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Background: Recent findings suggest that the mental health costs of unemployment are related to both short- and long-term mental health scars. The main policy tools for dealing with young people at risk of labor market exclusion are Active Labor Market Policy programs for youths (youth programs). There has been little research on the potential effects of participation in youth programs on mental health and even less on whether participation in such programs alleviates the long-term mental health scarring caused by unemployment. This study compares exposure to open youth unemployment and exposure to youth program participation between ages 18 and 21 in relation to adult internalized mental health immediately after the end of the exposure period at age 21 and two decades later at age 43.Methods: The study uses a five wave Swedish 27-year prospective cohort study consisting of all graduates from compulsory school in an industrial town in Sweden initiated in 1981. Of the original 1083 participants 94.3% of those alive were still participating at the 27-year follow up. Exposure to open unemployment and youth programs were measured between ages 18-21. Mental health, indicated through an ordinal level three item composite index of internalized mental health symptoms (IMHS), was measured pre-exposure at age 16 and post exposure at ages 21 and 42. Ordinal regressions of internalized mental health at ages 21 and 43 were performed using the Polytomous Universal Model (PLUM). Models were controlled for pre-exposure internalized mental health as well as other available confounders.Results: Results show strong and significant relationships between exposure to open youth unemployment and IMHS at age 21 (OR = 2.48, CI = 1.57-3.60) as well as at age 43 (OR = 1.71, CI = 1.20-2.43). No such significant relationship is observed for exposure to youth programs at age 21 (OR = 0.95, CI = 0.72-1.26) or at age 43 (OR = 1.23, CI = 0.93-1.63).Conclusions: A considered and consistent active labor market policy directed at youths could potentially reduce the short- and long-term mental health costs of youth unemployment. [ABSTRACT FROM AUTHOR]

Background: Comorbidity increases overall mortality in patients diagnosed with hematological malignancies. The impact of comorbidity on cancer-specific mortality, taking competing risks into account, has not been evaluated.Methods: Using the Swedish Cancer Register, we identified patients aged >18 years with a first diagnosis of acute myeloid leukemia (AML, N = 2,550), chronic myeloid leukemia (CML, N = 1,000) or myeloma (N = 4,584) 2002-2009. Comorbid disease history was assessed through in- and out-patient care as defined in the Charlson comorbidity index. Mortality rate ratios (MRR) were estimated through 2012 using Poisson regression. Probabilities of cancer-specific death were computed using flexible parametric survival models.Results: Comorbidity was associated with increased all-cause as well as cancer-specific mortality (cancer-specific MRR: AML = 1.27, 95 % CI: 1.15-1.40; CML = 1.28, 0.96-1.70; myeloma = 1.17, 1.08-1.28) compared with patients without comorbidity. Disorders associated with higher cancer-specific mortality were renal disease (in patients with AML, CML and myeloma), cerebrovascular conditions, dementia, psychiatric disease (AML, myeloma), liver and rheumatic disease (AML), cardiovascular and pulmonary disease (myeloma). The difference in the probability of cancer-specific death, comparing patients with and without comorbidity, was largest among AML patients <70 years, whereas in myeloma the difference did not vary by age among the elderly. The probability of cancer-specific death was generally higher than other-cause death even in older age groups, irrespective of comorbidity.Conclusion: Comorbidities associated with organ failure or cognitive function are associated with poorer prognosis in several hematological malignancies, likely due to lower treatment tolerability. The results highlight the need for a better balance between treatment toxicity and efficacy in comorbid and elderly AML, CML and myeloma patients. [ABSTRACT FROM AUTHOR]

Background: The Seven Countries Study in the 1960s showed very low mortality from coronary heart disease (CHD) in Japan, which was attributed to very low levels of total cholesterol. Studies of migrant Japanese to the USA in the 1970s documented increase in CHD rates, thus CHD mortality in Japan was expected to increase as their lifestyle became Westernized, yet CHD mortality has continued to decline since 1970. This study describes trends in CHD mortality and its risk factors since 1980 in Japan, contrasting those in other selected developed countries.Methods: We selected Australia, Canada, France, Japan, Spain, Sweden, the UK and the USA. CHD mortality between 1980 and 2007 was obtained from WHO Statistical Information System. National data on traditional risk factors during the same period were obtained from literature and national surveys.Results: Age-adjusted CHD mortality continuously declined between 1980 and 2007 in all these countries. The decline was accompanied by a constant fall in total cholesterol except Japan where total cholesterol continuously rose. In the birth cohort of individuals currently aged 50-69 years, levels of total cholesterol have been higher in Japan than in the USA, yet CHD mortality in Japan remained the lowest: >67% lower in men and > 75% lower in women compared with the USA. The direction and magnitude of changes in other risk factors were generally similar between Japan and the other countries.Conclusions: Decline in CHD mortality despite a continuous rise in total cholesterol is unique. The observation may suggest some protective factors unique to Japanese. [ABSTRACT FROM AUTHOR]

Background: Neck pain is a major health problem in populations worldwide and an economic burden in modern societies due to its high prevalence and costs in terms of health care expenditures and lost productivity. Massage and exercise therapy are widely used management options for neck pain. However, there is a lack of scientific evidence regarding their effectiveness for subacute and long-lasting neck pain. This study protocol describes a randomized controlled trial aiming to determine the effect of massage and/or exercise therapy on subacute and long-lasting neck pain over the course of 1 year.Methods/design: A randomized controlled trial in which at least 600 study participants with subacute or long-lasting nonspecific neck pain will be recruited and randomly allocated to one of four treatment arms: massage therapy (A), exercise therapy (B), exercise therapy plus massage therapy (C) and advice to stay active (D). The study has an E-health approach, and study participants are being recruited through advertising with a mix of traditional and online marketing channels. Web-based self-report questionnaires measure the main outcomes at 7, 12, 26 and 52 weeks after inclusion. The primary outcomes are a clinically important improvement in pain intensity and pain-related disability at follow-up, measured with a modified version of the Chronic Pain Questionnaire (CPQ). The secondary outcomes are global improvement, health-related quality of life (EQ-5D), sick leave, drug consumption and healthcare utilization. Adverse events are measured by questionnaires at return visits to the clinic, and automated text messages (SMSes) survey neck pain intensity and pain-related disability every week over one year.Discussion: The results of this study will provide clinicians and stakeholders much needed knowledge to plan medical care for subacute and long-lasting neck pain disorders.Trial Registration: Current Controlled Trials ISRCTN01453590. Date of registration: 3 July 2014. [ABSTRACT FROM AUTHOR]

The aim of the present pilot study was to provide an initial evaluation of a brief, 4-session, universal health promoting parenting group program, the 'ABC'. We examined the effects of the program on improving parental strategies, parental self-efficacy, and child well-being. We also hypothesized that in a health promoting intervention implemented in the general population, increased parental self-efficacy and parental strategies would be associated with improvements in child well-being after 4 months. Parents living in 11 municipalities and local community agencies in Sweden enrolled in the project were invited to participate in the study. A repeated measurement within group design was used to assess the effects. In total, parents of 104 children aged 2-12 years participated in the ABC-study. Parental and child outcomes were evaluated before, after the intervention, and at a 4-month follow-up with parental self-report questionnaires. Paired t tests and ANOVA repeated measures showed statistically significant improvements of parental strategies (showing guidance, empathy/understanding, having rules/boundaries), parental self-efficacy (self-competence, knowledge/experience), and child well-being (emotional well-being, independence) from pre- to post measurement, with small to moderate effect sizes. Improvements were maintained at the 4-month follow-up, apart from changes in parental knowledge. University education and increased pre- to post improvements in self-efficacy predicted child emotional well-being at the 4-month follow-up. The findings suggest that the ABC-group intervention was effective in terms of improving child well-being, parental strategies and self-efficacy. This pilot study provides promising evidence for the ABC as a universal parenting program but further more rigorous evaluations are needed. [ABSTRACT FROM AUTHOR]

Aims and objectives The main aim of this study was to evaluate whether addressing the written questions of heart failure patients could individualise the education and increase patient satisfaction. A further aim was to describe the learning needs of patients with newly diagnosed heart failure. Background Despite well-designed patient education, daily problems and self-care sometimes seem difficult to manage for the patient with heart failure. The literature suggested that nurses should include individualised educational interventions. Design The study had an evaluative and descriptive design. Methods A mixed-method approach was used. A quasi-experimental method was used to compare patients in the control group ( n = 41), who received regular education at the nurse-led heart failure clinic, with patients in the intervention group ( n = 44), who received regular education but also education addressing questions they had written down at home before coming to the clinic. Two instruments were used to investigate, respectively, whether the intervention caused patients to experience a greater sense of involvement in their education and greater satisfaction. The patients' questions were subjected to manifest content analysis. Results There was no significant difference in satisfaction with the education between the control group and the intervention group. However, the intervention group did feel more strongly that the information they received was related to their personal situation. The patients' learning needs before education were categorised as: causes and meaning of illness, control and management of the disease, impact on daily living and future health. Conclusion Asking heart failure patients to write down their learning needs before the education increases their chances of receiving education based on their individual needs. Relevance to clinical practice The method is simple and cost-effective and could be a way to improve the patient education and facilitate person-centred care. [ABSTRACT FROM AUTHOR]

Aims and objectives To evaluate the effectiveness of an individualised programme to promote self-care in sleep-activity in patients with coronary artery disease. Background Recent scientific findings have shown that low physical exercise and stress interfere with coronary artery disease patients' sleep quality and sleep efficiency independent of gender, age and co-morbidity. Design A randomised pretest-post-test control design. Methods Forty-seven patients who had undergone a coronary revascularisation procedure and/or pharmacological treatment three to seven weeks earlier at a general hospital were randomised to either an intervention group or a control group. Data collection was carried out by questionnaires, a study-specific sleep diary and actigraphy registration for 10 consecutive 24-hour periods, with a follow-up after three to four months. The intervention group underwent a nurse-led individualised education programme to promote self-care of sleep-activity. Sleep habits and sleep-related lifestyle together formed the basis for setting up individual goals together with the nurse. Individual advice on physical training, relaxation exercise and a CD-based relaxation programme was provided by a physiotherapist. Both groups received a brochure about sleep and stress. Results At a three- to four-month follow-up, the main improvements were seen in the intervention group regarding sleep quality, sleep duration and sleep efficiency in the sleep diary and sleep efficiency in actigraphy. Statistical improvements in health-related quality of life were revealed. This was not so obvious in the control group. Conclusions An individualised intervention programme to promote self-care of sleep-activity including relaxation in patients with coronary artery disease led by a nurse may improve sleep quality. However, a longitudinal study to promote self-care in sleep-activity should be performed using a larger sample and multiple sites with continuous follow-ups to determine whether any positive effects remain stable over time. Relevance to clinical practice Implementation of a multiprofessional individualised programme to promote self-care of sleep-activity including relaxation based on patients' needs, supported by a healthcare team and led by nurses, is important in clinical practice. [ABSTRACT FROM AUTHOR]

Aims and objectives To describe nursing students' experience of stress during clinical practice and evaluate the risk of stress in relation to the clinical setting characteristics and the organisation of the clinical education. Background Stress during clinical practice is well documented, but there is a lack of knowledge concerning whether the clinical setting characteristics and the organisation of the education make a difference. Design A cross-sectional study with evaluative design. Methods Data were collected by means of a numerical rating scale for the assessment of stress and questions about the clinical setting characteristics and the organisation of the education. One hundred and eighty-four students who had completed their final year on the nursing programme at three universities in Sweden were included. Results Nearly half of the students (43%) experienced high level of stress during clinical practice. Measured by decision in the tree analysis, the absolute risk of stress was 57% in students with placements in hospital departments, as compared to 13% in students with placements in other clinical settings. The risk of stress increased to 71% if the students with placement in a hospital took the national clinical final examination. Performance of practice in a hospital department overcrowded with patients was also associated with increased risk of stress. The organisation of supervision and number of students at the clinical placement had an effect on the experience of stress, but did not prove to be risk factors in the analysis. Conclusions The risk of stress in nursing students during their clinical practice differs depending on clinical setting characteristics. The taking of the national clinical final examination could be a source of stress, but this requires further investigation. Relevance to clinical practice It is important that supervisors are aware that students in hospital departments overcrowded with patients are at risk of stress and may have increased need of support. [ABSTRACT FROM AUTHOR]

Background: There is a lack of studies of the size of burden associated with informal care giving in psychosis. Aims: To evaluate the objective and subjective burden of informal care giving to patients with psychoses, and to com- pare a diary and recall method for assessments of objective burden. Method: Patients and their informal caregivers were recruited from nine Swedish psychiatric outpatient centres. Subjec- tive burden was assessed at inclusion using the CarerQoL and COPE index scales. The objective burden (time and money spent) was assessed by the caregivers daily using diaries over four weeks and by recall at the end of weeks 1 and 2. Results: One-hundred and seven patients (53% females; mean age 43 ± 11) and 118 informal caregivers (67%; 58 ± 15 years) were recruited. Informal caregivers spent 22.5 hours/week and about 14% of their gross income on care-related activities. The time spent was underestimated by two to 20 hours when assessed by recall than by daily diary records. The most prominent aspects of the subjective burden were mental problems. Conclusion: Despite a substantial amount of time and money spent on care giving, the informal caregivers perceived the mental aspects of burden as the most troublesome. The informal caregiver burden is considerable and should be taken into account when evaluating effects of health care provided to patients with psychoses [ABSTRACT FROM AUTHOR]

Aims and objectives. To evaluate the effect of a group-based multi-professional educational programme for family members of patients with chronic heart failure with regard to quality of life, depression and anxiety. The secondary aim was to investigate the impact of social support and sense of coherence on changes in quality of life, anxiety and depression during the period of the study. Background. When a person is diagnosed with heart failure, the daily life of the family members is also affected. Design. Randomised controlled trial. Methods. A total of 128 family members were randomly assigned to participate in a multi-professional educational programme or a control group. Analysis of variance and regression analysis were used. Results. There were no significant differences in anxiety, depression or quality of life between the intervention group and control group. Adequacy of social network was the only independent variable that explained levels of anxiety and depression after 12 months beyond baseline levels of anxiety ( p < 0·001, R2 = 0·35) and depression ( p = 0·021, R2 = 0·37). Younger family members were found to have a higher quality of life ( p < 0·01). Conclusion. Improved disease-related knowledge may need to be combined with other target variables to induce desired effects on depression, anxiety and quality of life of family members. Antecedents of depression and anxiety, such as sense of control, may need to be specifically targeted. Our results also suggest that intervention aimed at enhancing social support may be beneficial for family members. Relevance to clinical practice. Anxiety and depression did not decrease nor did quality of life improve after the intervention. An educational programme for family members with a component specifically targeting anxiety, depression and quality of life warrants testing. Furthermore, it is important that health care providers understand the influence of social support on anxiety, depression and quality of life when interacting with family members. [ABSTRACT FROM AUTHOR]

Aims and objectives This study aimed to evaluate effects of a non-pharmacological intervention on sleep, activity and fatigue in patients receiving peritoneal dialysis by the use of both actigraphy registration and self-assessed questionnaires. Background Insomnia is estimated to affect up to 60% of haemo- and peritoneal dialysis patients. It is associated with two common uremic symptoms, pruritus and restless legs syndrome. To our knowledge, no interventions have been evaluated by actigraphy. Design A prospective multiple baseline single-case experimental design. Methods Two women and seven men with sleep problems, 48-77 years, treated with PD participated in a 17-week study from January 2009 to February 2011. Two interventions were separately implemented. First, a pressure-relieving mattress and second, a four week individual sleep hygiene and sleep scheduling intervention. The two interventions were evaluated both objectively by actigraphy and subjectively by questionnaires. Results A total of 315 sleep-wake cycles from nine individuals were evaluated. Three patients improved clinically significantly in five or more of the nine outcomes, i.e. sleep onset latency, nocturnal sleep duration, numbers and duration of napping, movement and fragmentation index, number of steps, metabolic equivalent unit, sleep efficiency and fatigue. The other six patients also showed improvements but to a lesser degree. Physical activity advice was the intervention that yielded most sleep improvements. Conclusions This study illuminates the need for regular assessment of sleep and tiredness. It also demonstrates how a non-pharmacological treatment and self-management can be applied with renal supportive care to improve sleep quality. Relevance to clinical practice This study is a clinical example of a non-pharmacological intervention with supportive care and self-management. This model can improve health and reduce the pharmacological burden because hypnotics can be replaced by sleep hygiene self-care activities. [ABSTRACT FROM AUTHOR]

The developmental activities of 328 elite soccer players aged under-16 years from Brazil, England, France, Ghana, Mexico, Portugal and Sweden were examined using retrospective recall in a cross-sectional research design. The activities were compared to the early diversification, early specialisation, and early engagement pathways. Players started their involvement in soccer at approximately 5 years of age. During childhood, they engaged in soccer practice for a mean value of 185.7, s = 124.0 h · year−1, in soccer play for 186.0, s = 125.3 h · year−1, and in soccer competition for 37.1, s = 28.9 h · year−1. A mean value of 2.3, s = 1.6 sports additional to soccer were engaged in by 229 players during childhood. Players started their participation in an elite training academy at 11 to 12 years of age. During adolescence, they engaged in soccer practice for a mean value of 411.9, s = 184.3 h · year−1, in soccer play for 159.7, s = 195.0 h · year−1, and in soccer competition for 66.9, s = 48.8 h · year−1. A mean value of 2.5, s = 1.8 sports other than soccer were engaged in by 132 players during this period. There were some relatively minor differences between countries, but generally the developmental activities of the players followed a mixture of the early engagement and specialisation pathways, rather than early diversification. [ABSTRACT FROM PUBLISHER]

Objective The Swedish policy objectives in dental care provision - to meet public demands for dental care and to increase the cost-effectiveness of the service - require dentists to work in teams with dental hygienists and dental nurses. This study focused on the role of dentists in the distribution of work tasks within teams in one Swedish Public Dental Service organisation. Dental clinics were viewed as micro-political arenas in which dentists attempt to demarcate professional boundaries in response to teamwork. Methods Semi-structured interviews, observations and documents were used. The interviewed individuals were seven dentists employed at two clinics, the managers of each clinic and the general manager. The dentists were interviewed to investigate how they defend or blur professional boundaries. They were also observed at work. The clinic managers and the general manager were interviewed to identify their expectations of dentists concerning work division. The documents comprised organisational plans and annual reports. Results Dentists demarcated professional boundaries by utilising various power resources: treatment responsibility, specialist knowledge, discretion, and avoidance of work considered to be low status work. The dentists also contributed to blurred boundaries between themselves and the other dental professionals by discussing patient treatment, giving and receiving advice, and assisting the others in skill development. Conclusion Although dentists' boundary work could obstruct implementation of policy objectives, dentists' behaviour contributed to effective collaboration within the teams. [ABSTRACT FROM AUTHOR]

Background: Testing evidence-based interventions (EBIs) outside of their home country has become increasingly commonplace. There is a need for theoretically guided research on how to best create and test the effects of culturally adapted interventions. Objective: To illustrate how the field might raise the scientific and practical value of future effectiveness and dissemination trials of culturally adapted interventions, as well as to provide support for theoretically informed research on this subject to take greater root. Methods: Nine theories that offer guidance on how to adapt existing EBIs for a new cultural group were summarized and evaluated. Results: Commonalities among the selected theories included a focus on the need for collaboration as part of the adaptation process and shared emphasis on taking systematic steps to select an intervention to adapt, as well as calls for adaptations to be guided by specific types of empirical studies. Among the theories, variability existed in terms of what constituted an adaptation. Conclusions: As EBIs go global, intervention adaptation promises to be the subject of substantial future scholarly attention. There is a need to develop systematic evidence-based methods that allow for some degree of adaptation, while still bringing about EBIs' desired benefits. [ABSTRACT FROM AUTHOR]

The Child and Adolescent Twin Study in Sweden (CATSS) is an ongoing longitudinal twin study targeting all twins born in Sweden since July 1, 1992. Since 2004, parents of twins are interviewed regarding the children's somatic and mental health and social environment in connection with their 9th or 12th birthdays (CATSS-9/12). By January 2010, 8,610 parental interviews concerning 17,220 twins had been completed, with an overall response rate of 80%. At age 15 (CATSS-15) and 18 (CATSS-18), twins and parents complete questionnaires that, in addition to assessments of somatic and mental health, include measures of personality development and psychosocial adaptation. Twin pairs in CATSS-9/12 with one or both twins screening positive for autism spectrum disorders, attention deficit/hyperactivity disorder, tic disorders, developmental coordination disorder, learning disorders, oppositional defiant disorder, conduct disorder, obsessive–compulsive disorder, and/or eating problems have been followed with in-depth questionnaires on family, social environment and personality, and subsequently by clinical assessments at age 15 together with randomly selected population controls, including 195 clinically assessed twin pairs from the first 2 year cohorts (CATSS-15/DOGSS). This article describes the cohorts and study groups, data collection, and measures used. Prevalences, distributions, heritability estimates, ages at onset, and sex differences of mental health problems in the CATSS-9/12, that were analyzed and found to be overall comparable to those of other clinical and epidemiological studies. The CATSS study has the potential of answering important questions on the etiology of childhood mental health problems and their role in the development of later adjustment problems. [ABSTRACT FROM PUBLISHER]

Background The incorrect use of medications may result from improper prescribing. The poor interface and design of computerised physician order entry (CPOE) systems may contribute. To improve the quality of electronic drug prescription, ePrescribing, there is a need for an evaluation model that is able to assess the quality of the CPOE, focusing on usability. Objective To develop and apply a model to evaluate the usability of different CPOEs used for ePrescribing in electronic health records (EHRs) in primary care. Method An evaluation model for CPOEs was designed by assembling existing quality criteria for ePrescribing, supplemented with new criteria. The evaluation model was used to assess CPOEs from seven EHRs in primary care. Results The evaluation model included five categories comprising 73 single criteria. The model was found to be easy to use, and facilitated the assessment process. Evaluation of the EHRs revealed differences and similarities between the systems. None of the CPOEs was perfect in that all of them had distinct shortcomings. The most prominent deficiencies were a non-intuitive interface and incorrect dosage function. Conclusion The model developed might be used not only to evaluate usability in ePrescribing, but also as a basis for studying the usability of other CPOEs. To reduce the risk of drugs being prescribed with incorrect dosages, the most urgent improvement is the development of a more consistent and intuitive interface for the EHRs and an improvement in the dosage function. [ABSTRACT FROM AUTHOR]

Objective: To explore the experience of undergoing unsuccessful in vitro fertilization (IVF) treatment and of remaining childless 3 years after IVF in both women and men.Design: Qualitative-approach study.Sample: Ten women and nine men who had attended a public fertility clinic in Sweden.Methods: Individual qualitative semi-structured interviews were conducted with qualitative content analysis guiding the analysis.Results: Three years after the end of IVF treatment, most men and women were still processing and had not adapted to childlessness, indicating that the grieving process was unresolved. Unsuccessful IVF was experienced by women in terms of grief, whereas men took upon themselves a supportive role and did not express grief. A need for professional support and counseling in how to handle grief was described. An unstructured end after IVF treatment left unanswered questions.Conclusions: The grieving process after unsuccessful IVF treatment was hampered among both men and women. The provision of additional individual support during IVF is recommended as men and women experienced childlessness differently. Support and counseling concerning grief reactions following IVF failure, and a structured final consultation after IVF may facilitate the grieving process after undergoing unsuccessful IVF treatment. [ABSTRACT FROM AUTHOR]

Abstract This study employs multiple regression models based on DeFries and Fulker (1985), and a large sample of twins, to assess heritability in attitudes towards economic risk, and the extent to which this heritability differs between males and females. Consistent with Cesarini et al. (2009), it is found that attitudes towards risk are moderately heritable, with about 20 percent of the variation in these attitudes across individuals being linked to genetic differences. This value is less than one-half the estimates reported by Zyphur et al. (2009) and Zhong et al. (2009). While females are more risk averse than males, there is no evidence that heritability in attitudes towards risk differs between males and females. Even though heritability is shown to be important to economic risk-taking, the analyses suggest that multivariate studies of the determinants of attitudes towards risk which to not take heritability into consideration still provide reliable estimates of the partial effects of other key variables, such as gender and educational attainment. [ABSTRACT FROM AUTHOR]

Optimism has a positive influence on mental and somatic health throughout lifetime and into old age. This association is mainly due to shared genetic influences, with some indication of sex differences in the heritability of these and related traits (e.g., depression and subjective wellbeing). Here we extend our initial study of Australian twins by combining with data available from Swedish twins, in order to increase the power to explore potential sex differences in the genetic architecture of optimism, mental and self-rated health and their covariation. Optimism, mental, and self-rated health were measured in 3053 Australian (501 identical female (MZf), 153 identical male (MZm), 274 non-identical female (DZf), 77 non-identical male (DZm), and 242 non-identical opposite-sex twin pairs, and 561 single twins; mean age 60.97 +/- 8.76), and 812 Swedish (71 MZf, 53 MZm, 93 DZf and 67 DZm twin pairs, and 244 single twins; mean age 60 +/- 14.3) twin individuals using the Life Orientation Test (LOT), the General Health Questionnaire (GHQ) and a single-item self-rating of overall health, respectively. In females all three traits were moderately heritable (.27-.47), whereas in males heritability was substantially lower (.08-.19), but genetic modeling showed that sex differences were not significant. The absence of significant sex differences, despite the consistent trend across the two cohorts, is likely due to a lack of power, raising the importance for future studies, on the same or similar traits, to utilize large samples and to keep the possibility of sex differences in mind when conducting their analyses. [ABSTRACT FROM AUTHOR]

Background A blood test for S100B can be used to rule out intracranial complications after minor head injury and thereby reduce the need for computed tomography (CT) examinations. The aim of this study was to investigate the clinical importance of a possible influence of seasonal variation on S100B. Methods The individual seasonal variation of S100B in 69 healthy volunteers living at latitudes with extremely variable seasonal exposure to sunlight was investigated. Results The mean serum concentration of S100B was 13% higher in August than in February, but however, not statistically significant (p = 0.068). A good agreement between summer and winter S100B values was confirmed by Bland-Altman analysis and a significant correlation (r = 0.317, p = 0.008) was shown between summer and winter S100B values. Conclusion This study did not show any clinical importance of seasonal variation of S100B that may influence the decision of CT scanning patients with head injuries. [ABSTRACT FROM AUTHOR]

Background: The possible benefit of lifetime physical activity (PA) in reducing prostate cancer incidence and mortality is unclear.Methods: A prospective cohort of 45,887 men aged 45-79 years was followed up from January 1998 to December 2007 for prostate cancer incidence (n=2735) and to December 2006 for its subtypes and for fatal (n=190) prostate cancer.Results: We observed an inverse association between lifetime (average of age 30 and 50 years, and baseline age) total PA levels and prostate cancer risk. Multivariate-adjusted incidence in the top quartile of lifetime total PA decreased by 16% (95% confidence interval (CI)=2-27%) compared with that in the bottom quartile. We also observed an inverse association between average lifetime work or occupational activity and walking or bicycling duration and prostate cancer risk. Compared with men who mostly sit during their main work or occupation, men who sit half of the time experienced a 20% lower risk (95% CI=7-31%). The rate ratio linearly decreased by 7% (95% CI=1-12%) for total, 8% (95% CI=0-16%) for localised and 12% (95% CI=2-20%) for advanced prostate cancer for every 30 min per day increment of lifetime walking or bicycling in the range of 30 to 120 min per day.Conclusions: Our results suggest that not sitting for most of the time during work or occupational activity and walking or bicycling more than 30 min per day during adult life is associated with reduced incidence of prostate cancer. [ABSTRACT FROM AUTHOR]

We investigated common genetic variation in the entire ESR1 and EGF genes in relation to endometrial cancer risk, myometrial invasion and endometrial cancer survival. We genotyped a dense set of single-nucleotide polymorphisms (SNPs) in both genes and selected haplotype tagging SNPs (tagSNPs). The tagSNPs were genotyped in 713 Swedish endometrial cancer cases and 1567 population controls and the results incorporated into logistic regression and Cox proportional hazards models. We found five adjacent tagSNPs covering a region of 15 kb at the 5' end of ESR1 that decreased the endometrial cancer risk. The ESR1 variants did not, however, seem to affect myometrial invasion or endometrial cancer survival. For the EGF gene, no association emerged between common genetic variants and endometrial cancer risk or myometrial invasion, but we found a five-tagSNP region that covered 51 kb at the 5' end of the gene where all five tagSNPs seemed to decrease the risk of dying from endometrial cancer. One of the five tagSNPs in this region was in strong linkage disequilibrium (LD) with the untranslated A61G (rs4444903) EGF variant, earlier shown to be associated with risk for other forms of cancer. [ABSTRACT FROM AUTHOR]

The aim was to evaluate human papillomavirus (HPV) 'reflex genotyping' in cases of minor cytological abnormalities detected in the gynaecological screening programme in Stockholm, Sweden. Liquid-based cytology samples showing minor cytological abnormalities were analysed using HPV genotyping (Linear Array, Roche diagnostics). Colposcopically directed cervical biopsies were obtained and the HPV test results were correlated with the histological results. In all, 63% (70/112) of the samples were high-risk (HR) HPV (HR-HPV) positive. A statistically significant correlation was found between high-grade cervical lesions and HR-HPV (P=0.019), among which HPV 16, 18, and 31 were the most important. The negative predictive value of HR-HPV detection for histologically confirmed high-grade lesions was 100%. An age limit for HPV reflex testing may be motivated in cases of low-grade squamous intraepithelial neoplasia (LSIL), because of high HR-HPV prevalence among younger women. By using HPV reflex genotyping, additional extensive workup can safely be avoided in about 50% of all cases of atypical squamous cells of undetermined significance (ASCUS) and LSIL among women 30 years. This screening strategy could potentially reduce the total abnormal cytology-reporting rate in the Swedish screening programme by about 1% and provide more accurately directed follow-up, guided by cytological appearance and HPV test results. [ABSTRACT FROM AUTHOR]

Background: Over the last decade sickness absence and disability pension (DP) due to psychiatric disorders have increased considerably in Western countries. The scientific knowledge base about prognoses for such absences is very limited, but employers and clinicians often predict them to be very long. The aim of this study was to investigate sickness absence and disability pension in a cohort of employees who initially were on long-term sick leave due to psychiatric disorders, with regard to gender, age, socioeconomic status, and previous sickness absence.Methods: The cohort included 4,891 employees in Sweden, who, in 1999 were aged 20-61 and had a new sick-leave spell >90 days with a psychiatric disorder. Retrospective and prospective registry data on sickness absence and DP for 1996-2002 were obtained. Logistic regressions were performed to estimate odds ratios (ORs) with 95% confidence intervals (CIs) for having a low, intermediate, or high level of sickness absence (<17, 17-90, and 91-365 days, respectively) or DP in 2002.Results: The mean number of sick-leave days per person per year 3 years prior to inclusion was low; 17 days, but had increased to 211 days by 2000. In 2002, 26% had been granted DP, significantly higher rate among men, while a higher rate of the women had long-term sickness absence. Of all 4,891 subjects, 35% had <17 sick-leave days in 2002. The OR of having low, intermediate, or long-term sickness absence decreased with age. The reverse was found for obtaining DP, for which also low socioeconomic status was an independent predictor of an increased risk (OR = 3.40, CI 2.28-5.08).Conclusions: Employees with long-term sick leave due to psychiatric disorders did not have a high level of sickness absence in the 3 years prior to inclusion in the study. Also, 3 years after inclusion, only 35% had very low levels of sickness absence, whereas 26% had been granted DP. Employees who were aged 55-61 showed the lowest risk of sick leave but the highest risk of DP. Low SES was a significant predictor of DP in 2002. [ABSTRACT FROM AUTHOR]

Previous studies indicate that the emotional quality of marital relationships is mirrored in parent-child relationships. We explored the degree to which these associations are explained by genetic and environmental factors. Participants were drawn from the Twin and Offspring Study in Sweden (TOSS), and included 544 female twin pairs (258 monozygotic [MZ], 286 dizygotic [DZ]), and 311 male twin pairs (128 MZ, 183 DZ). The spouses and one adolescent child of each twin also participated in this study. The twins completed self-report measures that assessed their marital quality and their warmth and negativity towards their children. Observational ratings of marital warmth and negativity, and of maternal warmth and negativity were obtained for a subset of female twin pairs (150 MZ, 176 DZ). Self-reported marital satisfaction was associated with self-reported parental warmth and negativity for mothers (rs = .25, -.36) and fathers (rs = .25, -.44). For the observational measures, marital warmth was associated with maternal warmth (r = .42), while marital negativity was associated with maternal negativity (r = .34). On average genetic factors explained nearly half of the covariance between self-reported marital satisfaction and parenting for mothers (48%) and fathers (47%). Genetic factors explained 21% of the covariance between observed marital and maternal warmth, but did not contribute to associations between marital and maternal negativity. These findings indicate that parents' genetically influenced characteristics help shape the emotional climate of the family. [ABSTRACT FROM AUTHOR]

The possibility of genotype-environment interaction for memory performance and change was examined in 150 monozygotic (MZ) twin pairs from the Swedish Adoption Twin Study of Aging (SATSA). We used an MZ twin pair difference approach to examine the possibility that genotype was associated with intrapair variability and thus suggestive of genotype-nonshared environment interactions. Multiple 'variability genes' were found for longitudinal change in a semantic memory task including candidates coding for apolipoprotein E (APOE) and estrogen receptor alpha (ESR1) as well as serotonin candidates (HTR2A and 5HTT). One candidate also related to variability in change in episodic memory (5HTT). Of the significant associations observed, generally results indicated that MZ pairs who carry putative risk alleles were less variable than noncarriers, suggesting that noncarriers may be more sensitive to environmental contexts. We sought to 'contextualize' the possible nonshared environmental influences for found gene-environment (G x E) effects by considering intrapair differences in measured social and stress factors, including social support, life events and depressive symptoms. Results suggested that nonshared environmental influences associated with depressive symptoms may moderate the G x E relationship observed for ESR1 and APOE and longitudinal semantic memory change whereby noncarriers of putative risk alleles may be relatively more sensitive to depressionevoking environmental contexts than carriers of the risk allele. Thus, the contexts that facilitate or reduce depressive symptoms may affect semantic memory resiliency dependent on genotype. Further work ought to consider larger sample sizes as well as consider additional social and contextual factors. [ABSTRACT FROM AUTHOR]

The aim of this work was to determine mean absorbed doses to the unborn child in common conventional X-ray and computed tomography (CT) examinations and to find an approach for estimating foetal dose based on data registered in the Radiological Information System/Picture Archive and Communication System (RIS/PACS). The kerma-area product (KAP) and CT dose index (CTDI(vol)) in common examinations were registered using a human-shaped female dosimetry phantom. Foetal doses, D(f), were measured using thermoluminescent dosimeters placed inside the phantom and compared with calculated values. Measured foetal doses were given in relation to the KAP and the CTDI(vol) values, respectively. Conversion factor D(f)/KAP varies between 0.01 and 3.8 mGy/Gycm(2), depending on primary beam position, foetus age and beam quality (tube voltage and filtration). Conversion factors D(f)/CTDI(vol) are in the range 0.02 - 1.2 mGy/mGy, in which the foetus is outside or within the primary beam. We conclude that dose conversion factors based on KAP or CTDI(vol) values automatically generated by the RIS/PACS system can be used for rapid estimations of foetal dose for common examination techniques. [ABSTRACT FROM AUTHOR]

The Swedish Young Male Twins Study is a population-based longitudinal twin study founded in 1997 through record-linkages of several national registers. Details on pregnancy and birth were obtained from the Swedish Medical Birth Register and used to identify 3566 male twins (1783 pairs) born in Sweden between 1973 and 1979 and resident in Sweden in 1997. A record-linkage was made between the Medical Birth Register and the Military Service Conscription Register for the years 1991 to 1999, providing information on body weight, height, blood pressure, muscle strength, cognitive ability of these twins at age 18 and 19 years. In 1998, 2002 and 2005 to 2006, the twins were surveyed on their zygosity, socioeconomic status, lifestyle factors (such as eating habits, physical activity, smoking habits, use of alcohol etc), height and weight. In 2002, additional information was collected on perceived body shape and size, and eating behavior, according to the Three-Factor Eating Questionnaire. In 2003, DNA via buccal mucosa was collected from a subset of the twins. Recent research using the Swedish Young Male Twins datasets has explored the relationships between fetal growth, body size and blood pressure in young adulthood, genetic and environmental contributions to eating behavior and physical activity, and relationships between diet and physical activity patterns with longitudinal changes in body mass index and attained waist circumference. [ABSTRACT FROM AUTHOR]

Background: The aim of the study was to analyse the triggering or acute risk effect of psychiatric symptoms and interpersonal stressors on criminal violence.Method: One hundred and thirty three violent offenders were recruited from a forensic psychiatric evaluation (FPE) unit and a national prison evaluation unit in Sweden during 2002-2003, and were interviewed about trigger exposures. A case-crossover design was used eliminating long-term within individual confounding.Results: Suicidal ideation or parasuicide within 24 h before the violent event conferred a ninefold risk increase. In contrast, violent ideation did not trigger criminal violence. Hallucinations yielded a fourfold risk increase, whereas paranoid thoughts were associated with a small and statistically non-significant risk increase. Acute conflicts with others and being denied psychiatric care within 24 h before violence also increased the risk of acting violently.Conclusions: Some tested psychiatric symptoms and stressors triggered criminal violence, whereas others did not. The case-crossover design may be particularly useful for the study of triggers of violence. [ABSTRACT FROM AUTHOR]

Aim: To assess whether children with Noonan syndrome on long-term growth hormone (GH) therapy improve their final height to near mid-parental height.Methods: Twenty-five prepubertal children (13 girls) with Noonan syndrome (NS) were studied. A single clinician made the diagnosis based on clinical criteria. GH treatment started at an age ranging from 3.1 to 13.8 y and was continued for at least 2 y. Improvement or "gain" in final height (FH) was defined as either the difference between adult height SD scores (SDS) and pre-treatment height SDS (the childhood component of the Swedish reference) or height SDS compared to the Noonan reference.Results: Ten children received a GH dose of 33 microg/kg/d (mean age at start 7.7+/-2.1 y, mean age at stop 17.6+/-1.7 y) and 15 received a dose of 66 microg/kg/d (mean age at start 8.6+/-3.3 y, mean age at stop 18.4+/-2.1 y). Eighteen out of 25 patients reached FH. A substantial improvement in FH of 1.7 SDS, equivalent to 10.4 cm compared to pre-treatment height, was observed. No significant difference was seen between the two GH doses. Females gained a mean height of 9.8 cm and males 1-13 cm (FH 174.5+/-7.8 cm vs mean adult height of 162.5+/-5.4 cm for males with NS) at final height. Moreover, 60% reached a mid-parental height of+/-1 SD.Conclusion: GH treatment improves final height in patients with Noonan syndrome, with a mean gain of 1.7 SDS. The prepubertal height gain is maintained to final height and the children achieve a height close to their mid-parental height. [ABSTRACT FROM AUTHOR]

Aim: To examine socio-economic factors, smoking, coffee consumption and exclusive breastfeeding duration.Methods: This study was part of a prospective cohort study of children born between 1 October 1997 and 1 October 1999 (the All Babies in Southeast Sweden (ABIS) study). Eleven socio-economic characteristics (parental employment, civil status, whether parents were born in Sweden, parental education, residence at birth and during child's first year, crowded living), maternal smoking, coffee consumption, infant sex, siblings, parental age, and maternal alcohol consumption during pregnancy were analysed using logistic regression and Cox's proportional hazards method. All data were obtained through questionnaires distributed at infant birth and at 1 y of age. Exclusive breastfeeding duration<4 mo and actual breastfeeding duration were our main outcome measures.Results: Out of 10205 infants, 2206 (21.6%) were exclusively breastfed for less than 4 mo ("short exclusive breastfeeding"; SEBF). Backward stepwise regression analysis identified the following risk factors for SEBF: maternal smoking (95% confidence interval for adjusted odds ratio, 95% CI AOR 2.00-2.82), low maternal education (95% CI AOR 1.45-2.19), maternal employment less than 3 mo during pregnancy (95% CI AOR 1.17-1.54), paternal ageConclusion: This study indicates that socio-economic factors and smoking may be of importance to the risk of breastfeeding exclusively for less than 4 mo, while coffee consumption is not. [ABSTRACT FROM AUTHOR]

Aims: To study relations between test performance, academic self-esteem, self-reported stress and saliva cortisol levels in students exposed to test demands at school.Methods: 46 randomly selected 6th and 9th graders voluntarily participated in an experimental school test concerning reading and mathematics skills. Cortisol saliva samples were collected at awakening, 30 min later, before test and after test. Perceived stress was registered with a visual analogue scale (VAS). A standardized self-rating questionnaire for measuring self-esteem was administered together with questions about school stress and psychological reactions when exposed to stress during a test.Results: Experienced stress during the school test was correlated to low test performance and to low self-rated evaluation of self-esteem as well as to an increase of saliva cortisol levels during the test. There were also correlations between certain psychological reactions to demands and different cortisol measures. Children who reported that they applied the procedure "I say to myself: I can solve this task" in a school test situation had a lower morning increase of saliva cortisol. Reported use of the procedure "I get worried and will have problems solving other tasks too"--when referring to a school test situation--was correlated to an increase in cortisol levels during the test situation.Conclusion: Test performance, academic self-esteem, perceived stress and reactions of the hypothalamus-pituitary-adrenal axis (HPA axis) are highly intertwined. Furthermore, certain school stress psychological reactions to performance demands seem to be related to different cortisol reactions. [ABSTRACT FROM AUTHOR]

Aims: To analyse mothers' self-assessed quality of interaction with their children and their opinions about child difficulty with respect to socio-economic status and subjective factors: postnatal depression, social isolation, sense of coherence and locus of control.Methods and Material: A comprehensive questionnaire was completed by 1039 mothers of 18-mo-old children participating in the baseline measurements of a Swedish multicentre study developing and testing a new psychosocial model for the child health services.Results: All subjective factors, including the number of factors, showed significant associations with perceived interaction and difficultness. Effect sizes of subjective factors ranged from about 0.3 to 1 SD for interaction, and from about 0.2 to 0.8 SD for difficultness. As for difficultness, effect sizes were larger for boys. There were no associations between high socio-economic status and high-quality interaction or low child difficultness: the few significant differences in fact favoured low-status children.Conclusion: The results provided some contradictory findings to the well-known association between high socio-economic status and favourable outcome. This result is of practical relevance for interventions: supportive programmes cannot be limited to areas and families of low socio-economic status. Positive effects may ensue if subjective factors like those studied here can be promoted among parents and children through the child health services. [ABSTRACT FROM AUTHOR]

Aim: To describe an evidence-based model for preventive child health care and present some findings from baseline measurements.Methods: The model includes: parent education; methods for interaction and language training; follow-up of low birthweight children; identification and treatment of postnatal depression, interaction difficulties, motor problems, parenthood stress, and psychosocial problems. After baseline measurements at 18 mo (cohort I), the intervention was tested on children from 0 to 18 mo at 18 child health centres in Uppsala County (cohort II). Eighteen centres in other counties served as controls. Two centres from a privileged area were included in the baseline measurements as a "contrasting" sample. Data are derived from health records and questionnaires to nurses and mothers.Results: Baseline experiment (n = 457) and control mothers (n = 510) were largely comparable in a number of respects. Experiment parents were of higher educational and occupational status, and were more frequently of non-Nordic ethnicity. Mothers in the privileged area (n = 72) differed from other mothers in several respects. Experiment nurses devoted considerably fewer hours per week to child health services and to child patients than did control nurses.Conclusions: Despite certain differences, experiment and control samples appeared comparable enough to permit, in a second step, conclusions about the effectiveness of the intervention. [ABSTRACT FROM AUTHOR]

This study examined the relationship between the approval times for new pharmaceuticals and the number of adverse drug reactions reported to the Swedish Medical Products Agency. Yearly time-series data concerning the number of adverse drug reactions, as well as data concerning prices and quantities sold for 25 pharmaceutical substances during the period 1972-1996 were used. The results show that shorter approval times are associated with more adverse drug reactions, but also that the effects are quite small. [ABSTRACT FROM AUTHOR]

Background: Seniors aged 75 and above have the highest suicide rates of all age groups in most industrialized countries. However, research concerning risk factors for suicide in the old elderly is sparse.Objective: The purpose was to determine predictors for suicide among the old elderly (75+). Data concerning the young elderly (65-74 years) are shown for comparison.Methods: 85 consecutive cases of suicide that occurred in western Sweden and 153 control persons with the same sex, birth year, and zip code as the suicide cases were randomly selected from the tax register. The old elderly group included 38 cases and 71 controls; the young elderly group included 47 cases and 82 controls. Data concerning the suicide cases were collected through interviews with close informants; controls were interviewed in person. The interview included questions on past-year life events and mental and physical health. Medical records were reviewed for cases and controls. The Cumulative Illness Rating Scale - Geriatrics was used to rate illness burden.Results: Family conflict, serious physical illness, loneliness, and both major and minor depressions were associated with suicide in the 75+ group. Economic problems predicted suicide in the younger but not in the older elderly. Old elderly suicide victims with depression (major or minor) were less likely to have received depression treatment than their younger counterparts.Conclusions: Better recognition and treatment of both major and minor depression should constitute an important target for the prevention of suicide in the old elderly. Intervention studies with large numbers of senior participants are sorely needed. [ABSTRACT FROM AUTHOR]

We extend Nathan Keyfitz's research on continuous change in life expectancy over time by presenting and proving a new formula for decomposing such change. The formula separates change in life expectancy over time into two terms. The first term captures the general effect of reduction in death rates at all ages, and the second term captures the effect of heterogeneity in the pace of improvement in mortality at different ages. We extend the formula to decompose change in life expectancy into age-specific and cause-specific components, and apply the methods to analyze changes in life expectancy in Sweden and Japan. [ABSTRACT FROM AUTHOR]

This article aims to shed preliminary empirical light on the assumptions underpinning a culturally relevant theoretical framework for the study of successful aging. On the basis of the Kluckhohnian theory of cultural variation, this framework suggests that congruence exists between value orientations concerned with man-nature, time, activity, and relationships, and the manner in which the construct of successful aging is understood. Methodologically speaking, the research project upon which this article is based started out by adapting and further developing the vignette-based instrument that Kluckhohn and Strodtbeck designed to test the theory of cultural variation. Vignette-based interviews were then conducted with 30 Iranian immigrants to Sweden as a preliminary test of the hypothesis of congruence. The results presented in this article suggest that, as posed in the framework in question, there is a relationship between the value orientations that people prefer and the various understandings of successful aging that they uphold. The results suggest also that there is a variety of ways in which the construct of successful aging can be understood, and that variety encompasses other ways of thinking about successful aging besides the master nature, future, productivity, and individuality-oriented views that characterize the gerontological debate. Although further research is necessary, these preliminary results do infer that this framework might offer a theoretically interesting approach to the study of individual, generational, and cross-cultural understandings of successful aging. [ABSTRACT FROM AUTHOR]

The aim of the present study was to elucidate how telemedicine can be used in an integrated and comprehensive manner. Two Swedish telemedicine projects were studied. The technical platform was an ISDN videoconferencing system which could be connected to various items of medical equipment. The first project, general telemedicine, concerned communication between two primary care centres, one county hospital and one university hospital. The specialties involved were dermatology, orthopaedics and otolaryngology. The second project, telepathology, included pathology and cytology at the university hospital, and surgery and gynaecology at a county hospital. The first round of interviews was conducted to reveal the expectations of the physicians regarding the potential benefits and applications of the technology and potential organizational obstacles. Subsequent interview rounds were carried out to reveal what had happened since the previous interview. In total 62 interviews were carried out with 32 respondents. The main conclusions were that the technology's generic features, namely the transmission of pictures and sound, had been translated into appropriate fields of application, which had been diffused and routinized in organizational activities. In order to facilitate this process, there were two crucial issues for managers. First, due to the 'openness' of the technology, actors who had the will to test the limits of the technology had to be identified and engaged. Second, while the use of the new technologies implied that new patterns of action were established, it was necessary to discover and develop routines that could be used as a facilitator for the further use of telemedicine. [ABSTRACT FROM AUTHOR]

Background and Objective: Dyspepsia, peptic ulcer disease (PUD) and gastro-oesophageal reflux disease (GORD) involve a substantial cost to Swedish society. There is a lack of up-to-date nationwide cost estimates after 1985. This study was conducted to present a comprehensive and updated cost analysis and study the change over time of the national cost of these disorders.Design and Setting: Primarily, data from National Swedish databases and secondly, data from databases from the County of Uppsala for 1997 were used for the calculations and estimations.Perspective: Swedish societal perspective.Results: The total cost to Swedish society of dyspepsia, PUD and GORD in 1997 was $US424 million, or $US63 per adult. Direct costs totalled $US258 million (61%) while indirect costs totalled $US166 million (39%). The highest proportions of costs were due to drugs and sick leave, these being 37 and 34%, respectively.Conclusions: The cost of dyspepsia and GORD is substantial for patients, health providers and society. Since 1985, drug costs have increased substantially while the cost of sick leave has decreased. [ABSTRACT FROM AUTHOR]

Aluminum (Al) concentration was assessed in deciduous teeth in relation to sex, year of birth, tooth type, and the presence of caries and roots. Three hundred and twenty-three deciduous teeth from children born during the period 1952 93 in a county in southeast Sweden were sampled, and the Al content determined by graphite furnace atomic absorption spectrophotometry. The arithmetic mean of the Al concentration was 0.58 +/- 0.64 ppm dry weight (mean +/- standard deviation) and differed significantly between incisors (1.05 +/- 1.04 ppm) and canines (0.48 +/- 0.50 ppm) and between incisors and molars (0.53 +/- 0.55 ppm). A significant difference was found between teeth with and without caries. No significant differences were found between sexes. The Al concentration correlated significantly with tooth weight for incisors (r = -0.47) and canines (r = -0.45) but not for molars (r = 0.03). No significant change in Al concentration was found over time. Caries-free deciduous molars are suggested as the most useful teeth for biological monitoring of aluminum. [ABSTRACT FROM AUTHOR]

Objective: To compare the neonatal outcome in planned vaginal delivery and planned cesarean section in term singleton pregnancies with breech presentation in a Scandinavian clinic with a high rate of vaginal breech delivery.Methods: A retrospective study including 1050 term singleton breech pregnancies delivered at a Swedish tertiary referral center during 1988 to 2000. For 699 patients (67%) a vaginal delivery was planned, of whom 603 (86%) were delivered vaginally. In 327 (31%) cases a cesarean section was planned and performed. These two groups were compared regarding rates of acidemia at birth (cord artery pH <7.05), low Apgar scores and neonatal neurological morbidity. Long term sequels among infants with a complicated neonatal course were also identified.Results: Acidemia at birth, Apgar score below 7 at 5 minutes, and referral to neonatal intensive care unit all occurred at higher rates in planned vaginal delivery (5.3%, 3.6%, and 8.9%, respectively), than in planned cesarean delivery (0, 0, and 4.0%). The rate of neonatal neurological morbidity was 24/699 (3.4%) in planned vaginal delivery (18 cases with cerebral symptoms and six cases of brachial plexus palsy) compared to one case (cerebral symptoms) after a planned cesarean. These differences were all statistically significant (p< or =0.002). Of the neurologically affected neonates, two died and four had cerebral palsy (one delivered by planned cesarean section) at follow up.Conclusion: Neonatal morbidity may be reduced with planned cesarean delivery in breech presentation, also in a Scandinavian setting. [ABSTRACT FROM AUTHOR]

Unlabelled: Serum ferritin and serum transferrin receptor concentrations, growth and food habits were studied in healthy Swedish boys (n = 103) and girls (n = 124) at the age of 17 y and compared with those in the same adolescents at age 15. Between these ages, serum transferrin receptor increased significantly in both boys and girls. Serum ferritin increased significantly in boys but not in girls. The transferrin receptor/ferritin ratio increased significantly in girls but not in boys, indicating insufficient iron stores in the 17-y-old girls in relation to erythropoiesis and iron needs. Between 15 and 17 y the boys' frequency of consumption of milk and bread decreased, while they more often consumed pasta, cheese and coffee. The girls decreased their frequency intake of fat products, milk and meat. The frequency of meat consumption emerged as the single significant predictor for serum ferritin <12 microg/L in girls, but not in boys. The median daily iron intake, determined in a subsample, decreased in boys from 18.7 to 13.6 mg and in girls from 14.1 to 8.8 mg, and the decrease was to a large extent due to cessation of iron fortification of flour.Conclusions: The results indicate insufficient iron stores in the 17-y-old girls in relation to erythropoiesis and iron needs, but more favourable iron stores in the boys. The absence of a significant decrease in mean serum ferritin despite rapid growth suggests that the earlier iron fortification of flour only marginally contributed to the iron status of Swedish adolescents of this age group. [ABSTRACT FROM AUTHOR]

Background: Swedish formulary committees are expected to influence prescribing practice by establishing and issuing drug lists and clinical practice guidelines, particularly now that financial responsibility for prescription drugs has been transferred from the national to the county council level.Objective: The purpose of this exploratory study was to identify the information sources and decision criteria that individual committee members perceive as important in establishing clinical practice guidelines. Moreover, obstacles to the increased use of pharmacoeconomic evaluations in decision-making were also identified.Design and Setting: Data were gathered through a survey questionnaire administered in 1998 to members of central formulary committees throughout Sweden, as determined by a national register.Participants: 312 members of central formulary committees, of whom 69% responded.Results: Treatment policies/guidelines supplied by government authorities, or found in reviewed journals, are considered the most important sources of information, and criteria associated with costs and effects are considered the most important decision criteria. The members' years of experience and their professions affect their assessments of information sources, whereas education in health economics affects their assessments of decision criteria. Committee members voiced an interest in pharmacoeconomic issues, but warned that there was neither sufficient competence among committee members nor an adequate supply of relevant studies. Furthermore, a majority of the members identified difficulty in translating study results into clinical practice guidelines and limited possibilities in comparing studies as obstacles to the increased use of pharmacoeconomic evaluations.Conclusions: The results of this survey may be useful in designing future economic evaluations and when presenting and diffusing study results. [ABSTRACT FROM AUTHOR]

In Sweden, as in many other countries, paramedics or nurses constitute the majority of prehospital personnel. If tasks usually performed by doctors are to be performed by these personnel, there is a need for guidelines and triage in the handling of medical emergencies. We describe an information management system used in ambulances for data communication, documentation, triaging and presentation of checklists. In most cases, data are input while the patient is being cared for. The information is collected and stored together with data automatically received from the dispatch centre. The latter date are transferred by a mobile radio network to the ambulance. Medical date (e.g. electrocardiograms) are transferred from the ambulance over the data network to the receiving medical facility. All transferred data are finally collected in a database for statistical analysis and follow-up. [ABSTRACT FROM AUTHOR]

This study evaluates the predictability of a new language screening procedure in 3-y-olds. It is used in several Child Health Centres (CHC) in Sweden and has the character of a field study involving more than 60 CHC nurses. The main questions concern the (i) development in 3-y-olds assessed as severely language delayed and (ii) whether there are any earlier unknown severely disabled children identified at 4 y of age. Ninety-six percent of the original study population participated in the follow-up. The calculations are based on results from 2237 children. A well-established screening routine, which has been shown capable of predicting the risk of not being able to follow expected schooling, and case records were used as an acceptable proxy outcome measure, pending a better gold standard. In the group of severely disabled 3-y-olds, sensitivity, specificity and positive predictive values were 86, 99 and 43%, respectively. Finally, three false-negatives were identified. In light of the present results, continued application of the 3-y screening is discussed. [ABSTRACT FROM AUTHOR]

Rectangularization of human survival curves is associated with decreasing variability in the distribution of ages at death. This variability, as measured by the interquartile range of life table ages at death, has decreased from about 65 years to 15 years since 1751 in Sweden. Most of this decline occurred between the 1870s and the 1950s. Since then, variability in age at death has been nearly constant in Sweden, Japan, and the United States, defying predictions of a continuing rectangularization. The United States is characterized by a relatively high degree of variability, compared with both Sweden and Japan. We suggest that the historical compression of mortality may have had significant psychological and behavioral impacts. [ABSTRACT FROM AUTHOR]

Abstract. Dahlén GH, Weinehall L, Stenlund H, Jansson J-H, Hallmans G, Huhtasaari F, Wall S (Umeå University, Umeå; Skellefteå County Hospital; and Luleå-Boden County Hospital, Sweden). Lipoprotein(a) and cholesterol levels act synergistically and apolipoprotein A-I is protective for the incidence of primary acute myocardial infarction in middle-aged males. An incident case–control study from Sweden. J Intern Med 1998; 244: 425–30. ObjectiveTo further establish the importance of total plasma apolipoprotein A-I and lipoprotein(a) in the prediction of primary acute myocardial infarction (AMI) in men. DesignAn incident case–control study. SettingThe study was nested within the Västerbotten Intervention Program (VIP) and the Northern Sweden MONICA cohorts. SubjectsA total of 62 male AMI cases and 124 matched controls, randomly selected from the study cohorts. ResultsIn multivariate logistic regression, significant odds ratios (OR) were found for Lp(a) above 200 mg L-1, apo A-I below the mean value (1136 mg L-1) and total cholesterol (TC) above 7.8 mmol L-1. TC interacted significantly with Lp(a); for Lp(a) above 200 mg L-1 and TC below 6.5 mmol L-1, OR = 5.6; for Lp(a) above 200 mg L-1 and TC above 6.5 mmol L-1, OR = 12.6. To evaluate the potential effect of reducing high levels of Lp(a) or TC on the incidence of AMI in males, the attributable risk percentage (ARP) was calculated when interaction between the two variables was present. ARP is 31% for Lp(a) and 21% for TC, implying that 31% of the cases are due to high Lp(a) and 21% of the cases are due to high TC levels. ConclusionsIn the Swedish male population, total apo A-I in plasma is a protective factor and a plasma Lp(a) level above 200 mg L-1 is a risk factor for AMI in males. A TC level above 6.5 mmol L-1 increased the risk of AMI if the Lp(a) level was above 200 mg L-1, suggesting Lp(a) to be useful in identifying high risk individuals needed to be treated. [ABSTRACT FROM AUTHOR]

This article develops and applies two expressions for the rate of change of a population's mean age. In one, aging is shown to be negatively related to contemporary birth rates and death rates. In a general sense, aging occurs when vital rates are too low, as illustrated through applications to the United States, the Netherlands, and Japan. The other expression relates the rate of aging to a population's demographic history, in particular to changes in mortality, migration, and the annual number of births. Applications to the United States and Sweden show that the dominant factor in current aging in these countries is a history of declining mortality. Migration also contributes significantly but in opposite directions in the two countries. The two approaches are integrated after recognizing that the rate of change in the mean age is equal to the covariance between age and age-specific growth rates. A decomposition of this covariance shows that the two seemingly unrelated expressions contain exactly the same information about the age pattern of growth rates. [ABSTRACT FROM AUTHOR]

Methods are presented which produce Maximum Likelihood Estimates (MLE) of the degree of heterogeneity in individual mortality risks under a variety of assumptions about the age trajectory of those mortality risks. With these estimates of the degree of population heterogeneity it is possible to adjust comparisons of mortality risks across populations for the effects of population heterogeneity, differential mortality selection, and different age trajectories of the force of mortality. These methods are demonstrated by applying a variety of standard assumptions about the age trajectory of the force of mortality to the analysis of a broad range of cohort mortality data for the U.S. and Swedish populations. The estimates of the degree of heterogeneity, produced under all of the selected force of mortality models, consistently indicated a considerable degree of heterogeneity in mortality risks. [ABSTRACT FROM AUTHOR]