Health disparities based on neighbourhood and social conditions: Open Comparisons-an indicator-based comparative study in Sweden.

OBJECTIVE: The overarching goal of the Swedish public health policy is to create the right societal conditions for good and equitable health throughout the population and to reduce avoidable health inequalities within a generation. The objective of this article is to highlight the main findings of the Open Comparisons in Public Health (OCPH) 2019 study. STUDY DESIGN: The OCPH is a longitudinal indicator-based comparative study, encompassing 39 public health indicators with results from Sweden's 21 regions and 290 municipalities. METHODS: Descriptive statistics and 95% confidence intervals were used to compare results between municipalities, regions and time points. Correlation analysis was used to study the strength of the relationship between the results of municipalities and their socio-economic conditions. RESULTS: Across the population, levels of health are good and have, in some areas, improved over recent decades. However, some significant health disparities remain according to neighbourhood, sex, age and educational background. Health disparities related to the level of education are often larger than those between women and men, and there are larger differences within a region than between regions. Health disparities have, in some cases, increased, such as for life expectancy. CONCLUSION: If health equity is to be achieved, leaders at all levels must collaborate and advocate for political action and local efficient public health interventions to eliminate health disparities as a result of neighbourhood and social conditions.

Extremely different behaviours in high and low body weight lines of chicken are associated with differential expression of genes involved in neuronal plasticity.

Long-term selection (> 45 generations) for low or high body weight from the same founder population has generated two extremely divergent lines of chickens, the low (LWS) and high weight (HWS) lines, which at the age of selection (56 days) differs by more than nine-fold in body weight. The HWS line chickens are compulsive feeders, whereas, in the LWS line, some individuals are anorexic and others have very low appetites. The involvement of the central nervous system in these behavioural differences has been experimentally supported. We compared a brain region at 0 and 56 days of age containing the major metabolic regulatory regions, including the hypothalamus and brainstem, using a global cDNA array expression analysis. The results obtained show that the long-term selection has produced minor but multiple expression differences. Genes that regulate neuronal plasticity, such as actin filament polymerisation and brain-derived neurotrophic factor, were identified as being differentially expressed. Genes involved in lipid metabolism were over-represented among differentially expressed genes. The expression data confirm that neural systems regulating feeding behaviours in these lines are different. The results suggest that the lines are set in separate developmental trajectories equipped with slightly different nervous systems. We suggest that the lines adapt behaviourally different to changing situations post hatch, such as the transition from dependence on yolk to feeding, in order to obtain energy. The present study has identified and exemplifies the kind of changes that may underlie the extreme differences in such behaviours.

Comparison of the effiency of aluminium and ferric sulphate in the removal of natural organic matter during drinking water treatment process.

The removal of natural organic matter by coagulation in the drinking water treatment train was studied for a period of two years. In the middle of the study, the coagulation/flotation process was modified by replacing the aluminium sulphate by ferric sulphate. At the same time, the filtration unit was enhanced by adding a sand filter unit before the activated carbon filtration and by changing new carbons on to the activated carbon filters. A special aim was to compare the efficiency of the aluminium and ferric coagulants in the organic matter removal by several methods, including high-performance size-exclusion chromatography. A comparison of quantity and characteristics of organic matter in treated water before and after treatment process modification provided an insight into process performance. Approximately 95% of high molar mass organic substances were removed in the process with both coagulation agents. The greatest difference between the coagulants occurred in the removal of organic matter having molar masses of 1000-4000 g mol(-1). These intermediate molar mass organic compounds were removed 25% more efficiently with iron-based coagulant than with aluminium-based. Low molar mass material was poorly removed regardless of the coagulant. On average, only 10% of this fraction was removed. According to different measuring techniques used in the study, the ferric sulphate coagulation was 10% more efficient in the overall organic matter removal compared to the aluminium sulphate coagulation. Turbidity removal was more efficient with aluminium than with ferric sulphate. Turbidity even increased during winter in ferric sulphate coagulation. However, turbidity was effectively removed in filtrations.

Enhancement of the natural organic matter removal from drinking water by nanofiltration.

Finnish surface waters are abundant in natural organic matter. Natural organic matter can be removed from drinking water in a water treatment process by coagulation and filtration. The standard treatment operations are not able to remove the smallest molar mass fraction of organic matter and the intermediate molar mass matter is only partly removed. The removal of residual natural organic matter from drinking water by nanofiltration was evalueted in this study. Three different nanofiltration membranes were compared in filtering six pre-treated surface waters. The total organic carbon content of the feed waters varied from 2.0 to 4.2 mg l(-1). Other water quality parameters measured were conductivity, alkalinity, hardness, UV-absorbance, SUVA, E2/E3 value and molecular size distribution by high-performance size-exclusion chromatography. The natural organic matter removal efficiencies of the membranes were good and varied between 100% and 49%, and between 85% and 47% according to molecular size distribution and total organic carbon measurements, respectively. Removal of different molecular size fractions varied from 100% to 56%, 100% to 54% and 88% to 19%, regarding high molar mass, intermediate molar mass and low molar mass organic matter, respectively. The Desal-5 DL membrane produced the highest natural organic matter removals.

Molecular characterization of Salmonella enterica subsp. enterica serovar Typhimurium DT1 isolates.

Salmonella Typhimurium DT1 is endemic to Finland and has caused human outbreaks since the 1960s. Domestic DT1 isolates (n=235) from 1972 to 1999 from human cases, animals and other sources, as well as foreign DT1 isolates from human cases (n=20) were analysed by molecular methods. Pulsed-field gel electrophoresis (PFGE) yielded 38 XbaI profiles. Of these, XbaI profile 10 was seen in 49% (125/255) of the isolates. Twelve IS200 profiles were obtained; the most common IS200 profile D was seen in 64% (33/52) of the isolates. Two clusters were formed by compilation of the XhaI-, BlnI- and SpeI-PFGE and IS200 profiles and possession of the serovar-specific virulence plasmid. The major cluster contained eight IS200 profiles, including IS200 profile D and XhaI profile 10, and had no virulence plasmid, and can be regarded as typical of the endemic Typhimurium DT1 infection.

[47-percent 6-months-long survival for intensive care patients over 80]. / Halvårsöverlevnad 47 procent för intensivvårdade över 80 år.

All 112 patients aged 80 and above treated at the intensive care unit at the University Hospital in Lund, Sweden 1994-1995 were followed-up retrospectively in terms of six-month survival (SMS) and for survivors in terms of quality of life. Overall SMS was the same for both men and women--47%. Patients with the poorest SMS were those aged 90 and above with only one patient out of eleven surviving six months. Patients admitted for severe heart failure also showed a very poor outcome with SMS 27%. Patients were grouped in terms of living conditions prior to admission to the ICU, and a significant difference in six-month survival was noted between those living in their own homes (53%) prior to admission compared to those coming from a nursing home (25%). Patients surviving six months were interviewed by telephone regarding their living situation in March 1997. More than 50% of survivors were living in their own homes with external help no more than once a day. The average APACHE II score was 14.9 +/- 8.2. The average score for patients surviving six months was 13.4 +/- 5.9 and for those not surviving six months 16.8 +/- 5.1. No significant statistical difference in APACHE II scores between these two groups was shown.

Discrimination between endemic and feedborne Salmonella Infantis infection in cattle by molecular typing.

Salmonella enterica serovar Infantis is endemic in Finnish cattle. Feed contaminated with S. Infantis was distributed to cattle farms in May 1995. Following increased sampling, S. Infantis was detected on 242 farms in 1995. Molecular typing was used to differentiate the farms that were infected by the feed-related Infantis from those infected by other endemic strains. Twenty-three isolates from feed in 1995 and 413 from cattle (72 from 19924, 324 from 1995, 17 from 1996-7) were analysed. The feed-related Infantis was clonally related to the endemic infection by the ribotype, IS200-type and XbaI-profile. The feed isolates had a distinctive plasmid that appeared in pulsed-field gel electrophoresis as a 60 kb band when cleaved with XbaI or linearized by S1-nuclease. This plasmid appeared in cattle only since the outbreak and seemed stable on the follow-up farms. In addition to contact farms, the feedborne strain was found on 19% of the farms infected with S. Infantis in 1995 but not having bought suspected feedstuffs, possibly as secondary infections.

A clinical comparison of intranasal budesonide with beclomethasone dipropionate for perennial non-allergic rhinitis: a 12 month study.

To evaluate possible differences in efficacy and safety between budesonide and beclomethasone dipropionate when used intranasally in the treatment of perennial non-allergic rhinitis, a 12-month open study was undertaken in 24 patients suffering from perennial non-allergic rhinitis. Both drugs were applied intranasally from pressurised aerosols at a daily dosage of 400 micrograms. On entry and at visits after 1, 2, 4, 6, 9 and 12 months, rhinoscopy was performed and the severity of nasal symptoms graded according to a four-point rating scale. All nasal symptoms were reduced from baseline during the treatment period in both groups. Tachyphylaxis was not observed. No clinically significant changes in haematology or blood chemistry parameters were observed in either group, and analysis of plasma cortisol levels revealed no influence of either drug on the hypothalamic-pituitary-adrenal axis. Local adverse reactions were uncommon and mild. Budesonide and beclomethasone dipropionate used intranasally at 400 micrograms per day were found to be safe, and budesonide was found to have a significantly higher (p < 0.05) efficacy than beclomethasone dipropionate in alleviating symptoms of perennial non-allergic rhinitis.

Efficacy of topical corticosteroid powder for nasal polyps: a double-blind, placebo-controlled study of budesonide.

Budesonide has been used for a number of years as a topical nasal corticosteroid in the treatment of nasal allergy and nasal polyps. Recently, a new device for powder insufflation where no constituents or preservatives are included has been developed (Rhinocort Turbuhaler, Astra Draco AB, Sweden). The present investigation was designed in order to study the efficacy of topical budesonide powder as the only treatment of nasal polyps. A total of 126 patients entered the study. The medical history and clinical recordings included symptoms and signs, a semiquantitative test of smell and measurement of nasal expiratory peak flow index. Medication was either 200 or 400 micrograms of budesonide powder b.i.d. or placebo. After 1 month an overall assessment of treatment efficacy was made to determine whether the treatment had been a success or a failure. The results showed a statistically significant improvement of symptoms and signs in the actively treated groups. The increase in expiratory peak flow index was about 60% in the actively treated groups as opposed to 16% in the placebo group. The overall assessment of treatment efficacy showed success in about 82% of actively treated patients as opposed to about 43% in the placebo group. It is concluded that budesonide powder is useful in the treatment of nasal polyps.

Dry powder inhalation of budesonide in allergic rhinitis.

Topical steroids are known to be effective in allergic inflammatory airway diseases. However, progress in the treatment of these diseases has also called for the use of unadulterated drugs, without lubricants and preservatives. Rhinocort Turbuhaler, a multi-dose inhaler containing budesonide as a pure powder, is a newly developed device without any carrier gas, preservatives or lubricants. The efficacy and tolerance of this product were evaluated in 60 patients with birch pollen rhinitis. After a run-in period of 1 week the patients received once daily for 4 weeks either budesonide pure powder (400 micrograms) or placebo in a double-blind randomized fashion. Assessment of efficacy was made by comparing scores for different nasal and eye symptoms. The additional use of antihistamine tablets was assessed. In 22 of the patients nasal peak inspiratory flow rate was measured before and after 1 week of treatment. Budesonide was significantly more effective than placebo in controlling the nasal symptoms (P-values ranging from 0.011-0.045). The use of antihistamine tablets was significantly lower in the budesonide group (P = 0.012). The nasal inspiratory flow rate was increased after 1 week of treatment in the budesonide treated group of patients as compared with placebo (P = 0.007). No differences were observed between the groups with regard to eye symptoms or adverse effects. The results show that budesonide delivered from a dry powder inhaler is an effective and well tolerated treatment of seasonal allergic rhinitis.

Powder administration of pure budesonide for the treatment of seasonal allergic rhinitis.

The objective of this study was to compare the efficacy and safety of a pure powder formulation of budesonide, delivered from a new multi-dose dispenser for nasal drug application, with the commercially available budesonide pressurized aerosol, and with placebo. Of 116 patients with grass pollen-induced allergic rhinitis, 112 finished the study, which comprised a 4-week treatment period, preceded by a 1-week run-in period. The patients were randomized to four parallel treatment groups: budesonide powder 400 micrograms daily; budesonide powder 800 micrograms daily; budesonide aerosol 400 micrograms daily; and placebo powder. Treatment was given once daily in the morning. The study was double-blind regarding comparison between budesonide powder and placebo. Assessment of efficacy, made by comparing mean scores of nasal symptoms and use of rescue medication, showed equal efficacy of all three budesonide groups compared with placebo. There were no differences between budesonide-and placebo-treated groups with regard to side effects. Budesonide treatment had no demonstrable effect on the HPA-axis assessed by measurement of 24-h urine cortisol. We conclude that budesonide, delivered as pure powder from a multi-dose dispenser, is effective and safe for the treatment of seasonal allergic rhinitis. This new formulation is a good alternative to the commercially available preparations, as it does not contain carrier gas, preservatives or lubricants.

A comparison between intranasal budesonide aerosol and budesonide dry powder in the treatment of hay fever symptoms.

Sixty patients with seasonal allergic rhinitis due to birch pollen were enrolled in an open, randomized parallel group study. Efficacy and side effects were studied after intranasal administration of budesonide given as a freon propellant aerosol or as dry powder with a sniff actuated inhalation device. Medication started a few days before the actual peak pollen season and lasted for three weeks. The dose was 400 micrograms once daily. Efficacy was assessed daily by patient-rated symptoms scores and by nasal peak inspiratory flow measurements at the visits to the clinic. Safety was assessed by monitoring clinical adverse events. No clear changes in nasal symptom scores or nasal peak flow occurred during the pollen season in either treatment group as compared to the pretreatment period, although the pollen season was very difficult in Finland during the study, ad 12000 grains per m3. Substantial or total control of symptoms was achieved in 93% of the patients in the aerosol group and in 79% in the powder group. Side effects were minimal in both groups. We conclude that dry powder administration of budesonide is as effective and well tolerated as the aerosol in the treatment of seasonal allergic rhinitis.

Effects of prenatal exposure to tributyltin and trihexyltin on behaviour in rats.

The effects of prenatal administration of tributyltin (1 and 5 mg/kg) and trihexyltin (5 mg/kg) upon the development and behavioural repertoire of rats were studied. The dose levels were selected so as not to induce maternal toxicity. No consistent delay upon occurrence of various maturation markers of the organotin-treated offspring was seen. As adults the tributyltin-treated offspring showed considerable hyperactivity following the initial habituation whereas the trihexyltin-treated offspring showed hyperactivity to a lesser degree. In the spatial learning tasks applied, the radial arm maze and the circular swim maze, tributyltin-treated rats demonstrated a clearly retarded aquisition of the radial arm maze task whereas trihexyltin-treated rats performed as well as the control rats; no differences were obtained in the swim maze task. The tributyltin-treated offspring showed a drastic potentiation of d-amphetamine-induced hyperactivity, whereas trihexyltin treatment induced only a marginal increase.

Effect of a single dose of a topical glucocorticoid and a cyclo-oxygenase inhibitor on allergen-induced changes in nasal reactivity.

The inflammatory response of airway mucosa to allergen exposure is a complex phenomenon featuring symptoms, the influx of inflammatory cells, the release of mediators, and changes in local reactivity. These features and their pharmacological modifications can be successfully studied in nasal challenge models. We performed a nasal allergen challenge followed by a rechallenge with allergen 24 h later in order to monitor changes in specific reactivity due to the initial allergen challenge. Symptoms were monitored, as was the generation of TAME-esterase activity in nasal lavage fluids. Prior to each challenge a nasal brush specimen was taken. In a double blind, cross-over, double-dummy manner the patients were pretreated with placebo, a single dose of 200 micrograms of budesonide (topical corticosteroid) given 2 h prior to rechallenge with allergen or 600 mg ibuprofen (cyclooxygenase inhibitor) given per os t.i.d. to steady state starting 24 h prior to the initial allergen challenge. Treatment with ibuprofen induced a slightly lower composite symptom score (P less than 0.05) at the initial allergen challenge when compared with placebo. No differences were noted in the relevant TAME-esterase activities. The allergen challenge resulted in significantly increased proportions of eosinophils in the brush specimens 24 h after the initial allergen challenge (P less than 0.001) with no differences between the different treatment alternatives. At rechallenge there was a reduction in the symptoms of secretion and nasal blockage in both groups receiving active treatment compared with placebo (P less than 0.05), whereas the number of sneezes was not affected and no differences were noted in TAME-esterase activity.(ABSTRACT TRUNCATED AT 250 WORDS)

Nasal inhalation of the glucocorticoid budesonide from a spacer for the treatment of patients with pollen rhinitis and asthma.

Glucocorticoid sprays are increasingly used for the treatment of allergic rhinitis and asthma. This therapy is highly effective, and side effects are few and mild. It was the aim of the present study to evaluate a physiological nasal inhalation technique, which results in airway deposition of the steroid molecule similar to that of inhaled allergen particles. Thirty adults with grass pollen-induced rhinitis and asthma inhaled the steroid molecule budesonide through the nose from a pressurized aerosol attached to a spacer device. Compared with inhalation of placebo, the treatment resulted in a significant reduction of nasal symptoms (P = 0.005), of bronchial symptoms (P = 0.005), but not of eye symptoms. In addition, nasal peak inspiratory flow (P = 0.0003) and oral peak expiratory flow (P = 0.02) increased. There was no difference between budesonide and placebo with regard to local side effects, such as nose bleeding, hoarseness, and irritation in mouth and throat. It is concluded that nasal inhalation of a steroid from a spacer offers effective therapy of pollen rhinitis and asthma without significant local side effects. This therapeutic modality may have advantages over the ordinarily used nasal and bronchial spray treatment in patients with both rhinitis and asthma, especially when conventional spray therapy is associated with local side effects.

Allergen-induced increase of eosinophil cationic protein in nasal lavage fluid: effect of the glucocorticoid budesonide.

It was our aim to study the effect of nasal allergen provocation on the concentration of eosinophil cationic protein (ECP) in nasal lavage fluid, with and without glucocorticoid pretreatment. Twenty grass-pollen sensitive volunteers were provoked outside the pollen season on 2 consecutive days after pretreatment for 2 weeks with the glucocorticoid, budesonide, as a nasal spray (400 micrograms/day) and with placebo with a double-blind, crossover design. Nasal lavage fluid was repeatedly collected during a 10-hour period to study both early and late-phase responses. 99mTechnetium-albumin was added to the lavage fluid, making it possible to calculate the amount of secretion and the degree of dilution. The results were as follows: (1) There was no correlation between ECP concentration and dilution factor in the individual samples. (2) The mean concentration of ECP in lavage fluid from untreated, prechallenge noses was 400 micrograms/L. (3) The ECP level did not increase during the early phase response. (4) There was a late occurring increase in the ECP concentration (6 to 24 hours). (5) This increase was completely inhibited by budesonide pretreatment. (6) The glucocorticoid therapy also reduced the prechallenge ECP concentration. In conclusion, allergen provocation in the nose results in a late occurring increase of ECP in nasal lavage fluid, and one of the therapeutic effects of topical glucocorticoid therapy may be an inhibition of the allergen-induced increase of this cytotoxic molecule.

Intranasally administered budesonide, a glucocorticoid, does not exert its clinical effect through vasoconstriction.

Dermally applied topical glucocorticoids induce a pallor of the skin. 'vasoconstriction', which has been used to grade the anti-inflammatory potency of such preparations. This study was performed in order to explore the possibility of a similar 'vasoconstrictor' phenomenon existing in the upper airway mucosa, which might thus offer one explanation for the clinically beneficial effect of topical glucocorticosteroid preparations in the treatment of allergic and non-allergic rhinitis. The possibility of a changed sensitivity to alpha and/or beta-adrenergic stimulation was also evaluated. Ten normal subjects participated in the present double-blind, randomized, crossover, placebo-controlled study. After establishing a baseline in nasal peak flow and nasal mucociliary clearance, the patients were treated for 8 days with either budesonide 100 micrograms/nasal cavity morning and evening, or a matching placebo. After a wash-out period of 2 weeks the treatment was repeated using the other treatment alternative. Nasal peak flow measurements were taken immediately before and 1 h after each application of treatment. After 1 week of treatment the nasal mucociliary transport was determined and the subjects were subjected to an intranasal challenge with 0.05 mg of oxymetazoline and 5.2 mg terbutaline on 2 different days in order to test for alpha and beta-adrenoceptor sensitivity. The response to these challenges was monitored by symptom scores and nasal peak flow measurements. Neither active treatment with budesonide aqueous suspension nor the placebo treatment induced any change in the mucociliary transport time nor in nasal airway as measured with the peak flow meters.(ABSTRACT TRUNCATED AT 250 WORDS)

The clinical efficacy of budesonide in hay fever treatment is dependent on topical nasal application.

During the last decade topical glucocorticoids have been established as the first hand choice for the treatment of allergic rhinitis. Although they are clinically effective, their precise mode of action has not been sufficiently clarified. In order to evaluate whether the clinical effect is dependent on the topical administration a randomized, double-blind, double-dummy study was performed. Ninety-eight patients with allergic rhinitis due to birch pollen were recruited at two centres in southern Sweden. The patients received one of the following three treatment alternatives: 200 micrograms of nasally applied budesonide twice daily, 250 micrograms of budesonide given orally twice daily or a placebo. The selection of the doses was based on previous pharmacokinetic studies giving almost equal plasma levels of the nasally and orally administered budesonide. To evaluate the possible clinical efficacy of the treatment, the patients kept a diary in order to register symptoms according to a 0-4 scale. After a run-in week with no treatment the patients entered the treatment period which lasted for 3 weeks. A total of 96 patients completed the study. The symptom data showed that topically applied budesonide was clinically effective with a pronounced reduction in all the nasal symptoms registered and compared with placebo treatment there was a statistically significant difference in favour of the budesonide treatment (P less than 0.001). The nasal symptoms of the patients receiving oral budesonide did not differ from those receiving placebo. Intranasally administered budesonide proved to be significantly more effective than orally applied budesonide (P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Long-term safety of budesonide nasal aerosol: a 5.5-year follow-up study.

The effects of prolonged treatment with intranasally applied budesonide was studied in twenty-four patients with perennial allergic or non-allergic rhinitis. Patients on continuous treatment were followed up for 5.5 years. At entry and follow-up visits, rhinoscopic findings, nasal symptom scores, blood chemistry, haematology, urine analysis and determination of plasma cortisol levels, before and after stimulation with ACTH (Synacthen, Ciba-Geigy AG, Basel, Switzerland), were registered. Biopsies of the nasal mucosa were taken before entry into the study, after 1 year of treatment, and after varying time intervals ranging from 2.5 to 5.5 years during the treatment. The biopsy specimens were examined blindly by an independent pathologist. The analyses revealed no histopathological changes in the nasal mucosa. All nasal symptom parameters assessed by the patients were significantly reduced from the baseline during the entire follow-up period. No clinically significant changes in the haematological and blood chemistry parameters were observed. Plasma cortisol analyses before and after challenge with ACTH revealed no influence on the hypothalamic pituitary adrenal (HPA) axis. The present study suggests that intranasal budesonide in the dose of 200-400 micrograms/day is also a safe treatment for prolonged treatment of perennial rhinitis.

Budesonide nasal spray as prophylactic treatment after polypectomy (a double blind clinical trial).

This double-blind parallel-group study compared the effect of budesonide with placebo, in the prophylaxis of nasal polyp recurrence after evulsion. Seventy-three patients with first time or recurrent polypectomy were enrolled. At revisits 3 and 6 months after evulsion, the budesonide-treated patients had significantly lower polyp scores than the placebo-treated patients. Only patients with recurrent nasal polyposis benefited from the budesonide treatment, whereas no effect was evident in patients with first time evulsion.