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PubMed1990

Incidence of hip fracture in Saskatchewan, Canada, 1976-1985.

The authors ascertained the incidence of hip fracture in Saskatchewan, Canada, residents aged 65 years or older for the 10 years 1976-1985 from computerized hospital discharge records and compared it with rates for several other populations in Northern Europe and the United States. In Saskatchewan, the average annual incidence was 5.5 per 1,000 person-years. The incidence in women was twice that in men, the incidence in urban areas was 27% greater than that in nonurban areas, and there was no secular trend of increasing rates. The incidence of hip fracture in Saskatchewan was lower than that for populations in Scandinavia and the United States but was comparable to rates in English populations. Further study is needed to elucidate the genetic, environmental, and behavioral factors responsible for this variation.

Aged↗
PubMed1995

Injury mortality among Iowa farmers, 1980-1988: comparison of PMR and SMR approaches.

State and provincial proportional mortality studies in the United States and Canada have found increased ratios of overall injury mortality among farmers, including occupational injuries and other unintentional injuries, such as those from motor vehicle crashes and fires, as well as suicides. In contrast, Scandinavian standardized mortality (morbidity) studies have found no increase in the injury fatality or morbidity ratios of farmers in comparison with the rest of the population. This study reviews the injury mortality of Iowa farmers for the years 1980-1988. Among white male farmers, we found an increased proportional mortality ratio for all injuries of 1.26 (95% confidence interval (CI) 1.21-1.31). In part, this was a result of the increased proportional mortality ratio for at-work injuries of 3.77 (95% CI 3.35-4.24), but there were also elevated proportional mortality ratios for such nonoccupational injuries as suicides, 1.20 (95% CI 1.09-1.32), motor vehicle crashes, 1.23 (95% CI 1.12-1.34), and electrocutions, 1.78 (95% CI 1.08-2.95). For younger farmers aged 20-64 years, we calculated standardized mortality ratios as well. The standardized mortality ratios were generally within 10% of the proportional mortality ratios, which suggests that the differences between North America and Scandinavia are not the result of methodological differences, but are more likely related to differences in environmental exposures and safety practices.

Accidents, Occupational↗
PubMed1994

Incidence of ectopic pregnancy. First results of a population-based register in France.

A population-based register of ectopic pregnancy was established in 1992 for two French departments, with the primary aim of monitoring the trend in ectopic pregnancy over a prolonged period. In this paper, data collected during the first year of registration (1992) are analysed. The rate of ectopic pregnancy was 20.2 per 1000 live births, 15.8 per 1000 reported pregnancies and 9.5 per 10,000 women aged 15-44 years. The ectopic pregnancy rate per 1000 live births increased steeply after the age of 30 years and especially after the age of 35 years, whereas rates per 10,000 women of reproductive age steadily increased until the age of 35 years and decreased thereafter. The rates of ectopic pregnancy were lower in spring and summer than autumn and winter. These results are discussed and comparisons with similar studies conducted in the USA and Scandinavia are attempted.

Adolescent↗
PubMed1998

Patterns of extensive genetic differentiation and variation among European harbor seals (Phoca vitulina vitulina) revealed using microsatellite DNA polymorphisms.

The harbor seal (Phoca vitulina) has the most extensive distribution of any phocid seal species. An analysis of population structure in this species across its European range was made using 7 phocid derived microsatellites in a sample of 1,029 individuals from 12 separate geographic areas. Despite the species potential for long-distance movement, significant genetic differentiation between areas was observed using an unbiased estimator of RST. Six distinct population units were identified: Ireland-Scotland, English east coast, Waddensea, western Scandinavia (Norway-Kattegat-Skagerrak-west Baltic), east Baltic, and Iceland. Little local substructuring is present along coastlines with a continuous distribution of breeding animals, but differentiation does increase with geographic distance. The degree of differentiation is greater over equivalent distances where the distribution is discontinuous, such as along coasts where breeding colonies are separated by large distances or by stretches of open sea. Patterns of population differentiation derived from microsatellites are very similar to those obtained from previous mitochondrial DNA analysis and suggest that philopatry in harbor seals operates over 300-500 km. In Europe, harbor seals have experienced a complex demographic history and patterns of population structure are likely to have been affected by natural environmental influences such as Pleistocene glaciations and epizootics. Comparison of Nm values from an unbiased estimator of RST, GST, and theta are consistent and, in some cases, may indicate populations where conditions deviate from the expectations of the RST model.

Animals↗
PubMed2005

Co-proxamol and suicide: preventing the continuing toll of overdose deaths.

Restricting means for suicide is a key element in suicide prevention strategies of all countries where these have been introduced. Preventing deaths from analgesic overdoses is highlighted in the National Suicide Prevention Strategy for England. The problem of self-poisoning with the prescription-only drug co-proxamol (dextropropoxyphene plus paracetamol) has received attention in several countries. We have conducted a review of the international literature related to possible strategies to tackle this problem. In England and Wales in 1997-1999, 18% of drug-related suicides involved co-proxamol; these constituted 5% of all suicides. Death usually results from the toxic effects of dextropropoxyphene on respiration or cardiac function. Death from co-proxamol overdose may occur rapidly, the lethal dose can be relatively low, and the effects are potentiated by alcohol and other CNS depressants. The majority of co-proxamol overdose deaths occur before hospital treatment can be received. The risk can extend to others in the household of the person for whom the drug is prescribed. While there is limited evidence that educational strategies have been effective in reducing deaths from co-proxamol poisoning, initiatives in Scandinavia, Australia and the UK to restrict availability of co-proxamol have produced promising results. Given the paucity of evidence for superior therapeutic efficacy of co-proxamol over other less toxic analgesics, there are good reasons to question whether it should continue to be prescribed.

Acetaminophen↗
PubMed1987

Bone marrow transplantation for immunodeficiency diseases.

Allogeneic bone marrow transplantation (BMT) was applied in 1968 to treat severe combined immunodeficiency disease (SCID). Almost simultaneously, marrow from an MHC-matched donor corrected the immunological deficiency of a patient with Wiscott-Aldrich Syndrome (WAS). In the first successful treatment of X-linked SCID the match was imperfect and, although SCID was cured, a graft vs. host reaction caused pancytopenia. A second BMT from the same donor successfully treated a complicating aplastic anemia. Subsequently, it has been possible to cure most patients with SCID who are in reasonably good condition at the time of BMT without other manipulation if a matched sibling donor is available. Successes are reported from Holland, France, Italy, England, Scandinavia, Japan, Germany, and from many centers in the United States. Similarly, BMT is used to correct SCID due to adenosine deaminase (ADA) deficiency or nucleoside phosphorylase (NP) deficiency, which underlie two forms of SCID. Bone marrow transplantation using HLA-matched sibling donors can now treat, successfully, at least eight genetically separable forms of SCID. Highly lethal defects of phagocytic function (including LFA-1, MO-1, CR-3 deficiencies, IL-2 and IL-1 receptor deficiencies), defects of killing after phagocytosis (as in chronic granulomatous disease, WAS, and Kostmann's Syndrome), and certain inborn errors of metabolism can be cured by BMT.(ABSTRACT TRUNCATED AT 250 WORDS)

Bone Marrow Transplantation↗
PubMed1994

Vagotomy, antrectomy, and Roux-en-Y diversion for complex reoperative gastroesophageal reflux disease.

OBJECTIVE: Failure of conventional surgical therapy for treatment of patients with gastroesophageal reflux disease (GERD) taxes the ingenuity of the esophageal surgeon. This study defines the role of vagotomy, antrectomy, and Roux-en-Y diversion coupled, when necessary, with resection of the esophagogastric junction as an alternative to other surgical procedures currently employed for these complicated cases. SUMMARY BACKGROUND DATA: Currently, the operation in question rarely is performed in the United States. Other procedures, such as interposition of short or long segments of intestine and total esophagectomy with gastric pull-up, are preferred. However, surgeons from Scandinavia, Great Britain, and Europe have published widely on the subject, some even preferring its use as a primary procedure in GERD. METHODS: This report reviews the indications and results of the operation in 36 patients who underwent operation between January 1970 and January 1994. Follow-up evaluation was available for review in 33 patients observed from 1 to 20 years postoperatively (average, 6 2/3 years). Of these patients, 32 had undergone 66 previous operative procedures on the distal esophagus and stomach ranging from 1 to 6 per patient. There were no hospital deaths, but complications developed in nine patients (25%); only half of these complications were major. Of patients available for follow-up, 85% were improved by the operation, 24 of the 33 having excellent or good results. CONCLUSIONS: The operation of vagotomy, antrectomy, and Roux-en-Y diversion, embodying the principles of acid suppression and alkaline diversion, has proved to be a successful alternative to other operative procedures currently favored in the United States for the treatment of the complex reoperative patient with GERD.

Anastomosis, Roux-en-Y↗
PubMed1994

The AIDS epidemic among Scandinavian women: 1980-1990.

OBJECTIVE: To describe trends and patterns in the AIDS epidemic among Scandinavian women with AIDS. SUBJECTS AND METHODS: All women with AIDS reported to national surveillance units in Denmark, Norway and Sweden in 1980-1990 were included for analyses. RESULTS: The number of heterosexually infected female AIDS cases increased over time. AIDS-defining diseases varied with transmission categories, a variation similar to that found among heterosexual Danish male AIDS cases. Heterosexually infected women were more frequently diagnosed with Pneumocystis carinii pneumonia than with oesophagus candidiasis compared with intravenous drug using women. Twenty-five out of 56 heterosexually infected women reported having a male partner who was bisexual or from a Pattern II country, while one in four did not recognize any risk in their sex partner(s). Survival time increased between 1980 and 1990 and did not differ from survival in male AIDS cases. In a proportional hazards model, age, year of diagnosis and the duration of known HIV-positivity before development of AIDS had an independent impact on survival. The number of women known to be HIV-positive for more than 1 year before diagnosis of AIDS increased over time, although the number of women tested for HIV close to the development of AIDS was especially high among heterosexually infected women. CONCLUSION: Increasing numbers of heterosexually infected women are being diagnosed with AIDS in Scandinavia.

AIDS-Related Opportunistic Infections↗
PubMed1998

Time trends in HIV infection among pregnant women in Europe.

OBJECTIVE: To estimate time trends in HIV prevalence among pregnant women delivering livebirths in 14 European countries using a uniform methodology. METHODS: A form of back-projection was used to estimate HIV prevalence among pregnant women based on reported cases of AIDS due to perinatally acquired HIV infection. The method used estimates the rate of progression to AIDS in children with HIV, and the rate of transmission of HIV from mother to child, derived from published studies. RESULTS: The prevalence of HIV among pregnant women delivering livebirths was estimated to be highest in Spain (2.61 per 1000 livebirths in 1992-1993), relatively high (> or = 0.3 per 1000 livebirths) throughout the period 1984-1993 in France, Italy and Switzerland, and low (< 0.2 per 1000 livebirths) in Germany, The Netherlands and Scandinavia. There were large and statistically significant increasing trends in the estimated HIV prevalence among pregnant women in Portugal (an estimated 77% increase per 2-year period), Spain (40% increase) and the United Kingdom (77% increase; all P < 0.001). Statistically significant increasing trends of a smaller magnitude were estimated for France (24% increase) and Italy (23% increase; both P < 0.001). CONCLUSIONS: Sharp increases in HIV prevalence among pregnant women were estimated for several European countries, whereas in other countries no trends in the estimated prevalence were detected.

Adolescent↗
PubMed1988

Modeling the effects of exhaust ventilation on 222Rn entry rates and indoor 222Rn concentrations.

Continuous mechanical exhaust ventilation of moderately air-tight residences is common in Scandinavia and has recently been employed in several U.S. residences. Exhaust ventilation decreases the indoor pressure and, thus, increases the pressure difference which drives 222Rn entry. Relatively simple analytical (i.e. closed form) models were developed and used to examine the impacts of exhaust ventilation on 222Rn entry rates and concentrations in houses with either a crawl space or a basement. A more complex finite difference model was also developed for the house with a basement and yielded soil gas entry rates within 16% of those predicted with the analytical model. The models indicate that exhaust ventilation is suitable, but not optimal (from the perspective of indoor 222Rn), for houses with a vented crawl space. Exhaust ventilation is also indicated to be suitable for houses with basements surrounded by relatively impermeable soil (10(-12) m2 or less). If soil permeabilities are between 10(-12) and 10(-10) m2, exhaust ventilation may cause substantial increases in indoor 222Rn when soil gas 222Rn concentrations are above average. If soil permeabilities are greater than 10(-10) m2, exhaust ventilation is indicated to be inappropriate, unless some procedure is employed to inhibit soil gas entry. These conclusions should be considered tentative, since extensive verification of the models is still required.

Air Pollutants, Radioactive↗
PubMed1989

Chernobyl source term, atmospheric dispersion, and dose estimation.

The Chernobyl source term available for long-range transport was estimated by integration of radiological measurements with atmospheric dispersion modeling and by reactor core radionuclide inventory estimation in conjunction with WASH-1400 release fractions associated with specific chemical groups. These analyses indicated that essentially all of the noble gases, 60% of the radioiodines, 40% of the radiocesium, 10% of the tellurium, and about 1% or less of the more refractory elements were released. Atmospheric dispersion modeling of the radioactive cloud over the Northern Hemisphere revealed that the cloud became segmented during the first day, with the lower section heading toward Scandinavia and the upper part heading in a southeasterly direction with subsequent transport across Asia to Japan, the North Pacific, and the west coast of North America. The inhalation doses due to direct cloud exposure were estimated to exceed 10 mGy near the Chernobyl area, to range between 0.1 and 0.001 mGy within most of Europe, and to be generally less than 0.00001 mGy within the United States. The Chernobyl source term was several orders of magnitude greater than those associated with the Windscale and TMI reactor accidents. However, the 137Cs from the Chernobyl event is about 6% of that released by the U.S. and U.S.S.R. atmospheric nuclear weapon tests, while the 131I and 90Sr released by the Chernobyl accident was only about 0.1% of that released by the weapon tests.

Accidents↗
PubMed2000

Soil-to-plant transfer factors for radiocesium and radiostrontium in agricultural systems.

A database of soil-to-plant transfer factors for radiocesium and radiostrontium has been compiled for arable crops from published and unpublished sources. The database is more extensive than previous compilations of data published by the International Union of Radioecologists, containing new information for Scandinavia and Greece in particular. It also contains ancillary data on important soil characteristics. The database is sub-divided into 28 soil-crop combinations, covering four soil types and seven crop groups. Statistical analyses showed that transfer factors for radiocesium could not generally be predicted as a function of climatic region, type of experiment, age of contamination, or soil characteristics. However, significant relationships accounting for more than 30% of the variability in transfer factor were identified between transfer factors for radiostrontium and soil pH/organic matter status for a few soil-crop combinations. Best estimate transfer factors for radiocesium and radiostrontium were calculated for 28 soil-crop combinations, based on their geometric means: only the edible parts were considered. To predict the likely value of future individual transfer factors, 95% confidence intervals were also derived. A comparison of best estimate transfer factors derived in this study with recommended values published by the International Union of Radioecologists in 1989 and 1992 was made for comparable soil-crop groupings. Whilst there were no significant differences between the best estimate values derived in this study and the 1992 data, radiological assessments that still use 1989 data may be unnecessarily cautious.

Agriculture↗
PubMed1982

Reactive psychoses.

Scandinavian psychiatrists have been pre-eminent in elucidating the concept of reactive psychoses. This diagnosis has never found much acceptance except in Scandinavia, and the new Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition category of brief reactive psychosis is quite different from reactive psychosis as described by most Scandinavian clinicians and researchers. The concept of psychogenic psychoses is, however, not new. Indeed, many psychiatrists of the early 20th century stressed the psychogenic factors in psychotic mental disturbances. Reactive psychoses have generally been considered illnesses distinct not only from schizophrenia but also from manic-depressive psychosis with a distinctive genetic component. Of 283 hospitalized patients at Johns Hopkins for whom long-term follow-ups were available and of whom all were first admissions, Astrup retrospectively diagnosed 91 as reactive psychoses. A contrasting group of 78 "systematic schizophrenics" by Leonhardt's criteria were identified. Stephens found that these two groups differed significantly in that the reactive patients had a) a more acute onset, b) more precipitating stress, c) more affective symptoms, d) more confusion, e) less affective blunting, f) a better premorbid adjustment, g) less premorbid schizoid traits, h) fewer schizophrenic relatives, and i) a much more favorable long term outcome.

Adult↗
PubMed1997

Kikuchi's disease: report of three cases and an overview.

We describe, to our knowledge, the first native Finnish patients with Kikuchi's histiocytic necrotizing lymphadenitis. The diagnosis was based in all cases on histopathological findings in open biopsy. The disease was first detected in Japan in 1972, but in Scandinavia, until this decade, there had been no cases reported. Our patients were young, otherwise healthy women who had cervical lymphadenopathy, fever, and fatigue as their main symptoms. In two of them, the disease was mild and subsided spontaneously within 2-6 months. One patient with more fulminant lymphadenopathy was treated with antimicrobial and antiinflammatory drugs. She became symptomless in 3 months. The cause of Kikuchi's disease is unknown. A viral or postviral hyperimmune reaction has been proposed as its etiology. Malignant lymphoma and systemic lupus erythematosus are differential diagnoses. Histopathological findings are pathognomonic and pathologists must be aware of its typical characteristics.

Adult↗
PubMed1996

Embolization of cerebral arteriovenous malformations: Part II--Aspects of complications and late outcome.

OBJECTIVE: From 1987 through 1993, we performed embolizations on 150 patients with cerebral arteriovenous malformations (AVMs) at Sahlgrenska University Hospital. The patients ranged in age from 5 to 70 years (35.5 +/- 14.8 yr, mean +/- standard deviation) and were selected by neurosurgeons in Scandinavia. We analyzed the risk of complications and late outcome to have a better basis for the decision to perform embolization. METHODS: The follow-up was a personal clinical examination of all surviving patients by a neurologist. Files for all patients were also studied. RESULTS: In 34 patients, the AVMs were eliminated by embolization alone (20 patients) or by supplementary surgery (14 patients). In 66 patients, the AVMs were embolized to a size suitable for supplementary stereotactic radiation. The clinical course was stable for those 100 patients. Another group of 50 patients who had undergone embolization was only partially treated, and as a group, those patients had less favorable outcomes. The manifestations or symptoms leading to diagnosis were in concordance with other studies. Headache and epilepsy showed a positive response to treatment in patients whose AVMs had been eliminated as well as in those who received only partial treatment. A history of cerebral bleeding did not influence the prognosis of recurrent bleeding. Conversely, AVMs with feeder or nidus aneurysms were related to an increased risk of bleeding. If there was a history of bleeding in a patient with large, partially treated AVMs, the prognosis for survival was diminished. CONCLUSION: The indication for treatment increases with the occurrence of AVMs with associated aneurysms. For patients with large AVMs, a history of bleeding justifies a more aggressive approach to treatment. The reduced risk of complications during the last years of the study also increases the indication for embolization.

Adolescent↗
PubMed2000

The mystery of the missing Viking helmets.

Based on archaeological finds and old Norse literature, this study describes the Scandinavian helmet tradition from the Bronze Age to the Viking Age, as well as the Viking culture, with special emphasis on weaponry and head protection. Contrary to what is commonly believed, the study shows that metal helmets must have been used very infrequently by the Vikings. In fact, only one Viking helmet has been retrieved in Scandinavia. Possible reasons for the widespread misconception that the Vikings wore helmets are discussed, and the responsibility for not correcting this misunderstanding is placed with the archaeological profession.

Anthropology, Cultural↗
PubMed1975

Role of needle aspiration biopsy in diagnosis of carcinoma of the breast.

Needle aspiration of a breast mass, a procedure widely employed in Scandinavia but neglected in the United States, has an imporant role in the diagnosis of carcinoma of the breat. Five hundred and ninety-seven patients has aspirations from 706 lesions, 415 solid and 291 cystic. There were 83 malignancies, with abnormal cells in 73. In the majority the diagnosis could be made readily. There is no known contraindication to the procedure. Aspiration at the initial visit may alert the physician to malignancy, thus avoiding undue delay in treatment.

Biopsy, Needle↗
PubMed1990

Haemophilus influenzae type b infections in Victoria, Australia, 1985 to 1987.

Invasive Haemophilus influenzae type b (HIB) infections occurring from 1985 to 1987 in children younger than 16 years of age living in the state of Victoria were reviewed. There were 547 cases which fulfilled the case definition, including 231 cases of meningitis, 219 of epiglottitis and 97 other infections; 14 (2.6%) children died, 8 with meningitis, 5 with epiglottitis and 1 with pneumonia. Ninety-five percent of cases occurred in children younger than 5 years of age, in whom the case attack rate was 58.5/100,000/annum. Nearly two-thirds of cases (46% of meningitis; 91% of epiglottitis; 45% of other infections) occurred in children more than 18 months of age (the age at which vaccine is presently given in the United States). Compared with the United States, the case attack rate for HIB disease in Victoria is lower, the mean age of affected children higher and the proportion with epiglottitis is greater. However, the incidence, age distribution and clinical manifestations of HIB disease in Victoria are similar to those described in Scandinavia before the successful introduction of vaccines. Effective conjugate vaccines against HIB disease are now available and the majority of cases are preventable (depending on the immunization schedule used). These data suggest that immunization of Victorian children against HIB infection should be cost-effective.

Adolescent↗