Care of the elderly in Norway, Sweden, and Denmark; observations from a geriatric study tour. 2. Sweden and Denmark.
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A Swedish cooperative trial demonstrated that 5 years of adjuvant tamoxifen was more beneficial than 2 years of tamoxifen in the treatment of postmenopausal women with estrogen receptor (ER) positive, early stage, invasive breast cancer. The main aim of the present study was to investigate the importance of progesterone receptor (PgR) and ER concentration levels for patients participating in the trial and still distant recurrence free two years after the primary operation. Subgroup analyses revealed that only patients with ER positive and PgR positive breast cancer had improved distant recurrence free survival (DRFS) by prolonged tamoxifen therapy (p = 0.0016). Patients with ER negative and PgR negative as well as ER positive and PgR negative tumors showed no significant effect of prolonged tamoxifen (p = 0.53 and p = 0.80, respectively). The percentage of ER negative and PgR positive breast cancers was too small (2.2%) for any meaningful subgroup analysis. There was a significant positive trend that the concentration level of PgR (high positive vs. low positive vs. negative) decreased the recurrence rate for those with prolonged therapy. No corresponding pattern was found for the ER content. S-phase fraction did not correlate to the recurrence rate of PgR positive breast cancers. Patients recurring during tamoxifen therapy had receptor negative tumors to a greater extent than those recurring after tamoxifen treatment. In conclusion, prolonged tamoxifen therapy for 5 years instead of 2 years was found to be beneficial for patients with ER positive and PgR positive breast cancer, whereas three extra years of tamoxifen had little or no effect for patients with ER positive but PgR negative tumors as well as for steroid receptor negative patients.
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Several studies have reported poorer infant outcome among immigrants, but contrary evidence also exists. Between 1940 and 1999 more than a half million Finns emigrated to Sweden, which made Finns the largest minority group in Sweden. Our aim was to investigate fertility trends, parturients' background and pregnancy outcomes among Finns in Sweden, and to compare the findings with those obtained among Swedes in Sweden and Finns in Finland. The data came from the Finnish and Swedish Medical Birth Registers for the years 1987-1998. All deliveries by women born in Finland and having given birth in Sweden (N=33874) were compared with a 10% sample of all deliveries by Swedish parturients in Sweden (N=108549) and of all Finnish deliveries (n=75133). Among Finns in Sweden, the number of live births per 1000 women aged 15-49 years declined significantly in the late 1990s. The change in the total fertility rate was less dramatic: the rate for Finns in Sweden followed the total Swedish rate although it remained from 5% to 10% higher up to the mid-1990s. Finns who had given birth in Sweden were older, had a higher parity and a higher prevalence of previous miscarriages, and smoked more often than did Swedes in Sweden or Finns in Finland. The crude infant outcomes of Finns having given birth in Sweden were equal to those among Swedes in Sweden (except for the incidence of small for gestational age), but poorer than in Finland. Biological factors explained the differences between Finns in Sweden and Finland in being small for gestational age, and biological factors and smoking explained the difference in prematurity. The difference in low birth weight remained statistically significant (3.9% versus 3.6% among singletons). In conclusion, fertility trends followed the pattern prevailing in the resident country. The relatively good outcome of children whose mothers were born in Finland but who had given birth in Sweden can partly be explained by the healthy migrant effect.
Prior to 1940 the population of Sweden was one of the most homogeneous in Europe, with only 0.5% foreign born. Fifty years later, in 1990, the proportion of immigrants was around 15%. In order to describe and analyze consumption of dental care in different refugee groups in Sweden, data registered by the Department of Immigration and the National Social Insurance Board, on a random sample of 2489 refugees arriving in Sweden 1975-85, were merged. Information on nationality, date of arrival in Sweden, date of granting of permanent resident status and statistics on consumption of dental care were retrieved. During the period studied a total of 50,521 refugees arrived in Sweden. The average interval between arrival in Sweden and the first dental visit was 4.5 yr (95% < 1: 4.2-4.7). The total treatment time during the first course of treatment was 165.5 min (95% < 1: 148.7-182.3). Consumption of dental care did not decrease with an increased number of treatments. Only 38% of the refugees had visited a dentist at all in Sweden. With increasing number of years in Sweden the number of courses of dental treatment increased, but 41% of the refugees who had visited the dentist in Sweden had done so only once. This study shows a low utilization of dental services among refugees in Sweden in general. Refugees with dental visits in Sweden, in particular, had a high dental consumption.
This review covers the geographic distribution and host relationships of the tick species in Sweden. Ixodes uriae White, I. caledonicus Nuttall, I. unicavatus Neumann, I. arboricola Schulze & Schlottke, and I. lividus Koch are ornithophagous species. I. trianguliceps Birula, I. canisuga Johnston, I. hexagonus Leach, and Argas vespertilionis (Latreille) are mammalophagous. I. ricinus (L.) and Haemaphysalis punctata Canestrini & Fanzago feed on both birds and mammals. All these tick species may be considered to be permanently present in Sweden. I. persulcatus Schulze, Hyalomma marginatum Koch, and the brown dog tick, Rhipicephalus sanguineus (Latreille), may be regarded as not indigenous to Sweden although they may be regularly introduced by spring-migrating birds or imported dogs, respectively. The first European record of the American dog tick, Dermacentor variabilis (Say), is reported. There are several records of Hyalomma aegyptium (L.) from imported tortoises in Sweden. Excluding other ticks imported on exotic pets and zoo animals, another 13 tick species are listed that may occur, at least occasionally, in Sweden. Because of its wide geographic distribution, great abundance, and wide host range, I. ricinus is medically the most important arthropod in northern Europe. I. ricinus is common in southern and south-central Sweden and along the coast of northern Sweden and has been recorded from 29 mammal species, 56 bird species, and two species of lizards in Sweden alone. The potential introduction to Sweden of exotic pathogens with infected ticks (e.g., I. persulcatus and H. marginatum on birds or Dermacentor spp. and R. sanguineus on mammals) is evident.
A survey of allergic dermatitis (sweet itch) in Sweden contained information on 441 Icelandic horses. Results of a questionnaire indicated that approximately 15 per cent of the country's Icelandic horses suffered from the disease. The prevalence of allergic dermatitis was significantly higher among horses imported from Iceland (26.2 per cent) compared to that of Swedish-born animals (6.7 per cent). In addition, horses born in Iceland were significantly more severely affected than horses born in Sweden. The risk of allergic dermatitis in Sweden appeared to be more than six times higher for horses exported from Iceland to Sweden relative to that of horses originally born in Sweden. The prevalence of disease for horses of seven years or older was 30 per cent for Icelandic-born individuals as compared to 7.3 per cent for horses born in Sweden. Similarly, the risk of allergic dermatitis in Sweden for horses of seven years or older appeared to be nearly 10 times higher for horses imported from Iceland relative to that of horses born in Sweden. Allergic dermatitis usually appeared during the third grazing season for imported horses and during the fourth season for horses born in Sweden. Furthermore, the course of the disease tended to become worse with time. Analysis of the prevalence of allergic dermatitis relative to gender revealed no significant differences. Certain geographical variations in the prevalence of the disease was also found.
STUDY OBJECTIVE: Finland has a higher mortality overall and for major causes of death than Sweden, primarily in men. The objective of this study was to analyse mortality in migrants from Finland to Sweden. DESIGN: A longitudinal study based on the Finnish Twin Cohort Study. Information about migration from Finland to Sweden, duration of stay in Sweden for the migrants, and deaths 1976-1995 was obtained from national registers. Observed numbers of deaths in migrants were compared with expected numbers based on the age standardised mortality experience of the Finnish Twin Cohort. First deaths in migrants and non-migrants of migrant discordant pairs were compared controlling for genetic and early childhood factors. PARTICIPANTS: Twin pairs of the Finnish Twin Cohort Study where at least one twin had migrated to Sweden (1542 twin pairs). MAIN RESULTS: Among men, migrants from Finland to Sweden showed an overall similar mortality compared with all subjects of the Finnish Twin Cohort (SMR 1.1; 95% CI 0.9 to 1.4). Mortality from non-violent causes was increased for migrants with at most 20 years in Sweden (SMR 1.9; 95% CI 1.2 to 2.6) and decreased in those with a longer stay (SMR 0.7; 95% CI 0.4 to 0.9). Similar results were obtained concerning first deaths in twin pairs discordant for migration. Among women, migrants had an increased mortality overall (SMR 1.4; 95% CI 1.0 to 1.8), from cardiovascular disease (SMR 1.7; 95% CI 1.0 to 2.7), and from violent causes (SMR 2.5; 95% CI 1.2 to 4.6) compared with all women of the Finnish Twin Cohort. In analyses of migrant discordant pairs only first deaths from cardiovascular disease tended to be more common in the migrants than in non-migrant co-twins. CONCLUSIONS: Migrants from Finland to Sweden seem to have an overall mortality comparable to that prevailing in Finland suggesting no strong influence on mortality by the migration. Duration of stay seems to be associated with mortality in the migrants, at least in men, with a lower mortality after several years in Sweden.
BACKGROUND: Both trends in socioeconomic inequalities in mortality, and cross-country comparisons, may give more information about the causes of health inequalities. We analysed trends in socioeconomic differentials by mortality from early 1980s to late 1990s, comparing Sweden with New Zealand. METHODS: The New Zealand Census Mortality Study (NZCMS) consisting of over 2 million individuals and the Swedish Survey of Living Conditions (ULF) comprising over 100, 000 individuals were used for analyses. Education and household income were used as measures of socioeconomic position (SEP). The slope index of inequality (SII) was calculated to estimate absolute inequalities in mortality. Analyses were based on 3-5 year follow-up and limited to individuals aged 25-77 years. Age standardised mortality rates were calculated using the European population standard. RESULTS: Absolute inequalities in mortality on average over the 1980s and 1990s for both men and women by education were similar in Sweden and New Zealand, but by income were greater in Sweden. Comparing trends in absolute inequalities over the 1980s and 1990s, men's absolute inequalities by education decreased by 66% in Sweden and by 17% in New Zealand (p for trend <0.01 in both countries). Women's absolute inequalities by education decreased by 19% in Sweden (p = 0.03) and by 8% in New Zealand (p = 0.53). Men's absolute inequalities by income decreased by 51% in Sweden (p for trend = 0.06), but increased by 16% in New Zealand (p = 0.13). Women's absolute inequalities by income increased in both countries: 12% in Sweden (p = 0.03) and 21% in New Zealand (p = 0.04). CONCLUSION: Trends in socioeconomic inequalities in mortality were clearly most favourable for men in Sweden. Trends also seemed to be more favourable for men than women in New Zealand. Assuming the trends in male inequalities in Sweden were not a statistical chance finding, it is not clear what the substantive reason(s) was for the pronounced decrease. Further gender comparisons are required.
Antimicrobial growth promoters (AGPs) were phased out in Denmark, Norway and Sweden in 1998-1999, 1995 and 1986, respectively. The annual usage of therapeutic antimicrobials in animals in Denmark almost doubled during the period when AGPs were phased out (1988-1999) and in the subsequent 2 years. The increase was mainly due to an increased consumption of therapeutic antimicrobials in weaning pigs. The annual increase in usage of therapeutic antimicrobials and the annual increase in numbers of slaughter-swine produced in Denmark correlates well, except for 1999 when AGP use was discontinued in weaning pigs, and the following year. In Norway, the usage of therapeutic antimicrobials in animals decreased by 39% from 1995 to 2000. During 2001-2003 the annual usage remained at the 2000-level. The annual numbers of slaughter-swine produced in Norway increased gradually by 10% after the AGP discontinuation (from 1995 to 2003). In Sweden, the usage of therapeutic antimicrobials in animals increased by 21% the first 2 years subsequent to the AGP ban (1986-1988), remained then constant until 1994; from 1994 to 2003 this usage declined by 47%. The initial increase was caused by increased use in broilers and in weaning piglets. The amounts used in animals in Sweden in 2003 were half of the amounts used in 1994. The annual numbers of slaughter-swine produced in Sweden declined gradually by 16% in the study period, although fluctuating. In Denmark, Norway and Sweden the number of dairy cattle and beef cattle declined only slightly in the various study periods while numbers of broilers produced increased notably, especially in Norway and Sweden. Following the termination of AGPs the total usage of antimicrobials (AGPs and therapeutic antimicrobials) in animals in Denmark declined 36% (from 1996 to 2003): in Norway this figure was 45% (from 1995 to 2003). In Sweden, the total usage of antimicrobials in animals in 2003 amounted to only one third of the amounts used in 1984 (decreased from 51 to 16 tonnes). Termination of AGPs was only a temporary risk factor for increased usage of therapeutic antimicrobials in food-animals in Sweden and Denmark; however, an exception might be usage in weaning piglets in Denmark. Furthermore, the discontinuation of AGP use has decreased the overall annual usage of antimicrobials in animals in Denmark, Norway and Sweden considerably.