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Biomedical subjects

L Svanström

Publications and source records attributed to L Svanström.

At least 19 recordsLinked to original sources
PubMed2006

Drowning--a major but neglected child health problem in rural Bangladesh: implications for low income countries.

This study was intended to estimate the magnitude and explore the determinants of childhood drowning in rural Bangladesh. A cross-sectional survey as well as a population-based case - control study was conducted. By multistage cluster sampling 51 147 children aged 1 - 4 years were identified from 108 827 rural households. All drownings in children aged 1 - 4 years in the preceding 5 years were identified and recruited as cases and two living children of the same age group were selected from the same localities as controls. Socio-economic, demographic, environmental and other related information was collected from mothers of both cases and controls by face-to-face interview with the help of structured questionnaires. The incidence of drowning among children aged 1 - 4 years old was 156.4 per 100 000 children-year. The highest rate (328.1 per 100 000; 95% CI 254.8 - 421.7) was observed in 1 year old male children. The proportional mortality due to drowning in the children was 27.9%. Mothers' age and literacy and family income were identified as risk factors. Drowning is one of the major causes of 1 - 4 years childhood mortality in Bangladesh. One-year-old male children from poor families were at great risk of drowning in rural Bangladesh.

Age Distribution↗
PubMed2005

Rationales for home safety promotion in the Iranian primary healthcare system: results from a pilot study.

OBJECTIVE: To analyse the prerequisites for a nationwide primary healthcare (PHC) home safety promotion programme in Iran. BACKGROUND: Injury is a major public health problem throughout the world, currently accounting for one-seventh of all premature deaths and disabilities. Within 20 years, it is estimated that the proportion will increase to one-fifth. The present healthcare system in Iran was started in 1979, with a major focus on easy access to services and prevention. The system is based on the 'health house', which is run by community health workers. A survey shows that 36% of injuries occur in the home environment. A pilot phase of the Home Safety Promotion Programme was initiated in 1994, and included safety checking at home for fences, kitchens, drugs and poisons, heaters, electricity, and stairs and ladders. The pilot study covered 478,551 households out of the 12 million (approximately) in Iran. Sixty-nine supervisors were involved individually, assembled into eight focus groups. RESULTS: Household safety increased by 10-20% over the 4 years of the study. The frequency of home visits changed from annual to seasonal, since all participants agreed that there were seasonal differences in safety problems. The supervisors showed a high level of knowledge of injury as a public health problem, and also positive attitudes towards doing something about safety on the basis of a PHC scheme. The role of a surveillance system was highlighted, and it was suggested that such a system should be added to the programme. DISCUSSION AND CONCLUSION: Based on our preliminary findings, there were reasons to obtain a policy decision concerning a national programme for safety promotion before extending the pilot scheme to the whole country. A national safety programme was decided upon following completion of the pilot study. It includes a home-related-injury surveillance system that is mandatory in rural areas and voluntary in some cities.

Accidents, Home↗
PubMed2005

Unintentional home-related injuries in the Islamic Republic of Iran: findings from the first year of a national programme.

BACKGROUND: As elsewhere, unintentional injuries are a leading cause of death in Iran, but non-fatal injuries occurring in the home environment have not been analysed. OBJECTIVES: The primary purposes of this study were to describe the pattern of home-related injuries and to obtain incidence rates for their determinants in order to monitor intervention programmes for preventive purposes. METHODS: A surveillance system for home-related injuries in selected rural and urban areas was established for the systematic collection of data. The information obtained covers emergency department visits and health services provided between March 1998 and March 1999. RESULTS: In total, 79,723 unintentional home-related injuries were reported, primarily burns (49%, incidence of 19/10,000 rural and 13/10,000 urban inhabitants) and lacerations/cuts caused by contact with sharp instruments (30%, incidence of 8.4/10,000 rural and 11/10,000 urban inhabitants). Injury rates were highest among children aged 0--4 years and lowest among the elderly (60 years or over). Rates varied between the sexes; among children under 15 years of age, most patients were male, but the opposite applied to all groups >15 years of age. Leading causes of death were burns, falls and poisoning among 628 people who died because of home-related injuries. CONCLUSIONS: The injury pattern found in this study is generally similar to that of many other countries, with the striking exception of burns. Other reports focus on the same problem, particularly with regard to Iran. The prevention of burns should be an important feature of any national injury prevention programme. Due to the varied causes of home-related injuries in Iran, interventions should be targeted at people at the greatest risk, namely children. Home visitation as a tool for face-to-face training with a sharper focus on burns, falls and poisoning prevention can be recommended as a part of primary health care policy. Greater investment in surveillance also provides a way of reducing the threat of injury in the community.

Accidents, Home↗
PubMed2005

Temporal trends, gender, and geographic distributions in child and youth injury rates in Sweden.

OBJECTIVE: Sweden has the lowest child injury mortality rate in the world, 5.2/100 000 for children under 15. This paper describes temporal trends in Sweden, as well as gender related and geographic differences. DESIGN: The Swedish Cause-of-Death Register (1987-2001) and the Hospital Patient Register (1987-2002) were used to compare rates for the country as a whole and for discharges aged 0-20 by municipality, using the SEATS time series analysis program. RESULTS: There was a decrease in the rate of fatal unintentional injuries from 7 to 4 per 100 000 for girls and from 16 to 10 per 100 000 for boys since 1987. The gap between girls and boys was reduced and boys now have almost the same mortality rate as girls for violence related deaths. Road and other unintentional injuries show a general decrease whereas the pattern for falls varies by age and sex. Self inflicted injuries increased for both sexes, but more for girls. Substantial differences in injury rates between municipalities were also found-up to six times for girls and eight times for boys. CONCLUSION: Substantial declines in injury fatalities over time were found, but these were different for boys and girls. There remain substantial differences between municipalities. These data, published in a child injury atlas, have prompted substantial interest among media and the authorities.

Accidents↗
PubMed2001

Bicycle-related injuries among the elderly--a new epidemic?

Bicycling in Sweden has almost doubled between 1980 and 1992/3 among persons aged 25-64 y. The upward trend is continuing. For the elderly (65 or older) the bicycle is a common means of transport, in both Sweden and a number of other countries. Almost one-third of the Swedish population aged 65 or older bike at some time during the year. The objectives of this study are to describe the pattern of, and trend in, bicycle-related injuries among the elderly in Sweden and to discuss possible means of injury prevention. Mortality data come from official death certificates (1967-96). Hospital-discharge data (1985-96) are also employed, divided into three age groups (-14, 15-64 and 65-), by external cause according to the ICD-9, and also into 'all diagnoses' and 'head injuries'. Number of cases and days of hospital care for persons aged 65 or more, on aggregate and by gender, are reported for 1996. The whole of Sweden and its northern and southern parts separately were investigated. 2830 bicyclists were killed over the period 1967-96, of which 47% were 65 or older. The risk of dying due to bicycling was about 3.7 times greater among the elderly than among children aged 14 or under. There were significant changes in injury trends for all age groups between 1985 and 1996 with regard to hospital care. Annual average decreases for children, of 2.2% for all diagnoses and of 3.4% for head injuries, were observed. For the other two age groups there were increases in all injuries of 3.4% (15-64) and of 2.9% (65-), and increases in head injuries of 4.6% (15-64) and 2.7% (65-). For the elderly living in the southern part of Sweden, there was an increase on average of 2.2% per year over the period, compared with 4.2% for those in the northern part. Males showed a higher incidence of injuries and received longer periods of care than females. Do we have an epidemic of bicycle injuries among the elderly? They face a greater risk of being injured or killed than his/her younger counterpart. For all ages the risk is 7.4 times higher for a bicyclist than for a car driver. The risk for the elderly is about 3 times greater than for the average bicyclist, and as much as 6 times higher for the age group 75-84 y. With some few exceptions, there is no doubt that society has neglected the problem. Decision-makers have a tendency to focus on the relatively young. But people are living longer today and the elderly are healthier, which indicates the need for greater interest and more intervention. We have signs of an epidemic, but one that can be ameliorated or prevented. Just waiting for injury to occur leads only to premature death or lifelong disability.

Adolescent↗
PubMed2001

Development of a national injury prevention/safe community programme in Vietnam.

The aim of this study is to describe the initiation of a national programme on injury prevention/safe community (IP/SC). Market economy, Doi Moi, was introduced in Vietnam in 1986, and since then the injury pattern has been reported to have changed. The number of traffic injury deaths has increased three-fold from 1980 to 1996 and traffic injuries more than four-fold. Injuries are now the leading cause of mortality in hospitals. There are difficulties in obtaining a comprehensive picture of the injury pattern from official statistics and, in conjunction with the work initiated by the Ministry of Health, a number of local reporting systems have already been developed. Remarkable results have been achieved within the IP/SC in a very short time, based on 20 years of experience. An organizational construction system has been built from province to local community areas. Management is based on administrative and legislative documents. IP/SC implementation is considered the duty of the whole community, local authorities and people committees, and should be incorporated into local action plans. The programme is a significant contribution towards creating a safe environment in which everybody may live and work, allowing the stability for society to develop. Implementation of the programme in schools is a special characteristic. The programme will be developed in 800 schools with a large number of pupils (25% of the population). This model for safer schools is considerably concerned and is a good experience to disseminate. The recommendations are that more pilot models of IP/SC should be conducted in other localities and that the programme should be expanded to a national scale. Furthermore, co-operation between sectors and mass organizations should be encouraged and professional skills of key SC members at all levels should be raised.

Accidents, Traffic↗
PubMed2000

Potential of using existing injury information for injury surveillance at the local level in developing countries: experiences from Bangladesh.

Although injury is a major public health problem in Bangladesh, as in other low income countries in the world, it has gained very little attention from policy makers, or even health professionals, mainly due to the lack of valid injury information in these countries. To address the injury problem, there is an urgent need to develop injury surveillance activities, based on existing sources of potential interest for obtaining injury information. This study is an evaluation of existing injury data sources in terms of prevention orientation representativeness, and sustainability with respect to the use of these sources in injury surveillance at the local level in Bangladesh. The regular injury information sources that have been used in this study include hospital records, post-mortem reports, newspaper reports, and police reports. In addition, 60 health practitioners in the area, representing various categories, were interviewed according to questionnaire, and ten others were interviewed in-depth about their opinions regarding their participation in the injury surveillance system. The information sources were then assessed for their potential to be included in the surveillance system. The validity was estimated by means of comparisons of the different sources. All the existing sources of injury information suffer from certain deficiencies such as, lack of representativeness, low prevention orientation and poor sustainability. Post-mortem reports and police reports have been found to be potential sources of mortality data but not morbidity data. Hospital records can be seen as potential sustainable sources of injury morbidity data but suffer from low prevention orientation and representativeness. The injury information was not consistent from source to source and failed to depict the true picture of injury in the area. To develop an injury surveillance system, a combination of data obtained from several different sources is necessary to compensate for inadequacies in the individual sources and to improve the overall usefulness of the system. Updated with E-codes, hospital discharge records could be used for injury morbidity surveillance, and updated police and post-mortem data can be used for mortality data in injury surveillance systems at the local level in developing countries.

Bangladesh↗
PubMed2000

Cigarette smoking, oral moist snuff use and glucose intolerance.

OBJECTIVE: To investigate the association between cigarette smoking and use of oral moist snuff and impaired glucose tolerance and type 2 diabetes. DESIGN: We performed a population-based cross-sectional study of glucose intolerance and tobacco use in Stockholm during 1992-94. The sample consisted of 3128 men, aged 35-56 years, of whom 52% had a family history of diabetes. In an oral glucose tolerance test, we detected 55 men with type 2 diabetes and 172 with impaired glucose tolerance. Information on cigarette smoking and oral moist snuff use was collected by a questionnaire. RESULTS: The odds ratio of type 2 diabetes was increased for smokers of 25+ cigarettes day-1 (odds ratio = 2.6, 95% confidence interval = 1.1-5.9) as well as for moist snuff dippers of 3+ boxes week-1 (odds ratio = 2.7, 95% confidence interval = 1.3-5.5). The odds ratio of relatively high (highest tertile) fasting insulin levels in subjects with impaired glucose tolerance associated with cigarette smoking of 25+ cigarettes day-1 was 1.5 (95% confidence interval = 0.7-3.6). The corresponding estimate of a relatively low (lowest tertile) 2 h insulin response was 2.5 (95% confidence interval = 0.9-7.1). CONCLUSIONS: These results indicate that heavy users of cigarettes or moist snuff have an increased risk of type 2 diabetes. The results could suggest that tobacco use is associated with a low insulin response.

Adult↗
PubMed1999

Family history of diabetes in middle-aged Swedish men is a gender unrelated factor which associates with insulinopenia in newly diagnosed diabetic subjects.

We have investigated the association of a family history of diabetes with glucose tolerance in a population of Swedish men. All men 35-54 years of age in 1992 and living in four different local municipalities of the outer Stockholm area were screened by questionnaire. From 10236 completed questionnaires 1622 men, selected for presence of such a history but without known diabetes, as well as 1507 men without a family history underwent an oral glucose tolerance test. Diabetes (2 h-plasma glucose levels > 11.0 mmol/l) was detected in 55 and impaired glucose tolerance (plasma glucose levels 7.8-11.0 mmol/l) in 172 subjects. The odds ratio of diabetes, associated with a family history, was 4.1, confidence interval 2.1-8.3 and for impaired glucose tolerance 1.6, confidence interval 1.2-2.3. Influence of a family history was measurable also within the range of normal 2-h glucose concentrations: compared to 2-h glucose levels < 3.8 mmol/l; the odds ratio associated with a family history was 1.4, confidence interval 1.1-1.7 and 1.3, confidence interval 1.1-1.6 for concentrations 4.8-5.7 mmol/l and 5.8-7.7 mmol/l respectively. The odds ratio of diabetes and impaired glucose tolerance among men with a family history increased with number and closeness of relatives with diabetes but was not affected by the gender of the family member. Overweight (BMI > 25.0 kg/m2) increased the odds ratio of diabetes in subjects with a family history, the odds ratio being 24, confidence interval 3-177, when both conditions were present. In subjects with Type II (non-insulin-dependent) diabetes mellitus discovered during the investigation, the presence of a family history of diabetes was associated with decreased insulin secretion rather than insulin resistance as assessed by fasting insulin, homeostasis model assessment, and the 2-h insulin response to the oral glucose tolerance test. We conclude that a family history of diabetes strongly but independently of gender associates with decreased glucose tolerance. Furthermore, the results are compatible with a major role for low insulin secretion in the diabetogenic influence of a family history of diabetes in middle-aged Swedish men. Lastly, the very high risk for diabetes in middle-aged men with both a family history of diabetes and obesity indicates that such people should, for the purpose of therapeutic intervention, be identified in the general population.

Adult↗
PubMed1999

Unintentional injury mortality in children: a priority for middle income countries in the advanced stage of epidemiological transition.

OBJECTIVES: To examine the relationship between the magnitude, and the relative importance of unintentional child injury mortality with socioeconomic development, and to conceptualise the dynamic changes in injury mortality within the framework of epidemiological transition. DESIGN: Ecological cross sectional study using data on 51 countries. MAIN OUTCOME MEASURES: The relationship between total mortality rates, unintentional injury mortality rates, and percentage in children 1-14 years of age with gross national product (GNP) per capita. RESULTS: Unintentional injury mortality rates in children were negatively correlated with GNP per capita. However, by categorising the data, we found some areas of non-correlation: in children 5-14 years in low income versus lower middle income countries, and in all age and gender groups in lower high income versus higher high income countries. A high percentage of total deaths due to injuries was clearest in the lower middle income countries in all age and gender groups. CONCLUSIONS: The changes in child injury mortality in relation to socioeconomic development could be conceptualised as three stages: a stage of high magnitude; a stage of high priority; and a stage of improvement. Most middle income countries are in the high priority stage where both injury mortality rates and injury percentage of total deaths are high.

Adolescent↗
PubMed1999

Low birth weight, family history of diabetes, and glucose intolerance in Swedish middle-aged men.

OBJECTIVE: To investigate the association between low birth weight and glucose intolerance in relation to family history of diabetes. RESEARCH DESIGN AND METHODS: We conducted a population-based cross-sectional study of 2,237 men born in 1938-1957 in four municipalities in the outskirts of Stockholm, 50% of whom had a family history of diabetes (at least one first-degree or two second-degree relatives with diabetes). Oral glucose tolerance testing detected 35 cases of type 2 diabetes, 102 cases of impaired glucose tolerance, and 57 cases of impaired fasting glucose. RESULTS: In subjects without a family history of diabetes, low (< or = 3,000 g) birth weight was associated with an odds ratio of 2.3 (95% confidence intervals = 0.4-14.4) for diabetes, 1.8 (0.7-4.3) for impaired glucose tolerance, and 3.3 (1.0-10.4) for impaired fasting glucose. In subjects with a family history of diabetes, the corresponding figures were approximately similar, except for diabetes, for which the odds ratio was 5.4 (2.0-14.9). For men with low birth weight in combination with a family history of diabetes, the odds ratio was 10.9 (2.9-41.2) for diabetes, 2.4 (1.1-5.6) for impaired glucose tolerance, and 5.9 (2.1-16.3) for impaired fasting glucose. CONCLUSIONS: This study indicated that low birth weight is associated with type 2 diabetes, impaired glucose tolerance, and impaired fasting glucose in men. This finding was most pronounced in subjects with diabetes in the family, but it was also indicated in those without a family history of diabetes. Men with the combination of low birth weight and family history of diabetes seem to be at particularly high risk of developing type 2 diabetes.

Adult↗
PubMed1998

Weight history, glucose intolerance, and insulin levels in middle-aged Swedish men.

The association between weight history and glucose intolerance was examined in a cross-sectional study consisting of 3,128 Swedish men aged 35-56 years, 52 percent of whom had a family background of diabetes mellitus. Oral glucose tolerance testing detected 55 cases of type 2 (non-insulin-dependent) diabetes and 172 cases of impaired glucose tolerance. Among men with no family history of diabetes, the estimated odds ratios for impaired glucose tolerance associated with short (<5 years) and long (> or =10 years) durations of obesity (body mass index (weight (kg)/height2 (m2) > or =25.0) were 1.3 (95% confidence interval (CI) 0.2-7.7) and 11.8 (95% CI 3.3-41.9), respectively. Among men with a family history of diabetes, the odds ratios were 2.0 (95% CI 0.8-4.7) and 4.0 (95% CI 1.8-9.1), respectively. Corresponding estimates of the odds of type 2 diabetes, adjusted for family history of diabetes, were 1.9 (95% CI 0.5-7.1) and 7.3 (95% CI 2.2-23.7), respectively. The odds of high (> or =30.0 mU/liter) fasting insulin levels in subjects with impaired glucose tolerance were 6.9 (95% CI 0.6-74.2) and 21.0 (95% CI 2.1-206.4) for short and long durations of obesity, respectively. Corresponding estimated odds of low 2-hour insulin response (< or =71.9 mU/liter) were 0.7 (95% CI 0.2-2.9) and 3.3 (95% CI 1.2-8.9). Homeostasis model assessment of insulin resistance yielded an odds ratio of 6.7 (95% CI 0.6-73.4) for a short duration of obesity and 20.0 (95% CI 2.0-200.6) for a long duration. Examination of beta-cell function with homeostasis model assessment resulted in odds ratios of 0.2 (95% CI 0.0-1.6) and 2.0 (95% CI 0.7-5.4) for short and long durations of obesity, respectively. These data indicate that obesity decreases glucose tolerance by way of progressively increased insulin resistance and, in the case of prolonged duration, by decreased insulin secretion as well.

Body Mass Index↗
PubMed1998

Medical help seeking behaviour of injury patients in a community in Bangladesh.

While looking for a valid source of injury information in developing countries, it is important to know the help-seeking pattern of injury patients. A population-based study of 3258 households was conducted to explore the flow of injury patients in a local area of Bangladesh. Trained field level health workers collected the information by face-to-face interviews with the head of households, using three pretested structured forms. A total of 191 injury cases and 18 injury deaths were identified with a reference period of 15 d and 5 y, respectively. The estimated annual incidence rate of injury is 311 per 1000 inhabitants per year. The majority of the injury cases were minor (70.7%) and occurred in the home area (42%) or workplace (42%). Of the total 191 injured people, 41 (21.5%) did not seek any type of treatment for their injury but almost all of these cases were simple. Only 23.3% of injury cases who sought any type of medical treatment, went to the hospital. All severe cases, 40% of the moderate cases, and only 12.5% of minor cases were attended to at a hospital for treatment of their injuries. Allopathic quack or medicine shop owners were consulted by 42% of the injury patients. Most of the educated people preferred hospital treatment for moderate injury cases. In injury deaths, 61.1% had no opportunity to receive treatment before death, and postmortem examinations were performed in 66.7% of cases.

Adolescent↗
PubMed1997

Can a combination of local, regional and national information substantially increase bicycle-helmet wearing and reduce injuries? Experiences from Sweden.

Is it possible to substantially reduce the incidence of injuries related to cycling through the provision of information on helmet wearing? This issue has been investigated in Skaraborg County, Sweden, where 90 percent of all pre-school children now use bicycle helmets. For children under 15, there was an average annual decrease in all bicycle-related injuries of 3.1 percent, equivalent to a decrease of 48 percent over the study period, 1978-93 (for head injuries, 59%). Sweden as a whole showed a reduction of 32 percent in bicycle-related injuries (head injuries, 43%). In Skaraborg, children have been the target of helmet-wearing programs at local and regional levels since 1982, and at national level since 1987. The elderly have not been targeted in helmet-wearing programs; currently, they scarcely wear helmets at all, and showed a significant increase in their injury rate over the period (4.7% annually). The number of concussions sustained by helmet-wearers is estimated to be one-third fewer than that of non-wearers. Comparisons with Australia and some parts of the U.S.A. indicate that, despite the significant decrease in Skaraborg, greater effects might be achievable if information is supplemented by compulsory-helmet-wearing legislation.

Adolescent↗
PubMed1997

National adaptations of the ICD rules for classification--a problem in the evaluation of cause-of-death trends.

In 1981, the registration routines of the Swedish cause-of-death register were adjusted. The aim of this study was to assess what influence these changes in registration practice might have had on the cause-of-death trends after 1981. The Eighth Revision of the International Classification of Diseases (ICD-8) was used throughout the study period (1976-1985). Significant changes in the registered number of cases were found in 13 of the 18 diagnostic groups scrutinized. Four main types of outcomes were observed: (a) the number of underlying causes increased while the number of contributing causes decreased or vice versa; (b) the number of both underlying and contributory causes changed in the same direction, due to the transfer of a diagnostic group from one ICD category to another; (c) the number of both underlying and contributory causes changed in the same direction, but not due to the transfer of a diagnostic group; or (d) the number of either underlying or contributory causes changed, but not both. In general, the altered registration practice led to more conditions that are often considered as terminal complications to other diseases being registered as the underlying cause of death. While most of the 1981 instructions meant a more literal application of the ICD-8, those concerning cardiac valvular diseases deviated substantially from it. We conclude that (a) important changes in registration practice may occur at any point in time, and not only in connection with the implementation of a new version of the ICD; and (b) national adaptations of the ICD coding instructions may amount to a reversal of the instructions included in the ICD manuals. These findings must be considered when comparing cause-of-death statistics from different countries, and both underlying and contributing cause-of-death statistics should be considered in such analyses of cause-of-death trends.

Cause of Death↗