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PubMed2002

Diurnal, weekly and seasonal rhythm of out of hospital cardiac arrest in Sweden.

AIM: To describe the diurnal, weekly and seasonal rhythm among patients suffering from out of hospital cardiac arrest in Sweden. METHODS: All patients in Sweden between 1990 and 1999 participating in a National Registry covering 65% of all patients suffering from out of hospital cardiac arrest where cardiopulmonary resuscitation (CPR) was attempted. Only patients with a cardiac arrest of a cardiac aetiology and aged > 18 years were included in the survey. RESULTS: 10,868 patients fulfilled inclusion criteria. In terms of the diurnal rhythm, there was a progressive increase in the development of cardiac arrest from 06:00 h, reaching a peak at about 10:00 h. Thereafter, there was a progressive decline until 05:00 h. The diurnal rhythm was more marked among patients aged > 65 years and among patients in whom the arrest occurred outside home. There was a weekly rhythm with an increased incidence of cardiac arrest on Mondays. This was particularly evident among patients aged < 66 years and among men. A cardiac arrest occurred most frequently in January and December. This was particularly observed in the large cities. CONCLUSION: We found that out of hospital cardiac arrest of a cardiac etiology has a diurnal, weekly and seasonal rhythm occurring most frequently in the morning hours, on Mondays and in December and January. Age, sex and place of arrest influence these rhythms.

Adolescent↗
PubMed2000

The impact of internal parasites on the productivity of young cattle organically reared on semi-natural pastures in Sweden.

A grazing experiment with young cattle was conducted over two consecutive (1997, 1998) grazing seasons on semi-natural pasturelands in central-eastern Sweden. Comparisons were made between groups of animals that were either untreated and set-stocked, ivermectin bolus treated and set-stocked or untreated but moved in mid-summer (mid-July) to ungrazed pasture. The whole experimental area had remained virtually free of cattle during the previous two seasons and the cattle had been raised indoors since birth. To introduce low-levels of parasite infection into the experimental system, each animal received a 'priming dose' of approximately 10, 000 infective trichostrongylid larvae at the time of turnout for both years. Results of the first year study showed that the level of parasitism was so low that it failed to induce any productivity losses in both groups of untreated cattle, which grew as well as those given boluses at turnout. In contrast, in 1998 both groups of untreated cattle suffered varying degrees of sub-clinical and clinical parasitism to result in an average of 30kg liveweight depression, compared with the bolus treated cattle, at the end of the season. The only major departure between the two years was that in the latter, the cattle in the untreated groups were exposed to infective larval pickup, which had overwintered on pasture. Cattle in the move treatment grazed in the same sequence on pastures used by similar classes of animals during the previous year. That is, their pastures at turnout had not been grazed since mid-summer of the previous year. Clearly this early season (1997) grazing by young cattle resulted in sufficient overwintered larvae at the start of the following year (1998) to cause productivity losses of the same magnitude as those recorded for young cattle grazing on pastures contaminated for the entire grazing season of the previous year. This was confirmed by tracer tests that were carried out on all treatments, at the time of turnout and the mid-summer move in 1999. These results have major significance to organic cattle producers in Sweden who have a much higher tendency to practice a variety of grazing management techniques aimed at controlling nematode parasite infections in young cattle, than their conventional farming colleagues. It has been identified that one of these strategies is to simply use summer/autumn saved pastures for young stock at turnout, which if grazed by young stock prior to this, could prove to be counter-productive.

Animal Husbandry↗
PubMed2001

A field survey on the status of internal parasites in calves on organic dairy farms in southwestern Sweden.

Infections with internal parasites are one of the most important causes of reduced productivity in first-grazing season cattle (FGSC). In conventional herds, nematode infections can be controlled by prophylactic anthelmintic treatments, but this is prohibited in organic production. The purpose of this investigation was to monitor the status of internal parasitism on 15 organic cattle enterprises in southwestern Sweden during the 1997 and 1998 grazing seasons, and to estimate the benefits of some management practices in parasite control. On each farm, the numbers of Eimeria alabamensis oocysts per gram of (opg) faeces were counted in seven fresh dung pats collected from the paddock 8-10 days after the turnout of FGSC. Faecal samples from 5 to 15 FGSC were also analysed for nematode eggs per gram (epg) faeces at four occasions during each grazing season. In addition, the FGSC and one group of second-grazing season cattle (SGSC) were weighed at turnout and housing and at the same time blood samples were collected, and analysed for serum pepsinogen concentration and antibodies against the lungworm, Dictyocaulus viviparus. On seven farms, 1-6 samples with more than 100000 opg were found, indicating considerable pasture contamination by E. alabamensis. However, clinical signs of coccidiosis were not observed. The highest outputs of nematode eggs were observed 45-55 days after turnout. More than 500 epg were only observed in 12 (2.2%) of the calves in 1997 and in three (0.6%) animals in 1998. Only 1% of the serum samples had pepsinogen values exceeding 3.6 U tyrosine, indicative of subclinical Ostertagia ostertagi infection. Lungworm infection was detected in five and nine herds in 1997 and 1998, respectively. The number of seropositive animals on these farms ranged between one (10%) and seven (70%). Clinical signs of dictyocaulosis were observed on two farms. The results indicate that dictyocaulosis is a problem in organic dairy herds in Sweden. On the other hand, the study shows that good management such as usage of parasite safe pastures and supplementary feeding may help control gastrointestinal parasites.

Animals↗
PubMed2003

Evaluation of gastro-intestinal nematode parasite control strategies for first-season grazing cattle in Sweden.

A three-year grazing experiment (1998-2000) was conducted with first-season grazing cattle (FSGC) on improved pastures in central-eastern Sweden. Comparison was made between five groups with 10 calves in each group where four of these were set stocked and either (1) untreated, (2) ivermectin bolus treated, (3) subjected to biological control with the nematophagous fungus Duddingtonia flagrans, or (4) treated with a copper wire particle bolus. The fifth treatment was an evasive grazing strategy, whereby untreated calves were turned out onto pasture used by older cattle the previous year and then these calves were moved to silage aftermath in mid-July. To introduce low-levels of parasite infection to the experiment, each animal received a 'priming dose' of approximately 5,000 Ostertagia ostertagi and 5,000 Cooperia oncophora infective third stage larvae immediately prior to the start of the first grazing year of the trial. Results showed that efficient and sustainable parasite control of FSGC was possible to achieve without the use of anthelmintics by using turnout pastures that the previous year had been grazed by older cattle, in combination with a mid-July move to aftermath leys. Biological control also proved beneficial but the efficacy was impaired if high faecal egg counts coincided with rapid dung pat degradation due to heavy rainfall. No indication of parasite control was observed with the copper wire particle bolus. It was also demonstrated that the impact of gastrointestinal (GI) parasitism varied between years and that the level of overwintering contamination is important but likewise, is unpredictable. Although faecal egg counts in 1999 were low, due both to a delayed turnout and drought for the major part of the grazing season, deposited eggs successfully developed to infective larvae and overwintered in large numbers. The population of overwintered infective larvae at the time of turnout in early May played an important role in the course of infection in 2000 and resulted in an average 65 kg advantage of the ivermectin treated calves compared with the untreated calves.Thus, this three-year grazing experiment has emphasised the importance of subclinical gastrointestinal nematode infections in FSGC in Sweden. In addition, the study has shown that adequate parasite control may be achievable without the use of anthelmintics.

Animal Husbandry↗
PubMed2001

Knowledge, attitudes and management strategies in Scandinavia concerning hormone replacement therapy: a comparison between gynecologists in Denmark, Norway and Sweden.

OBJECTIVES: To describe and compare attitudes, knowledge and management strategies concerning the prescription of hormone replacement therapy (HRT) between gynecologists from three Scandinavian countries. DESIGN AND METHODS: In a cross-sectional study gynecologists in Denmark (n=386), Norway (n=475) and Sweden (n=1323) were invited by letter to complete and return an enclosed questionnaire. Then 1653 of the 2184 (76%) contacted gynecologists completed and returned the questionnaire. RESULTS: of the 1653 Scandinavian gynecologists, 42% offered HRT to all women provided there was no contraindication, while 58% recommended HRT to selected women after considering the advantages and disadvantages of HRT. In Norway and Sweden, the proportion of gynecologists routinely prescribing HRT for women without contraindications increased with age and in the oldest age group of gynecologists (>55 years) 49 and 56%, respectively, recommended HRT to all women. The gynecologists were unanimous in their choice of the type of HRT for perimenopausal women as 94% preferred cyclical or sequential combined (estrogen/progestogen) treatment or estrogen monotherapy (orally or transdermally) for hysterectomized women (95%). For postmenopausal women, 75% of the gynecologists offered continuous combined HRT while cyclical combined therapy was chosen by 15% of the gynecologists. No significant differences were found between physicians in the three countries regarding indications and contraindications to HRT. CONCLUSIONS: Scandinavian gynecologists are generally well informed concerning HRT and liberally recommend HRT for women without contraindications.

Adult↗
PubMed2000

Cervical cancer screening in Sweden.

Organised cervical cancer screening was implemented in Sweden in the mid-1960s. A marked decline in cervical cancer incidence could be attributed to the time-point of start of screening. Squamous cell carcinoma has declined by 60%, whereas adenocarcinoma has increased. About 950000 papanicolaou (Pap) smears are taken annually. Only 31% of the smears taken in the organised screening programme. As of 1998, the screening guidelines are 3-yearly tests between 23 and 50 years of age and 5-yearly tests between 50 and 60 years of age. The article reviews the screening practise in Sweden, the current efforts to improve the quality of the screening programme, as well as the ongoing randomised evaluations of organised primary screening for cervical human papilloma virus (HPV) infection.

Adult↗
PubMed2001

A founder mutation of the BRCA1 gene in Western Sweden associated with a high incidence of breast and ovarian cancer.

The aim of this study was to describe and characterise a founder mutation of the BRCA1 gene in western Sweden. Of 62 families screened for BRCA mutations, 24 had BRCA1 mutations and two had BRCA2 mutations. Tumours that occurred in family members were histologically reviewed and mutational status was analysed using archival paraffin-embedded tissues. The same BRCA1 mutation, 3171ins5, was found in 16 families who were clustered along the western coast of Sweden. Mutation analysis revealed a maternal linkage in 13 families and a paternal linkage in 3. There was complete agreement between mutation analysis results obtained from blood and archival tissues. The penetrance of breast or ovarian cancer by age 70 years was estimated to be between 59 and 93%. There were no differences in survivals between breast or ovarian cancer patients with the mutation and age-matched controls. Thus, a predominant BRCA1 gene founder mutation associated with a high risk of breast and ovarian cancer has been identified and found to occur in a restricted geographical area, thereby allowing timely and cost-effective mutation screening using blood samples or archival histological material.

Adult↗
PubMed1997

Malignant salivary gland tumours in Sweden 1960-1989--an epidemiological study.

Epidemiological data from the Swedish Cancer Registry of new cases of malignant major and accessory salivary gland tumors in Sweden between 1960 and 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 salivary gland 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 new malignant major salivary gland tumors was 2557, representing approximately 85 new cases per year and 0.3% of all new diagnosed cancers in Sweden. In addition, approximately 25 new cases per year of malignant accessory salivary gland tumors were reported. If all malignant salivary gland tumours were considered, the most common location was found in the parotid glands with a relative frequency of 57.5%, and the next most common site was malignant accessory salivary gland tumours with 22.6%. I(s) was 10.2 for the major and 3.0 for the accessory salivary glands. No major difference between the examined 10-year periods was found concerning the relative frequency, and no statistically significant difference in I(s) was found between the examined 10-year periods, except for a statistically significant decrease in the I(s) between the time periods 1960-1969 and 1980-1989 for the multiple or unspecified malignant salivary glands from 0.5 to 1.4. A difference in the distribution of various histopathological types of malignant salivary gland tumours was observed between the different time periods. This was particularly valid for the diagnoses adenoid cystic carcinomas and mucoepidermoid carcinomas which increased in number and the diagnosis malignant salivary gland tumours of mixed type, which decreased in number during the examined time periods.

Adenoma, Pleomorphic↗
PubMed2001

Gendered construction of sexual risks: implications for safer sex among young people in Kenya and Sweden.

This study compared perceptions of sexual risk and sexual practices among youth in Kenya and Sweden. Self-generated questions on the body, perceptions of sexual risk and sexual practices were collected in Kenya while focus group discussions and individual interviews on these same issues were used in Sweden. The most striking differences between the two countries were in the level of knowledge on matters of sexuality and the ability to talk with ease on these matters. The refusal in Kenya to provide adolescents with information and services has left the 'safe period' as their only protective option and pregnancy as the overriding concern. Communication at the partner level and lack of condom use are problematic in both countries and even where access to information and preventive services exist, these may not be used optimally. In both countries, boys had more sexual freedom, while girls were controlled through labelling and rumours, and girls were assigned responsibility for safer sex. We conclude that sexual education should be based more broadly on an understanding of the social norms defining sexual behaviour. It is at the level of sexual relations that the tensions between culturally-defined sexual and gender norms and public health assumptions should be addressed, a level at which health policy and education are silent in both countries.

Adolescent↗
PubMed2002

Sex behavior among high school students in Sweden: improvement in contraceptive use over time.

PURPOSE: To investigate sexual behavior and attitudes toward sexuality among first-year high school students in Sweden in 1999 and to compare the sexual behavior with that reported from similar studies in 1979 and 1989. METHODS: In Spring 1999, a questionnaire with 47 questions mainly of multiple-choice nature was administered to a random sample of 20 classes in senior high school in two medium-sized cities in Sweden. The median age of the students was 16 years. Differences in sexual behavior and attitudes were evaluated with the Chi-square and Student's t-test. RESULTS: Almost half of the students (46%) had had intercourse, showing that the age of coitarche had not decreased during the past two decades. The median age at intercourse of those who had had intercourse was 15 years in both genders. More students in practical (vocational-technical) programs (60%) than in theoretical (college preparatory) ones (37%) had had sexual intercourse. More teenagers in theoretical (90%) than in practical programs (64%) had used contraceptives at their first intercourse, an increase from 65% in 1979 to 76% in 1999. One-fourth of the teenagers were under the influence of alcohol at the first intercourse, a decrease, compared with 1979. CONCLUSIONS: Contraceptive use at coitarche has increased and alcohol use decreased over the 20-year-period. The tendency noted 10 years ago that students attending practical programs put themselves at more health risk than students in theoretical programs continues. This fact should be considered when planning for counseling and sex education.

Adolescent↗
PubMed1992

Cost-effectiveness of misoprostol in Sweden.

Based on an American multicenter study, an economic evaluation of prophylactic misoprostol was undertaken in Sweden. The study included 420 patients with osteoarthritis and nonsteroidal anti-inflammatory drug (NSAID)-associated abdominal pain, but no gastric ulcer at inclusion. The frequency of ulcer development with and without prophylactic misoprostol was assessed at 21.7% and 5.6%, respectively, for a 3-month period. All costs for drugs, ambulatory care, hospital care, loss of production, as well as other factors such as dosage and compliance, were transferred to Swedish conditions. It was concluded that in patients with osteoarthritis and NSAID-induced abdominal pain, prophylaxis with misoprostol is cost-effective in Sweden, which is similar to what is found for other countries. A prerequisite for this result is a frequency of ulcer development of 15%. A patient compliance to prophylactic treatment of more than 60% is also presupposed (79% was observed in the above study). Due to the high age of the osteoarthritis patient population, the cost-effectiveness is influenced to only a minor extent by whether indirect costs are included in the calculation.

Adult↗
PubMed2004

Health technology assessment and priority setting for health policy in Sweden.

This article describes the development of health technology assessment (HTA) in Sweden, its influence on decision making, and its link with priority setting. Sweden has a well established governmental HTA body, the Swedish Council on Technology Assessment in Health Care (SBU), and an increasing number of regional/local HTA organizations. HTA has had an impact on clinical practice and is used to some extent in policy decisions. Several initiatives have now been taken to develop processes for open priority setting of health-care services. With the establishment of a new agency to undertake reimbursement decisions on pharmaceuticals, and greater patient and public involvement in decision making, it seems inevitable that HTA will play a more important role in priority setting in the near future.

Data Collection↗
PubMed2005

Reassessment of the cost-effectiveness of hormone replacement therapy in Sweden: results based on the Women's Health Initiative randomized controlled trial.

OBJECTIVES: The purpose of the study is to reassess the cost-effectiveness of hormone replacement therapy (HRT) based on new medical evidence found in the Women's Health Initiative (WHI). Within a model framework using an individual state transition model, the cost-effectiveness of 50- to 60-year-old women with menopausal symptoms is assessed based on a societal perspective in Sweden. METHODS: The model has a 50-year time horizon divided into a cycle length of 1 year. The model consists of the following disease states: coronary heart disease, stroke, venous thromboembolic events, breast cancer, colorectal cancer, hip fracture, vertebral fracture, and wrist fracture. An intervention is modeled by its impact on the disease risks during and after the cessation of therapy. The model calculates costs and quality-adjusted life years (QALYs) with and without intervention. The resulting cost per QALY gained is compared with the value of a QALY gained, which is set to SEK 600,000. The model requires data on clinical effects, risks, mortality rates, quality of life weights, and costs valid for Sweden. RESULTS: The cost-effectiveness ratios are estimated at approximately SEK 10,000, which is below the threshold value of cost-effectiveness. On the condition that HRT increases the quality of life weight more than 0.013 units, the therapy is cost-effective. CONCLUSIONS: In conclusion, given the new evidence in WHI, there is still a high probability that HRT is a cost-effective strategy for women with menopausal symptoms.

Cost-Benefit Analysis↗
PubMed2001

Low incidence of toxoplasma infection during pregnancy and in newborns in Sweden.

To estimate the burden of disease due to congenital toxoplasmosis in Sweden the incidence of primary infections during pregnancy and birth prevalence of congenital toxoplasmosis in 40,978 children born in two regions in Sweden was determined. Women possibly infected during pregnancy were identified based on: 1, detection of specific IgG based on neonatal screening of the phenylketonuria (PKU) card blood spot followed by retrospective testing of stored prenatal samples to detect women who acquired infection during pregnancy and follow up of their children to 12 months: 2, detection of specific IgM on the PKU blood spot. The birth prevalence of congenital toxoplasmosis was 0.73/10,000 (95 % CI 0.15-2.14) (3/40,978). The incidence of primary infection during pregnancy was 5.1/10,000 (95% CI 2.6-8.9) susceptible pregnant women. The seroprevalence in the southern part was 25.7% and in the Stockholm area 14.0%. The incidence of infection during pregnancy was low, as the birth prevalence of congenital toxoplasmosis. Neonatal screening warrants consideration in view of the low cost and feasibility.

Algorithms↗
PubMed2004

GIS-supported investigation of human EHEC and cattle VTEC O157 infections in Sweden: geographical distribution, spatial variation and possible risk factors.

This article describes the spatial and temporal distribution of verotoxin-producing Escherichia coli among humans (EHEC) and cattle (VTEC) in Sweden, in order to evaluate relationships between the incidence of EHEC in humans, prevalence of VTEC O157 in livestock and agricultural structure by an ecological study. The spatial patterns of the distribution of human infections were described and compared with spatial patterns of occurrence in cattle, using a Geographic Information System (GIS). The findings implicate a concentration of human infection and cattle prevalence in the southwest of Sweden. The use of probability mapping confirmed unusual patterns of infection rates. The comparison of human and cattle infection indicated a spatial and statistical association. The correlation between variables of the agricultural structure and human EHEC incidence was high, indicating a significant statistical association of cattle and farm density with human infection. The explained variation of a multiple linear regression model was 0.56.

Adolescent↗
PubMed2003

Estimating the natural background atmospheric deposition rate of mercury utilizing ombrotrophic bogs in southern Sweden.

A critical gap in the understanding of the global cycling of mercury is the limited data describing the natural background atmospheric deposition rate of mercury before the advent of pollution. Existing estimates of the natural deposition rate are typically about 2-5 microg of Hg m(-2) year(-1) (see, for example, Swain et al. Science 1992, 257, 784-787), based on studies that generally rely on short, 210Pb-dated lake sediment and peat cores that span the past 150 years. Analyses of mercury in long peat cores in southcentral Sweden indicate that natural mercury deposition rates in the period 4000-500 BP were lower, about 0.5-1 microg of Hg m(-2) year(-1). This suggests that recent mercury accumulation rates in the peat (15-25 microg of Hg m(-2) year(-1)) and measured atmospheric deposition rates of mercury in Sweden over the past 3 decades (5-30 microg of Hg m(-2) year(-1)) (Munthe et al. Water, Air, Soil Pollut.: Focus 2001, 1, 299-310) are at least an order of magnitude greater than the prepollution deposition rate, rather than representing only a 3-5-fold increase, as has generally been estimated.

Air Pollutants↗
PubMed2004

Higher brominated diphenyl ethers and hexabromocyclododecane found in eggs of peregrine falcons (Falco peregrinus) breeding in Sweden.

Several brominated flame retardants (BFRs) were analyzed in peregrine falcon eggs collected in 1987-1999, including the constituents of the technical polybrominated diphenyl ether (PBDE) products Penta (BDE-47, -99, -100, -153, -154), Octa (BDE-183), and Deca (BDE-209), hexabrominated biphenyl (BB-153), and hexabromocyclododecane (HBCD). The eggs represented females from three different breeding populations, northern Sweden, southwestern Sweden, and a captive breeding population. All BFRs analyzed for were found, including BDE-183 and -209, and concentrations were much higher in wild falcons (geometric mean sigmaPBDE, BB-153, and HBCD for northern/southern populations of 2200/2700, 82/77, and 150/250 ng/g lw, respectively) than in captive falcons (39, 8 ng/g lw, and not detected, respectively). This is the first time, to our knowledge, that BDE-183 and -209 have been quantified in high trophic level wildlife.

Animals↗
PubMed2001

Determination and distribution of diesel components in igneous rock surrounding underground diesel storage facilities in Sweden.

In Sweden, a preliminary investigation of the contamination situation of igneous rock surrounding underground storage facilities of diesel showed that the situation was severe. The diesel was believed to have penetrated into the rock as far as 50 m from the walls of the vaults. Consequently, the risk for contamination of groundwater and recipients could not be neglected. To be able to assess the fate of diesel components in rock, both a suitable drilling method and a method for the determination of a wide range of diesel components were needed. The analytical method presented made it possible to quantify a number of hydrocarbons in rock samples collected with triple-tube core drilling. The samples were dissolved in hydrofluoric acid (HF) with hexane in Teflon centrifuge tubes. After digestion of the rock, extraction of the analytes with hexane was performed. Determination of the individual hydrocarbons present was done with gas chromatography-mass spectrometry (GC-MS). The method was used to study the environmental impact of the underground storage of diesel. The drilling method enabled sampling without contamination risks. Our data show that the major transport of diesel components in rock occurs through fracture systems and that diffusion of diesel through the rock is of minor importance. The results have drastically changed the view of the contamination situation of diesel in the vicinity of storage facilities in hard rock in Sweden.

Gas Chromatography-Mass Spectrometry↗