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L Nystrom

Publications and source records attributed to L Nystrom.

18 recordsLinked to original sources
PubMed2005

Does maternity care improve pregnancy outcomes in women with previous complications? A study from Zimbabwe.

To determine the utilization of maternal health care services and pregnancy outcomes for women with a history of complications in previous pregnancy, we analysed the pregnancy records of multiparous women (parity > or =1) who booked and completed follow-up in Gutu district, Zimbabwe between January 1995 and June 1998. Women with previous uncomplicated pregnancies (n = 6140) were classified as low risk, whereas those with complications of previous pregnancy (n = 1077) were classified high risk. At enrolment, there was no difference in maternal age and parity between low- and high-risk women. A higher proportion of high-risk women had more than five antenatal visits (32% versus 21%; P<0.001) and gave birth in hospital (47% versus 18%; P<0.001). The risk of antenatal (relative risk [RR] 1.57; 95% confidence interval [CI] 1.32-1.88), labour/delivery (RR 1.98; 95% CI 1.75-2.25) and neonatal (RR 1.83; 95% CI 1.44-2.34) complications was elevated in high-risk women. There was increased risk for perinatal death in high-risk women, but this did not reach statistical significance (RR 1.56; 95% CI 0.98-2.49). The recurrence ratio for most complications was low and the sensitivity of historical risk markers in predicting women likely to develop further complicated pregnancies was only 23%. Most women with previous pregnancy complications can safely give birth in the rural health centre. We concluded that high-risk women had an elevated risk of complications in the index pregnancy and that better utilization of maternal health care, especially for delivery, reduced adverse perinatal outcomes.

Adult↗
PubMed2004

The epidemiology of Type 1 diabetes mellitus is not the same in young adults as in children.

AIMS/HYPOTHESIS: This prospective study examined the epidemiology of Type 1 diabetes in young adults in Europe. METHODS: We ascertained incident cases of Type 1 diabetes in the 15 to 29 years (both inclusive) age group throughout Europe over a period of 2 years. Diabetes registries in nine countries, in which incidence rates for Type 1 diabetes in the 0 to 14 age group were available, took part. Incidence rates were estimated per 100000 person years and standardised for sex and age. Cumulative incidences per 1000 from birth to age 30 were estimated. Heterogeneity between centres was tested with a Poisson regression model. RESULTS: A total of 2112 diabetes cases were ascertained in 1996 and 1997, of which 61.4% were considered to be Type 1 diabetes. Completeness of ascertainment varied from 70 to 90%. Standardised incidence varied from 4.8 per 100000 person years to 13.4 per 100000 person years. The male-female ratio was estimated to be one or more, and in the 25 to 29 age group 1.5 or more in all countries. Cumulative incidences for males and females indicate that the former exceeds the latter from age 24. In the two centres with highest childhood incidence, this applied already from 14 years of age. CONCLUSIONS/INTERPRETATION: The incidence of Type 1 diabetes in adults is lower than in children and the range of incidence is also reduced, with a less than threefold variation in adults, against an eightfold variation in children. There is a male excess in incidence, especially in the age group 25 to 29 years.

Adolescent↗
PubMed2002

No benefit, but increased harm from high dose (100 microg) misoprostol for induction of labour: a randomised trial of high vs. low (50 microg) dose misoprostol.

Misoprostrol, a synthetic analogue of prostaglandin E(1), has been used for cervical preparation. Its ideal dose, route and frequency of administration are still under investigation. We conducted a randomised controlled trial, in a tertiary hospital in a developing country, to compare misoprostol 50 microg (low) and 100 microg (high) for effectiveness and safety in induction of labour at term. Women admitted for induction of labour with a singleton live fetus in cephalic presentation after 37 weeks' gestation were recruited. A misoprostol tablet was inserted in the posterior vaginal fornix at 8-hour intervals. Main outcomes were duration of induction, maternal and fetal complications. The mean duration of induction was 15.4 (SD 10.6) and 14.2 (SD 13.6) h in the low- and high-groups respectively (P = 0.095). There was no difference in need for augmentation with oxytocin (OR 0.82; 95% Cl 0.36-1.86) or operative delivery (OR 1.29; 95% CI 0.26-6.84). There were two uterine ruptures and four intrapartum stillbirths in the high misoprostol group. There was no difference in postpartum haemorrhage, 9.5% vs. 7.9% (P = 1.00) and admissions to the neonatal unit 18.8% vs. 17.0% (P = 0.980) in the 1ow- and high-groups) respectively. Misoprostol 50 microg was as effective as the 100 microg dose for induction of labour whereas the higher dose had an increased risk of serious complications.

Adolescent↗
PubMed2001

Low risk and high risk human papillomaviruses (HPVs) and cervical cancer in Zimbabwe: epidemiological evidence.

OBJECTIVE: To establish the prevalence of detectable low-risk and high-risk, oncogenic HPV types in cervical swabs of women with histologically proven cancer of the cervix. DESIGN: Cross sectional study. SETTING: Harare Central and Parirenyatwa Hospitals. SUBJECTS: 119 women with histologically proven cervical cancer of whom 63 had the degree of differentiation of the tumour reported. MAIN OUTCOME MEASURES: Frequency of infection with high and low-risk human papillomaviruses. RESULTS: The presence of HPV DNA was demonstrated in 63% (75/119) of cases. Low risk HPVs were present in 26% (31/119) and high-risk HPVs were demonstrated in 51% (61/119) of samples tested. Co-infection with both low-risk and high-risk HPVs was observed in 14% (17/119) of the specimens. High-risk HPVs were detected in 55% (21/38) of poorly differentiated tumours while 60% (15/25) of moderately and well-differentiated tumours showed the presence of high-risk HPVs. CONCLUSION: High-risk human papillomaviruses are associated with cervical cancer. There was no significant difference in the frequency of high-risk HPV types in women with moderately to well-differentiated tumours and those with poorly-differentiated tumours.

Adult↗
PubMed2000

Symptoms and findings related to HIV in women in rural Gutu District, Zimbabwe, 1992 to 1993.

OBJECTIVE: To relate self-reported morbidity and clinical findings to HIV-status in rural women in Zimbabwe. DESIGN: A cross sectional study. SETTING: 12 randomly selected villages in rural Gutu District, Zimbabwe. SUBJECTS: In 1992 to 1993 all women of fertile age (15 to 44 years) in the selected villages were interviewed and examined (n = 1,213). Retrospectively, HIV status was assessed anonymously from frozen blood samples. MAIN OUTCOME MEASURES: Self-reported morbidity, body mass index (BMI), arm circumference, palpable lymphnodes, prevalence of syphilis, haemoglobin, HIV status. RESULTS: Overall HIV prevalence was 22%. Mean haemoglobin (Hb) was significantly lower (p < 0.005) and anaemia was significantly more common (p < 0.001) among HIV positive women. Syphilis prevalence was 2.2%, a positive syphilis test increased the risk of being HIV positive three-fold. Persistent cough was significantly more common in HIV positives (OR = 3.0, 95% CI 1.4-6.2). Palpable lymphnodes was the most common clinical finding and generalised lymph adenopathy had a positive predictive value of 67% for HIV. Self-reported morbidity was low and no increased pregnancy loss was reported related to HIV. CONCLUSION: The low morbidity found in 1992 to 1993, in spite of the high prevalence, indicates a fairly short duration of the HIV infection and would also have contributed to the late awareness of the problem.

Adolescent↗
PubMed1999

The complexity of pregnancy anemia in Dar-es-Salaam.

OBJECTIVES: To investigate the main causes of anemia in pregnancy in Dar-es-Salaam and identify appropriate investigations at all levels of care. MATERIALS: All pregnant women booking for antenatal care at 2 clinics (n = 2,235) were screened for anemia. Investigations for etiology of anemia were done in all anemic women (Hb <10.5 g/dl) (n = 361). METHODS: Blood cell counts, microscopy of blood films, S-ferritin, C-reactive protein, HIV, stool parasite and bone marrow analysis were performed. RESULTS: Iron deficiency dominated in 86% and malaria in 1/3 of anemia cases. Since 42% had indication of ongoing inflammation, S-ferritin was less useful as indicator of iron deficiency but blood film microscopy identified most cases.

Acquired Immunodeficiency Syndrome↗
PubMed1999

The relationship between malaria and HIV.

OBJECTIVE: To determine if there is an association between HIV and malaria infection. DESIGN: A cross sectional survey. SETTING: Sanyati Rural District, a malarious endemic area of Zimbabwe. SUBJECTS: 338 volunteers aged 15 months to 76 years. MAIN OUTCOME MEASURES: Prevalence of Malaria and HIV. RESULTS: The prevalence of malaria and HIV was 26.6% and 26.3% respectively. There was no association between prevalence of HIV and malaria. CONCLUSION: There is no association between malaria and HIV.

Adolescent↗
PubMed1997

Unplanned pregnancies in Harare: what are the social and sexual determinants?

A hospital-based study was undertaken in Harare, Zimbabwe to estimate the proportion of unplanned or unintended pregnancy among mothers who delivered at the referral hospital and to analyse their socio-demographic pattern and sexual relationships. A case-referent study design was used with systematic sampling of maternity records of mothers who had delivered. Interviews were performed before discharge using a semi-structured questionnaire. Mothers who reported that the index pregnancy was unplanned or unintended constituted the cases, and the referents were those reporting the pregnancy as planned. Out of 923 deliveries, 41% were unplanned and 9% unwanted. The mean age of the mothers was 25 years and women aged 19 or below [Odds Ratio (OR) = 2.2, 95% CI = 1.5-3.2] and 35 or above (OR = 2.8, 95% CI = 1.7-4.6) were significantly more likely to present with unplanned pregnancy. Nulliparous women (OR = 2.4) and mothers with five or more pregnancies (OR = 8.2) had a significantly increased likelihood of the pregnancy being unplanned. Level of education in the mothers studied had no independent association to planning of pregnancy. Unemployed (OR = 14) and single (OR = 7.8), or divorced/separated/widowed (OR = 5.1) women as well as those with low income (OR = 2.1) and whose partner earned no income (OR = 2.2), were more at risk of unplanned pregnancy. Those living with their own parents despite being pregnant were also more likely to report an unplanned pregnancy. In conclusion, there are documentable social and reproductive factors underlying unwanted pregnancy. Risk factors for unplanned pregnancy form a pattern similar to those for maternal mortality. Thus unplanned pregnancy is a major indicator of the presence of factors known to increase the risk of maternal death. Policy makers and health education should address factors contributing to unplanned pregnancy and its prevention in order to prevent reproductive mortality and morbidity. The presence of those factors associated with unplanned pregnancy at booking or delivery should also alert service providers to the need for appropriate contraceptive counselling as part of post delivery care.

Adult↗
PubMed1997

Unplanned pregnancies in Harare, Zimbabwe: what is the contraceptive history and awareness of the mothers?

OBJECTIVES: The study aimed to estimate the proportion of unplanned pregnancies among mothers delivering at the referral Harare Hospital and to describe their levels of contraceptive use and awareness in relation to the planning of pregnancy. DESIGN: Systematic sample of mothers who had just delivered identified through maternity delivery, records. The study was analysed as a case-referent study where cases where mothers who had unintended pregnancies and those with intended or planned pregnancies served as referents. SETTING: Postnatal wards of Harare Maternity Hospital. SUBJECTS: 923 mothers following delivery. MAIN OUTCOME MEASURES: Socio-demographic characteristics, pregnancy planning, contraceptive history and contraceptive knowledge. RESULTS: Of the 923 deliveries studied, 377 (41%) were unintended (cases), of which 9% were unwanted. Mothers aged 19 years or below (Odds ratio [OR] = 2.4; 95% confidence interval [CI] = 1.6 to 3.7) and those aged 35 years or above (OR = 3.2, 95% CI = 1.8 to 5.5) were significantly more likely to report the index pregnancy as having been unintended. Nulliparous (OR = 2.4) and parity five or more (OR = 8.2) mothers were at significantly increased risk of unintended pregnancy. Mothers presenting with unintended pregnancies were also significantly more likely to be single (OR = 7.8), divorced/separated or widowed (OR = 6.0). Contraceptive ever use was 53% and 58% in cases and referents, respectively. The combined oral contraceptive pill was the most commonly known and used method of contraception. Contraceptive failure was reported by 23% of mothers with unplanned pregnancies. Previous use of the progesterone only pill (OR = 2.2), the condom (OR = 2.3) or the IUCD (OR = 6.3) were significantly associated with the likelihood of reporting with unplanned pregnancy. Mothers in both groups were concerned about contraceptive method failure, irregular menstruation and perceived subsequent infertility with contraception. Failure to discuss family planning with the male partner (OR = 2.3) or partner refusing use of contraception (OR = 2.8) constituted risk factors for unplanned pregnancy. CONCLUSION: Results point to the need for wider contraceptive counselling and provisions which encourage and involve the male partner. Programmes for reproductive health services and education should target women in identified high risk circumstances.

Adolescent↗
PubMed1997

Effect of a new antenatal care programme on the attitudes of pregnant women and midwives towards antenatal care in Harare.

OBJECTIVE: The aim was to study the effect of a new antenatal care (ANC) programme on the attitudes of pregnant women and midwives towards antenatal care. DESIGN: This was a controlled trial in which the attitudes of women and staff using the standard programme of ANC were compared to those using a new one. The new programme contained fewer but objective oriented visits, and was designed to improve consumer and provider satisfaction with ANC. SETTING: Antenatal sessions at primary care clinics in Harare. SUBJECTS: 200 pregnant women and 65 midwives. MAIN OUTCOME MEASURES: The satisfaction of pregnant women and staff with ANC, reasons for lack of satisfaction, and time spent waiting for consultations. RESULTS: The new programme did not make any impact on the time spent by women waiting to be seen at the clinics, nor on the time made available for the consultations. There was no significant impact on the degree of satisfaction with the care among the women. In the control clinics, significantly more staff wished the women to make fewer visits, and in the study clinics, significantly more staff thought the use of appointments was appropriate. The major problem limiting access to ANC was lack of money to pay for the booking fees. Other problems mentioned by the women were ignorance regarding the best time to book, lack of privacy and insufficient staff at the clinics. CONCLUSIONS: The solutions to some of the problems identified require infrastructural changes at policy making level, rather than changes within the antenatal care programmes.

Adult↗
PubMed1996

An overview of the Swedish randomised mammography trials: total mortality pattern and the representivity of the study cohorts.

OBJECTIVES: To analyse the cause of death pattern in the cohorts of women included in the Swedish randomised mammography screening trials by comparing the groups of invited and control women both with each other and with the general population of Swedish women. SETTING: Since 1977 four randomised trials of mammography screening have been performed in Sweden: Malmö, Kopparberg and Ostergötland (the two county trial), Stockholm, and Gothenburg. DESIGN: Overview of four randomised mammography screening trials. RESULTS: The total numbers of deaths in the invited and control groups respectively were 15 695 and 11 887 corresponding to a relative risk (RR) of 1.00. There were no significant differences between the invited and control groups for cause-specific mortality, except for breast cancer. When the total mortality in the invited and the control groups was compared with that for Swedish women in general the standardised mortality ratio was close to 100. CONCLUSIONS: The cause of death pattern in the invited group was, except for breast cancer, very similar to that in the control group, showing that the groups were comparable. Similarly, the total mortality including breast cancer mortality in the control group was almost identical to that in Swedish women in general. The same was true, with the exception of breast cancer, for the invited group. These observations confirm that the trial cohorts are representative of Swedish women and indicate that the quantitative results from these trials may safely be generalised to the Swedish populations.

Adult↗
PubMed1996

Health education for pregnancy care in Harare. A survey in seven primary health care clinics.

OBJECTIVE: The aim of this study was to evaluate how health education is currently practiced in the antenatal clinics in Harare and to make recommendations for its improvement. DESIGN: This was a descriptive study in which data was collected through subject interviews and by observations of antenatal clinics in progress. SETTINGS: Antenatal sessions at primary care clinics in Harare. SUBJECTS: 100 pregnant women and 65 midwives. MAIN OUTCOME MEASURE: The timing, frequency and methods used in health education and the attitude of the pregnant mothers and staff to health education. RESULTS: The results revealed that health education was given once in pregnancy, on the first visit only. The lecture was the most used teaching method. The lecture was full of distractions which affected the concentration of the audience. Midwives decided on the subject matter for health education without consultation with the expectant women. As a result many women could not follow the practical advice given to them. Midwives overestimated their use of other methods of health education. Both the staff and the pregnant women agreed that there should be greater use of written material for women to read at home with their spouses. CONCLUSION: The lecture is not the most appropriate method of health education during pregnancy and greater use should be made of other methods of communication such as the mass media and pamphlets.

Adult↗
PubMed1995

A community based investigation of causes of maternal mortality in rural and urban Zimbabwe. Maternal Mortality Study Group.

UNLABELLED: Most data on maternal mortality in Zimbabwe has been urban hospital based. Using a network of informants and sensitized health workers an attempt was made to identify and investigate all maternal deaths in rural Masvingo and urban Harare over a two year period. The present report discusses place of death and the medical causes in both populations. Results gave maternal mortality rates of 168 and 85 per 100,000 live births for Masvingo and Harare respectively. These rates are significantly higher than those from conventional reporting systems especially in the rural area where 27 pc of deaths occurred at home or in transit. The leading medical causes of death were haemorrhage in Masvingo (25 pc of deaths) and eclampsia in Harare (26 pc), with puerperal and post abortal sepsis as the next most common causes in both cases. Malaria featured as the major indirect cause in Masvingo (7.6 pc). There were four suicides committed following unwanted pregnancy. The rural/urban variation in causation of death is discussed and the study results compared with other community based studies internationally. SYNOPSIS: This community based study revealed higher maternal mortality rates (MMR) than conventional statistics, especially in the rural area where deaths occurred at home or in transit. In the rural area the MMR was higher and the leading cause of death was haemorrhage, compared to eclampsia in the urban area. Strategies to reduce maternal deaths should include factors both within and outside health service structures.

Adolescent↗
PubMed1983

Treatment of constipation with high-bran bread in long-term care of severely demented elderly patients.

Constipation in institutionalized elderly is a common and difficult problem. Thirty-three institutionalized demented patients with severe constipation were given a high-bran bread instead of their accustomed laxatives. Changes in defecation habits, food and liquid intake, and metabolic status were registered. During the high-bran bread treatment period, the number of bowel evacuations and the estimated volume of feces increased. The total laxative consumption (doses given per day) decreased by 93 per cent. Nutritional data and metabolic status were unchanged during the high-bran bread period except for a reduction of the postprandial blood glucose response after the glucose tolerance test.

Aged↗
PubMedDate not supplied

Change in maternal concerns during the 6 weeks postpartum period: a study of primaparous mothers in Dar es Salaam, Tanzania.

The purpose of this study was to describe the postpartum concerns of primiparas. A cohort study included 79 mothers in Dar es Salaam, Tanzania. Mothers sorted topics into worry, interest, and confidence. Trends of decreasing worry and increasing interest and confidence for baby-related and mother-related topics were observed from 1 to 6 weeks. At 1 week mothers worried about baby's eyes, respiration, temperature, safety, and crying; but, at 6 weeks only crying was a problem. Need for information was constant about general health, baby behavior, and care of the baby. At 1 week mothers worried about swollen perineum, and feeling tired and nervous. They wanted information about preventing hemorrhage and infection and taking care of the perineum, breasts, and nipples. Trends of increasing worry and decreasing confidence were observed with respect to family relationships. At 6 weeks, mothers worried about the husband/partner's reaction to themselves and to the baby. Confidence in relatives' reaction to themselves and the baby decreased. Being aware of the changes in the way concerns are expressed may guide nursing/midwifery interventions for mothers as to the content and timing.

Adult↗
PubMedDate not supplied

Field efficiency of syphilis screening in antenatal care: lessons from Gutu District in Zimbabwe.

OBJECTIVES: To determine coverage for antenatal syphilis screening in a rural area and evaluate the accuracy of on-site Rapid Plasma Reagin (RPR) tests performed by nurse-midwives. DESIGN: Descriptive cross sectional. SETTING: Rural Health Centres (n = 23) in the Gutu District of Zimbabwe. SUBJECTS: Women booking for antenatal care in the district were used to determine coverage of screening. Results from women who had an RPR test performed during a nine week period were used in assessing the accuracy of tests performed by nurse-midwives. INTERVENTION: On-site antenatal screening for syphilis using an RPR kit with immediate results and treatment for women who tested positive. MAIN OUTCOME MEASURES: Prevalence of syphilis (positive RPR) at booking and the level of agreement between three observers (RHC nurse-midwife, medical practitioner under field conditions and medical laboratory technologist). RESULTS: Eighty five percent of women were screened for syphilis at the first antenatal visit and 11% had a positive RPR. Almost all (97.3%) women with a positive RPR test result were treated. The accuracy of tests performed by RHC staff was poor with a sensitivity of 40% (95% CI 21.8 to 61.1) when compared to those done by the medical practitioner and 8.7% (95% CI 1.5 to 29.5) when compared to those done in a laboratory. The predictive value of a positive test was 22.7% and that of a negative test was 94.9%. CONCLUSION: The coverage of screening for syphilis in pregnant women in Gutu District was good but the results were unreliable. There is need for nurse-midwives, who perform the majority of RPR tests in the RHC, to receive adequate training to ensure competence in testing and to strengthen quality control procedures.

Antibodies, Bacterial↗