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Sacrococcygeal teratoma in Sweden between 1978 and 1989: long-term functional results.

Thirty-four patients operated with sacrococcygeal teratoma in Sweden between 1978 and 1989 were reviewed. Twenty-five children were available for functional follow-up. The patients and their parents were interviewed for bowel and micturition habits. Fourteen patients from this number were subjected to anorectal manometry (56%). Fifteen children reported normal bowel habits (60%). In 10 patients (40%) soiling was observed. However, four of them were under 3 years of age and wearing diapers, which made the functional evaluation difficult. The manometries showed normal and resting tone and squeezing pressures in 10 patients and subnormal values in four patients who also had soiling problems. All investigated children showed normal rectoanal inhibition reflex. Twenty-one patients reported normal micturition, in four (16%) urinary incontinence was recorded. Two of the latter children required intermittent clean catheterization, one was on medication and the last one lives without any treatment. No difference in functional outcome was noted between patients with intrapelvic or extrapelvic tumor location. Retrospectively, it is not possible to know whether the observed functional outcome is due to tumor growth or the result of surgery. Preoperative clinical investigation and in some cases anorectal manometry and cystometry could theoretically resolve this problem.

Adolescent↗

Mutagenicity research and testing in Sweden.

A survey is given of Swedish legislation for control of chemicals in the environment. Although no direct legal requirements for mutagenicity testing of chemicals exist at present in Sweden, such requirements can be enforced within the existing laws. Testing and research in chemical mutagenicity are especially performed at the Environmental Toxicology Unit of the Wallenberg laboratory, University of Stockholm. An outline is given of the organization of the unit, which is based on an interdisciplinary cooperation, among divisions of organic and analytical chemistry, cellular toxicology, and genetics. As examples of projects under joint investigation results on polychlorinated biphenyl (PCB) and on vinyl chloride are briefly described.

Animals↗

Distribution of 23 elements in the kidney, liver and lungs of workers from a smeltery and refinery in North Sweden exposed to a number of elements and of a control group.

The levels of antimony, arsenic, cadmium, caesium, chromium, cobalt, copper, gold, iron, lanthanum, lead, manganese, mercury, molybdenum, phosphorus, rubidium, scandium, selenium, silver, tellurium, tin, tungsten and zinc in the kidney, liver and lungs of autopsy specimens from exposed workers in North Sweden, as well as from a control group, have been assayed quantitatively. The workers had been exposed to several elements and their compounds, e.g. lead, mercury, arsenic and cadmium, for long periods in arsenic, lead or selenium plants and in a lead or copper smelter. The chemical analysis was by neutron activation analysis and atomic absorption spectrophotometry. Median levels of antimony, arsenic, cadmium, chromium cobalt, lanthanum, lead or selenium in kidney, liver or lungs in the exposed worker group were found to be about 2 to 16 times as great as the corresponding levels for the control group. Long biological half-life values were observed for these elements, especially in lung tissue.

Aged↗

Concentrations of arsenic in urine of the general population in Sweden.

The concentration of the sum of the metabolites of inorganic arsenic (inorganic arsenic, methylarsonic acid and dimethylarsinic acid) as well as the concentration of organic arsenic compounds, mainly in the form of arsenobetaine, in the urine of human subjects from two cities in Sweden have been studied. The median concentration of metabolites of inorganic arsenic was approximately 8 micrograms As/g creatinine, independent of place of residence, sex, smoking and consumption of beer and wine. However, subjects who frequently ate flatfish and crustacea had somewhat higher (1.5 times) concentrations than those who very seldom ate such food. Flatfish, mainly in the form of plaice, and crustacea were found to be the main source of organic arsenic compounds. Subjects eating this type of seafood more than once a week had approximately 40 micrograms organic As/g creatinine (median value), compared with about 12 micrograms organic As/g creatinine in subjects who very seldom ate it. Other types of seafish or freshwater fish did not give rise to elevated concentrations of arsenic in the urine. The total range of organic arsenic compounds in urine was less than 1 to 525 micrograms As/g creatinine.

Adult↗

Chernobyl's challenge to the environment: a report from Sweden.

This paper reports the levels of radiocesium registered in about 9000 samples collected in different parts of Sweden following the Chernobyl accident during the period May-November 1986. The maximum Cs levels were detected in reindeer, freshwater fish and mushrooms. Parameters possibly affecting the nuclide concentration in different biota are briefly discussed.

Accidents↗

The Swedish Environmental Specimen Bank with reference to the National Contaminant Monitoring Programme in Sweden.

The environmental Specimen Bank (ESB) at the Swedish Museum of Natural History constitutes the base for the National Contaminant Monitoring Programme in Sweden. This is a part of the Swedish Environmental Monitoring Programme (PMK). Since the beginning of the 1960s more than 120,000 organisms have been collected and stored in the Swedish ESB. The present PMK-programme started in 1978 under the authority of the Swedish Environmental Protection Agency. The present paper gives a brief presentation of main types of material and species annually collected for storage in the Swedish ESB, with special reference to the Contaminant Monitoring Programme.

Animals↗

Mercury levels in the hair of pregnant women in a polluted area in Sweden.

Total mercury concentration in hair, sampled at delivery, was determined in women living in an area polluted with atmospheric emissions of mercury from a metal smelter, (n = 122) and in a control area (n = 75). Information on fish consumption was obtained at the 10th week of pregnancy. The average mercury concentration in hair was 0.27 mg/kg (range 0.07-0.96 mg/kg), which is somewhat lower than previously reported for pregnant women in Sweden and very low compared with levels in fish-eating populations in other parts of the world. Women living in the polluted area had significantly lower mercury levels in hair than women in the control area when comparing groups with quantitatively similar consumption of freshwater fish. Possibly, the population in the smelter area does not catch fish in the neighbourhood and/or the fish in the control area has elevated mercury levels. Consumption of freshwater fish > or = once a week resulted in approximately twice as high hair mercury levels as in those who did not eat freshwater fish at all. Also consumption of saltwater fish > or = once a week resulted in significantly higher hair mercury levels than in those consuming saltwater fish < once a month. Hair levels from the 10th week of pregnancy were similar to the levels at delivery in women with high (> or = once a week) consumption of freshwater fish but decreased during this period in women who did not eat freshwater fish at all, which could be explained by decreased exposure during pregnancy and measurement in recently formed hair.

Adult↗

Increasing cancer risk in younger birth cohorts in Sweden.

There is controversy about cancer mortality trends; some analyses show increasing mortality, but others suggest that rates are falling in the youngest age groups. We have investigated trends in cancer incidence in the whole of Sweden for the period 1958 to 1987. 837,085 cancer cases were registered during the period studied. Incidence rate patterns were studied by age-period-cohort modelling. The risk of cancer was higher for people born during the 1950s than for those born in 1873-82; for women the risk was doubled and for men it was trebled. Although the rate of increase slowed, it showed no sign of levelling off in the youngest birth cohorts. The frequency of smoking-related cancers increased greatly in both sexes, but such tumours could explain only part of the rise in total cancer. These trends predict a continuing rise in the incidence rate of cancer, and suggest a worrying pattern of increasing population exposure to carcinogenic influences.

Adult↗

Intra- and extrafamilial child homicide in Sweden 1971-1980.

Over the 10-year period studied, a total of 96 children under 15 years of age were killed in Sweden. This number constituted an average annual rate of 0.6 per 100,000 children. The violence, most frequently involving strangulation, shooting, and stabbing, was largely directed at young children. The pattern of child homicide was mainly characterized by intrafamilial violence, especially in connection with the suicide of a parent-perpetrator. Extrafamilial homicides were rare and only committed by male perpetrators. Cases of child abuse by a parent and cases of sexual abuse were infrequent. By psychiatric examination after the crime, only 10 perpetrators out of 47 examined were found not mentally ill.

Adolescent↗

Detection of potential virulence markers of Vibrio vulnificus strains isolated from fish in Sweden.

A variety of potential virulence markers such as the production of cytotoxin, haemolysin, exoenzymes, bactericidal action of sera, presence of capsule and adhesion to human intestinal cells were investigated on Vibrio vulnificus strains isolated from eels in Sweden. The strains had the capacity of producing all or some of the above-mentioned virulence markers, to varying degrees though none of the strains produced any capsule. The strains also bound specifically to human intestinal cells in vitro with maximum adhesion levels of 30 bacteria/cell. The results on binding of V. vulnificus cytotoxin to HeLa cells, showed that a very short exposure time (30 min) was required for inducing the cytotoxic effects. V. vulnificus is a relatively new addition to the list of bacteria pathogenic for humans, and since there are increasing reports on its isolation from aquatic environments and seafood (e.g. raw oysters, crabs and shellfish), the results on virulence profiles of V. vulnificus strains presented above emphasize the importance of these organisms in public health and epidemiological studies.

Animals↗

Enterotoxigenicity and drug sensitivity of Aeromonas hydrophila isolated from well water in Sweden: a case study.

A large number of Aeromonas spp. have been found in drinking water from a drilled well in Sweden. Isolates identified as A. hydrophila were tested for production of enterotoxin, hemolysin, enzymes and for resistant patterns to different antibiotics. The enterotoxin-producing A. hydrophila could be responsible for the long-term diarrhoeal case of a 1 1/2 year old child who consumed the contaminated water.

Aeromonas↗

Occurrence of Listeria monocytogenes in soft and semi-soft cheeses in retail outlets in Sweden.

Samples of 333 retail cheeses produced in or imported into Sweden were examined for the presence of Listeria monocytogenes. Listeria monocytogenes was isolated from 6% of the cheese samples. Cheeses made from raw milk were more frequently contaminated with L. monocytogenes (42%) than cheeses made from heat-treated milk (2%). The incidence of the organism in whole cheeses and pre-cut wedges was similar (6%). L. monocytogenes was only found in imported cheeses (18 from France, and one from Germany and Italy, respectively). The numbers of L. monocytogenes varied from < 1 x 10(2) to 1 x 10(5) cfu/g. All L. monocytogenes strains belonged to serogroup 1/2, except isolates from two samples that belonged to serogroup 4.

Cheese↗

The capital decision-making process in regionalized public health systems: some evidence from Sweden and Denmark.

This paper evaluates health capital policy in two regionally structured delivery systems, those of Sweden and Denmark. After a short overview of each nation's health care system, the paper examines the decision-making process for capital equipment and major capital construction in each country. By comparing aspects of system design and subsequent policy outcome, the paper highlights the degree to which capital policy can vary within an apparently similar regionalized framework.

Capital Expenditures↗

Growth of private medicine in Sweden: the new diversity and the new challenge.

The growth of private medical care in Sweden has occurred despite the lack of overt encouragement by the long-term Social Democrat government. This can be documented from official government statistics, private insurance sales, media sources, membership growth in the private doctors association, purchase of private risk insurance, growth of private health care organizations and services, and particularly an increase in public sector private contracting. While the percent of the population with private insurance is close to 1%, it is probable that over 20% of physicians engage in some form of private practice. Explanations range from increasing criticism of poor service orientation in the public system, long waiting lists and the reduced rate of public spending, to a general atmosphere that asserts more individual choice. With the Social Democrats now out of power, it is likely that the Moderate coalition will officially promote some forms of privatization. What will be the impact on the long-cherished Swedish principle of equity?

Advertising↗

Cost-effectiveness of a tobacco 'quit and win' contest in Sweden.

Tobacco is one of the major causes of premature deaths in the world, and any effort to improve the cost-effectiveness of smoking cessation is worth while. The costs and effects in years of life saved (YLS) were estimated for a tobacco 'Quit and Win' (Q&W) contest in Sweden. The contest was conducted during the autumn of 1988 and included two strategies: a national mass media strategy and an organizational strategy for Stockholm County. A total of 12,840 people participated in the Q&W contest. The model for analysis included programme effects and programme costs, and the data was presented in (YLS). Both effects and costs were discounted. Data about non-smoking participants after 12 months and the number of spontaneous quitters was based on random samples of participants and of the general population, respectively. The programme costs included intervention as well as evaluation costs, e.g. costs of personnel, campaign materials, distribution, prizes for the contest, rent and administration and overhead costs for the project group and the collaborating organizations. The cost per YLS varied between US$188 and US$1222. The Q&W contest, as a method of helping tobacco users quit, compares favourably with most preventive and treatment programmes, and the method seems to be quite an effective way for society to use scarce resources.

Adolescent↗

The impact of aging on health care expenditure in Sweden.

This study measures the impact of aging on health care expenditure in Sweden in 1970-1985 and the projected impact for 1985-2005. In addition, the distribution of health care expenditure over different age groups is analysed. The study shows that changes in population aging account for barely 13% of the total increase in health care expenditure during the period 1970-1985, and that is the combined effect of changes in population aging plus the faster increase in health care expenditure per capita in older age groups that governs the development of an increasing concentration of health care expenditure to older age groups. During the period 1976-1985 the per capita health care expenditure increased modestly for the ages 0-74, but 54% for persons older than 74 years.

Age Factors↗

Setting health care priorities in Sweden: the politician's point of view.

In this report, the results of interviews with sixty local health care politicians in southern Sweden will be presented. It is evident from the material that despite their formal responsibility, the politicians are of the opinion that other actors exert greater influence upon the allocation of resources. They do not think that health care expenditure need be extended, whereas fields such as care of the elderly and preventive medicine ought to receive extended contributions at the expense of other publicly financed activities such as general mammography and in vitro fertilization. Somewhat more than a third of the politicians hold that the goal stipulated in the Swedish Health Care Act, i.e. to provide good health and care on equal terms, has not been fulfilled. Their attitudes towards priority criteria such as personal responsibility, age, life expectancy, parenthood and productivity differ from case to case, and there is no clear-cut consensus. However, approximately half of the respondents agree wholly or partly that a person who promises to alter his or her unhealthy habits should be treated before someone who does not make such a promise. The same applies to the principle that those employed ought to be given priority in operating queues, and in consequence of this utility perspective there are also increased demands upon the physicians to take economy into consideration in treating an individual patient.

Attitude to Health↗

'Bed-blockers': delayed discharge of hospital patients in a nationwide perspective in Sweden.

Between 1989 and 1992 the number of 'bed-blocking' patients in Sweden decreased from 15 to 7% according to national registers containing approx. 4000 patients. Part of this reduction can be explained by the 1992 Elderly Reform, which placed economic responsibility for bed-blockers on municipalities. However, the decrease began before the economic reform, implying that other factors are also involved, such as access to alternative institutional beds and other forms of care. An in-depth study of one district has provided a description of these often elderly patients, their heavy hospital utilization both before and after the bed-blocking period and their mortality. Nearly half the patients were dead within a year. Bed-blocking is a poorly defined concept requiring urgent discussion. Other related topics to which attention should be drawn are the administrative costs of economic control systems and efficient utilization of public resources as a whole.

Aftercare↗