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We present the results of the medical knowledge test after fulfilled internship for Swedish medical authorization during the years 2009 to the spring of 2015. A total of 7,613 tests were analyzed. Interns graduated from Swedish universities failed in 2.7% to 3.8% of the test moments. Interns who graduated from countries within the European Union (EU) failed in 21.2% and interns graduated from a non-EU country failed in 41.6%. The results from those who graduated from EU and non-EU countries have worsened compared to an earlier study in 2009. Proper measures have now to be implemented for doctors graduated from a non-Swedish university to improve the outcome and introduction to the Swedish health care system.

In a socio-economically stable community with free access to medical care, a prospective comparison was made of pregnancy, delivery and neonatal data concerning 480 grand multiparas (> or = 5 deliveries) and 325 controls. The mean diastolic blood pressure was slightly higher (79.8 vs. 77.8 mmHg) among the grand multiparas and the rates of episiotomy differed greatly (5.8% in the grand multiparas vs. 45.7% in the controls). The main clinical difference was a slightly higher incidence of placental complications-i.e., praevia, abruptio and retentio (3.4% vs. 0.9%; P < 0.05) in the grand multiparas. The differences had no effect on neonatal outcome. Grand multiparity should be regarded as an obstetrical risk factor, mainly because of the higher frequency of placental complications. With good obstetric care there should be no adverse effects on the mother or the newborn.