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Biomedical subjects

Staffan Bergström

Publications and source records attributed to Staffan Bergström.

At least 19 recordsLinked to original sources
PubMed2006

Determination of polybrominated diphenyl ethers at trace levels in environmental waters using hollow-fiber microporous membrane liquid-liquid extraction and gas chromatography-mass spectrometry.

In this study, we present a simple and easy-to-use extraction method that is based on a hollow-fiber microporous membrane liquid-liquid extraction (HF-MMLLE), as an extraction technique, followed by gas chromatography-mass spectrometry (GC-MS) to determine a group of brominated flame retardants (BFRs), polybrominated diphenyl ethers (PBDEs), at trace levels in aqueous samples. The hollow-fiber membrane (HF) filled with organic solvent was immersed into the aqueous sample, spiked with the analytes at ng l(-1) level, and stirred for 60 min. The proposed method could attain enrichment factors (E(e)) up to 5200 times, after optimising parameters, such as organic solvent, stirring speed and extraction time, that affect the extraction. The HF-MMLLE-GC-MS method was successfully applied to the extraction of PBDEs from tap, river and leachate water samples with spike recoveries ranging from 85% to 110%. The method validation with reagent and leachate water samples provided good linearity, detection limits of 1.1 ng l(-1) or lower, both in reagent and leachate water, as well as satisfactory precision in terms of repeatability and reproducibility with values of % relative standard deviation (%RSD) lower than 8.6 and 16.9, respectively.

Bromine↗
PubMed2006

Extracting Syringe for determination of organochlorine pesticides in leachate water and soil-water slurry: a novel technology for environmental analysis.

The Extracting Syringe (ESy), a novel membrane-based sample preparation technique directly coupled as an autosampler to gas chromatography, has been employed for the analysis of organochlorine pesticides (OCPs) in raw leachate water. The ESy has also been applied for extraction of OCPs from contaminated soil samples and its performance has been compared to liquid-solid extraction (LSE) and accelerated solvent extraction (ASE). Extraction of 3-mL leachate sample at the optimised conditions resulted in enrichment factors from 32 (Endrin aldehyde) to 242 (Endrin) and detection limits from 1 to 20 ng/L. The inter-day and intra-day repeatability (% RSD) at 100 and 500 ng/L were <6% and <24%, respectively. The relative recovery at 100 and 500 ng/L ranged from 68% (Aldrin) to 116% (Endrin aldehyde); except Heptachlor that showed 51 and 60%, respectively. The ESy extraction of the slurry-made soil samples revealed occurrence of Endosulfan I (18.2 microg/g soil), 4,4'-DDE (2.6 ng/g soil), Endosulfan II (8.7 microg/g soil) and Endosulfan sulfate (1.1 microg/g soil); showing good agreement with LSE results. The total ESy consumption of organic solvents was 4.2 mL from which only 0.6 mL n-undecane was used during the extraction step (7 microL for the extraction per se), while in the LSE and ASE, it was 420 and 18.1 mL, respectively. The ESy extraction time (0.5 h) was comparable to the ASE time (0.6 h); and the time required for the LSE was 3.75 h. To sum up, the ESy has shown its competency to LSE and ASE technologies, demonstrating its applicability for environmental analysis of organic pollutants, towards green techniques for green environment.

Acetonitriles↗
PubMed2006

Being different and vulnerable: experiences of immigrant African women who have been circumcised and sought maternity care in Sweden.

The purpose of the study was to explore the encounters with the health care system in Sweden of women from Somalia, Eritrea, and Sudan who have been genitally cut. A qualitative study was performed through interviews with 22 women originally from Somalia, Sudan, and Eritrea who were living in Sweden. The women experienced being different and vulnerable, suffering from being abandoned and mutilated, and they felt exposed in the encounter with the Swedish health care personnel and tried to adapt to a new cultural context. The results of this study indicate a need for more individualized, culturally adjusted care and support and a need for systematic education about female genital cutting for Swedish health care workers.

Adult↗
PubMed2006

The challenge of improving perinatal care in settings with limited resources. Observations of midwifery practices in Mozambique.

The aim of this study was to observe and analyse midwifery care routines related to asphyxia and hypothermia during the perinatal period and to investigate the effect of an in-service education program. A direct non-participant pre- and post-intervention observation study of midwifery a performance during childbirth was conducted at a labour ward in Maputo. The observed groups consisted of 702 and 616 midwifery-attended deliveries. Examination was also conducted of the partographs (702 vs. 616). The quality of midwifery care related to prevention and early detection of asphyxia and hypothermia was found to be inadequate and the intervention had no significant effect upon the midwives' performances. This could be attributed to the quality of the intervention itself or to failure of implementing managerial decisions such as transfer of partograph documentation from obstetricians to midwives. Change in professional performance does not automatically follow awareness of evidence-based midwifery practices, but requires behavioural change, which may be more difficult to achieve.

Adolescent↗
PubMed2005

Postpartum hemorrhage: a prospective, comparative study in Angola using a new disposable device for oxytocin administration.

BACKGROUND: Postpartum hemorrhage (PPH) is the single most common cause of maternal death in the world, and oxytocin is known to be effective for its prevention and treatment. The use of syringes can be problematic in areas affected by HIV. The aim of this study was to introduce Uniject (a new disposable device for administration of 10 IU oxytocin) as part of active management of the third stage of labor (AMTL) and try to reduce PPH. METHODS: A prospective, comparative study was performed between March 1998 and May 2000 in Luanda. Seven hundred and eighty-two parturient women with physiological management were compared to 814 with AMTL. Postpartum lost blood was collected using a plastic sheet during labor and a bucket placed under a cholera bed for 2 h postpartum. Student's t-test and chi(2) test were used. RESULT: PPH was reduced from 40.4 to 8.2% and severe PPH (> or =1000 ml) from 7.5 to 1% in the AMTL group (P < 0.001). CONCLUSIONS: Uniject was well tolerated and offers an alternative for oxytocin administration. AMTL should be implemented also in resource-poor settings as a routine management to reduce PPH.

Angola↗
PubMed2005

Obstetric ectoscopy: an eye-opener for hospital-based clinicians.

Obstetricians show a disproportionately small or even insignificant interest in alarming maternal mortality and maternal ill health in underserved and impoverished countries. We keep silent or are indifferent in areas of our expertise instead of reminding politicians of the "scandal of our time", the maternal mortality. The historical roots of this fallacy is discussed. An outward-looking attitude ("ectoscopy") is needed in undergraduate and postgraduate training in obstetrics and gynecology, incorporating skills in auditing various aspects of quality care in community obstetrics. Programming to reduce maternal and perinatal ill-health should be given emphasis in specialist training in obstetrics and gynecology.

Attitude of Health Personnel↗
PubMed2005

Obstetric ectoscopy, also a paediatric concern.

By coining a new concept, "obstetric ectoscopy", attention is drawn to the fact that undergraduate and postgraduate training in obstetrics and perinatal medicine in low-income countries is not geared towards community obstetrics, rather to more prestigious and lucrative endoscopy. It is argued that the devastation of maternal mortality leaves the clinical profession inactive and indifferent and that a more ectoscopic spirit would better prepare future obstetricians in efforts to enhance maternal and perinatal survival.

Developing Countries↗
PubMed2005

Urogenital complications among girls with genital mutilation: a hospital-based study in Khartoum.

To explore paediatric complications of female genital mutilation (FGM), 255 consecutive girls aged 4-9 years presenting to an emergency ward in Sudan were included in this clinical study. Full examination, including inspection of genitalia, was performed. Dipsticks for nitrite and leucocytes were used to diagnose suspected urinary tract infection (UTI). Girls with a form of FGM narrowing vulva had significantly more UTI than others, and among girls below the age of seven there was a significant association between FGM and UTI. Only 8% of girls diagnosed as having UTI reported urogenital symptoms. In spite of the fact that 73% of the girls subjected to FGM were reported to have been bedridden for one week or more after the operation, only 10% stated immediate complications. We conclude that FGM contributes significantly to morbidity among girls, a large share of which does not come to medical attention.

Child↗
PubMed2005

Women's perceptions of pain and discomfort after childbirth in Angola.

Prophylactic treatment against postpartum haemorrhage is a widely investigated area and injection of Oxytocics has been considered as the best choice. The occurrence of postpartum pain and discomfort was studied in a population of birthing women in an overcrowded labour ward in Angola where the oxytocin-filled device Uniject was used. This study indicates that birthing women's perceived postpartum pain increases with parity and during breastfeeding, but does not confirm that injection of oxytocin increases pain and discomfort. This is an important finding, since it might facilitate the introduction of a management practice, likely to reduce haemorrhage-related maternal morbidity and mortality after delivery in underprivileged populations. The birthing women were, by and large, satisfied with the care and treatment provided, but the encounters with midwives seem to vary in quality. Further investigation is needed to elucidate parturient women's experience of postpartum pain and their perceptions of the quality of care and treatment.

Adult↗
PubMed2004

Miniaturized and automated sample pretreatment for determination of PCBs in environmental aqueous samples using an on-line microporous membrane liquid-liquid extraction-gas chromatography system.

A new, fast, and automated sample pretreatment technique for determination of lipophilic organic compounds in aqueous samples has been developed and applied to the determination of polychlorinated biphenyls (PCBs) in environmental river water. It is based on miniaturized microporous membrane liquid-liquid extraction coupled on-line to gas chromatography (GC) with electron capture detection. The heart of the system that simultaneously connects the sample pretreatment step to the final GC analysis has been named the extracting syringe (ESy). The ESy carries a miniaturized membrane extraction card attached to an electrically and mechanically designed installment and is mounted directly over a GC injector for fully automated injection of the extract. A method was developed to extract 10 PCB congeners from 1-mL water samples (after addition of 40% acetonitrile) with an extraction time of 10 min. The optimized methodology showed good linearity (in the dynamic concentration range of 5 ng L(-)(1)-1 microg L(-)(1)), enrichment factors of 33-40 times, repeatable extractions (RSD 2-5%, n = 4), and low detection limits (2-3 ng L(-)(1)). Acetonitrile had to be added to the samples in order to overcome the influence of PCB adsorption on the repeatability of extraction and enrichment and to minimize the overall memory effect (OME). OME and carryover depended not only on the concentration of the organic solvent added to the sample and that used in the washing procedure but also on whether the extracting card was changed or not. When an optimized washing procedure was applied, the OME was approximately 0.2% at high concentrations (i.e., 1 microg L(-)(1)). When each extraction took place in a new extraction card, no OME was detected. Additionally, no significant adsorption onto glass surfaces or a matrix effect on extraction was noticed. The main features of this methodology are good extraction repeatability, low detection limits at short extraction time, and the unsurpassed characteristic of no detectable OME in the entire system when each sample is processed in a new card. The total consumption of organic (nonchlorinated) solvents is less than 5 mL per sample.

Journal Article↗
PubMed2004

An explorative study of Sudanese midwives' motives, perceptions and experiences of re-infibulation after birth.

OBJECTIVE: to explore Sudanese midwives' motives for and perceptions and experiences of re-infibulation after birth and to elucidate its context and determinants. DESIGN: triangulation of methods, using observational techniques and open-ended interviews. SETTING AND PARTICIPANTS: two government hospitals in Khartoum/Omdurman, Sudan, for the observations and in-depth interviews with 17 midwives. FINDINGS: midwives are among the major stakeholders in the performance of primary female genital cutting (FGC) as well as re-infibulation. Focusing on re-infibulation after birth, midwives were trying to satisfy differing, and sometimes contradictory, perspectives. The practice of re-infibulation (El Adel) represented a considerable source of income for the midwives. The midwives integrated the practice of re-infibulation into a greater whole of doing well for the woman, through an endeavour to increase her value by helping her to maintain her marriage as well as striving for beautification and completion. They were also trying to meet socio-cultural requests, dealing with pressure from the family while balancing on the edge of the law. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: the findings confirm that midwives are important stakeholders in perpetuating re-infibulation, and indicate that the motives are more complex than being only economic. The constant balancing between demands from others puts the midwives in a difficult position. Midwives' potential role to influence views in the preventative work against FGC and re-infibulation should be acknowledged in further abolition efforts.

Adult↗
PubMed2004

A longitudinal study on different models of postabortion care in Tanzania.

OBJECTIVE: To identify women having unsafe abortions and elucidate whether an acceptable follow-up rate among these women can be retrieved. STUDY POPULATION: One thousand three hundred and fifty-seven women attended Temeke Municipal Hospital, Dar es Salaam with an abortion-related diagnosis. METHODS: Women having unsafe abortions were identified by an empathetic dialogue, offered a contraceptive service and asked to return for follow-up. Three different ways of achieving follow-up information were tested. In phase 1, a combination of hospital-based and home-based interviews was utilized, in phase 2, an additional 1-month control visit was added to the protocol, and in phase 3, the contraceptive counseling and service was provided by technically well-skilled counselors. RESULTS: Seven hundred and eighty-eight women were identified as having had unsafe abortions and 491 women as spontaneous abortions. Women having unsafe abortions were younger, more often single and of higher parity than women having spontaneous abortions. The follow-up rate achieved varied from 47%-72%, being lowest in phase 1 and highest in phase 3. The two most common reasons for loss to follow-up were the interviewer's inability to locate the respondent's house either because of an unspecific or a remote address (58%) and migration (29%). CONCLUSION: If hospital-based and confidential home-based interviews are used combined and if the women having unsafe abortions are counseled by technically well-skilled counselors, it is possible to achieve a reasonable follow-up rate among women having unsafe abortions.

Abortion, Induced↗
PubMed2003

Choice of antibiotics for infection prophylaxis in emergency cesarean sections in low-income countries: a cost-benefit study in Mozambique.

BACKGROUND: There is a need to assess the cost-benefit of different models of antibiotic administration for the prevention of post cesarean infection, particularly in resource-scarce settings. DESIGN: Randomized, nonblinded comparative study of a single combined preoperative dose of gentamicin and metronidazole vs. a post cesarean scheme for infection prophylaxis. METHODS: Pregnant women (n = 288) with indication for emergency cesarean section were randomly allotted to two groups. Group 1 (n = 143) received the single, combined dose of prophylactic antibiotics and group 2 (n = 145) received, over 7 days, the postoperative standard scheme of antibiotics followed in the department. Both groups were followed up during 7 days for detection of signs of wound infection, endometritis, peritonitis and urinary tract infection. MAIN OUTCOME MEASURES: Prevalence of postoperative infection, mean hospital stay and costs of antibiotics used. RESULTS: Women completing the study (n = 241) were distributed into group 1 (n = 116) and group 2 (n = 125). No significant difference was found neither in the prevalence of postoperative infection nor in the mean hospital stay. No death occurred. The cost of the single dose of prophylactic antibiotics was less than one-tenth of the cost of the standard postoperative scheme. CONCLUSION: In our setting, the administration of a single dose of 160 mg of gentamicin in combination with 500 mg of metronidazole before emergency cesarean section for prevention of infection is clinically equivalent to existing conventional week-long postoperative therapy, but at approximately one-tenth of the cost.

Adult↗
PubMed2003

The impact of adjustment for parity and mid-upper-arm circumference on sensitivity of symphysis-fundus height measurements to predict SGA foetuses in Mozambique.

BACKGROUND: With a new symphysis-fundus height (SFH) growth chart, based on Mozambican women with ultrasound-dated singleton pregnancies, the aim was to examine the possibility to enhance sensitivity of predicting small for gestational age (SGA) newborns by attempts to adjust the chart for parity and for mid-upper-arm circumference (MUAC). METHODS: Two antenatal clinics were chosen in the suburban area of Maputo City. A cohort of 904 consecutively recruited antenatal clients was followed until birth. Gestational age was determined by ultrasound at enrolment. The growth of the SFH was measured every 2-3 weeks. Women with multiple pregnancy or with gestational age >21 weeks at enrolment were excluded. Attempts were made to adjust SFH measurements for parity and MUAC by developing a mathematical model to increase sensitivity of the SFH method to predict a foetus being SGA. RESULTS: Parous women had on average 0.5-1 cm higher SFH readings than nulliparous women. Women with a body mass index (BMI) <19 and women with BMI >27 had approximately 1 cm lower and 1 cm higher readings, respectively, compared with women of normal BMI. There was a significant correlation between BMI and MUAC (r = 0.621; P < 0.001). The usefulness of SFH measurements to predict SGA newborns was analysed. The sensitivity was 49%, the specificity was 66%, the positive predictive value was 14% and the negative predictive value, 93%. By using the correlation between BMI and MUAC we tried to find a simple and useful method to improve the sensitivity of SFH to detect SGA foetuses. By reducing the SFH measurement by 1 cm for women with MUAC >29 and by 1 cm for multiparous women the sensitivity raised to 65% at the expense of reducing the specificity to 51%. Using a linear function of BMI, MUAC and parity to adjust the SFH measurement for each individual woman, it was possible to get a sensitivity of 70% with a corresponding specificity of 56%. CONCLUSION: By using BMI, MUAC and parity, it might be possible to improve the sensitivity of the SFH growth chart in predicting newborn being SGA but mostly at the expense of specificity.

Arm↗
PubMed2003

Infectious aetiology of jaundice among pregnant women in Angola.

The contribution of viral hepatitis, human immunodeficiency virus (HIV) infection and malaria to jaundice among pregnant women in Luanda, Angola, was studied. 20 pregnant women with jaundice (cases) were identified in 2 large maternity hospitals and compared with 40 pregnant women without jaundice (controls). Among the cases 6 patients died, whereas no death occurred in the control group (p < 0.001). Five spontaneous abortions and 6 stillbirths were also noted among the cases, implying foetal loss in 55% and stillbirth in 30%. One stillbirth was registered among control women. Of the cases 40% had anti-hepatitis E virus antibodies compared with 13% of the controls (p = 0.02). Plasmodium falciparum parasitaemia occurred in 47.5% and 5% of cases and controls, respectively (p < 0.001). There was no difference in the prevalence of antibodies against hepatitis C or HIV among cases and controls. The carriership of hepatitis B surface antigen was 10% in both groups. In conclusion, jaundice during pregnancy is often associated with maternal mortality in Luanda, women suffering from jaundice during pregnancy have an extremely high case fatality rate, and P. falciparum and hepatitis E are associated with jaundice in the setting studied.

Angola↗