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Premature mortality in lung cancer as an indicator of effectiveness of tobacco use prevention in a gender perspective--a comparison between Poland and Sweden.

This contribution presents a comparative analysis of the probability of premature overall deaths and lung cancer mortality for men and women between one Nordic country--Sweden--and one country in transition in central Europe, namely Poland. Furthermore the study compares the pattern of smoking prevalence for both sexes in the two countries. Male lung cancer mortality is constant in Sweden during the last two decades, which is completely contrary to the trend in Poland with a long period of increase followed by a slow decrease during the last years. Lung cancer mortality for women in both countries is on a continuous increase and the rate is exactly the same. The premature mortality in lung cancer in Sweden in the age group of 20-44 years now is higher for women than for men. Swedish men have reduced their smoking habit strongly and far more than Polish men (17 respectively 42% 1999). The male use of moist snuff in Sweden is taken into consideration when discussing the low rate of lung cancer in Sweden. Concerning the pattern of tobacco use it is obvious that Swedish and Polish women during the last decades have had the same and slowly decreasing smoking prevalence (21 respectively 23% 1999). The conclusion is that the best way to control the lung cancer epidemic is to reduce smoking prevalence in the population. Lung cancer mortality in younger and middle aged groups is a good indicator of the success in tobacco control in a country as well for women as for men, especially in the middle age groups.

Adult↗

Increased carotid intima-media thickness in men born in east Finland: a twin study of the effects of birthplace and migration to Sweden on subclinical atherosclerosis.

BACKGROUND: There is a clear east-west difference in coronary heart disease (CHD) mortality and incidence in Finland, people living in east Finland having higher CHD rate. A study of Finnish immigrants to Sweden has suggested that a long stay in Sweden would be associated with reduced CHD risk. AIM: To determine whether structural and functional markers of subclinical atherosclerosis differ between men originating from east and west Finland, and whether migration to Sweden influences subclinical atherosclerosis. METHOD: Carotid intima-media thickness (IMT) and brachial artery flow-mediated dilatation (FMD) with high-resolution ultrasound and a set of cardiovascular risk factors were measured in 76 middle-aged male twin pairs (55 pairs from east and 21 pairs from west Finland) discordant for migration to Sweden. RESULTS: Among men living in Finland, IMT was significantly higher in men originating from east Finland compared to those from west Finland (0.796 +/- 0.212 versus 0.704 +/- 0.123 mm, P = 0.02). A similar east-west difference was observed in men who had migrated to Sweden (0.766 +/- 0.220 versus 0.686 +/- 0.089 mm, P = 0.03). The east-west difference in IMT persisted after adjustment for the major traditional cardiovascular risk factors. No east-west difference was seen in FMD. Smoking, Framingham risk score and physical activity had a greater impact on IMT in men originating from east compared to west Finland. CONCLUSIONS: Men originating from east Finland, irrespective of their current residence, have a greater degree of subclinical atherosclerosis and they may be more susceptible to the impact of conventional cardiovascular risk factors than men originating from west Finland.

Carotid Arteries↗

Timing and effect of fissure sealants on permanent molars: a study in Finland and Sweden.

Fissure sealants are frequently used in the Nordic countries for the prevention of caries in children. The aim here was to analyse their use and effect on dental health in children and adolescents in Finland and Sweden. A retrospective longitudinal population-based study was performed in northern Finland and Sweden, where different strategies have been adopted for sealing teeth. The timing of sealant and restoration placements up to 18 years was studied in representative samples of subjects born in the early 1980s in Kemi, Oulu, Raahe and Tornio in Finland (n = 908) and compared with a random sample of subjects from Norrbotten, Sweden (n = 634). A sensitive survival analysis method was applied to all the permanent molars separately (Virtanen et al. 1996). About 80-90% of molars had been sealed in the Finnish subjects, and approximately 30% in the Swedish cases, employing selective criteria. The filling increments were statistically significantly higher in Sweden than in Finland, although the differences were not of the same magnitude as the reduction in sealants. More than 30% of first molars and 50% of second molars had not been treated, i.e. were without sealants or fillings, by the end of the follow-up in Sweden, compared with 10% and 20%, respectively, in Finland. Fissure sealants were effective in preventing caries in molars in children and adolescents, and the use of selective criteria for targeting this treatment can yield savings in effort and costs in a low caries situation, although more research is needed to find the optimum cost-effective strategy.

Adolescent↗

Rett syndrome in Sweden. Neurodevelopment--disability--pathophysiology.

Rett syndrome (RS), a complex and severely disabling neuromotor disorder affecting young girls, was not internationally recognized until in the middle eighties. In Austria and Sweden only, there are clinical experiences since the sixties. The aims of this study were to 1) define the nucleus group of RS in Sweden, 2) develop a frame of defined stages for describing the clinical progress of disease, 3) identify early developmental patterns and their predictivity, 4) give the natural history of neuromotor impairments and disability in adults, 5) analyse the period of clinical regression as to developmental profiles, patterns and progression of symptoms, 6) search informative neurophysiologic correlates to clinical symptoms and signs. By a 6 year (1984-90), nationwide search procedure, comprising an information and tracing program, a travelling consultant program, and a neuropediatric and laboratory examination program, 88 females were added to those 17, observed in Sweden during the sixties and seventies. By March, 1990, 105 females, aged 19 months-44 years (median 17 1/2 years), had entered this series, which was considered representative for the nucleus group of RS in Sweden. 97/105 females (92.3%) fulfilled the criteria for classic RS, according to internationally accepted clinical criteria, and 8 (7.7%), represented so called "formes frustes". The prevalence for classic RS in the south-west region of Sweden was 1:12.000-13.000 girls, the birth years 1965-76 and 1960-84. Based on 29 females with RS, aged 13-28 years, a clinical staging system was constructed and evaluated in 1985, emphasizing the main different phases of the disorder throughout life. This staging system was found a valuable tool for clinical assessment, documentation, and research approach, and has become internationally accepted and widely used. Further experiences have given rise to minor adjustments, which are proposed. By scrutinizing early documentation from 10 girls, at referral aged 20 months-6 1/4 years (median 3 1/4 years) and retrospectively applying the Denver Developmental Screening Test frames, early achievements, signs and symptoms were reconstructed in 1986. Although characteristic neuromotor and neurobehavioural patterns of help for early suspicion, and even subtle signs, possibly reflecting a disorder already during the first months of life, could be identified, predictive clinical manifestations of diagnostic value were not found.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗

Problems associated with restorative materials--dentists' views in Finland and Sweden.

During the past 10-15 years the possible side-effects of dental restorative materials, especially due to amalgam fillings, have caused a lively debate in Sweden. There is an extensive literature on the chemical and biological properties of dental materials but no investigations have dealt with the providers' attitudes. The purpose of this study was to find out the dentists' experiences of and attitudes to patients who state they have problems related to dental restorative materials and compare the dentists' subjective assessments of those side-effects in two neighboring countries, Finland and Sweden. Information was collected by postal questionnaires addressed to dentists chosen at random in Finland (n = 625) and in Sweden (n = 960). The response rate was 73 per cent and 72 per cent respectively. The results showed that 99 per cent of the respondents had patients questioning the safety of dental materials. The number of such patients was estimated to be three times higher in Sweden (124 patients per dentist in 1989) than in Finland (39 patients per dentist). More than 90 per cent of the questions from the patients regarded amalgam fillings. Statistically significant differences were found between the respondents' opinions of amalgam, 81 per cent of the Finnish contrary to 59 per cent of the Swedish respondents considered the risk of side-effects to be low when using this material. About 90 per cent of the respondents considered glass-ionomer, gold and ceramic restorations safe, but only half of them were convinced of the safety of composite. A great majority of the Swedish respondents (79 per cent) claimed that the patients should get their fillings changed without odontologic indications if they insisted on it and paid for the treatment in comparison to 22 per cent of the Finnish respondents (p less than 0.001). In case dental insurance was to pay for this kind of treatment it was accepted by 6 per cent of the Finns and 25 per cent of the Swedes. The attitude to amalgam was in general less favorable among the dentists in Sweden than in Finland.

Adult↗

A comparison of antibiotics consumption and bacterial resistance patterns in Kuwait and Sweden.

The total utilization of antimicrobial drugs, expressed as DDD/1000 inhibitants/day, was 19 in Kuwait and 15 in Sweden. Aminoglycosides, tetracyclines and trimethoprim/sulphonamide were used more in Kuwait than in Sweden. The utilization of cephalosporins, however, was more prevalent in Sweden than in Kuwait. Hospital use of aminoglycosides was more pronounced in Kuwait than in Sweden, whereas trimethoprim/sulphonamide was less utilized in Kuwait. The overall consumption of antimicrobial drugs expressed as DDD/500 hospital beds, was highest in one of the Swedish hospitals where, for example, the consumption of tetracyclines was 15-fold higher than that in the comparable Kuwaiti hospital. Regarding bacterial resistance patterns, the large use of aminoglycosides and ampicillin was reflected in a higher resistance frequency among the Kuwaiti isolates. Resistance frequencies for trimethoprim/sulphonamide was also relatively much higher in Kuwait than in Sweden. In this case there was, however, no simple correlation to utilization figures, which are lower for the Kuwaiti hospital than for the Swedish. Resistance to chloramphenicol was prevalent in both countries, in spite of the very limited use of this drug.

Anti-Bacterial Agents↗

Reproductive medical care in Sweden and the Province of Ontario, Canada. A comparative study.

Reproductive medical care in Ontario, Canada and in Sweden are compared. Accurate statistical information is more readily available for Sweden. The perinatal mortality is significantly higher in Ontario. The populations are comparable in size. Except for a higher percentage of first generation immigrants in Ontario, the composition of the childbearing population is very similar. The percentage of low birth weight infants is higher in Ontario. Swedish governmental authorities realized in the 1930's that social reforms and preventive antenatal care could reduce perinatal mortality and morbidity and regionalization of perinatal care started several decades ago. A difference in attitude towards pregnant women is reflected in the fact that in Sweden, the maternal benefit is paid under the Health and Social Insurance system, whereas in Ontario it is paid by the Department of Employment and Immigration. The highly specialized neonatal and perinatal units in Ontario have outstanding results, and could serve as models to improve the care of the very low birth-weight infants in Sweden, as could the transport system for high-risk mothers and infants in Ontario. If the advantages of each of the two systems for perinatal care in Ontario and Sweden were combined excellent perinatal statistics would be expected, including a decreased incidence of handicap.

Child, Preschool↗

Oral health in groups of refugees in Sweden.

In recent years the impact of ever-increasing numbers of refugees on the resources of the host countries has become a global concern. Health personnel face unanticipated demands complicated by different cultural, ethnic and religious factors and an unfamiliar disease panorama. Sweden today has around 1 million immigrants, 15% of the population. The aim of this thesis was to describe oral status with respect to caries and periodontal conditions, to analyse the need for dental treatment, to evaluate the effect of a preventive dental health programme, to study attitudes and knowledge of preventive dentistry and to describe and analyse utilization of dental services by different groups of adult refugees in Sweden. Three different methods were used: a descriptive clinical survey of a random sample of 193 Chilean and 92 Polish refugees, an experimental survey of a random sample of 159 Chilean refugees and a register survey, using national health statistics, consisting of a random sample of 2,489 refugees arriving in Sweden 1975-1985. The Chilean and Polish refugees had markedly poorer oral status than corresponding Swedish population groups. No association could be found between oral health or estimated treatment need and the length of time in Sweden. The simplified preventive program in the form of group discussion had a lasting effect on improved periodontal conditions and also improved knowledge of dental health care in the group of Chilean refugees. The register survey showed a generally low utilization of dental services but a high dental consumption among adult refugees in Sweden. The total treatment time for a course of treatment showed no marked decrease with subsequent courses of treatment. Immigration may have a profound effect on oral health care needs in a given population by introducing undetermined accumulated needs for oral care, and by stimulating changes in attitudes to and preferences in oral health and care.

Analysis of Variance↗

Cost of radiotherapy in Sweden.

This chapter addresses the economic aspects of radiotherapy. It includes a summary of the costs for radiotherapy in Sweden, a literature review of economic studies on cancer radiotherapy, and estimates of radiotherapy costs in Sweden for 1991. Appendix I describes the types of economic assessments relevant to an economic analysis of radiotherapy. Appendix II analyzes potential economies of scale, and the economic consequences of changed fractionation schedules. Cancer diagnosis and treatment accounts for approximately 5% of the total healthcare expenditure in Sweden (1), corresponding to 6.9 billion Swedish kronor (SEK) per year in 1993 monetary value. The costs of radiotherapy, an important modality for treating cancer, have not been fully described. This report presents such an estimate. The cost of external radiotherapy in Sweden in 1991 was approximately 260 million SEK. This corresponds to approximately 4% of the cost for cancer care. On average, the cost per irradiated field was approximately 500 SEK, the cost per fraction approximately 1125 SEK, and the cost per patient approximately 17,200 SEK. The estimates per patient vary widely by group. A rough estimate of the cost for curative radiotherapy for breast cancer would be approximately 31,000 SEK, which can be contrasted with a cost of approximately 7000 SEK for palliative treatment of bone metastases. The cost for brachytherapy in 1991 was, according to departmental financial reports, approximately 36 million SEK. Hence, the costs for external radiotherapy and brachytherapy were approximately 300 million SEK in 1991. In 1993 prices, this corresponds to approximately 330 million SEK, representing the total direct costs for radiotherapy in Sweden. However, this figure does not include costs for, eg, hospitalization in conjunction with radiotherapy, nor the other costs associated with this type of treatment. Several potential sources of error underlie these figures. The following overview presents and evaluates the foundation for these estimates. Appendix I to this chapter discusses the problem of how these estimates should be defined, and how costs should be related to the different ways for measuring treatment results.

Cost-Benefit Analysis↗

Body mass and social class: a comparison of Finland and Sweden in the 1990s.

High physical weight affects public health as well as people's social relations. This study seeks to examine the distribution of physical weight across the social structure in Finland and Sweden in the early 1990s. We compare physical weight, classified by overweight and obesity, 1) between men and women, 2) between different age groups, and 3) between social classes in these two countries. Comparable interview surveys were conducted in Finland 1994 (N = 8,650, response rate 73%) and in Sweden 1991 (N = 5,306, response rate 79%). Physical weight, overweight and obesity of populations are described in terms of body mass index (BMI = weight (kg)/height (m2)). The average BMI is higher in Finnish men (25.6) and women (24.6) than in their Swedish counterparts (24.6 and 23.2, respectively). In both countries, the average BMI is higher in men than in women below the age of about 55-64 years. In both countries and in both genders the average BMI is higher, the higher the age. The level of overweight as well as obesity is lower in Sweden than in Finland. Social class differences can be found in both countries. The odds ratio for overweight is higher in Finnish male and female farmers (OR = 1.57 and 1.94, respectively) as compared to upper white collars (OR = 1.0). In Sweden, high odds ratio for overweight can be found among male entrepreneurs (OR = 1.80) and female unskilled manuals (OR = 2.65). Obesity varies by social class in Swedish men and women as well as in Finnish women, but not in Finnish men. The results show that Finnish men and women are more often overweight and obese than their Swedish counterparts, but social class differences in overweight and obesity are larger in Sweden than in Finland.

Adult↗

Third molar treatment outcome: a comparison of patients' preferences in Sweden and Wales.

AIM: To elucidate and compare patients' outcome preferences for removal and retention of mandibular third molars in Sweden and Wales. SUBJECTS AND METHOD: The subjects comprised patients referred and scheduled for removal of one or both mandibular third molars in Sweden and Wales. The multi-attribute utility (MAU) methodology was applied to study patients' preferences for outcomes of removal and retention of the mandibular third molar. RESULTS: Relative weighting of domains was similar in the two countries. "Home and social life" received the highest relative weighting in Sweden and "general health and wellbeing" in Wales. "Your appearance" received the lowest relative weighting in both countries. In both Sweden and Wales operative jaw fracture was considered to be the outcome with most impact, and dentigerous cyst and imbricated incisors the least impact. Outcome ranking was similar in both countries and operative outcomes were considered by patients to be more detrimental to health than retention outcomes. CONCLUSIONS: This comparison showed that patients' preferences in Sweden and Wales were similar and that the outcomes of surgery were considered worse after third molar removal than retention. Patient-orientated treatment decisions were less subject to variation than clinician-orientated decisions.

Adolescent↗

Invasive cutaneous malignant melanoma in Sweden, 1990-1999. A prospective, population-based study of survival and prognostic factors.

BACKGROUND: The objective of the current study was to compile prospective, population-based data on cutaneous invasive melanomas in Sweden during the period from 1990 to 1999, to describe and analyze survival data and prognostic factors, and to make comparisons with previously published Swedish and international data. METHODS: Twelve thousand five hundred thirty-three patients, which included 97% of all registered melanomas in Sweden, were included and described. Among these, 9515 patients with clinical Stage I and II melanoma were included in an analysis of survival and in a univariate analysis, and 6191 patients were included in a multivariate analysis of prognostic factors. RESULTS: There was no significant change in melanoma incidence during 1990-1999. Favorable prognostic factors were found, especially in younger and female patients, resulting in a relative 5-year survival rate of 91.5%. In the multivariate analysis, significant factors that had a negative effect on survival were Clark level of invasion, Breslow thickness, ulceration, older patient age, trunk location, greatest tumor dimension, nodular histogenetic type, and male gender. CONCLUSIONS: During the period from 1990 to 1999, the 5-year survival of patients with malignant melanoma in Sweden was better compared with the previously reported rates in published, population-based studies from Sweden, probably as a result of better secondary prevention due to better knowledge and awareness by both patients and the medical profession. The more favorable prognostic factors and the change in melanoma location found in younger patients, compared with earlier reports, may reflect changes in clothing as well as tanning habits; however, a decrease also was found in Clark Level II and thin melanomas for the same patient group. The authors concluded that further improvements can be achieved with better access to health care and with the use of early melanoma detection campaigns.

Adolescent↗

Epidemiology of primary biliary cirrhosis in a defined rural population in the northern part of Sweden.

The northern part of Sweden is sparsely populated and must be regarded as a rural region. An investigation into the incidence and prevalence of primary biliary cirrhosis was conducted and the course of the disease was followed. In total, 111 patients with primary biliary cirrhosis were identified for the 10-yr period 1973 to 1982 in the northern health region of Sweden. The mean annual incidence amounted to 13.3 per million and the point prevalence was 151 per million, which is the highest reported so far. There was a significantly higher prevalence in the most northern county of Sweden, both with respect to total number of primary biliary cirrhosis patients and symptomatic patients. Asymptomatic patients amounted to 37%. During the study period 25 patients out of the 111 died (23%), 14 as a direct consequence of the liver disease. Three patients died of primary hepatocellular carcinoma, one having an asymptomatic liver disease without cirrhosis. Primary biliary cirrhosis seems to be more common in Sweden, especially in the northern part, than it is elsewhere. A high frequency of extrahepatic symptoms (85%), mainly musculoskeletal, was recorded. These symptoms may lead to the first contact with the health service, rather than signs of liver disease. Thus, an increasing number of patients are diagnosed with asymptomatic liver disease, who must be followed to check for the eventual development of symptoms.

Adult↗

Cancer incidence in Estonian migrants to Sweden.

Cancer incidence in Estonians who took refuge in Sweden in 1944-1945 has been compared with that in the total Swedish population and that among Estonians in Estonia in 1974-1985 using data from the Swedish and the Estonian countrywide population-based cancer registries. The vast majority of the Estonian immigrants studied had been living in Sweden for 30 years when the follow-up with respect to cancer incidence started in this investigation. In spite of the long residence in Sweden, differences in cancer incidence could be observed between these immigrants and the total Swedish population. The age-standardized incidence of stomach cancer was higher in the Estonian migrants than in the total Swedish population (SIR = 1.6 and 2.1 for males and females, respectively). Breast cancer incidence was lower in the migrant women (SIR = 0.75) and lung cancer incidence higher in migrant men (SIR = 1.5). An increased incidence of colorectal cancer was also found for both sexes in the migrant population (SIR = 1.4 for both males and females). A comparison between Estonians in Estonia and the total Swedish population revealed that the cancer incidence for the Estonians was lower than expected at age 70 and over. Male lung cancer and stomach cancer showed a higher incidence in the Estonian population than in the Swedish and in the migrant populations. The migrant population showed an intermediate incidence relative to Estonians in Estonia and the entire Swedish population. The colon-cancer risk in Estonian migrants to Sweden was higher than the risk for Estonians in Estonia and for the Swedish population. This contrasts with most findings in the present and other studies on intermediate risks of migrants compared to the risks in the country of origin and in the new country of residence.

Adult↗

Therapeutic traditions in Northern Ireland, Norway and Sweden: II. Hypertension. WHO Drug Utilization Research Group (DURG).

A questionnaire survey based on hypertension case histories was performed among a representative sample of 400 GP's and hospital doctors in Northern Ireland, Norway and Sweden, countries having markedly different utilization of antihypertensive drugs. We found a greater propensity to start antihypertensive drug treatment in Northern Ireland than in Norway and Sweden. This was true both in mild diastolic and isolated systolic hypertension. Yet the utilization of antihypertensive drugs in Sweden is about 60% higher than in Northern Ireland and 30% higher than in Norway. Swedish physicians preferred beta-blockers as their first choice to a greater extent than physicians in Northern Ireland and Norway who selected thiazides more often. In general, the choice of drugs agreed with the sales and prescribing patterns in the three countries. Besides providing more insight in therapeutic traditions the study indicates that the lower prescribing of antihypertensive drugs in Northern Ireland, and to some extent in Norway, compared to Sweden, might be due to differences in true or apparent morbidity.

Antihypertensive Agents↗

Picture archiving and communication systems and related developments in Sweden.

Large PACS (Picture Archiving and Communication Systems) installations do not yet exist in Sweden, but some hospitals have had experience with limited PACS activities. At present there are four mini PACS installations in radiology departments and about 12 teleradiology systems in use in Sweden. A couple of small Swedish enterprises work in the market segment of digital imaging including PACS and teleradiology, although the radiology market is dominated by the large international companies. Interest in PACS and teleradiology in Sweden has increased during the last few years, along with advancements in technology and international experience. However, radiology is organized very differently in the United States, Japan, Southern Europe, and Scandinavia. Because of this, PACS will be introduced in different ways, and experience with PACS gained in one health care system may differ from that gained from other health care systems. This article reviews the status of PACS and related developments in Sweden.

Humans↗

Certifying diabetes-related cause-of-death: a comparison of inappropriate certification statements in Sweden, Taiwan and the USA.

AIMS/HYPOTHESIS: The aim of this study was to assess differences in the certification practices of physicians in Sweden, Taiwan and the USA with regard to diabetes-related cause-of-death (COD) statements. METHODS: Multiple-cause-of-death data from Sweden (2000), Taiwan (2001) and the USA (2001) were used for this study. All deaths with mention of diabetes anywhere on the death certificate were extracted for analysis. Two types of inappropriate COD statements were: (1) reporting two or more diagnoses per line; and (2) entering an incorrect causal sequence among reported diagnoses. RESULTS: Of those deaths in which diabetes was reported in Part I of the death certificate, American physicians (19%) were less likely to report two or more diagnoses per line than physicians in Sweden (46%) and Taiwan (56%). On the other hand, Swedish physicians (5%) were less likely to report incorrect causal sequences than were their counterparts in Taiwan (21%) and the USA (28%). CONCLUSIONS/INTERPRETATION: These findings reveal substantial differences in diabetes-related COD statements among physicians in Sweden, Taiwan and the USA, implying that caution should be used when interpreting differences in mortality statistics between these countries.

Automation↗

Physical child abuse in Sweden: a study of police reports between 1986 and 1996.

BACKGROUND: This study aims at investigating physical child abuse in Sweden during 1986-1996, a period when alarm was being raised about an increased number of police reports on physical child abuse. The study focuses on abuse committed by a parent or carer and aims at analyzing the victim and the perpetrator, family environment, injuries and judicial consequences of physical abuse. METHOD: All police reports on physical child abuse (0-14 years old) in a designated police district in Sweden during 1986-1996 were examined, as well as any judicial proceedings that followed. RESULTS: Our research yielded three major findings. Firstly, a large part of the increased number of police reports had to do with violence outside the family: 145 children (0.5 per 1000 children) were found abused within the families, by a parent or a carer. Secondly, there was a tendency toward males abusing boys and females abusing girls, and the biological father was the most frequent suspected perpetrator. Thirdly, 20% of the police reports led to prosecutions, and the investigations were time consuming. Known risk factors for physical abuse, such as unemployment, violent spouse relations, substance and drug abuse and poor mental health were found in several families, often among the prosecuted perpetrators. When examining incidence of physical abuse, Sweden was comparable to the other Scandinavian countries, where legislation and social context are similar. CONCLUSIONS: The numbers of physically abused children that have been reported to the police in Sweden has increased during the investigated period. Familiar risk factors are present in our study, accompanied by new findings, such as, for instance, a gender preference towards the abuse victim.

Adult↗