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PubMed1997

[HIV/AIDS development in Denmark and Sweden. Are there differences?].

National surveillance data from Denmark and Sweden were analyzed for trends in the incidence of HIV and AIDS. By the end of 1995, the cumulative number of AIDS cases was higher in Denmark than in Sweden, but since the annual incidence was still increasing in Sweden and slightly decreasing in Denmark, the Denmark:Sweden ratio of the overall annual AIDS incidence has decreased since 1992, and so has this ratio of incidence among homo/bisexual men. The cumulative number of acquired infections was estimated to be higher in Denmark than in Sweden, although the bi-annual proportional increase in incidence from 1987 to 1993 was higher in Sweden than in Denmark. In both countries, the annual number of new identified HIV infections among homo/bisexual men has become stable, although the Denmark:Sweden ratio has decreased since 1990. In conclusion, the national epidemiological data do not indicate that the Swedish strategy has been more effective than the Danish in preventing new HIV infections.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Vector-borne viral diseases in Sweden--a short review.

Ockelbo disease, caused by a Sindbis-related virus transmitted to man by mosquitoes, was first described in the central part of Sweden in the 1960s as clusters of patients with fever, arthralgia and rash. An average annual rate of 30 cases was recorded in the 1980s but no cases have been diagnosed during the last few years. Nephropathia epidemica (NE) characterized by fever, abdominal pain and renal dysfunction has been known to cause considerable morbidity in Sweden during the last 60 years but the etiologic agent (Puumala virus) was not isolated until 1983. This virus's main reservoir is the bank vole (Clethrionomys glareolus). NE is endemic in the northern two thirds of Sweden where more than a hundred cases are diagnosed each year. Tick-borne encephalitis transmitted by Ixodes ricinus ticks is restricted to the archipelago and Lake M-alaren on the east coast close to Stockholm. Between 30 and 110 cases are diagnosed every year. Inkoo virus, a California encephalitis group virus, has been isolated from mosquitoes in Sweden. The antibody prevalence to Inkoo virus is very high in a normal population, but no disease has as yet been associated with this virus in Sweden. Among the vector-borne virus diseases imported to Sweden, dengue is the most important, with approximately 50 cases recorded every year.

Alphavirus Infections↗
PubMed2005

Different labelling of obstructive airway diseases in Estonia, Finland, and Sweden.

Large differences in prevalence of asthma have been reported between westernised countries and the former Eastern European countries, and still no consensus about the reasons for the differences exists. The aim of this study was to assess diagnostic labelling of obstructive airway diseases, comparing subjects with respiratory symptoms and the diagnoses obtained in Estonia, Finland, and Sweden. A postal questionnaire was sent to population-based random samples, and 44,483 (76%) answers were obtained from the 58,661 invited in 1996. Among men, current smoking was most common in Estonia, 60%, followed by Finland, 39%, and Sweden, 28%. In all three countries, 30% of women were current smokers. Most respiratory symptoms including wheezing were most common in Estonia, also among non-smokers. The prevalence of asthma was 2.0% and chronic bronchitis 10.7% in Estonia, while the opposite was found in Sweden with an asthma prevalence of 7.8% and a chronic bronchitis prevalence of 3.1%. The pattern in Finland was similar to that of Sweden. The same differences between the three countries were found also among young subjects. The total proportion of diagnosed obstructive lung diseases in subjects with respiratory symptoms was similar, but the diagnosis of asthma was considerably more common in Finland and Sweden. Chronic bronchitis was favoured in Estonia, also among young adults irrespectively of what symptoms were present. In a multivariate model with correction for confounders, the risk (OR) for having a diagnosis of asthma was 5.65 (95% CI: 4.86-6.56) when living in Sweden, and 3.51 (95% CI: 3.00-4.12) in Finland, whereas risk for chronic bronchitis was 0.28 (0.25-0.31) and 0.22 (0.19-0.25), respectively, compared to Estonia. The study indicates differences in diagnostic practices of obstructive lung diseases between the three countries.

Adult↗
PubMed2004

A fourfold difference in the incidence of type 1 diabetes between Sweden and Lithuania but similar prevalence of autoimmunity.

We investigated whether other autoimmune disorders in addition to type 1 diabetes are more common in Sweden than Lithuania, and if there are any differences in inheritance patterns of both type 1 diabetes and other autoimmune disorders. Data from 517 children in southeast Sweden and 286 children in Lithuania aged 0-15 years were included in the study. Age- and sex-matched control children were randomly selected. Information was collected by questionnaire. Of the children with diabetes in Sweden, 13.2% had a family member with type 1 diabetes compared to 7% of children with diabetes in Lithuania (P < 0.01) (OR = 2.01). No such difference was seen for other autoimmune diseases in family members of children with diabetes (Sweden 12%, Lithuania 14%, n.s.). Control children in Lithuania had family members with autoimmunity more frequently (15.3%) than control children in Sweden (7.4%, P < 0.001) (OR = 2.26). This difference was most pronounced in mothers. The Lithuanian control children had an autoimmune disease more frequently than the controls in Sweden (4.7% versus 1.5%, respectively, P < 0.001) (OR = 3.21). There seem to be environmental factors that specifically contribute to the development of type 1 diabetes, factors which are less related to the development of autoimmunity in general.

Adolescent↗
PubMed1998

Prevalence of bronchial hyper-responsiveness in the southern, central and northern parts of Sweden.

Studies have suggested that there is a higher prevalence of asthma in northern Sweden than in southern Sweden. Bronchial hyper-responsiveness (BHR) has been shown to be associated with asthma. The aim of this study was to explore the prevalence of bronchical hyper-responsiveness in different parts of Sweden. As part of the European Community Respiratory Health Survey (ECRHS), interviews, skin prick tests, lung function tests and methacholine provocation tests of the airways were performed in 1448 randomly selected subjects in southern, central and northern Sweden. The Mefar dosimeter was used according to the ECRHS protocol. The responsiveness was calculated both as the PD20 and as the dose response slope (DRS). BHR was defined as a PD20 of < or = 1.6 mg. Atopy was defined as at least one skin prick test of > or = 3 mm. The prevalence of BHR was 12.7%, 10.6% in men and 15.0% in women. No difference in prevalence was found between the three different regions of Sweden. The prevalence of BHR was higher in women than in men and higher in smokers than in non-smokers. Using multiple logistic regression, with BHR as the dependent variable, atopy, being female, having a low FEV1 (% predicted) and smoking (both own and passive) increased the odds of having BHR, while age and the region of Sweden did not influence BHR. Defining BHR as a PD20 of < or = 1.0 mg or a PD20 of < or = 2.0 mg did not change this. Multiple regression using log DRS as the dependent variable produced the same result. Both BHR and increasing DRS were associated with self-reported wheezing, attacks of shortness of breath during the daytime at rest or after strenuous activity, being awakened by a feeling of tightness in the chest or an attack of shortness of breath. In subjects without self-reported asthma, BHR was associated with self-reported wheezing and attacks of shortness of breath after strenuous activity. In conclusion, we found that the prevalence of BHR in the three investigated areas was 12.7%. We found a trend towards a higher prevalence of BHR in the most northerly of the study areas, but the difference between the areas was not statistically significant. BHR and DRS were associated with atopy, smoking, female sex and FEV1 (% predicted). The reporting of symptoms from the airways was associated with the degree of bronchical responsiveness.

Adult↗
PubMed2002

Risk factors for coronary heart disease in 55- and 35-year-old men and women in Sweden and Estonia.

OBJECTIVE: To illustrate the geographical West-to-East division of coronary heart disease (CHD) by comparing a population from Sweden, that represents a Western country to a population from Estonia, that represents an Eastern country. Estonia has an approximately 2-4-fold higher CHD prevalence for 55-year-old women and men, respectively, than Sweden. DESIGN: Randomized screening of 35- and 55-year-old men and women in Sollentuna county, Sweden and Tartu county, Estonia. Eight hundred subjects, 100 from each cohort, were invited to participate in the study, 272 Swedes and 277 Estonians participated. SETTING: Preventive cardiology, administered by a primary health care centre at the Karolinska Hospital, Sweden and a cardiology centre at Tartu University Hospital, Estonia. MAIN OUTCOME MEASURES: The CHD risk factors (smoking, blood pressure, concentrations of lipoproteins, fibrinogen, and glucose) and certain environmental factors and attitudes related to CHD risk by questionnaires (fat-type and alcohol ingestion, self-assessed rating of CHD susceptibility). RESULTS: Of the 55-year-old men, 57% smoked in Estonia and 20% smoked in Sweden. Similar, although less pronounced differences showing higher smoking prevalence, were seen for 35-year-old Estonian men and women, whilst for 55-year-old women, less than 20% smoked in either country. Estonian 55-year-old women had lower HDL cholesterol and higher LDL cholesterol serum concentrations than Swedish 55-year-old women. Estonians reportedly ate food containing more saturated fats than Swedes, as indicated by the scale-score questionnaire. Estonians, relative to Swedes, rated their chance of developing CHD higher, and paradoxically, Estonians did to a much lesser degree believe that life style influences the risk of developing CHD. CONCLUSIONS: Elevated smoking prevalence is a striking difference between the Estonian and Swedish populations likely to explain the much higher CHD prevalence in Estonian men. The lower HDL cholesterol and higher LDL cholesterol in Estonian 55-year-old women may explain the higher CHD prevalence in Estonian women. Furthermore, the SWESTONIA CHD study (i.e. comparison between Sweden and Estonia) shows several environmental differences between the countries populations related to fat content in food, alcohol drinking patterns, and views on CHD risk and the importance of lifestyle intervention, that could contribute to the higher CHD prevalence in Estonia.

Adult↗
PubMed2000

Dental conditions in middle-aged and older people in Denmark and Sweden: a comparative study of the influence of socioeconomic and attitudinal factors.

In 1998-99 two parallel questionnaire studies were performed in Denmark and Sweden. In Denmark the age group was 45-69 years and in Sweden 55-79 years. One aim was to study the influence of socioeconomic and attitudinal factors on dental status in the two countries. For the comparable age groups 55-69 years there was a striking difference in dental conditions between the countries. In Sweden, 72% had either all teeth remaining, missing teeth replaced by fixed prosthodontics, or only one or two single missing teeth not replaced. The corresponding figure for Denmark was 44%. Among Danes, 34% were wearing removable denture(s) or were edentulous in one jaw or both jaws, compared with 15%, among Swedes. In logistic regression models, higher income and longer education were significantly associated with the best dental status categories in Denmark but not in Sweden. In the model with wearing removable denture(s) as the dependent variable, lower income and lower education level showed a significant influence for the Danes. In Sweden, lower income showed a significant influence but education level was insignificant. In both Denmark and Sweden, a positive attitude toward the importance of dental appearance was associated with an increased risk of wearing removable denture(s).

Aged↗
PubMed1999

Indicators of health and well-being in Iceland and Sweden. A comparative study of various indicators concerning standards of living and mortality.

OBJECTIVE: To study various indicators concerning health and well-being in two Nordic countries with special attention to standards of living and mortality. DESIGN: Comparative study of the mortality rates from various causes of death during the years 1983-1992 and some indicators of standard of living derived from official reports and registers in Iceland and Sweden. SETTING, SUBJECTS: The total populations of Iceland and Sweden. MAIN OUTCOME MEASURES: Mortality rates, indicators of living standard, gross domestic product and demographic variables such as divorces and unemployment. RESULTS: The mortality rates for all causes of death were similar for women in Iceland and Sweden during 1983-1992 but were lower for men in Iceland than in Sweden. The mortality rates from cardiovascular diseases decreased during the study period. The rates for malignant disease were higher in Iceland for both men and women. Iceland has a larger population growth but a much lower population density. Most of the demographic variables were similar in the two countries. Unemployment rates were higher in Sweden. CONCLUSION: In spite of large similarities between Iceland and Sweden in socio-demographic variables there are substantial differences in mortality rates between the countries. The causes for these mortality differences are obscure and should be further investigated.

Cause of Death↗
PubMed2005

The impact of country of birth and time in Sweden on overweight and obesity: a population-based study.

AIMS: A study was undertaken to investigate the relationship between country of birth, time in Sweden, and overweight and obesity. METHODS: Approximately 4,000 people aged 20-80 participated in a cross-sectional survey in 1994. The ethnic differences in overweight and obesity were analysed in a multivariate logistic regression analysis adjusting for age and education. The effect of number of years spent in Sweden on overweight and obesity was assessed for some of the ethnic groups compared with the Swedish-born group. RESULTS: Men from Yugoslavia and Arabic-speaking countries were overweight/obese (BMI 25.0-) and obese (BMI 30.0-) to a significantly higher extent than men born in Sweden. Women born in Poland, Arabic-speaking countries, and all other countries were overweight/obese and obese to a significantly higher extent than women born in Sweden. Both Arabic men and women who had immigrated to Sweden in 1989 or earlier had an increased risk of overweight/obesity and obesity compared with the participants born in Sweden, while no increased risk was observed for the Arabic group that immigrated after 1989. CONCLUSIONS: There were significant differences in overweight and obesity between the country of birth groups. The findings follow the patterns of low leisure time physical activity among certain ethnic groups reported in a previous study, which has implications for public health measures directed to decrease differences in overweight and obesity by country of birth.

Adult↗
PubMed2005

Driving under the influence of drugs in Sweden with zero concentration limits in blood for controlled substances.

OBJECTIVE: This article describes the background and implementation in Sweden of zero-concentration limits for controlled drugs in the blood of drivers. Eliminating the need to prove that a person's ability to drive safely was impaired by drugs has greatly simplified the prosecution case, which now rests primarily on the forensic toxicology report. Driving under the influence of a prescription drug listed as a controlled substance is exempt from the zero-limit law provided the medication was being used in accordance with a physician's direction and the person was not considered unfit to drive. METHODS: The prevalence of driving under the influence of drugs (DUID) in Sweden was evaluated from police reports with the main focus on the toxicological findings. A large case series of DUID suspects was compared before and after introducing zero concentration limits in blood for controlled substances on July 1, 1999. The spectrum of drugs used by typical offenders and the concentrations of various licit and illicit substances in blood were evaluated and compared. RESULTS: Immediately after the zero-limit law came into force, the number of cases of DUID submitted by the police for toxicological analysis increased sharply and is currently ten-fold higher than before the new legislation. Statistics show that about 85% of all blood samples sent for toxicological analysis have one or more banned substances present. Amphetamine is by far the leading drug of abuse in Sweden and was identified in about 50-60% of all DUID suspects either alone or together with other controlled substances. The next most frequently encountered illicit drug was tetrahydrocannabinol (THC), with positive findings in about 20-25% of cases. Various prescription drugs, mainly sedative-hypnotics like diazepam and flunitrazepam, were also highly prevalent and these occurred mostly together with illicit substances. Opiates, such as 6-acetyl morphine and morphine, the metabolites of heroin, were high on the list of substances identified. Most DUID suspects in Sweden were men (85%) who were poly-drug users combining illicit substances, like amphetamine and/or cannabis, with a prescription medication such as various benzodiazepines. CONCLUSIONS: Sweden's zero-concentration limit has done nothing to reduce DUID or deter the typical offender because recidivism is high in this population of individuals (40-50%). Indeed, many traffic delinquents in Sweden are criminal elements in society with previous convictions for drunk and/or drugged driving as well as other offenses. The spectrum of drugs identified in blood samples from DUID suspects has not changed much since the zero-limit law was introduced.

Automobile Driving↗
PubMed1982

Incidence of myocardial infarction among male Finnish immigrants in relation to length of stay in Sweden.

In Finland, the incidence of coronary heart disease is reported to be about twice as high as in the neighbouring country of Sweden. The aim of this study was to find out what happens to this excess risk among Finnish immigrants to Sweden. A geographically defined population in Stockholm County was followed up in the in-patient care registry and the cause-of-death registry in order to find cases for a case-control study. All episodes of myocardial infarction (ICD numbers 410.00 and 410.99) that had occurred in men born between 1911 and 1935 during the period 1974-76 were recorded. An age-matched control group was randomly selected from the population. By means of the civil registration system it was possible to identify country of birth and length of stay in Sweden. Of the 356 cases, 32 (9%) had been born in Finland compared with 55 (6%) of the 887 controls. The overall relative risk for the Finnish immigrants compared with native Swedes was 1.7. For the group of Finnish immigrants who had been in Sweden for 20 years or more the relative risk was 1.3. It was concluded that since the relative risk decreases during the stay in Sweden the environmental factors dominate the explanation of the difference in the relative risk of developing myocardial infarction between Finland and Sweden.

Age Factors↗
PubMed1987

Tuberculosis in Bacillus Calmette-Guérin-immunized and unimmunized children in Sweden: a ten-year evaluation following the cessation of general Bacillus Calmette-Guérin immunization of the newborn in 1975.

An analysis was made of childhood tuberculosis in Sweden between 1969 and 1984 which included the 6.25 years before and the 9.75 years after the cessation of general Bacillus Calmette-Guérin (BCG) immunization of the new-born on April 1, 1975. The annual incidence of tuberculosis per 100,000 children ages 0 to 4 years increased from an average of 1.1 cases in the period 1970 to 1974 to 1.3 cases in the period 1975 to 1979 and to 2.1 cases in the period 1980 to 1984, including both children born in Sweden and those born abroad. Among children born in Sweden after April 1, 1975, tuberculosis occurred in 58 (57 unimmunized and one BCG-immunized), or 1.3 cases per 100,000 person years up to and including 1984. Eighteen of the 58 children were asymptomatic. Minor symptoms were reported in 13 and clinical illness in 27 children, 2 of whom developed meningitis and 1 of whom died of miliary infection. The relative increase of tuberculosis in the mainly unimmunized cohorts born in Sweden after April 1, 1975, compared with the mainly BCG-immunized cohorts born in Sweden in the period 1969 to 1974 was, by the end of 1984, estimated at 6.0 (95% confidence interval, 2.3, 16.1). Tuberculosis was about 10 times more common in non-BCG-immunized children born in Sweden of foreign parents than in those born of Swedish parents.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2006

Children born to HIV-1-infected women in Sweden in 1982-2003: trends in epidemiology and vertical transmission.

To describe the HIV-1 epidemic among childbearing women and their children in Sweden, a population-based analysis of data on all known mother-child pairs in Sweden with perinatal exposure to HIV-1 1982-2003 was conducted. The mother-to-child transmission (MTCT) rate in children prospectively followed from birth decreased from 24.7% in 1985-1993 to 5.7% in 1994-1998 and 0.6% in 1999-2003. The use of antiretroviral treatment of the mother during pregnancy and/or prophylactic antiretroviral intervention increased from 2.3% to 91.6% during the same period, and the elective cesarean delivery rate increased from 8.0% to 80.3%. No MTCT of HIV-1 occurred in Sweden after 1999.Fifty-one vertically HIV-1-infected children aged 2.7 to 17.6 years were living in Sweden by 31 December 2003, 71% being treated with antiretroviral agents. No HIV-1-related child death has been reported in Sweden after 1996. The conclusion is that MTCT of HIV-1 can be almost eliminated when appropriate resources are available. A national pregnancy screening program for HIV-1 running since 1987 with a high acceptance rate and the implementation of measures to prevent MTCT since 1994 have resulted in a significant decrease in the number of infected children. Inasmuch as knowledge of the infection status of the mother is crucial for reduction in MTCT of HIV-1, continued antenatal screening is important even in a low-prevalence country such as Sweden.

Adult↗
PubMed1984

Use of dental services by Finnish immigrants in Sweden assessed by questionnaire.

The purpose of this work was to assess the dental visiting behaviour of Finnish immigrants in Sweden, and factors which determined this. The initial material consisted of a probability sample of 1332 Finnish citizens aged 20 to 59 years, resident in a Stockholm suburb. The response rate was 80%. About 23% of the respondents had never been to a dentist in Sweden. They were mostly newly immigrated and had a poor knowledge of Swedish. About 36% of the subjects visited a dentist in Sweden regularly (at least every second year), a lower rate than reported from studies on Swedish populations. Twenty-three per cent of the subjects had on some occasion been to a dentist in Finland while resident in Sweden. Difficulty in getting an appointment, indifference, fear, language difficulties and poor knowledge of the dental care system in Sweden were mentioned as reasons for not attending a dentist. Thus prevailing attitudes as well as the many other problems in connection with immigration seemed to result in dental health being given low priority by Finnish immigrants in Sweden.

Adult↗
PubMed2006

Epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) in Sweden 2000-2003, increasing incidence and regional differences.

BACKGROUND: The occurrence of methicillin-resistant Staphylococcus aureus (MRSA) has gradually become more frequent in most countries of the world. Sweden has remained one of few exceptions to the high occurrence of MRSA in many other countries. During the late 1990s, Sweden experienced a large health-care associated outbreak which with resolute efforts was overcome. Subsequently, MRSA was made a notifiable diagnosis in Sweden in 2000. METHODS: From the start of being a notifiable disease in January 2000, the Swedish Institute for Infectious Disease Control (SMI) initiated an active surveillance of MRSA. RESULTS: The number of reported MRSA-cases in Sweden increased from 325 cases in 2000 to 544 in 2003, corresponding to an overall increase in incidence from 3.7 to 6.1 per 100,000 inhabitants. Twenty five per cent of the cases were infected abroad. The domestic cases were predominantly found through cultures taken on clinical indication and the cases infected abroad through screening. There were considerable regional differences in MRSA-incidence and age-distribution of cases. CONCLUSION: The MRSA incidence in Sweden increased over the years 2000-2003. Sweden now poises on the rim of the same development that was seen in the United Kingdom some ten years ago. A quarter of the cases were infected abroad, reflecting that international transmission is now increasingly important in a low-endemic setting. To remain in this favourable situation, stepped up measures will be needed, to identify imported cases, to control domestic outbreaks and to prevent transmission within the health-care sector.

Adolescent↗
PubMed1993

An epidemiologic study of hemorrhagic fever with renal syndrome in Bashkirtostan (Russia) and Sweden.

The incidence and antibody prevalence of hemorrhagic fever with renal syndrome (HFRS) in Bashkirtostan (European part of Russia) and northern Sweden was compared with the abundance of Clethrionomys glareolus (bank voles) in the two areas. In Bashkirtostan, 10% of the women and 15% of the men were found to be antibody positive. The corresponding figures for Sweden were 8% and 16% for women and men, respectively. The annual incidence of HFRS in Bashkirtostan was 50 cases per 100,000 inhabitants, with a male:female ratio of 4.6:1. The incidence in the endemic area of Sweden was seven cases per 100,000 inhabitants, with a male:female ratio of 1.8:1. A similar age distribution of cases, with a peak in the middle age groups, especially in men, was found in both Bashkirtostan and Sweden. The incidence of HFRS in humans and the abundance of bank voles varied with time in both Bashkirtostan and Sweden, but the study failed to find any significant correlation between the two variables. The study showed that HFRS causes significant human morbidity in the areas studied but that both incidence and possibly bank vole abundance was higher in Bashkirtostan than in northern Sweden.

Adolescent↗
PubMed2004

[The history of polio in Sweden - from infantile paralysis to polio vaccine].

Although other epidemics declined due to improved hygiene and sanitation, legislation, and vaccination, polio epidemics appeared in Sweden in 1881 and at the turn of the 20th century the disease became and annual feature in the Swedish epidemiological pattern. Due to the vaccination starting in 1957 epidemics ceased to exist in Sweden around 1965. This article deals with the history polio epidemics in Sweden, 1880-1965 and gives a brief description of: the demographical influence of polio, how did the medical authorities investigate and try to combat it, and the different comprehensions of how polio affected its victims.A study of polio incidence in Sweden at the national level during 1905-1962 reveals that the disease caused major epidemics in 1911-1913 and 1953. At the beginning of the 20th century polio primarily attacked children up to 10 years of age, and at the end of the period victims were represented in all age groups, but mainly in the ages 20-39. Due to its enigmatic appearance, polio was not considered as an epidemic infectious disease during the 19th century. Sweden's early epidemics enabled Swedish medical science to act and together with American research institutes it acquired a leading role in international medical research on the disease. In the 1955 Jonas Salk produced the first successful vaccine against polio but also Sweden developed its own vaccine, different in choice of methods and materials from the widely used Salk-vaccine.

Adult↗
PubMed1985

Trends in coronary heart disease mortality in New Zealand and Sweden. Why the difference?

Coronary heart disease mortality has shown a downward trend in New Zealand during the 1970s as in most western countries. In contrast, Sweden, which has a similar health care system to New Zealand, has shown a continuing increase in coronary mortality for males during the same period. Medical and surgical management of ischaemic heart disease in Sweden is very similar to that found in New Zealand and possibly more intensive in some respects. Hypertension detection and control measures have been successfully applied in Sweden as in New Zealand and a similar reduction in cigarette smoking has occurred in both countries. However, whereas significant beneficial changes have occurred in the New Zealand diet during the past two decades, dietary change, although actively promoted, has not occurred in Sweden for various reasons. The lack of dietary change in Sweden has been coupled with a probable reduction in habitual physical activity in the adult population. Diet appears to be a principal determinant of coronary disease incidence, and population dietary change an important prerequisite for effective primary prevention. In the absence of dietary change, the effect of primary and secondary preventive measures may be limited. The reasons that appropriate dietary recommendations have not been successful in Sweden can be examined and are instructive for effective prevention in all countries.

Adult↗