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Biomedical subjects

G Lindmark

Publications and source records attributed to G Lindmark.

At least 73 records · Page 4Linked to original sources
PubMed1997

Obstetric interventions and perinatal asphyxia in growth retarded term infants.

BACKGROUND: The monitoring of fetal growth during pregnancy is usually justified because of the increased perinatal risk of these babies. METHODS: In 1552 infants from the Scandinavian Small for Gestational Age Study the need for obstetric interventions, risk of fetal asphyxia and immediate neonatal outcome at term have been studied in relation to different types of fetal growth retardation, including sub-groups with low ponderal index or low amount of subcutaneous fat. RESULTS: The need for obstetric intervention indicated by suspected fetal asphyxia before or during labor was increased 3-fold (6-8%) for growth retarded infants both in SGA infants in general and infants with asymmetric body proportions. The immediate perinatal outcome, however, was favorable with Apgar below 8 at 5 min in only 2% irrespective of the type of growth retardation, in spite of the fact that less than 25% of the SGA pregnancies and 10% of those with asymmetric fetal growth had been eligible for close antenatal fetal monitoring. CONCLUSION: With a moderate increase in interventions at delivery, perinatal outcome was highly favorable for term infants with a weight for gestational age, weight for length or skinfold for weight below the 10th percentile in this population of Scandinavian parous mothers.

Apgar Score↗
PubMed1997

Quality assurance--a process for improving perinatal care.

Quality assurance is an ongoing process, including not only the assessment and evaluation of the quality of care, but also the definition and implementation of strategies to improve the quality. The process of quality assurance must start from the identification of health problems and of the appropriate interventions to address those problems. In perinatal care, however, appropriate assessment of the effectiveness of diagnostic and therapeutic interventions and care routines has often been lacking. This symposium will discuss examples of the various steps in quality assurance in perinatal care from countries in the Baltic region.

Baltic States↗
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

Randomised controlled trial of a reduced-visits programme of antenatal care in Harare, Zimbabwe.

BACKGROUND: Many of the individual components of antenatal care have been studied in randomised controlled trials, but few studies have compared whole programmes of antenatal care. Our aim was to test the hypothesis that a new programme of antenatal care with fewer goal-oriented visits would give an equivalent or better result in the outcomes associated with pregnancy and delivery. METHODS: In a randomised clinical trial in Harare, Zimbabwe, we compared a new programme of antenatal care with the standard programme. The new programme consisted of fewer but more objectively oriented visits and fewer procedures per visit. Seven primary care clinics were randomly assigned to the two programmes-three to the standard programme and four to the new programme. FINDINGS: Over a 2-year period, 15,994 women were recruited into the study at the time they booked antenatal care. 97% of the women were followed up, 9,394 who had followed the new programme, and 6,138 from clinics with the standard one. Women allocated to the new programme made, as planned, fewer visits than those in the standard programme (median 4 vs 6 visits, respectively). The proportion of antenatal referrals was also lower (13.6 vs 15.3%; odds ratio 0.87 [95% CI 0.79-0.95]) because of significantly fewer referrals for pregnancy-induced hypertension (2.5 vs 3.8%; 0.66 [0.55-0.79]). Nevertheless, there were significantly fewer labour referrals for severe hypertension or eclampsia (2.1 vs 2.6%; 0.81 [0.66-1.00]). The risk for preterm (< 37 weeks) delivery was significantly lower for women on the new programme (10.1 vs 11.5%; 0.86 [0.78-0.96]). There were no other significant differences between the programmes in other major indices of pregnancy outcome, including antenatal referrals for other causes, labour referrals, obstetric interventions, low birthweight, and perinatal and maternal mortality and morbidity. INTERPRETATION: An antenatal care programme with fewer more objectively oriented visits can be introduced without adverse effects on the main intermediate outcome pregnancy variables.

Adult↗
PubMed1996

NM-23 H1 immunohistochemistry is not useful as predictor of metastatic potential of colorectal cancer.

This study aimed to investigate whether immunohistochemical staining for nm23-H1 protein in the primary tumour is correlated with tumour stage, tumour differentiation, DNA ploidy, cell proliferative index, p53 status and patient survival time in colorectal cancer. Full-cross colorectal cancer biopsies were collected from 202 consecutive surgical specimens between 1987 and 1990. Immunohistochemical expression of nm23-H1 protein was investigated in cryosections, using a monoclonal anti-nm23-H1 antibody (clone NM 301). The staining pattern was classified as follows: strong homogeneous intensity, moderate homogeneous intensity, moderate focal intensity, or as negative. Immunohistochemical expression of p53 was investigated using a monoclonal anti-p53 antibody (DO-7). The DNA ploidy and cell proliferative index were determined by flow cytometry. Possible correlation between nm23-H1 staining patterns and the other studied tumour characteristics was explored at the end of 1994. Median survival time of living patients was 66 months, range 50-93 months. No correlation was found between various nm23-H1 staining patterns and tumour stage, cell proliferative index or p53 status. Nm23-H1-negative tumours and tumours with moderate focal staining intensity were less differentiated than tumours with strong homogeneous or moderate homogeneous staining intensity (P < 0.05). Of the nm23-H1-negative tumours, a significantly higher number was near-diploid rather than aneuploid, as compared with those expressing positive nm23-H1 (P < 0.05). The number of dead patients in Dukes' stages B and C did not correlate significantly with the nm23-H1 staining pattern. The nm23-H1 staining pattern alone, or combined with either of the other explored tumour characteristics, did not correlate with patient survival time. Immunohistochemical studies of the nm23-H1 protein expression are of minor value in the staging and prognostic prediction of colorectal cancer.

Adult↗
PubMed1996

Maternal smoking and body composition of the newborn.

The influence on neonatal anthropometry of maternal cigarette smoking in pregnancy was investigated in 933 parous women. Anthropometric growth parameters including skinfold measurements were studied in the newborns. After adjustment for maternal age, pre-pregnancy weight, height and pregnancy weight gain, smoking had a clear dose-dependent negative effect on all anthropometric characteristics in the infant. In contrast to the results obtained in other investigations, the reduced birth weight of the infants of smoking mothers was not found to be primarily due to a reduction in lean body mass; nor was fat deposition found to be reduced. Fetal anthropometry was also negatively affected in infants born to mothers who stopped smoking during pregnancy.

Adult↗
PubMed1996

Prognostic significance of the microvascular count in colorectal cancer.

PURPOSE: To investigate the potential correlations between a high microvascular count and the survival rate in colorectal cancer. MATERIALS AND METHODS: Three markers for endothelial cells--Ulex Europaeus Lectin (UEA), a polyclonal anti-von Willebrand factor (vWF) antibody, and a monoclonal anti-CD31 antibody (all from Dakopatts, Glostrup, Denmark)--were used for immunohistochemical detection of microvessels in whole-mount sections from 15 colorectal cancers. Areas with higher microvascular density were homogeneously distributed in the sections, regardless of the marker used. The anti-vWF antibody was subsequently used for quantification of microvessels in full-cross tumor biopsies collected from 212 consecutive surgical specimens. The correlations between the mean number of microvessels in areas with the highest microvascular density and tumor differentiation, tumor stage according to Dukes', and survival time were investigated. RESULTS: A significantly longer survival time was shown for patients who had tumors with a mean of more than 10 anti-vWF-positive microvessels, as compared with those who had < or = five. Tumors with a microvascular count between six and 10 microvessels behaved in-between. There was no correlation between the number of microvessels and tumor differentiation or Dukes' stage. CONCLUSION: The number of microvessels measurable in tumor biopsies seems to be a prognostic predictor independent of Dukes' stage in colorectal cancer. However, our results are opposite to the findings in other tumor types investigated so far; we found that a high microvascular count predicted a longer survival time, rather than a shorter one. Determination of the microvascular count can be of importance in therapy selection even before, or immediately after, surgery, ie, before Dukes' stage is known.

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

The association of preoperative serum tumour markers with Dukes' stage and survival in colorectal cancer.

The tumour markers carcinoembryonic antigen (CEA), tissue polypeptide antigen (TPA), TPS, CA 19-9, CA 50 and CA 242 were analysed in serum from 203 potentially curable colorectal cancer patients. The levels of all markers increased with increasing tumour stage, and all markers correlated with survival. Multivariate analyses indicated that the Dukes stage had the best prognostic explanatory power, followed by TPA. In the subset of 166 potentially cured patients, the prognostic information by the markers was substantially reduced. We conclude that preoperative serum tumour marker measurements have the potential to aid therapy selection, but also that their clinical usefulness is not immediately apparent.

Adult↗
PubMed1995

Symphysis-fundus height: construction of a new Swedish reference curve, based on ultrasonically dated pregnancies.

Repeated measurements of the symphysis-fundus (SF) distance is generally regarded as an acceptable screening instrument for antenatal detection of intrauterine growth retardation (IUGR). In the present investigation an SF curve is constructed, based on measurements from 1650 Swedish women with ultrasound dated pregnancies. The SF measurements were included in a cross-sectional stratified manner; only one measurement from each woman was used and the same number of measurements (n = 75) was used for each gestational week from 20 through 41. A regression analysis by a polynomial equation of third degree was applied on the means and standard deviations of the SF measurements in each week respectively to construct a graph of fundal height. This SF curve was compared with the SF curve in common use in Sweden (constructed by Westin); in the new curve the mean measurement was about one cm higher up to 37 gestational weeks, after which time the curves almost coincided. Neither did the mean SF height differ between smokers and non-smokers nor between nulliparous and parous women. The mean SF difference between the heaviest women (> or = 79 kg) and the lightest (> or = 53 kg) was about two cm throughout pregnancy. The validity of the constructed SF curve as a screening instrument for IUGR needs to be investigated in a different study.

Birth Weight↗
PubMed1995

Anaemia in pregnancy: perceptions of patients in Dar-es-Salaam.

This study was performed to assess the pregnant women's knowledge and attitudes towards anaemia, its causes, prophylaxis, and treatment and to describe existing problems with interventions for anaemia in antenatal clinics. A total of 310 women were interviewed from three MCH-clinics in suburban Dar-es-Salaam. Anaemia was considered a major problem by 88% and 75%, respectively in the two peripheral MCH clinics, but by only 44% of attenders in the hospital MCH clinic. Over 85% of interviewees were aware of the causes of and ways of preventing anaemia. The most frequently mentioned cause of anaemia were related to nutrition while intestinal parasites was mentioned by a few women. Only 5% believed that anaemia might not be dangerous for the mother. In all three clinics more than 90% were aware of the advantages of early booking for antenatal care. None of the mothers had received any ferrous supplements during the current pregnancy, and only a minority (38%) in the previous pregnancy though 40% of them said they were informed they had anaemia in the previous pregnancy. Side effects were not reported as a reason for non-compliance. Thus, mothers were aware that anaemia is a health problem in pregnancy. They would accept effective intervention if they were offered them. The irregular and inadequate supply of haematinics to antenatal clinics is a far more important obstacle to the implementation of the anaemia prevention programme than the knowledge and attitudes of the mothers.

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↗
PubMed1994

Vitronectin in colorectal adenocarcinoma--synthesis by stromal cells in culture.

We have investigated the expression and cellular source of vitronectin in colorectal adenocarcinoma. Immunofluorescence staining of tissue sections revealed the presence of vitronectin in the stroma of the 11 tumors studied, but not in adjacent normal colon. A method was devised for the isolation from colorectal adenocarcinomas of fibroblast-like cells that stained positive for vimentin but negative for cytokeratin. These tumor-derived stromal cells synthesized and secreted vitronectin, as revealed by metabolic labeling and immunoprecipitation. This was confirmed by Southern blot analysis of polymerase chain reaction amplification products from reverse-transcribed RNA. Normal skin fibroblasts did not synthesize vitronectin. Immunofluorescence staining showed vitronectin deposited at focal contact sites in the tumor-derived cells, where it colocalized with vinculin and the alpha v integrin subunit. The deposition of vitronectin into focal contact sites was not dependent on the presence of serum. The finding that vitronectin can be synthesized and secreted by tumor-derived fibroblast-like cells in culture indicates that vitronectin expression can be promoted by as yet unknown signals provided in disease states, such as cancer.

Adenocarcinoma↗
PubMed1994

Prognostic predictors in colorectal cancer.

PURPOSE: Better prognostic predictors in colorectal cancer than the Dukes stage are necessary for individualized therapy and follow-up. METHODS: Survival among 212 patients operated on for colorectal cancer was examined regarding various clinical, histopathologic, cellular, and serologic tumor characteristics. RESULTS: Beside the Dukes stage, which was the most powerful variable, the erythrocyte sedimentation rate, leukocyte blood count, alkaline phosphatase, aspartate aminotransferase, six different serum tumor markers, number of small blood vessels, and age were found to be significantly associated with survival. The leukocyte blood count, alkaline phosphatase, and aspartate aminotransferase retained their significance in a multivariate model including tumor differentiation, local tumor stage, and age. Inclusion of tissue polypeptide antigen, the most powerful tumor marker in the multivariate model, showed that only the tumor stage, tissue polypeptide antigen, and age were statistically significantly correlated to survival. This was valid both for the group of patients considered as potentially curable and for those who potentially have been cured (Dukes Stages A-C). CONCLUSIONS: A great number of prognostic predictors failed to discard Dukes stage as the best one. One serum tumor marker, tissue polypeptide antigen, contains independent additional prognostic information.

Adult↗
PubMed1994

Recognition of risk factors in pregnancy among women attending antenatal clinic at Mbagala, Dar es Salaam.

A study on the recognition of risk factors in pregnancy by pregnant women attending antenatal clinic (ANC) at Mbagala, Dar es Salaam, Tanzania was done. 203 women with ages ranging from 15-43 years were seen on their first visit. 32.51% were primigravidas while 67.5% were multiparous with parity varying from 2-13 deliveries. 32.5% had received no formal education; 13.4% had 1-6 years education, while 54.2% had 7-12 years of formal education. Most of the women did not know when in the course of pregnancy they should start ANC: 52% of the women booked and reported that the best gestational age for booking was in the second trimester. There was no definite answer as to why the women came for the 1st visit to the ANC at a particular gestational age. 5% of the women felt that a woman could start to have children between age 10-14 years. 62.1% thought a woman could start to have children between 15-20 years. 10.3% did not know when a woman could start to have children. Some of the risk factors identified at the clinic included: shortness, age below 19 (11.8%), age 35 and more than 4 deliveries (13.3%) and HB below 75%, malaria and hookworm (9.9%). It appears that pregnant women attending Mbagala ANC booked within the second and third trimester. Their knowledge regarding risk factors in pregnancy was very low. A comprehensive antenatal intervention programme should be introduced at Mbagala ANC to educate women on risk factors in pregnancy. It should be conducted through client oriented problem and need approach.

Adolescent↗