This study deals with the history of smallpox in Sweden between 1750 and 1900 and the two preventive measures that were used against it: inoculation during the eighteenth and vaccination during the nineteenth Century. Between 1750 and 1800 300,000 children died from smallpox in Sweden. During the nineteenth Century smallpox death rates decreased considerably and by the end of the Century the disease was very rare. The purpose of this study has been to examine the occurrence of smallpox at local, regional and national levels and to explain the changes in the light of general models of the epidemiologic transition. Smallpox mortality has been analyzed by demographic variables such as age, sex, and social class. The adaptation and practise of inoculation and vaccination has been examined by using a model of preventive health care behaviour. When smallpox mortality decreased sharply at the beginning of the nineteenth century, a greater proportion of adults were represented. More men than women died. Due to diminished immunity most of those who were vaccinated became susceptible about ten years later. There is only a slight tendency that smallpox impaired a persons fertility. Sterility, however, often resulted from an infection. Disfiguring facial pockmarks were also a serious complication of smallpox infection. Those who had been infected from smallpox married later in life than those who were susceptible or vaccinated. Inoculation was never widely accepted in eighteenth-century Sweden since a fatalistic attitude did not encourage preventive measures. The physicians monopoly and a general lack of organization were other important impediments. Vaccination was successfully implemented in 1802 and became the single most important factor for the decrease in smallpox mortality. By employing the clergy and allowing everyone to practise vaccination a great majority of the new-born were immunized. Vaccination rates were raised further when the method was made compulsory in 1816. Since there were no risks involved and after experiencing the advantages of vaccination during smallpox epidemics the inhabitants of Sweden were easily to persuaded of its benefits. By then smallpox had changed from a fatal killer to a rare disease. / digitalisering@umu

The concept of 'cancer transition' in selected European countries Abstract This paper examines the concept(s) of 'cancer transition' which consists of interpretation of the cancer epidemiology development dynamics. The conceptualizations by various important authors are compared. Comparation is also made between them and the concepts of epidemiologic and health transition. The concepts of 'cancer transition' are then given the context of selected characteristics of the cancer epidemiology. The concepts are additionally illustrated by visualization of the age-standardized mortality and incidence rates in selected European countries - Czechia, Ireland, Norway and Malta in the 1960-2017 period. Keywords: cancer transition, epidemiologic transition, cancer, mortality

Rationale: Vital registration is lacking in developing settings where health and development problems are most pressing. Policy-makers confront an “information paradox”: the critical need for information on which to base priorities and monitor progress, and the profound shortage of such information. Aims: To better understand the dynamics of mortality transition in rural South Africa over a decade of profound socio-political change coupled with emerging HIV/AIDS. Thereby to inform health and development programming, policy formulation, and the research agenda; and contribute to debate on the nature of the ‘health transition’. Methods: The Agincourt health and demographic surveillance system is based on continuous monitoring of the Agincourt sub-district population in rural north-east South Africa. This involves annual recording of all vital events, specifically deaths, births and migrations in 11,700 households comprising some 70,000 persons. A “verbal autopsy” is conducted on every death, and special modules provide additional data. Key findings: A major health transition has occurred over the past decade, with marked changes in population structure and rapidly escalating mortality particularly among children and younger adults. A quadruple burden of disease is evident with persisting infectious disease and malnutrition in children, emerging non-communicable disease in the middle-aged and older, high levels of violence in an apparently peaceful community, and rapidly escalating HIV/AIDS and tuberculosis. There is evidence of sex differences and socio-economic differentials in mortality; vulnerable sub-groups include the children of Mozambican immigrants and recently returned labour migrants. Implications: With respect to health transition, empirical data demonstrate a marked “counter transition” with mortality increasing in children and young adults; “epidemiologic polarization” is evident with the most vulnerable experiencing a higher mortality burden; and a “protracted transition” is reflected in the co-existence of persisting infectious disease and malnutrition, emerging HIV/AIDS, and increasing chronic non-communicable disease. With respect to health policy and practice there is urgent need to: strengthen HIV/AIDS prevention, treatment and care; offer effective long-term care to control the rising burden of chronic illness and related risk; maintain and improve maternal and child health services; and address differential access to care. This poses a substantial challenge to a severely stretched health system.