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Biomedical subjects

U Högberg

Publications and source records attributed to U Högberg.

At least 19 recordsLinked to original sources
PubMed2004

Wellbeing and mental growth-long-term effects of legal abortion.

The present study aims to increase knowledge about coping with legal abortion by studying women's reasoning, reactions and emotions over a period of 1 year. The study comprises interviews focusing on the experiences and effects of abortion in 58 women, 4 and 12 months after the abortion. The women also answered a questionnaire before the abortion concerning their living conditions, decision-making process and feelings about the pregnancy and the abortion. Majority of the women did not experience any emotional distress post-abortion and almost all the woman reported that they had coped well at the 1-year follow-up, although 12 had had severe emotional distress directly post-abortion. Furthermore, almost all described the abortion as a relief or a form of taking responsibility and more than half reported only positive experiences such as mental growth and maturity of the abortion process. Those without any emotional distress post-abortion stated clearly before the abortion that they did not want to give birth since they prioritised work, studies and/or existing children. The study shows that women generally are able to make the complex decision to have an abortion without suffering any subsequent regret or negative effects, as ascertained at the 1-year follow-up.

Abortion, Legal↗
PubMed2002

The role of demographic surveillance systems (DSS) in assessing the health of communities: an example from rural Ethiopia.

Longitudinal demographic surveillance systems (DSSs) in selected populations can provide important information in situations where routine health information is incomplete or absent, particularly in developing countries. The Butajira Rural Health Project is one such example, initiated in rural Ethiopia in 1987. DSSs rely on regular community-based surveillance as a means of vital event registration, among a sufficient population base to draw meaningful conclusions about rates and trends in relatively rare events such as maternal death. Enquiries into specific health problems can also then use this framework to quantify particular issues or evaluate interventions. Demographic characteristics and trends for a rural Ethiopian population over a 10-y period are presented as an illustration of the DSS approach, based on 336 000 person-years observed. Overall life expectancy at birth was 50 y. Demographic parameters generally showed modest trends towards improvement over the 10-y period. The DSS approach is useful in characterising populations at the community level over a period of time, providing important information for health planning and intervention. Methodological issues underlying this approach need further exploration and development.

Adolescent↗
PubMed2002

The impact of neonatal mortality on subsequent survival in rural Ethiopia.

In countries where most deliveries occur at home and most available information is hospital-based, accurate information on neonatal mortality is difficult to obtain. This study was conducted in a rural community in Ethiopia that has been under monthly demographic surveillance since 1987. The analysis in this paper was based on data collected in the 1st decade (1987-96) and this database was used to calculate mortality incidence rates and analyse survival. The overall neonatal mortality rate was 27/1000 live births (95% CI 24.5-29.5). The rates in the early and late neonatal periods were 20 and 8/1000 live births, respectively (95% CIs 18.0-22.9 and 6.6-9.4). The mortality incidence rates show that, every day, three of every 1000 newborns die in their 1st week of life. Neonatal mortality accounted for 43% of infant mortality. If all neonates survived the 1st week of life, life expectancy would increase by 1 year. Increased risk of neonatal mortality was found to be associated with living in a rural lowland area, twin births and male gender. This paper also addresses the need for further identification of the complex environmental and behavioural risk factors for neonatal mortality and for instituting appropriate and affordable interventions to reduce neonatal mortality.

Developing Countries↗
PubMed2001

Legal abortion: a painful necessity.

This study was conducted to increase knowledge about the psychosocial background and current living conditions of Swedish women seeking abortion, along with their motives for abortion and their feelings towards pregnancy and abortion. Two hundred and eleven women answered a questionnaire when they consulted the gynaecologist for the first time. The study indicates that legal abortion may be sought by women in many circumstances and is not confined to those in special risk groups. For example, most women in the sample were living in stable relationships with adequate finances. The motives behind a decision to postpone or limit the number of children revealed a wish to have children with the right partner and at the right time in order to combine good parenting with professional career. The study shows that prevailing expectations about lifestyle render abortion a necessity in family planning. One-third of the women had had a previous abortion(s) and 12% had become pregnant in a situation where they had felt pressured or threatened by the man. Two-thirds of the women characterised their initial feelings towards the pregnancy solely in painful words while nearly all the others reported contradictory feelings. Concerning feelings towards the coming abortion, more than half expressed both positive and painful feelings such as anxiety, relief, grief, guilt, anguish, emptiness and responsibility, while one-third expressed only painful feelings. However, almost 70% stated that nothing could change their decision to have an abortion. Thus, this study highlights that contradictory feelings in relation to both pregnancy and the coming abortion are common but are very seldom associated with doubts about the decision to have an abortion.

Abortion, Legal↗
PubMed2001

Long-term impact of reproductive factors on the risk of cervical, endometrial, ovarian and breast cancer.

The influence of maternal age, parity, low or high birthweight, multiple births, and pre-eclampsia on the risk of cervical, endometrial, ovarian and breast cancers was studied. Data on 40951 women and the outcomes of their deliveries between 1955 and 1995 were obtained from birth registers. For the mothers, data from the Swedish Cancer Registry and the Cause of Death Register were added. The sample was evaluated using Cox's regression in univariate and bivariate analyses where the relative risk and its 95% confidence interval were calculated. Increasing maternal age at first birth was associated with an increasing relative risk of endometrial, ovarian, and breast cancers, and with a decreased risk of cervical cancer. Multiparity was a protective factor for all gynaecological cancers, including cervical and breast cancers. Multiple births were associated with an increased risk of endometrial cancer.

Adolescent↗
PubMed2001

Fetal exposure, heredity and risk indicators for cardiovascular disease in a Swedish welfare cohort.

BACKGROUND: The overall aim was to test whether low birthweight (LBW) in newborns is associated with the risk indicators for cardiovascular disease in early middle age, even in a welfare society. Further, a possible interaction of LBW and heredity for myocardial infarction or stroke was investigated. METHODS: Overall, subjects were identified as newborns in a local birth register, and as adult participants, in the Västerbotten Intervention Program (n = 7876). Outcome measures such as systolic (SBP) and diastolic blood pressures (DBP), body mass index (BMI), cholesterol, triglycerides and anthropometrics were investigated (at age 29-41 years) in relation to LBW. RESULTS: Low birthweight was associated with increased SBP and DBP. Triglycerides were elevated among women with LBW and total cholesterol was elevated in men with LBW. Heredity for myocardial infarction or stroke interacted with LBW, and indicated a synergistic effect on the level of SBP. The BMI did not differ between LBW and normal birthweight subjects. CONCLUSIONS: Our interpretation is that the 'fetal origins' hypothesis' is valid for middle-age subjects who grow up in a welfare society. The population attributable proportions that result from different exposures to LBW were relatively small overall; from a public health perspective, heredity was more important than LBW for elevated SBP.

Adult↗
PubMed2001

The very preterm infant - a population-based study.

OBJECTIVES: The aim of this study was to assess perinatal risk factors and the survival of the very preterm infant in comparison with birth beyond 32nd birthweek, as well as health care utilization by mothers and infants in the Northern Health Region of Sweden. DESIGN: A population-based study was designed of all children (66,646) born in the Northern Health Region of Sweden during 1991-1996 and registered in the Swedish Medical Birth Registry. METHODS: Maternal and perinatal factors of infants born very preterm, that is, at < or =27 and 28-31 weeks of gestation, were analyzed for relative risk (RR), and a 95% confidence interval (CI), and compared with those of infants born 32-36 weeks of gestation. RESULTS: Of the 66,646 infants registered, 3,493 (5.2%) were born at 32-36 weeks, 394 (0.6%) at 28-31 weeks, and 199 (0.3%) at 22-27 weeks' gestation. No special socio-demographic maternal factors characterized these preterm births. The very preterm infants were more prone to perinatal complications such as premature rupture of the membranes (PROM) (RR=4.13; 95% CI=3.07-5.55), and both PROM and hemorrhage (RR=7.80; 95% CI=3.43-17.72). Infants born very preterm were more often twins, growth-retarded, malformed, and affected by sepsis and respiratory distress. There was significantly better survival of preterm infants born at < or =27 weeks' gestation if their mothers were given tertiary perinatal care. For infants born extremely preterm, survival tended to be better if they were delivered by cesarean section. CONCLUSION: The very preterm birth is more often than not a result of a complicated pregnancy. The infant is often sick before birth, and for its survival is highly dependent on the highest level of perinatal care.

Adult↗
PubMed2001

Contraceptive risk-taking in women and men facing legal abortion.

OBJECTIVE: The aim of the study was to gain knowledge about contraceptive use, reproductive risk-taking and sexuality in Swedish women seeking abortion and their partners. METHODS: Two hundred and eleven women and 75 men answered a questionnaire before the abortion. The data have been divided into six subgroups: women with and without previous experience of abortion, single women and women with a partner relationship, and women whose partner participated in the study and the male partners. RESULTS: The main findings showed that there are more similarities than differences between the subgroups. Overall, there were no differences regarding use of contraceptives, sexual life and psychosocial characteristics. However, women with previous abortion experience were found to be older, had longer partner relationships and more often had children. Some gender differences were also found, i.e. women favored coitus-dependent contraceptives to a larger extent and took more responsibility for preventing unwanted pregnancies. At the time of conception, half the participants had not used any contraceptive methods and one-fifth had relied on 'natural family planning'. The most common reasons for not using contraceptives were related to risk-taking and/or to strong sexual desire. Twelve per cent of the women had felt pressure/threat from their partner in connection with the conception. CONCLUSION: In efforts to prevent undesired pregnancies, this study highlights the need to incorporate a gender perspective both in communication about risk-taking and in counselling about contraceptives.

Abortion, Legal↗
PubMed2000

Somalis giving birth in Sweden: a challenge to culture and gender specific values and behaviours.

OBJECTIVES: Giving birth in a foreign country implies going through a life event with little or no access to your own traditions and social support. The aim of this study was to study the childbirth experiences of Somali women and men in Sweden. DESIGN: Qualitative. Nine women and seven men were interviewed. Data collection was characterised by an openness to new ideas during the interview and the interviews were analysed according to the grounded theory technique. FINDINGS: The meeting of Somalis with Swedish antenatal and delivery care was a multicultural event. It revealed social, medical, cultural and gender factors advocating space in the arena of childbirth. The Somalis constituted a homogeneous group with regard to their cultural belonging and motives for exile. The subjects were heterogeneous in that they represented a great variety in social and demographic background as well as in experiences, feelings and modes of expression. One striking finding was the Somali man's dramatic entrance into childbirth, which seemed to have a strong impact on the Somali woman's well-being during delivery. The study showed difficulties in getting used to the Swedish model of parenthood and in finding new role divisions in the couple relationship. Some of the subjects had experienced a strengthening of their marriage and an increased understanding of each other. Others commented that various aspects of traditional womanhood and manhood were lost as a result of the unfamiliar gender structures in Sweden. CONCLUSION: The Somalis' experiences of childbirth in Sweden can be understood by using the theoretical concept of gender, rather than culture. Our own and other studies show that women and men may have different frames of reference in childbirth, where the women mainly focus on biological circumstances and the men on the social and cultural aspects of birth. The Somali couple were found to be vulnerably positioned, with the professionals having the important role of supporting and empowering Somali parents.

Culture↗
PubMed2000

Prolonged labour attributed to large fetus.

The aim of this study is to assess the interactive dynamics of power, passenger and passage in relation to an adverse course of labour. The design was a community-based follow-up of all women with singleton pregnancies experiencing spontaneous term labour. Median of first stage was 2.6 h for multiparas and 3.7 h for primiparas. Median of second stage was 20 min for multiparas and 91 min for primiparas. Heavy birth weight significantly influenced a prolonged late first stage OR 6.6 (CI 2.1-21) and second stage of labour OR 4. 5 (CI 1.5-14) among primiparas. The attributable proportions of heavy birth weight for prolonged labour were 19-21%. Large paediatric head circumference showed a positive correlation to prolonged late first stage OR 3.2 (CI 1.2-9) and intervention OR 7.2 (CI 1.8-35), with an attributable proportion of 22%. For multiparas no significant association were found. To conclude, this study indicates that heavy birth weight and large head circumference contribute to 1/5th of the prolongation of labour and interventions among primiparas.

Body Height↗
PubMed2000

Suffocated prone: the iatrogenic tragedy of SIDS.

Epidemiologic research has shown that prone sleeping is a major risk factor for sudden infant death syndrome (SIDS). In a public health review from Sweden, we explored the historical background of the SIDS epidemic, starting with the view of the Catholic Church that sudden infant deaths were infanticides and ending with the slowly disseminated recommendation of a prone sleeping position during the 1960s, 1970s, and 1980s. The story of the SIDS epidemic illustrates a pitfall of preventive medicine--the translation of health care routines for patients to general health advice that targets the whole population. False advice, as well as correct advice, may have a profound effect on public health because of the many individuals concerned. Preventive measures must be based on scientific evidence, and systematic supervision and evaluations are necessary to identify the benefits or the harm of the measures. The discovery of the link between prone sleeping and SIDS has been called a success story for epidemiology, but the slow acceptance of the causal relationship between prone sleeping and SIDS illustrates the weak position of epidemiology and public health within the health care system.

Asphyxia↗
PubMed2000

Community-based prevention of perinatal deaths: lessons from nineteenth-century Sweden.

BACKGROUND: Perinatal deaths have been more difficult to prevent than infant deaths in low- income countries due to its close relation to poor maternal outcome. The aim of the study was to perform a comprehensive population-based analysis of perinatal mortality in a high mortality setting and to determine the impact of midwifery-assisted home deliveries. METHOD: The study design was a community-based cohort study. In all, 4876 perinatal deaths were recorded among 116 211 newborns in the districts of Sundsvall and Skellefteâ in northern Sweden during the years 1831-1899. Relative risks, 95% CI, population attributable proportions and prevented fractions were calculated. RESULTS: The overall perinatal mortality rate was 42.0 per 1000 births. A previous stillbirth represented one of the most important risk factors (RR = 3.25, 95% CI : 2.97-3.56), with a population attributable proportion of 7%. Two or more previous stillbirths gave an RR of 8.50 (95% CI : 7.58-9.53) and a population attributable proportion of 4%. There was an increased risk of perinatal mortality for mothers over 35 years old, the primiparous and the unmarried, while grandparous women had a higher perinatal mortality that was accounted for completely by a poor history of previous stillbirths and infant deaths among these women. The children of crofters, farmers and workers had higher perinatal mortality, but area had no significant impact. During the years 1881-1890 and 1891-1899, the prevented fractions of midwifery were 15% and 32%, respectively. CONCLUSION: Poor reproductive history, particularly previously high perinatal mortality, is associated with high perinatal mortality. Midwifery-assisted at home deliveries successfully reduced perinatal mortality.

Female↗
PubMed2000

Swedish maternal mortality in the 19th century by different definitions: previous stillbirths but not multiparity risk factor for maternal death.

BACKGROUND: The high maternal mortality levels in today's developing countries were also found throughout the history of currently affluent countries. The parish information system in Sweden offers unique possibilities for research in historical cohorts. Furthermore, vital events surveillance systems are scarce in today's developing countries. METHODS: This cohort study covers 42,387 mothers who gave birth to 150,932 infants during the 19th century in the Skellefteå and Sundsvall areas. Among these women, 1,237 were dead within one year after delivery. The analysis of the cause of these deaths was done according to the various ICD definitions. Parity five and above was defined as grand multiparity. RESULTS: Maternal mortality ratios, deaths per 100,000 live births were as follows: 256.4 (direct obstetric deaths), 320.7 (direct and indirect obstetric deaths), 489.2 (pregnancy-related deaths), 347.8 (late maternal deaths) and 837.0 (maternal deaths and late maternal deaths). In this study, 59% of all maternal deaths occur within the first 42 days of delivery, two thirds of them having direct and indirect obstetric causes. Of the late maternal deaths, the bulk were infectious or other indirect deaths, mirroring more general female mortality and the pre-existent endemic situation of tuberculosis and other infectious diseases. The combination of previous stillbirth and infant death represented the highest risk ratios, RR 2.77-3.62, while grand multiparity was not associated with increased risk. Urbanized and industrialized areas tended to have higher maternal mortality. CONCLUSIONS: In conclusion, this study shows that the mother's reproductive history was the most important risk factor measured for all definitions of maternal death. Grand multiparity did not increase the risk of maternal death. Maternal mortality ratio varied threefold in the study population, depending on the definition used. The high mortality ratios found in this study, only declining by the end of the century, should be interpreted as a general condition of the society since no significant differences could be perceived regarding social class, while unmarried women were more at risk.

Cause of Death↗
PubMed2000

Aims, options and outcomes in measuring maternal mortality in developing societies.

BACKGROUND: Effective methods for measuring maternal mortality in developing countries are important, particularly in assessing interventions aiming for safer motherhood. Here the performance of different approaches is compared in the same setting. METHODS: Estimates of maternal mortality in a rural Ethiopian community are reported, made by direct observation, a case-control approach, and the sisterhood method. RESULTS: Adjusted estimates of MMR using these methods ranged between 440 and 665 per 100,000 live births. CONCLUSIONS: The advantages and disadvantages of the different approaches are compared, both for operational feasibility and outcome.

Adolescent↗
PubMed1999

Characteristics of pregnancy and birth and malignancy in the offspring (Sweden).

OBJECTIVES: The aim of the study was to investigate whether factors of pregnancy and birth influence the risk of malignancy in the offspring. METHODS: Data on all deliveries (248,701 births) in two counties in Sweden 1955-90 were extracted from two birth registries. The follow-up period closed at the end of 1994 and the subjects were followed up to early middle-age at most (39 years). Incidence rates of malignancy were obtained from the Cancer Register 1958-1994. Standardized incidence ratios (SIR) and relative risks (RR) were calculated. RESULTS: Overall, few associations were detected. A significantly increased standardized incidence ratio (SIR) of 50.00 (95% CI = 13.45-99.99) was found for the relationship between Down's syndrome and lymphatic leukaemia. Elder maternal age (> or =35 years) and lymphatic leukaemia were associated with a significantly enhanced risk (SIR = 2.00; 95% CI, 1.16-3.20). Maternal age 25-34 years, compared to younger age, was associated with a reduced risk of cervical cancer (RR = 0.47; 95% CI = 0.26-0.86). CONCLUSIONS: Although some associations, the consistent pattern of non-association indicated a low impact of intrauterine environment or changed genetic material on the future development of malignancy in the offspring up to early middle-age.

Adolescent↗