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PubMed1992

Stroke incidence rates were unchanged, while fatality rates declined, during 1971-1987 in Göteborg, Sweden.

BACKGROUND AND PURPOSE: Stroke risk factors have been shown to change with time in several places; simultaneously, stroke incidence rates have increased in some and decreased in other places. In Göteborg, Sweden, cardiovascular epidemiological research has included stroke registration since 1971. From these data on stroke, incidence and fatality rates from a 17-year period are given. METHODS: During the period 1971-1987 all cases of stroke occurring in people aged 15-65 years in the city of Göteborg were uniformly recorded, with an estimated case detection rate of 90% or more. RESULTS: Age-adjusted incidence rates of first-ever stroke by sex did not change during the period. Age-specific rates and rates for individual types of stroke (subarachnoid hemorrhage, intracerebral hemorrhage, and cerebral infarction-unspecified stroke combined) were also largely unchanged. A slight increase in the incidence rate of intracerebral hemorrhage may be due to better detection after computed tomography came into use in 1976. Stroke fatality rates declined through the whole period in both sexes and all age groups, markedly so for intracerebral hemorrhage and subarachnoid hemorrhage. CONCLUSIONS: This conforms with vital statistics for Göteborg and for Sweden of declining stroke mortality during the period. The decline in stroke fatality rates may be related to decreases in smoking habits and blood pressure together with an increase in the percentage of people on antihypertensive treatment among middle-aged men, and to some extent even middle-aged women, reported from the same population. Why stroke incidence rates did not decline concomitantly is unexplained.

Adolescent↗
PubMed1994

Costs of stroke in Sweden. A national perspective.

BACKGROUND AND PURPOSE: Cost-effectiveness analyses of stroke management are hampered by paucity of economic data. We made an update of the direct and indirect costs of stroke in Sweden (population, 8.5 million). METHODS: Direct costs (ie, the costs for hospital and outpatient care and social services) were estimated on the basis of two prospective population-based studies of stroke and of two nationwide cross-sectional inventories of bed-days and diagnoses. Indirect costs (ie, the costs for loss of productivity and early retirement) were based on official statistics. RESULTS: The direct annual costs of care for stroke patients in 1991 equaled 7836 million Swedish krona (SKr) ($1306 million in US dollars), and the indirect costs, 2430 million SKr ($405 million). The cost of stroke care was 1208 SKr ($201) per inhabitant in Sweden. The expected direct costs per patient from first stroke to death were 440,000 SKr ($73,333). When prestroke costs for other diseases and advanced age were subtracted, the sum was reduced to 180,000 SKr ($30,000). CONCLUSIONS: Costs for hospital and outpatient care and social services accounted for 76% of Swedish stroke costs and for 24% of costs for loss of production and early retirement. Only 41% of direct costs were stroke-related.

Aged↗
PubMed1994

Trends in incidence, case-fatality rate, and severity of stroke in northern Sweden, 1985-1991.

UNLABELLED: BACKGROUND AND PURPOSE--Incidence, case-fatality rate at 28 days, and severity of acute stroke were recorded for 7 years in a large population-based stroke register to understand the reasons for the decline in stroke mortality in northern Sweden. METHODS: Within the framework of the World Health Organization MONICA Project, acute stroke was monitored in people aged 35 to 74 years in northern Sweden from 1985 through 1991 (target population in 1985, 238,948). RESULTS: The annual incidence of stroke decreased by an average of 2.3%/y in men aged 35 to 64 years (P = .074) and increased significantly by 1.1%/y in men aged 65 to 74 years (P = .041). No significant changes in incidence occurred in either age group in women. The 28-day case-fatality rate in first-ever strokes (both sexes together) declined from 21.9% to 15.4% in patients aged 65 to 74 years (P = .02). Among survivors, the proportion with extensive motor deficits (at any time during the first 28 days) declined in patients younger than 65 years as well as in those older than 65 years (P = .007 and P = .019, respectively). In patients aged 35 to 64 years, the proportion with aphasia/dysphasia also decreased significantly (P = .032), but no such trend was seen in those aged 65 to 74 years. CONCLUSIONS: A shift toward higher ages has been noted in the occurrence of first-ever strokes in men, while incidence has remained unchanged in women. During the 7 years of observation, stroke has become a less severe disease.

Adult↗
PubMed1997

Epidemiology and etiology of ischemic stroke in young adults aged 18 to 44 years in northern Sweden.

BACKGROUND AND PURPOSE: The aim of this study was to conduct a population-based epidemiological survey among young adults aged 18 to 44 years in Northern Sweden and furthermore to gain further insight into the etiology of ischemic stroke in this age group. METHODS: Two studies were done. In the first part, epidemiological data were collected to calculate incidence and mortality from 1991 through 1994. This was based on the World Health Organization Northern Sweden MONICA register of acute stroke events. Eighty-eight first-ever ischemic stroke patients were identified during that period. In the second part, 107 consecutive patients aged 18 to 44 years with ischemic stroke referred to a university hospital were studied prospectively during a 5-year period and were extensively evaluated according to a standardized protocol. On the basis of modified Trial of ORG 10172 in Acute Stroke Treatment (TOAST) criteria, the patients were classified into eight subtypes of ischemic stroke. RESULTS: The average population-based annual incidence rate for ischemic stroke (cases per 100,000 per year) was 11.3 (95% confidence interval, 6.7 to 16.1). The case-fatality rate was 5.7%. According to the modified TOAST criteria, a probable cause of ischemic stroke was identified in 36% and remained unexplained in 21% of cases. Spontaneous cervical arterial dissection was the leading probable etiology (13%). Patent foramen ovale or atrial septal aneurysm was a possible cause of stroke in 28% of cases. The percentages of ischemic stroke attributed to IgG anticardiolipin antibodies (4.7%), atherothrombotic vasculopathy (3.7%), oral contraceptive use (7%), and migraine (1%) were lower than reported in recent clinical series. CONCLUSIONS: The incidence rate for ischemic stroke was higher than previously reported from most countries in Western Europe. The higher incidence was not explained by a higher prevalence of premature atherosclerotic vasculopathy. Without the additional diagnostic information derived from advanced cardiac imaging, the proportion of indeterminate cases would have constituted 37% of the patients.

Adolescent↗
PubMed1998

Time trends in long-term survival after stroke: the Northern Sweden Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) study, 1985-1994.

BACKGROUND AND PURPOSE: Stroke mortality rates and case fatality of stroke have declined since the beginning of the 1970s in Sweden, but the incidence of stroke has been stable. The aim of this study was to analyze trends in long-term survival after stroke. METHODS: Within the framework of the population-based WHO Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) Project, all acute stroke events were recorded in the age group 25 to 74 years in northern Sweden during the period 1985 to 1994. All first-ever stroke patients were followed for information on vital status (minimum follow-up time was 1 year). Survival time was related to time period of stroke onset, stroke diagnosis, and concomitant diseases. RESULTS: Survival times for a total of 6819 first-ever stroke patients (4057 men and 2762 women) were analyzed. Age-adjusted odds ratio for death within 1 year after stroke was 0.70 (95% confidence interval [CI], 0.55 to 0.88) in the period 1993 to 1994 as compared with the period 1985 to 1986 in men and 0.69 (95% CI, 0.53 to 0.90) in women. Corresponding odds ratios were 0.73 in men and 0.70 in women among those who survived the first 28 days. Similar improvements were seen for 3- and 5-year survival. Improvements in survival over time were most marked among patients with ischemic stroke. There was no improvement in survival over time among patients with the most severe deficits at onset. CONCLUSIONS: Gradually improved survival, both short and long term, was observed during the 10-year study period. The improvements are not explained by changes in known confounding prognostic factors.

Adult↗
PubMed2005

Lessons from European population genetic databases: comparing the law in Estonia, Iceland, Sweden and the United Kingdom.

The advent of large-scale, population genetic databases (PGDs) in several countries around the world marks a significant development in human DNA banking and genetic research. The European countries that have led the way in the development of PGDs are Iceland, Sweden, Estonia and the U.K. In legal terms, the emergence of PGDs has been far from straightforward as such projects pose a range of difficult and complex issues for the law to address. This article canvasses the current law in Iceland, Estonia, Sweden and the U.K. on four fundamental issues of principle pertaining to PGDs, in order to illustrate the difficulties that have emerged around PGDs, highlight key areas of legal concern, and shed light on possible ways forward. It compares and contrasts the differing legal positions and lawmakers' responses to date in these four European countries that have established PGDs or are seeking to do so. The four fundamental issues examined are: (1) consent, especially for secondary research purposes; (2) ownership of biological samples, data and databases; (3) the rights of certain third parties to gain access to, and to use, PGD biological samples and data; and (4) benefit sharing, including the provision of feedback and genetic counselling to participants. This analysis may offer some guidance for policymakers in other jurisdictions where PGDs have been proposed or are being established.

Databases, Genetic↗
PubMed1997

Exposure to mercury vapor and impact on health in the dental profession in Sweden.

Possible adverse effects of mercury exposure in dentistry have been discussed in several studies. The objective of the present study was to carry out detailed measurements of mercury exposure in the dental profession in Sweden, and to search for adverse health effects from such exposure. We examined 22 dentists and 22 dental nurses, working in teams, at six Swedish dental clinics. Measurements of air mercury, performed with personal, active air samplers, showed a median air Hg of 1.8 micrograms/m3 for the dentists, and 2.1 micrograms/m3 for the dental nurses. Spot measurements with a direct reading instrument displayed temporarily elevated air Hg, especially during the preparation and application of amalgam. The average concentration of mercury in whole blood (B-Hg) was 18 nmol/L, in plasma (P-Hg) 5.1 nmol/L, and in urine (U-Hg) 3.0 nmol/mmol creatinine. Possible effects on the central nervous system (CNS) were registered with three questionnaires: Q16, Eysenck Personality Inventory (EPI), and the Profile of Mood Scales (POMS). In the Q16, the number of symptoms was statistically significantly higher in the dentistry group compared with an age- and gender-matched control group (n = 44). The urinary excretion of albumin and urinary activity of the tubular enzyme N-acetyl-beta-glucose-aminidase (NAG) did not differ between the two groups. The results confirm that exposure to mercury in the dental profession in Sweden is low. The air Hg levels were mainly influenced by the method of amalgam preparation and inserting, and by the method of air evacuation during drilling and polishing.

Adult↗
PubMed1996

In vitro study of the accuracy of bone mineral measuring devices in Norway and Sweden.

PURPOSE: The aim of the study was to investigate the performance of +different types of equipment for bone mineral assessment in Sweden and Norway with standardised phantoms. MATERIAL AND METHODS: Measurements of the bone mineral content of 2 semianthropomorphic phantoms, one simulating the human torso and one the lower arm, at 21 hospitals in Norway and Sweden, were undertaken. The phantoms had inserts of hydroxyapatite in different concentrations and were measured together with additions of stearic acid simulating fat. The phantoms were repeatedly measured on 14 dual X-ray absorptiometry, 5 single X-ray absorptiometry, and 3 single photon absorptiometry devices and 1 quantitative CT device. RESULTS: The measurements showed a large spread in the measured hydroxyapatite concentrations among different devices. The inaccuracy was slightly lower than 10% without fat present when the results were expressed as bone mineral areal mass (BMA, g/cm2). With fat included the inaccuracy was at worst 50%. CONCLUSION: The large inaccuracy found in this study gives rise to a large overlap between healthy and osteoporotic cases and make the diagnosis of osteoporosis difficult in the individual patient.

Absorptiometry, Photon↗
PubMed1994

Cross-sectional analysis of the differences between patients with systemic lupus erythematosus in England, Brazil and Sweden.

This study is a cross-sectional analysis of the differences between SLE outpatients seen in Rheumatology departments at University centres in England, Brazil and Sweden, using a standard protocol. The demographic characteristics, extent and activity of disease of 209 patients with SLE were studied; 112 patients were seen in England, 33 in Brazil and 64 in Sweden. The median age of disease onset of Brazilian and English patients was 25 years and of Swedish patients 31.5 years. Disease activity was measured by the BILAG index. In most systems Brazilian patients experienced more activity than English patients and English patients more activity than Swedish patients. Non-Caucasians experienced more active disease than Caucasians. No sex or occupational differences were observed in disease activity. English patients were the most likely to have experienced photosensitivity, oral ulcers and haematological disorders, Brazilian patients renal disorders and Swedish patients discoid rashes. Brazilian patients were the most likely to be prescribed only one drug for treatment of SLE and to be taking steroids and the highest dose of steroids, in contrast to the European patients who were often prescribed steroids and an antimalarial agent or azathioprine. The results of this cross-sectional assessment of disease activity using a standardized instrument indicate that there are real differences in the extent and degree of activity of SLE in different national groups. This reflects a combination of genetic, environmental and social influences on disease expression and has implications for treatment and monitoring of SLE patients.

Adolescent↗
PubMed2006

Being different and vulnerable: experiences of immigrant African women who have been circumcised and sought maternity care in Sweden.

The purpose of the study was to explore the encounters with the health care system in Sweden of women from Somalia, Eritrea, and Sudan who have been genitally cut. A qualitative study was performed through interviews with 22 women originally from Somalia, Sudan, and Eritrea who were living in Sweden. The women experienced being different and vulnerable, suffering from being abandoned and mutilated, and they felt exposed in the encounter with the Swedish health care personnel and tried to adapt to a new cultural context. The results of this study indicate a need for more individualized, culturally adjusted care and support and a need for systematic education about female genital cutting for Swedish health care workers.

Adult↗
PubMed1999

Meanings and practices of health among married Thai immigrant women in Sweden.

The aim of this qualitative study was to explore and explain the meanings and practices of health among Thai immigrant women in Sweden with Swedish husbands. In agreement with Leininger's theory of cultural care, data were collected through observation-participation and ethnographic interviews with 10 key informants and 16 general informants living in Uppsala. The principal meanings of health of the Thai immigrant women were abstracted from the raw data using structural analysis. They were found to be (a) state of well-being, (b) absence of illness, (c) ability to perform daily role activities, and (d) adaptation to their new life situation. The principal factors for the promotion of health among these women were (a) mental support from family, (b) nutrition, (c) physical exercise, (d) no smoking, and (e) modest drinking. Knowledge among health care professionals of meanings and practices of health, such as those found here, is vital for the provision of culturally congruent care in a multicultural society such as Sweden.

Adult↗
PubMed2006

Poor self-reported health and sleeping difficulties among Kurdish immigrant men in Sweden.

This study explores the association between ethnicity and poor self-reported health and psychological distress, sleeping difficulties, and use of psychotropic drugs among immigrant Kurdish men and native Swedish men, based on data from the first Swedish National Survey of Immigrants and the Swedish Level-of-Living Surveys collected in 1996 by Statistics Sweden. The age-adjusted odds of poor self-reported health and sleeping difficulties among Kurdish men was about 3.5 times higher than among Swedish men. The odds ratio decreased to 2.1 and 2.7 respectively in a model adjusted for age and the other explanatory variables. Yearning for the home country, perceived discrimination and unemployment in the host country seem to be possible explanations for the higher levels of distress among Kurdish immigrants to Sweden.

Adult↗
PubMed1982

Mortality among the widowed in Sweden.

This study consists of three parts. In the first part the risk of death for widowed persons is studied as a function of time interval since the day of bereavement. The effects of bereavement on mortality are investigated in all widowed people in Sweden (about 360 000) from 1968 to 1978. Among widowers above 65 years of age there are nine deaths per 1000 in excess compared with married men during the first 3 months after bereavement. In comparison with married people in the age group 70-74 it is found that among widows there is an increased mortality by 22% and among widowers by 48% during the first 3 months after bereavement. Further observation, during a period of altogether 11 years, showed that excess mortality continues, though at a lower level. In the second part, causes of death in the age group 70-74, divided according to marital status, are studied on the basis of data from the National Central Bureau of Statistics. The excess in mortality is due mainly to cancer and cardiovascular deaths, but also accidents, suicides and cirrhosis of the liver. The third part deals with differences between marital status groups with respect to tobacco smoking and alcohol abuse by using data from the population study of "70-year-olds in Göteborg" (H 70). By using data from central registers together with data from the population study it is possible to show that life style factors have an impact on the difference in mortality pattern between married and widowed people in Sweden.

Aged↗
PubMed1984

Dental health and perceived treatment needs of Finnish immigrants in Sweden.

The purpose of this study was to analyse the dental health and perceived treatment needs of Finnish immigrants in Sweden, using a representative sample and questionnaire technique. The material consisted of a random sample of 1 332 persons aged 20-59 years, resident in a Stockholm suburb. The response rate was 80%. Validity of the questionnaire was tested in a subgroup by comparing the number of teeth reported present in the questionnaire with the number observed clinically. Correlation coefficient (r) was 0.98. Compared with a study of Swedes, the mean number of remaining teeth was found to be lower and the proportion of edentulous persons higher in this study. The mean number of teeth was, however, higher than that found in a clinical study of Finnish immigrants 5 years previously, indicating a possible slight improvement in the dental health of Finnish immigrants. Almost 70% of the younger and about 45% of the older respondents had a perceived treatment need, primarily for fillings and scaling, older respondents also requiring prostheses. The real treatment need was probably greater than the study indicated. The study shows that Finnish immigrants to Sweden, as a social group, are in great need of dental treatment.

Adolescent↗
PubMed1987

Smoking habits and their confounding effects among occupational groups in Sweden.

Smoking habits among different occupational groups in Sweden were estimated from nation wide surveys of living conditions in 1977 and 1980/81. These surveys were conducted by Statistics Sweden and consist of interviews covering the Swedish population aged 16-74 years. The sample includes about 12,000 persons for each of the two investigations. The results show that those who may be exposed to excess risks in their work environment, smoke more than those in other occupational groups. Transport and manufacturing workers, miners, wood and paper workers and painters, for example, have higher rates of daily smokers than the national average. The highest rates, however, were found among the category of early retired or unemployed. These findings confirm that an appropriate evaluation of occupationally-related diseases affected by smoking must take smoking data into consideration. If smoking data are available from other sources, adjusted work-related risks could be calculated. This presumes the absence of interaction effects. Procedures are given and illustrated. The paper also discusses the declining trends in smoking habits between 1977 and 1980/81 and possible reasons for differences in smoking habits between occupations.

Adolescent↗
PubMed1989

Greek immigrant children in southern Sweden in comparison with Greek and Swedish children. I. General living conditions.

Greek immigrant children belonging to the second generation of immigrants in Sweden have been compared with Swedish children and Greek children in Greece regarding general living conditions. Interviews were performed in the homes of all participants. The parents in the two Greek groups had the lowest educational level. The yearly salary of immigrant families was similar to that of the Swedish families. Immigrant and Swedish parents worked outside their homes to the same extent, Greek immigrant mothers fulltime, Swedish mothers mostly part time. For economical reasons the immigrant parents looked after their children within the family while the Swedish families almost always utilized community day care facilities. The immigrant families had fewer children than the Swedish and Greek rural families and their dwellings were smaller. Corporal punishment was a common method of upbringing in Greece and among the immigrants. The immigrant families had extremely few contacts with Swedish families. A majority of the immigrant families were unsure about their future in Sweden, whether or not to stay. In conclusion, the Greek immigrant group in many respects had adapted to Swedish customs but they had also at the same time retained much of the Greek cultural characteristics.

Acculturation↗
PubMed1992

Suicide among young people aged 10-29 in Sweden.

This study analyses the incidence of suicide among children and young people aged between 10 and 29 in Sweden, during the period 1974-1986. The study comprises 4,624 individuals whose deaths were the outcome of verified, E950-E959 (n = 3,511) and undetermined, E980-E989 (n = 1,113) suicides. Regression analysis of different age groups separately and all age groups combined shows that the frequency of suicide among children and young people in Sweden did not increase in this period. Nonetheless, mortality figures are high, especially for boys and young men aged 15-29. The maximum suicide-mortality rate (43.2 per 10,000) is noted for young men aged 25-29 in 1984. The male-female ratio with respect to deaths from suicide is 2.5 for the entire group, the smallest difference being in the 15-19 age group (1.7) and the largest in the 25-29 age group (2.8). Methods of committing suicide vary between the sexes and the various age groups. Boys and young men use violent methods more often, and this situation has remained stable throughout the 13-year period. Girls use non-violent methods to a greater extent, but young women aged 18-29 use violent and non-violent methods to almost the same extent. During the 13-year period studied, a change took place in the girls' and young women's choice of methods towards more violent methods in the 1980s compared with the 1970s. Regardless of sex, there are significantly (p less than 0.001) fewer married and more divorced people among those committing suicide compared with corresponding age groups in the overall population.

Adolescent↗
PubMed1992

War-wounded refugees. Quality of life after 2-3 years in Sweden.

The Medical Center for Refugees in Linköping, Sweden, includes a medical ward for refugees and asylum applicants. It was started in January, 1986 and is financed by the Swedish Immigration Board. Sixty percent of the patients are war-wounded and 40% have diagnoses non-related to war. This article describes a group of 19 refugees who were the war-wounded patients at this ward in June, 1986. In most of them the main medical impairment was amputation. They were followed up in 1988 by interview and self-ratings. The aim was to illuminate their quality of life after 2-3 years in Sweden. Most of them were satisfied with their external living conditions. Their psychological well-being, however, was not so good and they were very occupied by thoughts of their native countries. Their physical handicaps seemed to be of secondary importance.

Adult↗