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  • 301.
    Arving, Cecilia
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Brandberg, Yvonne
    Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
    Feldman, Inna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Johansson, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Oncology.
    Glimelius, Bengt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Oncology. Dept. of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
    Cost-utility analysis of individual psychosocial support interventions for breast cancer patients in a randomized controlled study2014In: Psycho-Oncology, ISSN 1057-9249, E-ISSN 1099-1611, Vol. 23, no 3, p. 251-258Article in journal (Refereed)
    Abstract [en]

    Background The Distress Thermometer (DT) has been used in psycho-oncology research across the globe and has been recommended as a clinical tool to be used routinely in cancer settings to detect clinically significant distress. We sought to characterize the translation and validation of the DT in cancer patients in different countries and cultures and summarize how the translated versions function to detect clinically significant distress. Methods An electronic mail survey was sent to the members of the International Psychosocial Oncology Society Federation of Psycho-Oncology Societies and electronic searches of English language databases were conducted to identify translations of the DT and studies designed to validate these translations. Results Our efforts yielded a total of 21 non-English translations of the DT; 18 of these were validated in studies designed for that purpose. A variety of instruments were used in receiver operating characteristic curve analysis to derive an optimal cut-off score indicative of clinically significant distress. Cut-off scores varied by language, country, and clinical setting and to sample characteristics. In the majority of studies, a score of 4 maximized sensitivity and specificity relative to an established criterion. Conclusions These findings provide a broad, international perspective on the current state of psychosocial screening using the DT. Findings also demonstrate widespread awareness of the need for psychological and social support of persons diagnosed with and treated for cancer.

  • 302.
    Arvonen, Miika
    et al.
    Kuopio Univ Hosp, Dept Pediat, Kuopio, Finland.;Oulu Univ Hosp, Med Res Ctr, Oulu, Finland.;Univ Oulu, Oulu, Finland.;Univ Oulu, PEDEGO Res Unit, Oulu, Finland..
    Berntson, Lillemor
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Pokka, Tytti
    Oulu Univ Hosp, Med Res Ctr, Oulu, Finland.;Univ Oulu, Oulu, Finland.;Univ Oulu, PEDEGO Res Unit, Oulu, Finland.;Oulu Univ Hosp, Dept Children & Adolescents, Oulu, Finland..
    Karttunen, Tuomo J.
    Oulu Univ Hosp, Med Res Ctr, Oulu, Finland.;Univ Oulu, Oulu, Finland.;Univ Oulu, Canc & Translat Med Res Unit, Oulu, Finland.;Oulu Univ Hosp, Dept Pathol, Oulu, Finland..
    Vahasalo, Paula
    Oulu Univ Hosp, Med Res Ctr, Oulu, Finland.;Univ Oulu, Oulu, Finland.;Univ Oulu, PEDEGO Res Unit, Oulu, Finland.;Oulu Univ Hosp, Dept Children & Adolescents, Oulu, Finland..
    Stoll, Matthew L.
    Univ Alabama Birmingham, Dept Pediat, CPP N 210 M,1600 7th Ave South, Birmingham, AL 35233 USA..
    Gut microbiota-host interactions and juvenile idiopathic arthritis2016In: Pediatric Rheumatology, ISSN 1546-0096, E-ISSN 1546-0096, Vol. 14, article id 44Article, review/survey (Refereed)
    Abstract [en]

    Background: Juvenile idiopathic arthritis is the most common form of chronic arthritis in children. There is mounting evidence that the microbiota may influence the disease. Main body: Recent observations in several systemic inflammatory diseases including JIA have indicated that abnormalities in the contents of the microbiota may be factors in disease pathogenesis, while other studies in turn have shown that environmental factors impacting the composition of the microbiota, such as delivery mode and early exposure to antibiotics, affect the risk of chronic inflammatory diseases including JIA. Microbial alterations may predispose to JIA through a variety of mechanisms, including impaired immunologic development, alterations in the balances of pro- versus anti-inflammatory bacteria, and low-grade mucosal inflammation. Additional confirmatory studies of microbiota aberrations and their risk factors are needed, as well as additional mechanistic studies linking these alterations to the disease itself. Conclusions: The microbiota may influence the risk of JIA and other systemic inflammatory conditions through a variety of mechanisms. Additional research is required to improve our understanding of the links between the microbiota and arthritis, and the treatment implications thereof.

  • 303. Asembekova, GU
    et al.
    Buchljaeva, EM
    Palovitch, CV
    Larsen, S
    Langhoff-Ross, J
    Lindmark, G
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    To modern approaches for the evaluation of the structure of perinatal losses.1998In: Asian Health of Obstetrics and Gynecology, Vol. 4, p. 39-Article in journal (Refereed)
  • 304.
    Ashish, K. C.
    et al.
    United Nations Childrens Fund, Nepal Country Off, POB 1187,UN House, Kathmandu, Nepal..
    Nelin, Viktoria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Raaijmakers, Hendrikus
    United Nations Childrens Fund, Nepal Country Off, POB 1187,UN House, Kathmandu, Nepal..
    Kim, Hyung Joon
    United Nations Childrens Fund, Nepal Country Off, POB 1187,UN House, Kathmandu, Nepal..
    Singh, Chahana
    United Nations Childrens Fund, Nepal Country Off, POB 1187,UN House, Kathmandu, Nepal..
    Målqvist, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Increased immunization coverage addresses the equity gap in Nepal2017In: Bulletin of the World Health Organization, ISSN 0042-9686, E-ISSN 1564-0604, Vol. 95, no 4, p. 261-269Article in journal (Refereed)
    Abstract [en]

    Objective To compare immunization coverage and equity distribution of coverage between 2001 and 2014 in Nepal. Methods We used data from the Demographic and Health Surveys carried out in 2001, 2006 and 2011 together with data from the 2014. Multiple Indicator Cluster Survey. We calculated the proportion, in mean percentage, of children who had received bacille Calmette-Guerin (BCG) vaccine, three doses of polio vaccine, three doses of diphtheria-pertussis-tetanus (DPT) vaccine and measles vaccine. To measure inequities between wealth quintiles, we calculated the slope index of inequality (SII) and relative index of inequality (RII) for all surveys. Findings From 2001 to 2014, the proportion of children who received all vaccines at the age of 12 months increased from 68.8% (95% confidence interval, CI: 67.5-70.1) to 82.4% (95% CI: 80.7-84.0). While coverage of BCG, DPT and measles immunization statistically increased during the study period, the proportion of children who received the third dose of polio vaccine decreased from 93.3% (95% CI: 92.7-93.9) to 88.1% (95% CI: 86.8-89.3). The poorest wealth quintile showed the greatest improvement in immunization coverage, from 58% to 77.9%, While the wealthiest quintile only improved from 84.8% to 86.0%. The SII for children who received all vaccines improved from 0.070 (95% CI: 0.061-0.078) to 0.026 (95% CI: 0.013-0.039) and RII improved from 1.13 to 1.03. Conclusion The improvement in immunization coverage between 2001 and 2014 in Nepal can mainly be attributed to the interventions targeting the disadvantaged populations.

  • 305.
    Ashish, K. C.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Nepal Country Off, United Nations Childrens Fund, Lalitpur, Nepal..
    Wrammert, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Nelin, Viktoria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Ewald, Uwe
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Clark, Robert
    Latter Day St Char, Salt Lake City, UT USA..
    Målqvist, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Uppsala Univ, Dept Womens & Childrens Hlth, Int Maternal & Child Hlth, Uppsala, Sweden..
    Level of mortality risk for babies born preterm or with a small weight for gestation in a tertiary hospital of Nepal2015In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 15, article id 877Article in journal (Refereed)
    Abstract [en]

    Background: Globally, 15 million babies were born prematurely in 2012, with 37.6 % of them in South Asia. About 32.4 million infants were born small for gestational age (SGA) in 2010, with more than half of these births occurring in South Asia. In Nepal, 14 % of babies were born preterm and 39.3 % were born SGA in 2010. We conducted a study in a tertiary hospital of Nepal to assess the level of risk for neonatal mortality among babies who were born prematurely and/or SGA. Methods: This case-control study was completed over a 15-month period between July 2012 and September 2013. All neonatal deaths that occurred during the study period were included as cases and 20 % of women with live births were randomly selected as referents. Information on potential risk factors was taken from medical records and interviews with the women. Logistic regression analyses were conducted to determine the level of risk for neonatal mortality among babies born preterm and/or SGA. Results: During this period, the hospital had an incidence of preterm birth and SGA of 8.1 and 37.5 %, respectively. In the multivariate model, there was a 12-fold increased risk of neonatal death among preterm infants compared to term. Babies who were SGA had a 40 % higher risk of neonatal death compared to those who were not. Additionally, babies who were both preterm and SGA were 16 times more likely to die during the neonatal period. Conclusions: Our study showed that the risk of neonatal mortality was highest when the baby was born both preterm and SGA, followed by babies who were born preterm, and then by babies who were SGA in a tertiary hospital in Nepal. In tertiary care settings, the risk of mortality for babies who are born preterm and/or SGA can be reduced with low-cost interventions such as Kangaroo Mother Care or improved management of complications through special newborn care or neonatal intensive care units. The risk of death for babies who are born prematurely and/or SGA can thus be used as an indicator to monitor the quality of care for these babies in health facility settings.

  • 306.
    Asif, Sana
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Clinical Immunology.
    Ekdahl, Kristina N
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Clinical Immunology. Linnæus Center of Biomaterials Chemistry, Linnæus University, SE-391 82 Kalmar, Sweden.
    Fromell, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Clinical Immunology.
    Gustafson, Elisabet
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Paediatric Surgery.
    Barbu, Andreea
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Clinical Immunology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology.
    Le Bland, Katarina
    Division of Clinical Immunology and Transfusion Medicine, Department of Laboratory Medicine, Karolinska Institute, and Hematology and Regenerat ive Medicine Centre at Karolinska University Hospital Huddinge, SE-141 86 Stockholm, Sweden.
    Nilsson, Bo
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Clinical Immunology.
    Teramura, Yuji
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Clinical Immunology. Department of Bioengineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan.
    Heparinization of cell surfaces with short pepetide-conjugated PEG-lipid regulates thromboinflammation in thransplantation of human MSCs and hepatocytes2016In: Acta Biomaterialia, ISSN 1742-7061, E-ISSN 1878-7568, Vol. 35, p. 194-205Article in journal (Refereed)
    Abstract [en]

    Infusion of therapeutic cells into humans is associated with immune responses, including thromboinflammation, which result in a large loss of transplanted cells\ To address these problems, heparinization of the cell surfaces was achieved by a cell-surface modification technique using polyethylene glycol conjugated phospholipid (PEG-lipid) derivatives. A short heparin-binding peptide was conjugated to the PEG-lipid for immobilization of heparin conjugates on the surface of human mesenchymal stem cells (hMSCs) and human hepatocytes. Here three kinds of heparin-binding peptides were used for immobilizing heparin conjugates and examined for the antithrombogenic effects on the cell surface. The heparinized cells were incubated in human whole blood to evaluate their hemocompatibility by measuring blood parameters such as platelet count, coagulation markers, complement markers, and Factor Xa activity. We found that one of the heparin-binding peptides did not show cytotoxicity after the immobilization with heparin conjugates. The degree of binding of the heparin conjugates on the cell surface (analyzed by flow cytometer) depended on the ratio of the active peptide to control peptide. For both human MSCs and hepatocytes in whole-blood experiments, no platelet aggregation was seen in the heparin conjugate-immobilized cell group vs. the controls (non-coated cells or control peptide). Also, the levels of thrombin-antithrombin complex (TAT), C3a, and sC5b-9 were significantly lower than those of the controls, indicating a lower activation of coagulation and complement. Factor Xa analysis indicated that the heparin conjugate was still active on the cell surface at 24 h post-coating. It is possible to immobilize heparin conjugates onto hMSC and human hepatocyte surfaces and thereby protect the cell surfaces from damaging thromboinflammation. Statement of Signigficance We present a promising approach to enhance the biocompatibility of therapeutic cells. Here we used short peptide-conjugated PEG-lipid for cell surface modification and heparin conjugates for the coating of human hepatocytes and MSCs. We screened the short peptides to find higher affinity for heparinization of cell surface and performed hemocompatibility assay of heparinized human hepatocytes and human MSCs in human whole blood. Using heparin-binding peptide with higher affinity, not only coagulation activation but also complement activation was significantly suppressed. Thus, it was possible to protect human hepatocytes and human MSCs from the attack of thromboinflammatory activation, which can contribute to the improvement graft survival.

  • 307.
    Ask, Alexandra
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    REPLICATING THE TUMOUR MICROENVIRONMENT:CHEMOSENSITIVITY TESTING IN FIBROBLAST COCULTURES2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 308. Askelöf, M
    et al.
    Halldin Stenlid, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Edlund, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Eating behaviour and body image in overweight adolescent girls with or without hyperandrogenicity2007In: Eating and Weight Disorders, ISSN 1124-4909, E-ISSN 1590-1262, Vol. 12, no 1, p. 41-47Article in journal (Refereed)
    Abstract [en]

    We addressed the question of whether a combination of obesity and hyperandrogenicity has a more severe influence on psychosocial behaviours, as reflected by eating behaviour and body image, compared to obesity alone. AIM: To study eating behaviour and body image in age-, pubertal- and BMI-matched overweight adolescent girls with and without hyperandrogenicity, and to compare the data with those from a control group of normal weight girls. METHODS: Overweight adolescent girls in late puberty with (n=10) and without hyperandrogenicity (n=8) and a control group of normal weight girls (n=9) were studied. The Eating Disorder Inventory for children (EDI-C) questionnaire was used to obtain information on eating behaviours and psychological characteristics, and silhouettes were used to evaluate body image. RESULTS: The girls with overweight but without hyperandrogenicity showed more disturbed eating behaviour and more psychological problems than did the girls with both overweight and hyperandrogenicity as compared to the healthy controls. The overweight group also had more feelings of ineffectiveness than the hyperandrogenic group. Both the overweight and the hyperandrogenic girls estimated themselves as being significantly larger and their ideal shape as being significantly smaller than their Current shape. However, all overweight girls considered their Current shape to be significantly smaller than it was objectively. CONCLUSIONS: The girl With overweight alone seemed to have more disturbed eating behaviour and more psychological problems than girls with combined overweight and hyperandrogenicity. This could indicate that different therapeutic interventions might be needed in attempts to reduce weight in the two groups.

  • 309.
    Askelöf, Ulrica
    et al.
    Karolinska Inst, Div Obstet & Gynecol, Dept Clin Sci Intervent & Technol, Stockholm, Sweden.;Sahlgrens Univ Hosp, Swedish Natl Umbil Cord Blood Bank, Gothenburg, Sweden..
    Andersson, Ola
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Domellöf, Magnus
    Umea Univ, Dept Clin Sci, Unit Pediat, Umea, Sweden..
    Fasth, Anders
    Sahlgrens Univ Hosp, Swedish Natl Umbil Cord Blood Bank, Gothenburg, Sweden.;Univ Gothenburg, Inst Clin Sci, Dept Pediat, Gothenburg, Sweden..
    Hallberg, Boubou
    Karolinska Inst, CLINTEC, Dept Neonatol, Stockholm, Sweden.;Univ Hosp, Stockholm, Sweden..
    Hellström-Westas, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Perinatal, Neonatal and Pediatric Cardiology Research.
    Pettersson, Karin
    Karolinska Inst, Div Obstet & Gynecol, Dept Clin Sci Intervent & Technol, Stockholm, Sweden.;Sahlgrens Univ Hosp, Swedish Natl Umbil Cord Blood Bank, Gothenburg, Sweden..
    Westgren, Magnus
    Karolinska Inst, Div Obstet & Gynecol, Dept Clin Sci Intervent & Technol, Stockholm, Sweden.;Sahlgrens Univ Hosp, Swedish Natl Umbil Cord Blood Bank, Gothenburg, Sweden..
    Wiklund, Ingela E.
    Danderyd Hosp, Dept Clin Sci, Stockholm, Sweden..
    Gotherstrom, Cecilia
    Karolinska Inst, Div Obstet & Gynecol, Dept Clin Sci Intervent & Technol, Stockholm, Sweden.;Sahlgrens Univ Hosp, Swedish Natl Umbil Cord Blood Bank, Gothenburg, Sweden.;Karolinska Inst, Ctr Hematol & Regenerat Med, Stockholm, Sweden..
    Wait a minute?: An observational cohort study comparing iron stores in healthy Swedish infants at 4 months of age after 10-, 60-and 180-second umbilical cord clamping2017In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, no 12, article id e017215Article in journal (Refereed)
    Abstract [en]

    Background and objective: Umbilical cord blood (UCB) is a valuable stem cell source used for transplantation. Immediate umbilical cord (UC) clamping is widely practised, but delayed UC clamping is increasingly advocated to reduce possible infant anaemia. The aim of this study was to investigate an intermediate UC clamping time point and to evaluate iron status at the age of 4 months in infants who had the UC clamped after 60 s and compare the results with immediate and late UC clamping.

    Design: Prospective observational study with two historical controls.

    Setting: A university hospital in Stockholm, Sweden, and a county hospital in Halland, Sweden.

    Methods: Iron status was assessed at 4 months in 200 prospectively recruited term infants whose UC was clamped 60 s after birth. The newborn baby was held below the uterine level for the first 30 s before placing the infant on the mother’s abdomen for additional 30 s. The results were compared with data from a previously conducted randomised controlled trial including infants subjected to UC clamping at ≤10 s (n=200) or ≥180 s (n=200) after delivery.

    Results: After adjustment for age differences at the time of follow-up, serum ferritin concentrations were 77, 103 and 114 µg/L in the 10, 60 and 180 s groups, respectively. The adjusted ferritin concentration was significantly higher in the 60 s group compared with the 10 s group (P=0.002), while the difference between the 60 and 180 s groups was not significant (P=0.29).

    Conclusion: In this study of healthy term infants, 60 s UC clamping with 30 s lowering of the baby below the uterine level resulted in higher serum ferritin concentrations at 4 months compared with 10 s UC clamping. The results suggest that delaying the UC clamping for 60 s reduces the risk for iron deficiency.

  • 310. Asling-Monemi, K
    et al.
    Pena, R
    Ellsberg, MC
    Persson, LA
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Violence against women increases the risk of infant and child mortality: acase-referent study in Nicaragua.2003In: Bull World Health Organ, Vol. 81, p. 10-Article in journal (Refereed)
  • 311.
    Aspholm, R
    et al.
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Medical Sciences.
    Zuo, S
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Medical Sciences.
    Fohlman, J
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Medical Sciences.
    Frisk, G
    Department of Women's and Children's Health.
    Friman, G
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Medical Sciences.
    Blomberg, J
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Medical Sciences.
    A novel serological technique: polymerase chain reaction enhancedimmunoassay. Application to enterovirus IgM diagnosis.1999In: J Virol Methods, Vol. 80, p. 187-Article in journal (Refereed)
  • 312.
    Assey, V. D.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Peterson, Stefan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Greiner, Ted
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Sustainable universal salt iodization in low-income countries: time to re-think strategies?2008In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 62, no 2, p. 292-294Article in journal (Refereed)
    Abstract [en]

    Objective: Sustained iodine deficiency control requires sustainable mechanisms for iodine supplementation. We aim to describe the status of salt iodation machines, salt producers' experiences and quality of salt produced in Tanzania. Methods: Qualitative and quantitative data was collected from the factory sites, observations were made on the status of UNICEF-supplied assisted-iodation machines and convenience samples of salt from 85 salt production facilities were analysed for iodine content. Results: A total of 140 salt works visited had received 72 salt iodation machines in 1990s, but had largely abandoned them due to high running and maintenance costs. Locally devised simple technology was instead being used to iodate salt. High variability of salt iodine content was found and only 7% of samples fell within the required iodation range. Conclusion: Although iodine content at factory level is highly variable, overall iodine supply to the population has been deemed largely sufficient. The need for perpetual iodine fortification requires reassessment of salt iodation techniques and production-monitoring systems to ensure sustainability. The emerging local technologies need evaluation as alternative approaches for sustaining universal salt iodation in low-income countries with many small-scale salt producers.

  • 313.
    Assey, Vincent D.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Greiner, Ted
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Mzee, R. K.
    Abuu, H.
    Mgoba, C.
    Kimboka, S.
    Peterson, Stefan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Iodine deficiency persists in the Zanzibar Islands of Tanzania2006In: Food and Nutrition Bulletin, ISSN 0379-5721, E-ISSN 1564-8265, Vol. 27, no 4, p. 292-299Article in journal (Refereed)
    Abstract [en]

    Background. Iodine is an essential micronutrient for normal human growth and development. It is estimated that more than 1.6 billion people live in iodine-deficient environments, yet there are still some countries and areas where the prevalence of iodine-deficiency disorders is unknown. Objective. To establish the prevalence of iodine-deficiency disorders in the Zanzibar Islands, a community assumed to have ready access to iodine-rich seafoods. Methods. In a cross-sectional study, 11, 967 schoolchildren were Palpated for goiter prevalence, a subsample was evaluated for urinary iodine concentration, and the availability of iodated salt was assessed at the household and retail levels. Results. The mean total goiter prevalence was 21.3% for Unguja and 32.0% for Pemba. The overall median urinary iodine concentration was 127.5 ug/L. For Unguja the median was 185.7 mu g/L, a higher value than the median of 53.4 mu g/L for Pemba (p <.01). The household availability of iodated salt was 63.5% in Unguja and 1.0% in Pemba. The community was not aware of the iodine-deficiency problem and had never heard of iodated salt. Conclusions. The inadequate intake of iodine documented in the Zanzibar Islands belies the common assumption that an island population with access to seafood is not at risk for iodine-deficiency disorders. We urge health planners to implement mandatory salt iodation and education efforts to alleviate the situation.

  • 314.
    Assey, Vincent D.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Mgoba, Celestin
    Mlingi, Nicholaus
    Sanga, Alfred
    Ndossi, Godwin D.
    Greiner, Ted
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Peterson, Stefan
    Remaining challenges in Tanzania's efforts to eliminate iodine deficiency2007In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 10, no 10, p. 1032-1038Article in journal (Refereed)
    Abstract [en]

    Objective: To determine iodine levels in salt and iodine deficiency prevalence in school-aged children in 16 districts in Tanzania with previous severe iodine deficiency. Design: A cross-sectional study in schoolchildren. Systematic probability sampling was used to select schools and subjects for goitre assessment and urinary iodine determination. Setting: Sixteen districts randomly selected from the 27 categorised as severely iodine-deficient in Tanzania. Subjects: The stndy population was primary-school children aged 6-18 years who were examined for goitre prevalence and urinary, iodine concentration (UIC). Salt samples from schoolchildren's homes and from shops were tested for iodine content. Results. The study revealed that 83.3% of households (n = 21 160) in the surveyed districts used iodised salt. Also, 94% of sampled shops (n = 397) sold iodised salt, with a median iodine level of 37.0 ppm (range 4.2-240 ppm). Median UIC in 2089 schoolchildren vas 235.0 mu g 1(-1) and 9.3% had UIC values below 50 mu g 1(-1). The overall unweighted mean visible and total goitre prevalence was 6.7% and 24.3%, respectively (n = 16 222). The age group 6-12 Nears had the lowest goitre prevalence (3.6% visible and 18.0% total goitre, 11 = 7147). The total goitre prevalence had decreased significantly in all districts from an unweighted mean of 65.4% in the 1980s to 24.3% in 1999 (P < 0.05). We believe this difference was also biologically significant. Conclusion: These findings indicate that iodine deficiency is largely eliminated in the 16 districts categorised as severely iodine-deficient in Tanzania, and that the iodine content of salt purchased from shops is highly variable.

  • 315.
    Assey, Vincent D
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Peterson, Stefan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Kimboka, Sabas
    Tanzania Food and Nutrition Centre, Dar Es Salaam, Tanzania.
    Ngemera, Daniel
    Mgoba, Celestin
    Ruhiye, Deusdedit M
    Ndossi, Godwin D
    Greiner, Ted
    Tylleskär, Thorkild
    Tanzania national survey on iodine deficiency: impact after twelve years of salt iodation.2009In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 9, p. 319-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In many low-income countries, children are at high risk of iodine deficiency disorders, including brain damage. In the early 1990s, Tanzania, a country that previously suffered from moderate to severe iodine deficiency, adopted universal salt iodation (USI) as an intervention strategy, but its impact remained unknown. METHODS: We report on the first national survey in mainland Tanzania, conducted in 2004 to assess the extent to which iodated salt was used and its apparent impact on the total goitre prevalence (TGP) and urinary iodine concentrations (UIC) among the schoolchildren after USI was initiated. In 2004, a cross-sectional goitre survey was conducted; covering 140,758 schoolchildren aged 6 - 18 years were graded for goitre according to new WHO goitre classification system. Comparisons were made with district surveys conducted throughout most of the country during the 1980s and 90s. 131,941 salt samples from households were tested for iodine using rapid field test kits. UIC was determined spectrophotometrically using the ammonium persulfate digestion method in 4523 sub-sampled children. RESULTS: 83.6% (95% CI: 83.4 - 83.8) of salt samples tested positive for iodine. Whereas the TGP was about 25% on average in the earlier surveys, it was 6.9% (95%CI: 6.8-7.0) in 2004. The TGP for the younger children, 6-9 years old, was 4.2% (95%CI: 4.0-4.4), n = 41,965. In the 27 goitre-endemic districts, TGP decreased from 61% (1980s) to 12.3% (2004). The median UIC was 204 (95% CF: 192-215) microg/L. Only 25% of children had UIC <100 microg/L and 35% were > or = 300 microg/L, indicating low and excess iodine intake, respectively. CONCLUSION: Our study demonstrates a marked improvement in iodine nutrition in Tanzania, twelve years after the initiation of salt iodation programme. The challenge in sustaining IDD elimination in Tanzania is now two-fold: to better reach the areas with low coverage of iodated salt, and to reduce iodine intake in areas where it is excessive. Particular attention is needed in improving quality control at production level and perhaps the national salt iodation regulations may need to be reviewed.

  • 316.
    Assey, Vincent D.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Tylleskär, Thorkild
    Centre for International Healht, University of Bergen, Norway.
    Momburi, Philip B.
    Geological Survey of Tanzania, Ministry of Energy and Minerals, Dodoma, Tanzania.
    Maganga, Michael
    Food Science and Nutrition Department, Tanzania.
    Mlingi, Nicholaus V.
    Food Science and Nutrition Department, Tanzania.
    Reilly, Marie
    Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Greiner, Ted
    Food and Nutrition Department, Hanyang University, Seoul, South Korea.
    Peterson, Stefan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Improved salt iodation methods for small-scale salt producers in low-resource settings in Tanzania2009In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 9, p. 187-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Universal salt iodation will prevent iodine deficiency disorders (IDD). Globally, salt-iodation technologies mostly target large and medium-scale salt-producers. Since most producers in low-income countries are small-scale, we examined and improved the performance of hand and knapsack-sprayers used locally in Tanzania. METHODS: We studied three salt facilities on the Bagamoyo coast, investigating procedures for preparing potassium-iodate solution, salt spraying and mixing. Different concentrations of solution were prepared and tested using different iodation methods, with the aim of attaining correct and homogeneous iodine levels under real-life conditions. Levels achieved by manual mixing were compared to those achieved by machine mixing. RESULTS: The overall median iodation level in samples of salt iodated using previously existing methods was 10.6 ppm (range 1.1 - 110.0 ppm), with much higher levels in the top than the bottom layers of the salt bags, p < 0.0001. Experimentation using knapsack-sprayers and manual mixing led to the reliable achievement of levels (60.9 ppm +/- 7.4) that fell within the recommended range of 40 - 80 ppm. The improved methods yielded homogenous iodine concentrations in all layers of salt-bags (p = 0.58) with 96% of the samples (n = 45) falling within 40 - 80 ppm compared to only 9% (n = 45) before the experiment and training (p < 0.0001). For knapsack-spraying, a machine mixer improved the iodine levels and homogeneity slightly compared to manual mixing (p = 0.05). CONCLUSION: Supervised, standardized salt iodation procedures adapted to local circumstances can yield homogeneous iodine levels within the required range, overcoming a major obstacle to universal salt iodation.

  • 317.
    Ata, Humera
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    The quality of Antenatal care and its determinants in women of reproductive age in Pakistan: A cross-sectional study using Pakistan's Demographic Health survey data 2012-132016Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Background: Antenatal care (ANC) coverage rates have increased in Pakistan, but little is known about its quality. This study investigated the prevalence and factors associated with the quality of ANC in Pakistan.

    Methods: Based on cross-sectional data from Pakistan’s Demographic and Health Survey 2012-13, this study evaluated 5,522 women aged 15-49 years having at least one ANC consultation in their last pregnancy for the receipt of quality antenatal care. It was measured in terms of access and effectiveness (early initiation, four or more ANC visits, care by a skilled provider, and receipt of seven basic components of focused ANC) and was assessed for its association with structural, household, and individual factors. Sampling weights and generalized linear mixed-effects models were used.

    Results: ANC coverage was 71% and 38% for one and ≥ 4 visits, respectively. The prevalence of ANC quality was 11%. Higher household wealth and maternal educational level, older maternal age, lower gravidity status, and bad obstetric history significantly increased the odds of receiving quality care, whereas, living in Balochistan and Sindh provinces and attending non-formal care sources was associated with lower odds of getting quality care. Among the basic ANC components, blood pressure measurement was most frequently, whereas, health education was least frequently provided.

    Conclusions: Due to suboptimal quality, antenatal care in Pakistan is unlikely to achieve its potential to reduce the maternal and perinatal burden of disease. There is a dire need to address socio-demographic inequality in the receipt of quality ANC and to target the underprivileged.

  • 318.
    Attevall, Janine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Genetic investigation of rare microdeletions and microduplications with distinct clinical features2018Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Chromosomal microduplications and microdeletions represent the largest significant fraction of Copy Number Variants (CNV) and some can cause developmental delay and intellectual disability. The relatively common microdeletions and microduplications syndromes are well known but there are clinical cases with unique microduplications/-deletions that have not been studied sufficiently. The aim of this study was to verify positive SNP-microarray results during the genetic investigation of four patients with different unique microduplications or microduplications with metaphase-FISH. Since sodium heparin tubes contain the existing test material for these patients, a validation of RNA extraction was also made to verify if blood taken in these tubes can be used for further gene expression analysis.

    Blood samples and amniotic fluid were analyzed with SNP-microarray and verified with metaphase-FISH. RNA was extracted from blood taken in EDTA and sodium heparin tubes from five different individuals. Gene expression analysis with RT-qPCR were performed as a control for the RNA extraction using the genes ISPD and GUSB.

    FISH-analysis could detect the chromosomal rearrangements in all patients and investigation of the parents showed that these rearrangements were de novo. These results contribute to a better understanding of these unique aberrations and the patients´ phenotypes. There was no significant difference in RNA quality between sodium heparin and EDTA tubes. However RT-qPCR showed lower efficiency for both target gene (ISPD) and reference gene (GUSB) in RNA samples extracted from sodium heparin tubes. Blood samples in sodium heparin tubes should therefore not be used for RNA-analysis in further investigations.

  • 319.
    August, Furaha
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Effect of Home Based Life Saving Skills education on knowledge of obstetric danger signs, birth preparedness, utilization of skilled care and male involvement: A Community-based intervention study in rural Tanzania2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Use of skilled care during antenatal visits and delivery is recommended to address the burden of maternal mortality. However there are few facility deliveries and insufficient knowledge of danger signs, especially in rural Tanzania. 

    The aim of this thesis was to explore the perceptions and challenges that the community faces while preparing for childbirth and to evaluate an intervention of the Home Based Life Saving Skills education programme on knowledge of danger signs, facility delivery and male involvement when delivered by rural community health workers in Tanzania.

    In Paper I, Focus Group Discussions explored the perceptions and challenges that the community encounters while preparing for childbirth. Structured questionnaires assessed men’s knowledge of danger signs and birth preparedness and complication readiness in Paper II. The effect of the Home Based Life Saving Skills education programme in the community was assessed with a before-and-after evaluation in two districts; one intervention and one comparison. Paper III assessed the effect of the programme on knowledge of danger signs and birth preparedness and facility delivery among women, while Paper IV evaluated its effect on male involvement.

    The community perceived that all births must be prepared for and that obstetric complication demands hospital care; hence skilled care was favoured. Men’s knowledge of danger signs was limited; only 12% were prepared for childbirth and complications. Preparedness was associated with knowledge of obstetric complications (AOR=1.4 95% CI 1.8 – 2.6). The intervention showed women utilizing antenatal care (four visits) significantly more (43.4 vs 67.8%) with a net effect of 25.3% (95% CI: 16.9 – 33.2; p < .0001). The use of facility delivery improved in the intervention area (75.6 vs 90.2%; p = 0.0002), but with no significant net effect 11.5% (95% CI: -5.1 – 39.6; p = 0.123) when comparing the two districts. Male involvement improved (39.2% vs 80.9%) with a net intervention effect of 41.1% (CI: 28.5 – 53.8; p < .0001). Improvements were demonstrated in men’s knowledge level, in escorting partners for antenatal care and delivery, making birth preparations, and shared decision-making.

    The intervention, in educating this rural community, is effective in improving knowledge, birth preparedness, male involvement and use of skilled care.

     

  • 320.
    August, Furaha
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Pembe, Andrea B.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Kayombo, Edmund
    Mbekenga, Columba
    Axemo, Pia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Darj, Elisabeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Birth preparedness and complication readiness - a qualitative study among community members in rural Tanzania2015In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 8, p. 1-U12, article id 26922Article in journal (Refereed)
    Abstract [en]

    Background: Birth preparedness and complication readiness (BP/CR) strategies are aimed at reducing delays in seeking, reaching, and receiving care. Counselling on birth preparedness is provided during antenatal care visits. However, it is not clear why birth preparedness messages do not translate to utilisation of facility delivery. This study explores the perceptions, experiences, and challenges the community faces on BP/CR. Design: A qualitative study design using Focused Group Discussions was conducted. Twelve focus group discussions were held with four separate groups: young men and women and older men and women in a rural community in Tanzania. Qualitative content analysis was used to analyse the data. Results: The community members expressed a perceived need to prepare for childbirth. They were aware of the importance to attend the antenatal clinics, relied on family support for practical and financial preparations such as saving money for costs related to delivery, moving closer to the nearest hospital, and also to use traditional herbs, in favour of a positive outcome. Community recognised that pregnancy and childbirth complications are preferably treated at hospital. Facility delivery was preferred; however, certain factors including stigma on unmarried women and transportation were identified as hindering birth preparedness and hence utilisation of skilled care. Challenges were related to the consequences of poverty, though the maternal health care should be free, they perceived difficulties due to informal user fees. Conclusions: This study revealed community perceptions that were in favour of using skilled care in BP/CR. However, issues related to inability to prepare in advance hinder the realisation of the intention to use skilled care. It is important to innovate how the community reinforces BP/CR, such as using insurance schemes, using community health funds, and providing information on other birth preparedness messages via community health workers.

  • 321.
    August, Furaha
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Pembe, Andrea B.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Mpembeni, Rose
    Department of Epidemiology and Biostatistics, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
    Axemo, Pia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Darj, Elisabeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Community Health workers can improve male involvement in maternal health: Evidence from rural Tanzania2016In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 9, article id 30064Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Male involvement in maternal health is recommended as one of the interventions to improve maternal and newborn health. There have been challenges in realising this action, partly due to the position of men in society and partly due to health system challenges in accommodating men. The aim of this study was therefore to evaluate the effect of Home Based Life Saving Skills training by community health workers on improving male involvement in maternal health in terms of knowledge of danger signs, joint decision-making, birth preparedness, and escorting wives to antenatal and delivery care in a rural community in Tanzania.

    DESIGN:

    A community-based intervention consisting of educating the community in Home Based Life Saving Skills by community health workers was implemented using one district as the intervention district and another as comparison district. A pre-/post-intervention using quasi-experimental design was used to evaluate the effect of Home Based Life Saving Skills training on male involvement and place of delivery for their partners. The effect of the intervention was determined using difference in differences analysis between the intervention and comparison data at baseline and end line.

    RESULTS:

    The results show there was improvement in male involvement (39.2% vs. 80.9%) with a net intervention effect of 41.1% (confidence interval [CI]: 28.5-53.8; p <0.0001). There was improvement in the knowledge of danger signs during pregnancy, childbirth, and postpartum periods. The proportion of men accompanying their wives to antenatal and delivery also improved. Shared decision-making for place of delivery improved markedly (46.8% vs. 86.7%), showing a net effect of 38.5% (CI: 28.0-49.1; p <0.0001). Although facility delivery for spouses of the participants improved in the intervention district, this did not show statistical significance when compared to the comparison district with a net intervention effect of 12.2% (95% CI: -2.8-27.1: p=0.103).

    CONCLUSION:

    This community-based intervention employing community health workers to educate the community in the Home Based Life Saving Skills programme is both feasible and effective in improving male involvement in maternal healthcare.

  • 322.
    August, Furaha
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Muhimbili Univ Hlth & Allied Sci, Dept Obstet & Gynaecol, Dar Es Salaam, Tanzania..
    Pembe, Andrea B.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Muhimbili Univ Hlth & Allied Sci, Dept Obstet & Gynaecol, Dar Es Salaam, Tanzania..
    Mpembeni, Rose
    Department of Epidemiology and Biostatistics, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
    Axemo, Pia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Darj, Elisabeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Norwegian Univ Sci & Technol, Dept Publ Hlth & Gen Practice, N-7034 Trondheim, Norway..
    Effectiveness of the Home Based Life Saving Skills training by community health workers on knowledge of danger signs, birth preparedness, complication readiness and facility delivery, among women in Rural Tanzania2016In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 16, article id 129Article in journal (Refereed)
  • 323.
    August, Furaha
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Pembe, Andrea B
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Mpembeni, Rose
    Department of Epidemiology and Biostatistics, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
    Axemo, Pia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Darj, Elisabeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Men's Knowledge of Obstetric Danger Signs, Birth Preparedness and Complication Readiness in Rural Tanzania2015In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 5, p. e0125978-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Men's involvement in reproductive health is recommended. Their involvement in antenatal care service is identified as important in maternal health. Awareness of obstetric danger signs facilitates men in making a joint decision with their partners regarding accessing antenatal and delivery care. This study aims to assess the level of knowledge of obstetric complications among men in a rural community in Tanzania, and to determine their involvement in birth preparedness and complication readiness.

    METHODS: A cross-sectional survey was conducted where 756 recent fathers were invited through a two-stage cluster sampling procedure. A structured questionnaire was used to collect socio-demographic characteristics, knowledge of danger signs and steps taken on birth preparedness and complication readiness. Data were analyzed using bivariate and multivariable logistic regression to determine factors associated with being prepared, with statistically significant level at p<0.05.

    RESULTS: Among the invited men, 95.9% agreed to participate in the community survey. Fifty-three percent could mention at least one danger sign during pregnancy, 43.9% during delivery and 34.6% during the postpartum period. Regarding birth preparedness and complication readiness, 54.3% had bought birth kit, 47.2% saved money, 10.2% identified transport, 0.8% identified skilled attendant. In general, only 12% of men were prepared. Birth preparedness was associated with knowledge of danger signs during pregnancy (AOR = 1.4, 95% CI: 1.8-2.6). It was less likely for men living in the rural area to be prepared (AOR=0.6, 95% CI; 0.5-0.8).

    CONCLUSION: There was a low level of knowledge of obstetric danger signs among men in a rural district in Tanzania. A very small proportion of men had prepared for childbirth and complication readiness. There was no effect of knowledge of danger signs during childbirth and postpartum period on being prepared. Innovative strategies that increase awareness of danger signs as well as birth preparedness and complication readiness among men are required. Strengthening counseling during antenatal care services that involve men together with partners is recommended.

  • 324.
    Austeng, Dordi
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ophthalmology.
    Blennow, Mats
    Ewald, Uwe
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Fellman, Vineta
    Fritz, Thomas
    Hellström-Westas, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Hellström, Ann
    Holmgren, Per Ake
    Holmström, Gerd
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ophthalmology.
    Jakobsson, Peter
    Jeppsson, Annika
    Johansson, Kent
    Kallen, Karin
    Lagercrantz, Hugo
    Laurini, Ricardo
    Lindberg, Eva
    Lundqvist, Anita
    Marsal, Karel
    Nilstun, Tore
    Nordén Lindeberg, Solveig
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Norman, Mikael
    Olhager, Elisabeth
    Oestlund, Ingrid
    Serenius, Fredrik
    Simic, Marija
    Sjörs, Gunnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Stigson, Lennart
    Stjernqvist, Karin
    Strömberg, Bo
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Tornqvist, Kristina
    Wennergren, Margareta
    Wallin, Agneta
    Westgren, Magnus
    Incidence of and risk factors for neonatal morbidity after active perinatal care: extremely preterm infants study in Sweden (EXPRESS)2010In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 99, no 7, p. 978-992Article in journal (Refereed)
    Abstract [en]

    Aims: The aim of this study was to determine the incidence of neonatal morbidity in extremely preterm infants and to identify associated risk factors. Methods: Population based study of infants born before 27 gestational weeks and admitted for neonatal intensive care in Sweden during 2004-2007. Results: Of 638 admitted infants, 141 died. Among these, life support was withdrawn in 55 infants because of anticipation of poor long-term outcome. Of 497 surviving infants, 10% developed severe intraventricular haemorrhage (IVH), 5.7% cystic periventricular leucomalacia (cPVL), 41% septicaemia and 5.8% necrotizing enterocolitis (NEC); 61% had patent ductus arteriosus (PDA) and 34% developed retinopathy of prematurity (ROP) stage >= 3. Eighty-five per cent needed mechanical ventilation and 25% developed severe bronchopulmonary dysplasia (BPD). Forty-seven per cent survived to one year of age without any severe IVH, cPVL, severe ROP, severe BPD or NEC. Tocolysis increased and prolonged mechanical ventilation decreased the chances of survival without these morbidities. Maternal smoking and higher gestational duration were associated with lower risk of severe ROP, whereas PDA and poor growth increased this risk. Conclusion: Half of the infants surviving extremely preterm birth suffered from severe neonatal morbidities. Studies on how to reduce these morbidities and on the long-term health of survivors are warranted.

  • 325.
    Austeng, Dordi
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Källen, Karin B. M.
    Tornbladsinstitutet, Lund University.
    Ewald, Uwe W.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Jakobsson, Peter G.
    Department of Ophthalmology, Linköping University.
    Holmström, Gerd E.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Incidence of retinopathy of prematurity in infants born before 27 weeks' gestation in Sweden2009In: Archives of ophthalmology (1960), ISSN 0003-9950, Vol. 127, no 10, p. 1315-1319Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To determine the incidence of retinopathy of prematurity (ROP) in extremely preterm infants born before 27 weeks' gestation in Sweden during a 3-year period. METHODS: A national, prospective, population-based study was performed in Sweden from April 1, 2004, to March 31, 2007. The ophthalmologic part of the study was separately organized, and screening for ROP was performed beginning postnatal week 5. The criteria for the treatment of ROP agreed with the recommendations of the Early Treatment for Retinopathy of Prematurity Cooperative Group. RESULTS: During the study, 506 of 707 live-born infants survived until the first eye examination. Of these, 368 (72.7%) had ROP: 37.9% had mild ROP and 34.8% had severe ROP. Ninety-nine infants (19.6%) were treated. Gestational age at birth was a stronger predictor of ROP than was birth weight. A log-linear relationship between severe ROP and gestational age at birth was found in the present cohort, and the risk of ROP was reduced by 50% for each week of increase in gestational age at birth. CONCLUSIONS: Today, extremely preterm infants are surviving, and this population-based study with ROP as a primary outcome shows a higher incidence of this condition than in previously reported national cohorts.

  • 326.
    Austeng, Dordi
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Källen, Karin B. M.
    Lund University.
    Ewald, Uwe W.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Wallin, Agneta
    St.Erik's Eye Hospital.
    Holmström, Gerd E.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Treatment for retinopathy of prematurity in infants born before 27 weeks of gestation in Sweden2010In: British Journal of Ophthalmology, ISSN 0007-1161, E-ISSN 1468-2079, Vol. 94, no 9, p. 1136-1139Article in journal (Refereed)
    Abstract [en]

    AIMS: To study various aspects of treatment for retinopathy of prematurity (ROP) in a Swedish population of extremely preterm infants born before 27 weeks of gestation. METHODS: A national, prospective and population-based study was performed in Sweden from April 1, 2004 to March 31, 2007. The criteria for treatment of ROP accorded with the recommendations of the Early Treatment for Retinopathy of Prematurity Cooperative Group. RESULTS: Twenty percent of the infants (99/506) were treated for ROP. The likelihood of reaching treatment criteria nearly doubled for each week of reduction in gestational age (GA) at birth. The first treatment was performed at an earlier postmenstrual age in the most immature infants. One third of the infants had more than one session of laser treatment. CONCLUSIONS: A high percentage of these extremely preterm infants required treatment for ROP. The likelihood of reaching treatment criteria increased with a decline in GA at birth. Although only a few infants progressed to ROP Stages 4 and 5, our findings indicate a potential for improvement of the treatment routines, both regarding timing and number of laser spots at the first treatment.

  • 327.
    Austin, Paul F.
    et al.
    Washington Univ, St Louis Childrens Hosp, Div Urol, St Louis, MO 63110 USA..
    Bauer, Stuart B.
    Harvard Univ, Childrens Hosp, Sch Med, Dept Urol, Boston, MA 02115 USA..
    Bower, Wendy
    Skejby Univ Hosp, Pediat Nephrol Sect, Aarhus, Denmark..
    Chase, Janet
    Cabrini Hosp, Childrens Ctr, Melbourne, Vic, Australia..
    Franco, Israel
    New York Med Coll, Valhalla, NY 10595 USA..
    Hoebeke, Piet
    Ghent Univ Hosp, Pediat Urol & Nephrol, Ghent, Belgium..
    Rittig, Soren
    Skejby Univ Hosp, Pediat Nephrol Sect, Aarhus, Denmark..
    Vande Walle, Johan
    Ghent Univ Hosp, Pediat Urol & Nephrol, Ghent, Belgium..
    von Gontard, Alexander
    Saarland Univ Hosp, Dept Child & Adolescent Psychiat, Saarbrucken, Germany..
    Wright, Anne
    St Thomas Hosp, Evelina Childrens Hosp, Pediat, London, England..
    Yang, Stephen S.
    Buddhist Med Fdn, Taipei Tzu Chi Hosp, Div Urol, New Taipei, Taiwan.;Buddhist Tzu Chi Univ, Sch Med, Hualien, Taiwan..
    Nevéus, Tryggve
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    The standardization of terminology of lower urinary tract function in children and adolescents: Update report from the standardization committee of the International Children's Continence Society2016In: Neurourology and Urodynamics, ISSN 0733-2467, E-ISSN 1520-6777, Vol. 35, no 4, p. 471-481Article in journal (Refereed)
    Abstract [en]

    AimThe impact of the original International Children's Continence Society (ICCS) terminology document on lower urinary tract (LUT) function resulted in the global establishment of uniformity and clarity in the characterization of LUT function and dysfunction in children across multiple healthcare disciplines. The present document serves as a stand-alone terminology update reflecting refinement and current advancement of knowledge on pediatric LUT function. MethodsA variety of worldwide experts from multiple disciplines within the ICCS leadership who care for children with LUT dysfunction were assembled as part of the standardization committee. A critical review of the previous ICCS terminology document and the current literature was performed. Additionally, contributions and feedback from the multidisciplinary ICCS membership were solicited. ResultsFollowing a review of the literature over the last 7 years, the ICCS experts assembled a new terminology document reflecting current understanding of bladder function and LUT dysfunction in children using the resources from the literature review, expert opinion and ICCS member feedback. ConclusionsThe present ICCS terminology document provides a current and consensus update to the evolving terminology and understanding of LUT function in children.

  • 328.
    Austin, Paul F
    et al.
    Division of Urology, Washington University in St. Louis, St. Louis Children’s Hospital, Missouri.
    Bauer, Stuart B
    Department of Urology, Children’s Hospital and Harvard Medical School, Boston, Massachusetts.
    Bower, Wendy
    Pediatrics (Nephrology Section), Skejby University Hospital, Aarhus, Denmark.
    Chase, Janet
    The Children’s Centre, Cabrini Hospital, Melbourne, Australia.
    Franco, Israel
    New York Medical College, Valhalla, New York.
    Hoebeke, Piet
    Pediatric Urology and Nephrology, Gent University Hospital, Ghent, Belgium.
    Rittig, Søren
    Pediatrics (Nephrology Section), Skejby University Hospital, Aarhus, Denmark.
    Walle, Johan Vande
    Pediatric Urology and Nephrology, Gent University Hospital, Ghent, Belgium.
    von Gontard, Alexander
    Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany.
    Wright, Anne
    Pediatrics, Evelina Children’s Hospital, St Thomas’ Hospital, London, England.
    Yang, Stephen S
    Division of Urology, Taipei Tzu Chi Hospital, The Buddhist Medical Foundation, New Taipei.
    Nevéus, Tryggve
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    The Standardization of Terminology of Lower Urinary Tract Function in Children and Adolescents: Update Report from the Standardization Committee of the International Children's Continence Society.2014In: Journal of Urology, ISSN 0022-5347, E-ISSN 1527-3792, Vol. 191, no 6, p. 1863-1865Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The impact of the original International Children's Continence Society (ICCS) terminology document on lower urinary tract (LUT) function resulted in the global establishment of uniformity and clarity in the characterization of LUT function and dysfunction in children across multiple healthcare disciplines. The present document serves as a stand-alone terminology update reflecting refinement and current advancement of knowledge on pediatric LUT function.

    MATERIALS AND METHODS: A variety of worldwide experts from multiple disciplines within the ICCS leadership who care for children with LUT dysfunction were assembled as part of the standardization committee. A critical review of the previous ICCS terminology document and the current literature was performed. Additionally, contributions and feedback from the multidisciplinary ICCS membership were solicited.

    RESULTS: Following a review of the literature over the last 7 years, the ICCS experts assembled a new terminology document reflecting current understanding of bladder function and LUT dysfunction in children using the resources from the literature review, expert opinion and ICCS member feedback.

    CONCLUSIONS: The present ICCS terminology document provides a current and consensus update to the evolving terminology and understanding of LUT function in children.

  • 329. Avall-Lundqvist, Elisabeth
    et al.
    Staf, Christian
    Bjurberg, Maria
    Borgfeldt, Christer
    Dahm-Kahler, Pernilla
    Falconer, Henrik
    Holmberg, Erik
    Kjolhede, Preben
    Stålberg, Karin Glimskär
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Rosenberg, Per
    Hogberg, Thomas
    A population-based study of pelvic serous carcinoma in Sweden: Primary site, FIGO stage and survival.2015In: Journal of Clinical Oncology, ISSN 0732-183X, E-ISSN 1527-7755, Vol. 33, no 15Article in journal (Other academic)
  • 330.
    Aweko, Juliet
    et al.
    Karolinska Inst, Dept Publ Hlth Sci, Stockholm, Sweden.
    De Man, Jeroen
    Inst Trop Med, Dept Publ Hlth, Antwerp, Belgium.
    Absetz, Pilvikki
    Univ Eastern Finland, Inst Publ Hlth & Clin Nutr, Joensuu, Finland.
    Östenson, Claes-Göran
    Karolinska Univ Hosp, Dept Mol Med & Surg, Stockholm, Sweden.
    Peterson, Stefan Swartling
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Mölsted Alvesson, Helle
    Karolinska Inst, Dept Publ Hlth Sci, Stockholm, Sweden.
    Daivadanam, Meena
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics. Karolinska Inst, Dept Publ Hlth Sci, Stockholm, Sweden.
    Patient and Provider Dilemmas of Type 2 Diabetes Self-Management: A Qualitative Study in Socioeconomically Disadvantaged Communities in Stockholm2018In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 15, no 9, article id 1810Article in journal (Refereed)
    Abstract [en]

    Studies comparing provider and patient views and experiences of self-management within primary healthcare are particularly scarce in disadvantaged settings. In this qualitative study, patient and provider perceptions of self-management were investigated in five socio-economically disadvantaged communities in Stockholm. Twelve individual interviews and four group interviews were conducted. Semi-structured interview guides included questions on perceptions of diabetes diagnosis, diabetes care services available at primary health care centers, patient and provider interactions, and self-management support. Data was analyzed using thematic analysis. Two overarching themes were identified: adopting and maintaining new routines through practical and appropriate lifestyle choices (patients), and balancing expectations and pre-conceptions of self-management (providers). The themes were characterized by inherent dilemmas representing confusions and conflicts that patients and providers experienced in their daily life or practice. Patients found it difficult to tailor information and lifestyle advice to fit their daily life. Healthcare providers recognized that patients needed support to change behavior, but saw themselves as inadequately equipped to deal with the different cultural and social aspects of self-management. This study highlights patient and provider dilemmas that influence the interaction and collaboration between patients and providers and hinder uptake of self-management advice.

  • 331.
    Awor, Phyllis
    et al.
    School of Public Health, College of Health Sciences, Makarere University, Kampala, Uganda.
    Miller, Jane
    Malaria and Child Survival Department, Population Services International, Nairobi, Kenya.
    Peterson, Stefan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Systematic literature review of integrated community case management and the private sector in Africa: Relevant experiences and potential next step2014In: Journal of Global Health, ISSN 2047-2978, E-ISSN 2047-2986, Vol. 4, no 2Article in journal (Refereed)
  • 332.
    Awor, Phyllis
    et al.
    Makerere Univ, Sch Publ Hlth, Kampala, Uganda.
    Peterson, Stefan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. Makerere Univ, Sch Publ Hlth, Kampala, Uganda;Unicef, New York, NY USA.
    Gautham, Meenakshi
    London Sch Hyg & Trop Med, London, England.
    Delivering child health interventions through the private sector in low and middle income countries: challenges, opportunities, and potential next steps2018In: BMJ. British Medical Journal, E-ISSN 1756-1833, Vol. 362, article id k2950Article, review/survey (Refereed)
  • 333. Awor, Phyllis
    et al.
    Wamani, Henry
    Bwire, Godfrey
    Jagoe, George
    Peterson, Stefan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Private sector drug shops in integrated community case management of malaria, pneumonia, and diarrhea in children in Uganda2012In: American Journal of Tropical Medicine and Hygiene, ISSN 0002-9637, E-ISSN 1476-1645, Vol. 87, no 5 Suppl, p. 92-96Article in journal (Refereed)
    Abstract [en]

    We conducted a survey involving 1,604 households to determine community care-seeking patterns and 163 exit interviews to determine appropriateness of treatment of common childhood illnesses at private sector drug shops in two rural districts of Uganda. Of children sick within the last 2 weeks, 496 (53.1%) children first sought treatment in the private sector versus 154 (16.5%) children first sought treatment in a government health facility. Only 15 (10.3%) febrile children treated at drug shops received appropriate treatment for malaria. Five (15.6%) children with both cough and fast breathing received amoxicillin, although no children received treatment for 5-7 days. Similarly, only 8 (14.3%) children with diarrhea received oral rehydration salts, but none received zinc tablets. Management of common childhood illness at private sector drug shops in rural Uganda is largely inappropriate. There is urgent need to improve the standard of care at drug shops for common childhood illness through public-private partnerships.

  • 334.
    Awor, Phyllis
    et al.
    Centre for International Health, Department of Global Public Health and Primary Health Care, University of Bergen, Norway.
    Wamani, Henry
    School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
    Tylleskar, Thorkild
    Centre for International Health, Department of Global Public Health and Primary Health Care, University of Bergen, Norway.
    Jagoe, George
    Medicines for Malaria Venture, Geneva, Switzerland.
    Peterson, Stefan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Increased access to care and appropriateness of treatment at private sector drug shops with integrated management of malaria, pneumonia and diarrhoea: a quasi-experimental study in Uganda2014In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 9, no 12, p. e115440-Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION:

    Drug shops are a major source of care for children in low income countries but they provide sub-standard care. We assessed the feasibility and effect on quality of care of introducing diagnostics and pre-packaged paediatric-dosage drugs for malaria, pneumonia and diarrhoea at drug shops in Uganda.

    METHODS:

    We adopted and implemented the integrated community case management (iCCM) intervention within registered drug shops. Attendants were trained to perform malaria rapid diagnostic tests (RDTs) in each fever case and count respiratory rate in each case of cough with fast/difficult breathing, before dispensing recommended treatment. Using a quasi-experimental design in one intervention and one non-intervention district, we conducted before and after exit interviews for drug seller practices and household surveys for treatment-seeking practices in May-June 2011 and May-June 2012. Survey adjusted generalized linear models and difference-in-difference analysis was used.

    RESULTS:

    3759 (1604 before/2155 after) household interviews and 943 (163 before/780 after) exit interviews were conducted with caretakers of children under-5. At baseline, no child at a drug shop received any diagnostic testing before treatment in both districts. After the intervention, while no child in the non-intervention district received a diagnostic test, 87.7% (95% CI 79.0-96.4) of children with fever at the intervention district drug shops had a parasitological diagnosis of malaria, prior to treatment. The prevalence ratios of the effect of the intervention on treatment of cough and fast breathing with amoxicillin and diarrhoea with ORS/zinc at the drug shop were 2.8 (2.0-3.9), and 12.8 (4.2-38.6) respectively. From the household survey, the prevalence ratio of the intervention effect on use of RDTs was 3.2 (1.9-5.4); Artemisinin Combination Therapy for malaria was 0.74 (0.65-0.84), and ORS/zinc for diarrhoea was 2.3 (1.2-4.7).

    CONCLUSION:

    iCCM can be utilized to improve access and appropriateness of care for children at drug shops.

  • 335. Awor, Phyllis
    et al.
    Wamani, Henry
    Tylleskar, Thorkild
    Peterson, Stefan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Drug seller adherence to clinical protocols with integrated management of malaria, pneumonia and diarrhoea at drug shops in Uganda2015In: Malaria Journal, ISSN 1475-2875, E-ISSN 1475-2875, Vol. 14, article id 277Article in journal (Refereed)
    Abstract [en]

    Background: Drug shops are usually the first source of care for febrile children in Uganda although the quality of care they provide is known to be poor. Within a larger quasi-experimental study introducing the WHO/UNICEF recommended integrated community case management (iCCM) of malaria, pneumonia and diarrhoea intervention for community health workers in registered drug shops, the level of adherence to clinical protocols by drug sellers was determined. Methods: All drug shops (N = 44) in the intervention area were included and all child visits (N = 7,667) from October 2011-June 2012 to the participating drug shops were analysed. Drug shops maintained a standard iCCM register where they recorded the children seen, their symptoms, diagnostic test performed, treatments given and actions taken. The proportion of children correctly assessed and treated was determined from the registers. Results: Malaria management: 6,140 of 7,667 (80.1%) total visits to drug shops were of children with fever. 5986 (97.5%) children with fever received a malaria rapid diagnostic test (RDT) and the RDT positivity rate was 78% (95% CI 77-79). 4,961/5,307 (93.4%) children with a positive RDT received artemisinin combination therapy. Pneumonia management: after respiratory rate assessment of children with cough and fast/difficult breathing, 3,437 (44.8%) were categorized as "pneumonia", 3,126 (91.0%) of whom received the recommended drug-amoxicillin. Diarrhoea management: 2,335 (30.5%) child visits were for diarrhoea with 2,068 (88.6%) correctly treated with oral rehydration salts and zinc sulphate. Dual/Triple classification: 2,387 (31.1%) children had both malaria and pneumonia and 664 (8.7%) were classified as having three illnesses. Over 90% of the children with dual or triple classification were treated appropriately. Meanwhile, 381 children were categorized as severely sick (with a danger sign) with 309 (81.1%) of them referred for appropriate management. Conclusion: With the introduction of the iCCM intervention at drug shops in Eastern Uganda, it was possible to achieve high adherence to the treatment protocols, which is likely compatible with increased quality of care.

  • 336. Axelsson, I
    et al.
    Gebre-Medhin, M
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Hernell, O
    Jakobsson, I
    Michaelsen, KF
    Samuelson, G
    [A reply about milk porridge. Infant food is also a question of nutritional phisiology1999In: Läkartidningen, May 26, Vol. 96, p. 2624-Article in journal (Other scientific)
  • 337. Axelsson, I
    et al.
    Gebre-Medhin, M
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Hernell, O
    Jakobsson, I
    Michaelsen, KF
    Samuelson, G
    [Recommendations for prevention of iron deficiency. Delay cow´s milk intake as a beverage to infants until 10-12 months of age]1999In: Läkartidningen, may 5, Vol. 96, p. 2206-Article in journal (Other scientific)
  • 338. Axelsson, I
    et al.
    Gebre-Medhin, M
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Hernell, O
    Jakobsson, I
    Michaelsen, KF
    Samuelson, G
    [The AD-drops can be replaced by D-drops]1999In: Läkartidningen may 5, Vol. 96, p. 2200-Article in journal (Other scientific)
  • 339. Axelsson, Irene
    et al.
    Finkel, Yigael
    Michaelsen, Kim Fleischer
    Gebre-Medhin, Mehari
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Hernell, Olle
    Jakobsson, Irene
    Perlhagen, John
    Jansson, Martina
    [Complementary food to breastfed infants. Introduction can wait until the age of six months but not longer]2004In: Lakartidningen, ISSN 0023-7205, Vol. 101, no 3, p. 195-7Article in journal (Other scientific)
  • 340.
    Axelsson, O
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    The Swedish medical birth register.2003In: Acta Obstet Gynecol Scand, Vol. 82, p. 491-Article in journal (Refereed)
  • 341.
    Axelsson, O
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    [Ultrasound and fetoscopy make intrauterine treatment possible. But the new methods create new ethical problems]1998In: Lakartidningen, Vol. 95, p. 4820-Article in journal (Other scientific)
  • 342.
    Axelsson, O
    et al.
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Heimer, G
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Graffman, K
    Department of Medical Sciences.
    Färdighetsträning inom klinisk grundutbildning. Proffspatienter som utbildare.1995In: Läkartidningen, Vol. 92, p. 3456-Article in journal (Other scientific)
  • 343.
    Axelsson, Ove
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Placentafysiologi2001In: Lärobok för barnmorskor, Studentlitteratur , 2001, p. 71-74Chapter in book (Other scientific)
  • 344.
    Axelsson, Ove
    et al.
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Backe, Björn
    Franklin, Jonas
    Stornes, Inger
    Tapanainen, Juha
    CME/CPD in obstetrics and Gynecology in the nordic countries2000Other (Other (popular scientific, debate etc.))
  • 345.
    Axelsson, Ove
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Marsal, karel
    Valentin, Lil
    Ultraljudsundersökning av foster kräver medicinsk indikation: Riskerna till stor del outforskade, vissa fynd kan oroa2007In: Läkartidningen, ISSN 0023-7205, Vol. 104, no 16, p. 1216-Article in journal (Other academic)
    Abstract [en]

    Fosterundersökningar med diagnostiskt ultraljud är ett ovärderligt instrument vid övervakning av graviditeter och för upptäckt av fosteravvikelser.

    Höga nivåer ultraljudsenergi kan medföra biologiska effekter i vävnader.

    Hittills har inga skadliga effekter påvisats hos foster undersökta med diagnostiskt ultraljud under graviditet. De kunskapsbrister som finns vad gäller säkerhetsaspekterna liksom det faktum att moderna utrustningar kan ge betydligt högre energier än tidigare manar dock till försiktighet.

    Ultraljud för fosterundersökningar skall undvikas om medicinsk vinst inte kan förväntas.

  • 346.
    Axemo, P
    et al.
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Brauner, A
    Department of Medical Biochemistry and Microbiology.
    Pettersson, M
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Eriksson, L
    Department of Genetics and Pathology.
    Rwamushaija, E
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Bergstrom, S
    Amniotic fluid interleukins in Swedish and Mozambican pregnant women.1996In: Gynecol Obstet Invest, Vol. 41, p. 113-Article in journal (Refereed)
  • 347.
    Axemo, P
    et al.
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Fu, X
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Lindberg, B
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Ulmsten, U
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Wessen, A
    Department of Surgical Sciences.
    Intravenous nitroglycerin for rapid uterine relaxation.1998In: Acta Obstet. Gynecol. Scand., Vol. 77, p. 50-Article in journal (Refereed)
  • 348.
    Axemo, P
    et al.
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Liljestrand, J
    Bergstrom, S
    Gebre-Medhin, M
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Aetiology of late fetal death in Maputo1995In: Gynecol Obstet Invest, Vol. 39, p. 103-Article in journal (Refereed)
  • 349.
    Axemo, Pia
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Maternal and Reproductive Health and Migration.
    Wijwardena, Kumudu
    Department of Community Medicine Health, University of Sri Jayewardenepura, Colombo.
    Fonseka, Ruvani
    Joint Doctoral Program in Public Health, University of California, San Diego/San Diego State University, United States of America.
    Cooray, Sharika
    United Nations Population Fund, Colombo, Sri Lanka.
    Darj, Elisabeth
    Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.
    Training university teachers and students in Sri Lanka on Gender Based Violence: testing of a participatory training program2018In: MedEdPublisher, ISSN 2312–7996Article in journal (Refereed)
    Abstract [en]

    In all societies, violence is a social problem and violation of human rights. Changing attitudes and behaviors, which accept violence atindividual and societal levels are key components in prevention strategies.

    The aim of this study was to produce educational material on Gender Based Violence (GBV). A participatory study design including educators and university students was used to create four teaching modules. The teaching was evaluated by descriptive surveys before andafter the training and focus group discussions followed the training session. The questionnaire covered attitudes to gender, violence and laws. One hundred eleven teachers and 25 students representing different faculties and universities participated in separate workshops in three Sri Lankan universities. The students lacked knowledge of the meaning of GBV, consequences and existing laws. Women held more gender-equitable attitudes. Both women and men favoured equal participation of work and decision in the households. Male undergraduates showed less accepting attitudes toward rape or blaming women for rape Three categories emerged after the FGDs; Maketraining module compulsory and teacher led; Mind your own business; What can be done.

    The newly prepared and context specific material was well-received by educators and students and they provided valuable inputs, which improved the educational modules.

  • 350.
    Axfors, Cathrine
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Eckerdal, Patricia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Volgsten, Helena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Wikström, Anna-Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Obstetrics.
    Ekselius, Lisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Ramklint, Mia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Sundström Poromaa, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Reproductive Health.
    Skalkidou, Alkistis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Neuroticism is not independently associated with adverse obstetric or neonatal outcomes: An observational studyIn: Article in journal (Refereed)
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