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Biomedical subjects

Gunnar Kvåle

Publications and source records attributed to Gunnar Kvåle.

At least 19 recordsLinked to original sources
PubMed2006

Family history of breast cancer and short-term effects of childbirths on breast cancer risk.

The long-term protective effect of a pregnancy on breast cancer risk is preceded by a short-term adverse effect, possibly reflecting a promoting effect of pregnancy hormones. In the present study, we explore whether a family history of breast cancer modifies time-related effects of pregnancies, with special emphasis on the transient increase in risk of breast cancer shortly after birth. Our study cohort comprises 1,067,289 Norwegian women aged 20-74 years. The mean follow-up time was 18 years. Incidence rate ratios were estimated by Poisson regression analyses of person-years at risk. Of the 7,377 women diagnosed with breast cancer during follow-up, a total of 828 (11%) had a mother or a sister with breast cancer diagnosis. Women with a family history of breast cancer had a 2-3-fold higher risk of breast cancer than did women without any affected family member, highest for those with a relative diagnosed before they were 50 years. Similar to women without a familial excess risk, increasing parity was associated with an overall protective effect among women with a familial predisposition, regardless of age at diagnosis of the relative. Whereas women with no familial excess risk experienced a transient increase in risk mainly after late age births, women with a family history of breast cancer experienced an adverse effect of pregnancies also at younger ages. The present results give further support to the hypothesis that the adverse effect of a term birth can be explained by a promoting effect of pregnancy hormones.

Adult↗
PubMed2006

Antenatal clinic-based HIV prevalence in Zambia: declining trends but sharp local contrasts in young women.

OBJECTIVES: To describe regional variation in human immunodefffeciency virus (HIV) prevalence trends in the period 1994-2002 and to assess the effects on prevalence trends of residence, educational level and age, and potential interaction between these variables. METHODS: The data were from the national HIV sentinel surveillance system comprising information collected using interviews and unlinked anonymous testing of blood among pregnant women attending antenatal clinics in 22 sites in 1994, 1998 and 2002. RESULTS: There was a decline in HIV prevalence in the age group 15-24 years in the period 1994-2002 both in rural (by 11%) and urban (by 26%) areas. The decline was strongest among highly educated women. However, this overall decline masked striking differences at community (site) levels with clearly declining epidemics in many sites contrasted by increasing epidemics in some and stability in others. Urban/rural residence, age, educational attainment, marital status and parity were factors closely associated with HIV infection. Having born many children was associated with lower risk of being infected by HIV, even in the age group 15-24. CONCLUSIONS: The HIV prevalence decline in young women is likely to reflect a drop in incidence during the period. However, there were sharp geographical contrasts in trends. Such local contrasts probably indicate differences in effectiveness of preventive interventions. Understanding factors and mechanisms explaining the differences will be of critical importance to better guide preventive interventions.

Adolescent↗
PubMed2006

Clinical stage of breast cancer by parity, age at birth, and time since birth: a progressive effect of pregnancy hormones?

Breast cancer diagnosed during pregnancy or 1 to 2 years after birth often occurs at a late stage. Little is known about tumor characteristics in the high-risk period shortly after a childbirth. We here explore whether stage of disease differs according to timing of births. Results are based on 22,351 Norwegian breast cancer patients of parity 0 to 5, ages 20 to 74 years. The proportion of stage II to IV tumors was considerably higher among parous than nulliparous women at age <30 years (52.7% versus 36.8%, P=0.009), but similar or lower in other age groups (P(interaction)=0.029). In general, the largest proportion of stage II to IV tumors was found among women diagnosed during pregnancy or <2 years after birth. However, among women with late-age births (first or second birth >or=30 years, third birth >or=35 years), as well as women with an early second birth (<25 years), the proportion with advanced disease was rather similar or even higher among those diagnosed 2 to 6 years after birth (49.3-56.0%). The association between clinical stage and time since birth reached statistical significance among women with a late first or second birth and among all triparous women (P <or= 0.032). The subgroups with a high proportion of advanced disease 2 to 6 years after birth corresponded quite well to those previously found to have the most pronounced transient increase in risk after birth. Thus, pregnancy hormones may have a progressive effect on breast cancer tumors in addition to a possible promoting effect. A potential effect of prolactin is discussed.

Adolescent↗
PubMed2005

Perceived susceptibility to and perceived causes of road traffic injuries in an urban and rural area of Tanzania.

The aim of the study was to investigate social and behavioral correlates of perceived vulnerability to traffic injuries in an urban and rural setting in Tanzania. In 2002, a sample of 494 adults aged 15 years and above participated in household interviews in Dar es Salaam (urban) and Hai District (rural). The study was part of a population-based survey that collected self-report data on non-fatal injuries. In Dar es Salaam 75 and 82% of males and females, respectively, perceived it as likely that they would experience a traffic injury in general. The corresponding figures in Hai were 63 and 64%. Men rated their road traffic vulnerability similarly to women (OR=0.8, 95% CI 0.5-1.3). Factors associated with high perceived vulnerability as a pedestrian or being injured by a bicycle were amount of road safety information received from health workers and friends, having caused a car to swerve and having crossed a road while talking. Respondents perceived driver recklessness and driver drunkenness as the leading causes of traffic injuries in both areas. Differences were found between the urban and rural setting with respect to perceived risk for traffic injury. The implications of these findings in the context of traffic injury prevention are discussed.

Accidents, Traffic↗
PubMed2005

Injury morbidity in an urban and a rural area in Tanzania: an epidemiological survey.

BACKGROUND: Injuries are becoming a major health problem in developing countries. Few population based studies have been carried out in African countries. We examined the pattern of nonfatal injuries and associated risk factors in an urban and rural setting of Tanzania. METHODS: A population-based household survey was conducted in 2002. Participants were selected by cluster sampling. A total of 8,188 urban and 7,035 rural residents of all ages participated in the survey. All injuries reported among all household members in the year preceding the interview and resulting in one or more days of restricted activity were included in the analysis. RESULTS: A total of 206 (2.5%) and 303 (4.3%) persons reported to have been injured in the urban and rural area respectively. Although the overall incidence was higher in the rural area, the incidence of major injuries (> or = 30 disability days) was similar in both areas. Males were at a higher risk of having an injury than females. Rural residents were more likely to experience injuries due to falls (OR = 1.6; 95% CI = 1.1 - 2.3) and cuts (OR = 4.3; 95% CI = 3.0 - 6.2) but had a lower risk of transport injuries. The most common causes of injury in the urban area were transport injuries and falls. In the rural area, cuts and stabs, of which two thirds were related to agriculture, formed the most common cause. Age was an important risk factor for certain types of injuries. Poverty levels were not significantly associated with experiencing a nonfatal injury. CONCLUSION: The patterns of injury differ in urban and rural areas partly as a reflection of livelihoods and infrastructure. Rural residents are at a higher overall injury risk than urban residents. This may be important in the development of injury prevention strategies.

Adolescent↗
PubMed2004

Age at natural menopause and stroke mortality: cohort study with 3561 stroke deaths during 37-year follow-up.

BACKGROUND AND PURPOSE: Young age at natural menopause has been related to increased cardiovascular mortality, but few studies have examined the relationship with stroke risk specifically. METHODS: In a cohort of 19,731 Norwegian women, we analyzed the relationship between age at natural menopause and stroke mortality. A total of 3561 women died of stroke during the 37-year follow-up from 1961 through 1997. Smoking prevalence was low in the underlying population, and use of hormone replacement therapy was very rare. RESULTS: No significant linear relationship was found between age at menopause and stroke mortality. A 3-year increase in age at menopause was associated with a 1.0% estimated increase in stroke mortality (95% CI, -1.5, 3.6). No relationships were found for ischemic strokes (271 deaths) or hemorrhagic strokes (389 deaths) when considering the stroke deaths with sufficient information on death certificates. The estimate of the association between age at natural menopause and stroke mortality was hardly influenced by mortality in women with very early (aged <40 years) or late (aged >55 years) menopause, or by a number of possible confounding variables. CONCLUSIONS: Age at natural menopause is essentially unrelated to stroke mortality.

Adult↗
PubMed2004

Severe pneumococcal meningitis heralding a deep hypogammaglobulinaemia related to common variable immunodeficiency, at the age of 27 years.

Common variable immunodeficiency with an associated broad immunoglobulin (0.7%) deficit affecting all subclasses, was revealed in a 27-y-old previously healthy female, upon development of a severe pneumococcal meningitis. We report the third case of purulent meningitis complicating this primary immunodeficiency, and the second due to Streptococcus pneumoniae. Clinicians should maintain an elevated suspicion for congenital immunodeficiency, especially when observing adult patients with a negligible prior history.

Adult↗
PubMed2003

Age at natural menopause and all-cause mortality: a 37-year follow-up of 19,731 Norwegian women.

In a cohort of 19,731 Norwegian postmenopausal women, the authors analyzed relations between the age at natural menopause and all-cause mortality. A total of 18,533 women died during the 37 years of follow-up from 1961 to 1997. An inverse relation was found between the age at menopause and the all-cause mortality rate (p = 0.003). The strength of the association was moderate, however, with 1.6% (95% confidence interval: 0.6, 2.7) reduced mortality per 3 years' increase in age at menopause. The impact appeared to be stronger in women with an attained age of less than 70 years (3.7% reduction in risk) than in women aged 80 years or more (1.0%). The inverse relation could not be explained by extreme mortality rates in women with very early (<40 years) or late (>55 years) menopause or by possible confounding variables like birth cohort, place of residence, occupational category (own or husband's occupation), body mass index, age at menarche, and first and last delivery or parity. The smoking prevalence was low in the underlying population, and the use of hormone replacement therapy was very rare. The authors conclude that age at natural menopause is inversely related to all-cause mortality.

Adult↗
PubMed2003

Frequency and perceived credibility of reported sources of reproductive health information among primary school adolescents in Arusha, Tanzania.

AIMS: To describe adolescents' sources of reproductive health information and perceived credibility of these sources. METHODS: A questionnaire survey was conducted among 1247 seventh grade pupils in Arusha district; enquiring their sources of reproductive health information and perceived credibility of these sources. Mean scores were computed for each type of information in relation to frequency of source and credibility, and scales for reproductive health information sources and credibility constructed. Analysis of covariance was used to compare mean scores by demographic and sexual behaviour variables. RESULTS: Mass media ranked first as sources of reproductive health information, followed by teachers and health workers. Health workers ranked first in credibility followed by parents, while credibility rating for media was low. Religious leaders and respondents' friends played a rather minor role as sources of reproductive health information, and their credibility ratings were also low. CONCLUSION: Mass media were the most frequent sources of reproductive health information for primary school adolescents, but parents and health workers were regarded as more credible sources. Programmes seeking to promote reproductive health of young people should take into account the diverse arenas through which young people currently obtain reproductive health information, and strive to tap into and strengthen the full range of these arenas. Increased involvement of parents and health workers in providing reproductive health information to young people seem indispensable.

Adolescent↗
PubMed2003

Perinatal mortality in northern rural Tanzania.

The study was conducted to investigate the association between perinatal mortalityand factors relating to nutrition and infections in a rural population in northern Tanzania. A cohort of 3,618 women attending antenatal clinics was registered with background information and the results of antenatal examinations, and followed up after delivery. Stillbirths and neonatal deaths were identified and traced for an interview with the closest relatives. No information on outcome of pregnancy was obtained for seven women, and incomplete information was obtained for 99. The perinatal mortality rate was 27/1,000 births [95% confidence interval (CI) 22/1,000-33/1,000]; 44% were early neonatal deaths; and 56% were stillborn. There was an increased risk of perinatal death among babies with low birth-weight [for babies weighing 2,000-2,499 g, adjusted odds ratio (AOR) 5.8, 95% CI 2.1-15.8, babies below 2,000 g AOR 45.7; 95% CI 18.3-114.1], babies of women with a small arm circumference (below 23 cm, AOR 5.3, 95% CI 1.3-22.2), babies of women with positive VDRL serology (AOR 5.1, 95% CI 1.0-25.7), babies of mothers who had previously lost a baby (AOR 1.9, 95% CI 1.1-3.2), and among babies of nulliparous women (AOR 1.7; 95% CI 1.0-3.0). Infections and nutritional deficiencies should be addressed at antenatal clinics.

Adult↗
PubMed2003

Avoidable stillbirths and neonatal deaths in rural Tanzania.

OBJECTIVE: To determine the causes of stillbirths and neonatal deaths in the community in rural Tanzania and to evaluate whether the deaths were avoidable under the prevailing circumstances. DESIGN: Review of stillbirths and neonatal deaths. SETTING: Rural northern Tanzania, Mbulu and Hanang districts. SAMPLE: One hundred and nineteen stillbirth and neonatal deaths identified in a prospective cohort of antenatal attendees and 21 stillbirths and neonatal deaths identified retrospectively in a household survey in seven rural communities. METHODS: Verbal autopsy was done to reach a diagnosis, in many cases supplemented with information from antenatal records and hospital records. The avoidability of deaths under the prevailing circumstances was assessed for each case. An account of risk factors detectable at antenatal clinic was done and compared with the woman's recall of the risk assessment and recall of being referred. MAIN OUTCOME MEASURES: Avoidability of stillbirths and neonatal deaths. RESULTS: There were 60 stillbirths, 49 early neonatal deaths and 27 late neonatal deaths. Infection-related deaths were most common (n = 53), followed by asphyxia-related deaths (n = 32) and immaturity-related deaths (n = 20). Malaria was the most common infectious agent observed (21 children and 20 mothers). Twenty-one deaths (15%) were probably avoidable and 13 (10%) were possibly avoidable. A patient-oriented avoidable factor was identified in 17 (51%) and a provider-oriented avoidable factor was identified in 22 cases (65%). Twenty-six of the 34 avoidable deaths had risk factors, but only two of the women were aware of it and only one recalled being referred to a hospital for the risk factor. There were eight deaths among the 133 mothers who experienced a perinatal death. CONCLUSION: Our data indicate that prevention and adequate treatment of infections and asphyxia in the newborn should have high priority in low-income settings. The relatively low proportion of avoidable stillbirths and neonatal deaths may be partly due to accessible emergency obstetric care in the area. Future efforts should emphasise improving the communication between midwife and women at the antenatal clinics, preparing the women-and their families-for the delivery and to be ready for complications.

Asphyxia Neonatorum↗