Synergistic effects of a cremophor EL drug delivery system and its U0126 cargo in an ex vivo model.

Neuroprotection has proven clinically unsuccessful in subarachnoid hemorrhage. We believe that this is because the major component in the early damage pathway, the vascular wall, has not been given the necessary focus. U0126 is a potent inhibitor of vascular phenotypical changes, exemplified by functional endothelin B (ETB) receptor upregulation. The current study aimed to determine the optimal dose of U0126 ex vivo and test the toxicology of this dose in vivo. To find the optimal dose and test a suitable in vivo delivery system, we applied an ex vivo model of blood flow cessation and investigated functional ETB receptor upregulation (using a specific agonist) as the primary endpoint. The secondary endpoint was depolarization-induced contractility assessed by 60 mM K+ stimuli. Furthermore, an in vivo toxicology study was performed on the optimal selected doses. U0126 (10 µM) had a strong effect on the prevention of functional ETB receptor contractility, combined with minimal effect on the depolarization-induced contractility. When cremophor EL was chosen for drug delivery, it had an inhibitory and additive effect (combined with U0126) on the ETB receptor contractility. Hence, 10 µM U0126 in 0.5% cremophor EL seems to be a dose that will be close to the maximal inhibition observed ex vivo on basilar arteries, without exhibiting side effects in the toxicology studies. U0126 and cremophor EL are well tolerated at doses that have effect on ETB receptor upregulation. Cremophor EL has an additional positive effect, preventing functional ETB receptor upregulation, making it suitable as a drug delivery system.

Enhanced contractility of intraparenchymal arterioles after global cerebral ischaemia in rat - new insights into the development of delayed cerebral hypoperfusion.

AIM: Delayed cerebral hypoperfusion is a secondary complication found in the days after transient global cerebral ischaemia that worsens the ischaemic damage inflicted by the initial transient episode of global cerebral ischaemia. A recent study demonstrated increased cerebral vasoconstriction in the large arteries on the brain surface (pial arteries) after global cerebral ischaemia. However, smaller arterioles inside the brain (parenchymal arterioles) are equally important in the regulation of cerebral blood flow and yet their pathophysiology after global cerebral ischaemia is largely unknown. Therefore, we investigated whether increased contractility occurs in the intraparenchymal arterioles. METHODS: Global cerebral ischaemia was induced in male Wistar rats by bilateral common carotid occlusion for 15 min combined with hypovolaemia. Regional cerebral blood flow was determined by quantitative autoradiography. Intraparenchymal arterioles were isolated and pressurized, and concentration-response curves to endothelin-1 with and without the endothelin B receptor-selective antagonist BQ788 was generated. Endothelin B receptor expression was investigated by quantitative flow cytometry and immunohistochemistry. RESULTS: We observed increased endothelin-1-mediated contractility of parenchymal arterioles correlating with reduced cerebral blood flow of the cortex, hippocampus and caudate nucleus 48 h after global cerebral ischaemia. The increased endothelin-1-mediated contractility was abolished by BQ788, and the vascular smooth muscle cell-specific expression of endothelin B receptors was significantly increased after global cerebral ischaemia. CONCLUSION: Increased endothelin-1-mediated contractility and expression of endothelin B receptors in the intraparenchymal vasculature contributes to the development of delayed cerebral hypoperfusion after global cerebral ischaemia in combination with vascular changes of the pial vasculature.

Gait speed and one-leg standing time each add to the predictive ability of FRAX.

Gait speed or one-leg standing time (OLST) as additional predictors in FRAX. Population 351 elderly women followed 10 years. Both could improve predictions. The area under curve (AUC) for FRAX is 0.59, OLST is 0.69 and gait speed is 0.71. The net reclassification index (NRI) for classification to highest risk quartile or lowest three quartiles was 0.24 for gait speed and non-significant for OLST. INTRODUCTION: The risk of falls and bone strength are two main determinants of hip fracture risk. The fracture risk assessment tool FRAX, however, lacks direct measures of fall risk1. A short OLST and a slow gait speed are both fall-related risk factors for hip fractures. The aim of this study was to investigate whether the addition to FRAX of either gait speed or OLST could improve the predictive ability for hip fractures, compared to FRAX alone. METHODS: A population-based sample of 351 women aged between 69 and 79 years were tested for one-leg standing time with eyes open and mean gait speed over a 15 + 15-m walk. Fracture and mortality data were obtained from health care registers. RESULTS: The AUC for the receiver operating characteristic (ROC) increased from 0.61 to 0.71 when gait speed was added to FRAX. The AUC was 0.69 for OLST added to FRAX. The highest quartile of hip fracture risks according to FRAX had an absolute 10-year risk of ≥15%. The population was divided into one group with a hip fracture risk of ≥15% and one group with a fracture risk of <15%. NRI for addition of gait speed to FRAX was 0.24 (p = 0.023), while NRI was 0.08 (p = 0.544) for addition of OLST to FRAX. CONCLUSION: Gait speed tended to improve the predictive ability of FRAX more than OLST, but they both added value to FRAX.

Cerebrovascular endothelin-1 hyper-reactivity is associated with transient receptor potential canonical channels 1 and 6 activation and delayed cerebral hypoperfusion after forebrain ischaemia in rats.

AIM: In this study, we aimed to investigate whether changes in cerebrovascular voltage-dependent calcium channels and non-selective cation channels contribute to the enhanced endothelin-1-mediated vasoconstriction in the delayed hypoperfusion phase after experimental transient forebrain ischaemia. METHODS: Experimental forebrain ischaemia was induced in Wistar male rats by a two-vessel occlusion model, and the cerebral blood flow was measured by magnetic resonance imaging two days after reperfusion. In vitro vasoreactivity studies, immunofluorescence and quantitative PCR were performed on cerebral arteries from ischaemic or sham-operated rats to evaluate changes in vascular voltage-dependent calcium channels, transient receptor potential canonical channels as well as endothelin-1 receptor function and expression. RESULTS: The expression of transient receptor potential canonical channels 1 and 6 in the vascular smooth muscle cells was enhanced and correlated with decreased cerebral blood flow two days after forebrain ischaemia. Furthermore, under conditions when voltage-dependent calcium channels were inhibited, endothelin-1-induced cerebrovascular contraction was enhanced and this enhancement was presumably mediated by Ca(2+) influx via upregulated transient receptor potential canonical channels 1 and 6. CONCLUSIONS: Our data demonstrates that endothelin-1-mediated influx of extracellular Ca(2+) activates transient receptor potential canonical channels 1 and 6 in cerebral vascular smooth muscle cells. This seems to have an important role in the enhanced cerebral vasoconstriction in the delayed post-ischaemic hypoperfusion phase after experimental forebrain ischaemia.

Bariatric surgery in adolescents: what do we know so far?

INTRODUCTION: Obesity represents a vast and rapidly increasing global burden. Bariatric surgery is the only intervention achieving sustained weight loss, among its wide-ranging benefits. METHODS: In this article, we describe the growing challenges presented by adolescents with severe obesity and review the literature on surgical and other treatment options. RESULTS: Outcomes in terms of weight loss, metabolic and quality of life improvement, reversal of obstructive sleep apnea, insulin resistance, type II diabetes mellitus, hypertension, and dyslipidemia appear comparable to those seen in adults. However, long-term data on safety and sustainability are lacking. There is a growing acceptance of the need for surgery as a treatment for the morbidly obese adolescent population, and the number of studies reporting outcomes after adolescent bariatric surgery is increasing. CONCLUSION: Accumulating evidence suggests that the benefits seen in adult bariatric surgery can be reproduced in adolescents. Thus, adolescent bariatric surgery appears to be safe and effective in achieving benefits desired in terms of weight control and improvements in metabolic health and quality of life. However, particular care must be taken when treating a young population, and long-term outcomes are awaited to properly define indications and limitations.

One-leg standing time and hip-fracture prediction.

UNLABELLED: A hip fracture results in a lower quality of life and a cost of £30,000. In this study, one-leg standing time (OLST) had a negative linear relationship to the risk of a hip fracture. OLST could be a useful tool to assess the need for fracture-preventive interventions. INTRODUCTION: A hip fracture immobilizes, restricts autonomy, shortens life expectancy, and results in a cost of £30,000 in the UK health care system. However, effective preventive treatments can be offered to high-risk individuals. Impaired postural balance is an important risk factor for hip fractures, and the aim of this study was to evaluate whether OLST can predict hip fractures in elderly women. FRAX is the most established fracture risk assessment tool worldwide and a secondary aim was to relate the predictive ability of OLST to that of FRAX in this population. METHODS: Three hundred fifty-one women aged between 69 and 79 years were timed standing on one leg up to 30 s with eyes open and assessed with FRAX. Fracture data was obtained from registers. RESULTS: The main outcome, a hip fracture, occurred in 40 of the 351 participants (11.4%). The age-adjusted risk of a hip fracture was 5% lower with 1 s longer OLST (Hazard ratio 0.95, 95% CI 0.927-0.978). The relation between OLST and hip fracture risk was linear. Harrell's c was 0.60 for FRAX and 0.68 for OLST adjusted for age. CONCLUSION: With 1 s longer OLST, the risk of a hip fracture decreased significantly by 5%. This risk reduction was not explained by differences in the classic fracture risk factors included in FRAX. OLST had a predictive ability similar to FRAX. OLST is an easily performed balance test which may prove to be valuable in the assessment of hip fracture risk.

The longitudinal age and birth cohort trends of smoking in Sweden: a 24-year follow-up study.

OBJECTIVES: The aim of this study is to analyse longitudinally, the annual effects of age group and birth cohort on smoking in the Swedish population during a 24-year period and to analyse the smoking trends for different levels of education. METHODS: A random sample of adult, non-institutionalized persons aged 16-71 years was interviewed every 8 years by professional interviewers. In addition to three time-related variables--year of interview, age at the time of the interview, and year of birth--we included the following explanatory variables in the analyses: sex, educational level, and urbanization. RESULTS: We found significant decreases in smoking prevalence in all studied subgroups. The adjusted odds ratios for age were 0.89 (95 % CI 0.88-0.90) and 0.92 (95 % CI 0.91-0.93) for men and women, respectively. The decreases in smoking over time were significant in all levels of education, except for in women with low educational level. CONCLUSIONS: In Sweden, the prevalence of smoking has decreased in most age groups and cohorts, and in persons in most levels of education, albeit less so in women with low educational level.

Functional dyspepsia impairs quality of life in the adult population.

BACKGROUND: Data on the impact of functional dyspepsia on health-related quality of life in the general adult population are scarce. AIM: To explore the impact of functional dyspepsia applying the Rome III definition on health-related quality of life in the general population. METHOD: A random sample of an adult Swedish population (n=1001, The Kalixanda study) was invited to undergo an oesophagogastroduodenoscopy. An extended abdominal symptom questionnaire and Short Form-36 (SF-36) questionnaire, which includes eight domains measuring physical, mental and social aspects of quality of life, were completed at the clinic visit just before oesophagogastroduodenoscopy. RESULTS: Two hundred and two (20%) individuals reported uninvestigated dyspepsia (UID), 157 (16%) functional dyspepsia (FD), 52 (5%) epigastric pain syndrome (EPS) and 122 (12%) postprandial distress syndrome (PDS). UID, FD and PDS had a clinically meaningful (a ≥ 5 point) and statistically significant impact (P<0.05) on health-related quality of life in all SF-36 domains except for Role Emotional. EPS had a significant impact on Bodily Pain and Vitality. Overlap of FD with irritable bowel syndrome (IBS) had a significant impact on Bodily Pain (P=0.002) and General Health (P=0.02) while FD overlap with gastro-oesophageal reflux symptoms (GERS) had a significant impact on Bodily Pain (P=0.02) compared with FD without any overlap with IBS or GERS. CONCLUSION: Functional dyspepsia impacts all main domains describing physical, mental and social aspects of health-related quality of life in the general population. Overlap of functional dyspepsia with irritable bowel syndrome or gastro-oesophageal reflux symptoms impacts the domain related to bodily pain.

Estimation of diabetes prevalence among immigrants from the Middle East in Sweden by using three different data sources.

AIMS: To estimate diabetes prevalence in immigrants from the Middle East in Sweden compared with Swedish-born subjects. This group accounts for around 15% of Sweden's non-European immigrants. METHODS: Three samples were used: self-reported diabetes in a random sample (SALLS sample) of subjects aged 35-64 years in Sweden (n=22,032); known diabetes among patients aged 35-64 years in primary care (PC) at four primary healthcare centers in Stockholm County (n=30,679); and known and newly diagnosed diabetes in a random population sample of subjects aged 60 years in Stockholm County (n=4106). RESULTS: The odds ratio (OR) for subjects from the Middle East was: 1.69 (95% confidence interval [CI] 0.96-2.99) in the SALLS sample; 4.43 (95% CI 3.38-5.56) in the PC sample; and 3.96 (95% CI 1.98-7.92) in the age-60 sample, compared with native Swedes. Subjects from European and other Organization for Economic Cooperation and Development (OECD) countries showed an excess risk only in the SALLS sample (1.43, 95% CI 1.11-1.83). CONCLUSIONS: Immigrants from the Middle East showed a four-fold higher risk of diabetes compared with Swedish-born subjects in two of the three data sources. More studies are needed to confirm these results, but the findings call for targeted preventative strategies in this population group.

Physical activity and body mass index in elderly Iranians in Sweden: a population-based study.

BACKGROUND/OBJECTIVES: To analyze whether elderly Iranians in Sweden have a higher mean body mass index (BMI) and are less physically active than elderly Swedes after adjustment for possible confounders. SUBJECTS/METHODS: A total of 402 men and women (167 Iranian-born and 235 Swedish-born) aged 60-84 years residing in Stockholm, Sweden, were included in this population-based survey. Iranian participants were weighed and their height was measured. BMI values from the Swedish participants were based on self-reported data adjusted for the known discrepancy between objectively measured and self-reported weight and height. The outcome variables, BMI and self-reported leisure-time physical activity, were analyzed by linear regression and unconditional logistic regression. RESULTS: Overall, Iranian women had the highest mean BMI (29.2) of all subgroups. The model that included an interaction between sex and length of time in Sweden showed that there was no significant difference in BMI between Swedish men (reference) and Swedish women or Iranian men. In contrast, Iranian women had significantly higher BMI than the reference group after adjustment for age, education and marital status. The largest difference in BMI compared to the reference group was found among Iranian women who immigrated to Sweden in 1989 or later (beta-coefficient=3.41, 95% CI=1.99-4.83). Iranians and Swedes had almost the same odds of >or= once-weekly leisure-time physical activity. CONCLUSIONS: Elderly Iranian immigrants and especially women who immigrated to Sweden in 1989 or later must be targeted in order to decrease their burden of risk factors for cardiovascular disease.

Nutritional status, as determined by the Mini-Nutritional Assessment, and osteoporosis: a cross-sectional study of an elderly female population.

OBJECTIVE: To investigate the relationship between osteoporosis and nutritional status as determined by the Mini-Nutritional Assessment (MNA). DESIGN: A cross-sectional study. SETTING: Stockholm, Sweden. SUBJECTS: A total of 351 elderly free-living women (mean age 73+/-2.3 years). METHODS: MNA (range 0-30 points; <17 indicates malnutrition, 17.5-23.5 risk of malnutrition and >or=24 well nourished), measurements of bone mineral density of the left hip and lumbar spine using Hologic QDR 4500, and of the heel using Calscan DEXA-T. RESULTS: The median MNA score was 27 (range 12.5-30). One woman was classified as malnourished and 7.4% were at risk of malnutrition. Osteoporosis of the femoral neck was observed in 22% and a fracture after the age of 50 was reported by 31% of the participants. The following items in the MNA questionnaire exhibited an increased risk of having osteoporosis in the femoral neck and/or total hip: an MNA score of <27 (odds ratio (OR)=2.09; CI=1.14-3.83); a mid-arm circumference of less than 28 cm (OR=2.97; CI=1.29-6.81); and regular use of more than 3 drugs each day (OR=2.12; CI=1.00-4.50). A body weight of more than 70 kg exhibited a decreased risk of having osteoporosis (OR=0.31; CI=0.14-0.70). CONCLUSIONS: In general, the nutritional status was good in this population of free-living elderly women. Nevertheless, half of the women who displayed an MNA score <27 points had a twofold increased risk of having osteoporosis. SPONSORSHIP: Karolinska Institutet, Stockholm County Council.

The trend of cardiovascular disease in immigrants in Sweden.

Little is known as to whether the declining trend in cardiovascular disease (CVD) and coronary heart disease (CHD) in the Western countries has reached the immigrant populations. Incidence rates of CVD and CHD between 1991-1993 and 1997-1999 were compared by analysing the relative risk (RR) using the Poisson regression model and the data from 1991-1993 within each group as a reference. The whole Swedish population aged 35-74 years was included and we focused on 12 different immigrant groups. The morbidity from CHD in men from Sweden, Finland and countries in the OECD decreased slightly in an age-adjusted model (RR: 0.91, 0.93, and 0.88, respectively) during the 1990s. The opposite results were observed in women from Southern Europe, Turkey and Iran, in whom CHD morbidity increased (RR: 1.35, 1.54 and 1.40, respectively). The declining trend in CVD and CHD is continuing among men from Sweden, Finland and the OECD countries, but it is unchanged for women from these countries and all other groups studied, and even with increases in some female groups. This might be a sign of a breaking trend in these diseases.

Month of birth, socioeconomic background and development in Swedish men.

Season of birth has been shown to correlate with many aspects of somatic and mental disorders, development and social adaptation (so-called 'birth-date effects'). In a sample of young Swedish men, corresponding roughly to a one-year birth cohort, the results of intelligence tests, psychologists' ratings of psychological function, school achievement, body height, weight and self-reported health during childhood, were found to be correlated with month of birth, and--more strongly--father's socioeconomic status. The results were more favourable for men who were born during March-May (the period of highest birth rate), and whose fathers were of higher socioeconomic status, than for those born in November and December (the period of lowest birth rate), and whose fathers were in the lower socioeconomic group. It seems reasonable to conclude, from this study and previously reported findings, that these so-called 'birth-date effects' are determined by varying and often interacting biological and psychosocial factors. Among these factors, the light-induced entrainment of circadian and annual rhythms in the fetus and/or infant seems to be of pivotal importance. The organization of children into one-year age classes therefore produces an unfair lack of equality of possibilities.

Neighbourhood deprivation and incidence of coronary heart disease: a multilevel study of 2.6 million women and men in Sweden.

STUDY OBJECTIVE: To examine whether neighbourhood deprivation predicts incidence rates of coronary heart disease, beyond age and individual income. DESIGN: Follow up study from 31 December 1995 to 31 December 1999. Women and men were analysed separately with respect to incidence rates of coronary heart disease. Multilevel logistic regression was used in the analysis with individual level characteristics (age, individual income) at the first level and level of neighbourhood deprivation at the second level. Neighbourhood deprivation was measured at small area market statistics level by the use of Care Need Index. SETTING: Sweden. PARTICIPANTS: All women and men aged 40-64 in the Swedish population, in total 2.6 million people. MAIN RESULTS: There was a strong relation between level of neighbourhood deprivation and incidence rates of coronary heart disease for both women and men. In the full model, which took account of individual income, the risk of developing coronary heart disease was 87% higher for women and 42% higher for men in the most deprived neighbourhoods than in the most affluent neighbourhoods. For both women and men the variance at neighbourhood level was over twice the standard error, indicating significant differences in coronary heart disease risk between neighbourhoods. CONCLUSIONS: High levels of neighbourhood deprivation independently predict coronary heart disease for both women and men. Both individual and neighbourhood level approaches are important in health care policies.

Validation of the translation and cross-cultural adaptation into Finnish of the Abdominal Symptom Questionnaire, the Hospital Anxiety and Depression Scale and the Complaint Score Questionnaire.

BACKGROUND: Epidemiological surveys require questionnaires to be validated in the native language of the participants. The aim of this study was to validate the Finnish translations of the Abdominal Symptom Questionnaire (ASQ), the Hospital Anxiety and Depression Scale (HAD) and the Complaint Score Questionnaire (CSQ). METHODS: A random sample of adults (n = 3000) in a northern Swedish bilingual district was surveyed using a mailed ASQ offered in both SwedIsh and Finnish, and 2122 responded (239 in Finnish). A random subsample of the responders (n = 1001, 123 preferring Finish) was then surveyed once more using the ASQ, the HAD and the CSQ. The first 50 responders of the latter survey were then given the three questionnaires again within two weeks. The Finnish versions had been put through a comprehensive translation procedure RESULTS: A factor analysis comparison between the responders using either language in the mailed survey gave a comparable factor construction, and this was also comparable with an earlier analysis of the Swedish version. The Finnish responses to the second survey were further evaluated by testing internal consistency reliability, convergent validity towards previously validated relevant instruments (ShortForm-36 and the Gastrointestinal Symptom Rating Scale) and the test/re-test accuracy of the three questionnaires. These were found to be reliable, as was the correlation between the ASQ and the CSQ, for relevant domains. CONCLUSION: The Finnish translations of the ASQ, HAD and CSQ questionnaires all seem to be robust and usable for population-based surveys among Finnish adults.

Valid symptom reporting at upper endoscopy in a random sample of the Swedish adult general population: the Kalixanda study.

BACKGROUND: Upper oesophagogastroduodenoscopy is considered to be the gold standard for upper gastrointestinal disease assessment, but is currently seldom used in epidemiological studies. One concern is that the procedure may bias sampling among volunteers in a general adult population. The aim of this study was to explore whether the procedure affects symptom reporting. METHODS: A random sample of 3000 adults aged 20-81 years (mean age 50.4), from two Swedish municipalities (n=21,610) was surveyed using a validated postal questionnaire (the Abdominal Symptom Questionnaire) assessing gastrointestinal symptoms. A subsample of the responders was invited, in random order, to undergo an upper endoscopy and repeated symptom reporting using the same questionnaire, as well as a serology test for Helicobacter pylori. RESULTS: The response rate to the initial questionnaire was 74.2% and the participation rate for those eligible for the upper endoscopy was 73.3% (n = 1001, mean age 54.0 years, 48.8% male). No major social or symptom sampling error was encountered from the selection process, with the exception of an excess of symptom reporters among the youngest subjects. The prevalence of reflux symptoms, dyspeptic symptoms and irritable bowel symptoms was 40%, 37.6% and 29.6%, respectively, which is relatively high, but in no way extreme. CONCLUSIONS: The upper endoscopy survey strategy was successful. The response rate was high and there was no major selection bias of clinical relevance. The cohort selected for this study appears to be representative of the general Swedish adult population.

Increasing trends of obesity in Sweden between 1996/97 and 2000/01.

BACKGROUND: During the last two decades, obesity has reached epidemic proportions in industrialised societies such as Sweden. OBJECTIVE: The first aim of this study is to examine whether the body mass index (BMI) and obesity increased between 1996/97 and 2000/01 in different subgroups in the Swedish population. The second aim is to examine whether there were any differences in BMI between subgroups of the population, characterised by age, gender, educational status, smoking habits, degree of urbanisation, and country of birth. The third aim is to examine whether BMI increased between the two periods after adjustment for all the explanatory variables. METHODS: This study is based on two cross-sectional, random samples of the entire population aged 16-84 y, the first from 1996/97 including 5622 men and 5940 women and the second from 2000/01 including 5515 men and 5838 women. To investigate the possible change in obesity between the two periods, a logistic model adjusted for age was applied, after stratification by gender. To study the relationship between BMI and the explanatory variables, and the possible change in the subgroups of the population between the two periods, a linear regression model was used. RESULTS: The total BMI mean increased by 0.4 units from 1996/97 to 2000/01 for both men and women. The prevalence of obesity also increased to about 10% in 2000/01. In some subgroups, the prevalence of obesity was especially high, for example, men and women aged 55-74 y, men with middle educational status, women with low educational status, former smokers, and Finnish-born men and women. CONCLUSIONS: These findings illustrate that both BMI and obesity increased in the Swedish population between 1996/97 and 2000/01. This increase in BMI and obesity is most likely due to environmental factors, such as diet and a sedentary lifestyle. Health interventions need to target both certain subgroups and the whole population.

Impact of country of birth on hospital admission for women of childbearing age in Sweden: a five year follow up study.

STUDY OBJECTIVE: This study examines whether morbidity, defined as the first psychiatric hospital admission and the first somatic hospital admission, differs among subgroups of foreign born and second generation (that is, native born with at least one parent born abroad) women compared with Swedish born women (that is, with both parents native born) after adjusting for sociodemographic factors. DESIGN SETTING: In this follow up study the population consisted of 1 452 944 women, of whom 369 771 have an immigrant background (including second generation immigrants), aged 20-45 years. The population of 31 December 1993 was followed up to 31 December 1998. Differences in risk (hazard ratio) between different groups of immigrant women were estimated, adjusting for age, marital status, number of children, and disposable income. MAIN RESULTS: All four groups of foreign born women had higher age adjusted risks (HRs varied from 1.44 to 1.67) for a first psychiatric hospital admission than Swedish born women. The risk decreased only marginally when the sociodemographic factors were taken into consideration. Additionally, second generation women also had a higher age adjusted risk (HR = 1.42; CI = 1.37 to 1.48) than Swedish born women. The risk decreased only slightly in the main effect model. However, on analysing country of birth and first somatic hospital admissions, only non-European refugee women showed an increased age adjusted risk (HR = 1.26; CI = 1.24 to 1.29), which remained after adjusting for sociodemographic factors. CONCLUSIONS: Foreign born and second generation women of childbearing age had a higher risk than Swedish born women for a first psychiatric hospital admission. However, only non-European refugees were at higher risk of somatic hospital admissions.

Diabetes mellitus in Turkish immigrants in Sweden.

This study analyses the risk of self-reported diabetes mellitus among Turkish-born immigrants in Sweden. Two simple random samples were used: The Swedish National Board of Health and Welfare Immigrant Survey, and the Swedish Survey of Living Conditions, both from 1996. Totally 526 Turkish immigrants, 285 men and 241 women, were compared with 2854 Swedish controls, 1425 men and 1429 women, all in ages 27-60 years. Data were analysed by sex in an age-adjusted model, and a full model also included education, employment status, BMI and country of birth (logistic regression). Among Turkish men, age-adjusted diabetes prevalence was not higher than among Swedish men, odds ratio (OR) 1.04 (95% confidence interval (CI) 0.35-3.11). Among Turkish women, age-adjusted diabetes prevalence was higher than among Swedish women, OR 3.22 (95% CI 1.36-7.64), but when also adjusting for educational level, employment status and BMI, OR was 1.22 (95% CI 0.41-3.66). We conclude, that age-adjusted presence of known diabetes was higher among Turkish-born women than among Swedish women, but was explained by lower employment rate, lower educational status and a higher level of overweight and obesity.

Morbidity in cardiovascular diseases in immigrants in Sweden.

INTRODUCTION: Although immigration to Sweden has increased in the last few decades, the incidence rates of cardiovascular disease and coronary heart disease in immigrants are unknown. The aim of the present study is to estimate whether place of birth affects the incidence rates of cardiovascular disease and coronary heart disease. MATERIAL AND METHODS: The study was designed as a follow-up study on morbidity in cardiovascular disease and coronary heart disease between 1 January 1997 and 31 December 1998, including three and a half million persons with age range 35-64 years, of whom 550 000 were born abroad, from the database MigMed consisting of the whole Swedish population. Incidence rates and relative risks were estimated by indirect standardization and a proportional hazard model. RESULTS: The age-adjusted risk of coronary heart disease was higher in most foreign-born groups than in Swedes. For example, in nine of 12 male groups, the relative risks varied between 1.1 and 2.2, and in seven of 12 female groups, the relative risks varied between 1.4 and 2.5. When also adjusting for level of education and employment status, the risks were still high, but on a lower level. CONCLUSIONS: Foreign-born people possess an over-risk of cardiovascular or coronary heart disease(CVD/CHD) compared with Swedish-born persons, also when level of education and employment status are taken into account.