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Sexual behaviour among youth clinic visitors in Sweden: knowledge and experiences in an HIV perspective.

OBJECTIVE: To study the knowledge and experience of sexuality, contraception and sexually transmitted diseases among sexually active adolescents in Sweden. SUBJECTS: Youth clinic visitors. SETTING: Seventy-four youth clinics from all over the country of Sweden. METHODS: A questionnaire with 17 multiple choice and nine open questions was distributed to all visitors at participating youth clinics during a 2-month period. RESULTS: A total of 9277 young persons answered the questionnaire. Their mean age was 17.5 years. Ninety-three percent were females. Knowledge on STD and STD protection was wide-spread and good. Chlamydia and HIV was recognised as STDs by 90% and 87% respectively. More than 99% knew of the condom method as a means for STD protection. Knowledge on contraceptive methods for pregnancy protection was also good. Ninety-three percent of the investigated adolescents had had coitus. Nine percent had experienced pregnancies and 17% STDs. The mean number of life-time sexual partners was 3.2. CONCLUSIONS: In spite of good knowledge on preventive measures among Swedish youth clinic visitors their sexual behaviour carriers risks for future health. Further interventions are needed to minimise these risks.

Adolescent↗

Adolescent sexual health in Sweden.

In Sweden, society's attitudes towards teenage sexual relationships are liberal, and sexual and reproductive health issues are given high priority. Family and sex education has been taught in schools since the 1950s. The age of sexual consent is 15 years. Since 1975, abortion has been free on demand. Contraceptive counselling is free, easily available at family planning and youth health clinics. Screening for genital chlamydial infection is performed at these clinics, thus providing a "one stop shop" service. Condoms and oral contraception are available at low cost, emergency contraception is sold over the counter. Teenage childbearing is uncommon. However, sexual and reproductive health problems are on the increase among young people. During the 1990s, a period of economic stagnation in Sweden, schools have suffered budget cut backs. Sex education is taught less. Social segregation, school non-attendance, smoking, and drug use have increased. Teenage abortion rates have gone up, from 17/1000 in 1995 to 22.5/1000 in 2001. Genital chlamydial infections have increased from 14,000 cases in 1994 to 22,263 cases in 2001, 60% occurring among young people, and with the steepest increase among teenagers. Thus, a question of major concern is whether and how adolescent sexual behaviour has shifted towards more risky practices during the late 1990s.

Abortion, Induced↗

Usage of antibacterial and antiparasitic drugs in animals in Sweden between 1988 and 1993.

The total usage of antibacterial and antiparasitic drugs in animals in Sweden between 1988 and 1993 was assessed. The data for the antibacterial drugs were divided among the different classes of drug used each year. Special attention was paid to the use of antibacterial drugs in feeding stuffs and to their use in pigs and fish. During the period studied, the total usage of antibacterial drugs remained stable at approximately 35 tonnes of active substance annually. The use of antibacterial drugs for growth-promoting purposes was prohibited in Sweden in 1986 and became available by veterinary prescription only. As a result the total amount used annually has decreased and stabilised at a level about 35 per cent lower than before the ban. Important changes during 1988 to 1993 were a doubled usage of tetracyclines and a 50 per cent decrease in the use of olaquindox. The five major classes of antibacterial drugs used in 1993 were benzyl penicillin (13.2 tonnes), tetracyclines (8.8 tonnes), olaquindox (3.5 tonnes), sulphonamides (2.0 tonnes) and aminoglycosides (1.9 tonnes). The total annual usage of coccidiostatic drugs, mainly used in the poultry industry, was stable at approximately 10 tonnes, while the usage of other antiparasitic drugs increased slightly to 7.7 tonnes.

Aminoglycosides↗

Common melanocytic nevi in 7-year-old schoolchildren residing at different latitudes in Sweden.

BACKGROUND: Current epidemiologic research shows consistently that increased number of acquired common melanocytic nevi (CMN) is an important risk factor for cutaneous malignant melanoma. The purpose of this study was to investigate the number of CMN in relation to tanning habits and complexion among 7-year-old children residing at different latitudes in Sweden. METHODS: Two municipalities were chosen at latitude 65 degrees N to 68 degrees N in the north of Sweden and two at latitude 57 degrees N in the south. Children born in 1994 and registered in the municipalities were to be included (N = 1,676). A questionnaire was sent to their parents asking about the child's tanning habits. A body examination of CMN of size >or=2 mm was done by the same trained nurse in 1,380 (82.3%) of the children. RESULTS: CMN was significantly less prevalent among children living in the north with a prevalence of 5.6 [95% confidence interval (95% CI), 4.8-6.5] inland and 6.2 (95% CI, 5.3-7.2) coastal compared with the south with a prevalence of 9.5 (95% CI, 8.2-11.0) inland and 10.4 (95% CI, 8.9-12.0) coastal. In addition, blond hair, blue/gray/green eyes, holidays at seaside resorts abroad, more frequent sunburns, and parents fancying tanning were significant predictors of higher prevalence of CMN. CONCLUSIONS: These findings support previous evidence that the development of CMN is related to the level of sun exposure in childhood expressed as latitude of residence, holidays at seaside resort abroad, and number of sunburns. To reduce the incidence of cutaneous malignant melanoma, a change in attitude and behavior must start with young children and their parents.

Child↗

Autoantibodies in Estonia and Sweden, populations with different responses to allergens.

BACKGROUND: There are substantial differences in immune-mediated disease prevalence between different countries and populations which cannot be explained by genetic variability. AIMS: To compare the prevalence of antinuclear (ANA), antimitochondrial, antireticulin, liver-kidney microsomal, parietal cell, thyroid microsomal and double-stranded DNA (dsDNA) antibodies among adults aged 20-44 years in two towns, i.e. in Tartu, Estonia (n = 448) and in Uppsala, Sweden (n = 532) with a low and a high prevalence of allergy. METHODS: For autoantibody detection, standard indirect immunofluorescence tests on tissue and Chritidia lucilia antigenic preparations were used (sera were diluted starting from 1:10). RESULTS: The prevalence of ANA was lower in Tartu than in Uppsala (3 vs. 10% among males and 11 vs. 16% among females; p<0.01 and p<0.1, respectively). Furthermore, dsDNA antibody-positive cases were only identified in Uppsala. The largest difference between the two populations was revealed for IgM type ANA, both among males (1 vs. 6%; p<0.02) and females (5 vs. 11%; p<0.01). In addition, the antibody titers were lower in Tartu than in Uppsala (p<0.05). The prevalence of other autoantibodies was similar in the two towns. CONCLUSIONS: The findings could support that Th2-like immune responses are commoner in Sweden than in Estonia, as previously suggested by the higher prevalence of allergy.

Adult↗

Seasonal patterns of incidence and case fatality of stroke in Malmo, Sweden: the STROMA study.

BACKGROUND: Studies on the temporal variation in stroke incidence have reported inconsistent results. Few have studied the temporal variations in case fatality. No study on incidence and case fatality of stroke by season in Sweden has been found. This study explores the weekly, monthly and seasonal variations in incidence and 28-day case fatality of stroke. METHODS: A total of 7,129 patients with first-ever stroke during the period 1989-1999 were retrieved from the Stroke Register of Malmo, Sweden. chi(2) test was performed to test the seasonal differences and Poisson regression analysis was used to calculate the case fatality ratios adjusted for sex and age. RESULTS: The stroke cases were on the whole randomly distributed over the study period of 4,017 days. Incidence of all types of stroke, intracerebral hemorrhage and subarachnoid hemorrhage showed no variation by season, month or weekday, but incidence of cerebral infarction for the total population was higher in autumn and winter. Twenty-eight-day case fatality (930 fatal events, 13%) clustered significantly over the study period. Winter emerged as the peak season among men (12.5%), women (17.2%) and total population (15.1%). No consistent variation of incidence and case fatality of stroke by month or weekday was found. CONCLUSION: Case fatality after stroke demonstrates a seasonal variation with a peak in winter. Incidence of stroke showed no consistent association with season, month or weekday.

Aged↗

Tracers for paralysis agitans in epidemiological research. IV. Trends in national drug policy and measurement of the prevalence of the disease in Sweden.

This study is a time series analysis of the utilization of L-dopa derivatives (LDD) and bromocriptine by parkinsonism (PA) patients and of the age-specific PA prevalences estimated by using a previously reported model. The model combines information on LDD sales, infant mortality rates (IMR) and demographic data for Sweden during the period 1974-1984. Valid yearly prevalence estimates were obtained since 1980 when the early increments of LDD sales were less than 7.9% and the early introduction of bromocriptine in the treatment of PA had already occurred. The crude PA prevalence calculated for 1984 was 254.8 per 100,000. The precision of the estimates during the period 1980-1984 was 2.6%. The model monitored the age-specific prevalence of PA in Sweden during that period, giving increasing figures for the age group 70 years and older, and was not especially sensitive to any particular type of inaccurate input. Time trend analyses of yearly estimates for populations higher than 100,000 individuals and of LDD diffusion are recommended when using this model.

Adolescent↗

Alpha 1-antitrypsin phenotypes in Northern Sweden.

By means of isoelectric focusing the alpha 1-antitrypsin phenotypes were examined in 1,869 Swedes from northern Sweden, 300 Finns and 217 Swedish Lapps. The M2 frequency was low among the Lapps and in the northeastern part of Sweden. The frequencies of the S and Z genes were low in the Lapps and in the north-Swedish population. The frequencies of rare phenotypes among Finns from northern Finland were significantly higher than among Finns from southwestern Finland and Aland Islanders.

Finland↗

Population studies in northern Sweden. XI. The Duffy blood group polymorphism.

Frequencies of the Duffy blood groups were studied in 222 Swedish Lapps and in a series of 3,151 Swedish conscripts and blood donors from the counties of Norrbotten and V asterbotten in northern Sweden. The conscripts and blood donors were distributed according to place of birth into 23 subpopulations. The frequency of the Fya gene among the Lapps was significantly higher than that in the Norrbotten and V asterbotten populations. The inbreeding coefficient FST for northern Sweden was found to be 2.8 . 10(-3) and significant (p less than 0.05). The Fya gene frequency in V asterbotten county was significantly higher than that in Norrbotten county. The overall picture of geographical variation of the Fya gene was not explainable in terms of Lappish and Finnish influence, it was rather contrary to the expected ethnic influence. The reason for this discrepancy is discussed.

Blood Group Antigens↗

Distribution of ABO genes in southeast Sweden.

ABO blood group data from about 78,000 conscripts born 1900-1935 in Southeast Sweden have been analyzed for regional differentiation using a hierarchical subdivision of the area. Heterogeneity was present at all levels of division. Gene diversity among subpopulations has been compared to a corresponding estimate performed on data from the country of Västerbotten in northern Sweden.

ABO Blood-Group System↗

Population studies in northern Sweden. XIV. Variation of the A1A2B0 blood group gene frequencies.

Frequencies of the A1A2B0 blood group genes were studied in a material of 5,632 conscripts and blood donors from the counties of Norrbotten and Västerbotten in northern Sweden. The individuals were distributed according to place of birth into 23 subpopulations. In northern Sweden different clines were found for the A1, A2 and 0 genes. The frequencies of the A1 and A2 genes were increasing in the northeastern respectively northern direction, and the frequency of the 0 gene was increasing in the southwestern direction. These geographical patterns could be explained in terms of Finnish and Lappish influence.

ABO Blood-Group System↗

Familial amyloidotic polyneuropathy in Sweden: geographical distribution, age of onset, and prevalence.

Familial amyloidotic polyneuropathy (FAP) in Swedish patients is associated with the same transthyretin mutation (TTRMet30) as in Portuguese, Japanese, Brazilian and Majorcan patients. Yet, the age of onset of FAP is much later in Sweden than in other populations. We have studied 239 cases of FAP from northern Sweden, their geographical distribution, differences in age of onset, and estimated prevalence and incidence rates. Cases and families concentrate mainly in two areas, around the towns of Skellefteå and Piteå. Mean age of onset was found to be later in the Piteå (58.8 +/- 10.8) than in the Skellefteå area (54.4 +/- 13.5). Unusually high figures were found for prevalence rates (91 x 10(-5) and 104 x 10(-5), respectively) in 1985. Mean yearly incidences were 3.1 x 10(-5) and 4.4 x 10(-5), respectively, over the period 1985-1989.

Adult↗

Population studies in northern Sweden. 18. Geographical covariation between hypercholesterolemia and Finnish genetic influence.

The population of northern Sweden shows a marked ethnic heterogeneity and a unique distribution of disorders with a monogenic or polygenic background, among them cardiovascular diseases. We have studied variations between 23 North Swedish subpopulations (regions) with respect to hypercholesterolemia and its possible determinants including dietary factors, obesity and the degree of Finnish genetic influence. A significant regional heterogeneity was found concerning hypercholesterolemia, obesity and high consumption of 'boiled' coffee. Hypercholesterolemia showed significant geographical covariations with Finnish genetic influence and consumption of 'boiled' coffee. The results are consistent with the hypothesis that in addition to environmental factors Finnish genetic influence contributes to the development of hypercholesterolemia and thereby to the increased rate of cardiovascular disease found in northern Sweden.

Adult↗

Population studies in northern Sweden. XIX. The orosomucoid polymorphism.

Genetic polymorphism of orosomucoid (ORM1) was studied by isoelectric focusing in 3,817 conscripts and blood donors from the countries of Norrbotten and Västerbotten in northern Sweden. The individuals were distributed according to place of birth into 23 subpopulations. There was a significant heterogeneity between the 23 subpopulations with respect to the allele frequencies (p = 1 x 10(-8)). The ORM1*2 allele varied between 27 and 46%, and a clineal variation was observed with decreasing ORM1*2 allele frequencies in the northern direction. Significant correlations were found between the frequencies of the ORM1 alleles and previously studied Finnish and Saamish marker genes. The geographical variation of ORM1 alleles was in close agreement with the pattern expected from the known mixture of Finns, Saamis, and Swedes in northern Sweden and further underlines the impact of ethnic heterogeneity on the genetic differentiation of the north Swedish population.

Alleles↗

Hospital infection control in Sweden.

In Sweden the 23 counties are respnsible for the medical care of their inhabitants. They own and run virtually all hospitals. This system facilitates a county-based hospital infection control system. The infection control team is based in the county hospital department of clinical bacteriology. It is headed by an MD clinical bacteriologist or, in some counties, by an infectious disease specialist. In the majority of cases this is a part-time job besides other duties in the department, but some ten hospital epidemiologists work full-time with infection control. Totally there are only some 50 full-time infection control nurse positions in Sweden. This means that on the average every infection control nurse is in charge of some 2,400 hospital beds, of which some 800 are somatic acute-care ones. These beds are situated in several hospitals, often at considerable distance from each other. The county-wise organization of hospitals facilitates infection control work. Medical and nursing procedures can be coordinated between the different hospitals within the county, and teaching is facilitated. However, the scarcity of infection control nurses makes it impossible to perform ongoing complete surveillance. Only surveillance based on laboratory reports can be performed routinely. In Swedish geriatric care there has been a strong movement not to accept incontinence as a reason for inserting and maintaining indwelling urinary catheters. This has greatly reduced urinary tract infections, and the rates of other infections as well. It has also reduced the costs in this type of medical care.(ABSTRACT TRUNCATED AT 250 WORDS)

Cross Infection↗

The dominant form of hereditary palmoplantar keratoderma in the northernmost county of Sweden (Norrbotten).

The frequency of autosomal dominant inherited palmoplantar keratoderma (HPPK) in the northernmost county of Sweden (Norrbotten) is 0.55%. Histopathological examination of 91 biopsies from patients with the dominant form of HPPK revealed no case of epidermolytic PPK. This finding is in contrast to the results of a re-examination of descendants of the original family published by Thost which showed the characteristic features of epidermolytic PPK, and re-evaluation of biopsies from other families has shown that it is the most frequent type. The existence of PPK type Unna-Thost in relation to epidermolytic PPK and to HPPK of the northernmost county of Sweden will be discussed. At the same time a revision of designation of this type is proposed. A dermo-epidermal mononuclear cell infiltrate belongs to the classical description of PPK Unna-Thost. It was shown that this cell infiltrate occurs significantly more often in patients with HPPK and dermatophytosis. Relapsing vesicular eruptions along the hyperkeratotic border are a clinical sign of the severity of dermatophyte infections. Such spongiotic vesicles together with a mononuclear cell infiltrate should be considered as eczematous reaction to dermatophytosis.

Biopsy↗

Strong founder effect for the fragile X syndrome in Sweden.

We analyzed the FRAXAC2 and DXS548 microsatellites in normal and fragile X chromosomes from Sweden and the Czech Republic in order to investigate a possible founder effect for chromosomes carrying a fragile X mutation. We report a much stronger linkage disequilibrium between the marker haplotypes and the disease in Swedish fragile X chromosomes than in Czech and most other previously studied Caucasian populations. Two haplotypes accounted for 64% of Swedish fragile X chromosomes and for only 14% of normal chromosomes. Neither of these two haplotypes was found in Czech chromosomes, but the most common Swedish fragile X haplotype is the same as that reported to be predominant in Finnish fragile X patients. Linkage disequilibrium was observed in the Czech fragile X chromosomes but the haplotypes were more diverse and similar to those observed in other Caucasian populations. The most prevalent Swedish fragile X haplotype was traced back from affected males to common ancestors in the early 18th century. This indicates an apparently silent segregation of fragile X alleles through up to nine generations. The geographical distribution of the two major at-risk haplotypes in Sweden suggests that they were present among early settlers in different parts of the country.

Chi-Square Distribution↗

Genome-wide linkage scan of common stroke in families from northern Sweden.

BACKGROUND AND PURPOSE: Taking advantage of low genetic variations in northern Sweden, we performed a genome-wide linkage scan to investigate the susceptibility loci for common forms of stroke. METHODS: Fifty-six families, containing multiple cases of stroke and whose data had been previously used to replicate linkage to the phosphodiesterase 4D locus on chromosome 5q, were genotyped in a genome-wide scan. Fine mapping was performed, and subsequently 53 additional families from the same region were genotyped over the candidate regions. RESULTS: Linkage calculations were performed by using 3 different disease models, from a very broad (all stroke cases defined by World Health Organization MONICA criteria) to a narrower (ischemic stroke only) stroke phenotype. With all models, nonparametric multipoint linkage analysis yielded allele-sharing log of the odds (LOD) scores >1.2 at 9 locations: 1p34, 5q13, 7q35, 9q22, 9q34, 13q32, 14q32, 18p11, and 20q13. The highest allele-sharing LOD scores were obtained on chromosomes 5q (previously reported), 1p (LOD=2.09), and 18p (LOD=2.14). Fine mapping resulted in increased allele-sharing LOD scores for chromosome 5q (previously reported) and 9q22 (LOD=1.56), but all others decreased. Combining these initial results with a subsequent analysis of 53 additional families, we obtained the highest allele-sharing LOD scores on chromosomes 5q, 13q, and 18p, although none reached the initial genome-wide allele-sharing LOD scores. CONCLUSIONS: Genetic analysis of stroke in families from northern Sweden did not identify any new major stroke loci. This indicates that multiple minor susceptibility loci in addition to the previously known locus on chromosome 5 could contribute to the disease.

Aged↗