Osteoporosis in Sweden

Sweden has one of the highest incidences of hip fractures in the world and we have started to consider osteoporosis as an important disease. We have created guidelines for BMD measurements and the recommendations for treatment are based on risk assessment. New guidelines for treatment with drugs will soon be developed by the Swedish FDA.     

Cryptosporidiosis in southern Sweden

Two different groups of patients with diarrhoea, altogether 1,478 individuals, were examined for cryptosporidium oocysts. The technique used was feces concentration and staining according to a modified Ziehl-Neelsen method. 20 cases of cryptosporidiosis (3%) were found among 698 consecutive patients with acute gastroenteritis. In feces samples sent for parasitological examination from 780 patients, cryptosporidia were found on 9 occasions (1%). None of 519 healthy persons excreted cryptosporidia. 19/29 patients with cryptosporidiosis had recently been abroad and in 8 of these additional enteric pathogens were found. The median duration of diarrhoea was 14 days. All patients except 1 were cryptosporidia-negative in faeces within 2 months. An immunosuppressed patient excreted cryptosporidia for 14 months.     

Anorectal malignant melanoma in Sweden

Clinicopathologic features and prognosis of 49 patients with anal malignant melanoma were investigated in the total Swedish population between 1970 and 1984. Median age was 71 years (range, 50 to 87 years), and there was a female predominance (31 females, 18 males). The most common symptom at presentation was bleeding. The majority of tumors ranged between 2 and 5 cm in diameter and all invaded at least into the submucosa and/or the lamina propria. At diagnosis, one third of the patients had either regional or distant metastasis with a median survival of 5 months. The remaining patients were surgically treated with curative intent, either by abdominoperineal resection (APR) or local excision. Median survival was poor in both treatment groups (APR, 12 months; local excision, 13 months). Most patients died with distant metastasis. Our results confirm the opinion that APR offers no more curative potential than a more conservative surgical approach. However, tumor sizes were on average smaller in the group treated by local excision. This could indicate that, in the absence of known distant metastasis, radical surgery should be performed, particularly since local recurrences tended to be more common after a local excision.     

Epidemiology of Diabetes Mellitus in Sweden

ABSTRACT All newly diagnosed cases of diabetes mellitus aged 15–34 years in Sweden, where the population in this age interval is about 2.3 million, were registered on standardized forms. During 1983, the first year of the study, there were 311 males and 161 females, excluding 280 with gestational diabetes. The annual incidence of diabetes was 26.2 per 100000 in males and 14.2 in females. The respective figures for type I were 18.5 and 10.1, and for type II 5.7 and 2.9. The incidence of type I diabetes was similar for the four age groups (15–19, 20–24, 25–29, 30–34 years), while for type II it was highest in the oldest group. Types I and II, but not the sexes, differed as regards the cumulative distribution curves of the maximum blood glucose concentration during the first two weeks after diagnosis. The present incidence of diabetes in Sweden is higher, particularly in males than the rates for similar age groups in Oslo (1925–64) and Denmark (1970–77).     

Aspects of haemophilia prophylaxis in Sweden

Summary.  Prophylactic treatment of haemophilia has been gaining acceptance as the optimal therapeutic option in an increasing number of haemophilia centres in the developed world in recent years. This paper focus on three aspects of prophylactic therapy: when to start treatment, venous access and the dose/dose interval. Evidence is in favour of prophylactic treatment to be started at an early age using either a peripheral vein with 1–2 injections per week and a successive increase in the frequency depending on the child and the veins, or, using a Port-A-Cath which allows a better prophylactic coverage by infusions preferably every second day in haemophilia A and every third day in haemophilia B.     

Nurse-led heart failure clinics in Sweden

OBJECTIVE: The aim of this study was to describe the nurse-led heart failure care in Sweden. METHODS: A postal questionnaire was sent to all 86 hospitals in Sweden treating heart failure patients. All hospitals completed the questionnaire, which contained 20 questions about heart failure nurses, patient education, heart failure clinics, co-operation with primary healthcare and care programmes. RESULTS: Sixty-nine percent of all hospitals (n=86) had nurses specialised in taking care of heart failure patients, in total 148 heart failure nurses. The nurses were involved in patient education and follow-up. There were nurse-led heart failure clinics in 66% of the hospitals. The clinics provided follow-up after hospitalisation, telephone counselling and drug titration. The majority of the heart failure nurses had been delegated the responsibility for making protocol-led changes in medications. Most clinics registered the number of annual visits to the clinic, and the largest clinic had up to 1000 visits. Approximately half of the hospitals had a special care plan for patients with heart failure and an organised co-operation with primary healthcare. CONCLUSION: The first nurse-led heart failure clinic started in Sweden in 1990 and since then the model has been spread to two-thirds of the Swedish hospitals.     

Epidemiology of hepatitis B in Sweden

All the cases of clinical hepatitis B reported in Sweden since 1969 have been studied. The 10-year period 1976-1985 has been analysed intensively. For comparative purposes, the study also includes the hepatitis cases reported in 1962 and 1967. Serum hepatitis first affected young adults aged 15-24 years at the beginning of the 1960s. Cyclical outbreaks of hepatitis B due to transmission among drug abusers have been recognised since 1969. The disease was first observed in urban areas but later in rural parts of Sweden also. After 1976, a year in which outbreaks arose in various parts of Sweden, the numbers of hepatitis B cases decreased. In 1969, more than 50% of the cases reported as serum hepatitis concerned drug abusers. During the period 1976-1985, the main risk factor was drug abuse for between 20 and 52% of cases and sexual activity for between 8 and 28% of cases. Since 1969, 2-3% of cases annually have been related to blood-transfusion. In the last 5-year period, a total of 129 cases was reported among persons employed in the medical and dental fields. Of these, 59 had non-occupational exposure. During the same period, 33 patients reported contacts with infected persons, mostly household contacts. Seventy five persons had been travelling abroad.