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Objective: To identify risk factors for serious and specific early complications of laparoscopic gastric bypass surgery using a large national cohort of patients., Background: Bariatric procedures are among the most common surgical procedures today. There is, however, still a need to identify preoperative and intraoperative risk factors for serious complications., Methods: From the Scandinavian Obesity Surgery Registry database, we identified 26,173 patients undergoing primary laparoscopic gastric bypass operation for morbid obesity between May 1, 2007, and September 30, 2012. Follow-up on day 30 was 95.7%. Preoperative data and data from the operation were analyzed against serious postoperative complications and specific complications., Results: The overall risk of serious postoperative complications was 3.4%. Age (adjusted P = 0.028), other additional operation [odds ratio (OR) = 1.50; confidence interval (CI): 1.04-2.18], intraoperative adverse event (OR = 2.63; 1.89-3.66), and conversion to open surgery (OR = 4.12; CI: 2.47-6.89) were all risk factors for serious postoperative complications. Annual hospital volume affected the rate of serious postoperative complications. If the hospital was in a learning curve at the time of the operation, the risk for serious postoperative complications was higher (OR = 1.45; CI: 1.22-1.71). The 90-day mortality rate was 0.04%., Conclusions: Intraoperative adverse events and conversion to open surgery are the strongest risk factors for serious complications after laparoscopic gastric bypass surgery. Annual operative volume and total institutional experience are important for the outcome. Patient related factors, in particular age, also increased the risk but to a lesser extent.

Aim: To study the mortality and causes of death among homeless men and women in relation to the risk indicators, previous treatment for alcohol and drug abuse, previous treatment for mental disorders and non-Swedish citizenship., Methods: The mortality was studied in a cohort comprising 1,757 men and 526 women compared with the general population and persons with inpatient treatment for alcohol- and drug-related disorders. The follow-up period was from 1995 to 1997 until the end of 2005. The causes of death were analyzed., Results: 421 deaths occurred during the follow-up period. The relative risk of death was 3.1, with no difference in mortality between homeless men and homeless women. Previous treatment for alcohol and drug abuse disorders was related to excess mortality and previous treatment for mental disease to lower mortality. Homeless people with inpatient treatment for alcohol or drug use disorders had no higher mortality than the general population in Stockholm with a similar history. There was a dominance of alcohol- and drug-related causes of death., Discussion: Compared with previous studies of homeless people in Stockholm the excess mortality among men found in this study is of the same magnitude. Mortality among women is lower. The mortality rate in homeless people with previous treatment for an alcohol and illicit drug use disorder did not differ from those treated for these disorders in the general population., Conclusions: The most important finding is that excess mortality among homeless men and women in Stockholm is entirely related to alcohol and drug abuse.

Swedish voters' support for the labor movement has decreased from about 50 percent to less than 40 percent in recent decades, with a resulting loss of the majority in parliament. Over the same period, capitalism has undergone profound changes--transfer of production across borders, the huge growth and ultra-rapid movement of financial capital, and subordination of social welfare to the interests of profit. A new phase in the development of capitalism can be detected: from welfare capitalism to financial capitalism. Large parts of the public sector have been privatized by both conservative and labor governments, even while retaining public funding. The social gaps grow, and a new line of conflict is emerging in the values and interests that should govern care-taking, schools, and living conditions. The labor movement's ideological and scientific analyses have taken a backseat to liberal-conservative think tanks. An effective response to financial capitalism, transnational production chains, and European integration will require trade union and political actions across national borders to strengthen the power resources in the hands of the majority of the population, so as to counter the increasingly destructive powers of capitalism.

Background: Obesity is associated with increased mortality. Weight loss improves cardiovascular risk factors, but no prospective interventional studies have reported whether weight loss decreases overall mortality. In fact, many observational studies suggest that weight reduction is associated with increased mortality., Methods: The prospective, controlled Swedish Obese Subjects study involved 4047 obese subjects. Of these subjects, 2010 underwent bariatric surgery (surgery group) and 2037 received conventional treatment (matched control group). We report on overall mortality during an average of 10.9 years of follow-up. At the time of the analysis (November 1, 2005), vital status was known for all but three subjects (follow-up rate, 99.9%)., Results: The average weight change in control subjects was less than +/-2% during the period of up to 15 years during which weights were recorded. Maximum weight losses in the surgical subgroups were observed after 1 to 2 years: gastric bypass, 32%; vertical-banded gastroplasty, 25%; and banding, 20%. After 10 years, the weight losses from baseline were stabilized at 25%, 16%, and 14%, respectively. There were 129 deaths in the control group and 101 deaths in the surgery group. The unadjusted overall hazard ratio was 0.76 in the surgery group (P=0.04), as compared with the control group, and the hazard ratio adjusted for sex, age, and risk factors was 0.71 (P=0.01). The most common causes of death were myocardial infarction (control group, 25 subjects; surgery group, 13 subjects) and cancer (control group, 47; surgery group, 29)., Conclusions: Bariatric surgery for severe obesity is associated with long-term weight loss and decreased overall mortality., (Copyright 2007 Massachusetts Medical Society.)

Objective: Lack of adherence with pharmacological therapy is a public health concern that compels tremendous costs for the health care system and the community. To analyse the association between socioeconomic disadvantage and primary non-adherence with medication, and to explore possible mediating effects of trust in health care and lifestyle profile., Design: Cross-sectional population-based study based on data from the Swedish national public health surveys 2004-2005., Participants: The study comprised 13603 men and 18292 women aged 21-84 years who had any contact with a physician at a hospital or primary care centre. Measures Primary non-adherence with medication based on whether respondents reported that they refrained from purchasing at the pharmacy prescribed medication. Socioeconomic Disadvantage Index was based on four different indicators of economic deprivation., Results: Socioeconomic disadvantage was associated with primary non-adherence with medication independent of long-term illness, risky lifestyle, low education, living alone and low trust for health care. This association increased with older age, particularly among women. Among individuals aged 21-34 years, severe compared with no socioeconomic disadvantage, was associated with two-fold increased odds for non-adherence with medication. The corresponding odds among individuals aged 65-84 years were three-fold increase among elderly men (OR=3.3, 95% CI: 1.4-7.8) and six-fold increase among elderly women (OR=6.2, 95% CI: 2.5-15.3). Yet every seventh elderly woman aged 65-84 years suffered from long-term illness., Conclusions: Results indicate that health policies for 'care on equal terms' in Sweden have been less successful in relation to equitable access to prescribed medication, especially among the elderly.

A 5-year follow-up study was performed on 82 homeless men, with mental problems, who had been contacted by an outreach team run by the Social welfare administration of Stockholm 1995/1996. Data have been collected from the Cause of Death Register, death certificates, forensic autopsy reports, hospital medical reports, Hospital Discharge Register, interviews with social workers and with those men who were able to participate. The standardized mortality ratio (SMR) was 4.7 times higher than expected. The highest mortality was found in the group where drug addiction was dominant; 46% had died. In the group of men with severe psychiatric disorders, with diagnosis such as schizophrenia, none had died. Compared with the others, they had spent less time in homelessness. Among the survivors, 75% were still homeless at the follow-up in spite of considerable treatment interventions from the social services and health authorities. Residential institutions or treatment seemed to have some protective effect concerning misuse, diseases and injuries. Among the still homeless, the mental health problems combined with substance use problems had increased with 17%. The life and housing situation for the whole group seemed not to have improved, even if fewer of them were staying in hostels for homeless people.

Data from measurements on the body burden of (134)Cs, (137)Cs and (40)K in various Swedish populations between 1959 and 2001 has been compiled into a national database. The compilation is a co-operation between the Departments of Radiation Physics in Malmö and Göteborg, the National Radiation Protection Authority (SSI) and the Swedish Defense Research Agency (FOI). In a previous study the effective ecological half time and the associated effective dose to various Swedish populations due to internal contamination of (134)Cs and (137)Cs have been assessed using the database. In this study values of human body burden have been combined with data on the local and regional ground deposition of fallout from nuclear weapons tests (only (137)Cs) and Chernobyl debris (both (134)Cs and (137)Cs), which have enabled estimates of the radioecological transfer in the studied populations. The assessment of the database shows that the transfer of radiocesium from Chernobyl fallout to humans varies considerably between various populations in Sweden. In terms of committed effective dose over a 70 y period from internal contamination per unit activity deposition, the general (predominantly urban) Swedish population obtains 20-30 microSv/kBq m(-2). Four categories of populations exhibit higher radioecological transfer than the general population; i.) reindeer herders ( approximately 700 microSv/kBq m(-2)), ii.) hunters in the counties dominated by forest vegetation ( approximately 100 microSv/kBq m(-2)), iii.) rural non-farming populations living in sub-arctic areas (40-150 microSv/kBq m(-2)), and iv.) farmers ( approximately 50 microSv/kBq m(-2)). Two important factors determine the aggregate transfer from ground deposition to man; i.) dietary habits (intakes of foodstuff originating from natural and semi-natural ecosystems), and ii.) inclination to follow the recommended food restriction by the authorities. The transfer to the general population is considerably lower ( approximately a factor of 3) for the Chernobyl fallout than during the 1960s and 70s, which is partly explained by a higher awareness of the pathways of radiocaesium to man both by the public and by the regulating authorities, and by the time-pattern of the nuclear weapons fallout during the growth season in Sweden.

The fallout in Sweden of radiocesium from nuclear weapons tests during the 1960's (137Cs) and from the Chernobyl accident in 1986 (134Cs and 137Cs) has transferred to humans through different ecological pathways. Data from whole-body burden measurements of 134Cs, 137Cs, and 40K in various Swedish populations between 1964 and 2002 have been compiled. This database enables an evaluation of the temporal and geographical dependence of the transfer of radiocesium from ground deposition to humans and the associated absorbed dose. The body burdens of 137Cs gradually decrease after the peak values reached in 1965 from nuclear weapons fallout and in 1987 from the Chernobyl fallout, but at a varying rate depending on the population. Assuming a dual exponential decrease, a short-term component of typically 1-2 y and a long-term component of 5-10 y are found in urban populations in Sweden. Among reindeer herders and hunters the effective ecological half-time is mono-exponential with a half-time of 5-7 y. The estimated time-integrated effective dose to an individual during a period of 50 y from the Chernobyl fallout is, on average, approximately 10 mSv for reindeer herders, which is 10-100 times higher than the estimated dose received by urban populations in the three major Swedish urban areas (Malmö, Göteborg, and Stockholm).

Background: Obesity is associated with increased morbidity rates and pharmaceutical costs. To what extent various medication costs are affected by intentional weight loss is unknown., Methods: A cross-sectional comparison of the use of prescribed pharmaceuticals was conducted in 1286 obese individuals in the Swedish Obese Subjects (SOS) intervention study and 958 randomly selected reference individuals. Medication changes for 6 years after bariatric surgery were evaluated in 510 surgically and 455 conventionally treated SOS patients., Results: Compared with the reference group, obese individuals were more often taking diabetes mellitus, cardiovascular disease, nonsteroidal anti-inflammatory and pain, and asthma medications (risk ratios ranging from 2.3-9.2). Average annual costs for all medications were 1400 Swedish kronor (SEK) (US $140) in obese individuals and 800 SEK (US $80) in the reference population (P<.001). Average yearly medication costs during follow-up were 1849 (US $185) in surgically treated patients (weight change -16%) and 1905 SEK (US $190) in weight-stable conventionally treated patients (P =.87). The surgical group had lower costs for diabetes mellitus (difference: -94 SEK/y (-US $9]) and cardiovascular disease medications (difference: -186 SEK/y (-US $19]) but higher costs for gastrointestinal tract disorder (difference: +135 SEK/y [US $13]) and anemia and vitamin deficiency medications (difference: +50 SEK/y [US $5])., Conclusions: Use and cost of medications are markedly increased in obese vs reference populations. Surgical obesity treatment lowers diabetes mellitus and cardiovascular disease medication costs but increases other medication costs, resulting in similar total costs for surgically and conventionally treated obese individuals for 6 years.

Background: Although intentional weight reduction improves obesity-related comorbidities, the associations between weight reduction, medication and related costs are rarely studied. This study investigates the long-term effects of weight change on medication for diabetes and cardiovascular disease (CVD) in severely obese subjects., Methods: In the intervention study Swedish Obese Subjects, 510 surgically and 455 conventionally treated obese patients have so far been followed for 6 y. Changes in the use and costs of medication were analyzed in relation to treatment and weight change., Results: In comparison with controls, larger fraction of surgically treated patients discontinued the use of medication for CVD and diabetes at 2 and 6 y (risk ratios 0.56-0.77). Among subjects not initially on medication, surgery reduced the frequency of started treatments (risk ratios 0.08-0.80). Relative weight loss >or=10% was necessary to reduce costs of medication for CVD and diabetes among subjects with such treatment at baseline. To reduce initiation of new treatment against the two conditions, weight loss >or=15% was required. Over 6 y, the average annual cost for diabetes and CVD medication increased by 463 SEK (96%) in subjects with weight loss <5%, and decreased by 39 SEK(8%) in the weight loss group >or=15%., Conclusion: Long-term intentional weight loss is associated with reduced medication and medication costs for diabetes and CVD. The effects appear to be more marked among subjects who are initially on medication for these conditions, whereas greater weight reduction is needed to prevent new subjects from starting on medication.

To study seasonal variations in 137Cs, whole-body content measurements of adults from Swedish hunter families have been performed in autumn 1997 and spring 1998. Measurements were performed in three locations, By, Harbo and Gävle, geographically close (within 100 km of each other) but with large differences in ground deposition levels. The hunter families at these three locations were previously measured in 1994. The measured persons were also asked for their frequency of intake of moose, roe-deer, reindeer, freshwater fish, mushrooms and berries. A statistically significant lower frequency of intake of mushrooms and berries in By, moose, roe deer and mushrooms in Harbo, and moose in Gävle was found in springtime compared to autumn. In one of the locations, there was a statistically significant lower average 137Cs whole-body content in spring 1998 than in autumn 1997 while in the other two locations no such effects could be seen. The 137Cs whole-body content has decreased by 37% from 1994 and to 1998 (including physical decay) correlated to an effective ecological half time of 6 years.

Objectives: To analyse sick leave and disability pension among surgically and conventionally treated obese patients., Design: A prospective study over five years. Differences in sick leave and disability pension were analysed using multiple and logistic regressions. Possible confounding factors were analysed and controlled for., Setting: Nine counties in Sweden., Subjects: 369 surgically treated patients and 371 matched obese controls, included in the Swedish Obese Subjects (SOS) study. At baseline, mean body mass index (BMI) was 42 kg/m2 in surgical patients and 41 kg/m2 in controls. After four years of treatment, weight reduction was 20% among surgical patients while the control patients kept their initial weight., Intervention: Gastric bariatric surgery., Measurements: Days of sick leave plus disability pension, and days of disability pension., Results: In the year prior to treatment, adjusted average number of days of sickness due to sick leave plus disability pension was similar in surgical patients and controls. Compared with controls, the surgical group had 35% more days of sickness during the first year after initiation of treatment, but 10-14% fewer days during years 2-3. During year four, days of sickness tended to be lower in the surgical group (P = 0.07). In the sub-group, aged above the median, surgical patients had 14-18% fewer days of sickness than controls, during years 2-3 after initiation of treatment This difference did not occur in the group below median age., Conclusion: Surgical treatment of obesity results in a reduction of sick leave and disability pension, compared to controls, particularly in subjects aged 47-60 y.

The whole-body content of radiocesium has been measured in Swedish men and women from households where at least one member is a hunter. Measurements were performed at 5 locations in Sweden where the ground deposition levels ranged from 7 to 80 kBq m(-2). The average whole body content of 137Cs varied between 0.3 and 1.9 kBq for women and 0.6 and 4.7 kBq for men, depending on the deposition level. The transfer factor for 137Cs, relating ground deposition to activity concentration in humans, was less dependent on deposition level for the hunter families than for previously studied populations. The transfer factor varied between 0.4 and 1.1 Bq kg(-1)/kBq m(-2), and was dependent on ground deposition and sex.

This study analyzes the mortality, hospitalizations, and arrests in a cohort of severe intravenous heroin users divided into three groups: those in methadone treatment, those discharged from treatment, and those who never received treatment. The study population consists of 101 heroin users, of whom 56 were HIV-seropositive. Because of intensive drug misuse, they underwent coercive residential treatment in Stockholm during the 3-year period 1986-1988. The mortality was lower in the methadone group, and all seven deaths were related to HIV-infection. Outside the program, 24 of 29 persons died from external violence and poisoning.

A cohort of 1640 hospitalized drug addicts was studied over an 8-year period, and consisted of 678 heroin users, 578 amphetamine users and 384 users of other drugs. In total, 234 addicts were HIV-positive, most of them heroin users. During the observation period, 214 deaths occurred in the cohort. The total mortality was 2.2% annually. Death linked to injection of heroin was the main cause of death not only among heroin users but also among subjects classified as users of amphetamines or other drugs. During the observation period, a total of 222 addicts (115 of whom were HIV-positive) entered the methadone programme. No deaths occurred among the HIV-negative subjects who were participating in the methadone programme. A total of 15 HIV-positive subjects died while taking part in the programme--13 of these subjects from natural causes (mostly HIV/AIDS).

A new Swedish population register, created by linking Census data to the Cause of Death Registry and covering over 99% of the population, has been used to study the relationship between occupational category, marital status and citizenship in 1970 and mortality in closely alcohol-related diseases during 1971-1980 for the ages 25-64 years. Age-standardized rate ratios (SRR) have been computed for mortality in alcoholism, alcohol intoxication and alcohol psychosis ("AAA") and in liver cirrhosis. SRR-values for both diagnose categories and both sexes were higher than average among not gainfully employed (SRR = 3.71 among males and SRR = 1.96 among females in 1976-80 for "AAA"), among employees in the service sector, engine-drivers and unskilled workers and increased in liver cirrhosis among artists and authors. Among females there were smaller variations in mortality for occupational groups than among males. The SRR-values showed a tendency to be higher in 1976-80 than in 1971-75, probably due to health-related selection to some extent. The alcohol-related mortality was also increased among divorced, widows (SRR = 1.37 for "AAA" and 2.81 for liver cirrhosis in 1976-80) and widowers and among never married males. SRR was much higher among Finnish citizens in Sweden (SRR for "AAA" = 3.85 among males and 2.35 among females in 1976-80) than among males and females living in Finland (SRR for "AAA" = 1.13 among males and 0.36 among females) and also higher than among immigrants from other countries, summed (SRR for "AAA" = 0.62 among males and 0.64 among females).(ABSTRACT TRUNCATED AT 250 WORDS)

In Sweden sales of alcohol dropped 17% from 1976 to 1982. Similarly, comparison of data from 1979 and 1982 shows that the mortality from cirrhosis of the liver declined appreciably, by 28% in men and 29% in women. During 1979-82 mortality from pancreatitis also declined noticeably, by 30% in men and 36% in women. By contrast, no decrease occurred in mortality from alcoholic psychosis, alcoholism, or alcohol intoxication. The decrease in mortality from cirrhosis of the liver and pancreatitis is probably explained by a decrease in the consumption of alcohol among an important subgroup of high consumers of alcohol. The lack of a decrease in mortality from alcoholic psychosis, alcoholism, and alcohol intoxication may be because such diagnoses are often made in socially deteriorated, more dependent alcoholic subjects who have not been able to reduce their consumption.

The mortality and the causes of death have been studied in a cohort consisting of 1548 male alcoholics in Stockholm. During the period 1969-1981 there were 542 cases of death in this population. The mortality rates were triple those for males in Stockholm generally. Using the official causes of death there was a highly significant excess mortality in the following diagnostic groups: Cancer in the upper digestive region, primary hepatic cancer, cirrhosis in the liver, pancreatitis, pneumonia, alcoholism and alcoholic poisoning, suicides and other causes of violent death as well as ischemic heart disease. The underlying and contributing causes of death on the death certificates were reclassified according to ICD-rules using clinical records and autopsy protocols. It was found that the underlying cause of death was incorrect in 21.8% of the cases. Important information was withheld in further 19.8%. After validation there was no longer any excess mortality in ischemic heart disease. The number of alcohol-related diagnoses, i.e. alcoholic cardiomyopathy, cirrhosis and fatty liver with alcoholism and alcoholic intoxication, was much greater. It is concluded that there is a underreporting of alcohol-related diseases and injuries which has a great influence on the reliability of death statistics.