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Background The herpes zoster burden of disease in Sweden is not well investigated. There is no Swedish immunization program to prevent varicella zoster virus infections. A vaccine against herpes zoster and its complications is now available. The aim of this study was to estimate the herpes zoster burden of disease and to establish a pre-vaccination baseline of the minimum incidence of herpes zoster. Methods Data were collected from the Swedish National Health Data Registers including the Patient Register, the Pharmacy Register, and the Cause of Death Register. The herpes zoster burden of disease in Sweden was estimated by analyzing the overall, and age and gender differences in the antiviral prescriptions, hospitalizations and complications during 2006-2010 and mortality during 2006-2009. Results Annually, 270 per 100,000 persons received antiviral treatment for herpes zoster, and the prescription rate increased with age. It was approximately 50 % higher in females than in males in the age 50+ population (rate ratio 1.39; 95% CI, 1.22 to 1.58). The overall hospitalization rate for herpes zoster was 6.9/100,000 with an approximately three-fold increase for patients over 80 years of age compared to the age 70-79 group. A gender difference in hospitalization rates was observed: 8.1/100,000 in females and 5.6/100,000 in males. Herpes zoster, with a registered complication, was found in about one third of the hospitalized patients and the most common complications involved the peripheral and central nervous systems. Death due to herpes zoster was a rare event. Conclusions The results of this study demonstrate the significant burden of herpes zoster disease in the pre-zoster vaccination era. A strong correlation with age in the herpes zoster-related incidence, hospitalization, complications, and mortality rates was found. In addition, the study provides further evidence of the female predominance in herpes zoster disease. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the association between renal dysfunction and long-term prognosis among middle-aged women surviving an acute coronary syndrome (ACS). Methods: The Stockholm Female Coronary Risk Study included 291 women <66 years of age, hospitalized for an ACS during the years 1991–1994 in the greater Stockholm area. All patients underwent clinical screening for cardiovascular prognostic factors, including blood samples 3 to 6 months after the event. Creatinine clearance (CCr) was calculated using the Cockcroft-Gaults formula and related to adverse outcome. Hazard ratios (HR) for all-cause and cardiovascular mortality, respectively, in each tertile of CCr, were estimated using Cox proportional hazards regression. Results: There were 40 deaths, including 23 from cardiovascular causes, during a median follow-up of 9 years. The unadjusted HRs for all-cause mortality for the 1st (CCr < 78 mL/min) and 2nd (CCr 78–96 mL/min) tertiles of CCr were 3.17 (95% confidence interval [CI] 1.34-7.45) and 1.76 (95% CI 0.69-4.48), respectively, compared with the 3rd (CCr > 96 mL/min) tertile. The corresponding HRs for cardiovascular mortality were 3.66 (95% CI 1.20-11.1) and 1.28 (95% CI 0.34-4.76). After multivariable adjustment for potential confounders, the association between all-cause mortality and CCr in the 1st compared with the 3rd tertile remained statistically significant (HR 4.37, 95% CI 1.39-13.7). Conclusions: Renal dysfunction is related to long-term mortality in middle-aged women hospitalized for ACS. [ABSTRACT FROM AUTHOR]

Abstract: Background: Despite venous thromboembolism (VTE) being a major cause of morbidity and mortality, there is still limited information on its prevalence and incidence in the general population. Objective: To evaluate risk factors, distribution and epidemiology of VTE in the Malmö area with 280 000 inhabitants. Methods: Patients diagnosed with VTE at Malmö University Hospital in 1998–2006 were invited to a prospective population-based study. Blood sampling and a questionnaire study could be performed in 70% of patients. Remaining 30% were excluded due to language problems, dementia, other severe disease, or unwillingness to participate. Results: During 1998–2006 1140 VTE patients (559 men [49%, age 62±16 years] and 581 women [51%, age 61±20 years]) were included. Deep venous thrombosis (DVT) occurred in 882 (77%), pulmonary embolism (PE) in 330 (29%), and both DVT and PE in 72 (6%). The most common acquired risk factors among VTE patients were hormone therapy (24% of female DVT patients and 19% of female PE patients), immobilisation (17% of DVT patients and 18% of PE patients), previous surgery (13% of DVT patients and 19% of PE patients), and concomitant malignant disease (12% of DVT patients and 11% of PE patients). A positive family history for VTE was obtained from 25% of DVT patients and 22% of PE patients. Yearly incidences of VTE, DVT and PE in Malmö were 66, 51, and 19/100.000, respectively. Conclusion: Hormone therapy, immobilisation, previous surgery and concomitant malignancy were the most common acquired risk factors among VTE patients in this population-based study. The VTE-incidence was lower than in earlier epidemiological studies. [Copyright &y& Elsevier]

The article presents a study which examined the association between consistent compliance to Dietary Approaches to Stop Hypertension (DASH) diet and lower incidence of heart failure (HF) in 36, 019 women aged between 48 and 83 years old in Sweden. Food intake of DASH diet components were scored based on recommended food and nutritional guidelines, and the rate of HF-associated hospitalization or mortality were measured with the use of Cox proportional hazard models. Results showed that there were 443 women who developed HF, but adjustments for age, physical activity, and health status identified a 37% lower incidence of HF. It concludes that diets that comply with the DASH diet are associated to lower rate of HF.

Objective We sought to analyse how much of the total burden of disease in Sweden, measured in disability-adjusted life years (DALYs), is a result of inequalities in health between socioeconomic groups. We also sought to determine how this unequal burden is distributed across different disease groups and socioeconomic groups. Methods Our analysis used data from the Swedish Burden of Disease Study. We studied all Swedish men and women in three age groups (15-44, 45-64, 65-84) and five major socioeconomic groups. The 18 disease and injury groups that contributed to 65% of the total burden of disease were analysed using attributable fractions and the slope index of inequality and the relative index of inequality. Findings About 30% of the burden of disease among women and 37% of the burden among men is a differential burden resulting from socioeconomic inequalities in health. A large part of this unequally distributed burden falls on unskilled manual workers. The largest contributors to inequalities in health for women are ischaemic heart disease, depression and neurosis, and stroke. For men, the largest contributors are ischaemic heart disease, alcohol addiction and self-inflicted injuries. Conclusion This is the first study to use socioeconomic differences, measured by socioeconomic position, to assess the burden of disease using DALYs. We found that in Sweden one-third of the burden of the diseases we studied is unequally distributed. Studies of socioeconomic inequalities in the burden of disease that take both mortality and morbidity into account can help policy-makers understand the magnitude of inequalities in health for different disease groups. [ABSTRACT FROM AUTHOR]

The aim of this study was to quantify the global burden of osteoporosis as judged by hip fracture and the burden in different socio-economic regions of the world. The population mortality in 1990 and the incidence of hip fracture in different regions were identified, where possible in 1990. Excess mortality from hip fracture used data for Sweden, and disability weights were assigned to survivors from hip fracture. In 1990 there were an estimated 1.31 million new hip fractures, and the prevalence of hip fractures with disability was 4.48 million. There were 740,000 deaths estimated to be associated with hip fracture. There were 1.75 million disability adjusted life-years lost, representing 0.1% of the global burden of disease world-wide and 1.4% of the burden amongst women from the established market economies. We conclude that hip fracture is a significant cause of morbidity and mortality worldwide. [ABSTRACT FROM AUTHOR]

Objective: This study of myocardial infarction (MI) amongst urban women has sought to assess whether there are differences in fatal outcome, in-hospital respectively out-of-hospital, between residential areas defined in terms of socio-economic circumstances.Design: Register-based surveillance study 1986-95.Setting: Seventeen residential areas in the city of Malmö, Sweden.Subjects: Women 20-74 years of age.Main Outcome Measures: Differences in fatal outcome, in-hospital respectively out-of-hospital, between residential areas were expressed in terms of age-adjusted odds ratios (ORs), calculated by means of logistic regression. Socio-economic circumstances in the areas were expressed in terms of a composite score.Results: Between residential areas there were marked and statistically significant differences in incidence (range 124-328/10(5), P < 0.001, d.f.=16) and mortality (range 38-132/10(5), P < 0.005, d.f.=16). Area rates of mortality covaried with incidence (r=0.85, P < 0.001) and with odds ratios of fatal outcome out-of-hospital (r=0.52, P=0.031) but not in-hospital. The odds ratios of fatal outcome out-of-hospital decreased in a statistically significant stepwise fashion from areas in the lowest socio-economic quintile (reference) to areas in the highest socio-economic quintile (OR: 0.67, 95% CI: 0.48-0.94). There was no corresponding association with the odds ratios of fatal outcome in-hospital.Conclusions: The high rate of mortality from MI amongst women in areas with deprived socio-economic circumstances was related to deaths occurring out-of-hospital. In order to assess the preventive potential there is a need for further studies that may clarify to what extent the association with socio-economic circumstances can be explained by other factors and conditions known to influence the probability of survival. [ABSTRACT FROM AUTHOR]

SummaryBackgroundA 1999 study found no decrease in breast-cancer mortality in Sweden, where screening has been recommended since 1985. We therefore reviewed the methodological quality of the mammography trials and an influential Swedish meta-analysis, and did a meta-analysis ourselves.MethodsWe searched the Cochrane Library for trials and asked the investigators for further details. Meta-analyses were done with Review Manager (version 4.0).FindingsBaseline imbalances were shown for six of the eight identified trials, and inconsistencies in the number of women randomised were found in four. The two adequately randomised trials found no effect of screening on breast-cancer mortality (pooled relative risk 1.04 [95% CI 0.84-1.27]) or on total mortality (0.99 [0.94-1.05]). The pooled relative risk for breast-cancer mortality for the other trials was 0.75 (0.67-0.83), which was significantly different (p=0.005) from that for the unbiased trials. The Swedish meta-analysis showed a decrease in breast-cancer mortality but also an increase in total mortality (1.06 [1.04-1.08]); this increase disappeared after adjustment for an imbalance in age.InterpretationScreening for breast cancer with mammography is unjustified. If the Swedish trials are judged to be unbiased, the data show that for every 1000 women screened biennially throughout 12 years, one breast-cancer death is avoided whereas the total number of deaths is increased by six. If the Swedish trials (apart from the Malmo trial) are judged to be biased, there is no reliable evidence that screening decreases breast-cancer mortality. [ABSTRACT FROM AUTHOR]

The author reflects on three studies conducted to examine the relationship between low carbohydrate-high protein diet and mortality among the women in Sweden, Greece and the United States. The high-protein and low-carbohydrate diet caused increased cardiovascular mortality in cohort of Swedish women while showing positive signs in Greece. The diet has no effect on the US women. The author opines that the analytical methods used in the studies were not identical causing the variance in results.

Background: Gender differences in cardiovascular diseases (CVD) among the Sami have been reported previously. The aim of the present study was to investigate the incidence of and mortality from stroke, subarachnoid haemorrhage (SAH), and acute myocardial infarction (AMI) in the Swedish Sami population between 1985 and 2002, and to analyse the potential impact of income and level of education on cardiovascular morbidity and mortality. Methods: A Sami cohort of 15,914 persons(4,465 reindeer herding and 11,449 non-herding Sami) were followed up from 1985 to 2002 with regard to incidence and mortality rates of AMI, stroke, and SAH. Incidence and mortality ratios were calculated using a demographically matched non-Sami control population (DMC) as the standard (71,550 persons). Results: There was no elevated risk of developing AMI among the Sami compared with the DMC. However, the mortality ratio of AMI was significantly higher for Sami women. Higher incidence rates of stroke and SAH for both Sami men and women was observed, but no differences in mortality rates. Apart from the reindeer-herding men who demonstrated lower levels of income and education, the income and education levels among Sami were similar to the DMC. Conclusions: High mortality rates from AMI rather than stroke explain the excess mortality for CVD previously shown among Sami women. The results suggest that the differences in incidence of stroke between herding and non-herding Sami men, and between Sami women and non-Sami women, are caused by behavioural and psychosocial risk factors rather than by traditional socioeconomic ones. [ABSTRACT FROM AUTHOR]