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Biomedical subjects

B Sjögren

Publications and source records attributed to B Sjögren.

At least 37 records · Page 2Linked to original sources
PubMed1998

A comparison of women's memories of care during pregnancy, labour and delivery after stillbirth or live birth.

OBJECTIVE: To compare women's reports of aspects of their care during pregnancy, labour and delivery following stillbirth and live birth. DESIGN: Data were collected by postal questionnaire in 1994. SETTING: A Swedish nation-wide population-based study of cohorts defined in 1991. PARTICIPANTS: Three hundred and fourteen women with stillbirth (subjects) and 322 women with live birth (controls). MEASUREMENTS AND FINDINGS: Labour and delivery were assessed as physically 'insufferably hard' by 52 (17%) of the subjects and 33 (10%) of the controls. The corresponding figures for emotional strains were 144 (47%) and 21 (7%). Obstetric analgesia was more frequently used during labour for stillbirth. One hundred and thirty-eight (44%) subjects, as compared to 44 (2%) of the controls, left hospital within 24 hours of birth. Almost all the women with stillbirth 296 (95%) stated that it was important to have an explanation of the baby's death. Adverse events related to bromocriptine given to inhibit postpartum lactation, were reported by 60 (22%) of the subjects. KEY CONCLUSIONS: It is possible to ease the distress of labour and delivery for stillbirth. Discussion of the aetiology of the baby's death with the mother should be a priority. The optimal length of stay in hospital after stillbirth remains to be defined. Non-pharmacological inhibition of lactation may be presented as an alternative to bromocriptine, breast binding is a concrete 'reality confrontation' for the woman and may aid her in her grieving process. Further studies concerning breast binding vs pharmacological inhibition of lactation and long-term psychological outcome are warranted.

Adult↗
PubMed1998

Fear of childbirth and psychosomatic support. A follow up of 72 women.

BACKGROUND: Women with severe anxiety of childbirth need special support. AIMS: To follow up women who had received individualized psychological/obstetric support because of anxiety of delivery and to describe this model of support. METHODS: Questionnaires were sent to 100 women who had suffered from anxiety of delivery and to 100 matched references; 72 pairs provided answers. RESULTS: Some women in the study group (25%) accepted psychotherapy during the pregnancy, and the others a modified support. In comparison with the references they remembered the pregnancy as a less positive experience (p=0.02), less vigor (p=0.002), less psychic well-being (p=0.04), more worry about health (p=0.04), more need for encouragement (p=0.001) and less emotional preparedness for delivery (p=0.01). Their experiences of delivery were similar as the references' and in some respects even more positive. The women who initially had wished a cesarean section but eventually underwent a vaginal delivery were as satisfied as those who had not wished a cesarean section. The women recommended the staff to take women's worry seriously (study and reference group 64% and 26% respectively, p-value 0.003) and to build up trust and give support (30% and 19% respectively, p-value 0.003). CONCLUSION: Women with fear of childbirth remembered the pregnancy as distressing, in spite of support. They remembered the delivery similarly as references, also those who initially had asked for a cesarean section but eventually underwent a vaginal delivery.

Adult↗
PubMed1997

Occupational exposure to dust: inflammation and ischaemic heart disease.

OBJECTIVES: To review the possible association between occupational exposure to dust and ischaemic heart disease (IHD). METHODS: A literature search was performed of relevant studies regarding IHD in specific exposures to dust. The chosen exposures were arsenic, asbestos, beryllium, lead, polycyclic aromatic hydrocarbons, and quartz. The chosen occupations were farmers, paper and paper pulp workers, sawyers, and welders. DISCUSSION: A theory was launched in 1995 that urban particulate air pollution may provoke alveolar inflammation, with release of mediators capable of increasing blood coagulability in susceptible people and cause cardiovascular deaths. The present review expands this hypothesis and links occupational exposure to inhaled particles with the occurrence of ischaemic heart disease. CONCLUSION: This hypothesis should be tested by comparing the concentrations of fibrinogen in workers exposed and nonexposed to particles with control for other possible confounders such as smoking habits.

Arsenic↗
PubMed1997

Mortality among Welders Exposed to High and to Low Levels of Hexavalent Chromium and Followed for More Than 20 Years.

Hexavalent chromium particles are generated in the welding of stainless steel. A cohort consisting of 233 welders working on stainless steel and exposed to high levels of chromium was selected. According to an earlier survey, the hexavalent chromium exposures of such welders are often above 20 µg/m(3). Another cohort consisting of 208 railway track welders exposed to low levels of chromium was also selected. The participants of both cohorts had welded for at least five years between 1950 and 1965 and were followed for mortality until December 1992. Among the welders exposed to high levels of chromium, six deaths due to pulmonary tumors occurred. This number is higher than the two deaths that occurred among the welders exposed to low levels of chromium and the corresponding mortality of the general population, but not significantly higher. Thus, exposure to stainless steel welding fumes might increase the incidence of pulmonary tumors.

Journal Article↗
PubMed1997

Stillbirth and maternal well-being.

BACKGROUND: Stillbirth imposes severe strains on the mother. Little is known about the long-term well-being after such an experience. METHODS: The study population comprises 380 women who experienced stillbirth and 379 control women with a livebirth in 1991. Data were collected by a postal questionnaire in 1994 in a nationwide study in Sweden. The response rate was 84%. RESULTS: The index women stated more often than controls that they had an improved relationship with the baby's father at the time of follow-up than before the child's birth, the ratio of proportions (with 95% confidence interval) of women with an improved relationship being 1.8 (1.4-2.2). The corresponding figure for high satisfaction with home and family situation at the time of the survey was 1.3 (1.1-1.6) and 3.7 (1.6-8.3) for low satisfaction with the appreciation they encountered outside the home. The cumulative incidence of separation/divorce after a stillbirth was the same as after a livebirth, 8%. Marital status strongly modified the results; for single women the ratio of proportions (stillbirth compared to livebirth) for an improved relationship with the baby's father was 0.2 (0.0-1.4) and for high satisfaction with home and family situation 0.1 (0.0-0.9). CONCLUSIONS: Stillbirth increases satisfaction with the relationship with the baby's father and the home and family situation, but it decreases maternal satisfaction of appreciation by others outside of the home. This traumatic experience does not affect the risk of separation/divorce, but single women are at risk of social complications after stillbirth, and psychosocial support may be appropriate for this subgroup.

Divorce↗
PubMed1997

Obstetric outcome in 100 women with severe anxiety over childbirth.

BACKGROUND: Extreme fear of delivery with request of cesarean section is a problem. The obstetric outcome in women given psychological and obstetric support is described. METHODS: Women, consecutively referred to the Psychosomatic outpatient clinic because of fear of delivery (n = 100), were compared to a matched reference group (n = 100). RESULTS: The women in the study group had higher frequency of psychic problems than the references. The majority, 68 of the women (68%) initially requested cesarean section (CS). After individualized psychological and obstetrical support, 38 of these women agreed to vaginal delivery (38%) and 30 had an elective CS (30%). In the end another 13 (13%) women had a CS for obstetric or mixed reasons. Complication rate was low and similar in the groups. The 57 women who eventually had a vaginal delivery (57%) showed an obstetric outcome similar to the reference group. They had a higher frequency of induction of labor (p = 0.02). and of epidural and pudendal blocks for pain relief (p = 0.002 and 0.05 respectively). They had shorter labor time (p = 0.05). The cost of the psychological therapy was well compensated for by the savings due to the reduction in the number of CS. CONCLUSIONS: Psychosomatic support for women with severe fear of delivery resulted in a 50% reduction of CS for psychosocial indications and vaginal deliveries similar to a reference group. The cost of psychosomatic support was less than savings due to fewer cesarean sections.

Adult↗
PubMed1997

Reasons for anxiety about childbirth in 100 pregnant women.

The aims were to document conscious reasons for anxiety about childbirth. Pregnant women (n = 100), consecutively referred from antenatal centers to a psychosomatic outpatient clinic because of extreme fear of childbirth, were interviewed. Three subgroups are described: primiparae (n = 36), women with a normal previous delivery (n = 18) and women with a previous complicated delivery (n = 46). Anxiety over the deliver was related to lack of trust in the obstetrical staff (73%), fear of own incompetence (65%), fear of death of mother, infant or both (55%), intolerable pain (44%) or loss of control (43%). In the description of the anxiety, more than one focus could be described. A previous complicated delivery predisposed for fear of death (p < 0.001). In other aspects, the subgroups were similar. Fear of death in a previous labor was associated with this fear regarding the impending delivery (100%, 21%, p < 0.001) and with fear of loss of control (61%, 18% p < 0.01). Many women (37%) had partners who admitted anxiety over the delivery. Anxiety over childbirth is related to fundamental human feelings: lack of trust, fear of female incompetence and fear of death. Fear of pain is important but not predominant. The results are discussed with regard to stress, theoretical and psychodynamic points of view.

Adult↗
PubMed1996

Psychological complications after stillbirth--influence of memories and immediate management: population based study.

OBJECTIVE: To identify factors that may predict long term psychological complications among women who have had a stillborn child. DESIGN: Nationwide population based study using epidemiological methods. SUBJECTS: 380 subjects and 379 controls who had had a stillborn or non-deformed live child in Sweden in 1991. RESULTS: Information was provided by 636 (84%) women. The ratio (95% confidence interval) of proportions of women with symptoms related to anxiety above the 90th centile for women who had had a stillborn child compared with those who had not was 2.1 (1.2 to 3.9). An interval of 25 hours or more from the diagnosis of death in utero to the start of delivery gave a ratio of 4.8 (1.5 to 15.9). The ratio was 2.3 (1.1 to 5.3) for not seeing the child as long as the mother had wished and 3.1 (1.6 to 6.0) for no possession of a token of remembrance. CONCLUSION: It is advisable to induce the delivery as soon as feasible after the diagnosis of death in utero. A calm environment for the woman to spend as much time as she wants with her stillborn child is beneficial, and tokens of remembrance should be collected.

Adult↗
PubMed1996

Psychological indications for prenatal diagnosis.

Women undergoing prenatal diagnosis (PND) for psychological reasons constitute a considerable proportion (10-20 per cent) of tests carried out on pregnant women. In these cases, the couple is below the lower limit for parental age, and there is no increased genetic risk. The aim of the present study was to describe the psychosocial background of women asking for PND on psychological grounds and to evaluate their wish for PND. A consecutive series of 51 women were interviewed in the 12th-15th week of gestation before attending for the test. Forty-five per cent were close to the limit for advanced maternal age (35-37 years). Most of them were educated and had stable partners; more than half of the women worked in nursing. Almost half (23/51) of them had previous psychic problems and 29/51 showed depressive mood. During childhood, 21 women had experienced severe disease or handicap. One-third (17/51) of them had been a consolidating member in their family. More than half (33/51) described considerable problems in relation to their mother or to motherhood and 10/51 in their relation to their father. Half of the women described at least three and only three women none of the following six identified predisposing factors: previous or present psychic insufficiency, experience of disability in childhood, role as a significant supporter in childhood, problems in relation to own mother, problems in relation to own father. These women's anxiety was understandable when their psychological history and current mental status were recognized. More than half of the women (29/51) were considered to have strong and 22 moderately strong psychological reasons for their desire to have prenatal diagnosis.

Adult↗
PubMed1996

A follow-up study of five cases of aluminosis.

Five men were investigated after having pulmonary aluminosis due to exposure to aluminium pyrotechnic flake powder during the late 1940s. Two of the men had died 6 years and 20 years after exposure respectively, due to their lung disease. One man had died from heart failure 34 years after the end of exposure. Today, more than 40 years after exposure, two men were available for investigation. They had no respiratory symptoms and their vital lung capacities had not deteriorated during these years. One of the two survivors had developed a dementia with motor disturbances, which is not consistent with Alzheimer's dementia. This man had a very high concentration of aluminium in his cerebrospinal fluid. The other survivor had a normal concentration and was not demented.

Adult↗
PubMed1996

Symptoms and sickleave among forestry machine operators working with pronated hands.

Nineteen forestry machines operators worked with two types of hand controls. Harvesting operators, who worked with their hands in pronated position, were more often on sickleave compared with operators working with their hands semi-pronated. This is one of several important factors related to musculoskeletal symptoms. The experience from laboratory studies as well as epidemiological studies should be carefully considered when designing hand controls for machine operators.

Journal Article↗
PubMed1996

Stillbirth is no longer managed as a nonevent: a nationwide study in Sweden.

BACKGROUND: Giving birth to a stillborn child is a tragedy. The aim of this study is to investigate the meeting of mothers with their stillborn children and the women's experiences of support during and after the delivery. METHODS: In a nationwide study in Sweden, data from 636 women who gave birth to a stillborn or live baby were collected by means of an anonymous postal questionnaire in 1994. RESULTS: Among the 314 women who gave birth to a stillborn child, nearly every mother had seen her child, and 80 percent had carressed her baby. More than 90 percent of the mothers stated that the medical staff showed respect, and about 80 percent of the mothers stated that staff exhibited tenderness toward their dead children. The mother's assessment of respect and tenderness to her child by medical staff was almost identical between stillbirths and live births. Nearly 70 percent of the women reported that the hospital had good routines to support mothers of stillborn children. Feelings of sadness and having been deeply hurt or angered by the medical staff's behavior were reported by 37 percent of the women. A difficult balance is still to be achieved between women being forced to encounter the baby when not yet ready versus others who wish the staff had given more encouragement. The value of properly taken photographs is described. CONCLUSIONS: Treating stillbirth as a nonevent has been largely, if not entirely, abandoned in Sweden. Most mothers of a stillborn child experience that the medical staff treat their dead children appropriately.

Adult↗
PubMed1996

Effects on the nervous system among welders exposed to aluminium and manganese.

OBJECTIVES: The purpose was to study the effects on the nervous system in welders exposed to aluminium and manganese. METHODS: The investigation included questionnaires on symptoms, psychological methods (simple reaction time, finger tapping speed and endurance, digit span, vocabulary, tracking, symbol digit, cylinders, olfactory threshold, Luria-Nebraska motor scale), neurophysiological methods (electroencephalography, event related auditory evoked potential (P-300), brainstem auditory evoked potential, and diadochokinesometry) and assessments of blood and urine concentrations of metals (aluminium, lead, and manganese). RESULTS: The welders exposed to aluminium (n = 38) reported more symptoms from the central nervous system than the control group (n = 39). They also had a decreased motor function in five tests. The effect was dose related in two of these five tests. The median exposure of aluminium welders was 7065 hours and they had about seven times higher concentrations of aluminium in urine than the controls. The welders exposed to manganese (n = 12) had a decreased motor function in five tests. An increased latency of event related auditory evoked potential was also found in this group. The median manganese exposure was 270 hours. These welders did not have higher concentrations of manganese in blood than the controls. CONCLUSIONS: The neurotoxic effects found in the groups of welders exposed to aluminium and manganese are probably caused by the aluminium and manganese exposure, respectively. These effects indicate a need for improvements in the work environments of these welders.

Adult↗
PubMed1996

Psychic and social consequences of women in relation to memories of a stillborn child: a pilot study.

Prevalence and determinants of long-term psychosocial morbidity among women giving birth to a stillborn child are largely unknown. Few, if any, systematic epidemiologic studies are available. In this pilot study we investigated one alternative way to collect data from relevant patient populations and formulated some hypotheses. Moreover, questions found unhelpful in this context were identified, e.g., whether the mother had bathed her dead child or not. Fruitful hypotheses found worthwhile testing were, among others: the risk of long-term anxiety-related symptoms is reduced if (1) the woman has seen her stillborn child, (2) she has an ultrasonic or photographic picture of the child, and (3) she has gone through a ritual, primarily burial of the child; moreover, (4) divorce may be a social consequence of the intrauterine loss of a child.

Adult↗