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Describes a study that analyzed how students in three different Swedish university programs conceived of the meaning of problem-based learning and how they experienced their studies within a problem-based learning program. Discusses learning in context, social interaction, meta-cognitive reasoning and self-directed learning, and academic cultures. (Author/LRW)

The article focuses on the factors that promote or constrain community participation in health programs in Sweden. A survey was conducted with the general public and actors at different levels on community-based programs for prevention of cardiovascular diseases and diabetes. Public health programs deal mainly with individual deliberations and decision making, but they also concern knowledge, power, influence, control and participation, in the building of society. The study revealed that the community-based health programs did not increase the citizens' opportunities to influence the health care system or the decisions taken by the municipality.

This paper aims to describe the nature of pediatric cardiology teams (PCTs) based in Sweden through the use of a mixed methods approach. Questionnaires examining issues about the organization/ways of working, functions/tasks and attitudes were answered by 30 PCTs. Focus group interviews were conducted with six PCTs, selected purposefully by size and location, and information on experiences and attitudes on interprofessional teamwork was explored in depth. Results from the quantitative indicated that in 17 of the teams, where the nurse acted as the central coordinator, there was a positive attitude to the value of teamwork. In the interviews, different problems and needs of improvements were mentioned regarding structure, leadership, presence of physicians in the team as well as the team's mandate. All of the participants, however, agreed that interprofessional teams were required to manage the complexity of the children's care. In conclusion, this study suggests that PCTs need further support to develop structure, leadership and coordination of resources to function in a more effective manner. National plans or recommendations that mandate the organization and working methods of PCTs would be helpful for the ongoing development of PCTs in Sweden.

Background: The productive capacity of retired people is usually not valued. However, some retirees produce much more than we might expect. This diary-based study identifies the activities of older people, and suggests some value mechanisms. One question raised is whether it is possible to scale up this diary study into a larger representative study., Methods: Diaries kept for one week were collected among 23 older people in the north of Sweden. The texts were analysed with a grounded theory approach; an interplay between ideas and empirical data., Results: Some productive activities of older people must be valued as the opportunity cost of time or according to the market value, and others must be valued with the replacement cost. In order to make the choice between these methods, it is important to consider the societal entitlement. When there is no societal entitlement, the first or second method must be used; and when it exists, the third must be used., Conclusions: An explicit investigation of the content of the entitlement is needed to justify the choice of valuation method for each activity. In a questionnaire addressing older people's production, each question must be adjusted to the type of production. In order to fully understand this production, it is important to consider the degree of free choice to conduct an activity, as well as health-related quality of life.

Objectives: To describe the lifestyle of the Sami of southern Lapland 50 to 70 years ago in relation to the present-day Sami and non-Sami populations and, thereby, to provide a basis for future studies of culturally related determinants of health and illness., Study Design: A qualitative analysis, and a quantitative comparison of Sami and non-Sami groups., Methods: Semi-structured interviews were conducted with 20 elderly Sami concerning their parents' lifestyle and diet 50 to 70 years ago. Questionnaire data from 81 reindeer-herding Sami, 226 non-reindeer-herding Sami and 1,842 sex-, age- and geographically matched non-Sami from the population-based Västerbotten Intervention Project were analysed by non-parametric tests and partial least squares methodology., Results: Surprisingly, fatty fish may have been more important than reindeer meat for the Sami of southern Lapland in the 1930s to 1950s, and it is still consumed more frequently by reindeer-herding Sami than nonreindeer-herding Sami and non-Sami. Other dietary characteristics of the historical Sami and present-day reindeer-herding Sami were higher intakes of fat, blood and boiled coffee, and lower intakes of bread, fibre and cultivated vegetables, compared with present-day non-Sami. Physical activity was also a part of the daily life of the Sami to a greater extent in the 1930s to 1950s than today. Sami men often worked far from home, while the women were responsible for fishing, farming, gardening (which was introduced in the 1930-1950 period), as well as housework and childcare., Conclusions: For studies investigating characteristic lifestyle elements of specific ethnic groups, the elements of greatest acknowledged cultural importance today (in this case reindeer meat) may not be of the most objective importance traditionally.

Unlabelled: Technical developments in paediatric cardiology over the last few decades have increased expectations on professionals, demanding of them more emotional competence and communicative ability. The aim of this study was to examine the approach of paediatric cardiologists in informing and communicating with the family of the patient., Method: A qualitative interview method was first tested in a pilot study with two paediatric cardiologists. There were nine subsequent semi-structured interviews that were carried out with paediatric cardiologists. A researcher performed all the interviews, which were taped, transcribed, decoded, and analysed., Results: Among paediatric cardiologists, how to break bad news to the family is an important concern, evident in findings regarding the significance of trust and confidence, the use of different emotional positions, and a common ambition to achieve skills to handle the situation. There is a need for reflection, education, and sharing of experiences. The cardiologists desire further development of teamwork and of skills in medical students and residents for delivering bad news., Conclusions: Doctors are expected to cope with the complexities of diagnoses and decisions, while simultaneously being sensitive to the feelings of the parents, aware of their own emotions, and able to keep it all under control in the context of breaking the bad news to the parents and keeping them informed. These conflicting demands create a need to expand the professional role of the doctor by including more training in emotional competence and communicative ability, beginning in medical school and continuing through consultancy.

Nine women who had been subjected to severe intimate partner violence during pregnancy narrated their ambiguous and contradictory feelings and the various balancing strategies they used to overcome their complex and difficult situations. Because allowing anyone to come close posed a threat, the women mostly denied the situation and kept up a front to hide the violence from others. Three women disclosed ongoing violence to the midwives, but only one said such disclosure was helpful. This article highlights the complexity of being pregnant when living with an abusive partner and challenges antenatal care policies from the perspective of pregnant women.

This article deals with discourses of intimate partner violence and is based on interviews with professionals who meet violent men. The professionals emphasized the importance of men taking unreserved responsibility for their violent behavior. Intimate partner violence was viewed not only as "power and control" but as the result of complex situations and interplays. The discourses presented an ambivalent explanation of violent men as both ordinary and deviant. They were understood as having a strained background, but to be rather ordinary, often functioning well at work and in society. Yet, they have nonstandard views of women, act deviant in their communication and interplay with others, and cannot cope with certain situations in intimate relationships. Based on the interviews, men inclined to partner violence may be generalized as those who: attack immediately, explode unexpectedly, or ultimately become aggressive. The discussion challenges unreflected discourses as means for change when counteracting violence.

Background: Public health interventions are directed towards social systems and it is difficult to foresee all consequences. While targeted outcomes may be positively influenced, interventions may at worst be counterproductive. To include self-reported health in an evaluation is one way of addressing possible side-effects. This study is based on a 10 year follow-up of a cardiovascular community intervention programme in northern Sweden., Methods: Both quantitative and qualitative approaches were used to address the interaction between changes in self-rated health and risk factor load. Qualitative interviews contributed to an analysis of how the outcome was influenced by health related norms and attitudes., Results: Most people maintained a low risk factor load and a positive perception of health. However, more people improved than deteriorated their situation regarding both perceived health and risk factor load. "Ideal types" of attitude sets towards the programme, generated from the interviews, helped to interpret an observed polarisation for men and the lower educated., Conclusion: Our observation of a socially and gender differentiated intervention effect suggests a need to test new intervention strategies. Future community interventions may benefit from targeting more directly those who in combination with high risk factor load perceive their health as bad and to make all participants feel seen, confirmed and involved.

The aim of this study was to explore what individuals who have been on sick leave experienced as important in the process of returning to work, moving to long-term sick leave, or receiving a disability pension. Grounded Theory was used for interpreting interviews with 15 people who had been on sick leave four years previously. In the results four ideal types were crystallized which are presented in the form of vignettes. The ideal types were discussed focusing on occupational life using the Model of Human Occupation and the theories of Sense of Coherence and Status Passage. The study provided a deeper understanding of people's experiences during the process of their sick leave. Valuable predictors for re-entry into work or disability retirement were: individual mental resources; clear or unclear diagnosis; how long had been spent in the sick-leave process; and personal belief in an ability to work in the future. The interventions and support given by professionals and the social environment, the balance and sense of coherence in life, and participation in the sick leave process were also important. The idealtypes found could be helpful to professionals working in this field in deepening their understanding of the clients.

Purpose: Our analysis of data collected in 1995 showed that 12-year-olds' self-esteem was associated with demographic/socioeconomic background variables and lifestyle variables and with the quality of the variable "oral health behavior." The study reported here was conducted to identify changes at ages 14 (in 1997) and 16 years (in 1999) in the strength of the association between self-esteem and "oral health behavior.", Methods: In 1995, 3370 12-year-olds answered questions about their demographic/socioeconomic background, personal attitudes/resources, and lifestyle, including "oral health behavior." Two and four years later the same study group (3105 14-year-olds in 1997 and 2836 16-year-olds in 1999) answered similar questionnaires with redefinition of "oral health behavior" as "tooth-brushing." Multivariate and logistic regression analyses were conducted using "self-esteem" and "oral health behavior/tooth-brushing" as the dependent variables. The association was also analyzed between "oral health behavior/tooth-brushing" and components of "self-esteem" (two cognitive: "How do you think your teacher would rate your school work?," "How do you think you are performing in school?," and one emotional: "How content are you with your body/looks?")., Results: The association between "self-esteem" and "oral health behavior/tooth-brushing" disappeared during adolescence, but whereas the influence of cognitive components decreased, the influence of the emotional component increased. Overall, the strongest predictor of poor oral health behavior (tooth-brushing less than twice per day) was male gender., Conclusion: The motives for good oral health behavior changed from age 12 to age 14 years.

The aim of this study was to identify recurrent respiratory papillomatosis patients who may benefit from interferon (IFN)-alpha treatment and to determine the means of IFN-alpha action. The presence of human papillomavirus (HPV) and viral load and proliferation rate in pre-, ongoing and post-treatment respiratory papillomatosis biopsies were examined retrospectively in 25 patients, 18 of whom were IFN-alpha treated and seven of whom were IFN-alpha non-treated. Using PCR, HPV was found to be present in 20/25 respiratory papillomatosis patients and HPV type was determined for 18/25 patients (12 HPV6 and six HPV11). Eighteen of the patients were treated with IFN-alpha, 14 of whom were HPV positive (eight HPV6, five HPV11 and one undefined HPV). Response to IFN-alpha therapy was observed in 12 patients (7/8 HPV6, 3/5 HPV11, 1/1 undefined HPV and 1/4 HPV negative), while six patients (1/8 HPV6, 2/5 HPV11 and 3/4 HPV negative) did not respond to therapy. Viral load, determined by quantitative real-time PCR (between 0.03 and 533 HPV copies per cell), and proliferation rate, determined as the percentage of Ki-67-positive cells (between 8 and 54 %), were similar in IFN-alpha-treated and non-treated patients and were generally unaffected by IFN-alpha treatment. In summary, most (12/18) IFN-alpha-treated patients responded to therapy. Moreover, there was a tendency for patients with HPV6-positive (7/8) respiratory papillomatosis to respond more frequently to IFN-alpha therapy than patients with HPV11 (3/5) or HPV-negative (1/4) respiratory papillomatosis. Finally, the presence of HPV and viral load and proliferation in respiratory papillomatosis biopsies was similar in patients treated or not with IFN-alpha and were in general unaffected by IFN-alpha treatment.

Since 1989, the City of Göteborg Immigrant Services Administration has been making efforts to inform about HIV/AIDS. The purpose has been to ensure that even immigrant residents of the City of Göteborg (Gothenburg) have access to relevant information about HIV/AIDS. The administration's efforts have been a part of the collected efforts of Gothenburg to prevent the spreading of HIV. This paper attempts to discover and describe experiences against HIV/AIDS/STDs of Somalis in Exile in Gothenburg, Sweden. A qualitative sociological in-depth interviews with 13 individuals (6 women and 7 men) and with semi-structured and themetized emerging design was carried on. A follow up focus group interviews with 10 individuals (2 women and 8 men) was also performed. The paper reveals that the general understanding of subjects on the issues under discussion is almost the same though details may vary from one research participant to the other. They have described this through narratives. STDs and specially HIV/AIDS was perceived as something dishonourable by the subjects. The HIV/AIDS is perceived as a sin which Allah sends to punish those who have fornication or sex without marriage (Zinna). Of course, this tendency of shying off the problem leads to ignorance of how to behave, which in turn decreases the risk of perceptions and as a result may also increase the risk of being infected. As concerns protection as a preventive measure, attitudes vary. The traditionalists have argued that condom increased the possibility of promiscuity or fonication, while young and more modern people saw condom as something good. We may conclude that Somalis who have arrived in Western world and in Sweden as adults did never have a modern sexual education for themselves due to socio-cultural reasons and this has important implication for giving proper information to their children about sex organs, human sexual development and preventive measures against HIV/AIDS/STDs. These immigrant parents should be offered culturally sensitive communication and educational programmes aimed at raising their awareness about teenagers sexuality and the preventive measures against HIV/AIDS/STDs.

Political upheaval and poverty at home has been forcing many Somalis to immigrate. These immigrants do not only leave their physical house, families, relatives, loved ones, friends, but also familiarities, culture, customs, and often they do end up in no man's land being between their own and new home culture. Available reports suggest that there are about 15,000 Somalis in Sweden and their majority came here from late 1989 to 1996. About one third these immigrants live in and around the city of Gothenburg. This paper explores and describes gendered experiences of conflict and co-operation in heterosexual relations of Somalis in exile in Gothenburg, Sweden. A qualitative sociological in-depth interviews with 6 women and 7 men was performed during May 1999 to January 2000. A follow up focus group interviews with 10 people (2 women and 8 men) was also carried on. The results show that both the Somali culture and Muslim religion do not support the children being taught sex education in schools or the names of the sex organs being pronounced other than to be used as metaphors. The girls, unlike their age group males, experience a very painful and terrifying process during childhood in which their self-esteem is downgraded by means of serious degrading traditional active violence such as female genital mutilation and visible virginity control. The narratives tell stories in which Somali women are degraded and expected to obey in situations characterised by their man's arbitrariness. They are subject to a very extensive form of social control, which is especially pronounced on issues regarding sexuality. Their integrity as women is, consequently set aside. When Somali refugees came to Sweden some of them came to adopt much of the modern lifestyle and cultural norm systems, preferable young people and some of the females. Relating to a new culture with its new expectations on the norm obedience also created changes in self-esteem. Exile situation tends to generate horizontal conflicts, among spouses and between groups of people. It also tends to generate vertical conflicts because now generations stand up against each other and this is especially pronounced when it is about issues of sexuality and sexual relations. The young generations questions their parents authority. They are now living in new social context and perceive risks, as well as possibilities. Their new dreams and choices, however, do not fit their parents' expectations, which sometimes leads to big problems. From a traditional perspective these deviants lack of respect for traditions and the original culture. From a male perspective this means more specifically a lack of respect for male dominance and superiority.

In a town in northern Sweden, 3.3% of the 15-year-old adolescents were vegans in 1996. This study describes the process of becoming a vegan among adolescents and interprets the informants' descriptions by constructing categories, which later on were related to relevant theories. Group interviews were conducted with three vegans and in-depth interviews were performed with three other vegan adolescents. The methodology was grounded theory and the adolescents' perceptions were analyzed in the framework of symbolic interactionism. Three types of vegans were identified: the Conformed Vegan, the Organized Vegan, and the Individualistic Vegan. The decision to become a vegan was reported to be influenced by perceived internal reasons such as ethics, health, distaste for meat, and preference for vegetarian food. In addition, friends, family, school, media, and music influenced the decision to become a vegan. The perceived consequences of becoming a vegan were positive as well as negative and differed between the three types of vegans. Veganism as a new type of status passage with specific characteristics was illustrated. No modifications or new properties were discovered that add to the theory of status passage which indicates that the general model is applicable also in a vegan context.

Objectives: To examine how self-rated ill-health interacts with biomedical stroke risk factors in predicting stroke and to explore differences between men and women and educational groups., Design: An incident case-referent study where the study subjects had participated in a prior health survey., Setting: Nested within the Västerbotten Intervention Program (VIP) and the Northern Sweden MONICA cohorts., Subjects: The 473 stroke cases had two referents per case, matched for age, sex and residence, from the same study cohorts., Results: Self-rated ill-health independently increased the risk of stroke, specifically for men. The interaction effect between self-rated health and biomedical risk factor load was greater for men than for women. The attributable proportion due to interaction between having a risk factor load of 2+ and self-rated ill-health was 42% for men and 15% for women. Better-educated individuals with self-rated ill-health and two or more of the biomedical risk factors had a higher risk of stroke than the less educated. Calculations of the respective contribution to the stroke cases of self-rated health, hypertension and smoking showed that self-rated ill-health had a role in 20% of the cases and could alone explain more than one-third of the cases among those who rated their health as bad, more so for men than for women., Conclusions: The results underscore the importance of including both a gender and a social perspective in discussing the role of self-rated health as a predictor of disease outcome. Physicians must be more gender sensitive when discussing their patient's own evaluation of health in relation to biomedical risk factors.

Purpose: To describe and analyse physicians' experiences of working with sick-listing and vocational rehabilitation, their perceptions of their co-actors and the interaction they participate in., Method: Thematic interviews with 14 physicians in Västerbotten County, northern Sweden. The physicians were active in primary or occupational health care, or as hospital doctors. The interviews were conducted during the autumn of 1996. The interviews were tape recorded and analysed according to Grounded theory., Results: Feelings of isolation and diminished control, lack of time and increased demands are all seen as obstacles for doing an optimal job with sick-listing and rehabilitation. Other obstacles are insufficient knowledge regarding the labour market and the social insurance legislation. Interaction between primary and in-patient care does not function satisfactorily. The doctors believe in their patients and a majority of the doctors feel that the patients' own understanding of/need for sick-listing guides the doctor in his or her position regarding sick-listing. To facilitate return to work, the doctors encourage part-time sick-listing., Conclusions: The interviews show that the physicians experience a growing discrepancy between ideal and reality. They want to be able to act as "team players", but experience increasing demands due to the increased number of patients who are sicker than before. The doctors experience that decision latitude has diminished and this has been followed by less time for patients.

Background: One hundred twenty women alcoholics recruited to a treatment program called EWA (Early Treatment for Women With Alcohol Addiction) were studied. The selected women were not previously treated for alcohol abuse., Methods: The women were followed up by use of a structured personal interview, biomarkers sensitive for alcohol abuse (i.e., glutamyl transpeptidase), and questionnaires, by using defined criteria for abstinence, social drinking, satisfactory drinking outcome, and unsatisfactory drinking outcome., Results: Drinking outcome was good (i.e., total abstinence, social drinking, or satisfactory drinking outcome) for 67% of the women during the total follow-up time, by use of strict criteria for relapse. The results were corroborated by the biomarkers. Similar results were reported from two previously studied groups of women from the same department. However, the frequency of abstinence was higher and social drinking was significantly lower among this sample of women. Daily drinking, the use of sedatives, and a long duration of pretreatment alcohol abuse predicted an unfavorable outcome. However, a long duration of outpatient treatment predicted a good outcome, whereas treatment dropout was related to an unsatisfactory drinking outcome. A majority of the women (96%) rated the treatment experience and the treatment program favorably. The overall good results might reflect the selection of the subjects studied., Conclusions: Improving treatment program adherence would probably improve outcome for the women with an unsatisfactory drinking outcome.

The aim was to identify differences and similarities in views regarding asthma management among general practitioners in four European countries (Germany, Netherlands, Norway and Sweden), and to explore reasons for suboptimal performance. The results are to be used for the development and tailoring of educational interventions. Semistructured interviews with 20 GPs in each country were conducted and analysed using a phenomenographic approach. The domains of (i) general view of asthma, (ii) the doctor-patient relationship in managing asthma, and (iii) overall management of asthma (treatment goals and evaluation of results) were approached during the interviews. There were different ways of experiencing phenomena related to asthma management both within and between the four countries. Three general views on asthma were found where different perspectives were emphasised: a medical, a 'global' (including community health, social and environmental aspects) and a patient's perspective. Within the medical perspective, only a few German doctors emphasised a psychological aetiology of asthma. The views on the doctor-patient relationship described as 'authoritarian', 'teaching' or 'empowering' occurred similarly in all countries. The majority of the doctors showed confidence in the effectiveness of the pharmaceutical treatment of asthma, some doctors were concerned about limitations, but only in Germany a few doctors were explicitly critical of the values of conventional pharmaceutical treatment. The main treatment goals were either conceived as getting the patient symptom-free (Netherlands, Norway, and Germany) or to control the inflammatory process (Sweden). Several German and some Norwegian doctors expressed the view that patients had to accept the disease and learn how to manage it, while a few German doctors aimed at alternative treatments of asthma. The existence of qualitatively different ways of experiencing asthma management, both in and between countries, calls for consideration when trying to implement general evidence-based treatment guidelines. A variation of approaches in continuing medical education for GPs is needed to address such existing beliefs and conceptions that could sometimes be opposed to the content of educational messages.

This study focus on the socio-psychological concept of self-esteem and examines its association with oral health behaviour and with some background variables that have been shown to be of importance in previous studies. In 1995, 3370 12-year-olds answered a questionnaire on social and demographic factors. Questions on attitudes and behaviour were also included. After reducing the number of variables and constructing new variables, multivariate analyses were performed. A polytomous regression on self-esteem showed that having very poor self-esteem as opposed to poor, good and very good self-esteem was associated with being a girl, not living with one's biological parents, poor social support, having less interest in politics, poor adaptation in school and poor oral health behaviour. The results also showed that being a boy, choosing statements reflecting less exemplary behaviour, and being less well adapted in school increased the risk of having poor oral health behaviour, as did ethnic group affiliation and having poor self-esteem. Our results showed that self-esteem is a crucial intervening variable between variables measuring social background and outcome variables, especially oral health behaviour.

Objectives: Giving birth in a foreign country implies going through a life event with little or no access to your own traditions and social support. The aim of this study was to study the childbirth experiences of Somali women and men in Sweden., Design: Qualitative. Nine women and seven men were interviewed. Data collection was characterised by an openness to new ideas during the interview and the interviews were analysed according to the grounded theory technique., Findings: The meeting of Somalis with Swedish antenatal and delivery care was a multicultural event. It revealed social, medical, cultural and gender factors advocating space in the arena of childbirth. The Somalis constituted a homogeneous group with regard to their cultural belonging and motives for exile. The subjects were heterogeneous in that they represented a great variety in social and demographic background as well as in experiences, feelings and modes of expression. One striking finding was the Somali man's dramatic entrance into childbirth, which seemed to have a strong impact on the Somali woman's well-being during delivery. The study showed difficulties in getting used to the Swedish model of parenthood and in finding new role divisions in the couple relationship. Some of the subjects had experienced a strengthening of their marriage and an increased understanding of each other. Others commented that various aspects of traditional womanhood and manhood were lost as a result of the unfamiliar gender structures in Sweden., Conclusion: The Somalis' experiences of childbirth in Sweden can be understood by using the theoretical concept of gender, rather than culture. Our own and other studies show that women and men may have different frames of reference in childbirth, where the women mainly focus on biological circumstances and the men on the social and cultural aspects of birth. The Somali couple were found to be vulnerably positioned, with the professionals having the important role of supporting and empowering Somali parents.

This study identifies personality characteristics in a group of Swedish women (N = 60) attending their first treatment for alcohol problems. The treatment programme specifically addressed women in an early phase of their drinking career, and was called "Early Treatment of Women with Alcohol Addiction" (EWA). Rorschach personality profiles of the 60 women differed significantly in almost all investigated aspects in a psychopathological direction from norms reported by Exner for a reference group of female non-patients. The findings are consistent with the assumption that, although the EWA women were socially well-functioning and fairly early in their drinking career, they nevertheless reveal serious underlying psychopathology. Clinical implications of the findings are discussed.

Epidemiological studies have demonstrated an excess mortality caused by cancer and cardiovascular diseases among the workers employed at a smeltery in Northern Sweden. The aim of this paper is to elucidate the attitudes of the smelter workers to their working environment and to their health and to examine how these attitudes have changed over time. Moreover, in the analysis, we have sought explanations in the norm systems surrounding the workers and the changes in these. Interviews were carried out with 40 employees and previous employees at the smeltery. The interviewees were strategically chosen to reflect the development process of these norms within the company from its inception in the 1920s and onwards. We have attempted to describe the differences in behavioural patterns and norm expectations which characterize different periods in the history of the smeltery using four ideal type categories; the heroic man, the working-class man, the independent man and the anomic man. The workers' reactions to the norm systems have shifted gradually from conformity to indifference. The degree of individuality during these decades could be shown as a u-shaped curve.

The study provides a social and psychiatric description of development, drinking pattern and concomitant psychiatric disturbances of 100 female alcoholics, admitted to the Department of Alcohol Disease, Karolinska Hospital in Stockholm between 1963 and 1969. Comparisons are made between this group of women and 100 men of the same age, who were admitted during the same period. The criteria for selection were: 1) at least 7 days of in-patient treatment; 2) early cases. The subjects were between 20 and 65 years of age with a mean age of 40. It is shown that the women started drinking alcohol at higher ages than the men. The episodic use of alcohol passed into regular use, which progressed into misuse at significantly higher ages. The duration of the development from the onset to an alcoholic drinking pattern was significantly shorter and so was the duration of abuse at the time of admission. Notably more women than men showed a lonely drinking pattern and cited a specific external cause problem drinking. The women reported more nervous symptoms both in the growing ages and at admission, had received more psychiatric treatment both during childhood and in later life, and showed symptoms of other psychiatric disturbances in combination with alcoholism to a significantly higher degree than the men. Family history of alcoholism showed no differences between men and women, but the incidence of psychiatric illness was considerably higher for the first-degree relatives of the females.

Data from the public health insurance societies regarding 66 female alcoholics, hospitalized for the first time for alcoholism at the Department of Alcohol Diseases, Karolinska Hospital, Stockholm, were studied, and the developmental pattern of morbidity was compared with that of 68 male alcoholics fulfilling the same criteria. The observation period was 15 years. The progress of the alcoholism was not reflected in data from the social insurance societies up to the time of the first clinical treatment. However, the morbidity increased in both sexes after the treatment period, with higher disability, severity, and frequency rates, a large number of persons with disability pensions and increasing social stigmatization. The proportion of women granted disability pensions increased to significantly higher values than that of men, and that of women in the general population. The women had significantly fewer registrations in social registers than the men during the whole period. Women and older patients had higher disability rates, more sick-days due to "mental diseases" and a higher severity rate before admission. All differences were equalized in the last part of the study.

The studies in man concerning foetal alcohol damage have mostly covered skid row female alcoholics, and no study has described the outcome of pregnancy of a larger group of women receiving inpatient care for alcoholism. In another study we have described the medical and social characteristics of such a group (n = 92) of women, as well as those of an age-matched control group. This article reports retrospectively on the pregnancies and the infants of these women. The pregnancies and deliveries were normal in both groups. There was no significant difference in rate of stillbirths, neonatal mortality, perinatal asphyxia or neonatal distress. In infants born to alcoholic mothers after established regular alcohol consumption (n = 31), a significant reduction of mean placental weight, birth weight, length at birth and head circumference at birth, was found compared with control infants (n = 170). In the former group 12.9% of the infants were small for gestational age, in the latter 1.3%. Congenital malformations were significantly increased in the former group. Thus, in female inpatients at an alcohol clinic a history of increased risk for adverse neonatal outcome was found.

The aim of this study has been to explore and compare the mortality of 100 female and 100 male alcoholics, admitted to a department of alcoholic diseases in 1963-69. The patients were early cases and mortality was studied during an observation period of 6-12 years. A total of 18 women and 16 men died. As compared with the general population, mortality was 5.6 and 3.0 times higher than expected for the women and men, respectively. Among the women a significant excess mortality was found for accidents, suicides, diseases of the respiratory system, and especially cirrhosis of the liver. Mortality among the men was significantly higher than expected due to suicides, diseases of the circulatory system, neoplasms, chronic alcoholism, and acute alcohol poisoning. The excess mortality from suicides found for both sexes was highest in the female group. Despite the hitherto rather small number of deaths in the two groups, the high frequency of cirrhosis of the liver among the women is striking.

Women with alcohol problems constitute an increasing number of patients in medical service. Do they need special care? How should the treatment program be designed? The specialized female Karolinska Project for Early Treatment of Women with Alcohol Addiction (EWA) unit at the Karolinska Hospital in Stockholm, Sweden, was opened in 1981. The aim of the project is to reach women in an early stage of alcohol dependence behavior and to develop treatment programs specific to the needs of females alone. In order to investigate the value of such a specialized female unit a controlled 2-year follow-up study was carried out including 200 women. The probands were treated in the female only EWA-unit, whereas the controls were placed in the care of traditional mixed-sex alcoholism treatment centers. The 2-year follow-up study showed a more successful rehabilitation regarding alcohol consumption and social adjustment for the women treated in the specialized female unit (EWA). Improvement was noted also for the controls but to a lesser extent. Probably one of the most important achievements of a specialized female unit, such as EWA, is to attract women to come for help earlier.

The aim of this study has been to describe the different ways in which 100 alcoholics of each sex sought treatment, with special reference to the females. In addition, some psychiatric and social characteristics of the two groups of patients are presented. A significantly higher number of the females were admitted as a result of an acute complication: unconsciousness, suicide attempt, confusion, neurological disorders, etc., while the males generally sought treatment under less dramatic circumstances. As the patients selected were early cases, most had not been treated before, but in those with previous in-patient psychiatric treatment a diagnosis without an alcohol connection was significantly more common among the women. Drug abuse was considerably more frequent among the female as compared with the male alcoholics, and the specific lonely drinking pattern was also more common among the women. A striking difference between the sexes appeared with respect to partner: more than one-half of the married women had alcoholic husbands. The corresponding figure for the married men amounted to about 10%.