Sickness absence at a young age and later sickness absence, disability pension, death, unemployment and income in native Swedes and immigrants.

BACKGROUND: Sickness absence with cash benefits from the sickness insurance gives an opportunity to be relieved from work without losing financial security. There are, however, downsides to taking sickness absence. Periods of sickness absence, even short ones, can increase the risk for future spells of sickness absence and unemployment. The sickness period may in itself have a detrimental effect on health. The aim of the study was to investigate if there is an association between exposure to sickness absence at a young age and later sickness absence, disability pension, death, unemployment and income from work. METHODS: Our cohort consisted of all immigrants aged 21-25 years in Sweden in 1993 (N = 38 207) and a control group of native Swedes in the same age group (N = 225 977). We measured exposure to sickness absence in 1993 with a follow-up period of 15 years. We conducted separate analyses for men and women, and for immigrants and native Swedes. RESULTS: Exposure to ≥60 days of sickness absence in 1993 increased the risk of sickness absence [hazard ratio (HR) 1.6-11.4], unemployment (HR 1.1-1.2), disability pension (HR 1.2-5.3) and death (HR 1.2-3.5). The income from work, during the follow-up period, among individuals with spells of sick leave for ≥60 days in 1993 was around two-thirds of that of the working population who did not take sick leave. CONCLUSIONS: Individuals on sickness absence had an increased risk for work absence, death and lower future income.

Unemployment at a young age and later sickness absence, disability pension and death in native Swedes and immigrants.

BACKGROUND: Youth unemployment is an increasing problem for societies around the world. Research has revealed negative health effects of unemployment, and this longitudinal register-based cohort study examined the relationship between unemployment and later sickness absence, disability pension and death among youth in Sweden. METHOD: The study group of 199,623 individuals comprised all immigrants born between 1968 and 1972 who immigrated before 1990 (25,607) and a random sample of native Swedes in the same age-range (174,016). The baseline year was 1992, and the follow-up period was from 1993 to 2007. Subjects with unemployment benefit in 1990-91, disability pension in 1990-92, severe disorders leading to hospitalization in 1990-92 and subjects who emigrated during follow-up were excluded. RESULTS: Those who were unemployed in 1992 had elevated risk of ≥60 days of sickness absence (OR 1.02-1.49), disability pension (HR 1.08-1.62) and all except native Swedish women had elevated risk of death (HR 1.01-1.65) during follow-up compared with non-unemployed individuals. The risk of future sickness absence increased with the length of unemployment in 1992 (OR 1.06-1.54), and the risk of sickness absence increased over time. A larger part of the immigrant cohort was unemployed at baseline than native Swedes. Selection to unemployment by less healthy subjects may explain part of the association between unemployment and the studied outcomes. CONCLUSION: Unemployment at an early age may influence the future health of the individual. To a society it may lead to increased burdens on the welfare system and productivity loss for many years.

Overqualification at work and risk of hospitalization for psychiatric and somatic diseases among immigrants in Sweden - a prospective register-based study.

OBJECTIVES: This study aimed to (i) describe the prevalence of overqualification at work among immigrants in Sweden and (ii) analyze any association between overqualification and the risk of hospitalization for somatic and psychiatric disease among refugees and labor immigrants. METHODS: We performed a prospective register study in a cohort of 120 339 adults who immigrated to Sweden in 1991-2005 and were employed in 2006. Education-occupation status was defined as the combination of an individual's highest level of education and their occupation skill level. Individuals were followed from 2007 to 2016 with regard to hospitalization for a psychiatric, cardiovascular, respiratory or musculoskeletal disease or diabetes. Hazard ratios (HR) with 95% confidence intervals (CI) were calculated in a multivariate Cox regression analysis adjusted for age, gender, reason for residence and duration of residence. RESULTS: The overall prevalence of overqualification among immigrants with an academic education was 39%. Overqualified individuals had an increased risk of hospitalization for any disease (HR 1.33, 95% CI 1.21-1.46) compared to "job-matched with an academic education". However, the risk estimates were lower than that of "job-matched with no academic education" (HR 1.56, 1.46-1.68). The increased risk of hospitalization for a psychiatric disease of overqualified individuals did not differ from that of job-matched with no academic education. CONCLUSION: Our study showed that being overqualified was associated with poorer health outcomes than job-matched individuals with an academic education. Considering the high prevalence of overqualification in immigrants, this constitutes a concern, for both society and individuals.

Predictors of post-COVID-19 and the impact of persistent symptoms in non-hospitalized patients 12 months after COVID-19, with a focus on work ability.

Background: Better knowledge of long-term symptoms following coronavirus disease 2019 (COVID-19), the so-called post-COVID-19, in non-hospitalized patients is needed. The aim of this study was to study persisent symptoms up to 12 months after COVID-19 in non-hospitalized patients and their impact on work ability. We also investigated predictors of persistent symptoms. Methods: This study encompassed non-hospitalized adult subjects with a COVID-19 infection confirmed via positive nasopharyngeal swab polymerase chain reaction test during the first wave of the pandemic in Uppsala, Sweden. In total, 566 subjects were sent a survey via e-mail or post with an invitation to participate in the survey 12 months post-diagnosis. The majority of subjects were healthcare workers, as this group was prioritized for testing. Results: A total of 366 subjects responded, with 47% reporting persistent symptoms 12 months after their COVID-19 diagnosis. The most commonly reported symptoms at this time were impaired sense of smell and/or taste and fatigue. Among the predictors of persistent symptoms were being born abroad, lower physical fitness compared with peers before COVID-19, body mass index >25 kg/m2, cooccurrence of hypertension and chronic pain, and having more than seven of the general COVID-19 symptoms at the onset. Respondents with symptoms after 12 months self-reported negatively about their general health and work ability. Conclusions: This study indicated that many people who had mild COVID-19 might have a variety of long-term symptoms. It highlights the importance of considering work ability after mild COVID-19.

Patterns and predictors of sick leave among Swedish non-hospitalized healthcare and residential care workers with Covid-19 during the early phase of the pandemic.

Healthcare and residential care workers represent two occupational groups that have, in particular, been at risk of Covid-19, its long-term consequences, and related sick leave. In this study, we investigated the predictors of prolonged sick leave among healthcare and residential workers due to non-hospitalized Covid-19 in the early period of the pandemic. This study is based on a patient register (n = 3209) and included non-hospitalized healthcare or residential care service workers with a positive RT- PCR for SARS-CoV-2 (n = 433) between March and August 2020. Data such as socio-demographics, clinical characteristics, and the length of sick leave because of Covid-19 and prior to the pandemic were extracted from the patient's electronic health records. Prolonged sick leave was defined as sick leave ≥ 3 weeks, based on the Swedish pandemic policy. A generalized linear model was used with a binary distribution, adjusted for age, gender, and comorbidity in order to predict prolonged sick leave. Of 433 (77% women) healthcare and residential care workers included in this study, 14.8% needed longer sick leave (> 3 weeks) due to Covid-19. Only 1.4% of the subjects were on sick leave because of long Covid. The risk of sick leave was increased two-fold among residential care workers (adjusted RR 2.14 [95% CI 1.31-3.51]). Depression/anxiety (adjusted RR 2.09 [95% CI 1.31-3.34]), obesity (adjusted RR 1.96 [95% CI 1.01-3.81]) and dyspnea at symptom onset (adjusted RR 2.47 [95% CI 1.55-3.92]), sick leave prior to the pandemic (3-12 weeks) (adjusted RR 2.23 [95% CI 1.21-4.10]) were associated with longer sick leave. From a public health perspective, considering occupational category, comorbidity, symptoms at onset, and sick leave prior to the pandemic as potential predictors of sick leave in healthcare may help prevent staff shortage.

Grade of left main coronary artery stenosis does not influence long-term mortality after coronary artery bypass surgery.

OBJECTIVE: To assess if grade of left main coronary artery (LMCA) stenosis influences early or long-term mortality after coronary artery bypass grafting (CABG). DESIGN: Among all 1 384 patients with LMCA stenosis at Karolinska Hospital, Stockholm, Sweden during 1990-1999, 131 deaths occurred within 5 years of surgery (cases). Matched controls (n=146) were randomly selected from all surviving LMCA patients taking gender, age and year of surgery into account. Angiographies were classified for grade of LMCA stenosis before the operation. RESULTS: High-grade LMCA stenosis was equally common among cases and controls (50 vs. 45%). The odds ratio (OR) of mortality 5 years after the operation in patients with high-grade versus low-grade LMCA stenosis based on the matched pairs was 1.2 (95% confidence interval (CI) 0.7-2.0) and after multivariable adjustment using information on all subjects the OR was 1.0 (95% CI 0.6-1.7). For early and one year mortality similar odds ratios were observed but with wide confidence intervals. CONCLUSIONS: Grade of LMCA stenosis does not appear to influence early or long-term mortality after CABG performed during 1990-1999.

Elevated glycosylated haemoglobin (HbA1c) is a risk marker in coronary artery bypass surgery.

OBJECTIVE: To evaluate if glycosylated haemoglobin 1 (HbA1c) was associated with increased risk of infection and mortality after coronary artery bypass grafting (CABG). DESIGN: Prospective observational study. Preoperative HbA1c concentrations were correlated to outcome in patients followed for an average of 3.5 years after CABG. RESULTS: HbA1c was > or =6% in 68% of 161 patients with diabetes mellitus (DM) and in 3% of 444 patients without DM. Superficial sternal wound infection was observed in 13.9% if HbA1c > or =6% versus in 5.5% if <6% (p=0.007). Mediastinitis occurred in 4.9% if HbA1c > or =6% and in 2.1% if HbA1c <6% (p=0.20) (Hazard ratio (HR) 1.9, 95% CI 0.6-5.9). Follow-up mortality was 18.9% in patients with HbA1c > or =6% compared to 4.1% if HbA1c <6% (p<0.001) with HR 5.4, (95% CI 3.0-10.0) after multivariable adjustment. The risk of death was similar regardless of DM diagnosis. CONCLUSIONS: HbA1c > or =6% was associated with an increased risk of postoperative superficial sternal wound infections and a trend for higher mediastinitis rate and significantly higher mortality three years after CABG.

A supportive climate and low strain promote well-being and sustainable working life in the operation theatre.

BACKGROUND: Shortage of health-care workers e.g. in operating theatres is a global problem. A shortage of staff negatively affects patient outcomes, making it important to keep the employees from quitting. The aim of this survey was to study if well-being, zest for work, and thoughts about leaving work in an operating theatre can be related to the psychosocial work environment, as described by the job demand-control-support (JDCS) model. METHODS: A questionnaire was provided to personnel in operating theatres of seven Swedish hospitals (n = 1405, with a response rate of 68%) that included the JDCS model, personal factors, work ability, well-being, zest for work, and thoughts about leaving their position. Ordinal scale regression was used for analyses. RESULTS: A majority reported moderate to high zest for work (76%). A minority (30%) had sometimes thought during at least one month in the last year of leaving their position. Lower social support scores and high demands together with low control (high-strain) scores were related to lower well-being, lower zest for work, and more thoughts about leaving the position. Anaesthetists scored in the low-strain field, nurse anaesthetists and assistant nurses in the passive field, and operating nurses in the active field, in comparison to all personnel. CONCLUSION: According to the JDCS model, both lower social support and high strain were related to lower well-being and negative thoughts about the position. Social support scores were about the same for different occupational groups in the operating theatre, and no occupation scored on average in the high-strain field.

Risk of death or acute myocardial infarction 10 years after coronary artery bypass surgery in relation to type of diabetes.

BACKGROUND: The aim of this study was to assess the long-term risk of death or acute myocardial infarction (AMI) in patients with diabetes mellitus (DM) compared with that in patients without DM after coronary artery bypass grafting (CABG). METHODS: National registers were used to record death or AMI occurring in 6727 patients who had CABG during 1980 to 1995. Diabetes mellitus in 856 patients (13%) was classified as type 1 (6%) or type 2 treated with insulin (29%), oral drugs (46%), or diet (19%). RESULTS: The risk of death < or = 30 days of the operation was increased in patients with insulin-treated type 2 DM (odds ratio [OR] 4.6, 95% CI 2.5-8.4) and in those on oral antidiabetic drugs (OR 2.0, 95% CI 1.0-3.8), but not in diet-treated diabetic patients, compared with that in patients without diabetes. At 10 years, the relative risk of death or having an AMI was 1.8 (95% CI 1.5-2.2) in insulin-treated patients and 1.4 (95% CI 1.2-1.7) in patients on oral drugs. No increased risk of late death or AMI was observed in diet-treated patients with diabetes compared with patients without diabetes. Survival at 10 years without an AMI was 40% in insulin-treated type 2 diabetic patients, 48% if on oral drugs, and 59% if diet managed, compared with 66% in nondiabetic patients. CONCLUSION: Type 2 DM requiring insulin treatment or oral antidiabetic drugs is associated with an increased early and long-term risk of death or AMI after CABG, whereas diet-treated patients have a risk similar to that in patients without diabetes.

Working conditions, serotonin transporter gene polymorphism (5-HTTLPR) and anxiety disorders: a prospective cohort study.

BACKGROUND: The etiology and pathology of anxiety disorders involve both genetic and environmental influences. Adverse working conditions may contribute to the development of anxiety. The serotonin transporter-linked polymorphic region (5-HTTLPR) has been implicated in stress sensitivity. Therefore, we investigated the potential interplay between 5-HTTLPR and job-related risk factors in the prediction of the occurrence of anxiety. METHODS: We conducted a prospective study using the first two waves of a Swedish population-based cohort. At Wave I, 1585 individuals without anxiety, depression or dysthymia who were active in the labor market during both waves were included. Information on job demands, skill discretion, decision authority and social climate was collected at Wave I. After a three year interval, the presence of anxiety disorders was determined at Wave II. All 1585 participants were genotyped for 5-HTTLPR. Both additive and multiplicative models were considered in examining the potential interaction between 5-HTTLPR and adverse working conditions on the development of anxiety. RESULTS: Anxiety was associated with high job demands but not with 5-HTTLPR. An interaction was observed between 5-HTTLPR and high job demands among females. Individuals with 5-HTTLPR high expression genotype (LL) developed anxiety disorders more frequently when exposed to high job demands compared to 'LS/SS' carriers. LIMITATIONS: A limited number of participants developed anxiety. CONCLUSIONS: High job demands predict the development of anxiety. The 5-HTT polymorphism has a moderating effect on the relationship between high job demands and anxiety among females.

Country of birth-specific and gender differences in prevalence of diabetes in Sweden.

OBJECTIVE: The aim was to investigate country or region of birth-specific prevalence and gender differences of diabetes in residents in Sweden, using Swedish-born men and women as referent. METHODS: The Apolipoprotein MOrtality RISk (AMORIS) cohort was used (184,000 men and 151,453 women) aged between 20 and 80 years, with data from the CALAB laboratory, Stockholm, 1985-1996. Diabetes was defined as fasting glucose ≥ 7.0 mmol/L or a hospital diagnosis of diabetes. Country of birth was obtained by linkage to Swedish Censuses 1970-1990. Standardized prevalence rate ratios (SPRR) with 95% confidence intervals (95% CI) were estimated. RESULTS: Five groups of women and one group of men had a significantly higher prevalence than Swedish-born (based on SPRR): women born in Iraq (6.0 (95% CI 1.3-28.9)), North Africa (6.9 (95% CI 3.1-15.3)), South Asia (3.1 (95% CI 1.0-10.0)), Syria (5.3 (95% CI 1.8-16.0)), Turkey (3.7 (95% CI 1.2-10.9)) and men born in other Middle Eastern countries (2.3 (95% CI 1.0-5.5)). Swedish-born men had a higher age-standardized prevalence of diabetes (3.9%) than Swedish born women (2.5%). A higher prevalence among men was also seen in other Western countries. In contrast, a higher age-standardized prevalence among women was observed in immigrants from Turkey (8.9% vs. 3.1%, p<0.001), Syria (13.1% vs. 4.0%, p=0.002), and North Africa (16.8% vs. 6.6%, p<0.001). CONCLUSION: Female immigrants to Sweden from Iraq, North Africa, South Asia, Syria, and Turkey have an increased prevalence of diabetes of substantial public health concern.

Dyslipidemia is a strong predictor of myocardial infarction in subjects with chronic kidney disease.

AIM: To evaluate dyslipidemia as predictor of myocardial infarction (MI) in subjects with or without chronic kidney disease (CKD). METHODS: In 142,394 middle-aged Swedes referred for laboratory evaluation, glomerular filtration rates (GFR) were estimated using the Modification of Diet in Renal Disease study equation. CKD was defined as GFR 15-60 mL/min/1.73 m(2). Subjects were stratified into presence or absence of CKD, and lipid measures were related to MI using Cox's proportional hazards regression. RESULTS: During 12 years of follow-up there were 5,466 MIs. The adjusted hazard ratio for MI for the highest versus the lowest quartile of the apolipoprotein (apo) B/apoA-1 ratio among individuals without CKD was 2.88 (95% confidence interval 2.54-3.26) and for those with CKD 3.35 (2.25-4.91). The corresponding estimates for the total cholesterol/high-density lipoprotein (HDL) cholesterol ratio were 3.13 (2.78-3.52) and 3.54 (2.43-5.17), respectively. Receiver operator characteristics analyses showed an advantage in the prediction of MI for the apoB/apoA-1 ratio as compared to conventional lipids (P < 0.0001). CONCLUSIONS: The ratio of apoB/apoA-1, the ratio of total cholesterol/HDL cholesterol, and non-HDL cholesterol were all strong predictors of myocardial infarction, both among subjects with and without renal dysfunction, with a possible advantage for the apoB/apoA-1 ratio.

Improved survival after coronary artery bypass grafting has not influenced the mortality disadvantage in patients with diabetes mellitus.

OBJECTIVES: We sought to compare mortality after coronary artery bypass grafting in patients with and without diabetes mellitus undergoing operations during different time periods. METHODS: We performed analyses of 12,415 primary isolated coronary artery bypass grafting operations performed during 1970-2003, with follow-up of 5-year mortality up to December 2006. RESULTS: The prevalence of diabetes mellitus continuously increased up to 25% among patients undergoing coronary artery bypass grafting in 2003. The 1892 patients with type 2 diabetes mellitus were older, more often female, and more frequently had cardiovascular risk factors, acute coronary syndrome, 3-vessel disease, and severely reduced left ventricular function than patients without diabetes mellitus. Early mortality was 3.4% in patients with diabetes mellitus versus 1.8% in patients without diabetes mellitus. The multivariable adjusted odds ratio was 2.0, and the 95% confidence interval was 1.4 to 2.7. Early adjusted mortality was significantly lower in patients operated on during 2000-2003 than those operated on during 1970-1989 in patients with diabetes mellitus (odds ratio, 0.3; 95% confidence interval, 0.1-0.9) and without diabetes mellitus (odds ratio, 0.4; 95% confidence interval, 0.2-0.7). Mortality until 5 years was 14.6% in patients with diabetes mellitus versus 8.3% in patients without diabetes mellitus (hazard ratio, 1.8; 95% confidence interval, 1.5-2.0). Five-year mortality was reduced by 40% in patients operated on during 2000-2003 compared with that seen in those operated on during 1970-1989 in patients with and without diabetes mellitus. CONCLUSIONS: Diabetes mellitus was associated with an almost 2-fold increased risk of early and 5-year mortality. Early and late mortality were substantially reduced in patients with and without diabetes mellitus operated on more recently, but the mortality disadvantage associated with diabetes mellitus was not eliminated.

Cervical, endometrial and ovarian cancers among immigrants in Sweden: importance of age at migration and duration of residence.

In order to compare the risk of gynaecologic cancer among foreign-born women to the risk among those born in Sweden and to elucidate risk of cancer in relation to age at migration and duration of residence, we followed a cohort of 5.3 million women between 1969 and 2004 in Sweden. Through linkage with the national cancer register, we estimated cancer risk as rate ratios (RRs) with 95% confidence intervals (CIs) using Poisson regression. We reported RRs adjusted for age, calendar year of follow-up and years of education. Overall, 18,247 cases of cervical, 35,290 cases of endometrial and 32,227 cases of ovarian cancers occurred during 117 million person-years of follow-up. We found that adjusted RRs of all the three cancers were lower or the same among foreign-born women compared to those born in Sweden. As for cervical cancer, women aged 35-49 years born in Poland and Bosnia and women aged 50 years or more born in South America showed an increased risk, which was related to increasing age at migration. The risk was lowest among women born in Iran, Iraq, Organisation for Economic Cooperation & Development (OECD) and Finland, and highest among women born in Bosnia and Eastern Europe during their first 5 years since immigration. RRs for endometrial and ovarian cancers did not vary by duration of residence or by age at migration. Health care providers should be aware of the higher risk of cervical cancer among immigrants from high-risk areas, especially among those who immigrate at older ages. On the other hand, protective factors for ovarian and endometrial cancers seem to be retained upon migration.

Associations between parents' and 12-year-old children's sport and vigorous activity: the role of self-esteem and athletic competence.

BACKGROUND: The aims of this study were to investigate parent-child physical activity (PA) associations and whether children's self-esteem or athletic competence mediates such associations. METHODS: The study population comprised 1124 12-year-old children and their parents. Parents' PA was assessed using the Baecke questionnaire and a question about sport participation. Children's PA was assessed by questions about participation in sport and vigorous activities. The children's self-esteem and athletic competence were assessed by Harter's Self-Perception Profile for Adolescents. RESULTS: Parents' PA was strongly associated with their children's PA. With 2 active parents, the odds ratio for their children to participate in sport was 3.9 (95% CI = 2.2-6.9, girls) and 8.8 (95% CI = 4.3-18.0, boys) compared with having inactive parents. Athletic competence partly mediated these associations. CONCLUSIONS: The family is an important target for interventions to increase PA among children, and it might be important to consider ways to reinforce children's athletic competence.

Risk of thyroid cancer among Iranian immigrants in Sweden.

OBJECTIVES: Studies of immigrants are of value to elucidate the role of environmental factors in cancer causation, but large cohorts are needed in order to study rare cancers. We conducted a register-based study of a cohort of 59,274 (32,236 men and 27,038 women) Swedish residents born in Iran, with follow-up between 1969 and 2004. We identified 50 incident cases of thyroid cancer during more than 800 thousands person-years of observation. METHODS: Rate ratios (RR) were calculated based on Poisson models estimated by the maximum likelihood method, using Swedish born residents with both parents born in Sweden as reference population. 95% confidence interval was estimated on the assumption that the observed numbers of cancers follow a Poisson distribution. RESULTS: The adjusted RR of thyroid cancer among Iranian immigrants was 2.6 (95% CI 2.0-3.5), without appreciable sex differences. In both sexes, the excess risk was highest among people who were younger than 30 years at immigration. Among women, the largest excess risk (adjusted RR = 4.6, 95% CI 2.9-7.4) was observed during the first 5 years from immigration, while for men, during the second decade from immigration. The rate ratio was higher among subjects who immigrated before 1990 (adjusted RR = 2.7, 95% CI 2.0-3.8) than among those immigrated thereafter, particularly among men. CONCLUSION: The observed excess risk among Iranian immigrants compared to Swedish-born residents is compatible with differential burden of environmental risk factors, the most likely of which are iodine deficiency and high natural levels of ionizing radiation.

Renal insufficiency and long-term mortality and incidence of myocardial infarction in patients undergoing coronary artery bypass grafting.

AIMS: To evaluate the impact of renal insufficiency (RI) on long-term mortality and incident myocardial infarction (MI) in patients undergoing coronary artery bypass grafting (CABG). METHODS AND RESULTS: All patients (n = 6575) without dialysis-dependent RI undergoing a first isolated CABG during 1980-1995 at the Karolinska hospital who survived 30 days post-operatively were included. Estimated glomerular filtration rate (eGFR) was related to the incidence of MI and all-cause mortality within 5 years. There were 628 deaths and 496 incident MIs during follow-up. After multivariable adjustment, patients with mild (eGFR 60-90 mL/min), moderate (eGFR 30-60 mL/min), and severe (eGFR <30 mL/min) RI had an increased mortality within 5 years post-CABG; hazard ratio (HR) 1.2 [95% confidence interval (CI) 1.0-1.6], HR 1.8 (95% CI 1.3-2.4), and HR 5.2 (95% CI 3.1-8.6), respectively, compared with patients with normal renal function (eGFR >90 mL/min). In patients with moderate and severe RI, there was an increased incidence of MI; HR 1.5 (95% CI 1.1-2.1) and HR 3.5 (95% CI 1.8-6.8), respectively. There were no gender differences. CONCLUSION: Already mild RI predicts late all-cause mortality after coronary artery bypass grafting (CABG), and moderate and severe RI is associated with an increased long-term incidence of MI post-CABG.

High mortality after coronary bypass surgery in patients with high-grade left main coronary artery stenosis.

OBJECTIVE: To determine mortality after coronary artery bypass grafting (CABG) in relation to degree of left main coronary artery (LMCA) obstruction. DESIGN: All patients without LMCA stenosis (n=3370), with low-grade stenosis (n = 261), high-grade stenosis (n = 224) or total occlusion of the LMCA (n = 15) were followed for ten years after CABG performed during 1970-1989. RESULTS: Early mortality was 1.9% and 2.3%, respectively, if there was no or a low-grade LMCA stenosis vs. 6.3% if the stenosis was high-grade. Ten-year survival was 76% if no LMCA obstruction, 74% if low-grade stenosis and 64% if the stenosis was high-grade. Risk of early death (odds ratio 2.6, 95% CI 1.4-4.8) and mortality at ten years (relative risk 1.5, 95% CI 1.1-2.0) was higher in patients with high-grade stenosis than in those without LMCA stenosis. There was no increased long-term mortality in patients with low-grade stenosis or among the few patients with occlusion of the LMCA. CONCLUSIONS: High-grade LMCA stenosis was associated with a three-fold increased risk of early and fifty percent higher risk of late death than in patients without LMCA stenosis.

Changes in shape and location of BMI distributions of Swedish children.

AIMS: One aim was to disentangle how the shape and location of the BMI distribution changed among Swedish children over a 12 y period. Another aim was to identify the age during childhood when changes occurred or became manifest. METHODS: Two population-based cohorts-2,591 children from Stockholm born 1985-1987 and 3,650 from Gothenburg born 1973-1975-were compared with respect to BMI distributions from 2 to 15 y of age. RESULTS: Differences between the BMI distributions of the two cohorts were present from 5-6 y of age. From age 7, the children born in 1985-1987 and belonging to the upper parts of the BMI distribution, e.g. those above the 90th or 95th BMI percentiles, had much higher BMI mean values compared to their counterparts born 12 y earlier. Comparisons with respect to the 5th, 10th, 25th, 50th, 75th, 90th and 95th BMI percentiles showed that changes appeared above the 25th percentile and became increasingly pronounced in the upper parts of the BMI distributions. CONCLUSION: School-aged children in the rightmost parts of the BMI distributions may be more susceptible to "obesogenic" environmental exposures than those in the middle or leftmost parts. The results support the suggestion that the period of BMI rebound is critical for the development of obesity.