BACKGROUND: Before iodination of Swedish table salt in 1936, iodine deficiency resulting in goitre and hypothyroidism was common. Sweden has become iodine sufficient, as shown in a national survey in 2007, proving its iodination fortification programme effective for the general population. The objective of this study was to collect drinking water from water treatment plants nationally and test if water iodine concentration (WIC) correlated to urinary iodine concentration (UIC) of school-aged children in a national survey 2007 to former goitre frequency in 1929 and to thyroid volume data in 2007. METHODS: In 2012, 166 treatment plants, located in 57% (166 of 290) of all Swedish municipalities, were asked to collect drinking water samples of approximately 10 ml. In 2007, tap water samples of the same volume were collected from 30 randomly selected schools for the national survey. Analysis of WIC was done in both treatment plants in 2012 (n = 166) and tap water in 2007 (n = 30). The correlation of WIC to the children's UIC and thyroid volume after iodination was tested based on data from the national survey in 2007. The association of WIC to former goitre frequency was tested based on pre-iodination data, derived from a map of goitre frequency drawn in 1929. RESULTS: The median WIC from water treatment plants was 4.0 μg/L (range 0-27 μg/L). WIC was similar in coastal and inland areas, for both ground and surface water. WIC correlated with historical goitre areas and was lower in the goitre areas than in non-goitre areas (p < 0.001). WIC in the same municipalities as the schools correlated with the UIC of children (p < 0.01), but not with their thyroid volume. CONCLUSIONS WIC still contributes to iodine nutrition in Sweden, but iodination overrides the goitre effect.
Adolescent ; Child ; Drinking Water ; chemistry ; Female ; Food, Fortified ; analysis ; Goiter ; epidemiology ; history ; History, 20th Century ; History, 21st Century ; Humans ; Iodine ; analysis ; urine ; Male ; Sodium Chloride, Dietary ; analysis ; Sweden ; epidemiology ; Thyroid Gland ; anatomy & histology

INTRODUCTION: A new third version of the Copenhagen Psychosocial Questionnaire (COPSOQ III) has been developed in response to trends in working life, theoretical concepts, and international experience. A key component of the COPSOQ III is a defined set of mandatory core items to be included in national short, middle, and long versions of the questionnaire. The aim of the present article is to present and test the reliability of the new international middle version of the COPSOQ III.METHODS: The questionnaire was tested among 23,361 employees during 2016–2017 in Canada, Spain, France, Germany, Sweden, and Turkey. A total of 26 dimensions (measured through scales or single items) of the middle version and two from the long version were tested. Psychometric properties of the dimensions were assessed regarding reliability (Cronbach α), ceiling and floor effects (fractions with extreme answers), and distinctiveness (correlations with other dimensions).RESULTS: Most international middle dimensions had satisfactory reliability in most countries, though some ceiling and floor effects were present. Dimensions with missing values were rare. Most dimensions had low to medium intercorrelations.CONCLUSIONS: The COPSOQ III offers reliable and distinct measures of a wide range of psychosocial dimensions of modern working life in different countries; although a few measures could be improved. Future testing should focus on validation of the COPSOQ items and dimensions using both qualitative and quantitative approaches. Such investigations would enhance the basis for recommendations using the COPSOQ III.
Canada ; France ; Germany ; Psychometrics ; Risk Assessment ; Spain ; Sweden ; Turkey ; Weights and Measures

BACKGROUND: Evidence on associations between occupational diesel exhaust and gasoline exposure and colorectal cancer is limited. We aimed to assess the effect of workplace exposure to diesel exhaust and gasoline on the risk of colorectal cancer. METHODS: This caseecontrol study included 181,709 colon cancer and 109,227 rectal cancer cases diagnosed between 1961 and 2005 in Finland, Iceland, Norway, and Sweden. Cases and controls were identified from the Nordic Occupational Cancer Study cohort and matched for country, birth year, and sex. Diesel exhaust and gasoline exposure values were assigned by country-specific job-exposure matrices. Odds ratios and 95% confidence intervals were calculated by using conditional logistic regression models. The results were adjusted for physical strain at work and occupational exposure to benzene, formaldehyde, ionizing radiation, chlorinated hydrocarbons, chromium, and wood dust. RESULTS: Diesel exhaust exposure was associated with a small increase in the risk of rectal cancer (odds ratio 1/4 1.05, 95% confidence interval 1.02–1.08). Gasoline exposure was not associated with colorectal cancer risk. CONCLUSION: This study showed a small risk increase for rectal cancer after workplace diesel exhaust exposure. However, this finding could be due to chance, given the limitations of the study.
Benzene ; Case-Control Studies ; Chromium ; Cohort Studies ; Colonic Neoplasms ; Colorectal Neoplasms ; Dust ; Finland ; Formaldehyde ; Gasoline ; Hydrocarbons, Chlorinated ; Iceland ; Logistic Models ; Norway ; Occupational Exposure ; Odds Ratio ; Parturition ; Radiation, Ionizing ; Rectal Neoplasms ; Scandinavian and Nordic Countries ; Sweden ; Vehicle Emissions ; Wood

Currently, the South Korean Government does not provide sickness benefits from the National Health Insurance, which is different from most other Organization for Economic Cooperation and Development countries. The sickness benefit guarantees a part of lost income due to injuries or diseases. The purpose of this study is to propose a sickness benefit scheme for South Korea. To this end, we compare health care systems, sickness benefit schemes, and delivery systems of those in Germany, Japan, and Sweden, focusing on the seven categories: management authority, object, level of payment, duration of payment, qualification requirements, connection with paid sick leave of workplace, and financial resources, and as to delivery system, the six categories: the number of procedures, transferring document between institutions, whether or not utilizing electronic reporting system, applicant, and administrative convenience. Based on the implications derived from the case study, we propose the sickness benefit scheme and its delivery pathway and other details for South Korea. This study is first to propose the sickness benefit for health insurance in Korea with its level of details. More studies should follow with case studies of other countries, as well as productive debates to build a feasible and sustainable sickness benefit system in South Korea.
Delivery of Health Care ; Germany ; Insurance, Health ; Japan ; Korea ; National Health Programs ; Organisation for Economic Co-Operation and Development ; Sick Leave ; Sweden

BACKGROUND: There is little information on the dose–response relationship between exposure to occupational carcinogenic agents and mesothelioma. This study aimed to investigate this association as well as the existence of agents other than asbestos that might cause mesothelioma. METHODS: The Swedish component of the Nordic Occupational Cancer (NOCCA) study consists of 6.78 million individuals with detailed information on occupation. Mesothelioma diagnoses recorded in 1961–2009 were identified through linkage to the Swedish Cancer Registry. We determined cumulative exposure, time of first exposure, and maximum exposure intensity by linking data on occupation to the Swedish NOCCA job-exposure matrix, which includes 29 carcinogenic agents and corresponding exposure for 283 occupations. To assess the risk of mesothelioma, we used conditional logistic regression models to estimate hazard ratiosand 95% confidence intervals. RESULTS: 2,757 mesothelioma cases were identified in males, including 1,416 who were exposed to asbestos. Univariate analyses showed not only a significant excess risk for maximum exposure intensity, with a hazard ratio of 4.81 at exposure levels 1.25–2.0fb/ml but also a clear dose–response effect for cumulative exposure with a 30-, 40-, and 50-year latency time. No convincing excess risk was revealed for any of the other carcinogenic agents included in the Swedish NOCCA job-exposure matrix. CONCLUSION: When considering asbestos exposure, past exposure, even for short periods, might be enough to cause mesothelioma of the pleura later in life.
Asbestos ; Diagnosis ; Humans ; Logistic Models ; Male ; Mesothelioma* ; Occupations ; Pleura ; Sweden*

BACKGROUND/AIMS: IBD2020 is a global forum for standards of care in inflammatory bowel disease (IBD). The aim of the IBD2020 survey was to identify and describe variations in quality care of IBD. METHODS: Patients with IBD from Finland, Italy, France, Canada, Germany, UK, Spain and Sweden were surveyed during 2013 to 2014, covering: disease characteristics; impact on life and work; organization and perceived quality of care. RESULTS: Seven thousand five hundred and seven patients participated (median age, 39 years [range, 10–103 years]; 2,354 male [31.4%]), including 4,097 (54.6%) with Crohn’s disease (CD) and 3,410 (45.4%) with ulcerative colitis (UC). Median time from symptom onset to diagnosis was 1 year for both CD (range, 0–47 years) and UC (range, 0–46 years), with no clear evidence of improvement in diagnostic delay over the preceding 24 years. Half of the patients (3,429; 50.0%) rated their care as “excellent” or “very good,” with similar results for CD and UC across countries. Five factors were significantly (P < 0.01) associated with perceived good quality of care: quality of specialist communication; review consultation being long enough; failure to share information; no access to a dietician; speed of advice. CONCLUSIONS: The IBD2020 survey has highlighted areas related to quality of care of IBD from the patients’ perspective, with scope for improvement.
Canada ; Colitis, Ulcerative ; Crohn Disease ; Diagnosis ; Finland ; France ; Germany ; Humans ; Inflammatory Bowel Diseases ; Italy ; Male ; Nutritionists ; Quality of Health Care ; Spain ; Specialization ; Standard of Care ; Surveys and Questionnaires ; Sweden

Tick-induced mammalian meat allergy has become an emergent allergy world-wide after van Nunen et al. first described the association between tick bites and the development of mammalian meat allergy in 2007. Cases of mammalian meat allergy have now been reported on all 6 continents where humans are bitten by ticks, in 17 countries
Africa ; Americas ; Anaphylaxis ; Asia ; Australia ; Belgium ; Central America ; Europe ; Germany ; Great Britain ; Humans ; Hypersensitivity ; Italy ; Ixodes ; Meat ; Public Health ; South America ; Spain ; Sweden ; Switzerland ; Tick Bites ; Ticks ; United States

BACKGROUND: The aim of this study was to investigate which physical and psychosocial work demands were associated with excellent work ability in individuals with neck pain, and to investigate age and sex differences in these associations. METHODS: The study sample was obtained from the Statistics Sweden cross-sectional Work Environment survey and consisted of workers who reported neck pain after work (N = 3,212). RESULTS: The findings showed an association between excellent work ability and self-reported low exposure to lifting, twisted work posture, working with hands in shoulder level or higher, and leaning forward without support and combination of exposures containing these work demands. Low exposure to seated work and high demands showed a reversed association. The associations were present mainly among older workers and were generally stronger for men than for women. CONCLUSION: This study indicates that a lower level of physically demanding work is an important element to maintain excellent work ability, especially for the older worker with neck pain.
Female ; Hand ; Humans ; Lifting ; Male ; Neck Pain* ; Neck* ; Posture ; Sex Characteristics ; Shoulder ; Sweden

OBJECTIVES: We updated the Swedish component of the Nordic Occupational Cancer (NOCCA) Study through 2009 in order to investigate the incidence of mesothelioma of the peritoneum and pleura in both genders, and explored occupational exposures that may be associated with mesothelioma. METHODS: The Swedish component of the NOCCA Study includes 6.78 million individuals. Data from this cohort were linked to the population-based Swedish Cancer Registry and Swedish Total Population Registry for three periods between 1961 and 2009, and then further linked to the Swedish NOCCA job-exposure matrix, which includes 25 carcinogenic substances and the corresponding exposure levels for 280 occupations. Multivariate analysis was used to calculate standardized incidence ratios (SIRs) for mesothelioma of the peritoneum and pleura by gender, occupational category, carcinogenic substance, and for multiple occupational exposures simultaneously. RESULTS: A total of 3,716 incident mesotheliomas were recorded (21.1% in women). We found a significantly increased risk of mesothelioma in 24 occupations, as well as clear differences between the genders. Among men, increased risks of mesothelioma of the pleura were observed in male-dominated occupations, with the greatest elevation of risk among plumbers (SIR, 4.99; 95% confidence interval, 4.20 to 5.90). Among women, increased risks were observed in sewing workers, canning workers, packers, cleaners, and postal workers. In multivariate analysis controlling for multiple occupational exposures, significant associations were only observed between asbestos exposure and mesothelioma. CONCLUSIONS: Asbestos exposure was associated with mesothelioma incidence in our study. The asbestos ban of 1982 has yet to show any clear effect on the occurrence of mesothelioma in this cohort. Among women, the occupations of canning workers and cleaners showed increased risks of mesothelioma of the pleura without evidence of asbestos exposure.
Asbestos* ; Cohort Studies ; Epidemiology ; Female ; Humans ; Incidence* ; Male ; Mesothelioma* ; Multivariate Analysis ; Occupational Exposure ; Occupations* ; Peritoneum ; Pleura ; Sweden*

PURPOSE: To provide information on the type of “hypersensitivity-friendly” components available for primary total knee arthroplasty (TKA) in the current market. MATERIALS AND METHODS: Implant manufactures were identified using the 2013 National Joint Registries of the United Kingdom and Sweden and contacted to obtain information about the products they offer for patients with metal hypersensitivity. RESULTS: Information on 23 TKA systems was provided by 13 implant manufacturers. Of these, 15 systems had options suitable for metal hypersensitivity patients. Two types of “hypersensitivity-friendly” components were identified: 10 implants were cobalt chrome prostheses with a “hypersensitivity-friendly” outer coating and 5 implants were made entirely from non-cobalt chrome alloys. CONCLUSIONS: The results of this study suggest that several hypersensitivity TKA options exist, some of which provide the same designs and surgical techniques as the conventional implants. The information in this study can guide TKA surgeons in making informed choices about implants and identifying implants that could be examined in future controlled studies comparing outcomes between “hypersensitivity-friendly” and conventional implants.
Alloys ; Arthroplasty ; Arthroplasty, Replacement, Knee ; Cobalt ; Great Britain ; Humans ; Hypersensitivity ; Joints ; Knee ; Prostheses and Implants ; Registries ; Surgeons ; Sweden