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A longitudinal study on anthropometric and clinical development of Indian children adopted in Sweden. I. Clinical and anthropometric condition at arrival.

One hundred and fourteen children (60% girls) adopted from India through five major adoption organizations, were recruited consecutively. This paper describes the environment of the children in India and in Sweden, discusses the certainty of the ages and reports their condition at arrival in Sweden. The median age at arrival was 9.3 months, 62% being below one year of age (range 3-72 months). Infectious diseases similar in kind and frequency to those noted in child populations in developing countries, were found. Height/age and weight/age mean values were approximately -2 standard deviation scores (SDS) of the NCHS/WHO standard, which is similar to the anthropometric status of Indian average children. There were no significant sex differences. Thirty-seven birth weights were known, the majority below 2,500 g. Psychomotor retardation was found in 29% of the children. In the children with stunting and in those with weight/age less than -3 SDS at arrival there were high percentages of psychomotor retardation, anaemia and combined wasting and stunting. Therefore these children should be regarded as a risk group and be followed up with special care.

Adoption↗

Changing methods of hip fracture osteosynthesis in Sweden. An epidemiological enquiry covering 46,900 cases.

An enquiry covering all hospitals in Sweden operating on hip fractures was conducted in 1990. The results were compared with enquiries from 1982 and 1985. In cervical hip fractures the use of single nail has almost disappeared in favor of 2 LIH hook pins and, lately, the Uppsala subchondral screws. Primary hip prosthesis is the ultimate method of choice in Sweden. Among trochanteric hip fracture the Ender nail has almost totally been replaced by a sliding screw and plate device.

Bone Nails↗

Epidemiology of gonorrhoea: serogroup, antibiotic susceptibility and auxotype patterns of consecutive gonococcal isolates from ten different areas of Sweden.

Consecutively isolated gonococcal strains from 10 representative geographical areas in Sweden were serogrouped according to the previously described W antigen class. The majority of the strains were antibiotic susceptibility tested and approximately one fourth of them were auxotyped. Statistically significant differences of the serogroup patterns were demonstrated between the 2 largest towns, which represented highly urbanized areas where serogroup W II dominated, and the middle sized towns with adjoining rural districts, where serogroup W I dominated. The serogroup patterns of the strains isolated in 3 university towns were representative for Sweden as a whole. Statistically significant differences were demonstrated between urban and rural areas with regard to the susceptibility of gonococci to beta-lactam antibiotics. About 95% of serogroup W I strains were highly sensitive to ampicillin whereas about 65% and 90% of W II and W III strains, respectively, showed decreased susceptibility. The majority of the auxotyped strains belonged to 4 main types: Pro-, Pro-Arg-Ura-, AHU- and prototrophic. The majority of the AHU- strains belonged to serogroup W I and were highly susceptible to beta-lactam antibiotics and tetracycline. Many of the Pro-Arg-Ura-strains belonged to 2 particular subserogroups within serogroup W II and showed increased resistance to beta-lactam antibiotics. Serological classification of gonococci by co-agglutination is a simple and rapid technique without need of special equipment. It could serve 2 purposes: 1) as a confirmation test for gonococci cultured from clinical specimens; 2) for serogrouping of gonococcal isolates to study the epidemiology of gonorrhoea with regard to geographical areas, race, sexual preference, treatment failure and other demographic and medical factors.

Cross-Sectional Studies↗

Difference in prevalence of hepatitis B markers in children born either in Sweden or in Turkey of Assyrian immigrants.

Sera from 95 children below 20 years of age born to Assyrian immigrants were tested for markers for hepatitis B virus (HBV). HBV markers were found in 26% of the study population. However, no markers were demonstrated in children born in Sweden. Of the 62 children born in Turkey or the Middle East 39% had HBV markers and 4 (6.5%) had HBsAg. Three of the 4 HBsAg+ children had anti-HBe and 1 HBeAg. These results suggest that the transmission of HB in Assyrians may be mainly horizontal rather than vertical. Children of Assyrian immigrants born in Sweden do not seem to constitute a risk group for transmission of HB, whereas those born in Turkey or the Middle East constitute the same risk as reported in a general population of Turks.

Adolescent↗

Genetic correlations among protein yield, productive life, and type traits from the United States and diseases other than mastitis from Denmark and Sweden.

Sire genetic evaluations for protein yield, productive life, and selected type traits from the US were correlated with sire evaluations for disease from Denmark and Sweden and were then adjusted to approximate genetic correlations. Disease categories from Denmark included reproductive diseases, foot and leg diseases, metabolic and digestive diseases, and all diseases other than mastitis. Genetic evaluations for Denmark were from separate analyses for each disease category using a multiple-trait sire model with first, second, and third lactations handled as multiple traits. Evaluations from Sweden for all diseases other than mastitis were from a single-trait sire model using only first lactations. In addition, Danish and Swedish genetic evaluations were regressed on US type evaluations to test for quadratic relationships. Relationships were based on 104 bulls with US and Danish evaluations (88 with US type) and 84 bulls with US and Swedish evaluations (83 with US type). Genetic correlations between US protein yield and diseases were unfavorable, but correlations were favorable between productive life and disease. Genetic correlations among US type and diseases were around zero, except for correlations with US dairy form (range -0.34 to -0.73). Genetic correlations calculated from residual correlations (adjusted for predicted transmitting abilities for milk) between productive life and diseases were favorable (range 0.29 to 0.51). Genetic correlations calculated from residual correlations (adjusted for predicted transmitting abilities for milk) between dairy form and diseases ranged from -0.10 to -0.53. Selection for increased productive life may reduce disease occurrences, but selection for higher dairy form scores will increase disease occurrences.

Animals↗

Overall outcome in aneurysmal subarachnoid hemorrhage. A prospective study from neurosurgical units in Sweden during a 1-year period.

The present prospective study, with participation of five of the six neurosurgical centers in Sweden, was conducted to evaluate the overall management results in patients with aneurysmal subarachnoid hemorrhage (SAH). The participating centers covered 6.93 million (81%) of Sweden's 8.59 million inhabitants. All patients with verified aneurysmal SAH admitted between June 1, 1989, and May 31, 1990, were included in this prospective study. A uniform management protocol was adopted involving ultra-early referral, earliest possible surgery, and aggressive anti-ischemic treatment. A total of 325 patients were admitted during the study period, 69% within 24 hours after hemorrhage. On admission, the patients were graded according to the scale of Hunt and Hess: 43 patients (13%) were classified in Grade I, 119 (37%) in Grade II, 53 (16%) in Grade III, 76 (23%) in Grade IV, and 34 (11%) in Grade V. Nimodipine was administered to 269 of the 325 patients: intravenously in 218, orally in 15, and intravenously followed by orally in 36. At follow-up examination 3 to 6 months after SAH, 183 patients (56%) were classified as having made a good neurological recovery, 73 patients (23%) suffered some morbidity, and 69 (21%) were dead. Surgery was performed in 276 (85%) of the patients; emergency surgery with evacuation of an associated intracerebral hematoma was carried out in 30 patients. Early surgery (within 72 hours after SAH) was performed in 170 individuals, intermediate surgery (between Days 4 and 6 post-SAH) in 29 patients, and late surgery (Day 7 or later after SAH) in 47 individuals. Of 145 patients with supratentorial aneurysms who were preoperatively in Hunt and Hess Grades I to III and who were treated within 72 hours, 81% made a good recovery; in 5.5% of patients, the unfavorable outcome was ascribed to delayed ischemia. It is concluded that, among patients with all clinical grades and aneurysmal locations, almost six of 10 SAH victims referred to a neurosurgical unit can be saved and can recover to a normal life.

Adolescent↗

A one-year study of foodborne illnesses in the municipality of Uppsala, Sweden.

Surveillance was enhanced and a retrospective interview study performed in 1998-99 to determine incidence, causes, and costs of foodborne illnesses in Uppsala, Sweden. Sixty-eight percent of the detected foodborne illness incidents were single cases, and 32% were outbreaks. Most (85%) of the incidents came to the attention of the municipal authorities through telephone calls from affected persons. Calicivirus, Campylobacter spp., and Staphyloccocus aureus were the most common etiological agents; meat, meat products, and mixed dishes were the most implicated food categories. The incidence of foodborne illness was estimated to be 38 cases per 1,000 inhabitants per year. The estimated average costs per illness were 2,164 Swedish Krona (SEK) ($246) to society and 500 SEK ($57) to the patient. The annual cost of foodborne illnesses in Sweden was estimated to be 1,082 million SEK ($123 million).

Adolescent↗

The 2000 tularemia outbreak: a case-control study of risk factors in disease-endemic and emergent areas, Sweden.

A widespread outbreak of tularemia in Sweden in 2000 was investigated in a case-control study in which 270 reported cases of tularemia were compared with 438 controls. The outbreak affected parts of Sweden where tularemia had hitherto been rare, and these "emergent" areas were compared with the disease-endemic areas. Multivariate regression analysis showed mosquito bites to be the main risk factor, with an odds ratio (OR) of 8.8. Other risk factors were owning a cat (OR 2.5) and farm work (OR 3.2). Farming was a risk factor only in the disease-endemic area. Swollen lymph nodes and wound infections were more common in the emergent area, while pneumonia was more common in the disease-endemic area. Mosquito bites appear to be important in transmission of tularemia. The association between cat ownership and disease merits further investigation.

Agriculture↗

Human hantavirus infections, Sweden.

The prevalent human hantavirus disease in Sweden is nephropathia epidemica, which is caused by Puumala virus and shed by infected bank voles (Clethrionomys glareolus). To evaluate temporal and spatial patterns of this disease, we studied 2,468 reported cases from a highly disease-endemic region in northern Sweden. We found that, in particular, middle-aged men living in rural dwellings near coastal areas were overrepresented. The case-patients were most often infected in late autumn, when engaged in activities near or within manmade rodent refuges. Of 862 case-patients confident about the site of virus exposure, 50% were concentrated within 5% of the study area. The incidence of nephropathia epidemica was significantly correlated with bank vole numbers within monitored rodent populations in part of the region. Understanding this relationship may help forestall future human hantavirus outbreaks.

Adolescent↗

Continuing education in Sweden--to what purpose?

BACKGROUND: Continuing education (CE) or recurrent education has long been used in Sweden to maintain and develop the competence of health care professionals. The purpose of this article is to describe the effects of CE with regards to changes in work activities, cognitive abilities, the use of knowledge, and involvement in research and development projects. METHOD: A questionnaire was distributed to all students (966 individuals) in CE courses at the Department of Advanced Nursing Education at Göteborg University, Sweden. RESULTS: Results indicated that CE leads to enhanced work satisfaction, extended work relevant competence, the attainment of professional goals, and enhanced self-confidence. The results further suggest that CE has not led to increased salaries, more power or authority, or greater possibilities to influence working situations. CONCLUSION: CE leads to positive development at the level of individual knowledge and competence but is not always reflected in changes in the respondents' working situations or in forms of rewards. The question is: How long are nurses prepared to continue raising their professional competence without compensation in terms of higher pay, better professional recognition, and new duties?

Adult↗

Ockelbo disease in Sweden: epidemiological, clinical, and virological data from the 1982 outbreak.

An outbreak of Ockelbo disease, a syndrome with rash, arthralgia and moderate fever reactions, which occurred in Sweden 1982 is described. A virus, designated Edsbyn 5/82, isolated from mosquitoes and closely related to Sindbis virus (Togaviridae: Alphavirus) is the probable etiologic agent. Sixty-five patients with typical clinical manifestations of the disease became ill in August 1982 and exhibited antibody titer rises against both Edsbyn 5/82 and Sindbis viruses by indirect immunofluorescence and the mixed hemadsorption technique. With the latter method, but not by the neutralization tests, antibody titers were significantly higher against Edsbyn 5/82 virus than against Sindbis virus. Most cases occurred in central Sweden between the 60th and 63rd parallels. The frequency of antibody in healthy individuals (blood donors) within the endemic area was 2-3% and in foci with high incidence, antibody positivity reached 8%. Antibody frequencies continuously decreased south and north of this area. Antibody decline was followed in a group of 12 patients who had Ockelbo disease in 1981. Mixed hemadsorption titers were 4-6 times higher against Edsbyn 5/82 than against Sindbis virus. A 2- to 4-fold antibody decline took place from early convalescence to 20 months after onset.

Adolescent↗

Association of a Sindbis-like virus with Ockelbo disease in Sweden.

An alphavirus isolated from Culiseta mosquitoes has been associated with Ockelbo disease, an exanthema arthralgia syndrome occurring in Sweden. The isolate was made from mosquitoes collected in Edsbyn (central Sweden), an area with considerable Ockelbo disease morbidity. This isolate proved to be indistinguishable from Sindbis virus by complement-fixation and hemagglutination-inhibition tests, and was antigenically related to Sindbis in plaque reduction neutralization tests. Patients with Ockelbo disease developed neutralizing antibodies to the virus in their convalescent sera, suggesting that it is the etiologic agent of the disease.

Aedes↗

Antigenic comparison of Ockelbo virus isolates from Sweden and Russia with Sindbis virus isolates from Europe, Africa, and Australia: further evidence for variation among alphaviruses.

The plaque-reduction neutralization test (PRNT) was used to compare 15 isolates of Ockelbo virus from Sweden, one isolate of Ockelbo virus from Russia, the Egyptian prototype Sindbis virus, and Sindbis-like viruses from Slovakia, South Africa, Cameroon, and Australia. Strains from northern Europe (Sweden and Russia) were indistinguishable by PRNT. We observed some antigenic variation between isolates of Sindbis virus from Europe, Africa, and Australia. An Australian strain (C-377) was shown to be distinct from prototype Sindbis virus, and the Acrocephalus strain from Slovakia was shown to be identical to prototype Sindbis virus. All other strains, including Ockelbo virus isolates, were shown to be subtypes of prototype Sindbis virus.

Alphavirus↗

A summary of reported foodborne disease incidents in Sweden, 1992 to 1997.

Reports of foodborne disease incidents in Sweden from 1992 to 1997 are summarized. The results are based on reports from the municipal environmental and public health authorities to the National Food Administration and from medical authorities to the Swedish Institute for Infectious Diseases Control. A total of 555 incidents, of which 84% were outbreaks, were reported, involving 11,076 ill people. In 66% of the incidents, no disease agent was determined. Bacterial agents were implicated in 25% and viruses in 8% of the incidents. Calicivirus was the most reported agent both in terms of incidents and cases. Mixed dishes was the food category most often implicated in outbreaks, and smorgasbord and casserole or stews were the subcategories that caused the most cases. The place of consumption was unknown in 8% of the incidents. In about 60% of the incidents, the implicated food was consumed in commercial food establishments; in approximately 20% of incidents, it was consumed at home. The average annual incidence of reported foodborne disease in Sweden was estimated to be 21 cases per 100,000. The average annual incidence of reported foodborne salmonellosis and campylobacteriosis was estimated to be 2.0 and 0.6 cases per 100,000, respectively. The awareness and motivation to report foodborne diseases need to be improved, but additional sources of information are needed to counteract some of the limitations of reporting discussed in this work.

Caliciviridae↗

Antibodies to Ockelbo virus in three orders of birds (Anseriformes, Galliformes and Passeriformes) in Sweden.

Sera from 324 birds collected in an Ockelbo virus disease endemic area in central Sweden were examined for the presence of specific antibodies to Ockelbo virus by a plaque reduction neutralization test. Birds examined belonged to the orders Anseriformes (n = 207), Galliformes (n = 66) and Passeriformes (n = 51). Ockelbo virus neutralizing antibodies were detected in 26 (8%) of the specimens, including species from each of the three orders tested. Specific antibodies found in caged birds and in 6- to 10-week-old birds suggested local transmission. The highest antibody prevalence (27%, 14/51) was observed in the Passeriformes in which 5 of 9 species tested contained antibodies. The high antibody prevalence in passeriforms and the very large population of this group in relation to other avian groups in Sweden gives them a high potential as amplification hosts for Ockelbo virus.

Alphavirus↗

Is the small mammal (Clethrionomys glareolus) or the tick vector (Ixodes ricinus) the primary overwintering reservoir for the Lyme borreliosis spirochete in Sweden?

We determined the capacity of bank voles (Clethrionomys glareolus) to infect feeding Ixodes ricinus ticks with Borrelia burgdorferi sensu lato (infectivity), during June to October 1991 and June to September 1992 in south-central Sweden. In both years, the infectivity of older voles to ticks was higher in August to September (48% to 59%) than in June to July (20% to 32%). We propose that the infectivity of bank vole populations in Sweden decreases during winter and spring due to death of highly infective voles and recruitment of uninfective young ones, and that the tick vector, rather than the mammalian host, is the primary overwintering reservoir of B. burgdorferi.

Animals↗

Serological survey of Toxoplasma gondii infection in free-ranging Eurasian lynx (Lynx lynx) from Sweden.

To investigate the prevalence of Toxoplasma gondii infection in free-ranging Eurasian lynx (Lynx lynx) in Sweden, serosanguinous fluids and feces were collected from 207 carcasses of lynx killed or found dead from 1996 to 1998. Sera were tested for antibodies against T. gondii by the direct agglutination test, and 156 (75.4%) of the sera tested positive at antibody titers>or=40. Antibody prevalence was significantly lower in lynx originating from the northern parts of Sweden than in lynx from the more southern regions that are more densely populated by humans. Age-related differences also were found, with a significantly lower prevalence (55%) in juvenile (<1-yr-old) than in subadult and adult animals (82%). There was no significant difference in seroprevalence between males and females. Oocysts typical of T. gondii were not detected in any of the fecal samples.

Animals↗

[A study of Creutzfeldt-Jakob disease during 1985-96. No indication of cases of the "mad cow disease" in Sweden].

A retrospective study of Creutzfeldt-Jakob disease (CJD) in Sweden during the period 1985-96 yielded an annual incidence of 1.18 per million. Data for incidence, age distribution (at onset and at death), and duration of illness were similar to those of other countries, with the exception of new variant CJD (nvCJD) cases in the UK, and as far as can be judged the symptomatology was also similar. So far, there is no indication of the occurrence of any cases of nvCJD in Sweden.

Animals↗