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Biomedical subjects

Ulf Högberg

Publications and source records attributed to Ulf Högberg.

At least 19 recordsLinked to original sources
PubMed2007

A pilot study of eye movement desensitisation and reprocessing treatment (EMDR) for post-traumatic stress after childbirth.

OBJECTIVE: to explore the possibility of using eye movement desensitisation and reprocessing (EMDR) to treat women who have experienced post-traumatic stress after childbirth. DESIGN: the pilot study consisted of a 'before and after' treatment design combined with follow-up measurements 1-3 years after EMDR treatment. Quantitative data from questionnaires (Traumatic Event Scale [TES]) were collected. In addition, qualitative data from individual interviews with the participants were collected as well as data from the psychotherapist's treatment notes of the EMDR treatment sessions. SETTING: the north of Sweden. PARTICIPANTS: four women with post-traumatic stress disorder (PTSD) after childbirth (one pregnant and three non-pregnant). FINDINGS: all participants reported reduction of post-traumatic stress after treatment. After 1-3 years, the beneficial effects of EMDR treatment remained for three of the four women. Symptoms of intrusive thoughts and avoidance seemed most sensitive for treatment. IMPLICATIONS FOR PRACTICE: EMDR might be a useful tool in the treatment of non-pregnant women severely traumatised by childbirth; however, further research is required.

Adult↗
PubMed2006

Assessing a new approach to verbal autopsy interpretation in a rural Ethiopian community: the InterVA model.

OBJECTIVE: Verbal autopsy (VA) -- the interviewing of family members or caregivers about the circumstances of a death after the event -- is an established tool in areas where routine death registration is non-existent or inadequate. We assessed the performance of a probabilistic model (InterVA) for interpreting community-based VA interviews, in order to investigate patterns of cause-specific mortality in a rural Ethiopian community. We compared results with those obtained after review of the VA by local physicians, with a view to validating the model as a community-based tool. METHODS: Two-hundred and eighty-nine VA interviews were successfully completed; these included most deaths occurring in a defined community over a 1-year period. The VA interviews were interpreted by physicians and by the model, and cause-specific mortality fractions were derived for the whole community and for particular age groups using both approaches. FINDINGS: The results of the two approaches to interpretation correlated well in this example from Ethiopia. Four major cause groups accounted for over 60% of all mortality, and patterns within specific age groups were consistent with expectations for an underdeveloped high-mortality community in sub-Saharan Africa. CONCLUSION: Compared with interpretation by physicians, the InterVA model is much less labour intensive and offers 100% consistency. It is a valuable new tool for characterizing patterns of cause-specific mortality in communities without death registration and for comparing patterns of mortality in different populations.

Adolescent↗
PubMed2006

Some Swedish women's experiences of prolonged labour.

OBJECTIVE: to elucidate women's experiences of prolonged labour. DESIGN: qualitative research interviews were conducted and thematic content analysis was applied. PARTICIPANTS: 10 primiparae who, 1-3 months previously, had a prolonged labour with assisted vaginal or caesarean delivery. FINDINGS: the narratives about giving birth were interpreted and formulated into three themes and six sub-themes. The first theme, 'being caught up in labour', described the sense of not making progress during labour. The second theme was 'being out of control', and was related to the women's insufficient control of their own bodily processes, and consisted of descriptions of exhaustion and powerlessness. The third theme was 'being dependent on others', and described the women's dependence on care and on the support of the caregivers, and included descriptions of caregivers' assistance with birth as an experience of being relieved from pain and distress. KEY CONCLUSIONS: the experience of giving birth was not the experience of a healthy woman in labour, but one of severe labour pains that seemed to go on forever. The experience of prolonged labour could be understood as an experience of suddenly falling ill or finding oneself in a life-threatening condition associated with intractable pain, dependence on others and an overwhelming fear of losing oneself. IMPLICATIONS FOR PRACTICE: women with prolonged labour are more dependent on their caregivers than are women without prolonged labour. They have a special need for extra support and encouragement during the delivery as well as increased nursing and midwifery care.

Adult↗
PubMed2006

Satisfying parents' preferences with regard to various models of postnatal care is cost-minimizing.

BACKGROUND: This study describes three options for postnatal care in Sweden and contains a cost analysis of the options in various combinations. The aim of the study was to calculate the cost of a postnatal care model according to new parents' preferences. METHODS: Staff costs were calculated for various models of postnatal care, comprising the maternity ward, the family suite, and/or the early discharge program. One of the models was based on answers from 342 parents who specified their preferences with regard to postnatal care in the event of another birth. RESULTS: Comparing costs for five different models of postnatal care showed that the proportion of mothers receiving care at the maternity ward crucially influences the total costs. The staff costs differed significantly between the models, ranging from US$448 000 to US$778 000 per 1500 mother-child dyads. MAIN OUTCOME MEASURES: Cost calculation of various care models and parents' preferences for postnatal care. CONCLUSIONS: Because the parents' preferences with regard to postnatal care created one of the most cost-minimizing care models in the study, it would be possible to better meet parent's desires and, at the same time, reduce costs, without increasing risks in comparison with the early discharge program.

Cost Control↗
PubMed2005

Low psychosocial resources during early pregnancy are not associated with prolonged labour.

OBJECTIVES: To examine if a low level of psychosocial resources in early pregnancy is associated with the occurrence of prolonged labour. STUDY DESIGN: A cross sectional study of 644 women expecting their first child. Participants were asked to complete a questionnaire at their first antenatal visit, measuring psychosocial resources defined as social network and support, work-related psychosocial factors, control of daily life and health characteristics. Outcome was prolonged labour at the end of the pregnancy. RESULTS: A low level of psychosocial resources was not associated with prolonged labour. The majority of women reported that the degree of support was high in early pregnancy. CONCLUSIONS: A perceived low level of psychosocial resources in early pregnancy did not increase the risk of prolonged labour at the subsequent delivery.

Adult↗
PubMed2005

Evidence-based changes in term breech delivery practice in Sweden.

OBJECTIVE: Medical documentation on term breech delivery (TBD) advocates planned abdominal delivery based on evidence. The aim of the present study was to describe a change in TBD practice in Sweden following evidence-based documentation arguing in favor of TBD by cesarean section (CS). MATERIALS AND METHODS: The study was a population-based observational study based on data from the Swedish Medical Birth Register. Eligible subjects were all mothers with singleton children in term breech (TB) presentation born between 1999 and 2001 at > 36 weeks' gestational age. Data were processed, and subjects were subdivided into groups, according to mode of delivery. RESULTS: The CS rate increased from 75.3% in 1999 to 86.0% in 2001, due to an increase in planned abdominal deliveries. The change towards abdominal deliveries was more obvious for hospitals with fewer deliveries. While today, an increasing number of hospitals clearly have a non-selective CS policy, with a > 95% CS rate, others still deliver 30% of TB babies vaginally. CONCLUSION: In conclusion, the evidence-based recommendation for TBD has so far had considerable impact on Swedish obstetric practice.

Adult↗
PubMed2005

The negative birth experience of prolonged labour: a case-referent study.

AIMS: This study aimed to analyse and describe women's different perceptions and experiences of childbirth following prolonged or normal labour. BACKGROUND: In clinical practice prolonged labour, or dystocia, is a common delivery complication often causing a negative birth experience. METHOD: Women giving singleton live birth to their first child with spontaneous labour after more than 37 completed weeks' pregnancy at three hospitals in northern Sweden were recruited to a case-referent study. Cases (n = 84) were women following a prolonged labour with assisted vaginal or abdominal delivery, and referents (n = 171) delivered following a normal labour. Participants completed a questionnaire that investigated childbirth experiences, previous family relationships and childhood experiences. RESULTS: Women with prolonged labour had a negative childbirth experience more often (34%) than did women who had a normal labour (4%) (P < 0.05). Cases agreed significantly more than the referents with the statement, 'Pain relief during the delivery saved me' (OR 4.5, 95% CI: 1.9-11.1) and 'My difficulties during the delivery will mark me for life' (OR 12.4, 95% CI: 4.4-35.9). There were no differences between the cases and referents regarding perceived experience of professional or social support. RELEVANCE TO CLINICAL PRACTICE: To improve care, midwives and doctors can alleviate pain and relieve the negativity and difficulty associated with the experience of prolonged labour from the perspective of the woman giving birth.

Adult↗
PubMed2005

Violence against pregnant women: prevalence and characteristics. A population-based study in Nicaragua.

OBJECTIVE: This study aims to estimate the prevalence and characteristics of partner abuse during pregnancy as well as to investigate associated social factors in León, Nicaragua. DESIGN: Cross-sectional community-based study. SETTING: All pregnant women from 50 randomly selected geographical clusters out of 208 in the municipality of León, Nicaragua. SAMPLE: A total of 478 pregnant women were included; only one woman refused to participate. METHOD: The domestic violence questionnaire from the WHO-co-ordinated Multi-Country Study on Women's Health and Life Events was used with each participant being interviewed twice during pregnancy. MAIN OUTCOME MEASURES: Prevalence and characteristics of partner violence during pregnancy. RESULTS: The prevalence of emotional, physical and sexual abuse during pregnancy was 32.4%, 13.4% and 6.7%, respectively. Seventeen percent reported experience of all three forms of violence. Two-thirds of the victims reported repeated abuse. Half of the abused women had experienced punches and kicks directed towards the abdomen and 93% had been injured. Most women had not sought health care in relation to the abuse, but those who did were usually hospitalised. Factors such as women's age below 20 years, poor access to social resources and high levels of emotional distress were independently associated with violence during pregnancy. CONCLUSION: Violence against pregnant women in Nicaragua is common and often repeated. Although these women have poor access to social resources and high levels of emotional distress, they are rarely assisted by the health services. Innovative strategies are needed to provide support and counselling.

Adult↗
PubMed2004

Proactive management promotes outcome in extremely preterm infants: a population-based comparison of two perinatal management strategies.

OBJECTIVE: There is a need for evidence-based knowledge regarding perinatal management in extreme prematurity. The benefit of a proactive attitude versus a more selective one is controversial. The objective of the present study was to analyze perinatal practices and infant outcome in extreme prematurity in relation to different management policies in the North (proactive) and South of Sweden. METHODS: A population-based, retrospective, cohort study design was used. Data in the Swedish Medical Birth Register (MBR) from 1985 to 1999 were analyzed according to region of birth and gestational age (22 weeks + 0 days to 27 weeks + 6 days). A total of 3 602 live-born infants were included (North = 1040, South = 2562). Survival was defined as being alive at 1 year. Morbidity in survivors, based on discharge diagnoses of major morbidity during the first year of life, was described by linking the MBR to the Hospital Discharge Register. RESULTS: In infants with a gestational age of 22 to 25 weeks, the proactive policy was significantly associated with 1) increased incidence of live births, 2) higher degree of centralized management, 3) higher frequency of caesarean section, 4) fewer infants with low Apgar score (<4) at 1 and 5 minutes, 5) fewer infants dead within 24 hours, and 6) increased number of infants alive at 1 year. There were no indications of increased morbidity in survivors of the proactive management during the first year of life, and the proportion of survivors without denoted morbidity was larger. CONCLUSION: In infants with a gestational age of 22 to 25 weeks, a proactive perinatal strategy increases the number of live births and improves the infant's postnatal condition and survival without evidence of increasing morbidity in survivors up to 1 year of age.

Birth Rate↗
PubMed2004

The decline in maternal mortality in Sweden: the role of community midwifery.

The maternal mortality rate in Sweden in the early 20th century was one third that in the United States. This rate was recognized by American visitors as an achievement of Swedish maternity care, in which highly competent midwives attend home deliveries. The 19th century decline in maternal mortality was largely caused by improvements in obstetric care, but was also helped along by the national health strategy of giving midwives and doctors complementary roles in maternity care, as well as equal involvement in setting public health policy. The 20th century decline in maternal mortality, seen in all Western countries, was made possible by the emergence of modern medicine. However, the contribution of the mobilization of human resources should not be underestimated, nor should key developments in public health policy.

Community Health Nursing↗
PubMed2003

Postpartum care should provide alternatives to meet parents' need for safety, active participation, and 'bonding'.

OBJECTIVE: To describe new parents' choice of the type of maternity care they wanted to receive, the family suite (FS) or an early discharge (ED), and to gain a better understanding of parents' experiences of different postnatal care alternatives. DESIGN: A qualitative study using semi-structured interviews. The interviews were analysed by content analysis. SETTING AND PARTICIPANTS: Eleven couples and one mother, including both first-time and experienced parents. Six families received care at a FS while the others chose an ED within 24 hours after birth. MEASUREMENTS AND FINDINGS: The postpartum period was experienced as an unpredictable time for new parents, when the need for safety, participation in decision-making, and 'bonding' was felt to be central and decisive to their choice of care. The type of care that the parents felt best met their needs varied according to the mother's assessment of her own and the baby's health status, the parents' requirements and experience and the way in which they, as parents, handled the opportunities and demands of different environments. However, the opportunities for the parents to choose the form of care they considered best for their family were limited. PRACTICAL IMPLICATIONS: To best fulfil parents' wishes and needs in postnatal care alternative care forms are needed. Also, a way to treat the family as a whole on an individual family basis must be found and parents of newborn babies should be allowed to choose the form of care they consider best.

Adult↗
PubMed2003

Impaired fasting glucose and impaired glucose tolerance are related to both heredity and low birth weight.

AIM: The aim of the study was to test the hypothesis of an association between low birth weight (LBW), abnormal glucose metabolism and heredity. METHODS: Common subjects were identified as newborns in a local birth register and as adult participants in the Västerbotten Intervention Programme (n=7796). Outcome measures such as impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) were investigated in relation to LBW, family history of diabetes, and sex. RESULTS: Fasting plasma glucose and two-hour plasma glucose were elevated among women with LBW in relation to normal birth weight (NBW). Men and women with NBW had increased risks of IFG and IGT if there was a hereditary background of diabetes mellitus. LBW and hereditary background of diabetes mellitus interacted on the risk of IFG and IGT in women. CONCLUSIONS: Hereditary background of diabetes and LBW increase the risk of abnormal glucose metabolism such as IFG and IGT in early middle age. LBW and hereditary background of diabetes have a synergy effect on the risk of IFG and IGT in women.

Adult↗
PubMed2002

Occupational and environmental risks of spontaneous abortions around a smelter.

BACKGROUND: This study represents part of a follow-up study on reproductive outcome around a smelter in Sweden. METHODS: Employees at the smelter, a random sample including neighbors of the smelter and referents were analyzed by a register study, covering 1982-1990, a questionnaire study performed in 1992 and a case-referent study with cases of spontaneous abortions and live borns as referents. Risk factors were studied by logistic regression. A validity-study between register and questionnaire data on spontaneous abortions and legal abortions was completed. RESULTS: The studies showed no risk increase for the exposed groups of smelter workers and neighbors compared to the reference group, 10, 11, and 12%, respectively. A validation of the data on abortions between register and questionnaire data showed good agreement. CONCLUSIONS: We found no increase of spontaneous abortion associated to smelter work or to living close to the smelter which could be a result of radically reduced emissions.

Abortion, Spontaneous↗
PubMed2002

Physical partner abuse during pregnancy: a risk factor for low birth weight in Nicaragua.

OBJECTIVE: To assess whether being physically abused during pregnancy increases the risk of a low birth weight (LBW) infant. METHODS: We conducted a hospital-based case-control study in León, Nicaragua. Cases consisted of 101 newborns with a birth weight under 2500 g, and for each case two controls with a birth weight over 2500 g were selected randomly from infants born the same day. Anthropometry of newborns was done immediately after birth, and background information and data on experiences of violence and potential confounders were obtained through private interviews with mothers. Crude and adjusted odds ratios (ORs) and population-attributable proportion were calculated for exposure to partner abuse in relation to LBW. Multivariate logistic regression analysis was used to control for potential confounding. RESULTS: Seventy-five percent of LBW newborns (cases) were small for gestational age and 40% were preterm. Twenty-two percent of the mothers of LBW infants had experienced physical abuse during pregnancy by their intimate partners compared with 5% of controls. Low birth weight was associated with physical partner abuse even after adjustment for age, parity, smoking, and socioeconomic status (OR 3.9; 95% confidence interval 1.7, 9.3). Given a causal interpretation of the association, about 16% of the LBW in the infant population could be attributed to physical abuse by a partner in pregnancy. CONCLUSION: Physical abuse by a partner during pregnancy is an independent risk factor for LBW.

Case-Control Studies↗
PubMed2002

Violence against pregnant women will remain hidden as long as no direct questions are asked.

OBJECTIVE: to assess the experience, knowledge, attitudes and routines regarding violence against pregnant women among midwives working at antenatal clinics in the county of Västerbotten, northern Sweden. DESIGN: five qualitative research interviews with midwives were conducted. In addition, questionnaires were sent to all midwives working at the antenatal clinics in the county. FINDINGS: the midwives, although very knowledgeable about and sensitive to pregnant women and their needs, still rarely revealed the occurrence of violence. Symptoms and signals of abuse may vary and are not easily recognised by an outsider. Among pregnant women registered at the antenatal clinic, the midwives roughly estimated that the frequency of known cases of physical and sexual abuse before and during the current pregnancy was 2.3 and 0.6%, respectively for the preceding calendar year. The local programme for antenatal care provided no guidelines regarding response to violence, no instruments for disclosure and no directions about support when confronted with an abused pregnant woman. The midwife did not usually ask any questions if she was merely suspicious but had no strong supporting evidence. In answering the questionnaire however, the midwives were positive towards asking every pregnant woman about abuse in approximately the same way as they asked about other issues already incorporated in the records. CONCLUSION: most likely the midwives in this study were disclosing only a fraction of the cases of abuse against women. Violence of this kind will probably remain hidden as long as the whole issue of violence is not included in the national recommendations or in the local programme for antenatal care. IMPLICATIONS FOR PRACTICE: there should be specific written recommendations in the national antenatal care programme to guide and support the midwives in questioning all pregnant women about violence. To achieve adequate and optimal assessment and intervention at the antenatal clinic, the midwives need to be given education and training and provided with a supportive professional network both for themselves and for the abused women.

Attitude of Health Personnel↗