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Biomedical subjects

M Rosén

Publications and source records attributed to M Rosén.

At least 19 recordsLinked to original sources
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↗
PubMed1997

Telomeres terminating with long complex tandem repeats.

Telomeres of most investigated species terminate with short repeats and are elongated by telomerase. Short repeats have never been detected in dipteran species which have found other solutions to end a chromosome. Whereas in Drosophila melanogaster retroelements are added onto the termini, chironomids have long complex repeats at their chromosome ends. We review evidence that these units are terminal and probably have evolved from short telomeric repeats. In Chironomus pallidivittatus the units have been shown to belong to different subfamilies which have specific inter- and intrachromosomal distribution, the most terminal subfamily of repeats being characterized by pronounced secondary structures for the single strand. The complex repeats are efficiently homogenized both within and between different chromosome ends. Gene conversion is probably an important component in the coordinate evolution of the repeats but it is not known whether it is used for net synthesis of DNA. RNA is used as an intermediate in telomere elongation both by organisms having chromosomes terminating with short repeats and by D. melanogaster. It is therefore interesting that the terminal repeats in chironomids are transcribed.

Animals↗
PubMed1996

Socioeconomic differences in 'avoidable' mortality in Sweden 1986-1990.

BACKGROUND: 'Avoidable' mortality is commonly studied as an indicator of the outcome of health care. In this study socioeconomic differences in avoidable mortality in Sweden from 1986 to 1990 are analysed and related methodological issues discussed. METHODS: The 1985 Swedish Population and Housing Census was linked to the National Cause of Death Register 1986-1990. Mortality from potentially 'avoidable' causes of death was analysed for the age group 21-64 years. Analyses were performed for different socioeconomic groups, blue-collar workers, white-collar workers and the self-employed as well as for individuals outside the labour market. Standardized Mortality Ratios were calculated using standardization by age and sex. RESULTS: For all indicators studied, the death rates for those not in work were higher than for people at work. The largest differences were found for chronic bronchitis, diabetes, bacterial meningitis, ulcer of the stomach and duodenum, chronic rheumatic heart disease, asthma and hypertensive and cerebrovascular disease. For these causes of death the risk of dying was between 3.1 and 7.5 times greater in the non-working population than in the work-force. The differences in avoidable mortality between blue-collar workers and white-collar workers and the self-employed were, however, much smaller. For most of the indicators no significant differences were found. For ulcers of the stomach and duodenum, however the death rate for blue-collar workers was 2.8 times higher than those for other categories in work. CONCLUSIONS: The small difference in mortality outcome for different socioeconomic groups within the work-force indicates an equal quality of care for these groups. The greatly increased risk among the non-working population, however, is a warning sign. These results may be due to a 'healthy worker' effect. The measurement of socioeconomic differences in mortality may be dependent on the time-period chosen between occupational exposure and mortality outcome.

Adult↗
PubMed1996

Cost effectiveness and equity of a community based cardiovascular disease prevention programme in Norsjö, Sweden.

STUDY OBJECTIVE: To evaluate the cost effectiveness and equity of a community based cardiovascular disease prevention programme. DESIGN: A prospective cross sectional design. SETTING: A community based intervention to reduce cardiovascular disease in the district of Norsjö (n = 5500), Sweden. The intervention was aimed at both the general population and at individuals thought to be at special risk, the emphasis being on changing dietary habits and reducing cholesterol concentrations. PARTICIPANTS: The participants were men and women aged 30-60 years. MAIN RESULTS: The mean serum cholesterol concentration in the Norsjö population was reduced by nearly 20% during the first six years of intervention. It was estimated that the programme's overall total societal costs were 363,000 pounds and estimates of the cost per year of life saved ranged from 14,900 pounds to net savings, according to different assumptions. Taking only health care costs and savings into account, the cost per year of life saved ranged from 1100 pounds to 4050 pounds. The results varied between different sex and age groups, but not between social classes. Even if a causal relationship exists between low cholesterol concentrations and excess mortality, the estimated side effects of lowering cholesterol values in Norsjö were negligible in comparison with the expected benefits. CONCLUSIONS: The community based intervention in Norsjö seems to be cost effective even under conservative assumptions. The approach used seems to have benefited all social classes. Cost effectiveness analyses that take consequences for equity into account are valuable tools in decision making.

Adult↗
PubMed1995

Digestive organs.

Explore the source record for details and available documents.

Adolescent↗
PubMed1995

Cancer survival in Sweden during three decades, 1961-1991.

Cancer survival in Sweden in 1961-1991 is presented as a comprehensive report from the Swedish Cancer Registry. The report shows both successes and failures, confirms some earlier published results and presents some new findings worth further analysis. Survival has increased for female breast cancer, malignant melanoma, cancers of the testis and thyroid gland, acute leukemia, and Hodgkin's disease. No improvements are found for multiple myeloma or cancers of the liver, gall bladder, and pancreas. Small increases are shown for colorectal cancer and cancers of the stomach, oesophagus, and kidney. Increases in postoperative survival are shown for sites dominated by histologically benign tumors, i.e., intracranial neurinoma, meningioma, and cancers of the endocrine glands such as parathyroid tumors. From 1970-1972 to 1980-1982 the 10-year relative survival rate (RSR) increased from 30% to 38% for males and from 44% to 51% for females. Hence, cancer survival for all cases combined has approached the survival of the general population somewhat. Most of the increases took place in the 1970's. Changes in the distribution of incidence towards cancer sites with better prognoses account for some 10-20% of the observed increases in RSR, whereas the aging of the cancer population reduces the upward trend in RSR for all cases combined by some 1-2%. Cancer patients have poorer survival than the population long after 5 years of follow-up. They reach the survival of the population after about 8-12 years for colorectal cancer, 10 years for cervical cancer, 7-10 years for malignant melanoma, 13-18 years for kidney cancer, and more than 19 years for female breast and prostate cancer. For patients diagnosed in 1970-1972 this occurred 16 years after diagnosis at 29% for males and 43% for females when all cancer cases were combined. The extended time until 'statistical cure' for most cancer forms clearly indicates the need to augment the commonly used 5-year RSR with other outcome measures. If cancers on average are discovered earlier today, the 5-year RSR gives an exaggerated impression of the improvement over time. In this case the change in the 10-year RSR is a less biased criterion.

Age Factors↗
PubMed1994

Are people willing to pay for a community-based preventive program.

This pilot study is the first known attempt to test the willingness-to-pay or willingness-to-accept (WTP/WTA) method of assessment on a community-based primary prevention program against cardiovascular disease. The results indicate that the population's perceived WTA outweighs the program's costs by at least three to one. However, the methodological problems of using the WTP/WTA method in community-based programs are far from solved, and further research in this area is required.

Cardiovascular Diseases↗
PubMed1993

[The use of disease registries--a question of ethics].

The Nordic countries have unique possibilities for performing register-based epidemiological research. Current proposals by the European Community and the Council of Europe may radically hamper such research, however. It is important that researchers enter into the debate and demonstrate the value of such epidemiological research. The article consists in an account of the registers now available that are suitable for use from the point of view of research, and some of the results obtained. The conclusion is that it would be unethical not to take advantage of the abundant source of data represented by the disease registers.

Epidemiology↗