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PubMed1985

Abortion in Thailand and Sweden: health services and short-term consequences.

In Thailand, where abortion is still illegal, abortion services (health services) outside Bangkok, and outside hospitals or clinics, are provided by non-physician practitioners. In the studies reported here, those practitioners were interviewed in 1978 and 1981 about their methods and the characteristics of their clients. The first study revealed that massage is the method most widely used by rural practitioners and that uterine injection with different solutions comes second. The second study was in agreement with these findings. The health consequences of these induced abortions were studied by interviewing the clients of the rural practitioners in 1980 and 1981. In Sweden, where abortion has been legal for quite a long time, all women who need an abortion have access to safe and convenient health services throughout the country.

Abortion, Illegal↗
PubMed1985

Occupational health reporting systems in Sweden.

Legislation covering worker's compensation influences occupational health reporting and data gathering. Five programs recently enacted in Sweden are outlined and discussed. These include: 1) Labour Market No-Fault Liability Insurance, 1974; 2) The National Sickness Insurance Act, 1977; 3) The Work Injury Insurance Act, 1977; 4) The Work Environment Act, 1977; 5) The Occupational Injury Information System, 1979.

Humans↗
PubMed1986

Nasal cancer and occupation in Sweden, 1961-1979.

Using national population-based registries which link cancer incidence (1961-1979) with 1960 census data on industry and occupation for all employed individuals in Sweden, a systematic assessment was made of nasal cancer (ICD 7th Rev. 160) with special reference to occurrence in manufacturing industries and craftsman-tradesman occupations. Data are presented for three histologic categories: adenocarcinoma, squamous cell carcinoma, and other histologic types. The highest risks (18-fold) were observed for adenocarcinoma among men employed in furniture making. Elevated risks were also observed for textile workers of both sexes. The findings are generally consistent with previous reports from other countries and help clarify the role of occupation in the origins of nasal cancer.

Adenocarcinoma↗
PubMed1990

Farmers' health and safety programs in Sweden.

In 1977, the Swedish Farmers' Federation initiated a pilot project of preventive occupational health services to farmers. After a few years it was decided that this occupation-specific service, Farmers' Preventive Health Service (Lantbrukshälsan), should be permanently established within the federation of farmers. Today, 33 special regional centers have been established around Sweden, providing occupational health services to farmers, farm workers, and others occupied in farm-related enterprises. At another 30 locations collaboration has been established with other existing health care centers. Farmers must pay a fee to become a member of the organization and to provide affiliation is voluntary. Today about 40,000 farmers are members. The main goal of the farmers' preventive health service (FPHS) is to prevent work-related injuries and illnesses and to provide clinical services to farmers for occupational medical problems. Every second year a health check-up is performed; during the years in between other services such as farm visits, first aid courses, and sessions on prevention/amelioration of back and neck problems are provided. A team of occupational nurses, physiotherapists, agricultural safety engineers, doctors, and secretaries work together to provide comprehensive services. This integrated medical-technical approach to service provision is a prerequisite to successful intervention for the many occupational hazards which may cause damage to health. Respiratory problems related to inhalation of organic dust, pesticide exposures, allergies, and orthopedic diseases are important. Psychosocial work-related problems seem to be increasing among farmers.

Accidents, Occupational↗
PubMed1993

Mortality and cancer incidence among PVC-processing workers in Sweden.

The mortality pattern and the cancer incidence were investigated among 717 men who had been employed for at least 3 months during 1964-1974 in three Swedish PVC-processing plants. The mortality was followed 1964-1986 and the cancer incidence 1964-1984. Expected figures were calculated from Swedish national rates. Among Swedish citizens, the observed mortality and cancer incidence was close to the expected in most diagnoses. Among immigrants, mostly from Finland, there was a marked excess of circulatory deaths. This finding was probably due to the higher incidence of coronary mortality in Finland compared to Sweden. In the whole cohort, five cases of malignant melanoma had occurred as compared to 1.5 expected (SMR = 3.4, 95% confidence limit 1.1-7.9). This may be due to chance but merits further investigation since an increased incidence of malignant melanoma has previously been found among Norwegian PVC-manufacturing workers.

Chemical Industry↗
PubMed1991

Mechanical surface analysis of bone: a case study of cut marks and enamel hypoplasia on a Neolithic cranium from Sweden.

A method for measuring, recording, and studying fine surface irregularities in three dimensions is presented. The method, which involves recording the movements of a diamond-tipped stylus as it scans the surface being studied, is demonstrated on a Neolithic cranium from Sweden. The cranium emanates from a pile dwelling dated to about 3000 B.C. Its frontal bone exhibits distinct cut marks indicative of scalping, and the teeth show signs of enamel hypoplasia. The surface topography of the putative cut marks and hypoplastic enamel were investigated using the stylus method. Measurements of enamel hypoplasia were also carried out for comparison on a front tooth from the lower jaw, and the cut mark study was compared with scanning electron micrographs. The results of this case study demonstrate that the stylus method can obtain high-resolution measurements of fine surface details directly on the original bone without preparation of or damage to the specimen.

Computer Simulation↗
PubMedDate not supplied

Antecedents of neurosis in a cohort of 30,344 twins in Sweden.

We analyzed questionnaire survey responses in a cohort of 30,344 twins in Sweden, 280 of whom became inpatients due to neurosis within the subsequent 10 years. As a group, they differed substantially in their reported health profile from the survey responders who were not admitted for psychiatric treatment. When subclassified into anxiety, depressive, and other neuroses, these were indistinguishable from each other regarding self-perceived health and personality traits. Women were more likely to be hospitalized for neurosis. These mental and social antecedents for both anxiety and depression are in keeping with the concept of a shared diathesis which is supported by neurophysiological, treatment and genetic epidemiological studies.

Adolescent↗
PubMed2005

Risk and case characteristics of tuberculosis in rheumatoid arthritis associated with tumor necrosis factor antagonists in Sweden.

OBJECTIVE: Because treatment with tumor necrosis factor (TNF) antagonists may increase the risk of tuberculosis (TB), and because knowledge of the risk of TB in rheumatoid arthritis (RA) not treated with biologics is scarce and of uncertain generalizability to low-risk populations, this study sought to determine the risk of TB among Swedish patients with RA. METHODS: Using data from Swedish nationwide and population-based registers and data from an ongoing monitoring program of TNF antagonists, the relative risks of TB in patients with RA (versus the general population) and of TB associated with TNF antagonists (versus RA patients not treated with biologics) were determined by comparing the incidence of hospitalization for TB in 3 RA cohorts and 2 general population cohorts from 1999 to 2001. We also reviewed the characteristics of all reported cases of TB in RA patients treated with TNF antagonists in Sweden and calculated the incidence of TB per type of TNF antagonist between 1999 and 2004. RESULTS: During 1999-2001, RA patients who were not treated with TNF antagonists were at increased risk of TB versus the general population (relative risk 2.0, 95% confidence interval [95% CI] 1.2-3.4). RA patients treated with TNF antagonists had a 4-fold increased risk of TB (relative risk 4.0, 95% CI 1.3-12) versus RA patients not treated with TNF antagonists. The reported TB cases during 1999-2004 in RA patients exposed to TNF antagonists (9 infliximab, 4 etanercept, 2 both) were predominantly pulmonary. TB occurred up to 3 years following the start of treatment. CONCLUSION: Irrespective of whether TNF antagonists are administered, Swedish patients with RA are at increased risk of TB. During 1999-2001, TNF antagonists were associated with an increased risk of TB, up to 4-fold in magnitude. This increased risk may persist over time during treatment and is related to both infliximab and etanercept.

Adolescent↗
PubMed2005

Gastrointestinal stromal tumors: the incidence, prevalence, clinical course, and prognostication in the preimatinib mesylate era--a population-based study in western Sweden.

BACKGROUND: Recent breakthroughs regarding gastrointestinal stromal tumors (GIST) and their pathogenesis have redefined diagnostic criteria and have led to the development of molecularly targeted drug therapy. New treatment options mandate more accurate information regarding the incidence, prevalence, clinical behavior, and prognostic factors of GIST. METHODS: All patients (n=1460) who potentially had GIST diagnosed from 1983 to 2000 in western Sweden (population, 1.3-1.6 million) were reviewed, and 288 patients with primary GIST were identified. The incidence and prevalence of GIST were determined, and predictive prognostic factors, including current risk-group stratifications, were analyzed statistically. RESULTS: Ninety percent of GISTs were detected clinically due to symptoms (69%) or were incidental findings at surgery (21%); the remaining 10% of GISTs were found at autopsy. Forty-four percent of symptomatic, clinically detected GISTs were categorized as high risk (29%) or overtly malignant (15%), with tumor-related deaths occurring in 63% of patients and 83% of patients, respectively (estimated median survival, of 40 months and 16 months, respectively). Tumor-related deaths occurred in only 2 of 170 of patients (1.2%) with very-low-risk, low-risk, or intermediate-risk tumors. The annual incidence of GIST was 14.5 per million. The prevalence of all GIST risk groups was 129 per million (31 per million for the high-risk group and the overtly malignant group). CONCLUSIONS: GIST has been under recognized: Its incidence, prevalence, and clinical aggressiveness also have been underestimated. Currently existing risk-group stratification systems based on tumor size and mitotic rate delineate GIST patients who have a poor prognosis. Prognostication in patients with GIST can be refined using a proposed risk score based solely on tumor size and proliferative index.

Age Factors↗
PubMed2006

Treatment outcome in young adults and children >10 years of age with acute lymphoblastic leukemia in Sweden: a comparison between a pediatric protocol and an adult protocol.

BACKGROUND: Several studies have reported a more favorable outcome for teenagers and young adults with acute lymphoblastic leukemia (ALL) when they were treated in pediatric oncology departments compared with adult hematology departments. However, biased risk grouping and high treatment-related mortality have hampered some of those comparisons. METHODS: In Sweden during the 1990s, adolescents with ALL were treated in a pediatric oncology unit or in an adult hematologic unit, depending on the initial referral. In the current national, comparative, retrospective study, patients with ALL aged 10 years to 40 years who were treated either according to the Nordic Society of Pediatric Hematology and Oncology (NOPHO) ALL protocol (1992-2000) (NOPHO-92 protocol) or according to the Swedish Adult ALL Group protocol (1994-2000) (Adult protocol) were included. None of the protocols had age as a high-risk criterion. RESULTS: In total, 243 patients with B-precursor and T-cell ALL were treated according to the protocols. There was a significant difference in the remission rate between the NOPHO-92 protocol (99%; n = 144 patients) and the Adult protocol (90%; n = 99 patients; P < .01), and the event-free survival (EFS) was also superior for the NOPHO-92 protocol compared with the Adult protocol (P < .01). However, EFS was higher for patients aged 15 years to 25 years compared with patients aged 26 years to 40 years within the Adult protocol group (P = .01). The treatment protocol itself was identified as an independent risk factor. CONCLUSIONS: The NOPHO-92 protocol resulted in a better outcome than the Adult protocol; therefore, adolescents may benefit from the pediatric protocol treatment strategy. Prospective trials are warranted to determine whether young adults would benefit from similar treatment.

Adolescent↗
PubMedDate not supplied

Aspiration cytology in Sweden: The Karolinska Group.

The method of aspiration biopsy cytology began to receive international attention after publications, innovations, and courses originating at the Karalinska Hospital in Sweden. Sixteen Franzen, Josef Zajieek, Pier Esposti, and Torsten Lowhagen were prime movers of this clinical and scientific development. The history of their arrival at the Karolinska and their seminal contributions is reviewed.

Biopsy, Needle↗
PubMed1994

Recurrence risk for major congenital heart defects in Sweden: a registry study.

During the period 1981-1986, 1605 infants presenting a major congenital heart defect (CHD) were identified in Sweden. Using the personal identification numbers of the mothers, 1507 of them could be linked to the Medical Birth Registry and two controls were selected for each infant. For this total of 4521 infants, 2686 postoccurrence sibs born during the period 1981-1989 were identified from the Medical Birth Registry. The tendency to have one or more sibs was higher among cases than among controls and was correlated to the life status of the proband. This tendency did not vary according to the type of CHD when controlling for life status. The prevalence at birth of CHD was almost four times higher among sibs of CHD infants than among sibs of normal infants. The tendency to have a sib with an extracardiac malformation did not differ between CHD probands and normal probands. The importance of only including births occurring after the proband when evaluating recurrence risks is stressed.

Family Health↗
PubMed2006

Informing the efficient use of health care and health care research resources - the case of screening for abdominal aortic aneurysm in Sweden.

BACKGROUND: An analytical framework using Bayesian decision theory and value-of-information analysis has recently been advocated for the economic evaluation of health technologies. The purpose of this study was to apply this framework to screening for abdominal aortic aneurysm (AAA) in Sweden and to compare the conclusions from this study with the conclusions presented in an assessment performed by the Swedish Council of Technology Assessment (SBU). METHODS: A probabilistic decision-analytical model was developed to establish the cost-effectiveness of a screening programme for AAA relative to current clinical practice and to calculate the value-of-information. RESULTS: The cost per quality-adjusted life-year for screening was 9700 euro. The expected value of perfect information for the assessment of overall cost-effectiveness was low, suggesting little benefit in conducting further research. Expected value of perfect partial information indicated that rupture probabilities were associated with the highest uncertainty. By contrast, the SBU report concluded there was limited evidence of cost-effectiveness and proposed further research. CONCLUSION: The investigated screening programme for AAA is likely to be cost-effective and conducting another clinical trial is unlikely to add much valuable information to this decision problem. These recommendations contrast with the vaguer recommendations from SBU that more evidence is required of costs-effectiveness.

Aortic Aneurysm, Abdominal↗
PubMed2003

The value of the change in health in Sweden 1980/81 to 1996/97.

The study aimed to estimate the value of the change in health in Sweden 1980/81 to 1996/97. Quality-adjusted life years (QALYs) for men and women at specific ages were estimated for 1980/81, 1988/89 and 1996/97, by combining survival rates and health state scores. Data from the Swedish Survey of Living Conditions (n = 39,966) were used to estimate age-specific health state scores. Responses to selected survey questions were mapped into the EQ-5D measure, using the UK EQ-5D index tariff to derive health state scores. The monetary value of a QALY was assumed to be 100,000 dollars. Life expectancy for infants increased by 3.68 years for males and 2.70 years for females between 1980/81 and 1996/97. Average health status decreased in younger age groups whereas it increased in older age groups. Expected QALYs for infants increased by 2.64 for males and 0.54 for females. With 3% discounting the gain was 0.11 QALYs (11,000 dollars) among males and a loss by 0.58 QALYs (58,000 dollars) among females. The corresponding gain in discounted QALYs for a 75-year-old was 1.15 (115,000 dollars) and 0.80 (80,000 dollars), respectively. It is concluded that older persons have experienced considerable health gains whereas the health gains have been small or non-existent for younger women.

Adolescent↗
PubMedDate not supplied

Evaluation of some prognostic factors in small squamous cell carcinoma of the mobile tongue: a multicenter study in Sweden.

In a retrospective study of 58 patients from all over Sweden, treated for small squamous cell carcinoma of the mobile tongue (T1N0M0), different prognostic factors were evaluated. A partial glossectomy was performed as primary treatment in all patients. The cancer recurred in 28 (38%) of 58 patients. One of 7 patients with only local recurrence, and 9 of 14 with recurrence in the neck died of their disease. The relative survival rate was 77%. Of the prognostic factors tested, tumor thickness was found to be the most significant. In patients with tumor thickness was found to be the most significant. In patients with tumor thickness exceeding 10 mm, recurrences occurred in 58% (P less than 0.0048), and 87% (P less than 0.0164) died of their cancer. This represents a statistically significant higher degree when compared with tumor thickness of less than 10 mm. Elective treatment of the neck nodes is recommended in epidermoid cancer of the mobile tongue when tumor thickness exceeds 10 mm, even in stage I tumors (i.e., the surface extension diameter is smaller than 20 mm at most).

Adult↗
PubMedDate not supplied

Epidemiological measures in planning: observations from Sweden.

This article reviews how epidemiological measures can be used in health planning. Theoretical considerations are discussed together with empirical data from Sweden. Formulation of targets, priority settings, resource allocation and monitoring systems are some ways in which epidemiological data can improve health planning. One important lesson for planning is that problems related to health, inequalities in health, and access to care, must be made visible to politicians, health personnel and the public. Further, there is a need to complement a national health policy with a decentralized planning system that takes local conditions and needs into consideration.

Data Collection↗
PubMed2006

Mirtazapine naturalistic depression study (in Sweden)--MINDS(S): clinical efficacy and safety.

OBJECTIVE: To study how implementation of a naturalistic trial design for mirtazapine treatment in major depressive disorder for six (up to 12) months could be used and evaluated by means of clinical efficacy and safety. METHOD: An open-labelled, prospective, multicenter, non-comparative trial was conducted during a 2-year period in patients with major depression according to DSM-IV treated in psychiatric departments and primary care in Sweden. Minimal inclusion and exclusion criteria were used in order to diminish the potential patient selection bias. Maximum flexibility of the dosage of mirtazapine was allowed, and clinical assessments included MADRS, CGI, vital signs and spontaneous reporting of adverse events. RESULTS: 192 patients were found eligible and enrolled in the study. A significant improvement in depressive symptoms according to MADRS and CGI was observed including particularly marked sleep improvement early in the treatment. Slight increases in body weight and BMI were observed. The investigational drug was well tolerated overall. CONCLUSION: The clinical efficacy and safety of mirtazapine found in this naturalistic setting is in line with previously reported data on mirtazapine in traditional controlled clinical trials. The results confirm that the naturalistic study design facilitated conduct of the trial. The authors suggest that this type of study design should also be applied to other antidepressant drugs that are frequently prescribed in the general population.

Adolescent↗
PubMed2002

Improved survival in both histologic types of oesophageal cancer in Sweden.

The prognosis among patients diagnosed with oesophageal cancer is poor with an overall 5-year survival close to 5% in most countries. Improved diagnostic and surgical strategies might influence the survival, however. We investigated the observed and relative survival among all patients in Sweden diagnosed with oesophageal adenocarcinoma (n = 1,441) or squamous cell carcinoma (n = 6395) from 1961-1996 with follow-up to December 1997. Observed survival rates were calculated by the life-table method. Relative survival rates were computed as the ratio of the observed to the expected survival. The expected survival was inferred from the survival among the entire Swedish population in the same age, sex and calendar year strata. The 5-year observed survival rate for adenocarcinoma increased from a stable figure close to 4% during the entire period 1961-1989 to 10.5% during 1990-1996. Similarly, the 5-year relative survival rate was stable around 5% during 1961-1989, but during 1990-1996 the survival was increased to 13.7%. For squamous cell carcinoma, the survival improved slightly by each decade, starting with 3.8% 5-year observed survival in 1961-1969 to 7.0% during 1990-1996. Similarly, the 5-year relative survival improved from 5.0% to 8.9% during the study period. In conclusion, the survival rates for both oesophageal adenocarcinoma and squamous cell carcinoma have increased significantly during the 1990s compared to those in the previous 3 decades (p < 0.001).

Adenocarcinoma↗