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PubMed2001

Borrelia burgdorferi antibodies in outdoor and indoor workers in south-west Sweden.

Two hundred and fifty-three farmers and forest workers and 249 clerks from south-west Sweden were recruited to a cross-sectional seroprevalence study to find out if individuals working outdoors are more prone to acquire Borrelia burgdorferi infection than indoor workers and to find undiagnosed cases of Lyme borreliosis. The participants answered a questionnaire and blood specimens were collected to estimate the prevalence of antibodies to B. burgdorferi in each group. Sera were analysed with an enzyme-linked immunoassay technique to determine IgG antibodies to B. burgdorferi flagellum. The prevalence of B. burgdorferi antibodies was 7.6% in the farmers and forest workers vs. 5.3% in the clerks (adjusted odds ratio [age, sex] = 1.2 [95% confidence interval = 0.5-2.8]). One case of Lyme borreliosis was diagnosed. The positive predictive value of the antibody test was estimated to be 3% in the studied populations. B. burgdorferi infection is of low endemicity in south-west Sweden and is probably not an occupational risk among outdoor workers. Undiagnosed cases of Lyme borreliosis are uncommon. The test used is not acceptable for screening purposes.

Adult↗
PubMed2002

Management of patients with community-acquired pneumonia treated in hospital in Sweden.

To investigate the management of patients with community-acquired pneumonia (CAP) treated in hospital in Sweden, a multicentre retrospective cohort study was performed with medical record review of 982 patients (mean age 63 y) at 17 departments of infectious diseases at hospitals in Sweden. Information on antimicrobial therapy, demographic characteristics, comorbid conditions, physical examination findings, and laboratory and microbiological test results were recorded. Outcome measures were in-hospital mortality and length of hospital stay (LOS). Cultures were obtained from blood in 80% and from sputum in 22% of the patients. A microbiological aetiology was determined for 23% of the patients, with Streptococcus pneumoniae as the dominating agent (9%). The initial antibiotic treatment was mostly given intravenously (78%). Penicillin (50%) or a cephalosporin (30%) was the most common choice. Both of these drugs were usually given as a single agent. The overall mortality was 3.5% and the mean LOS was 6.4 d. Thus, the outcome was favourable despite the empirical antibiotic treatment having a narrow spectrum compared with the broader approach recommended in most recent guidelines on the management of CAP. These findings suggest that a majority of patients who are hospitalized with moderately severe pneumonia can be treated initially with penicillin alone.

Adolescent↗
PubMed2003

Bartonella and Coxiella antibodies in 334 prospectively studied episodes of infective endocarditis in Sweden.

Bartonella spp. have been identified as aetiological agents in culture-negative infective endocarditis (IE). Coxiella burnetii may cause chronic Q-fever with endocarditis, 334 blood samples collected from 329 patients (334 episodes) with IE diagnosed between 1984 and 1996 in Göteborg, Sweden, were investigated for antibodies to Bartonella spp. and C. burnetii. 71 of the episodes (21%) were blood culture negative. A microimmunofluorescence assay revealed immunoglobulin G (IgG) antibodies to Bartonella in 13 of the culture verified episodes and in 2 of the culture-negative episodes. Three of the patients had IgG antibodies to > or = 200 in the blood culture-verified group, but none had a titre > or = 800, the cut-off level for Bartonella endocarditis. One patient had elevated antibodies to C. burnetii, diagnosing chronic Q-fever endocarditis. In conclusion, serologically verified Bartonella endocarditis is not prevalent in western Sweden and Q-fever endocarditis is rare.

Antibodies, Bacterial↗
PubMed2006

Cost-effectiveness of peginterferon alfa-2b in combination with ribavirin as initial treatment for chronic hepatitis C in Sweden.

The aim of the study was to assess the cost-effectiveness of peginterferon alfa-2b (pegIFN) compared to interferon alfa-2b (IFN), both in combination with ribavirin, as initial therapy for chronic hepatitis C in Sweden. A computer based Markov model describing the natural course of chronic hepatitis C was used to assess costs and quality-adjusted life-y (QALY) for the treatment strategies. Study population was a cohort of hepatitis C patients from the age of 43 y until death. Natural history and response data were obtained from the literature and from Swedish clinical experts. Costs were obtained from different health care providers in Sweden and based on Swedish clinical practice. In our base case analysis for genotype 1 patients, pegIFN plus ribavirin therapy generated 0.29 incremental QALYs and was cost saving (dominant strategy). Corresponding results for genotype 2/3 patients were 0.09 QALYs at an incremental cost of 941 euros (10,500 euros/QALY). A probabilistic sensitivity analysis was performed to study the stability of our results. From the results we conclude that for genotype 1 patients treatment with pegIFN and ribavirin increased quality-adjusted life expectancy and was cost-effective as initial therapy for hepatitis C. The cost-effectiveness for patients infected with genotype 2/3 was less obvious.

Adult↗
PubMed2005

Genetic profiling of Campylobacter jejuni strains from humans infected in Sweden or in Thailand, and from healthy Swedish chickens, studied by pulsed-field gel electrophoresis (PFGE).

The major objective of the study was to explore the genomic diversity between Campylobacter jejuni (C.jejuni) from different sources as a tool for epidemiological considerations. Subtyping was performed using pulsed-field gel electrophoresis (PFGE) and the enzyme used for cleavage was SmaI. Isolates originated from humans infected in Sweden (n=49) and Thailand (n=32) and from healthy Swedish chickens (n=51). Eight PFGE groups were formed in a dendrogram and 48% of the isolates belonged to 1 of these groups. In 2 PFGE groups, strains from humans infected in both Sweden and Thailand were represented. Four of the PFGE groups comprised high frequencies of strains from domestic human infection, as well as from healthy chickens. The PFGE pattern was also compared with the antibiotic resistance pattern in all the above-mentioned isolates. In conclusion, C.jejuni was a diverse group based on PFGE genotyping; about 24% of the clones from Swedish patients and healthy Swedish chickens were similar; and there was no correlation between the antibiotic resistance pattern and the PFGE profiling among the studied strains. Our findings are also in accordance with our hypothesis that there may be similarities between Swedish and Thai strains, which might support a theory of globally occurring C.jejuni.

Animals↗
PubMed2003

Non-systematic screening for prostate cancer in Sweden--survey from the National Prostate Cancer Registry.

OBJECTIVE: The large increase in the incidence of prostate cancer is largely due to testing of serum levels of prostate-specific antigen (PSA). Little is known about how PSA testing is used in clinical practice outside of screening programmes. Essentially, PSA can be used in the health check-ups of men without symptoms as a form of non-systematic screening or in the work-up of symptomatic patients. The aim of this study was to investigate the cause of initiating a work-up leading to a diagnosis of prostate cancer, with emphasis on T1c tumours. MATERIAL AND METHODS: Data on the cause of initiation of work-up leading to a diagnosis of prostate cancer were retrieved from the National Prostate Cancer Registry for 6361 incident cases in tumour category T1c and local stages T2, T3 and T4 registered in Sweden in 2000. RESULTS: For 1496 cases in tumour category T1c (non-palpable tumours detected during work-up of elevated PSA), the cause of PSA testing was health check-ups in 32% of cases, work-up of symptoms suspected to emanate from the prostate in 51% and other causes/not reported in 17%. For all stages combined, the cause of initiation of the diagnostic work-up was health check-ups in 18% of cases, symptoms in 68% and other causes/not reported in 14%. CONCLUSION: Non-systematic screening using PSA testing has been introduced in Sweden. However, prostate cancer is still most commonly diagnosed during the work-up of symptomatic patients.

Age Distribution↗
PubMed2004

Costs and effects of prostate cancer screening in Sweden--a 15-year follow-up of a randomized trial.

OBJECTIVE: To estimate the lifetime cost per detected potentially curable cancer and the economic impact on healthcare of repeated screening for prostate cancer in Sweden in a cohort of men aged 50-69 years. MATERIAL AND METHODS: All 9171 men in a geographically defined population were included: 1492 were randomized to screening in four rounds every third year and 7679 constituted a control group. Digital rectal examination and prostate-specific antigen screening in different combinations were used as diagnostic measures. Costs associated with administration of the screening programme, loss of patient time, diagnostic measures and management strategies were included. A decision model was developed to calculate the total cost of the programme. RESULTS: The incremental cost per extra detected localized cancer was 168,000 SEK and per potentially curable cancer 356,000 SEK. Introducing this screening programme for prostate cancer in Sweden would incur 244 million SEK annually in additional costs for screening and treatment compared to a non-screening strategy. CONCLUSION: There is still no scientific evidence that patients will benefit from screening programmes. Prostate cancer screening would probably be perceived as cost-effective if potentially curable patients gained on average at least 1 year of survival.

Age Distribution↗
PubMed2004

Renal replacement therapy in Sweden.

OBJECTIVE: The Swedish Registry for Active Treatment of Uraemia (SRAU) was founded in 1991 with the objective of documenting demographic data on patients treated for end-stage renal disease (ESRD). The aim of this study was to describe the prevalence, incidence, comorbidity risk factors and survival of patients with ESRD who underwent dialysis treatment and/ or kidney transplantation in Sweden between 1991 and 2002. MATERIAL AND METHODS: All dialysis and transplant units (n = 65) presently report to the SRAU and almost all patients are reported and followed until death. RESULTS: The prevalence of patients on dialysis and transplantation, being approximately 750 per million population (PMP), has increased by 75% in 12 years. The recent annual rise is approximately 3% (200 patients). The incidence has been stable since 1997 at approximately 125 patients PMP. In 2002, there were 1113 new patients, the majority of whom were aged > or =65 years. Their original kidney disease was most often diabetic nephropathy (23.7%), with nephrosclerosis (19.0%) being the second most common disease. The total number of renal transplantations performed has decreased to some extent. The overall 5-year patient survival rate was 23.1% in patients on dialysis and 85.5% after kidney transplantation. The major cause of death was cardiovascular disease (48%) and an increasing frequency of malignancy after transplantation (26%) was noted. CONCLUSION: The prevalence of ESRD has nearly doubled since 1990 and the number of new patients being referred for dialysis has increased. These patients are becoming older, with a large proportion having non-renal complicating diseases. Survival after transplantation was excellent. The shortage of cadaveric donors in Sweden in recent years and increasing mortality from malignant disease after transplantation are issues of great concern.

Adolescent↗
PubMed1996

Levels of certain trace elements in beef and pork imported to Sweden.

The levels of Pb, Cd, Ni, Cr, Co, Zn, Cu, Mn, As and Se were determined in beef and pork imported to Sweden from six different countries. Samples of Swedish beef and pork were included for comparison. The results of this survey showed in most cases little difference in levels of these elements between the countries and agreed well with the results from our previous studies. All results for Pb, Cd, Ni and As were below the detection limits of 0.007, 0.001, 0.016 and 0.030 mg/kg fresh weight, respectively. Chromium and cobalt were, in both beef and pork, close to, or below, the detection limits of 0.004 and 0.003 mg/kg fresh wt, respectively. The level of selenium in beef varied considerably between countries, from < 0.030 to 0.18 mg/kg fresh wt. The levels of lead and cadmium from this study differed strongly in some cases from what have been reported in surveys from several countries, among them some countries exporting to Sweden. The importance of a rigorous quality control programme is emphasized.

Animals↗
PubMed2000

Sense of coherence in different stages of health and disease in northern Sweden--gender and psychosocial differences.

OBJECTIVE: To investigate "Sense of Coherence" (SOC) and its relation to perceived health, different stages of disease, and different psychosocial factors in a population-based study. DESIGN: Postal survey of a population-based sample, the MONICA study (1994). SETTING: Norrbotten and Västerbotten, the two northernmost counties in Sweden, with a total population of 510000 inhabitants. SUBJECTS: 837 men and 882 women in three mutually-exclusive groups: stomach trouble of many years' standing, identified disease (stroke, cardiac infarction, diabetes, anti-hypertension treatment) and no reported disease. MAIN OUTCOME MEASURES: SOC scores in relation to sociodemographic variables and perceived health. RESULTS: We found a relationship between low SOC scores and poor perceived health, low social support and low emotional support on a population level. When comparing persons with stomach trouble with those without disease, or with established diseases, we found similar relationships between low mean SOC scores in all strata for both women and men. "Perceived health", however, was only significantly correlated for women, and women had an overall stronger relationship. CONCLUSIONS: In a study in northern Sweden, female patients with stomach trouble comprise a vulnerable group. The concept of SOC introduces a new dimension for perceiving health and disease. In clinical practice, care providers can identify and elaborate on the relationship between SOC scores and sociodemographic data.

Adult↗
PubMed2005

Social background, aspects of lifestyle, body image, relations, school situation, and somatic and psychological symptoms in obese and overweight 15-year-old boys in a county in Sweden.

OBJECTIVE: To compare lifestyle and health aspects among obese, overweight, and normal-weight 15-year-old boys living in the county of Västmanland, Sweden. DESIGN: A cross-sectional school-based survey. Setting. All schools in the county of Västmanland, Sweden. SUBJECTS: A questionnaire was completed anonymously by 989 boys. MAIN OUTCOME MEASURES: The relations between body mass index and social factors, eating habits, physical activity, body image, relations, school situation, use of alcohol, drugs and tobacco, somatic and psychological symptoms in boys. RESULTS: Obese boys had a significant negative outcome in 19 out of 31 items studied compared with normal-weight boys, while the overweight boys had a significant negative outcome in 9 out of 31. The obese boys reported more irregular eating habits than normal-weight boys, were less satisfied with their weight and looks, and had fewer friends. A larger proportion of the obese boys reported that they did not like school, were more absent from school, and had been exposed to more violence. They bullied their schoolmates more often. The obese boys had tried sniffing solvents and used illicit drugs more frequently than their peers. They reported more somatic and psychological symptoms as well as suicidal thoughts and attempts. CONCLUSIONS: Obese 15-year-old boys differed from overweight and normal-weight boys in lifestyle and in the frequency of somatic and psychological symptoms. Early and vigorous intervention is necessary, as they may belong to a risk group that could develop not only medically but also socially negative consequences.

Adolescent↗
PubMed1999

Ways of experiencing asthma management. Variations among general practitioners in Sweden.

OBJECTIVE: To identify and describe variations in ways of experiencing asthma management among general practitioners (GPs) in Sweden. DESIGN: Descriptive and explorative study using a phenomenographic approach. Semi-structured tape-recorded face-to-face interviews, focusing on the GP's own experiences regarding asthma management. SETTING: Primary health care. SUBJECTS: Twenty GPs (12 men, eight women) from 16 health centres in seven counties in central Sweden, 15 from rural areas and small cities and five from medium sized cities or Stockholm suburbs. MAIN OUTCOME MEASURES: Descriptions of ways of experiencing asthma management. RESULTS: Four categories were identified, which described qualitatively different ways of experiencing asthma management: A. The GP focuses on transferring factual knowledge to the patient; B. The GP primarily addresses the patients' application of knowledge in management of the disease; C. The GP aims at improving the patients' understanding of the disease and its management as a prerequisite for self-management; D. The GP concentrates on how to maintain/improve the patient's quality of life despite the asthma disease. CONCLUSION: The GPs describe their ways of experiencing asthma management in qualitatively different ways, likely to have implications for patient care and educational programmes on asthma for GPs.

Asthma↗
PubMed1999

Impaired health status, and mental health, lower vitality and social functioning in women general practitioners in Sweden. A cross-sectional survey.

OBJECTIVE: The aim was to analyse differences between female and male general practitioners (GPs) in health status and lifestyle and compared with the general population in health-related quality of life. DESIGN: A simple random sample of 1004 GPs from the whole of Sweden (71.2%) participated in a survey in May 1996 about self-reported health status, smoking habits, physical activity, and SF-36 quality of life survey. They were compared as regards SF-36 with the general population in Sweden in three approximately similar-sized age groups of women and men aged 30-44, 45-49, and 50-64. RESULTS: Female GPs had a higher risk than male GPs of impaired health status. Of the female GPs aged 45-49, 22.8% reported that their health was impaired compared with 12.6% of male GPs. Less than 5% of the GPs younger than 45 were daily smokers. Female GPs had higher means for physical functioning but lower means for vitality, social functioning, and role emotional and mental health compared with the general population. CONCLUSIONS: The significant increased risk in poor health among female GPs, especially those aged 45-49, is worrying and argues for appropriate analysis and prevention that are tailored to their working conditions.

Adult↗
PubMedDate not supplied

The meaning of postponed motherhood for women in the United States and Sweden: aspects of feminism and radical timing strategies.

This exploratory study considered certain psychosocial, medical, and cultural aspects of the phenomenon of postponed motherhood for one cohort of white women born between 1947 and 1953 in Sweden and the United States. A cross-cultural comparison was made of the experience of pregnancy and the early perinatal period in 15 American and 16 Swedish women to find out (a) whether timing decisions reflected the influence of feminist ideology toward a reproductive strategy radically different from the conventional one, and (b) whether the pattern of delayed motherhood was culture specific. Results indicated that the patterns of delayed motherhood were culture specific. Feminist ideology clearly influenced the timing of the American women's first birth but was evident in Sweden. Women in the U.S. exhibited more nonconventional behaviors and attitudes, whereas Swedish women were more conventional. However, the husbands in both groups were remarkably similar in infant caretaking behaviors, regardless of culture and level of education attainment. These findings indicate postponed motherhood has different meanings in the cultural context of these two Western industrialized societies.

Adult↗
PubMed2001

Cerebral palsy in southern Sweden I. Prevalence and clinical features.

UNLABELLED: The prevalence, clinical features and gross motor function of children with cerebral palsy in southern Sweden were investigated. The study covered the birth year period 1990-1993, during which 65,514 livebirths were recorded in the area. On the census date (1 January 1998), 68366 children born in 1990-1993 lived in the area. The study comprised 167 children, 145 of them born in Sweden and 22 born abroad. The livebirth prevalence was 2.2 per 1,000, and the prevalence including children born abroad was 2.4 per 1,000. The distribution according to gestational age, birthweight and subdiagnoses was similar to that in earlier Swedish studies, except for a higher rate of dyskinetic syndromes in this study. CONCLUSION: The point prevalence of cerebral palsy was 2.4 and the livebirth prevalence was 2.2. Children born abroad had a higher prevalence and were more often severely disabled. Severe disability was often combined with associated impairments such as mental retardation, epilepsy and visual impairment.

Cerebral Palsy↗
PubMed2001

Cerebral palsy in southern Sweden II. Gross motor function and disabilities.

UNLABELLED: The gross motor function and disabilities in children with cerebral palsy in southern Sweden were investigated and related to clinical features. The study covered the birth year period 1990-1993 and comprised 167 children, 145 of them born in Sweden and 22 born abroad. The clinical features and gross motor function were analysed at a mean age of 6.8 y. Clinical features were obtained from a continuing healthcare follow-up programme. Gross motor function was classified according to the Gross Motor Function Classification System (GMFCS). Walking independently was possible for 86% of the hemiplegic, 63% of the pure ataxic, 61% of the diplegic and 21% of the dyskinetic children. None of the tetraplegic children was able to walk. The classification of gross motor function revealed that 59% of the children were categorized into levels I and II (mildly disabled), 14% into level III (moderately disabled) and 27% into levels IV and V (severely disabled). Children born abroad were more severely disabled. CONCLUSION: The standardized age-related classification system GMFCS enabled a specific description of gross motor function in relation to clinical features. Significant differences between GMFCS levels and subgroups of diagnosis, aetiology. intellectual capacity, epilepsy and visual impairment were found.

Activities of Daily Living↗
PubMed2002

Free sialic acid storage (Salla) disease in Sweden.

UNLABELLED: The first 23 patients diagnosed with Salla disease in Sweden are presented. A high incidence of the "Finnish" R39C mutation, together with genealogical data, indicates that a large proportion of the mutations are of Finnish origin. All patients had pathologically high levels of free sialic acid in urine and in fibroblasts. The clinical picture confirms what has already been reported from Finland, with early psychomotor retardation, ataxia and speech problems. One-third of the patients had epilepsy. CONCLUSIONS: Salla disease is more common in Sweden than supposed. A large proportion of the mutated alleles seem to be of Finnish origin. The clinical picture is the same as that reported from Finland.

Female↗
PubMed2003

Increasing prevalence of overweight in young schoolchildren in Umeå, Sweden, from 1986 to 2001.

AIM: To investigate the current prevalence and trend of overweight in young schoolchildren in Umeå, Sweden. METHODS: Two cross-sectional samples of children were studied: 1115 randomly selected children from preschool class to grade 6 (aged 6-13 y) attending school in 2001 and a matched sample of 507 schoolchildren from grades 0, 1 and 4 (aged 6-11 y) attending school in 1986. Overweight was defined according to age- and gender-specific body mass index (BMI) cut-off values, corresponding to BMI values of 25 kg/m2 (level 1) and 30 kg/m2 (level 2) at late adolescence. RESULTS: In the population from 2001, the prevalence of overweight was 23% (18% at level 1, 5% at level 2). The prevalence differed with age, with a higher prevalence at the ages of 6 and 13 y. Comparing children from grades 0, 1 and 4, attending school in 1986 and 2001, respectively, the total prevalence of overweight was twice as high in 2001 as in 1986. Regarding severe overweight (level 2), the difference was even larger (five times). In the 1986 sample, the prevalence of overweight did not differ between girls and boys, while significantly more girls than boys were overweight in 2001. CONCLUSION: In this sample of young children from Sweden, the prevalence of overweight doubled over the past 15 y and severe overweight increased even more, suggesting a need for intensified preventive efforts in young schoolchildren.

Adolescent↗