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Biomedical subjects

G Lindmark

Publications and source records attributed to G Lindmark.

At least 91 records · Page 5Linked to original sources
PubMed1994

Female mortality in reproductive ages in Dar es Salaam, Tanzania.

An audit of all cases of female mortality in the reproductive age groups has been performed in Dar es Salaam during 1991-93. Multiple sources of information was used to collect information on deaths. None of the sources of information on death was alone adequate. 73% of the interviews was done at home. The mother or another close relative was interviewed in more than 70% of the cases. A total of 645 deaths were identified and 18% of these were related to pregnancy. Fever, shortness of breath and weight loss were the most common symptoms before death followed by pallor and vomiting. Almost 90% visited a health facility before death. AIDS (27%), tuberculosis (13%) and malaria (12%) were the most common causes of death. Diagnosis could not be made from audit data in 22 cases, and the relatives attributed 7.6% of all deaths to witchcraft or just God's will. AIDS and related diseases are now a major cause of death in the female reproductive age group. There is need to identify preventive measures of this disease as well as prevention of malaria and tuberculosis.

Adolescent↗
PubMed1993

Maternal mortality in rural and urban Zimbabwe: social and reproductive factors in an incident case-referent study.

A community-based incidence case-referent study was undertaken in a rural and an urban setting in Zimbabwe in order to define risk factors associated with maternal deaths at family, community, primary and referral health care levels. Referent subjects were drawn from place or area of delivery for each consecutive maternal death. Using a multiple source confidential reporting network for all maternal deaths, the maternal mortality rate for the rural setting was 168/100,000 live births and that for the urban setting was 85/100,000 live births. A model for interacting factors contributing to maternal mortality was designed. Haemorrhage and abortion sepsis were the major direct causes while malaria was the leading indirect cause in the rural setting. In the urban setting, eclampsia, abortion and puerperal sepsis were the leading causes of maternal deaths. It was found that all situations associated with diminished, or absent social support, that is, being single (Odds Ratio = 4.7, 95% CI = 2.2-9.8) divorced, widowed, one of several wives, cohabiting, or self-supporting carried an increased risk for maternal mortality, especially in the rural area. Income and level of education for index and referent subjects were comparable, probably because of the limited part of the population under study that belonged to a more affluent class. Distribution of cases and referents by religious-affiliation was also comparable. Age > 35 years and parity > 6 were significant risk factors for maternal mortality in the rural setting, whereas bad reproductive history with reported stillbirth or abortion constituted a high risk both in the city and in the rural areas (Odds Ratios 4-6).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Cessation of smoking during pregnancy improves foetal growth and reduces infant morbidity in the neonatal period. A population-based prospective study.

All pregnant women in Uppsala county in 1987 were questioned on three different occasions about smoking habits, socio-demographic factors and obstetric history. After delivery, information was collected regarding their children. Twenty percent of the mothers continued to smoke during pregnancy, while 8% stopped smoking. The mean birth weight of infants of smokers was 3378 g and of non-smokers 3589 g. The difference was significant (p < 0.001) and persisted after statistical adjustment for maternal age, parity and educational level. Perinatal morbidity (admission to the Department of Neonatology) was higher in the smoking group (11.4% versus 8.8%, p < 0.05). The proportion of infants with a birth weight less than 2500 g and that of small-for-gestational-age infants were 60% and 100% greater, respectively, in the smoking group. The mean birth weight and perinatal morbidity rate in infants of mothers who stopped smoking were almost identical to those in infants of non-smokers. Cessation of smoking improves foetal growth and perinatal health.

Adolescent↗
PubMed1993

Effect of smoking on maternal glucose metabolism.

Maternal smoking, studied in late pregnancy, was found to be associated with lower blood glucose values, both during fasting and after an intravenous glucose load. As a correlation between blood glucose levels and infant birth weight has been reported, it is possible that smoking during pregnancy might reduce fetal growth through an effect on maternal glucose metabolism.

Birth Weight↗
PubMed1993

Prediction of high birthweight from maternal characteristics, symphysis fundal height and ultrasound biometry.

The possibility to predict a large infant during pregnancy was assessed using data from a prospective cohort study of 537 singleton pregnancies with term deliveries. Maternal characteristics, symphysis fundal height and ultrasound measurements were used in multivariate analyses for the prediction of an infant with a birthweight of > or = 4,500 or > or = 4,000 g. The positive predictive value was 55% for a birthweight > or = 4,000 g when only maternal characteristics were used, and increased slightly when symphysis fundal height was added. The corresponding value for a single ultrasound measurement at 37 gestational weeks was 52%. Using all available clinical data, positive predictive values of 45 and 80% could be achieved for birthweights of > or = 4,500 and > or = 4,000 g, respectively.

Adult↗
PubMed1993

Pre-pregnancy risk factors of small-for-gestational age births among parous women in Scandinavia.

To study the etiology and consequences of intrauterine growth retardation (IUGR), a prospective study was organized by the National Institute of Child Health and Human Development, NIH, with the Universities of Trondheim and Bergen in Norway, Uppsala in Sweden, and Alabama in the United States. This paper reports on the Scandinavian portion of the study. 6,354 women were referred to the study and 5,722 women, who were expecting their second or third child between January 1986 and March 1988, were eligible and made their first appointment for the study. Of these, 1,945 women and their births were selected for follow-up at four prenatal visits, delivery, and during the first year of life. This report analyzes the relative impact of various maternal pre-pregnancy risk factors associated with SGA birth. For example, mothers who smoked cigarettes around the time of conception, but who had none of the other major risk factors, nearly doubled their risk of SGA birth. A previous low birth weight (LBW) delivery increased the risk nearly two and a half times among non-smokers. If a mother both smoked and had a previous LBW, the relative risk rose to nearly five and a half. Low maternal pre-pregnancy weight (< 50 kg) increased the risk of SGA birth almost twofold among non-smokers, while low pre-pregnancy weight and smoking together increased the risk of SGA birth fourfold. A low weight mother who smoked and also had a previous LBW delivery, had a risk of SGA birth that was nearly six times that of a mother without those characteristics.

Adult↗
PubMed1993

Microvascular pericytes express platelet-derived growth factor-beta receptors in human healing wounds and colorectal adenocarcinoma.

The expression of platelet-derived growth factor- beta (PDGF-beta) receptors in the microvasculature of human healing wounds and colorectal adenocarcinoma was investigated. Frozen sections were subjected to double immunofluorescence staining using monoclonal antibodies (MAbs) specific for pericytes (MAb 225.28 recognizing the high-molecular weight-melanoma-associated antigen, expressed by activated pericytes during angiogenesis), endothelial cells (MAb PAL-E), laminin, as well as PDGF-beta receptors (MAb PDGFR-B2) and its ligand PDGF-B chain (MAb PDGF 007). Stained sections were analyzed by computer-aided imaging processing that allowed for a numerical quantification of the degree of colocalization of the investigated antigens. An apparent background colocalization, varying between 23 and 35%, between markers for cells not expected to co-localize was recorded. This background could be due to limitations of camera resolution, to out-of-focus fluorescence, and to interdigitations of the investigated structures. In all six tumor specimens, co-localization of PDGF-beta receptors and PAL-E was not different from the background co-localization, whereas that of PDGF-beta receptors and high-molecular weight-melanoma-associated antigen was significantly higher with mean values between 57 and 71%. Qualitatively, the same pattern was obtained in the two investigated healing wounds. PDGF-B chain did not co-localize with either PAL-E or high-molecular weight-melanoma-associated antigen, but PDGF-B chain-expressing cells were, however, frequently found juxtaposed to the microvasculature. The expression of PDGF-beta receptors on pericytes in activated microvessels and the presence of PDGF-B chain-expressing cells in close proximity to the microvasculature of healing wounds and colorectal adenocarcinoma is compatible with a role for PDGF in the physiology of the microvasculature in these conditions.

Adenocarcinoma↗
PubMed1993

Stromal expression of platelet-derived growth factor beta-receptor and platelet-derived growth factor B-chain in colorectal cancer.

BACKGROUND: The importance of growth factors, such as platelet-derived growth factor (PDGF), for stromal activation in colorectal cancer is unclear. EXPERIMENTAL DESIGN: The expression of beta-receptors for PDGF, and PDGF B-chain (PDGF AB and PDGF BB) was investigated by immunohistologic techniques in full-thickness biopsies from 210 colorectal cancers. These antigens were detected by the monoclonal antibodies PDGFR-B2 and PDGF 007, respectively. RESULTS: All tumors contained granular clusters of PDGF beta-receptor expressing stromal cells, whereas tumor epithelium was invariably negative. The staining was most prominent in vascular cells. There were several cells in the tumor stroma that expressed PDGF AB/BB. Double immunofluorescence stainings in specimens from four patients performed in order to characterize PDGF beta-receptor- and PDGF AB/BB expressing cells showed that cells expressing PDGF beta-receptors did not express PDGF AB/BB. About 20% of cells in the stroma expressing PDGF AB/BB were macrophages (CD68-positive cells), whereas the nature of the remaining stromal cells expressing PDGF AB/BB could not be disclosed. Furthermore, about 30% of CD68-positive macrophages expressed PDGF AB/BB, but not PDGF beta-receptors. The extent of clusters of PDGF beta-receptor expressing cells varied considerably between tumors, and its prognostic value was considered in the entire tumor material. The number of clusters did, however, not correlate to tumor differentiation, tumor stage according to Dukes', or outcome. CONCLUSIONS: The presence of cells expressing PDGF beta-receptor and PDGF AB/BB respectively, i.e., expression of the receptor and its ligand, fulfills two of the prerequisites for a role of PDGF in the activation of stromal cells in colorectal cancers. The data suggest that stromal activation, characterized by clusters of PDGF beta-receptor expressing cells, is of importance for the formation of tumor stroma per se. However, the expression of the PDGF beta-receptor has no potential as a prognostic marker.

Carcinoma↗
PubMed1993

Interconnection of integrins alpha 2 and alpha 3 and structure of the basal membrane in colorectal cancer: relation to survival.

The expression and distribution of integrin subunits alpha 2 and alpha 3 and two of their putative ligands, type IV collagen and laminin, were examined by immunohistochemistry in specimens from 33 consecutive patients operated on for colorectal adenocarcinomas. Both tumour cells and normal epithelium expressed the alpha 2 and alpha 3 subunits. Two typical patterns of expression could be discerned; a basolateral expression and a diffuse cytoplasmic expression. The stained tumour specimens were assessed according to (i) distribution of integrin expression (diffusely cytoplasmic or basolateral), (ii) continuity in basolateral integrin expression, and (iii) interconnection of integrin expression and expression of type IV collagen and laminin. These parameters were then related to tumour differentiation, tumour stage according to Dukes' classification, DNA-ploidy and patient survival (median observation time was 30 months; range 24-35). The continuity in the basolateral expression of alpha 3 but not of alpha 2, correlated with the basal membrane expression of type IV collagen (P < 0.001). Loss of continuity in the basolateral expression of both integrins was significantly related to impaired tumour differentiation (alpha 2 P = 0.02; alpha 3 P = 0.01), more advanced Dukes' stage (alpha 2 = 0.07, alpha 3 P < 0.001), survival rate (both integrins P < 0.05), but not to DNA-ploidy. These data suggest that determination of the pattern of expression of the integrin subunits alpha 2 and alpha 3 in the preoperative biopsy and the surgical specimen could be used as a prognostic indicator.

Adenocarcinoma↗
PubMed1992

The value of endosonography in preoperative staging of rectal cancer.

Sixty-three patients with mobile rectal cancer were examined preoperatively with endorectal ultrasonography (EUS). The depth of infiltration and the presence of mesorectal lymph node metastases could be assessed in 53 patients. Doppler ultrasonography was performed in 16 cases with suspected lymph node enlargement in order to discriminate between lymph nodes and blood vessels. Tumour growth in the bowel wall was correctly estimated in 43 (81%) patients. The degree of spread was overestimated in five patients and underestimated in five. The evaluation of the mesorectal lymph node status was also accurate in 43 (81%) patients. Nine patients had one or several regional lymph node metastases, but the EUS revealed only some of the metastatic lymph nodes in each case. In the other 34, no lymph node metastases were found. In two patients the EUS was falsely positive since no lymph nodes could be demonstrated in the operative specimens. In eight patients the examination was falsely negative. EUS is considered to be an accurate method for preoperative assessment of tumour infiltration in the bowel wall as the risk of understaging was under 10%. Preoperative irradiation and surgery may be chosen based on the EUS-determined tumour extension into the rectal wall.

Arteries↗
PubMed1992

Assessing the scientific basis of antenatal care. The case of Sweden.

The Swedish routine program for antenatal care is based on a number of scheduled visits for the detection of symptomless complications, as well as psychosocial support and health education. The scientific evidence to support the present timing and contents of routine visits is unsatisfactory, and there is a great need for evaluation both of single diagnostic procedures and interventions and of programs of antenatal care.

Female↗
PubMed1992

Competence and compliance in antenatal care. Experience from Sweden.

Swedish antenatal care is staffed by midwives working within the primary health care system, but with close collaboration with the hospital. The compliance to the program both from staff and mothers is very high, with 13.2 visits on average. There is a regional variation both in the number of visits and in the use of routine tests.

Female↗
PubMed1992

Who continues to smoke while pregnant?

STUDY OBJECTIVE: The aim was to study changes in smoking habits during pregnancy and differences in characteristics between women who stop smoking and those who continue to smoke during pregnancy. DESIGN: The study was a population based prospective study. Self administered questionnaires were completed on three occasions. SETTING: The study area was Uppsala county, Sweden, in 1987. PARTICIPANTS: The participants were women registered with antenatal care clinics, which included all pregnant women in the county. Ninety six percent (n = 3678) of all pregnant women completed the first questionnaire. Thirty two percent of these were smokers at time of conception. MEASUREMENTS AND MAIN RESULTS: Twenty nine percent of the smokers stopped smoking at some stage of pregnancy, and the majority did so before having registered for antenatal care. Using logistic regression analysis it was found that high parity number, not living with infant's father, heavy smoking, and daily passive smoking at home were associated with significantly increased risk for continued smoking during pregnancy. High level of education and high age at onset of smoking decreased the risk. CONCLUSIONS: In order to reduce the smoking related risks for unsuccessful pregnancy outcome, general preventive efforts in society must be combined with the development of more specialised antenatal programmes designed with consideration of the characteristics and life situation of the pregnant smoker.

Adolescent↗
PubMed1992

The risk of medical complications after female circumcision.

The medical complications of the practice of circumcision were studied in 290 Somali women between ages of 18-54. Thirty-nine percent of the interviewed women had experienced significant complications after circumcision, most commonly haemorrhage, infection or urinary retention. Thirty-seven of the women reported a late complication of circumcision. Among these complications were dermoid cyst at the site of the amputated clitoris, urinary problems such as pain at micturition, dribbling urine incontinence and poor urinary flow. Forty of the women had experienced problems at the time of menarche and ten of them were operated because of haematocolpos. Most of the married women of the study sample were defibulated naturally by their husbands.

Adolescent↗