Bengt Brorsson

Induction of labor versus expectant management for post-date pregnancy: Is there sufficient evidence for a change in clinical practice?

Objectives. To compare perinatal and maternal outcomes between elective induction of labor versus expectant management of pregnancies at 41 weeks and beyond. Design. Systematic review and meta‐analysis. Methods. We searched PubMed, CINAHL, Cochrane Database of Systematic Reviews (CDSR), Database of Abstracts of Reviews of Effectiveness (DARE) and PsycINFO (1980 to November, 2007). Inclusion criteria were systematic reviews and randomized controlled trials comparing elective induction of labor versus expectant management of pregnancies at 41 weeks and beyond. Three or more reviewers independently read and evaluated all selected studies. Data were extracted and analyzed using Review Manager Software. Main outcome measures. Perinatal mortality. Results. Thirteen trials fulfilled the inclusion criteria for the meta‐analysis. Elective induction of labor was not associated with lower risk of perinatal mortality compared to expectant management (relative risks (RR): 0.33; 95% confidence intervals (CI): 0.10–1.09). Elective induction was associated with a significantly lower rate of meconium aspiration syndrome (RR: 0.43; 95% CI: 0.23–0.79). More women randomized to expectant management were delivered by cesarean section (RR: 0.87; 95% CI: 0.80–0.96). Conclusions. The meta‐analysis illustrated a problem with rare outcomes such as perinatal mortality. No individual study with adequate sample size has been published, nor would a meta‐analysis based on the current literature be sufficient. The optimal management of pregnancies at 41 weeks and beyond is thus unknown.

Quality of life in diabetic patients registered with primary health care services in Sweden

OBJECTIVE To evaluate the health-related quality of life in diabetic subjects in primary health care. DESIGN A cross-sectional, questionnaire survey of diabetic patients registered with primary health services, compared with a standard population sample. SETTING Three community health centres in the Metropolitan Stockholm area. SUBJECTS 341 diabetic individuals aged 21-84 years, with 229 respondents, i.e. 67%. Matched controls of the same age and sex from a standard population sample of 2366 individuals. MAIN OUTCOME MEASURES Quality of life was assessed by the Swedish Health-Related Quality of Life Survey (SWEDQUAL), adopted from the Medical Outcomes Study and consisting of 61 items covering aspects of physical, mental, social, and general health. Medical data were extracted from the medical records. RESULTS Diabetic patients had significantly lower scores on all scales (p < 0.001 for ten, and p < 0.01 for one), except for social health, when compared with the standard population sample. Outcomes were correlated with vascular and non-vascular comorbidity, age, and income, but not with level of metabolic control. CONCLUSIONS Diabetic patients in primary health care have a markedly lower health-related quality of life, compared with a standard population.

Quality of life among diabetic patients in Swedish primary health care and in the general population: comparison between 1992 and 1995

To assess change over time in health-related quality of life (HRQoL) in diabetic patients in primary health care and differences to general Swedish population samples, 341 diabetic subjects in 1992 and 413 in 1995, aged 20–84 years, were chosen from three community health centres (CHCs) in the Metropolitan Stockholm area and compared to controls matched by age and sex in randomly selected samples of 2,366 subjects in 1991 and 2,500 in 1995 from the general population. HRQoL was assessed by the Swedish Health-Related Quality of Life Survey (SWED-QUAL), adapted from the Medical Outcomes Study, which measures aspects of physical, mental, social and general health in 13 scales. Information on diabetic and general medical data were extracted from the medical records at the CHCs. HRQoL was lower in diabetic subjects compared with the general population in both 1992 and 1995 in all scales except family functioning and marital functioning. The level of HRQoL did not change significantly between the diabetic samples, but decreased in the population samples, making the difference compared to diabetic patients smaller in five of the scales. The most significant predicting factors for the SWED-QUAL results in diabetic patients in 1995 were the vascular and non-vascular co-morbidity.

The risk of accidents among older drivers

The number of older persons holding a drivers licence is rapidly increasing, as is the number of older persons driving a car. This paper examines driver accident-risk by age group, focusing on the older driver. Two different measures of accident risk are used; involvement in personal injury traffic accidents per million kilometers driven, and involvement in traffic accidents where one or more pedestrians were injured per million kilometers driven. The latter measure is used to refute the assumption that the elderlys risk of being involved in personal injury accidents might, to some extent, be explained by the fact that older drivers generally tend to run a higher risk than younger drivers of being injured in the event of a traffic accident. Another motive is that it provides a measure of the extent to which drivers of different ages present a risk to their fellow road users. This study shows that drivers in the 75-84 age group are at four to six times greater risk than are middle-aged drivers of being involved in personal injury traffic accidents.

Assessing Sexual Functioning in Patients with Chronic Disorders by using a Generic Health-related Quality of Life Questionnaire

This study was an assessment of sexual functioning by making cross-sectional surveys of patients aged 45–84 years with chronic disorders; 397 had diabetes, 248 had glaucoma and 1914 had chronic, stable, angina pectoris; 1669 came from a standard population sample (SPS). Sexual functioning was assessed on one scale from the Swedish health-related quality of life survey (SWED-QUAL), adapted from the medical outcomes study (MOS). Both sexual functioning in general and specific sexual items were studied. Values were adjusted for non-respondents and standardised to the Swedish population. Response rates in the samples were 54–64% among men and 22–41% among women, decreasing with age for women. General sexual functioning decreased with age and was most apparent in patients with diabetes and angina pectoris, while glaucoma patients reported better results than the SPS. Loss of male erectile function was as common in diabetes (30%) as in angina pectoris (29%) and significantly higher than in the SPS (20%) (p<0.001). Besides age, significant factors for erectile dysfunction were, in diabetes, the presence of microvascular complications, treatment with long-acting nitroglycerine and psychiatric disease, and in angina, the presence of diabetes and peripheral artery disease.

Fetal monitoring with computerized ST analysis during labor: a systematic review and meta-analysis

Background. Computerized ST analysis of fetal electrocardiography (ECG) combined with cardiotochography (CTG) has been introduced for intrapartum monitoring and is the prevailing method when ST analysis (STAN®) is used. Objective. To assess the evidence that computerized ST analysis during labor reduces the incidence of fetal metabolic acidosis, hypoxic ischemic encephalopathy, cesarean section, instrumental vaginal delivery or the number of instances where fetal scalp blood sampling is used as compared with CTG only. Methods. Search of PubMed, Cochrane Library, EMBASE, Web of Science, CINAHL and CRD databases. Selection criteria. CTG only compared with CTG + computerized ST analysis. Data collection and analysis. Studies were assessed using pre‐designed templates. Meta‐analyses of included randomized controlled trials were performed using a random effects model. Results. Risk ratio for cord metabolic acidosis with STAN® was 0.96 [95% confidence interval (CI) 0.49–1.88]. Risk ratio for cesarean sections or instrumental vaginal deliveries for fetal distress was 0.93 (95%CI 0.80–1.08) and for fetal scalp blood sampling 0.55 (95%CI 0.40–0.76). Encephalopathy cases were not assessed due to their low incidence. Conclusions. There is not enough scientific evidence to conclude that computerized ST analysis reduces the incidence of metabolic acidosis. Cesarean sections and instrumental vaginal deliveries due to fetal distress or other indications are the same, regardless of method, but STAN® reduces the number of instances which require scalp blood sampling.

AIDS in the minds of Swedish people: 1986-1989.

In order to assess changes in knowledge, attitudes and behaviour related to AIDS, annual mail surveys (1986-1989) were sent to random samples of the general public, aged 16-44 years. In total, 16,900 individuals were sampled, with an average response rate of 71%. Knowledge about the major routes of infection was generally good during the entire study period. The fear of unverified infection risks and of contact with HIV-infected people decreased during the period studied, but still remained high in 1989. Over the entire period, respondents expressed a strong fear concerning the spread of HIV in the population. Although an increasing percentage of respondents reported altered sexual habits as a result of fear of AIDS, overall sexual behaviour did not change sufficiently to reduce the risk of spread of any sexually transmissible disease. Progress toward knowledge, attitudes, and behaviour aimed at prevention of transmission of infection and unnecessary fear and counteraction of prejudice was most rapid during the middle of the study period when public debate concerning AIDS was at its peak. Knowledge and attitudes did not change during the last year of the study, but, in some respects, reverted to previous levels.

Psychic and socioeconomic consequences with diabetes compared to other chronic conditions

The present study relies on data for the years 1988 and 1989 from the Swedish continuous Surveys of Living Conditions (SLC), which are based on random samples from the population among individuals aged 16 through 84 years. We compared the rates of self-reported mental health for subjects reporting diabetes (n = 361), a musculoskeletal condition but without diabetes (n = 2187), hypertension but without diabetes (n = 980), and healthy free from any medical condition (n = 6654). Comparisons are based on age- and gender-standardized rates, using the diabetes group as standard. The results show that more diabetic respondents had psychic symptoms and long-standing psychiatric disorders than the healthy respondents, with otherwise no differences compared to the other chronic conditions. The diabetic respondents had lower mean disposable income, and a higher rate of disability pension than the respondents with hypertension, and than the healthy. They also reported more sick leave days than the healthy respondents.

SINGLE-VEHICLE ACCIDENTS IN SWEDEN: A COMPARATIVE STUDY OF RISK AND RISK FACTORS BY AGE

Abstract Single-vehicle accidents account for almost 50% of all injured passenger car occupants in Sweden. Young male drivers account for a high percentage of these accidents. This study investigates how the single-vehicle accident risk per distance driven varies by age and sex, and attempts to explain the variability by examining factors related to the driver, the vehicle, and the road. To this end, single-vehicle accidents resulting in personal injury as reported by the police for 1984 were used; data on traffic exposure were taken from a travel survey carried out by Statistics Sweden in 1984; and 467 (62%) of the severely injured drivers answered a questionnaire regarding possible risk factors. The data used indicated that men 18–19 years of age were exposed to an eight times greater risk level compared to men 25–54 years of age; there was a 40 times greater risk level on Friday and Saturday evenings and nights, compared to the average risk level observed for all drivers at all times; one third of the drivers were suspected by the police to have been driving when drunk; and suspected drunk driving was much more common among middle-aged drivers as among young drivers. However, the results from the questionnaire show no, or very little, difference between age groups in reported frequencies of different risk factors, In fact, neither drunk driving, speeding, fatigue, illness, vehicle, road conditions, or lack of drivers license could explain the much higher risk level among young as compared to middle-aged drivers.

Diabetic patients in primary health care--quality of care three years apart.

OBJECTIVE To compare registering of diabetic complications and metabolic control in diabetic subjects in primary health care in 1992 and 1995. DESIGN Cross-sectional surveys of medical records. SETTING Three community health centres in Stockholm County. SUBJECTS Diabetic patients aged 18-84 years in 1992 (n = 177) and in 1995 (n = 413). MAIN OUTCOME MEASURES Rate of noted diabetic complications and metabolic values. RESULTS Retinopathy examination was noted in 64% in 1992 versus 65% in 1995, neuropathy examination in 44 versus 49%, and urine examination in 88% versus 73% (p < 0.001). HbA1c was examined in 52% in 1992 versus 68% (p < 0.001) in 1995, fasting blood glucose in 89 versus 90%, and cholesterol in 34 versus 42%. Acceptable HbA1c values were noted in 51% in 1992 versus 46% in 1995. Smoking habits were available in 26% in 1992 versus 53% in 1995 (p < 0.001) and BMI in 5 versus 39% (p < 0.001). Diabetic blindness was present in 2.2% in 1995, uraemia in 0.3%, and amputation due to gangrene in 1.2%. CONCLUSION Documented examination rates of diabetic patients are unacceptably low, and the metabolic level unsatisfactory in most cases. Severe complications are, however, rare.