (Cd), mercury (Hg), and lead (Pb). Concentrations in erythrocytes (Ery) were determined in a subsample of the population-based MONICA surveys from 1990, 1994, and 1999 in a total of 600 men and women aged 25-74 years. The study took place in the two northernmost counties in Sweden. To assess the effect of changes in the environment, adjustments were made for life-style factors that are determinants of exposure. Annual decreases of 5-6% were seen for Ery-Pb levels (adjusted for age and changes in alcohol intake) and Ery-Hg levels (adjusted for age and changes in fish intake). Ery-Cd levels (adjusted for age) showed a similar significant decrease in smoking men. It is concluded that for Pb and maybe also Hg the actions against pollution during recent decades have caused a rapid decrease of exposure; for Hg the decreased use of dental amalgam may also have had an influence. For Cd, the decline in Ery-Cd was seen only in smokers, indicating that Cd exposure from tobacco has decreased, while other environmental sources of Cd have not changed significantly. To further improve the health status in Sweden, it is important to decrease the pollution of Cd, and actions against smoking in the community are important.

Adult↗
PubMed2006

Economic strain and self-rated health among lone and couple mothers in Sweden during the 1990s compared to the 1980s.

OBJECTIVES: Changes on the labour market and in Swedish welfare policy during the 1990s may have affected lone mothers. This study analysed economic strain and self-rated health (SRH) among lone and couple mothers in Sweden in the 1980s and the 1990s. PARTICIPANTS: 22,308, mothers, 19,122 couple and 3186 lone mothers, who responded to the Swedish Survey of Living Conditions in the years 1979-1998. METHODS: Exposure for economic strain was defined as having had difficulties to make ends meet in the last year, the outcome measure was less than good SRH. Prevalence rates were calculated and logistic regression analysis was used in the analysis. Adjustments were made for type of mother, age, time period, socio-economic group, income, born in Sweden/foreign born and employment. RESULTS: Prevalence rates of economic strain and less than good SRH increased during the 1990s compared to the 1980s among lone and couple mothers. A polarisation in SRH was noted among lone mothers, with worsening health in poorer groups and improved health among better off groups. Economic strain had a substantial explanatory value for the excess risk of less than good SRH throughout the period studied. The association between economic strain and SRH did not change between lone and couple mothers between the 1980s and the 1990s or in different income groups. CONCLUSIONS: The increased prevalence of less than good SRH among sub-groups of lone mothers may in part be due to an increase of financial problems among these groups in Sweden. Economic strain was an important explanatory factor.

Adolescent↗
PubMed2004

A pharmacoeconomic evaluation of aggressive cholesterol lowering in Sweden.

OBJECTIVE: To estimate the short-term healthcare costs and incremental cost per event avoided, associated with aggressive atorvastatin treatment in patients with acute coronary syndrome in Sweden. METHODS: The total expected 16-week healthcare costs per patient on atorvastatin 80 mg per day and placebo were compared using clinical outcomes data from The Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering (MIRACL) study and Swedish cost data sources. The incremental cost per event avoided was also assessed for. The clinical outcomes measured in this pharmacoeconomic analysis included: death, cardiac arrest, non-fatal myocardial infarction, fatal myocardial infarction, angina pectoris, non-fatal stroke, congestive heart failure, and surgical or percutaneous coronary revascularizations. All direct medical costs were taken into account. RESULTS: The probability of the occurrence of an event was 40.4% per patient in the placebo cohort and 36.6% per patient in the atorvastatin cohort. The total expected cost per patient was SEK 17,887 (1950.21 euro) in the placebo group and SEK 18,465 (2013.06 euro) in the atorvastatin group, resulting in an incremental cost of SEK 578 (63.0137 euro) per patient. The cost per event avoided was SEK 15,076 (1643.64 euro). Sixty six percent of the cost of atorvastatin treatment was offset by the cost savings obtained through the reduction in the number of events in the atorvastatin group compared to the placebo group. CONCLUSIONS: In Sweden, the clinical benefits of aggressive short-term atorvastatin treatment administered within a few days after acute coronary syndrome is associated with a substantial hospitalization cost offset secondary to the clinical benefits of atorvastatin.

Angina, Unstable↗
PubMed2005

Work situation of registered nurses in municipal elderly care in Sweden: a questionnaire survey.

BACKGROUND: Organizational changes have occurred in municipal elderly care in Sweden during the past decades. The 'Adel' reform transferred responsibility for the care of older persons from the county councils to the municipalities. Furthermore, the specialisation in dementia care divided elderly care into two groups: dementia and general care. This change has had a significant impact on the work situation of registered nurses (RNs). AIM: The main focus was to describe RNs' work situation and their characteristics in municipal elderly care. Another aim was to compare RNs working solely in dementia care with those working in general care of older persons with diverse diagnoses. DESIGN: A non-experimental, descriptive design with a survey research approach was used. SETTINGS: Sixty special housing units with underlying units including those offering daytime activities in a large city in the middle of Sweden. PARTICIPANTS: The number of participating RNs was a total of 213, with a response rate of 62.3%. Of the 213 RNs, 95 (44.6%) worked in dementia care, and 118 (55.4%) in general care. METHOD: A questionnaire survey. RESULTS: The results indicated high levels of time pressure in both groups. Greater knowledge and greater emotional and conflicting demands were found in dementia care. The majority perceived a greater opportunity to plan and perform daily work tasks than to influence the work situation in a wider context. Support at work was perceived as generally high from management and fellow workers and higher in dementia care. CONCLUSION: It is important to decrease RNs' time pressure and increase their influence on decisions made at work.

Adult↗
PubMed2006

Registered nurses' education and their views on competence development in municipal elderly care in Sweden: a questionnaire survey.

BACKGROUND: Recent changes of municipal elderly care in Sweden have resulted in that persons 65 years and older, previously nursed in hospital facilities, are now being cared for in the municipality. This change has had a significant impact on the work situation of registered nurses (RNs) and calls for appropriate educational preparation to enable RNs to undertake their new roles effectively. AIM: The main focus was to describe RNs' education and their view of competence development in municipal elderly care. Another aim was to compare RNs working solely in dementia care (DC) with those working in general elder care (GC) of older persons with diverse diagnoses. DESIGN: A non-experimental, descriptive design with a survey research approach was used. SETTINGS: Sixty special housing with subunits including those offering daytime activities in a large city in the middle of Sweden. PARTICIPANTS: The number of participating RNs was a total of 213, with a response rate of 62.3%. Of the 213 RNs, 95 (44.6%) worked in DC, and 118 (55.4%) in GC. METHOD: A questionnaire survey. RESULTS: The findings showed that RNs possessed a broad range of competence. The majority lacked a bachelor's degree in nursing. Few had adequate specialist competence. RNs' in DC wanted to invest more in competence development whereas RNs in GC were more motivated to attain greater authority in the making of important decisions and to seek another position. CONCLUSION: An important future prospect is to develop the competence of RNs in elderly care. In order to ensure high quality and security in elderly care, it is also essential to increase the number of RNs with specialist competence.

Adult↗
PubMed2006

The relationship between different work-related sources of social support and burnout among registered and assistant nurses in Sweden: a questionnaire survey.

BACKGROUND: This cross-sectional study addresses the relationship between organisational and social factors and burnout in a group of registered and assistant nurses in Sweden. OBJECTIVE: The main objective of the study was to analyse the relationship (and the specific relationship patterns) between three different work-related sources of social support and Maslach's three burnout dimensions, while taking the dimensions in the Karasek job-demand-control model, emotional demands, workload outside the work situation and demographic factors into account. DATA AND METHOD: Data was collected using a questionnaire which was based on validated instruments, in accordance with the job-demand-control model and Maslach's Burnout Inventory. Descriptive statistics, correlation analysis and three hierarchical regression analyses were conducted using a sample of 1561 registered and assistant nurses in Sweden. RESULTS: The results showed statistically significant correlations between the three support indicators and all three burnout dimensions. In the regression analyses, co-worker and patient support were statistically significantly related to all three burnout dimensions, whereas supervisor support was only statistically significantly related to emotional exhaustion. In accordance with prior findings, high levels of psychological demands were most strongly related to high emotional exhaustion. Further, high levels of emotional demands showed the strongest correlations with high personal accomplishment.

Adult↗