Anna-Karin Dykes

Quality of life in old people with and without cancer.

The aim was to investigate the influence of age and gender on quality of life (QoL), complaints, and the presence and nature of self-reported diseases in persons aged 75 and older with cancer (n = 150), compared to a matched group without cancer (n = 138). A second aim was to investigate factors associated with poor QoL in people aged 75 and older. QoL was measured with Short Form (SF-12) and European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-30). The study showed that the cancer group had lower (poorer) scores in different domains of QoL, more complaints, and more self-reported diseases than the group without cancer. In both groups, oldest old persons had more complaints than the youngest old. The cancer group had significantly more complaints than the noncancer group. In the youngest old, the cancer group had significantly more complaints than the comparison group. Women with cancer reported the poorest QoL compared to men with cancer and women without cancer. Receiving help for daily living from others and degree of complaints were associated with poor QoL for both the physical and mental component scores (PCS, MCS) of the SF-12. Thus, caregivers should be aware that the most vulnerable cancer patients are women, and that the complaints by cancer patients have implications for QoL especially among the youngest old.

Incidence and outcomes of dystocia in the active phase of labor in term nulliparous women with spontaneous labor onset

Objective. To estimate the incidence of dystocia among nulliparous women without apparent co‐morbidity and to examine maternal and fetal short‐term outcomes after dystocia. Design. A multi‐center cohort study with prospectively collected data. Setting. Nine obstetric departments with annual birth rates between 850 and 5,400. Population. Low‐risk nulliparous women in term spontaneous labor with a singleton fetus in cephalic presentation. Methods. Follow‐up of 2,810 nulliparas using self‐administered questionnaires supplemented with clinical records. Criteria for dystocia. Cervical dilatation ≤2 cm over four hours during the first stage of labor or no descent during two hours (three hours with epidural analgesia) in the descending phase of second stage or no progress for one hour during the expulsive phase of the second stage. Inclusion took place between May 2004 and July 2005. Main outcome measures. Incidences of dystocia, maternal, and fetal outcomes. Results. The cumulative incidence of dystocia was 37% and of the diagnoses 61% were given in the second stage of labor. Women with dystocia treated by augmentation had more cesarean and ventouse deliveries, more often non‐clear amniotic fluid, more post‐partum hemorrhage and their children were more often given low one‐minute neonatal Apgar scores as compared to women delivered without a diagnosis of dystocia. Conclusions. A dystocia incidence of 37% was found in healthy term nulliparas with no indication for induction or elective cesarean delivery. The adverse maternal and neonatal birth outcomes may be related to the cause of dystocia or to augmentation of labor and this question calls for further studies.

Obstetric risk indicators for labour dystocia in nulliparous women: A multi-centre cohort study

BackgroundIn nulliparous women dystocia is the most common obstetric problem and its etiology is largely unknown. The frequency of augmentation and cesarean delivery related to dystocia is high although it is not clear if a slow progress justifies the interventions. Studies of risk factors for dystocia often do not provide diagnostic criteria for the diagnosis. The aim of the present study was to identify obstetric and clinical risk indicators of dystocia defined by strict and explicit criteria.MethodsA multi-centre population based cohort study with prospectively collected data from 2810 nulliparous women in term spontaneous labour with a singleton infant in cephalic presentation. Data were collected by self-administered questionnaires and clinical data-records. Logistic regression analyses were used to estimate adjusted Odds Ratios (OR) and 95% confidence intervals (CI) are given.ResultsThe following characteristics, present at admission to hospital, were associated with dystocia during labour (OR, 95% CI): dilatation of cervix < 4 cm (1.63, 1.38–1.92), tense cervix (1.31, 1.04–1.65), thick lower segment (1.32, 1.09–1.61), fetal head above the inter-spinal diameter (2.29, 1.80–2.92) and poor fetal head-to-cervix contact (1.83, 1.31–2.56). The use of epidural analgesia (5.65, 4.33–7.38) was also associated with dystocia.ConclusionVaginal examinations at admission provide useful information on risk indicators for dystocia. The strongest risk indicator was use of epidural analgesia and if part of that is causal, it is of concern.

Fear of childbirth in obstetrically low‐risk nulliparous women in Sweden and Denmark

The prevalence of troublesome fear of childbirth (FOC) in Western countries is about 20%, of which approximately 6–10% suffer from severe FOC that impacts daily life. The countries of Sweden and Denmark are quite alike as far as childbirth culture is concerned. However, to some extent they differ in the organisation of midwifery care during the antenatal and labour period, respectively, and this may influence womens FOC. The aims of this study were to compare FOC among Danish and Swedish nulliparous women and to investigate a possible difference in FOC between women who, during pregnancy, had met the midwife who they were subsequently coincidentally allocated to receive labour care from and women who had not previously met the midwife. In total 165 women participated, comprising 55 Swedes and 110 Danes, of whom 55 among the latter group had met the midwife during pregnancy. Severe FOC was found in 10%. There were no differences between the Swedish women and the Danish women who had or had not met the midwife. Fear of childbirth measured in gestational week 37 correlated positively with fear at admission to the labour ward.

The experiences of older people living with cancer

Nursing care for older people with cancer requires an understanding of their history and current needs from both an individual and generalized view. The aim of this study was to investigate the experience of older people living with cancer and the way it affects their daily life. During the study, 41 individuals 75 years of age and older (mean age, 83 years) who had a cancer diagnosed within the past 5 years were interviewed in their homes. After verbatim transcription, the interviews were analyzed with latent content analysis. Four main categories were identified: 1) living with cancer means bodily, mental, social, and existential experiences; 2) being aware of the disease or not; 3) handling of daily life; 4) feeling affirmation or rejection from healthcare professionals. Experiences of daily life with cancer were influenced by the combination of old age, comorbidities, and the perception of current and previous life. This combination more or less affected all aspects of life. The power to choose the approach to daily life with cancer, the disease, and its treatment proved to be crucial for handling cancer and the outcome. It seems that the main role for healthcare professionals is to empower the older person to choose for himself or herself. Furthermore, it seems to be important that healthcare professionals support older persons in their choices, whether they choose to take an active part in understanding the disease and handling of daily life or whether they decide to be more passive and hand themselves over to the healthcare system.

Sports and Leisure Time Physical Activity During Pregnancy in Nulliparous Women.

To describe patterns of leisure time physical activity during pregnancy in relation to pre-pregnancy leisure time physical activity, socio-demographic characteristics, fertility history, and lifestyle factors. 4,718 nulliparous with singleton pregnancy and intended spontaneous vaginal delivery were included in the study at gestational week 33 from May 2004 to July 2005. Information was provided by self-administered questionnaires. Leisure time physical activity was categorised into four categories: competitive sport, moderate-to-heavy, light or sedentary. In this population of nulliparous women, 4% participated in competitive sport, 25% in moderate-to-heavy activities, 66% in light activities, and 5% in sedentary activities in the year prior to pregnancy. Physical activity before pregnancy was statistically significantly associated with age, pre-pregnancy BMI, chronic diseases, number of years at school, and smoking habits. The proportion of women who took part in competitive sports, and moderate-to-heavy activities decreased over the three trimesters of pregnancy. The proportion of women with light physical activity was stable during pregnancy while the proportion of women with sedentary activity increased from 6% to 29%. During the third trimester women performing competitive sports or moderate-to-heavy activities before pregnancy continued to have a higher level of physical activity than women with light activities or sedentary activities before pregnancy. In general the intensity and time spent on exercise decreased during pregnancy. Women with the highest level of exercise prior to pregnancy continued to be the most active during pregnancy. Among women with sedentary activities before pregnancy one-fourth changed to light activity during pregnancy.

Influence of smoking and oral contraceptives on bone mineral density and bone remodeling in young women: a 2-year study.

The objective of the study was to explore the influence of menstrual irregularities, oral contraceptives and smoking on bone mineral density (BMD) development and bone turnover with time. Healthy young women (n = 118) were divided into four categories: (a) women neither smoking nor using oral contraceptives; (b) women who were smokers; (c) women using oral contraceptives; (d) women who were smoking and using oral contraceptives. They responded to a validated questionnaire with 34 questions concerning lifestyle and the Sense of Coherence scale (SOC). BMD was measured by dual energy x-ray absorptiometry (DEXA). Deoxypyridinoline (DPD) was measured in urine. Data were analyzed by multiple linear regression analysis. Among smokers, BMD level decreased during a 2-year period and smoking was associated with a larger negative change in BMD. Use of oral contraceptives moderated the negative impact of smoking. Women using oral contraceptives at baseline and with regular bleeding induced by contraceptive pills had a significantly higher BMD at baseline and at follow-up. They also had lower SOC than women who had natural regular bleedings. Use of oral contraceptives in combination with smoking was linked to high alcohol consumption and higher frequency of self-reported body weight reduction, which reduced the negative BMD change in this category. DPD level and difference were strongly associated with estrogen influence. It is concluded that smokers without OCs had a negative BMD development and BMD in young women with irregular menstruations seems to be improved by OC.

Sports and leisure‐time physical activity in pregnancy and birth weight: a population‐based study

We examined the association between sports and other leisure‐time physical activities during pregnancy and birth weight of babies born after 37 completed weeks of gestation. All Danish‐speaking pregnant women attending routine antenatal care at the Department of Obstetrics, Aarhus University Hospital, Denmark, from August 1989 to September 1991 were invited to participate in the study. A total of 4458 healthy women who delivered after 37 completed gestational weeks participated in this study. The associations between sports (0, 1–2, 3+ h/week) or leisure‐time physical activity (sedentary, light, and moderate to heavy) and birth weight were examined by linear and logistic regression and adjusted for potential confounding factors such as smoking, parity, schooling, pre‐pregnancy body mass index and gestational age. The results showed that pregnant women who practiced sports or were moderate to heavy leisure‐time physical active during the early second or the early third trimester gave birth to infants with a similar birth weight as inactive women. The proportion of newborns with a low (<2500 g) or a high birth weight (≥4500 g) was also unchanged. In conclusion, in this large population‐based study, we found no association between sports and leisure‐time physical activity and low‐birth weight, high‐birth weight, or average‐birth weight.

Experiences of physical activity during pregnancy in Danish nulliparous women with a physically active life before pregnancy. A qualitative study

BackgroundNational guidelines recommend that healthy pregnant women take 30 minutes or more of moderate exercise a day. Most women reduce the level of physical activity during pregnancy but only a few studies of womens experiences of physical activity during pregnancy exist. The aim of the present study was to elucidate experiences and views of leisure time physical activity during pregnancy in nulliparous women who were physically active prior to their pregnancy.MethodsA qualitative study was conducted by means of personal interviews. Nineteen women, all with a moderate pre-pregnancy level of physical activity but with different levels of physical activity during pregnancy, participated in the study. Content analysis was applied.ResultsIn the analyses of experiences and views of physical activities during pregnancy, four categories and nine sub-categories were developed: Physical activity as a lifestyle (Habit and Desire to continue), Body awareness (Pregnancy-related discomfort, Having a complicated pregnancy and A growing body), Carefulness (Feelings of worry and Balancing worry and sense of security) and Sense of benefit (Feelings of happiness and Physical well-being).ConclusionAs other studies have also shown, women find that the discomfort and complications associated with pregnancy, the growing body, and a sense of insecurity with physical activity are barriers to maintaining former levels of physical activity. This study adds a new perspective by describing womens perceptions of these barriers and of overcoming them - thus, when pregnant, the majority of the women do not cease to be physically active but continue to be so. Barriers are overcome by applying ones own experience, looking to role models, mirroring the activities of other pregnant women and following the advice of experts (midwives/physiotherapists). Women then continue to be physically active during pregnancy, most often to a lesser extent or in alternative activities, and derive considerable enjoyment and physical well-being from this.

Utilisation of antenatal care by country of birth in a multi-ethnic population: a four-year community-based study in Malmö, Sweden.

Background. The aim of this study was to investigate differences in use of antenatal care in a multi‐ethnic population in Malmö, Sweden, over a 4‐year period. Age, parity, cohabiting status, use of an interpreter, and tobacco‐use were examined to assess the potential effects of confounding factors. Methods. A 4‐year (2000–2003) retrospective community‐based register study was performed. Low‐risk singleton pregnancies (n = 5,373) registered for antenatal care at 5 municipal clinics and at the delivery ward at Malmö University Hospital were included, and divided into 6 subgroups by country of origin. The odds for utilisation of antenatal care were analysed by means of logistic regression. Results. Significantly increased odds of lower utilisation of planned antenatal care were found among some groups of foreign‐born women. Women born in Eastern and Southern Europe, Iraq and Lebanon, and Asia had fewer antenatal visits than recommended, and all foreign‐born women (except for women born in Iraq and Lebanon, and South and Central America) had a late first visit compared to Swedish‐born women. Foreign‐born women had, in general, fewer unplanned visits to a physician at the delivery ward, but women originating from Asia, Iraq and Lebanon, and Africa had higher utilisation visits to midwives at the delivery ward compared to Swedish‐born women. Conclusions. Foreign‐born women had lower utilisation of planned antenatal care. Approximately 50% of women had higher utilisation of care, by making unplanned visits to the delivery ward. This puts strain on both economical as well as staff resources. The delivery clinic at the hospital level is not intended to handle routine visits, and, moreover, some of these women do not receive the full benefits of planned routine antenatal care.