| 1. |
- Amer-Wåhlin, Isis, et al.
(författare)
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Cardiotocography only versus cardiotocography plus ST analysis of fetal electrocardiogram for intrapartum fetal monitoring: a Swedish randomised controlled trial
- 2001
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Ingår i: The Lancet. - 1474-547X. ; 358:9281, s. 534-538
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Previous studies indicate that analysis of the ST waveform of the fetal electrocardiogram provides information on the fetal response to hypoxia. We did a multicentre randomised controlled trial to test the hypothesis that intrapartum monitoring with cardiotocography combined with automatic ST-waveform analysis results in an improved perinatal outcome compared with cardiotocography alone. METHODS: At three Swedish labour wards, 4966 women with term fetuses in the cephalic presentation entered the trial during labour after a clinical decision had been made to apply a fetal scalp electrode for internal cardiotocography. They were randomly assigned monitoring with cardiotocography plus ST analysis (CTG+ST group) or cardiotocography only (CTG group). The main outcome measure was rate of umbilical-artery metabolic acidosis (pH <7.05 and base deficit >12 mmol/L). Secondary outcomes included operative delivery for fetal distress. Results were first analysed according to intention to treat, and secondly after exclusion of cases with severe malformations or with inadequate monitoring. FINDINGS: The CTG+ST group showed significantly lower rates of umbilical-artery metabolic acidosis than the cardiotocography group (15 of 2159 [0.7%] vs 31 of 2079 [2%], relative risk 0.47 [95% CI 0.25-0.86], p=0.02) and of operative delivery for fetal distress (193 of 2519 [8%] vs 227 of 2447 [9%], 0.83 [0.69-0.99], p=0.047) when all cases were included according to intention to treat. The differences were more pronounced after exclusion of 291 in the CTG+ST group and 283 in the CTG group with malformations or inadequate recording. INTERPRETATION: Intrapartum monitoring with cardiotocography combined with automatic ST-waveform analysis increases the ability of obstetricians to identify fetal hypoxia and to intervene more appropriately, resulting in an improved perinatal outcome.
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| 2. |
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| 3. |
- Noren, Håkan, 1948, et al.
(författare)
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STAN in clinical practice--the outcome of 2 years of regular use in the city of Gothenburg
- 2006
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Ingår i: Am J Obstet Gynecol. ; 195:1, s. 7-15
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The purpose of this study was to monitor the introduction of the STAN-methodology (Noventa Medical, Moelndal, Sweden). STUDY DESIGN: This was a prospective observational study covering the total population of deliveries at term during 2 years. Four thousand eight hundred and thirty out of 14,687 term pregnancies were monitored using the STAN S 21 fetal heart monitor and the associated clinical guidelines. Cord artery metabolic acidosis, neonatal outcome, and rates of operative deliveries for fetal distress were assessed. RESULTS: The annual rate of STAN usage increased from 28.1% to 37.7% and was associated with a significant reduction in metabolic acidosis rate in the total population from 0.76% to 0.44% (P < .05). The compliance with the clinical guidelines increased in cases requiring intervention. The rates for moderate/severe hypoxic neonatal encephalopathy were consistently low, 0.55 and 0.68 per 1000 deliveries, respectively, and corresponding to previous findings. The rate of operative delivery did not change during the 2 years in the total population. CONCLUSION: Increasing STAN usage provided consistent improvements in fetal outcome equalling those noted in the Swedish randomized controlled trial (RCT) without increasing operative interventions for fetal distress.
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| 4. |
- Thorek, D L J, et al.
(författare)
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Prostate-specific kallikrein-related peptidases and their relation to prostate cancer biology and detection. Established relevance and emerging roles.
- 2013
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Ingår i: Thrombosis and haemostasis. - 0340-6245. ; 110:3, s. 484-92
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Tidskriftsartikel (refereegranskat)abstract
- Kallikreins are a family of serine proteases with a range of tissue-specific and essential proteolytic functions. Among the best studied are the prostate tissue-specific KLK2 and KLK3 genes and their secreted protease products, human kallikrein 2, hk2, and prostate-specific antigen (PSA). Members of the so-called classic kallikreins, these highly active trypsin-like serine proteases play established roles in human reproduction. Both hK2 and PSA expression is regulated by the androgen receptor which has a fundamental role in prostate tissue development and progression of disease. This feature, combined with the ability to sensitively detect different forms of these proteins in blood and biopsies, result in a crucially important biomarker for the presence and recurrence of cancer. Emerging evidence has begun to suggest a role for these kallikreins in critical vascular events. This review discusses the established and developing biological roles of hK2 and PSA, as well as the historical and advanced use of their detection to accurately and non-invasively detect and guide treatment of prostatic disease.
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| 5. |
- Örlefors, Håkan, et al.
(författare)
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Positron emission tomography with 5-hydroxytryprophan in neuroendocrine tumors
- 1998
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Ingår i: Journal of Clinical Oncology. - 0732-183X .- 1527-7755. ; 16:7, s. 2534-2541
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: Carcinoid tumors, especially those of midgut origin, produce serotonin via the precursors tryptophan and 5-hydroxytryptophan (5-HTP). We have evaluated the usefulness of positron emission tomography (PET) with carbon-11-labeled 5-HTP in the diagnosis and treatment follow-up evaluation of patients with neuroendocrine tumors. PATIENTS AND METHODS: PET using 11C-labeled 5-HTP was compared with computed tomography (CT) in 18 patients (14 midgut, one foregut, one hindgut carcinoid, and two endocrine pancreatic tumors [EPT]). In addition, 10 of 18 patients were monitored with PET examinations during treatment. RESULTS: All 18 patients, including two with normal urinary 5-hydroxyindole acetic acid (U-5-HIAA), had increased uptake of 11C-labeled 5-HTP in tumorous tissue as compared with normal tissue. Liver metastases, as well as lymph node, pleural, and skeletal metastases, showed enhanced 5-HTP uptake and PET could detect more lesions than CT in 10 patients and equal numbers in the others. Tumor visibility was better for PET than for CT due to the high and selective uptake of 5-HTP with a high tumor-to-background ratio. Binding studies indicated an irreversible trapping of 5-HTP in the tumors. Linear regression analyses showed a clear correlation (r = .907) between changes in U-5-HIAA and changes in the transport rate constant for 5-HTP during treatment. CONCLUSION: PET with 11C-labeled 5-HTP demonstrated high uptake in neuroendocrine gastrointestinal tumors and thereby allowed improved visualization compared with CT. The in vivo data on regional tumor metabolism, as expressed in 11C-5-HTP uptake and transport rate, provided additional information over conventional radiologic techniques. The close correlation between the changes in 11C-5-HTP transport rate and U-HIAA during medical treatment indicates the potential of 11C-5-HTP-PET as a means to monitor therapy.
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| 6. |
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| 7. |
- Abrahamsson, Per-Anders, et al.
(författare)
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Radioimmunoassay of beta-microseminoprotein, a prostatic-secreted protein present in sera of both men and women
- 1989
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Ingår i: Clinical Chemistry. - 0009-9147. ; 35:7, s. 1497-1503
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Tidskriftsartikel (refereegranskat)abstract
- We describe a simple radioimmunoassay of beta-microseminoprotein, one of the three most abundant secretory proteins of the prostate gland. The detection limit of the assay is 1 microgram/L, and its precision, expressed as the total coefficient of variation, is less than 10% for values between 10 and 150 micrograms/L. Using this assay, we found that beta-microseminoprotein immunoreactivity was present in sera from both sexes at about the same concentration. The protein detected had the same molecular size on gel chromatography as the protein isolated from seminal plasma, and dilution curves for the sera paralleled that for the pure protein. The findings suggest that beta-microseminoprotein is present in serum of healthy subjects of both sexes and that it originates in tissue other than the prostate gland. The range of the serum concentration was 0-10.6 micrograms/L (median 4.1) for 51 healthy adult women and 1.1-14.7 micrograms/L (median 6.2) for 35 healthy adult men not older than 40 years. In males with prostatic cancer the concentration in serum was highly variable and often greatly increased. The concentration of beta-microseminoprotein was correlated with that of creatinine in serum, suggesting that the protein is eliminated--at least partly--from the circulation by glomerular filtration. Little of the protein was present in the urine of women. In urine from men the concentration was high and variable, probably because of local contribution from the prostate gland to the urethral urine.
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| 8. |
- Aladdin Haglund, Berit, et al.
(författare)
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Unexpected out-of-hospital deliveries--experiences from the Gothenburg area. Centralized obstetrical care requires competent ambulance staff
- 2004
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Ingår i: Lakartidningen. ; 101:41, s. 3148-50
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Tidskriftsartikel (refereegranskat)abstract
- One hundred and sixty-seven women gave birth before arrival at the hospital during a six-year period in the Goteborg area. Most of these women had given birth before. The actual delivery most often started at term during the night, proceeded normally but rapidly and the neonatal outcome was good. Sixty-two per cent of the women delivered at home. Complicated lacerations or major hemorrhages were uncommon. The distance to the delivery ward was one of the risk factors for prehospital delivery. This is important to take into consideration in the ongoing process of centralizing the delivery clinics. Basic knowledge in obstetrics is mandatory for the ambulance personnel, as well as regular observation visits to the delivery ward and practice in birth simulators.
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| 9. |
- Andersson, Lena, et al.
(författare)
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Quartz and dust exposure in Swedish iron foundries
- 2009
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Ingår i: Journal of Occupational and Environmental Hygiene. - Philadelphia, PA : Taylor & Francis. - 1545-9624 .- 1545-9632. ; 6:1, s. 9-18
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Tidskriftsartikel (refereegranskat)abstract
- Exposure to respirable quartz continues to be a major concern in the Swedish iron foundry industry. Recommendations for reducing the European occupational exposure limit (EU-OEL) to 0.05 mg/m3 and the corresponding ACGIH® threshold limit value (ACGIH-TLV) to 0.025 mg/m3 prompted this exposure survey. Occupational exposure to respirable dust and respirable quartz were determined in 11 Swedish iron foundries, representing different sizes of industrial operation and different manufacturing techniques. In total, 436 respirable dust and 435 respirable quartz exposure measurements associated with all job titles were carried out and are presented as time-weighted averages. Our sampling strategy enabled us to evaluate the use of respirators in certain jobs, thus determining actual exposure. In addition, measurements using real-time dust monitors were made for high exposure jobs. For respirable quartz, 23% of all the measurements exceeded the EU-OEL, and 56% exceeded the ACGIH-TLV. The overall geometric mean (GM) for the quartz levels was 0.028 mg/m3, ranging from 0.003 to 2.1 mg/m3. Fettler and furnace and ladle repair operatives were exposed to the highest levels of both respirable dust (GM = 0.69 and 1.2 mg/m3; range 0.076-31 and 0.25-9.3 mg/m3 and respirable quartz (GM = 0.041 and 0.052 mg/m3; range 0.004-2.1 and 0.0098-0.83 mg/m3. Fettlers often used respirators and their actual quartz exposure was lower (range 0.003-0.21 mg/m3, but in some cases it still exceeded the Swedish OEL (0.1 mg/m3. For furnace and ladle repair operatives, the actual quartz exposure did not exceed the OEL (range 0.003-0.08 mg/m3, but most respirators provided insufficient protection, i.e., factors less than 200. In summary, measurements in Swedish iron foundries revealed high exposures to respirable quartz, in particular for fettlers and furnace and ladle repair workers. The suggested EU-OEL and the ACGIH-TLV were exceeded in, respectively, 23% and 56% of all measurements regardless of the type of foundry. Further work on elimination techniques to reduce quartz concentrations, along with control of personal protection equipment, is essential.
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| 10. |
- Assel, Melissa, et al.
(författare)
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A Four-kallikrein Panel and β-Microseminoprotein in Predicting High-grade Prostate Cancer on Biopsy : An Independent Replication from the Finnish Section of the European Randomized Study of Screening for Prostate Cancer
- 2019
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Ingår i: European Urology Focus. - : Elsevier BV. - 2405-4569. ; 5:4, s. 561-567
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Tidskriftsartikel (refereegranskat)abstract
- Background: A panel of four kallikrein markers (total, free, and intact prostate-specific antigen [PSA] and human kallikrein-related peptidase 2 [hK2]) improves predictive accuracy for Gleason score ≥7 (high-grade) prostate cancer among men biopsied for elevated PSA. A four-kallikrein panel model was originally developed and validated by the Dutch center of the European Randomized Study of Screening for Prostate Cancer (ERSPC). The kallikrein panel is now commercially available as 4Kscore™. Objective: To assess whether these findings could be replicated among participants in the Finnish section of ERSPC (FinRSPC) and whether β-microseminoprotein (MSP), a candidate prostate cancer biomarker, adds predictive value. Design, setting, and participants: Among 4861 biopsied screening-positive participants in the first three screening rounds of FinRSPC, a case-control subset was selected that included 1632 biopsy-positive cases matched by age at biopsy to biopsy-negative controls. Outcome measurements and statistical analysis: The predictive accuracy of prespecified prediction models was compared with biopsy outcomes. Results and limitations: Among men with PSA of 4.0-25. ng/ml, 1111 had prostate cancer, 318 of whom had high-grade disease. Total PSA and age predicted high-grade cancer with an area under the curve of 0.648 (95% confidence interval [CI] 0.614-0.681) and the four-kallikrein panel increased discrimination to 0.746 (95% CI 0.717-0.774). Adding MSP to the four-kallikrein panel led to a significant (Wald test; p = 0.015) but small increase (0.003) in discrimination. Limitations include a risk of verification bias among men with PSA of 3.0-3.99. ng/ml and the absence of digital rectal examination results. Conclusions: These findings provide additional evidence that kallikrein markers can be used to inform biopsy decision-making. Further studies are needed to define the role of MSP. Patient summary: Four kallikrein markers and β-microseminoprotein in blood improve discrimination of high-grade prostate cancer at biopsy in men with elevated prostate-specific antigen. Four kallikrein markers and β-microseminoprotein (MSP) in blood improve discrimination of high-grade cancer at biopsy in men with elevated prostate-specific antigen. These kallikrein markers can be used to inform biopsy decision-making. Further studies are needed to define the role of MSP.
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| 11. |
- Bergqvist, Liselotte, et al.
(författare)
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Labor augmentation by means of oxytocin – women's experiences
- 2007
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Ingår i: American Journal of Obstetrics and Gynecology. ; 195:6
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Objective To study labor experiences in women exposed to oxytocin treatment vs no or delayed treatment of spontaneous, but prolonged labor in nulliparos women. Study design A randomised controlled study. If labor was prolonged during the active phase with no further opening of the cervix for two hours, the subject were randomly allocated to either labor augmentation by means of oxytocin (SG) or expectancy (EG). 461 women filled out a questionnaire including the following items: level of sense of security, pain, sense of control, experience of their own role in labor, and satisfaction with healthcare. Results The oxytocin-treated women's labor experiences did not differ in secondary inertia as compared with the women who chose to delay oxytocin treatment for three hours. The number of women who experienced a labor that met with their expectations was significantly higher in the oxytocin group than in the delay group. Both groups had a high level of lasting memories from their labor experience that resulted in a state of depression or low-spiritedness one month postpartum, SG (41%) and EG (35%), with no significant difference between the two groups. Conclusion Although the labor experiences of both groups were equivalent, the women of the oxytocin group felt that their labor process had proceeded as expected to a higher degree than the women who postponed oxytocin treatment for three hours. Hence, this study does not support the assertion that there would be a difference in labor experience if oxytocin stimulation is postponed. Many patients with inertia have lasting memories from the labor process which result in a state of depression or low-spiritedness one month postpartum, SG (41%) and EG (35%). Questionnaires filled out from women without inertia showed that the group giving spontaneous birth withouth any intravenous drip the proportion for depression was 12%.
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| 12. |
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| 13. |
- Björk, Thomas, et al.
(författare)
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Comparison of analysis of the different prostate-specific antigen forms in serum for detection of clinically localized prostate cancer
- 1996
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Ingår i: Urology. - 1527-9995. ; 48:6, s. 882-888
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To compare different forms and ratios of serum prostate-specific antigen (PSA) to determine which form or ratio provides optimal diagnostic specificity and sensitivity in distinguishing between benign prostatic hyperplasia (BPH) and clinically localized prostate cancer. METHODS: Serum samples were obtained from 47 patients with BPH and 39 with clinically localized prostate cancer. Patients with BPH underwent either transurethral resection of the prostate or transurethral microwave thermotherapy. Patients with prostate cancer, all of whom had no metastases on radionucleotide bone scans and no pelvic lymph node involvement, underwent either radical external beam radiation therapy or radical retropubic prostatectomy. All patients had pretreatment serum PSA levels between 1 and 20 ng/mL. The different forms of serum PSA (free PSA [PSA-F], PSA complexed to alpha 1-antichymotrypsin [PSA-ACT], and total PSA [PSA-T]) were measured using different monoclonal antibodies against PSA and ACT and immunofluorometric assay techniques. Furthermore, three ratios (PSA-F/PSA-T, PSA-ACT/PSA-T, and PSA-F/PSA-ACT) were calculated. RESULTS: By receiver operating characteristic curve analysis, the performance of the different forms and ratios were compared. The PSA-F/PSA-T ratio had the greatest area under the curve (AUC, 0.776), significantly larger than that for PSA-T (0.612; P = 0.024). For PSA-ACT/PSA-T, the AUC was 0.695 (P = 0.283 versus PSA-T) and 0.773 for PSA-F/PSA-ACT (P = 0.051 versus PSA-T). At a cutoff level < 0.17, PSA-F/PSA-T had a sensitivity of 79%, a specificity of 66%, and a positive predictive value of 66% compared with 74%, 38%, and 50%, respectively, for PSA-T at a cutoff level > 4.0 ng/mL. CONCLUSIONS: The PSA-F/PSA-T ratio gives the best diagnostic performance compared with that for other forms and ratios of PSA and will reduce the number of prostatic biopsies in patients with BPH.
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| 14. |
- Bullarbo, Maria, 1958, et al.
(författare)
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Nitroglycerin for management of retained placenta: a multicenter study.
- 2012
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Ingår i: Obstetrics and gynecology international. - : Hindawi Limited. - 1687-9597 .- 1687-9589. ; 2012
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Tidskriftsartikel (refereegranskat)abstract
- The primary aim was to determine if sequential administration of oxytocin and nitroglycerin is effective for management of retained placenta when performed by obstetricians with no experience of the method. Secondary aims were to examine possible adverse effects of nitroglycerin. One hundred and five women with retained placenta were randomly selected to receive either 1mg nitroglycerin or placebo tablets sublingually if intravenous oxytocin had failed to expel the placenta. At two of the hospitals some of the midwives were familiar with the use of nitroglycerin. The other midwives and all the participating obstetricians had no clinical experience of the method. In the treatment group, detachment of placenta following nitroglycerin occurred in 37.3% of the women compared to 20.4% in the placebo group (P = 0.056). In the two hospitals with some experience of the method, placenta was removed in 9 of 19 (47.4%) women in the nitroglycerin group compared to 3 of 17 (15.0%) women in the placebo group. No adverse effects of clinical importance were registered. Although the difference between the two groups did not reach statistical significance, the higher success rate in the two hospitals with some experience could indicate that clinical experience is of importance in order to achieve placental detachment.
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| 15. |
- Cronberg, Tobias, et al.
(författare)
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Long-term neurological outcome after cardiac arrest and therapeutic hypothermia.
- 2009
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Ingår i: Resuscitation. - : Elsevier BV. - 1873-1570 .- 0300-9572. ; 80, s. 1119-1123
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Tidskriftsartikel (refereegranskat)abstract
- AIM OF THE STUDY: To analyse the neurological status of survivors after cardiac arrest (CA) treated with hypothermia. METHODS: We prospectively included all patients with CA treated with hypothermia at intensive care units (ICU) in two university hospitals and one regional hospital. All adult survivors at 6 months after CA, n=48, were invited for neurological follow-up and 43 accepted. History, clinical status, ability testing and questionnaires were administered to screen for difficulties, including Assessment of Motor and Process Skills, Neurobehavioral Cognitive Status Examination, Frontal Lobe Assessment Battery, EQ-VAS quality of life scale, Skåne Sleep Index, Hospital Anxiety and Depression Rating Scale, Self-reported Montgomery and Astrand Depression Rating Scale, Global Deterioration Scale, Rivermead Behavioural Memory Test, and the Cerebral Performance Categories (CPC). RESULTS: No patient was found to be in a chronic vegetative state and all patients were living at home, one with extensive help. Thirty-six patients were in CPC1 at follow-up, and some degree of neurological sequelae was found in 40 patients, but was mild in all but 3. Three patients had no subjective complaints, nor could any deficits be detected. Initial defects improved over-time. Short-term memory loss, executive frontal lobe dysfunction along with mild depression and sleep rhythm disturbances were the most common findings. CONCLUSIONS: Mild cognitive impairment is common following hypothermia-treated cardiac arrest but has little effect on activities of daily living or quality of life.
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| 16. |
- Dencker, Anna, 1956, et al.
(författare)
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A randomized trial of labor augmentation by oxytocin vs delayed oxytocin treatment or no oxytocin in nulliparous women with spontaneous contractions
- 2005
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Ingår i: American Journal of Obstetrics and Gynecology. ; 193:6
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Objective To study the effects of oxytocin treatment vs. no or delayed oxytocin treatment on the obstetrical and neonatal outcome of spontaneous but prolonged labor in nulliparous women. Study design A randomized controlled study of healthy nulliparous women at term with normal pregnancies and spontaneous labor. If labor was prolonged during the active phase with no further opening of the cervix or descent of the head for two hours the women were randomly allocated to either labor augmentation by oxytocin infusion (standard care group= SG) or to expectancy (Expectant care group=EG) and observed for another 3 hours. If the women in the EG after the 3 hours still do not progress in their labor, a reassessment regarding the need for labor augmentation was done. Results Totally 516 women participated in the study, 276 in the SG and 241 in the EG. All 241 women in the SG received oxytocin vs 211 (87.6%) in the EG (p<0,001). There were no differences in gestational age between the groups. Mean gestational age was 40 weeks in both groups. There were no difference in cervical dilatation at randomization, cx dilatation in centimeters was 5,7 (SD1,5) in the SG vs 5,5 (SD 1,3), p= 0.17 in the EG. The time from randomization to delivery differed, 332 (SD=211) minutes in the SG vs 457 (SD=238) minutes in the EG (p <.0001). There was no differences in mode of delivery, Caesarean sectio 23 (8,3%) in the SG vs 21 (8,7%) in the EG, (p=0.9), operative vaginal delivery 44 (15,9%) SG vs 25 (10,4%) EG p=0.07, Spontaneous vaginal delivery 209 (75,7%) SG vs 195 (80,9%) EG p=0.2,. Usage of epidural anesthesia was 29 (10,5%) SG vs 39 (16,2%) EG p=0.07. Apgar score below 7 after 5 minutes was found in 5 (1.8%) in SG vs 9 (3.7%) in EG. Conclusion In nulliparous women at term with spontaneous contractions a policy of delaying the initiation of oxytocininfusion in prolonged active phase for 180 minutes resulted in no difference in mode of delivery, usage of epidural anesthesia or neonates with apgar score below 7 at 5 minutes. The time from randomization to delivery differed by 125 minutes.
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| 17. |
- Dencker, Anna, 1956, et al.
(författare)
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Childbirth experience questionnaire (CEQ): development and evaluation of a multidimensional instrument.
- 2010
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Ingår i: BMC pregnancy and childbirth. - : Springer Science and Business Media LLC. - 1471-2393. ; 10:81
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Tidskriftsartikel (refereegranskat)abstract
- Background: Negative experiences of first childbirth increase risks for maternal postpartum depression and may negatively affect mothers' attitudes toward future pregnancies and choice of delivery method. Postpartum questionnaires assessing mothers' childbirth experiences are needed to aid in identifying mothers in need of support and counselling and in isolating areas of labour and birth management and care potentially in need of improvement. The aim of this study was to develop and evaluate a questionnaire for assessing different aspects of first-time mothers' childbirth experiences. Methods: Childbirth domains were derived from literature searches, discussions with experienced midwives and interviews with first-time mothers. A draft version of the Childbirth Experience Questionnaire (CEQ) was pilot tested for face validity among 25 primiparous women. The revised questionnaire was mailed one month postpartum to 1177 primiparous women with a normal pregnancy and spontaneous onset of active labor and 920 returned evaluable questionnaires. Exploratory factor analysis using principal components analysis and promax rotation was performed to identify dimensions of the childbirth experience. Multitrait scaling analysis was performed to test scaling assumptions and reliability of scales. Discriminant validity was assessed by comparing scores from subgroups known to differ in childbirth experiences. Results: Factor analysis of the 22 item questionnaire yielded four factors accounting for 54% of the variance. The dimensions were labelled Own capacity, Professional support, Perceived safety, and Participation. Multitrait scaling analysis confirmed the fit of the four-dimensional model and scaling success was achieved in all four sub-scales. The questionnaire showed good sensitivity with dimensions discriminating well between groups hypothesized to differ in experience of childbirth. Conclusion: The CEQ measures important dimensions of the first childbirth experience and may be used to measure different aspects of maternal satisfaction with labour and birth.
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| 18. |
- Dencker, Anna, 1956, et al.
(författare)
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Deficiency in rest and nutrition increase the risk for prolonged labor in nulliparous women
- 2007
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Ingår i: American Journal of Obstetrics and Gynecology. ; 195:6
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Konferensbidrag (refereegranskat)abstract
- Objective To identify factors that may influence the labor progress in nulliparous women with spontaneous contractions. Study design A prospective study of healthy nulliparous women at term with normal pregnancies and spontaneous labor. At inclusion the women were asked to measure levels of pain and sense of security on a Visual Analogue Scale and asked to report amount of rest/sleep and intake of food during the last 24 hours before onset of active labor. The progress of labor was followed every 2-3 hours and new VAS-measurements were made postpartum. Prolonged labor was defined as no further opening of the cervix for two hours after amniotomy or rupture of the membranes in the first stage of labor. Results After informed consent 2,086 nulliparous women in active labor with spontaneous contractions were included in the study. Prolonged labor was defined in 29% of the women (n=614). The women who developed a prolonged labor reported fewer hours of rest/sleep (p<0.0001) and a lower intake of food (p<0.0001) during the last 24 hours than the women with normal progress in the first stage of labor. At inclusion the women with normal progress measured higher levels of labor pain (p=0.002) together with more frequent contractions (p<0.0001) at onset of active labor. Cesarean section was more often performed among the women with prolonged labor, 11.7% versus 1,3% (p<0.0001). Postpartum the women with prolonged labor measured lower levels of experienced sense of security during the delivery (p=0.0009). There was no difference in mean of experienced labor pain between the groups postpartum. Conclusion Low intake of food and few hours of rest can contribute to prolonged labor among low risk nulliparous women with spontaneous contractions.
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| 19. |
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| 20. |
- Dencker, Anna, 1956, et al.
(författare)
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Identification of latent phase factors associated with active labor duration in low-risk nulliparous women with spontaneous contractions
- 2010
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Ingår i: ACTA OBSTETRICIA ET GYNECOLOGICA SCANDINAVICA. - 0001-6349. ; 89:8, s. 1034-1039
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Tidskriftsartikel (refereegranskat)abstract
- Objective. The aim of this prospective study was to identify latent phase predictors of active labor duration. Design. Prospective clinical study. Setting. Two delivery units in Sweden. Sample. Healthy nulliparous women with a normal pregnancy, spontaneous onset of active labor at term, and a cervical dilatation of 4 cm or more on admission to the delivery ward (n = 2,072). Methods. The women were asked to answer questions concerning their food and fluid intake, amount of rest and sleep during the preceding 24 hours and to assess their labor pain, sense of security and expectations of the childbirth on a visual analog scale (VAS). Duration and intervals of contractions, cervical dilatation, and position of the fetal head were noted by the midwife. A multiple regression analysis was performed with active labor duration as the outcome variable. Main outcome measure. Predictive factors of active labor duration. Results. Normal food intake during the preceding 24 hours was associated with short labor duration. A long latent phase, low levels of assessed labor pain and few hours of rest and sleep during the preceding 24 hours were significant independent predictors of extended active labor duration, when high birth weight, long contraction intervals, slight cervical dilatation, intact membranes within 2 hours of admission, high maternal age and malposition of the fetal head were controlled for. Conclusion. New findings are that latent phase duration as well as food intake and the amount of rest and sleep during the preceding 24 hours are independent predictors of labor duration. Read More: http://informahealthcare.com/doi/abs/10.3109/00016349.2010.499446
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| 21. |
- Dencker, Anna, 1956, et al.
(författare)
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Predictive factors related to labour duration in healthy nulliparous women with spontaneous onset of active labour - a prospective study
- 2011
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Ingår i: ICM 29th Triennial Congress i Durban, Sydafrika 19 - 23 Juni 2011.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background: Slow progress in labour is a major problem among nulliparous women as it is one of the main indications for emergency caesarean deliveries and related to several other adverse maternal and neonatal outcomes. Aim: To identify predictive factors of labour duration in healthy nulliparous women. Setting: Two delivery units in Sweden, between October 1998 and December 2003. Participants: Healthy nulliparous women (n=2.072) with a normal pregnancy, spontaneous onset of active labour at term and a cervical dilatation of 4 – 9 centimetres at admission to the delivery ward. All gave informed consent. Methods: At admission to the delivery ward the women were asked to answer questions concerning food and fluid intake, amount of rest/sleep the last 24 hours and to assess labour pain. Contractions, cervical dilation and the number and timing of interventions as epidural analgesia and oxytocin augmentation were noted by the midwife during childbirth. Key findings: Normal food intake during the preceding 24 hours was associated with short labor duration. A long latent phase, low levels of assessed labor pain and few hours of rest and sleep during the preceding 24 hours were significant independent predictors of extended active labor duration, when high birth weight, long contraction intervals, slight cervical dilatation, intact membranes within two hours of admission, high maternal age and malposition of the fetal head were controlled for. Amniotomy decreased and epidural analgesia increased labour duration. Use of oxytocin augmentation had most influence on decreased labour duration. Clinical implications: More attention should be devoted to latent phase factors in clinical practice and counseling to women who are about to give birth should include information about the benefits of food intake and rest during the latent phase.
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| 22. |
- Ekberg, Olle, et al.
(författare)
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Autonomic nerve dysfunction in patients with bolus-specific esophageal dysmotility
- 1995
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Ingår i: Dysphagia. - 1432-0460. ; 10:1, s. 44-48
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Tidskriftsartikel (refereegranskat)abstract
- The pathogenetic mechanisms causing esophageal dysmotility is not well understood. We examined 13 patients with solid bolus dysphagia in a radiologic barium study including the swallowing of a 14-mm tablet. In all 13 patients the tablet was caught in the proximal or midesophagus. In 8 patients, the entrapment was associated with symptoms (Group 1) whereas in 5 patients (Group 2), no symptoms were reported. All 13 patients together with a control group of 56 healthy, nondysphagic subjects were tested for autonomic nerve function. Autonomic nerve function tests included registration of electrocardiographic R-R interval variation during deep breathing test (E/I ratio), a test of parasympathetic, vagal, nerve function. The results showed that the E/I ratio was significantly lower in patients with symptoms of bolus-specific esophageal dysmotility (-2,19 [1.76]) (median [interquartile range]) compared with patients without symptoms (0.05 [2, 87], p = 0.0192) and controls (-0.25 [1.26], p = 0.0009). In conclusion, symptomatic bolus-specific esophageal dysmotility is associated with vagal nerve dysfunction.
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| 23. |
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| 24. |
- Eriksson, Barbro, et al.
(författare)
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Positron emission tomography (PET) in neuroendocrine gastrointestinal tumors
- 1993
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Ingår i: Acta Oncologica. - 0284-186X .- 1651-226X. ; 32:2, s. 189-196
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Tidskriftsartikel (refereegranskat)abstract
- Positron emission tomography (PET) makes it possible to study effects of medical treatment in vivo. Carcinoid tumors with liver metastases, especially those of midgut origin, produce serotonin via the precursors tryptophan and 5-hydroxytryptophan (5-HTP) and this overproduction contributes to the clinical symptoms of the carcinoid syndrome. Seven patients with histopathologically verified neuroendocrine tumors and liver metastases, five of whom with ileal carcinoids, one a lung carcinoid and one an endocrine pancreatic tumor, were included in the study. All patients had elevation of urinary 5-HIAA with the exception of one patient with a solitary liver metastasis of midgut origin. After an intravenous injection of 11C-5-HTP, PET was performed and the uptake of radioactivity in tumor tissue, normal liver and plasma were compared. All patients with elevated urinary 5-HIAA and also the patient with a solitary liver metastasis and normal urinary 5-HIAA had high accumulation and signs of a high rate of binding of 5-HTP in the liver metastases. The uptake was relatively homogeneous in midgut carcinoid liver metastases but in large necrotic metastases the radioactivity was localized to the periphery. In three patients PET examination was repeated after 3 months of interferon treatment and in agreement with circulating tumor markers and ultrasonography the uptake of 5-HTP was unchanged. Another patient who received the somatostatin analog somatuline progressed on treatment and accordingly the uptake of 5-HTP also increased. The experience with PET in neuroendocrine gastrointestinal tumors is very limited. Our results so far indicate that 5-HTP can be used to visualize serotonin-producing neuroendocrine tumors and furthermore it might prove to be of value to monitor the effects of treatment, possibly also as an early predictive test of the outcome of treatment.
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| 25. |
- Fagevik Olsén, Monika, 1964, et al.
(författare)
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A comparison of high- versus low-intensity, high-frequency transcutaneous electric nerve stimulation for painful postpartum uterine contractions
- 2007
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Ingår i: Acta obstetricia et gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 86:3, s. 310-4
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Breast-feeding in the postpartum period is known to induce intense uterine contractions with pain in the lower abdomen. AIMS: The primary aim of this study was to compare the effects of high and low intensity, high frequency Transcutaneous Electric Nerve Stimulation (TENS) on pain and discomfort of postpartum uterine contractions. The secondary aim was to evaluate discomfort experienced from the stimulation itself. METHODS: Twenty-one newly delivered women participated in this single-blind trial, 12 women received high intensity, high-frequency TENS (HI TENS) and 9 women received low intensity, high-frequency TENS (LI TENS). The electrodes were placed abdominally on each side of the uterus. Stimulation was done during one minute. Visual analogue scales were used to evaluate the intensity of the pain before and after stimulation. A verbal scale was used to estimate sensation of discomfort before, during and after stimulation. RESULTS: The median decrease in pain ratings before and after treatment by VAS was larger in the HI TENS group -49 mm (95% CI -66.5--33.2) than in the LI TENS group -21 mm (95% CI -39.0--20.0). The reduction of pain was most pronounced in the HI TENS group (median difference 28 (95% CI was 14.0-53.0). Furthermore, the HI TENS group experienced significantly less discomfort of the uterine contractions after stimulation (p<0.01) but they also experienced more discomfort of the stimulation than women in the LI TENS group (p<0.01). CONCLUSION: The women treated with HI TENS, experienced significantly less postpartum pain and discomfort to those treated with LI TENS even though the discomfort from the stimulation with HI TENS was greater.
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