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Biomedical subjects

B Backe

Publications and source records attributed to B Backe.

At least 37 records · Page 2Linked to original sources
PubMed1994

Term prediction in routine ultrasound practice.

STUDY OBJECTIVE: Evaluation of the precision of routine ultrasound term prediction. DESIGN: Population based follow-up without intervention. SETTING: Ultrasound screening in routine clinical practice. MATERIAL: 1650 women residing in one Norwegian county giving birth during a 12-month period. All pregnancies were singleton with spontaneous onset of labor, all records contained a term predicted with routine ultrasound in the second trimester. OUTCOME MEASURE: Difference between actual and predicted day of delivery, and difference between ultrasound predicted term and term calculated from last menstrual period. MAIN RESULTS: More women delivered within two weeks of ultrasound term than two weeks of term calculated from the last menstrual period (87.5% and 79.3%, p < 0.001). Deliveries were significantly closer to the ultrasound predicted term than the term calculated from the last menstrual period, with the exception of deliveries in the 39th week after LMP where no significant difference was found between ultrasound term and LMP-term. No difference was found in the mean performance of 14 different ultrasound operators. CONCLUSIONS: In a population representative of deliveries in one county, routine ultrasound term prediction performed in three medium sized hospitals more accurately predicted day of delivery than term calculated from the date of last menstrual period.

Analysis of Variance↗
PubMed1994

Societal costs of antenatal and obstetrical care.

Perinatal health care is an important part of a nation's health care system. In the Nordic countries this type of health care is provided by the national public health systems without cost for the women. The societal costs of the care provided have, however, not been known. The aim of the present study was to estimate societal costs of antenatal and obstetrical care in a Norwegian county during a twelve month period 1988-89. A total of 1908 women delivered during the registration period. The mean total cost was estimated to NOK 36.300 per woman. Primary care antenatal visits accounted for 8%, outpatient visits (inclusive ultrasound screening) 4%, and hospital care in connection with delivery represented 36% of the total cost. The major determinant of societal costs was sick leave during pregnancy, contributing 43% to the total cost. This underlines the importance of the ongoing debate about sick leave in pregnancy. The mean cost of primary care based antenatal care, averaging 10.8 visits per woman, was estimated to NOK 2.800. An important factor was use of patients' own time, accounting for 35% of this amount. The prevalence at the time of admission for delivery of five important complications or obstetrical conditions (pre-eclampsia, placenta previa, intrauterine growth retardation, twin pregnancy, and breech presentation) was recorded. The mean total societal cost for women with the indicator conditions was approximately one fifth greater than for women without any of the indicator conditions.

Costs and Cost Analysis↗
PubMed1994

General practitioners' compliance with guidelines for antenatal care.

OBJECTIVE: To assess general practitioners' compliance with Norwegian guidelines for antenatal care issued in 1984 and to identify characteristics of physicians with low compliance. SETTING: Routine clinical practice in primary care. STUDY POPULATION: All women permanently residing in the county of Oppland who gave birth during a 12-month period 1988-89 and the general practitioners who provided their antenatal care. METHODS: The content of the care was assessed from nine procedures, the selection of which was based on a previous perinatal audit. A 'compliance score' was established and logistic regression analysis was used to estimate pregnant women's odds for a low score by characteristics of their care-providing GPs. RESULTS: GPs' compliance with the guidelines was lower for procedures which required recording of a clinical judgment. The odds for a low score increased significantly if the doctor was a male or worked in a single rather than a group practice. There was no association between compliance score and fetal outcome, or between compliance score and the effectiveness of antenatal care measured as the detection of major obstetric disorders. CONCLUSION: The gender specific differences in GPs' antenatal care performance were the same as those reported by others. These findings warrant further research.

Adolescent↗
PubMed1993

[Hysterectomy in Norway. Quality of data and clinical practice].

A nation-wide register of discharges from hospitals was used to analyze the practice of hysterectomy in Norwegian hospitals during the three-year period 1988 to 1990. A total of 10.167 hysterectomies were recorded, 20% of them were subtotal hysterectomies. Incidental appendectomy was performed in 4%. Approximately 60 hospitals performed hysterectomy. At 17 hospitals the number was ten or less per year, while at two hospitals more than 200 hysterectomies were performed per year. The national hysterectomy rate was 164 per 100,000 women or 198 per 100,000 women > or = 15 years. The rate is almost 50% higher than a previously reported rate from the period 1977 to 1978, but is still remarkably low compared with the rates reported in the international literature.

Adolescent↗
PubMed1993

Effectiveness of antenatal care: a population based study.

OBJECTIVE: To analyse the effectiveness of antenatal care as a screening for nonsymptomatic disease and obstetrical risk conditions. DESIGN: Programme evaluation of antenatal care in a geographically based cohort. SETTING: Routine clinical practice in primary and specialist level of health care without intervention. SUBJECTS: One thousand nine hundred and eight women residing in one Norwegian county giving birth during a 12 month period, 1988 to 1989. OUTCOME MEASURES: The detection rates at the time of delivery, for women with five conditions: twin pregnancies, placenta praevia, breech presentation, small for gestational age (SGA) and pre-eclampsia. RESULTS: Two hundred and ninety-two women had one or more of the actual conditions, 124 (42%) had been diagnosed at the time of the delivery. The detection rate for SGA was remarkably low (14%). The detection rates for pre-eclampsia (75%), breech presentation (69%), placenta praevia (57%) and twin pregnancies (94%) were in the same range as results reported in the literature. The number of false positive antenatal diagnosis was insignificant. CONCLUSIONS: Assessing the effectiveness of antenatal diagnosis of growth retardation is connected with major unsolved methodological problems. Clinical management of such cases may be better than indicated by the results based on the ultimate SGA classification. For important obstetrical conditions this study describes an applicable method for practical evaluation of the effectiveness of antenatal care. Areas where care could be improved are demonstrated.

Adolescent↗
PubMed1993

Maternal smoking and age. Effect on birthweight and risk for small-for-gestational age births.

STUDY OBJECTIVE: To analyse the information on maternal smoking routinely recorded during antenatal care by general practitioners, with emphasis on the impact of smoking on birth weight and risk for small-for-gestational age (SGA) births. DESIGN: Geographically based cohort study. SETTING: Evaluation of information recorded by general practitioners in antenatal records, in routine clinical practice without intervention. MATERIAL: Women residing in one Norwegian county delivering during a 12 month period 1988/1989. MAIN RESULTS: 1908 women gave birth. 30% were recorded as smokers at first antenatal visit, 4% lacked information on smoking. The recording of smoking habits in week 36 was deficient as data were missing in 75% of the women who smoked at first antenatal visit. Smokers experienced a mean birthweight impairment of 182 grams (adjusted for parity and age). A dose-response effect on birth weight of the number of cigarettes smoked per day at first visit was found. Also, a synergistic effect of increasing maternal age and smoking with regard to risk for SGA was demonstrated. The relative risk for SGA for smokers below 25 years was not significant, whereas women of 35 years and more had a relative risk of 3.8 for SGA. 18% of the SGA-cases among the study subjects were attributable to smoking. CONCLUSIONS: Using the routinely collected information on smoking at first antenatal visit, the well known effects of smoking on birthweight are reproduced. The routine recording of smoking habits in week 36 is insufficient. Information on smoking registered in the antenatal records should be recorded in the Medical Birth Registry. Smoking in pregnancy appears not to be equally harmful for all women. The highest risk for SGA is found in the age group where smoking is most frequent. The question of a more differentiated approach to the problem of smoking cessation in pregnancy, is raised.

Adolescent↗
PubMed1992

[Infection control in Norwegian somatic hospitals 1990].

The authors present results from a survey of infection control in Norwegian somatic hospitals, carried out during summer/autumn 1990. In 15 of 74 hospitals (20%) one of the hospital doctors was appointed as responsible for infection control. 35 hospitals (48%) had an infection control nurse. Only nine hospitals (12%) reported routine prospective surveillance of hospital infections. The survey revealed a clear under-utilization of commonly accepted methods to survey and prevent hospital infections. Many of the respondents stated the need for national guidelines for infection control. The health authorities should take the initiative to remedy this situation. A new law concerning secondary health care will be passed in the near future, requiring hospitals to establish effective quality assurance systems. Infection control is a very concrete example of quality assurance, and should be given priority when setting up quality assurance systems for hospitals.

Cross Infection↗
PubMed1992

Attitudes towards and level of information on perimenopausal and postmenopausal hormone replacement therapy among Norwegian women.

In order to investigate women's attitudes towards and level of information on perimenopausal and postmenopausal hormone replacement therapy (HRT) 1019 women over 17 years of age constituting a representative sample of the Norwegian female population were interviewed in 1990 as part of a monthly national opinion poll (response rate 96.5%). Women's magazines proved to be the most important source of information on hormone therapy. Only in the over-45 age group were doctors mentioned frequently as information sources. A high self-assessed information level was associated with a positive attitude towards hormone therapy. Those who had obtained information from a doctor were more positive than those who had not. More than half of those who expressed an opinion believed that hormone therapy increased the risk of heart infarction, stroke, breast cancer and cancer in general. There was a strong association between a negative attitude, towards using hormones and belief in an increased risk of serious disease. The women were more positive towards the use of HRT for the prevention of osteoporosis and for postmenopausal urogenital complaints than for the alleviation of climacteric symptoms.

Adolescent↗
PubMed1992

General practitioners' attitudes to oestrogen prescription in the menopause: a national survey in Norway.

A questionnaire was mailed to a random sample of approximately 10% of Norwegian general practitioners (GPs) in order to investigate attitudes to the prescription of hormone replacement therapy (HRT) in menopausal women. Nine short case histories were presented, and the GPs indicated their attitude to oestrogen prescription in each case on a five-step scale. Each case history contained four items that were systematically varied so that the effect of each could be investigated by comparing the answers from case to case. 251 GPs (74%) responded to the questionnaire. The answers indicated restrained attitudes towards prescription of HRT. Smoking and a family history of cardiovascular disease were regarded as contraindications. Angina pectoris was considered a contraindication for local oestrogen application in elderly women with urogenital complaints.

Adult↗
PubMed1991

A circadian variation in the observed duration of labor. Possible causes and implications.

UNLABELLED: The distribution of the duration of labor during the day was analyzed. MATERIAL: A one-year material consisting of 1,881 deliveries at the Department of Obstetrics, Regional Hospital of Trondheim, Norway. Only singleton pregnancies with spontaneous onset of contractions and intended vaginal delivery were included. Duration of labor was routinely recorded by the midwife. METHODS: Stepwise multiple regression. Logarithmic transformation of the dependent variable (duration measured in hours) was applied. Parity (0/1+) and hour of birth were the independent variables. RESULTS: The variable indicating delivery during the night (0 to 08) contributed significantly to explain the variation in the duration of labor, in terms of a decrease in the median duration. The effect is substantial, median duration of labor 1.2 h shorter than for deliveries during the day. The variable indicating delivery during the evening (16-24) did not reach the required level of significance (0.05). This reflects a clustering of cases with longer duration of labor, unfavourable progress and less good prognosis during the latter half of the day, which has practical implications for the obstetrical staff. This may explain the similar circadian pattern in perinatal mortality which has been repeatedly documented, the etiology of which has remained enigmatic.

Circadian Rhythm↗
PubMed1990

[Incidence of extrauterine pregnancy in Norway in 1986. A population based overview from 15 counties].

Hospitalization for ectopic pregnancy was examined in 15 out of 19 Norwegian counties in 1986. The incidence of ectopic pregnancy was 1.5 per 1,000 women aged 15-44 years. The incidence was highest in the five northernmost counties and Oslo. Women aged 25-34 years, who had the highest rate of conception, also had the highest rate of ectopic pregnancy. Measured as a ratio per 100 live births, ectopic pregnancy increased with the patient's age and was six times as high among women aged 35-44 compared to women aged 15-24. The overall ratio was 2.5 ectopics per 100 live births. The age-specific rates and ratios were consistent with varying overall incidence of ectopic pregnancy in the counties.

Female↗
PubMed1990

Reduced use of diagnostic obstetric ultrasound in Norway. Result of consensus panel recommending routine screening in pregnancy?

PURPOSE: To investigate the practice of obstetric ultrasound in Norway before and 2 years after a consensus conference recommending routine screening. Material, method: Two national representative materials sampled with a 2-year interval are compared. RESULTS: The average number of examinations was reduced from 2.46 to 2.2 (p = 0.014). Obstetrical institutions practising screening examined their patient less frequently than non-screening institutions (2.10 vs. 2.75 times, p less than 0.001 whereas in 1986 the converse was the case. CONCLUSIONS: Screening has become more widespread, and a more rational practice has developed.

Consensus Statements as Topic↗
PubMed1989

[Use of ultrasonics in obstetrics in 1988].

The Norwegian consensus conference on ultrasound in pregnancy 1986 stated that a beneficial effect of routine ultrasound examinations had not been scientifically proven. Despite this, the panel recommended that, on certain conditions, and in an effort to reduce the number of examinations performed, one examination should be offered to all pregnant women. A survey of the practice of ultrasound examinations has now been carried out. All Norwegian obstetrical institutions were invited to participate. Institutions covering 99.6% of births in Norway registered the number of examinations that had been performed on women delivering during a 7-day period. The main finding is a change in the practice of ultrasound in relation to a similar investigation in 1986: On average, each woman is now examined 2.23 times, compared with 2.46 in the 1986-survey. One or two examinations are now more common than in 1986, when a greater number of women were examined more often. Almost every pregnant woman is now examined with ultrasound, and there are now more institutions offering routine screening examination.

Female↗
PubMed1989

Cost effectiveness of testing for chlamydial infections in asymptomatic women.

Routine testing for Chlamydia trachomatis during gynecological visits, as well as treatment of those found positive, has been suggested as a preventive measure against the serious consequences of chlamydial genital infections, e.g., pelvic inflammatory disease (PID), infertility, and ectopic pregnancy. This article examines the cost and effectiveness of this practice. The study is based on a model that predicts how routine testing and treatment will affect the future number of cases of PID, infertility, and ectopic pregnancy. The costs of test and treatment are estimated, as are the savings resulting from prevention. Results indicate that although routine testing was not effective in reducing the overall morbidity caused by chlamydial infections, for women 18-22 years of age routine testing during regular gynecologic sessions can be a cost-effective personal health service.

Adolescent↗
PubMed1988

Look to Norway! (But not uncritically).

The authors of the paper argue that Norway's national health service, despite public perceptions, is both inexpensive and technologically advanced. Norway has a highly regulated medical system at both the national and local levels, and many distribution issues take the form of political debate. As a result, the authors believe that medical care and equipment is equitably distributed, but perhaps over-densely, throughout the country. Although the overall picture is optimistic, there is some concern that technologies, health care priorities, and decision-making processes should be more carefully examined by consensus conferences, advisory groups, and experts in technology assessment.

Communication↗