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  • 1.
    Alexopoulou, Sofia
    et al.
    Örebro University, School of Humanities, Education and Social Sciences.
    Fart, Frida
    Örebro University, School of Medical Sciences.
    Jonsson, Ann-Sofie
    Örebro University, School of Hospitality, Culinary Arts & Meal Science.
    Karni, Liran
    Örebro University, Örebro University School of Business.
    Kenalemang, Lame Maatla
    Örebro University, School of Humanities, Education and Social Sciences.
    Krishna, Sai
    Örebro University, School of Science and Technology.
    Lindblad, Katarina
    Örebro University, School of Music, Theatre and Art.
    Loutfi, Amy
    Örebro University, School of Science and Technology.
    Lundin, Elin
    Örebro University, School of Health Sciences.
    Samzelius, Hanna
    Örebro University, School of Humanities, Education and Social Sciences.
    Schoultz, Magnus
    Örebro University, School of Humanities, Education and Social Sciences.
    Spang, Lisa
    Örebro University, School of Health Sciences.
    Söderman, Annika
    Örebro University, School of Health Sciences.
    Tarum, Janelle
    Örebro University, School of Health Sciences.
    Tsertsidis, Antonios
    Örebro University, Örebro University School of Business.
    Widell, Bettina
    Örebro University, School of Humanities, Education and Social Sciences.
    Nilsson, Kerstin (Editor)
    Örebro University, School of Medical Sciences.
    Successful ageing in an interdisciplinary context: popular science presentations2018Book (Other (popular science, discussion, etc.))
  • 2.
    Allbrand, Marianne
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Dept Obstet & Gynaecol, Örebro Univ Hosp, Örebro, Sweden.
    Björkqvist, Maria
    Örebro University, School of Medicine, Örebro University, Sweden. Örebro University Hospital. Dept Paediat, Örebro University Hospital, Örebro, Sweden.
    Nilsson, Kerstin
    Örebro University, School of Medicine, Örebro University, Sweden. Örebro University Hospital. Dept Obstet & Gynaecol, Örebro University Hospital, Örebro, Sweden.
    Östlund, Ingrid
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Dept Obstet & Gynaecol, Örebro University Hospital, Örebro, Sweden.
    Åman, Jan
    Örebro University Hospital. Örebro University. Dept Paediat, Örebro University Hospital, Örebro, Sweden.
    Placental gene expression of inflammatory markers and growth factors: a case control study of obese and normal weight women2015In: Journal of Perinatal Medicine, ISSN 0300-5577, E-ISSN 1619-3997, Vol. 43, no 2, p. 159-164Article in journal (Refereed)
    Abstract [en]

    Objective: To survey the placental gene expression of inflammatory markers and growth factors in non-smoking obese women with an uncomplicated pregnancy without associated morbidity and delivery at term compared with normal weight women.

    Methods: Placental tissue samples from 32 obese women (body mass index, BMI >= 35.0 kg/m(2)) were compared with samples from 94 normal weight women (BMI 18.5-25.0 kg/m(2)) matched for age (+/- 1 year), gestational age (+/- 3 days), parity and mode of delivery. Semi-quantitative reverse transcription polymerase chain reaction (RT-PCR) was used to analyse toll receptor-2 and -4, interleukin-6 and -8, tumour necrosis factor-alpha, leptin, adiponectin, insulin-like growth factor-1 and -2, hepatocyte growth factor, hepatocyte growth factor receptor and insulin receptor.

    Results: There was no significant difference in gene expression in placental tissue samples from obese and normal weight women.

    Conclusion: We found no difference in the occurrence of inflammatory marker and growth factor mRNA levels in placental tissue samples from a large group of obese women without associated morbidity and with healthy infants compared to a closely matched control group of healthy normal weight women. Compared with the previous studies, this anomalous finding may be explained by the absence of associated morbidity in the obese women in our study.

  • 3.
    Allbrand, Marianne
    et al.
    Örebro University, School of Medical Sciences. Department of Obstetrics and Gynecology.
    Åman, Jan
    Department of Pediatrics, School of Medical Sciences, Örebro University, Örebro, Sweden.
    Nilsson, Kerstin
    Örebro University, School of Medical Sciences. Department of Obstetrics and Gynecology.
    Cao, Yang
    Örebro University, School of Medical Sciences. Örebro University Hospital. Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Lodefalk, Maria
    Örebro University, School of Medical Sciences. Department of Pediatrics, School of Medical Sciences, Örebro University, Örebro, Sweden; University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Expression of genes involved in inflammation and growth: does sampling site in human full-term placenta matter?2019In: Journal of Perinatal Medicine, ISSN 0300-5577, E-ISSN 1619-3997, Vol. 47, no 5, p. 539-546Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate the placental gene expression of substances in the inflammatory cascade and growth factors at nine different well-defined sampling sites in full-term placentas from 12 normal weight healthy non-smoking women with an uncomplicated singleton pregnancy.

    Methods: All placentas (six girls and six boys) were delivered vaginally. Quantitative real-time polymerase chain reaction was used to analyze toll receptor-2 and -4, interleukin-6 and -8, tumor necrosis factor-α, leptin, ghrelin, insulin-like growth factor-1 and -2, hepatocyte growth factor, hepatocyte growth factor receptor and insulin receptor (IR).

    Results: The leptin gene and the IR gene showed higher expression in lateral regions near the chorionic plate compared to central regions near the basal plate (P = 0.028 and P = 0.041, respectively).

    Conclusion: Our results suggest that the sampling site may influence the gene expression for leptin and IR in placental tissue obtained from full-term normal pregnancies. We speculate that this may be due to differences in placental structure and perfusion and may be important when future studies are designed.

  • 4.
    Andersson, Gunnel
    et al.
    Örebro University, Department of Clinical Medicine. Department of Urology, Örebro University Hospital, Örebro, Sweden; Centre for Evidence Based Medicine and Assessment of Medical Technology, Örebro, Sweden.
    Johansson, Jan-Erik
    Örebro University, Department of Clinical Medicine. Department of Urology, Örebro University Hospital, Örebro, Sweden; Centre for Evidence Based Medicine and Assessment of Medical Technology, Örebro, Sweden.
    Sahlberg-Blom, Eva
    Örebro University, Department of Nursing and Caring Sciences.
    Pettersson, Nicklas
    Department of Public Health, O¨ rebro County Council, O¨ rebro, Sweden.
    Nilsson, Kerstin
    Örebro University, Department of Clinical Medicine. Centre for Evidence Based Medicine and Assessment of Medical Technology, O¨ rebro, Sweden; Department of Obstetrics and Gynaecology, Örebro University Hospital, Örebro, Sweden.
    Urinary incontinence - why refraining from treatment?: a population based study2005In: Scandinavian Journal of Urology and Nephrology, ISSN 0036-5599, E-ISSN 1651-2065, Vol. 39, no 4, p. 301-307Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate why persons with urinary incontinence (UI) refrain from seeking care and treatment.

    MATERIAL AND METHODS: A population-based study was undertaken in which a public health survey and a specific UI questionnaire were sent to 15 360 randomly selected residents (age 18-79 years) of Orebro County, Sweden. For all persons reporting UI, the expressed wish for treatment or no treatment was analyzed in relation to relevant variables from both inquiry forms using binary logistic regression analysis.

    RESULTS: The response rate was 64.5%. UI was reported by 2194 persons, 1724 of whom comprised the study population. A statistically significant association was found between the degree of UI and a desire for treatment. Persons who did not experience daily leakage and those who did not perceive the leakage as troublesome or having an affect on their daily life mostly stated that they did not desire treatment. Socioeconomic or other health-related factors were not associated with desiring or not desiring treatment for UI.

    CONCLUSIONS: Our results show that it is the perceived severity of UI that determines whether afflicted persons desire treatment or not. Other factors, relating to seeking healthcare in general, were not found to be of importance. Interventions to identify those in need of treatment for UI should primarily be directed towards those with severe symptoms.

  • 5.
    Baumgart, Juliane
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Obstetrics and Gynecology.
    Nilsson, Kerstin
    Örebro University, School of Medicine, Örebro University, Sweden. Örebro University Hospital. Department of Obstetrics and Gynecology, Örebro University Hospital, Örebro, Sweden.
    Evers, A. Stavreus
    Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden .
    Kallak, T. Kunovac
    Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
    Kushnir, M. M.
    ARUP Institute for Clinical and Experimental Pathology, Salt Lake City UT, USA; Department of Pathology, University of Utah School of Medicine, Salt Lake City, USA; Analytical Chemistry/Department of Chemistry, Biomedical Center and SciLife Laboratory, Uppsala University, Uppsala, Sweden.
    Bergquist, J.
    Department of Pathology, University of Utah School of Medicine, Salt Lake City UT, USA; Analytical Chemistry/Department of Chemistry, Biomedical Center and SciLife Laboratory, Uppsala University, Uppsala, Sweden.
    Poromaa, I. Sundström
    Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden .
    Androgen levels during adjuvant endocrine therapy in postmenopausal breast cancer patients2014In: Climacteric, ISSN 1369-7137, E-ISSN 1473-0804, Vol. 17, no 1, p. 48-54Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate plasma steroid hormone levels in postmenopausal breast cancer patients with and without adjuvant endocrine therapy and in healthy postmenopausal women.

    Methods: Steroid hormone levels in postmenopausal breast cancer patients treated with aromatase inhibitors (n = 32) were compared with breast cancer patients treated with tamoxifen (n = 34), breast cancer patients without adjuvant endocrine therapy (n = 15), and healthy postmenopausal women (n = 56). Pregnenolone, 17-hydroxypregnenolone, 17-hydroxyprogesterone, 11-deoxycortisol, cortisol, cortisone, dehydroepiandrosterone (DHEA), androstenedione, total testosterone, dihydrotestosterone, estrone and estradiol were measured using liquid chromatography-tandem mass spectrometry. Sex hormone binding globulin was measured by solid-phase chemiluminescent immunometric assays, and the free androgen index was calculated.

    Results: Aromatase inhibitor users did not differ in dihydrotestosterone, total testosterone, androstenedione, DHEA, or free androgen index levels from healthy controls or untreated breast cancer patients. The highest total testosterone levels were found in tamoxifen-treated women, who had significantly higher plasma concentrations than both women treated with aromatase inhibitors and breast cancer patients without adjuvant treatment. Concentrations of cortisol and cortisone were significantly greater in aromatase inhibitor users as well as tamoxifen users, in comparison with healthy controls and untreated breast cancer patients. Aromatase inhibitor users had lower estrone and estradiol plasma concentrations than all other groups.

    Conclusion: Adjuvant treatment with aromatase inhibitors or tamoxifen was associated with increased cortisol and cortisone plasma concentrations as well as decreased estradiol concentrations. Androgen levels were elevated in tamoxifen-treated women but not in aromatase inhibitor users.

  • 6.
    Baumgart, Juliane
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Obstetrics and Gynecology.
    Nilsson, Kerstin
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Obstetrics and Gynecology.
    Evers, Anneli Stavreus
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Kallak, Theodora Kunovac
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Poromaa, Inger Sundström
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Sexual dysfunction in women on adjuvant endocrine therapy after breast cancer2013In: Menopause: The Journal of the North American Menopause, ISSN 1072-3714, E-ISSN 1530-0374, Vol. 20, no 2, p. 162-168Article in journal (Refereed)
    Abstract [en]

    Objective: The goal of this study was to investigate sexual function in postmenopausal breast cancer patients treated with aromatase inhibitors.

    Methods: A population-based, cross-sectional study was conducted among postmenopausal breast cancer patients on adjuvant endocrine treatment and age-matched controls with and without estrogen treatment. Sexual function was assessed with a standardized questionnaire.

    Results: In all, 42.4% of aromatase inhibitor-treated breast cancer patients were dissatisfied with their sex life in general, and 50.0% reported low sexual interest; this was significantly more common than in tamoxifen-treated patients and controls (P < 0.05). Aromatase inhibitorYtreated patients reported insufficient lubrication in 73.9% and dyspareunia in 56.5% of cases, which were significantly more common than in controls, irrespective of hormonal use (P < 0.05). Tamoxifen-treated patients reported significantly more dyspareunia (31.3%; P < 0.05) but resembled controls in all other concerns.

    Conclusions: Our findings suggest that sexual dysfunction in aromatase inhibitorYtreated women is a greatly underestimated problem.

  • 7. Baumgart, Juliane
    et al.
    Nilsson, Kerstin
    Örebro University, School of Health and Medical Sciences.
    Stavreus-Evers, Anneli
    Kask, Kristiina
    Villman, Kenneth
    Lindman, Henrik
    Kallak, Theodora
    Sundström-Poromaa, Inger
    Urogenital disorders in women with adjuvant endocrine therapy after early breast cancer2011In: American Journal of Obstetrics and Gynecology, ISSN 0002-9378, E-ISSN 1097-6868, Vol. 204, no 1, p. 26.e1-Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate the prevalence of urogenital symptoms and vaginal atrophy in postmenopausal breast cancer patients on adjuvant endocrine therapy. STUDY DESIGN: A population-based, cross-sectional study on postmenopausal breast cancer patients on adjuvant endocrine treatment and age-matched control subjects. Vaginal atrophy was assessed by gynecologic examination and atrophy-related symptoms by validated questionnaires. RESULTS: In all, 57.6% of aromatase inhibitor-treated and 32.4% of tamoxifen-treated breast cancer patients rated at least 1 vaginal atrophy symptom as moderate/severe, which was significantly more common than in control subjects ( P < .01). Aromatase inhibitor-treated patients more often had moderate or severe vaginal atrophy ( P < .05), a more atrophic cytohormonal evaluation, and significantly higher vaginal pH ( P < .05) than all control subjects, irrespective of hormonal use. CONCLUSION: Our findings indicate that the frequency of vaginal atrophy symptoms, particularly in aromatase inhibitor-treated women, might have been underestimated in previous clinical trials.

  • 8. Crafoord, Kristina
    et al.
    Sydsjö, Adam
    Nilsson, Kerstin
    Örebro University, Department of Clinical Medicine.
    Kjølhede, Preben
    Primary surgery of genital prolapse: a shift in treatment tradition2006In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 85, no 9, p. 1104-1108Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The use of complete repairs in genital prolapse surgery has been questioned because of the possible adverse effects of the surgery on the urogenital and sexual function and selective repairs have been advocated. The aims of this study were to establish information about genital prolapse surgery and to analyze whether a shift from extensive prolapse surgery with complete repairs to selective repairs occurred during a 10-year period. METHODS: A retrospective study of 610 consecutive patients operated upon for genital prolapse during 1983 (Period I) and 1993 (Period II) in a sample of three Swedish hospitals was conducted. Data were obtained from the patient records. 542 women had primary surgery and were analyzed with emphasis on demographic, clinical, and surgical data. RESULTS: The demographic and clinical data of the patients showed no significant differences between the two periods. In Period I, 69% of the patients underwent complete repair compared with 37% in Period II (p<0.001). The proportion of prolapse operations without posterior colporrhaphy increased significantly from the first to the second period from 14 to 43% (p<0.001). CONCLUSION: The surgery for genital prolapse seems to have changed from complete repairs towards selective repairs and posterior colporrhaphy was more often avoided in the second period. The implication of this shift in surgical treatment on pelvic floor function is not known. Further studies are needed to disclose the effect of the surgery on pelvic floor function and dysfunction in the long term.

  • 9.
    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)
  • 10.
    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.

  • 11.
    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)
  • 12. Falk, Gabriella
    et al.
    Östlund, Ingrid
    Örebro University, Department of Clinical Medicine.
    Magnuson, Anders
    Schollin, Jens
    Örebro University, Department of Clinical Medicine.
    Nilsson, Kerstin
    Örebro University, Department of Clinical Medicine.
    Teenage mothers: a high-risk group for new unintended pregnancies2006In: Contraception, ISSN 0010-7824, E-ISSN 1879-0518, Vol. 74, no 6, p. 471-475Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: One of the targets of national health programs is to prevent unintended pregnancies, especially among teenagers. It is well established that these often lead to abortion. Preventive programs aimed at decreasing abortion rates should identify target groups at risk for unintended pregnancies.

    PURPOSE: This study was conducted to determine whether young mothers under 20 years of age constitute a group at risk for new unintended pregnancies.

    METHODS: A retrospective cohort study comprising teenagers giving birth to their first child from 1996 to 2000 was performed at Orebro University Hospital, Sweden. Data were collected from antenatal and medical records with particular regard to compliance with the postpartum visit and to whether a contraceptive method was prescribed. Information concerning repeat pregnancies during the 12 months after delivery was obtained.

    RESULTS: A total of 250 deliveries were recorded; 70% of the mothers attended the postpartum visit, and 71% received contraceptive prescriptions. At the 12-month follow-up, 56 (25%) had a new pregnancy, and of those, 20 (36%) had a legal abortion, making the abortion rate fivefold higher than expected in this age group.

  • 13.
    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.

  • 14.
    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.

  • 15.
    Franzén, Karin
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital.
    Johansson, Jan-Erik
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital.
    Karlsson, Jan
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital.
    Nilsson, Kerstin
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital.
    Validation of the Swedish version of the incontinence impact questionnaire and the urogenital distress inventory2013In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 92, no 5, p. 555-561Article in journal (Refereed)
    Abstract [en]

    Objective. To validate the Swedish versions of the Incontinence Impact Questionnaire (IIQ-7) and Urogenital Distress Inventory (UDI-6). Design and setting. Prospective study, university hospital. Population and method. We analyzed reliability, validity, and responsiveness in a clinical sample of 96 women with urinary incontinence. Main outcome measures. Construct and criterion validity, reliability via test-retest and internal consistency. Responsiveness via calculation of effect size. 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 six months was moderate in the Stress Urinary Incontinence group and small in the Urge Urinary Incontinence + Mixed Urinary Incontinence group. There was a moderate to strong correlation between UDI-6 and IIQ-7 and treatment satisfaction at six, 12, and 24 months for both groups. Conclusion. The UDI-6 scale did not produce the same solid result in the psychometric analysis as the IIQ-7 scale, but these newly translated Swedish forms of UDI-6 and IIQ-7 show good responsiveness and are easy to administer and to fill out.

  • 16.
    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.

  • 17.
    Holmdahl, C.
    et al.
    Örebro University Hospital, Örebro, Sweden; Department of Clinical Medicine, Örebro University, Örebro, Sweden.
    Schöllin, I.-L.
    Örebro University Hospital, Örebro, Sweden.
    Alton, M.
    Örebro University Hospital, Örebro, Sweden.
    Nilsson, Kerstin
    Örebro University, School of Health and Medical Sciences. Centre for Assessment of Medical Technologies in Örebro, Sweden.
    CPAP treatment in obstructive sleep apnoea: a randomised, controlled trial of follow-up with a focus on patient satisfaction2009In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 10, no 8, p. 869-874Article in journal (Refereed)
    Abstract [en]

    AIM OF THE STUDY: To assess a simplified model for follow-up in patients undergoing CPAP-treatment for obstructive sleep apnoea syndrome.

    PATIENTS AND METHODS: A total of 200 patients in stable condition were randomised to annual follow-up visits either by a specialist nurse (intervention) or physician-led visits including oximetry (control). Patients were followed for two years and assessed for the following outcomes: global satisfaction, quality of life, medical events, and resource utilisation.

    RESULTS: The overall experience of CPAP treatment was rated as excellent or good by 99% in each group. Global satisfaction was high in both groups, and there were no clinically significant differences between the groups. Quality of life did not differ between the groups. No serious medical events related to OSAS occurred during the study period. Extra physician consultations occurred rarely, and were managed within the limits of the follow-up visits.

    CONCLUSION: For stable patients undergoing CPAP treatment for obstructive sleep apnoea, regular follow-up visits by a specialist nurse can optimise the use of health care resources while retaining high patient satisfaction, without increasing medical risks.

  • 18.
    Hultgren Hörnquist, Elisabet
    et al.
    Örebro University, School of Health and Medical Sciences.
    Nilsson, Kerstin
    Örebro University, School of Health and Medical Sciences.
    Andersson, T.
    Örebro University, School of Health and Medical Sciences.
    Tidefelt, Ulf
    Örebro University, School of Health and Medical Sciences.
    Lidskog, Marie
    Örebro University, School of Health and Medical Sciences.
    Building a PBL-based integrated curriculum for a new medical school in Sweden2011Conference paper (Other academic)
  • 19.
    Jansson, Markus
    et al.
    Örebro University, School of Medical Sciences. Department of Obstetrics and Gynecology.
    Cao, Yang
    Örebro University, School of Medical Sciences. Örebro University Hospital. Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Nilsson, Kerstin
    Örebro University, School of Medical Sciences. Department of Obstetrics and Gynecology.
    Larsson, Per-Göran
    Department of Obstetrics and Gynecology, Skaraborgs Hospital, Skövde, Sweden.
    Hagberg, Lars
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Center.
    Cost-effectiveness of antibiotic prophylaxis in elective cesarean section2018In: Cost Effectiveness and Resource Allocation, ISSN 1478-7547, E-ISSN 1478-7547, Vol. 16, article id 66Article in journal (Refereed)
    Abstract [en]

    Background: The proportion of pregnant women delivered by cesarean section has increased steadily during the past three decades. The risk of infection is 10-fold augmented after elective cesarean section compared to vaginal delivery. Antibiotic prophylaxis may reduce endometritis by 62% and superficial wound infection by 38% after elective cesarean section. International guidelines recommend antibiotic prophylaxis in elective cesarean section, but this procedure is not routinely followed in Sweden. Studies of costs of antibiotic prophylaxis in cesarean section show conflicting results and are based on substantially different incidence of postoperative infections. No study of costs of antibiotic prophylaxis in elective cesarean section in a Swedish or Nordic context has been pursued. The aim of this study was to investigate if antibiotic prophylaxis is cost-reducing in elective cesarean section in orebro County, Sweden.

    Methods: All women undergoing elective cesarean in the Region orebro County health care system during 2011-2012 were eligible for inclusion. Postoperative infections and risk factors for infections were registered. A hypothetical situation in which all participants had received antibiotic prophylaxis was compared to the actual situation, in which none of them had received antibiotic prophylaxis. The reduction in the risk of postoperative infections resulting from antibiotic prophylaxis was based on a meta-analysis. Costs for in-patient care of postoperative infections were extracted from the accounting system, and costs for out-patient care were calculated according to standard costs. Costs for antibiotic prophylaxis were calculated and compared with the cost reduction that would be implied by the introduction of such prophylaxis.

    Results: The incidences of deep and superficial surgical site infection were 3.5% and 1.3% respectively. Introduction of antibiotic prophylaxis would reduce health care costs by 31 Euro per cesarean section performed (95% credible interval 4-58 Euro). The probability of cost-saving was 99%.

    Conclusions: Antibiotic prophylaxis in elective cesarean section is cost-reducing in this health care setting. Our results indicate that the introduction of antibiotic prophylaxis in elective cesarean section can also be cost-saving in low infection rate settings.

    Trial registration Ethical approval was given by the Regional Ethical Review Board in Uppsala (registration number 2013/484).

  • 20.
    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.

  • 21.
    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)
  • 22.
    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.

  • 23.
    Kallak, Theodora Kunovac
    et al.
    Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
    Baumgart, Juliane
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Obstetrics and Gynecology, Örebro University Hospital, Örebro, Sweden.
    Nilsson, Kerstin
    Örebro University, School of Medicine, Örebro University, Sweden. Department of Obstetrics and Gynecology, Örebro University Hospital, Örebro, Sweden.
    Åkerud, Helena
    Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
    Poromaa, Inger Sundström
    Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
    Stavreus-Evers, Anneli
    Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
    Vaginal Gene Expression During Treatment With Aromatase Inhibitors2015In: Clinical Breast Cancer, ISSN 1526-8209, E-ISSN 1938-0666, Vol. 15, no 6, p. 527-535.e2Article in journal (Refereed)
    Abstract [en]

    Vaginal gene expression in aromatase inhibitor-treated women was compared with postmenopausal control women treated with vaginal estrogen therapy. Vaginal tissue from aromatase inhibitor-treated women had low expression of genes involved in cell differentiation, proliferation, and cell adhesion, and associated with vaginal discomfort. The presence of vaginal aromatase suggests that this is the result of local and systemic aromatase inhibition.

    Background: Aromatase inhibitor (AI) treatment suppresses estrogen biosynthesis and causes genitourinary symptoms of menopause such as vaginal symptoms, ultimately affecting the quality of life for many postmenopausal women with breast cancer. Thus, the aim of this study was to examine vaginal gene expression in women during treatment with AIs compared with estrogen-treated women. The secondary aim was to study the presence and localization of vaginal aromatase.

    Patients and Methods: Vaginal biopsies were collected from postmenopausal women treated with AIs and from age-matched control women treated with vaginal estrogen therapy. Differential gene expression was studied with the Affymetrix Gene Chip Gene 1.0 ST Array (Affymetrix Inc, Santa Clara, CA) system, Ingenuity pathway analysis, quantitative real-time polymerase chain reaction, and immunohistochemistry.

    Results: The expression of 279 genes differed between the 2 groups; AI-treated women had low expression of genes involved in cell differentiation, proliferation, and cell adhesion. Some differentially expressed genes were found to interact indirectly with the estrogen receptor alpha. In addition, aromatase protein staining was evident in the basal and the intermediate vaginal epithelium layers, and also in stromal cells with a slightly stronger staining intensity found in AI-treated women.

    Conclusion: In this study, we demonstrated that genes involved in cell differentiation, proliferation, and cell adhesion are differentially expressed in AI-treated women. The expression of vaginal aromatase suggests that this could be the result of local and systemic inhibition of aromatase. Our results emphasize the role of estrogen for vaginal cell differentiation and proliferation and future drug candidates should be aimed at improving cell differentiation and proliferation.

  • 24.
    Kunovac Kallak, T.
    et al.
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Baumgart, Juliane
    Department of Obstetrics and Gynecology, Örebro University Hospital, Örebro, Sweden.
    Stavreus Evers, A.
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Sundström Poromaa, I.
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Moby, L.
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Kask, K.
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Norjavaara, E.
    Gothenburg Pediatric Growth Research Center, Department of Pediatrics, Institute of Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
    Kushnir, M. M.
    ARUP Institute for Clinical and Experimental Pathology, Salt Lake City UT, USA.
    Bergquist, J.
    Department of Physical and Analytical Chemistry, Analytical Chemistry, Uppsala University, Uppsala, Sweden.
    Nilsson, Kerstin
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Obstetrics and Gynecology, Örebro University Hospital, Örebro, Sweden.
    Higher than expected estradiol levels in aromatase inhibitor-treated, postmenopausal breast cancer patients2012In: Climacteric, ISSN 1369-7137, E-ISSN 1473-0804, Vol. 15, no 5, p. 473-480Article in journal (Refereed)
    Abstract [en]

    Objective: Vaginal estradiol is considered contraindicated in aromatase inhibitor (AI)-treated patients because of the risk of elevated estrogen levels. This leaves limited treatment options for patients experiencing gynecological symptoms. However, in clinical practice, no precise estimation has been performed of circulating estrogens and aromatase index in postmenopausal breast cancer patients on long-lasting AI or tamoxifen treatment.

    Methods: Steroid hormones were measured using liquid chromatography tandem mass spectrometry (LC-MS/MS) and extraction radioimmunoassay (RIA). Postmenopausal AI-treated patients (n =33) were compared with tamoxifen-treated patients (n =34) and controls without vaginal treatment (n =56), with vaginal estradiol (n =25), or with estriol (n =11) treatment.

    Results: By use of LC-MS/MS, median (range) estradiol plasma concentrations were 16.7 (2.4-162.6), 31.0 (13.4-77.1), 27.2 (7.8-115.8) and 33.3 (20.3-340.1) pmol/l in AI-treated breast cancer patients, tamoxifen-treated breast cancer patients, postmenopausal controls and postmenopausal controls on vaginal estradiol, respectively. The AI-treated group and subgroups had significantly lower estradiol and estrone concentrations than all other groups (p <0.05). There was extensive interindividual variation in estradiol concentration within the AI-treated group, measured using both LC-MS/MS (2.3-182.0 pmol/l) and extraction RIA (2.4-162.6 pmol/l). The AI-treated group had lower aromatase index compared to all other groups (p <0.05-0.001).

    Conclusion: Circulating estrogen levels may have been underestimated in previous longitudinal studies of AI-treated breast cancer patients. Additional studies are required to further evaluate the role of circulating estrogens in breast cancer patients suffering from gynecological symptoms.

  • 25. Liljegren, Göran
    et al.
    Chabok, A.
    Wickbom, M.
    Smedh, K.
    Nilsson, Kerstin
    Örebro University, School of Health and Medical Sciences.
    Acute colonic diverticulitis: a systematic review of diagnostic accuracy2007In: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 9, no 6, p. 480-488Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To appraise the literature on the diagnosis of acute colonic diverticulitis by ultrasound (US), computed tomography (CT), barium enema (BE) and magnetic resonance imaging (MRI). METHOD: The databases of Pub Med, the Cochrane Library and EMBASE were searched for articles on the diagnosis of diverticulitis published up to November 2005. Studies where US, CT, BE, or MRI were compared with a reference standard on consecutive or randomly selected patients were included. Three examiners independently read the articles according to a prespecified protocol. In case of disagreement consensus was sought. The level of evidence of each article was classified according to the criteria of the Centre for Evidence-Based Medicine (CEBM), Oxford, UK. RESULTS: Forty-nine articles relevant to the subject were found and read in full. Twenty-nine of these were excluded. Among the remaining 20 articles, only one study, evaluating both US and CT reached level of evidence 1b according to the CEBM criteria. Two US studies and one MRI study reached level 2b. The remaining studies were level 4. CONCLUSION: The best evidence for diagnosis of diverticulitis in the literature is on US. Only one small study of good quality was found for CT and for MRI-colonoscopy.

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

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

  • 27.
    Rönnberg, Ann-Kristin
    et al.
    Department of Obstetrics and Gynecology, Örebro University Hospital, Örebro, Sweden.
    Hanson, Ulf
    Örebro University, School of Health Sciences. Department of Obstetrics and Gynecology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Nilsson, Kerstin
    Örebro University, School of Medical Sciences.
    Effects of an antenatal lifestyle intervention on offspring obesity: a 5-year follow-up of a randomized controlled trial2017In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 96, no 9, p. 1093-1099Article in journal (Refereed)
    Abstract [en]

    Introduction: Strategies to limit excessive maternal gestational weight gain could also have positive health effects for the offspring. This study informs us on the effect of an antenatal lifestyle intervention on offspring body mass index (BMI) trajectory until age five.

    Material and methods: A secondary analysis of a randomized controlled trial aimed at reducing gestational weight gain, set in Orebro, Sweden (Clinical Trials.gov Id NCT00451425). Offspring were followed with standardized measures of weight and height until age five. Mean BMI z-score and proportion (%) of over- and undernutrition (BMI z-score > 2 standard deviations) was compared between groups. Risk estimates for obesity at age five were analyzed in relation to maternal gestational weight gain and prepregnancy BMI as a secondary outcome.

    Results: We analyzed 374 children at birth and 300 at age five. No significant difference in mean BMI z-score was seen at birth (0.68 (I) vs 0.56 (C), p = 0.242) or at age five (0.34 (I) vs 0.26 (C), p = 0.510) and no significant difference in proportion of over- or undernutrition was seen. Excessive maternal gestational weight gain was an independent risk factor for offspring obesity at birth (OR = 4.51, p < 0.001) but not at age five. Maternal obesity was an independent risk factor for offspring obesity at age five (OR = 4.81, p = 0.006).

    Conclusions: Our composite antenatal lifestyle intervention did not significantly reduce the risk of obesity in offspring up until age five.

  • 28.
    Rönnberg, Ann-Kristin
    et al.
    Örebro University, School of Medical Sciences.
    Hanson, Ulf
    Örebro University, School of Health Sciences.
    Nilsson, Kerstin
    Örebro University, School of Medical Sciences.
    Effects of antenatal lifestyle intervention on offspring obesity: a five year follow-up of a randomized controlled trialManuscript (preprint) (Other academic)
  • 29.
    Rönnberg, AnnKristin
    et al.
    Department of Obstetrics & Gynecology, Örebro University Hospital, Örebro, Sweden.
    Hanson, Ulf
    Örebro University, School of Health Sciences. Department of Obstetrics & Gynecology, Örebro University Hospital, Örebro, Sweden.
    Östlund, Ingrid
    Örebro University, School of Medical Sciences. Department of Obstetrics & Gynecology, Örebro University Hospital, Örebro, Sweden.
    Nilsson, Kerstin
    Örebro University, School of Medical Sciences. Department of Obstetrics & Gynecology, Örebro University Hospital, Örebro, Sweden.
    Effects on postpartum weight retention after antenatal lifestyle intervention: a secondary analysis of a randomized controlled trial2016In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 95, no 9, p. 999-1007Article in journal (Refereed)
    Abstract [en]

    Introduction: High weight retention after pregnancy is related to an increased risk of future obesity. The objective was to evaluate if an antenatal intervention, compared to standard care, could reduce postpartum weight retention (PPWR).

    Material and methods: Women with body mass index >19, age ≥18 years, knowledge of Swedish, and pregnancy ≤16 weeks' gestation were randomized. Standard care was compared to a composite intervention including a personalized weight graph, education on recommended weight gain, prescription of exercise, and monitoring of weight until one year after delivery. Mean (kg) PPWR was compared between the groups and risk estimates (odds ratio) for excessive weight retention were calculated.

    Results: Of 445 women randomized, 267 remained for analysis at ≤16 weeks postpartum and 168 at one year postpartum. The intervention group had a significantly lower mean PPWR at ≤16 weeks (1.81 kg (standard deviation, SD, 4.52) vs. 3.19 kg (SD 4.77), p=0.016). At one year postpartum, mean retention was still 0.7 kg lower in the intervention group (0.30 kg (SD 5.52) vs. 1.00 kg (SD 5.46)), the difference was not statistically significant (p=0.414). Gestational weight gain above Institute of Medicine recommendations was a significant risk factor for excessive weight retention (>5 kg) one year after delivery (OR 2.44; 95% CI; 1.08-5.52, p=0.029).

    Conclusions: A composite lifestyle intervention during pregnancy reduced short-term weight retention, but the effect of the intervention did not remain at one year postpartum. A gestational weight gain above Institute of Medicine recommendations increases the risk of excessive long-term weight retention.

  • 30.
    Rönnberg, Ann-Kristin
    et al.
    Örebro University, School of Health and Medical Sciences.
    Nilsson, Kerstin
    Örebro University, School of Health and Medical Sciences.
    Interventions during pregnancy to reduce excessive gestational weight gain: a systematic review assessing current clinical evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system2010In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 117, no 11, p. 1327-1334Article in journal (Refereed)
    Abstract [en]

    Background Excessive weight gain during pregnancy is common in developed countries and increases the risk of complications during pregnancy, delivery and the postpartum period, which can affect both maternal and fetal outcome. Interventions to reduce excessive gestational weight gain have previously not been systematically evaluated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. Objectives To determine whether published trials of interventions to reduce excessive gestational weight gain are of sufficient quality and provide sufficient data to enable evidence-based recommendations to be developed for clinical practice in antenatal care. Search strategy A literature search was conducted in the scientific databases PubMed, Cochrane Library, Cinhal and Pedro, and the reference lists of relevant articles were reviewed. The literature search was concluded on 15 August 2009. Selection criteria All randomised controlled trials (RCTs) were considered for inclusion. As the number of published RCTs was limited, we also considered for inclusion all nonrandomised intervention studies that included a control group. Systematic reviews were examined to identify additional original studies. Data collection and analysis Two reviewers independently assessed the quality of the methods and results of all included articles. Extracted data were classified using the GRADE system. Main results Four intervention studies with a randomised controlled design and four intervention trials with a nonrandomised controlled design met the inclusion criteria. As a consequence of important limitations in study design, inconsistency and lack of directness, the overall quality of evidence was judged to be very low using the GRADE system. Authors' conclusions The results of published intervention trials are of insufficient quality to enable evidence-based recommendations to be developed for clinical practice in antenatal care.

  • 31.
    Rönnberg, AnnKristin
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Obstetrics & Gynaecology, Örebro University Hospital, Örebro, Sweden.
    Östlund, Ingrid
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Obstetrics and Gynaecology, Örebro University Hospital, Örebro, Sweden .
    Fadl, Helena
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Obstetrics & Gynaecology, Örebro University Hospital, Örebro, Sweden.
    Gottvall, T.
    Department of Obstetrics and Gynaecology, Linköping University Hospital, Linköping, Sweden .
    Nilsson, Kerstin
    Örebro University, School of Medicine, Örebro University, Sweden. Department of Obstetrics & Gynaecology, Örebro University Hospital, Örebro, Sweden.
    Intervention during pregnancy to reduce excessive gestational weight gain: a randomised controlled trial2015In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 122, no 4, p. 537-544Article in journal (Refereed)
    Abstract [en]

    Objective: To evaluate if a feasible, low-cost intervention could decrease the percentage of women gaining weight above the Institute of Medicine (IOM) recommendations on gestational weight gain (GWG) compared with standard maternity care.

    Design: A randomised controlled interventional design.

    Setting: Antenatal clinics (n=14) in orebro county, Sweden, participated.

    Population: Healthy women with a body mass index (BMI) 19kg/m(2), age 18years and adequate knowledge of Swedish language who signed in for maternity care at 16weeks of gestation.

    Methods: Standard care was compared with a composite intervention consisting of education on recommended GWG according to IOM, application of personalised weight graph, formalised prescription of exercise and regular monitoring of GWG at every antenatal visit.

    Outcome: The proportion of women gaining weight above IOM guidelines (1990) and mean GWG (kg) was compared between groups.

    Results: In all, 445 women were randomised and 374 women remained for analysis after delivery. A majority of the women analysed were normal weight (72%). The intervention reduced the proportion of women who exceeded the IOM guidelines (41.1% versus 50.0%). The reduction was, however, not statistically significant (P=0.086). Mean GWG was significantly lower among women receiving the intervention, 14.2kg (SD 4.4) versus 15.3kg (SD 5.4) in the standard care group (P=0.029).

    Conclusions: The low-cost intervention programme tested did significantly reduce the mean GWG but the proportion of women who exceeded the IOM recommendations for GWG was not significantly lower. ClinicalTrials.gov Id NCT00451425

  • 32.
    Wijk, Lena
    et al.
    Örebro University, School of Medical Sciences. Department of Obstetrics and Gynecology, Örebro University Hospital, Örebro, Sweden.
    Franzén, Karin
    Örebro University, School of Medical Sciences. Department of Obstetrics and Gynecology, Örebro University Hospital, Örebro, Sweden.
    Ljungqvist, Olle
    Örebro University, School of Medical Sciences. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Nilsson, Kerstin
    Örebro University, School of Medical Sciences. Department of Obstetrics and Gynecology, Örebro University Hospital, Örebro, Sweden.
    Enhanced Recovery after Surgery Protocol in Abdominal Hysterectomies for Malignant versus Benign Disease2016In: Gynecologic and Obstetric Investigation, ISSN 0378-7346, E-ISSN 1423-002X, Vol. 81, no 5, p. 461-467Article in journal (Refereed)
    Abstract [en]

    Background: The enhanced recovery after surgery (ERAS) protocol combines unimodal evidence-based interventions aiming to enhance recovery after surgery and reduce length of stay (LOS). We introduced an ERAS protocol in gynecological surgery and compared outcomes after hysterectomies performed for malignant vs. benign indications.

    Methods: This prospective cohort study was conducted at the Department of Obstetrics and Gynecology, Örebro University Hospital, Sweden, among 121 consecutive patients undergoing abdominal hysterectomy and salpingo-oophorectomy for malignant (n = 40) or benign (n = 81) indications between 2012 and 2014. Clinical data were prospectively collected and extracted from the patient records and from a specific database. The primary outcomes were LOS and proportion of patients achieving target LOS (2 days).

    Results: Patients operated for malignant vs. benign disease did not differ significantly in terms of LOS (2 (1-5) vs. 2 (1-11) days; p = 0.505), proportion discharged at target LOS (62 vs. 69%; p = 0.465; OR 0.74, 95% CI 0.3-1.6), complications (2 vs. 7% in primary stay, 8 vs. 11% within 30 days after discharge), re operations (0 vs. 2%), or readmissions (2 vs. 1%).

    Conclusion: The ERAS protocol may be equally applicable to patients undergoing hysterectomy either for a malignant or for a benign disease.

  • 33.
    Wijk, Lena
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Dept Obstet & Gynecol, Univ Örebro, Örebro, Sweden.
    Franzén, Karin
    Örebro University, School of Medicine, Örebro University, Sweden. Dept Obstet & Gynecol, Univ Örebro, Örebro, Sweden; Sch Hlth & Med Sci, Univ Örebro, Örebro, Sweden.
    Ljungqvist, Olle
    Örebro University, School of Medicine, Örebro University, Sweden. Örebro University Hospital. Dept Surg.
    Nilsson, Kerstin
    Örebro University, School of Medicine, Örebro University, Sweden. Dept Obstet & Gynecol, Örebro University Hospital, Örebro, Sweden.
    Implementing a structured Enhanced Recovery After Surgery (ERAS) protocol reduces length of stay after abdominal hysterectomy2014In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 93, no 8, p. 749-756Article in journal (Refereed)
    Abstract [en]

    Objective: To study the effects of introducing an Enhanced Recovery After Surgery (ERAS) protocol, modified for gynecological surgery, on length of stay and complications following abdominal hysterectomy.

    Design: Observational study.

    Setting: Department of Obstetrics and Gynecology, Orebro University Hospital, Sweden.

    Population: Eighty-five patients undergoing abdominal hysterectomy for benign or malignant indications between January and December 2012, with or without salpingo-oophorectomy. Outcomes were compared with all consecutive patients who had undergone the same surgery from January to December 2011, immediately before establishing the ERAS protocol (n = 120).

    Methods: The ERAS protocol was initiated in January 2012 as part of a targeted implementation program. Data were extracted from patient records and from a specific database.

    Main outcome measures: Length of stay and the proportion of patients achieving target length of stay (2 days).

    Results: Length of stay was significantly reduced in the study population after introducing the ERAS protocol from a mean of 2.6 (SD 1.1) days to a mean of 2.3 (SD 1.2) days (p = 0.011). The proportion of patients discharged at 2 days was significantly increased from 56% pre-ERAS to 73% after ERAS (p = 0.012). No differences were found in complications (5% vs. 3.5% in primary stay, 12% vs. 15% within 30 days after discharge), reoperations (2% vs. 1%) or readmission (4% vs. 4%).

    Conclusions: Introducing the ERAS protocol for abdominal hysterectomy reduced length of stay without increasing complications or readmissions.

  • 34.
    Wijk, Lena
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Ljungqvist, Olle
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Nilsson, Kerstin
    Örebro University, School of Medical Sciences.
    Female sex hormones in relation to insulin resistance after hysterectomyManuscript (preprint) (Other academic)
  • 35.
    Wijk, Lena
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Obstetrics and Gynaecology.
    Ljungqvist, Olle
    Örebro University, School of Medical Sciences. Department of Surgery, Örebro University Hospital, Sweden.
    Nilsson, Kerstin
    Örebro University, School of Medical Sciences.
    Female sex hormones in relation to insulin resistance after hysterectomy: A pilot study2019In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 38, no 6, p. 2721-2726Article in journal (Refereed)
    Abstract [en]

    BACKGROUND & AIM: Surgery causes development of insulin resistance. Women undergoing hysterectomy have different female sex hormonal status, ranging from premenopausal to postmenopausal. The aim of the study was to explore the relation between the female sex hormones and insulin resistance (IR%) after hysterectomy.

    METHODS: A secondary analysis from a randomised controlled single-centre study at the Department of Obstetrics and Gynaecology, Örebro University Hospital, Sweden. Twenty women were randomised to robot-assisted laparoscopic or abdominal hysterectomy. Blood were drawn before and after surgery for measurement of oestrogens, progesterone, and gonadotropins alongside determination of insulin sensitivity using the hyperinsulinemic normolycaemic clamp.

    RESULTS: Female sex hormonal status was not correlated to insulin sensitivity before operation. Premenopausal women developed more IR% than postmenopausal women (p = 0.012). Premenopausal women also showed a significant decrease in absolute levels of oestradiol (E2) (p = 0.016), and the relative decrease in E2 from preoperative to postoperative values (E2%) was significantly higher (p = 0.001). There was a significant positive correlation in the entire study population between E2% and IR% (r = 0.72, p = 0.001, r2 0.51) that remained when adjusted for age (p = 0.028), BMI (p = 0.001), and preoperative insulin sensitivity (p = 0.011) separately.

    CONCLUSIONS: Premenopausal women developed a higher degree of postoperative insulin resistance that was associated with a parallel relative change in oestradiol levels compared with the postmenopausal women. It remains unclear whether these are independent phenomena in the overall stress response or whether a causal relationship exists.

  • 36.
    Wijk, Lena
    et al.
    Örebro University, School of Medical Sciences. Department of Obstetrics and Gynaecology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Nilsson, Kerstin
    Örebro University, School of Medical Sciences.
    Ljungqvist, Olle
    Örebro University, School of Medical Sciences. Department of Surgery, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Metabolic and inflammatory responses and subsequent recovery in robotic versus abdominal hysterectomy: A randomised controlled study2018In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 37, no 1, p. 99-106Article in journal (Refereed)
    Abstract [en]

    BACKGROUND & AIMS: Surgery causes inflammatory and metabolic responses in the body. The aim of the study was to investigate whether robotic-assisted total laparoscopic hysterectomy induces less insulin resistance than abdominal hysterectomy, and to compare inflammatory response and clinical recovery between the two techniques.

    METHODS: A randomised controlled study at the Department of Obstetrics and Gynaecology, Örebro University Hospital, Sweden. Twenty women scheduled for a planned total hysterectomy with or without salpingo-oophorectomy between October 2014 and May 2015, were randomly allocated to robotic-assisted total laparoscopic hysterectomy or abdominal hysterectomy. Insulin resistance after surgery was measured by the hyperinsulinemic normoglycaemic clamp method, inflammatory response measured in blood samples, and clinical recovery outcomes registered.

    RESULTS: There were no differences in development of insulin resistance between the robotic group and the abdominal group (mean ± SD: 39% ± 22 vs. 40% ± 19; p = 0.948). The robotic group had a significantly shorter hospital stay (median 1 vs. 2 days; p = 0.005). Inflammatory reaction differed; in comparison to the robotic group, the abdominal group showed significantly higher increases in serum interleukin 6 levels, white blood cell count and cortisol from preoperative values to postoperative peak values.

    CONCLUSIONS: Robotic laparoscopic surgery reduced inflammatory responses and recovery time, but these changes were not accompanied by decreased insulin resistance.

    CLINICAL TRIAL REGISTRATION: www.ClinicalTrials.gov Identifier no NCT02291406.

  • 37.
    Wijk, Lena
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Dept of Obstetrics and Gynaecology, Örebro University Hospital, Örebro, Sweden.
    Nilsson, Kerstin
    Örebro University, School of Medical Sciences. Dept of Obstetrics and Gynaecology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Ljungqvist, Olle
    Örebro University, School of Medical Sciences. Dept of Surgery,Dept of Obstetrics and Gynaecology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Robotic versus abdominal hysterectomy; metabolic and inflammatory responses and subsequent recovery: A randomised controlled study2016In: Clinical Nutrition ESPEN, ISSN 2405-4577, Vol. 12, article id e47Article in journal (Refereed)
    Abstract [en]

    Objectives: The aim was to study if robotic assisted total hysterectomy (RTLH) would induce less insulin resistance than abdominal hysterectomy (AH). In addition, inflammatory response and clinical recovery were compared.

    Methods: We conducted a randomised controlled study at the Department of Obstetrics & Gynaecology, Örebro University Hospital; Sweden. Twenty women scheduled for a planned total hysterectomy with or without salpingo-oophorectomy, between October 2014 and May 2015, were randomly allocated to robotic assisted laparoscopic hysterectomy or abdominal hysterectomy. Insulin resistance after surgery was measured by the hyperinsulinemic normoglycemic clamp method. Inflammatory response was measured in blood samples and clinical recovery outcomes registered.

    Results: There were no differences in development of insulin resistance (mean ± SD) for robotic group (39±22%) vs abdominal group (40±19%; p=0.948). The robotic group had a significantly shorter hospital stay (median 1 vs. 2 days, p=0.005). Inflammatory reaction differed in form of significantly greater increase in serum interleukin 6 levels and white blood cell count, from preoperative value to postoperative peak value, in abdominal group compared with robotic group.

    Conclusion: Robotic assisted hysterectomy reduced inflammatory responses and recovery time but these changes were not accompanied by less insulin resistance.

  • 38.
    Wätterbjörk, Inger
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Blomberg, Karin
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Nilsson, Kerstin
    Örebro University, School of Medicine, Örebro University, Sweden.
    Sahlberg Blom, Eva
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Gravida kvinnors och deras partners beslut om KUB-test2012Conference paper (Other academic)
  • 39.
    Wätterbjörk, Inger
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Blomberg, Karin
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Nilsson, Kerstin
    Örebro University, School of Medicine, Örebro University, Sweden.
    Sahlberg Blom, Eva
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    To decide about prenatal screening2012Conference paper (Refereed)
  • 40.
    Wätterbjörk, Inger
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Blomberg, Karin
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Nilsson, Kerstin
    Örebro University, School of Medicine, Örebro University, Sweden.
    Sahlberg Blom, Eva
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Tvåstegssamtal inför beslut om fosterdiagnostik2010Conference paper (Other academic)
  • 41.
    Wätterbjörk, Inger
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Blomberg, Karin
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Nilsson, Kerstin
    Örebro University, School of Medicine, Örebro University, Sweden.
    Sahlberg Blom, Eva
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Tvåstegssamtal inför beslut om fosterdiagnostik2010Conference paper (Other academic)
  • 42.
    Wätterbjörk, Inger
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Blomberg, Karin
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Nilsson, Kerstin
    Örebro University, School of Medicine, Örebro University, Sweden.
    Sahlberg Blom, Eva
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Tvåstegssamtal inför beslut om fosterdiagnostik: en kvalitativ studie2010Conference paper (Other academic)
  • 43.
    Wätterbjörk, Inger
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Blomberg, Karin
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Nilsson, Kerstin
    Örebro University, School of Medicine, Örebro University, Sweden.
    Sahlberg Blom, Eva
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Tvåstegssamtal inför beslut om fosterdiagnostik: resultat från en kvalitativ studie2010Conference paper (Other academic)
  • 44.
    Wätterbjörk, Inger
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Family Medicine Research Center, AFC, Örebro, Sweden.
    Blomberg, Karin
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Nilsson, Kerstin
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Obstetrics and Gynaecology, Örebro University Hospital, Örebro, Sweden.
    Sahlberg-Blom, Eva
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Pregnant women's and their partners' perception of an information model on prenatal screening2012In: Prenatal Diagnosis, ISSN 0197-3851, E-ISSN 1097-0223, Vol. 32, no 5, p. 461-466Article in journal (Refereed)
    Abstract [en]

    Objective: Extended verbal information on prenatal screening was given when combined ultrasound and biochemistry screening test was offered at Örebro County Council, Sweden, in 2008. The aim of this study was to describe pregnant women's and her partners' perceptions of this information model.

    Method: The interviews were semi-structured, and altogether, 26 interviews were performed with pregnant women and partners. Qualitative content analysis was used to analyze the data.

    Results: The result consists of two main categories, ‘form and content’ and ‘managing the information’, to describe the couples' perceptions of the information given. Nine categories describe the information model in: voluntariness, a separate visit, a special midwife, the content, missing information, ethical considerations, a visit on equal terms, communication within the couple, communication with other people, and emotional management.

    Conclusion: The information model helps expecting parents to focus on prenatal screening. Only information about prenatal screening and diagnosis was not enough for everybody; some couples want this to be an opportunity to discuss with a professional the pros and cons of prenatal screening as well as ethical considerations. The information visit gives the partner a chance to be involved and an opportunity for the couple to discuss the subject.

  • 45.
    Wätterbjörk, Inger
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Blomberg, Karin
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Sahlberg Blom, Eva
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Nilsson, Kerstin
    Örebro University, School of Medicine, Örebro University, Sweden.
    Information aboutprenatal screening: midwives informs in two steps2013Conference paper (Refereed)
  • 46.
    Wätterbjörk, Inger
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Family Medicine Research Centre.
    Sahlberg-Blom, Eva
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Blomberg, Karin
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Nilsson, Kerstin
    Örebro University, School of Medicine, Örebro University, Sweden.
    Decision-making about prenatal screening: are pregnant women and partners satisfied with their decision?2013Manuscript (preprint) (Other academic)
    Abstract [en]

    Objective The combined test for Down syndrome is offered to pregnant women. Qualitative studies have shown that the decision, whether or not to accept the test,is a rational one for most couples, although for some it may be difficult. Little is known about the couples’ satisfaction with the decision afterwards; the aim of this study was to extend that knowledge

    Method Pregnant women and their partners were invited to fill out a questionnaire at approximately pregnancy week 20. The questionnaire, which covered aspects of their decision on prenatal testing, was based on the Decision Regret Scale, with additional questions

    Results The response rate was 77% (295/359 women and 223/315 partners). The decision whether or not to participate in the combined test was seen as mutual by 95% of the women and 96% of the partners, and was perceived as uncomplicated by 93% of both women and partners. The decision was considered as difficult/very difficult by 6%. With a range of 93% – 99% women and partners were satisfied with their decision afterwards, but 1%–7% were not

    Conclusion The majority of the participants were satisfied wither their decision. However, a small minority were not, which is important to recognize.

  • 47.
    Wätterbjörk, Inger
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Sahlberg-Blom, Eva
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Nilsson, Kerstin
    Örebro University, School of Medicine, Örebro University, Sweden.
    Blomberg, Karin
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Reasons for declining extended information visit on prenatal screening among pregnant women and their partners2015In: Prenatal Diagnosis, ISSN 0197-3851, E-ISSN 1097-0223, Vol. 35, no 12, p. 1232-1237Article in journal (Refereed)
    Abstract [en]

    Objective: A two-step model on information on prenatal screening consists of brief information at the first visit at the Maternal Health Care Centre and an offer of extended information at a separate visit. There is a lack of knowledge why some pregnant women and their partners refrain from the extended information visit. The aim of this study was to explore their reasons

    Method: Eight qualitative interviews were analysed using Interpretive Description.

    Results: In the first theme “From an individual view”, the interviewees saw the invitation from their own points of view. They refrained because they did not want to receive any more information or had taken an individual position against chromosomal testing. In the theme, “From a societal view”, the interviewees perceived the offer as part of a societal view on prenatal screening that they could not support.

    Conclusion: The findings shows that these interviewees' reasons of declining an extended information visit are multidimensional and influenced by different views, from both an individual perspective and a more societal one. Health care professionals should be aware that some persons could have a different view on health care services and could be reluctant to accept offered services.

  • 48.
    Wätterbjörk, Inger
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Sahlberg-Blom, Eva
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Nilsson, Kerstin
    Örebro University, School of Medicine, Örebro University, Sweden.
    Blomberg, Karin
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Views on prenatal screening among pregnant women and partners declining an extended informationArticle in journal (Refereed)
    Abstract [en]

    Objective: A County Council in Sweden has implemented a two-step information model about prenatal screening. In addition to the regular brief information delivered by the midwife at the first routine visit at the maternal health care centre, the two-step model includes an offer of extended information at a separate visit. However, a substantial number of the couples decline and there is a lack of knowledge about their reasons. The aim of this study was to describe views about prenatal screening among couples who had not taken part in an extended information visit, to increase understanding of the perspectives of prenatal screening in this group.

    Method: Qualitative interviews were performed with seven couples not participating in an extended information visit about prenatal screening. Data were analysed using Interpretive Description. Results: The results showed two themes. In the theme “From an individual view”, with the subthemes Declining further information and, Position taken against prenatal screening, the couples saw the invitation and prenatal screening from their own points of view. They refrained because they did not want to receive any more information. In the other theme, “From a societal view”, with the subthemes Society has a hidden agenda and, The health care service’s responsibilities, the couples perceived the offer as part of a societal view on prenatal screening, that they could not support.

    Conclusion: The findings in this group of couples shows that couples’ perceptions of prenatal screening are multidimensional and influenced by different views, from both an individual perspective and a more societal one.

    Practice Implications: Health care professionals should be aware that some persons could be reluctant to accept health care service, and that the challenge is to meet all individuals, without violating their autonomy. Person-centred care could assist with an approach to meeting the person as an individual.

1 - 48 of 48
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