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PubMed1982

Clostridium difficile and antibiotic associated diarrhoea in Sweden.

Distribution of age and sex among patients with Clostridium difficile enterocolitis shows an increased ratio female: male (3:1) in age group 20 to 40 years and a corresponding 2:1 ratio in patients over 70 years of age, the latter group constituting 45% of 505 patients investigated. Being the only laboratory in Sweden performing cytotoxin-assay from cases of C. difficile enterocolitis during 1979-1981, we have observed that the frequencies with which clindamycin/lincomycin are associated with C. difficile enterocolitis have decreased from 30% (1979) to 9% (1981) while the role of cephalosporins has increased from 18% to 29%. Corresponding figures for the penicillins are 31% and 47% for the respective years. Against a background of sales statistics of these antibiotics in Sweden the risk of contracting C. difficile enterocolitis is appreciated for clindamycin/lincomycin and the cephalosporins in comparison to that of the penicillins. These calculations yielded a 63 times greater risk for clindamycin/lincomycin and a 36 times greater risk for the cephalosporins compared to that of penicillins. The susceptibility patterns of 96 clinical isolates of C. difficile are given showing an increased resistance to ceftriaxon, cephalotin, cefoperazone, cefoxitin and moxalactam, as compared to the susceptibility to other antibiotics. The cytotoxin and the enterotoxin produced by C. difficile are described. In our hands the enterotoxin causes hemorrhagic fluid accumulation and gross mucosal damage to rabbit ileal mucosa while the cytotoxin causes only mild inflammatory changes. It is pointed out that the assay demonstrating toxin in cases of C. difficile enterocolitis currently used in practise only measures the presence of cytotoxin and that a routine method for demonstration of enterotoxin is lacking to date.

Adolescent↗
PubMed1982

Utilization of analgesics from 1970 to 1978. Prescription patterns in the county of Jämtland and in Sweden as a whole.

A comparative analysis of the usage of analgesics in the county of Jämtland and in Sweden 1970-78 has been carried out. An attempt was also made to map out the indications for prescribing such drugs. Both in Jämtland and in Sweden as a whole, analgesics sold over the counter accounted for more than half of the total usage. The same was true for fixed drug combinations. Analgesics were prescribed each year to 17% of the population of Jämtland. Fixed drug combinations containing sedatives maintained a large fraction of the amount of analgesics prescribed--31% of defined daily doses (DDDs) in 1978. Arylalkanoic acids (ibuprofen and naproxen), introduced in 1975, soon took a substantial part of the market--13% of DDDs in 1978. Though arylalkanoic acids were registered for treatment of degenerative joint diseases, four of five patients in Jämtland received them only once or twice during a two-year period. In the national study, every third prescription of these drugs was for degenerative joint diseases. The pattern of usage revealed in this study calls for improved pharmacotherapeutic training of physicians to make drug treatment more rational.

Analgesics↗
PubMedDate not supplied

Subarachnoid spinal analgesia. A comparative survey of current practice in Scotland and Sweden.

A postal inquiry into the current use of subarachnoid spinal analgesia obtained replies from approximately 70% of consultants in both Scotland and Sweden. Although medico-legal anxiety was still an important feature of Scottish practice, the publication of large series with a low incidence of complications had also exerted some influence, and 40% of consultants employed the technique. In contrast, 70% of Swedish replies indicated current use of spinal analgesia and the individual frequency of administration was considerably higher. The present popularity of epidural analgesia has contributed to some decline in the use of subarachnoid spinal analgesia in Sweden, particularly in the case of longer surgical procedures. Anaesthetists in both countries expressed dissatisfaction with the limited choice of available spinal agents and considered their duration of action to be inadequate. In Scotland, conditional indications, such as diabetes mellitus and respiratory disease, were of major importance, whereas Swedish users more often specified surgical procedures for which subarachnoid spinal analgesia was considered to be the anaesthetic of choice. Few anaesthetists had experience of complications and no major neurological sequelae were reported. More than 80% of replies indicated that subarachnoid spinal anaesthesia had a useful place in anaesthetic practice.

Anesthesia, Spinal↗
PubMed1981

Histidinaemia in Sweden. Report on a neonatal screening programme.

Histidinaemia screening was included in the epidemiological survey of the Swedish neonatal screening programme, 1971-72. Dried blood samples on filter paper collected neonatally from 171,000 infants were analysed the Guthrie method. A blood histidine level above 0.96 mmol/1 (15 mg per 100 ml) was regarded as a positive test and was found in 639 infants - i.e., 1/270. No further diagnostic measures were taken until 1977 when stored dried blood samples from 273 infants with a positive screening test were analysed for urocanic acid. Four children had undetectable blood urocanic acid. They were studied and histidinaemia was confirmed in two children, and excluded in two. Both histidinaemia children had normal psychomotor development at 7 years of age, in spite of the fact that no dietary treatment was given. The incidence of histidinaemia in Sweden was estimated as 1/37,00, on the basis of neonatal screening. In addition, histidinaemia was diagnosed in four individuals who were not detected in the neonatal screening programme; of these, only one had an IQ less than 85. At present, general neonatal screening histidinaemia in Sweden does not seem justified.

Adolescent↗
PubMed1995

Anoplocephala perfoliata in horses in Sweden: prevalence, infection levels and intestinal lesions.

Distal ileum, caecum and proximal colon of 470 horses were examined for helminths during 1 year at an abattoir in central Sweden. The infection levels of the horse tapeworm Anoplocephala perfoliata, their stage of development, site of attachment and gross pathological lesions caused by the worm were recorded. Faecal samples from 395 of the horses were examined specifically for tapeworm segments and eggs in order to correlate these findings with the numbers in the alimentary canal. In total 65% of the horses were infected with A. perfoliata and the mean intensity of infection was 79 worms per infected horse with a maximum of 912. The level of infection was significantly higher in (1) 3rd and 4th than in 1st and 2nd quarter of the year; (2) older horses than in yearlings; (3) females than in males and geldings; (4) thoroughbred and cold-blooded horses than in Swedish standard breeds and ponies. The level of infection was unaffected by the usage of anthelminthics against nematodes. Of the horses examined 51% had 1-100 worms whereas 14% were infected with more than 100 worms. Of the tapeworm positive horses 72% had mixed infections with both adult and juvenile worms, 20% solely juveniles, and 8% solely adults. The severity of intestinal lesions exacerbated by increasing numbers of A. perfoliata. About 11% of the intestines examined had severe lesions, but there was no history of acute abdominal distress in any of the horses included in this study. Although the number of detectable eggs was significantly higher for horses heavily infected with A. perfoliata, the egg recovery among infected horses was only 35%. An additional field survey comprising 218 horses on 88 premises in central and southern parts of Sweden showed that the prevalence of A. perfoliata egg positive horses was the same as found on faecal examination during the abattoir survey.

Animals↗
PubMed1995

Survival of oocysts of Eimeria alabamensis on pastures under different climatic conditions in Sweden.

The extent to which oocysts of the coccidian parasite Eimeria alabamensis can survive the winter and cause clinical coccidiosis in different parts of Sweden was investigated. Fecal samples were collected between May and July 1993 from calves on 59 farms where calves had grazed the same pasture for at least 5 consecutive years. The farms were situated in 9 regions of Sweden with different climatic conditions in the winter. On each farm, 5 samples of feces were collected from the floor of the calf-house before the calves were turned out in the spring, and again from the pasture on days 4 or 5, 8 or 9 and 10 or 11 after they were turned out. Overwintering of oocysts of E. alabamensis was considered to have occurred if an increase in the excretion rate of oocysts of this species could be demonstrated 8 to 11 days after calves had been turned out to pastures that had not been grazed since the previous autumn. Oocysts were shown to have overwintered on 27 farms, representing all 9 regions. Samples from 20 (34%) of the farms representing all the climatic regions contained more than 850,000 oocysts per g of feces. This was comparable with the numbers found in animals with clinical coccidiosis due to E. alabamensis. Delaying turnout until the beginning of July did not affect the infection rate of the calves. However, calves which were turned out to pastures that had been grazed by older cattle or horses, either earlier in the spring or in previous years, excreted significantly fewer oocysts than calves which were turned out to pastures that had been grazed only by calves. A questionnaire answered by 321 dairy farmers revealed that of the 298 farmers who turned their first-season grazing cattle out to traditional pastures, 179 (60%) had used the same pasture for at least 5 years. These 179 farmers had experienced a significantly higher incidence of diarrhoea in their calves during the first 2 weeks at pasture than those farmers who had used different pastures.

Animals↗
PubMed1995

[On-duty medical service regulation in Norway, Sweden, Finland and Denmark].

Out of hours services are under discussion in the Nordic countries, and their organisations in Norway, Sweden, Finland and Denmark are compared in the article. Only in Denmark all such services are free of charge. In Denmark and in most parts of Norway, the patient must first phone a call-in service manned by a physician who acts as receptionist cum dispatcher. House calls are very rarely made in Sweden and Finland but account for approximately 20 percent of the out of hours workload in Norway and Denmark.

Denmark↗
PubMed1995

Impact of legislative measures on the sales of analgesics and the subsequent prevalence of analgesic nephropathy: a comparative study in France, Sweden and Belgium.

In a number of European countries (e.g. Belgium), analgesic nephropathy continues to be a highly prevalent renal disease, whereas in other countries (e.g. Sweden) the problem has been resolved after legislative measures were taken. In still other countries, e.g. France, the official prevalence of analgesic nephropathy has always been low. The aim of the present study is to detect whether specific legislation in particular countries has played a role in the prevalence of analgesic nephropathy. Hence, we compared analgesic legislation in Belgium, France and Sweden, and then compared it with the respective sales data of non-narcotic analgesics and with the prevalence data of analgesic nephropathy in the dialysis population. Each investigated country represents a different evolution pattern in the prevalence of analgesic nephropathy. This study indicates that legislation restricting the over-the-counter availability of the majority of analgesic components and resulting in the absence of analgesic mixtures--containing two analgesic substances and one potentially addictive substance--on the market, has effectively resulted in a substantially lower prevalence of analgesic nephropathy. Moreover, it shows that permissive legislation could be associated with very different sales data, depending on the marketing strategy of the pharmaceutical industry and the subsequent purchasing behaviour of the population. These findings indicate that, in order to eradicate analgesic nephropathy, there is a need to elaborate legislation that prohibits the availability of analgesic mixtures containing two analgesic components and at least one potentially addictive substance.

Analgesics↗
PubMed1994

The hospitalized cases of contact lens induced keratitis in Sweden and their relation to lens type and wear schedule: results of a three-year retrospective study.

All hospitalized cases of contact lens induced keratitis with stromal involvement among cosmetic wearers in Sweden over a 3-year period were reviewed for risk factors in relation to lens type and wear schedule. Information on every case was obtained from ophthalmology departments. Lens type and wear schedule were identified. The number of lens wearers, subdivided by lens type and wear schedule, was obtained from a study by the Swedish Contact Lens Association. Annual incidence figures were then calculated as expressions of risk factors. There were 30.7 cases per year, on average, of hospitalized lens induced keratitis in Sweden. The annual incidence per 10,000 wearers was 0.51 for daily wear and 3.12 for extended wear of conventional soft lenses, 0.16 for daily wear and 4.17 for extended wear of disposable soft lenses, and 1.21 for daily wear of rigid gas permeable lenses. It may be concluded that daily wear of disposable lenses was associated with significantly (P < 0.05-0.01) less risk of hospitalized keratitis than daily wear of the other lens types. Extended wear of conventional and disposable soft lenses showed a significantly (P < 0.01-0.001) higher risk of hospitalized keratitis than daily wear. However, the two extended wear groups did not differ significantly (P > 0.2). Microbial keratitis was significantly (P < 0.001) more common than sterile (no growth of microbes) keratitis among conventional soft lens wearers, whereas the opposite was true (P < 0.05) among disposable lens wearers.

Acanthamoeba Keratitis↗
PubMed1994

Occupational risks for colon cancer in Sweden.

Using the Cancer-Environment Registry of Sweden, which links census information (1960) with cancer incidence data (1961 to 1979), we conducted a systematic, population-based assessment of colon cancer incidence among cohorts defined by industry and occupation for all employed persons in Sweden. Small but statistically significant excesses of colon cancer were observed among white-collar occupations, including administrators, professionals, and clerical and sales workers, whereas a reduction in incidence was found among workers in agricultural and related jobs, such as farmers, fishermen, and hunters. Analysis by subsite within the colon revealed little difference in results. The observed risk patterns are consistent with previous reports on colon cancer risk and occupational physical activity levels, ie, elevated risk among sedentary white-collar workers and reduced risk among agricultural workers. Few craftsman and production processing jobs were linked to colon cancer, although statistically significant excesses were observed among shoe and leather workers, metal smiths, and foundry workers in the metal manufacturing industry. The findings indicate that occupation in general is likely to play a relatively small role in colon cancer etiology, with perhaps its major contribution an indirect one via physical activity.

Cohort Studies↗
PubMed1993

Attitudes and knowledge about preventive dental care in Chilean refugees in Sweden.

The aim of this study was to evaluate the effects of a simplified oral health programme on attitudes to and knowledge of preventive dentistry. The subjects were Chilean refugees and the programme was delivered at one or two sessions in the form of group information/discussion. Because of increasing immigration, Sweden has become a multicultural society. The number of non-Nordic immigrants has doubled in the past decade. The major refugee groups have come from Iran, Chile and Poland. The subjects comprised 193 Chilean refugees: 106 in a single-visit group and 87 in a two-visit group. The oral health programme was completed by 94 and 65 subjects respectively and was evaluated after 6 months. Positive effects were discernible in attitudes to and knowledge of preventive dentistry, particularly with respect to oral hygiene. A key to success may have been group discussion in which the refugees could relate oral health problems to their own ethnic group. This could have an important function in bridging cultural, linguistic and situational barriers. Different forms of outreach programmes for oral health via groups, organisations or authorities in close contact with refugees shortly after arrival in Sweden are proposed. This approach may be particularly effective in a multicultural society and also in the context of the turbulent conditions the newly-arrived refugee experiences.

Attitude to Health↗
PubMed1993

Evaluation of HIV testing in Sweden, 1985-1991.

OBJECTIVE: Evaluation of the extent and outcome of HIV testing in Sweden. DESIGN: Data from screening programmes, laboratory and clinical reports were compared and a national survey on HIV testing was performed. RESULTS: The proportion found to be positive in screening of blood donors, pregnant women and sexually transmitted disease patients were approximately 1/100,000, 1/10,000 and 1-2/1000, respectively. One-quarter of the men and one-third of the women in Sweden aged 16-74 years reported that they had been tested for HIV at least once. CONCLUSION: There is a high cost involved in detecting HIV-infected individuals through general testing. This cost can be justified if we believe that awareness of an infection substantially reduces the risk of further transmission.

Adolescent↗
PubMed1993

High prevalence of asthma and related symptoms in teenagers in northern Sweden.

Recent reports have suggested an increased asthma prevalence in the Nordic countries. The prevalence of asthma and related symptoms from lower airways in Umeå, Northern Sweden, was investigated in 1987. We used a questionnaire and a skin prick test in 1,112 teenagers. Individuals with symptoms or positive skin prick tests were examined further. The clinical examination included an interview, a ventilatory lung function test, serum specific immunoglobulin E (IgE) test, and a physical examination. Individuals with symptoms from the lower airways underwent a methacholine inhalation test. Asthma was defined as recurrent attacks of dyspnoea and/or wheezing, triggered by known stimuli (excluding infections), and at least one of the following: signs of obstructive airways at examination or provocation concentration giving a 20% fall in forced expiratory volume in one second (PC20) < 8 mg.ml-1. Using this definition, the prevalence of asthma was 6.8%, with a significantly higher prevalence in girls (9.6%) than in boys (4.1%). Furthermore, 16.4% had dyspnoea, wheeze or prolonged cough but did not fulfil our criteria for asthma. The prevalence of asthma and of symptoms from lower airways is higher than has previously been found in Sweden.

Adolescent↗
PubMed1993

Frequency and enterotoxigenicity of Campylobacter jejuni and C. coli in domestic animals in Pakistan as compared to Sweden.

Domestic and wild animals have been considered to be the most common reservoirs of Campylobacter for human infections. This study has been conducted to establish the frequency and enterotoxigenicity of C. jejuni and C. coli in the stools of domestic animals in a developing versus a developed country. Faecal samples of 300 chickens and laying hens, 102 horses, 180 cows, 92 goats and sheep were collected from Pakistan and Sweden. The hippurate hydrolysis test and CHO-cell test were performed for species differentiation and enterotoxigenicity determination respectively. The pattern and sequence of frequency distribution of Campylobacter in animals in Pakistan and Sweden were similar, the main difference being a significantly higher frequency in Pakistani samples. C. jejuni was the dominant species from both countries and Pakistani strains were more enterotoxigenic than Swedish strains. We conclude that the spread of Campylobacter infection in developing countries originates from different sources in the neighbourhood, for example animals, and unless hygienic conditions improve no change can be expected.

Animals↗
PubMed1993

[Health effects in Sweden of the Chernobyl accident].

An international committee (2) which has studied the health and environmental effects of the Chernobyl accident within the borders of the former Soviet Union does not expect that any increase in cancer frequency among adults can be demonstrated epidemiologically. However, the possibility of an observable increase in the incidence of thyroid cancer and increase in juvenile leukemia could not be excluded. The statistics in Sweden is more accurate, though the radiation doses were significantly lower. It would appear to be unlikely that any changes in cancer incidence (even among children), in mental development in children, in malformations or genetic changes ascribable to the Chernobyl accident will ever be demonstrated in Sweden.

Accidents↗
PubMed1995

A national telepathology trial in Sweden feasibility and assessment.

The telepathology trial in Sweden was designed to study several parameters, eg, the specific need, practical handling, image quality and acceptance of a static imaging system for consultations between pathologists. From September 1992 until December 1993, six telepathology systems were leased and temporarily installed for 8 to 10 weeks in 29 pathology departments in Swedish hospitals. Three telepathology systems were purchased by the university hospitals in Gothenburg, Linkôping and Uppsala and served as permanent nodes. To assess the project, pre and post field-test questionnaire (focusing on attitudes/expectations and experience/wishes for the future, respectively) were sent to all participating pathologists and cytologists. Although other assessment methods were included in the project, this paper concentrates on the study of questionnaire results. The study shows that the major medical requirements for telepathology in Sweden involve diagnostic questions concerning: cancers in general, grade of malignancy, malignancy of soft tissue, haematopoetic system, skeletal system, breast, uro-genital systems and applications in the field of dermatology, inflammations and transplantations. Telepathology will enhance diagnostic accuracy according to 37% of the responding physicians in the pre field-test study and 31% in the post field-test study, a drop which may reflect excessively high expectations or less than optimal test conditions. A static-image transfer telepathology system was used but the assessment clearly shows that pathologists and cytologists prefer a dynamic imaging telepathology system for the future. Image resolution is crucial and was not adequate for all applications in the study. Half of the respondents preferred having a telepathology system in their own departments.(ABSTRACT TRUNCATED AT 250 WORDS)

Computer Communication Networks↗
PubMedDate not supplied

Reported treatment of hypercholesterolemia by family physicians in Sweden and Minnesota.

Swedish guidelines on treatment of hyperlipidemia recommend higher cut-off levels for initiating treatment than do American guidelines, but are virtually identical for instituting and performing therapy. The aim of this study was to compare family physicians' reported practices in Sweden and Minnesota. We selected random samples of family physicians in southern Sweden and Minnesota for telephone interviews. Participation rates were 236/264 (89%) and 183/209 (88%), respectively. Swedish and Minnesota physicians adhered to their guidelines on cut-off levels in a case describing a 48-year-old man but, contrary to guidelines, reported higher cut-off levels for a 65-year-old man and a 65-year-old woman. In all cases described, Swedish physicians reported significantly higher cut-off levels. Swedish physicians were less prone to institute medication in older patients and less familiar with drugs. Minnesota physicians were more inclined to advise nicotinic acid derivatives (P < .0001 for all patient categories). Swedish physicians more frequently preferred resins (P = .00029) or fibrates (P = .0028) for the 48-year-old man and resins for the 65-year-old man (P = .0026). Despite common medical knowledge, the two medical communities are directed by different guidelines. Although adherence to cut-off levels was equally high in both groups, the use of lipid-lowering drugs has not become a familiar part of the therapeutic armamentarium for Swedish family physicians.

Aged↗
PubMed1996

The functional independence measure in Sweden: experience for outcome measurement in rehabilitation medicine.

The purpose of the study was to describe the Functional Independence Measure (FIM) in Sweden and to analyse some aspects on its structure and the possibility to predict length of stay in a rehabilitation ward. It assesses the degree of dependence with 13 physical and 5 social and cognitive items, using a 7-level ordinal scale. Data are presented from a total of 312 patients and from 267 first admission patients with a mean age of 45 (SD 13) years, 66% being men, in rehabilitation medicine wards in three hospitals in Sweden. The patients were divided into six diagnostic groups. Ratings were made at admission and at discharge. The level of dependence in physical and social cognitive items was reduced during the stay at the ward. Using Rasch analysis, separate physical and social-cognitive items and personal measures were obtained on a linear scale. It was demonstrated that the relative order of the items was similar at admission and discharge. There were minor differences between diagnostic groups for the physical items, whereas more diagnostic-specific differences were seen for the social-cognitive items, for stroke patients with and without aphasia. Individual statistics were used for demonstrating FIM changes during the rehabilitation period. There was a high correlation between admission and discharge FIM values, and the admission FIM (physical items) accounted for up to nearly 50% of the variation in length of stay in a homogeneous sample such as stroke patients, but for less than 40% in the total sample. FIM can be used to follow changes during inpatient rehabilitation and for comparisons between different rehabilitation units.

Activities of Daily Living↗