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Our aim was to map and compare genomic imbalances in human papillomavirus (HPV)-positive and -negative squamous cell carcinomas of the tonsil. Twenty-five primary carcinomas were analyzed by comparative genomic hybridization. Fifteen (60%) were found to be HPV-positive by PCR, and the majority were HPV-16. There were statistically significant differences in the distribution of DNA gains and losses between the HPV-positive and -negative samples. Eleven of 15 HPV-positive samples (73%) showed gain on chromosome 3q24-qter, while only 4/10 (40%) HPV-negative samples had the same gain (p = 0.049). Furthermore, 4/10 (40%) HPV-negative samples but no HPV-positive samples had gain on chromosome 7q11.2-q22 (p = 0.017). As expected, and similar to previous studies, patients with an HPV-positive tumor had a statistically significantly better disease-specific survival than patients with an HPV-negative tumor (p = 0.002). The most common changes, e.g., gain on 3q or 8q, loss on 11q or 13 and loss on chromosome 7q in HPV-negative tumors, did not have any influence on prognosis. However the number of cases in each subgroup was limited., (Copyright 2003 Wiley-Liss, Inc.)

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.

The aim of our study was to investigate the physical state and the viral load of HPV-16 in tonsillar cancer and to correlate these findings with clinical outcome. To distinguish between integrated and episomal forms of HPV, 22 fresh-frozen tonsillar cancer samples were analysed by a method based on restriction enzyme cleavage, ligation and PCR (rliPCR). HPV-16 was detected in 11/22 and HPV-33 in 1/22 of the cancers, hence 12/22 (55%) of the tumours were HPV positive. Only extrachromosomal forms of HPV-16 were observed. Full-length episomal HPV was detected exclusively in 7/11 of the cancers, whereas both full-length and deleted forms of episomal HPV-16 were found in parallel in 2 other tumours. In 1 tumour only a deleted episomal form of HPV-16 was present. In the remaining HPV-16 positive tumour both full-length episomal as well as an 11 kbp PCR product were detected and if the 11 kbp product contained integrated HPV, or was off-size linearised episomal could not be determined. In 2 cervical cancer controls, HPV-16 was integrated and could be chromosome located. HPV-16 was quantified by real-time PCR and most tonsillar cancers contained between 10 to a few hundred copies of HPV per beta-actin. The 6 patients with tumour sections with > or =190 HPV-16 copies/beta-actin remained tumour free (p = 0.026) and had a better survival rate (p = 0.039) when compared to the 5 patients with tumours sections with < or =60 HPV-16 copies/beta-actin. In conclusion, HPV-16 is mainly episomal in tonsillar cancer. The viral load showed a wide distribution and the clinical outcome in our study was better when the HPV load was higher., (Copyright 2002 Wiley-Liss, Inc.)

Objective: To investigate effects of beta-aminopropionitrile and a combination of insulin-like growth factor (IGF)-I and beta-aminopropionitrile on metabolism of equine tendon fibroblasts., Sample Population: Flexor tendon explants from 3 horses., Procedure: Explants received 1 of 4 treatments (control, IGF-I, beta-aminopropionitrile, and IGF-I/beta-aminopropionitrile) for 10 days, and message expression for collagen types I and III was assessed by use of in situ hybridization. Histologic findings, new protein production, and quantitative determinations of glycosaminoglycan, DNA, and de novo collagen synthesis were made., Results: Insulin-like growth factor-I stimulated an anabolic response in tendon. Collagen synthesis and glycosaminoglycan and DNA content of explants were all increased. Beta-aminopropionitrile significantly suppressed collagen synthesis, which was not ameliorated by concurrent IGF-I treatment. Beta-aminopropionitrile caused alterations in cell morphology characterized by large round cells with eccentric nuclei and decreased density of collagen fibers. Protein production and collagen type-III mRNA expression were reduced in these cells., Conclusions and Clinical Relevance: Treatment with beta-aminopropionitrile resulted in decreased production of protein and collagen synthesis, which could be expected to suppress tendon healing. The negative effects of beta-aminopropionitrile could not be abrogated by addition of IGF-I to the medium. Treatment resulted in alterations in cell morphology and matrix consistency, which could further delay tendon healing. Beta-aminopropionitrile may impair tendon healing at a cellular level by decreasing collagen production or increasing rate of degradation of existing matrix. Because of reduced crosslinking during beta-aminopropionitrile treatment, in combination with transiently decreased tensile strength, alterations in collagen content and structure may weaken the healing tendon.

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.

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.

Our knowledge about the content of strategies used by staff members in a surgical recovery unit for assessment of post-operative pain is fairly limited. The aim of the present study was to describe variations in the content of strategies used by nurses and physicians in practical clinical pain assessments and to evaluate the clinical accuracy of the strategies used. Critical care nurses (n = 30), physicians (n = 30) and postsurgical patients (n = 180) comprise the respondents. Applying a phenomenographical approach, interview data were tape-recorded during 180 clinical pain assessments. The pain assessments were related to comparative bedside pain ratings (Visual analogue Scale, VAS), both by staff members and post-operative patients. The recorded interviews were analysed to describe variations in ways of assessing pain. Pain assessment strategies were established by combining categories describing the impact of experience and categories of assessment criteria. The present observations, if included in the education of clinical staff members, could increase the understanding and thereby the quality of the pain assessment process.

Pain assessment and management are major clinical problems that many categories of healthcare professionals have to deal with. Although there are many potentially successful approaches available for pain management, there is still a shortage of knowledge about the strategies used by staff members for the actual assessment of pain and how reliable these strategies are. The fact that patients often undergo a great deal of suffering from pain and lack of adequate pain relief may be considered an indicator of this shortage of knowledge. Clinical studies from different parts of the world reveal that the incidence of pain reported by patients is still high, with about 75% reporting moderate pain and an additional 15% severe pain. The aim of the present study was to validate different categories used in acute pain assessment and their accuracy in a new clinical sample and to explore further different dimensions of how staff members experience pain assessment. Intensive care nurses (n = 10) were carrying out pain assessment of postoperative patients (n = 30). Each pain assessment was followed by a detailed interview and indicating the estimated pain intensity on a visual analogue scale (VAS, 0-10 cm). The pain ratings by the nurses were compared to those of the patients to assess the accuracy of the pain assessments of the staff members. A previously developed category system for describing the initial empirical material regarding criteria the nurses relied on when assessing pain, combined with what experience has taught them in this respect, was used to assess the validity of previous observations. The results indicate that similar approaches were still used by the nurses but the accuracy of pain assessment had considerably improved.

The research reported is an experimental study on the effects of intensified education of parents of children with amblyopia on their understanding of the nature of the defect, its origins and treatment. Parents in the control group were exposed to the ordinary information provided at two departments of paediatric ophthalmology, whereas parents in the experimental group, attending the same clinics, were asked to read a booklet aiming at enhancing their understanding of amblyopia and its treatment. Experimental as well as control subjects were thereafter interviewed about their understanding of the meaning of amblyopia and amblyopia-related phenomena. Data were generated in single subject, semi-structured, in-depth interviews which were taped and transcribed in extenso. The interviews were analyzed according to the phenomenographic approach: i.e. the outcome is a description of the various conceptions that emerged in the interviews. In almost all cases the categories of meaning could be hierarchically ordered with regard to the level of understanding implied. Parallel to the interviews the subjects had also filled out a questionnaire assessing general and specific attitudes towards disease and treatment (the Health Belief Model, HBM). The results reveal a superior understanding among parents in the experimental group. The experimental group had also changed attitudes towards disease and treatment in a direction that would favour compliance, more than could be observed in the control group. The outcome is discussed in terms of the role of understanding for a compliant behaviour. It is also emphasised that health care personnel would profit from being aware of the nature of common misconceptions of diseases and their treatment, in the sense that they would be better prepared for entering instructional dialogues with patients or, as in this case, other persons responsible for the management of prescriptions provided.

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.

Objective: To determine the vaccination rate among infants discharged from a neonatal intensive care unit (NICU) and factors affecting that rate., Design: Cross-sectional survey conducted when the children were 12 to 18 months of age., Setting: NICU at the Royal University Hospital, Saskatoon, Sask., Participants: All 395 infants discharged from the NICU between Jan. 1 and June 30, 1992., Main Outcome Measures: Vaccination rate, ethnic background (native or non-native), place of residence (urban or rural), health status (number of days spent in the NICU), reasons for delay in or incomplete vaccinations (those involving parents' responsibility, infant illness or contraindications)., Results: Of the 395 infants, 20 (5.0%) had died and incomplete information was available for 30 (7.6%). Complete data were available for 345 (87.3%). Of the infants for whom data were available, 8 (2.3%) had never been vaccinated and 142 (41.2%) had a delayed vaccination schedule or had not completed their scheduled vaccinations. Only 195 (56.6%) of the infants had received a full vaccination series. Non-native ethnic background was a predictor of completed vaccinations (odds ratio [OR] 5.40, 95% confidence interval [CI] 3.05 to 9.52). In a univariate model, urban area of residence was not a significant predictor of vaccination status, but when ethnic background was controlled for in a multivariate logistic regression analysis, urban area of residence was found to be inversely associated with completed vaccinations (OR 0.34, 95% CI 0.15 to 0.79). The number of days the child had spent in the NICU was not a significant predictor of vaccination status., Conclusion: The vaccination rate of infants discharged from the NICU is not optimal. Urban native children appears to be at risk of not being vaccinated. Non-native infants are five times more likely than native infants to have completed all of their scheduled vaccinations. Methods to improve the rate of completed vaccinations, especially for native children, must be sought and tested.

This paper deals with psychiatric comorbidity among 60 women problem drinkers treated in a specialized women-only treatment programme (EWA) at Karolinska Hospital, Stockholm, Sweden. The programme attracts women who have not been previously treated for alcohol problems. The methods used were structured interviews (SCID-I and SCID-II) applied at least 10 days after the start of treatment. All but two of the women had a definite alcohol dependence according to the DSM-III-R, and a majority (60%) also fulfilled the criteria for at least one psychiatric disorder during their lifetime. However, only 23% had a personality disorder (PD), and all subjects with a PD also had at least one Axis I disorder. The most common disorders were mood disorders (48%) and anxiety disorders (38%). However, alcohol dependence developed without definite pre-existing psychiatric disorders among a substantial proportion of the women (40%). It remains to be seen whether and how psychiatric disturbances among female problem drinkers affect treatment compliance and long-term outcome.

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.

Twenty primary care physicians at 12 health centres in Sweden were interviewed in a semi-structured way. Analysis was conducted using a phenomenographic method. Concerning the general attitude towards cardiovascular disease (CVD), there were two categories of answers; (A) CVD is a big threat to public health, and the health care system should play an active role in treatment and prevention, and (B) CVD is a symptom of normal aging with little or no need for active health care intervention. Questions on the management of hypercholesterolaemia showed a general acceptance of diet and lifestyle alterations, with a marked reluctance to use drugs except in cases of hereditary hypercholesterolaemia. The physicians were positive to non-commercial information from official sources. Critical opinions existed, however, questioning the adequacy and applicability of the national expert recommendations. There was a general acknowledgement of the importance of patient information, whereas a lack in communication skills was expressed. The description of attitudes and conceptions can assist in the understanding of mechanism underlying physicians' behaviour and provide a base for future information programmes.

Heterotopic salivary tissue was diagnosed in a 7-month-old Quarter Horse colt with a history of a draining wound in the left temporal region from time of birth. Surgical excision of the tract was performed for diagnosis and treatment. Histologically, tissues were compatible with a mixed-type salivary gland, most likely of parotid salivary gland origin. Complete resolution of the drainage was achieved after surgical removal of the ectopic tissue.

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.

While female alcoholism has increased particularly in the younger generation alcohol-related complications are now more frequently observed among older women. It is generally hard to identify an alcohol problem in a woman who tries at all costs to conceal it and often skillfully masks her difficulties. Such women repeatedly seek help from the medical services for diverse symptoms, both psychological and physical.

Carbohydrate-deficient transferrin (CDT) in serum was determined by micro anion exchange chromatography and a transferrin radioimmune assay in 58 consecutive women treated for early alcohol dependence compared, with 62 healthy females with an alcohol consumption of 0-15 g of ethanol/day. The upper normal CDT level was 74 mg/l. CDT was elevated above this value in 83% of the alcoholic women with an intake of 60 g of ethanol/day or more for at least 7 days within the preceding two weeks. CDT values were significantly positively correlated with daily alcohol consumption but not with GT, ASAT, ALAT or MCV. During abstinence CDT level declined exponentially with a half-life of 14 +/- 3 days. The results indicated that CDT may be as sensitive and specific a marker in women with early alcohol addiction as in previously studied male alcoholics. The amount of alcohol consumed appeared to be more important than sex or liver function. Determination of CDT may thus offer a means for early objective diagnosis and adequate treatment also of women in early stages of alcoholism.

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 study examined the occurrence of acute tobacco withdrawal symptoms among three methods of smoking cessation. Smokers were asked to smoke ad lib for 3 days and then randomly assigned to one of three groups for the next 5 days: (1) total cigarette cessation; (2) 50% reduction of number of cigarettes; or (3) reduction of nicotine yield of cigarettes. Of the 13 measures of tobacco withdrawal, six of the measures showed significant differences in severity of withdrawal symptoms between the total cessation group and partial reduction groups. There were no significant differences in severity of withdrawal between the two partial reduction groups.

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%.

Vigabatrin, as a single oral dose of 50 mg/kg, was administered to 11 patients with drug-refractory complex partial epilepsy. Serial lumbar punctures were performed prior to and 5 times within the first week following treatment. Cerebrospinal fluid (CSF) concentrations of total GABA, free GABA, homocarnosine, homovanillic acid (HVA), 5-hydroxyindoleacetic acid (5-HIAA) and vigabatrin were determined as well as blood vigabatrin levels. CSF GABA, homocarnosine, HVA and 5-HIAA concentrations increased by 6 h after the single dose and remained elevated for up to 5-7 days. In contrast, CSF and blood vigabatrin levels were maximal within the first 24 h and were no longer detectable thereafter. Hence, these results are consistent with vigabatrin acting as an irreversible inhibitor of GABA-transaminase and suggest that it may also increase biogenic amine turnover.

The prevalence of smoking among psychiatric outpatients (N = 277) was significantly higher than among either local or national population-based samples (N = 1,440 and 17,000) (52% versus 30% and 33%). The higher prevalence was not associated with the age, sex, marital status, socioeconomic status, alcohol use, coffee use, or institutionalization of the psychiatric patients. Smoking was especially prevalent among patients with schizophrenia (88%) or mania (70%) and among the more severely ill patients. Hypotheses about why psychiatric patients are more likely to smoke and why they do not have a high rate of smoking-induced illnesses are presented.