Papers by Lennarth Nyström
Combining the perspectives of midwives and doctors improves risk assessment in early pregnancy
Acta Obstetricia et Gynecologica Scandinavica, 2007
Traditionally, risk identification in early pregnancy in Swedish antenatal care [ANC] is performe... more Traditionally, risk identification in early pregnancy in Swedish antenatal care [ANC] is performed by the midwife at booking, and confirmed by the doctor at a routine visit in early pregnancy, but this extra visit has been questioned. This study compared the risk assessment by the two professions. In a cluster randomised trial, a planning conference, where midwives reported new mothers to a doctor, replaced the routine consultation with the doctor. Ten ANC-clinics with the new program (942 mothers) were compared to 10 clinics with standard care (758 mothers). Risk factors were registered independently by midwives and doctors. Degree of agreement in risk identification between midwives and doctors was estimated by the kappa coefficient. The degree of agreement in risk registration was good for previous pregnancy complications (kappa = 0.62; CI: 0.55-0.68), and recommendations for the doctor's consultation (kappa = 0.67; CI: 0.62-0.72); fair for social problems (kappa = 0.29; CI: 0.03-0.55), and poor for registration of symptoms and problems in index pregnancy (kappa = 0.09; CI: 0.03-0.21) and psychosocial aspects, such as anxiety (kappa = 0.09; CI: 0.03-0.21). Significantly more risk factors were registered in the study group. Replacing the routine consultation with the doctor early in pregnancy with a planning conference had no negative impact on risk identification. The results support that the different perspectives of the two professions in combination are important for the safety of surveillance and the psychosocial support expected from antenatal care.
… Journal of Primary …, 1988
The aim of this study was to examine whether observed high mortality from ischaemic heart disease... more The aim of this study was to examine whether observed high mortality from ischaemic heart disease (IHD) among males in the municipality of Hofors, Sweden, is accurate, or the result of some artefact. The validity of death certificates from Hofors municipality and from a control area (Gavle) were ascertained by comparing them with medical records from hospitals and district physician'offices, and reports from clinical or medicolegal autopsies. The results indicate that the observed high mortality from IHD among Hofors males cannot be explained by deficiencies in establishing the cause of death. Results from other validity studies indicate, however, that there is a risk of local variation when reporting c a w of death. In many instances this motivates checking the validity of data before they are incorporated into official statistics and used as a basis for planning.
PLoS ONE, 2013
Young people face sexual and reproductive health (SRH) problems including Human immunodeficiency ... more Young people face sexual and reproductive health (SRH) problems including Human immunodeficiency virus (HIV) and Acquired immunodeficiency syndrome (AIDS). It is critical to continue documenting their situation including the contexts they live in. As part of a larger study that explored perspectives of men to SRH and more specifically abortion and contraceptive use, 546 pupils (51% female; age range 9-25 years) from a rural area in Zimbabwe were invited to write anonymously questions about growing up or other questions they could not ask adults for fear or shame. The pupils were included following descriptions by adults of the violence that is unleashed on unmarried young people who engaged in sex, used contraceptives, or simply suggested doing so. The questions by the young people pointed to living in a context of prohibitive silence; their sexuality was silenced and denied. As a consequence they had poor knowledge and their fears and internal conflicts around sexuality and pregnancy were not addressed. Current action suggests concerted effort at the policy level to deal with young people's SRH in Zimbabwe. It nevertheless remains necessary, as a way to provide support to these efforts, to continue examining what lessons can be drawn from the past, and how the past continues to reflect in and shape present dynamics and relations. There is also need to look more critically at life skill education, which has previously been described as having failed to address adequately the practical needs of young people. Life skill education in Zimbabwe has rarely been systematically evaluated. A fuller understanding is also needed of the different factors co-existing in contemporary African societies and how they have been and continue to be constituted within history, and the implications to the promotion of adolescent SRH. Citation: Chikovore J, Nystrom L, Lindmark G, Ahlberg BM (2013) ''How Can I Gain Skills if I Don't Practice?'' The Dynamics of Prohibitive Silence against Pre-Marital Pregnancy and Sex in Zimbabwe. PLoS ONE 8(1): e53058.
BJOG: An International Journal of Obstetrics & Gynaecology, 2007
Objective To compare a five-visit antenatal care (ANC) model with specified goals with the standa... more Objective To compare a five-visit antenatal care (ANC) model with specified goals with the standard model in a rural area in Zimbabwe.
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Papers by Lennarth Nyström