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  • 51.
    Fadl, Helena
    et al.
    Örebro University Hospital. Department of Obstetrics and Gynaecology .
    Östlund, Ingrid
    Örebro University Hospital. Department of Obstetrics and Gynaecology .
    Nilsson, Kerstin
    Örebro University Hospital. Department of Clinical Medicine, Section of Obstetrics and Gynaecology.
    Hanson, U.
    Department of Woman’s and Children’s Health, Uppsala University, Uppsala, Sweden.
    Fasting capillary glucose as a screening test for gestational diabetes mellitus2007In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 114, no 3, p. 373-373Article in journal (Refereed)
  • 52.
    Fadl, Helena
    et al.
    Örebro University Hospital. Department of Obstetrics and Gynaecology .
    Östlund, Ingrid
    Örebro University Hospital. Department of Obstetrics and Gynaecology .
    Nilsson, Kerstin
    Örebro University Hospital. Department of Obstetrics and Gynaecology and Department of Clinical Medicine, Section of Obstetrics and Gynecology.
    Hanson, U
    Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
    Fasting capillary glucose as a screening test for gestational diabetes mellitus2006In: BJOG: an International Journal of Obstetrics and Gynaecology, ISSN 1470-0328, Vol. 113, no 9, p. 1067-71Article in journal (Refereed)
    Abstract [en]

    Objective: To evaluate fasting capillary glucose as a screening test for gestational diabetes mellitus (GDM) compared with traditional risk factors and repeated random capillary glucose measurements.

    Design: Cross-sectional, population-based study.

    Setting: Maternal Health Care Clinics in Orebro County, Sweden.

    Population: An unselected population of women without diabetes.

    Methods: Fasting capillary glucose levels were measured at gestational weeks 28-32. Random capillary glucose levels were measured four to six times during pregnancy. Traditional risk factors for GDM were registered. GDM was diagnosed using a 75-g oral glucose tolerance test.

    Main outcome measures: Sensitivity, specificity, likelihood ratios.

    Results: In 55 of 3616 women participating in the study, GDM was diagnosed before 34 weeks of gestation. For fasting capillary glucose cutoff values between 4.0 and 5.0 mmol/l, sensitivity was in the range between 87 and 47% and specificity between 51 and 96%. Using a combined screening model of traditional risk factors with fasting capillary glucose at various cutoff values increased the sensitivity only slightly compared with using fasting capillary glucose alone.

    Conclusion: In this Swedish, unselected, low-risk population, fasting capillary glucose measurements were found to be an acceptable and useful screening test for GDM.

  • 53.
    Fadl, Helena
    et al.
    Örebro University Hospital. Department of Obstetrics and Gynaecology.
    Östlund, Ingrid
    Örebro University Hospital. Department of Obstetrics and Gynaecology.
    Nilsson, Kerstin
    Örebro University Hospital. Department of Clinical Medicine, Section of Obstetrics and Gynaecology.
    Hanson, U.
    Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
    Fasting capillary glucose as a screening test for gestational diabetes mellitus - Author's reply2007In: BJOG: an International Journal of Obstetrics and Gynaecology, ISSN 1470-0328, Vol. 114, no 2, p. 238-239Article in journal (Refereed)
  • 54.
    Fagerli, Tove A.
    et al.
    National Center for Fetal Medicine, Trondheim University Hospital, Trondheim, Norway.
    Mogren, Ingrid
    Department of Clinical Sciences, Obstetric and Gynecology, Umeå University, Umeå, Sweden.
    Adolfsson, Annsofie
    Örebro University, School of Health Sciences. University College of Southeast Norway, Tønsberg, Norway.
    Edvardsson, Kristina
    Department of Clinical Sciences, Obstetric and Gynecology, Umeå University, Umeå, Sweden; School of Nursing and Midwifery, College of Science, Health and Engineering, La Trobe University, Australia.
    Åhman, Annika
    Department of Clinical Sciences, Obstetric and Gynecology, Umeå University, Umeå, Sweden.
    Holmlund, Sophia
    Department of Clinical Sciences, Obstetric and Gynecology, Umeå University, Umeå, Sweden.
    Darje, Elisabeth
    Department of Public Health and Nursing, Norwegian University of Technology and Science and Department of Women’s Health, StOlavs Hospital, Trondheim, Norway.
    Eggebø, Torbjørn M.
    National Center for Fetal Medicine, Trondheim University Hospital, Trondheim, Norway; Department of Laboratory Medicine, Children’s and Women’s Health, Norwegian University of Science and Technology, Trondheim, Norway.
    Midwives’ and obstetricians’ views on appropriate obstetric sonography in Norway2018In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 16, p. 1-5Article, review/survey (Refereed)
    Abstract [en]

    Introduction: The primary aim of this study was to investigate midwives' and obstetricians' views on how many ultrasound examinations should be part of standard care during pregnancy in Norway.

    Material and methods: This study is a part of a larger study, the CROss-Country Ultrasound Study (CROCUS), an international investigation of midwives' and obstetricians' experiences of and views on the use of ultrasound. We distributed 400 questionnaires to respondents in all five health regions in Norway: 40 to municipal midwives, 180 to midwives working in hospitals and 180 to obstetricians. The questionnaire included specific questions about the appropriate number of examinations during pregnancy, examinations without medical indication, non-medical ultrasound, commercialisation and safety.

    Results: The response rate was 45%. Of the respondents, 58% reported satisfaction with the offer of one scheduled ultrasound examination during pregnancy, as recommended in the Norwegian guidelines. Health care professionals who used ultrasound themselves were significantly more likely to want to offer more ultrasound examinations: 52% of the ultrasound users wanted to offer two or more ultrasound examinations vs. 16% of the non-users (p < .01). The majority of obstetricians (80%) reported that pregnant women expect to undergo ultrasound examination, even in the absence of medical indication.

    Conclusion: The majority of Norwegian health care professionals participating in this study supported the national recommendation on ultrasound in pregnancy. Ultrasound users wanted to offer more ultrasound examinations during pregnancy, whereas non-users were generally content with the recommendation. The majority of respondents thought that commercialisation was not a problem at their institution, and reported that ultrasound is often performed without a medical indication. The ultrasound users thought that ultrasound is safe.

  • 55.
    Falconer, Henrik
    et al.
    Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
    Palsdottir, Kolbrun
    Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
    Stalberg, Karin
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Dahm-Kähler, Pernilla
    Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden.
    Ottander, Ulrika
    Department of Clinical Sciences, Umeå Universitet Medicinska fakulteten, Umea, Sweden.
    Lundin, Evelyn Serreyn
    Obstetrics and Gynecology, Linköpings universitet, Linköping, Sweden; Linköpings Universitet Institutionen for klinisk och experimentell medicin, Linköping, Sweden.
    Wijk, Lena
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Kimmig, Rainer
    Gynecology and Obstetrics, University Hospital of Duisburg-Essen, Essen, Germany.
    Jensen, Pernille Tine
    Faculty of Health Science, Aarhus University, Aarhus, Denmark.
    Eriksson, Ane Gerda Zahl
    Gynecologic Oncology, Universitetet i Oslo, Oslo, Norway.
    Mäenpää, Johanna
    Faculty of Medicine and Medical Technology, Tampere University, Tampere, Pirkanmaa, Finland.
    Persson, Jan
    Department of Obstetrics and Gynecology, Lund University Hosptial, Lund, Sweden.
    Salehi, Sahar
    Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
    Robot-assisted approach to cervical cancer (RACC): an international multi-center, open-label randomized controlled trial2019In: International Journal of Gynecological Cancer, ISSN 1048-891X, E-ISSN 1525-1438, Vol. 29, no 6, p. 1072-1076Article in journal (Refereed)
    Abstract [en]

    Background: Radical hysterectomy with pelvic lymphadenectomy represents the standard treatment for early-stage cervical cancer. Results from a recent randomized controlled trial demonstrate that minimally invasive surgery is inferior to laparotomy with regards to disease-free and overall survival.

    Primary Objective: To investigate the oncologic safety of robot-assisted surgery for early-stage cervical cancer as compared with standard laparotomy.

    Study Hypothesis: Robot-assisted laparoscopic radical hysterectomy is non-inferior to laparotomy in regards to recurrence-free survival with the advantage of fewer post-operative complications and superior patient-reported outcomes.

    Trial Design: Prospective, multi-institutional, international, open-label randomized clinical trial. Consecutive women with early-stage cervical cancer will be assessed for eligibility and subsequently randomized 1:1 to either robot-assisted laparoscopic surgery or laparotomy. Institutional review board approval will be required from all participating institutions. The trial is coordinated from Karolinska University Hospital, Sweden.

    Major Inclusion/Exclusion Criteria: Women over 18 with cervical cancer FIGO (2018) stages IB1, IB2, and IIA1 squamous, adenocarcinoma, or adenosquamous will be included. Women are not eligible if they have evidence of metastatic disease, serious co-morbidity, or a secondary invasive neoplasm in the past 5 years.

    Primary Endpoint: Recurrence-free survival at 5 years between women who underwent robot-assisted laparoscopic surgery versus laparotomy for early-stage cervical cancer.

    Sample Size: The clinical non-inferiority margin in this study is defined as a 5-year recurrence-free survival not worsened by >7.5%. With an expected recurrence-free survival of 85%, the study needs to observe 127 events with a one-sided level of significance (alpha) of 5% and a power (1-beta) of 80%. With 5 years of recruitment and 3 years of follow-up, the necessary number of events will be reached if the study can recruit a total of 768 patients.

    Estimated Dates for Completing Accrual and Presenting Results: Trial launch is estimated to be May 2019 and the trial is estimated to close in May 2027 with presentation of data shortly thereafter.

  • 56.
    Forsum, Elisabet
    et al.
    Division of Nutrition, Dept. of Biomedicine and Surgery, Linköpings Universitet, Linköping, Sweden.
    Boström, Karin
    Lust och Hälsa, Linköping, Sweden.
    Eriksson, Britt
    Linköping University, Linköping, Sweden.
    Olin-Skoglund, Sabina
    Kvinnans vikt före och under graviditet har betydelse för barnet: Riktlinjer från USA skulle gagna svensk folkhälsa [A woman's weight before and during pregnancy is of importance to her infant. USA guidelines would benefit public health in Sweden]2003In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 100, no 48, p. 3954-3956Article in journal (Refereed)
    Abstract [sv]

    This paper describes weight gain during pregnancy in Sweden in relation to guidelines from the United States. These guidelines take into consideration the fact that optimal weight gain during pregnancy is related to the woman's prepregnant weight in relation to her height. Almost 50 per cent of women delivering babies in Sweden during the year 2000 were obese or overweight. In the three populations studied, less than 50 per cent gained weight in accordance with the US guidelines, while more than 20 per cent gained less weight than recommended. The results indicate that, in Sweden, more attention should be paid to the body weight of women who bear children.

  • 57.
    Franzén, Karin
    et al.
    Örebro University, School of Health and Medical Sciences.
    Johansson, Jan Erik
    Örebro University, School of Health and Medical Sciences.
    Karlsson, Jan
    Örebro University, School of Health and Medical Sciences.
    Nilsson, Kerstin
    Örebro University, School of Health and Medical Sciences.
    Validation of the Swedish version of the Incontinence Impact Questionnaire, IIQ-7 and the Urogenital Distress Inventory, UDI-6.Manuscript (preprint) (Other academic)
    Abstract [en]

    Introduction and hypothesis:

    The purpose was to validate the Swedish versions of the Incontinence Impact Questionnaire (IIQ-7) and Urogenital Distress Inventory (UDI-6). Methods: We analyzed reliability, validity, and responsiveness in a clinical sample of 96 women with UI. Result:Test-retest reliability ranged from moderate to almost perfect. Cronbach’s alpha was 0.39 (UDI-6) and 0.83 (IIQ-7). Effect size calculation of change after treatment demonstrated good responsiveness. The effect size at 6 months was moderate in the SUI group and small in the UUI+MUI group. There was a moderate to strong correlation between UDI-6 and IIQ-7 and treatment satisfaction at 6, 12, and 24 months for both groups. ConclusionThe Swedish UDI-6 and IIQ-7 show good responsiveness and are easy to administer and fill out. UDI-6 did not produce the same solid psychometrical results as IIQ-7, but both scales can be of clinical importance and are recommended for clinical use.

  • 58.
    Franzén, Karin
    et al.
    Department of Clinical Medicine and Section of Obstetrics and Gynaecology, Örebro University Hospital, Örebro, Sweden.
    Johansson, Jan-Erik
    Department of Clinical Medicine and Section of Urology, Örebro University Hospital, Örebro, Sweden; Centre for Assessment of Medical Technology, Örebro County Council, Örebro, Sweden.
    Andersson, Gunnel
    Department of Clinical Medicine and Section of Urology, Örebro University Hospital, Örebro, Sweden; Centre for Assessment of Medical Technology, Örebro County Council, Örebro, Sweden.
    Nilsson, Kerstin
    Department of Clinical Medicine and Section of Obstetrics and Gynaecology, Örebro University Hospital, Örebro, Sweden.
    Urinary incontinence: evaluation of an information campaign directed towards the general public2008In: Scandinavian Journal of Urology and Nephrology, ISSN 0036-5599, E-ISSN 1651-2065, Vol. 42, no 6, p. 534-538Article in journal (Refereed)
    Abstract [en]

    Objective. To study and evaluate the effect of an information campaign in the form of a brochure on urinary incontinence (UI) directed towards the general public, concerning knowledge, individual health behaviour, self-reported healthcare utilization and how the information was perceived.

    Material and methods. Within a community in central Sweden a random sample of the population, in age groups from 18 years upwards, was selected from the population registry, resulting in a total sample of 3658 people. The study group was sent the brochure "Treatment of urinary incontinence", produced by SBU (Swedish Council on Technology Assessment in Health Care) in March 2003 and a questionnaire 1–2 months after the brochure was received.

    Results. The overall response rate was 47.5%. Eighty per cent of the responders stated UI as an important health problem in society and 66% that they had gained new knowledge on UI. Twenty-eight per cent of the responders reported a current or previous history of UI, of whom 49% felt that they had received useful information for self-treatment and 21% had begun self-treatment.

    Conclusion. This population-based study found that the distribution of a brochure on UI to the general public was well received and can be an efficient method to spread knowledge and encourage self-management. 

  • 59.
    Franzén, Karin
    et al.
    Örebro University, School of Health and Medical Sciences. 2 Obstetrics and Gynaecology, Örebro County Council, Örebro, Sweden.
    Johansson, Jan-Erik
    Örebro University, School of Health and Medical Sciences. Urology, Örebro University Hospital, Örebro, Sweden; Centre for Assessment of Medical Technology, Örebro County Council, Örebro, Sweden.
    Andersson, Gunnel
    Örebro University, School of Health and Medical Sciences. Urology, Örebro University Hospital, Örebro, Sweden.
    Pettersson, Nicklas
    Department of Statistics, Stockholm University, Stockholm, Sweden.
    Nilsson, Kerstin
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Obstetrics and Gynaecology,Örebro County Council, Örebro, Sweden; Centre for Assessment of Medical Technology, Örebro County Council, Örebro, Sweden.
    Urinary incontinence in women is not exclusively a medical problem: a population-based study on urinary incontinence and general living conditions2009In: Scandinavian Journal of Urology and Nephrology, ISSN 0036-5599, E-ISSN 1651-2065, Vol. 43, no 3, p. 226-232Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The aim of the study was to analyse differences in general health and general living conditions between women with and without urinary incontinence (UI).

    MATERIAL AND METHODS: This cross-sectional population-based study was conducted in Orebro County, Sweden. A public health questionnaire, "Life and Health", was sent to a randomly selected sample of the population. The questionnaire consisted of 87 questions on broad aspects of general and psychiatric health. An additional questionnaire was enclosed for those respondents who reported experiencing UI. The data were analysed using binary logistic regression. The final study population constituted 4609 women, 1332 of whom had completed both questionnaires. The remaining 3277 had completed only the Life and Health questionnaire. Effect measures were odds ratios (ORs) with corresponding 95% confidence intervals (CIs).

    RESULTS: Statistically significant associations were found between UI and the occurrence of musculoskeletal pain (OR 1.45, 95% CI 1.20-1.76), fatigue and sleeping disorders (OR 1.59, 95% CI 1.30-1.95), feelings of humiliation (OR 1.29, 95% CI 1.12-1.50), financial problems (OR 1.36, 95% CI 1.11-1.66), and reluctance to seek medical care (OR 1.43, 95% CI 1.21-1.68).

    CONCLUSION: UI among women is commonly associated with a number of different psychosocial problems as well as an expressed feeling of vulnerability.

  • 60.
    Franzén, Karin
    et al.
    Örebro University, School of Health and Medical Sciences. Örebro University Hospital, Örebro, Sweden.
    Johansson, Jan-Erik
    Örebro University, School of Health and Medical Sciences. Örebro University Hospital, Örebro, Sweden; Ctr Assessment Med Technol, Örebro Cty Council, Örebro, Sweden.
    Lauridsen, Inger
    Dept Urol, Torsby Hosp, Torsby, Sweden.
    Canelid, Jill
    Dept Obstet & Gynaecol, Karlstad Hosp, Karlstad, Sweden.
    Heiwall, Bengt
    Dept Obstet & Gynaecol, Karlstad Hosp, Karlstad, Sweden.
    Nilsson, Kerstin
    Örebro University, School of Health and Medical Sciences. Örebro University Hospital, Örebro, Sweden; Ctr Assessment Med Technol, Örebro Cty Council, Örebro, Sweden.
    Electrical stimulation compared with tolterodine for treatment of urge/urge incontinence amongst women: a randomized controlled trial2010In: International Urogynecology Journal, ISSN 0937-3462, E-ISSN 1433-3023, Vol. 21, no 12, p. 1517-1524Article in journal (Refereed)
    Abstract [en]

    Introduction and hypothesis: Few randomized controlled trials have compared electrical stimulation treatment with drug therapy. Our hypothesis was that electrical stimulation treatment in women with urgency/urge incontinence would be more efficient compared to drug treatment.

    Methods: Women ≥18 years of age with urgency/urge incontinence were randomized to receive either ten electrical stimulation treatments vaginally and transanally over a period of 5-7 weeks or tolterodine 4 mg orally once daily.

    Results: Sixty-one women completed the study. There was no significant difference between the two treatment groups in micturition rate from baseline to 6 months, mean difference, -0.40 (95% confidence interval (CI), -1.61 to 0.82), but a clearly significant difference within each group for electrical stimulation, -2.8 (95% CI, -3.7 to -1.9), and for tolterodine, -3.2 (95% CI, -4.1 to -2.4).

    Conclusions: Both treatments reduced the number of micturitions, but electrical stimulation was not found to be superior to tolterodine.

  • 61.
    Franzén, Karin M
    et al.
    Örebro University, School of Medicine, Örebro University, Sweden. Örebro University Hospital. Department of Obstetrics and Gynecology, Örebro University Hospital, Örebro, Sweden.
    Andersson, Gunnel
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Odeberg, Jenny
    Swedish Council on Health Technology Assessment (SBU), Stockholm, Sweden.
    Midlöv, Patrik
    Center for Primary Health Care Research, Lund University, Malmö, Sweden.
    Samuelsson, Eva
    Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Stenzelius, Karin
    Department of Care Science, Malmö University, Malmö, Sweden.
    Hammarström, Margareta
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Surgery for urinary incontinence in women 65 years and older: a systematic review2015In: International Urogynecology Journal, ISSN 0937-3462, E-ISSN 1433-3023, Vol. 26, no 8, p. 1095-1102Article in journal (Refereed)
    Abstract [en]

    Introduction and hypothesis: Urinary incontinence (UI) is common among the elderly, but the literature is sparse on the surgical treatment of UI among the elderly. This systematic review aims to assess the effectiveness of surgical interventions as treatment for urinary incontinence in the elderly population ≥65 years of age.

    Methods: Randomized controlled trials (RCT) and prospective nonrandomized studies (NRS) were included. The databases PubMed (NLM), EMBASE (Elsevier), Cochrane Library (Wiley), and Cinahl (EBSCO) were searched for the period 1966 up to October 2013. The population had to be ≥65 years of age and had to have undergone urethral sling procedures, periurethral injection of bulking agents, artificial urinary sphincter surgery, bladder injection treatment with onabotulinumtoxin A or sacral neuromodulation treatment. Eligible outcomes were episodes of incontinence/urine leakage, adverse events, and quality of life.

    The studies included had to be at a moderate or low risk of bias. Mean difference (MD) or standard mean difference (SMD)as well as risk difference (RD) and the 95 % CI were calculated.

    Results: Five studies-all on the suburethral sling procedure in women- that fulfilled the inclusion criteria were identified. The proportion of patients reporting persistent SUI after surgery ranged from 5.2 to 17.6 %. One study evaluating quality of life (QoL) showed a significant improvement after surgery. The complication rates varied between 1 and 26 %, mainly bladder perforation, bladder emptying disturbances, and de novo urge.

    Conclusion: The suburethral sling procedure improves continence as well as QoL among elderly women with SUI; however, evidence is limited.

  • 62.
    Ginsberg, Ylva
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    D'Onofrio, Brian M.
    Karolinska Institutet, Stockholm, Sweden; Indiana University, Bloomington IN, USA.
    Rickert, Martin E.
    Indiana University, Bloomington IN, USA.
    Class, Quetzal A.
    University of Illinois, Chicago IL, USA.
    Rosenqvist, Mina A.
    Karolinska Institutet, Stockholm, Sweden.
    Almqvist, Catarina
    Karolinska Institutet, Stockholm, Sweden; Astrid Lindgren Children′s Hospital, Karolinska University Hospital, Stockholm, Sweden.
    Lichtenstein, Paul
    Karolinska Institutet, Stockholm, Sweden.
    Larsson, Henrik
    Örebro University, School of Medical Sciences. Karolinska Institutet, Stockholm, Sweden.
    Maternal infection requiring hospitalization during pregnancy and attention-deficit hyperactivity disorder in offspring: a quasi-experimental family-based study2019In: Journal of Child Psychology and Psychiatry and Allied Disciplines, ISSN 0021-9630, E-ISSN 1469-7610, Vol. 60, no 2, p. 160-168Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Maternal infection during pregnancy (IDP) has been associated with increased risk of attention-deficit/hyperactivity disorder (ADHD) in offspring. However, infection is associated with social adversity, poor living conditions and other background familial factors. As such, there is a need to rule out whether the observed association between maternal IDP and ADHD might be attributed to such confounding.

    METHODS: This nationwide population-based cohort study using a family-based, quasi-experimental design included 1,066,956 individuals born in Sweden between 1992 and 2002. Data on maternal IDP (bacterial or viral) requiring hospitalization and ADHD diagnosis in offspring were gathered from Swedish National Registers, with individuals followed up through the end of 2009. Ordinary and stratified Cox regression models were used for estimation of hazard ratios (HRs) and several measured covariates were considered. Cousin- and sibling-comparisons accounted for unmeasured genetic and environmental factors shared by cousins and siblings.

    RESULTS: In the entire population, maternal IDP was associated with ADHD in offspring (HR = 2.31, 95% CI = 2.04-2.61). This association was attenuated when accounting for measured covariates (HR = 1.86, 95% CI = 1.65-2.10). The association was further attenuated when adjusting for unmeasured factors shared between cousins (HR = 1.52, 95% CI = 1.12-2.07). Finally, the association was fully attenuated in sibling comparisons (HR = 1.03, 95% CI = 0.76-1.41).

    CONCLUSIONS: This study suggests that the association between maternal IDP and offspring ADHD is largely due to unmeasured familial confounding. Our results underscore the importance of adjusting for unobserved familial risk factors when exploring risk factors for ADHD.

  • 63.
    Gustafsson, Per A
    et al.
    Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry, Linköping University, Linköping, Sweden.
    Gustafsson, Per E
    Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden.
    Anckarsäter, Henrik
    Department of Neuroscience and Physiology, Forensic Psychiatry, Gothenburg University, Gothenburg, Sweden.
    Lichtenstein, Paul
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Ljung, Therese
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Nelson, Nina
    Department of Clinical and Experimental Medicine, Department of Pediatrics, Linköping University, Linköping, Sweden.
    Larsson, Henrik
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Heritability of cortisol regulation in children2011In: Twin Research and Human Genetics, ISSN 1832-4274, E-ISSN 1839-2628, Vol. 14, no 6, p. 553-561Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The normal development of cortisol regulation during childhood is thought to be influenced by a complex interplay between environmental and genetic factors.

    METHOD: The aim of this study was to estimate genetic and environmental influences on basal cortisol levels in a sample of 151 twin pairs aged 9-16 years. Salivary cortisol was collected on two consecutive days when the children attended school--immediately after awakening, 30 min post-awakening and at bedtime.

    RESULTS: Heritability was highest (60%) for cortisol levels about 30 min after awakening. For samples taken immediately at awakening heritability was less pronounced (28%) and in the evening low (8%).

    CONCLUSION: The limited genetic influence on evening levels, moderate on cortisol at awakening and high on awakening response, might imply two genetic regulation patterns, one specifically for awakening response and one for the circadian rhythm proper. These findings could explain divergent results in previous studies and highlight the importance of taking the circadian rhythm into account in studies of cortisol levels in children.

  • 64. Hermansson, Ruth
    et al.
    Olovsson, Matts
    Lindström, Annika K.
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    HPV prevalence and HPV-related dysplasia in elderly women2018Conference paper (Other academic)
  • 65.
    Hermansson, Ruth S.
    et al.
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Department of Oncology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Olovsson, Matts
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Hoxell, Emelie
    Center for Clinical Research, Dalarna, Uppsala University, Uppsala, Sweden.
    Lindström, Annika K.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Center for Clinical Research, Dalarna, Uppsala University, Uppsala, Sweden; Clinical Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    HPV prevalence and HPV-related dysplasia in elderly women2018In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 1, article id e0189300Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: In Sweden, where screening ends at the age of 60, about 30% of the cervical cancer cases occur in women older than 60. The aim of the present study was to investigate the prevalence of HPV and cervical dysplasia in women of 60 years and above.

    PATIENTS AND METHODS: From September 2013 until June 2015, 1051 women aged 60-89 years (mean 68 years) were sampled for an HPV test when attending an outpatient gynecology clinic. Women with positive results had a second HPV test and liquid based cytology (LBC), after 3.5 months on average. Those with a positive second HPV test were examined by colposcopy, and biopsy and a sample for LBC was obtained.

    RESULTS: The prevalence of HPV was 4.1%, (95%CI 3.0-5.5, n = 43) at the first test, and at the second test 2.6% remained positive (95%CI 1.7-3.8, n = 27). The majority of women positive in both HPV tests, had dysplasia in histology, 81.5% (22/27) (4 CIN 2-0.4%, 18 CIN 1-1.7%). HPV-related dysplasia was found in 2.1%, (95%CI 1.3-3.2, n = 22) of the 1051 women. Four of the 22 women with positive HPV tests also had abnormal cytology, one ASCUS and three CIN 1. No cancer or glandular dysplasia was detected.

    CONCLUSION: A significant proportion of elderly women were found to have a persistent cervical HPV infection. Among them there was a high prevalence of CIN diagnosed by histology. The HPV test showed high sensitivity and specificity in detecting CIN in elderly women, while cytology showed extremely low sensitivity.

  • 66. Hildingsson, Ingegerd
    et al.
    Tingvall, Maria
    Örebro University, School of Health and Medical Sciences.
    Rubertsson, Christine
    Partner support in the childbearing period: a follow up study2008In: Women and birth, ISSN 1878-1799, Vol. 21, no 4, p. 141-148Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Social support is important during pregnancy and childbirth and the partner is usually the main source of support. Lack of partner support is associated with less emotional well-being and discontinuation of breastfeeding. RESEARCH PROBLEM: The purpose of the study was to investigate the proportion of women dissatisfied with partner support in early pregnancy, and to identify risk factors associated with dissatisfaction through a follow up 2 months and 1 year after childbirth. PARTICIPANTS AND METHODS: A national cohort of 2430 Swedish speaking women recruited in early pregnancy and followed up 2 months and 1 year postpartum. Data were collected by means of three postal questionnaires. RESULTS: Five percent of women were dissatisfied with partner support in early pregnancy. Women dissatisfied with partner support were more likely to be multiparas, not living with their partner in early pregnancy and to report unfavorable timing of pregnancy. They experienced more physical symptoms, and less emotional well-being in terms of more depressive symptoms, more major worries and a lower sense of coherence. One year after childbirth a higher rate of divorces and disappointment with the partner's participation in childcare and household chores and understanding from partner was found in women being dissatisfied in early pregnancy. DISCUSSION AND CONCLUSIONS: This study shows that it might be possible to identify women who are lacking partner support already in early pregnancy. Women's social network and their support from partner should be investigated by health care providers and women in need of additional support should be refereed to available community resources.

  • 67.
    Hildén, Karin
    et al.
    Örebro University, School of Medical Sciences.
    Arntyr-Hellgren, Paulina
    Magnuson, Anders
    Hanson, Ulf
    Simmons, David
    Örebro University, School of Medical Sciences.
    Fadl, Helena
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Born over 4500 g: the trends in birth trauma and mode of delivery in women with GDM and type 1 diabetes in Sweden between 1998-20122018Conference paper (Refereed)
    Abstract [en]

    Background: We have previously shown that during the years 1998-2012, the overall incidence of LGA and birthweight decreased in both women with and without GDM in Sweden, and unpublished preliminary results show that there is a converse trend among women with T1DM. The incidence of Erbs palsy also decreased in the GDM and background population, but remained unchanged for women with T1DM. Since macrosomia is one of the most prominent risk factors for Erb´s palsy and delivery complications, the aim of the study was to evaluate trends in incidence of Erb´s palsy and delivery mode in the macrosomic group defined as weight ≥4500g and we present here our preliminary results.

    Method: This is a cohort study in Sweden 1998-2012 , including singleton macrosomic (≥4500 g) births. Vaginal deliveries were selected for the analyses relating to Erb´s plasy. Poisson regression was used to evaluate trends per year in both the GDM, T1DM and the background population. Results were partly stratified on BMI, to be able to detect any group differences in trends. P-value of <0.05 was considered statistically significant.

    Results: In total there were 57 2015 macrosomic infants, of whom (n= 36 933, 64,6%) were delivered vaginally. Of these, only 2.1 % (n=798) were vaginally delivered by women with GDM, (1.4%) type 2 diabetes (0.1%) or T1DM (0.7%). The trend in Erb´s palsy decreased significantly in the background population at a rate of OR 0.954 (95% CI 0.936-0.973) per year. For women with GDM or T1DM there was no significant change in incidence of trends over these years for Erb´s palsy. As for Caesarean section (CS) there was a significant increase per year for GDM pregnancies (OR 1.028, 95% CI 1.007-1.049) and in the background population (1.018 95% CI 1.013-1.022). No change was seen for CS in pregnancies with T1DM.

    Conclusion: Even though the rates of LGA and birthweight have decreased in Sweden over this time period for women with GDM and the background population, we could not see a significant decrease in Erb´s palsy among women with vaginal births in either the GDM group or for women with T1DM in the macrosomic infants. However, a decrease was seen in the incidence of Erb´s palsy in the macrosomic babies in the background population. The rates of CS have significantly increased in the background population and for GDM pregnancies, but been stable for T1DM. We conclude that the disparity in risk of Erbs has grown over this time period. Further work is needed to ascertain whether this is due to the need for improved surveillance, a higher CS rate, and/or improved glycaemic management (or other factors).

  • 68.
    Hogström, Lars
    et al.
    Department of Obstetrics and Gynecology, Central Hospital, Skövde, Sweden.
    Johansson, Marianne
    Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; School of Health Sciences, University of Borås, Borås, Sweden.
    Janson, Per Olof
    Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Berg, Marie
    Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Francis, Jynfiaf
    Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Sogn, Jan
    Department of Obstetrics and Gynecology, Central Hospital, Uddevalla, Sweden.
    Hellström, Anna-Lena
    Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Adolfsson, Annsofie
    Department of Obstetrics and Gynecology, Central Hospital, Skövde, Sweden; School of Life Sciences, University of Skövde, Skövde, Sweden.
    Quality of life after adopting compared with childbirth with or without assisted reproduction2012In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 91, no 9, p. 1077-1085Article in journal (Refereed)
    Abstract [en]

    Objective: This study compares quality of life among couples who had adopted a child 4-5.5 years previously with couples whose conception was spontaneous, as well as with couples who had successful or unsuccessful in vitro fertilization (IVF) treatment.

    Design: Cross-sectional study.

    Setting: Tertiary level university hospital.

    Sample: From the following groups, 979 responses were obtained: adoption; successful IVF; unsuccessful IVF-living with children; unsuccessful IVF-living without children; and childbirth after spontaneous conception (controls).

    Methods: Quality of life was studied with the Psychological General Well Being (PGWB) and Sense of Coherence (SOC) instruments. Demographic, socio-economic and health data were obtained with additional questionnaires. Multiple variance analysis was applied.

    Main outcome measures: The PGWB and SOC scores.

    Results: After adjustment for seven confounders, the adoption group had higher PGWB scores than the unsuccessful IVF-living without children and the controls and higher SOC scores than all other groups. The unsuccessful IVF-living without children had lower PGWB and SOC scores than all other groups. The PGWB and SOC scores among controls did not differ from those with successful IVF or unsuccessful IVF-living with children.

    Conclusions: Adjusted PGWB and SOC scores revealed a high quality of life in the adoption group. However, the group unsuccessful IVF-living without children had low quality of life scores. Quality of life appears to be independent of the outcome of IVF treatment as long as there are children in the family.

  • 69.
    Hosford-Donovan, Adrian
    et al.
    Örebro University, School of Health Sciences.
    Nilsson, Andreas
    Örebro University, School of Health Sciences.
    Wåhlin-Larsson, Britta
    Örebro University, School of Health Sciences.
    Kadi, Fawzi
    Örebro University, School of Health Sciences.
    Observational and mechanistic links between C-reactive protein and blood pressure in elderly women2016In: Maturitas, ISSN 0378-5122, E-ISSN 1873-4111, Vol. 89, p. 52-57Article in journal (Refereed)
    Abstract [en]

    It is hypothesized that chronic systemic inflammation contributes to the age-related decline in cardiovascular function. The aim of the present study was to combine an assessment of the relationship between the serum level of C-reactive protein (CRP) and systolic and diastolic blood pressure in 108 elderly women (65 and 70 years) with an in-vitro exploration of the effects of CRP on the proliferative and angiogenic potential of endothelial cells exposed to serum in elderly women. Based on the median CRP level in our population, LowCRP (CRP<1.3mg/L) and HighCRP (>1.3mg/L) groups were identified. Body mass index, waist circumference, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were significantly higher in the HighCRP group than in the LowCRP group (p<0.05). The influence of CRP on SBP and DBP remained significant after adjustments for BMI and use of antihypertensive medication (p<0.05). When adjusting for waist circumference the observed influence of CRP on SPB was attenuated (p=0.062). We next evaluated the ability to form capillary tubes (angiogenesis assay) and the proliferation rate of endothelial cells exposed to the sera of elderly women. Increased serum CRP levels were associated with an increased doubling time of endothelial cells (R(2)=0.39; p<0.05) and decreased capillary tube length (R(2)=0.30; p<0.05), indicating a reduction in the proliferation rate of endothelial cells and angiogenic potential. In conclusion, chronic inflammation influences blood pressure in elderly women and compromises endothelial cell function, thus contributing to the age-related decline in vascular health.

  • 70. Hultin, Hella
    et al.
    Hellman, Per
    Lundgren, Ewa
    Olovsson, Matts
    Ekbom, Anders
    Rastad, Jonas
    Montgomery, Scott M.
    Örebro University, School of Health and Medical Sciences.
    Association of parathyroid adenoma and pregnancy with preeclampsia2009In: Journal of Clinical Endocrinology and Metabolism, ISSN 0021-972X, E-ISSN 1945-7197, Vol. 94, no 9, p. 3394-3399Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Case reports have described associations between calcium metabolism disturbances and primary hyperparathyroidism with preeclampsia, suggesting parathyroid involvement in preeclampsia etiology. This study examines whether parathyroid adenoma, the main cause of hyperparathyroidism, diagnosed and treated before pregnancy is associated with preeclampsia. DESIGN: We conducted a register-based study to assess the association between parathyroid adenoma and subsequent preeclampsia. SETTING: Births among Sweden's general population were studied. POPULATION: The study population included 52 women with a diagnosis of parathyroid adenoma and 519 without, all of whom had a subsequent singleton pregnancy between 1973 and 1997. METHODS: We performed a conditional logistic regression investigating the association of parathyroid adenoma with subsequent preeclampsia in the first singleton pregnancy with adjustment for potential confounding factors. MAIN OUTCOME MEASURE: The main outcome was a diagnosis of preeclampsia that does not include women with prior chronic hypertension. To ensure that treatment of parathyroid adenoma was completed before pregnancy, those with a diagnosis of parathyroid adenoma made less than 2 yr before delivery (and the matched comparison women) were excluded. RESULTS: Statistically, parathyroid adenoma prior to delivery is significantly (P < 0.001) associated with preeclampsia, producing an adjusted odds ratio of 6.89 (95% confidence interval, 2.30, 20.58). CONCLUSION: A history of parathyroid adenoma should be viewed as a risk for preeclampsia.

  • 71. Högberg, Thomas
    et al.
    Sorbe, Bengt
    Örebro University, School of Health and Medical Sciences.
    Åvall-Lundqvist, Elisabeth
    Gynekologisk onkologi2008In: Onkologi / [ed] Ulrik Ringborg, Tina Dalianis, Roger Henriksson, Stockholm: Liber , 2008, 2, p. 488-533Chapter in book (Other academic)
  • 72. Jansson, Caroline
    et al.
    Adolfsson, Annsofie
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Swansons omvårdnadsteori applicerad vid missed abortion i Sverige2010In: Familjefokuserad Omvårdnad, 2010Conference paper (Refereed)
  • 73.
    Jansson, Markus
    et al.
    Örebro University, School of Medical Sciences. Department of Obstetrics and Gynecology, Örebro University Hospital, Örebro, Sweden.
    Nilsson, Kerstin
    Örebro University, School of Medical Sciences.
    Franzén, Karin
    Örebro University, School of Medical Sciences. Department of Obstetrics and Gynecology, Örebro University Hospital, Örebro, Sweden.
    Development and validation of a protocol for documentation of obstetric perineal lacerations2019In: International Urogynecology Journal, ISSN 0937-3462, E-ISSN 1433-3023, Vol. 30, no 12, p. 2069-2076Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION AND HYPOTHESIS: The aim of this study was to develop a new protocol for documentation of perineal lacerations and to validate the latter against the most common obstetric record system in Sweden. The hypothesis was that the new protocol would render more complete data on perineal lacerations than the current documentation method.

    METHODS: A protocol for documentation of perineal lacerations was developed to be sufficiently comprehensive to serve research purposes. All women delivering their first child vaginally from 13 October 2015 to 1 February 2016 at Örebro University Hospital were eligible for the validation study. Perineal lacerations were documented using the protocol in parallel with the regular obstetric record system (ObstetriX). Cross tabulations were used to compare the coverage regarding perineal lacerations between the two documentation methods. McNemar's test was used to evaluate systematic differences between the methods.

    RESULTS: A total of 187 women were included. The coverage of documentation regarding perineal laceration was significantly higher (p < 0.001) in the new protocol (89%) compared with ObstetriX (18%). Incidence of second-degree perineal tears was 26% according to the new protocol and 11% according to ObstetriX. The incidence of third-degree perineal tears A, B, and C was 2.7%, 2.1%, and 2.1%, respectively, according to the new protocol, and 3.2%, 2.7%, and 1.1% according to ObstetriX.

    CONCLUSIONS: This validation study of a new documentation protocol showed that it delivered significantly more comprehensive information regarding perineal lacerations than the most common obstetric record system in Sweden.

  • 74.
    Jelenkovic, Aline
    et al.
    Department of Social Research, University of Helsinki, Helsinki, Finland; Department of Genetics, Physical Anthropology and Animal Physiology, University of the Basque Country UPV/EHU, Leioa, Spain.
    Tuvblad, Catherine
    Örebro University, School of Law, Psychology and Social Work. Department of Psychology, University of Southern California, Los Angeles CA, USA.
    Silventoinen, Karri
    Department of Social Research, University of Helsinki, Helsinki, Finland; University Graduate School of Medicine, Osaka University, Osaka, Japan.
    Zygosity differences in height and body mass index of twins from infancy to old age: a study of the CODATwins project2015In: Twin Research and Human Genetics, ISSN 1832-4274, E-ISSN 1839-2628, Vol. 18, no 5, p. 557-570Article in journal (Refereed)
    Abstract [en]

    A trend toward greater body size in dizygotic (DZ) than in monozygotic (MZ) twins has been suggested by some but not all studies, and this difference may also vary by age. We analyzed zygosity differences in mean values and variances of height and body mass index (BMI) among male and female twins from infancy to old age. Data were derived from an international database of 54 twin cohorts participating in the COllaborative project of Development of Anthropometrical measures in Twins (CODATwins), and included 842,951 height and BMI measurements from twins aged 1 to 102 years. The results showed that DZ twins were consistently taller than MZ twins, with differences of up to 2.0 cm in childhood and adolescence and up to 0.9 cm in adulthood. Similarly, a greater mean BMI of up to 0.3 kg/m(2) in childhood and adolescence and up to 0.2 kg/m(2) in adulthood was observed in DZ twins, although the pattern was less consistent. DZ twins presented up to 1.7% greater height and 1.9% greater BMI than MZ twins; these percentage differences were largest in middle and late childhood and decreased with age in both sexes. The variance of height was similar in MZ and DZ twins at most ages. In contrast, the variance of BMI was significantly higher in DZ than in MZ twins, particularly in childhood. In conclusion, DZ twins were generally taller and had greater BMI than MZ twins, but the differences decreased with age in both sexes.

  • 75.
    Johansson, Marianne
    et al.
    Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden,.
    Adolfsson, Annsofie
    Berg, Marie
    Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Francis, Jynfiaf
    Reproductive Medicine Unit, Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Hogström, Lars
    Department of Obstetrics and Gynecology, Central Hospital, Skövde, Sweden.
    Janson, Per Olof
    Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Sogn, Jan
    Department of Obstetrics and Gynecology, Central Hospital, Uddevalla, Sweden.
    Hellström, Anna-Lena
    Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Gender perspective on quality of life, comparisons between groups 4-5.5 years after unsuccessful or successful IVF treatment2010In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 89, no 5, p. 683-691Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To describe and compare quality of life in men and women who had in vitro fertilization (IVF) within the Swedish public health system 4-5.5 years previously, either unsuccessfully and were subsequently living without children, or successfully, having children aged 4-5.5 years. These groups were compared to a control group of men and women with children born at the same time as in the successful group.

    DESIGN: Cross-sectional study.

    SETTING: Reproductive Unit, Sahlgrenska University Hospital, Gothenburg, Sweden.

    SAMPLE: Twenty-six men and 37 women in the unsuccessful group, 135 men and 154 women in the successful group and 93 men and 118 women in the control group.

    METHODS: Questionnaire study. The respective gender differences were studied in the control and study groups.

    MAIN OUTCOME MEASURES: Psychological general well-being (PGWB), sense of coherence (SOC), experience of infertility, demographic-socio-economic, and health characteristics.

    RESULTS: Men in the unsuccessful IVF group scored lower in total PGWB and SOC indices than the successful group men. They reported more depression, lower PGWB and lower SOC than the control group men. Women in the unsuccessful IVF group reported more anxiety, depression, and lower SOC than the successful group women and more depression and lower SOC indices than control group women. Men and women in the unsuccessful IVF group did not differ in any of the parameters. Men in the successful IVF group had higher PGWB, less signs of depression and more self-confidence than women in that group.

    CONCLUSION: Quality of life in men seems more negatively affected by involuntary infertility than reported in earlier studies.

  • 76.
    Johansson, Marianne
    et al.
    Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Adolfsson, Annsofie
    Berg, Marie
    Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Francis, Jynfiaf
    Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Hogström, Lars
    Department of Obstetrics and Gynecology, Central Hospital, Skövde, Sweden.
    Janson, Per Olof
    Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Sogn, Jan
    Department of Obstetrics and Gynecology, Central Hospital, Uddevalla, Sweden.
    Hellström, Anna-Lena
    Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Quality of life for couples 4-5.5 years after unsuccessful IVF treatment2009In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 88, no 3, p. 291-300Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To describe quality of life in men and women who had terminated in vitro fertilization (IVF) within the public health system 4-5.5 years previously, and for whom treatment did not result in childbirth.

    DESIGN: Cross-sectional study.

    SETTING: Reproductive Unit, Sahlgrenska University Hospital, Gothenburg, Sweden.

    SAMPLE: Four hundred pairs were invited to participate, 71% accepted and 68% completed questionnaires.

    METHODS: Questionnaire study. Study subgroups were compared with a control group with children and with each other.

    MAIN OUTCOME MEASURE: Psychological General Well-Being (PGWB), Sense of Coherence (SOC), experience of infertility, demographic-socio-economic and health characteristics were measured.

    RESULTS: Surprisingly, 76.7% had or lived together with children; 39.6% had biological children, 34.8% had adopted and 3.7% were parents to both biological and adopted children. No differences were found between the study and the control groups, except in SOC which scored lower in the study group. The study group with children had a higher PGWB index than the 23.3% without children and the controls. SOC scored higher in the subgroup with than those without children. Infertility was still a central issue in the subgroup without children.

    CONCLUSION: Despite having undergone unsuccessful IVF within the public health system, more than 75% lived with children 4-5.5 years later. This subgroup had a better quality of life, compared to those without children. Additional IVF treatment may result in increased quality of life.

  • 77. Jonsson, Maria
    et al.
    Nordén-Lindeberg, Solveig
    Östlund, Ingrid
    Örebro University, Department of Clinical Medicine.
    Hanson, Ulf
    Örebro University, School of Health and Medical Sciences.
    Acidemia at birth, related to obstetric characteristics and to oxytocin use, during the last two hours of labor2008In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 87, no 7, p. 745-750Article in journal (Refereed)
    Abstract [en]

    Objective. Evaluate obstetric characteristics during the last two hours of labor in neonates born with acidemia. Design. Case-control study. Setting. Delivery units at two university hospitals in Sweden. Study population. Out of 28,486 deliveries during 1994-2004, 305 neonates had an umbilical artery pH value <7.05 at birth. Methods. Cases: neonates with an umbilical artery pH < 7.05. Controls were neonates with pH ≥ 7.05 and an Apgar score ≥7 at 5 minutes. Obstetric characteristics, cardiotocographic patterns and oxytocin treatment during the last two hours of labor were recorded. Results. In the univariate analysis, ≥6 contractions/10 minutes (odds ratio (OR) 4.94, 95% confidence interval (CI) 3.25-7.49), oxytocin use (OR 2.20, 95% CI 1.66-2.92), bearing down ≥45 minutes (OR 1.77, 95% CI 1.31-2.38) and occipito-posterior position (OR 2.18, 95% CI 1.19-3.98) were associated with acidemia at birth. In the multivariate analysis, only ≥6 contractions/10 minutes (OR 5.36, 95% CI 3.32-8.65) and oxytocin use (OR 1.89, 95% CI 1.21-2.97) were associated with acidemia at birth. Among cases with ≥6 contractions/10 minutes, 75% had been treated with oxytocin. Pathological cardiotocographic patterns occurred in 68.8% of cases and in 26.1% of controls (p<0.001). Conclusion. A hyperactive uterine contraction pattern and oxytocin use are the most important risk factors for acidemia at birth. The increased uterine activity was related to overstimulation in the majority of cases. The duration of bearing down is less important when uterine contraction frequency has been considered.

  • 78.
    Jonsson, Maria
    et al.
    Dept Womens & Childrens Hlth, Uppsala Univ, Uppsala, Sweden.
    Ågren, Johan
    Dept Womens & Childrens Hlth, Uppsala Univ, Uppsala, Sweden.
    Norden-Lindeberg, Solveig
    Dept Womens & Childrens Hlth, Uppsala Univ, Uppsala, Sweden.
    Ohlin, Andreas
    Örebro University Hospital. Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Hanson, Ulf
    Dept Womens & Childrens Hlth, Uppsala Univ, Uppsala, Sweden.
    Suboptimal care and metabolic acidemia is associated with neonatal encephalopathy but not with neonatal seizures alone: a population-based clinical audit2014In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 93, no 5, p. 477-482Article in journal (Refereed)
    Abstract [en]

    Objective: To determine the incidence of moderate to severe neonatal encephalopathy (NE) and neonatal seizures without encephalopathy, and the association with metabolic acidemia. Secondly, to investigate the occurrence of suboptimal intrapartum care and its impact on neonatal outcome.

    Design: Clinical audit.

    Setting: Two university hospitals in Sweden.

    Population: Neonates 34weeks with moderate or severe NE and neonatal seizures alone, i.e. without encephalopathy, from a population of 71189 births, where umbilical blood gases were routinely analyzed.

    Methods: Neonates were categorized depending on the presence of metabolic acidemia at birth by umbilical artery pH<7.00, base deficit 12mmol/L. Records were audited for suboptimal care and a decision was made on whether management was assessed to have impacted neonatal outcome.

    Main outcome measures: Encephalopathy and seizures alone.

    Results: We identified 80 neonates with NE and 30 with seizures alone, of which 48 (60%) and none, respectively, had metabolic acidemia. Suboptimal care could be assessed in 77 and occurred in 28 (36%) NE cases and in one neonate with seizures alone (p<0.001). In 47 NE cases with metabolic acidemia, suboptimal care occurred in 22 (47%) vs. 6/30 (20%) without metabolic acidemia (p=0.02). Suboptimal care had an impact on outcome in 18/77 (23%) NE cases but in no cases with seizures alone.

    Conclusion: Suboptimal care was commonly seen with NE, particularly in neonates with metabolic acidemia, and also affected neonatal outcome. No such associations were found in neonates with seizures alone.

  • 79.
    Jonsson, Maria
    et al.
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Ågren, Johan
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Nordén-Lindeberg, Solveig
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Ohlin, Andreas
    Örebro University Hospital. Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Hanson, Ulf
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Neonatal encephalopathy and the association to asphyxia in labor2014In: American Journal of Obstetrics and Gynecology, ISSN 0002-9378, E-ISSN 1097-6868, Vol. 211, no 6, p. 667.e1-667.e8, article id S0002-9378(14)00596-1Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: In cases with moderate and severe neonatal encephalopathy, we aimed to determine the proportion that was attributable to asphyxia during labor and to investigate the association between cardiotocographic (CTG) patterns and neonatal outcome.

    STUDY DESIGN: In a study population of 71,189 births from 2 Swedish university hospitals, 80 cases of neonatal encephalopathy were identified. Cases were categorized by admission CTG patterns (normal or abnormal) and by the presence of asphyxia (cord pH, <7.00; base deficit, ≥12 mmol/L). Cases with normal admission CTG patterns and asphyxia at birth were considered to experience asphyxia related to labor. CTG patterns were assessed for the 2 hours preceding delivery.

    RESULTS: Admission CTG patterns were normal in 51 cases (64%) and abnormal in 29 cases (36%). The rate of cases attributable to asphyxia (ie, hypoxic ischemic encephalopathy) was 48 of 80 cases (60%), most of which evolved during labor (43/80 cases; 54%). Both severe neonatal encephalopathy and neonatal death were more frequent with an abnormal, rather than with a normal, admission CTG pattern (13 [45%] vs 11 [22%]; P = .03), and 6 [21%] vs 3 [6%]; P = .04), respectively. Comparison of cases with an abnormal and a normal admission CTG pattern also revealed more frequently observed decreased variability (12 [60%] and 8 [22%], respectively) and more late decelerations (8 [40%] and 1 [3%], respectively).

    CONCLUSION: Moderate and severe encephalopathy is attributable to asphyxia in 60% of cases, most of which evolve during labor. An abnormal admission CTG pattern indicates a poorer neonatal outcome and more often is associated with pathologic CTG patterns preceding delivery.

  • 80.
    Kallak, Theodora K.
    et al.
    Dept Womens & Childrens Health, Uppsala University, Uppsala, Sweden.
    Baumgart, Juliane
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Dept Obstetrics & Gynecology, Örebro University Hospital, Örebro, Sweden.
    Nilsson, Kerstin
    Örebro University, School of Medicine, Örebro University, Sweden. Dept Obstetrics & Gynecology, Örebro University Hospital, Örebro, Sweden.
    Poromaa, Inger Sundstrom
    Dept Womens & Childrens Health, Uppsala University, Uppsala, Sweden.
    Evers, Anneli Stavreus
    Dept Womens & Childrens Health, Uppsala University, Uppsala, Sweden.
    Treatment with aromatase inhibitor acts indirectly through the estrogen receptor pathway causing decreased junction plakoglobin mRNA expression and vaginal atrophy2013In: Menopause: The Journal of the North American Menopause, ISSN 1072-3714, E-ISSN 1530-0374, Vol. 20, no 12, p. 1328-1328Article in journal (Other academic)
  • 81.
    Kallak, Theodora Kunovac
    et al.
    Dept Womens & Childrens Hlth, Uppsala Univ, Uppsala, Sweden.
    Baumgart, Juliane
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Dept Obstet & Gynecol, Örebro University Hospital, Örebro, Sweden.
    Göransson, Emma
    Dept Womens & Childrens Hlth, Uppsala Univ, Uppsala, Sweden..
    Nilsson, Kerstin
    Örebro University, School of Medicine, Örebro University, Sweden. Örebro University Hospital. Dept Obstet & Gynecol, Örebro University Hospital, Örebro, Sweden.
    Poromaa, Inger Sundström
    Dept Womens & Childrens Hlth, Uppsala Univ, Uppsala, Sweden..
    Stavreus-Evers, Anneli
    Dept Womens & Childrens Hlth, Uppsala Univ, Uppsala, Sweden..
    Aromatase inhibitors affect vaginal proliferation and steroid hormone receptors2014In: Menopause: The Journal of the North American Menopause, ISSN 1072-3714, E-ISSN 1530-0374, Vol. 21, no 4, p. 383-390Article in journal (Refereed)
    Abstract [en]

    Objective: Women with breast cancer who are treated with aromatase inhibitors often experience vaginal atrophy symptoms and sexual dysfunction. This work aims to study proliferation and the presence and distribution of steroid hormone receptors in vaginal biopsies in relation to vaginal atrophy and vaginal pH in women with breast cancer who are on adjuvant endocrine treatment and in healthy postmenopausal women.

    Methods: This is a cross-sectional study that compares postmenopausal aromatase inhibitor-treated women with breast cancer (n = 15) with tamoxifen-treated women with breast cancer (n = 16) and age-matched postmenopausal women without treatment (n = 19) or with vaginal estrogen therapy (n = 16). Immunohistochemistry was used to study proliferation and steroid hormone receptor staining intensity. Data was correlated with estrogen and androgen levels, vaginal atrophy scores, and vaginal pH.

    Results: Aromatase inhibitor-treated women had a lower grade of proliferation, weaker progesterone receptor staining, and stronger androgen receptor staining, which correlated with plasma estrone levels, vaginal atrophy scores, and vaginal pH.

    Conclusions: Women with aromatase inhibitor-treated breast cancer exhibit reduced proliferation and altered steroid hormone receptor staining intensity in the vagina, which are related to clinical signs of vaginal atrophy. Although these effects are most probably attributable to estrogen suppression, a possible local inhibition of aromatase cannot be ruled out.

  • 82.
    Kumakech, Edward
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Human immunodeficiency virus (HIV), human papillomavirus (HPV) and cervical cancer prevention in Uganda: prevalence, risk factors, benefits and challenges of post-exposure profylaxis, screening integration and vaccination2015Doctoral thesis, comprehensive summary (Other academic)
    List of papers
    1. Occupational exposure to HIV: a conflict situation for health workers.
    Open this publication in new window or tab >>Occupational exposure to HIV: a conflict situation for health workers.
    2011 (English)In: International Nursing Review, ISSN 0020-8132, E-ISSN 1466-7657, Vol. 58, no 4, p. 454-62Article in journal (Refereed) Published
    Abstract [en]

    AIM: To determine the frequency of occupational exposure to human immunodeficiency virus (HIV), the circumstances and predisposing factors, the high-risk groups, the extent to which exposures are reported and the post-exposure prophylaxis (PEP) utilized by health-care workers (HCWs) and students in a Ugandan hospital.

    BACKGROUND: Occupational exposure to HIV is a low but potential risk of HIV infection to health workers.

    METHOD: Self-administered questionnaire was given to 224 participants (including 98 HCWs and 126 students) in Mbarara Hospital, Uganda. Data were analysed with descriptive statistics using the Statistical Package for the Social Sciences version 15.0 (SPSS Inc, Chicago, IL, USA).

    FINDINGS: Of the 224 participants surveyed, 19.2% reported having sustained injection needle stick injuries in the previous year, of which 4.46% occurred with HIV-infected blood. Other reported injuries were cannula needle stick injury (0.89%), suture needle stick injuries (3.13%), scalpel cut injuries (0.45%) and muco-cutaneous contamination (10.27%). The most affected groups were nurses-midwives for scalpel injuries and students for stick injuries. The predisposing factors reported included lack of protective devices and recapping of needles. Exposures were under-reported. Uptake of PEP was also low.

    CONCLUSION: Occupational exposure to HIV presents a conflict situation for HCWs. It remains a frequent occurrence particularly among student nurses-midwives, despite being avoidable. Its prophylactic treatment is hampered by poor reporting and investigation of exposures, and poor access to PEP. Strict adherence to universal precaution and proper handling of occupational exposure to HIV should be encouraged.

    Keywords
    HIV, Cervical cancer, Screening, Integration, Uganda
    National Category
    Nursing
    Identifiers
    urn:nbn:se:oru:diva-44594 (URN)10.1111/j.1466-7657.2011.00887.x (DOI)000297507900011 ()22092324 (PubMedID)2-s2.0-81855182078 (Scopus ID)
    Note

    Funding Agency: Mbarara University of Science and Technology HIV/AIDS Institutional Policy 

    Available from: 2015-05-11 Created: 2015-05-11 Last updated: 2018-05-07Bibliographically approved
    2. Integration of HIV and cervical cancer screening perceptions of healthcare providers and policy makers in Uganda
    Open this publication in new window or tab >>Integration of HIV and cervical cancer screening perceptions of healthcare providers and policy makers in Uganda
    2014 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 14, article id 810Article in journal (Refereed) Published
    Abstract [en]

    Background: HIV-positive women have an increased risk of developing cervical cancer (CC) compared to the HIV-negative women. Despite this, HIV and CC screening programs in many developing countries have remained disintegrated. Therefore, the objective of the study was to explore perceptions of healthcare providers (HCP) and policy makers (PM) about integration of HIV and CC screening services in Uganda.

    Methods: This was a qualitative study conducted among 16 participants comprising of 12 healthcare providers and 4 policy makers in Uganda. Data were collected through individual interviews. Participants were purposively selected from different level of health facilities with clinics for HIV and CC screening services. Content analysis method was used to analyze the data.

    Results: Three themes emerged from the data, namely appreciating benefits of integration, worrying about the limited health system capacity and potential consequences of integration and feeling optimistic about integration under improved health system conditions. The benefits embraced the women - particularly the HIV-positive women- but also men, healthcare providers and the health system or the government. There were worries that HIV stigma and shortage of healthcare workers would affect the effective delivery of the integrated program.

    Conclusion: Integration of HIV and CC screening can offer manifold benefits to all stakeholders in the health system, more so to the women. However, its feasibility in developing countries such as Uganda will most likely be hampered by weak and inefficient health systems. Therefore, when considering HIV and CC screening integration, it is important not to only recognize the benefits but also take into account resources requirements for addressing the existing weaknesses and inefficiencies in the health systems such as limited infrastructure, insufficient drugs and supplies, inadequate and poorly motivated healthcare workers.

    Place, publisher, year, edition, pages
    BioMed Central, 2014
    Keywords
    HIV, Cervical cancer, Screening, Integration, Uganda
    National Category
    Occupational Health and Environmental Health
    Identifiers
    urn:nbn:se:oru:diva-37680 (URN)10.1186/1471-2458-14-810 (DOI)000341734500001 ()25099996 (PubMedID)2-s2.0-84907043465 (Scopus ID)
    Note

    Funding Agency:

    Sida/SAREC

    Available from: 2014-10-13 Created: 2014-10-13 Last updated: 2018-06-10Bibliographically approved
    3. Integration of HIV and cervical cancer screening perceptions and preferences of communities in Uganda
    Open this publication in new window or tab >>Integration of HIV and cervical cancer screening perceptions and preferences of communities in Uganda
    2015 (English)In: BMC Women's Health, ISSN 1472-6874, E-ISSN 1472-6874, Vol. 15, no 1, article id 23Article in journal (Refereed) Published
    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.

    Place, publisher, year, edition, pages
    London, United Kingdom: BioMed Central, 2015
    Keywords
    Cervical cancer, HIV, Integration, Perceptions, Screening, Uganda
    National Category
    Obstetrics, Gynecology and Reproductive Medicine
    Research subject
    Obstetrics and Gynaecology
    Identifiers
    urn:nbn:se:oru:diva-44236 (URN)10.1186/s12905-015-0183-4 (DOI)000350950300001 ()25783655 (PubMedID)2-s2.0-84925124216 (Scopus ID)
    Funder
    Sida - Swedish International Development Cooperation Agency
    Available from: 2015-04-14 Created: 2015-04-14 Last updated: 2018-06-29Bibliographically approved
    4. Prevalence, genotypes and risk factors for vaccine and non-vaccine types of Human Papillomavirus (HPV) infections among Bivalent HPV-16/18 vaccinated and non-vaccinated young women in Ibanda district Uganda: 5 year follow up study
    Open this publication in new window or tab >>Prevalence, genotypes and risk factors for vaccine and non-vaccine types of Human Papillomavirus (HPV) infections among Bivalent HPV-16/18 vaccinated and non-vaccinated young women in Ibanda district Uganda: 5 year follow up study
    Show others...
    (English)Manuscript (preprint) (Other academic)
    Keywords
    Bivalent HPV16/18 vaccine, Human papillomavirus, genotypes, young women, Uganda
    National Category
    Medical and Health Sciences Infectious Medicine
    Identifiers
    urn:nbn:se:oru:diva-44595 (URN)
    Available from: 2015-05-11 Created: 2015-05-11 Last updated: 2017-10-17Bibliographically approved
  • 83.
    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.

  • 84.
    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.

  • 85. Kuusela, Phila
    et al.
    Fadl, Helena
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Wesström, Jan
    Lindgren, Peter
    Hagberg, Henrik
    Jacobsson, Bo
    Wennerholm, Ulla-Britt
    Valentin, Lil
    Intra- and Interrater reliability of Transvaginal Sonographic Measurements of Cervixal length2018Conference paper (Refereed)
  • 86.
    Larsson, Amanda
    et al.
    Department of Obstetrics and Gynecology, University Hospital Örebro, Örebro, Sweden.
    Rönnberg, Ann-Kristin
    Örebro University, School of Medical Sciences. Department of Obstetrics and Gynecology, University Hospital Örebro, Örebro, Sweden.
    Expanding a woman's options to include home use of misoprostol for medical abortion up until 76 days: An observational study of efficacy and safety2019In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 98, no 6, p. 747-752Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Home use of misoprostol for medical abortion is increasingly being practiced. With gestational length up until 70 days, it is considered effective, safe and acceptable by women. Knowledge of safety and efficacy with higher gestational lengths is limited and studies are required in order to further expand women's options to include this method of abortion.

    MATERIAL AND METHODS: A retrospective cohort study was designed to compare home use of misoprostol for medical abortion at gestational length 64-76 days to its use at 57-63 days. Primary outcome was success rate. Success was defined as complete uterine evacuation without need of surgical intervention due to incomplete abortion and no failed abortion with ongoing pregnancy. Secondary outcomes were rates of unscheduled return visits, telephone consultations, admissions to hospital, infections and the need for blood transfusion.

    RESULTS: We included 397 women, 270 within 57-63 days and 127 within 64-76 days of gestation at abortion. Success rate was 95.6% at 57-63 days and 93.7% at 64-76 days. The difference was not statistically significant (p=0.431). The rate of unscheduled return visits was high overall but not significantly different in relation to gestational length at abortion (>63d; 20.5% vs. <64d; 16.3%, p=0.308).

    CONCLUSIONS: Our study indicates that home use of misoprostol for medical abortion at 64-76 days gestation may be as safe and effective as at 57-63 days. Further studies with larger sample size are needed to confirm our findings and to explore the acceptance of and experiences among women performing abortion at home at higher gestational length, before further implementation in clinical practice.

  • 87.
    Larsson, Per-Göran
    et al.
    Department of Obstetrics and Gynaecology, Skaraborgs Hospital, Skövde, Sweden; University of Linköping, Linköping, Sweden.
    Poutakidis, Georgios
    Department of Obstetrics and Gynaecology, Danderyd Hospital, Stockholm, Sweden.
    Adolfsson, Annsofie
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. University College of Southeast Norway, Tönsberg, Norway.
    Charonis, Georgios
    Mitera General and Maternity Hospital, Athens, Greece.
    Pasi, Bauer
    Department of Obstetrics and Gynaecology, Skaraborg Hospital, Skövde, Sweden.
    Ekström, Linnea
    Department of Obstetrics and Gynaecology, Skaraborgs Hospital, Skövde, Sweden.
    Treatment of bacterial vaginosis in early pregnancy and its effect on spontaneous preterm delivery and preterm rupture of membranes2016In: Clinical Microbiology: Open Access, E-ISSN 2327-5073, Vol. 5, no 5, article id 1000259Article in journal (Refereed)
  • 88.
    Lillsunde-Larsson, Gabriella
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Characterization of HPV-induced vaginal and vulvar carcinoma2014Doctoral thesis, comprehensive summary (Other academic)
    List of papers
    1. Human Papillomavirus (HPV) and HPV 16-Variant Distribution in Vulvar Squamous Cell Carcinoma in Sweden
    Open this publication in new window or tab >>Human Papillomavirus (HPV) and HPV 16-Variant Distribution in Vulvar Squamous Cell Carcinoma in Sweden
    Show others...
    2012 (English)In: International Journal of Gynecological Cancer, ISSN 1048-891X, E-ISSN 1525-1438, Vol. 22, no 8, p. 1413-1419Article in journal (Refereed) Published
    Abstract [en]

    Objective: To investigate the human papillomavirus (HPV) and HPV type 16-variant distribution in a series of vulvar squamous cell carcinomas (VSCC) and to evaluate the impact of HPV and HPV 16-variant on prognosis.

    Methods: A series of 133 patients who had a diagnosis of VSCC (1983-2008) was selected for the study. Detection of 11 high-risk HPV types (16, 18, 31, 33, 39, 45, 51, 52, 56, 58, and 59) and 2 low-risk HPV types (6 and 11) was performed with real-time polymerase chain reaction. Samples positive for HPV 16 were further analyzed for variant determination of 7 positions in the E6 gene with polymerase chain reaction and pyrosequencing.

    Results: Forty (30.8%) of 130 tumors were found to be HPV positive. Human papillomavirus type 16 was found in 31 cases, HPV 18 was found in 2 cases, HPV 33 was found in 5 cases, and HPV 56 and HPV 59 were found in one case each. All but one tumor harboring HPV 16 were of European linage, and the 3 most common variants were E-p (n = 13), E-G350 (n = 7), and E-G131 (n = 5). HPV positivity was associated with the basaloid tumor type and occurred in significantly younger patients. Overall and recurrence-free survival rates were better in HPV-positive cases, but after correction for age and tumor size, HPV status was no longer an independent and significant prognostic factor. The survival rates of the various HPV 16 variants were not significantly different, but there was a trend of worse outcome for the E-G131-variant group.

    Conclusions: Human papillomavirus positivity of 30.8% is similar to other reports on VSCC. To our knowledge, this first variant determination of HPV 16 in vulvar carcinoma in a Swedish cohort indicated that the variant E-G131 may have an increased oncogenic potential in patients with VSCC.

    Keywords
    Vulvar carcinoma, Human papillomavirus, HPV 16 variants
    National Category
    Obstetrics, Gynecology and Reproductive Medicine
    Identifiers
    urn:nbn:se:oru:diva-43018 (URN)10.1097/IGC.0b013e31826a0471 (DOI)000309543700023 ()23013732 (PubMedID)2-s2.0-84867268780 (Scopus ID)
    Available from: 2015-02-27 Created: 2015-02-27 Last updated: 2018-05-14Bibliographically approved
    2. Prognostic impact of human papilloma virus (HPV) genotyping and HPV-16 subtyping in vaginal carcinoma
    Open this publication in new window or tab >>Prognostic impact of human papilloma virus (HPV) genotyping and HPV-16 subtyping in vaginal carcinoma
    Show others...
    2013 (English)In: Gynecologic Oncology, ISSN 0090-8258, E-ISSN 1095-6859, Vol. 129, no 2, p. 406-411Article in journal (Refereed) Published
    Abstract [en]

    Objective

    The objectives of this study are to investigate the human papilloma virus (HPV) distribution in vaginal cancer and to evaluate HPV-genotype as well as HPV16-variant impact on prognosis.

    Methods

    Sixty-nine patients diagnosed with primary vaginal carcinoma (1975-2002) were included in the study. Detection of twelve high-risk HPV (hr HPV) and two low-risk HPV (lr HPV) was performed with realtime-PCR. Samples positive for HPV-16 were analyzed for variants in the E6-gene with PCR and pyrosequencing.

    Results

    53.6% (37/69) of the tumors were found to be HPV-positive, mostly for HPV-16 (N=26). Other HPV-types were HPV-18 (N=2), HPV-31 (N=2), HPV-33 (N=2), HPV-45 (N=1), HPV-52 (N=2), HPV-56 (N=1) and HPV-58 (N=1). Only European subtypes of HPV-16 were represented and the two most common HPV-16-variants were E-p (N=13) and E-G350 (N=11). Patients with HPV-positive tumors (N=37) had a significantly (log-rank test=3341; p = 0.0008) superior 5-year overall survival rate as well as cancer-specific survival rate and progression-free survival rate (p = 0.0002; p = 0.0004), compared with patients with HPV-negative tumors (N=32). Interestingly, patients with HPV-16-positive tumors had a superior overall survival compared with patients with tumors containing other HPV-genotypes. In a Cox proportional multivariate analysis age, tumor size, and HPV-status were independent and significant prognostic factors with regard to overall survival rate.

    Conclusions

    HPV-status is of prognostic importance in vaginal carcinoma and varies with viral genotype. In this era of HPV-vaccination, genotypes other than those included in the vaccination program could still lead to vaginal carcinoma with unfavorable prognosis.

    Keywords
    Vaginal carcinoma, Human papilloma virus, HPV-16-variants, Prognosis
    National Category
    Obstetrics, Gynecology and Reproductive Medicine
    Research subject
    Biomedicine
    Identifiers
    urn:nbn:se:oru:diva-29270 (URN)10.1016/j.ygyno.2013.02.004 (DOI)000318058600024 ()23402906 (PubMedID)2-s2.0-84876292443 (Scopus ID)
    Available from: 2013-05-31 Created: 2013-05-31 Last updated: 2018-05-18Bibliographically approved
    3. Viral Load, Integration and Methylation of E2BS3 and 4 in Human Papilloma Virus (HPV) 16-Positive Vaginal and Vulvar Carcinomas
    Open this publication in new window or tab >>Viral Load, Integration and Methylation of E2BS3 and 4 in Human Papilloma Virus (HPV) 16-Positive Vaginal and Vulvar Carcinomas
    2014 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 9, no 11, article id e112839Article in journal (Refereed) Published
    Abstract [en]

    Objective: To investigate if viral load, integration and methylation of E2BS3 and 4 represent different ways of tumor transformation in vaginal and vulvar carcinoma and to elucidate its clinical impact.

    Methods: Fifty-seven samples, positive for HPV16, were selected for the study. Detection of viral load was made with realtime-PCR using copy numbers of E6 and integration was calculated from comparing E2 to E6-copies. Methylation of E2BS3 and 4 was analysed using bisulphite treatment of tumor DNA, followed by PCR and pyrosequencing.

    Results: Vaginal tumors were found to have a higher viral load (p=0.024) compared to vulvar tumors but a high copy number (> median value, 15 000) as well as high methylation (> 50%) was significantly (p=0.010 and p=0.045) associated with a worse cancer-specific survival rate in vulvar carcinoma, but not in vaginal carcinoma. Four groups could be defined for the complete series using a Cluster Two step analysis; (1) tumors holding episomal viral DNA, viral load below 150 000 copies not highly methylated (n=25, 46.3%); (2) tumors harboring episomal viral DNA and being highly methylated (>50%; n=6, 11.1%); (3) tumors with viral DNA fully integrated (n=11, 20.4%), and (4) tumors harboring episomal viral DNA and being medium-or unmethylated (< 50%) and having a high viral load (> total mean value 150 000; n=12, 22.2%). The completely integrated tumors were found to be distinct group, whilst some overlap between the groups with high methylation and high viral load was observed.

    Conclusion: HPV16-related integration, methylation in E2BS3 and 4 and viral load may represent different viral characteristics driving vaginal and vulvar carcinogenesis. HPV16-related parameters were found to be of clinical importance in the vulvar series only.

    Place, publisher, year, edition, pages
    Public Library Science, 2014
    National Category
    Cancer and Oncology
    Identifiers
    urn:nbn:se:oru:diva-42542 (URN)10.1371/journal.pone.0112839 (DOI)000347709300111 ()2-s2.0-84911948854 (Scopus ID)
    Note

    Funding Agency:

    Örebro County Council Research Committee OLL-324811 OLL-259341

    Available from: 2015-02-09 Created: 2015-02-09 Last updated: 2018-06-15Bibliographically approved
    4. HPV genotyping assays for archival clinical samples: an evaluation study
    Open this publication in new window or tab >>HPV genotyping assays for archival clinical samples: an evaluation study
    (English)Manuscript (preprint) (Other academic)
    National Category
    Obstetrics, Gynecology and Reproductive Medicine
    Identifiers
    urn:nbn:se:oru:diva-43020 (URN)
    Available from: 2015-02-27 Created: 2015-02-27 Last updated: 2017-10-17Bibliographically approved
  • 89.
    Lillsunde-Larsson, Gabriella
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Carlsson, Jessica
    Karlsson, Mats G.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital.
    Helenius, Gisela
    Örebro University, School of Medicine, Örebro University, Sweden. Örebro University Hospital.
    HPV genotyping assays for archival clinical samples: an evaluation studyManuscript (preprint) (Other academic)
  • 90.
    Lillsunde-Larsson, Gabriella
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital, Örebro, Sweden.
    Helenius, Gisela
    Örebro University, School of Medicine, Örebro University, Sweden. Örebro University Hospital, Örebro, Sweden.
    Andersson, Sören
    Örebro University Hospital, Örebro, Sweden.
    Elgh, Fredrik
    Umeå University Hospital, Umeå, Sweden.
    Sorbe, Bengt
    Örebro University, School of Health and Medical Sciences. Örebro University Hospital, Örebro, Sweden.
    Karlsson, Mats G.
    Örebro University Hospital, Örebro, Sweden.
    Human Papillomavirus (HPV) and HPV 16-Variant Distribution in Vulvar Squamous Cell Carcinoma in Sweden2012In: International Journal of Gynecological Cancer, ISSN 1048-891X, E-ISSN 1525-1438, Vol. 22, no 8, p. 1413-1419Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate the human papillomavirus (HPV) and HPV type 16-variant distribution in a series of vulvar squamous cell carcinomas (VSCC) and to evaluate the impact of HPV and HPV 16-variant on prognosis.

    Methods: A series of 133 patients who had a diagnosis of VSCC (1983-2008) was selected for the study. Detection of 11 high-risk HPV types (16, 18, 31, 33, 39, 45, 51, 52, 56, 58, and 59) and 2 low-risk HPV types (6 and 11) was performed with real-time polymerase chain reaction. Samples positive for HPV 16 were further analyzed for variant determination of 7 positions in the E6 gene with polymerase chain reaction and pyrosequencing.

    Results: Forty (30.8%) of 130 tumors were found to be HPV positive. Human papillomavirus type 16 was found in 31 cases, HPV 18 was found in 2 cases, HPV 33 was found in 5 cases, and HPV 56 and HPV 59 were found in one case each. All but one tumor harboring HPV 16 were of European linage, and the 3 most common variants were E-p (n = 13), E-G350 (n = 7), and E-G131 (n = 5). HPV positivity was associated with the basaloid tumor type and occurred in significantly younger patients. Overall and recurrence-free survival rates were better in HPV-positive cases, but after correction for age and tumor size, HPV status was no longer an independent and significant prognostic factor. The survival rates of the various HPV 16 variants were not significantly different, but there was a trend of worse outcome for the E-G131-variant group.

    Conclusions: Human papillomavirus positivity of 30.8% is similar to other reports on VSCC. To our knowledge, this first variant determination of HPV 16 in vulvar carcinoma in a Swedish cohort indicated that the variant E-G131 may have an increased oncogenic potential in patients with VSCC.

  • 91.
    Lillsunde-Larsson, Gabriella
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital.
    Helenius, Gisela
    Örebro University, School of Medicine, Örebro University, Sweden. Örebro University Hospital, Region Örebro County, Örebro, Sweden.
    Andersson, Sören
    Örebro University Hospital, Region Örebro County, Örebro, Sweden.
    Sorbe, Bengt
    Örebro University Hospital, Region Örebro County, Örebro, Sweden.
    Karlsson, Mats G.
    Örebro University Hospital. Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital, Region Örebro County, Örebro, Sweden.
    Prognostic impact of human papilloma virus (HPV) genotyping and HPV-16 subtyping in vaginal carcinoma2013In: Gynecologic Oncology, ISSN 0090-8258, E-ISSN 1095-6859, Vol. 129, no 2, p. 406-411Article in journal (Refereed)
    Abstract [en]

    Objective

    The objectives of this study are to investigate the human papilloma virus (HPV) distribution in vaginal cancer and to evaluate HPV-genotype as well as HPV16-variant impact on prognosis.

    Methods

    Sixty-nine patients diagnosed with primary vaginal carcinoma (1975-2002) were included in the study. Detection of twelve high-risk HPV (hr HPV) and two low-risk HPV (lr HPV) was performed with realtime-PCR. Samples positive for HPV-16 were analyzed for variants in the E6-gene with PCR and pyrosequencing.

    Results

    53.6% (37/69) of the tumors were found to be HPV-positive, mostly for HPV-16 (N=26). Other HPV-types were HPV-18 (N=2), HPV-31 (N=2), HPV-33 (N=2), HPV-45 (N=1), HPV-52 (N=2), HPV-56 (N=1) and HPV-58 (N=1). Only European subtypes of HPV-16 were represented and the two most common HPV-16-variants were E-p (N=13) and E-G350 (N=11). Patients with HPV-positive tumors (N=37) had a significantly (log-rank test=3341; p = 0.0008) superior 5-year overall survival rate as well as cancer-specific survival rate and progression-free survival rate (p = 0.0002; p = 0.0004), compared with patients with HPV-negative tumors (N=32). Interestingly, patients with HPV-16-positive tumors had a superior overall survival compared with patients with tumors containing other HPV-genotypes. In a Cox proportional multivariate analysis age, tumor size, and HPV-status were independent and significant prognostic factors with regard to overall survival rate.

    Conclusions

    HPV-status is of prognostic importance in vaginal carcinoma and varies with viral genotype. In this era of HPV-vaccination, genotypes other than those included in the vaccination program could still lead to vaginal carcinoma with unfavorable prognosis.

  • 92.
    Linden, Karoline
    et al.
    Institute of Health and Care Sciences, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; University of Gothenburg Centre for Person-Centred care, Gothenburg, Sweden.
    Adolfsson, Annsofie
    Örebro University, School of Health Sciences. The Centre for Women’s, Family and Child Health, Faculty of Health Sciences, Buskerud & Vestfold University College, Kongsberg, Norway.
    Sparud Lundin, Carina
    Institute of Health and Care Sciences, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; University of Gothenburg Centre for Person-Centred care, Gothenburg, Sweden.
    Berg, Marie
    Institute of Health and Care Sciences, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; University of Gothenburg Centre for Person-Centred care, Gothenburg, Sweden.
    A midwifery challenge diabetes: supporting well-being in early pregnant women with type 1 diabetes2017In: ICM 31th Congress, 2017Conference paper (Refereed)
    Abstract [en]

    Background: Pregnant women with type 1 diabetes face many obstacles in their struggle to achieve normal blood glucose levels and thus optimise the chanceto give birth to a healthy child. It is a challenge for midwives to support women’s well-being during pregnancy and especially in relation to chronicillness such as diabetes. However, little is known about well-being and diabetes management in early pregnant women with type 1 diabetes.

    Purpose/Objective: To explore well-being and diabetes management in women with Type 1 diabetes in early pregnancy and to investigate associations betweenperceived well-being, diabetes management and maternal characteristics.

    Method: Data was collected in early pregnancy from 168 Swedish pregnant women with Type 1 diabetes, including information from their medical recordsand self- reported questionnaires measuring aspects of health/well-being, diabetes management and socio demographics.

    Key Findings: Relatively high scores of diabetes self-management (SWE-DES-10: 3.91 (0.51)) and self-perceived health (excellent (6.5%), very good (42.3%),good (38.7%), fair (11.3%) and poor (1.2%)) were reported. Moderate scores for general well-being (WBQ-12: 22.6 (5.7)) and sense ofcoherence (SOC-13: 68.9 (9.7), moderate/low scores for hypoglycemia fear (SWE-PAID-20: 27.1 (15.9)) and low scores of diabetes-distress(SWE-PAID-20 27.1 (15.9)) were given. Higher capability of diabetes self-management showed positive correlations with self-perceived health (r s=-0.41, p<.0001) and well-being (rs =0.34, p<.0001) as well as negative correlations with diabetes distress (r s =-0.51, p<.0001) and hypoglycemiaworries (rs =-0.27, p=0.0009).

    Discussion: Midwives are in a unique position to uphold well-being in women with type 1 diabetes in early pregnancy. Based on this result it could be topromote women´s self-awareness, strengthen their own capabilities in terms of goal achievement, and to support them to handle diabetes relateddistress as well as possible fear of hypoglycemia.

  • 93.
    Linden, Karoline
    et al.
    Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Centre for Person-Centred Care, University of Gothenburg, Gothenburg, Sweden.
    Berg, Marie
    Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Centre for Person-Centred Care, University of Gothenburg, Gothenburg, Sweden.
    Adolfsson, Annsofie
    Örebro University, School of Health Sciences. Faculty of Health Sciences, Department of Nursing Science, University College of Southeast Norway, Kongsberg, Norway.
    Sparud Lundin, Carina
    Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Centre for Person-Centred Care, University of Gothenburg, Gothenburg, Sweden.
    Person-centred web-based support in pregnancy and early motherhood for women with Type 1 Diabetes Mellitus: a randomized controlled trial2018In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 5, no 2, p. 232-241Article in journal (Refereed)
    Abstract [en]

    Aims: To report results from and explore use of a multicentre, parallel-group, unblinded, randomized controlled trial testing the effectiveness in terms of well-being and diabetes management of a person-centred, web-based support programme for women with Type 1 diabetes, in pregnancy and postpartum.

    Methods: Between 2011 and 2014, 174 pregnant women with Type 1 diabetes were randomly allocated (1:1) to web-based support and standard care (intervention group, n=83), or standard care (control group, n=91). The web-based support consisted of evidence-based information; a self-care diary for monitoring of daily activities; and peer support in a discussion forum. The primary outcomes (mean difference, measured at 6 months after childbirth) were well-being and diabetes management.

    Results: No differences were found with regard to the primary outcome measure scores for general well-being [1.04 (95% CI -1.28 to 3.37); P= 0.68] and self-efficacy of diabetes management [0.076 (95% CI -0.123 to 0.275); P= 0.75], after adjustment for baseline differences in the insulin administration method, nor with regard to the secondary outcome measures.

    Conclusions: At 6 months after childbirth, the web-based support plus standard care was not superior to standard care in terms of general well-being or self-efficacy of diabetes management. This might be explained by the low number of participants who had a high activity level. Few simultaneously active participants in the web-based programme and stressors in motherhood and diabetes postpartum were the main barriers to its use. Further intervention studies that offer web-based support are needed, with lessons learned from the present study.

  • 94.
    Lindström, Annika K.
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Center For Clinical Research, Dalarna.
    Matilda, Larsson
    School Of Medicine, Faculty Of Medicine And Health, Örebro University, Örebro, Sweden.
    Screening history of elderly women diagnosed with cervical cancer2018In: International Journal of Gynecology & Obstetrics, ISSN 0020-7292, E-ISSN 1879-3479, Vol. 143, no S3, p. 927-927Article in journal (Refereed)
    Abstract [en]

    Objectives: Cervical cancer in elderly women is often discovered at advanced stages and the prognosis is poor. In Sweden, where the screening program ends at the age of 60 in most counties, approximately 30% of the women diagnosed with cervical cancer are older than 60. The aim of this study was to investigate the cytological screening history in women diagnosed with cervical cancer at the age of 61 years and older.

    Method: This is a retrospective study including women from the counties of Örebro, Dalarna, and Gävleborg, (Sweden,) diagnosed with cervical cancer at the age of 61 years and older between 2001 and 2016. Screening history was obtained from 1967.

    Results: Out of the 223 women, 142 (63.7%) had participated in the screening program at least once and 95 (42.6%) had participated in the screening five times or more. Of the 142 women with at least one screening sample, 76 (53.5%) had a benign screening history. Of all women 76 (34.1%) had benign screening history, 66 (29.6%) had had dysplasia and 19 (8.5%) high-grade dysplasia. It was more common with a benign screening history among women diagnosed with adenocarcinomas compared to squamous cell carcinomas (p=0.002).

    Conclusions: In elderly women diagnosed with cervical cancer, more than one third had not participated in the screening program, nearly one third had a benign screening history and one-third of the women had dysplasia in their screening history. Continuing screening past the age of 60 can decrease the incidence of cervical cancer.

  • 95.
    Lindström, B. E.
    et al.
    Center for Clinical Research, Falun, Sweden; Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Hellberg, D.
    Center for Clinical Research, Falun, Sweden; Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Lindström, Annika K.
    Center for Clinical Research, Falun, Sweden; Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Urethral instillations of clobetasol propionate and lidocaine: a promising treatment of urethral pain syndrome2016In: Clinical and Experimental Obstetrics & Gynecology, ISSN 0390-6663, Vol. 43, no 6, p. 803-807Article in journal (Refereed)
    Abstract [en]

    Purpose: To evaluate topical treatment with clobetasol propionate and lidocaine in women with urethral pain syndrome (UPS) in a retrospective pilot study.

    Materials and Methods: Urethral instillations of two ml clobetasol propionate cream and two ml lidocaine gel in 30 Caucasian women age 15-74 years with UPS between 1999 and 2006 were evaluated retrospectively. Instillations were given approximately once a week until the patient improved. Between one and 15 (median three) instillations were given. In substudy I a review was undertaken of the medical records to register the treatment effect at the end of the treatment (the last instillation) and any relapses six months thereafter. Substudy II was a follow-up at least five years after last instillation based on medical records and a written questionnaire.

    Results: Substudy I (n=30): By the end of the treatment 18 women had no symptoms and 12 were improved. Five patients had relapsed within six months. Substudy II (n=28): Twenty-eight women responded to the questionnaire. Four women remained with no symptoms, 18 remained improved, and six had the same symptoms as before treatment. Twenty women thought the treatment was very effective, five rather effective, and three women reported poor effect. Twenty-six women would ask for retreatment if a relapse occurred, two patients would not. No side effects, except transient pain, were reported.

    Conclusions: This retrospective study and long-term follow-up suggests that urethral instillation of clobetasol propionate and lidocaine is effective in treating women with UPS. Randomized control studies are warranted.

  • 96.
    Lindén, Karolina
    et al.
    Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.
    Adolfsson, Annsofie
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Berg, Marie
    Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.
    A woman-centered web-support program during pregnancy and early motherhood for women with type 1 diabetes2014Conference paper (Refereed)
    Abstract [en]

    Background: Midwives have the responsibility to strengthen normal birth and promote breastfeeding; this challenge also includes women with chronic illness, such as diabetes type 1. Due to a constant struggle to achieve normoglycemia normal pregnancy related processes may be neglected in pregnant women with type 1 diabetes. The medical risks during pregnancy and labor might increase stress, anxiety and feelings of hopelessness.

    Aim: To describe the design of a woman-centered web-support for pregnant women and new mothers with type 1 diabetes in order to strengthen wellbeing.

    Method: A web-support has been developed using participatory design. A research project management group had the responsibility of steering the project forward. Different stakeholders including, midwifery, medical, nursing and target group expertise participated in the development. The web-support is implemented through a randomized controlled trial.

    Result: The developed web-support consists of three parts: 1) Specific information about pregnancy, childbirth, and early motherhood in relation to type 1 diabetes, where the challenge is to balance the core values of normal childbearing with diabetes related issues. 2) A self-care diary, including a device for documenting and evaluating blood glucose levels, insulin doses, food intake and physical activities. This enables the woman to keep in control of her own health. 3) A forum for peer support through communication between women and mothers in pregnancy and early motherhood. This enables sharing of similar experiences and of strategies to handle daily life. Clinical relevance By addressing diabetes related health risks and problems in a manner that still emphasizes the normality of being pregnant, giving birth and breastfeeding, a balance between focusing on potential risks and the joy of childbearing, birth and motherhood could be achieved.

  • 97.
    Lindén, Karolina
    et al.
    Göteborgs universitet, Göteborg, Sweden.
    Adolfsson, Annsofie
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Berg, Marie
    Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Sparud Lundin, Carina
    Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Att stödja hälsosamt mödraskap för kvinnor med typ II diabetes2013In: Barnmorskekonferensen 2013, 2013Conference paper (Refereed)
  • 98.
    Lindén, Karolina
    et al.
    Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.
    Adolfsson, Annsofie
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Ranerup, Agneta
    Department of Applied IT, University of Gothenburg, Gothenburg, Sweden.
    Berg, Marie
    Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden .
    Sparud Lundin, Carina
    Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.
    Ongoing research: a social and learning community to support self-management in childbearing women with type 1 diabetes2013In: Medicine 2.0.: 6th World Congress on Social Media, Mobile Apps, Internet/Web 2.0. London, 23-24 September 2013, London, United Kingdom, 2013, p. 226-227Conference paper (Refereed)
    Abstract [en]

    Background: Women with type 1 diabetes have a demanding life situation during the period of pregnancy and early motherhood. There is a need to develop person-centered models of care for women with type 1 diabetes in relation to pregnancy and early motherhood. People, who share a concern for something, learn together as they regularly interact. For example, people learn from each other as they discuss experiences, treatment and self-management issues in daily life. To empower women during with type 1 diabetes during pregnancy and in early motherhood, a website promoting self-management through a social and learning community has been developed.

    Objectives: To describe the design and content of a specially designed person-centered web support for women with type 1 diabetes during the period of pregnancy through early motherhood. This web-based support aims at improving the women’s self-management of diabetes and overall well-being.

    Methods: The web-based support has been developed through a participatory design involving different stakeholders such as health care professionals, mothers with type 1 diabetes, web designers and researchers. The project is under evaluation in a randomized controlled trial. Women with type 1 diabetes are randomized in early pregnancy to either usual care or web-based support in addition to usual care. All study participants are followed from baseline in early pregnancy to six months after childbirth.

    Results: The developed person-centered web-basedsupport consists of three complementary parts: 1) specific information about pregnancy, childbirth and early motherhood in relation to type 1 diabetes; 2) a self-care diary including a device for documenting and evaluating blood glucose levels, insulin doses, food intake, physical activities and overall well-being; and 3) a forum for communication between women with type 1 diabetes in the childbearing period. The support is developed for computer and mobile use.

    Conclusions: This website for self-care, self-learning and peer support is a person-centered and easy accessible service. Taking a person-centered approach means that the pregnant women with diabetes must be treated and supported in ways that allow them to be people rather than objectified as individuals with a chronic illness. The website can complement usual health care organizational arrangements and provides possibilities for documenting health and related issues. This social and learning community may strengthen self-care ability by empowering women with type 1 diabetes during a vulnerable period.

  • 99.
    Lindén, Karolina
    et al.
    Göteborgs universitet, Göteborg, Sweden.
    Sparud-Lundin, Carina
    Göteborgs Universitet, Göteborg, Sweden.
    Adolfsson, Annsofie
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Berg, Marie
    Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Att stödja hälsosamt moderskap: Webbstöd till gravida kvinnor och nyblivna mödrar med typ 1 diabetes2013Conference paper (Other academic)
  • 100.
    Liu, Jianghong
    et al.
    School of Nursing, University of Pennsylvania, Philadelphia PA, USA.
    Tuvblad, Catherine
    Department of Psychology, University of Southern California, Los Angeles CA, USA.
    Li, Linda
    School of Nursing, University of Pennsylvania, Philadelphia PA, USA.
    Raine, Adrian
    Departments of Criminology, Psychiatry, and Psychology, University of Pennsylvania, Philadelphia PA, USA.
    Baker, Laura A.
    Department of Psychology, University of Southern California, Los Angeles CA, USA.
    Medical record validation of maternal recall of pregnancy and birth events from a twin cohort2013In: Twin Research and Human Genetics, ISSN 1832-4274, E-ISSN 1839-2628, Vol. 16, no 4, p. 845-860Article in journal (Refereed)
    Abstract [en]

    This study aims to assess the validity of maternal recall for several perinatal variables 8-10 years after pregnancy in a twin sample. Retrospective information was collected 8-10 years after the delivery event in a cohort of mothers from the University of Southern California Twin Study (N = 611) and compared with medical records for validity analysis. Recall of most variables showed substantial to perfect agreement (κ = 0.60-1.00), with notable exceptions for specific medical problems during pregnancy (κ ≤ 0.40) and substance use when mothers provided continuous data (e.g., number of cigarettes per day; r ≤ 0.24). With the exception of delivery method, neonatal intensive care unit admission, birth weight, neonatal information, and post-delivery complications were also recalled with low accuracy. For mothers of twins, maternal recall is generally a valid measure for perinatal variables 10 years after pregnancy. However, caution should be taken regarding variables such as substance use, medical problems, birth length, and post-delivery complications.

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