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PubMed1996

Stillbirth is no longer managed as a nonevent: a nationwide study in Sweden.

BACKGROUND: Giving birth to a stillborn child is a tragedy. The aim of this study is to investigate the meeting of mothers with their stillborn children and the women's experiences of support during and after the delivery. METHODS: In a nationwide study in Sweden, data from 636 women who gave birth to a stillborn or live baby were collected by means of an anonymous postal questionnaire in 1994. RESULTS: Among the 314 women who gave birth to a stillborn child, nearly every mother had seen her child, and 80 percent had carressed her baby. More than 90 percent of the mothers stated that the medical staff showed respect, and about 80 percent of the mothers stated that staff exhibited tenderness toward their dead children. The mother's assessment of respect and tenderness to her child by medical staff was almost identical between stillbirths and live births. Nearly 70 percent of the women reported that the hospital had good routines to support mothers of stillborn children. Feelings of sadness and having been deeply hurt or angered by the medical staff's behavior were reported by 37 percent of the women. A difficult balance is still to be achieved between women being forced to encounter the baby when not yet ready versus others who wish the staff had given more encouragement. The value of properly taken photographs is described. CONCLUSIONS: Treating stillbirth as a nonevent has been largely, if not entirely, abandoned in Sweden. Most mothers of a stillborn child experience that the medical staff treat their dead children appropriately.

Adult↗
PubMed2006

Use of acupuncture and sterile water injection for labor pain: a survey in Sweden.

BACKGROUND: Acupuncture and sterile water injections are nonpharmacological pain relief methods used for labor pain in Swedish delivery wards. Their use has changed over time, the reasons for which are unclear, and acupuncture is currently in more common use than sterile water injections. The aim of this study was to elucidate the clinical use of acupuncture and sterile water injections as pain relief and relaxation during childbirth in Sweden. METHODS: Twelve hundred questionnaires were sent out to all delivery wards in Sweden. Nine hundred sixty midwives fulfilled the inclusion criteria, and the response rate was 565 (59%). RESULTS: Acupuncture was used for both pain relief and relaxation, whereas sterile water injections were used almost exclusively for pain relief. The midwives' own choice of pain relief during childbirth for a possible future delivery was similar to their choice of method in clinical practice. CONCLUSIONS: Our study shows that acupuncture was used for both pain relief and relaxation, whereas sterile water injections were used almost exclusively for pain relief. The results also indicate a weakness in midwives' awareness and use of scientific knowledge and general recommendations about these methods.

Acupuncture Therapy↗
PubMedDate not supplied

Obesity, survival, and hospital costs-findings from a screening project in Sweden.

OBJECTIVE: Our aims were to estimate 1) the costs of hospital treatment and 2) the value of lost production due to early death associated with overweight and obese patients, and then to extrapolate the findings to national costs. METHODS: We use regression models to analyze survival, expected number of days in hospital treatment for patients with different body mass index (BMI), and costs with data obtained from screening of 33,196 middle-aged subjects living in Malmö, Sweden, and collected during a 15-year follow-up period. We subsequently scale up costs to national aggregate level using the BMI prevalence data from the screening project to the national population. RESULTS: The total excess hospital (somatic, psychiatric) care cost (Swedish krona or SEK) for the national health-care budget, excess as compared to normal weight patients for obese (BMI > 30) and overweight (25 < or = BMI < 30) was estimated to SEK2155 million per annum (269 million dollars, assuming 1 dollar = SEK8), or about 2.3% of total hospital care costs in Sweden. The corresponding indirect costs due to early death were estimated to SEK2935 million (367 million dollars). For males at age 55, the potential hospital costs saving, excluding costs of the intervention that could be gained by an intervention that successfully and safely could alter the weight of an obese individual to become normal weight, was estimated on average to SEK4434 (554 dollars) per annum. CONCLUSION: Hospital treatment costs are found to be higher for obese and overweight patients than for normal weight patients indicating potential cost savings especially on indirect costs by effective, safe and low cost weight-loss intervention.

Adult↗
PubMedDate not supplied

Cost of hypoglycemia in patients with Type 2 diabetes in Sweden.

OBJECTIVES: Hypoglycemia is a common side effect of antidiabetic therapy. In addition to reducing well-being, hypoglycemic events may lead to substantial costs of medical care and lost productivity. The cost of hypoglycemia is, however, not well identified, particularly in patients with Type 2 diabetes. The purpose of this study was to assess the cost of hypoglycemia in Type 2 diabetes in Sweden. METHODS: A cost-of-illness approach, based on an incidence methodology, was used to estimate the cost of hypoglycemia in patients with Type 2 diabetes. A hypoglycemic event was defined as an episode with symptoms of low blood glucose levels during which the patient required assistance from another person. The events were divided into mild, moderate, and severe, and the incidence and costs of the different events were estimated based on data in the literature. RESULTS: Assuming that there are 300,000 patients with Type 2 diabetes in Sweden, it was estimated that 26,942 hypoglycemic events would occur annually in these patients, corresponding to a rate of 0.09 events per patient-year. The total cost of hypoglycemia was, in base case, estimated at about Euro 4,250,000 (Euro 14 per patient with Type 2 diabetes) per year. Moderate hypoglycemia contributed the largest proportion of these costs. CONCLUSIONS: The results indicate that hypoglycemic events lead to substantial costs, but data are scarce and more studies are needed to better understand the cost and consequences of hypoglycemia.

Adult↗
PubMed1997

Drug and alcohol use among injured motor vehicle drivers in Sweden: prevalence, driver, crash, and injury characteristics.

Injured motor vehicle drivers who were hospitalized (Umeå: n = 130) and fatally injured drivers who were autopsied (Umeå, Northern Sweden: n = 111; Gothenburg, Western Sweden: n = 136) from May 1991 through December 1993 were tested for alcohol and for both licit and illicit drugs. Nineteen percent of the Umeå-hospitalized drivers (UHDs), 26% of the Umeå fatally injured drivers (UFDs), and 21% of the Gothenburg fatally injured drivers (GFDs) tested positive for drugs and/or alcohol. Ten percent of the UHDs, 8% of the UFDs, and 6% of the GFDs tested positive for drugs. Almost 5% of the UHDs, had illicit drugs, and 6% had licit drugs. Only 3% of the GFDs and none of the UFDs had illicit drugs. Benzodiazepines, followed by opiates, tetrahydrocannabinol, and amphetamine were the most common drugs detected. Twelve percent of the UHDs, 24% of the UFDs, and 17% of the GFDs tested positive for alcohol. Two percent of the UHDs, 6% of the UFDs, and 2% of the GFDs had a combination of drugs and alcohol.

Accidents, Traffic↗
PubMed1995

The use of medicines with anticholinergic effects in older people: a population study in an urban area of Sweden.

OBJECTIVE: To investigate the use of medicines with anticholinergic properties among older people in an urban population in Sweden. DESIGN: A cross-sectional survey. SETTING: Ordinary homes, sheltered accommodations, nursing homes, and geriatric departments. PARTICIPANTS: All residents aged 75 and older in a district of Stockholm, Sweden. MEASUREMENTS: Structured interviews with older persons, their relatives and/or health care personnel; prescription forms; medical records. RESULTS: The overall use of medicines with anticholinergic effects was comparatively low. Doses of these medicines were also generally low. Concurrent use of several such medicines was uncommon. The most prevalent therapeutic/pharmacological group was neuroleptics. In contrast, antidepressants were used by few older people. The prevalence of medicines with anticholinergic effects was highest at institutions, where neuroleptics were frequent and use of low-potency neuroleptics was not uncommon. CONCLUSION: Our results indicate that the risk of anticholinergic side effects may be quite low in the present population as a whole. However, there may be grounds for revising the therapy in institutions, where the use of neuroleptics was shown to be high and low-potency neuroleptics, known to have a higher incidence of anticholinergic side effects, were not avoided.

Age Factors↗
PubMed1996

Physical restraints in geriatric care in Sweden: prevalence and patient characteristics.

OBJECTIVE: Physical restraints are used frequently in geriatric care to promote the safety of frail older patients. This study investigated the prevalence of the use of physical restraints in geriatric care and the way in which patient characteristics are related to the use of physical restraints. DESIGN: A point prevalence study of patients cared for in various types of geriatric settings. SETTING: Eight nursing homes, 15 old people's homes, a somatic geriatric clinic, and a psychogeriatric clinic in a health care district in northern Sweden. PARTICIPANTS: A total of 1325 patients, mean age 82 years, 64% of whom were women. MEASUREMENTS: The Multi-Dimensional Dementia Assessment Scale (MDDAS) was used to measure motor function, vision, hearing, speech, ADLs, behavioral symptoms, psychiatric symptoms, use of psychoactive drugs, and the physical and psychological workload of the staff. In addition, questions concerning the use of physical restraints were added to the instrument. RESULTS: Twenty-four percent of the patients were physically restrained. The highest prevalence was found in nursing homes and psychogeriatric care. Physical restraints were found to relate most strongly to cognitive impairment, impaired ADLs, and speech and walking ability. Ninety-four percent of the restrained patients were cognitively impaired. Other variables relating to the use of physical restraints were psychiatric symptoms and behavioral disturbances. CONCLUSIONS: This study has shown that physical restraints are used frequently in geriatric care in Sweden and that cognitive and physical impairments relate very closely to the use of physical restraints.

Activities of Daily Living↗
PubMed1994

Rising mortality from motor neurone disease in Sweden 1961-1990: the relative role of increased population life expectancy and environmental factors.

Recent studies of mortality from motor neurone disease (MND) in Sweden have demonstrated rising levels of mortality from the disease, especially amongst older age groups. Case-control investigations have suggested that certain environmental factors are significantly related to variations in mortality from the disease, and are associated with a probable individual susceptibility to MND. This study applies an innovative epidemiological technique to longitudinal and cohort analysis of Swedish mortality from MND during the period 1961 to 1990. Survival modelling shows that a subpopulation susceptible to MND exists in Sweden, as has been demonstrated in other countries. The increased life expectancy of the Swedish population since 1961 has resulted in more of that susceptible population living to the ages at which MND is expressed, explaining the majority of the increase in mortality from the disease. However, environmental factors may play a role in accelerating the course of MND and may affect the timing of death within the susceptible sub-population.

Adolescent↗
PubMed1999

Survey of the management of patients with minor head injuries in hospitals in Sweden.

OBJECTIVES: Development of guidelines for quality assurance in head injury care has to be based on knowledge about how today's management is organized. To address the need for guidelines in minor head injury (MHI), the authors studied management practice in Sweden. METHODS: We performed a cross-sectional mail survey including all 76 hospitals treating head-injured patients. The questionnaire outlined present management practice in MHI; including routines for clinical and radiological examinations, in-hospital observation, discharge criteria and follow-up. RESULTS: The initial evaluation is frequently performed by inexperienced physicians. The level of consciousness is assessed according to the Swedish Reaction Level Scale or the Glasgow Coma Scale in 96% of the hospitals. Routine computerized tomography is used in 4%. Skull radiography is not routinely performed. Eighty percent of the hospitals discharge selected patients without in-hospital observation and most (93%) offer no routine follow-up. CONCLUSIONS: This survey shows a variation in the management of MHI in hospitals in Sweden. Routines for assessment of consciousness level are satisfactory, but CT scan for detection of skull fracture and early diagnoses of intracranial complications is usually not performed. Guidelines should be based on present routines including decision rules for CT scan.

Adult↗
PubMed2005

Endophthalmitis following cataract surgery in Sweden: national prospective survey 1999-2001.

PURPOSE: To investigate the epidemiology of postoperative endophthalmitis (POE) following cataract surgery in Sweden during a 3-year period, using the framework of the Swedish National Cataract Register. METHODS: Clinically presumed cases of POE were reported in a prospective survey involving all Swedish ophthalmic surgical units except one. Data on results of the intraocular culture and visual outcome after infection, as well as patient age and gender and various elements of the surgical procedure, were collected. RESULTS: The nationwide incidence of POE was 0.0595%, representing 112 cases in 188 151 cataract operations. Gram-positive bacteria were the predominant aetiology, with an 84.6% share of culture-positive cases. A significantly decreased risk for POE was found for patients who had received prophylactic intracameral antibiotics (mainly cefuroxime) in comparison with those who had been treated with topical antibiotics only. CONCLUSIONS: The prevalence of POE after cataract surgery in Sweden is at the lower end of the spectrum of incidence currently reported in the developed world. The administration of intracameral antibiotics may have contributed to these results.

Adolescent↗
PubMed1979

Trends in suicide in Sweden 1749-1975.

Changes in the suicide rate in Sweden have been studied over the period 1749-1975. It has risen from about 2 per 100,000 inhabitants at the middle of the 18th century to about 20 per 100,000 during the period 1971-1975. Thus a more than tenfold increase is evident. From the non-standardized figures a real and substantial increase can be demonstrated which becomes even more apparent after standardization. This increase is independent of variations in the age composition of the population. The increase has occurred in the younger age groups: between the ages of 20 and 35 years, i. e.during the most active years of life, suicide is the leading cause of death today. An account of legislative measures for suicide prevention during this period is also presented. There is considerable support for the assumption that the low suicide rate registered in Sweden up to the beginning of the 19th century was an effect of the powerful influence of religion over the population.

Adolescent↗
PubMed1988

Psychiatric hospital care of children and adolescents in Sweden.

In Sweden in-patient psychiatric care of children and adolescents is in decline. At the same time the out-patient care is increasing. These findings stem from a study of the annual patient statistics provided by the National Board of Health and Welfare. There are considerable differences among the counties in Sweden. In certain counties more than four times as many children and adolescents receive hospital care as in other counties. The distribution between child and adolescent psychiatry and adult psychiatry also varies considerably. However, it is usual that from the age of 18 years care is given in adult psychiatric clinics. Among patients with a diagnosis of psychosis and when compulsory care is necessary, adult psychiatric clinics are also responsible for patients 16 and 17 years old. Care of children at mental hospitals, still common in the 1960's, is nowadays no longer existent. The study is a starting-point for a discussion about how to attain better co-operation between child and adolescent psychiatry and adult psychiatry.

Adolescent↗
PubMed1992

Similarities in diagnostic comorbidity between suicide among young people in Sweden and the United States.

A significant difference in the prevalence of personality disorders was reported between similar studies of suicide among young people (under age 30) performed in San Diego, California (10% of 133 cases), and Göteborg, Sweden (34% of 58 cases). The difference was due entirely to the absence of borderline personality disorder (BPD) reported in the San Diego sample. In this study, we used preselected variables to reassess the suicides from the San Diego study for criteria consistent with BPD. We found that 41% met the criteria, which was now not significantly different from the Göteborg sample. Comparisons among a number of other demographic, social, and diagnostic variables revealed many similarities in the two samples, particularly Axis I comorbidity with depression and/or substance abuse and Axis II comorbidity with antisocial personality disorder. We conclude that the characteristics associated with BPD identify similar young persons who committed suicide in Sweden and the United States. Questions remain as to whether or not Axis I and II disorders are independent in relation to suicide. The comorbidity pattern described here must be considered seriously in the clinical setting for its fatal implications.

Adolescent↗
PubMed1995

Definite and undetermined forensic diagnoses of suicide among immigrants in Sweden.

A total of 707 cases of violent death (suicide, undetermined mode or accident) occurring in 1990 were investigated at the Department of Forensic Medicine in Stockholm. The catchment area of the Department includes about 1.9 million people. Fourteen percent of the population in the area are immigrants. The largest single immigrant group was the 91,015 Finnish-born inhabitants, who represented 33% of the overall immigrant population. Thirty percent of all undetermined deaths and 20% of the suicides were among people born outside Sweden. A significant overrepresentation of the largest immigrant group (Finnish-born) was found in both the definite and undetermined suicide categories. There was also an overall overrepresentation of immigrants among the undetermined cases and a trend towards overrepresentation among definite suicides. Also, there was a significant overall overrepresentation of immigrants in the total cases of undetermined and definite suicide. Some psychosocial factors found predominant among the immigrant sample were social isolation, low social class and poor social network. The findings in this study indicates that immigrant status should be considered as a risk factor for suicide in Sweden. Previous reports on the high suicide rates among immigrants in Australia, Canada, Great Britain and the United States suggest that the overrepresentation of immigrants found in our study could represent a worldwide epidemiological trend related to voluntary and forced migration. Possible hypotheses that could explain this phenomenon are discussed.

Adolescent↗
PubMed1997

The utilization of antidepressants--a key issue in the prevention of suicide: an analysis of 5281 suicides in Sweden during the period 1992-1994.

Antidepressants detected by the National Department of Forensic Chemistry in 5281 suicides in Sweden during the period 1992-1994 were related to data on usage expressed in person-years of exposure. Antidepressants were detected in 874 subjects (16.5%). In relation to their use, fluvoxamine, citalopram, moclobemide, mianserin and trimipramine were found more often than the reference drug, amitriptyline (i.e. over-risks). Toxic concentrations of antidepressants were detected in 232 subjects (4.4%). Most people committing suicide were not taking antidepressants immediately before their death, even though 40-85% may have been depressed. Undertreatment and therapeutic failure are the main problems with antidepressants, not the risk of using antidepressants in overdose. Comparisons of new antidepressants should focus on efficacy in relation to reference tricyclics. The huge increase in the use of antidepressants in Sweden since 1990-1991 has been paralleled by a significant decrease in suicide rates.

Amitriptyline↗
PubMed1980

Longitudinal study of oral hygiene and dietary habits among immigrant children in Sweden.

Families immigrating to Sweden from Finland and Southern Europe (Greece, Yugoslavia, and Turkey), as well as Swedish control families of the same social class, were interviewed twice on their children's oral hygiene and dietary habits and on the parents' knowledge of oral health. The first interview was made on the immigrants' arrival in Sweden and the second one 30 months later. The material comprised 35 Finnish, 23 South-European and 54 Swedish families. During the observation period more immigrant than control children had complained about toothache. The frequency of toothbrushing was lower among the immigrants than among the Swedes at both interviews. The frequency of sweets consumption was significantly higher among the immigrants. Fewer immigrant than Swedish children had been examined or treated by a dentist before the first interview. There was no difference between the immigrants and the controls in channels of information about oral hygiene, the schools and the dentists being the foremost source of information for both groups. The Swedish parents had a more competent knowledge of oral hygiene than the parents of the immigrant children. It was concluded that Finnish and South-European immigrant children definitely have a great need of preventive dentistry.

Adolescent↗
PubMed1985

Dental attendance of some of the common immigrant groups in Sweden.

The aim of this study was to see how Greek, Polish, Turkish, Yugoslavian and Finnish immigrants utilized dental services offered, as compared to Swedes. The study covered the years 1976-79, using figures from the National Social Insurance Board (NSIB). All foreign citizens of the aforementioned groups born on the 20th of any month and living in the country of Stockholm were selected, together with a comparison group of Swedish citizens. During the 4 yr in question, only 31% of the Greeks, 50% of the Poles, 28% of the Turks, 40% of the Yugoslavs and 75% of the Finns visited a dentist in Sweden, while 87% of the Swedes did. Few immigrants except some Finns went annually. A great majority of all Greeks, Turks and Yugoslavs either saw a dentist only once or else not at all during the whole period. Emergency treatment was significantly more common for these groups than for Poles, Finns or Swedes. The study revealed a fragmentary and episodic use of the dental services offered to most common immigrant groups in Sweden.

Adult↗
PubMed1989

Per capita consumption of sugar-containing products and dental caries in Sweden from 1960 to 1985.

The aim of the present report was to analyze sugar consumption in relation to dental caries in Sweden from 1960 to 1985. Sugar consumption is based on official statistics from the National Swedish Agricultural Board and is expressed in grams per person and day. Over this quarter-century total sugar consumption decreased approximately 5%, from 116 to 110 g/person/day. A shift occurred from direct consumption to indirect (sugar used by the food industry), the former decreasing from 76 to 50 and the latter rising from 40 to 60 g/person/day. Available epidemiologic data on dental caries in children from the National Swedish Board of Health and Welfare indicate that the frequency of caries decreased dramatically from 1960 to 1985, though comparable data were difficult to obtain for the whole 25-yr period. The conclusion from this study is that these changes in caries prevalence in Sweden cannot be attributed to a corresponding decrease in the per capita consumption of sugar and sugar-containing products. On the contrary, the intake of some products traditionally related to dental caries, such as candy and soft drinks, increased during 1960-1985.

Adolescent↗