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Ångerud, K., Annerbäck, E.-M., Tydén, T., Boddeti, S. & Kristiansson, P. (2018). Adverse childhood experiences and depressive symptomatology among pregnant women. Acta Obstetricia et Gynecologica Scandinavica, 97(6), 701-708
Open this publication in new window or tab >>Adverse childhood experiences and depressive symptomatology among pregnant women
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2018 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 97, no 6, p. 701-708Article in journal (Refereed) Epub ahead of print
Abstract [en]

INTRODUCTION: Adverse childhood experiences (ACE) result in somatic and mental health disturbances. Its influence on antenatal depression is scarcely studied. This study examined the association between experience of ACE and antenatal depressive symptomatology.

MATERIAL AND METHODS: 1257 women from 172 antenatal clinics in Sweden were surveyed during pregnancy and one year after delivery. Demographics, previous medical history and Edinburgh Postpartum Depression Scale (EPDS) were collected in pregnancy and postpartum and ACE one year postpartum. ACEs were partitioned into 10 categories. Statistical analyses used linear and logistic regression with EPDS score as main outcome measure.

RESULTS: 736 (58.6%) women reported at least one ACE category and 88 women (7%) reported five or more ACE categories. An EPDS score of ≥13, which qualifies for a probable depression diagnosis, was reported by 277 (23%) women. In simple regression analyses the EPDS score was positively associated with the number of ACEs, cigarette smoking before pregnancy, body mass index and psychiatric disorders while education level was inversely associated. In a multiple regression analysis ACEs, education level and psychiatric disorder remained associated to the EPDS score. Among women with an ACE score ≥5 the odds ratio of having an EPDS score indicating probable depression was 4.2 (CI; 2.5-7.0).

CONCLUSIONS: ACE was commonly reported. ACE and depressive symptomatology in late pregnancy were strongly associated in a dose-response manner. Women with several ACEs had high odds of depressive symptomatology in late pregnancy and were more likely to report depressive symptoms both in late pregnancy and postpartum.

Keywords
Adverse childhood experiences, cohort study, depression, longitudinal, pregnancy
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-346742 (URN)10.1111/aogs.13327 (DOI)000431613400009 ()29431859 (PubMedID)
Available from: 2018-03-21 Created: 2018-03-21 Last updated: 2018-07-25Bibliographically approved
Ekstrand Ragnar, M., Hultstrand, J. N., Tydén, T. & Larsson, M. (2018). Development of an evidence-based website on Preconception health. Upsala Journal of Medical Sciences, 123(2), 116-122
Open this publication in new window or tab >>Development of an evidence-based website on Preconception health
2018 (English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 123, no 2, p. 116-122Article in journal (Refereed) Published
Abstract [en]

Introduction: Many women and men lack knowledge about fertility, including timing of the fertile window, age-related decline, and lifestyle factors that may impair fertility. The Internet has become an important source of information, but evidence-based information on fertility and reproduction in Swedish on the Internet is limited. The present study aimed to develop and evaluate an evidence-based fertility awareness website, 'reproduktivlivsplan.se', to increase awareness of fertility and provide guidance for improved preconception health and care among individuals and healthcare providers. Methods: The website's content, design, and layout were evaluated qualitatively among a total of 20 nursing students. An expert group of researchers also provided feedback on the content. Finally, healthcare providers (n = 24) answered a questionnaire covering attitudes and views on the Reproductive Life Plan website as a tool for counselling. Results: The developing process resulted in a mobile-friendly website, 'reproduktivlivsplan.se' (in English: Reproductive Life Plan). The website, including the content and layout, was positively evaluated by most participants and was amended according to suggested improvements. Uppsala University was found to be a trustworthy source. Conclusion: The evidence-based website 'reproduktivlivsplan.se' was well received among users and healthcare providers and may provide guidance for improved preconception health and care if it becomes well known and frequently used.

Place, publisher, year, edition, pages
TAYLOR & FRANCIS LTD, 2018
Keywords
Fertility awareness, health behaviour, internet-based information, preconception health, reproductive life plan
National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-360561 (URN)10.1080/03009734.2018.1476423 (DOI)000438159000007 ()29909720 (PubMedID)
Available from: 2018-09-14 Created: 2018-09-14 Last updated: 2018-09-14Bibliographically approved
Grandahl, M., Paek, S. C., Grisurapong, S., Sherer, P., Tydén, T. & Lundberg, P. (2018). Parents' knowledge, beliefs, and acceptance of the HPV vaccination in relation to their socio-demographics and religious beliefs: A cross-sectional study in Thailand. PLoS ONE, 13(2), Article ID e0193054.
Open this publication in new window or tab >>Parents' knowledge, beliefs, and acceptance of the HPV vaccination in relation to their socio-demographics and religious beliefs: A cross-sectional study in Thailand
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2018 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 2, article id e0193054Article in journal (Refereed) Published
Abstract [en]

Thailand has one of the world's highest prevalence of cervical cancer, mainly caused by the human papillomavirus (HPV). HPV infections can successfully be prevented by vaccination, which is available at a cost but not yet implemented in the national vaccination program. Parents play a critical role in deciding whether to vaccinate their child against HPV. Thus, the aim was to examine the association between parents' knowledge, beliefs, and acceptance of the HPV vaccination for their daughters, considering their socio-demographics and religious beliefs. A cross-sectional design was used among three schools in Thailand: Nakorn Phatom province (suburban) and Bangkok (urban). Parents of 9-12-year-old daughters completed the questionnaires, guided by the Health Belief Model. In total, 359 parents completed the questionnaires; of those, 301 were included in the final analyses. The ordinary least squares (OLS) regression analysis showed that background knowledge of HPV and the HPV vaccine was positively related to knowledge of HPV and cervical cancer. For beliefs, knowledge was positively associated with susceptibility (i.e., parents' perceived risk of an HPV infection/related disease), severity, and benefit. However, knowledge was not significantly related to barriers. For acceptance, higher susceptibility and benefit were related to higher acceptance, and greater knowledge was associated with higher acceptance. Thus, we found associations between parents' knowledge, beliefs, and acceptance of the HPV vaccination for their daughters, considering their socio-demographics and religious beliefs. Parents, who reported religion as important, as opposed to those who did not, were more favorable toward the HPV vaccination. Four out of ten mothers had never undergone a cervical cancer screening, but most had accepted previous childhood vaccinations for their daughters. The overall acceptance of the vaccine was high, and we believe our results are promising for future implementation of the HPV vaccination in the national childhood vaccination program in Thailand.

Place, publisher, year, edition, pages
PUBLIC LIBRARY SCIENCE, 2018
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-348918 (URN)10.1371/journal.pone.0193054 (DOI)000425283900104 ()29447271 (PubMedID)
Funder
The Swedish Foundation for International Cooperation in Research and Higher Education (STINT), IB2014-5900
Available from: 2018-04-25 Created: 2018-04-25 Last updated: 2018-04-25Bibliographically approved
Salih Joelsson, L., Tydén, T., Wanggren, K., Georgakis, M. K., Stern, J., Berglund, A. & Skalkidou, A. (2017). Anxiety and depression symptoms among sub-fertile women, women pregnant after infertility treatment, and naturally pregnant women. European psychiatry, 45, 212-219
Open this publication in new window or tab >>Anxiety and depression symptoms among sub-fertile women, women pregnant after infertility treatment, and naturally pregnant women
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2017 (English)In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 45, p. 212-219Article in journal (Refereed) Published
Abstract [en]

Background

Infertility has been associated with psychological distress, but whether these symptoms persist after achieving pregnancy via assisted reproductive technology (ART) remains unclear. We compared the prevalence of anxiety and depressive symptoms between women seeking for infertility treatment and women who conceived after ART or naturally.

Methods

Four hundred and sixty-eight sub-fertile non-pregnant women, 2972 naturally pregnant women and 143 women pregnant after ART completed a questionnaire in this cross-sectional study. The Anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A≥8) and Edinburgh Postnatal Depression Scale (EPDS≥12) were used for assessing anxiety and depressive symptoms, respectively. Multivariate Poisson regression models with robust variance were applied to explore associations with anxiety and depressive symptoms.

Results

The prevalence of anxiety and depressive symptoms among sub-fertile, non-pregnant women (57.6% and 15.7%, respectively) were significantly higher compared to women pregnant after ART (21.1% and 8.5%, respectively) and naturally pregnant women (18.8% and 10.3%, respectively). History of psychiatric diagnosis was identified as an independent risk factor for both anxiety and depressive symptoms. The presence of at least one unhealthy lifestyle behavior (daily tobacco smoking, weekly alcohol consumption, BMI≥25, and regular physical exercise < 2 h/week) was also associated with anxiety (Prevalence Ratio, PR: 1.24; 95%CI: 1.09–1.40) and depressive symptoms (PR: 1.25; 95%CI: 1.04–1.49).

Conclusions

Women pregnant after ART showed no difference in anxiety and depressive symptoms compared to naturally pregnant women. However, early psychological counseling and management of unhealthy lifestyle behaviors for sub-fertile women may be advisable, particularly for women with a previous history of psychiatric diagnosis.

Keywords
anxiety, depression, infertility, assisted reproductive technology, pregnancy
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:uu:diva-338378 (URN)10.1016/j.eurpsy.2017.07.004 (DOI)000414461300029 ()28957789 (PubMedID)
Funder
Swedish Research Council
Available from: 2018-01-08 Created: 2018-01-08 Last updated: 2018-06-04Bibliographically approved
Grandahl, M., Larsson, M., Dalianis, T., Stenhammar, C., Tydén, T., Westerling, R. & Nevéus, T. (2017). Catch-up HPV vaccination status of adolescents in relation to socioeconomic factors, individual beliefs and sexual behaviour. PLoS ONE, 12(11), Article ID e0187193.
Open this publication in new window or tab >>Catch-up HPV vaccination status of adolescents in relation to socioeconomic factors, individual beliefs and sexual behaviour
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2017 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, no 11, article id e0187193Article in journal (Refereed) Published
Abstract [en]

In 2012, human papillomavirus (HPV) vaccination was introduced free of charge in the Swedish national school-based vaccination programme for 10-12-year-old girls, and as catch-up vaccination for young women. In Sweden, there is an ongoing discussion about including boys in the national vaccination programme. Few studies are undertaken about adolescents' knowledge, beliefs and HPV vaccination status in relation to socioeconomic status and sexual experience. Thus, the aim was to examine HPV catch-up vaccination status in adolescents in relation to 1) socioeconomic factors, 2) beliefs and knowledge about HPV prevention, and 3) sexual behaviour. The Health Belief Model was used as a theoretical framework. Upper secondary school students (n = 832) aged 16, randomly chosen from a larger sample, were invited to participate in conjunction with the general health interview with the school nurse. A total of 751/832 (90.3%), girls (n = 391, 52%) and boys (n = 360, 48%) completed the questionnaire. HPV vaccination was associated with ethnicity and the mothers' education level; i.e. girls with a non-European background and girls with a less educated mother were less likely to have received the vaccine (p<0.01 and p = 0.04 respectively). Vaccinated girls perceived HPV infection as more severe (p = 0.01), had more insight into women's susceptibility to the infection (p = 0.02), perceived more benefits of the vaccine as protection against cervical cancer (p<0.01) and had a higher intention to engage in HPV-preventive behaviour (p = 0.01). Furthermore, boys and girls were almost equally sexually experienced, although fewer girls had used condom during first intercourse with their latest partner (p = 0.03). Finally, HPV vaccinated girls were less likely to have unprotected sex (p<0.01). In summary, catch-up HPV vaccination among young girls was associated with a European background and high maternal education level, as well as more favourable beliefs towards HPV prevention and less sexual risk-taking. Further preventive measures should therefore be directed at the migrant population.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Caring Sciences
Identifiers
urn:nbn:se:uu:diva-333214 (URN)10.1371/journal.pone.0187193 (DOI)000414377900014 ()29099839 (PubMedID)
Projects
Prevention of Human Papillomavirus in a school-based setting
Funder
Swedish Cancer Society, 130744
Available from: 2017-11-08 Created: 2017-11-08 Last updated: 2018-02-20Bibliographically approved
Skogsdal, Y., Fadl, H., Karlsson, J., Cao, Y. & Tydén, T. (2017). Contraceptive counseling is a golden opportunity to talk about fertility and reproductive health. Paper presented at 33rd Annual Meeting of the European-Society-of-Human-Reproduction-and-Embryology (ESHRE), JUL 02-05, 2017, Geneva, SWITZERLAND. Human Reproduction, 32, 67-67
Open this publication in new window or tab >>Contraceptive counseling is a golden opportunity to talk about fertility and reproductive health
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2017 (English)In: Human Reproduction, ISSN 0268-1161, E-ISSN 1460-2350, Vol. 32, p. 67-67Article in journal, Meeting abstract (Other academic) Published
National Category
Obstetrics, Gynecology and Reproductive Medicine Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-347732 (URN)000416390500139 ()
Conference
33rd Annual Meeting of the European-Society-of-Human-Reproduction-and-Embryology (ESHRE), JUL 02-05, 2017, Geneva, SWITZERLAND
Note

Supplement: 1

Meeting Abstract: O-147

Available from: 2018-04-06 Created: 2018-04-06 Last updated: 2018-04-06Bibliographically approved
Larsson, M., Berglund, M., Jarl, E. & Tydén, T. (2017). Do pregnant women want to know the sex of the expected child at routine ultrasound and are they interested in sex selection?. Upsala Journal of Medical Sciences, 122(4), 254-259
Open this publication in new window or tab >>Do pregnant women want to know the sex of the expected child at routine ultrasound and are they interested in sex selection?
2017 (English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 122, no 4, p. 254-259Article in journal (Refereed) Published
Abstract [en]

Background: The aim of the study was to investigate if expecting parents wanted to know the sex of the fetus during ultrasound examination and if they had discussed it with the midwife. Another aim was to explore any interest in sex selection. Methods: A longitudinal survey in early and late pregnancy among 2393 women in Sweden. Results: Almost all (95.8%, n = 2289) women had discussed sex determination with the partner before the ultrasound scan, and 57% (n = 1356) of women and their partners wanted to find out the fetal sex. The expecting parents mostly initiated a discussion with the midwife (46%, n = 1088), but 10% (n = 229) stated that the midwives initiated the discussion. Few (5%, n = 118) expressed a potential interest in selecting sex of a baby. Women who were interested in sex determination did not differ from those who were not, with respect to age, origin, education, parity, level of pregnancy planning, or importance of religion, but women who had chosen another fetal diagnostic method were more interested in sex determination and in potential sex selection. Conclusions: Half of women and their partners wanted to know the fetal sex, and 5% were interested in sex selection. This high interest in sex determination is a challenge, since present national guidelines do not include sex determination as an option.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2017
Keywords
Parents, pregnancy, sex determination, sex selection, ultrasound
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-345242 (URN)10.1080/03009734.2017.1408723 (DOI)000423294800008 ()29299974 (PubMedID)
Available from: 2018-03-08 Created: 2018-03-08 Last updated: 2018-03-08Bibliographically approved
Bodin, M., Käll, L., Tydén, T., Stern, J., Drevin, J. & Larsson, M. (2017). Exploring men's pregnancy-planning behaviour and fertility knowledge: a survey among fathers in Sweden. Upsala Journal of Medical Sciences, 122(2), 127-135
Open this publication in new window or tab >>Exploring men's pregnancy-planning behaviour and fertility knowledge: a survey among fathers in Sweden
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2017 (English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 122, no 2, p. 127-135Article in journal (Refereed) Published
Abstract [en]

Introduction: Research about pregnancy-planning behaviour mostly focuses on women, even though pregnancy planning usually also concerns men. The purpose of this study was to investigate how men plan for family, and to measure their fertility knowledge after having become fathers. Material and methods: Data were collected in 2014 as part of a Swedish longitudinal pregnancy-planning study. Men were recruited through their female partner one year after childbirth. Participants were asked to fill out a questionnaire about pregnancy planning, lifestyles, and fertility. Results: Of the 796 participants, 646 (81%) stated that the pregnancy had been very or fairly planned, and 17% (n=128) had made a lifestyle adjustment before pregnancy to improve health and fertility. The most common adjustments were to reduce/quit the consumption of alcohol, cigarettes, or snuff, and to exercise more. First-time fathers and those who had used assisted reproductive technology to become pregnant were more likely to have made an adjustment. Fertility knowledge varied greatly. Men with university education had better fertility knowledge than men without university education. Conclusion: Our findings indicate that there is variation in how men plan and prepare for pregnancy. Most men did not adjust their lifestyle to improve health and fertility, while some made several changes. Both pregnancy-planning behaviour and fertility knowledge seem to be related to level of education and mode of conception. To gain deeper understanding of behaviour and underlying factors, more research is needed.

Place, publisher, year, edition, pages
TAYLOR & FRANCIS LTD, 2017
Keywords
Fathers, fertility knowledge, gender equality, lifestyle, preconception health, pregnancy planning
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-323499 (URN)10.1080/03009734.2017.1316531 (DOI)000401756500009 ()28471260 (PubMedID)
Available from: 2017-06-21 Created: 2017-06-21 Last updated: 2018-03-27Bibliographically approved
Grandahl, M., Larsson, M., Tydén, T. & Stenhammar, C. (2017). School nurses' attitudes towards and experiences of the Swedish school-based HPV vaccination programme - A repeated cross sectional study. PLoS ONE, 12(4), Article ID e0175883.
Open this publication in new window or tab >>School nurses' attitudes towards and experiences of the Swedish school-based HPV vaccination programme - A repeated cross sectional study
2017 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, no 4, article id e0175883Article in journal (Refereed) Published
Abstract [en]

The aim was to investigate school nurses' attitudes towards, and experiences of vaccination against human papillomavirus (HPV), and compare the results with a similar study three years earlier. School nurses (n = 736) from all counties in Sweden completed a questionnaire in spring 2016, four years after the implementation of the national HPV vaccination programme, and three years after the previous survey. Overall, the school nurses had more favourable attitudes towards the HPV vaccination programme compared to the study in 2013 (p = 0.015). More than half of the nurses (n = 415, 56%) strongly agreed that boys should also be offered the vaccine (p<0.001). There were no differences in school nurses' perceived knowledge about HPV in order to inform and to answer questions about the vaccine from the girls or from the parents. More than half of the nurses (n = 409, 56%) reported that they needed more education about HPV. Almost all nurses (n = 659, 90%) had been contacted by parents with questions about the vaccine, and most questions were related to vaccine safety. School nurses have a more favourable attitude towards the vaccination programme against HPV compared to three years earlier, although almost all nurses had been contacted by parents with diverse questions and concerns. The nurses believed that they needed more education about HPV. Thus, it is essential to provide ongoing education and training for school nurses who are key healthcare professionals for providing information about HPV and HPV vaccination to parents and to pupils.

Keywords
Human-papillomavirus, provider communication, professional practice, hesitancy, knowledge, parents, trust
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-322806 (URN)10.1371/journal.pone.0175883 (DOI)000399875200050 ()28419156 (PubMedID)
Available from: 2017-09-13 Created: 2017-09-13 Last updated: 2017-11-29Bibliographically approved
Bodin, M., Tydén, T., Käll, L. & Larsson, M. (2017). The effect of introducing Reproductive Life Plan-based counselling during men's sexual health visits: a randomized controlled trial. Paper presented at 33rd Annual Meeting of the European-Society-of-Human-Reproduction-and-Embryology (ESHRE), JUL 02-05, 2017, Geneva, SWITZERLAND. Human Reproduction, 32, 395-396
Open this publication in new window or tab >>The effect of introducing Reproductive Life Plan-based counselling during men's sexual health visits: a randomized controlled trial
2017 (English)In: Human Reproduction, ISSN 0268-1161, E-ISSN 1460-2350, Vol. 32, p. 395-396Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
OXFORD UNIV PRESS, 2017
National Category
Obstetrics, Gynecology and Reproductive Medicine Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-347734 (URN)000416390503152 ()
Conference
33rd Annual Meeting of the European-Society-of-Human-Reproduction-and-Embryology (ESHRE), JUL 02-05, 2017, Geneva, SWITZERLAND
Available from: 2018-04-06 Created: 2018-04-06 Last updated: 2018-04-06Bibliographically approved
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ORCID iD: ORCID iD iconorcid.org/0000-0002-2172-6527

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