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In a survey of 3302 people in an area of central Sweden, tinea versicolor was diagnosed in 0.5% of males and 0.3% of females; all those infected were adults. Tinea versicolor is much less common in Sweden than in the tropics.
A collection of 143 strains of enteropathogenic Escherichia coli (EPEC) of 11 different serogroups isolated from children with diarrhoea, 71 in Sweden and 72 in Iran, was tested for similarity with a computerised biochemical fingerprinting method. From Sweden, there were 54 different phenotypes, 42 consisting of a single strain and 12 (common phenotypes) containing more than one isolate. From Iran, there were 48 different phenotypes, 38 with only one strain and 10 with more than one. Many of the strains which were biochemically similar, in both countries, also had similar virulence factors. Nine Swedish and 20 Iranian isolates showed biochemical identity to at least one of the strains of the other country, most of them belonging to serogroups O55, O119, O126, O127 and O128. The value of the biochemical fingerprinting method as an epidemiological tool and its ability to evaluate clonal relations among E. coli strains in different geographical areas is discussed.
BACKGROUND: New clinical guidelines (CGs) for ovarian cancer in the western health care region in Sweden were established, beginning in September 1993 and still in effect. METHODS: A retrospective evaluation of 5 years of quality registration linked to CGs for ovarian cancer in this region was undertaken. The study material comprised 718 patients. Relative survival rates for the studied patients were compared with National Cancer Register data for the western health care region during the same period. The National Cancer Register data were also used to compare survival rate during the studied period and the preceding 5-year period. RESULTS: Relative 5-year survival rate in our material was 46.1%. Relative survival in western Sweden during the studied period was found to be improved compared with that during the preceding period (P<0.02). CONCLUSIONS: The CGs have led to an improved, tighter organization, with fewer clinicians in special 'tumor teams' performing more aggressive tumor reduction surgery. Chemotherapy prescription is centralized, while the actual administration is decentralized. This has probably been important for the good 5-year survival results.
OBJECTIVES: To compare perinatal and infant mortality in breech and cephalic presentations and between planned vaginal and cesarean section (CS) breech deliveries in Sweden. METHODS: The study comprised two parts. Study A is a national cohort study for the period 1991-2001, including 22 549 breech presentations and 875 249 cephalic presentations born at > or =38 completed weeks. Study B is a case-control study, including all 164 breech deliveries with perinatal or 1-year infant death (during 1991-1999 in Sweden) and controls. RESULTS: Study A: Among non-malformed infants, the total mortality rate was 0.46% in breech and 0.28% in cephalic presentations [adjusted odds ratio (OR) 1.6; 95% confidence interval 1.3-1.9]. Non-malformed breech babies were at an increased risk of antenatal death (breech versus cephalic hazard ratio: 2.7, 2.1-3.6). The infant mortality among non-malformed breech deliveries was higher in vaginal birth than in delivery by CS before labor (OR 2.5, 1.2-5.3). The perinatal + infant mortality among non-malformed breech babies was higher at delivery after 39 completed weeks than at CS delivery at 38 weeks (0.53% versus 0.14%; OR 3.5, 1.9-6.4). The estimated needed number of CS to avoid one death was 400. Study B: In breech presentations without malformations, OR for perinatal or infant death was 3.1 (1.7-5.8) at planned vaginal delivery compared with planned CS delivery, and when breech presentations not diagnosed at 37 gestational weeks were excluded, OR was 3.7 (1.6-9.2). CONCLUSIONS: These large population-based and case-control studies both show a significant reduction of perinatal and infant mortality with planned CS in term breech pregnancy.
This study estimates the economic cost of diabetes mellitus in Sweden 1978. It also addresses the question of potential savings from improved metabolic control. Economic costs of illness include direct costs for medical care and indirect costs from lost production due to morbidity and premature death. The total costs of diabetes are estimated at 1300 million SEK in Sweden 1978. The direct costs for medical care accounted for 43% of these costs. Lost production due to permanent disability is the dominating indirect costs, and accounts for 60% of indirect costs and one third of the total costs. Institutional care accounts for two thirds of the direct costs. The costs for drugs and medical devices amount to 128 million SEK or 1000 SEK per insulin- or oraldependent diabetic. Costs for control of diabetes are estimated to 20% of the total cost and 50% of direct costs. The conclusion is that there are great potential benefits to be expected from improved self control of diabetes.
In the WHO MONICA Study, determinants and trends in cardiovascular disease are monitored during a 10-year period in 40 centers in 27 countries. The Northern Sweden MONICA Center is located furthest to the north of all participating centers. In this report, baseline data on cardiovascular risk factors are presented. In the first population screening, 1,625 of 2,000 (81%) invited individuals participated. Diastolic blood pressure greater than or equal to 90 mmHg was recorded in 19% and 9% were on drug treatment for hypertension. Median cholesterol level was 6.10 mmol/l and the frequency of hypercholesterolemia was high. A body mass index of greater than or equal to 30, indicating severe obesity, was observed in 9%, a lower proportion than in most other European populations. Among men, the total proportion of tobacco consumers was 49%, including 22% snuffers. Of the women, 31% were tobacco consumers, very few being snuffers. Women had, in general, a more favorable cardiovascular risk factor profile up to the age of 45. Thereafter, the two genders were similar. By international comparisons, the population in northern Sweden is characterized by high serum cholesterol levels, intermediate blood pressure levels, a relatively low prevalence of severe obesity and a high consumption of smokeless tobacco.
We studied the chance of receiving dialysis and transplantation in Sweden and Stockholm based on age and sex. The number of patients accepted for chronic dialysis, divided into men and women or five age groups, were set in relation to the number of patients who died of ESRD (end-stage renal disease) in the same groups. The transplanted patients were likewise related to patients waiting on chronic dialysis. Although older patients were increasingly accepted for treatment, age is still strongly inversely correlated to acceptance. Thus in 1985, young patients aged 16-39 years had an 85% chance of being dialyzed, but patients over age 70 had only a 17% chance. Of potential male candidates, 44% received dialysis, but only 38% of women received it. Similar age, but less sex inequality, existed in the selection of patients for transplantation. In Sweden, age and sex influence the selection of patients for dialysis and transplantation.
AIM: In February 2000, a trial started with Saturday opening of alcohol retail shops in certain parts of Sweden (phase I), and in July 2001, Saturday opening was extended to the whole country (phase II). The aim of this study is to assess the impact of phase II, and to probe previous results regarding phase I. DESIGN: Prior to February 2000, all alcohol monopoly outlets were closed on Saturdays. After this date, stores in an experimental area (six counties) were open on Saturdays. In the control area (seven counties) the shops remained closed. To prevent biases due to trade leakage, the experimental and control areas were separated by a buffer area (seven counties). Because continuous evaluations of the trial did not reveal any negative consequences, the Saturday opening was implemented in the whole of Sweden after 17 months. DATA AND METHODS: The outcome measures included alcohol sales and indicators of assaults and drunk driving. The pre-intervention period covered the time period January 1995-January 2000, phase I of the post-intervention period February 2000-June 2001 (17 months), and phase II July 2001-July 2002 (13 months). The effects of the two phases were estimated through analyses of monthly data (auto-regressive integrated moving-average (ARIMA) modelling) depicting how sales and harm rates evolved in the experimental area compared to the control area during phase I as well as during phase II. RESULTS: The analysis uncovered a statistically significant increase in alcohol sales of 3.7% during phase I, and about the same increase during phase II (3.6%). There were no significant changes in any of the assault indicators, neither during phase I nor during phase II. There was a statistically significant increase in drunk driving (12%) during phase I, but no change during phase II. The analyses suggested that the increase during phase I was mainly due to a change in the surveillance strategy of the police. CONCLUSIONS: The results lend support to the public health perspective in that the increased accessibility to alcohol rendered by Saturday opening also seems to have increased consumption. On the other hand, we could not detect any increase in alcohol-related harm. The question of whether this may be due to insufficient statistical power is discussed, together with some other methodological complications that were highlighted by the study.
A total of 1036 nursing mothers were investigated for their nursing behaviour, status of nutrition and menstrual cycle, serum prolactin and progesterone; 61 in Sweden, 457 in an urban area of Zaïre (Bukavu, Kivu) and 518 in a rural area of the same region (Kabare, Kivu). Lactational hyperprolactinaemia is influenced by the frequency but not by the duration of suckling. The return of luteinization of follicles, but not that of menstrual bleeding, was inversely related to the degree of lactational hyperprolactinaemia. Significant luteinization took place in only some 10% of the mothers during the first three months of lactation in Sweden and within the first year in Zaïre. In these mothers with luteinized follicles the average progesterone was only slightly above 1.0 ng/ml indicating poor luteinization. Lactational hyperprolactinaemia, the return of menstruation and luteinization during lactation were not related to the nutritional status as evaluated by the body weight indices and serum albumin. However, suckling and hyperprolactinaemia do not appear to be the only factors involved in the control of fertility during lactation. When serum prolactin levels were equally low, i.e. below 500 microU/ml, twice the number of lactating mothers with signs of luteinization were found in the urban than in the rural population of Zaïre.
The Swedish and Canadian 80+ studies are collecting longitudinal data regarding medical, psychological and sociological aspects of the lives of people who are 80 years of age and older. A paper entitled 'Informal and formal support from a multidisciplinary perspective: a Swedish follow-up between 80 and 82 years of age', was based on the Swedish 80+ study. It examined psychosocial and health measures by support type (i.e. no support, and formal and informal support). Support is defined as care given by either friends and family (informal support) or healthcare professionals (formal support). The present paper compares participant characteristics between two groups of 80-year-olds from two study sites (i.e. Lund, Sweden, and Fredericton, NB, Canada), using the Swedish study site data. Only those participants who participated at both 80 and 82 years of age were included in the analyses. The intent of the descriptive analyses was to compare cross-culturally the two groups of participants and the level of support that they received. Between the two groups, the level of support received by the participants was rather dissimilar: Canadians reported receiving far more informal and formal support compared to Swedes. This finding was despite the fact that the Swedish state provides more funded support than that of Canada to its citizens. Therefore, the present authors speculate that the concept of support has a different meaning in Sweden than in Canada. This speculation raises concerns about cross-cultural studies, particularly when survey questions involve culturally ambiguous concepts such as the term 'support'.
The hypothesis that cold climate is associated with high coronary mortality in Sweden is tested. Cold exposure was calculated in each of the 284 municipalities of Sweden. There was a significant association between cold exposure and coronary mortality in both sexes in all age groups. The strongest association was found in men aged 40-64 years (coefficient of determination k = 0.39). The decile of men aged 40-64 years who lived in the coldest municipalities had a 40% excess mortality. A significant association was also found between cold exposure and mortality from cerebrovascular diseases. We conclude that there is a strong regional association between cold exposure and high coronary mortality.
Hypertensive patients still face a considerable risk of cardiovascular disease in spite of drug treatment in many studies. This may partly be explained by metabolic disturbances, both primarily linked to hypertension but also secondarily influenced by anti-hypertensive drugs themselves. In order to evaluate residual cardiovascular risk factors we investigated 1915 treated hypertensives (912 males, 1003 females) attending 128 health centres from all parts of Sweden. Mean blood pressure was 148/91 mmHg for males and 151/90 for females, but a substantial proportion of all patients were not well controlled, having a diastolic blood pressures > or = 100 mmHg (17% males, 12% females). Total cholesterol and HDL-cholesterol were 6.03 and 1.25 mmol l-1 for males, and 6.40 and 1.50 for females. The corresponding figures for serum triglycerides were 2.03 and 1.72 mmol l-1, respectively. In all, 38% of the hypertensives had hypercholesterolaemia (> or = 6.5 mmol l-1) and 27% hypertriglyceridaemia (> or = 2.3 mmol l-1). The lipid/lipoprotein findings may also be influenced by the various anti-hypertensive drugs used in Sweden. The prevalence of smoking and diabetes mellitus were 25% and 11% for men, and for women 24% and 9%. In conclusion, Swedish hypertensives show evidence of significant residual cardiovascular risk factors in spite of treatment. This may be of importance for future relative and absolute cardiovascular risk. It is time to re-evaluate the effectiveness of our management and care of hypertensive patients.
OBJECTIVES: To study the effects of changes in smoking and exercise habits on body weighty in Sweden. DESIGN: Analysis of factors affecting relative body weight by construction of regression equations using two models: one adjusted for age, education, socioeconomic group, geographical region and nationality, the other further adjusted for cigarette smoking and leisure-time physical activity. SETTING: Cross-sectional interview data derived from the Undersökning om LevnadsFŏrhållanden' (Living Conditions) survey 1980-81 and 1989-89. SUBJECTS: Nationally representative samples of Swedish men and women aged 16-84. MAIN OUTCOME MEASURES: Changes in body-mass index (BMI) in Sweden during the 1980s. RESULTS: Using the first model, an increase in the BMI of 0.23 kg/m2 in men and 0.17 kg/m2 in women, from 1980 to 1989, was found. When controlling for smoking and physical activity, these values were 0.20 and 0.18 kg/m2, respectively. (P at least < 0.003). CONCLUSIONS: These findings indicate that the reported decrease in smoking and changes in physical activity during the 1980s only marginally explain the BMI increase in the adult Swedish population. The health programmes launched during the 1980s seem to have little beneficial effects on body-weight development, in particular in younger generations of both sexes.
BACKGROUND: The aim of this study was to compare time trends in incidence, case fatality and mortality due to myocardial infarction (MI) in patients with or without diabetes. METHODS: This study was based on the Northern Sweden MONICA Project MI registry with a target population of about 200,000 inhabitants in the age group 35--64 years in the two northernmost counties of Sweden. During 1989--2000, 6254 patients who had had an MI according to MONICA criteria were included in this study: 4569 patients had a first MI and 1685 had a recurrent MI. Sixteen per cent of the men and 20% of the women had had diabetes mellitus diagnosed prior the MI. RESULTS: Over the 12-year period, there was a declining trend in incidence and case fatality in first MI. Also, the event rates (first ever and recurrent MI) declined in men without diabetes. In women without diabetes favourable time trends were seen in first ever MI, recurrent MI and in case fatality. There were no favourable time trends for any of these outcomes in patients with diabetes. CONCLUSION: In nondiabetic subjects below the age of 65, the incidence of, and case-fatality in, MI declined. This led to a decreased mortality over the 12-year period. These favourable trends over time were not observed in diabetic subjects.
OBJECTIVES: To analyse whether there is an association between country of birth in first-generation immigrants and first hospitalization for or death from coronary heart disease (CHD) and to analyse whether this association remains in second-generation immigrants. DESIGN: In this follow-up study, the MigMed database at the Karolinska Institute, Stockholm, was used to identify all hospital diagnoses of and deaths from incident CHD in first- and second-generation immigrants in Sweden between 1 January 1987 and 31 December 2001. Incidence ratios standardized by age, geographical region and socio-economic status were estimated by sex in first- and second-generation immigrants; the reference group was Swedish-born people whose parents were both born in Sweden. SUBJECTS: The total Swedish population aged 25-69 years. RESULTS: First-generation immigrants from Finland, central European countries, other eastern European countries and Turkey had higher rates of CHD than men or women in the reference group. First-generation immigrant women born in southern Europe, other western European countries and Baltic countries had lower CHD risks than the reference group. Sons of both male and female first-generation immigrants showed CHD risks similar to or slightly higher than those of their parents. Amongst second-generation women, only subjects with Finnish fathers or mothers had higher risks of developing CHD than the reference. CONCLUSIONS: Increased risks of CHD found in some first-generation immigrant groups often persist in second-generation immigrant men. Healthcare professionals and policy makers should take this into account when designing and undertaking measures to prevent CHD.
Perinatal mortality rate (PMR) is often taken as an indicator of the quality of obstetric care. Its decline started in the early 1940s in Denmark and Sweden, at the same time as in several other European countries, and its development has been strikingly parallel in the two Scandinavian countries. The changes in the mothers' ages and birth order do not coincide with the changes in the PMR. The percentage of children born weighing less than 2500 g has been very stable over time, albeit higher in Denmark. The move towards hospital confinements in obstetric care took place mainly in the 1930s in Sweden, i.e. before the decline started, and in the 1950s and 1960s in Denmark. The factors investigated have contributed very little to explain why the PMR started to decline in the early 1940s. Factors associated with the distribution of perinatal deaths in a population do not seem to be able to explain the changes taking place over time. In the current study it is postulated that factors behind the change in the PMR are improvements in the mothers' health together with the decline in the total period fertility rate from the beginning of this century. With a smaller number of children the risk of infection was reduced and the amount of food available to each child and pregnant woman increased. This better health in early life may be associated with improved reproductive health in the adult years.
All livebirths resulting from singleton pregnancies reported to the Czech (n = 380,633) and Swedish (n = 351,775) birth registries in 1989-91 were studied with respect to social variation in birthweight, ponderal index (weight/length at birth3) and preterm delivery. The mean birthweight was significantly lower in the Czech population (3310 g vs. 3522 g, P < 0.001). The mean difference in birthweight between children of mothers with primary and university education was 197 g [95% CI 190, 205] in the Czech and 136 g [95% CI 128, 144] in the Swedish population, adjusted for maternal age, parity and sex of the infant. Mean birthweight was significantly higher in mothers who were married or lived with partners in both countries; the difference was 167 g [95% CI 161, 173] in the Czech Republic (CR) and 86 g [95% CI 78, 94] in Sweden, adjusted for age, parity and sex. The extent of social variation in ponderal index and frequency of preterm birth was also greater in the CR. Between 1989 and 1991, mean birthweight in the CR fell from 3323 g to 3292 g (P < 0.001) and the social differences increased, largely as a result of more rapid worsening in the lower socio-economic groups. There did not appear to be such a decline in birthweight in Sweden. We suggest that the fall in mean birthweight and the increasing social variation in birth outcome in the CR is related to decline and divergence in living standards in 1989-91.
We evaluated the allergy status of 134 immigrants from Asia, Africa, the Middle East and South America, who were referred to our clinic during the past 10 years. Fifty Swedish patients were used for comparison. When the atopy state was not taken into account, no significant difference was found between the two groups with respect to total IgE levels. However, IgE levels of non-atopic immigrants were significantly higher than the IgE levels of non-atopic Swedes. While there was no significant difference in IgE levels between atopic and non-atopic immigrants, this difference was significant in Swedish patients. In general, IgE levels of immigrants showed a decline with time and reached approximately the same levels as for the Swedish patients in 10.5 years. In the immigrant group atopic women had a considerably lower IgE level than the atopic men. Among the atopics there were no differences between sexes. In Swedes and immigrants pollen was the most common group of allergens. The spectrum of allergy in the immigrant group changed with time in Sweden, and gradually became more similar to the Swedish spectrum. Skin and/or RAST positivity to birch increased from 16% within 2.5 years to 53% after more than 10.5 years in Sweden. Our data indicate that environmental factors rather than hereditary differences determine the IgE state. Within a few years the immunologic status of immigrants adapts to the new environment.