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Biomedical subjects

I Krantz

Publications and source records attributed to I Krantz.

At least 19 recordsLinked to original sources
PubMed2006

Association between low concentrations of antibodies to protein alpha and Rib and invasive neonatal group B streptococcal infection.

BACKGROUND: Infection with group B streptococci (GBS) is a serious neonatal disease. The GBS cell surface proteins alpha and Rib elicit protective immunity in animal models and have been suggested as potential antigens in a vaccine against human GBS disease. AIMS: To test the hypothesis that transplacentally transferred maternal antibodies to GBS proteins contribute to the protection of the neonate from GBS infection. METHODS: Thirty neonates with invasive infection were included in a case-control study. IgG antibody concentrations were measured in sera from these neonates, their mothers, and from 60 non-infected controls, neonates as well as mothers. RESULTS: A clear association was found between concentrations of antibody to proteins alpha and Rib in neonatal and maternal sera, indicating that transplacental transfer had occurred. Moreover, low concentrations of antibodies to alpha and Rib in neonatal sera were associated with invasive GBS infection caused by strains expressing the Rib protein. The odds ratio was 0.0007 (95% confidence interval 0.000 to 0.54) for antibodies to alpha and 0.002 (95% confidence interval 0.000 to 0.57) for antibodies to Rib. CONCLUSION: These findings support the notion that antibodies to GBS surface proteins contribute to the protection against neonatal infection.

Adult↗
PubMed2001

Gendered construction of sexual risks: implications for safer sex among young people in Kenya and Sweden.

This study compared perceptions of sexual risk and sexual practices among youth in Kenya and Sweden. Self-generated questions on the body, perceptions of sexual risk and sexual practices were collected in Kenya while focus group discussions and individual interviews on these same issues were used in Sweden. The most striking differences between the two countries were in the level of knowledge on matters of sexuality and the ability to talk with ease on these matters. The refusal in Kenya to provide adolescents with information and services has left the 'safe period' as their only protective option and pregnancy as the overriding concern. Communication at the partner level and lack of condom use are problematic in both countries and even where access to information and preventive services exist, these may not be used optimally. In both countries, boys had more sexual freedom, while girls were controlled through labelling and rumours, and girls were assigned responsibility for safer sex. We conclude that sexual education should be based more broadly on an understanding of the social norms defining sexual behaviour. It is at the level of sexual relations that the tensions between culturally-defined sexual and gender norms and public health assumptions should be addressed, a level at which health policy and education are silent in both countries.

Adolescent↗
PubMed2001

Borrelia burgdorferi antibodies in outdoor and indoor workers in south-west Sweden.

Two hundred and fifty-three farmers and forest workers and 249 clerks from south-west Sweden were recruited to a cross-sectional seroprevalence study to find out if individuals working outdoors are more prone to acquire Borrelia burgdorferi infection than indoor workers and to find undiagnosed cases of Lyme borreliosis. The participants answered a questionnaire and blood specimens were collected to estimate the prevalence of antibodies to B. burgdorferi in each group. Sera were analysed with an enzyme-linked immunoassay technique to determine IgG antibodies to B. burgdorferi flagellum. The prevalence of B. burgdorferi antibodies was 7.6% in the farmers and forest workers vs. 5.3% in the clerks (adjusted odds ratio [age, sex] = 1.2 [95% confidence interval = 0.5-2.8]). One case of Lyme borreliosis was diagnosed. The positive predictive value of the antibody test was estimated to be 3% in the studied populations. B. burgdorferi infection is of low endemicity in south-west Sweden and is probably not an occupational risk among outdoor workers. Undiagnosed cases of Lyme borreliosis are uncommon. The test used is not acceptable for screening purposes.

Adult↗
PubMed2001

Traditional healers in Zambia and their care for patients with urethral/vaginal discharge.

OBJECTIVE: The aim of this study was to describe the knowledge and practices of traditional healers in relation to the management of patients with urethral/vaginal discharge. SUBJECTS AND METHOD: Eighty (80) traditional healers, 54 from an urban and 26 from a rural setting in Zambia, who attend to patients with urethral/vaginal discharge, were interviewed using a semistructured questionnaire. RESULT: All of the traditional healers had knowledge of urethral/vaginal discharge being a symptom of a sexually transmitted disease (STD) and that individuals get the infection through sexual relations with infected persons. The healers were all able to cite other symptoms associated with urethral/vaginal discharge. The treatment the healers used was mostly herbal preparations in the form of roots or powders administered orally to induce diarrhea, vomiting, and diuresis. Patients were not allowed to combine traditional and biomedical therapies. Almost half of the healers did apply some biomedical practices in the management of patients with urethral/vaginal discharge, such as history taking and examination of patients before diagnosis and prescription. The healers also advised patients to avoid sex while on treatment and to avoid reinfection by remaining with one partner and using condoms. Some healers advised their patients to bring their sexual partners for consultation. CONCLUSION: Because traditional healers attend to patients with STDs, both in rural and urban areas, efforts should be made to promote cooperation between traditional and biomedical health care providers, so that treatment of patients and their partners could be improved. Traditional management that concurs with biomedical practices could thus be a starting point for discussion and cooperation.

Adult↗
PubMed2001

Diagnosis of genital cervical schistosomiasis: comparison of cytological, histopathological and parasitological examination.

Granulomatous inflammation of the cervix uteri is a common manifestation of infection with Schistosoma haematobium. In women the cervix is the most common site of infection by S. haematobium. Three methods were used to assess the performance of three different ways of detecting schistosome eggs in cervical tissue: cytological examination of a cervical smear, histological examination of a cervical biopsy, and direct examination of cervical tissue obtained by forceps biopsy (quantitative compressed biopsy technique [QCBT]). Of 228 women studied who lived in an S. haematobium endemic area in Tanzania, 112 (49%) had schistosome eggs detected in the cervix using QCBT. Histological examination detected eggs in 40 of 228 (18%). The cytological examination of cervical smears yielded only 6 positive results (3%). The median egg load in the cervical tissue of cases correctly diagnosed by histology was significantly higher than the egg load in the misclassified cases, indicating that the sensitivity of histological sectioning increases with egg density. We conclude that the QCBT is the diagnostic test of choice for schistosomiasis of the genital cervix.

Adolescent↗
PubMed2000

Carriage of penicillin-susceptible and non-susceptible pneumococci in healthy young children in Göteborg, Sweden.

OBJECTIVES: To study carriage of Streptococcus pneumoniae among healthy young children, determine the proportion of strains with decreased susceptibility to penicillin, and study possible risk factors for the carriage of penicillin-resistant strains. METHODS: Between February 1996 and February 1997, 620 healthy, 18-month-old children in Goteborg, Sweden were screened for carriage of S. pneumoniae with decreased susceptibility to penicillin. Nasopharyngeal samples were obtained from children visiting child health centres for routine health control. RESULTS: Streptococus pneumoniae was found in 322 samples and 18 strains (5.6%, CI95 3.4; 8.8) of all pneumococci showed decreased susceptibility to penicillin G with minimum inhibitory concentrations (MICs) ranging from 0.125 to 1.0 mg/l. The proportion of strains with decreased susceptibility was similar to that found in a laboratory-based material (6%), from the same geographical area and time period. A majority of the children with strains with decreased susceptibility to penicillin (n = 11) were not attending day-care centres. CONCLUSIONS: The prevalence of S. pneumoniae with reduced susceptibility to penicillin is still low in unselected healthy Swedish children.

Carrier State↗
PubMed2000

Female genital schistosomiasis of the lower genital tract: prevalence and disease-associated morbidity in northern Tanzania.

Female genital schistosomiasis (FGS) is a neglected disease manifestation of schistosomiasis. A cross-sectional study was carried out to assess in a schistosomiasis-endemic area the proportion of women affected by FGS of the lower reproductive tract and to compare the frequency of symptoms and signs possibly associated with FGS between women with proven FGS (n=134), endemic referents (n=225, women living in an endemic site), and referents (n=75, women living in a nonendemic site). Urinary schistosomiasis was diagnosed in 36% (239/657) and FGS in 37% (134/359) of the women. Cervical lesions occurred in 75% of the FGS cases, in 48% of endemic referents, and in 36% of nonendemic referents. The high prevalence of FGS in all age groups and the high levels of pathologic cervical alterations such as swollen and disrupted epithelium support the hypothesis that FGS might be a risk factor for the transmission of human immunodeficiency virus.

Adolescent↗
PubMed2000

"Shopping" for sexually transmitted disease treatment: focus group discussions among lay persons in rural and urban Zambia.

BACKGROUND: In Zambia, persons use different types of services when seeking treatment for sexually transmitted diseases (STDs). GOAL: To gain insight into the rationale behind the selection of treatment sources by investigating perceptions of STDs and by identifying STD treatment sources used. STUDY DESIGN: Focus group discussions were held with 57 men and 44 women in one urban and one rural area in Zambia between May 1997 and June 1997. The focus group discussions were audiotaped and analyzed qualitatively. RESULTS: Participants combined traditional and modern treatment. The main reason given was that even when biomedical medicine was effective, STDs could only be totally cured if the patient was cleansed by traditional herbs. Factors influencing health-seeking behavior were the person's perception, how the diagnosis was determined, type and cost of treatment, demand for sexual partners, and attitudes of health workers, parents, and the church. CONCLUSION: Barriers and enabling factors for the use of treatment sources were identified. Interventions to improve services and cooperation between the health sectors need to consider these factors.

Adolescent↗
PubMed2000

Screening of Tanzanian women of childbearing age for urinary schistosomiasis: validity of urine reagent strip readings and self-reported symptoms.

The screening of women of childbearing age for haematuria, leukocyturia and proteinuria to detect urinary schistosomiasis can be confounded by several factors such as menstruation, pregnancy and genitourinary infections. We therefore undertook a study in an area endemic for Schistosoma haematobium in the United Republic of Tanzania to carry out the following: assess the sensitivity, specificity and predictive values--in women of childbearing age--of indirect indicators of urinary schistosomiasis, as measured by urine reagent strip readings; assess the predictive values of self-reported symptoms; and finally to estimate the morbidity attributable to S. haematobium. A total of 303 women (128 and 175, respectively, living in high- and low-risk sites) participated in the study. Haematuria was more frequent among women excreting S. haematobium eggs than among those who did not (65% versus 32%). The predictive potential of all indirect disease markers was poor in the highly endemic site, while in the sites with low endemicity the negative predictive values were high. Among infected women, 54% of haematuria could be attributed to S. haematobium, but for patients with more than 10 eggs/10 ml the attributable fraction rose to 70%. Symptoms of "bloody urine" and "pain while urinating" were recalled significantly more often by women living in the highly endemic site. On a population level, one-third of the self-reported cases with bloody urine could be attributed to urinary schistosomiasis. Screening of women of childbearing age for urinary schistosomiasis using urine reagent strips can be biased in two directions. The prevalence of S. haematobium will be overestimated if other causes of haematuria, such as reproductive tract infections, are highly endemic. On the other hand, women with light or very light infections will be missed and will not be treated. This is of concern because genital schistosomiasis, a possible risk factor for the transmission of HIV, occurs among women even with light infections.

Adolescent↗
PubMed1999

Schistosomiasis of the female genital tract: public health aspects.

In this paper Gabriele Poggensee, Hermann Feldmeier and Ingela Krantz discuss the public health relevance of female genital schistosomiasis (FGS). Some of the stated hypotheses are supported only by clinical observations and/or circumstantial evidence as valid epidemiological and immunological data of this disease entity are still very scanty. Morbidity caused by the presence of schistosome eggs in the lower and upper genital tract have been almost completely neglected during the past two decades. This has been acknowledged by the WHO and, in 1997, the Gender Task Force of the WHO's Tropical Disease Research Programme (TDR) included FGS in a list of scientific areas that deserve high research priority.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Schistosomiasis of the lower reproductive tract without egg excretion in urine.

The individual and public health impact of female genital schistosomiasis (FGS) has been studied and FGS as a risk factor for acquiring human immunodeficiency virus is discussed. In a community-based study in Tanzania, 40% of the women of child-bearing age (n=543) showed excretion of Schistosoma haematobium eggs in the urine (median=2.2 eggs/10 ml of urine) and 32% (n=263) had S. haematobium eggs in their cervical tissue. Urinary and genital schistosomiasis coexisted in 62% of the women, but S. haematobium eggs were found in the cervix without detectable egg excretion in the urine in 23%. Only 43% of the FGS cases had hematuria. Since FGS frequently exists in women with scanty or no egg excretion in the urine and because this disease manifestation is a considerable individual and public health hazard in S. haematobium-endemic areas, mass treatment targeted to women of child-bearing age should be considered.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Health-seeking behaviour of patients with sexually transmitted diseases in Zambia.

The aim of this paper is to describe health-seeking behaviour, time with symptoms and sexual activity during symptom period among patients attending the public health sector in urban and rural Zambia for treatment of an STD. The study was conducted at two urban health centres and at one rural mission hospital during four months in 1994 and 1995. Four hundred and seventy nine patients seeking health care for STD symptoms were interviewed. The patients had experienced STD symptoms for one to two weeks before they came to the clinic. During this period two thirds in the urban and one third in the rural setting had had sex. Sixty per cent of the patients in the urban and 50% in the rural setting had taken some kind of medicine before they came to the clinic. More people had used modern compared to traditional medicine, especially in the urban area. Market places, other clinics and doctors, friends, and relatives were common treatment sources. Ten per cent had received medicine from a traditional healer. Thus, a majority of the patients had received medication from other sources before they came to the clinic. Sex during periods with STD symptoms was common. This has serious implications for STD as well as HIV transmission.

Adult↗
PubMed1997

[Children in poor countries also have right to good health care. A new care program will reduce child mortality].

According to the WHO (World Health Organization), 12 million children die annually before reaching the age of five. Seventy per cent of the deaths are related to one or more of five common diseases: acute respiratory tract infection, diarrhoea, measles, malaria and malnutrition. Consequently, drawing on international experience and expertise, the WHO and UNICEF (United Nations International Children's Emergency Fund) have compiled and developed guidelines for the primary care of Third World children. This programme, entitled Integrated management of childhood illness (IMCI), is expected to improve the care of children in areas and situations resources are limited.

Bacterial Infections↗
PubMed1997

Quality of STD care in an urban Zambian setting: the providers' perspective.

The aim of this paper is to analyse obstacles to optimal STD care in an urban setting in Zambia. Eight-two health professionals answered a questionnaire with closed and open-ended questions. More than 50% were not satisfied with their working conditions, due to heavy workload, lack of equipment/drugs, poor salary, and lack of continuing education. Negative opinions about STD patients were common. Treatment and preventive activities were considered important but most respondents found patient compliance poor--especially for partner notification. To improve the quality of STD care, training in STD management should be combined with improved working conditions.

Education, Nursing, Continuing↗
PubMed1997

Quality of STD care in Zambia. Impact of training in STD management.

STUDY OBJECTIVE: To assess quality of care of sexually transmitted diseases (STDs) and evaluate interactive training methods aimed at improving providers' performance. DESIGN AND SETTING: This comparative study, with a baseline, intervention, and evaluation phases was conducted at two urban health centers in Zambia. The personnel at one health center were trained in STD management using interactive training methods. The other health center acted as a control. SUBJECTS AND METHODS: Two-hundred patients with STD were interviewed and their interaction with health care providers observed before and after the training. Another 200 interviews and observations were conducted at the control health center. RESULTS: The proportion of patients being examined, given health education and informed about partner notification increased significantly after the intervention. The proportion of patients who had complaints about the health care did not decrease. Long waiting time and lack of time to discuss the disease were the main complaints. CONCLUSION: The training solved some, but not all, problems of poor case management. This indicates the need for a more process-oriented approach for improving quality of care.

Adult↗