A nationwide case-control study on cardiovascular and respiratory-related disorders in patients with gambling disorder in Sweden

OBJECTIVES

We aimed to examine potential relationships and gender differences between cardiovascular disease (CVD), diabetes, obesity, respiratory-related disorders, and gambling disorder (GD). We hypothesized that (1) GD patients would be more likely than controls to have CVD, diabetes, obesity, and respiratory-related diseases; and (2) females with GD would be more likely than men with GD to have CVD, diabetes, obesity, and respiratory-related diseases.

STUDY DESIGN

National retrospective case-control study.

METHODS

We used data from the Swedish National Board of Health and Welfare between 2005 and 2019. A total of 10,766 patients were included, and 3592 of them had GD. Every GD patient was matched with two age- and gender-matched controls. Patient data, including the history of medical diagnoses, were extracted. Descriptive statistics, Chi-squared and Fisher's exact tests were used to compare GD patients and controls.

RESULTS

GD patients had a higher prevalence of CVD and respiratory-related disorders than controls. Diabetes rates were 5% for GD patients and 2% for controls; CVD (18% vs 12%); respiratory-related disease (7% vs 4%); and obesity (7% vs 3%). Women with a diagnosis of GD have a higher prevalence of obesity and somatic comorbidities other than diabetes compared to men.

CONCLUSIONS

This is the largest case-control study conducted to date showing GD patients have a higher prevalence of CVD, diabetes, obesity, and respiratory-related disorders than controls. Women with GD appear to be more susceptible than men to CVD, obesity, and respiratory-related disorders; however, this may be partially explained by differences in help-seeking behavior. Thus, our findings highlight the importance of early identification of GD patients who may also have somatic conditions requiring treatment. This can be accomplished by implementing a screening program for GD, CVD, diabetes, obesity, and respiratory-related disorders, and by including healthy lifestyle management strategies.

Nationwide, Multioperator Self-Exclusion and Psychiatric Comorbidity in Patients with Gambling Disorder: A Retrospective Chart Review Study from a Regional Treatment Unit

Gambling disorder is an addictive disorder that has been shown to have a detrimental effect on an individual's health, social, and financial situations. Voluntary self-exclusion is one way for patients to reduce harm in gambling disorder, but breaching one's self-exclusion appears to be common. In January 2019, Sweden launched a nationwide, multioperator self-exclusion instrument called Spelpaus (literally "game break"). Spelpaus is unique to Sweden, and there is limited research on the use of this type of nationwide, multioperator self-exclusion services, also in relation to gambling disorder and mental health. There is a reason to follow the clinical picture of treatment seeking for gambling disorder over time, and this study aims to explore clinical characteristics of patients seeking clinical gambling disorder treatment, including sex distribution and mental health comorbidity, as well as the use of Spelpaus amongst patients with gambling disorder and how frequently users gambled despite ongoing self-exclusion, in relation to sex and psychiatric comorbidities. A retrospective chart study was carried out on patients presenting to a regional gambling disorder treatment unit. Information regarding self-exclusions using Spelpaus, gambling despite self-exclusion, and the method of gambling despite self-exclusion as well as psychiatric comorbidities were extracted from medical records. Females were markedly more likely to report overall psychiatric comorbidities (48% vs. 25% among males, p < 0.001), affective, neurotic/anxiety-related (p < 0.001), and behavioral/emotional (p = 0.028) diagnoses and more likely to have two or more diagnoses excluding gambling disorder (p = 0.001). From 120 patients from whom information regarding self-exclusion was present, 114 (95%) had chosen to self-exclude. From the 114 self-excluders, 67 reported to have gambled despite self-exclusion, with unregistered websites being the most common method. Self-exclusion was not significantly related to sex (p = 0.146) or to psychiatric comorbidities (p = 0.178). In conclusion, psychiatric comorbidity was particularly common in female gambling disorder patients and gambling despite self-exclusion was common. Gambling regulations should be improved to help self-excluders avoid being able to gamble on unlicensed gambling operators. Further research should focus on sex differences and the association with psychiatric comorbidities.

Self-exclusion and breaching of self-exclusion from gambling: a repeated survey study on the development of a nationwide self-exclusion service

BACKGROUND

Voluntary self-exclusion from gambling is a common harm reduction tool in individuals with a gambling disorder. Previous data have demonstrated that many gamblers breach their own self-exclusion, typically through other online services outside the jurisdiction in which they are self-excluded. The present study aimed to carry out a new follow-up measure-similar to previous studies in the same setting-of self-exclusion and its breaching in Sweden, in order to allow for the follow-up assessment of a nationwide, multi-operator self-exclusion system introduced in Sweden in 2019.

METHODS

A web survey to the web panel of a market survey company addressed 1505 past-year gamblers, who responded to a number of questions about gambling habits, including screening for gambling problems using the Problem Gambling Severity Index and self-exclusion-related items corresponding to previous studies.

RESULTS

Nine percent of past-year gamblers had self-excluded using the Spelpaus service. In logistic regression, self-exclusion was significantly associated with gambling problems, past-year online casino gambling, and absence of online poker gambling. Among self-excluders, 49 percent had ever gambled despite being self-excluded. Among those breaching their self-exclusion, the most common gambling types during self-exclusion were online casino (82 percent), sports betting (47 percent) and lotteries (43 percent).

DISCUSSION

Self-exclusion remains a popular harm reduction tool against problem gambling, more common than in previous studies, mostly in individuals with recent gambling problems and in online casino gamblers. However, breaching self-exclusion is somewhat more common than in previous research. Online casino represents the most common means of self-exclusion breaching. Policy-making in the area needs to further address the risk of breaching one's self-exclusion and may further address the risk of overseas gambling.

Superusers experiences in using naloxone to reverse opioid overdose - A qualitative study

Introduction

Since June 2018, multi-site overdose prevention education and naloxone distribution has been available in the County of Skåne, Sweden. Among the participants there are individuals who have used naloxone to reverse overdose on multiple occasions (three times or more). Situations of overdose management are characterized by different conditions which inevitably lead to different decisions and outcomes.

Objectives

To investigate the complex interaction of individual, social, and environmental factors of opioid overdose management, how these overdose situations affect responders´ lives, what impact prior experiences may have on engagement in future overdose situations and if needs of support to deal with these situations are met.

Methods

Qualitative study employing semi-structured interviews with individuals trained at needle exchange programs within the region who have used naloxone on more than two occasions to reverse opioid overdose. Interviews will be conducted during Q4 2021 and analysed thematically during Q1 2022.

Results

Preliminary clinical observations point to the ambivalence between positive consequences of empowerment and pride in saving lives, and negative feelings of prior decisions and the burden to engage in future overdoses, in addition to insufficient access to support when dealing with these negative consequences.

Conclusions

Not yet available.

Disclosure

No significant relationships.

Fear of COVID-19, compliance with recommendations against virus transmission, and attitudes towards vaccination in Sweden

Following the immense impact of the COVID-19 pandemic on health and everyday lives world-wide, people's fear of COVID-19 has been studied in a number of settings using the Fear of COVID scale. In Sweden, virus-preventing strategies have differed from comparable countries, with low use of formal lock-down procedures. It is crucial to study correlates of non-compliance with COVID-19 recommendations, and unwillingness to become vaccinated. This study aims to study whether fear of COVID is associated with mental distress and attitudes towards the pandemic, and to study correlates of non-compliance with key anti-COVID recommendations and with reluctancy to vaccination. This anonymous online survey study in web panel participants (N = 1,501) aimed to study a range of behavioral changes during COVID-19. Recommendations and vaccinations reluctancy were analyzed in logistic regressions against socio-demographic data, COVID-19 status, and mental health history. Internal consistency of the Fear of COVID scale was calculated. The Fear of COVID scale had a satisfactory internal consistency (Cronbach-alpha 0.84), and was significantly associated with compliance with all COVID-19 recommendations and with mental health. Non-compliance with recommendations was associated with low fear of disease and younger age, among other variables. Being against vaccination was associated, among other variables, with low fear of disease and with low education. In conclusion, the Fear of COVID scale appears to be associated with key attitudes towards the COVID-19 disease. Anti-virus strategies may need to promote compliance with recommendations in subgroups who feel low fear of disease or who believe not to be in a risk group for severe disease.

Match-Fixing Causing Harm to Athletes on a COVID-19-Influenced Gambling Market: A Call for Research During the Pandemic and Beyond

Match-fixing, although not a new problem, has received growing attention during the COVID-19 pandemic, which has been reported in the media to have increased the risk of match-fixing events. Gambling is a well-documented addictive behavior, and gambling-related fraud, match-fixing, is a challenge to the world of sports. Most research on match-fixing has a judicial or institutional perspective, and few studies focus on its individual consequences. Nevertheless, athletes may be at particular risk of mental health consequences from the exposure to or involvement in match-fixing. The COVID-19 crisis puts a spotlight on match-fixing, as the world of competitive sports shut down or changed substantially due to pandemic-related restrictions. We call for research addressing individual mental health and psycho-social correlates of match-fixing, and their integration into research addressing problem gambling, related to the pandemic and beyond.

The societal costs of problem gambling in Sweden

BACKGROUND

Problem gambling is a public health issue affecting both the gamblers, their families, their employers, and society as a whole. Recent law changes in Sweden oblige local and regional health authorities to invest more in prevention and treatment of problem gambling. The economic consequences of gambling, and thereby the potential economic consequences of policy changes in the area, are unknown, as the cost of problem gambling to society has remained largely unexplored in Sweden and similar settings.

METHODS

A prevalence-based cost-of-illness study for Sweden for the year 2018 was conducted. A societal approach was chosen in order to include direct costs (such as health care and legal costs), indirect costs (such as lost productivity due to unemployment), and intangible costs (such as reduced quality of life due to emotional distress). Costs were estimated by combining epidemiological and unit cost data.

RESULTS

The societal costs of problem gambling amounted to 1.42 billion euros in 2018, corresponding to 0.30% of the gross domestic product. Direct costs accounted only for 13% of the total costs. Indirect costs accounted for more than half (59%) of the total costs, while intangible costs accounted for 28%. The societal costs were more than twice as high as the tax revenue from gambling in 2018. Direct and indirect costs of problem gambling combined amounted to one third of the equivalent costs of smoking and one sixth of the costs of alcohol consumption in Sweden.

CONCLUSIONS

Problem gambling is increasingly recognized as a public health issue. The societal costs of it are not negligible, also in relation to major public health issues of an addictive nature such as smoking and alcohol consumption. Direct costs for prevention and treatment are very low. A stronger focus on prevention and treatment might help to reduce many of the very high indirect and intangible costs in the future.

Clinical characteristics distinguishing tramadol-using adolescents from other substance-using adolescents in an out-patient treatment setting

BACKGROUND

Non-medical Prescription Opioid Use (NMPOU) has increased worldwide during the last decades, and specifically, tramadol misuse may represent a novel pattern of substance use among adolescents. The present study aims to analyze characteristics distinguishing tramadol-using adolescents from other substance-using adolescents seeking out-patient treatment.

METHODS

This is a cross-sectional study of treatment-seeking patients between 13 and 24 years of age in an out-patient facility for substance use problems in Malmö, Sweden. A total of 526 treatment-seeking adolescents at an out-patient treatment center were included. Data on substance use, treatment history and socio-demographic variables were extracted through a semi-structured interview method aimed specifically for adolescents with alcohol or drug problems (Ung-DOK). Lifetime tramadol users were compared to non-users, and also, primary tramadol users were compared to remaining subjects.

RESULTS

Thirty-one percent (n = 162) were tramadol users (lifetime prevalence). In logistic regression, the tramadol group showed a significantly increased risk of tobacco use, problematic lifetime cocaine, benzodiazepine and amphetamine use, and were more likely to report contacts with the judicial system, and less likely to report contacts with child or adult psychiatry, and more likely to have parents born outside the Scandinavian countries. In logistic regression, primary tramadol use was negatively associated with frequent cannabis use.

CONCLUSIONS

Tramadol use appears to be a novel pattern among treatment-seeking adolescents. They showed a significantly increased risk of initiation of other illicit drugs and criminal behaviour, despite less contact with psychiatric care. More attention may be needed to this relatively novel pattern of opioid use.

Role of Gambling in Payback Failure in Consumer Credit-Data from a Large Body of Material Regarding Consumer Loan Recipients in Sweden

Indebtedness is associated with poor health outcomes, and problem gambling may contribute to indebtedness through consumer credits related to gambling expenses. The assessment of consumers’ applications for loans may be an opportunity to detect and prevent further problem gambling. The present study analyzed a number of variables including gambling-related transactions and their association with payback failure in 48,197 loans to 20,750 individuals in Sweden. Sums and frequency of gambling deposits or withdrawals generally did not predict failure to pay back loans. Instead, having a loan defaulted at some time was associated with a baseline pattern describing a theoretical loss-of-control gambling pattern (short-term intense gambling), with a higher ratio of gambling deposits or withdrawals per occasion, and with several instances of gambling in close association with a loan. While several group differences were modest, signs of rapid, short-term and intense gambling, rather than gambling itself, may identify risk of payback failure and risk of indebtedness. Implications for early problem-gambling detection and prevention, such as by gambling operators and financial institutes, are discussed and may promote better public health in relation to gambling indebtedness.

Television gambling advertisements: Extent and content of gambling advertisements with a focus on potential high-risk commercial messages

Background

In problem gambling, recent years have seen an expansion of online gambling in treatment-seeking patients. Television advertising may promote risky gambling, and this study aimed to assess gambling-related advertisements, with respect to potentially risky messages, in a country with high rates of online gambling among treatment seekers, for online casino particularly in treatment-seeking women.

Methods

A total of 144 h in six commercial television channels were studied with respect to frequency, extent and content of gambling-related advertisements, which were analyzed with respect to potentially risky messages and specific target groups, and compared with respect to legal status of gambling companies and for online casino gambling vs other gambling types. Aspects to analyze were elected theoretically and based on acceptable inter-rater agreement between the authors.

Results

Nineteen percent (11–28% across different channels) of advertisements promoted gambling, with online casino being by far the most common type of gambling exposed. Messages promoting ease to gamble (including bonuses and rapid cash-out messages) and a female focus were significantly more common in online casino gambling and in non-licensed companies, whereas sports-related messages were more common in licensed companies. Gambling-related advertisements were also common in relation to family movies, and appeared even during children's programs.

Conclusions

Online casino was by far the most common type of televised gambling advertisements. Several risky messages were identified, and female gender, as well as messages promoting the rapidity and facility of gambling, were more commonly addressed by online casino companies. Public health aspects are discussed.

•

Gambling advertisements are common in television in a country where online games are predominating in treatment settings.

•

Several potentially hazardous gambling messages are common, and more common in online casino-related advertisements.

•

Online casino-related advertisements more commonly addressed women, with potential implications for the health of female gamblers.

•

Findings call for increased attention to gambling advertisements as a public health issue.

Problem gambling and gaming in elite athletes

Background

High-level sports have been described as a risk situation for mental health problems and substance misuse. This, however, has been sparsely studied for problem gambling, and it is unknown whether problem gaming, corresponding to the tentative diagnosis of internet gaming disorder, may be overrepresented in athletes. This study aimed to study the prevalence and correlates of problem gambling and problem gaming in national team-level athletes.

Methods

A web-survey addressing national team-level athletes in university studies (survey participation 60%) was answered by 352 individuals (60% women, mean age 23.7), assessing mental health problems, including lifetime history of problem gambling (NODS-CLiP) and problem gaming (GASA).

Results

Lifetime prevalence of problem gambling was 7% (14% in males, 1% in females, p < 0.001), with no difference between team sports and other sports. Lifetime prevalence of problem gaming was 2% (4% in males and 1% in females, p = 0.06). Problem gambling and problem gaming were significantly associated (p = 0.01).

Conclusions

Moderately elevated rates of problem gambling were demonstrated, however with large gender differences, and interestingly, with comparable prevalence in team sports and in other sports. Problem gaming did not seem more common than in the general population, but an association between problem gambling and problem gaming was demonstrated.

•

Problem gambling is moderately elevated in national team-level athletes in Sweden.

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Problem gambling is markedly more common in male athletes than in female athletes.

•

Problem gambling may be associated with problem gaming.

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Problem gaming in athletes is not clearly more common than in the general population.

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Problem gaming in athletes may be more common among males than females.

Role of parenting styles in adolescent substance use: results from a Swedish longitudinal cohort study

OBJECTIVE

Adolescent substance use is an area of concern because early substance use is associated with a higher risk of adverse outcomes. Parenting style, defined as the general style of parenting, as well as substance-specific parenting practices may influence children's substance use behaviour. The present study aims to probe the impact of parenting style on adolescent substance use.

METHOD

A cohort of 1268 adolescents (48% girls), aged 12-13 years at baseline, from 21 junior high schools was assessed in the first semester of junior high school, and then again in the last semester of the 9th grade, 32 months later. Parenting style, operationalised as a fourfold classification of parenting styles, including established risk factors for adolescent substance use, were measured at baseline.

RESULTS

Neglectful parenting style was associated with worse substance use outcomes across all substances. After adjusting for other proximal risk factors in multivariate analyses, parenting style was found to be unrelated to substance use outcomes with one exception: authoritative parenting style was associated with less frequent drinking. Association with deviant peers, delinquent behaviour, provision of alcohol by parents, and previous use of other substances were associated with substance use outcomes at follow-up.

CONCLUSIONS

The results of the present study indicate that parenting style may be less important for adolescent substance use outcomes than what has previously been assumed, and that association with deviant peers and delinquent behaviour may be more important for adolescent substance use outcomes than general parenting style.

NLS

Cooperation across national borders is of paramount importance for the security in border close regions. Timely and adequate training, reflection, and preparation are core tools for facilitating and stimulating such interregional cooperation. Hence, NetAgora, a service oriented web portal for security cooperation, was designed. In NetAgora there is first a service package with accident- and emergency scenarios. Here multi-actors can train their cooperation and decision making skills. The R-statistics open source package is applied for recording and analyzing data from those training occasions. In subsequent debriefing sessions this is used for post-learning. Further, from anticipatory modeling and simulation it is found that rescue operations are delayed and misguided due to shortcomings in the communication between security command and communication centers. Hence, the NetAgora Learning System is designed and prototyped in order to overcome that problem. It will facilitate and stimulate reflection in action and double loop learning and aims at improving communication patterns by anticipatory pre-learning.

Tailoring of defect levels by deformations: Te-antisite in CdTe

The properties of the Te-antisite defect in the neutral state in CdTe were examined using ab initio calculations. The influence of three types of deformations (1D, 2D and 3D) on the defect energy levels and formation energies was investigated. It was found that the 2D deformation is the most effective for pushing the defect levels towards the band edges and opening up the bandgap of the semiconductor, and hence may improve the performance of CdTe as a detector material. We studied the defect levels and their occupancies including Jahn-Teller distortions. The Jahn-Teller distorted configuration places the 2A1(a) defect level closer to the valence band and this defect level position coincides with the 'unknown deep donor' measured in some experiments. Partial densities of states and band structures have been analysed to understand the arrangement of the defect bonds.

Increased sensitivity through maximizing the extinction ratio of SOI delay-interferometer receiver for 10G DPSK

We present an optimized design for a 10G- differential-phase-shift-keyed (DPSK) receiver based on a silicon-on-insulator (SOI) unbalanced tunable Mach-Zehnder interferometer (MZI) switch in sequence with a Mach-Zehnder delay interferometer (MZDI). The proposed design eliminates the limitation in sensitivity of the device produced by the waveguide propagation losses in the delay line. A 2.3 dB increase in receiver sensitivity at a bit-error-rate (BER) of 10(-9) is experimentally measured over a standard implementation. The enhanced sensitivity is achieved with zero power consumption by tuning the operating wavelength or with less than 5 mW for a fixed wavelength using microheaters. Also the foot-print of the device is minimized to 0.11 mm(2) by the use of compact spirals.

Patient specific biomodel of the whole aorta - the importance of calcified plaque removal

BACKGROUND

The use of anatomical models produced by 3D printing technique (rapid prototyping, RP) is gaining increased acceptance as a complementary tool for planning complex surgical interventions. This paper describes a method for creating a patient specific replica of the whole aorta.

METHODS

Computed tomography angiography (CTA) DICOM-data was converted to a three-dimensional computer aided design-model (CAD) of the inner wall of the aorta representing the lumen where the calcified plaque contribution was removed in a multi-step editing-manoeuvre. The edited CAD-model was used for creating a physical plaster model of the true lumen in a 3D-printer. Elastic and transparent silicon was applied onto the plaster model, which was then removed leaving a silicon replica of the aorta.

RESULTS

The median (interquartile range) difference between diameters obtained from CTA- and RP plaster-model at 19 predefined locations was 0.5 mm (1 mm) which corresponds to a relative median difference of 4.6% (7.0%). The average wall thickness of the silicone model was 3.5 mm. The elasticity property and performance during intervention was good with an acceptable transparency.

CONCLUSIONS

The integration of RP-techniques with CAD based reconstruction of 3D-medical imaging data provides the needed tools for making a truly patient specific replica of the whole aorta with high accuracy. Plaque removal postprocessing is necessary to obtain a true inner wall configuration.

Cytochrome P450 2E1 gene polymorphisms/haplotypes and Parkinson's disease in a Swedish population

Cytochrome P450 2E1 (CYP2E1), which inter alia is located in dopamine containing neurons in the substantia nigra, has been hypothesized to be of importance for the pathophysiology of Parkinson's disease (PD), either by its production of reactive oxygen species (ROS) or by its capability to detoxify putative neurotoxins. Numerous polymorphisms in the coding and non-coding regions of the gene for this enzyme have been reported. Different variants may account for inter-individual differences in the activity of the enzyme or production of ROS. In this study, the CYP2E1 gene was examined in a control population (n = 272) and a population with PD (n = 347), using a tag-single nucleotide polymorphism (tSNP) approach founded on HapMap Data. Six tSNPs were used in the analysis and haplotype block data were obtained. In case of significance, the SNP was further examined regarding early/late age of disease onset and presence of relatives with PD. We found an association between allele and genotype frequencies of the C/G polymorphism at intron 7 (rs2070676) of this gene and PD (P value of 0.026 and 0.027, respectively). Furthermore, analysis of the rs2070676 polymorphism in subgroups of patients with age of disease onset higher than 50 years and those not having a relative with PD also demonstrated a significant difference with controls. This was seen in both genotype (corresponding to P value = 0.039 and 0.032) and allele (P = 0.027 and 0.017 respectively) frequency. As a representative of many polymorphisms or in possible linkage disequilibrium with other functional variants, it is possible that rs2070676 could influence the regulation of the enzyme. In conclusion, our results display an association between the rs2070676 polymorphism and PD. Additional investigations are needed to elucidate the importance of this polymorphism for the activity of CYP2E1 and PD susceptibility.

Fathers and their children's health: a telephone interview study

OBJECTIVE

To study fathers' perception of, and involvement in, their children's health.

DESIGN

Telephone interviews according to a structured guide.

SETTING

County of Skåne, Sweden.

MAIN OUTCOME MEASURES

Answers regarding care and upbringing of child, child's health and ill health, and role of father.

SUBJECTS

237 fathers of small children.

RESULTS

Fathers seem to be involved in their children to a large extent, both in caring and playing activities with their children. Most of them (82%) think that the child's health is good, and half of them (55%) have, at some time, contacted a doctor. The fathers mention security, love and commitment as important factors for being a good father, and almost all (97%) think that they are good fathers. Yet, only slightly more than half of them (54%) state that they have sufficient time for the child.

CONCLUSIONS

Today, fathers are subject to quite different expectations to participate actively in their children's everyday life than was the case for previous generations. Therefore, more studies of fathers' involvement in their children are needed, as well as a new approach within the health care system to fathers' participation.

Rose hip and Lactobacillus plantarum DSM 9843 reduce ischemia/reperfusion injury in the mouse colon

Ischaemia/reperfusion (I/R) of the colon is an inflammatory condition that leads to tissue injury where reactive oxygen species play a central role. Rose hip is rich in biologically active polyphenols with antioxidative properties, which may be important in prevention of lipid peroxidation. L. plantarum DSM 9843 possesses enzymatic activity towards polyphenols. The objective of this study was to define the effect of oral administration of L. plantarum and rose hip in I/R injury. Administration of rose hip and L. plantarum significantly decreased MDA levels in caecum tissue and Enterobacteriaceae counts in caecum stool. A positive correlation between MDA levels and Enterobacteriaceae counts was found. The results support a synergistic/additive role of rose hip and L. plantarum in reducing lipid peroxidation. Therefore rose hip and L. plantarum may be used as a pretreatment to tissue injuries, e.g. colonic surgery, organ transplantation and vascular surgery.

Comment on "Theory of tailoring sonic devices: diffraction dominates over refraction"

Recently, Garcia et al. [Phys. Rev. E 67, 046606 (2003)] studied theoretically several acoustic devices with dimensions on the order of several wavelengths. Those authors also discussed experimental results previously reported by several of us [Phys. Rev. Lett. 88, 023902 (2002)]] and concluded that it is diffraction rather than refraction that is the dominating mechanism explaining the focusing effects observed in those experiments. In this Comment we reexamined their calculations and discussed why some of their interpretations of our results are misleading.

Association between the estrogen receptor beta gene and age of onset of Parkinson's disease

The purpose of this study was to investigate the potential contribution of genetic variants in the estrogen receptor beta gene to the aetiology of Parkinson's disease (PD). Several lines of evidence from human and animal studies suggest a protective role for estrogen in PD. Recently the estrogen receptor beta subtype was reported to be an important mediator of estrogen actions in the nigrostriatal dopamine system. Two single nucleotide polymorphisms at position 1730 and 1082 in the ER beta gene were genotyped, using pyrosequencing, in 260 patients with PD and 308 controls recruited from the Swedish population. Neither of the two estrogen receptor beta polymorphisms was associated with an increased risk for PD. However, the G allele of the A1730G polymorphism was more frequent in patients with an early age of onset than in patients with a late age of onset of PD (P = 0.006). Patients carrying the GG genotype had an odds ratio of 2.2 for having an early onset of PD compared to non-carriers. In conclusion, our results indicate that genetic variation in the estrogen receptor beta gene may influence the age of onset of PD.

On the biological relevance of MHC class II and B7 expression by tumour cells in melanoma metastases

A large number of studies have indicated that specific immune reactivity plays a crucial role in the control of malignant melanoma. In this context, expression of MHC I, MHC II and B7 molecules by melanoma cells is seen as relevant for the immune response against the tumour. For a better understanding of the biological relevance of MHC II and B7 expression by tumour cells in metastatic melanoma, we studied the expression of these molecules in melanoma metastases in relation to the inflammatory response, regression of the tumour and survival from 27 patients treated with biochemotherapy (30 mg m(-2) Cisplatin and 250 mg m(-2) decarbazine (dimethyl-triazene-imidazole-carboxamide, DTIC) on days 1-3 i.v., and 10(7) IU IFN-alpha 2b 3 days a week s.c., q. 28d). In 19 out of 27 lesions studied, we found expression of MHC II by the tumour cells, while only in one out of 11 tumour biopsies obtained from untreated metastatic melanoma patients, MHC II expression was detected. Expression of B7.1 and B7.2 by tumour cells was found in nine out of 24 and 19 out of 24 lesions, respectively. In all cases where B7.1 expression was found, expression of B7.2 by the tumour cells was also seen. In general, no or only few inflammatory cells positive for B7 were found. Expression of MHC II by tumour cells was positively correlated with the presence of tumour-infiltrating lymphocytes, regression of the lesion, and with time to progression (TTP) and overall survival (OS) of the patient. However, no significant correlation between B7.1 or B7.2 expression and regression of the tumour, TTP or OS was found. In light of other recent findings, these data altogether do support a role as biomarker for MHC II expression by tumour cells; however, its exact immunological pathomechanism(s) remain to be established.

A voice accumulator device: evaluation based on studio and field recordings

A voice accumulator is a portable device for long-term measurements of voice use in natural conditions. A contact microphone attached to the front part of the neck registers vocal fold vibrations. The purposes of the present study were: 1) to evaluate the voice accumulator's two measuring programs optimized for registration of fundamental frequency (F0) and phonation time, respectively; and 2) to test the voice accumulator for field recordings. Four healthy subjects were recorded in a sound-proof booth simultaneously with one contact microphone into a voice accumulator and one contact microphone into a computer. In terms of F0 and phonation time, the results showed that correlations between the voice accumulator's two measuring programs and a signal-processing program were high (r > or = 0.85) for all subjects but one. The inter-subject variability was large. A prerequisite for reliable vocal fold vibration detection by the voice accumulator was a careful placement and a firm attachment of the contact microphone on the neck. Four subjects were recorded with the voice accumulator during a working day. It was concluded that the voice accumulator is an overall good instrument for measurements of F0 and phonation time, and thus is useful for both clinical work and research.

Measuring the size of ulcers by planimetry: a useful method in the clinical setting

OBJECTIVE

The aim of this study was to compare four measurement methods. Digital planimetry was compared with mechanical planimetry, placing the film over graph paper and counting the squares (grid tracing), and multiplying the two maximal perpendicular diameters of the ulcer (diameter product).

METHOD

Twenty patients with 50 chronic leg ulcers of various aetiology and sizes (20 ulcers were < or = 3 cm2, 15 ulcers were > 3 cm2 and < or = 10 cm2, and 15 ulcers were > 10 cm2) were enrolled consecutively into this study. Ulcer area was calculated from film transparency tracings using a digital planimeter, a mechanical planimeter, grid tracing and diameter product.

RESULTS

The mean difference of digital planimetry versus mechanical planimetry, grid tracing and diameter product was 0.51 cm2, 0.72 cm2 and -5.38 cm2, respectively. For all methods difference tended to increase with ulcer size.

CONCLUSION

Digital and mechanical planimetry, together with grid tracing, appear to be appropriate means of obtaining accurate surface area measurements. Digital planimetry is a quick and practical method and could therefore be recommended in the clinical setting.

Biochemotherapy of metastatic malignant melanoma. Predictive value of tumour-infiltrating lymphocytes

The therapeutic efficacy of biochemotherapy in metastatic malignant melanoma still carries a low remission rate, but with some durable responses. It would therefore be of considerable importance if patients with a high probability of responding could be identified using predictive tests. The response to interferon-alpha (IFN-alpha) correlates with the occurrence of CD4(+) lymphocytes identified by fine-needle aspirates from melanoma metastases (Håkansson et al, 1996). The present investigation studies a possible correlation between tumour-infiltrating CD4(+) lymphocytes in malignant melanoma metastases and the therapeutic effect of biochemotherapy. A total of 25 patients with systemic and 16 with regional metastatic melanoma were analysed before initiation of biochemotherapy (cis-platinum 30 mg/m(2) d.1-3, DTIC 250 mg/m(2) d.1-3 i.v. and IFN-alpha 2 b 10 million IU s.c. 3 days a week, q. 28d.). A monoclonal antibody, anti-CD4, was used to identify tumour-infiltrating lymphocytes in fine-needle aspirates before start of treatment. The presence of these lymphocytes was correlated to response, time to progression and overall survival. A statistically significant correlation (P = 0.01) was found between the occurrence of CD4(+) lymphocytes and tumour regression during biochemotherapy in patients with systemic disease. Out of 14 patients with moderate to high numbers of infiltrating CD4(+) lymphocytes, 12 achieved tumour regression. In contrast, among patients with low numbers of these cells in metastatic lesions, 8 out of 11 had progressive disease. We also found a significantly longer time to progression (P < 0.003) and overall survival (P < 0.01) among patients with moderate to high numbers of these cells compared to patients with low numbers of these cells before initiation of biochemotherapy. Furthermore, in patients with regional disease, we found a significantly longer time to progression (P = 0.01) and a trend toward a longer overall survival time (P = 0.09). Based on these results and as previously shown with IFN-alpha therapy alone, there seems to be a need for CD4(+) lymphocytes infiltrating the tumours before the start of biochemotherapy to make the treatment successful. Determination of these cells in fine-needle aspirates seems to be a method to predict responders to biochemotherapy, thus increasing the cost-benefit of this treatment strategy considerably, both in terms of patient adverse reactions and health care costs.

Counseling Hypertensive patients: an observational study of 21 public health nurses

This study observed the public health nurse's and the patient's activity level during blood pressure measurement and the kind of nonpharmacological treatment that was given. Using the Nurse Practitioner Rating Form, three structured observations were made of 21 public health nurses at their offices at health care centers. The nurses were randomly selected from 22 health care centers in Southern Sweden. The public health nurses used nonpharmacological treatment at 18 out of 63 visits, mainly diet and physical activity. The nonpharmacological conversation had a psychosocial aspect at 15 observations. During the visits, most of the facts and advice concerned somatic aspects of health promotion. Almost all patients were asked about their medication. At more than half of the observations, the nurses and the patients met at the same medium or high communication level. The nurses need training and information about nonpharmacological treatment to practice health promotion in hypertension care.

Prescribing, prescription costs and adherence to formulary committee recommendations: long-term differences between physicians in public and private care

BACKGROUND

In southern Sweden, many general practitioners (GPs) participate in an extensive postgraduate drug education programme, and many health centres are also fed back crude local drug statistics from pharmacists in the area. Private physicians and hospital physicians have not participated in these programmes.

OBJECTIVE

The drug prescribing habits and costs of GPs, hospital physicians and private physicians were compared.

METHODS

Each March, from 1990 to 1997, all prescriptions dispensed at the eight pharmacies in Växjö, a city and municipality in southern Sweden, were registered, specifying drug(s) prescribed, price, patient's age, sex and area of residence, and prescriber's place of work and category.

RESULTS

Overall, the costs of prescribed drugs increased with time, even in 1997 when the prescribing volume was reduced due to changes in the reimbursement system. The cost increase was caused by increased prescribing of newer, more expensive drug alternatives. However, within each of the eleven major drug groups, the drugs prescribed by GPs were less expensive than those prescribed by hospital physicians and, particularly, private physicians. Moreover, even though GPs prescribed more and a wider range of drugs, they also had a higher degree of adherence to the recommendations by the formulary committee.

CONCLUSION

GPs prescribed less expensive drugs and had a higher degree of adherence to the recommendations by the formulary committee than other categories of physicians. One reason for these differences may be that the GPs participated in regional and local educational activities aimed at the rationalisation of drug prescribing.

In vivo activation of dendritic cells and T cells during Salmonella enterica serovar Typhimurium infection

The present study was initiated to gain insight into the interaction between splenic dendritic cells (DC) and Salmonella enterica serovar Typhimurium in vivo. Splenic phagocytic cell populations associated with green fluorescent protein (GFP)-expressing bacteria and the bacterium-specific T-cell response were evaluated in mice given S. enterica serovar Typhimurium expressing GFP and ovalbumin. Flow cytometry analysis revealed that GFP-positive splenic DC (CD11c+ major histocompatibility complex class II-positive [MHC-II+] cells) were present following bacterial administration, and confocal microscopy showed that GFP-expressing bacteria were contained within CD11c+ MHC-II+ splenocytes. Furthermore, splenic DC and T cells were activated following Salmonella infection. This was shown by increased surface expression of CD86 and CD40 on CD11c+ MHC-II+ cells and increased CD44 and CD69 expression on CD4+ and CD8+ T cells. Salmonella-specific gamma interferon (IFN-gamma)-producing cells in both of these T-cell subsets, as well as cytolytic effector cells, were also generated in mice given live bacteria. The frequency of Salmonella-specific CD4+ T cells producing IFN-gamma was greater than that of specific CD8+ T cells producing IFN-gamma in the same infected animal. This supports the argument that the predominant source of IFN-gamma production by cells of the specific immune response is CD4+ T cells. Finally, DC that phagocytosed live or heat-killed Salmonella in vitro primed bacterium-specific IFN-gamma-producing CD4+ and CD8+ T cells as well as cytolytic effector cells following administration into naïve mice. Together these data suggest that DC are involved in priming naïve T cells to Salmonella in vivo.

Early patient contact in primary care: a new challenge

BACKGROUND

The Medical School of Lund University, Sweden, has introduced an early patient contact course, including training in communication and examination skills. The course runs parallel with theoretical subjects during the students' first two-and-a-half years. General practitioner (GP) participation is gradually increasing, and in the last half-year of the course GPs in all health centres in the area are involved. Little is known about the GPs' interest, competence and time for this new task.

AIM

To describe the GPs' attitudes towards teaching and the rewards and problems they experience.

SUBJECTS

30 GPs teaching third-year medical students.

METHOD

Semistructured interview study. Data analysis by a method described by Malterud.

RESULTS

The attitude towards teaching was mostly positive and the teachers were confident about teaching examination procedure. Among rewards of teaching, improved quality of clinical practice was the main theme, but imparting knowledge to others, contact with enthusiastic students, and gains in self-esteem were also mentioned. Problems with teaching were mostly due to external factors such as lack of time and space, but concern about a negative effect on patient care was also recognized. Educational objectives of the course were not completely accepted. GPs were not fully aware about what to expect from the students, with subsequent problems concerning how to assess students' performance and how to give effective feedback.

CONCLUSIONS

The teaching of junior medical students is maintained by the GPs' enthusiasm for teaching. However, teacher training is required and the crucial issues of time and space have to be considered.

Common cancer-related symptoms among GP patients. Opportunistic screening in primary health care

OBJECTIVE

To study the occurrence of symptoms related to the five most common forms of cancer among patients regularly visiting primary care. To estimate the proportion of symptoms needing GP examination, and the number of tumours thus diagnosed.

DESIGN

Patients with some form of non-malignant chronic disease received a letter with information about cancer-related symptoms along with an invitation to regular check-up. The letter described the most common symptoms of breast, colorectal, lung, prostate and skin cancers.

SETTING

12 health centres in Kalmar County, Sweden.

SUBJECTS

5200 patients aged over 40 years.

RESULTS

One patient in 13 reported cancer-related symptoms to the GP. Women reported more symptoms than men, and almost half of them had had symptoms at previous check-ups. The GP was able to explain 7 out of 10 patients' symptoms directly. When other symptoms were examined, 8 cancers were diagnosed as well as 6 pre-malignant tumours, corresponding to 3 tumour diagnoses per 1000 check-ups.

CONCLUSION

While attending regular check-ups, patients may not report symptoms which cause anxiety and sometimes indicate serious diseases. It is possible to widen the perspective and link both primary and secondary prevention of certain cancers to the check-up.

Parents: the best experts in child health care? Viewpoints from parents and staff concerning child health services

The aim was to describe what parents and staff think about child health care, to identify agreements and disagreements. A qualitative study was made with semi-structured interviews based on a phenomenographic approach. Sixty parents, 14 nurses and six doctors from southern Sweden were interviewed. Parents and staff emphasized two tasks as being of particular importance: support and check-ups. There was a conflict between parents' need for security versus integrity. Individual nurses experienced a conflict between what they wanted to do and what they felt that they had to do. The parents viewed parental education as a chance to exchange experiences with other parents and receive support from other adults, while the staff mainly saw it as an opportunity to inform parents and strengthen them in their parental role. The study gives grounds for reflection about how the work of child health care can be changed in the future.

Combustion of gasolines in premixed laminar flames European certified and California phase 2 reformulated gasoline

Two gasoline qualities, European unleaded certified gasoline (EUCG) and California phase 2 reformulated gasoline (P2 RFG), were analysed. EUCG contained about twice the amount of alkyl benzenes compared to P2 RFG and a large amount of cyclohexane. As a balance, P2 RFG contained higher amounts of isooctane and MTBE. The gasolines were burned in a premixed laminar flame burner at 1 atm and at about stoichiometric fuel/air ratio. The species profiles were measured using on-line GC/MS. About 40 compounds were be detected in the gasoline flames. The EUCG resulted in formation of more reactive and toxic compounds. The combustion profiles of the fuel components showed a similar slope, which suggests that the fuel components burn quite independently of each other. Ethene and propene were the dominating species produced from the two gasolines. Commonly, substantial amounts of higher alkenes were found. Combustion of P2 RFG produced higher amounts of isobutene, propene, propyne, propadiene and methanol compared to combustion of EUCG. The high amount of isobutene is reasonably a result of high concentration of isooctane and MTBE in the fuel. The high amount of methanol formed is probably due to the MTBE present in the gasoline. EUCG produced significantly higher amounts of 1,3-butadiene, which quite likely is formed from the cyclohexane in the fuel. The benzene profiles from both gasolines shows an almost constant level up to 800 microm from the burner surface; this is probably due to formation of benzene from alkyl benzenes.

Leg ulcers in patients with rheumatoid arthritis--a prospective study of aetiology, wound healing and pain reduction after pinch grafting

OBJECTIVE

To study the aetiology of leg ulcers in patients with rheumatoid arthritis (RA) and to study healing and pain relief after pinch grafting.

METHODS

Twenty patients with RA and leg ulcers were studied. Diagnosis of the ulcers was founded on the clinical picture and measurements of the ankle-brachial pressure index. To detect vasculitis, skin biopsies were taken for immunohistochemistry and histopathology. Pain severity was assessed pre- and post-operatively using a visual analogue scale.

RESULTS

Ten of the 20 patients had ulcers with multifactorial aetiology. Fifteen had signs of venous insufficiency, 11 had histopathological evidence of vasculitis, four had reduced arterial circulation and two patients had diabetes. Healing after pinch grafting was found in eight patients, all of whom had an ulcer area less than 15 cm(2). Eleven out of 18 patients had pain reduction after pinch grafting.

CONCLUSION

The causation of leg ulcers in patients with RA was found to be multifactorial, with vasculitis and venous insufficiency as the main determinants. Pinch grafting seems to be a good alternative to conservative treatment for minor leg ulcers for these patients, regarding both wound healing and pain relief.

[Residential care after the geriatric care reform. District nurses experience extensive responsibility and limited rights]

We studied the care of patients in homes for the elderly and in special homes for the demented in the city of Malmö. Nine district nurses were interviewed using a tape recorder, and the content of the interviews was analyzed. Many patients needed extensive care, and resources were insufficient regarding both number of staff and their competence. The management of nursing in the various districts of the city was not well-defined. More consulting time was requested on the part of both district nurses and general practitioners in homes for the elderly and homes for the demented.

Risk factors for respiratory tract infections in children aged 2-5 years

OBJECTIVE

To study risk factors for respiratory tract infections (RTIs) in children aged 2-5 years.

DESIGN

A questionnaire was used to chart the number of visits to doctors and the number of antibiotics courses because of RTIs during a 1-year period. The risk factors studied were age, sex, birth weight, breastfeeding, atopy, siblings, smoking and childcare.

SETTING

The catchment area of Oxie health centre in southern Sweden.

SUBJECTS

190 pre-school children.

MAIN OUTCOME MEASURES

Number of visits to doctors and number of antibiotics courses.

RESULTS

The risk of having to consult a doctor, as well as the risk of receiving treatment with antibiotics, because of RTIs was greater among children at daycare centres than among children who were mostly at home (adjusted OR 2.78 (95% CI 1.34-5.78) and 2.73 (1.38-5.43), respectively).

CONCLUSION

Attending a daycare centre is the most important risk factor for RTIs in children aged 2-5 years.

Characterization of binding of human lactoferrin to pneumococcal surface protein A

Human lactoferrin is an iron-binding glycoprotein that is particularly prominent in exocrine secretions and leukocytes and is also found in serum, especially during inflammation. It is able to sequester iron from microbes and has immunomodulatory functions, including inhibition of both complement activation and cytokine production. This study used mutants lacking pneumococcal surface protein A (PspA) and PspC to demonstrate that the binding of human lactoferrin to the surface of Streptococcus pneumoniae was entirely dependent on PspA. Lactoferrin bound both family 1 and family 2 PspAs. Binding of lactoferrin to PspA was shown by surface colocalization with PspA and was verified by the lack of binding to PspA-negative mutants. Lactoferrin was expressed on the body of the cells but was largely absent from the poles. PspC showed exactly the same distribution on the pneumococcal surface as PspA but did not bind lactoferrin. PspA's binding site for lactoferrin was mapped using recombinant fragments of PspA of families 1 and 2. Binding of human lactoferrin was detected primarily in the C-terminal half of the alpha-helical domain of PspA (amino acids 167 to 288 of PspA/Rx1), with no binding to the N-terminal 115 amino acids in either strain. The interaction was highly specific. As observed previously, bovine lactoferrin bound poorly to PspA. Human transferrin did not bind PspA at all. The binding of lactoferrin to S. pneumoniae might provide a way for the bacteria to interfere with host immune functions or to aid in the acquisition of iron at the site of infection.

Pinch grafting in hospital and primary care: a cost analysis

The cost of treating venous leg ulcers with pinch grafting was evaluated for 58 consecutive patients: 29 in hospital care and 29 in primary care. The mean age was 76.8 and 74.3 years and the mean ulcer size 15.1 and 13.5 cm2, respectively. The operation technique, pinch grafting, was the same for all patients but primary care patients were not immobilised postoperatively. Healing rate within 12 weeks was the same for patients in hospital care and primary care (31%). Treatment costs for one week pre-operatively and three weeks postoperatively amounted to 5109 Pounds per patient in hospital care and 870 Pounds per patient in primary care (p < 0.001), and the costs for one week pre-operatively and 12 weeks postoperatively were 6738 Pounds and 1806 Pounds, respectively (p < 0.001). Costs for patients whose ulcers healed within 12 weeks were 5552 Pounds for those receiving hospital care and 1676 Pounds for those receiving primary care (p < 0.001). Pinch grafting in primary care was shown to cost 3.3 to 5.9 times less, with the same healing outcome, than pinch grafting in hospital care.

Diagnostic delay in pediatric malignancies--a population-based study

This study describes the discovery and diagnosis of malignant tumors from a primary care perspective in a Swedish county. Between 1984 and 1995, 68 children between the ages 0-16 years were diagnosed with a malignant tumor giving an incidence of 14/100,000. Patient records from both primary care and hospital were analyzed for 64 children. Leukemia was diagnosed in 25 children, and brain tumors in 22 children. In 68% of the children the diagnostic process was initiated in primary care, and in 32% in specialist care. Median parent's delay (time from first symptoms to first consultation), and median doctor's delay (time from first consultation to diagnosis) were 5 and 3 weeks for children with brain tumors, and 1 and 0 weeks for children with leukemia. Median lag time (parent's + doctor's delay) was 9 weeks for patients with brain tumors and 3 weeks for children with leukemia.

A folding variant of human alpha-lactalbumin induces mitochondrial permeability transition in isolated mitochondria

A human milk fraction containing multimeric alpha-lactalbumin (MAL) is able to kill cells via apoptosis. MAL is a protein complex of a folding variant of alpha-lactalbumin and lipids. Previous results have shown that upon treatment of transformed cells, MAL localizes to the mitochondria and cytochrome c is released into the cytosol. This is followed by activation of the caspase cascade. In this study, we further investigated the involvement of mitochondria in apoptosis induced by the folding variant of alpha-lactalbumin. Addition of MAL to isolated rat liver mitochondria induced a loss of the mitochondrial membrane potential (Delta Psi(m)), mitochondrial swelling and the release of cytochrome c. These changes were Ca(2+)-dependent and were prevented by cyclosporin A, an inhibitor of mitochondrial permeability transition. MAL also increased the rate of state 4 respiration in isolated mitochondria by exerting an uncoupling effect. This effect was due to the presence of fatty acids in the MAL complex because it was abolished completely by BSA. BSA delayed, but failed to prevent, mitochondrial swelling as well as dissipation of Delta Psi(m), indicating that the fatty acid content of MAL facilitated, rather than caused, these effects. Similar results were obtained with HAMLET (human alpha-lactalbumin made lethal to tumour cells), which is native alpha-lactalbumin converted in vitro to the apoptosis-inducing folding variant of the protein in complex with oleic acid. Our findings demonstrate that a folding variant of alpha-lactalbumin induces mitochondrial permeability transition with subsequent cytochrome c release, which in transformed cells may lead to activation of the caspase cascade and apoptotic death.

Wound management for 287 patients with chronic leg ulcers demands 12 full-time nurses. Leg ulcer epidemiology and care in a well-defined population in southern Sweden

OBJECTIVE

To study the prevalence, aetiology and treatment of chronic leg and foot ulcers, and to estimate the nurse's time in wound management.

DESIGN

A structured questionnaire with 19 questions about chronic ulcers and wound management was sent to all district and community nurses in the county during 1 week in March 1998. A similar questionnaire has been administered regularly since 1986.

SETTING

Primary and community care in the county of Blekinge, Sweden, with a population of 1,51,610.

PATIENTS

287 patients with chronic leg and foot ulcers were identified during the week studied.

MAIN OUTCOME MEASURES

Prevalence of leg and foot ulcers, ulcer aetiology, treatment of ulcers and wound management time.

RESULTS

The estimated prevalence of chronic leg and foot ulcers was 0.19%. Venous ulcers were the most common (38%), of which 87% were treated with some form of compression therapy. Seven percent of the nurse's workload was devoted to ulcer care. During the period 1986 to 1998, ulcers with missing or unknown aetiology decreased from 31% to 6% and ulcers with a duration of more than 2 years from 44% to 27%, while treatment time per ulcer decreased from 2.1 to 1.7 hours/week.

CONCLUSION

Monitoring standards for ulcer aetiology through repeated questionnaires seems to ensure more accurate diagnoses. Thorough and detailed information about treatment time documents the workload for wound management.

Development of schoolchildren's smoking habits: questionnaire studies in intervention and control groups

The objective of the present study was to describe the development of smoking from the sixth grade (age 12) to the eighth (age 14), for girls and for boys, and to study the effect of a simple anti-smoking intervention carried out in the sixth grade. All the roughly 2000 schoolchildren in Kronoberg County, born in 1982, completed an annual anonymous classroom questionnaire on smoking habits in the years 1994-96. In 1994, there were two visits, each lasting 80 min, by a campaigner from A Non-Smoking Generation to the 59 schools which opted for intervention, and no visits to the 21 schools which declined intervention. Before the intervention there were no differences in the frequency of smokers between the intervention group and the control group. In 2 y the proportion of smokers then rose among the girls from 1% to 12% and among the boys from 2% to 7%. Two years after the intervention, the proportion of smokers in the intervention group was approximately two-thirds of that in the control group. When the statistical analysis was based on the individual pupils, the difference between the two groups was statistically significant, but if the schools were used as the unit of analysis, the result was non-significant. Even a small-scale intervention may have an effect on the development of smoking among schoolchildren, but other preventive measures in the schools probably also contributed to the positive development of smoking in the intervention group.

Research methods courses for GPs: ten years' experience in southern Sweden

At the Department of Community Medicine at Lund University we have given courses in basic research methodology since 1989. During a ten-year period, 138 (20%) of the 700 general practitioners (GPs) in our region completed the theoretical part of our course, 104 (75%) finished their research projects, and 17 signed up as PhD students at our department. Thus, we have provided a large number of GPs with a fundamental knowledge of research methods and we have recruited new PhD students to the field of general practice.