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Researching occupational mortality. The problem of comparison.

In a number of countries, studies on occupational mortality have proved to be a useful epidemiological tool for the surveillance of on-the-job health risks. In Scandinavia, studies of this type are facilitated by record linkages made possible by the personal identity number. Health selection of occupational groups makes the problem of comparison one of critical interest in analytical epidemiology of occupational mortality and morbidity. Three generally applied principles in choosing control groups are discussed. Uses of random samples of the whole population will most likely yield under- or overestimates of the true risk of the occupation. It is recommended that comparison groups be introduced from other occupations or from the same occupation if possible making the groups similar with respect to socio-economic factors and especially health selection.

Adult↗

A comparative study of trends in mortality rates of the ageing population in Norway, Sweden, Denmark, and Finland, 1966-1986.

The populations of Finland and the three Scandinavian countries (Denmark, Norway and Sweden) have experienced relatively marked differences regarding trends in mortality rates since the Second World War. To assess factors that might contribute to these differences, a cohort analysis was performed based upon vital statistics for the age category 45 years to 89 years, from the four countries, for the period 1966-86. The results of log-linear modelling, which included the effects of age, period, and cohort, on mortality rates, revealed differences in the effect of age parameters on mortality between Finland and the three Scandinavian countries. These differences may be related to a genetic component. Differences in patterns of mortality rates over time relating to period and cohort effects indicate a differential development in lifestyle-related risk factors associated with the major causes of death. Based on differences in goodness-of-fit of the log-linear models, it is suggested that the Finnish population has experienced a more heterogeneous development in mortality over time than has the Scandinavian. This may be related to the greater social inequities that have existed in Finland than in Scandinavia during the decades under study.

Aged↗

Injuries during leisure physical activity in a Swedish municipality.

The objective of this study was to provide an epidemiologic basis for planning community programmes preventing injuries during leisure physical activity, especially participation in sports. A total population survey of unintentional injuries was carried out in an area with a population of over 41,000. All sports injuries (n = 933) occurring within a 12-month period and requiring medical care were noted, giving a ratio of 22.5 per 1000 inhabitants. The majority of the injuries occurred in soccer (38.9%), followed by injuries in basketball/volleyball/handball (10.9%), and bandy/hockey (9.2%). The results correspond to previous studies in southern Scandinavia. In northern communities, the proportion of injuries in winter sports has been shown to be higher. Identification of these similarities and differences between the studies makes it possible to use the findings together in the design of general community-based sports injury prevention programmes suited to northern European conditions.

Accidental Falls↗

Adder bites. A report of 68 cases.

BACKGROUND AND AIMS: The adder (Vipera Berus) is the only venomous snake that exists naturally in Scandinavia. The aim of this study is to estimate the severity of adder bites, to form a general picture of symptoms of bites and to find out how effective the present treatment methods of adder bites are. MATERIAL AND METHODS: 68 true adder bites treated in Turku University Hospital during the years 1995-2000 were reviewed retrospectively. RESULTS: There were no deaths in this material. A bite caused severe symptoms to 10% of the patients. The symptoms were moderate in 21%, mild in 34% and minor in 35% of the cases. Children under 10 years were the proportionally biggest age group and severe poisonings were most frequent among small children. Rapidly progressive oedema, gastrointestinal symptoms, hypotension and early leucocytosis were signs of more severe poisonings. Antivenom therapy with specific ovine Fab antivenom proved to be an effective and safe treatment in severe poisonings. CONCLUSIONS: An adder bite may also cause severe symptoms for adults. All patients should be observed at least few hours after the bite and parental fluid therapy should be started at an early stage. In the treatment of severe poisonings an antivenom therapy should be considered. Rapidly progressive symptoms and early leucocytosis may serve as a warning signal for higher probability of severe reactions.

Adolescent↗

Osteoporosis and the orthopaedic surgeon.

During the recent years, data regarding osteoporosis has accumulated and indicates that osteoporotic fractures in Scandinavia still increase. At the same time diagnostics and treatments have been improved. However, only a minority of patients with fractures and osteoporosis become identified. Surgeons and hospitals treating fractures should find means to detect patients who suffer from fractures due to osteoporosis, and establish programs for further evaluation and adequate treatment.

Accidental Falls↗

High dose ifosfamide in combination with high dose methotrexate, adriamycin and cisplatin in the neoadjuvant treatment of extremity osteosarcoma: preliminary results of an Italian Sarcoma Group/Scandinavian Sarcoma Group pilot study.

With the intention of starting an international protocol between Italy and Scandinavia on neoadjuvant treatment of extremity osteosarcoma using the four active drugs at maximum doses (doxorubicin 75 mg/m2 pre-operatively, and 90 mg/m2 post-operatively, cisplatin 120 mg/m2, methotrexate 12 g/m2, and ifosfamide 15 g/m2), a single center (the Rizzoli institute) performed a pilot study to closely monitor toxicity, safety, and tumor necrosis. Only 7 patients (10%) had a reduced number of the scheduled cycles. A total of 1,050 of the expected 1,076 cycles (98%) were administered. Delays and dose reduction were minimal, leading to a mean received dose intensity of 89%. Limb salvage surgery was performed in 59 cases (87%), with 6 amputations and 3 rotation plasties. Chemotherapy-induced necrosis higher than 95% was observed in 38 patients (56%). Eleven patients had total necrosis (16%). At a median follow-up of 60 months (range 50-65 months), 53 patients (73%) were continuously disease-free. Six of the relapsed patients were rescued with further treatments leading to an overall survival of 87%. Hematological toxicity was remarkable despite the use of G-CSF and hospitalization due to febrile neutropenia occurred in 25 patients (37%). Platelet transfusions were required in 77 of the 194 episodes of grade 4 thrombocytopenia, but no case of major bleeding was observed. Red blood cell transfusions were necessary in all patients (in 15 cases perioperatively only). Non-hematological toxicity comprised grade 1-2 nephrotoxicity in 3 cases, CNS toxicity in 2 cases, and dilata- tive cardiopathy leading to heart transplantation in 1 case. In conclusion, the pilot study was feasible in the vast majority of cases with toxicity not superior to that of the previous protocols where chemotherapy was given in lower doses. The rate of limb salvage procedures, event-free survival and overall survival seemed to be higher than in previous protocols. On the basis of this study, in March 1997 the Italian and Scandinavian Sarcoma Groups started a new protocol for osteosarcoma of the extremities.

Adolescent↗

Global use of asbestos and the incidence of mesothelioma.

In Western Europe, Scandinavia, North America, and Australia the manufacture and use of asbestos products peaked in the 1970s. Current incidences of mesothelioma range from 14 to 35 cases/million/year in 11 industrialized countries that had used asbestos 2.0 to 5.5 kg/capita/year about 25 years earlier. A significant linear correlation (r = 0.80, p 0.01) exists between the two variables. Accordingly, about 170 tons of produced and consumed asbestos will cause at least one death from mesothelioma, most often as a consequence of occupational exposure.

Asbestos↗

Human leukocyte antigen genes may outweigh racial background when generating a specific immune response in sarcoidosis.

Presented is a sarcoidosis patient of African origin, who was adopted at an early age and grew up in Sweden. This patient displayed an immune response identical to that previously reported in human leukocyte antigen (HLA)-DR17 positive Caucasian sarcoidosis patients in Scandinavia, with T-cell receptor AV2S3+ T-cells accumulating in the lungs. HLA typing also established that she was DR17 positive, which is a rare HLA type for individuals of African origin. To the authors' knowledge, this specific immune response has not previously been reported in patients of African origin. Moreover, the clinical manifestations of sarcoidosis were similar to those known to be strongly linked to HLA-DR17 in Scandinavians, i.e. with Löfgren's syndrome. The case presented here suggests certain human leukocyte antigen genes to be strongly linked to specific immune responses that are identical irrespective of the racial background. If such an immune response were important for the subsequent clinical manifestations, this case would argue for the importance of human leukocyte antigen genes in the genetic predisposition to sarcoidosis.

Adoption↗

Associations between markers of respiratory morbidity in European children.

School-aged children often experience acute respiratory symptoms. In a multicentre European study, the association between chronic respiratory symptoms (reported in a questionnaire), skin-prick test results, and lung function, and the occurrence of acute respiratory morbidity, was examined among children aged 6-12 yrs with chronic respiratory symptoms. Children with chronic respiratory symptoms, living in 10 European countries, were selected from a parent-completed questionnaire (n=4,307). Atopy was measured with skin-prick tests, and lung function with spirometry. A total of 1,854 (86% of those in the initial cohort) children kept a successful daily diary regarding their respiratory symptoms for 2-3 months. In multivariate logistic regression analyses, children with asthmatic symptoms, particularly those with doctor-diagnosed asthma, had a greater risk of occurrence of lower respiratory symptoms (odds ratio (OR): 6.12; 95% confidence interval (CI): 4.99-8.35) than children with a dry nocturnal cough as their only symptom. Atopy, particularly a positive reaction to indoor allergens, was significantly associated with occurrence of lower respiratory symptoms. For atopy the OR was 1.62 (95% CI: 1.34-1.96). A reduced level of maximal mid-expiratory flow was associated with an increased risk of lower respiratory symptoms, cough and phlegm. The associations were similar in Scandinavia, Central Eastern, Western and Southern Europe. To conclude, asthmatic symptoms reported in a questionnaire, atopic status and a reduced level of maximal mid-expiratory flow were associated with the occurrence of acute respiratory symptoms, especially those of lower respiratory symptoms.

Acute Disease↗

Diuretic treatment in essential hypertension.

In North America, diuretics remain the most common first-line drug therapy for essential hypertension based on efficacy, safety and cost. The promotion of step-care programmes has firmly established their dominant use on this continent whereas in Europe, particularly in Scandinavia and Great Britain, beta-adrenoceptor blocking agents are more frequently chosen as first-line therapy. On both continents, combined therapy with a diuretic and a beta-blocker is probably the most common second step for patients with blood pressures uncontrolled on a single agent alone and diuretics remain useful, if not essential, to prevent sodium retention commonly observed with other antihypertensive agents. Although the forced loss of sodium and water may be responsible for their initial antihypertensive effect, the mechanism underlying their long-term effect is unknown but probably involves some alteration of vascular smooth muscle reactivity. More recently, concern has been expressed about their long-term safety as larger populations are being exposed to diuretic agents for a significant proportion of their life-span. These concerns include haemodynamic and biochemical consequences of diuretic therapy - excessive tachycardia at rest and with minimal exercise, postural hypotension, hypokalaemia and arrhythmias, muscle cramps or fatigue, glucose intolerance, hyperuricaemia and altered circulating lipids as markers or promotors of atherosclerosis and its complications. At present, there is insufficient evidence to alter the present recommendation of diuretic agents as first-line drug therapy in the treatment of hypertension.

Aged↗

Generation and analysis of 9792 EST sequences from cold acclimated oat, Avena sativa.

BACKGROUND: Oat is an important crop in North America and northern Europe. In Scandinavia, yields are limited by the fact that oat cannot be used as a winter crop. In order to develop such a crop, more knowledge about mechanisms of cold tolerance in oat is required. RESULTS: From an oat cDNA library 9792 single-pass EST sequences were obtained. The library was prepared from pooled RNA samples isolated from leaves of four-week old Avena sativa (oat) plants incubated at +4 degrees C for 4, 8, 16 and 32 hours. Exclusion of sequences shorter than 100 bp resulted in 8508 high-quality ESTs with a mean length of 710.7 bp. Clustering and assembly identified a set of 2800 different transcripts denoted the Avena sativa cold induced UniGene set (AsCIUniGene set). Taking advantage of various tools and databases, putative functions were assigned to 1620 (58%) of these genes. Of the remaining 1180 unclassified sequences, 427 appeared to be oat-specific since they lacked any significant sequence similarity (Blast E values > 10(-10)) to any sequence available in the public databases. Of the 2800 UniGene sequences, 398 displayed significant homology (BlastX E values < or = 10(-10)) to genes previously reported to be involved in cold stress related processes. 107 novel oat transcription factors were also identified, out of which 51 were similar to genes previously shown to be cold induced. The CBF transcription factors have a major role in regulating cold acclimation. Four oat CBF sequences were found, belonging to the monocot cluster of DREB family ERF/AP2 domain proteins. Finally in the total EST sequence data (5.3 Mbp) approximately 400 potential SSRs were found, a frequency similar to what has previously been identified in Arabidopsis ESTs. CONCLUSION: The AsCIUniGene set will now be used to fabricate an oat biochip, to perform various expression studies with different oat cultivars incubated at varying temperatures, to generate molecular markers and provide tools for various genetic transformation experiments in oat. This will lead to a better understanding of the cellular biology of this important crop and will open up new ways to improve its agronomical properties.

Acclimatization↗

Population genomics, demography, and circum-Baltic connectivity of Early Medieval southwestern Finland.

BACKGROUND: Knowledge of Early Medieval Finland (1050-1250 CE) relies primarily on archaeological evidence, as contemporary sources are scarce. The available evidence indicates two distinct cultural-economic zones: coastal and inland. Using newly generated genomic data from 34 ancient individuals alongside modern Finnish genomes, we characterise Late Iron Age and Early Medieval ancestry in southwestern Finland, reconstruct demographic patterns, and place individuals within a circum-Baltic relatedness network. RESULTS: Early Medieval ancestry in inland southwestern Finland was very similar to that of present-day inhabitants. Ancient coastal and inland individuals were genetically indistinguishable, whereas modern coastal populations showed substantially more Scandinavian ancestry, and less Baltic ancestry compared to their ancient counterparts. IBD (identity-by-descent) analyses also indicate a major genetic shift in the coastal zone since the Early Medieval Period. Effective population size increased throughout the study period and was&#x2009;~&#x2009;13,000 by 1250 CE. IBD links between Scandinavia and Early Medieval Finland align with known archaeological connections. Furthermore, we identify IBD links between individuals from Early Medieval Finland and victims of the Kronan warship sinking. CONCLUSIONS: We demonstrate nearly a millenium of population continuity in the inland zone of southwestern Finland, contrasted by a large, contemporaneous genetic shift in the coastal zone. This ancestry shift corresponds with documented medieval emigration from Sweden to Finland. The regional population rapidly expanded during this time period, likely due to new agricultural practices and favourable climatic conditions. Our circum-Baltic IBD network indicates that southwestern Finland was firmly embedded into the wider, pre-modern Baltic world.

Humans↗

Identical triplets with infantile autism and the fragile-X syndrome.

In a continuing twin study of autism in Scandinavia and Finland, moderately mentally retarded triplets fulfilling Rutter's criteria for infantile autism were reported. Judging by physical appearance the triplets were identical. Behaviourally they were extremely similar though one was intellectually slightly better than the other two. All three showed the physical stigmata characteristic of the fragile-X syndrome, in spite of their overall appearance being non-conspicuous. The triplets had between 8 and 12 per cent of fragile-X positive cells and showed a distinct pattern of urinary excretion of substances yielding absorbency at 280 nM. Their mother and sister also had a high count of fragile-X positive cells.

Autistic Disorder↗

Psychiatric and legal aspects of persistent litigation.

There is a paucity of literature in English about those people who persistently complain. In Germany and in Scandinavia, a diagnosis of querulent paranoia may be made, although this interesting and uncommon syndrome is rarely recognised in the UK. Five cases of litigiousness or persistent complaining are reported, to illustrate the typical psychopathology and the types of diagnosis that occur. Four of these people are barred from further litigation by the courts (vexatious litigants) and were contacted directly for the purpose of this study.

Adult↗

Population-wide infant screening for HLA-based type 1 diabetes risk via dried blood spots from the public health infrastructure.

The frequency of type 1 diabetes mellitus (T1DM)-associated HLA DQ alleles in the U.S. Pacific Northwest is as high as in Scandinavia, which has the highest T1DM incidence in the world. The high regional rate of islet autoimmunity observed among DPT-1 relatives supports this notion. Fortunately, Washington State archives dried blood spots after legislature-mandated newborn screening. The Diabetes Evaluation in Washington (DEW-IT) study aims to show that population-based prospective prediction of T1DM by HLA genotype screening followed by autoantibody surveillance can be performed within the public health infrastructure.

Diabetes Mellitus, Type 1↗

Anaplasma phagocytophilum in ruminants in Europe.

The agent that causes tick-borne fever (TBF) in sheep was first described in 1940, 8 years after the disease was first recognized in Scotland. The same agent was soon shown to cause TBF in sheep and pasture fever in cattle in other parts of the UK, Scandinavia, and other parts of Europe. After the initial use of the name Rickettsia phagocytophila, the organism was given the name Cytoecetes phagocytophila to reflect its association with granulocytes and its morphological similarity with Cytoecetes microti. This name continued to be used by workers in the UK until the recent reclassification of the granulocytic ehrlichiae affecting ruminants, horses, and humans as variants of the same species, Anaplasma phagocytophilum. TBF and pasture fever are characterized by high fever, recurrent bacteremia, neutropenia, lymphocytopenia, thrombocytopenia, and general immunosuppression, resulting in more severe secondary infections such as tick pyemia, pneumonic pasteurellosis, listeriosis, and enterotoxemia. During the peak period of bacteremia as many as 90% of granulocytes may be infected. The agent is transmitted transtadially by the hard tick Ixodes ricinus, and possibly other ticks. After patent bacteremia, sheep, goats, and cattle become persistently infected "carriers," perhaps playing an important role in the maintenance of infection, in the flock/herd. Little is known about how efficiently ticks acquire and maintain infection in ruminant populations or whether "carrier" domestic ruminants play an important role as reservoirs of infection, but deer, other free-living ruminants, and wild rodents are also potential sources of infection. During the late 1990s serological evidence of infection of humans was demonstrated in several European countries, creating a renewed interest and increased awareness of the zoonotic potential of TBF variants. More recently, a few cases of human granulocytic anaplasmosis (HGA) have been reported in some European countries, but it remains to be established whether the variants causing HGA in Europe are genetically and biologically different from those causing TBF in ruminants. TBF is readily diagnosed by demonstrating intracytoplasmic inclusions in peripheral blood granulocytes or monocytes of febrile animals or by detecting specific DNA by polymerase chain reaction (PCR), and TBF variants of A. phagocytophilum can be cultivated in tick cell lines, but the differentiation of TBF variants from HGA variants awaits further investigations.

Anaplasma phagocytophilum↗

Long-term somatic follow-up of prenatally treated children with congenital adrenal hyperplasia.

Prenatal virilization of female fetuses is a serious symptom associated with severe congenital adrenal hyperplasia. In attempt to avoid sexual ambiguity, prenatal treatment of 21-hydroxylase deficiency was initiated in 1984, with the first Scandinavian case treated in 1985. Here we have studied the outcome of prenatal diagnosis and therapy of 44 at-risk pregnancies monitored during the years 1985-1995 in Scandinavia. Treated mothers and children were compared with matched controls. Compared to their elder affected sisters, all 5 girls with severe congenital adrenal hyperplasia who were treated until term showed little virilization. Only 1 required surgery for labial fusion. The majority of the 44 dexamethasone-treated fetuses demonstrated normal pre- and postnatal growth compared to matched controls. However, several adverse events such as failure to thrive and delayed psychomotor development, were reported among the treated infants. In addition, treated mothers reported more side-effects during pregnancy than did controls. A significant increase in weight gain was observed during early pregnancy when treatment was initiated, but this initial rapid weight gain declined during late pregnancy or when treatment was terminated. Thus, experience to date suggests that prenatal treatment of affected female fetuses is generally efficient in minimizing virilization of external genitalia. However, there is still a need to collect more data concerning possible rare unfavorable effects of this therapy on mother and child.

Adrenal Hyperplasia, Congenital↗

The geographical scale factor in orientation of migrating birds

Migration routes of birds throw light on orientation performance at different geographic scales, over distances ranging from a few kilometres to more than 104 km. Detailed knowledge about the flight routes may be used to test predictions about optimal orientation according to theoretical principles and about the use of compasses based on celestial or magnetic cues. Ringing recoveries demonstrate that the migratory journey of many species, such as the wheatear and willow warbler, is divided into successive legs with different main orientation. Autumn and spring migration routes are often different, sometimes diverging on a continental scale. Aerial radiotracking of whooping cranes in North America and satellite tracking of brent geese migrating from Iceland across the Greenland ice cap point to the significant role of large-scale topography for the shaping of migration routes. Compass and position control are also required, e.g. during long passages across featureless sea or ice, but how these elements are integrated into the birds' orientation system remains unclear. Radar studies from the Arctic Ocean illustrate the importance of map projections for interpreting flight paths and suggest that birds accomplish approximate great circle orientation. Gradual course changes shown by migrating knots monitored by radar in Scandinavia are at variance with expected changes if the birds were to use a star, sun or magnetic compass over longer distances. Accurate recording of short flight segments shows how flying birds respond to visual, audible and electromagnetic cues, and also documents orientation precision and capacity to integrate rapidly shifting courses into a consistent resulting orientation. Analyses of flight patterns are crucial for understanding how birds find and follow their migration routes over different ranges of geographical scale.

Journal Article↗