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PubMed2004

Increasing incidence of childhood thyrotoxicosis in a population-based area of central Sweden.

AIM: To study the incidence, prevalence and clinical characteristics of childhood thyrotoxicosis in a population-based area comprising five counties in central Sweden. METHODS: Retrospective analysis of the medical records of all children below 16 y of age with thyrotoxicosis during a 10-y study period. RESULTS: Forty-six children were identified with thyrotoxicosis. The median age at onset was 11.7 y and 85% were females. At the end of the study period on 31 December 1999, the prevalence was 0.08 per 1000. The mean annual incidence was four times higher in the second 5-y period than in the first (2.7 and 0.7 per 100000, respectively; p < 0.001). A first-degree relative with thyrotoxicosis was found in 21% of the children and 11/46 children (24%) showed autoimmune-related co-morbidity. Increased heart rate was observed in 95%, goitre in 67% and exophthalmos in 33% of the children. TSH was completely suppressed and free T4 was clearly above the upper reference limit in all children. TSH receptor-stimulating antibodies and peroxidase antibodies were observed in 80% and 71% of the children, respectively. CONCLUSION: This study indicates an increase in the incidence of childhood thyrotoxicosis in a population-based area of central Sweden. A prospective study aimed at identifying specific aetiological risk factors for development of thyrotoxicosis has been initiated.

Adolescent↗
PubMed2004

Prevalence trends of obesity and overweight among 10-year-old children in western Sweden and relationship with parental body mass index.

AIM: To determine the regional prevalence, secular and family-related trends of obesity and overweight among 10-y-old children. METHODS: A cross-sectional study of 10-y-old children, born in 1990, was performed during September 2000 to June 2001 at school health centres in three communities in the western part of Sweden. Evaluation was performed in 6311 children, or 81% of the target population. Data from a cohort of children, born in 1974, who form the national growth charts, were available for comparison. RESULTS: The mean body mass index was 17.9 kg/m2 in 10-y-old children born in 1990 and 17.0 kg/m2 for 10-y-olds born in 1974 (p < 0.0001). Of the 10-y-old children in 2000-2001, born in 1990, 18% were overweight and 2.9 % obese, which corresponds to a twofold increase in presence of overweight and a fourfold increase in presence of obesity among 10-y-old children from 1984 to 2000. There was a significant correlation between parental and child body mass index. The prevalence of obesity and being overweight appeared to be higher in children whose parents did not participate in the study. CONCLUSION: During a 16-y period, from 1984 to 2000, a twofold increase in being overweight and a fourfold increase in obesity were seen among 10-y-old children in the western part of Sweden. Parental ponderosity or reluctance to participate in the study was related to a higher prevalence of being overweight or obese in the children. There is a need for the healthcare system to recognize the threats to the health of the population of this new "epidemic" and initiate preventive measures and treatment programmes.

Body Mass Index↗
PubMed1999

Social determinants of birthweight, ponderal index and gestational age in Sweden in the 1920s and the 1980s.

This study compared the effect of social class and marital status on birth outcomes in Sweden, using (i) data on all births at the Akademiska Hospital in Uppsala from 1920 to 1924 with socioeconomic information from records at birth; and (ii) a linkage of the Medical Births Registry for all births in Sweden in November/December 1985 to the 1985 Census. Preterm births (<37 weeks) have become less common during the 20th century. Between 1920-24 and 1985, mean and median birthweight increased, as did mean ponderal index, indicating a shift to the right of the birthweight and ponderal index distributions. In 1920-24, birthweight and ponderal index were associated with the social class of the household and with the marital status of the mother. Babies of single mothers were lighter and thinner, and had a much greater probability of being born preterm. In contrast, in 1985, maternal marital status (and cohabitation status) had a weaker effect on birthweight and ponderal index. The importance of household social class for ponderal index and preterm birth changed similarly, but its importance for birthweight remained. The mediating mechanism may have changed. Mothers from farming households now gave birth to the heaviest babies (nearly 200 g heavier than those of unskilled workers). Adjustment for a number of factors, including smoking, had a limited effect on these social class differences. In conclusion, biological processes during the foetal period are systematically linked to the social circumstances of the mother, but in a different way in the 1920s and in 1985.

Adult↗
PubMed2003

Do parental rearing and personality characteristics have a buffering effect against psychopathological manifestations among Iranian refugees in Sweden?

The aim of the study was to investigate relationships between temperament, character and perceived parental rearing among Iranian refugees resettled in Sweden. Our hypothesis was that temperament, character and parental rearing exert buffering effect against post-traumatic stress disorder (PTSD) with the particular impact of specific factors. One hundred refugees participated in the project. They were assessed by means of the SCL-90-R, the Beck Depression Inventory (BDI), the EMBU and the Temperament and Character Inventory (TCI). A high level of self-directedness appeared as having a possible buffering effect against PTSD after several severe traumata. Furthermore, we found specific effects of other personality characteristics and of parental rearing in determining the relationships between the experience of several traumatic events and later psychopathological manifestations among the refugees. The educational level and the length of living in Sweden represented important socio-cultural factors in decreasing psychological disturbances. Even more, we found that despite the experience of an extreme trauma some of the refugees did not suffer from severe depression or other psychosomatic complaints.

Acculturation↗
PubMed1996

A questionnaire to measure knowledge of and education about tumor diseases in Sweden.

BACKGROUND: The increasing incidence of cancers in Sweden can only partly be explained by the increase in length of life. The general public is largely unaware of recent progress in scientific understanding of how a normal cell can be transformed into a cancer cell. METHODS: The authors constructed a questionnaire to assess public knowledge of cancer prevalence, causation, and pathogenesis, as well as attitudes towards risk factors and possibilities of prevention. It also included demographic and life-style factors. RESULTS: Reported here is the theoretical background for the questionnaire, which is published in its entirety. The questionnaire was distributed in 1993 to a random sample of 10% of the adults in two townships in southern Sweden (n = 1,005 and 972, respectively). The response rate was 70% within two weeks, and after a reminder, 78%. CONCLUSIONS: This response indicates a high level of public interest in cancer knowledge and constitutes a good basis for further education activities.

Adolescent↗
PubMed1998

Teaching oncology and cancer care to general practice trainees in Sweden: a two-year prospective, randomized study.

OBJECTIVE: To improve general practice (GP) trainees' knowledge of and attitudes towards oncology and their management of cancer patients. METHOD: A prospective study of 33 GP trainees who, after a first assessment, were randomized either to attend a two-year cancer course (n = 17) or to a control group (n = 16). Both groups were tested at the beginning (pretest) and end (post-test) of the two years. The maximum possible score was 76. All tests were corrected blindly by an oncologist and a general practitioner. RESULTS: The intervention group showed significant post-test-pretest improvements in the domains "knowledge" (mean difference 2.6, 95% CI 1.3-3.8) and "attitudes" (mean difference 2.9, 95% CI 0.8-5.0), but not in "patient management" (mean difference 0.3, 95% CI -0.6-1.2). There was no significant change in the test scores of the controls. The total mean (post-test-pretest) differences were 8.3 (95% CI 4.9-11.6 for the intervention group and -1.4 (95% CI -4.1-1.3) for the controls. CONCLUSION: A low-intensity two-year cancer course improved the knowledge and attitudes of GP trainees. Patient management, however, was not improved and may be more suited for hospital training. The current five-year specific training in general practice in Sweden seemed to be of limited value in the field of oncology. Thus, there is a need for further development of educational tools for cancer training of GP trainees, at least in Sweden.

Clinical Competence↗
PubMed1988

Radiation doses in Sweden resulting from the Chernobyl fallout: a review.

The risk associated with the Chernobyl fallout is the product of radiation dose and risk factor per dose unit. The radiation doses originate from inhalation of radioactive particles, ground irradiation from deposited nuclides and internal irradiation caused by contaminated food. In Sweden the largest dose contribution is due to external radiation. The deposition has been mapped by aerial measurements and in situ high-resolution gamma measurements at ground level over the whole country. On the basis of these measurements, population-weighted doses for external radiation have been estimated. Whole-body measurements on randomly selected individuals have been performed in order to estimate the average dose from internal irradiation. The collective dose, i.e. the sum of all individual doses, has been estimated to be about 1500 man-Sievert for the first year after Chernobyl and 5000-7000 man-Sievert for a 50-year period. Using a risk factor of 0.02 fatal cancers per man-Sievert the Chernobyl fallout over Sweden might cause 100-200 fatal cancers.

Accidents↗
PubMed1991

Environmental impact of the Chernobyl accident: mutagenesis in bank voles from Sweden.

An investigation was carried out in Sweden aimed at studying the possible genetic effects of the Chernobyl fallout on wild small mammals. The bank voles (Clethrionomys glareolus Schreb.) were obtained from three differently contaminated areas in Sweden and, for control, in an area with negligible contamination by fallout. Radionuclide determinations to assess the content of 137Cs and mutagenicity tests (bone marrow micronucleus test and sperm abnormality assay) were performed. The results obtained showed a positive correlation between the increase of micronucleated polychromatic erythrocytes (MPCE/1000 PCE) and both 137Cs content in muscle and in soil contamination. The estimated doses absorbed by the animals were far lower than those required for the same effect in laboratory experiments. An explanation of this discrepancy between dose and measured biological effect is not available, yet similar results have been repeatedly reported after the Chernobyl accident and should be a matter for further discussion. An increased frequency of micronucleated cells might occur at minimal dose gradients, and the micronucleus test appears to be a valid tool to show such effects.

Accidents↗
PubMed2005

Locus of control and regional differences in sickness absence in Sweden.

PURPOSE: The aim of this study was to investigate if there are differences in locus of control (LOC), at a societal level, between two residential areas in Sweden with substantial differences in sickness absence. METHOD: A postal questionnaire was sent to 1500 randomly selected men and women aged 20 - 64 years. Five hundred questionnaires were sent to people living in Stromsund (a sparsely populated municipality in northern Sweden with high rates of sickness absence) and 1000 questionnaires to people in the Swedish capital of Stockholm, which has a low rate of sickness absence. RESULTS AND CONCLUSION: A comparison of LOC in the two study areas supported our hypothesis to a certain extent, external locus being more prominent in Stromsund. When physical and mental health and income were considered, however, the differences disappeared. Consequently, this study did not support the opinion that differences in sickness absence can be explained by LOC at a societal level.

Adult↗
PubMed2005

Psychosurgery in Sweden 1944-1964.

This study presents results on hitherto unknown data on lobotomies performed at the former State Mental Hospital of Umedalen (from here on called simply "Umedalen") in the north of Sweden. More than 700 operations were carried out from 1947 through 1960, and we calculated the average rate of postoperative mortality to 7.4 percent, and that 63 percent of those who were operated were women. By considering annual hospital reports to the National Board of Health (Medicinalstyrelsen), we also made the first mapping of early psychosurgery in Sweden; approximately 4,500 lobotomies were performed between 1944 and 1966. Statistical analysis, qualitative content analysis, and discourse analysis were used. The study supports earlier findings of female preponderance in the number of lobotomy operations.

Female↗
PubMed2006

Is levoglucosan a suitable quantitative tracer for wood burning? Comparison with receptor modeling on trace elements in Lycksele, Sweden.

Particle emissions from residential wood combustion in small communities in Northern Sweden can sometimes increase the ambient particle concentrations to levels comparable to densely trafficked streets in the center of large cities. The reason for this is the combination of increased need for domestic heating during periods of low temperatures, leading to higher emission rates, and stable meteorological conditions. In this work, the authors compare two different approaches to quantify the wood combustion contribution to fine particles in Northern Sweden: a multivariate source-receptor analysis on inorganic compounds followed by multiple linear regression (MLR) of fine particle concentrations and levoglucosan used as a tracer. From the receptor model, it can be seen that residential wood combustion corresponds with 70% of modeled particle mass. Smaller contributions are also seen from local nonexhaust traffic particles, road dust, and brake wear (each contributing 14%). Of the mass, 1.5% is explained by long-distance transported particles, and 2% derives from a regional source deriving from either oil combustion or smelter activities. In samples collected in ambient air, a significant linear correlation was found between wood burning particles and levoglucosan. The levoglucosan fraction in the ambient fine particulate matter attributed to wood burning according to the multivariate analysis ranged from < 2% to 50%. This is much higher than the fraction found in the emission from the boilers expected to be responsible for most emissions at this site (between 3% and 6%). A laboratory emission study of wood and pellet boilers gave 0.3% wt to 22% wt levoglucosan to particle mass, indicating that the levoglucosan fraction may be highly dependent on combustion conditions, making it uncertain to use it as a quantitative tracer under real-world burning conditions. Thus, quantitative estimates of wood burning contributions will be very uncertain using solely levoglucosan as a tracer.

Air Pollutants↗
PubMed2006

Hospitalization due to alcohol and drug abuse in first- and second-generation immigrants: a follow-up study in Sweden.

The detrimental effects of substance abuse on the individual and on society are well known. Health care resources must target where they are most needed. This study investigated (1) whether the increased risk of being hospitalized for alcohol abuse and drug abuse among certain immigrant groups is present in the next generation and (2) whether having one parent born in the host country (i.e., Sweden) has a protective effect on the risk of being hospitalized for alcohol abuse and drug abuse among second-generation immigrants. In total, 2,243,546 persons aged 20-39 years were followed from 1 January 1992 until 31 December 1999 for first hospital admission due to alcohol abuse or drug abuse. A Cox regression model was used to estimate hazard ratios for each diagnosis group. When the Swedish majority population was used as reference, the highest risks of alcohol abuse and drug abuse were found among first- and second-generation Finns, after adjustment for income. Among second-generation Finns with one parent born in Sweden, the increased risk of being hospitalized for alcohol abuse and drug abuse was lower than among second-generation Finns with both parents born in Finland. Health care resources need to target certain groups of first- and second-generation immigrants.

Adult↗
PubMed2006

Patterns of drug use among drug misusers in Sweden. Gender differences.

The goal of the article is to provide information about polydrug abuse and drug misuse patterns in Sweden among women and men. The data has been taken from a 1998 national survey of "Heavy"/severe drug misuse in Sweden, project "MAX-98" (Olsson, Adamsson-Wahren, & Byqvist, 2001). The drug misusers were reported by various government agencies, including health services, social services, police, and correctional treatment facilities on a special form. One of the significant gender differences that emerged was that a greater percent of the women in the survey used and injected amphetamines, injected opiates, and used tranquilizers/sedatives, while a greater percent of the men smoked cannabis, smoked heroin, and misused alcohol. Furthermore, the most common combinations for both genders was amphetamines + cannabis, followed by amphetamines + heroin + cannabis. Alcohol played a large role for the narcotics users. Heroin as a primary drug has grown in the age groups under 35. The trends document that the use of ecstasy as well as chemical CNS-stimulating/hallucinogenic drugs has grown, that polydrug use has increased compared with earlier surveys, and that the methods of ingestion have changed. It is therefore more precise today to speak of different types of polydrug users than about users of exclusively one drug.

Adolescent↗
PubMed2002

Injuries in 8927 patients admitted after motor-cycle crashes in Sweden 1987-1994 inclusive.

OBJECTIVE: To discover morbidity and mortality rates after motor-cycle crashes on the national level in Sweden. DESIGN: Retrospective study. SETTING: Teaching hospital, Sweden. INTERVENTIONS: Extraction of data from International Classification of Diseases (ICD) codes E819C (motor-cycle drivers) and E819D (motor-cycle passengers) recorded in the Swedish Hospital Discharge Register (SHDR) between 1987 and 1994. MAIN OUTCOME MEASURES: Injury distribution, medical consequences, mortality, survival, and incidence by age, sex and geographical area. RESULTS: The number of people admitted to hospital after motor-cycle crashes decreased significantly during the period (from 1743 in 1987 to 1258 in 1994, p < 0.001). The most frequent injuries among drivers and passengers alike were fractures of the legs, arms, and vertebrae, followed by injuries to the head and brain. The in-hospital mortality was lower among drivers (n = 172, 2.2%) than among passengers (n = 31,3.3%). CONCLUSION: The incidence of injuries after motor-cyclist crashes decreased during the study period. The most common victims were young men with fractures and brain injuries. Those at most risk of dying were older passengers.

Accidents, Traffic↗
PubMed2005

Unaccompanied young adult refugees in Sweden, experiences of their life situation and well-being: a qualitative follow-up study.

OBJECTIVE: In the late 1980s unaccompanied children began arriving in Sweden. Many of them were teenage boys who had been called up or were at risk of being called up for military service in a war in their home country. Others had fled their homeland for political reasons. The purpose of the study was to describe how unaccompanied young adult refugees experienced their own life situation and well-being seven years after they had gained permanent residency. DESIGN: The original sample comprised 34 unaccompanied refugees who at 16-26 years of age were placed in a municipality in Sweden. Eleven of these participated in the present second follow-up study after a mean of 10 years in their new country. Qualitative interviews were conducted and analysed according to Giorgi's descriptive phenomenology. RESULTS: Most of the participants expressed contentedness with their lives and had begun to adjust to their new country. They had a social network of friends from the same ethnic group, and their Swedish contacts were mostly workmates. A few felt lonely and expressed despondency and depression. They were single and reported a small network and limited social support. One participant described symptoms of post-traumatic stress disorder (PTSD), even after 11 years in the new homeland. CONCLUSION: It appears that most of the participants in the present follow-up study had worked through the problems that typically face refugees and had begun adapting to their new country, while a few still felt lonely and did not feel part of the community. The results may be affected by non-response. Those who dropped out may live with more distress in everyday life and suffer depression more frequently.

Adult↗
PubMed2001

The outcome of children born with pulmonary atresia and intact ventricular septum in Sweden from 1980 to 1999.

OBJECTIVE: To study the outcome of all children born with pulmonary atresia and intact ventricular septum in Sweden between 1980 and 1999. DESIGN: Retrospective study of medical records with review of the initial, preoperative angiocardiographic and echocardiographic examinations. RESULTS: A total of 84 children were born with pulmonary atresia and intact ventricular septum, giving an incidence of 4.2 per 100,000 live births. In all, 77 were operated on with a 1-year survival rate of 75%. Thirty-six children had ventriculocoronary communications, with a 1-year survival rate of 50%. At the end of the study period, 52 children were alive, 32 with biventricular repair, and 19 with univentricular repair. Follow-up time was 14 days-20 years (median, 6 years). Statistical analysis of incremental risk factors for death showed statistical significance for low birth weight, male sex, muscular pulmonary atresia, and having a systemic-to-pulmonary shunt as the sole initial intervention. CONCLUSION: Complete national data of all patients born with pulmonary atresia and intact ventricular septum during 1980-1999 in Sweden revealed a total mortality in accordance with previous reports for results for surgery. Further improvements demand a thorough preoperative investigation of the cardiac anatomy, particularly of the ventriculocoronary communications, to enable right ventricular decompression whenever possible.

Child↗
PubMed2004

Inequality in access to coronary revascularization in Sweden.

OBJECTIVES: To investigate social and gender equality in access to coronary revascularization for those treated for coronary heart disease in Sweden between 1991 and 2000. DESIGN: All Swedish residents between 25 and 74 years old with a hospital stay for coronary heart disease were eligible for the study, in total about 153,000 persons. The Swedish Hospital Discharge Register from 1988 through 2000 was used to define the study population. Poisson regression analyses were used to estimate the effect of socio-economic status on the likelihood for coronary artery bypass grafting (CABG) within 2 years. In the analysis of gender differences, the likelihood for percutaneous coronary intervention (PCI) was also included. RESULTS: Males were 1.5 times more likely to undergo revascularization procedures than females even after adjusting for confounding factors and the fact that women are less eligible for interventions. The analyses also showed significant socio-economic inequalities in access to CABG among men, but not among women. CONCLUSIONS: There are gender and socio-economic inequalities in access to cardiac procedures in Sweden.

Adult↗
PubMed2004

In northern Sweden myocardial infarction morbidity and case fatality are lowest in rural areas.

OBJECTIVES: Previous studies have shown differences in the main cardiovascular risk factors between communities of different sizes in northern Sweden, with serum cholesterol levels, systolic blood pressure and body mass index being higher, but with fewer smokers in the smallest communities. We wanted to see if there also were differences in the morbidity and 28-day case fatality in acute myocardial infarction (AMI) between communities of different sizes in this area. DESIGN: The Northern Sweden MONICA Project database of AMI was examined for the years 1985-1999 for age-adjusted morbidity and 28-day case fatality for each sex in relation to the size of the community where each case lived. RESULTS: The age standardized morbidity and 28-day case fatality were the lowest in the smallest communities where the risk factor burden previously was shown to be highest, and the highest in intermediate size communities. CONCLUSIONS: Other factors than conventional biomedical risk factors seem to either confer protection in the smallest communities or increase the AMI risk in larger communities.

Acute Disease↗