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PubMed1996

The cost-effectiveness of hypertension treatment in Sweden: an analysis of the criteria for intervention and the choice of drug treatment.

Results of an analysis of the cost-effectiveness of hypertension treatment in Sweden are presented. The cost per life-year gained decreases with age for both men and women and is relatively low for middle-aged and older men and women even in the blood pressure range 90-94 mmHg. The results indicate that it is in general cost-effective to treat middle-aged and older men and women in Sweden with a diastolic blood pressure > or = 90 mmHg, but that it is questionable whether it is in general cost-effective to treat younger men and women with mild hypertension. It is furthermore shown that ACE-inhibitors and calcium-antagonists may be cost-effective in some patient groups at a high risk of coronary heart disease, if they achieve the epidemiologically expected risk reduction for coronary heart disease. Since an improved risk reduction has not been demonstrated in clinical trials ACE-inhibitors and calcium-antagonists cannot, however, at present be recommended for hypertension treatment in any patient groups unless treatment with diuretics and beta-blockers is contraindicated.

Adrenergic beta-Antagonists↗
PubMed1996

Dietary calcium, vitamin D, and the risk of colorectal cancer in Stockholm, Sweden.

The epidemiology of large bowel cancer suggests an etiological role for dietary factors. Although the evidence is inconsistent, several studies have suggested an inverse association between dietary vitamin D or calcium and colorectal cancer risk. We conducted a population-based case-control study to examine the relationship between dietary vitamin D and calcium and colorectal cancer among residents of Stockholm, Sweden. Between January 1986 and March 1988, 352 cases of colon cancer and 217 cases of rectal cancer diagnosed among living persons residing in Stockholm County were identified via a cancer surveillance network established among all the hospitals in Sweden and the Stockholm Regional Cancer Registry. Controls (512) were randomly selected from a computerized population registry. Dietary intake was assessed using a quantitative food frequency questionnaire focusing on average consumption during the preceding 5 years. Supplemental intake of vitamin D and calcium was not ascertained. Logistic regression was used to calculate odds ratios (ORs) as the measure of association between the exposure of interest (vitamin D or calcium) and cancer risk. Increasing levels of dietary vitamin D were inversely associated with the risk of colorectal cancer. The association was somewhat more pronounced for cancers of the rectum [OR, 0.5; 95% confidence interval (CI), 0.3-0.9 between the highest and lowest quartiles] than for cancers of the colon (OR, 0.6; 95% CI, 0.4-1.0) after adjustment for age, sex, and total caloric and protein intake. Dietary calcium was not associated with the adjusted risk of colon (OR, 1.2; 95% CI, 0.7-2.1) or rectal cancer (OR, 1.0; 95% CI, 0.5-1.9). Further adjustments for fat and dietary fiber intake, body mass index, and physical activity had little or no effect on the results. These results suggest that dietary vitamin D may reduce the risk of large bowel cancer, particularly rectal cancer. In addition, although some of the previous data suggested a protective effect for calcium against cancers of the large bowel, we could not document such an effect.

Aged↗
PubMed1996

Eldercare in Sweden: issues in service provision and case management.

Sweden's extensive eldercare system emphasizes home and community-based care provided by municipal government. Recent policy reform is designed to improve the provision and coordination of long-term care by transferring the responsibility and resources for the health care component from regional to local government. Policy designed to help older people manage at home has emphasized formal care, but support for family caregivers is now receiving increased attention. Care managers in municipal eldercare are responsible for individual client need assessment and level of care determination. Recent reforms in service provision combined with a weaker economy in the 1990s have increased the importance of the care manager's role in Sweden. Many municipalities are now testing new forms of service delivery that focus on the roles of care managers. These include a purchaser-provider model in which the care manager decides on a package of care and purchases some of the services from private or public providers. Under this system the care manager has increased responsibility for monitoring outcomes and determining how resources are used more effectively.

Aged↗
PubMed1997

How outcome studies have changed total hip arthroplasty practices in Sweden.

The Swedish Hip Registry has defined the epidemiology of total hip replacement in Sweden. Most hip implants are fully cemented. Serious complications and rates of revision associated with total hip replacement have declined significantly despite an increasing number of patients at risk. During the past 5 years only 9% to 10% of hip replacement procedures are revision procedures. Aseptic loosening with or without osteolysis is the major problem and constitutes 73% of the revisions, but the incidence has decreased four times during the past 15 years to less than 3% at 10 years. Even septic complications can be prevented effectively. Demographics are important because male gender and young age increase the risk for revision because of aseptic loosening. Young female patients with rheumatoid arthritis and male patients with a previous hip fracture have five times higher revision rates than elderly patients. The quality of the surgical technique is the most important factor for reducing the risk for revision because of aseptic loosening, but choice of implant is also important. The variations among hospitals in type of surgical technique used is big enough to cause a 100% difference in revision rate for aseptic loosening. Total hip replacement practice in Sweden has improved based on information from this Registry about individualized patient risks, implant safety, and the efficacy of improving surgical and cementing techniques.

Arthroplasty, Replacement, Hip↗
PubMed1997

Periodontal health in adopted children of Asian origin living in Sweden.

In the present study the periodontal condition of a group of adopted 6-17 year-old children of Asian origin living in Sweden was compared with that of age- and sex matched Sweden children. Thirty-one Asian children and 31 Swedish children participated. Data on general health for all the children and on age at arrival for the Asian children was collected by interview. A clinical examination included recording of presence of plaque, supragingival calculus, bleeding on probing, probing depth, and caries. Radiographs were used to determine marginal bone loss (distance between the cemento-enamel junction and the marginal bone level > 2 mm), proximal calculus, and proximal caries. In addition, previously taken and filed radiographs of the primary dentition of the older children and current radiographs of the younger children with primary teeth were analysed to determine the prevalence of bone loss and calculus. The children of Asian origin showed a significantly higher number of surfaces with plaque and bleeding on probing. No significant differences were noted in the number of individuals with probing depths > or = 4 mm, supragingival calculus, or radiographic calculus. Three of the Asian and none of the Swedish children displayed radiographic bone loss. The retrospective analysis of all available radiographs from the primary dentition showed that 9 of 29 (31%) Asian children and 2 of 29 (7%) Swedish children had experienced bone loss in primary teeth.

Adolescent↗
PubMed1998

Costs of treating primary open-angle glaucoma and ocular hypertension: a retrospective, observational two-year chart review of newly diagnosed patients in Sweden and the United States.

PURPOSE: The objective of this study was to investigate what treatment strategies prevail in different countries for patients newly diagnosed with primary open-angle glaucoma (POAG) or ocular hypertension (OH) only and initiated on treatment with beta-blockers, and to estimate the total direct cost of treatment for two years. In addition, differences in costs between and within the countries and the determinants of variations in costs across patients were examined. MATERIALS AND METHODS: The authors performed a retrospective medical record analysis in several academic and office-based study centers in Sweden and the United States. Standard costs for each resource item were determined and applied to all centers within the country. Differences in treatment costs within the countries are thus the effect of differences in treatment strategies, not of differences in prices. RESULTS: There was considerable variation between the centers of each country. Sweden had a higher number of surgical interventions, which may be explained by the fact that the Swedish cohort had a higher mean intraocular pressure (IOP) at baseline and a higher proportion of patients with definite POAG and exfoliation glaucoma. However, in both countries the mean IOP at study end was approximately 18 mm Hg. Total direct costs for two years were 15,119 SEK (US$2,160; $1US = 7 SEK) and $2,109, respectively. In a multiple regression analysis, the estimated effects of baseline IOP and of IOP change after treatment initiation on treatment costs were positively and negatively significant, respectively, in both countries. CONCLUSION: Despite differences in baseline diagnosis and in treatment strategies, mean IOP was decreased to 18 mm Hg in both countries. Baseline IOP was positively correlated with treatment costs, while the initial IOP-lowering effect of treatment was negatively correlated with two-year costs.

Adrenergic beta-Antagonists↗
PubMed1998

Criminal multilation of the human body in Sweden--a thirty-year medico-legal and forensic psychiatric study.

During the 30-year period 1961-1990, a total of 22 deaths with criminal multilation/dismemberment of the human body were registered in Sweden. The multilations occurred in time clusters, mostly during the summer and winter periods, and increased during the three decades, with incidence rates of 0.05, 0.1, and 0.125 per million inhabitants and year, respectively. Multilation was noted 6.6 times more often in large urban areas than in the rest of Sweden. Defensive mutilation, in order to get rid of the corpse or make its identity more difficult, was noted in ten instances, aggressive mutilation following outrageous overkilling in four, offensive mutilation (lust murder) in seven, and necromanic multilation in one instance. In the last-mentioned case the cause of death was natural, while all deaths in the first three groups were homicidal, or homicide was strongly suspected. All perpetrators were males, in six instances assisted by other persons. In more than half of the cases the perpetrator's occupation was associated with application of anatomical knowledge, e.g., butcher, physician, veterinary assistant, or hunter. The perpetrators of the defensive and aggressive mutilations were mostly disorganized, i.e., alcoholics or drug users with previous psychiatric contacts and criminal histories, while the lust murderers were mostly organized, with a history of violent crimes (including the "serial killing" type), drug abuse and mental disorders with anxiety and schizophrenia, in that order to a diminishing degree. There were differences in mode of mutilation, depending on whether the mutilation was carried out by a layman, a butcher, or a physician. In only one case was the perpetrator convicted for the mutilation act itself; in the remaining instances the manslaughter, as a more serious crime, assimilated the mutilation. When the mutilation made it impossible to establish the cause of death, the perpetrators, despite strong circumstantial evidence indicating murder, were acquitted.

Adolescent↗
PubMed1997

ENVIRONMENTAL AUDITING: Exceedance of Critical Loads for Lakes inFinland, Norway, and Sweden: Reduction Requirements for AcidifyingNitrogen and Sulfur Deposition

/ The main objectives of this study were to identify the regions inFennoscandia where the critical loads of sulfur (S) and acidifying nitrogen(N) for lakes are exceeded and to investigate the consequences for depositionreductions, with special emphasis on the possible trade-offs between S and Ndeposition in order to achieve nonexceedance. In the steady-state model forcalculating critical loads and their exceedances, all relevant processesacting assinks for N and S are considered. The critical loads of N and S areinterrelated (defining the so-called critical load function), and therefore asingle critical load for one pollutant cannot be defined without makingassumptions about the other. Comparing the present N and S deposition withthe critical load function for each lake allows determination of thepercentage of lakes in the different regions of Fennoscandia where: (1) Sreductions alone can achieve nonexceedance, (2) N reductions alone aresufficient, and (3) both N and S reductions are required but to a certaindegree interchangeable. Secondly, deposition reduction requirements wereassessed by fixing the N deposition to the present level, in this wayanalyzing the reductions required for S, and by computing the percentage oflakes exceeded in Finland, Norway and Sweden for every possible percentdeposition reduction in S and N, in this way showing the (relative)effectiveness of reducing S and/or N deposition. The results showed clearregional patterns in the S and N reduction requirements. In practically thewhole of Finland and the northern parts of Scandinavia man-made acidificationof surface waters could be avoided by reducing S deposition alone. In thesouthern parts of Sweden some reductions in N deposition are clearly neededin addition to those for S. In southern Norway strong reductions are requiredfor both N and S deposition.KEY WORDS: Acidification; Critical load; Exceedance; Sulfur; Nitrogen;Deposition; Lake

Journal Article↗
PubMed2003

Cost-effectiveness of fondaparinux vs. enoxaparin as venous thromboembolism prophylaxis in Sweden.

Deep-vein thrombosis and pulmonary embolism are important causes of morbidity and mortality among patients undergoing major surgery. Fondaparinux is a new antithrombotic agent for use in prophylaxis, and this study compared its cost and effect vs. enoxaparin as prophylactic treatment in patients undergoing total knee replacement, total hip replacement, or hip-fracture surgery in Sweden. The analyses were based on a simulation model. Swedish data on cost for deep-vein thrombosis and pulmonary embolism were obtained from a large sample of patients undergoing major orthopedic surgery. The relative risk reduction for treatment with fondaparinux was estimated from results of four recently published clinical trials. The base case analyses showed that fondaparinux was cost saving and more effective than enoxaparin after total knee replacement and hip-fracture surgery and had costs per prevented venous thromboembolism of about 239 after total hip replacement. Fondaparinux is thus more cost-effective than enoxaparin as prophylactic treatment in patients undergoing major surgery in Sweden.

Journal Article↗
PubMed1998

Trends in needle and soil chemistry of Norway spruce and Scots pine stands in South Sweden 1985-1994.

The nutrient status of the trees and soil in 42 stands of Norway spruce (Picea abies (L.) Karst.) and Scots pine (Pinus sylvestris L.) in Scania, South Sweden was followed from 1985 to 1994. Samples from needles taken in winter 1985, 1987, 1990, and 1994, and soils in 1988 and 1993 were analyzed. Concentrations, as well as ratios to N, of K and Cu in needles of both species decreased by approximately 40% from 1985 to 1994. Soil analyses indicate ongoing soil acidification and leaching of mineral nutrients from the soil profile. Together with deposition data and corroboration from modeled scenarios, these data support the recent contention that one consequence of enhanced deposition of N and S will be the development of nutrient imbalances in trees growing in southern Sweden.

Journal Article↗
PubMed1997

Symptoms related to snoring and sleep apnoea in subjects with chronic bronchitis: report from the Obstructive Lung Disease in Northern Sweden Study.

To assess the relationship between chronic bronchitis and obstructive sleep apnoea, a postal survey was performed. A postal questionnaire was sent to 523 subjects identified as having chronic bronchitis or long-standing cough and sputum production in the Obstructive Lung Disease in Northern Sweden Study I (OLIN I). In 1986-88, all 6610 adults born in 1919-20, 1934-35 and 1949-50 living in representative areas in Northern Sweden were screened for airway diseases according to different methods. A random sample of healthy adults identified in the screening were chosen as references (n = 625). Subjects were asked about a variety of airway symptoms, smoking habits and symptoms related to obstructive sleep apnoea syndrome (OSAS). In the bronchitic group, 20% did not report bronchitic symptoms in the present study, and 26% of the formerly healthy reference group reported at least one bronchitic symptom in the present study. Snoring, apnoea and liability to 'nod off' during activity were much more common in the bronchitic group in both men and women, and most common in men, as expected. Snoring was reported by 29% of the men in the bronchitic group and by 14% in the reference group. In women, the corresponding figures were 14 and 8%, respectively, and for apnoea, the figures were 25 vs. 11% in men and 6 vs. 4% in women. The prevalence of OSAS symptoms was similar in subjects with attacks of breathlessness, long-standing cough, sputum production and recurrent wheezing. Bronchitic symptoms may influence quality of sleep and contribute to daytime tiredness, but this does not fully explain the high prevalence of snoring and apnoea reported by subjects in this cohort. This study indicates a positive correlation between chronic bronchitis and OSAS, but sleep studies are required to confirm this.

Adult↗
PubMed2003

Secular trends in body dimensions and physical fitness among adolescents in Sweden from 1974 to 1995.

AIM: To investigate changes over time in body dimensions, and muscular and aerobic fitness in a representative sample of 16-year-old-girls and boys in secondary schools in Sweden from 1974 to 1995 (n = 855). METHOD: Height and weight were measured and five tests were performed: run-walk, two-hand-lift, Sargent jump, sit-ups, and bench-press. RESULTS: In 1995, girls and boys had higher body mass index (BMI) than in 1974. Girls and boys performed less well in bench-press, sit-ups, and run-walk-tests in 1995. Boys, but not girls, performed better in Sargent jump in 1995 than in 1974. Girls and boys performed better in two-hand-lift in 1995 than in 1974. However, after adjustment for body dimensions, there were no differences in performance in two-hand-lift or run-walk-tests between 1974 and 1995. CONCLUSION: There was a decreased aerobic fitness and an increased maximal static strength among adolescents in Sweden between 1974 and 1995. These changes were partly due to increased BMI. However, decreased daily physical activity level cannot be excluded as a contributing factor to the decreased aerobic fitness. The reduced performance in muscular endurance in 1995 was not related to increased BMI. Instead, it is suggested that it is to be related to a specific decrease in hip flexion and arm muscle endurance.

Adolescent↗
PubMed2002

Smoking cessation among daily smokers, aged 45-69 years: a longitudinal study in Malmö, Sweden.

OBJECTIVE: To investigate differences in snuff consumption, socio-demographic and psychosocial characteristics between baseline daily smokers who had remained daily smokers, become intermittent smokers or stopped smoking at the 1-year follow-up. DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS: A population of 12 507 individuals aged 45-69 years, interviewed at baseline in 1992-94 and at a 1-year follow-up, was investigated in this longitudinal study. The three groups of baseline daily smokers were compared to the total population according to socio-demographic, psychosocial and snuff consumption characteristics. A multivariate logistic regression model was used to assess differences in psychosocial conditions, adjusting for age, sex, country of origin, marital status, education and snuff consumption. FINDINGS: Eighty-six per cent of all baseline daily smokers remained daily smokers, 6.5% had become intermittent smokers and 7.3% had stopped smoking at the 1-year follow-up. The daily smokers who remained daily smokers were more likely to be born in other countries than Sweden, not married, have a lower educational level and poorer psychosocial conditions than the total population, while the socio-demographic characteristics and psychosocial resources of those daily smokers who had become intermittent smokers or had stopped smoking were much more similar to the general population, with the exception of a higher snuff consumption, especially for intermittent smokers. CONCLUSIONS: Daily smokers who remained daily smokers at the 1-year follow-up had poorer psychosocial assets, especially social participation, than baseline daily smokers who had become intermittent smokers or had stopped smoking, and the general population. The results suggest that low levels of social participation are a potent barrier against smoking cessation. Snuff consumption may explain a part of the increase in smoking cessation among men as opposed to women in Sweden.

Aged↗
PubMed1990

Transmission of Ockelbo virus by Aedes cinereus, Ae. communis, and Ae. excrucians (Diptera: Culicidae) collected in an enzootic area in central Sweden.

Studies were conducted to determine the ability of Aedes excrucians (Walker), Ae. cinereus Meigen, and Ae. communis (De Geer) group mosquitoes, collected in an Ockelbo (OCK) virus enzootic area in central Sweden, to transmit this virus. All three species were highly susceptible to infection; at least 96% of the specimens of each species became infected after ingesting blood from a viremic chicken. Recovery of virus from the legs of all 61 of the Ae. excrucians and from 51% (24 of 47) and 75% (6 of 8) of the Ae. cinereus and Ae. communis tested, respectively, indicated that OCK virus readily disseminated from the midgut to the hemocoel in these species. Although none of the Ae. communis refed, Ae. cinereus and Ae. excrucians successfully transmitted OCK virus by bite. Because these Aedes species are attracted to avian and mammalian hosts and because OCK virus has been isolated from field-collected specimens in Sweden and the USSR, Aedes mosquitoes should be considered a possible link between human infections and the enzootic cycle involving birds and Culex and Culiseta mosquitoes.

Aedes↗
PubMed2003

Therapeutic drug monitoring of racemic citalopram: a 5-year experience in Sweden, 1992-1997.

Racemic citalopram (CIT) was introduced in Sweden in 1992 for management of major depression. During a 5-year period, 1992 to 1997, serum samples of CIT and desmethylcitalopram (DCIT) were collected for therapeutic drug monitoring (TDM) from patients from all over Sweden. These samples were accompanied by clinical information on a specially designed TDM request form. They represented men and women of various ages (11-94 years) usually on multiple concomitant medications and treated in a naturalistic setting. The TDM samples eligible for evaluation (n = 749), all trough values at steady state, were studied with respect to inter- and intraindividual pharmacokinetic variability. Extensive, interindividual serum concentration variability was seen on all dose levels. For dose-corrected concentrations (C/D) and for clearance (Cl) we found the coefficient of variation (CV) to be approximately 55% for all variables (C/D CIT, C/D DCIT, the ratio DCIT to CIT, and for Cl CIT). The intraindividual variations over time for the same parameters were 30% to 35%. On a population level, signs of a possible saturation of CYP2D6 associated with increasing DCIT-to-CIT ratios with increasing daily doses was observed. Age and gender affected the pharmacokinetics of CIT and DCIT. Women showed significantly higher C/D CIT and C/D DCIT and lower Cl CIT values compared with men, and patients aged more than 65 years had higher C/D CIT and C/D DCIT and lower Cl CIT values compared with younger patients. Finally, concomitant medication affected the outcome of serum concentrations by a general increase in C/D CIT and C/D DCIT but without alteration in the DCIT-to-CIT ratio. Thus, this tendency of changes in the CIT disposition when multiple drugs are used (and multiple diseases are prevailing?) seems more general in character than specific for a certain drug or type of drugs.

Adolescent↗
PubMed2005

Do foreign-born women in Sweden have an increased risk of non-normal childbirth?

BACKGROUND: In this cross-sectional study, we analyze whether foreign-born women in Sweden had more non-normal childbirths than Swedish-born women during 1996-1998, adjusting for age, parity, level of education, number of antenatal care visits, and complications in pregnancy. METHODS: The study includes 215 497 singleton deliveries (including the first childbirth of each woman during the time period) of women aged 18-47 in Sweden during 1996-1998, divided into 12 subgroups of countries. The risk of non-normal birth was analyzed by means of logistic regression. RESULTS: Women from Sub-Saharan Africa, Iran, Asia, and Latin America had a higher age-adjusted risk of non-normal childbirth than Swedish-born women that remained and even increased for the African and Latin American women in the main effect model. Interactions between country of birth and antenatal care visits showed that women from Sub-Saharan Africa, Iran, Asia, and Latin America had almost 50% higher risk of non-normal birth with > or =13 antenatal care visits than Swedish-born women. Interactions between country of birth and complications in pregnancy showed that women from Turkey, Iran, Asia, and Latin America had over 50% higher risk of non-normal birth than the Swedish-born women. CONCLUSIONS: This study shows an association between being foreign-born and non-normal childbirth. Questions can be raised whether we are aware of, pay sufficient attention to, and allocate sufficient resources for these women at higher risk of non-normal birth in maternity care.

Adolescent↗
PubMed1993

Methacholine reactivity and asthma. Report from the Northern Sweden Obstructive Lung Disease Project.

Methacholine tests were used in an epidemiologic study of the prevalence of asthma and chronic bronchitis in northern Sweden. Of 6610 subjects in three age groups from eight representative geographic areas in the northernmost province of Sweden, 5698 (86%) completed a postal questionnaire on respiratory symptoms, and 1506 underwent a structured interview and a lung function test. A total of 292 (5%) were diagnosed as having asthma. A subsample of 284 subjects (of 320 invited) classified at the interview as having asthma (n = 98) or as having respiratory symptoms that might be due to asthma but not fulfilling the interview criteria for the diagnosis of asthma (n = 186) underwent a methacholine test. Subjects who, before the interview study, already had a well-defined asthma diagnosis were not invited to the methacholine testing. Of those 98 subjects classified as having asthma, 61% reacted to methacholine doses < or = 4 mg/ml and 79% to doses < or = 8 mg/ml, while the corresponding figures in the symptomatic but nonasthma group were 20% and 34%, respectively. The results show that a carefully performed structured interview accurately diagnoses asthma in epidemiologic studies. The methacholine tests provide important diagnostic information primarily in subjects in whom the medical history is equivocal.

Adult↗
PubMed1998

Caries preventive services for children and adolescents in Denmark, Iceland, Norway and Sweden: strategies and resource allocation.

According to the dental acts of Denmark, Iceland, Norway and Sweden, emphasis is placed on preventive dental care. The purpose of this study was to describe and compare two aspects of the caries preventive services: the strategies and the resource allocation for preventive dental care of children and adolescents in Denmark, Iceland, Norway and Sweden. Questionnaires were sent to samples of dentists and other dental personnel who provided preventive care to children during 1995 and 1996. Comparisons between the countries showed significant differences in recall routines and in implementation of risk-based and population-based preventive strategies. Multivariate analyses showed that the time used for preventive care varied by country and was not associated with the DMFT of the children. More time was allocated for prevention when more operating dental auxiliaries were available at the clinic, when the recall interval was shorter, when the time used for routine examination was longer and when the clinician was an auxiliary rather than a dentist. In conclusion, resource allocation and strategies used for prevention were not consistent between the countries.

Adolescent↗