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PubMed2003

Distribution of the common tick, Ixodes ricinus (Acari: Ixodidae), in different vegetation types in southern Sweden.

The aim of this study was to investigate whether differences in Ixodes ricinus (L.) nymphal relative density exist among different vegetation types in southern Sweden. Nymphal I. ricinus were sampled in southeastern Scania in southern Sweden during June-August 1997. A total of 110-180 25-m2 samples were taken by blanket-dragging from each of nine different vegetation types. There was a highly significant difference in nymphal abundance between the open areas as one group and the forested areas as another group (P < 0.0001). Vegetation types that differed significantly in median nymphal abundance from all other vegetation types were pine forest (16 nymphs/100 m2) and beech forest (40 nymphs/100 m2). No significant differences in median nymphal density were revealed among mixed deciduous forest, alder forest, oak forest, and hazel forest (28-32 nymphs/100 m2), or among dry meadow, meadow, and heath (0 nymphs/100 m2). Forestation of open areas is likely to lead to increased I. ricinus abundance and disease risk.

Animals↗
PubMed1986

Power and change: primary health care at the crossroads in Sweden.

This paper is based on in-depth interviews with members of Sweden's medical interest groups involved in a national effort to control health care costs. Sweden is faced with escalating costs due primarily to a growing high technology hospital sector. Simultaneously, consumer demand for primary care services and for gerontological care is rising rapidly. The Swedish way of changing the health care system is described and an analysis of the power struggle between physicians, health care bureaucrats and politicians is presented.

Cost Control↗
PubMed1992

Consumption of antibiotics in Sweden, 1975 to 1992: pharmacoeconomic and clinical aspects.

Using official statistics for the consumption of antibiotics in Sweden during the period 1975 to 1991, the pharmacoeconomic consequences were analysed. An increase of more than 25% in Swedish consumption of antibiotics during the study period was found. There is no obvious clinical explanation; indeed, improved hospital hygiene as well as decreased frequencies of some common bacterial infections should have resulted in a decrease in total consumption. Overconsumption was most marked for oral antibiotics. In 1991 the most often used antibiotic, phenoxymethylpenicillin, was given in about 20 million defined daily doses (DDD), corresponding to 2.4 DDDs per member of the population per year. From a pharmacoeconomic viewpoint, this overconsumption is acceptable because the drug has a low price and causes a minimum of severe adverse reactions. More serious is the marked misuse of tetracyclines (12 million DDDs in 1991) and macrolides (5.3 million DDDs in 1991), with which adverse reactions are more common, and where the high consumption has led to increasing frequencies of resistance among common bacterial pathogens. This emergent resistance often leads to a need to use newer more expensive antibiotics, in addition to the costs resulting from therapeutic failures of the initial treatment. Of the parenteral antibiotics, the cephalosporins, particularly cefuroxime, dominate in Sweden. The introduction of 'diagnosis-related groups' (DRGs) for reimbursement of hospitals for in-patient care is likely to result in the development of antibiotic use in 'intensive home care' as has occurred in the US.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMed1995

The cost effectiveness of hypertension treatment in Sweden.

The aim of this study was to carry out an analysis of the cost effectiveness of antihypertensive drug treatment in different patient groups in Sweden. The cost-effectiveness ratios were estimated as net costs (treatment costs minus reduced costs of cardiovascular morbidity) divided by the number of life-years gained (the increase in life expectancy). The analysis was based on the reduction of coronary heart disease and stroke in the most recent meta-analysis of antihypertensive treatment, to which Swedish cost data were applied. We found that the cost per life-year gained decreases with age for both men and women, and is relatively low for middle-aged and older patients, even when the diastolic blood pressure (DBP) range is 90 to 94mm Hg. In conclusion, the results indicate that, in Sweden, antihypertensive treatment is generally cost effective in middle-aged and older patients with a DBP of > or = 90 mm Hg. However, it is questionable whether it is generally cost effective to treat younger patients with mild hypertension.

Adult↗
PubMed2004

Cost effectiveness of raloxifene in the treatment of osteoporosis in Sweden: an economic evaluation based on the MORE study.

BACKGROUND: The Multiple Outcomes of Raloxifene Evaluation (MORE) study showed that treatment with raloxifene reduces the risk of vertebral fracture and breast cancer in postmenopausal women with osteoporosis. OBJECTIVE: Based on the MORE study the aim of the present study was to assess the cost effectiveness of raloxifene (compared with no treatment) for the treatment of osteoporosis in postmenopausal women in Sweden. DESIGN: A revised version of a previously developed computer simulation model was used. The impact of the risk-reducing effect of raloxifene on vertebral fractures and breast cancer on cost effectiveness was analysed using a clinical and a morphometric definition of vertebral fracture. Benefits of raloxifene treatment were measured in quality-adjusted life-years (QALYs) and life-years gained. The study estimated the cost effectiveness mainly from a healthcare perspective but the cost effectiveness taking a societal perspective was also analysed. RESULTS: Intervention costs (in Swedish kronor [SEK] and euros [euro], year 2001 values) in postmenopausal women with a relative risk of vertebral fracture of 2 were SEK372000 (euro40000), SEK303000 (euro33000) and SEK263000 (euro28000) per QALY for women aged 60, 70 and 80 years, at start of treatment, respectively, when the clinical vertebral definition was used. The cost effectiveness using a clinical morphometric vertebral fracture definition was similar to the cost effectiveness using a clinical vertebral fracture definition. CONCLUSIONS: In relation to accepted threshold values for cost per QALY in Sweden, this model indicates, with its underlying assumptions and data, that raloxifene (compared with no treatment) is cost effective for the treatment of postmenopausal women at an increased risk of vertebral fracture, from the Swedish healthcare and societal perspectives.

Adult↗
PubMed1979

Comparative social policy and political conflict in advanced welfare states: Denmark and Sweden.

There has developed an abundant literature on the social and political determinants of social policies, but few have addressed the question of how state policies, once implemented, affect the system of stratification in civil society. This article examines the political consequences of social policy in Denmark and Sweden, countries in which a social democratic labor movement has predominated for decades. Superficially, these two highly developed welfare states appear very similar. Yet the political and social contexts in which their social policies have evolved differ substantially. I shall demonstrate the argument that the traditional welfare state approach may be conducive to a new and powerful political conflict, which directly questions the legitimacy of the welfare state itself, unless government is successful in subordinating private capitalist growth to effective public regulation. In Denmark, where social democratic governments have failed to match welfare state growth with more control of private capital, social policy has tended to undermine the political unity of the working class. Consequently, the Social Democratic Party has been weakened. Social welfare programs, in effect, have helped create new forms of stratification within the working class. In Sweden, social democratic governments have been quite successful in shifting a decisive degree of power over the private market to the state. This has helped avert a crisis of the welfare state, and has also been an important condition for continued social democratic hegemony and working-class unity. I conclude that social reform politics tend to be problematic from the point of view of the future power of social democratic movements.

Conflict, Psychological↗
PubMed2003

The National Diabetes Register in Sweden: an implementation of the St. Vincent Declaration for Quality Improvement in Diabetes Care.

OBJECTIVE: To monitor glycemic control, treatable risk factors, and treatment profile for quality assessment of diabetes care on a national scale. RESEARCH DESIGN AND METHODS: Four samples of 23,546, 32,903, 30,311, and 29,769 patients with diabetes (1996-1999) were studied based on a repeated national screening and quality assessment of diabetes care by the National Diabetes Register, Sweden, with participation of both hospitals and primary health care. Clinical characteristics included were age, sex, diabetes duration and treatment, glycemic control (HbA(1c)), office blood pressure (BP), BMI, smoking habits, and use of lipid-lowering drugs in patients with type 1 or type 2 diabetes. RESULTS: Favorable decreases of mean HbA(1c) and BP values were registered during the 4-year study period for both type 1 (HbA(1c) 7.5-7.3% and BP 130/75-130/74 mmHg) and type 2 diabetic patients (HbA(1c) 7.0-6.7% and BP 151/82-147/80 mmHg). Treatment aims of HbA(1c) and BP levels were also achieved in increasing proportions for type 1 (HbA(1c) <7.5%: 50-58% and BP </=140/85 mmHg: 77-79%), and type 2 diabetic patients (HbA(1c) <7.5%: 66-73% and BP </=140/85 mmHg: 32-42%). The use of lipid-lowering drugs increased for type 1 (4-11%) and type 2 diabetic patients (10-22%). In type 2 diabetic patients, treatment with oral agents alone decreased, but combination therapy (insulin and oral agents) increased during the study period. Mean BMI increased during 1996-1999 in type 2 diabetic patients. High HbA(1c) and BP values in 1999 were predicted by high BMI values 1996 and by high increase of BMI during the period, independent of diabetes duration, age, and sex. CONCLUSIONS: Decreasing mean HbA(1c) and BP levels and the wider use of lipid-lowering drugs during the late 1990s in patients with diabetes in a national sample from Sweden should translate into clinical benefits regarding micro- and macrovascular complications as well as diabetes-related mortality.

Adult↗
PubMed1995

An epidemic of tinea corporis caused by Trichophyton tonsurans among wrestlers in Sweden.

An epidemic of tinea corporis due to Trichophyton tonsurans among wrestlers in Sweden is described. Totally 19 patients, 14 patients from Malmö and 5 from Gothenburg, were found. The suspected source of this epidemic was from a wrestlers' team from the USA visiting Sweden in April, 1993. All patients were treated orally with either griseofulvin, fluconazole or terbinafine, and all were cured. To prevent spreading, epidemiological tracing of secondary cases is important.

Adolescent↗
PubMed1999

Evaluations of the effects of Sweden's spanking ban on physical child abuse rates: a literature review.

Sweden's 1979 law banning corporal punishment by parents was welcomed by many as a needed policy to help reduce physical abuse of children. This study reviews the published empirical evidence relevant to that goal. Only seven journal articles with pertinent data were located. One study reported that the rate of physical child abuse was 49% higher in Sweden than in the USA, comparing its 1980 Swedish national survey with the average rates from two national surveys in the United States in 1975 and 1985. In contrast, a 1981 retrospective survey of university students suggested that the Swedish abuse rate had been 79% less than the American rate prior to the Swedish spanking ban. Some unpublished evidence suggests that Swedish rates of physical child abuse have remained high, although child abuse mortality rates have stayed low there. A recent Swedish report suggested that the spanking ban has made little change in problematic forms of physical punishment. The conclusion calls for more timely and rigorous evaluations of similar social experiments in the future.

Child Abuse↗
PubMed2001

Distributions by age and sex of the dimensions of temperament and character inventory in a cross-cultural perspective among Sweden, Germany, and the USA.

Distribution by age and sex of the dimensions of the Temperament and Character Inventory were assessed cross-culturally for samples in Sweden, Germany, and the USA. The Temperament and Character Inventory is a 240-item (Sweden, 238-item), self-administered, true-false format, paper-and-pencil test developed by Cloninger and his coworkers based on his unified biosocial theory of personality. The inventory measures the Temperament dimensions Novelty Seeking, Harm Avoidance, Reward Dependence, and Persistence as well as the Character dimensions, Self-directedness, Cooperativeness, and Self-transcendence. The samples consisted of 300 German subjects, 300 Swedish subjects, and 300 U.S. subjects matched by age cohort and sex. Stability of the personality dimensions was evaluated across samples as were their age and sex distributions. We found significant effects of age, sex, and culture in univariate and multivariate comparisons on the personality dimensions. However, several significant differences in the personality dimensions for both European samples appear to be similar compared with those of the U.S. sample. We have to conclude that sex- and age-specific norms for the dimensions of the Temperament and Character Inventory are necessary given the established significant differences.

Adolescent↗
PubMed1976

Exposure to drugs and other possibly harmful factors during the first trimester of pregnancy. Comparison of two prospective studies performed in Sweden 10 years apart.

474 women in mid-pregnancy, interviewed at ten different hospitals in Sweden, were questioned on a number of social and medical items: e.g., drug use, contraceptive technique used before pregnancy, exposure to possibly deleterious factors in the environment. The study, compared with a similar study made ten years earlier in Sweden, showed little or no difference in the use of iron and/or vitamin preparations, analgesic drugs, antibiotics, or endocrine drugs; but a drastic reduction is noted in the use of psychotropic drugs and of antihistaminic drugs. A marked decrease in frequency of first trimester X-ray exposures can be found, but no marked changes in smoking habits. Appr. 18% of the women used contraceptive pills within 6 months of becoming pregnant---3 had used them during early pregnancy. About 4% (18 women) had used IUD---one became pregnant with a Cu-UID (intra-uterine device inpregnated with copper).This type of study can provide some information on the prevalence of relatively common factors, but it must be considerably extended in order to permit an analysis of rare events, e.g., use of most drugs.

Abnormalities, Drug-Induced↗
PubMed1985

The decline in maternal mortality in Sweden, 1931-1980.

Maternal mortality in Sweden has declined steeply over the past 50 years. The reasons for this gratifying trend have been analysed. A decreasing incidence of complications during pregnancy and delivery, together with a lower case fatality rate from complications have been found to account for the major part of the reduction in maternal mortality in Sweden. This has been achieved by improvements in obstetrical and antenatal care, by the introduction of antibiotics and blood transfusion, and by a favorable shift to more appropriate ages for reproduction.

Eclampsia↗
PubMed1986

Cesarean section and perinatal mortality in Sweden in 1981.

During the years 1973-81, the cesarean section (CS) birth rate increased from 5.5% to 12.4% in Sweden. During the same time, perinatal mortality declined from 12 to 7.1 per thousand children. The rates of CS and perinatal mortality, however, cannot be presented as reciprocally dependent variables without taking into consideration many of the other factors that have been at work during the same decade, e.g. improved results of the neonatologists in the lower weight groups, electronic fetal monitoring, use of steroids, introduction of tocolytic agents. The present study revealed that the incidence of CS could vary between 8% and 19% between different obstetric departments in Sweden during 1981. Despite this great difference in CS rate, no difference was noted in the rates of asphyxia or perinatal mortality. It is concluded that in the present study we have seen no indication that a marked increase in the CS rate would improve our present perinatal survival data and furthermore it still remains unproven that CS and perinatal mortality rates necessarily have a reciprocal relationship.

Asphyxia Neonatorum↗
PubMed1986

Eclampsia in Sweden, 1976-1980.

Among 480,969 births in Sweden during the period 1976 to 1980, 74 parturients with eclampsia were identified. The clinical characteristics of women developing eclampsia before 37 completed weeks of gestation differed markedly from those with eclampsia at term. In the pre-term group, subjective symptoms nearly always preceded the eclamptic attack, the newborns were generally small-for-gestational-age, the perinatal mortality was high, and the mothers more frequently had complications related to eclampsia. The only maternal death occurred in this group. In the term group the first convulsion often came unexpectedly without typical premonitory signs. The infants were with few exceptions within the average for gestational age. The general outcome for mothers and their babies was favorable and the length of hospital stay was on average 3 days longer than that of the overall obstetric population. Eclampsia cases in Sweden represent a small subfraction of parturients with hypertensive disorders of pregnancy. The incidence (29/100,000) in our material is, to our knowledge, the lowest yet reported. Despite the very regular attendance at the antenatal clinic, weekly from 36 weeks onwards, fewer than half of the patients had hypertension diagnosed 4 days or more prior to the eclamptic convulsion. A shortening of the intervals between the antenatal visits therefore does not seem warranted.

Adolescent↗
PubMed1991

Antenatal care in southern Sweden. A population-based prospective study describing the diagnostic panorama of pregnancy.

All pregnant women from the catchment areas of three health centres in southern Sweden, registered for antenatal care during the calendar year 1986, were included in the study population. Four hundred and nine women could be prospectively followed throughout pregnancy. By 15 completed weeks, 95% of the women were registered at an antenatal clinic. Only 2 women had no antenatal care at all. During the course of pregnancy the 409 women made altogether 6,058 (mean 14.8) visits to the health and medical services, most of them (95%) were to an antenatal clinic. Common obstetrical problems were vaginitis, symphysiolysis, threat of preterm labour, and vaginal bleeding; and common non-obstetrical problems were low back pain and respiratory tract infections. During pregnancy 42% of the women were prescribed some sort of medication, and 53% were sicklisted on one or more occasions. The outcome of pregnancy was comparable to figures for all Sweden.

Adult↗
PubMed1994

Multifetal pregnancy reduction in Sweden. Utilization rate and pregnancy outcome (1986-1992)

All departments of Obstetrics and Gynecology, as well as all private clinics in Sweden offering assisted conception, were surveyed by means of a questionnaire to determine the utilization rate and outcome of multifetal pregnancy reduction (MFR) for the period 1 January 1986 to 30 June 1992. The response rae was 100%. Multifetal reduction was performed in 26 women, giving an average utilization rate of 1/7 multiple births of three or more for the entire period. Of the various techniques used, intracardiac or intrathoracic injection of a potassium chloride solution was predominant. The experience of each center with multifetal reductions varied between one and six procedures. In this series, the overall complete pregnancy loss was 27% (n = 7). In 73% (n = 19) of women the pregnancy continued to delivery. One fetus died in utero in the second trimester, one child died from a subtentorial hemorrhage perinatally, and one child had a malformation of the right foot and hand. It seems necessary to limit MFR to a few centers in Sweden in order to maintain and increase the experience of the operators involved, and to decrease the fetal loss rate associated with the procedure. However, the ultimate goal is to make these procedures unnecessary when methods of avoiding excessive ovulation are refined and by limiting the number of replaced embryos in IVF-treatment.

Abortion, Therapeutic↗
PubMed1995

Sexually transmitted diseases in Swedish women with experience of casual sex with men of foreign nationalities within Sweden.

BACKGROUND: This study was performed in women who had attended the clinic for contraceptive advice to determine whether a history of casual sex with a foreign male, previously unknown to them (SFM) in their home country (Sweden), constituted an increased risk for acquiring sexually transmitted diseases (STD) as compared to women without such an experience (COMP). METHODS: Of 996 women enrolled, and who were subjected to a structured deep-interview performed by midwives, 595 (59.7%) stated that they had experienced casual sex within Sweden with for them a previously unknown Swedish male (SSM). RESULTS: A history of SFM was reported by 120 (12.0%) women. A history of chlamydial infection (26.0%) and gonorrhea (13.0%) were more common in the SFM women than in either the COMP (16.0% and 3.0%) or the SSM (19.0% and 4.0%) groups. Genital warts (8.0%) and bacterial vaginosis (23.0%) were found more often in the SFM group as compared to both the COMP (3.0% and 12.0%) and the SSM (4.0% and 13.0%) group. Women in the SFM group more often had a current genital chlamydial infection (13.0%) than those in the COMP group (8.0%). When adjustment was made for markers of sexual risk taking, only genital warts remained significantly (p = 0.05) associated with SFM as compared to both SSM and COMP. CONCLUSIONS: To conclude, the study shows that women with experience of SFM had, more often, a history of one or more STDs and were more often carriers of STD agents than those lacking experience of SFM and/or SSM. However, there was no such difference when comparing the SFM and SSM women when making adjustments for sexual risk behavior. Thus a sexual risky lifestyle is more important than the origin of the sex partner for acquiring STDs with possible exception of HIV/AIDS in the society studied.

Acquired Immunodeficiency Syndrome↗
PubMed1985

Dental health, dental care, and dietary habits in children in different parts of Sweden.

An epidemiological study of dental health, dental health care, and sociodemographic data in 817 4-, 8-, and 13-year-old children was carried out in 1980/81 in two areas in the county of Västerbotten, northern Sweden, and in one area in the northern part of the county of Alvsborg, in southwestern Sweden. Dietary habits and nutrient intake were studied in 738 of the children. The aim of the study was to examine the dental health in the different areas and to study the importance of variations in related background factors. The results showed great differences in dental health in all age groups between the two counties. There were also differences between the two areas in the north, but these were not as evident. A discriminant function analysis showed that age when organized dental care started and tooth-brushing frequency had greater explanatory power on dental caries than food habit factors.

Adolescent↗