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  • 1.
    Borneskog, Catrin
    et al.
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Lampic, Claudia
    Neurobiology, Care Sciences and Society, Karolinska Institute, Huddinge, Sweden.
    Bladh, Marie
    Division of Obstetrics and Gynecology, Department of Clinical and experimental Medicine, Faculty of Health and Science, Linköping University, Linköping, Sweden; Department of Gynecology and Obstetrics in Linköping, County Council of Östergötland, Linköping, Sweden.
    Sydsjö, Gunilla
    Division of Obstetrics and Gynecology, Department of Clinical and experimental Medicine, Faculty of Health and Science, Linköping University, Linköping, Sweden; Department of Gynecology and Obstetrics in Linköping, County Council of Östergötland, Linköping, Sweden.
    Skoog Svanberg, Agneta
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Relationship satisfaction in lesbian and heterosexual couples before and after assisted reproduction: a longitudinal follow-up study2014In: BMC Women's Health, ISSN 1472-6874, E-ISSN 1472-6874, Vol. 14, no 1, article id 154Article in journal (Refereed)
    Abstract [en]

    Background: More and more lesbian couples are planning parenthood through donor insemination and IVF and the number of planned lesbian families is growing in Sweden and other western countries. Research has shown that lesbian couples report as much overall satisfaction in their relationships as do heterosexual couples. However, although parenthood is highly desired, many parents are unaware of the demands of parenthood and the strain on their relationship that the arrival of the baby might bring. The aim of this study was to compare lesbian and heterosexual couples¿ perceptions of relationship satisfaction at a three-year follow up after assisted reproduction.

    Methods: The present study is a part of the Swedish study on gamete donation, a prospective longitudinal cohort study. The present study constitutes a three-year follow up assessment of lesbian and heterosexual couples after assisted reproduction. Participants requesting assisted reproduction at all fertility clinics performing gamete donation in Sweden, were recruited consecutively during 2005-2008. A total of 114 lesbian women (57 treated women and 57 partners) and 126 heterosexual women and men (63 women and 63 men) participated. Participants responded to the ENRICH inventory at two time points during 2005¿2011; at the commencement of treatment (time point 1) and about three years after treatment termination (time point 3). To evaluate the bivariate relationships between the groups (heterosexual and lesbian) and socio-demographic factors Pearson's Chi- square test was used. Kolmogorov-Smirnov test was used for testing of normality, Mann-Whitney U- test to examine differences in ENRICH between the groups and paired samples t-test to examine scores over time.

    Results: Lesbian couples reported higher relationship satisfaction than heterosexual couples, however the heterosexual couples satisfaction with relationship quality was not low. Both lesbian and heterosexual couples would be classified (?) accordingly to ENRICH-typology as vitalized or harmonious couples.

    Conclusions: At a follow-up after assisted reproduction with donated sperm, lesbian couples reported stable relationships and a high satisfaction with their relationships, even when treatment was unsuccessful.

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  • 2.
    Gustavsson, Catharina
    et al.
    Center for Clinical Research Dalarna, Uppsala University, Uppsala, Sweden; School of Education, Health and Social Studies, Dalarna University, Falun, Sweden; Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, BMC, Uppsala, Sweden.
    Eriksson Crommert, Martin
    Örebro University, School of Medical Sciences. University Health Care Research Center.
    Physiotherapists' and midwives' views of increased inter recti abdominis distance and its management in women after childbirth2020In: BMC Women's Health, ISSN 1472-6874, E-ISSN 1472-6874, Vol. 20, no 1, article id 37Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Physiotherapists and midwives in primary healthcare often encounter women with an increased separation between the two rectus abdominis muscle bellies after pregnancy, a so-called increased inter recti distance (IRD). There are few studies on the contribution of increased IRD to the explanation of post-partum health complaints, and very little guidance in the literature for health professionals on the management of increased IRD. The aim of this study was to describe how physiotherapists and midwives in primary healthcare perceive the phenomenon of increased IRD and its management in women after childbirth.

    METHODS: A purposeful sampling approach was used to select physiotherapists and midwives working in primary healthcare in three large county council healthcare organisations in Sweden having experience of encountering women with increased IRD after pregnancy. Sixteen physiotherapists and midwives participated in focus group discussions. Four focus groups with four participants in each were undertaken. A semi-structured topic guide was used to explore responses to the research questions and the discussions were analysed using qualitative content analysis.

    RESULTS: We identified an overarching theme: Ambivalence towards the phenomenon increased IRD and frustration over insufficient professional knowledge. The theme included three categories: Uncertainty concerning the significance of increased IRD as a causal factor for functional problems; perceived insufficient professional knowledge base for the management of increased IRD; and lack of inter-professional collaboration and teamwork in the management of patients with increased IRD. Due to sparse and somewhat contradictory research findings and absence of clinical guidelines, the health professionals lacked basic preconditions for applying an evidence-based practice concerning increased IRD. They obtained their information about increased IRD from the media and fitness coaches, and hence were somewhat unsure about what to believe regarding the phenomenon.

    CONCLUSIONS: There was no consensus among the health professionals on how to best approach increased IRD in the clinical setting. Our findings stress the importance of more research to increase the professional knowledge base among physiotherapists and midwives. The findings highlight the urgent need for policies and clinical guidelines advising health professionals in the management of increased IRD and for facilitating inter-professional collaboration and teamwork.

  • 3.
    Hadgu, Endale
    et al.
    Department of Biochemistry, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia.
    Seifu, Daniel
    Department of Biochemistry, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia.
    Tigneh, Wondemagegnhu
    Department of Oncology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia.
    Bokretsion, Yonas
    Department of Pathology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia.
    Bekele, Abebe
    Department of Surgery, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia.
    Abebe, Markos
    Armauer Hansen research Institute (AHRI), Addis Ababa, Ethiopia.
    Sollie, Thomas
    Dept of Laboratory Medicine, Örebro University Hospital, Örebro, Sweden.
    Merajver, Sofia D.
    University of Michigan Comprehensive Cancer Center, Ann Arbor MI, USA.
    Karlsson, Christina
    Örebro University, School of Health Sciences.
    Karlsson, Mats
    Örebro University, School of Medical Sciences. Department of Laboratory Medicine, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Breast cancer in Ethiopia: evidence for geographic difference in the distribution of molecular subtypes in Africa2018In: BMC Women's Health, ISSN 1472-6874, E-ISSN 1472-6874, Vol. 18, no 1, article id 40Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Breast cancer is a heterogeneous disease with several morphological and molecular subtypes. Widely accepted molecular classification system uses assessment of estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2) and proliferation marker Ki67. Few studies have been conducted on the incidence and molecular types of breast cancer in Sub-Saharan Africa. Previous studies mainly from Western and Central Africa, showed breast cancer to occur at younger ages and to present with aggressive features, such as high-grade, advanced stage and triple-negative phenotype (negative for ER, PR and HER2). Limited data from East Africa including Ethiopia however shows hormone receptor negative tumors to account for a lower proportion of all breast cancers than has been reported from elsewhere in Africa.

    METHODS: In this study from Tikur Anbessa Specialized Hospital, 114 breast cancer patients diagnosed between 2012 and 2015 were enrolled. ER, PR, Ki67 and HER2 receptor status were assessed using immunohistochemistry from tissue microarrays. FISH was used for assessment of gene amplification in all equivocal tumor samples and for confirmation in HER2-enriched cases.

    RESULTS: The distribution of molecular subtypes was: Luminal A: 40%; Luminal B: 26%; HER2-enriched: 10%; TNBC: 23%. ER were positive in 65% of all tumors and 43% the cases were positive for PR. There was statistically significant difference in median age at diagnosis between the molecular subtypes (P < 0.05). There was a bimodal distribution of molecular subtypes in different age ranges with Luminal B subtype being more common at younger ages (median = 36) and Luminal A subtype more prevalent at older ages (median = 42). There were no statistically significant differences in tumor grade, histology, and stage between the molecular subtypes of breast cancer.

    CONCLUSION: The present study detected Luminal A breast cancer to be the most common subtype and reveals a relatively low rate of hormone receptor negative and TNBC. Our findings and results from other East African studies suggest geographic variability in the distribution of the molecular subtypes of breast cancer in Africa and hence have important clinical and policy implications for breast cancer control and treatment in Ethiopia.

  • 4.
    Kumakech, Edward
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Pathology, Makerere University College of Health Sciences, Kampala, Uganda .
    Andersson, Sören
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Laboratory Medicine, Örebro University Hospital, Örebro, Sweden.
    Wabinga, Henry
    Department of Pathology, Makerere University College of Health Sciences, Kampala, Uganda .
    Berggren, Vanja
    Department of Health Sciences, Lund University, Lund, Sweden.
    Integration of HIV and cervical cancer screening perceptions and preferences of communities in Uganda2015In: BMC Women's Health, ISSN 1472-6874, E-ISSN 1472-6874, Vol. 15, no 1, article id 23Article in journal (Refereed)
    Abstract [en]

    Background: Despite the fact that HIV-positive women carry an increased risk of developing cervical cancer (CC) in comparison with HIV-negative women, HIV and CC screening programs in many developing countries have remained unintegrated. The objective of this study is to explore perceptions and preferences of community members in Uganda, including women, men, and village health teams, regarding the integration of HIV and CC screening services in a single-visit approach.

    Methods: This qualitative study was conducted in three districts in Uganda. Data were collected through focus group discussions with women and village health teams, and individual interviews with men. Respondents were purposely selected from among those linked to three CC clinics in the three districts. The content analysis method was used to analyze the data.

    Results: Three themes emerged from the data, namely appreciating the benefits of integration, worrying about the challenges of integration, and preferences for integration. The women endorsed the benefits. However, there were worries that integration would prolong the waiting time at the health facility and induce tiredness in both the healthcare providers and the women. There were also fears of being found positive for both HIV and CC and the consequences such as stress, self-isolation, and social conflicts. Participants, particularly the women, considered the challenges of screening integration to be manageable by, for example, taking a day off work to visit the hospital, delegating house chores to other family members, or taking a packed lunch on visiting the hospital.

    Conclusions: The community members in Uganda perceive the benefits of HIV and CC screening integration to outweigh the challenges, and expect that the challenges can be minimized or managed by the women. Therefore, when considering HIV and CC screening integration, it is important to not only recognize the benefits but also take into consideration the perceived challenges and preferences of community members.

  • 5.
    Kumakech, Edward
    et al.
    Örebro University, School of Health Sciences. School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda.
    Andersson, Sören
    Örebro University, School of Medical Sciences. Department of Laboratory Medicine, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Wabinga, Henry
    Department of Pathology, Kampala Cancer Registry, Makerere University, Kampala, Uganda.
    Musubika, Caroline
    Department of Medical Microbiology, Immunology Laboratory, Makerere University, Kampala, Uganda.
    Kirimunda, Samuel
    Department of Medical Microbiology, Immunology laboratory, Makerere University, Kampala, Uganda.
    Berggren, Vanja
    Department of Health Sciences, Lund University, Lund, Sweden.
    Cervical cancer risk perceptions, sexual risk behaviors and sexually transmitted infections among Bivalent Human Papillomavirus vaccinated and non-vaccinated young women in Uganda-5 year follow up study2017In: BMC Women's Health, ISSN 1472-6874, E-ISSN 1472-6874, Vol. 17, article id 40Article in journal (Refereed)
    Abstract [en]

    Background: Previous studies were conflicting regarding the associations between HPV vaccination, cervical cancer risk perceptions, high-risk sexual behaviors and STIs. This study compared the HPV-vaccinated and non-vaccinated young women in Uganda regarding cervical cancer risk perceptions, high-risk sexual behaviors, syphilis and HIV infections 5 years after vaccine implementation.

    Methods: This was a population-based comparative cross-sectional survey conducted in Uganda. The 438 participants were sexually active young women aged 15-24 years and mean age was 18.6 (SD 1.4). The majority (53.0%) were HPV-vaccinated in 2008 without assessment of sexual activity prior to HPV vaccination. Upon verbal assessment of sexual activity at the time of follow-up, data were collected using a questionnaire and laboratory testing of blood samples for syphilis and HIV infections.

    Results: There were no significant differences between the HPV-vaccinated and non-vaccinated groups regarding the prevalence of high-risk sexual behaviors, syphilis and HIV infections. Cervical cancer risk perceptions and age at sexual debut were nonetheless significantly lower among the vaccinated group compared to their non-vaccinated counterparts. However, HPV vaccination was not significantly associated to cervical cancer risk perceptions and early age at sexual debut in multivariate logistic regression analysis.

    Conclusions: We found no associations between HPV vaccination, cervical cancer risk perceptions, high-risk sexual behaviors, syphilis and HIV infections among young women in Uganda 5 years after vaccine implementation. Young girls in the study population were found to be sexually active at a young age, affirming the importance of targeting girls of younger age for HPV vaccination.

  • 6.
    Lundell, Inger Wallin
    et al.
    Dept Womens & Childrens Hlth, Uppsala Univ, Uppsala, Sweden; Sophiahemmet Univ, Stockholm, Sweden.
    Öhman, Susanne Georgsson
    Sophiahemmet Univ, Stockholm, Sweden; Dept Womens & Childrens Hlth, Karolinska Inst, Stockholm, Sweden.
    Frans, Orjan
    Dept Psychol, Uppsala Univ, Uppsala, Sweden.
    Helstrom, Lotti
    Dept Clin Sci & Educ, Karolinska Inst, Stockholm, Sweden.
    Hogberg, Ulf
    Dept Womens & Childrens Hlth, Uppsala Univ, Uppsala, Sweden.
    Nyberg, Sigrid
    Dept Clin Sci Obstet & Gynaecol, Umeå Univ, Umeå, Sweden.
    Poromaa, Inger Sundstrom
    Dept Womens & Childrens Hlth, Uppsala Univ, Uppsala, Sweden.
    Sydsjo, Gunilla
    Fac Hlth Sci, Dept Clin & Expt Med, Div Obstet & Gynaecol, Linköping University, Linköping, Sweden.
    Östlund, Ingrid
    Dept Obstet & Gynaecol, Örebro University Hospital, Örebro, Sweden.
    Svanberg, Agneta Skoog
    Dept Womens & Childrens Hlth, Uppsala Univ, Uppsala, Sweden.
    Posttraumatic stress among women after induced abortion: a Swedish multi-centre cohort study2013In: BMC Women's Health, ISSN 1472-6874, E-ISSN 1472-6874, Vol. 13, article id 52Article in journal (Refereed)
    Abstract [en]

    Background: Induced abortion is a common medical intervention. Whether psychological sequelae might follow induced abortion has long been a subject of concern among researchers and little is known about the relationship between posttraumatic stress disorder (PTSD) and induced abortion. Thus, the aim of the study was to assess the prevalence of PTSD and posttraumatic stress symptoms (PTSS) before and at three and six months after induced abortion, and to describe the characteristics of the women who developed PTSD or PTSS after the abortion. Methods: This multi-centre cohort study included six departments of Obstetrics and Gynaecology in Sweden. The study included 1457 women who requested an induced abortion, among whom 742 women responded at the three-month follow-up and 641 women at the six-month follow-up. The Screen Questionnaire-Posttraumatic Stress Disorder (SQ-PTSD) was used for research diagnoses of PTSD and PTSS, and anxiety and depressive symptoms were evaluated by the Hospital Anxiety and Depression Scale (HADS). Measurements were made at the first visit and at three and six months after the abortion. The 95% confidence intervals for the prevalence of lifetime or ongoing PTSD and PTSS were calculated using the normal approximation. The chi-square test and the Student's t-test were used to compare data between groups. Results: The prevalence of ongoing PTSD and PTSS before the abortion was 4.3% and 23.5%, respectively, concomitant with high levels of anxiety and depression. At three months the corresponding rates were 2.0% and 4.6%, at six months 1.9% and 6.1%, respectively. Dropouts had higher rates of PTSD and PTSS. Fifty-one women developed PTSD or PTSS during the observation period. They were young, less well educated, needed counselling, and had high levels of anxiety and depressive symptoms. During the observation period 57 women had trauma experiences, among whom 11 developed PTSD or PTSS and reported a traumatic experience in relation to the abortion. Conclusion: Few women developed PTSD or PTSS after the abortion. The majority did so because of trauma experiences unrelated to the induced abortion. Concomitant symptoms of depression and anxiety call for clinical alertness and support.

  • 7. Mol, Femke
    et al.
    Strandell, Annika
    Jurkovic, Davor
    Yalcinkaya, Tamer
    Verhoeve, Harold R.
    Koks, Carolien A. M.
    van der Linden, Paul J. Q.
    Graziosi, Giuseppe C. M.
    Thurkow, Andreas L.
    Hoek, Annemieke
    Hogström, Lars
    Klinte, Ingemar
    Nilsson, Kerstin
    Örebro University, School of Health and Medical Sciences.
    van Mello, Norah M.
    Ankum, Willem M.
    van der Veen, Fulco
    Mol, Ben W. M.
    Hajenius, Petra J.
    The ESEP study: salpingostomy versus salpingectomy for tubal ectopic pregnancy; the impact on future fertility : a randomised controlled trial2008In: BMC Women's Health, ISSN 1472-6874, E-ISSN 1472-6874, Vol. 8, p. 11-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: For most tubal ectopic pregnancies (EP) surgery is the treatment of first choice. Whether surgical treatment should be performed conservatively (salpingostomy) or radically (salpingectomy) in women wishing to preserve their reproductive capacity, is subject to debate. Salpingostomy preserves the tube, but bears the risks of both persistent trophoblast and repeat ipsilateral tubal EP. Salpingectomy, avoids these risks, but leaves only one tube for reproductive capacity. This study aims to reveal the trade-off between both surgical options: whether the potential advantage of salpingostomy, i.e. a better fertility prognosis as compared to salpingectomy, outweighs the potential disadvantages, i.e. persistent trophoblast and an increased risk for a repeat EP. METHODS/DESIGN: International multi centre randomised controlled trial comparing salpingostomy versus salpingectomy in women with a tubal EP without contra lateral tubal pathology. Hemodynamically stable women with a presumptive diagnosis of tubal EP, scheduled for surgery, are eligible for inclusion. Patients pregnant after in vitro fertilisation (IVF) and/or known documented tubal pathology are excluded. At surgery, a tubal EP must be confirmed. Only women with a tubal EP amenable to both interventions and a healthy contra lateral tube are included. Salpingostomy and salpingectomy are performed according to standard procedures of participating hospitals. Up to 36 months after surgery, women will be contacted to assess their fertility status at six months intervals starting form the day of the operation.The primary outcome measure is the occurrence of spontaneous viable intra uterine pregnancy. Secondary outcome measures are persistent trophoblast, repeat EP, all pregnancies including those resulting from IVF and financial costs. The analysis will be performed according to the intention to treat principle. A cost-effectiveness analysis will be performed within a decision analysis framework, based on costs per live birth, including IVF treatment whenever a spontaneous pregnancy does not occur. Patients' preferences will be assessed using a discrete choice experiment. DISCUSSION: This trial will provide evidence on the trade off between salpingostomy and salpingectomy for tubal EP in view of the pros and cons of both interventions and will offer guidance to clinicians in making the right treatment choice. TRIAL REGISTRATION: Current Controlled Trials ISRCTN37002267.

  • 8.
    Schückher, Fides
    et al.
    Örebro University, School of Medical Sciences. University Health Care Research Center.
    Sellin Jönsson, Tabita
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Center.
    Engström, Ingemar
    Örebro University, School of Medical Sciences. University Health Care Research Center.
    Berglund, Kristina
    Department of Psychology,University of Gothenburg, Göteborg, Sweden.
    History of childhood abuse is associated with less positive treatment outcomes in socially stable women with alcohol use disorder2019In: BMC Women's Health, ISSN 1472-6874, E-ISSN 1472-6874, Vol. 19, no 1, article id 159Article in journal (Refereed)
    Abstract [en]

    Background: To examine the relationship between treatment outcome, as measured according to change in alcohol consumption, and a history of childhood abuse (emotional, physical, sexual) in socially stable women undergoing treatment for alcohol use disorder (AUD).

    Methods: Participants were assessed using the Addiction Severity Index and the Mini International Neuropsychiatric Interview at the beginning of treatment (n = 75), end of treatment (n = 59) and 12 month follow-up after treatment (n = 57). Self-report data on alcohol consumption were obtained at all three time-points using the Alcohol Habits Inventory-Revised 2. Self-report data on childhood maltreatment were obtained at the beginning of treatment using the Childhood Trauma Questionnaire-short form. Study outcomes were changes in alcohol consumption (grams of pure alcohol per week), risk-drinking and reported abstinence.

    Results: Of the 75 women enrolled, 38 (50.7%) reported a history of childhood abuse and the rest did not. Both groups showed a significant improvement in all three outcomes at the end of treatment and at 12-month follow-up. At the end of treatment, a significant inter-group difference was found for reported abstinence (non-abused group, 39.3% vs abused, 12.9%; p < 0.05). At 12-month follow-up, significant inter-group differences were observed for all treatment outcomes, with superior outcomes being found for the non-abused group, including a higher proportion of women with reported abstinence (55.6% vs 13.3%; p < 0.01).

    Conclusion: The present findings suggest that an evaluation of a possible history of childhood abuse is warranted in all women seeking treatment for AUD, irrespective of social stability. In terms of clinical practice, the results suggest that additional interventions may be warranted in this population.

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