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At least 19 recordsLinked to original sources
PubMed2000

Effect of a surgical training programme on outcome of rectal cancer in the County of Stockholm. Stockholm Colorectal Cancer Study Group, Basingstoke Bowel Cancer Research Project.

BACKGROUND: The Stockholm I and II randomised trials demonstrated the value of preoperative radiotherapy in preventing local recurrence in rectal cancer. This, study investigated the potential for further improvement by introduction of the concept of total mesorectal excision (TME) to surgeons in Stockholm, Sweden. METHODS: Workshops started in 1994 and included 11 television-based demonstrations and two histopathology sessions. The study population consisted of all patients who underwent abdominal operations for rectal cancer in Stockholm County during 1995-96 (TME project; n=447). Outcomes at 2 years were compared with those from the Stockholm I (n=790) and II (n=542) trials as historical controls. FINDINGS: For patients with curative abdominal resections, there were no differences between the Stockholm I (n=686), Stockholm II (n=481), and TME project (n=381) groups in 30-day mortality (30 [4%], six [1%], and 12 [3%]), anastomotic leakage (27 [10%], 18 [9%], and 23 [9%]), or all complications (204 [30%], 169 [35%], and 134 [35%]). This similarity was achieved despite a decrease in the proportion of abdominoperineal procedures from 55-60% to 27%. Local recurrence occurred in significantly fewer of the TME group than of the Stockholm I and II groups (21 [6%] vs 103 [15%] and 66 [14%], p<0.001) as did cancer-related death (35 [9%] vs 104 [15%] and 77 [16%], p<0.002). INTERPRETATION: A surgical teaching initiative had a major effect on cancer outcomes. The proportion of abdominoperineal procedures and the local recurrence rate decreased by more than 50% and there is already evidence of a decline in rectal-cancer mortality.

Adult↗
PubMed1998

Decision latitude, job strain, and myocardial infarction: a study of working men in Stockholm. The SHEEP Study Group. Stockholm Heart epidemiology Program.

OBJECTIVES: This study examined the role of decision latitude and job strain in the etiology of a first myocardial infarction. METHODS: Eligible case patients were all full-time working men 45 to 64 years of age who suffered a first myocardial infarction during the period January 1992 to January 1993 in the greater Stockholm region. Referents were selected from the general population. Participation rates were 82% (case patients) and 75% (referents). RESULTS: Both inferred and self-reported low decision latitude were associated with increased risk of a first myocardial infarction, although this association was weakened after adjustment for social class. A decrease in inferred decision latitude during the 10 years preceding the myocardial infarction was associated with increased risk after all adjustments, including chest pain and social class. The combination of high self-reported demands and low self-reported decision latitude was an independent predictor of risk after all adjustments. CONCLUSIONS: Both negative change in inferred decision latitude and self-reported job strain are important risk indicators in men less than 55 years of age and in blue-collar workers.

Decision Making↗
PubMed1995

The Stockholm I trial of preoperative short term radiotherapy in operable rectal carcinoma. A prospective randomized trial. Stockholm Colorectal Cancer Study Group.

BACKGROUND: From 1980 to 1987, 849 patients with clinically resectable rectal adenocarcinoma were randomized into a controlled clinical trial to evaluate the role of preoperative radiotherapy. METHODS: Patients were given either 25 Gy during 5 to 7 days before surgery or underwent surgery alone. RESULTS: At a median follow-up time of 107 months (range, 62-144 months) the incidence of pelvic recurrence among 684 "curatively" operated patients was significantly lower among those who also received radiotherapy (P < 0.001) in all Dukes' stages. No significant difference was observed between the treatment groups with regard to frequency of distant metastases or overall survival. The time to local recurrence or distant metastasis and survival was significantly prolonged in the irradiated group. However, the postoperative mortality was 8% in the radiotherapy group compared with 2% in the surgery only group (P = 0.01). CONCLUSIONS: Preoperative short term radiotherapy reduced the incidence of pelvic recurrences and prolonged survival related to rectal cancer compared with surgery alone. The postoperative morbidity was significantly higher in the irradiated group.

Adult↗
PubMed1995

Physical strength and endurance in relation to perceived psychosocial work environment, sleep disturbance and coping strategies in men. Stockholm MUSIC I (MUsculo-Skeletal Intervention Centre) Study Group, Stockholm.

The study explored relationships between subjective descriptions of psychosocial work situation, sleep disturbance and coping patterns at work on the one hand and performance during a test of physical strength and perceived effort during a muscular endurance test on the other. The physical strength of the shoulders flexors was measured. The subjective degree of effort was rated 60 and 90 seconds after the beginning of a test of isometric endurance of the neck extensor muscles. Four samples with numbers of about 80 subjects each were studied, first of all one sample of men and one of women from the general working population and secondly a sample of "super male" workers (furniture removers) and a sample of "service oriented female" workers (medical secretaries). The findings indicated that there is a relationship among men between self-reported coping strategies at work and results in the physical tests. Thus, in the random sample of men, individuals who described open coping patterns were found to perceive more effort after one minute and also after one minute and a half of the physical endurance test and were also found to be physically stronger than other individuals. Those who described themselves as less supported socially than other men reported more subjective effort and tended to be physically stronger than other individuals. Among furniture removers, those who described that they had a high degree of covert coping tended to report a higher degree of subjective effort after one minute. Among men in both groups, a high degree of sleep disturbance tended to be associated with more perceived effort during the endurance test.(ABSTRACT TRUNCATED AT 250 WORDS)

Adaptation, Psychological↗
PubMed2005

Overserving at licensed premises in Stockholm: effects of a community action program.

OBJECTIVE: The aim of this research was to study the sustainable effects of a community action program on alcohol service to intoxicated patrons at licensed premises. METHOD: Since 1996, the hospitality industry and authorities in Stockholm, Sweden, have been cooperating to reduce problems related to alcohol consumption at licensed premises. The intervention has included community mobilization, training in responsible beverage service (RBS) and enforcement. A pretest in 1996 and follow-ups in the 1999 and 2001 designs were used to study licensed premises in Stockholm. Male actors portraying intoxicated patrons visited the licensed premises and attempted to order beer. Observers were present at each visit. At the pretest, 92 licensed premises were visited, 47 in north central Stockholm and 45 in south central Stockholm. In 1999, 103 establishments were visited, 61 in north central Stockholm and 42 in south central Stockholm. At the latest follow-up in 2001, 100 licensed premises were visited, 56 in north central Stockholm and 44 in south central Stockholm. RESULTS: The results from the latest follow-up in 2001 showed a statistically significant improvement over those of earlier measures, with a refusal rate of 70% compared with 47% in 1999 and 5% in 1996. There were improvements in both study areas (i.e., north and south central Stockholm). CONCLUSIONS: There has been a significant improvement in the rate of refusal of alcohol service at licensed premises in Stockholm during the project period. The reason for this is probably a combination of the intervention efforts: community mobilization, RBS training and a more efficient monitoring of alcohol service by authorities.

Alcoholism↗
PubMed2002

Prevalence and risk factors for asthma and chronic bronchitis in the capitals Helsinki, Stockholm, and Tallinn.

The aim of this part of the FinEsS-studies was to assess whether differences existed in prevalence of asthma, chronic bronchitis, and respiratory symptoms between three Baltic capitals, and to examine risk factor profiles for respiratory conditions. In 1996, a postal survey was performed in these cities with a response rate of 72% in Stockholm, 76% in Helsinki, and 68% in Tallinn. The prevalence of physician-diagnosed asthma was 76% in Stockholm, 6.2% in Helsinki, and 2.3% in Tallinn, while respiratory symptoms were most common in Tallinn. The prevalence of physician-diagnosed chronic bronchitis was 10.6% in Tallinn, 3.4% in Helsinki, and 3.0% in Stockholm. Risk factor analyses revealed a significantly increased risk for those living in Tallinn compared to that of Stockholm for wheezing conditions, OR 1.56-1.69, longstanding cough, OR 1.92 (1.74-2.13), attacks of shortness of breath during the previous 12 months, OR 1.35 (1.20-1.52), and chronic productive cough, OR 1.49 (1.28-1.74). Subjects having symptoms common in asthma were more likely to have physician-diagnosed asthma in Stockholm and Helsinki than in Tallinn, while subjects having bronchitis symptoms had more often physician-diagnosed chronic bronchitis in Tallinn. Prevalence of respiratory symptoms was higher in Tallinn than in Stockholm and Helsinki, while physician-diagnosed asthma was more common in Stockholm and Helsinki. The prevalence of physician-diagnosed chronic bronchitis was three times as high in Tallinn as in Helsinki or Stockholm. Our results also suggest large differences in diagnostic practices between the three countries, while the differences between the capitals in true prevalence of disease may be small.

Adult↗
PubMed2002

Quality of non-steroidal anti-inflammatory drug prescribing in Croatia (Rijeka) and Sweden (Stockholm).

OBJECTIVE: We compared the utilisation pattern and cost of non-steroidal anti-inflammatory drugs (NSAIDs) in Rijeka, Croatia and in Stockholm, Sweden using a newly introduced method for assessing the quality of drug use, i.e. to determine the number of drugs that account for 90% of the use and the adherence to evidence-based recommendations within this segment (the DU90% methodology). METHODS: We analysed prescription NSAIDs dispensed during the first 6 months of 2000 in Rijeka and in Stockholm and recorded number of prescriptions, number of defined daily doses (DDDs), number of DDDs/1000 inhabitants per day and percentages and determined the DU90% segment by substance and brand name. Within the DU90% segment we determined the proportion of NSAIDs associated with high (ketoprofen, piroxicam) and low (ibuprofen, diclofenac) risk for gastrointestinal (GI) toxicity according to a meta-analysis of controlled epidemiological studies. We also compared the cost for NSAIDs in both regions as well as the cost for each NSAID expressed in Euros. RESULTS: In Stockholm the utilisation of NSAIDs was twofold greater than in Rijeka (28.6 DDDs/1000 inhabitants/day vs 14.2 DDDs/1000 inhabitants/day). Within the DU90% segment we found four NSAIDs (of nine) in Rijeka and 16 (of 37) in Stockholm. In both regions diclofenac was the most commonly prescribed substance (55% in Rijeka and 25% in Stockholm). Diclofenac was also the cheapest drug in Rijeka. In Stockholm, the most commonly prescribed single brand drug was rofecoxib, a cyclooxygenase-2 inhibitor with a price far above the old NSAIDs. A significant proportion of "high GI risk" NSAIDs was found within the DU90% segment both in Rijeka (piroxicam, 23%) and in Stockholm (ketoprofen, 14%). Although the gross national product was five times higher in Sweden than in Croatia during 2000, on average, NSAIDs were three times more expensive in Sweden than in Croatia (0.52 Euros/DDD vs 0.18 Euros/DDD). Ibuprofen (DDD 1200 mg), the safest drug regarding GI toxicity, was not the most prescribed in either region. CONCLUSION: Our study suggests that evidence-based medicine was not the leading impact factor in prescribing NSAIDs during 2000. A proportionally higher use of ibuprofen (at a daily dose of 1200 mg) and a reduced use of either piroxicam or ketoprofen would improve the NSAID GI safety profile in both countries. As previously shown for Sweden and some other countries, the DU90% methodology was found to be a useful method for assessing the general quality of NSAID prescribing in Croatia.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1998

Hyperlipidaemia: differences in management practices and attitudes in two regions in Europe--Sicily and the Stockholm area.

In order to compare attitudes and management concerning hyperlipidaemia and risk factors for coronary heart disease among doctors in northern and in southern Europe, a questionnaire study was undertaken among doctors in primary health care and departments of internal medicine in Sicily and Stockholm. The regions differed in culture and health-care structure. Guidelines were similar, but screening of healthy individuals was recommended in Sicily, and not in Sweden. One hundred and fifty-three general practitioners in Sicily and 120 in Stockholm, 211 internists in Sicily and 83 in Stockholm participated. Main outcome measures were management policies for investigation and treatment and also attitudes. Routine lipid checks at first visits were done by few doctors in Stockholm but by a majority in Sicily (p < 0.001); in the presence of general cardiovascular risk factors (other than heredity, diabetes, cardiovascular disease and hypertension), routine checks were carried out more often by both general practitioners (p < 0.001) and internists (p < 0.005) in Stockholm. Drug treatment was initiated at lower cholesterol levels for secondary and primary intervention, cardiovascular disease, cardiovascular risk factors and hereditary hyperlipidaemia by both groups in Sicily (p < 0.001), as was dietary treatment. Secondary prevention was considered important by all groups, but primary prevention only by Sicilian doctors. We concluded that there were differences in views and management practice between doctors in Sicily and in Stockholm on the investigation and treatment of patients with hyperlipidaemia. Doctors tested lipids at first visits in Sicily but not in Stockholm. Treatment was initiated at lower levels of cholesterol in Sicily.

Drug Utilization↗
PubMed2005

Impact of a surgical training programme on rectal cancer outcomes in Stockholm.

BACKGROUND: Total mesorectal excision (TME) and use of adjuvant radiotherapy are major advances in the treatment of rectal cancer that have emerged in the past 20 years. The aim of this study was to evaluate the effects of an initiative to teach the TME technique on outcomes at 5 years after surgery. METHODS: TME-based surgery was introduced in Stockholm in 1994. The study population comprised all 447 patients who underwent abdominal operations for rectal cancer in Stockholm County during 1995 and 1996. Outcomes were compared with those in the Stockholm I (790 patients) and Stockholm II (542 patients) radiotherapy trials. RESULTS: The permanent stoma rate was reduced from 60.3 and 55.3 per cent in the Stockholm I and II trials respectively to 26.5 per cent in the TME project (P < 0.001). Five-year local recurrence rates decreased from 21.9 and 19.1 per cent to 8.2 per cent respectively (P < 0.001). Five-year cancer-specific survival rates increased from 66.0 and 65.7 per cent in the Stockholm trials to 77.3 per cent in the TME project (hazard ratio 0.62 (95 per cent confidence interval 0.49 to 0.80); P < 0.001). CONCLUSION: A surgical teaching programme had a major impact on rectal cancer outcome.

Adult↗
PubMed2003

Hand function tests and questions on hand symptoms as related to the Stockholm workshop scales for diagnosis of hand-arm vibration syndrome.

The severity of hand-arm vibration syndrome (HAVS) is usually graded according to the Stockholm workshop scales. Although the Stockholm workshop scales are regarded the gold standard for assessing the severity of HAVS, they are based primarily on subjective symptoms. The aim of the present study was to explore the agreement between Stockholm workshop scales and the outcome from ten well-defined clinical tests commonly used in hand rehabilitation for assessment of hand function. One hundred and eleven vibration-exposed workers participated in the study. Ten objective tests of hand function and four questions on subjective hand symptoms were included. The results indicated that, out of these tests, perception of vibration, perception of touch/pressure and dexterity showed a moderate agreement with Stockholm workshop scales. Among specific questions on hand symptoms, cold intolerance and pain showed a high agreement with Stockholm workshop scales. It is concluded that defined objective tests combined with directed questions on specific hand symptoms, together with the Stockholm workshop scales, may be helpful for diagnosing HAVS.

Adult↗