Attitudes towards pelvic examination in a random sample of Swedish women.

BACKGROUND: A pelvic examination is the most common procedure in gynecological practice. A majority of women have negative experiences of such examinations. The aim of the present study was to explore attitudes to and experiences of pelvic examinations, as well as possible background factors to such attitudes and experiences. METHODS: A postal inquiry was sent to 788 randomly selected Swedish women, of fertile age. Sixty-seven per cent answered the questionnaire, which had 56 items and covered, inter alia, attitudes to and experiences of pelvic examinations, as well as possible background factors. RESULTS: The women had positive, uniform attitudes to pelvic examinations in general, but negative experiences of the specific parts of the procedure. Women's attitudes to and experiences of pelvic examinations correlated. The experience of the first pelvic examination was more negative than the experience of the last. A negative experience in general and the experience of pain during the first pelvic examination correlated. The first pelvic examination emerged as a statistically powerful background factor for subsequent attitudes to pelvic examinations. CONCLUSIONS: Swedish women have positive attitudes to pelvic examination in spite of negative previous experiences. A powerful background factor for subsequent attitudes to pelvic examination was the experience of the first one. A woman's first pelvic examination should therefore be used as an opportunity to condition positive emotions and behaviors to the examination situation, as a basis for future positive experiences.

Changes in sick leave rates and the use of pregnancy-associated social benefits among pregnant Swedish women: an outcomes study.

We attempted to determine if an amended social security system has lessened the rate of sickness absence during pregnancy in Sweden over the period 1978-1989. We studied the records of 3998 women who gave birth in 1978, 1986, 1988, and 1989 at the University Hospital in Linköping and the Värnamo County Hospital. Retrospective collection of all data concerning the rates and durations of sickness absence during pregnancy, drawing of parental benefit, and use of granted pregnancy benefit was performed from Sweden's standardized social security files. Obstetric variables concerning the course and outcome of pregnancy and delivery, as well as the health status of the newborns, were obtained from standardized and antenatal care and delivery files. Between 1978 and 1989, the rate of sickness absenteeism during pregnancy increased by almost 100% for periods of absence not supported by a doctor's certificate and by about 50% for those with a doctor's certificate. During the same time, the average number of days of sick leave per pregnant woman more than doubled. The changes were most apparent among younger pregnant women. During the decade studied, no significant differences were found with regard to antenatal care, modes of delivery, or the health status of the newborns. In spite of the introduction within the Swedish social security system of more generous rules for pregnant women, the changes in the rates of registered sick leave during pregnancy observed over time were most unfavorable. The present study indicates that the rate of sick leave during pregnancy reflects a complex social phenomenon and cannot be explained solely by an increase in the rate of actual illness or sickness. Such a rate is also likely to depend on general attitudes and expectations among pregnant women, which may vary over time. When amendments in social benefits for pregnant women are considered to improve the health status of the pregnant population, society ought to clearly define the precise aim pursued and the consequences expected to escape unintended socioeconomic results.

Sick leave and social benefits during pregnancy--a Swedish-Norwegian comparison.

BACKGROUND: To analyze the correlation between sickness absence, working conditions, pregnancy outcomes and pregnancy associated social benefits in two urban pregnant populations in Sweden and Norway with different social benefit systems. METHODS: Relevant information on 1649 delivered women was manually extracted by the authors from the antenatal care and delivery records as well as from the personal social security files kept in the Värnamo and Hamar communities, and then computerized in a depersonalized form. RESULTS: The reproductive histories and the pregnancy outcomes appeared clinically similar in the two samples. Swedish pregnant women were significantly more often employed outside home (84 vs. 69 per cent). The types of occupations held were similar in Värnamo and Hamar. Swedish pregnant women were significantly more sick-listed during pregnancy than Norwegian women (64 vs. 32 per cent) and with a longer average duration of the sick-leave spells (61 days vs. 44 days). The sick-leave rate among Swedish employed pregnant women was 75 per cent as compared to 48 per cent in Norway. The differences appeared most evident in younger pregnant women (<25 years). The Swedish sick-leave rates were higher within all four occupational subgroups studied. During the observation period the pregnancy associated social benefits were significantly more generous in Sweden. CONCLUSIONS: Sickness absence during pregnancy does not seem to covariate in a simple way with ill health, working conditions or the amount of social benefits available. The increased sick-leave rates in Sweden may possibly be accounted for by a changing attitude towards pregnancy and its natural consequences, especially among younger women.

MCHS: an application software for family welfare programmes.

At the level of first contact, a primary health care centre, information management is an unwieldy task, therefore health information systems are reported to be inadequate and weak. Microcomputers could improve information management at this level, but there is little success due to a lack of specialized application software. In this paper we describe software developed after a multi-centre systems analysis study, on an essential data set, to support the delivery of the public health programmes for family welfare, i.e. maternal health care, family planning and immunization programmes. The modular approach was taken to develop a common application software for information management use at multiple sites. The software is tested in a laboratory mode by retrospective data entry from sites in Sweden and in India. All the information could be entered and site-specific reports that were generated are compared. The software provided a common data collection format, an essential platform for outcomes research.

Towards an essential data set: applicability in the domain of maternal health services.

There is a need for consensus on the quantity of data that must be available in a computer-based information system of a health care organization. In this paper we take up the issue of defining the data content of an information system and introduce the concept of Essential Data Sets with an explicit methodology which was applied to define a data set for the Maternal Health Services program. A key step in the method was a recognized technique used in systems development process called data modelling, in this case infological modelling, by an interdisciplinary group. A preliminary set of 86 data elements was identified and it provided the foundation for development of an application software for discussion and a real-world testing framework. The acceptability of the data set was tested in a laboratory perspective by retrospective data entry from records of 94 pregnant women registered at a maternal health care center in Sweden. Data from a total of 1,318 prenatal visits, an outcome visit, and a postnatal visit for each woman was entered into a computer using the software, with no loss of information. Thus, in a short-term perspective the acceptability of the data set was demonstrated. The software has since been implemented for pilot prospective studies at sites in India and Sweden. The use of a common data protocol is an essential foundation for patient outcome research, especially as the trend of health care management has changed from a "process of care" orientation to an "outcome of care" orientation.

hCG-treatment alone is insufficient for restitution of spermatogenesis in a state with arrest at the spermatogonial level.

In an infertile man with azoospermia and arrest at the spermatogonial stage, hCG treatment alone improved the spermatogenesis but not beyond the primary spermatocyte stage. During hCG treatment steroid conversion in vitro in testicular biopsy material, as well as serum testosterone concentrations increased dramatically. When hMG treatment was added, spermatogenesis was complete. Combined hCG/hMG treatment seems to be an efficient therapy in well-selected infertile men, whereas increased testosterone production induced by hCG-treatment may be insufficient for restitution of spermatogenesis.

Incomplete androgen insensitivity: asymmetry in morphology and steroid profile and metabolism of the gonads. An analysis of a case.

A patient with clinical manifestations of the incomplete androgen insensitivity syndrome was studied with respect to peripheral blood levels of steroids and steroid sulphates before, during and after gonadectomy. Steroid and steroid sulphate concentrations were also analyzed in spermatic venous blood and gonadal tissue collected during surgery. The metabolic capacity of gonadal tissue was also studied in vitro using progesterone, dehydroepiandrosterone sulphate and oestrone sulphate as substrates. Profound differences between the two gonads were noted with respect to both steroid content and release into pampiniform veins and to in vitro conversion of progesterone and oestrone sulphate. Histological examination revealed the presence of seminiferous tubules with carcinoma in situ in both gonads. It is suggested that the differences between the gonads may be due to an autonomous steroid production in the right gonad in spite of adequate or even elevated gonadotrophic stimulation resulting in a steroidogenic situation resembling the complete androgen insensitivity syndrome, while the conditions found in the left gonad more resembles the incomplete form of the disease.

In vitro metabolism of 3H-pregnenolone and 3H-progesterone by adult and prepubertal human testicular tissue before and during gonadotrophic treatment.

The in vitro conversion of tritiated pregnenolone and progesterone was studied in testicular tissue from three infertile adult males before and during 25-30 weeks of therapy with hCG alone or combined with hMG. Furthermore, the in vitro conversion of pregnenolone was studied in testicular tissue from five prepubertal boys with undescended testes, two of whom had been subjected to hCG treatment for 5 weeks. The gonadotrophic treatment appeared to augment the steroid conversion mediated by the enzymes 3 beta-hydroxysteroid dehydrogenase and 17 alpha-hydroxylase in adult as well as prepubertal testicular tissue. The conversion mediated by C17-20-lyase along the delta 4 metabolic pathway was not increased, causing a "trap" along the delta 4 metabolic pathway. The increased production of testosterone in vitro from tritiated pregnenolone, which was observed during gonadotrophic treatment, probably took place along the delta 5 metabolic pathway through the C17-20-lyase step, whereas C21 steroids converted to the delta 4 metabolic pathway were found to be "trapped" as 17 alpha-hydroxyprogesterone.

Conceptual dating by ultrasonic measurement of the fetal biparietal diameter in early pregnancy.

The accuracy and precision of gestational dating, based on single measurements of the fetal biparietal diameter (BPD), was estimated in a consecutive series of 970 apparently normal, singleton pregnancies. The BPD sizes used varied between 11 and 60 mm, corresponding to 9-22 postconceptional weeks. The 'conceptual ages', used for reference, were estimated by means of ultrasonic measurements of the fetal crown--rump lengths (CRL). The association between the estimated conceptual age (dependent variable) and BPD size (independent variable) was found to be well represented (R2 = 0.972) by a second order polynomial: conceptual age = 44.7 + 1.069 X BPD + 0.01382 X BPD X BPD. To check the validity of the proposed equation, we used 23 fetuses conceived by artificial insemination with donor semen as controls. There was good agreement between the virtual conceptual ages of the control cases and their corresponding BPD-estimated conceptual ages (0.5 days mean difference, 3.6 days SD) when the suggested regression equation was used. The estimated precision of BPD-dating was minumum +/- 4.4 days (= +/- 2SD) at 9-10 completed postconceptional weeks. At 14 completed weeks the corresponding precision was found to be +/- 11 days (+/- 2SD). At the end of the studied BPD size interval, i.e. 56-60 mm BPD corresponding to 22 conceptual weeks, the precision was +/- 15 days. From an obstetrical point of view it seems obvious that the imprecision of gestational dating associated with BPD measurements greater than 35 mm should call for ultrasonic dating procedures to be performed earlier in pregnancy.(ABSTRACT TRUNCATED AT 250 WORDS)

Who declines from antenatal serum alpha-fetoprotein screening--and why?

One hundred women who declined a voluntary alpha-fetoprotein screening test during early pregnancy and one hundred women who accepted the test were investigated by means of semistructured interviews with particular reference to background factors which could have influenced upon the decision making. Those who declined were, as expected, overrepresented among those opposed to legal abortion and they often showed an ambivalent or negative attitude towards prenatal diagnosis as such. These women were also more frequently legally married and active members of various religious denominations. Otherwise there were no socioeconomic, psychologic or other background factors specially associated with women who declined. The paramount individual reason given for abstaining from the test was the feeling that the test was 'unreliable'. The personal ethical attitude, together with the current reputation of the test in society, seem to be major factors affecting the rate of participation in an AFP-screening program.

Pregnancy-specific beta 1-glycoprotein, SP1, in maternal serum during uncomplicated single pregnancies.

Pregnancy-specific beta 1-glycoprotein (SP1) levels in uncomplicated single pregnancies were measured by radioimmunoassay from the time of ovulation until the 8th week of pregnancy in 129 blood samples from 78 women. SP1 was detectable in all samples examined from 34 days after the last menstrual period (LMP), and thereafter the SP1 level increased rapidly with time and 38 to 40 days after LMP the geometric mean SP1 concentration was 90 micrograms/l. From pregnancy weeks 8 to 41, SP1 levels were measured by nephelometry in 1255 blood samples from 1255 women. A 95% reference range was established using logarithmic transformation. There was a steady increase in the SP1 concentration until the last month of pregnancy, in which a tendency to level off was seen, the geometric mean levels ranging from 149 to 170 mg/l. The day-to-day variation was studied during 5 consecutive days in 10 women. No significant variation was found. The diurnal variation was studied in blood samples taken every 4th hour during a 24-hour period form 10 women. A significant decrease was found at midnight and at 4 a.m. The elimination rate of SP1 from serum was studied in 10 women following labor. Elimination was non-linear and the time taken for SP1 to decrease to 50% ranged from 24 to 50 hours. No correlation was found between the concentration of SP1 and parity, maternal age, or the sex of the infant. The SP1 concentration was significantly lower in heavier women (greater than 70 kg) than in lighter women (less than or equal to 70 kg).(ABSTRACT TRUNCATED AT 250 WORDS)

Postnatal emotional balance in women with and without antenatal fear of childbirth.

Women in the later stages of pregnancy were identified as 'suffering' or 'not suffering' from fear of childbirth by means of a special questionnaire. The two samples were interviewed two months after delivery. Women with antenatal fear of childbirth were found to run an increased risk of sustaining severe emotional imbalance postnatally with possible implications on their relationship to the child.