Eva Samuelsson

Signs of genital prolapse in a Swedish population of women 20 to 59 years of age and possible related factors

OBJECTIVE Our objective was to study the prevalence of genital prolapse and possible related factors in a general population of women 20 to 59 years of age. STUDY DESIGN Of 641 eligible women in a primary health care district, 487 (76%) answered a questionnaire and accepted an invitation to a gynecologic health examination. RESULTS The prevalence of any degree of prolapse was 30.8%. Only 2% of all women had a prolapse that reached the introitus. In a set of multivariate analyses, age (P <.0001), parity (P <.0001), and pelvic floor muscle strength (P <.01)-and among parous women, the maximum birth weight (P <.01)-were significantly and independently associated with presence of prolapse, whereas the womans weight and sustained hysterectomy were not. CONCLUSIONS Signs of genital prolapse are frequently found in the female general population but are seldom symptomatic. Of factors associated with genital prolapse found in this study, pelvic floor muscle strength appears to be the only one that could be affected.

A population study of urinary incontinence and nocturia among women aged 20-59 years. Prevalence, well-being and wish for treatment.

Background. The aim was to study urinary incontinence (UI) and nocturia in a female population: prevalence, effect on well‐being, wish for treatment and result of treatment in primary health care.

Determinants of urinary incontinence in a population of young and middle-aged women.

Background. Urinary incontinence and genital prolapse are prevalent conditions in the female population. The aim of this study was to study possible determinants of female urinary incontinence in a population‐based sample of young and middle‐aged women.

Large Outbreak of Cryptosporidium hominis Infection Transmitted through the Public Water Supply, Sweden

In November 2010, ≈27,000 (≈45%) inhabitants of Östersund, Sweden, were affected by a waterborne outbreak of cryptosporidiosis. The outbreak was characterized by a rapid onset and high attack rate, especially among young and middle-aged persons. Young age, number of infected family members, amount of water consumed daily, and gluten intolerance were identified as risk factors for acquiring cryptosporidiosis. Also, chronic intestinal disease and young age were significantly associated with prolonged diarrhea. Identification of Cryptosporidium hominis subtype IbA10G2 in human and environmental samples and consistently low numbers of oocysts in drinking water confirmed insufficient reduction of parasites by the municipal water treatment plant. The current outbreak shows that use of inadequate microbial barriers at water treatment plants can have serious consequences for public health. This risk can be minimized by optimizing control of raw water quality and employing multiple barriers that remove or inactivate all groups of pathogens.

Reproductive hormones and stress urinary incontinence in pregnancy

Background. The cause of transient stress urinary incontinence during pregnancy remains uncertain. Anatomical change, such as a pressure effect of the enlarged uterus, changes in renal function, and alterations in bladder and urethral function have been proposed. There is little information about the role of reproductive hormones in stress urinary incontinence with onset during pregnancy.

Incidence of venous thromboembolism in young Swedish women and possibly preventable cases among combined oral contraceptive users

Background.  We wanted to study the incidence of venous thromboembolism (VTE), acquired risk factors of VTE and preventable cases among users of combined oral contraceptives (COCs).

ICIQ symptom and quality of life instruments measure clinically relevant improvements in women with stress urinary incontinence

To determine whether changes in questionnaire scores on symptoms and condition‐specific quality of life reflect clinically relevant improvements in women with stress urinary incontinence (SUI).

Pregnancy-related deaths due to pulmonary embolism in Sweden

Background. The objective of this study was to report deaths from amniotic fluid embolism (AFE) and pregnancy‐related venous thromboembolism (VTE), to study contributing factors, and to analyse mortality trends. Methods. Using the Swedish Cause of Death Register (CDR), we identified all women aged 15–44, who died during 1990–1999, with VTE or AFE coded as the underlying or contributory cause of death. We scrutinised medical records, and women who had died during pregnancy or within 6 weeks of terminated pregnancy were included. We also used data from the Medical Birth Register (MBR) on incident and fatal cases. Mortality data from the 1970s and 1980s were based on previous studies, in which cases were identified through register linkage (CDR and MBR). Results. Five women died of AFE and 10 of VTE – 6 in early pregnancy – during the 1990s. Five of the cases were not registered as maternal deaths. Only 4 cases were reported as pregnancy‐related deaths from pulmonary embolism (PE). Cesarean section/surgery without thromboprophylaxis, overweight, severe intercurrent disease, delays in seeking health care, and verbal miscommunication were contributing factors in the VTE cases. VTE mortality rates (pregnancy >28 weeks and/or a registered birth) were 1.0 (0.5–1.8), 0.8 (0.3–1.6), and 0.4 (0.1–1.0) per 100,000 live births during the 1970s, 1980s and 1990s, respectively; the corresponding respective figures for AFE were 1.0 (0.5–1.8), 1.1 (0.6–2.1), and 0.5 (0.2–1.1) per 100,000 live births. The case fatality rate for VTE decreased from 4.5% in the 1970s, to 0.6% in the 1990s, paralleled with quadrupled incidence. The case fatality rate for AFE was unaltered and high, around 45%, during those 3 decades. Conclusions. Mortality from pregnancy‐related PE in Sweden is in the lowest range ever reported, and shows a downward trend during the 1990s, with a shift towards early pregnancy. In order to monitor mortality trends, death certificate quality must improve, and registers must be linked routinely.

Internet-based treatment of stress urinary incontinence: a randomised controlled study with focus on pelvic floor muscle training

Stress urinary incontinence (SUI) affects 10‒35% of women, and it is sometimes very distressful. Pelvic floor exercises are the first line of treatment, but access barriers or embarrassment may prevent women from seeking help. There is a need for new, simple, and effective ways to deliver treatment. Management of SUI without face‐to‐face contact is possible, and Internet‐based treatment is a new, promising treatment alternative.

Incontinence aids in Sweden: users and costs

Objective To study age‐ and sex‐specific use and costs of incontinence aids distributed free of charge in Sweden.