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PubMedDate not supplied

Higher proportion of CD8+ T cells in the blood in healthy adults from Ethiopia and Bangladesh compared with Sweden.

The phenotypic composition of peripheral blood lymphocytes in 45 healthy adults (15 each from Bangladesh, Ethiopia and Sweden) was analysed as an indicator of the influence of environment and/or ethnic background on the human immune response. The possible interference of technical factors was minimized by highly standardized handling of samples and by use of a similar simultaneous 3-colour flow cytometry analysis technique for all samples. The percentage of CD4+ cells was lower, and the percentage of CD8+ cells was higher, in Bangladeshi and Ethiopian subjects than in those from Sweden. A higher percentage of CD57+/CD8+ T cells was also found in these 2 groups than in Swedish subjects. The percentage of gamma delta T cells was higher in Bangladeshi subjects and a difference in T cell receptor V beta expression was also noted between Bangladeshi and Swedish subjects. The data suggest that environmental or genetic factors are important bias factors to be considered in immunophenotyping studies. Possibly differences in the pattern or level of microbial challenge, as well as nutritional factors, may lead to different adaptive changes in the immune response. The potential influence of such immune adaptation on the response to vaccination or pharmaceutical therapy may be important in the development of new strategies of medical intervention in different geographical regions or ethnic groups.

Adult↗
PubMedDate not supplied

Multivariate data evaluation of PCB and dioxin profiles in the general population in Sweden and Spain.

Thirty-three polychlorinated biphenyls and 20 dioxin-like congeners were determined by GC-MS in blood and adipose tissue samples from two general population groups, one in Spain (n = 35) and one in Sweden (n = 28). The results were evaluated by multivariate projection (Simca), after normalisation to the most abundant and stable congener in each data set, in order to reveal differences in the "national" congener profiles. The mean values of each population group did not differ significantly. The sum of PCBs in the Spanish was 1450 ng/g and in the Swedish 1310 ng/g. The sum of the dioxin-like compounds in Spain was 1180 pg/g and in Sweden 804 pg/g. The congener profiles differed between the countries. Mainly the higher chlorinated congeners for both the dioxin-like compounds and the PCBs are more dominant in the Spanish group compared to the Swedish.

Adipose Tissue↗
PubMed1998

'Mysterious' moose disease in Sweden. Similarities to copper deficiency and/or molybdenosis in cattle and sheep. Biochemical background of clinical signs and organ lesions.

The moose (Alces alces L.) in an acid rain affected region in south-west Sweden has developed a complex disease with numerous clinical signs, most of which are consistent with those of secondary copper (Cu) deficiency and/or molybdenosis in cattle and sheep. The clinical signs of the moose disease reported to date include diarrhoea, anorexia, emaciation, achromotrichia, alopecia, sudden heart failure and osteoporosis. Findings at necropsy included mucosal oedema, atrophied lymphoid tissues of the mucous membranes of the alimentary tract, neuropathy, neuronal degeneration and uni- or bilateral corneal opacity. In a study of clinically healthy animals from the affected region in Sweden over a 12-year period (1982-1994), the hepatic Cu concentration decreased by 50% and the liver and kidney cadmium (Cd) concentration decreased by 25-35%, while the molybdenum (Mo) concentration increased by 20-40%. These changes are probably related to an increase in the pH of the soil and water in the moose environment and a consequent change in the uptake of these elements by the plants consumed by the moose. It is noteworthy that the occurrence of the disease in the mid 1980s coincided with increased liming undertaken to counteract the noxious effects of acid rain in this region. Clinical signs and lesions of the moose disease resemble those reported for Cu deficiency and/or molybdenosis in cattle and sheep. To elucidate the complex, multi-faceted clinical signs of the moose disease, the clinical signs and necropsy findings are discussed in relation to the biochemical functions of certain well-known Cu-dependent enzymes, e.g. depigmentation of hair due to depressed tyrosinase activity, osteoporosis by depressed lysyl oxidase activity, sudden heart failure due to decreased activity of lysyl oxidase, cytochrome c oxidase and Cu/Zn-superoxide dismutase; in addition, mucosal lesions and ulcerations due to loss of activity of diamine oxidase as well as of lysyl oxidase and cytochrome c oxidase. It is concluded from the present findings that the moose disease is most probably a Cu deficiency and/or a molybdenosis-type syndrome.

Acid Rain↗
PubMed2002

Suicide, psychiatric illness, and social maladjustment in intercountry adoptees in Sweden: a cohort study.

BACKGROUND: Many intercountry adoptees are reaching adolescence in western Europe and the USA, and the mental health and social adjustment of these individuals as adolescents and young adults has now become an important issue. We aimed to assess mental health disorders and social maladjustment in adolescence and young adulthood in intercountry adoptees in Sweden. METHOD: Our data was obtained from the Swedish national registers for the cohort born in 1970-79. We used multivariate Cox's regression models of person-years to compare indicators of suicide death (1986-95), court sentences (1986-93), and discharges for psychiatric illness, suicide attempts, and substance abuse (1987-94) in 11,320 intercountry adoptees with 2343 Swedish-born siblings, 4006 immigrant children, and a general population of 853 419 Swedish-born residents. FINDINGS: After adjustment for major sociodemographic confounders, intercountry adoptees were more likely than other Swedish-born children to die from suicide (odds ratio 3.6, 95% CI 2.1-5.9); attempt suicide (3.6, 3.1-4.2); be admitted for a psychiatric disorder (3.2, 2.9-3.6), drug abuse (5.2, 2.9-9.3) or alcohol abuse (2.6, 2.0-3.3); or to commit a crime (1.6, 1.5-1.7). Siblings in adoptive homes had lower odds ratios for most outcomes than did adoptees, whereas adoptees and immigrant children had much the same odds ratios. INTERPRETATION: Adoptees in Sweden have a high risk for severe mental health problems and social maladjustment in adolescence and young adulthood. We advise professionals to give appropriate consideration to the high risk of suicide in patients who are intercountry adoptees.

Adolescent↗
PubMed1984

A clinical epidemiologic study of thyroid carcinoma in Malmö, Sweden.

The annual incidence of clinically diagnosed TC in Malmö was, on an average, 2.4 per 100,000 population during the years 1960-1977. This was 1.2 per 100,000 population lower than the corresponding incidence in the whole of Sweden as reported by the National Cancer Registry. The main reason for the difference was suggested to be inclusion in the official figures of autopsy cases and of cases with a benign diagnosis, rather than a true difference in the prevalence of TC. During the later part of the study an increase in the incidence of differentiated TC of approximately 70% was noted. This was considered to be due to increased health awareness and the availability of medical care, because only the number of tumors with less advanced growth increased. The average annual mortality from TC in Malmö was 0.9 per 100,000, which was 0.4 per 100,000 lower than the corresponding official rate in all of Sweden. The difference was suggested to be mainly due to inclusion in the official figures of persons not dying of TC. The mortality did not change significantly during the period of investigation. The percentage distribution by histologic type of tumors clinically diagnosed (N = 104) was as follows: papillary cancer, 65%; follicular, 21%; medullary, 4%; and anaplastic, 12%. The prognosis as estimated by the life table method was worst for patients with anaplastic TC, followed by those with follicular, papillary, and medullary TC. The validity of using the relationship of the tumor to the thyroid capsule (i.e., intrathyroidal and extrathyroidal growth) as a basis for classification into tumor stages was supported in the present study: the mortality in patients with intrathyroidal tumors was lower than in those with extrathyroidal tumors. The definition of occult TC--TC not larger than 1.5 cm, without regard to the relation to the thyroid capsule--was considered inappropriate and a change in the conception of occult TC was proposed. The presence or absence of node metastases in TC did not seem to have major significance for the prognosis. The significance of age for survival was strongly supported in our study. Deaths from TC clinically diagnosed before the age of 60 were infrequent, whereas the disease after this age increasingly often was fatal. This was partly due to a late onset of anaplastic TC and partly to a higher mortality in older than in younger patients with papillary or follicular TC.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed2004

Control of chemicals in Sweden: an example of misuse of the "precautionary principle".

With a background in biochemistry and radiation biology, I started to get involved in the control of chemicals area by battling the use of alkyl-mercury compounds in Swedish agriculture during the years 1964-1965 (C.-G. Rosén, H. Ackefors, and R. Nilsson, 1966, Seed dressing compounds based on organic mercury-economic aspects and health hazards, Svensk Kemisk Tidskrift 78, 8-19), and subsequently I acted as the sole technical advisor to the plaintiffs for the thalidomide children in Sweden for 4 years, ending in a 100 million US dollar (present value) settlement with the producers in 1969 (H. Sjöström and R. Nilsson, 1991, Thalidomide and the Power of the Drug Companies, Penguin, London, Feltrinelli, Milano, Iwanami Shoten, Tokyo Fisher Verlag, Berlin). I joined the Swedish EPA in 1974 and became head of the toxicological unit of the Products Control Division, where I was instrumental inter alia in pushing through regulations on reductions of lead in gasoline as well as the first general restrictions in world on the use of cadmium (R. Nilsson, 1989, Cadmium-an Analysis of Swedish Regulatory Experience, Report to the OECD Chemicals Group and Management Committee, January 1989). Since 1986 responsibility for control of chemicals was largely taken over from the Swedish EPA by the newly created National Chemicals Inspectorate (KEMI), an agency that employs me in the capacity of toxicologist. In between, I have been working for the OECD Chemicals Program as well as for WHO (IPCS) in various capacities and as a consultant in risk assessment for the US chemical industry under the Superfund Program. I was also associated with the Ministries of Environment of the governments of Iran and India. With respect to the latter, part of my recommendations were incorporated in the new Indian laws and regulations on chemicals that were issued subsequent to the Bhopal disaster (R. Nilsson, 1988, Procedures and Safeguards for Notification and Handling of Hazardous Chemicals in India, Report to WHO South-East Asia Region, SEA/EH/391, April 1988). As a consequence of a decreasing role for science in regulatory affairs, and a corresponding increasing influence from politics, for the past 8 years I have devoted myself mainly to research-oriented activities in my capacity as adjunct professor of molecular toxicology and risk assessment at the Stockholm University. In international collaboration, my projects have been supported by the Directorate General for Science, Research and Development of the Commission of the European Communities, the US Chemical Manufacturers' Association, the Coulston Foundation (Alamogordo, State of New Mexico), L'Oreal, Merck Co., and in the past to a limited extent also by my own agency, the National Swedish Chemicals Inspectorate. However, my position as member of the executive board for the International Society of Regulatory Toxicology and Pharmacology in the United States, which I held for 5 years, as well as my role as technical advisor in products liability litigation, reflects my continued interest in the "politics of chemical risk." In this context my critical comments with respect to the current regulatory policy for control of chemicals have caused considerable concern within the Swedish regulatory establishment (R. Nilsson, M. Tasheva, and B. Jaeger, 1993. Why different regulatory decisions when the scientific information base is similar? I. Human risk assessment, Regul. Toxicol. Pharmacol. 17, 292-332; R. Nilsson, 1994, Problems in the regulation of carcinogenic chemicals in an international perspective. III. Critical assessment of regulatory approaches. Rev. Int. Contam. Ambiental, México City, 10, 99-199; R. Nilsson, 1998, Integrating Sweden into the European Union: Problems concerning chemicals control. In The Politics of Chemical Risk-Scenarios for a Regulatory Future, R. Bal and Halffman, Eds, pp. 159-171, Kluwer Academic, Dordrecht).

Environment↗
PubMed2003

A time-series analysis of the effect of increased copayments on the prescription of antidepressants, anxiolytics, and sedatives in Sweden from 1990 to 1999.

BACKGROUND: Outpatient prescription medication spending in Sweden has increased sharply since 1974. The Swedish government has raised copayments to reduce medication consumption and limit the growth of medication spending. OBJECTIVE: The aim of this study was to examine the effect of the 1995 and 1997 copayment increases on Swedish consumption of antidepressants, anxiolytics, sedatives. METHODS: Monthly drug-use data for July 1990 through December 1999 for these 3 pharmaceutical classes were obtained from Apoteket AB (Stockholm, Sweden). Data were provided for both sexes in units of defined daily doses per 1000 inhabitants. These series were analyzed with the use of Box-Jenkins autoregressive, integrated, moving-average time-series modeling methods. RESULTS: Dispensing of all 3 drugs classes increased immediately before copayment changes, with the exception of male sedative use at the time of the 1997 reform. Permanent increases in male antidepressant and sedative use occurred before the 1995 copayment reform. Only female antidepressant use was permanently reduced following the 1997 copayment reform. CONCLUSIONS: Our findings suggest that Swedish patients' valuation of mental health medications exceeds the enacted price increases. The permanent increases in male antidepressant and sedative use, beginning in 1995, may have been the result of previous undertreatment. The permanent reduction in female antidepressant use, beginning in 1997, suggests that the price levels reached a threshold that matched or exceeded Swedish women's valuation of these modific

Anti-Anxiety Agents↗
PubMedDate not supplied

Economic impact of introducing propentofylline for the treatment of dementia in Sweden.

The purpose of this study was to estimate the impact of the introduction of propentofylline, a glial-cell modulator with neuroprotective properties, on the costs of dementia care in Sweden. To estimate the clinical effects of propentofylline treatment on dementia, we conducted a meta-analysis of four double-masked, placebo-controlled, randomized clinical trials and a simulation in a cohort of 57,000 patients with Alzheimer's disease (AD) or vascular dementia (VaD). This cohort represented the fraction of the total AD and VaD population in Sweden with mild-to-moderate disease, the target population for propentofylline treatment. The rate of progression of dementia was expressed in terms of the annual rate of change in score on the Mini-Mental State Examination (MMSE). The costs of care were estimated on the basis of a prospective population-based study. A regression model was used to quantify the costs of dementia care as a function of MMSE score. The estimates obtained were used to calculate and compare the costs of dementia care until death, with or without propentofylline treatment. The sensitivity of the results to a variety of model assumptions was also assessed. The total gross cost for 9 years under the current treatment strategy was SEK (Swedish kronor) 168.06 billion. Including propentofylline in the treatment strategy yielded net savings of SEK 0.8 billion, since the savings in the cost of patient care outweighed the drug acquisition costs. Over 9 years, this saving represents 3.8% of the costs of dementia care in the target population (MMSE score, 15-25 points) and 0.5% of the costs in the total AD and VaD population. The annual savings per patient ranged from SEK 5517 to 6387 during the first 4 years of propentofylline treatment. If an extended neuroprotective effect of propentofylline is assumed, savings increase to SEK 1.6 billion, equivalent to 7.6% of total care costs in the target population and 1.0% in the total population. Savings increase to SEK 14.6 billion if the extended neuro-protective effect is assumed to be effective in an extended target population (MMSE score, 0-25 points) without increased survival. In the sensitivity analysis, most scenarios yielded benefits in favor of propentofylline treatment. The clinical effects of propentofylline translate into meaningful economic effects. The drug acquisition costs are more than offset by the savings achieved in the cost of care. The inclusion of a broader range of outcomes may increase these savings.

Aged↗
PubMed1999

Supervision of chiropractors: a summary of results from two surveys involving chiropractic supervisors and graduates in England and Sweden.

BACKGROUND: Supervision of newly graduated health care practitioners takes place in many clinical settings, such as in different types of hospital departments, in general practice, and now also within the chiropractic profession. The author conducted an initial study to determine the most important issues regarding the supervision of chiropractic graduates in Sweden. Because it is important to define and discuss the format and contents for that part of the 1-year postgraduate education program for the newly graduated chiropractor that takes place in private chiropractic offices, a new study was conducted involving chiropractic supervisors and new graduates in Sweden and England. OBJECTIVES: To establish what chiropractic supervisors and new graduates believe is important for the graduates to learn during the clinical part of their postgraduate education, to describe the characteristics required (according to supervisors and graduates in the study) to be a good supervisor for a chiropractic graduate, and to investigate whether there are differences in opinions between supervisors and graduates and between the 2 countries. METHODS: Questionnaires were sent out to 11 Swedish chiropractic graduates, 30 English chiropractic graduates, and 30 English chiropractic supervisors who had chiropractic graduates at the time of the survey. RESULTS: Participants agreed that the most important aspect of the clinical activities was to have regular meetings with the graduate, to be professional, and to explain the patient's problems. The most important characteristic to become a good supervisor was that the supervisor is willing to spend time and listen to the graduate throughout the postgraduate training period. The Swedish participants more often considered it important to give the graduates academic articles to read. CONCLUSION: The results of this study suggest that it is the human aspect and the personal relationship between the supervisor and the graduate that are important during the graduate's 1-year postgraduate education at the chiropractic clinic. Chiropractic supervisors and new graduates both believe that one of the most important aspects of supervision is the ongoing dialogue between the supervisor and the graduate.

Chiropractic↗
PubMed2002

Risk of introduction of BSE into Sweden by import of cattle from the United Kingdom.

All cattle of United Kingdom origin imported to Sweden since 1980 were traced (n=94) and the probability that none of these imported cattle had clinical signs of bovine spongiform encephalopathy (BSE) at the year of slaughter (death) was calculated. If BSE had been introduced by live-animal imports, the consequences of such an event also was evaluated. The potential of the recently introduced surveillance system of high-risk cattle to detect such an event also was evaluated. We found that BSE most probably has not been introduced to Sweden by live-animal imports. We also found that, if this event had occurred and assuming a worst-case scenario that the animal was not prevented from being rendered, the rendering system (during certain periods) would not have prevented further spread of infection. Finally, we found that the BSE surveillance of high-risk cattle has not been in place long enough to verify that this event has not occurred (as of December 2001).

Abattoirs↗
PubMed2003

Long-term follow-up and consequences for severe road traffic injuries-treatment costs and health impairment in Sweden in the 1960s and the 1990s.

The purpose of this study is to provide information from two prospective long-term follow-ups for severe road traffic injuries in Sweden. The long-term consequences, in terms of loss of health and costs of care, are presented for severe injuries in Sweden in the early 1990s and are compared with information on injury severity and health care utilisation 25 years ago. The follow-up in the 1990s show that, 1 year after the accident 38% of the non-fatal adults were suffering of some functional disability, pain and distress. Adults suffering from long-term loss of health decreased to 23% on average 3.7 years after the accident. The average health care cost was estimated to SEK46200 (in 1995 prices), and the average in-patient care was 10 days. However, when also including subsequent expected life-long care for three severely injured patients, the average incidence-based health care cost was estimated to SEK100300. In the 4-5 year follow-up 25 years ago, severe traffic injuries were treated on average 21 days in hospital and 38% of the adults were still suffering from long-term physical effects. Conclusions to be drawn are that treatment in hospital of severe traffic injuries has shortened by half and long-term consequences have not been worsened. Our results indicate that long-term effects do not cause as serious loss of health nowadays as they did 25 years ago.

Accidents, Traffic↗
PubMed1999

Priority setting in health policy in Sweden and a comparison with Norway.

The development of priority setting policies has been an important part of the national agenda for health services in Sweden and Norway during the past 10 years. Both countries have health systems with a pronounced public character and a declared emphasis on equity and solidarity. Both countries have also had National Priority Commissions that have developed general documents providing advice, but not very detailed guidelines, on how to set priorities. Resource constraints and the rapid restructuring of the health care system were important characteristics forming the background for the National Priority Commission in Sweden (1995). In Norway, the starting point for the first-ever Priority Commission in the world (1987) was how to set limits for health care in a society with rapidly increasing wealth. The second Norwegian Commission (1997) critically reviewed the effects of the general principles for priority setting that have been put forward, and demonstrated the importance to link them to steering tools within health care services.

Ethics↗
PubMedDate not supplied

Teleradiology in southern Sweden--a tool for reorganization of health care and for education.

The county organization, including health care, is reorganized in the province of Scania in southern Sweden. As part of the restructuring of health care, a program for digitalization of the departments of diagnostic imaging, as well as for teleradiology, has been set up. Standards for network, radiology information systems, and workstations have been settled, and teleradiology links both for on-call consultations and for on-line consultations day-time have been implemented, mainly running at 10 Mb/s. Further digitalization and implementation of teleradiology is planned for the nearest years. Parallel to this, a video conference system including several disciplines, hospitals and health care levels in the whole of southern Sweden has been implemented. The links are now also used for education, both in the province and internationally.

Computer-Assisted Instruction↗
PubMed2003

Acidification-induced chemical changes in coniferous forest soils in southern Sweden 1988-1999.

Thirty-two Norway spruce [Picea abies (L.) Karst.] and Scots pine (Pinus sylvestris L.) stands in southern Sweden were studied for a period of 12 years to evaluate acidification-induced chemical changes in the soil. Soil, at 20-30 cm depth in the mineral layer, was sampled three times during this period (1988, 1993 and 1999). The results show that pH(BaCl2) in mineral soil decreased by, on average, 0.17 units between 1988 and 1999, accompanied by an increase in aluminium (Al) concentration and a decrease in base saturation in the soil. In 1999, the base saturation was below 5% in 58% of the 32 sites compared with 16% in 1988 and 7% in 1993. Concentrations of calcium (Ca), potassium (K) and magnesium (Mg) are low and decreasing. Based on C/N ratios in humus, 45% of the sites may be subjected to leaching of considerable amounts of nitrate. The results show that the acidification of coniferous forest soils in southern Sweden is continuing, and that the negative effects on the nutrient status in soil are extensive. The results are compared with reference values for productive, long-term sustainably managed boreal coniferous or mixed forest soils and implications for long-term sustainability are discussed.

Calcium↗
PubMed2002

Birth order and mortality: a life-long follow-up of 14,200 boys and girls born in early 20th century Sweden.

The present study examines the sex-specific patterns of mortality by birth order in four stages of the life-course, using Poisson and logistic regression analysis. The main question posed is whether there is any continuing social effect of birth order when (a) biological factors at birth, (b) other social factors at birth and (c) socio-economic circumstances in adulthood are adjusted for. The analyses are based on the Uppsala Birth Cohort Study consisting of all 14,192 boys and girls who were born alive at the Uppsala Academic Hospital in Sweden during the period 1915-9. The results showed that all-cause mortality differed according to birth order in all of the four studied age intervals when birth year, mother's age, birth weight, gestational age, diseases of mother, diseases of the infant, social class and mother's marital status at the time of childbirth were adjusted for. The general tendency was for laterborn siblings, particularly girls women, to demonstrate a higher mortality risk than firstborn children. However, in the oldest age group (55-80 years) the previously significant association between birth order and male mortality became insignificant when adult socio-economic circumstances were controlled for. This indicates that the long-term influence of childhood birth order position on mortality is partly mediated by adult social class, education and income. The concluding section of the paper notes that laterborn children, and especially girls, were a disadvantaged group in early 20th century Sweden. Thus, for the subjects in the present study, the childhood social conditions linked to birth order position seem to have had consequences for these individuals' health and survival that extend over the whole life-course.

Adolescent↗
PubMed2004

Sickness absence and early retirement at two workplaces--effects of organisational intervention in Sweden.

This study sought to compare sickness absence and early retirement at two workplaces in Sweden before and after they had received financial support from the Working Life Fund and implemented vocational rehabilitation activities. Two paper and pulp manufacturing plants were compared and a cohort study was set up. The cohort included everyone born in 1934 or later who was employed in December 1988 (918 employees at Plant A and 1543 at Plant B). For 10 years (1989-98), sick leave and disability pensions were monitored. The periods before and after the intervention (1989-93 and 1994-98, respectively) were compared. Cumulative incidence was calculated for short-, long-term and very long-term sick leave, company pension and early retirement. There was no difference between the plants in terms of the three different outcomes when sick leave was measured before and after the intervention. Sick leave in Period 1 was strongly correlated with an elevated risk of sick leave in Period 2. The cumulative incidence of short-term sick leave decreased from 0.92 (95% CI, 0.91-0.93) in Period 1 to 0.79 (95% CI, 0.77-0.80) in Period 2. For employees in the upper age groups, relative risk for long-term and very long-term sick leave was elevated in both periods. The incidence of early retirement and company pension differed between the companies. We conclude that the size of financial investments in rehabilitation programmes has no significant impact on sickness absence or disability pension, based on a comparison between two paper and pulp manufacturing plants in Sweden during the early 1990s.

Adult↗
PubMed1999

Resource dependency, doctors and the state: quality control in Sweden.

This paper focuses on the interaction between the state and the medical profession on the national level in Sweden with respect to issues concerning quality in health care. Using the concepts of policy network and resource dependency as points of departure, two examples of interorganisational relationships are analysed which relate to medical/professional quality and organisational quality, respectively. These are (1) the control of the national quality registers and (2) the development of third-party accreditation in health care organisations. During the 1990s the state has become increasingly dependent on participation by the profession in order to obtain outcome data and other resources controlled by the profession. In Sweden, a fragmented state has established various types of linkages with the organised medical profession, all of which are characterised by mutual resource dependency.

Accreditation↗
PubMed2000

Effect of bystander cardiopulmonary resuscitation in out-of-hospital cardiac arrest patients in Sweden.

BACKGROUND: Information from the Swedish Cardiac Arrest Registry was used to investigate: (a) The proportion of patients suffering an out-of-hospital cardiac arrest who were given bystander cardiopulmonary resuscitation (B-CPR). (b) Where and by whom B-CPR was given. (c) The effect of B-CPR on survival. METHOD: a prospective, observational study of cardiac arrests reported to the Swedish Cardiac Arrest Registry. Analyses were based on standardised reports of out-of-hospital cardiac arrests from ambulance organisations in Sweden, serving 60% of the Swedish population. From 1983 to 1995 approximately 15-20% of the population had been trained in CPR. RESULTS: Of 9877 patients, collected between January 1990 and May 1995, B-CPR was attempted in 36%. In 56% of these cases, the bystanders were lay persons and in 25% they were medical personnel. Most of the arrests took place at home (69%) and only 23% of these patients were given B-CPR in contrast to cardiac arrest in other places where 53% were given CPR. Survival to 1 month was significantly higher in all cases that received B-CPR (8.2 vs. 2.5%). The odds ratio for survival to 1 month with B-CPR was in a logistic regression analysis 2.5 (95% CI 1.9-3.1). CONCLUSIONS: In Sweden, the willingness and ability to perform B-CPR appears to be relatively widespread. More than half of B-CPR was performed by laypersons. B-CPR resulted in a two to threefold increase in survival.

Cardiopulmonary Resuscitation↗