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The high prevalence of obesity in Europe is similar to that in other industrialized areas. Obesity and its related diseases, such as hypertension, hyperlipidemia, diabetes, and hyperuricemia, have become a major problem, particularly in terms of cost. Prospective studies in Scandinavia strongly suggest obesity and its related diseases lower life expectancy. Divergent results from the Seven Countries Study are critically discussed.
The prevalence of elevated antibody titers against Yersinia enterocolitica was studied in normal subjects, patients with a variety of nonthyroidal illnesses, and patients with thyroid disease. In contrast to the low prevalence of antibodies in controls (less than 8%), 48 of 67 patients (75%) with a variety of thyroid disorders had titers greater than 1:8. Antibodies were found in 24 of 36 patients with Graves' disease, five of six with autonomous adenoma, seven of seven with Hashimoto's thyroiditis, three of five with idiopathic primary hypothyroidism, four of 11 with nontoxic nodular goiter, and one of two with thyroid carcinoma. Antibodies to serotype 3 were the most prevalent, occurred in the highest titers, and were found particularly in patients with Graves' disease. These observations indicate that in spite of the infreqent occurrence of yersinia infection in the United States as compared with Scandinavia, patients with thyroid disorders have a higher prevalence of antibodies to Yersinia than normal subjects or patients with other disorders.
A total of 1650 birds of 56 species representing 21 families (primarily Passeriformes), was examined for blood parasites in the Lorraine region of France. Only 120 (7.3%) birds were infected, with members of the Paridae, Sylviidae and Turdidae the most frequently parasitized. Haemoproteids were the most commonly encountered parasites followed by the leucocytozoids. Other avian hematozoon genera were uncommon. Prevalence of parasitism was closely similar each year over a three-year period. Immature birds were first noted to be infected with Leucocytozoon in mid-June, suggesting transmission in late May to early June. Haemoproteids were first noted in immature birds in early July, suggesting transmission in mid-June. A review of the literature indicates that the prevalence of parasitism by avian blood parasites has decreased in western Europe since the turn of the century and is currently much lower than the prevalence encountered in Scandinavia, central Russia and eastern North America.
Serum samples from 176 brown hares (Lepus europaeus P.) shot in three areas of south and central Sweden during 1984 and 1985 were analyzed for antibodies to the protozoan parasite Toxoplasma gondii using several serological assays. No toxoplasma antibodies were detected in any of the sera, either by direct agglutination test or by ELISA, and selected sera were also negative in the IFAT and the Sabin Feldman dye test. Based on the high incidence of acute fatal toxoplasmosis in hares in Scandinavia, we propose that the brown hare is exceptionally susceptible to primary T. gondii infection.
The UK appears in the middle of the European MRSA league table between Scandinavia and Romania, but the statistics are not all they seem.
INTRODUCTION: The CarboMedics Prosthetic Heart Valve has been in use since 1986, with more than 220,000 valves implanted through August of 1997 in more than 1550 centers in more than 100 countries. This paper presents the results of a multicenter, international clinical trial that has spanned 10 years. METHODS: There were 1128 valves implanted in patients at 10 sites. The mean follow-up for patients was 4.5 years, with a total of 5110.1 patient-years. Approximately one-third of the patients came from the United States, one-third from Canada, and one-third from Scandinavia. The mean age was 57.2 years; 54.8% were men and 45.2% were women. The primary disease was calcification/atherosclerosis in 37% of the patients and rheumatic disease in 32.7%, and reoperation accounted for 17.5%. There were 556 aortic valve replacements, 428 mitral valve replacements, 139 double valve replacements, and five tricuspid replacements. RESULTS: The survival rate of all implanted patients was 79% at 5 years postoperatively. The survival rate in redo valve patients was as good as the primary survival rate; the survival rate in double valve patients was not as good as the survival rate in single valve patients. There was no structural failure of the valve. Patient outcome as described by New York Heart Association class was significantly improved throughout the postoperative period. Rates of freedom from thrombosis, thromboembolism, and hemorrhage at 5 years were 98.9%, 90%, and 91%, respectively. SUMMARY: Clinical results of the CarboMedics Prosthetic Heart Valve in a midterm, multicenter study were excellent, with low rates of morbidity and mortality and no structural failure.
The Nordic Pediatric Renal Transplant Study Group was organized in 1994 to register and follow children under 16 years of age who receive renal allografts in the Nordic countries. It comprises all transplant centers in Scandinavia, four in Sweden, three in Denmark and one each in Norway and Finland. The following report is based on 430 transplantations performed in 1982-1996. 343 were first transplants and 57 were retransplants. The mean annual incidence of renal transplantations per million children below 16 years of age was 7.4. The mean incidence of retransplantations was 1.0 and therefore the mean incidence of primary transplantations was 6.5 per million children below 16 years of age. 12% of the children were less than 2 years of age, 20% 2-5 years of age and 68% 6-15 years of age. 231 (54%) of the transplants were performed with grafts from living-related donors (LD) and 199 (46%) with cadaveric grafts (CD). 72% of the children had congenital renal disorders and 28% acquired diseases. Cyclosporine-based immunosuppressive protocols were used in all centers. Antibody induction therapy (polyclonal or monoclonal) was used by only three of the nine participating centers. The mean 1-year graft survival rate for all age groups was 88% for recipients of living-donor grafts and 78% for recipients of cadaveric donor grafts.
The clinical and pathologic findings in a case of feline infectious peritonitis (FIP) in a 1-year-old male cat are described. The cat had been sick for about 3 weeks and presented itself clinically with depression, anorexia, dehydration, mild icterus and acites and a temperature of 39.5 degrees C. The sedimentation rate was elevated to 80 mm/30 min. An exploratory laparotomy was performed and ascitic fluid, found to be bacteriologically sterile, was collected. Pathologically, lesions involved both abdominal and thoracic serious membranes and viscera, especially the liver. They ranged from acute, focal necrosis or fibrino-necrotic changes to proliferative inflammation mainly characterized by infiltration with mononuclear cells. An identical disease was produced experimentally by intraperitoneal inoculation of ascitic fluid from the clinical case into 2 healthy cats. This is the first published report of the occurrence of FIP in Scandinavia.
NHS workforce planning has traditionally ignored the role of doctors and nurses trained in continental Europe and Scandinavia. At present doctors trained in the European Economic Area make up 10 per cent of senior house officers in England and Wales. But the numbers coming to the UK are falling. Falling medical unemployment in Europe will mean these doctors have less incentive to come to the UK, leaving a considerable gap in the NHS workforce. More local research is needed into working patterns and career plans of European-trained nurses and doctors.
Insulin-dependent diabetes mellitus (IDDM) is not only a common metabolic disorder in industrialised countries, but its incidence is still increasing, especially in Scandinavia. The article consists in a review of evidence implicating nitric oxide (NO) and the cytokine, interleukin-1 (IL-1), in the pathogenesis of IDDM. Cytotoxic effects of IL-1 and NO, generated through autoimmune reactions associated with insulitis and impairing the function of insulin-producing pancreatic beta-cells in IDDM, are discussed, as are possible pharmacological strategies for blocking this toxicity. Compounds capable of blocking IL-1 cell surface receptors and NO synthesis may prove beneficial in protecting beta-cells from autoimmune assault in IDDM. If IL-1 causes beta-cell dysfunction and destruction through NO synthesis in IDDM, several pathways in the IL-1-NO system are attractive potential targets for drugs protecting beta-cells against these effects, thus providing a means of intervening in the pathogenesis of IDDM.
Rock festivals are popular summer attractions in Scandinavia, and each of the largest festivals has its own voluntary medical crew of doctors, nurses and nursing auxiliaries. The medical crew is an important part of the festival safety facilities, providing free acute health care to festival visitors, and thus relieving pressure on local primary health centres and hospitals. In 1998, 797 of the 25,000 visitors to the three-day Hultsfred Festival were treated at the medical tent, 465 of them by a doctor; and 305 of the 17,000 people attending the two-day Fanclub88 event were treated at the medical tent, 132 by a doctor. No figures are available for the 1998 Roskilde Festival in Denmark, but at the 1997 festival, 3,369 of the 95,000 visitors were treated at the medical tent.
In the present multicenter study from the Scandinavian Sarcoma Group, local recurrence was analyzed regarding a change in the chemotherapy protocol and an increasing number of limb-salvage procedures 1982-97. Surgery was performed at 13 hospitals in Scandinavia. We analyzed the data of 223 patients with non-metastatic, high-grade osteosarcoma of the extremities, treated according to the SSG II and VIII protocols. The rate of limb-salvage surgery was 0.3 in SSG II, as compared to 0.6 in SSG VIII. The local recurrence rates of the limb-salvage patients were 10% (SSG II) and 11% (SSG VIII), as compared to 4% and 2%, respectively, among the amputated patients. We found no significant difference in outcome i.e., in local recurrence and survival rate despite an increased rate of good responders in SSG VIII, as compared to SSG II. It may be shown that the continuously increasing use of limb-salvage surgery is associated with a higher rate of local recurrence than with ablative surgery, despite better chemotherapy.
Until the late 1950s, few treatment modalities for patients with chronic renal failure were available. The first successful renal transplantation was performed in Boston, USA in 1954 when a young man with renal failure received a kidney from his monozygotic twin brother. Tissue typing was not available, there were few options for immunosuppressive treatment, and dialysis could be offered for short-term treatment only. At the Surgical Department A of the National Hospital, Oslo, Norway, treatment of acute renal failure by hemodialysis was started in 1956 and the first renal transplantation in Scandinavia performed the same year. In 1963, the first renal transplantation at Ullevål Hospital, Oslo was performed, the first in Norway with a long-term function transplant. Since 1983, all renal transplantations in Norway have been performed at the National Hospital. In 1969, Scandiatransplant was established as an organisation for organ exchange between the Scandinavian countries, and a national program for renal transplantation in Norway was launched. The Norwegian renal transplant program is based on co-operation between regional and central hospitals and the transplant centre at the National Hospital. In recent years, the number of renal transplantations per year has been 180-200, i.e. 40-45 per million population. Approximately 40% of the transplanted kidneys come from living related or spouse donors. The results in terms of renal graft survival are good.
The clinical presentation of primary hyperparathyroidism has changed considerably after the application of biochemical autoanalysers. The condition was previously found with characteristic symptoms in bone, kidneys and the gastrointestinal tract; less than 1% of patients were assumed to be asymptomatic. Today, most patients have mild and uncharacteristic symptoms. Primary hyperparathyroidism has been detected with increasing frequency in the western world, but there are large variations within demographically otherwise comparable areas. There are also regional differences regarding the incidence of surgical treatment of the disease. Demographic studies have shown increased morbidity and mortality primarily from cardiovascular and possibly malign diseases related to hypercalcemia. Follow-up studies based on surgical series have shown increased mortality related to preoperative serum calcium level. In view of the altered clinical picture of primary hyperparathyroidism, treatment of moderate and possibly "benign" primary hyperparathyroidism has been actualised. At an international consensus conference in 1990, this patient group was defined by an arbitrary serum calcium limit of 3.0 mmol/l, but this limit has been found to be unacceptably high. Regardless of where the upper limit is set, there are so far well accepted indications for surgery, but only one in two patients fulfil these criteria. A working group of endocrinologists and endocrine surgeons from nine university clinics in Scandinavia have recently initiated a prospective, randomised study evaluating surgical treatment and a systematic follow-up of patients with borderline primary hyperparathyroidism.
In the twelve clinical cases of human granulocytic ehrlichiosis (HGE) so far identified in Scandinavia (ten in Sweden, two in Norway), clinical presentation varied from a mild febrile illness to a severe septic condition with such systemic complications as acute respiratory distress syndrome (ARDS). Laboratory verification was based on PCR (polymerase chain reaction) in ten cases, and on serology in two cases. Sequence analysis of 16S rDNA showed the infectious agents to belong to the Ehrlichia phagocytophila genogroup. Seroprevalence data indicate widespread human exposure to granulocytic Ehrlichia; mean seroprevalence, 15-20% of 1,000 clinical sera from tick-exposed patients (mainly from Sweden and Norway). Proposals for diagnostic criteria and procedures, and case management are presented in the article.
Recent epidemiological studies on hormone replacement therapy (HRT) containing mainly conjugated equine estrogens indicate increased risk for venous thromboembolism (VTE). The purpose of the present epidemiological study was to evaluate the effect of HRT containing natural estrogens, i.e., estradiol, on the risk of VTE. HRT formulations containing estradiol are commonly used in Scandinavia. The study was a population-based case-control study. Cases were consecutive females, aged 44-70 years, discharged from Ullevål University Hospital with the diagnosis of deep venous thrombosis or pulmonary embolism during 1990-1996. Fifty-one women with cancer-associated thrombosis were excluded from the study. Controls were randomly collected from the same source population and matched by age. The material comprised 176 cases and 352 controls, i.e., 2 controls for each case. Only formulations containing estradiol were used. The frequency of HRT use was 28% (50/176) in cases and 26% (93/352) in controls. The estimated matched crude odds ratio with 95% confidence interval was 1.13 (0.71-1.78), which indicates no significant association of overall use of HRT and VTE. The estimated adjusted odds ratio was 1.22 (0.76-1.94) performing multi-confounder adjustment using the conditional logistic model and adjusting for hypertension, coronary heart disease, diabetes mellitus, smoking habit, BMI, and the presence of previous VTE. Stratification for time of exposure indicated an increased risk of VTE during the first year of use with a crude odds ratio of 3.54 (1.54-8.2). This effect was reduced by extended use to a crude odds ratio of 0.66 (0.39-1.10) after the first year of use. We conclude that use of HRT containing estradiol was associated with a threefold increased risk of VTE, but this increased risk was restricted to the first year of use.
Exposure to, and the potential effects of, pesticides and persistent organic pollutants in the East Baltic region are reviewed. Exposure of the average population to chlorinated compounds seems lower than in most of western Europe, and current pesticide use is very low. However, due to infrastructure failures and poor management controls, industrial hot spots and inadequate storage sites exist that cause high risks to small population fractions. The low exposure of the general population is indicated by low concentrations of polychlorinated dibenzo-p-dioxins, dibenzofurans and biphenyls in milk fat. Chlorophenol concentrations are also generally lower than in Scandinavia. Some organic pesticides have been found at higher concentrations in Baltic countries and the St. Petersburg area than in Norway, but the range is roughly similar to that in central Europe. Thus the overall risk caused by pesticide residues and persistent organic compounds in the Baltic countries and northwestern Russia is low, but local sites of concern exist.
Pivmecillinam is a beta-lactam antimicrobial marketed almost two decades ago. It has been used widely for the treatment of acute cystitis in selected areas of the world, particularly in Scandinavia. With increasing resistance of community Escherichia coli isolates to trimethoprim and trimethoprim/sulphamethoxazole, as previously observed for ampicillin and sulphonamides, reassessment of empiric antimicrobial regimens for acute uncomplicated urinary infection is necessary. Thus, it is timely to revisit the role of pivmecillinam for the treatment of acute cystitis. Clinical studies document the efficacy of this antimicrobial with short course therapy for acute cystitis, and clinical practice in countries where it has been used for many years confirms its efficacy and tolerability. If this agent were more widely used for empiric treatment for acute cystitis, use of antimicrobials such as the quinolones might be avoided. Further trials to define the comparative efficacy of pivmecillinam with other antimicrobials, and further studies of community resistance in E. coli isolates to this agent are needed.