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PubMed1997

The current status of nursing informatics in undergraduate nursing programs: comparative case studies between Sweden and Australia.

During the last ten years, the inclusion of education in health information systems has assumed an important role in graduate programs for health professionals. More recently, attention has focused on undergraduate programs. Throughout the world schools of nursing, organisations and associations are addressing the issue of educational offerings in nursing informatics. This paper reports on the status of nursing informatics at undergraduate level. Nurse academics from Gävle and Lund in Sweden, and from Melbourne and Sydney in Australia, took part in a survey of the respective nursing courses. The purpose of the study was to identify and describe examples of types of nursing informatics courses in Australia and Sweden. A convenient sample of academics were approached and interviewed. The results of the survey illustrate, in the schools surveyed, the slow emergence of nursing informatics into nursing curricula.

Curriculum↗
PubMed1999

Unemployment, labour market policy and health in Sweden during years of crisis in the 1990's.

OBJECTIVE: To give an overview of an economic crisis in Sweden and its health consequences for employed and unemployed groups together with some health-related data from participants in labour market programmes. OUTCOME AND CONCLUSIONS: During the first half of the 1990's, Sweden was hit by a pervasive crises characterised by steeply increasing unemployment and growing job insecurity. Long-term survey data show that somatic well-being continued to improve in the population, while psychological well-being deteriorated, and this deterioration was of a similar magnitude among unemployed and employed groups. Two non-traditional labour market programmes for unemployed individuals are briefly described. Both programmes resulted in some positive effects on subjective health, which, however, were not corroborated by psychophysiological data. It is argued that the employment-unemployment dichotomy can be replaced by a dimensional view on labour market connection, as insecure jobs may have as detrimental health effects as open unemployment. Impediments to empowerment in the labour market programmes are discussed.

Health Status↗
PubMed1999

Increased incidence rates but no space-time clustering of childhood astrocytoma in Sweden, 1973-1992: a population-based study of pediatric brain tumors.

BACKGROUND: Incidence patterns, trends, and spatial and/or temporal clustering of childhood brain tumors were analyzed in the population-based national cancer registry of Sweden. METHODS: Temporal trends were analyzed by a logistic regression procedure in which the average annual percentages of change in incidence rates and the corresponding 95% confidence intervals (CIs) were calculated. Spatial and/or temporal clustering were investigated by using a geographic information system and analyzed with a modified version of the Knox test and a spatial scan statistic. RESULTS: Primary brain tumors in 1223 children ages 0-15 years were registered during 1973-1992. In 80% of cases, the tumor was classified as malignant. Conclusive histopathology was classified in 1142 cases. The age-adjusted incidence rate for all subtypes of brain tumors was 35.9 cases per million children, and for malignant brain tumors 28.6. A statistically significant increasing temporal trend was observed for the group of malignant brain tumors as a whole (P=0.0001) and the astrocytoma subgroup (P=0.0001). The annual average increases were 2.6% (95% CI=1.5-3.8) and 3.0%, respectively (95% CI=1.6-4.4). The increase in astrocytoma cases was significantly larger for girls than for boys (P=0.021) and was most striking for girls ages 6-15 years, with an annual average increase of 4.7%. Rates had not increased for the primitive neuroectodermal tumor (PNET)/medulloblastoma or ependymoma subgroups. The geographic distribution of astrocytoma cases was homogenous. No statistically significant space-time interaction or local clusters in space and/or time were found for astrocytomas only or when astrocytomas were grouped with PNETs/medulloblastomas and ependymomas. CONCLUSIONS: The results show statistically increased incidence rates of childhood astroglial tumors, predominantly for girls, in Sweden during the period 1973-1992, but no clustering in space or time.

Adolescent↗
PubMed1998

Dental condition and identification marking of dentures in homes for the elderly in Göteborg, Sweden.

Denture marking is of crucial importance especially in homes for the elderly where dentures could be misplaced, particularly during cleaning by staff where there is a chance of loss or mix-up. Recent research regarding denture marking in homes for the elderly shows that only about 50% of the dentures were marked and that the issue should receive attention. The aim of this study was to investigate the number of subjects with natural teeth and the number of edentulous subjects in homes for the elderly in Göteborg, Sweden. The results of the present work show that only about 35% of the complete dentures were ID-marked. Thus, even if the number of complete denture wearers is few, in Sweden presently there are predictions that dentures will become more common in the future, and also in other parts of the world owing to the socio-economic conditions of today and likely in the future.

Aged↗
PubMed1999

Population density and perinatal mortality in Norway and Sweden 1975-1988.

Data from the medical birth registries in Norway and Sweden were used to study geographical variations in perinatal mortality in the two countries. The study population comprised 1.4 million single births during 1975-79 and 1985-88. Perinatal death (n=9,834) for infants with a birthweight of 1,000 g or more was the main measure of outcome. In both periods and in both countries, perinatal mortality was inversely associated with population density and annual number of births, with relative risks amounting to 1.4 in Norway and 1.2 in Sweden. Among live births, these gradients were observed in deaths from asphyxia or immaturity in the first time period, and in deaths from congenital malformations in the second time period. As care for premature infants and infants with respiratory problems improves, geographical variations in perinatal mortality may to a larger extent depend on differences in medical care of infants affected by congenital malformations as well as differences in efforts to reduce the prevalence at birth of serious congenital malformations.

Birth Order↗
PubMed1999

[The role of the social worker in mental health services--historical development in Sweden].

In a historical development of psychiatry as a medical discipline, there are periods when isolating the mentally disturbed patients and submitting them to crude treatments was a way to try to solve their mental problems. However, it was also noted that the patients often had social problems aggravating their treatment, or leading to deterioration of their psychical status when the patient was returning to his initial environment after completed therapy. That was the reason for social workers to overtake an important role in solving the social problems of mentally ill people in Sweden. The idea was to animate a social worker to act as "curator", which means, important person with strong social attitude, good communicational skills, and capable to actively participate in solving the social problems of mentally ill people. In this article is presented the role and methodology of a social worker acting as a curator in Sweden.

History, 20th Century↗
PubMed1999

Distribution of caries in 12-year-old children in Sweden. Social and oral health-related behavioural patterns.

OBJECTIVE: To describe the distribution of caries in 12-year-old children in Sweden according to socio-demographic and oral health related behaviour. PARTICIPANTS: The study group consisted of 3,373 12-year-old children residing in catchments of 26 different public dental health clinics in Sweden, geographically well represented. METHOD: The clinical examination for dental caries was performed by 28 calibrated dentists. A questionnaire on lifestyle was distributed to the children with questions on ethnicity, socio-economic level and oral health as well as overall health attitudes. RESULTS: The proportion of 12-year-old children with no experience of dentine caries was 47% and 35% were completely free from all caries. Intraoral distribution of caries showed most lesions on the first molar mesial surface, with 80% enamel and 20% dentine caries. Almost all children brushed their teeth twice a day and a third of the children had an extra intake of fluoride. Decayed surfaces including enamel caries (DeS) was chosen as a measure of ongoing caries and used when dividing children into three caries groups; caries free (50%), 1-3 lesions (40%) and the high caries group (10%) with more than 3 lesions. These groups showed distribution differences. More non-Swedish children, children from workers' homes, and children who brushed their teeth less than twice a day were found in the high caries group. More children from workers' homes living in big cities and snacking more than once a week were also found in the high caries group. This could not be shown for other social groups. Also children who had an extra intake of fluoride were classified in the high caries group.

Child↗
PubMed1976

An experience in dental education in Sweden.

On the basis of a one-year experience as a visiting professor at the University of Lund School of Dentistry in Malmmo, Sweden, the author discusses dental education in the Swedish system and compares it to its American counterpart. The power and independence of the department chairmen and the absolute dependence on research productivity as the criterion for advancement in the academic hierarchy are pervading influences in Swedish dental education. It is difficult to undertake curriculum study and revision in Sweden and to achieve coordination in the educational program. Research efforts in the Swedish schools are of high quality and are remarkably prolific.

Community Dentistry↗
PubMed2000

Incidence studies of systemic lupus erythematosus in Southern Sweden: increasing age, decreasing frequency of renal manifestations and good prognosis.

OBJECTIVE: To identify all new cases of systemic lupus erythematosus (SLE) within a defined area in Southern Sweden with validated methods of retrieval, and to compare 2 cohorts assembled during 1981-86 and 1987-91. METHODS: The catchment area, the health care district of Lund-Orup, had during 1981-91 a mean adult population (> 15 years of age) of 172,300 individuals. During 1987-91 we identified 379 individuals with potential SLE diagnosis from diagnosis registers and from central laboratory databases. Out of these, 121 had a previously known SLE diagnosis. All patient records were reviewed and patients with possible SLE not already known at the SLE unit were invited and examined. Organ damage was recorded as the Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) damage index. RESULTS: Forty-one new SLE cases were diagnosed during 1987-91, giving a median annual incidence of 4.8/100,000 inhabitants, with a median age at diagnosis of 47 years. The incidence is similar to that found 1981-86 (4.5/100,000/year) in the same population using the same methods for retrieval. Age and sex-specific incidence 1981-91 was notably highest at the age of 65-74 (14.1/100,000/year) in women and age 65-74 (3.2/100,000/year) in men. The point prevalence on December 31, 1986, was a 42/100,000 and on December 31, 1991, 68/100,000. The 5 year survival was 93% and 10 year survival 83%. While overall survival was not decreased, 10 year survival was slightly reduced compared with an age and sex matched healthy population (p = 0.03). In the 1987-91 cohort the sensitivity of the American Rheumatism Association criteria was 92.7% and the specificity was 94%. The frequency of renal manifestations was decreased in the latter cohort. The damage rate was highest during the first year and then constant during a 5 year followup, and was similar in the 2 cohorts. Damage that related to atherosclerosis was common and cardiovascular disease was the most common cause of death. CONCLUSION: The incidence of SLE in Sweden was notably constant during the 11 years 1981-91. Mortality was low and only late mortality (> 10 years disease duration) exceeded that in an age and sex matched control population. Atherosclerosis was the main cause of damage and mortality. Specificity and sensitivity of the ACR classification criteria are high in this epidemiologically recruited cohort.

Adolescent↗
PubMed2000

Incidence of Guillain-Barré syndrome in Sweden 1996.

We describe the incidence of Guillain-Barré syndrome (GBS) in Sweden in 1996. Information of incident GBS patients was mainly collected by a multicentre network of 18 neurologists prospectively monitoring a general population with 4.48 million inhabitants across the country and complemented with data from the national hospital in-patient registry. GBS diagnoses for all patients were validated by neurologists. While 53 patients with GBS were identified by the network neurologists from the study population, the other 20 GBS patients were recognized after carefully reviewing the registered data. There were 44 (60%) male patients and 29 (40%) female patients and the mean age at onset for all patients was 48.6 (SD 24.3) years. The GBS incidence, age-adjusted to the European standard population, was 1.51 (95% CI 1.18-1.90) per 100 000 person-years in 1996, higher in males and increased with age. When compared with selected studies, the GBS incidence in Sweden is moderately high, and the variation of GBS incidence in Europe seems to be small.

Adolescent↗
PubMed2000

Rheumatoid arthritis in Sweden. Drug prescriptions, costs, and adverse drug reactions.

OBJECTIVE: Many patients with rheumatoid arthritis (RA) need continuous medication, bringing considerable costs for drugs and a need for monitoring adverse drug reactions. We studied drug exposure, drug costs, and adverse drug reactions in patients with RA in Sweden from 1987 to 1997. METHODS: Prescription patterns, drug costs, and adverse drug reactions, and their distributions and trends were analyzed by cross sectional annual data. Drug exposures and costs were assessed from the National Diagnosis and Therapy Survey. All costs were recalculated to the 1997 level using the drug price index. Information on adverse drug reactions was obtained from the national pharmacovigilance system. RESULTS: The drug prescription level was, on average, 2 defined daily doses (DDD) throughout the study period. Nonsteroidal antiinflammatory drugs (NSAID) accounted for > 40% of the drugs prescribed, methotrexate (MTX) 10%, corticosteroids 10%, and sulfasalazine 5%. Analgesics and opioids made up 14% of prescriptions - a low estimate considering the availability of over-the-counter preparations. Disease modifying antirheumatic drugs (DMARD) increased their proportion from 28.5 to 39.3%. Total costs were stable at $16 million US annually. NSAID costs decreased, while those of sulfasalazine, MTX, and cyclosporine increased. On average, 91 adverse drug reactions were reported annually. Hematological reactions (agranulocytosis, thrombocytopenia, leukopenia, pancytopenia) predominated, constituting 21% of reported reactions. Skin and gastrointestinal reactions, mainly mild, accounted for 15 and 14%, respectively. Deaths from adverse drug reactions were uncommon, about 3 per year, and were mainly attributed to hematological reactions. CONCLUSION: The total volume as well as the total cost of drug consumption for RA in Sweden was relatively constant during our 11 year observation period, despite a notable increase in the use of DMARD. This was mainly due to a decrease in costs per DDD of NSAID, and an increased use of cyclosporine. Drug related adverse reactions were dominated by hematological reactions, and fatal events were few. This emphasizes the need for an extended evaluation of which safety procedures are most cost effective for monitoring the drugs used for RA.

Adverse Drug Reaction Reporting Systems↗
PubMed2000

Role of alcohol in unnatural deaths: a study of all deaths in Sweden.

BACKGROUND: Most previous research has concentrated on the role of alcohol in one type of unnatural death in a selected population, but the present objective was to investigate the role of alcohol in all unnatural deaths (autopsied and not autopsied). METHODS: All cases of unnatural death from 1992 through 1996 in Sweden were analyzed (n = 23,132). Death was attributed at least in part to alcohol if the deceased was a "known alcoholic"; if the underlying or contributing cause of death was alcohol-related; if the deceased had an alcohol-related inpatient diagnosis during the 3-year period prior to death; or if the deceased tested positive for blood alcohol. RESULTS: Just over 28% of the unnatural deaths could be associated with alcohol; the association with alcohol was more than twice as common in deaths of males (35%) as in females (16%). When only autopsied cases or only blood-tested cases were taken as the denominators, 38% and 44%, respectively, of the deaths were associated with alcohol. Alcohol involvement also was twice as common in intentional deaths (36%) as in unintentional deaths (18%). The intoxication group (78%) had the highest fraction of deaths that could be associated with alcohol, followed by the undetermined group (62%), homicide (49%), fire (41%), suicide (35%), asphyxia (29%), traffic (18%) and fall (9%) groups. In the 20- to 59-year age group, alcohol involvement was found in 51% of the males and 35% of the females (47% for males and females combined). CONCLUSIONS: The present estimates are conservative; alcohol involvement in unnatural deaths probably is even higher, up to 44% of the total. The present estimation is an important step in policy-making to lower the number of alcohol-related deaths in Sweden.

Accidents↗
PubMed2000

Suitability of the lang II random dot stereotest for detecting manifest strabismus in 3-year-old children at child health centres in Sweden.

The aim of the study is to examine the suitability of the Lang II Random Dot Stereotest for use by district nurses in primary healthcare centres. The Lang Stereotest is an inexpensive method. It is easy to apply, but the child's co-operation is required. Approximately 100 district nurses were given detailed information and instruction by an orthoptist prior to a randomized population-based community trial initiated in 1993. In the county of Uppsala in Sweden, all 4293 children born in 1990 were randomized to one of the following four study groups: intervention, control, reliability or validity. All children were followed from birth to 6.5 y of age with respect to the occurrence of strabismus. The kappa statistic for test-retest reliability among district nurses was 0.65 (95% CI, 0.51-0.80). A validation of the outcomes of district nurses' against orthoptists' examinations using the Lang Stereotest showed a sensitivity of 0.33 (95% CI, 0.09-0.65) and a specificity of 0.85 (0.80-0.89). Of 113 cases of strabismus, 53% were detected within the first 3 y of life. Examination of 1132 3-y-old children using the Lang Stereotest enabled the district nurses to detect 11 new cases of strabismus. Only one of these cases was referred to an orthoptist as a direct consequence of the screening. The Lang Stereotest showed low reliability and low validity in this community trial. It is concluded that the Lang II Random Dot Stereotest is not suitable for the screening of manifest strabismus in unselected populations of 3-y-old children in Sweden, where a large proportion of cases of strabismus is detected during the first 3 y of life.

Age Factors↗
PubMed2001

[Trends in dietary habits in Denmark and Sweden since the 1960s].

Dietary habits in Denmark and Sweden are compared during the period 1965-1998 based on data from Food Balance Sheets. Common trends are an increase in consumption of vegetables, fruits, berries and meat and a decrease in consumption of fats. In the latest ten years percentage of energy from fat has also decreased. Denmark has a higher consumption of fats and meat and a lower consumption of fruits, berries and fish. These differences contribute to a higher percentage of energy from fat in the Danish diet compared to the Swedish. Data consequently indicate that dietary habits in Sweden are healthier than in Denmark. Differences in dietary habits may have contributed to differences in life expectancy between the countries. Disparities in dietary habits are seen in both countries. The tendency is greater social differences in Denmark.

Denmark↗
PubMed2001

Prevalence of multiple sclerosis in Västerbotten County in northern Sweden.

OBJECTIVE: To estimate the prevalence and clinical characteristics of multiple sclerosis (MS) in Västerbotten County in northern Sweden. METHODS: Individuals with MS were identified from several sources. A follow-up interview and/or examination was performed in 94% of cases still living in the area during 1997-99. Onset adjusted prevalence and a definition of onset symptoms were applied. RESULTS: A total of 313 cases were identified, resulting in an onset adjusted crude prevalence of MS for January 1990 of 125/105 (95% confidence interval (CI): 112-140). Female predominance was evident (163/105 (95% CI: 142-187) vs 86/105 (95% CI: 71-104)). Diagnostic coding registers were the most important source for identification of cases. CONCLUSIONS: The crude prevalence of MS in Västerbotten was higher than previous reports from other major areas in Scandinavia. The adjusted prevalence was significantly higher when compared with a previous study from Göteborg, south-western Sweden. The methodology used in this study gives a high degree of case ascertainment and increases the comparability of multiple sclerosis epidemiological studies.

Adolescent↗
PubMedDate not supplied

Teenage childbearing and long-term socioeconomic consequences: a case study in Sweden.

CONTEXT: Whether long-term socioeconomic problems experienced by many teenage mothers are a reflection of preexisting disadvantage or are consequences of teenage motherhood per se remains unclear. METHODS: National data on all women born in Sweden from 1941 to 1970 who were younger than age 30 when they first gave birth (N=888,044) were analyzed. The outcome measures, assessed during adulthood, were employment status, socioeconomic status, educational attainment, single motherhood, family size, receipt of disability pension and dependence on welfare. Multiple logistic regression techniques were used to adjust for maternal birth cohort and for socioeconomic background of the woman's family. RESULTS: Compared with Swedish women who first gave birth at ages 20-24, those who were teenage mothers had significantly increased odds of each unfavorable socioeconomic outcome in later life, even after the data were adjusted for family socioeconomic situation and maternal birth cohort. For example, teenage motherhood was positively associated with low educational attainment (odds ratios of 1.7-1.9, depending on the specific age during adolescence when the woman gave birth), with single living arrangements (odds ratios, 1.5-2.3), with high parity (odds ratios, 2.6-6.0), with collecting a disability pension (odds ratios, 1.6-1.9) and with welfare dependency (odds ratios, 1.9-2.6). These trends were usually linear, with the highest odds ratios corresponding to women who had had their first child at the youngest ages. CONCLUSIONS: A longitudinal analysis of record-linkage data from Sweden supports the view that childbearing during adolescence poses a risk for socioeconomic disadvantage in later life--even for adolescents from relatively comfortable backgrounds and for those who studied beyond elementary school.

Adolescent↗
PubMed2001

Introduction of solids and formula to breastfed infants: a longitudinal prospective study in Uppsala, Sweden.

UNLABELLED: The introduction of solids and formula was studied among 506 breastfed infants in Uppsala, Sweden, based on daily recordings during the first year. The mothers had previously breastfed at least 1 infant for at least 4 mo. Thirty-four per cent of the infants were introduced to solids before the age of 4 mo (4-6 mo is recommended in Sweden). Accustoming the infants to solids was a lengthy process. Life-table analyses showed a median duration of 28 d from the first introduction of solids to consumption of >10 ml daily, and 46 d before the infants ate > or = 100 ml of solids in 1 d for the first time. These durations were longer the younger the infant was at the introduction of solids. Thirty-two per cent of infants given formula consumed > or = 100 ml the first time it was given, and 49% did so within I wk, regardless of infant age. CONCLUSION: Parents and healthcare personnel need to be aware that accustoming breastfed infants to solid food is a lengthy process, and that there is a strong age effect on this duration. It is also important to consider what consequences the (usually) more abrupt introduction of formula might have on breastfeeding.

Breast Feeding↗
PubMed2001

Traumatic experiences and post-traumatic stress reactions in children from Kurdistan and Sweden.

UNLABELLED: This paper examines the types and scores of traumatic experiences, post-traumatic stress symptom and behavioural disorders among Kurdistanian refugee children in Sweden and a comparative Swedish group. The Harvard-Uppsala Trauma Questionnaire for Children (HUTQ-C), the Post-Traumatic Stress Disorder for Children (PTSS-C) and the Child Behaviour Checklist (CBCL) were administered in interview form to 32 children from each sample, controlled for age, gender and trauma levels. No significant differences were found between the 2 samples regarding types of traumatic events, frequencies of post-traumatic stress disorder, post-traumatic stress symptom scores or behavioural problem scores, except in 3 aspects: Kurdistanian children reported more war experience and being lost, while Swedish children presented higher frequencies of leisure-time accidents. CONCLUSION: This study supports the assumption that children differ from adults by showing more similarities than differences regarding traumatic experiences and post-traumatic stress reactions, after being exposed to an equivalent number of reported traumatic events. The refugee children's stay in Sweden can be considered as a healing factor.

Adolescent↗