Sweden Introduction Research Articles

Swedish diabetes register, a tool for quality development in primary health care

Introduction In Sweden, quality indicators in health care have been the basis for developing National Quality Registers. The Swedish National Diabetes Register (NDR) - one of the largest diabetes registers globally - was introduced in primary health care (PHC) in the county of Östergötland by an implementation project, 2002-2005. Aim The aim of the present paper was to investigate, by using the results of the NDR, whether the registration led to sustained outcomes of medical results of diabetes care in PHC in the county during the period 2005-2009. Method HbA1c, blood pressure (BP), albuminuria and low-density lipoprotein-cholesterol were registered online in the NDR. In 2005 and 2006, goal achievement for HbA1c was measured and compared between PHC centres (PHCC) within the county. In 2007, achievements to national goals were compared between the PHCCs within the county and with those Swedish counties that had attained a sufficiently high registration rate. In 2008 and 2009, the average county results were compared with the corresponding national average measurements for all 21 Swedish counties combined. Result In 2005, a clear improvement trend for HbA1c and BP was shown within the county. In 2007-2009, goal achievements in the county studied were slightly better than the other counties measured and the country as a whole in almost every comparison. Discussion The present study has shown association between medical results and registration in the NDR. As the project was primarily a quality improvement work, the results have continuously influenced the development of diabetes care. Both the health professions and the county council now have - in the NDR - an effective and rapid method for evaluation and follow-up of diabetes care. The systematic documentation, followed by comparisons and analyses, create ideas for care improvements.

FC27-03 - A follow-up study of former child and adolescent psychiatric patients’ psychiatric care in adulthood

IntroductionIn Sweden there are three psychiatric disciplines, general psychiatry (GenP), forensic psychiatry and child and adolescent psychiatry (CAP). There are many similarities between GenP and CAP, but despite this, there is a virtual lack of information regarding possible early symptoms of mental disorders, and how they change during the process of maturing from childhood to adulthood.Aims and objectivesAn overall aim was to provide information about CAP-patients and their outcome as adults. This study describes and discusses the transition between CAP and GenP and illustrates the question if and which CAP-patients will proceed as patients within GenP.Methods1,400 patients, originally treated as in- and outpatients by CAP services were subsequently followed-up into mid-adulthood using official registries and hospital records.ResultsAt least a third of all CAP patients were later admitted to GenP. However, this group constituted only eleven percent of the corresponding age groups of GenP-patients. There seems to be a weak connection between diagnoses given to patients in CAP and later in GenP care.ConclusionsAt least three different pathways for becoming in need of GenP care as adults were identified. First, a “developmental trajectory” with early symptoms of parental neglect, later need of unspecific paediatric hospital treatment, school failure, behavioral problems and referral to CAP. Another way relates to the relatively uncommon development of psychotic disorders. However, the most common way relates to “adult problems” in the categories neurotic and stress-related disorders where the problems seem to have developed from accumulated stressful life-events.

Co-activation patterns in somatosensory areas: A meta-analysis study

Event Abstract Back to Event Co-activation patterns in somatosensory areas: A meta-analysis study Lars Forsberg1* and Per Roland1 1 Karolinska Institute, Sweden Introduction: NeuroGenerator is a project that generates statistical image databases from PET and fMRI studies (Roland et al. 2001). This is done by processing the raw data in a uniform manner. The statistical database contains statistical Z-images and cytoarchitectural population maps in Talairach space. In this study, we use the statistical images to find co-activation patterns for experiments engaging the somatosensory area 3b. Methods: We first made a voxel-wise correlation between all the statistical Z-images and the population map of cytoarchitectural area 3b. The statistical image with the highest correlation had a correlation of 0.20. This image was then used to calculate the voxel-wise correlation with all the other statistical images in the database. Nine statistical images were found to have a higher correlation than 0.10, which was considered fairly high given the small ratio between the size of the activations and the total size of the brain. A sum image was calculated from these images and then normalized in order to regard the noise as ~N(0,1). Finally, we used False Discovery Rate to find the threshold value for a corrected p = 0.01 in the normalized sum image. Results: The threshold level for the normalized sum image was found to be Z ≥ 2.90, which corresponds to an uncorrected p = 0.002 and a corrected p = 0.01. The results show significant activations in the left hemisphere for areas 3b, 4a and 4p (figure 1), and significant bilateral activations for the intraparietal areas ip1 and ip2 (figure 2). No activation was found in area 6. Conclusion: The experiments in the study have in common that they engage area 3b in the left hemisphere. For these experiments, we also found a bilateral co-activation pattern for the areas ip1 and ip2. The chosen method is sensitive to activations that are weak and unsignificant in each individual experiment but reproduced across experiments. There is a clear benefit of such a method compared to meta-analyses of databases with published functional neuroimaging experiments, where only reported findings from each study can be used in the meta-analysis.

INCREASED CANCER INCIDENCE IN NORTH SWEDEN-AN EARLY PROMOTING EFFECT CAUSED BY THE CHERNOBYL ACCIDENT

Introduction In Sweden the ground gamma radiation, due to uranium containing granite, contribute to the population's total radiation dose. After the Chemobyl nuclear power plant accident in 1986 as much as five percent of the released caesium-137 was deposited in Sweden, especially in the Northern part of the country. Our hypothesis was that this radiation caused increased cancer incidence, after adjustment by ground gamma radiation exposure. Methods The study base included the population of eight counties with the highest fallout after the Chernobyl accident, but also with unaffected areas in these counties serving as the reference. Each person 0–60 years of age living in the same parish at 31 December 1985 and 31 December 1987 were included in a cohort. With the coordinate of each person's dwelling from the National Land Survey of Sweden a total of 1 137 106 individuals could be given 1) ground gamma radiation exposure from the digital map of the Swedish Geological Agency and 2) caesium-137 exposure from a similar map created by Swedish Radiation Protection Institute. Accuracy of the dwelling coordinate was 100 metres and for the radiation exposures 200 metres as done by aeroplane measurements. Three time periods were analysed 1988–1991, 1992–1995 and 1988–1999. Results Population density, lung cancer incidence 1988–1999 and total cancer incidence 1986–1987 was risk factors for total cancer outcome in 1988–1999. Age adjusted ERR per 100 nGy/h for ground gamma radiation and total cancer incidence did not show any significant dose response measured, either in each three years time intervals or in the total period of 1988–1999. For caesium the ERR per 100 nGy/h (adjusted by population density, lung cancer incidence, total cancer incidence 1986–1987 and ground gamma radiation) was significant in 1988–1991 followed by a decline in risk 1992–1995 and then a slight but not complete return in risk. The ERR of 0.042 (95% CL 0.001;0.084) per 100 nGy/h for caesium exposure 1988–1999 is therefore dependent on the first three years increase, and to less extent by the following six years. Conclusion We have found an early effect of the Chernobyl fallout in Northern Sweden. However, even in the ERR of 0.101 per 100 nGy/h is relatively low in 1988–1991, it is stable in a stepwise regression, and therefore indicating a true effect. An interpretation of our results could be that the sudden exposure of ionizing radiation from Chernobyl might have acted as a late stage general promotor for cancer. Such an early effect can hitherto been overlooked in previous studies.

Diversity and Specificity in Cyanobacterial Symbioses

DIVERSITY AND SPECIFICITY IN CYANOBACTERIAL SYMBIOSES U. Rasmussen and C. Johansson U.Rasmussen (corresponding author; e-mailullarasmussen@ botan su se) and C Johansson, Department ofBotany,Stockholm University, 106 91 Stockholm, Sweden INTRODUCTION Cyanobacteria constitute one of the largest sub groups of Gram-negative photosynthetic prokary otes and are of great evolutionary antiquity, dating back to the Precambrian (2.8-3.5 billion years ago). They are found worldwide in highly diverse ecosystems, from aquatic (limnic and marine) habi tats to terrestrial systems and from polar to tropical regions of the globe. In terrestrial systems, nitro gen-fixing Nostoc isby far themost common genus and includes cyanobacteria capable of forming symbioses with a broad range of plants and other organisms. Hosts include fungi (Geosiphon species and lichenised fungi), bryophytes (liverworts and hornworts), aquatic ferns (genus Azolla), gym nosperms (cycads) and angiosperms (genus Gunnera) (Bergman et al. 1996). CELL DIFFERENTIATION IN NOSTOC The key to the success of the genus Nostoc, whether in the free-living form or in symbiosis, is most likely its extreme structural and functional plasticity. Influenced by environmental changes, Nostoc undergoes differentiation into several differ ent cell and filament types (P1. I).When grown under nitrogen-limited conditions or in symbiosis, vegetative cells differentiate to form specialised nitrogen-fixing heterocysts at a frequency of ap proximately 5% in the free-living form and up to 80% in symbiosis with hosts such as Gunnera spe cies. In addition, the entire vegetative filament can differentiate into amotile stage, the hormogonium, which serves as a means of dispersal under unfa vourable conditions and constitutes the 'infective unit' during establishment of the symbiosis. Finally, akinetes are differentiated under adverse conditions and function as spores. Akinete differentiation is an unusual stage in symbiotic associations and is known to play a role only in Azolla, in which akinetes function as cyanobacterial inocula for the next sporophyte generation. In addition, the cyanobacteria must change their metabolism from that of a free-living, phototrophic organism to that of a symbiotic, heterotrophic organism in order to be symbiotically competent. The mechanisms in volved in this shift are largely unknown. SPECIFICITY The specificity of the cyanobacterium-host inter action has been investigated by isolating and grow ing the two symbiotic partners separately and then reconstituting the symbiotic association under lab oratory conditions. Nostoc strains isolated from a cycad, the bryophyte Anthoceros and a lichen all infect Gunnera. Similarly, strains isolated from cycads, Gunnera and a lichen infect Anthoceros species. Hence, Nostoc in general exhibits a very low host specificity, with no correlation to the taxonomic status of the host. Furthermore, the host has a low specificity for its cyanobiont. Even certain strains of Calothrix and Chlorogloeopsis can infect both the homwort Phaeoceros and the liverwort Blasia (West and Adams 1997). Moreover, the cyanobiont shows great adap tive flexibility because the same strain has the capacity to infect different host organs. The cyanobacteria are found extracellularly among the fungal hyphae in lichens, in the cavities of bryophyte thalli and Azolla leaves and in the spe cialised roots of cycads, whereas they are found intracellularly in the fungus Geosiphon and in the stem glands of Gunnera. Taken together, these facts indicate that the host is the (more) selective part ner. Cyanobacteria are unique among symbiotic bacteria in their ability to infect a broad range of hosts and organs. GENETIC DIVERSITY The extreme morphological flexibility of Nostoc makes identification and taxonomy based onmorph ology problematic and unreliable. In the recent literature, many symbiotic isolates (from Gunnera, cycads, bryophytes and the fungus Geosiphon) have been referred to as N. punctiforme, but a pheno type-based characterisation has proved inadequate. No genetic analysis has yet been used to identify the taxonomic status of different symbiotic isolates. At present, the taxonomic interrelatedness of the symbiotic Nostoc strains is largely unknown and does not extend below the genus level. More precise genetic information must therefore be ob tained to establish a more reliable classification system. In recent years, molecular methods have contrbuted to amore detailed classification of the genus Nostoc (Table 1). BIOLOGY AND ENVIRONMENT PPOCEENDINGS OF THE ROYAL IRISHACADEMY, VOL 102B, No 1, 53-56 (2002) 0) ROYAL IRISHACAsEMY 53 BIOLOGY AND ENVIRONMENT P1...

The Cyanobacterial: Cycad Symbiosis

THE CYANOBACTERJAL- CYCAD SYMBIOSIS P. Lindblad and J.-L. Costa P Lindblad (corresponding author, e-mailpeterlindblad@ ebc uu se) and J -L Costa,Department of Physiological Botany, Evolutionary Biology Centre, Uppsala University, Villavagen 6, SE-752 36 Uppsala, Sweden INTRODUCTION Cycads are an ancient group of gymnosperms occurring naturally in tropical and subtropical re gions. They have a unique capacity to form symbi otic associations with heterocystous cyanobacteria (Nostoc) within apogeotropical coralloid roots This is the only example of a symbiosis between a gymnosperm and a nitrogen-fixing organism In this paper we present an overview of the location, establishment, charactenstics and specificity of the symbioses, aswell as information on the transfer of metabolites between the two partners. Cycads first appeared in the Pennsylvanian pernod and have existed for approximately 300 million years. Nearly 100 million years ago, cycads had a wide geographical distribution, extending from Alaska and Siberia to the Antarctic Today they are found on every continent except Europe and Antarctica but are restricted to small popula tions in the tropics and subtropics of both henm spheres. Moreover, many are facing possible extinction in nature The approximately 160 spe cies of cycads are distributed in three familles Cycadaceae, with a single genus, Cycas; Stangerl aceae, with two genera, Stangeria and Bowenia, and Zamiaceae, with eight genera, Ceratozamia, Chigua, Dioon, Encephalartos, Lepidozamia, Macrozamia, Microcycas and Zamia Cycads are mostly terrestrial and arborescent, except for at least one species (Zamia pseudoparasitica Yates), which is truly epi phytic, and can grow in a number of different habitats. Some species may be found in forests (both rainforest and seasonally dry forest), and others grow in open stands in grasslands Struc turally, cycads have a stem, normally columnar and woody, with the exception of Zamia pygmaea Sims ,which has a subterranean stem The aerial stem, which may be branched, is covered by persistent leaf bases In general, the vegetative shoots of cycads produce two types of leaves: scale leaves (called cataphylls) and foliage leaves The leaves are born terminally and are mainly pinnate, with the exception of the genus Bowenia, which has bipinnate leaves. Reproductively, cycads are dioecious, producing either pollen-bearing or ovule-beanng modified leaves called sporophylls The ovules, like those of true gymnosperms, are naked Cycads produce three types of root (1) a taproot equivalent to the primary root system found inmost plants (restricted to the genus Cycas, it is adventitious, arises from the lower side of trunk offsets and grows downwards close to the trunk); (ni) lateral roots, and (1ii) highly speciallsed lateral roots usually termed 'corallold roots' WHERE ARE THE SYMBIOTIC CYANOBACTERIA LOCATED? Corallold roots have been known to exist for a long time and have been recorded in all genera and all cycad species examined The ability to form this type of root is encoded by genes in the cycad, and the roots are formed before being invaded by symbiotic cyanobacterna Instead of themore com mon downward growth pattern, these roots show a marked negative geotropism and grow laterally and upwards toward the surface of the soil In seedlings of Macrozamia, the process of corallold root development begins with the initiation of paplllose roots called 'pre-corallold'. The first 'pre corallold' roots are adventitious and emerge from the hypocotyl immediately under the cotyledonary petioles Their subsequent development involves phases of maturation, cyanobactenal invasion, corallold formation, senescence and regeneration. When they are infected, the cyanobacteria are present in a specific cortical layer inside the root (the cyanobacterial zone) The presence of cyanobacteria inside the root induces irreversible modifications to the growth and development of the root The growth in length of these roots is much retarded compared with normal roots of the same age, but growth in diameter increases notice ably. Furthermore, the cells in the cyanobactenal zone undergo marked differentiation and elongate radially to connect the two adjacent cortical layers It has been suggested that these elongated cells are speciallsed cells responsible for the transfer of metabolhtes between the partners (Lindblad et al 1991; Pate et at 1988; Costa et a[ 1999, Adams 2000). ESTABLISHMENT OF THE SYMBIOSIS The process of infection is still unclear Invasion may occur at any stage of development of the root, but...

Young women requesting emergency contraception are, despite contraceptive counseling, a high risk group for new unintended pregnancies

Since its introduction in Sweden in 1994, emergency contraception has become a welcome addition to the campaign against unwanted pregnancy. In addition to an unplanned pregnancy, unprotected sexual intercourse may also involve the risk of contracting sexually transmitted diseases (STD). The aim of this study was to assess the short- and long-term risk of unintended pregnancy and to determine the frequency of chlamydia infections in women receiving emergency contraception. Between September 1998 and February 1999 young women aged 15–25 years had the opportunity to obtain emergency contraception (Yuzpe method) at a youth clinic in the city of Örebro where the opening hours were extended to include Saturdays and Sundays. A follow-up visit 3 weeks after treatment, which included contraceptive counseling, was offered to all participants. At both visits, a pregnancy test and a chlamydia test were performed, and the women completed a questionnaire. After the initial visit, the young women where monitored for new pregnancies during the following 12 months. One pregnancy occurred in the 134 young women who received emergency contraception during the study period. None of the women had a positive chlamydia test. Of those requesting emergency contraception, 54% did so because no contraception was used, 32% because of a ruptured condom, 11% because of missed oral contraceptives (OC), and 5% had mixed reasons. At long-term follow-up 1 year after the initial visit, 10 of the 134 young women had experienced an unplanned pregnancy that terminated in legal abortion in 9 women. All these women had either started and terminated OC or had never commenced the prescribed OC. Young women who request emergency contraception are, despite a planned follow-up with contraceptive counseling, a high risk group for new unintended pregnancies. In Sweden they do not seem to be a high risk group for STD.

Special Issue on Sweden Introduction

Special Issue on Sweden Introduction

3 - Pharmacology of Tocolytic Agents

Various drugs have been used to inhibit preterm labour. Selective beta-receptor agonists are the drugs of choice and have been extensively studied for more than ten years. Several controlled studies have demonstrated a significant prolongation of the pregnancy after treatment with beta-receptor agonists and some have demonstrated improved fetal outcome. There is apparently sufficient evidence to conclude that in selected patients, treated with these drugs for inhibition of preterm labour, there is a beneficial effect on the fetal outcome. These drugs are often given in high doses and therefore there is a potential risk of severe side effects. Careful monitoring of mother and infant is essential. There has been doubt as to the efficacy of beta-receptor agonist therapy since the rate of preterm deliveries (less than 37 weeks) is unchanged in most countries despite frequent use of these drugs. However, only 15 to 17 per cent of the preterm population constitutes deliveries before week 32, which is of greater interest than the overall preterm rate. Since the introduction in Sweden of beta-receptor agonist therapy there has been a significant decrease of deliveries prior to week 32 and of infants with a birthweight of less than 1500 g. In the same population the perinatal mortality rate has decreased from 60 per cent in 1973 to 40 per cent in 1980. Among the various factors influencing these figures the inhibition of preterm labour with beta-receptor agonists may have contributed to the successful results.

The Epidemiology of Severe Mental Retardation in Sweden

To facilitate comparative studies in future epidemiological research, a summary of the available epidemiological and etiological data on severely mentally retarded children from some demographically different areas in Sweden (Gustavson, Hagberg, Hagberg, & Sars, 1977a, b; Gustavson, Holmgren, Jonsell, & Bromquist, 1977c) may be of interest. The children concerned were born in the period 1959-1970, that is, just before the gradual introduction in Sweden of prenatal diagnosis and other measures to prevent congenital disorders and during a period when there was a decrease in perinatal mortality.

A new polarized headlight system

This paper discusses the basis of a polarized headlight system proposed for introduction in Sweden. Earlier work is reviewed briefly. Proposals for introducing the system are given and related to the relevant experimental studies; the equipment needed and its use in various traffic situations are described. Methods for overcoming problems inevitable in the transition period are outlined and the further researches necessary are listed.