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Biomedical subjects

L Bakketeig

Publications and source records attributed to L Bakketeig.

At least 19 recordsLinked to original sources
PubMed2004

Psychosocial factors at work in relation to low back pain and consequences of low back pain; a systematic, critical review of prospective cohort studies.

Relevant studies of low back pain (LBP) published between 1990 and 2002 were systematically retrieved via electronic databases and checking of reference lists. Forty papers fulfilled the inclusion criteria; 10 were of high quality. A wide variety of instruments had been used for collection of data on work related psychosocial factors, many of which had not undergone any form of validation. Moderate evidence was found for no association between LBP and perception of work, organisational aspects of work, and social support at work. There was insufficient evidence for a positive association between stress at work and LBP. No conclusions could be drawn regarding perception of work and consequences of LBP. There was strong evidence for no association between organisational aspects of work and moderate evidence for no association between social support at work and stress at work and consequences of LBP.

Cohort Studies↗
PubMed2003

Ambiguous relation between physical workload and low back pain: a twin control study.

AIMS: To examine the association between self reported physical workload and low back pain (LBP) in younger twins. To investigate whether genetic factors interact with physical workload in relation to LBP. METHODS: A twin control study was performed within a population based twin register using 1910 complete monozygotic (MZ) and same sexed dizygotic (DZ) twin pairs aged 25-42 and discordant for LBP. LBP in the affected twins was divided into two groups: "LBP for </=30 days during the past year", and "LBP for >30 days during the past year". Physical workload was divided into four categories: "sitting", "sitting/walking", "light physical", and "heavy physical". Data were analysed in a matched design using conditional logistic regression. MZ and DZ twins were analysed separately and together in order to determine possible genetic influences in relation to physical workload and LBP. RESULTS: Statistically significant graded relations were found for increasing workload and LBP of longer duration but not for LBP of shorter duration (</=30 days during the past year). In both LBP groups the "sitting" and "sitting/walking" groups were not statistically different. MZ and DZ twins did not differ significantly with respect to LBP in the various workload groups. CONCLUSIONS: There is evidence for a dose-response relation between physical workload and LBP of longer duration. Attention to clinically relevant subgroups based on duration, for example, is necessary in epidemiological studies dealing with LBP. Physical workload might be more important than genetic factors in LBP.

Adult↗
PubMed2002

The epidemiology of syphilis in pregnancy.

This study evaluated the magnitude, risk factors and outcomes of syphilis in pregnancy in a large cohort of women in four countries participating in the World Health Organization (WHO) antenatal care trial. All women attending the first prenatal care at each selected clinic were enrolled. Screening at the first antenatal visit was routinely performed with either rapid plasma reagin or Venereal Disease Research Laboratory and confirmed by fluorescent treponemal antibody absorption. All women also had the same syphilis tests after delivery. The initial prevalence, the incidence during pregnancy and the overall prevalence of syphilis at delivery were 0.9%, 0.4% and 1.3% respectively. Risk factors for syphilis during pregnancy were younger age for the incidence and older age and a history of stillbirth for the prevalence. Women with syphilis during pregnancy had significantly more adverse outcomes. We support the recommendation that in addition to the initial testing, a second routine test for syphilis ought to be established early in the third trimester even in low prevalence areas.

Adult↗
PubMed2001

WHO antenatal care randomised trial for the evaluation of a new model of routine antenatal care.

BACKGROUND: We undertook a multicentre randomised controlled trial that compared the standard model of antenatal care with a new model that emphasises actions known to be effective in improving maternal or neonatal outcomes and has fewer clinic visits. METHODS: Clinics in Argentina, Cuba, Saudi Arabia, and Thailand were randomly allocated to provide either the new model (27 clinics) or the standard model currently in use (26 clinics). All women presenting for antenatal care at these clinics over an average of 18 months were enrolled. Women enrolled in clinics offering the new model were classified on the basis of history of obstetric and clinical conditions. Those who did not require further specific assessment or treatment were offered the basic component of the new model, and those deemed at higher risk received the usual care for their conditions; however, all were included in the new-model group for the analyses, which were by intention to treat. The primary outcomes were low birthweight (<2500 g), pre-eclampsia/eclampsia, severe postpartum anaemia (<90 g/L haemoglobin), and treated urinary-tract infection. There was an assessment of quality of care and an economic evaluation. FINDINGS: Women attending clinics assigned the new model (n=12568) had a median of five visits compared with eight within the standard model (n=11958). More women in the new model than in the standard model were referred to higher levels of care (13.4% vs 7.3%), but rates of hospital admission, diagnosis, and length of stay were similar. The groups had similar rates of low birthweight (new model 7.68% vs standard model 7.14%; stratified rate difference 0.96 [95% CI -0.01 to 1.92]), postpartum anaemia (7.59% vs 8.67%; 0.32), and urinary-tract infection (5.95% vs 7.41%; -0.42 [-1.65 to 0.80]). For pre-eclampsia/eclampsia the rate was slightly higher in the new model (1.69% vs 1.38%; 0.21 [-0.25 to 0.67]). Adjustment by several confounding variables did not modify this pattern. There were negligible differences between groups for several secondary outcomes. Women and providers in both groups were, in general, satisfied with the care received, although some women assigned the new model expressed concern about the timing of visits. There was no cost increase, and in some settings the new model decreased cost. INTERPRETATIONS: Provision of routine antenatal care by the new model seems not to affect maternal and perinatal outcomes. It could be implemented without major resistance from women and providers and may reduce cost.

Adult↗
PubMed2001

Methodological considerations on the design and analysis of an equivalence stratified cluster randomization trial.

The World Health Organization and collaborating institutions in four developing countries have conducted a multi-centre randomized controlled trial, in which clinics were allocated at random to two antenatal care (ANC) models. These were the standard 'Western' ANC model and a 'new' ANC model consisting of tests, clinical procedures and follow-up actions scientifically demonstrated to be effective in improving maternal and newborn outcomes. The two models were compared using the equivalence approach. This paper discusses the implications of the equivalence approach in the sample size calculation, analysis and interpretation of results of this cluster randomized trial. It reviews the ethical aspects regarding informed consent, concluding that the Zelen design has a place in cluster randomization trials. It describes the estimation of the intracluster correlation coefficient (ICC) in a stratified cluster randomized trial using two methods and reports estimates of the ICC obtained for many maternal, newborn and perinatal outcomes. Finally, it discusses analytical problems that arose: issues encountered using a composite index, heterogeneity of the intervention effect across sites, the choice of the method of analysis and the importance of efficacy analyses. The choice of the clustered Woolf estimator and the generalized estimating equations (GEE) as the methods of analysis applied is discussed.

Adult↗
PubMed2000

Maternal smoking affects fetal growth more in the male fetus.

This study investigated the association between maternal cigarette smoking and fetal growth, evaluated by longitudinal ultrasound examinations and by neonatal anthropometric measurements. The investigation was carried out in a healthy population of affluent Scandinavian women, parity 1 and 2, who were selected consecutively and prospectively, and with term, normal pregnancies. Three hundred and six non-smoking, 242 light-smoking and 308 heavy-smoking mothers and their newborns were examined. Ultrasound measurements were performed in pregnancy weeks 17, 25, 33 and 37. Biparietal diameter (BPD), mean abdominal diameter (MAD) and femur length were recorded. The negative effect on fetal growth from maternal smoking was found to affect the male fetus proportionally more than the female. Boys born to heavy-smoking mothers had a weight reduction of 8.2% and a lower fat accretion (as measured by subscapular skinfold) of 12%, whereas girls had a weight and fat reduction of 4.8% and 2% respectively. In boys (but not girls) born to smokers, head circumference was significantly smaller, also reflected by significantly smaller mean BPD measurements recorded from pregnancy week 18 onwards. The MAD measurements became successively more negatively affected in the second half of pregnancy in both males and females. A greater intrauterine growth velocity and a different hormonal milieu are suggested as possible explanations of the greater male susceptibility.

Adult↗
PubMed2000

Cognitive development of term small for gestational age children at five years of age.

AIM: To assess the relative significance for cognitive development of small for gestational age, parental demographic factors, and factors related to the child rearing environment. METHODS: IQ of a population based cohort of 338 term infants who were small for gestational age (SGA) and without major handicap, and a random control sample of 335 appropriate for gestational age (AGA) infants were compared at 5 years of age. RESULTS: The mean non-verbal IQ was four points lower, while the mean verbal IQ was three points lower for the children in the SGA group. The results were not confounded by parental demographic or child rearing factors. However, parental factors, including maternal non-verbal problem solving abilities, and child rearing style, accounted for 20% of the variance in non-verbal IQ, while SGA versus AGA status accounted for only 2%. The comparable numbers for verbal IQ were 30 and 1%. Furthermore, we found no evidence that the cognitive development of SGA children was more sensitive to a non-optimal child rearing environment than that of AGA children. Maternal smoking at conception was associated with a reduction in mean IQ comparable to that found for SGA status, and this effect was the same for SGA and AGA children. The cognitive function of asymmetric SGA was comparable to that of symmetric SGA children. CONCLUSIONS: Our findings indicate that child cognitive development is strongly associated with parental factors, but only marginally associated with intrauterine growth retardation.

Case-Control Studies↗
PubMed1999

Perinatal risk factors for recurrent wheeze in early life.

The possible value of tidal flow volume (TFV) loops measured at birth in relation to the risk of developing recurrent or persistent bronchial obstruction within two years of life was assessed. TFV loops were measured at a mean age of 2.7 days in 802 neonates enrolled in the 'Environment and Childhood Asthma' (ECA) study in Oslo. Of these, 77 children developed recurrent or persistent bronchial obstruction (cases) and were included in a nested case-control study within the ECA study; 88 controls (the child born closest in time to the case), with no history of bronchial obstruction in the first two years of life, were also included. Information on socio-economic factors, parental atopic diseases and parental smoking habits during the pregnancy was collected from a questionnaire completed by the parents in the maternity ward, and cord blood IgE (CB-IgE) was determined as part of routine sampling in the delivery ward. Mean tPTEF/tE (time to reach peak flow to total expiratory time) was slightly lower in cases (0.31; 95% CI 0.28-0.34) than in controls (0.33; 0.31-0.35) (difference not significant), whereas geometric mean CB-IgE was significantly higher among cases (0.39; 0.30-0.52) than controls (0.27; 0.23-0.33). No significant differences between cases and controls were found for respiratory rate, peak tidal expiratory flow or expiratory volume. However, the odds ratio for developing recurrent or persistent bronchial obstruction was 3.5 (1.1-11.6) if tPTEF/tE was < 0.20 and 4.1 (1.1-14.5) with maternal daily smoking during the pregnancy, after adjusting for age, weight, sex, CB-IgE, parental atopy, maternal education and family income. The TFV parameter tpTEF/tE < 0.20 measured within the first week of life as well as maternal daily smoking during pregnancy are significant, independent risk factors for developing recurrent or persistent bronchial obstruction within the first two years of life.

Case-Control Studies↗
PubMed1998

The WHO antenatal care randomised controlled trial: rationale and study design.

The World Health Organisation and collaborating institutions in developing countries are conducting a multicentre randomised controlled trial to evaluate a new antenatal care (ANC) programme, consisting of tests, clinical procedures and follow-up actions scientifically demonstrated to be effective in improving maternal and newborn outcomes. These activities are distributed, for practical reasons, over four visits during the course of pregnancy and are aimed at achieving predetermined goals. The study is taking place in four countries, Argentina, Cuba, Saudi Arabia and Thailand. Recruitment of study subjects started on 1 May 1996. All 53 ANC clinical units had been enrolled by December 1996. Clinics in each country were randomly allocated (cluster randomisation) to provide either the new programme or the traditional programme currently in use. Approximately 24,000 women presenting for ANC at these clinics over an average period of 18 months will have been recruited. As women attending the control clinics receive the 'best standard treatment' as currently offered in these clinics, individual informed consent is requested only from women attending the intervention clinics. Authorities of the corresponding health districts and all participating clinics have provided written institutional informed consent before randomisation. The primary outcome of the trial in relation to maternal conditions is the rate of a morbidity indicator index, defined as the presence of at least one of the following conditions for which ANC is relevant: (a) pre-eclampsia or eclampsia during pregnancy or within 24 h of delivery; (b) postpartum anaemia (haemoglobin < 90 g/L); or (c) severe urinary tract infection/pyelonephritis, defined as an episode requiring antibiotic treatment and/or hospitalisation. The primary fetal outcome is the rate of low birthweight (< 2500 g). Adverse maternal and fetal outcomes are expected for approximately 10% of the control group. Several maternal and perinatal secondary outcomes are also considered. A comprehensive cost-effectiveness analysis and women's and providers' satisfaction evaluation are performed concurrently with the trial. Health-care programmes should be rigorously evaluated by randomised controlled trials, which are feasible in developing countries and should be conducted before introducing new treatments or health interventions.

Argentina↗
PubMed1998

Methodological considerations in the design of the WHO Antenatal Care Randomised Controlled Trial.

We discuss methodological issues arising in a recent evaluation trial of a new antenatal care programme, as sponsored by the Special Programme of Research, Development and Research Training in Human Reproduction, and WHO's Division of Reproductive Health (Technical Support). The randomisation unit for the trial is the antenatal care clinic, with 53 clinics located in four countries randomly allocated to provide either the new programme or the traditional programme currently in use. Approximately 24,000 women presenting for antenatal care over an average period of 18 months will have been recruited.

Argentina↗
PubMed1997

Perinatal outcome after leave of absence from work for twin-pregnant women.

AIM: To evaluate the association between the incidence of leave of absence from work and perinatal outcome for the twin-pregnant woman. MATERIAL AND METHODS: A 20.2% sample of all twin-pregnant women between 1982 and 1988 (1,331/6,602) was taken at random from the entire material of twin deliveries in Sweden, archived at the Medical Birth Registry (MBR), National Board of Health and Welfare. For each woman in the sample, information on period(s) and reasons for leave of absence from work during pregnancy was obtained by inquiry to all Regional Health Insurance Offices throughout Sweden. A comparison of perinatal outcome was also made with information from the Danish Fertility Database and the Norwegian Medical Birth Registry. RESULTS: Duration of leave from work increased from 58 days in 1982 to 97 days in 1988 (trend analysis; t = 7.9, p < 0.001). No association was seen between perinatal mortality for twins weighing < 1,500 g and changes in the incidence of leave of absence. The incidence of twins with a birthweight < 1,500 g varied among the three countries, increasing significantly only in Sweden (trend analysis chi 2 = 20.3, p < 0.0001). CONCLUSION: Although the number of days of leave of absence increased by 60%, there was no obvious association with perinatal mortality for twins weighing < 1,500 g. The incidence of Swedish twins with a birthweight < 1,500 g increased significantly, indicating that the effect of leave of absence from work on perinatal outcome may be less effective than previously thought.

Female↗
PubMed1996

Maternal human immunodeficiency virus infection and pregnancy outcome.

OBJECTIVE: A longitudinal study to determine the natural history of HIV-1 infection in pregnancy, infancy and early childhood was carried out in Ndola, Zambia. DESIGN: Prospective study. SETTING: Kabushi and Chifubu clinics. SUBJECTS: A total of 965 women attending antenatal care were screened for anti-HIV antibodies using the Welcozyme test. All reactive sera were confirmed by Western Blot. One hundred and fifty seropositive pregnant women (cases) with their age and parity matched pregnant control (seronegative) were recruited into the study. They were followed up through delivery. MAIN OUTCOME MEASURE: personal characteristics, socio-economic and other risk factors. RESULTS: The prevalence of anti HIV-1 antibodies among the 965 women was 15.5pc. Results of baseline data between the two groups of women indicate significant differences (p < 0.05) in the following variables; marital status, outcome of last pregnancy, whether last child is still alive, history of herpes zoster, lymphadenopathy, dermatitis, oral thrush and mean haemoglobin level. There were no differences in the incidence of abortions, stillbirths and neonatal deaths. However, the mean birth weight of babies born out of seropositive women was significantly lower than babies of seronegative women. CONCLUSION: It is concluded that HIV-1 infection in pregnancy is associated with low birth weight.

Adult↗
PubMed1993

Prediction of high birthweight from maternal characteristics, symphysis fundal height and ultrasound biometry.

The possibility to predict a large infant during pregnancy was assessed using data from a prospective cohort study of 537 singleton pregnancies with term deliveries. Maternal characteristics, symphysis fundal height and ultrasound measurements were used in multivariate analyses for the prediction of an infant with a birthweight of > or = 4,500 or > or = 4,000 g. The positive predictive value was 55% for a birthweight > or = 4,000 g when only maternal characteristics were used, and increased slightly when symphysis fundal height was added. The corresponding value for a single ultrasound measurement at 37 gestational weeks was 52%. Using all available clinical data, positive predictive values of 45 and 80% could be achieved for birthweights of > or = 4,500 and > or = 4,000 g, respectively.

Adult↗
PubMed1987

Organization of obstetrical ultrasound services in the Nordic countries.

This is a report of a questionnaire survey to all university departments of obstetrics in the five Nordic countries, concerning organization of ultrasound services. Answers were received from 23 out of 25. The services were differently organized, both between and within countries. This was true both of degree of centralization and of numbers and categories of personnel. The majority of departments in four countries had implemented routine screening programs, while in the fifth there was no organized ultrasound screening.

Hospital Departments↗
PubMed1979

Duration of labour with spontaneous onset.

Among 2242 women with spontaneous onset of labour, the median duration of labour for those delivered vaginally was 8 1/4 hours in para 0, 5 1/2 hours in para 1 and 4 3/4 hours in para 2+ mothers. In the parity groups 0, 1 and 2+ 90% had delivered within 16 1/4 hours, 10 1/2 hours and 10 3/4 hours, respectively, while 10% of para 0 labours lasted less than 4 hours, 10% of para 1 labours less than 2 1/4 hours and finally 10% of para 2+ labours less than 2 hours. In the first stage of labour the latent phase (cervical dilatation less than 4 cm), was nearly 2.5 times as long as the active phase (cervical dilatation 4-10 cm). The second stage (cervical dilatation 10 cm-birth) had a median duration of 16 min in para 0 and approximately 10 min in para 1+ mothers. The length of the latent and active phases and the second stage for para 1+ mothers was 60-70% of that of para 0 mothers. In individual mothers there were weak correlations between the length of the phases and stages. For example, the length of the latent phase appeared to be a relatively poor predictor of the length of the active phase of labour. However, selection bias may have weakened these correlations somewhat.

Delivery, Obstetric↗