Birgitta Hovelius

Qualitative study of pregnancy and childbirth experiences in Somalian women resident in Sweden

Objective To explore the attitudes, strategies and habits of Somalian immigrant women related to pregnancy and childbirth, in order to gain an understanding as to how cultural factors might affect perinatal outcome.

Nasopharyngeal Carriage of Bacteria in Otitis-prone and Non-otitis-prone Children in Day-care Centres

During a 2-year period nasopharyngeal specimens were taken monthly on scheduled occasions as well as at episodes of acute otitis media (AOM) from a population of children attending day-care centres. The carriage rates of pneumococci, Haemophilus influenzae and Branhamella catarrhalis in 26 otitis-prone (OP) children when asymptomatic and at episodes of AOM were compared with the carriage rates in 36 non-otitis-prone (NOP) children. Pneumococci, H. influenzae and B. catarrhalis were found as frequently in NOP as in asymptomatic OP children. At AOM episodes only B. catarrhalis was found significantly more often than in the scheduled cultures. The frequencies of the six most commonly isolated pneumococcal types/groups (6, 23, 19, 14, 11, 18) were similar in the cultures taken from NOP and OP children on scheduled occasions as well as in cultures taken at AOM episodes. In contrast to the NOP children H. influenzae and B. catarrhalis were isolated less frequently in the 3-4-year-old than in the 2-3-year-old asymptomatic OP children. Our data indicated that the presence of pneumococci, H. influenzae or B. catarrhalis in the nasopharynx does not per se increase the risk for the development of AOM.

Urinary Tract Infections Caused by Staphylococcus Saprophyticus: Recurrences and Complications

AbstractStaphylococcus saprophyticus is a coagulase-negative, novobiocin-resistant staphylococcus known to cause acute urinary tract infections in young women. We believe that the kidney can be involved in such infections. Of 57 randomly selected women with urinary tract infection caused by Staphylococcus saprophyticus clinical symptoms suggestive of renal involvement were reported by 29, 20 of whom had renal tenderness on examination. In 9 of 16 patients studied with the pitressin tannate test the renal concentrating capacity was reduced during the course of infection. All patients had regained the concentrating capacity on followup after antibiotic treatment. In the 57 women studied 38 had a history of recurrent urinary tract infection before entering the study. Recurrent urinary tract infection occurred in 17 patients during followup of 6 to 12 months, with Staphylococcus saprophyticus in 10 and gram-negative rods in 7. Twelve other women who had received treatment with nalidixic acid had persistent ur...

A Longitudinal Study of the Nasopharyngeal Carriage of Pneumococci as Related to Pneumococcal Vaccination in Children Attending Day-care Centres

A long-term study of nasopharyngeal carriership in 405 children, aged 6 months to 5 years, attending day-care centres was performed. The effect of pneumococcal vaccination was evaluated in a double-blind investigation where the children received either Pneumovax (a 14-valent pneumococcal vaccine) or saline. Nasopharyngeal cultures were taken monthly by a trained nurse during a 2-year follow-up period. No difference in pneumococcal carriage was found between vaccinees and controls. Pneumococci were found in 31.9% of all cultures. In day-care centres attended by greater than or equal to 45 children the carriage rate of pneumococci was significantly higher than in centres with less than 45 children. Spreading of pneumococci within day-care centres was common but rather short-lived. Children younger than 2 years showed the highest carriage rates. Pneumococci of group 6 were carried most frequently and for longer periods than groups 19 and 23.

Beneficial effect of pneumococcal vaccination on otitis media in children over two years old

The effect of immunization with a 14-valent pneumococcal vaccine (Pneumovax) was studied in a double-blind trial in which 405 children between the ages of 6 months and 5 years were matched in vaccine/control pairs according to age and history of otitis media. The fact that all the children attended day-care centres ensured that both vaccinees and controls were similarly exposed to upper respiratory tract pathogens. The total incidence of acute otitis media was reduced during a 2-year follow-up period by 24% (P less than 0.05) among those vaccinated between the ages of 2 and 5. For recurrent episodes a decrease by 40% was noted. Protective efficacy was demonstrable during the first post-vaccinational year, but not when more than 1 year had lapsed after the vaccination. These findings suggest that, while the vaccine had not effect on children under 2 years old, it may be a useful aid in preventing recurrent attacks of otitis media in children between 2 and 5 years of age.

Beta-Lactamase Production in the Upper Respiratory Tract Flora in Relation to Antibiotic Consumption: A Study in Children Attending Day Nurseries

The occurrence of beta-lactamase production in Haemophilus influenzae, Branhamella catarrhalis and Moraxella nonliquefaciens was compared in 191 healthy children attending day nurseries in 2 municipalities differing with regard to the prescription rate of beta-lactam antibiotics. A significantly higher frequency of beta-lactamase production was recorded in M. nonliquefaciens isolated in the municipality with the higher prescription rate. A corresponding difference was not recorded for H. influenzae or B. catarrhalis. Approximately 75% of the nasopharyngeal pathogens H. influenzae, B. catarrhalis and Streptococcus pneumoniae, as well as the commensal M. nonliquefaciens, were eliminated and often replaced by other strains of either species over a period of one month. Although none of the children were on antibiotics a substantial proportion of the acquired strains produced beta-lactamase. This suggested that the carrier rate of beta-lactamase producing strains of the respiratory tract is not only related to the effect of recent antibiotic treatment but also to the prevalence of such strains in the population.

Urinary Tract Infections in Men Caused by Staphylococcus saprophyticus

Clinical data of 49 male patients, whose urine contained Staphylococcus saprophyticus (greater than 10(5) bacteria/ml), were analyzed. The median age of the patients was 70 yr (range 7-83). Of the patients, 25 had catheter à demeure. Among the remaining patients, 22 had symptoms of acute urinary tract infection, 8 of whom had symptoms suggesting engagement also of the upper urinary tract. One 17-yr-old man had acute epididymitis. One patient was symptomless. No obstructive uropathy could be revealed in 13 (54%) of the 24 patients without catheter.

Drug prescription attitudes and behaviour of general practitioners

A producer-independent, problem-oriented, group-education programme with 2-day meetings on drug treatment in primary health care (PHC) was developed and evaluated. Initially, it was tested on a selected group of general practitioners (district physicians), using a non-exposed group as control. A comprehensive questionnaire was used to test changes in attitudes.There was a significant change in attitudes concerning both general opinions on drugs and drug use, on information about drug treatment, and on use of drugs in selected therapeutic areas. Also, the district physicians became more critical towards information from pharmaceutical companies. Prescribing patterns tended to change in accordance with the attitude changes. Subsequently, the programme was offered to all district physicians (about 550) in the southern Swedish health care region for a 10-year period, with 20–25 district physicians per 2-day meeting. The impact of the programme on the prescribing of a selected group of drugs (antibiotics) was assessed by voluntary registration of prescription by the participants, by regional prescription analyses and by analyses of drug sales data. There were significant, consistent, and sustained changes in the prescribing of antibiotics.The study supports the view that, if drug prescribing in general practice is to be improved, producer-independent, problem-oriented, face-to-face, small-group education on drug treatment is worthwhile.

Production of Betalactamase by Respiratory Tract Bacteria in Children: Relationship to Antibiotic Use

Sales of antibiotics have increased in Sweden during the past decade. This has been paralleled by an increase in the frequency of beta-lactamase-producing respiratory tract bacteria. To investigate the effects of regional differences in use of antibiotics on beta-lactamase production in respiratory tract bacteria, we collected nasopharyngeal specimens and information about antibiotic use from 1133 children attending day-care centres in four rural municipalities with low use, and one urban municipality with high use of antibiotics, use being assessed from pharmacy sales. The frequency of beta-lactamase production among isolates of Branhamella catarrhalis and Moraxella nonliquefaciens was significantly higher in the urban municipality. This appeared to be a long-term ecological effect of differences in the level of use of antibiotics between the urban and rural populations, rather than an effect of recent antibiotic treatment of individual patients.

Causes of Frequency and Dysuria in Women

Bacteria in excess of 10(4) colony-forming units per ml (CFU/ml), were isolated from voided urine specimens from 127 (79%) of 160 women, 15-45 years of age, consulting in general practice due to frequency and dysuria. Escherichia coli was the species most frequently isolated, followed by Staphylococcus saprophyticus. Chlamydia trachomatis was isolated from 8 (5%) patients, in 6 of whom greater than 10(4) CFU/ml urine were isolated. A 2-fold titre increase in micro-immunofluorescence antibodies to C. trachomatis was demonstrated in 8 cases, the organism itself being isolated in 1 case only. No viruses were isolated in any of 18 women with negative urine cultures. Proteinuria and/or haematuria was found more frequently in patients with S. saprophyticus than in patients with gram-negative rods. Tests for nitrite indicated bacteriuria in only 58% of the patients with greater than 10(4) CFU/ml urine, which can be partly explained by the fact that S. saprophyticus only occasionally reduces nitrate. Cocci were noted in urine sediment in 75% of patients in whom S. saprophyticus was isolated.