Search

Aims: This study was carried out to investigate how the locus of control (LOC) varies between those who stop smoking in connection with pregnancy and those who do not. The LOC reflects the extent to which a person is in control of her or his life events., Methods: One hundred and two women who were regular smokers at the time of conception and paid their first visits to the antenatal clinic (ANC) on account of the current pregnancy participated. The study was quantitative and questionnaire based, covering background factors, smoking habits, and the LOC. One hundred of the women were met a second time after the delivery. Smoking habits were monitored by the content of carbon monoxide in expired air. The LOC was recorded on a VAS scale (0-10). A lower index was consistent with a more internal LOC and a higher with a more external LOC., Results: The median LOC found was 4.0 (range 1.1-7.9). The LOC was not correlated to the CO in expired air. Younger age was linked to a more internal LOC, while worse sleep was correlated to a more external LOC (p<0.05). No differences were found between those who stopped smoking and those who did not. This was the case in both light and heavy smokers., Conclusion: The LOC does not seem to influence the ability to stop smoking during pregnancy.

Background: The proportion of women who stop smoking during pregnancy has varied between 17 and 40% percent in Sweden with a tendency of lower prevalence in recent years. The aim of the present study was to examine the factors that might influence the ability to stop smoking during pregnancy., Method: One hundred and two women were interviewed shortly after their first visit to the antenatal clinic and a second time approximately one month after delivery. Two women who had late spontaneous abortions were excluded. The women were asked about background factors, smoking habits of their parents, smoking history and current smoking habits. The carbon monoxide in expiratory air was measured to verify reported smoking habits., Results: Fifty-six of the 100 participating women had stopped smoking before the second interview. Having started smoking at an older age, having no previous children, smoking few cigarettes, a higher level of education, positive support from the partner and having lived with non-smoking parents were all associated with stopping smoking when tested as single factors. Reported smoking habits could be verified. Age, smoking habits of the partner, passive smoking at work, quality of sleep, general perceived health, length of sick-leave or amount of nausea were not correlated to stopping smoking., Conclusion: The presence of several factors found to influence stopping smoking during pregnancy, and the tendency for smoking habits to be passed over to the new generation, are reasons for comprehensive and individualized, anti-smoking support.

Surveillance was enhanced and a retrospective interview study performed in 1998-99 to determine incidence, causes, and costs of foodborne illnesses in Uppsala, Sweden. Sixty-eight percent of the detected foodborne illness incidents were single cases, and 32% were outbreaks. Most (85%) of the incidents came to the attention of the municipal authorities through telephone calls from affected persons. Calicivirus, Campylobacter spp., and Staphyloccocus aureus were the most common etiological agents; meat, meat products, and mixed dishes were the most implicated food categories. The incidence of foodborne illness was estimated to be 38 cases per 1,000 inhabitants per year. The estimated average costs per illness were 2,164 Swedish Krona (SEK) ($246) to society and 500 SEK ($57) to the patient. The annual cost of foodborne illnesses in Sweden was estimated to be 1,082 million SEK ($123 million).

Reports of foodborne disease incidents in Sweden from 1992 to 1997 are summarized. The results are based on reports from the municipal environmental and public health authorities to the National Food Administration and from medical authorities to the Swedish Institute for Infectious Diseases Control. A total of 555 incidents, of which 84% were outbreaks, were reported, involving 11,076 ill people. In 66% of the incidents, no disease agent was determined. Bacterial agents were implicated in 25% and viruses in 8% of the incidents. Calicivirus was the most reported agent both in terms of incidents and cases. Mixed dishes was the food category most often implicated in outbreaks, and smorgasbord and casserole or stews were the subcategories that caused the most cases. The place of consumption was unknown in 8% of the incidents. In about 60% of the incidents, the implicated food was consumed in commercial food establishments; in approximately 20% of incidents, it was consumed at home. The average annual incidence of reported foodborne disease in Sweden was estimated to be 21 cases per 100,000. The average annual incidence of reported foodborne salmonellosis and campylobacteriosis was estimated to be 2.0 and 0.6 cases per 100,000, respectively. The awareness and motivation to report foodborne diseases need to be improved, but additional sources of information are needed to counteract some of the limitations of reporting discussed in this work.

The objective of the present work was to develop a quantitative risk assessment model in which the exposure and risk of acquiring listeriosis from consumption of packaged smoked or gravad salmon and rainbow trout were estimated. An Excel spreadsheet model was constructed in which variables were represented by distributions based on surveys of L. monocytogenes in these food products, and on demographic and consumption data. Growth or inactivation was not included in the model. The model was run through Monte Carlo simulations using the @Risk software (Palisade Corporation). The probability of illness per serving was calculated using two dose-response models from the literature. The first was an exponential model in which the species specific constant R, that helps define the dose-response curve, previously has been estimated to be 1.18 x 10(-10) based on German data (GR). In this study, R was estimated to 5.6 x 10(-10) based on Swedish data. The second model was a flexible Weibull-Gamma model (WG), with different coefficients for high- and low-risk groups. The exponential model (GR), although conservative and generally overestimating the risk, still predicted a lower probability of illness than the WG-model. The estimated mean risk per serving was 2.8 x 10(-5) (GR, high-risk group), 2.0 x 10(-3) (WG, low-risk group) and 0.016 (WG, high-risk group), respectively. The average number of reported listeriosis cases in Sweden is 37 per year. In comparison, the mean number of annual cases predicted by the risk assessment model was 168 (range 47 to 2800, GR, high-risk group), and 95 000 (range 34 000 to 1.6 x 10(6), WG high-risk group), respectively. If 1 to 10% (uniform distribution) of strains, instead of all, were considered virulent, the mean number of predicted cases would decrease to nine (GR) and 5200 (WG), respectively. The mean annual cumulative individual risk in the high-risk group based on a monthly exposure was estimated to be 4.0 x 10(-4) (range 8.0 x 10(-8) to 5.4 x 10(-3), GR). This risk increased to 1.5 x 10(-3) (range 1.7 x 10(-5) to 9.2 x 10(-3), GR) based on a weekly exposure. The risk assessment model was most sensitive to the input distribution describing the level of contamination and to a lesser degree on the prevalence of L. monocytogenes, the proportion of virulent strains, and serving sizes. A lack of data on the prevalence and concentration of L. monocytogenes in these products, dose-response data and quantitative information on the proportion of virulent strains were identified.

In the study reported here 55 spouses of patients living with end-stage renal disease (ESRD) were investigated with respect to coping strategies and health-related quality of life. Findings from the study were compared to two random samples of the Swedish general population (n = 454, and n = 1200). The study design was correlational and comparative. Coping was measured by the Jalowiec Coping Scale, and quality of life (QoL) by the Swedish Health-Related Quality of Life Survey (SWED-QUAL). Data were analysed using a number of statistical tests including Pearson's product moment correlations, Student's t-test and two way ANOVAs. The combined sample of spouses used significantly more optimistic and palliative coping than the general population, but less confrontative, self-reliant, evasive and emotive coping. In the study fatalistic, evasive and emotive coping was associated with low perceived efficiency in handling various aspects of the partners' situation. The male spouses used significantly less optimistic, supportive and palliative coping than did the female spouses. The spouses of transplant patients had better overall quality of life than the continuous ambulatory peritoneal dialysis and haemodialysis spouse groups, most likely due to the lower age of the former group. The study findings suggest that emotive, evasive and fatalistic coping are less than optimal ways to deal with problems occasioned by the partner's treatment.

This study describes the perceived consequences of illness and treatment among end stage renal disease (ESRD) patients. A qualitative, explorative-descriptive design was used, which included continuous ambulatory peritoneal dialysis (CAPD) (n = 26), hemodialysis (HD) (n = 30), and transplantation (n = 30) patients. Data collection was performed using unstructured interviews, mostly in the patients' homes. All interviews were tape-recorded with permission from the informants, transcribed verbatim, and analyzed by content analysis. An overall theme was identified, "Wishes for independence and normality." Four main categories emerged: "Wish for normality," "Wish to manage one's own life," "Deprivation of one's normal life," and "Concerns." Interview statements were classified in 11 subcategories: live as usual, keep up appearances, social comparison, hope/fulfilled dreams, freedom/lack of freedom, control/lack of control, losses, dependence on others, physical problems, disgusted with oneself, and broodings. The perceived consequences of being an ESRD patient are multidimensional and involve several aspects of everyday life. It is important for nurses to appreciate the patient's view of illness as well as the patient's perceived stressors and expectations. It may help to direct the focus of nursing assessment in planning and implementing nursing care.

A random sample of the Swedish general population (n = 1,200), age range 18-80 years, was studied with regard to coping strategies and styles used for handling stressful situations. The total response rate was 65% (n = 519), and coping was assessed by the Jalowiec Coping Scale (JCS). The three most frequently used coping styles were the confrontative, the optimistic and the self-reliant. The three least used styles were the emotive, the supportant and the palliative. There were few differences between the age groups for the total material or for each gender separately. Young (18-29 years) and middle-aged (30-59 years) groups used confrontative and emotive styles significantly more than did the elderly (60-80 years) group. Young and middle-aged women used significantly more optimistic, evasive, emotive and supportant coping than did elderly women. All subscales except the self-reliant showed significant gender differences, with women reporting more frequent use than men. Ethnicity is a major determinant of the use of the emotionally-oriented coping styles. Those of Swedish origin used less of these styles than did those of non-Swedish origin. The results illustrate the importance of using different norm values for the JCS for groups differering in these demographic variables.

A nested PCR method was developed and its performance evaluated by detection of Shigella flexneri in food. The nested PCR amplifies sequences within an invasion-associated locus (ial) on the invasion plasmid specific for Shigella and enteroinvasive Eschrichia coli (EIEC). The nested PCR detected Sh. flexneri in lettuce inoculated with 2, 20 and 200 cfu g-1 after 1, 7 and 18 d of storage, respectively. In comparison, a culture method (NMKL no. 151) detected 10(5) cfu g-1 after 1 but not after 7 d of storage. The presence of inhibitors in blue cheese and shrimps reduced the sensitivity of the PCR assay. To overcome this inhibition, a sample preparation step based on buoyant density centrifugation was developed. This treatment resulted in a successful recovery of Sh. flexneri in lettuce, milk, shrimp and blue cheese inoculated with 10 cfu g-1. The proposed method, which includes a combination of enrichment, buoyant density centrifugation and a nested PCR, can be completed in less than two working days.

In a previous study, the Life Satisfaction Questionnaire (LSQ) was developed especially for women with breast cancer. The aim of the present study was to assess the psychometric properties of the LSQ in a randomized sample of Swedish women and to compare the perceived quality of life with that of women suffering from breast cancer. Another aim was to relate the result to educational background. A total of 257 women aged 20-80, randomly selected from the Swedish population register, answered the LSQ. The result was compared with that from 362 women aged 27-78 suffering from breast cancer. The construct validity was calculated by a principal component analysis, and the reliability by Cronbach alpha-coefficients. It was concluded that the LSQ has acceptable validity and reliability. The result also showed that the women with breast cancer rated their perceived quality of life higher than women in general with respect to the quality of personal relations and the quality of daily activities, but lower for physical symptoms. In the comparison with respect to educational background, women with university education rated their quality of life higher than women with other types of education. The testing of the LSQ will continue.

Vocational rehabilitation targeted to the socially disadvantaged long-term sick requires that the client keep in touch with a number of welfare state agencies, all of which have different regulations, conflicting goals and various types of benefits. This is an arduous and time-consuming task for clients with medical, social and labour market problems. Many of these clients run the risk of ending up in a no-man's land or being endlessly circulated between agencies because their problems do not correspond to the profile of the typical client. Both government and welfare workers see institutional co-operation between welfare state agencies as the remedy to such problems. This article, which is based on interviews with participants in fourteen cooperating projects, focuses on difficulties and opportunities experienced in such co-operation. It is concluded that such cooperation, when initiated in local settings and supported by local players, is a way of rejuvenating the existing Swedish model.

The present study describes CAPD patients' coping strategies and quality of life. A descriptive-comparative design was chosen and a consecutive series of patients (n = 26) was included. Data collection was performed through questionnaire and interview. Coping was measured by the Jalowiec Coping Scale and quality of life by the Swedish Health-Related Quality of Life Survey (SWED-QUAL). The main results show that an optimistic coping style was the most widely used by both men and women and this style was also considered to be the most effective in terms of dealing with stressful treatment aspects. Significantly more men than women found emotive coping to be less effective. Compared to a sample from the general population, CAPD patients had lower values on all SWED-QUAL sub-scales except those that tapped family functioning and emotional health. In general, women evidenced a more negative perception of their health than did men. With respect to emotional well-being/negative aspect, the CAPD patients achieved higher scores than the general population. The findings suggest targets for nurse practitioners' provision of support and information and in assisting patients to better utilize adequate coping methods to enhance their quality of life.

This report describes a method for the construction of a mimic molecule for monitoring PCR. A blue cheese homogenate spiked with Yersinia enterocolitica was used to demonstrate how false-negative PCR results may be avoided using the mimic. Further, the possibility of estimating bacterial numbers using the mimic was illustrated by varying the target concentration.

A consecutive series of hemodialysis (HD) patients (n = 30) was included in a descriptive-comparative design. The aim was to study coping strategies and quality of life compared to a group of patients on continuous ambulatory peritoneal dialysis (CAPD). Coping was measured on the Jalowiec Coping Scale. Quality of life was measured by the Swedish Health-Related Quality of Life Survey (SWED-QUAL). An optimistic coping style was the most widely adopted by men and women in both groups, and this style was also considered to be the most effective in terms of dealing with stressful treatment aspects. The HD sample used more evasive coping strategies than the CAPD sample. Compared to a sample from the general population, HD patients had lower values on all SWED-QUAL subscales. Further, the CAPD women scored lower on general health than did the HD women. Significant gender differences were found in that men in both samples regarded themselves as better able to cope with physical aspects of the illness. Women in both samples scored lower on general health. It seems important to identify patients who use emotive, evasive and palliative coping techniques extensively, because they seem to be less effective at handling their illnesses.

A sample treatment method based on buoyant density centrifugation which separates bacteria from food, concentrates bacteria and removes PCR inhibitors is described. The method involves a one minute centrifugation of food homogenate layered over a gradient medium (Percoll or BacXtractorTM) in Eppendorf tubes, followed by a single wash step. The small scale of this treatment makes it possible to process many samples in a short time. To evaluate the method beef and minced beef samples, spiked with strains of Escherichia coli O157:H7, were treated and then analysed by PCR aimed at verocytotoxin- (VT1 and VT2) and eae-genes. The detection limits in 1:10 (w/v) beef and minced beef homogenates were 125-250 cfu ml-1 (1250-2500 cfu g-1) and 1000 cfu ml-1 (1 x 10(4) cfu g-1), respectively. The enrichment of spiked samples in buffered peptone water at 37 degrees C for 6 hours before buoyant density centrifugation and PCR, allowed 0.5 cfu g-1 beef and 5 cfu g-1 minced beef to be detected. This combination of enrichment and buoyant density centrifugation was also used for analysis of 43 beef samples from a consignment in which E. coli O157:H7 had been detected, and detected VT-genes in all 43 samples. E. coli O157:H7 was also separated and detected in spiked samples of milk, lettuce, shrimps, and blue cheese at arbitrary concentrations of 3000 cfu ml-1. The present sample preparation method has the potential to be applicable to many other combinations of bacteria and food, and in connection with other detection methods than PCR as well.

The use of buoyant density centrifugation (BDC) to prepare samples for PCR analysis of food pathogens is described. Blue cheese and milk homogenates were inoculated with Shigella flexneri and layered on top of Percoll media. After BDC, the food homogenates remained in the upper part of the centrifuge tube, separated from the bacteria, which retained viability and were concentrated below the lighter Percoll layer. PCR inhibitors stayed in the homogenate and PCR analyses of treated samples consistently detected 10(4) cfu g-1 of blue cheese and 500 cfu ml-1 of milk, respectively. Differences in the density of live and killed Sh. flexneri and Yersinia enterocolitica were detected by BDC but were dependent on the mechanism of killing.

During the last ten years, the inclusion of education in health information systems has assumed an important role in graduate programs for health professionals. More recently, attention has focused on undergraduate programs. Throughout the world schools of nursing, organisations and associations are addressing the issue of educational offerings in nursing informatics. This paper reports on the status of nursing informatics at undergraduate level. Nurse academics from Gävle and Lund in Sweden, and from Melbourne and Sydney in Australia, took part in a survey of the respective nursing courses. The purpose of the study was to identify and describe examples of types of nursing informatics courses in Australia and Sweden. A convenient sample of academics were approached and interviewed. The results of the survey illustrate, in the schools surveyed, the slow emergence of nursing informatics into nursing curricula.

Japanese B encephalitis is a disease with high mortality and many of those surviving suffer from serious sequelae. During the 1992 epidemic in northern Vietnam 50 patients treated at the Institute for Protection of Children's Health in Hanoi were studied concerning the type of sequelae and the development of the symptoms during the first two months of the disease. The age span was 1 to 15 years. 29 of the patients (58%) did not recover fully during the observation period. Fifteen (30%) showed signs of both neurological and mental disturbances. Nine (18%) only had mental symptoms while 5 (20%) suffered from isolated neurological sequelae. EEG was pathological in 9 out of 30 tested cases (30%); 9 of 23 patients (39%) performed subnormal IQ tests. Deep coma, bronchopneumonia with cyanosis, apnea attacks, prolonged fever and coma were all correlated (without statistical significance) to a higher risk for subsequent sequelae.

The potential for enhanced mobility of hydrophobic pollutants by cotransport with bacteria in saturated soils was evaluated from measurements of biosorption of 14C-labeled hexachlorobenzene and dichlorodiphenyltrichloroethane (DDT) to five strains of soil and sewage bacteria. The sorption process could be described by a linear partition equation and appeared to be reversible, but desorption kinetics were slow and/or partly irreversible. The DDT partition coefficients varied with equilibration time, possibly reflecting DDT-induced changes in the physiology of the bacteria. The partition coefficients, normalized to the masses of the bacteria, ranged from 250 to 14,000 for live cells, but the largest coefficients were associated with autoclaved cells of a Pseudomonas sp. The sorptive capacity of the bacterial biomass was greater for DDT than for hexachlorobenzene but was not correlated to overall bacterial hydrophobicity, measured by hydrophobic interaction chromatography. In a column study, 1.2 x 10(9) cells of a Bacillus sp. strain per ml enhanced DDT transport about 8-fold, whereas an advective-dispersive-sorptive equilibrium model for two mobile phases, water and free-living bacteria, suggested a 14-fold enhancement, based on the DDT partition coefficient. The disagreement was in part due to a retarded nonequilibrium movement of the bacteria. Model calculations based on literature data covering a wide range of organisms and compounds suggested that 10(6) cells ml-1 would increase the mobility of very hydrophobic compounds (log octanol-water partition coefficient [K(ow) of greater than or equal to 6), whereas higher densities of bacteria (10(8) cells ml-1) would have a significant impact on compounds with a log K(ow) of greater than or equal to 4.(ABSTRACT TRUNCATED AT 250 WORDS)

Smoking habits of pregnant women and their partners at three health centres in Stockholm, Sweden, were monitored by a postal questionnaire. Of 582 women enlisted at the antenatal clinics, 433 (74%) were included. 253 (58%) women and 230 (53%) partners responded. 30% of the women were smokers at the start of pregnancy, compared with 27% of the men. During pregnancy 18% continued to smoke, and after the birth of the child 21% were smokers. The male partners stopped or decreased smoking less often. Fewer women aged 25 or more were smokers. The number of heavy smokers decreased considerably during and after pregnancy. The women were more prone to stop smoking if the partner was a non-smoker. 87% made some restriction in their smoking habits after the baby was born.

Dispersal of bacteria in saturated, porous soils can be characterized by the partitioning of cells between the aqueous and solid phases, as a result of the physical and chemical nature of the soil and water and cell surface modifications. The purpose of this work is to understand variations in partitioning as a consequence of the nutrient conditions and to use this information in mathematical models to predict the dispersal rate of bacteria in aquifer material. Two different models were used to describe dispersal: an advective-dispersive-sorptive model with a first order kinetic sink term to account for irreversible cell reactions, such as death and sorption; and a two-site reaction model, in which the retardation was assumed to be determined by two types of sites, one characterized by instantaneous equilibrium sorption reactions and the other by kinetic nonequilibrium reactions. Water-saturated sand columns were used as continuous-flow groundwater microcosms to test the models under different nutrient regimes. Two strains of indigenous groundwater bacteria were isolated from aquifer material and labelled with(3)H-alanine,(14)C-pyruvic acid,(3)H-glucose, and(3)H-adenosine for different measurements of sorption and dispersal, which were estimated from breakthrough curves. Both experimental data and model variables showed that dispersal of bacteria was a dynamic nonequilibrium process, possibly shaped by two subpopulations, one strongly, even irreversibly, adsorbing to the solid particles, and one with very slow adsorption kinetics. The cell surfaces were modified in response to the growth conditions, which was demonstrated by hydrophobic and electrostatic interaction chromatography. Cell surface hydrophobicity was about eight times higher in groundwater than in eutrophic lake water. The partition coefficient varied between 12.6 in the groundwater and 6.4 in the lake water, indicating the prime importance of hydrophobic binding for attachment in low nutrient conditions. The partitioning was also sensitive to the hydrodynamics of the system and the oxygen supply, as demonstrated by comparison of sorption in agitated test tubes, gently shaken vials, and air-flushed bottles. Sorption kinetics were demonstrated in a continuous flow cell. About 45% of a population was associated with sand particles with a continuous flow of pure groundwater and as little as 20% in lake water. However, more than 50% of the bacteria in the aqueous phase were associated with suspended material of less than 60 μm in diameter. This association may enhance dispersal for example, by size exclusion of the colloidal material in the interstitial pores.

The present study was a pilot project to determine the feasibility of a stress management program for treatment of hypertension in the Swedish primary health care system. Those patients in the catchment area of the primary health care center at Tumba hospital who were under 45 years old and diagnosed with primary hypertension during 1979-1981, were chosen to participate if they had had at least one measurement of 150 mmHg systolic and/or 95 mmHg diastolic during 1981. Patients on diuretic medication were included but those being medicated with beta-blockers were excluded for ethical reasons. Of the 21 people who fulfilled these criteria, 13 took part in the treatment, which lasted ten weeks. Both systolic and diastolic blood pressure decreased significantly (151.1 to 124.7 and 96.4 to 89.3, respectively). The conclusions drawn were that stress management may offer a viable alternative to medication of mild hypertension in primary health care and that it should be tested on a larger scale with systematic blood pressure measurements performed during daily activities, serving as a basis for baseline determination.

The ultrasound method for detection of deep vein thrombosis (DVT) of the leg has been used in a study comprising 47 patients. This method was compared in the same group with a clinical evaluation and was controlled by venography. Clinical evaluation gave a correct diagnosis in 28 (59.6%) of 47 patients, false positive or false negative in 19 (40.4%). With the ultrasound method, the correct diagnosis was made in 41 (87.2%) of 47 patients, false positive in 3 (6.4%) and false negative in 3 (6.4%). No cases were missed of thrombosis situated proximal to the popliteal vein. The method was less accurate in cases of thrombosis situated in or distal of the popliteal vein; the 3 patients in whom a false negative diagnosis was made, belonged to this group. Since the ultrasound method has been shown to give few false positive and false negative results, it should be suitable as a screening procedure in patients with symptoms suggestive of DVT.

The penicillinase mediated by the R factor R1 in Escherichia coli has been purified and characterized. The purification procedure contained the following three steps: spheroplast formation, chromatography of the spheroplast supernatant fluid on DEAE cellulose, and preparative polyacrylamide-gel electrophoresis. The protein obtained gave only one band in analytical polyacrylamide-gel electrophoresis. To obtain milligram quantities of the enzyme, gel filtration on Sephadex G75 was run before the last step in the purification. By gel filtration on Sephadex G75, the molecular weight was estimated as 22,000. The pH optimum, tested in universal buffer, was 7.0. The turnover numbers for benzylpenicillin, d-ampicillin, and 6-aminopenicillanic acid were 4.2 x 10(4), 6.3 x 10(4), and 2.2 x 10(4) moles of substrate hydrolyzed per min by 1 mole of enzyme, whereas the Michaelis constants were 100, 160, and 440 mum, respectively. Cephalosporins were much poorer substrates for the R1 penicillinase than were the penicillins. The turnover number for cephalosporin C, cephaloridine, and 7-amino-cephalosporanic acid were 2.4 x 10(3), 5 x 10(2), and less than 2 x 10(2), respectively. These properties show that the R1 penicillinase is quite different from the chromosomally mediated penicillinase of E. coli (11). However, the R1 enzyme resembles another R-factor penicillinase previously purified by Richmond and Datta.