Papers by Lennarth Nyström
Scandinavian Journal of Primary Health Care, 2012
Objective. The objective was to create a diabetes register and to evaluate the validity of the cl... more Objective. The objective was to create a diabetes register and to evaluate the validity of the clinical diabetes diagnosis and its classifi cation. Design. The diabetes register was created by linkage of databases in primary and secondary care, the pharmaceutical database, and ongoing population-based health surveys in the county. Diagnosis and classifi cation were validated by specialists in diabetology or general practitioners with special competence in diabetology. Analysis of autoantibodies associated with type 1 diabetes was used for classifi cation. Setting. Primary and secondary health care in the county of V ä sterbotten, Sweden. Patients. Patients with diabetes (median age at diagnosis 56 years, inter quartile range 50-60 years) who had participated in the V ä sterbotten Intervention Programme (VIP) and accepted participation in a diabetes register. Results. Of all individuals with diabetes in VIP, 70% accepted to participate in the register. The register included 3256 (M/F 1894/1362) diabetes patients. The vast majority (95%) had data confi rming the diabetes diagnoses according to WHO recommendations. Unspecifi ed diabetes was the most common (54.6%) classifi cation by the general practitioners. After assessment by specialists and analysis of autoantibodies the majority were classifi ed as type 2 diabetes (76.8%). Type 1 diabetes was the second largest group (7.2%), including a subgroup of patients with latent autoimmune diabetes (4.8%). Conclusion. It was concluded that it is feasible to create a diabetes register based on information in medical records in general practice. However, special attention should be paid to the validity of the diabetes diagnosis and its classifi cation.
Global health …, 2011
We are sorry, but NCBI web applications do not support your browser, and may not function properl... more We are sorry, but NCBI web applications do not support your browser, and may not function properly. More information here... ...
Gerontology, 1984
The reference intervals of 18 blood components were established for an elderly population in the ... more The reference intervals of 18 blood components were established for an elderly population in the 8th decade of life. The most significant findings were a broader range of values for most of the components, lower values of plasma folate and plasma potassium and higher values of erythrocyte sedimentation rate, plasma creatinine and serum cholesterol, the lattermost in women only, compared to younger people.
Acta Paediatrica, 2007
Coeliac disease has emerged as a public health problem. The aim of the present study was to analy... more Coeliac disease has emerged as a public health problem. The aim of the present study was to analyse trends in the occurrence of symptomatic coeliac disease in Swedish children from 1973 to 1997, and to explore any temporal relationship to changes in infant dietary patterns. We established a population-based prospective incidence register of coeliac disease in 1991, and, in addition, retrospective data from 1973 were collected. A total of 2151 cases fulfilled the diagnostic criteria. Furthermore. We collected national data on a yearly basis on duration of breastfeeding, intake of gluten-containing cereals and recommendations on when and how to introduce gluten into the diet of infants. From 1985 to 1987 the annual incidence rate in children below 2 y of age increased fourfold to 200-240 cases per 100000 person years, followed from 1995 by a sharp decline to the previous level of 50-60 cases per 100000 person years. This epidemic pattern is quite unique for a chronic disease of immunological pathogenesis, suggesting that prevention could be possible. The ecological observations made in this study are compatible with the epidemic being the result, at least in part, of a change in and an interplay among three factors within the area of infant feeding, i.e. amount of gluten given, age at introduction of gluten, and whether breastfeeding was ongoing or not when gluten was introduced. Other factor(s) may also have contributed, and the search for these should be intensified.
International Journal of Gynecology & Obstetrics, 2009
The mean age of the 72 patients was 22.3 yrs ± 5.4 yrs and 60% were primigravidas. Intrapartum ec... more The mean age of the 72 patients was 22.3 yrs ± 5.4 yrs and 60% were primigravidas. Intrapartum eclampsia was encountered in 44% of the patients followed by Antepartum eclampsia (26%). Overall 4.2% recurrent convulsion rate was documented and it is not different among the study groups. There were also no differences in both fetal and maternal outcomes in the two study groups. Conclusion: the effectiveness of low dose regimen of magnesium sulfate appeared comparable to the 'standard dose regimen'. Low dose regimen may guarantee more safety and in an environment (such as ours) where cost is an important determinant of accessibility to qualitative health services, it is certainly attractive. More studies are needed to establish the place of low dose regimen of magnesium sulfate in the management of eclampsia.
Läkartidningen, Jan 16, 2000
Acta Oncologica
The aim of the study was to develop a model for estimating the effect of the nation-wide service ... more The aim of the study was to develop a model for estimating the effect of the nation-wide service screening program with mammography on breast cancer mortality in Sweden. In 1997, the introduction of population-based service screening had been completed in all 26 counties. In approximately half of the counties suitable for evaluation, the lower age limit for invitation was 40 years (study population) and in the other half the age limit was 50 years (control population). The numbers of females aged 40 49 years for the two populations were 202,152 and 237,279, respectively (1988). The study and control populations were compared for the period 1986-1996 with regard to refined breast cancer mortality. To adjust for geographical differences, the period 1976 1986 was used as reference. With a mean follow-up time of 8 years, the estimated relative risk of breast cancer death in relation to invitation to service screening among women aged 40-49 years at breast cancer diagnosis was 0.91 (95% confidence interval 0.72-1.15). These findings were compatible with those presented in the previous overview of the Swedish randomized studies.
The Central African journal of medicine
To compare labour outcome in women who had labour induced with PGF2 alpha gel, PGE2 vaginal pessa... more To compare labour outcome in women who had labour induced with PGF2 alpha gel, PGE2 vaginal pessary or misoprostol administered intravaginally or orally. Unmasked randomised controlled trial. Department of Obstetrics and Gynaecology, University of Zimbabwe, Harare. Women with a singleton foetus in cephalic presentation after 37 weeks gestation admitted for induction of labour who were randomised to prostaglandin F2 alpha gel (n = 76), prostaglandin E2 pessary (n = 75) and misoprostol administered either intra-vaginally (n = 128) or orally (n = 127). Primary outcome was induction to delivery interval. Secondary outcomes included use of oxytocin during labour, mode of delivery, duration of labour, neonatal condition at delivery and maternal complications. Four hundred and six women admitted for induction of labour with a singleton foetus in cephalic presentation after 37 weeks gestation were enrolled. To estimate the risk with induction using other agents the odds ratio and 95% confidence interval was calculated using the group that received prostaglandin F2 alpha gel as referents. The women were comparable for baseline characteristics. Compared to prostaglandin F2 alpha gel, the need for augmentation with oxytocin in labour was significantly reduced in women induced with prostaglandin E2 pessary (OR 0.46; 95%CI 0.23 to 0.93), vaginal misoprostol (OR 0.34; 95%CI 0.18 to 0.63) and oral misoprostol (OR 0.42; 95%CI 0.22 to 0.78). There was no difference in mode of delivery. There was a significantly reduced risk (OR 0.20; 95%CI 0.04 to 0.86) of Caesarean section (CS) for failure to progress in the vaginal misoprostol group. Labour induced with misoprostol and prostaglandin E2 pessary was significantly shorter than in prostaglandin F2 alpha gel. Vaginal misoprostol significantly shortened the induction to delivery interval. There were more admissions to the neonatal unit in the misoprostol groups. Compared to prostaglandin F2 alpha gel, misoprostol and prostaglandin E2 pessary had reduced need for oxytocin and a shorter duration of labour. Effects of misoprostol on the foetus need further investigation before it is used as a routine agent for induction of labour.
International Journal of Gynecology & Obstetrics
Objecti¨e: To compare the effectiveness of vaginally administered misoprostol with extra-amniotic... more Objecti¨e: To compare the effectiveness of vaginally administered misoprostol with extra-amniotic prostaglandin Ž . F PGF gel for induction of labor. Method: A randomized controlled trial, with women allocated to receive 2 ␣ 2 ␣ either misoprostol 50 g intra-vaginally or extra-amniotic PGF gel 5 mg, was conducted in Harare Maternity 2 ␣ 2 ␣
Scandinavian journal of social medicine
Smoking habits among different occupational groups in Sweden were estimated from nation wide surv... more Smoking habits among different occupational groups in Sweden were estimated from nation wide surveys of living conditions in 1977 and 1980/81. These surveys were conducted by Statistics Sweden and consist of interviews covering the Swedish population aged 16-74 years. The sample includes about 12,000 persons for each of the two investigations. The results show that those who may be exposed to excess risks in their work environment, smoke more than those in other occupational groups. Transport and manufacturing workers, miners, wood and paper workers and painters, for example, have higher rates of daily smokers than the national average. The highest rates, however, were found among the category of early retired or unemployed. These findings confirm that an appropriate evaluation of occupationally-related diseases affected by smoking must take smoking data into consideration. If smoking data are available from other sources, adjusted work-related risks could be calculated. This presumes the absence of interaction effects. Procedures are given and illustrated. The paper also discusses the declining trends in smoking habits between 1977 and 1980/81 and possible reasons for differences in smoking habits between occupations.
The Journal of Rheumatology
To study the cause of death pattern in patients with giant cell arteritis (GCA) or polymyalgia rh... more To study the cause of death pattern in patients with giant cell arteritis (GCA) or polymyalgia rheumatica (PMR), and to analyze the effect of the disease, or its therapy, on the risk of a cardiovascular event (CVE). Patients with biopsy proven GCA or with PMR, whose condition was diagnosed between 1973 and 1979, were followed until December 31, 1995. The standardized mortality ratio (SMR) was estimated using data for the population of Västerbotten, Northern Sweden, as reference value. Information for sex, age at diagnosis, erythrocyte sedimentation rate (ESR) at diagnosis, corticosteroid therapy, comorbidity from diagnosis, and date and cause of death was collected. A total of 136 patients with GCA and 35 with PMR were identified. At the time of followup 114 patients with GCA and 25 with PMR were deceased. The overall mortality was significantly increased in the female patients, SMR = 133 (95% CI 110-162). Death due to cardiovascular disease (CVD) was significantly increased in both...
Journal of Epilepsy, 1994
An epidemiological community-based study of incident cases with non-provoked epileptic seizures, ... more An epidemiological community-based study of incident cases with non-provoked epileptic seizures, using case-referent methodology, was carried out to explore possible risk factors for epileptic seizures. 83 cases, between 17 and 74 years of age, of whom 67.4% had seizures of localized onset, were compared with 2 age- and sex-matched referents. Higher birth weight, movement disabilities, mental retardation, head trauma, brain tumor, depression, a period of unemployment during the previous 6 months and a history of epilepsy in relatives were more common in cases than in referent subjects. No difference was found in the socioeconomic factors investigated, except that the cases belonged to smaller households. Prematurity, home or hospital birth, parents' age at birth of cases or referents, febrile convulsions in relatives, various infections including meningitis and encephalitis, cerebrovascular disease, and alcohol, tobacco, sleep and nutritional habits were not found to be associated with development of seizures. The recent life events investigated, at home or at work, occurred as often in cases as in referents, except that significantly fewer cases had received any increase in salary during the last 6 months. The relationship between depression and development of seizures should be explored further. Moreover, the possibility of false negative results should be considered because of the sample size.
South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde
To estimate the effect of the severity of maternal anaemia on various perinatal outcomes. A cross... more To estimate the effect of the severity of maternal anaemia on various perinatal outcomes. A cross-sectional study. Labour Ward, Muhimbili National Hospital, Dar es Salaam, Tanzania. The haemoglobin of eligible pregnant women admitted for delivery between 15 November 2002 and 15 February 2003 was measured. Data on socio-demographic characteristics, iron supplementation, malaria prophylaxis, blood transfusion during current pregnancy, and current and previous pregnancy outcomes were collected and analysed. Anaemia was classified according to the World Health Organization (WHO) standards: normal--Hb > or = 11.0 g/dl; mild--Hb 9.0-10.9 g/dl; moderate--Hb 7.0-8.9 g/dl; and severe--Hb < 7.0 g/dl. Logistic regression analysis was performed to estimate the severity of anaemia. The following outcome measures were used: preterm delivery (<37 weeks), Apgar score, stillbirth, early neonatal death, low birth weight (LBW) (<2500 g) and very low birth weight (VLBW) (<1500 g). A tota...
The Central African journal of medicine
Sera from 871 AIDS and AIDS related complex patients were used to evaluate four ELISA and one agg... more Sera from 871 AIDS and AIDS related complex patients were used to evaluate four ELISA and one agglutination assays. Commercial tests compared were Abbot, Wellcoyzyme, Biotest, Du Pont and Serodia. Wellcozyme and Serodia had the highest sensitivity (96.8 pc and 98.8 pc respectively) but the lowest specificity (53.3 pc and 46.5 pc respectively). Du Pont was the least sensitive test (89.1pc). Biotest and Abbot were comparable--Biotest had a higher sensitivity (93.2pc as compared with 90.6pc) but Abbot had a higher specificity (94.1 pc as compared with 89.1 pc). Thus, Abbott and Biotest both had a satisfactory high sensitivity and specificity and could thereby be recommended for use in screening of HIV-1 antibodies in south east Africa.
Background: Breast cancer is the most common cancer afflicting women in Jordan. This study aimed ... more Background: Breast cancer is the most common cancer afflicting women in Jordan. This study aimed to assess the effects of an educational intervention through home visits, including offering free mammography screening vouchers, on changing women's breast health knowledge and screening practices for early detection of breast cancer in a less privileged area in Jordan.
Background: Breast cancer the most common malignancy afflicting women and the most common cancer ... more Background: Breast cancer the most common malignancy afflicting women and the most common cancer overall in Jordan. A woman's decision to go for screening is influenced by her social support network. This study aims to explore Jordanian men's perceptions about breast cancer and their role in women's screening decisions.
... Lennarth Nystrom, Gunilla Lindmark, and Beth Maina Ahlberg Denial and violence: Paradoxes in ... more ... Lennarth Nystrom, Gunilla Lindmark, and Beth Maina Ahlberg Denial and violence: Paradoxes in men's perspectives to premarital sex and pregnancy in Rural Zimbabwe Abstract This paper describes the perspectives of men on premarital sex and preg-nancy in rural ...
African Journal of Midwifery and Women's Health, 2014
ABSTRACT A cross-sectional survey of 345 health-care workers and 312 students was conducted to ex... more ABSTRACT A cross-sectional survey of 345 health-care workers and 312 students was conducted to explore attitudes and perceptions of intimate partner violence against women, and their views on care and prevention. All health-care workers and final-year students were included in the study. Students’ t-test was followed in the analysis using SPPSS computer program. Forty-three percent of female health-care workers recognised acts of controlling behaviour, while 68% of female students agreed to less than one statement justifying physical violence and 32% of men failed to recognise a woman&#39;s right to refuse sex. Ninety percent of both students and health-care workers had observed clients having unexplained feelings of sadness or loss of confidence. Between 45 and 70% of students and health-care workers believed that women exposed to violence were difficult to support. The study clearly indicates a need for adequate health-care resources, guidelines and training to influence a change of existing rigid gender norms.
Journal of medical screening, 2009
To characterize and quantify the differences in the number of cases and breast cancer deaths in t... more To characterize and quantify the differences in the number of cases and breast cancer deaths in the Swedish W-E Trial compared with the Swedish Overview Committee (OVC) summaries and to study methodological issues related to trials in secondary prevention. The study population of the W-E Trial of mammography screening was included in the first (W and E county) and the second (E-county) OVC summary of all Swedish randomized mammography screening trials. The OVC and the W-E Trial used different criteria for case definition and causes of death determination. A Review Committee compared the original data files from W and E county and the first and second OVC. The reason for a discrepancy was determined individually for all non-concordant cases or breast cancer deaths. Of the 2615 cases included by the W-E Trial or the OVC, there were 478 (18%) disagreements. Of the disagreements 82% were due to inclusion/exclusion criteria, and 18% to disagreement with respect to cause of death or vital...
South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde, 1996
To estimate the prevalence of hepatitis B viral markers. A sero-epidemiological community-based c... more To estimate the prevalence of hepatitis B viral markers. A sero-epidemiological community-based cross-sectional study. All nine provinces of Zimbabwe. From April 1989 to December 1991 serum samples were collected from 1,461 males and 1,933 females in the age group 10-61 years, the majority in the younger age groups. Sera were tested for hepatitis B surface antigen (HBsAg), hepatitis B e antigen (HBeAg), antibody to HBs-Ag (anti-HBs), antibody to hepatitis B core antigen (anti-HBc) and antibody to hepatitis B e antigen (anti-HBe). All sera were tested for HBsAg, anti-HBs and anti-HBc but for the detection of HBeAg and anti-HBe, only samples positive for HBsAg were examined. The male-to-female ratio in rural and urban settings was 0.82 and 0.66 respectively. The median age for males and females in rural areas was 21 and 22 years and 28 and 26 years respectively in urban areas. The overall prevalence of HBsAg was 15.4% (males 16.8%, females 14.3%). The difference between sexes was cons...
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Papers by Lennarth Nyström