As the health divide widens in Sweden and Britain, what's happening to access to care?
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Health Care Costs↗
Biomedical subjects
B Haglund
Publications and source records attributed to B Haglund.
Sudden infant death syndrome and smoking in the United States and Sweden.
The association between sudden infant death syndrome (SIDS) and maternal smoking was compared between the United States and Sweden-two countries with different health care and social support programs and degrees of sociocultural heterogeneity. For 1990-1991 among the five US race/ethnic groups studied, SIDS rates ranged from a high of 3.0 infant deaths per 1,000 live births for American Indians to a low of 0.8 for Hispanics and Asian and Pacific Islanders. The SIDS rate for Sweden (using 1983-1992 data) was 0.9. The strong association between maternal smoking and SIDS persisted after controlling for maternal age and live birth order. Adjusted odds ratios ranged from 1.6 to 2.5 for mothers who smoked 1-9 cigarettes per day during pregnancy (compared with nonsmokers) and from 2.3 to 3.8 for mothers who smoked 10 or more cigarettes per day during pregnancy. Although birth weight had a strong independent effect on SIDS, the addition of birth weight to the models lowered the odds ratios for maternal smoking only slightly, suggesting that the effect of smoking on SIDS is not mediated through birth weight. SIDS rates increased with the amount smoked for all US race/ethnic groups and for Sweden. Smoking is one of the most important preventable risk factors for SIDS, and smoking prevention/intervention programs have the potential to substantially lower SIDS rates in the United States and Sweden and presumably elsewhere as well.
Adolescent↗
Maternal smoking, birthweight and gestational age in sudden infant death syndrome (SIDS) babies and their surviving siblings.
To evaluate the effect of maternal smoking on intrauterine growth of babies who died of sudden infant death syndrome (SIDS), birthweights of SIDS infants and their surviving siblings were compared with birthweights of infants in sibships were all infants survived the first year of life. We studied 184,349 mothers with at least two births registered in the population-based Swedish Medical Birth Registry during 1983-91. The mother being the unit of analysis, birthweight and gestational age of her infants were the repeated measures used in a repeated measures analysis of variance. Mothers whose first two infants survived at least 1 year, smoked less than mothers of SIDS infants, 25 and 41% (P < 0.01). Overall, SIDS mothers did not smoke more while pregnant with the SIDS infant than while pregnant with the surviving sibling. SIDS siblings weighted, on average, 90 g less than infants in non-affected sibships. SIDS babies were even lighter, 193 g, and had 3.8 days shorter mean gestational age, compared with same birth-order babies in non-affected sibships. After adjustment for gestational age, the birthweight difference changed only slightly for SIDS siblings, while the difference for SIDS infants was reduced from 193 to 110 g. Further adjustment for smoking reduced the birthweight difference for SIDS siblings, from 74 to 50 g, and SIDS infants, from 110 to 82 g. Intrauterine growth retardation of sibships with a SIDS baby is explained only partly by maternal smoking. The even lower birthweight of the SIDS baby, resulting from shorter gestational age, cannot be explained by smoking, suggesting pregnancy factors specific to the SIDS baby and not to its siblings.
Analysis of Variance↗
Routine ultrasound screening in pregnancy and the children's subsequent growth, vision and hearing.
OBJECTIVE: To test a hypothesis of no association between ultrasound exposure in early fetal life and growth or impaired vision or hearing during childhood. DESIGN: Follow up of eight to nine year old children born to women who participated in a randomised controlled trial on ultrasound screening during pregnancy. SETTING: Nineteen antenatal care clinics run by three central hospitals in Sweden from 1985 to 1987. POPULATION AND METHODS: Of 4637 eligible singleton pregnancies, 3265 (71%) were followed up through a questionnaire sent to their mothers. Analyses were performed both according to randomised groups and to ultrasound exposure. MAIN OUTCOME MEASURES: Parents' report of vision and hearing tests as recorded on child's record card. Parents' report of their child's weight and height at 1, 4 and 7 years of age. RESULTS: Reduced hearing was reported by 3.4% in the screening group compared with 3.5% in the nonscreening group (odds ratio [OR] 1.0; 95% confidence interval [CI] 0.67-1.41). The same prevalences were found when analysed according to ultrasound exposure (OR 1.0; 95% CI 0.67-1.42). Reduced vision was reported by 6.3% in the screening group compared with 7.8% in the nonscreening group (OR 0.8; 95% CI 0.60-1.03). Corresponding figures for ultrasound exposed and unexposed were 6.2% and 8.0%, respectively (OR 0.8; 95% CI 0.58-1.00). No statistically significant differences in body weight or height at 1, 4 or 7 years of age between screened and not screened children or between exposed and unexposed were found. CONCLUSION: This study found no association between ultrasound exposure in early fetal life and growth or impaired vision or hearing during childhood.
Adult↗
Decreasing smoking prevalence during pregnancy in Sweden: the effect on small-for-gestational-age births.
OBJECTIVES: This study examined whether recent changes in smoking prevalence among pregnant women have affected risks of small-for-gestational-age births. METHODS: With data for all live single births in Sweden from 1983 through 1992 (n = 1048139), odds ratios [ORs] and attributable risks of small-for-gestational-age births were calculated for 1983 through 1985, 1986 through 1989, and 1990 through 1992. RESULTS: Daily smoking decreased from 29.4% in 1983 to 21.8% in 1992. For the three time periods, the odds ratios of small-for-gestational-age births by maternal smoking were almost identical: 1-9 cigarettes/day OR = 2.1 or 2.2; for > or = 10 cigarettes/day, OR = 2.8. The attributable risk of smoking for small-for-gestational-age births declined from 26.2% in 1983 through 1985 to 20.9% in 1990 through 1992. CONCLUSIONS: The findings point to a true decrease in tobacco exposure during pregnancy and a reduction in the attributable risk for small-for-gestational-age births.
Adolescent↗
[The welfare wall is cracked. Low-educated people are not favoured by health services].
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Adult↗
Evidence of a relationship between childhood-onset type I diabetes and low groundwater concentration of zinc.
OBJECTIVE: Zinc deficiency has shown to increase the risk for diabetes in diabetes-prone experimental animals. Low concentrations of zinc have also been shown in serum of recent onset cases with IDDM. The present study examines the hypothesis that exposure to a low concentration of zinc in drinking water could increase the risk for future onset of IDDM. RESEARCH DESIGN AND METHODS: Using the Swedish childhood diabetes registry and data on residence 3 years before the onset of disease, a case-control study was designed comparing cases and control subjects with estimates of groundwater contents of zinc obtained in biogeochemical samples from areas of residence. RESULTS: A high groundwater concentration of zinc was associated with a significant decrease in risk (odds ration [OR] = 0.8; 95% CI = 0.7-0.9). The same OR was obtained when the model included information of other metals that might act as possible confounders (chromium, vanadium, cobalt selenium, cadmium, lead, and mercury). In small rural areas, in which drinking water is taken from local wells and thus is closely associated with the groundwater content within the area, an even stronger association between zinc and diabetes (OR = 0.6; 95% CI = 0.4-0.9) was found. CONCLUSIONS: It is concluded that this study for the first time provides evidence that a low groundwater content of zinc, which may reflect long-term exposure through drinking water, is associated with later development of childhood onset diabetes.
Adolescent↗
Sudden infant death syndrome in Sweden, 1983-1990: season at death, age at death, and maternal smoking.
Several risk factors for sudden infant death syndrome (SIDS) have been consistently reported, while results regarding seasonality and age at death of SIDS victims are conflicting. In the present population-based cohort study, single births in Sweden from 1983 through 1990 were used to estimate the relative and absolute risks for SIDS associated with season at death, age at death, and maternal smoking. In the winter period, 283 SIDS deaths occurred, while only 98 infants died during summer (winter/summer ratio = 2.9). Taking person-time at risk into account and restricting the analysis to infants aged 7-180 days, the authors determined the relative risk for SIDS to be 3.5 times higher in winter than in summer. When comparing incidence rate differences, they found a more noticeable seasonal variation for early SIDS (7-90 days at death) than for late SIDS (91-180 days at death). For early SIDS, the incidence rate was 0.6 cases per 100,000 person-days higher among smokers than among nonsmokers; for late SIDS, the corresponding difference was 0.3. The effect of smoking on SIDS was not associated with seasonality. Since exposure to passive smoking is likely to vary by season, the results suggest that the effect of smoking on SIDS is prenatal rather than the result of passive smoking after birth.
Adolescent↗
Cancer prevention in schools: design and pilot testing of a nutritional curriculum for mid-adolescents.
Adolescents at schools ought to be easy to reach for dietary cancer prevention programs. Yet, traditional school health education interventions, however, do not affect behavior. We have a developed short-term (10 hour) program that supports adolescents in adopting a low-fat, high-fiber diet. The aim has been achieved by making the classroom activities work as part of a community intervention program and by including elements derived from Bandura's social learning theory and the self-efficacy construct. Following the theoretical constructs, the students are exposed to peers reporting on appropriate dietary behavior. In order to enhance self-efficacy, students are given the opportunity to experience successful self-initiated dietary changes. Thus, they set up an individual dietary goal and carry out changes based on this. A pilot test indicated that the program process works as planned. However, in order to evaluate behavioral effects, further studies are required.
Adolescent↗
Social differences in late fetal death and infant mortality in Sweden 1985-86.
Social differences in late fetal death and infant mortality were examined in a population-based prospective study. All singletons born to Nordic citizens in Sweden 1985-86 were included, 185,156 births in all. The overall rates of late fetal death and infant mortality were 3.5 and 5.3 per 1000 respectively. Socio-economic status of the household (SES) and mothers' education were used as social indicators. Logistic regression analyses showed significant odds ratios between 1.3 and 1.8 for late fetal death for blue-collar workers and women with less than 12 years education. The analyses of neonatal mortality showed a U-shaped relationship: both unskilled blue-collar workers and high level white-collar workers had significant odds ratios (OR) as compared with intermediate level white-collar workers (OR = 1.5). Similar results were obtained when using the mothers' education as indicator of social status: 9 years education or less or 15 years or more were associated with significant higher mortality rates than 12 years education (OR = 1.6). An inverse relationship between social status and post-neonatal mortality was seen in the crude analysis. Mothers' education revealed more social differences than SES (crude OR = 2.0 and 1.5 respectively in the least privileged group). However, when adjusting for the effects of maternal age, parity and smoking, no significant odds ratios for the social variables were obtained.
Adolescent↗
Cigarette smoking and sudden infant death syndrome: some salient points in the debate.
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Adult↗
Social differences in Swedish infant mortality by cause of death, 1983 to 1986.
OBJECTIVE: We sought to investigate social differences in Swedish infant mortality by cause of death. METHODS: All live single births in Sweden between 1983 and 1986 to mothers 15 to 44 years old with Nordic citizenship were studied. The causes of death were classified into six major groups. Mother's education was used as a social indicator. Logistic regression analysis was used with identical models for all groups of causes of death. RESULTS: There were 355,601 births and 2012 infant deaths. Only for sudden infant death syndrome were significant social differences found, with crude odds ratios of 2.6 for mothers with less than 10 years of education and of 1.9 for mothers with 10 to 11 years, compared with 1.0 for mothers with 15 years or more. After adjusting for age, parity, and smoking habits, these ratios were no longer significant. CONCLUSIONS: The social differences obtained could be explained by the fact that mothers with less education smoke more, are younger, and have higher parity than those with more education.
Cause of Death↗
[Local emergency care centers evaluated--radical changes are possible within the public health care system].
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Ambulatory Care Facilities↗
The relationship between stressful working conditions and high alcohol consumption and severe alcohol problems in an urban general population.
The relationship between 15 measures of stressful working conditions and high alcohol consumption (35 g 100% ethanol per day or more for men and 25 g or more for women) was studied, using cross-sectional data from a general population survey of 1344 males and 1494 females; the ages 25-64 years in metropolitan Stockholm in 1984. In a longitudinal component of the study, hospitalization and mortality with alcohol-related diagnosis was assessed during 1984-90, and also the association between previous experience of unemployment and high alcohol consumption. Some of the associations, expressed as age-adjusted odds ratios, were positive and some were negative when high alcohol consumption was the endpoint, but there was a clear variation by sex and social class. Generally the positive associations were stronger among male non-manual employees. Among males, there was a clear association between stressful working conditions and subsequent risk of severe medical alcohol-related problems, but the precision of the estimates was low due to low number of cases. The odds ratio was 6.18 (95% confidence interval 1.86, 20.61) for twisted working positions and 6.74 (95% confidence interval 1.67, 27.19). Previous unemployment among males was associated with increased risk for high alcohol consumption, with an odds ratio of 5.71 (95% CI 1.39, 15.97) among those who had been unemployed more than once, and 1.67 (95% CI 0.76, 3.64) among those who had been unemployed once during the previous 5 years. Those and other increased odds ratios were lower when subjects with an alcohol diagnosis at inpatient care during 1980-84 were excluded in the analyses. On the whole, our findings are not conclusive. The strong, but imprecise associations between stressful working conditions and severe alcohol problems, are however challenging, and warrants further studies, preferably with longitudinal design and repeated measurements of both working condition and alcohol habits.
Adult↗
Epidemiology and moral philosophy.
To an increasing extent ethical controversies affect and sometimes obstruct public health work and epidemiological research. In order to improve communication between the concerned parties a model for identification and analysis of ethical conflicts in individual-based research has been worked out in co-operation between epidemiologists and moral philosophers. The model has two dimensions. One dimension specifies relevant ethical principles (as beneficence, non-maleficence, autonomy and justice). The other dimension specifies the groups of persons involved in the conflict under consideration (for example: the study-population, individuals who may benefit from the results, the researchers and their personnel, the community at large). The model has been applied to the problem of legitimacy of case-register research and to problems in psychiatric health services research as well as epidemiological research.
Autopsy↗
Socio-economic factors and feto-infant mortality.
During this century, improvements in fetal and infant mortality have been dramatic in the western world, mainly as a result of improved socio-economic conditions. Relative to many other developed countries, the decrease has been more dramatic in the Nordic countries. Population-based health registries exist in all Nordic countries. By record-linkage between birth registries and census data, it is possible to perform population-based studies on the association between social factors and feto-infant mortality. Such studies have recently been carried out in Denmark, Finland, Norway and Sweden and socio-economic differences in late fetal and postneonatal death rates were seen. Death rates as well as the relative importance of socio-economic factors differed between these countries. In Norway, infants delivered by women with 9 years or less of schooling faced an almost three-fold increased risk of dying postneonatally as compared to infants delivered by women with at least 12 years of education. In order to successfully decrease the socio-economic differences in feto-infant mortality between and within the Nordic countries, it is necessary to analyse possible preventable risk factors that are distributed unevenly not only in different socio-economic groups but also between the Nordic countries.
Adult↗
Chronic open-angle glaucoma and advanced visual field defects in a defined population.
In a case-finding study in a municipality in central Sweden, 128 cases of chronic open-angle glaucoma with visual field defects (VFD) were found. The prevalence amounted to 1.4% in those greater than or equal to 45 years of age. Sixty-three percent had capsular glaucoma. Advanced visual field defects (AVFD), i.e. a restriction of the visual field to a diameter of less than or equal to 20 degrees, were seen in 49 patients. Four patients had AVFD in both eyes. Patients with AVFD were older, had had the disease longer, had higher mean initial intraocular pressure (IOP), and had more extensive VFD at the time of diagnosis. When age and duration were taken into consideration, the risk of developing AVFD was 14 times greater in those with VFD stage III at the time of diagnosis, i.e. a Bjerrum scotoma with nasal breakthrough or more widespread VFD. An IOP of greater than or equal to 35 mmHg signified that the risk of having VFD stage III at the time of diagnosis, when age and type of glaucoma were taken into consideration, was 8.6 times greater than if the IOP was less than 35 mmHg.
Aged↗
Longitudinal studies on environmental factors and disease. A model for analysis of ethical conflicts.
The use of individual-based data in research has recently come in for much discussion. The basic issue of the discussion is how to balance between different legitimate interests: the interest in improving knowledge on matters important to human health and the interest in respecting individual autonomy. In this paper we will use a model for description and analysis of ethical conflicts in individual-based research. The model consists of two dimensions: the first specifies the persons involved in the conflict, the second specifies the relevant ethical principles. We have chosen the case of the Rönnskär study as an example. For illustration we distinguish between: no study, a study without informed consent and a study with informed consent. In the Rönnskär study the decision between the three situations rests upon an assessment of the conflict between two obligations: to improve the working environment and to respect autonomy.
Conflict, Psychological↗