441 research outputs found
Rural Tanzanian women's awareness of danger signs of obstetric complications.
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Awareness of the danger signs of obstetric complications is the essential first step in accepting appropriate and timely referral to obstetric and newborn care. The objectives of this study were to assess women's awareness of danger signs of obstetric complications and to identify associated factors in a rural district in Tanzania. A total of 1118 women who had been pregnant in the past two years were interviewed. A list of medically recognized potentially life threatening obstetric signs was obtained from the responses given. Chi-square test was used to determine associations between categorical variables and multivariate logistic regression analysis was used to identify factors associated with awareness of obstetric danger signs. More than 98% of the women attended antenatal care at least once. Half of the women knew at least one obstetric danger sign. The percentage of women who knew at least one danger sign during pregnancy was 26%, during delivery 23% and after delivery 40%. Few women knew three or more danger signs. According to multivariate logistic regression analysis having secondary education or more increased the likelihood of awareness of obstetric danger signs six-fold (OR = 5.8; 95% CI: 1.8-19) in comparison with no education at all. The likelihood to have more awareness increased significantly by increasing age of the mother, number of deliveries, number of antenatal visits, whether the delivery took place at a health institution and whether the mother was informed of having a risks/complications during antenatal care. Women had low awareness of danger signs of obstetric complications. We recommend the following in order to increase awareness of danger signs of obstetrical complications: to improve quality of counseling and involving other family members in antenatal and postnatal care, to use radio messages and educational sessions targeting the whole community and to intensify provision of formal education as emphasized in the second millennium development goal.\u
Introduction of a qualitative perinatal audit at Muhimbili National Hospital, Dar es Salaam, Tanzania.
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Perinatal death is a devastating experience for the mother and of concern in clinical practice. Regular perinatal audit may identify suboptimal care related to perinatal deaths and thus appropriate measures for its reduction. The aim of this study was to perform a qualitative perinatal audit of intrapartum and early neonatal deaths and propose means of reducing the perinatal mortality rate (PMR). From 1st August, 2007 to 31st December, 2007 we conducted an audit of perinatal deaths (n = 133) with birth weight 1500 g or more at Muhimbili National Hospital (MNH). The audit was done by three obstetricians, two external and one internal auditors. Each auditor independently evaluated the cases narratives. Suboptimal factors were identified in the antepartum, intrapartum and early neonatal period and classified into three levels of delay (community, infrastructure and health care). The contribution of each suboptimal factor to adverse perinatal outcome was identified and the case graded according to possible avoidability. Degree of agreement between auditors was assessed by the kappa coefficient. The PMR was 92 per 1000 total births. Suboptimal factors were identified in 80% of audited cases and half of suboptimal factors were found to be the likely cause of adverse perinatal outcome and were preventable. Poor foetal heart monitoring during labour was indirectly associated with over 40% of perinatal death. There was a poor to fair agreement between external and internal auditors. There are significant areas of care that need improvement. Poor monitoring during labour was a major cause of avoidable perinatal mortality. This type of audit was a good starting point for quality assurance at MNH. Regular perinatal audits to identify avoidable causes of perinatal deaths with feed back to the staff may be a useful strategy to reduce perinatal mortality.\u
Figaros bryllup. 1. og 2. akt
No full textProgram. Vist 20., 21., 26. og 27. mai 2015 på Seilduken, Loftet 2. Forestillingen har fire avgangsstudenter fra årsstudium og bachelorutdanningen (Dagfinn, Sara, Carl Fredrik, Hanne), samt studenter fra bachelor 1. og 2. år (Mathilda, Agnes, Therese, Robert).Libretto: Lorenzo da Ponte
Rollene:
Greve Almaviva: Dagfinn Andersen, årsstudiet
Grevinne Almaviva: Sara Aasen (20/5 og 26/5), årsstudiet
Mathilda Sterby (21/5 og 27/5), bachelor 1.år
Figaro: Carl-Fredrik Thonée, bachelor 2.år
Susanna: Hanne K. Askeland (20/5 og 26/5), årsstudiet
Agnes Auer (21/5 og 27/5), bachelor 1.år
Cherubino: Therese Thylin Lindmark, bachelor 1.år
Don Basilio: Robert Lind, bachelor 1.år
Antonio: Emil Havold Næshage, gjest fra Barratt Due
Musikalsk ledelse: Gerhard Markson
Regi: Veselina Manolova
Piano: Gabor Nagy
Scenografi: Isak Wisløff, Kristoffer Christiansen og Jonas
Garson, studenter Design, bachelor 3.år
Veileder: professor Vigdis Ruud
Kostymedesign: Sarah Brinkmann, student Design master 1.år
Veileder: professor Christina Lindgren
Lysdesign: Sverre Randin
Inspisient: Julie Bakke Kvalen
Rekvisitør: Pernille Trøbråten
Scenemester: Ragnar Berntsson
Syersker: Else Ciljan Jacobsen og Caroline Cecilie Evju
Påkleder: Natalie Elverum
Sminke Lars Terje Gudem Hansen
Foto: Stephen Hutton
De scenografiske elementene er fremstilt i skolens scenetekniske verksteder.W34
Quality of Antenatal Care in Rural Tanzania: Counselling on Pregnancy Danger Signs.
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The high rate of antenatal care attendance in sub-Saharan Africa, should facilitate provision of information on signs of potential pregnancy complications. The aim of this study was to assess quality of antenatal care with respect to providers' counselling of pregnancy danger signs in Rufiji district, Tanzania. A cross-sectional study was conducted in 18 primary health facilities. Thirty two providers were observed providing antenatal care to 438 pregnant women. Information on counselling on pregnancy danger signs was collected by an observer. Exit interviews were conducted to 435 women. One hundred and eighty five (42%) clients were not informed of any pregnancy danger signs. The most common pregnancy danger sign informed on was vaginal bleeding 50% followed by severe headache/blurred vision 45%. Nurse auxiliaries were three times more likely to inform a client of a danger sign than registered/enrolled nurses (OR = 3.7; 95% CI: 2.1-6.5) and Maternal Child Health Aides (OR = 2.3: 95% CI: 1.3-4.3) and public health nurses (OR = 2.5; CI: 1.4-4.2) were two times more likely to provide information on danger signs than registered/enrolled nurses. The clients recalled less than half of the pregnancy danger signs they had been informed during the interaction. Two out of five clients were not counselled on pregnancy danger signs. The higher trained cadre, registered/enrolled nurses were not informing majority of clients pregnancy danger signs compared to the lower cadres. Supportive supervision should be made to enhance counselling of pregnancy danger signs. Nurse auxiliaries should be encouraged and given chance for further training and upgrading to improve their performance and increase human resource for health.\u
Studies on peripheral tolerance in Aire-deficient mice
No full textAutoimmune diseases such as diabetes mellitus and multiple sclerosis are increasing today, but the mechanism behind these diseases remains largely unknown. Autoimmunity arise when the immune system of an individual start to attack its own organs and tissues. Immune cells go through a selection in central and peripheral organs where they are taught to be non-reactive to self structures, a process referred to as tolerance.In this thesis we have investigated the function of the autoimmune regulator (AIRE), a gene that is important for the establishment of tolerance. The autoimmune polyendocrine syndrome type 1 (APS I) is a rare severe autoimmune disease caused by a single mutation in the AIRE gene. These patients suffer from a range of endocrine and non-endocrine manifestations such as hypoparathyroidism and chronic mucocutaneous candida infections. Aire deficient mice have been created in order to enable the investigation on how tolerance is lost in APS I patients. These mice have revealed that AIRE is involved in the deletion of autoreactive T-lymphocytes in the thymus. AIRE is thought to induce the expression of tissue specific antigens (TSAs) that are presented to T-lymphocytes in the thymus. However, Aire deficient mice display a phenotype suggesting that additional tolerance mechanisms are affected.In the first paper presented in this thesis we show that AIRE is involved in the regulation of T-cell independent B cell responses and that Aire-/- mice display an increased activation of B cells. This increased activation was demonstrated to be due to increased serum levels of the B cell activating factor of the TNF-family (BAFF) in Aire-/- mice and APS I patients. The increased levels of BAFF were in turn found to be due to uninhibited signaling of IFN-γ through the STAT1-pathway in absence of AIRE.In the second paper it was demonstrated that AIRE is expressed by a specific dendritic cell in the marginal zone of the spleen. These dendritic cells were found to regulate the activation of T lymphocytes in germinal center reactions and displayed a phenotype suggesting their involvement in tolerance mechanisms.In the third project we demonstrated that the expression of Aire in the marginal zone dendritic cells was regulated by IFN-γ. Upon IFN-γ stimulation both the expression of Aire and the TSA insulin was quickly down-regulated while the expression of inflammatory cytokines was up-regulated. These data suggest that the marginal zone dendritic cells are able to participate in tolerance induction during steady state and switch to an immunogenic state during an immune response.In the last project we investigated the development of the marginal zone dendritic cell in the bone marrow and found that Aire is expressed in a precursor cell to the dendritic cell in the spleen. Further, it was found that in absence of AIRE the regulation of transcription factors important for the development of this particular dendritic cell subset was impaired.The findings from this thesis suggest that AIRE play an important function in the periphery and adds to the view that AIRE regulates both central and peripheral tolerance.List of scientific papersI. Lindh E., Lind S., Lindmark E., Hässler S., Perheentupa J., Peltonen L., Winqvist O. and Karlsson M.C.I. (2008). AIRE regulates T cell independent B cell responses through BAFF. Proc Natl Acad Sci U S A. 105, 18466-71. https://doi.org/10.1073/pnas.0808205105 II. Lindmark E., Chen Y., Geourgodaki A., Dudziak D., Lindh E., Adams W.C., Loré K., Winqvist O., Chambers B.J. and Karlsson M.C.I. (2013). AIRE expressing marginal zone dendritic cells balances adaptive immunity and T-follicular helper cell recruitment. J Autoimmunity. 42, 62-70. https://doi.org/10.1016/j.jaut.2012.11.004 III. Lindmark E., Adams W.C., Loré K., Winqvist O., Chambers B.J. and Karlsson M.C.I. STAT1-mediated regulation of Aire expression in marginal zone dendritic cells. [Manuscript]IV. Lindmark E., Linton L., Adams W.C., Loré K., Arkestål K., Enocson A., Chambers B.J. Winqvist O., and Karlsson M.C.I. AIRE regulates genes important for development of dendritic cells in the bone marrow. [Manuscript]</p
Champion basketball team, Y.M.C.A.
No full textBack Row: A. G. Brooker (left guard), C. J. Worth (physical director), F. Haney (right guard). Front Row: C. D. Harrison (centre), K. G. McRae (captain, right forward), Chas. Newsome (left forward). C.F. Lindmark Trophy
Cigarette smoking and K-ras mutations in pancreas, lung and colorectal adenocarcinomas: etiopathogenic similarities, differences and paradoxes.
No full textSurprisingly different frequencies and patterns of K-ras mutations are observed in human adenocarcinomas of the pancreas, colorectum and lung. Their respective relationships with smoking are apparently paradoxical. We evaluated all the available types of clinical and epidemiological studies on the relationship between tobacco smoking and the occurrence of K-ras mutations in human adenocarcinomas of the pancreas, colorectum and lung. We identified 8, 7 and 12 studies that analyzed the relationship between K-ras mutations and tobacco smoking in human neoplasms of the pancreas, colorectum and lung, respectively. A meta-analysis was undertaken for each site separately. In pancreatic adenocarcinomas lifetime history of tobacco consumption was not significantly associated with the frequency of K-ras mutations (OR=1.26; 95% CI=0.82-1.94). Similarly, no association was observed between smoking and K-ras mutations in colorectal adenocarcinomas (OR=0.94; CI=0.79-1.12), neither when colorectal adenomas and adenocarcinomas were jointly analyzed (OR=0.96; 95% CI=0.83-1.13). In lung adenocarcinoma, where only 15-25% of cases harbor a K-ras mutation, tumors from smokers were more likely to have K-ras mutations than tumors from non-smokers (OR=3.67; 95% CI=2.47-5.45). Furthermore, in lung adenocarcinomas K-ras mutations have a pattern different from that in pancreatic and colorectal adenocarcinomas. Results support the hypothesis that smoking influences the risk of pancreatic cancer - and possibly colorectal cancer - through events other than K-ras mutations. In adenocarcinoma of the lung, smoking may play a role in the occurrence of K-ras mutations. If the influence of tobacco products in the induction, acquisition and persistence of K-ras mutations had some tissue specificity, or was dependent on different factors in different organs, the corresponding mechanisms would deserve detailed research
Unintentional Climate Policy: Swedish experiences of carbon dioxide emissions and economic growth 1950-2005
No full textThis paper examines the development of carbon dioxide emissions in Sweden, especiallyn with a focus on the absolute reductions during the post-war period, during the 1970s and 1980s. The paper shows that the largest reductions were achieved before the introduction of an active climate policy in 1991. This was in turn the result of significant improvements in energy efficiency and energy conversion, while structural changes were considerably less important. One reason behind this decoupling process may be that the active energy policy put pressure on households and industries to conserve energy and to substitute from oil to electricity and biofuels. The process was substantially reinforced by the development of world oil prices in combination with the development of domestic electricity prices, where nuclear power seems to have played an important role.Sweden; climate policy; economic growth; carbon dioxide reduction; carbon tax
A Rapid Assessment of the Quality of Neonatal Healthcare in Kilimanjaro Region, Northeast Tanzania.
No full textWhile child mortality is declining in Africa there has been no evidence of a comparable reduction in neonatal mortality. The quality of inpatient neonatal care is likely a contributing factor but data from resource limited settings are few. The objective of this study was to assess the quality of neonatal care in the district hospitals of the Kilimanjaro region of Tanzania. Clinical records were reviewed for ill or premature neonates admitted to 13 inpatient health facilities in the Kilimanjaro region; staffing and equipment levels were also assessed. Among the 82 neonates reviewed, key health information was missing from a substantial proportion of records: on maternal antenatal cards, blood group was recorded for 52 (63.4%) mothers, Rhesus (Rh) factor for 39 (47.6%), VDRL for 59 (71.9%) and HIV status for 77 (93.1%). From neonatal clinical records, heart rate was recorded for3 (3.7%) neonates, respiratory rate in 14, (17.1%) and temperature in 33 (40.2%). None of 13 facilities had a functioning premature unit despite calculated gestational age <36 weeks in 45.6% of evaluated neonates. Intravenous fluids and oxygen were available in 9 out of 13 of facilities, while antibiotics and essential basic equipment were available in more than two thirds. Medication dosing errors were common; under-dosage for ampicillin, gentamicin and cloxacillin was found in 44.0%, 37.9% and 50% of cases, respectively, while over-dosage was found in 20.0%, 24.2% and 19.9%, respectively. Physician or assistant physician staffing levels by the WHO indicator levels (WISN) were generally low. Key aspects of neonatal care were found to be poorly documented or incorrectly implemented in this appraisal of neonatal care in Kilimanjaro. Efforts towards quality assurance and enhanced motivation of staff may improve outcomes for this vulnerable group
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