Swedish Families Research Articles

Comprehensive counseling about combined hormonal contraceptives changes the choice of contraceptive methods: results of the CHOICE program in Sweden

To study the influence of counseling on women's contraceptive decisions. A cross-sectional multicenter study. Seventy Swedish family planning clinics. Women aged 15-40 years attending for a contraceptive consultation who expressed interest in a combined hormonal contraceptive (CHC) method. Structured counseling about three CHCs and questionnaires completed after counseling from the healthcare professional. Method originally requested, perceptions of CHC attributes, method chosen and reasons for the choice. In all, 173 healthcare professionals and 1,944 women participated. The mean standard deviation (SD) age of the women was 22.6(6.1) years. After structured counseling, a majority of women (56.0%; n=1 069; 95% confidence interval (CI) 53.1-58.9) chose the daily pill, 6.2% (n=118; 95% CI 4.9-7.8) chose the weekly patch, and 22.5% (n=430; 95% CI 20.2-25.1) chose the monthly ring. The weekly patch was chosen more often after counseling (6.2 vs 2.4% before counseling; p<0.0001). The greatest change was in the proportion of women who chose the contraceptive ring after counseling (22.5% vs. 8.5% before counseling; p<0.0001). The proportion of undecided women after counseling was reduced considerably (3.9% vs. 27.8% before counseling). Among the 523 women who were undecided before counseling, 50.6% chose the pill, 10.2% the patch and 24.6% the ring, while 20.9% of women who initially requested the pill changed to another method. Structured counseling facilitated choice of contraceptive method for most women, leading to changes in women's selection of a CHC method.

Stress, Coping, Adaptation, and Resilience in Swedish and American Families

Stress, Coping, Adaptation, and Resilience in Swedish and American Families

Child health care uptake among low‐income and immigrant families in a Swedish county

To study the uptake of child health care among low-income and immigrant families in the county of Uppsala, Sweden, to investigate whether these families received extra attention as proposed in the Swedish Child Health Services (CHS) state-of-the-art consensus document from the year 2000. Data were collected for 25,024 infants born 1998-2006 from the database of statistics of the Child Health Care Unit in Uppsala and socio-demographic indicators from Swedish national registers. Disposable income was divided into quartiles. Country of birth of the mother was categorized into four regions with two subgroups each, mothers with or without a Swedish-born partner. Analysis was conducted by Cox regression and linear regression models. Small differences between Swedish vs. immigrant and high vs. low-income families were detected. Low-income mothers (RR 0.78) as well as mothers born in all country of birth regions with an immigrant partner (RR 0.28-0.95) had lower rates of participation in parental groups. The CHS provided basic child health care to almost all infants including children in immigrant and low-income Swedish families. However, the results did not indicate that disadvantaged families received the extra attention proposed in the consensus document.

Family Policy and Shared Parenting in Nordic Countries

Increasing diversity in patterns of responsibility for the raising of children in families has presented serious challenges for welfare states. More complex family ties raise questions about the types of responsibility and obligation that should follow from different forms of private relationship, and the role the welfare state should play in governing family life. In this article, we compare how family policies in Finland, Norway and Sweden define parental responsibilities for supporting a child when its parents do not live together. We are particularly interested in whether the principle of Nordic family policy, shared parenting, operates when parents do not live together but raise their child together. Do parents have an opportunity, for example, to share family policy benefits, and if they have, what are the conditions under which this can be realised? Comparative examination shows variation between the logistics of Nordic family policies. Norwegian and Swedish family policy systems are flexible, and family policy there enables parents to share benefits in a way that supports shared residential arrangements. In Finland, however, the situation of parents living apart but sharing the daily care of their child has been given insufficient attention and family policy has still not been developed.

Marked accumulation of 27-hydroxycholesterol in the brains of Alzheimer's patients with the Swedish APP 670/671 mutation

There is a significant flux of the neurotoxic oxysterol 27-hydroxycholesterol (27OHC) from the circulation across the blood-brain barrier. Because there is a correlation between 27OHC and cholesterol in the circulation and lipoprotein-bound cholesterol does not pass the blood-brain barrier, we have suggested that 27OHC may mediate the effects of hypercholesterolemia on the brain. We previously demonstrated a modest accumulation of 27OHC in brains of patients with sporadic Alzheimer's disease (AD), consistent with a role of 27OHC as a primary pathogenetic factor. We show here that there is a 4-fold accumulation of 27OHC in different regions of the cortexes of patients carrying the Swedish amyloid precursor protein (APPswe) 670/671 mutation. The brain levels of sitosterol and campesterol were not significantly different in the AD patients compared with the controls, suggesting that the blood-brain barrier was intact in the AD patients. We conclude that accumulation of 27OHC is likely to be secondary to neurodegeneration, possibly a result of reduced activity of CYP7B1, the neuronal enzyme responsible for metabolism of 27OHC. We discuss the possibility of a vicious circle in the brains of the patients with familial AD whereby neurodegenerative changes cause an accumulation of 27OHC that further accelerates neurodegeneration.

Familial risk factors shared by venous thromboembolism and cancer: A nationwide epidemiological study of Swedish families

Background Cancer and venous thromboembolism (VTE) are associated disorders. In the present nationwide study, we analyzed the risk of cancer in siblings, offspring and spouses of individuals hospitalized for VTE (and vice versa) with the aim of identifying shared familial risk factors for cancer and VTE. Material and Methods The Multigeneration Register was linked to the Swedish Hospital Discharge Register and the Swedish Cancer Registry. Associations between the familial risks for VTE and cancer were examined by measuring the risk of developing specific cancers in the offspring of individuals diagnosed with VTE, and the risk of VTE in the offspring of individuals diagnosed with specific cancers. The analysis was repeated for siblings and spouses. Results No overall associations between cancer and VTE were observed in parent-offspring pairs. In contrast, the risk of cancer was slightly increased in siblings of VTE patients (OR 1.03, 95% CI 1.01-1.06), and the risk of VTE was also increased in siblings of cancer patients (OR 1.07, 95% CI 1.04-1.10). Risks of cancer were also slightly increased in the husbands (OR 1.09, 95% CI 1.07-1.11) and wives (OR 1.02, 95% 1.00-1.05) of individuals with VTE. Conclusion The present study provides evidence for minor familial risk factors shared by VTE and common cancers. These could be mostly environmental because of the positive associations in the spouse and sibling analyses and negative associations in the parent-offspring analysis, although the possibility of shared genetic risk factors also exists.

Swedish Family Policy – Continuity and Change in the Nordic Welfare State Model

AbstractThe main question addressed in this regional issue is whether or not the Nordic welfare states can still be considered a distinct welfare regime cluster given recent changes, such as the introduction of more private elements into the welfare state. The Nordic welfare states are often described as emphasizing full employment, economic and gender equality, and universal access to cradle‐to‐grave welfare state benefits and services. In the case of Sweden, often pointed to as the model of a social democratic welfare state, such elements remain intact in most aspects of the welfare state, even given the challenges presented by the global neo‐liberal economic paradigm since the 1970s. One way to determine whether or not the Nordic welfare states remain a distinct cluster is to provide an in‐depth examination of various welfare state policies in each Nordic country. To contribute to this analysis, an investigation of family policy in the Swedish context will be provided. Even given recent challenges, such as the introduction of private for‐profit childcare providers and a home care allowance, I argue that Swedish family policy has remained largely social democratic in its underlying goals, and thus acts to support the case for a distinct Nordic welfare regime cluster.

Ovarian cancer linked to lynch syndrome typically presents as early-onset, non-serous epithelial tumors

Objective Heredity is a major cause of ovarian cancer and during recent years the contribution from germline mismatch repair (MMR) gene mutations linked to Lynch syndrome has gradually been recognized. Methods We characterized clinical features, tumor morphology and mismatch repair defects in all ovarian cancers identified in Swedish and Danish Lynch syndrome families. Results In total, 63 epithelial ovarian cancers developed at mean 48 (range 30–79) years of age with 47% being early stage (FIGO stage I). Histologically, endometrioid (35%) and clear cell (17%) tumors were overrepresented. The underlying MMR gene mutations in these families affected MSH2 in 49%, MSH6 in 33% and MLH1 in 17%. Immunohistochemical loss of the corresponding MMR protein was demonstrated in 33/36 (92%) tumors analyzed. Conclusion The combined data from our cohorts demonstrate that ovarian cancer associated with Lynch syndrome typically presents at young age as early-stage, non-serous tumors, which implicates that a family history of colorectal and endometrial cancer should be specifically considered in such cases.

Activity contracts and directives in everyday family politics

In theorizing on family life, children’s agency is a feature of a modern type of family, marked by free choice and inter-generational negotiations rather than parental authority. A video ethnography of Swedish everyday family life documents directive sequences and inter-generational negotiations, including what is here called activity contracts: agreements that form a type of inter-generational account work around target activities (e.g. cleaning one’s room). Within local family politics, contracts and revised contracts emerge as parts of such account work. The analyses focus on how contracts emerge within successive downgradings and upgradings of parental directives. Activity contracts regulate mutual rights and obligations, invoking family rule statements and local moral order, drawing on an array of verbal and nonverbal resources, ranging from parents’ mitigated requests and children’s time bargaining to nonverbal escape strategies and gentle shepherding.

HLA-DRB1*04 is a novel fetal susceptibility allele in congenital heart block

ObjectiveCongenital heart block may develop in the fetus of Ro52 autoantibody positive women. The reported recurrence rate for autoantibody associated congenital heart block is however only 10–25%, indicating that other...

Incidence and mortality in epithelial ovarian cancer by family history of any cancer

Practically all data on familial risk in ovarian and other cancers are based on incident cancer, whereas familiality in cancer mortality is largely unknown. If fatal forms of cancer are a highly familial subtype, then familial risk for mortality may exceed that of incidence, which is relevant for clinical decision making and counseling. Ovarian cancer patients in the nationwide Swedish Family Cancer Database were classified according to fatal and nonfatal (incident) family history. Familial risks for incident and fatal ovarian cancer were calculated for offspring based on their parental or sibling family history of any cancer using standardized incidence ratios (SIRs) for incidence and standardized mortality ratios (SMRs) for mortality. Offspring without family history were referents. The database included 24,757 mothers and 8138 daughters with ovarian cancer. When a mother had ovarian cancer, the SIR for incident ovarian cancer in daughters was 2.69, and when a sister had ovarian cancer it was 3.49. The SMRs for fatal cancer by fatal cancer in probands were 3.39 and 5.80, respectively. For fatal serous cancers among siblings, the SMR was 6.16, compared with 10.01 for the endometrioid type. Ovarian cancer was associated with maternal (SIR, 1.22; SMR, 1.56) and sororal breast cancer (SIR, 1.27). Another discordant association was between ovarian and paternal prostate cancer (SIR, 1.12; SMR, 1.66). Fatal familial risks were higher for concordant ovarian, ovarian-breast, and ovarian-prostate cancers than the corresponding incident risks. This may suggest that highly fatal subtypes exist for these cancers, calling for genetic dissection.

Esophageal cancer risk among immigrants in Sweden

Esophageal squamous cell carcinoma is linked to alcohol drinking, whereas esophageal adenocarcinoma risk is increased by overweight and obesity. Both histologies are directly related to tobacco smoking. We wanted to define the risk of esophageal cancer by histology and length of stay among immigrants in Sweden. The nationwide Swedish Family Cancer database (2010 version: data on cancers originate from the nationwide Swedish Cancer Registry) was used to calculate standardized incidence ratios (SIRs) for esophageal cancer among immigrants compared with the native Swedes. SIRs for lung cancer were also calculated as a proxy for smoking prevalence. The patient series covered 5930 male and 1998 female Swedes, and 410 and 198 immigrants. The risk of esophageal cancer was increased in female Finns (SIR=1.66), Britons (3.73), and Southeast Africans (5.26), whereas male Baltic (0.44), former Yugoslavian (0.47), other Europeans (0.58), and other Asians (0.52) showed a decreased risk. The risk of squamous cell carcinoma was increased among Finns (men=1.32, women=1.90) and Iranian women (3.80), whereas Danish men (1.66) had an increased risk of adenocarcinoma. No trend was observed for the risks in immigrants according to the length of stay. We found no covariation between the birth region-specific SIRs for squamous cell carcinoma and lung cancer. Early childhood exposures or preservation of original habits might be the main environmental exposures influencing squamous cell carcinoma risks in some immigrants. The increased risk of adenocarcinoma among Danish men may confirm the role of obesity in adenocarcinoma risk.

Identification of an AluY‐mediated deletion of exon 5 in the CPOX gene by MLPA analysis in patients with hereditary coproporphyria

Hereditary coproporphyria (HCP) is an autosomal dominantly inherited hepatic porphyria, caused by a mutation in the coproporphyrinogen oxidase (CPOX) gene. The genetic defect leads to a partial defect of CPOX, the sixth enzyme involved in haem biosynthesis. Affected individuals can develop acute life-threatening attacks of neurovisceral symptoms and/or more rarely cutaneous symptoms such as skin fragility and blistering. The identification of the genetic defect in HCP families is of crucial importance to detect the carrier status which allows counselling to prevent possible triggering factors, e.g. certain drugs, alcohol, or fasting. In a total of nine Swedish HCP families, routine gene sequence analysis had identified a causative mutation in only five. In the present study, using an in-house developed synthetic probe set for multiplex ligation-dependent probe amplification (MLPA) analysis, we detected a deletion of the fifth exon in the CPOX gene in the remaining four families. The deletion is 3381 bp in size and has originated by an Alu-mediated mechanism. This finding emphasizes the usefulness of MLPA analysis as a complement to gene sequencing for comprehensive genetic diagnostics in HCP patients.

A large deletion identified in a Swedish family with type 1 VWD

A large deletion identified in a Swedish family with type 1 VWD

スウェーデンの家族変容

本稿では，スウェーデンにおける家族の変容を(1)統計データ，(2)異性カップルおよび同性カップルの共同生活の実態，(3)離別後の養育の側面から，既存の実証研究をもとに探究する．スウェーデンでは，1960年代後半から家族政策が，女性と男性の二重の解放を意味するジェンダー平等を土台にして，政府主導で推進される．その政策では，父性が強調され，父親の育児休業取得が奨励される．また，共同生活やジェンダーに対する中立性の原則に基づき家族法が改正され，同性カップルの親になる権利や同性婚も法的に認められる．その後，「子どもの最善の利益」が家族政策においても最優先すべきとされる．共働き家族は一般的になるが，しかし現在でも，家族政策の民主的家族の目標は，不平等な家事・育児の分担，「父親の権利」と「母親の義務」となっている不平等な親性，子どもの保護よりも父子関係の優先など，現実の家族生活において部分的にしか実現されていない．

Proactive and reactive plots: narratives in entrepreneurial identity construction

PurposeThe purpose of this paper is to offer a new perspective on entrepreneurial identity as a narrative construction, emerging in stories about entering the family business.Design/methodology/approachThe qualitative methodological approach involves an interpretative analysis of transcribed interviews conducted in narrative style with 12 women from Swedish family businesses.FindingsBy presenting entrepreneurial identity as a combination of two distinct narratives, the “passive” entrance into the family business is highlighted. The “Pippi Longstocking” narrative illustrates conscious choices, drive and motivation based on an entrepreneurial identification: the proactive plot. The “Alice in Wonderland” narrative on the other hand, illustrates women who happen to become entrepreneurs or business persons because the family business was there: the reactive plot. The contrasting and complementing narratives illustrate ambiguities in the identity process.Practical implicationsThe authors identified the following opportunities for women in family business: the family business can offer easy access to a career and on‐the‐job learning opportunities; education in other areas can be useful when learning how to manage and develop the family business; and the family business offers a generous arena for pursuing a career at different life stages. Implications for education as well as for policy makers are also presented.Originality/valueThe narratives presented are given metaphorical names with the intention to evoke the reader's reflection and reasoning by analogy, which can lead to new insights. The use of metaphors illustrates multiple layers and ambiguities in identity construction. Metaphors can also create awareness of the researcher as a co‐creator of knowledge.

Attributions and Attitudes of Mothers and Fathers in Sweden

SYNOPSIS Objective. The present study examined mean level similarities and differences as well as correlations between mothers' and fathers' attributions regarding successes and failures in caregiving situations and progressive versus authoritarian attitudes. Design. Interviews were conducted with mothers and fathers in 77 Swedish families. Results. Fathers reported higher adult-controlled failure and child-controlled failure attributions than did mothers; these differences remained significant after controlling for parents' age, education, and possible social desirability bias. Significant positive correlations were found for mothers' and fathers' progressive attitudes, authoritarian attitudes, and modernity of attitudes after controlling for parents' age, education, and possible social desirability bias. Conclusions. In Sweden, fathers are more likely to attribute failures in caregiving situations to themselves and to children than are mothers, and there is moderate concordance between fathers and mothers within the same family in progressive and authoritarian parenting attitudes.

The Baron's complaint

The Baron's complaint

Family links of eating behaviour in normal weight and overweight children

To map parent-child associations for eating behaviours including both parents and considering body size and sex as moderators. In this study 1258 Swedish families (mother, father and their 12-year-old child) had eating behaviour measured by the Dutch Eating Behaviour Questionnaire covering restrained, emotional and external eating. Most parent-child associations for eating behaviours were significant in relation to the mother and the father. The strongest associations were seen for external eating. Overweight children had a stronger parental link for external eating than normal weight children, and higher levels of restrained eating. The only moderating effect seen for the child's sex was a stronger mother-son link for external eating in normal weight boys. Girls had higher levels of restrained eating, and boys had higher levels of external eating. Most family links for eating behaviour in pre-adolescents are seen in relation to both parents and for daughters and sons alike. In particular, eating in response to external food cues is most strongly shared by parents and children, and overweight children are more likely to adopt their parents' external eating.

Origin of the Swedish long QT syndrome Y111C/KCNQ1 founder mutation

The Y111C/KCNQ1 mutation causes a dominant-negative effect in vitro but a benign clinical phenotype in a Swedish long QT syndrome population. The purpose of this study was to investigate the origin (genealogic, geographic, genetic, and age) of the Y111C/KCNQ1 mutation in Sweden. We identified 170 carriers of the Y111C/KCNQ1 mutation in 37 Swedish proband families. Genealogic investigation was performed for all families. Haplotype analysis was performed in 26 probands, 21 family members, and 84 healthy Swedish controls, using 15 satellite markers flanking the KCNQ1 gene. Mutation age was estimated using ESTIAGE and DMLE computer software and regional population demographic data. All probands were traced back to a northern river valley region. A founder couple born in 1605/1614 connected 26 of 37 families. Haplotyped probands shared 2-14 (median 10) uncommon alleles, with frequencies ranging between 0.01 and 0.41 (median 0.16) in the controls. The age of the mutation was estimated to 24 generations (95% confidence interval 18; 34), that is, 600 years (95% confidence interval 450; 850) assuming 25 years per generation. The number of now living Swedish Y111C mutation carriers was estimated to approximately 200-400 individuals for the mutation age span 22-24 generations and population growth rates 25%-27%. The Y111C/KCNQ1 mutation is a Swedish long QT syndrome founder mutation that was introduced in the northern population approximately 600 years ago. Enrichment of the mutation was enabled by a mild clinical phenotype and strong regional founder effects during population development of the northern inland. The Y111C/KCNQ1 founder population constitutes an important asset for future genetic and clinical studies.