PubMed Health⌕ Search

Biomedical subjects

L A Persson

Publications and source records attributed to L A Persson.

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

Saving more neonates in hospital: an intervention towards a sustainable reduction in neonatal mortality in a Nicaraguan hospital.

A process of change was initiated in a Nicaraguan regional hospital in order to achieve a sustainable reduction of early neonatal mortality. A series of organizational, educational and hygienic measures was introduced, involving all staff in antenatal care, delivery care and neonatal care. Neonatal mortality decreased from 56/1000 live births in 1985 to 11/1000 in 1993. A commission of maternal and child health, a weekly perinatal audit, the active involvement of all staff and dedicated work of key individuals, as well as national policy decisions, are considered important determinants of the process. Keeping neonatal mortality in focus through continuous analysis of care routines, and through external exchange of ideas is important in order to sustain improvements and to decrease further the mortality.

Adult↗
PubMed1997

Prevalence of diabetic retinopathy in children and adolescents with IDDM. A population-based multicentre study.

Vision-threatening diabetic retinopathy can be prevented if it is diagnosed before becoming too advanced. Since diabetic retinopathy has been reported to occur only rarely before the end of pubertal development, children and adolescents are seldom included in screening programmes. We invited 780 children and adolescents with insulin-dependent diabetes mellitus diagnosed before the age of 15.0 years (disease duration of < 12 years) and who were older than 9.0 years at the time of examination from eight regions of Sweden. Retinal examination was performed with stereoscopic fundus photograph. The photograph were rated according to a modified Airlie House classification. The dropouts (223/780, 28.6%) were significantly older and with a longer duration of diabetes than the examined children (p < 0.001 and 0.001, respectively). Photographs from 557 patients aged (median [interquartile range]:14.6 [12.4-17.0]) years and with a diabetes duration of 8.0 (5.5-9.9) years were evaluated. Retinopathy was demonstrated in 81 patients (14.5%):66 with background retinopathy, 2 with microaneurysms and hard exudates, 12 with preproliferative retinopathy, 1 with proliferative retinopathy. Preproliferative retinopathy was diagnosed in a 12.8-year-old girl in pubertal stage 3 and an 11.8-year-old boy in pubertal stage 2, and proliferative retinopathy was found in a 21.5-year-old girl. Retinopathy was demonstrated in 6% and 18% of patients in pubertal stages 1 and 5, respectively. The overall prevalence of retinopathy in this population may even be higher since the dropouts were older and had a longer duration of diabetes. Since background and preproliferative retinopathy were found in children before puberty, we recommend including children and adolescents in screening programmes for diabetic retinopathy from the age of 10 years.

Adolescent↗
PubMed1997

Excess female mortality in rural Somalia--is inequality in the household a risk factor?

Gender differences in mortality risks in rural Somali communities were studied to assess their relation to literacy, marital status and family economy between January 1987 and December 1989. In all, 6947 person-years form the basis for the demographic analysis and estimations of mortality rates and survival. Both sexes showed similar mortality risks in infancy and early childhood, but females demonstrated a greater risk of dying during their reproductive life than males. Respiratory symptoms, diarrhoea, fever and jaundice dominated the symptoms prior to death Illiteracy in women considerably increased the risk of dying from 15 years and onwards particularly when living with literate men. The life expectancy from 15 years was 58 for a literate male but only 42 years for an illiterate woman living with a literate head of household. Multivariate analyses showed after adjustment for marital status and literacy that an excess female mortality from 15 years, but especially from 45 years, was associated to a household situation, where the woman did not subside on farming but on other, mainly commercial, activities. This vulnerability of females was associated to the recession of the economy in the pre-war situation in Somalia, a backlash hitting women trying to earn their living. To conclude, gender differences in a number of factors in the household-literacy, marital status and especially source of income-were disadvantageous for the women, increasing the mortality risk in this setting.

Adolescent↗
PubMed1997

Gender and social differences in adolescent sexuality and reproduction in Nicaragua.

PURPOSE: The aim of this research was to study gender and social differences in adolescent sexuality and reproduction, as reflected in age at first intercourse and age at first pregnancy, as a basis for future interventions in the municipality of León, Nicaragua. METHODS: In a community-based cross-sectional study including 7789 households, all women aged 15-49 years (n = 10,867) were interviewed about socioeconomic, sexual, and reproductive issues. A random subsample of men (n = 388) and women (n = 413) aged 15-49 years was interviewed in more detail about sexual patterns and reproduction. RESULTS: The median age at first intercourse for women and men was 17.8 and 16.2 years, respectively. Women's average latency period to end of first pregnancy was 22 months. There was a significant tendency to start active sexual life later among today's girls aged 15-20 years, compared to the groups 21-27, 28-35, and 36-49 years old. A similar trend was found in age at first pregnancy. These secular trends were not found among men. Age at first pregnancy for current adolescents was lower among those having less formal education. CONCLUSIONS: The short latency period between first sexual intercourse and end of first pregnancy, probably reflecting lack of access to counseling and contraception, is worrying in light of the growing sexually transmitted disease/human immunodeficiency virus threat. The secular trend of later start of reproduction, however, is a positive sign which partly may be an effect of increasing education in the Nicaraguan society.

Adolescent↗
PubMed1997

Endurance running performance in relation to cardiovascular risk indicators in adolescents.

We evaluated endurance running performance and body mass index (BMI) in relation to biochemical cardiovascular disease (CVD) risk indicators (s-lipids, s-insulin, s-ferritin), and blood pressure in 14- and 17-year-old healthy Swedish adolescents (n = 879), also considering current dietary intake and physical activity. Endurance running performance was assessed using a 3 km running test and height, body weight, waist and hip circumference, and skinfolds were measured at clinical examination. Physical activity and dietary intake were evaluated using self-reported 7-day-records. The results showed that high endurance running performance was related to a favourable CVD risk indicator profile. Multiple regression analyses including running time, BMI, physical activity, dietary fat and iron intake, and age as independent and s-lipids, s-insulin, and s-ferritin as dependent variables revealed that, in both boys and girls, low BMI was associated to a favourable s-lipid profile and lower s-insulin values and, in boys but not in girls, also to lower s-ferritin values. There were, however, no independent associations between level of physical activity or endurance running performance on the one side and s-lipids, s-insulin, or s-ferritin values on the other. High dietary fat intake was associated to s-lipids in a non-atherogenic direction; in boys to higher HDL-C and in girls to lower TG. In conclusion the study showed that body mass seems to be the most important factor explaining the differences in s-lipid and s-insulin values between adolescents with different level of physical performance capacity. An interesting finding was, that s-ferritin, being a proposed risk factor for CVD, in the older boys related to body mass in a similar way as s-lipids and s-insulin.

Adolescent↗
PubMed1997

Are there social inequities in child morbidity and mortality in rural Vietnam.

This study was conducted to investigate the relationship between various socio-economic factors, and child morbidity and mortality during a period of rapid social change in Vietnam. One-thousand-one-hundred-and-thirty-two rural mothers with children under 5 years of age were interviewed regarding their reproductive history, survival of their children, and morbidity of their children under 5 years of age. Causes of child death were established by a verbal autopsy technique. Fifty-seven per cent of the children were reported to have suffered from some illness during the preceding 2 weeks. Acute respiratory infection (ARI) (46 per cent of all children) was most common. Two-thirds of the sick children had been treated with antibiotics. Eighty-one children under 5 years of age had died during the 10-year period 1982-1992. Two-thirds of these deaths occurred in infancy, most of them were related to prematurity, asphyxia or tetanus. ARI was more common in poor families while neither education nor occupation were associated with ARI occurrence. No significant relationship between education or occupation of the mother and mortality was found. The low under-5 mortality (U5MR) in spite of the high morbidity may be related to good child health care both by families and by the health care system.

Analysis of Variance↗
PubMed1997

Which babies die during the first week? A case control study in a Nicaraguan hospital.

In a hospital-based case control study (108 and 285 infants) on risk factors for early neonatal death in Nicaragua, an analysis was performed on the possible association with characteristics of the mother and her environment, her reproductive history and contact with antenatal services as well as characteristics of the child. Antenatal medical supervision was associated with a lower risk for neonatal death, even when adjusting for parents' literacy. This association disappeared if birth weight or gestational age was entered into the analysis. There was an interaction between mortality and the mother's versus the father's literacy, showing the highest risk if the mother was illiterate and the father was literate (odds ratio, OR 7.0, CI 2.6-19.3), while illiteracy of both parents was associated to a lower risk (OR 4.2, CI 1.0-18.3). The strong association between maternal literacy and early neonatal death is striking. Is maternal empowerment the important factor?

Asphyxia Neonatorum↗
PubMed1996

Child spacing and two child policy in practice in rural Vietnam: cross sectional survey.

OBJECTIVE: To explore the reproductive pattern of women in rural Vietnam in relation to the existing family planning policies and laws. DESIGN: Cross sectional survey with question-naires on reproductive history. SETTING: Tien Hai, a district in Red River Delta area, where the population density is one of the highest in Vietnam. SUBJECTS: 1132 women who had at least one child under 5 years of age in April 1992. MAIN OUTCOME MEASURES: Birth spacing and probability of having a third child. RESULTS: The mean age at first birth was 22.2 years. The average spacing between the first and the second child was 2.6 years. Mothers with a lower educational level, farmers, and women belonging to the Catholic religion had shorter spacing between the first and second child and also a higher probability of having a third child. In addition, women who had no sons or who had lost a previous child were more likely to have a third child. CONCLUSION: Most families do not adhere to the official family planning policy, which was introduced in 1988, stipulating that each couple should have a maximum of two children with 3-5 years' spacing in between. More consideration should be given to family planning needs and perceptions of the population, supporting the woman to be in control of her fertility. This may imply improved contraceptive services and better consideration of sex issues and cultural differences as well as improved social support for elderly people.

Age Factors↗
PubMed1996

Contraceptive patterns among women and men in León, Nicaragua.

The aim was to study the contraceptive patterns among men and women in León, Nicaragua. A questionnaire about sexual, contraceptive, reproductive and socioeconomic issues was directed to 7,789 households including 22% of all women of the municipality aged 15-49 years (n = 10,867). A subsample of 388 men and 413 women aged 15-49 years was drawn at random. Refusals were less than 2%. Private interviews revealed that among fertile women who had been sexually active within the last three months, non-pregnant and wishing to avoid pregnancy, 77% were contracepting. Female sterilization was the most common contraceptive method (39%), followed by intrauterine device (16%). Even though around 60% of women at some time had tried oral contraceptives, only 13% of contraceptors used them currently. The rhythm and interruption methods together constituted only 4%. Condom use was low and mainly occasional. Contraceptive use in sexually active women aged 15-44 years was lower among those having lower education, living in rural areas, and living under poverty conditions. The predominance of female sterilization and the occasional condom use-mainly reported by men-reflects a situation of relative male control over contraception and reproduction. This probably originates from "machista" values where men having many children with different women are considered strong. There was also a significantly higher use of contraceptives among the better-off women and men compared with the extremely poor. The situation of many poor women, in a country with limited contraceptive services, is worrying considering that abortion is illegal and the threat of HIV epidemic is growing. The situation for adolescents is particularly problematic with low experience in contraceptive use.

Adolescent↗
PubMed1996

Insulin resistance syndrome in adolescents.

To explore whether the so-called insulin resistance syndrome can be identified in adolescents, serum insulin level was measured in 842 healthy Swedish adolescents (462 boys and 380 girls) and the values were related to current serum lipoprotein and apolipoprotein values (triglyceride [TG], total cholesterol [TC], high-density lipoprotein cholesterol [HDL-C), low-density lipoprotein cholesterol [LDL-C], apolipoprotein [apo] A-I, apo B, and lipoprotein(a)), blood pressure (BP), and anthropometric measurements and previous physical growth. Mean serum insulin values were higher in 14-year-olds as compared with 17-year-olds and were highest in midpuberty. Adolescents with a high serum insulin had a higher attained height and weight during infancy and childhood. Obesity (body mass index [BMI] > 30 kg/m2) was found in 1% of both boys and girls, and hypertensive BP levels were found in 3% of the boys and 1% of the girls. Controlling for age, serum insulin correlated positively with BMI (r = .36 and .25 in boys and girls, respectively), TG (r = .32 and .14), LDL-C (r = .17 and .24), and apoB (r = .23 and .23) and negatively with HDL-C (r = -.13 and -.21). High serum insulin, TG, LDL-C, and BP and low HDL-C clustered in adolescents with high BMI. In conclusion, the findings of this study indicate that features typical of the insulin resistance syndrome are already present in adolescents.

Adolescent↗
PubMed1996

Maternal factors influencing the occurrence of low birthweight in northern Vietnam.

The relationship between the birthweight of newborn infants and their mothers' health characteristics as well as socio-economic status were studied in 1474 consecutive deliveries from eight areas in the delta region of north Vietnam. The results showed that the proportion of low birthweight (LBW) infants varied from 7.9% to 12.5%. Body mass index (BMI) of the mothers, good nutrition during pregnancy and maternity leave before delivery were negatively associated with the occurrence of LBW. The association between chronic energy deficiency (low BMI) and LBW was seen only among the farming women. Measures should be taken to reduce the workload and to supply sufficient food for pregnant women, and special priority should be given to rural areas.

Adult↗
PubMed1996

Cardiovascular risk indicators cluster in girls from families of low socio-economic status.

We evaluated tobacco use, physical activity, dietary intake and cardiovascular risk indicators (s-lipids, s-insulin, s-ferritin, anthropometric measurements, blood pressure, physical fitness) in healthy 14- and 17-year-old Swedish adolescents in relation to socio-economic status (SES) of their parents. Girls reported more smoking than boys (14-year-olds 10 and 3%, 17-year-olds 27 and 18%, girls and boys, respectively). Daily smoking was associated to low SES of the family, but was most strongly associated to smoking in peers (OR = 58.7). Tobacco use was considerably higher among adolescents attending vocational programs at secondary high school as compared with theoretical programs. Daily smokers had a more unfavourable serum lipid profile compared with non-smokers. Adolescents from families with a low educational level of the mother had a higher relative dietary fat intake. Boys and girls from families of low SES had higher body mass index (BMI), and girls, but not boys, also had lower physical fitness. Clustering of high BMI, low physical fitness and daily smoking was more pronounced in girls from families of low SES. In conclusion, our study shows that in both boys and girls low SES and educational level of the parents are related to an unfavourable cardiovascular risk profile in Swedish adolescents. Furthermore, smoking in adolescents is more related to smoking in peers than to smoking in parents, implying that preventive efforts should focus on peer groups.

Adolescent↗
PubMed1996

Utilisation of reproductive health services in rural Vietnam; are there equal opportunities to plan and protect pregnancies?

STUDY OBJECTIVES: To describe the utilisation of reproductive health services (family planning, antenatal care, and delivery services) and the socioeconomic determinants for utilisation of health services. DESIGN: This was a cross sectional survey, using a multistage sampling technique. SETTING: Tien Hai district, Thai Binh Province, Vietnam. Altogether 1132 mothers with children under 5 years of age were interviewed about antenatal, delivery, and family planning services utilisation during a five year period (1987-92). MAIN RESULTS: Seventy per cent of the women used contraceptive methods, with the intrauterine device being the most common. The use of the intrauterine device was positively associated with the number of children alive but not with other sociodemographic factors in the mothers. Thirty per cent of the women had attended an antenatal clinic for check ups during their last pregnancy. It was found that mothers with fewer deliveries, higher education, and who were Buddhist or of no religion had utilised antenatal services more frequently than the others. Seventy five per cent of the mothers in this study had been assisted by health professionals at their last delivery. Those mothers with fewer deliveries, higher education, who were Buddhist or had no religion, and had sufficient to eat were more likely to have their births attended by health professionals. CONCLUSIONS: In spite of a relatively high education level in the population and services which are generally available, there was an under utilisation of antenatal and delivery care and there was no equal opportunity for different groups of mothers to use these services. Family planning services were, however, frequently used and were used to the same extent by different groups of mothers. Except for abortion, alternatives to the intrauterine device method were rarely available. If pregnancies are to be protected in an efficient way in rural Vietnam, reproductive health care must be strengthened and efforts should be made to reach the women who are not using these services at present.

Adult↗
PubMed1996

Child mortality in a collapsing African society.

A cohort study of mortality among under-5-year-olds was carried out in two Somali villages in 1987-89, a period of economic and political collapse in the rural parts of the country. Analysed was the relative importance of the social characteristics for under-5-year-old mortality against a background of deteriorating political and economic conditions. Mortality increased among under-5-year-olds from 1987 (211 per 1000) to 1988 (323 per 1000) to 1989 (414 per 1000). The mortality risk was more pronounced for boys than girls and was more so for infants than children aged 1-4 years. The major signs prior to death were respiratory infections, diarrhoeal diseases, fever/malaria and tetanus in the neonatal period. Over the 3-year study period mortality rates for diarrhoeal diseases increased significantly, while those for respiratory infections and diseases preventable by immunization increased more slowly. The increasing trend in under-5-year-old mortality was more pronounced in instances when the mother derived her major income from sources other than farming and in larger households.

Child, Preschool↗
PubMed1996

Utilization of reproductive health services in a mountainous area in Vietnam.

This study uses data from two surveys performed in 1991 and 1994 in a mountainous district of northern Vietnam. The aim was to describe the utilization of family planning, antenatal care, delivery and immunization services during a period of rapid structural change in the health services in general and implementation of a primary health care project in the study area. This project was aimed at increasing access to health services and improving the quality of primary health care services. Factors influencing the utilization of reproductive health services were analyzed. The contraceptive prevalence among women aged 15-49 increased significantly from 48% in 1991 to 60% in 1994. The most commonly used contraceptive method was intra-uterine devices. The BCG coverage among children under five years of age increased from 36 to 70%. The proportion of pregnant women receiving three antenatal check-ups, as recommended by the health authorities was low and increased slightly from 15% in 1991 to 20% in 1994. About one third of the pregnant women were delivered in health care institutions during this period. The utilization of family planning, antenatal care and delivery services varied with ethnicity and was positively related to the mother's educational level both in 1991 and 1994. There is a need to strengthen the reproductive health services, especially antenatal care and delivery services, in terms of improving the quality of care and accessibility to women. Efforts should be made to reach women with a low education level as well as those belonging to ethnic minorities.

Adolescent↗
PubMed1995

Serum lipid values in adolescents are related to family history, infant feeding, and physical growth.

Total serum cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), triglycerides (TG), apolipoprotein A-I (apo A-I), apolipoprotein B (apo B), and lipoprotein (a) (Lp(a)) were analysed in 879 14- and 17-year-old healthy adolescents (477 boys and 402 girls), and related to family history of cardiovascular disease, early feeding, weight and length at birth, and physical growth during infancy and childhood. Mean TC was significantly higher in girls than in boys (4.4 and 4.2 mmol/l, respectively, both age-groups together). High TC values ( > 5.2 mmol/l) were more prevalent in girls than in boys: 14% and 17% compared to 6% and 12% in 14- and 17-year-old girls and boys, respectively. Mean TC and LDL-C values were lower during mid-puberty in both boys and girls while, in boys but not in girls, mean HDL-C values decreased and TG values increased successively with increasing pubertal stage. Girls who were taking oral contraceptives had higher mean values of TC (4.91/4.39 mmol/l), TG (1.32/0.83 mmol/l), and apo B (0.89/0.73 g/l). Boys with a family history of early deaths ( < 55 years) from myocardial infarction and girls with a family history of cerebral haemorrhage/thrombosis in fathers had higher mean values of TC (4.55/4.17 and 5.03/4.40 mmol/l, for boys and girls, respectively), LDL-C (2.84/2.47 and 3.08/2.56 mmol/l), and apo B (0.73/0.70 and 0.86/0.73 g/l). Adolescents with short duration of breast feeding ( < 6 months), or early introduction of infant formula, had higher mean values of TC (4.29/4.14 mmol/l) and apo B (0.72/0.68 g/l). There were no significant correlations between serum lipid values and body weight or length at birth, but adolescents with high LDL-C (upper quartile) seemed to have lower attained heights during infancy and childhood. In conclusion, this study shows that serum lipids in adolescence are primarily related to age and sex but also to early determinants like family history of cardiovascular diseases, infant feeding, and early physical growth.

Adolescent↗