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PubMed1991

Early oral contraceptive use and premenopausal breast cancer--a review of studies performed in southern Sweden.

In southern Sweden, extensive oral contraceptive use (OC use) among young women was a reality during the 1960s, thus making our region especially suited for studies investigating the hypothesis that early OC use is associated with the development of premenopausal breast cancer after a possible latency time between the exposure and the disease. The results of this study revealed that the risk of developing premenopausal breast cancer in women, who during the 1960s used the pill as teenagers, is five times greater than nonusers. The risk for early users is further modified by the duration of use at an early age, implying a dose-response relationship. Later use of OCs is not associated with an increased risk for the disease. Women with breast cancer, who at an early age have used the pill, have larger breast tumors, lower estrogen receptor concentrations of their primary tumor, and a worse prognosis compared with later and nonusers with breast cancer. The incidence of breast cancer in Sweden rapidly increased in women 25 to 40 years of age between 1970 and 1984. Conventional risk factors or a change in diagnostic activities of breast cancer cannot explain the increase in incidence which could be due to the OC exposure. Studies on the risk with modern OCs must wait another 20 years because of a too short latency time.

Adolescent↗

PubMed1991

Risk factors for coronary heart disease in New Zealand and Sweden: Dunedin and Uppsala compared.

OBJECTS: to compare men and women over the age of 35 years in Dunedin (New Zealand) and Uppsala (Sweden) in respect of anthropometric values, dietary habits and certain coronary heart disease risk factors in view of known differences in coronary mortality between the two countries. METHODS: one hundred and ninety-five Dunedin and 94 Uppsala residents were chosen randomly from the respective populations, in the former city by electoral roll, in the latter by use of unique personal number. Measurements of height, weight, waist/hip ratio, blood pressure, blood lipids were made and dietary and smoking habits assessed. RESULTS: the Swedes were taller and leaner than the New Zealanders. Blood pressure and smoking habits were not significantly different but total blood cholesterol levels were lower in Uppsala men and women. Blood triglycerides were higher in Dunedin women but high density lipoprotein cholesterol levels tended to be lower in men and women in Uppsala. CONCLUSIONS: it was found by analysis of variance that the blood lipid level differences between the two populations could be explained by body mass index. Correction of lipid values for the waist/hip ratio partly explained the higher cholesterol values in Dunedin but diet differences may also have been contributory. The differences in coronary mortality between the population of New Zealand and Sweden are compatible with the view that our blood cholesterol findings reflect the different levels of risk.

Adult↗

PubMed1991

HIV prevention among injecting drug users: three years of experience from a syringe exchange program in Sweden.

Exchange of syringes and needles has for the last 3 years been offered to injecting drug users as part of an HIV prevention project in a small university town in south Sweden. The program at the local hospital has been visited by 979 drug users, of which 182 have participated on a more regular basis. The typical participant is a 30-year-old male who has injected amphetamine or heroin for at least 10 years. The seroprevalence for HIV among drug users in south Sweden has been maintained at approximately 1% in contrast to up to 60% in subpopulations from other Scandinavian regions with a comparable drug problem. No project participant has become HIV infected during the study period and a reduction in risk behavior has been noted among local drug injectors. The HIV prevention project has attracted many individuals with no previous contact with drug rehabilitation programs; for a number of drug users, the syringe exchange has served as an introduction to such treatment efforts.

Adult↗

PubMed1979

Epidemiological events surrounding a paralytic case of poliomyelitis in Sweden.

A case of clinical poliomyelitis occurred in Sweden in January 1977; it was the first indigenous case in Sweden since 1962. This incident was of particular interest as it provided an opportunity to study the spread of virus in a cluster of unvaccinated persons and in individuals more or less fully vaccinated with inactivated vaccine. The patient excreted wild type 2 virus and the same type was isolated from 25 other individuals, all of whom were close contacts of virus excretors. Among the close contacts, 14 of 20 unvaccinated preschool children were found to excrete virus, but excretion was not found in any of the 7 vaccinated children examined.

Child, Preschool↗

PubMed1979

[Pesticide residues in feed-stuffs in Sweden (author's transl)].

The occurrence of pesticide residues was studied in samples of feed-stuffs produced in Sweden or imported to Sweden during the years 1972--1976. In all, 278 samples representing 37 types of feed-stuffs (components, as well as finished feeds) and 18 countries were analyzed. Residues of chlorinated hydrocarbon pesticides and PCBs were looked for in 224 samples, mostly feed components. The analytical method used involved solvent extraction, florisil-column clean-up, thinlayer chromatographic separation and gas-chromatographic determination. Chlorinated hydrocarbons were found in several samples. DDT and its transformation products were detected in 66 samples (29.5%), lindane in 44 (19.5%), PCBs in 25 (11.2%), alpha-BHC in 22 (9.8%), beta-BHC in 11 (4.9%) and dieldrin in 9 (4.0%). The levels were usually low (Table I). The chloropesticides occurred most frequently and at the highest levels in feed-stuffs of animal origin and in imported oil-feeds. In 25 of the samples the contents of sigmaDDT exceeded the maximum limit accepted by the National (Swedish) Food Administration for grain and bran intended for human consumption (0.05 mg/kg, Talbe IV). The highest residue level of sigmaDDT (0.66 mg/kg) was encountered in a sample of fish meal. The PCB levels found did not exceed the temporary tolerance established by FDA (1973) for finished animal feeds (0.2 mg/kg). One hundred and seven samples were analyzed for phenoxy acid residues using a thin-layer chromatographic and gas-chromatographic technique. Phenoxy acids were detected in only 2 of 62 randomly selected feed samples (0.05 and 0.2 mg/kg, respectively). The residue limit established by the National Food Administration for 2,4-D and MCPA in grain and bran intended for human consumption is 0.1 mg/kg. Fortyfour samples of feeds were submitted because of suspected phenoxy acid contamination. In 12 of the samples phenoxy acid residues were found. The highest level (3.5 mg/kg, MCPA) was observed in a sample of accidentally contaminated molasses. Considering the apparently low level of contamination of Swedish grain with chloropesticides, PCBs and phenoxy acids and the dilution on compounding feed-stuffs of animal origin and oil-feeds, only very low pesticide residue levels can be expected in Swedish finished animal feeds.

Animal Feed↗

PubMed1990

Gonorrhoea and syphilis in Sweden--past and present.

Gonorrhoea and syphilis that belong to our oldest recognized sexually transmitted diseases (STD) are also the prototypes of curable STDs. After the discovery of the causative organisms, Neisseria gonorrhoeae in 1879 and Treponema pallidum in 1905, diagnostic tests were developed and by this, in conjunction with instituted regulations and legislation, means were created for public health authorities to collect statistical data. Sweden has fairly reliable statistics of both syphilis and gonorrhoea from 1912 and onwards, and these data show many interesting characteristics. Syphilis was prevalent in Sweden among both males and females during World War (WW) I and peaked in 1920 with an incidence rate of 150 and 75 per 100,000 population, respectively. The incidence figures fell rapidly after 1920 and reached a low of less than 30 cases per 100,000 in the mid 1920s, probably as a result of systemic treatment with Salvarsan in conjunction with vigorous contact tracing, two important measures to bring an infectious disease under epidemiological control. There was a slight increase of male syphilis in the late 1920s and early 1930s, and of both male and female cases during WW II which never reached the incidence figures of WW I. Penicillin was introduced in the mid 1940s for treatment and was proved superior to Salvarsan. The incidence figures have been very low ever since the early 1950s.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗

PubMed1990

Differences in PCR reactivity between HIV proviruses from individuals in Ethiopia and Sweden.

The polymerase chain reaction (PCR), using primer pairs in the gag, pol, and env regions, was used in a comparative study of HIV-1 DNA in peripheral mononuclear blood cells from HIV-1-seropositive individuals in Ethiopia and Sweden. Although all Swedish samples were positive by PCR, the reactivity was more pronounced in samples from late stages than in those from early stages of infection. Six of nine Ethiopian samples from HIV-1-seropositive patients were positive by PCR, but the reactions were much weaker than those observed for Swedish samples, and in most cases seen with one primer pair only. These results suggest that the burden of HIV-1 DNA in peripheral mononuclear blood cells increases with advancing disease. PCR using primer pairs designed to detect HIV-1 infection in Europe and North America is not always suitable for the detection of HIV-1 infection in Ethiopia. The differences in PCR reactivity could possibly be a consequence of differences regarding host responses to the virus in the two countries, but more likely due to genomic differences between HIV-1 strains prevalent in Ethiopia and Sweden.

AIDS-Related Complex↗

PubMed1989

Training for wartime anesthesia in Sweden.

Sweden has been spared from wars and similar disasters for almost two centuries, and over the years the population and politicians have been lulled into the belief that "it'll never happen". This has affected the ability of the medical system to respond adequately to the enormous demands that a war would make upon us. The geographical and political situation and the basic facts about Swedish health care are briefly sketched. After a review of the history of anesthesia in war, current medical planning for war or similar disaster situations in Sweden is outlined and its weaknesses mentioned. A program is presented that aims at improving the situation in anesthesia manpower, postgraduate training and equipment. The expanded role of the already highly skilled and independent Swedish corps of nurse anesthetists (RNA's) is outlined, especially in the field of regional anesthesia. Standardized methods for anesthesia in war also are presented. The aim is to make optimal use of existing resources and enable patients to be transferred immediately postoperatively to understaffed wards.

Anesthesiology↗

PubMed1986

Secular trends in maternal mortality in Sweden from 1750 to 1980.

Mortality statistics have been kept continuously in Sweden since 1750 and reveal that the maternal mortality rate declined from 900 to 6 per 100 000 live births over the period 1750 to 1980. Two-thirds of this decrease occurred during the 19th century and the remainder in the 20th century. In the 18th century, 10% of deaths among women aged between 15 and 49 years were due to complications at parturition, but today this accounts for only 0.2% of deaths in women of this age group. Life-table analysis indicates that 1 out of 29 women in Sweden lost her life in parturition during the 18th century, while today only 1 out of 1000 women dies as a result of complications during pregnancy and parturition.

Adolescent↗

PubMed1986

Pheochromocytoma in Sweden 1958-1981. An analysis of the National Cancer Registry Data.

An epidemiological study of 439 cases (184 males, 255 females) of pheochromocytoma (paraganglioma) diagnosed in Sweden from 1958-81 is presented. From the mid 1960's an average of 22 cases have been diagnosed each year. In 255 cases, the pheochromocytoma was diagnosed by clinical examination and/or surgery. In 184 cases (40%), the diagnosis was achieved by autopsy and out of which 60 (14% of all cases) were reported as incidental findings. Ninety-five pheochromocytomas (22%) were located outside the adrenals. The average (+/- SD) age at diagnosis for the total study population was 55.8 +/- 17.7 years. Clinically diagnosed tumour cases were significantly younger (48.5 +/- 16.3 years) compared to cases diagnosed at autopsy (65.8 +/- 14.0). Pheochromocytomas were more common among women than among men. The age specific incidence rate increased continuously for both sexes from the youngest to the oldest age groups. The average incidence of pheochromocytoma in the 24 counties of Sweden was 2.1 cases per million inhabitants per year, range 0.9-5.3. A North to South gradient was noted with a higher incidence in the Southern parts of the country. Whether this is due to a real geographical variation of incidence, to a larger number of unreported cases in the Northern parts, or to presence of families with Sipple's syndrome in the South is unclear.

Adrenal Gland Neoplasms↗

PubMed1986

Epidemiology of diabetes mellitus in Sweden. Results of the first year of a prospective study in the population age group 15-34 years.

All newly diagnosed cases of diabetes mellitus aged 15-34 years in Sweden, where the population in this age interval is about 2.3 million, were registered on standardized forms. During 1983, the first year of the study, there were 311 males and 161 females, excluding 280 with gestational diabetes. The annual incidence of diabetes was 26.2 per 100,000 in males and 14.2 in females. The respective figures for type I were 18.5 and 10.1, and for type II 5.7 and 2.9. The incidence of type I diabetes was similar for the four age groups (15-19, 20-24, 25-29, 30-34 years), while for type II it was highest in the oldest group. Types I and II, but not the sexes, differed as regards the cumulative distribution curves of the maximum blood glucose concentration during the first two weeks after diagnosis. The present incidence of diabetes in Sweden is higher, particularly in males than the rates for similar age groups in Oslo (1925-64) and Denmark (1970-77).

Adolescent↗

PubMed1987

Occupational risks for meningiomas of the CNS in Sweden.

Using the Cancer-Environment Registry of Sweden, which links cancer incidence (1961 to 1979) with census information (1960) for all employed individuals in Sweden, a systematic, population-based assessment was made of the occurrence of meningiomas of the CNS according to industrial and occupational classifications. Statistically significant standardized incidence ratios (SIR) between 5 and 6 for meningioma were observed among glass, porcelain, or ceramic workers of both sexes. SIRs of similar magnitude were also found for men employed in the headwear fabrication and book publishing industries. Significantly elevated two- to three-fold risks were observed for men employed in health care, railroad and trolley construction, sheet and plate metal fabrication, and as moving equipment operators. Some of the findings of this descriptive survey may have arisen as a result of multiple comparisons, but several are consistent with earlier observations for brain cancer from other countries and deserve further study.

Central Nervous System Diseases↗

PubMed1979

[Thoracic surgery in Sweden; its structure and perspective (author's transl)].

In Sweden thoracic surgery is a surgical specialty. Treatment is organized by 5 hospitals for thoracic surgery. In 3 clinics there is although open heart surgery. From 1969 to 1977 the number of interventions on the lung, mediastinum and chest wall rose by 35%, the reason is the increasing number of patients with bronchogenic cancer. Vascular surgery (peripheral vessels) is mostly performed by general surgeons, pacemaker surgery in district hospitals. From a prospective study there is no reason to change the organization of thoracic surgery in Sweden during the next years.

Hospital Bed Capacity↗

PubMed1977

Health care and hospital pharmacy in Sweden.

Health care and hospital pharmacy in Sweden are discussed. The system of drug distribution in Sweden is reviewed, and the following functions of hospital pharmacies are discussed; drug and hygiene committees, inspection activities, drug information and educational services, radiopharmacy, and research activities. Pharmacy education, drug manufacturing, and Apoteksbolaget--The National Corporation of Swedish Pharmacies--are also discussed. Future developments in hospital pharmacy are expected to include increased sales to outpatients, a restructuring of the drug supply within outpatient care and recommendations from the hospital drug committees on outpatient care.

Delivery of Health Care↗

PubMed1980

Future nursing homes in Sweden -- users' opinion.

The purpose of this study was to gather knowledge in order to provide a basis for the future planning of local nursing homes in Sweden. A total of 306 patients, residents and staff of six nursing homes and four old age homes were interviewed. The interview was combined with questions regarding a model for the design of a nursing home. The subjects were found to have opinions on the designs on the design which, in some cases, differed significantly from what is generally assumed to be true today in Sweden.

Adult↗

PubMed1983

Antibiotic sensitivity of Haemophilus influenzae, Streptococcus pneumoniae, Streptococcus pyogenes and Branhamella catarrhalis isolated from upper respiratory tract infections in Sweden.

Isolates of Haemophilus influenzae, Streptococcus pneumoniae, Streptococcus pyogenes and Branhamella catarrhalis were collected from five laboratories in different geographical areas in Sweden. Nine hundred and fortyfour strains were tested by the agar dilution method for susceptibility to seven oral antibiotics: phenoximethylpenicillin, ampicillin, cefaclor, erythromycin, doxycycline, trimethoprim-sulfamethoxazole and chloramphenicol. The H. influenzae and B. catarrhalis strains were also tested for beta-lactamase production. Of the H. influenzae strains, 8% were beta-lactamase-producing, while 35% of B. catarrhalis strains produced beta-lactamase. The latter value is higher than has earlier been reported in Sweden. Five S. pneumoniae strains showed decreased sensitivity to penicillin, and 9.5% of the S. pneumoniae strains showed a decreased sensitivity to one or more of the seven antibiotics tested. The S. pyogenes strains were sensitive to all the antibiotics tested with the exception of 4% of the strains, which showed a decreased sensitivity to doxycycline.

Anti-Bacterial Agents↗

PubMed1984

Drug prescription patterns for rheumatic disorders in Sweden.

Drug prescription patterns, expressed in defined daily doses (DDD), were registered during the 1970s for disease modifying antirheumatic drugs (DMARD) and for nonsteroidal antiinflammatory drugs (NSAID). An increased prescription of DMARD was found at a national level (Sweden), starting with chloroquine, followed by penicillamine and finally by gold. This same tendency was seen at a county (Västerbotten) and a university hospital level (Umeå). Among NSAID for oral use, the prescription of indomethacin and phenylbutazone gradually decreased in Sweden. Naproxen and ibuprofen increased rapidly, surpassing the others from 1975. This increase was far less marked at the county level and at the rheumatology department of Umeå in which the overall prescription of NSAID for inpatients decreased during the 70s.

Administration, Oral↗

PubMed1984

Hemophilia in Sweden. Studies on demography of hemophilia and surgery in hemophilia and von Willebrand's disease.

Demography: All known hemophiliacs in Sweden, 564 cases, were subjected to a demographic survey in 1980. The ratio of hemophilia A/B was 81/19. The severe cases constituted 30% and the mild 54%. Mean and median ages for mild and moderate hemophiliacs did not differ from those of Swedish males but were approximately 10 years lower in the severe cases. The prevalence was 7 per 100,000 population. The incidence remained constant at 1.7 (+/- 0.1) per 10,000 live-born males in the period 1957-1978. Mortality: In the period 1957-1980, there was a substantial increase in the median age at death among 118 deceased hemophiliacs. This increase was most pronounced in severe hemophilia, from 19 to 50.5 years. Intracranial hemorrhage accounted for one third of the deaths. Six deaths were attributed to hepatic dysfunction caused by hepatitis. Age related deaths (ischemic heart disease and malignancy) increased from 8 % to 32 %. Longevity: Median life expectancy of hemophiliacs in Sweden increased faster than the median life expectancy of the male population. In the beginning of the century, severe hemophiliacs faced a median life expectancy of about 11 years which had increased to 58 years by 1969-1980. Median life expectancy in mild and moderate hemophilia was 72 years, only three and a half years less than the corresponding age for Swedish males. Surgery in hemophilia and von Willebrand's disease: Three hundred and twelve operations (225 in hemophilia and 87 in von Willebrand's disease) were performed on 180 patients (121 hemophiliacs) in the period 1956-1983 at the General Hospital in Malmö. During the first years reconstructive orthopedic surgery dominated among young, severely affected, hemophiliacs but in recent years surgical diseases unrelated to the bleeding disorders increased. Ninety-seven operations were indicated by ailments caused by the bleeding disorders, mainly hemophilic arthropathy and pseudotumours. In another 72 operations the bleeding disorders were considered a contributing factor, mainly gastric surgery for ulcers, hysterectomy indicated by menometrorrhagia and subdural hematomas. Reconstructive orthopedic surgery was almost exclusively performed in hemophilia but gastric surgery was more common in von Willebrand's disease. The operations claimed three fatalities. It was considered essential to extend the substitution therapy to at least two weeks, especially in orthopedic surgery and in severe hemophilia. Furthermore, it was of the utmost importance to have access to laboratory facilities for repeated determinations of VIII:C/IX:C in hemophilia, Duke bleeding time in von Willebrand's disease, and to exclude the presence of inhibitors.

Adolescent↗