Biomedical subjects
A Eskild
Publications and source records attributed to A Eskild.
[Abortion committees and geographical differences].
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Drug use during early pregnancy. The impact of maternal illness, outcome of prior pregnancies and socio-demographic factors.
OBJECTIVE: Socio-demographic factors have been associated with drug use in pregnancy. However, information on maternal illness has rarely been included in previous studies. The aim of this study was therefore to estimate the impact of maternal illness and prior pregnancy outcome on the use of analgesics/antipyretics, anti-infectives and antihistamines in early pregnancy controlling for socio-demographic factors. METHODS: One thousand nine-hundred and forty-five parous pregnant women from Norway and Sweden were included in an interview study. Information on drug use, obstetric history, maternal illness and socio-demographic factors was collected by specially trained midwives at gestational week 17 and form the basis for the present analyses. RESULTS: After control for socio-demographic factors, reported illness was associated with the use of analgesics/antipyretics, anti-infectives and antihistamines during early pregnancy. The use of analgesic/antipyretic and anti-infective drugs differed between study sites. Sociodemographic factors such as age, parity, marital status, education, occupation and smoking habits did not influence drug use in the multivariate analysis. CONCLUSION: Maternal illness during pregnancy was associated with drug use in early pregnancy. When studying factors related to drug use during pregnancy, it is important to include information on maternal illness. Socio-demographic factors may be confounders and lead to erroneous conclusions about the factors related to drug use.
Is preeclampsia an infectious disease?
BACKGROUND: Studies have suggested a strong paternal factor in the etiology of preeclampsia. If preeclampsia is caused by an infectious agent transmitted by the woman's partner, seronegative women who may experience primary infection in pregnancy should be at increased risk of preeclampsia as compared to previously infected women. The aim of this study was to assess the impact of being seronegative for some viruses transmitted by close contact on the risk of developing preeclampsia. METHODS: Nine hundred and seventy-eight women were randomly drawn from a basic study population of 35,940 pregnant women in Norway. A serum sample drawn at the first antenatal visit was analyzed for specific IgG antibodies against herpes simplex virus type-2, cytomegalovirus and Epstein-Barr virus. For comparison, antibody status against Toxoplasma gondii was also assessed. Information on preeclampsia in pregnancy was obtained through linkage to the Medical Birth Registry of Norway. RESULTS: Thirty-three (3%) women developed preeclampsia. The risk of developing preeclampsia seemed to be increased for women who were seronegative for the viruses studied. Seronegativity for Toxoplasma gondii did not show such a pattern. INTERPRETATION: Women who are seronegative for antibodies against viral agents transmitted through close contact seem more likely to develop preeclampsia. This finding indicates that women who are seronegative to such agents may acquire primary infection in pregnancy, and subsequently be at increased risk of preeclampsia. This hypothesis could represent a new approach to the causes of preeclampsia, and encourage search for yet unidentified microbes as a possible causal factor.
Review of validation studies of the Edinburgh Postnatal Depression Scale.
OBJECTIVE: To review validation studies of the Edinburgh Postnatal Depression Scale (EPDS). METHOD: A systematic search was performed in Medline and the Science Citation Index Expanded (ISI) from the period 1987-2000. For sensitivity and specificity of the EPDS presented in each study, 95% confidence intervals were estimated. Positive and negative predictive values were estimated assuming prevalences of postpartum depression ranging from 5% to 20%. RESULTS: Eighteen validation studies were identified. The study design varied between studies. The sensitivity and specificity estimates also varied: 65-100% and 49-100%, respectively. The confidence intervals were estimated to be wide. Our estimates suggest a lower positive predictive value in a normal population than in the validation study samples. CONCLUSION: Most studies show a high sensitivity of the EPDS. Because of the differences in study design and large confidence intervals, uncertainty remains regarding the comparability between the sensitivity and specificity estimates of the different EPDS versions.
Seasonal variation in the occurrence of pre-eclampsia.
OBJECTIVE: To obtain evidence for seasonal variability in pre-eclampsia using the assumption that environmental factors may have a role in the causal mechanisms. DESIGN: Cross sectional population-based study. POPULATION: All 1,869,388 deliveries in Norway in the years 1967 to 1998. METHOD: For each month, the percentage of births complicated by pre-eclampsia was calculated. The relative risks of pre-eclampsia by month of delivery were estimated as odds ratios using the month with lowest risk as the reference category. RESULTS: Mothers of children born in August had the lowest risk of pre-eclampsia, and the risk was highest in the winter months (for December adjusted OR: 1.26, 95% CI 1.20-1.31). This pattern was independent of parity. maternal age, year and place of living. CONCLUSION: The finding may provide a new clue for understanding the causes of pre-eclampsia. Environmental factors that show a similar seasonal variation should be investigated as possible causes.
[Postnatal care--sleep, rest and satisfaction].
BACKGROUND: During the last decade most hospitals in Norway have introduced breastfeeding according to the baby's needs during night-time as well. The aim of this study was to examine whether women had sufficient sleep and rest in the maternity unit, and the factors influencing insufficient sleep and rest. The degree of satisfaction with the stay in the maternity unit and factors associated with satisfaction were also studied. MATERIAL AND METHODS: From April to November 1998, 160 postnatal women in two Norwegian communities were included in a questionnaire-based study, representing 89% of all women eligible for the study. RESULTS: 47% (75/160) of the women reported lack of sleep and rest in the maternity unit. The factor most strongly associated with lack of sleep and rest was not having a single room (adjusted odds ratio 11.0; 95% confidence interval: 1.7-69.1). 56% (88/158) of the women reported to be very satisfied, 39% (68/158) were moderately satisfied, and 5% (8/158) dissatisfied with the stay at the maternity unit. Not being very satisfied was associated with the hospital of delivery (adjusted OR 18.0; 95% CI: 2.2-149.1), and with insufficient sleep and rest (OR 3.3: 1.3-8.1). INTERPRETATION: Our results suggest that women do not get sufficient sleep and rest under existing circumstances in maternity units.
[Induced abortion because of fetal abnormality in Norway, 1996-7].
BACKGROUND: The objective of this study was to estimate the national and regional rates of induced abortions after the 12th gestational week attributed to fetal maldevelopment in Norway during 1996 and 1997. MATERIALS AND METHODS: In 1998, the National Board of Health requested from all hospitals copies of relevant documents in the medical records of women who had applied for induced abortion after 12th gestational week. RESULTS: There were 303 women in 1996 and 1997 who applied for induced abortion because of diagnosed fetal maldevelopment. For all of these women the application was accepted. One woman did not have an abortion. The national rate of induced abortion attributed to fetal maldevelopment was 2.5 per 1000 births. There were regional differences in the rate of abortion. In 53% of all applications for induced abortion the fetal diagnosis was not reported. Among the reported diagnoses, 28% were chromosomal abnormalities. INTERPRETATION: There is a need for better knowledge of factors influencing the number of induced abortions attributed to fetal malformations. We also need a better understanding of the impact of such abortions on the observed perinatal mortality and occurrence of birth defects.
[Hepatitis C virus among pregnant women in Norway--occurrence of antibodies and pregnancy outcome].
BACKGROUND: Transmission of hepatitis C virus from mother to child is well documented. The prevalence of antibodies against hepatitis C virus among pregnant women in Norway is however, not known. The aim of this study was to estimate the maternal prevalence of antibodies against hepatitis C virus and to study the association between presence of antibodies and fetal death. MATERIAL AND METHODS: From a study of 35,940 pregnant women, a random sample of 970 women and all women with fetal death after 16 weeks of gestation (n = 283), were tested for antibodies against hepatitis C virus. RESULTS: 7 out of 970 women in the random sample (0.7%; 0.2-1.3%, 95% confidence interval) had antibodies against hepatitis C virus. The same prevalence (0.7%, 2 out of 283) was found among women with fetal death. INTERPRETATION: The prevalence of antibodies against hepatitis C virus among Norwegian women was unexpectedly high. Further research is necessary to understand the causes and implications of this observation.
[Hepatitis C virus infection among pregnant women and their children in Norway].
Estimates indicate the births of 6 to 78 children vertically infected with hepatitis C virus infection each year in Norway. There is insufficient knowledge of the magnitude of this health problem and the National Institute of Public Health commissioned the authors to approach issues relating to vertical transmission of hepatitis C virus (HCV) infection in Norway. The risk of vertical transmission of HCV appears to be associated with the titre of the maternal viral load. Vertical transmission from nonviraemic mothers has not been demonstrated. No postexposure prophylaxis exists. There is a lack of association between vertical HCV transmission and delivery mode and no association with breast feeding. Universal screening for HCV infection among pregnant women is not recommended. Children born to women known to be HCV-positive should be followed up with antibody and polymerase chain reaction investigations in order to clarify their HCV status. More studies of HCV infection among pregnant women and their children in Norway are needed.
[Should pregnant women be tested for antibodies against hepatitis C virus?].
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Herpes simplex virus type-2 antibodies in pregnant women: the impact of the stage of pregnancy.
In this study the impact of pregnancy duration on the measured level of HSV-2 antibodies was assessed. The study population comprised 35,940 pregnant women in Norway, in 1992-4, followed during pregnancy. A random sample of 960 women was selected. A mean of 2.6 serum samples from each woman were analysed for HSV-2 specific IgG antibodies at different times in pregnancy. Crude and adjusted odds ratios were estimated in logistic regression models taking all observations per women into account. Twenty-seven percent of the pregnant women had antibodies against HSV-2 in the first trimester. The adjusted odds ratio of being HSV-2 antibody positive decreased during the pregnancy and was 0.5 (0.2-0.9, 95% confidence interval) in the 40th as compared to the 10th week of pregnancy. About 50% of initially HSV-2 positive women did not have detecable antibodies by the end of the pregnancy. This may be explained by haemodilution during pregnancy. Our findings have diagnostic implications and should encourage further studies.
Changes in condom use after HIV diagnosis.
We investigated changes in condom use after HIV diagnosis. The study population comprised 78 asymptomatic HIV-infected subjects recruited from a clinic in Oslo, Norway, during 1988-92. In total, 240 follow-up visits were carried out. The response variable was repeated measurements of whether or not condoms were always used during anal/vaginal intercourse at follow-up. The explanatory variables were: time from HIV diagnosis to follow-up, exposure group (heterosexually infected, homosexual men, or infected through injecting drug use), time of HIV diagnosis (before 1987 or later), and history of condom use before HIV diagnosis. Random effects logistic regression analysis was used to study incremental changes in condom use, accommodating an unbalanced repeated measurement design. The use of condoms increased monotonously over time after HIV diagnosis in all exposure groups. Condom use was least likely among injecting drug users, subjects diagnosed before 1987 and subjects without a history of frequent condom use before HIV diagnosis.
Back-calculation based on HIV and AIDS registers in Denmark, Norway and Sweden 1977-95 among homosexual men: estimation of absolute rates, incidence rates and prevalence of HIV.
BACKGROUND: The Scandinavian countries, Denmark, Norway and Sweden, have established both HIV and AIDS registers to monitor the HIV epidemic. Information in such registers can be used to estimate the number of new HIV infections over time, incidence rates and prevalence. Information from the HIV registers made it possible to study what kind of effects such information had in the estimation process, compared with using information about new AIDS cases only. METHODS: A Markov model back-calculation approach was used. One model incorporated data on cases of both HIV and AIDS. Another model incorporated data on cases of AIDS only. Death or emigration prior to the onset of AIDS and effects of treatment were included in both models. RESULTS: Estimates of absolute rates of HIV for men who have sex with men (MSM) showed a distinct development in each country. Significant differences in incidence rates and prevalence of HIV among MSM were found between Scandinavian countries when information on diagnosed HIV was incorporated. Precision was improved when using both HIV and AIDS diagnosed cases compared with using AIDS cases only. The epidemic in Denmark was more extensive than in the two other countries for the whole study period. DISCUSSION: The results were fairly robust against reasonable variation in the model parameters. The more extensive epidemic in Denmark may have been caused by the homosexual culture denying that HIV was a disease more relevant to them than to others, until the HIV test was publicly available in 1985.
[Antibodies against Herpes simplex virus type 2 among pregnant women in Norway].
The prevalence of antibodies against herpes simplex virus type 2 (anti-HSV-2) among pregnant women in Norway is not known. To study the prevalence of anti-HSV-2, a random sample of 961 women was drawn from a study population of 35,940 pregnant women in Norway during 1992-94. 27% (256/961) had anti-HSV-2. The prevalence increased with age. 17% of the 20-24-year-olds and 34% of the 35 year-old or older had anti-HSV-2. The presence of antibodies also varied geographically, from 18% in the south to 39% in the north of Norway. Among women with repeated anti-HSV-2 tests during pregnancy, 2.6% of the seronegative women seroconverted (16/623). HSV-2 infection is common among pregnant women in Norway. The public health implications of this infection need to be clarified.
[Increase in fatal cases among narcotic addicts--do we know why?].
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The estimated impact of the CCR-5 delta32 gene deletion on HIV disease progression varies with study design. Oslo HIV Cohort Study Group.
OBJECTIVES: To study the impact of the genotype CCR-5 wild-type +/A32 on the progression rate to AIDS and death, and to discuss sources of bias according to study design. METHODS: A prospective study of 310 HIV-positive subjects with follow-up time from study entry (prevalent cohort), and a prospective study of 105 HIV-positive subjects with well-defined time of HIV seroconversion, with follow-up time from the retrospectively assessed date of HIV seroconversion (retrospective incident cohort). RESULTS: Slower progression to AIDS among subjects with CCR-5 +/delta32 than those with CCR-5 +/+ genotype was estimated in the prevalent cohort (P=0.07, log-rank test). Slower progression to death from any cause was also estimated for subjects with CCR-5 +/delta32 (P < 0.05, log-rank test). No differences in survival after AIDS diagnosis were seen (P=0.89, log-rank test). No differences in the progression rate to AIDS (P=0.82, log-rank test) or death (P=0.78, log-rank test) were estimated in the retrospective incident cohort. CONCLUSIONS: The varying estimates of the impact of CCR-5 genotype on progression to AIDS in this and other studies, may be real and reflect differences in the dependence of HIV on the CCR-5 receptor, or may be due to systematic errors caused by study design. Several methodological difficulties occur when the factor studied, such as CCR-5 genotype, is associated both with the risk of being HIV-infected and the progression of disease.
[Risk assessment in preventive medicine].
The aim of this article is to present and discuss the value of risk analysis in preventive medicine. Risk analysis consists of three major areas; risk assessment, risk management and risk communication. Risk analysis is illustrated here by two examples: exposure to radon and the risk of lung cancer, and infection with toxoplasma gondii in pregnancy and adverse pregnancy outcome. The analyses highlight the complementary elements of scientific judgement and political valuation. The barriers against implementation of preventive measures are many. Adequate risk assessment and consequence analysis based on empirical studies, together with risk communication are important for implementing the correct measures. We suggest that risk analysis should be used more often in medicine as a tool for systematic evaluation of the need and usefulness of preventive measures.