Christer Petersson

Which women stop smoking?, A population-based study of 403 pregnant smokers

OBJECTIVE To describe, in detail, the smoking cessation process during pregnancy, and to find out which women are most and least successful at reducing or giving up smoking. DESIGN Prospective, population-based study. SETTING All antenatal clinics in Kronoberg County in southern Sweden. SUBJECTS Four hundred and three women, smoking at the time of conception, and registered for antenatal care in the period June 1993 to September 1994. MAIN OUTCOME MEASURES Self-reported number of cigarettes smoked per day and percentage of smoking women in different weeks of pregnancy. Noted by midwives on special forms. RESULTS At the time of registration at the antenatal clinic, the proportion of smoking women had fallen from 100% to 76%, and at the postpartum check-up, the proportion had fallen further to 56%. For the women still smoking, the mean number of smoked cigarettes per day fell from 14.1 before the pregnancy, to 8.6 in week 12, and 6.3 in week 40, and then rose to 9.5 after the pregnancy. Heavy smokers and women with smoking partners continued smoking to a greater extent, as did multiparae and women in unqualified jobs. CONCLUSION The individual anti-smoking advice given during pregnancy should be aimed primarily at these risk groups, and the partner should be involved in the womans attempt to cease smoking. There is much left to be done at the antenatal clinic, as more than half of the women were still smoking a few months after pregnancy.

Asymptomatic bacteriuria in a population of elderly in municipal institutional care

Objective - To study the prevalence of asymptomatic bacteriuria (ABU) among patients in municipal institutional care for the elderly. Design - A cross-sectional study. Setting - Three different municipalities in southern Sweden. Subjects - 237 elderly people in municipal institutional care. Main outcome measures - Positive urine cultures. Results - In the first culture, the prevalence of bacteriuria was 42%; 47% for women and 30% for men. ABU occurred in 23% of the patients; in 26% of women and in 16% of men. Urinary incontinence was more common among patients with ABU. Conclusion - Bacteriuria is common among elderly people living in institutions. This should be borne in mind when patients in institutional care for the elderly have fever. Other differential diagnoses than urinary tract infection should be considered before antibiotic treatment is given.

A Retrospective Study of Respiratory Tract Infections among Children in Different Forms of Day Care

This retrospective study investigated the records from July 1985 to June 1986 of all medical visits due to acute respiratory tract infections (RTIs) in infants aged 1-3 years. The study, in a municipal district, included all visits to the district health centre as well as visits to the paediatric and ear, nose and throat departments of the nearby hospital. The study population consisted on 489 children, of whom 140 were cared for in day-care centres (DCC), 146 in family day-care (FDC), while 203 did not receive any sort of municipally-supported day care (home care, HC). During the year studied, 223 children needed treatment by a doctor for acute RTI on altogether 499 occasions leading to the prescription of 325 courses of antibiotics. As regards RTIs as a whole and regarding those treated with antibiotics, the incidence density was greatest among the DCC children and lowest among the HC children, while the FDC children formed an intermediate group.

General parental education in Sweden: participants and non-participants

Scand J Prim Health Care 2002;20:xxx-xx. ISSN 0281-3432 Objective - To study factors of importance for participation in parental education within routine child health care. Design - All parents of children born during 1 year were invited by the district nurse to participate in parental education; their participation during the infant year was registered. Setting - Catchment area of two health centres in Växjö, Sweden. Subjects - 221 infants and their parents. Main outcome measures - Number of educational sessions for mothers and fathers. Results - 63% of mothers and 20% of fathers attended at least one session. These mothers attended a mean of 5.7 (SD 2.2) sessions and these fathers a mean of 2.8 (SD 2.3) sessions. Logistic regression analyses showed that the only variable of significance for participation was being a first-time parent (odds ratio 3.9 for the mothers and 3.7 for the fathers). Odds ratios above 2.0 (non-significant) were found for married mothers and Swedish mothers, as well as for Swedish fathers. Conclusion - It is still a considerable problem to get certain groups involved in routine parental education in Swedish child healthcare programmes.

Learner-centred education in end-of-life care improved well being in home care staff: a prospective controlled study

The aim of this controlled study was to evaluate a 1-year learner-centred educational project in end-of-life care for home care staff in a rural district of Sweden. Another rural district in the same region served as a control area. A 20-item questionnaire measuring attitudes towards end-of-life care was designed, and the Hospital Anxiety and Depression (HAD) scale was used to measure mental well being. Increased agreement to 18 of 20 attitude statements was seen in the education group, while 2 of 20 items showed a decreased agreement in the control group. Test retest reliability of the 20-item questionnaire was good (r =0.92). The total HAD score decreased from 8.3 pretest to 5.3 post-test in the education group (95% CI=2.1– 3.7; P<0.001), and was 6.8 for both years in the control group. Our study shows that a comprehensive educational programme not only improved attitudes towards end-of-life care, but also the mental well being of the home care staff.

Alcohol‐based hand‐disinfection reduced children's absence from Swedish day care centers

Aim: To determine if the use of alcohol‐based hand‐disinfection as a complement to regular hand washing at daycare centers (DCCs) can reduce the childhood rate of absenteeism.

Infection prevention at day-care centres: Feasibility and possible effects of intervention

Objective. To study the effect of an educationally oriented intervention programme, with the recommendations from the National Board of Health and Welfare as a base. Design. A prospective intervention study. Setting. Six day-care centres in Växjö, Sweden. Three centres comprised the intervention group and three constituted the control group. Subjects and main outcome measures. The parents and personnel completed a questionnaire on their views concerning information about infectious diseases. During a nine-month period, parents of all children reported every episode of absence, the number of days absent, the cause of absence, and any contact with doctors or prescription of antibiotics. Results. The guidelines were implementable in routine child day-care. Parents found regular information valuable and felt better informed about infectious diseases. Multilevel analyses showed no statistically significant results of the intervention. “Infection-prone” children had more sickness absence, doctors consultations, and antibiotic prescriptions than those not “infection-prone”. Conclusion. It is possible to implement an educationally oriented intervention programme directed against infectious diseases in child day-care. No significant effect of the intervention was found, which is why a larger intervention study is needed.

Hip and fragility fracture prediction by 4-item clinical risk score and mobile heel BMD: a women cohort study

BackgroundOne in four Swedish women suffers a hip fracture yielding high morbidity and mortality. We wanted to revalidate a 4-item clinical risk score and evaluate a portable heel bone mineral density (BMD) technique regarding hip and fragility fracture risk among elderly women.MethodsIn a population-based prospective cohort study we used clinical risk factors from a baseline questionnaire and heel BMD to predict a two-year hip and fragility fracture outcome for women, in a fracture preventive program. Calcaneal heel BMD was measured by portable dual X-ray laser absorptiometry (DXL) and compared to hip BMD, measured with stationary dual X-ray absorptiometry (DXA) technique.ResultsSeven women suffered hip fracture and 14 women fragility fracture/s (at hip, radius, humerus and pelvis) among 285 women; 60% having heel BMD ≤ -2.5 SD. The 4-item FRAMO (Fracture and Mortality) Index combined the clinical risk factors age ≥80 years, weight <60 kg, prior fragility fracture, and impaired rise-up ability. Women having 2-4 risk factors showed odds ratio (OR) for hip fracture of 5.9 and fragility fracture of 4.4. High risk group hip fracture risk was 2.8% annually compared to 0.5% for the low risk majority (69%). Heel BMD showed hip fracture OR of 3.1 and fragility fracture OR of 2.6 per SD decrease. For 30 DXA assessed participants mean hip BMD at -2.5 SD level corresponded to a lower BMD at the heel. Five of seven hip fractures occurred within a small risk group of 32 women, identified by high FRAMO Index + prior fragility fracture + heel T-score ≤-3.5 SD.ConclusionsIn a follow-up study we identified high risk groups for hip and fragility fracture with our plain 4-item risk model. Increased fracture risk was also related to decreasing heel BMD in calcaneal bone, measured with a mobile DXL technique. A combination of high FRAMO Index, prior fragility fracture, and very low BMD restricted the high risk group to 11%, among whom most hip fractures occurred (71%). These practical screening methods could eventually reduce hip fracture incidence by concentrating preventive resources to high fracture risk women.

Infections in families with small children: Use of social insurance and healthcare

Objective. To examine infectious symptoms on a daily basis in families with small children and how often these infections cause people to stay at home or seek healthcare. Design. A population-based prospective study. Setting. Child health clinics in seven municipalities in Sweden. Subjects and main outcome measures. All family members of 835 families who came with an 18-month-old child to a child health clinic were asked to register all infectious symptoms in a diary for a month. They were also asked to indicate whether they had stayed at home from day-care or school, whether social insurance had been used, and whether they had contacted healthcare facilities or seen a physician. Results. In total, 7% of the 18-month-old children and 34% of the parents had no symptoms during the winter month. The most common symptom was a runny nose. The 18-month-old children had 1.6 symptom episodes with an average duration of 5.6 days. Of the symptom episodes 13% led to contact with healthcare facilities and 6% to an antibiotic prescription. Of the symptom days 27% required staying at home and in 10% social insurance was claimed. Conclusion. Symptoms of infection among families with small children were common, with a runny nose being the most common. Physician consultations and antibiotic prescriptions were used in a small proportion of the symptom episodes. Social insurance was claimed in about one-third of the days with absence from day-care.

Physician consultation and antibiotic prescription in Swedish infants: population-based comparison of group daycare and home care.

Background: Daycare infants have more infectious episodes, see a physician more often, and are prescribed antibiotics more often than home care infants.