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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.

Keyword
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: 2018-02-12Bibliographically 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)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: 2017-11-29Bibliographically 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
Keyword
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: 2017-06-21Bibliographically 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.

Keyword
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
Grandahl, M., Tydén, T., Westerling, R., Nevéus, T., Rosenblad, A., Hedin, E. & Oscarsson, M. (2017). To Consent or Decline HPV Vaccination: A Pilot Study at the Start of the National School-Based Vaccination Program in Sweden. Journal of School Health, 87(1), 62-70.
Open this publication in new window or tab >>To Consent or Decline HPV Vaccination: A Pilot Study at the Start of the National School-Based Vaccination Program in Sweden
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2017 (English)In: Journal of School Health, ISSN 0022-4391, E-ISSN 1746-1561, Vol. 87, no 1, p. 62-70Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

Parents' beliefs about human papillomavirus (HPV) vaccination influence whether they allow their daughters to be vaccinated. We examined the association between parents' refusal and sociodemographic background, knowledge and beliefs about HPV, and the HPV vaccination in relation to the Health Belief Model.

METHODS:

The sample consisted of 200 (55%) parents of children aged 11-12 years in the Swedish national vaccination program. Data were collected using a self-reported questionnaire. Most parents (N = 186) agreed to the vaccination. Pearson's chi-square, Fisher's exact test, and the Mann-Whitney U test were used to analyze data.

RESULTS:

Declining parents saw more risks and fewer benefits of HPV vaccination but no differences in beliefs regarding the severity or young girls' susceptibility to HPV were found. There was an association between refusing the HPV vaccine and lower acceptance of previous childhood vaccinations, and their main source of information was the Internet. Parents who declined the vaccine believed it could adversely affect condom use, the age of their daughter's sexual debut, and the number of sexual partners.

CONCLUSION:

Parents should have the possibility to discuss HPV and HPV vaccine with a school nurse or other health care professionals, and should have access to evidence-based information on the Internet.

Keyword
HPV vaccination; Health Belief Model; health beliefs; school nurses; school-based vaccination programs
National Category
Pediatrics
Identifiers
urn:nbn:se:uu:diva-308992 (URN)10.1111/josh.12470 (DOI)000393826900008 ()27917484 (PubMedID)
Available from: 2016-12-01 Created: 2016-12-01 Last updated: 2017-11-29Bibliographically approved
Salih Joelsson, L., Berglund, A., Wånggren, K., Lood, M., Rosenblad, A. & Tydén, T. (2016). Do subfertile women adjust their habits when trying to conceive?. Upsala Journal of Medical Sciences, 121(3), 184-191.
Open this publication in new window or tab >>Do subfertile women adjust their habits when trying to conceive?
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2016 (English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 121, no 3, p. 184-191Article in journal (Refereed) Published
Abstract [en]

AbstractAIM:

The aim of this study was to investigate lifestyle habits and lifestyle adjustments among subfertile women trying to conceive.

MATERIALS AND METHODS:

Women (n = 747) were recruited consecutively at their first visit to fertility clinics in mid-Sweden. Participants completed a questionnaire. Data were analyzed using logistic regression, t tests, and chi-square tests.

RESULTS:

The response rate was 62% (n = 466). Mean duration of infertility was 1.9 years. During this time 13.2% used tobacco daily, 13.6% drank more than three cups of coffee per day, and 11.6% consumed more than two glasses of alcohol weekly. In this sample, 23.9% of the women were overweight (body mass index, BMI 25-29.9 kg/m(2)), and 12.5% were obese (BMI ≥30 kg/m(2)). Obese women exercised more and changed to healthy diets more frequently than normal-weight women (odds ratio 7.43; 95% confidence interval 3.7-14.9). Six out of ten women (n = 266) took folic acid when they started trying to conceive, but 11% stopped taking folic acid after some time. Taking folic acid was associated with a higher level of education (p < 0.001).

CONCLUSIONS:

Among subfertile women, one-third were overweight or obese, and some had other lifestyle factors with known adverse effects on fertility such as use of tobacco. Overweight and obese women adjusted their habits but did not reduce their body mass index. Women of fertile age would benefit from preconception counseling, and the treatment of infertility should routinely offer interventions for lifestyle changes.

KEYWORDS:

Alcohol consumption; assisted reproduction; diet; infertility; lifestyle; obesity; pregnancy; tobacco use

Keyword
Alcohol consumption; assisted reproduction; diet; infertility; lifestyle; obesity; pregnancy; tobacco use
National Category
Obstetrics, Gynecology and Reproductive Medicine Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-301385 (URN)10.1080/03009734.2016.1176094 (DOI)000381958400006 ()
Available from: 2016-08-22 Created: 2016-08-22 Last updated: 2018-01-18Bibliographically approved
Olsén Sørensen, N., Marcussen, S., Grønbæk Backhausen, M., Juhl, M., Schmidt, L., Tyden, T. & Hegaard, H. K. (2016). Fertility awareness and attitudes towards parenthood among Danish university college students. Reproductive Health, 13, Article ID 146.
Open this publication in new window or tab >>Fertility awareness and attitudes towards parenthood among Danish university college students
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2016 (English)In: Reproductive Health, ISSN 1742-4755, E-ISSN 1742-4755, Vol. 13, article id 146Article in journal (Refereed) Published
Abstract [en]

Background: Postponing parenthood has steadily increased during the past decades in Western countries. This trend has affected the size of families in the direction of fewer children born per couple. In addition, higher maternal age is associated with an increased risk of pregnancy-related complications such as prematurity and foetal death, while higher paternal age increases the risk of miscarriage and affects time-to-pregnancy. Hence, understanding the circumstances and reflections that influence the decision is greatly needed and little is known about potential gender difference influencing the choice. The aim was to investigate attitudes towards parenthood, intentions for childbirth and knowledge about fertility issues among men and women. Methods: We conducted a cross-sectional study based on a validated 49-item questionnaire among students, who attended selected mandatory lectures at a Danish university college in February to April 2016. The participation rate was 99%, and 517 completed the questionnaire. Results: Though the majority of all participants wished to have children in the future (> 86%), there was significant difference between the genders (p = 0.002). Women rated having children to be more important than men did (p < 0.001), while men rated higher the likelihood of abstaining from having children if faced with infertility (p = 0.003). Knowledge about fertility issues was similar between genders including poor knowledge about the age-related decline in female fertility. While women found it more important to have children before being 'too old' (p = 0.04), still more than 40% of all respondents intended to have their last child after the age of 35 years. For both genders the most important prerequisite for parenthood was having a partner to share responsibility with. Perceived or experienced life changes related to parenthood were generally positive such as personal development. Conclusion: The majority of respondents wished to have children, but many desired to have these after the biological decline in female fertility. The moderate knowledge level among both genders uncovered in this study is of concern. Future research should address the potential link between fertility knowledge and planning of parenthood. We may benefit from intervention studies examining the effect of routine preconception care.

Keyword
Postponed parenthood, Fertility awareness, Parenting attitudes, Questionnaire
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:uu:diva-313960 (URN)10.1186/s12978-016-0258-1 (DOI)000390955800001 ()
Available from: 2017-02-13 Created: 2017-02-13 Last updated: 2018-01-13Bibliographically approved
Stern, J., Salih Joelsson, L., Tydén, T., Berglund, A., Ekstrand, M., Hegaard, H., . . . Kristiansson, P. (2016). Is pregnancy planning associated with background characteristics and pregnancy planning behavior?. Acta Obstetricia et Gynecologica Scandinavica, 95(2), 182-189.
Open this publication in new window or tab >>Is pregnancy planning associated with background characteristics and pregnancy planning behavior?
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2016 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 95, no 2, p. 182-189Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Prevalence of planned pregnancies varies between countries but is often measured in a dichotomous manner. The aim of this study was to investigate to what level pregnant women had planned their pregnancies and whether pregnancy planning was associated with background characteristics and pregnancy planning behavior.

MATERIAL AND METHODS: A cross-sectional study that utilized the baseline measurements from the Swedish Pregnancy Planning (SWEPP) study. Pregnant women (n= 3390) recruited at antenatal clinics answered a questionnaire. Data were analyzed with multinomial logistic regression, Kruskal-Wallis H and χ(2) tests.

RESULTS: Three out of four pregnancies were very or fairly planned and 12 % fairly or very unplanned. Of women with very unplanned pregnancies, 32 % had considered an induced abortion. Women with planned pregnancies were more likely to have a higher level of education, higher household income, to be currently working ≥50 %, and to have longer relationships than women with unplanned pregnancies. The level of pregnancy planning was associated with planning behavior, such as information seeking and intake of folic acid, but without a reduction in alcohol consumption. One third of all women took folic acid one month prior to conception, 17 % used tobacco daily and 11 % used alcohol weekly three months before conception.

CONCLUSIONS: A majority rated their pregnancy as very or fairly planned, with socio-economic factors as explanatory variables. The level of pregnancy planning should be queried routinely to enable individualized counselling, especially for women with unplanned pregnancies. Preconception recommendations need to be established and communicated to the public to increase health promoting planning behavior.

Keyword
Planned pregnancy; unplanned pregnancy; preconception care; folic acid; health behavior
National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-270500 (URN)10.1111/aogs.12816 (DOI)000368004300007 ()26566076 (PubMedID)
Available from: 2015-12-29 Created: 2015-12-29 Last updated: 2018-01-19Bibliographically approved
Grandahl, M., Rosenblad, A., Stenhammar, C., Tydén, T., Westerling, R., Larsson, M., . . . Neveus, T. (2016). School-based intervention for the prevention of HPV among adolescents: a cluster randomised controlled study. BMJ Open, 6(1), Article ID e009875.
Open this publication in new window or tab >>School-based intervention for the prevention of HPV among adolescents: a cluster randomised controlled study
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2016 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, no 1, article id e009875Article in journal (Refereed) Published
Abstract [en]

Objective: To improve primary prevention of human papillomavirus (HPV) infection by promoting vaccination and increased condom use among upper secondary school students. Design: Cluster randomised controlled trial. Setting: 18 upper secondary schools in Sweden. Participants: Schools were first randomised to the intervention or the control group, after which individual classes were randomised so as to be included or not. Of the 832 students aged 16 years invited to participate during the regular individual health interview with the school nurse, 751 (90.2%) agreed to participate and 741 (89.1%) students completed the study. Interventions: The intervention was based on the Health Belief Model (HBM). According to HBM, a person's health behaviour can be explained by individual beliefs regarding health actions. School nurses delivered 30 min face-to-face structured information about HPV, including cancer risks and HPV prevention, by propagating condom use and HPV vaccination. Students in the intervention and the control groups completed questionnaires at baseline and after 3 months. Main outcome measures: Intention to use condom with a new partner and beliefs about primary prevention of HPV, and also specifically vaccination status and increased condom use. Results: All statistical analyses were performed at the individual level. The intervention had a significant effect on the intention to use condom (p=0.004). There was also a significant effect on HBM total score (p=0.003), with a 2.559 points higher score for the intervention group compared to the controls. The influence on the HBM parameters susceptibility and severity was also significant (p<0.001 for both variables). The intervention also influenced behaviour: girls in the intervention group chose to have themselves vaccinated to a significantly higher degree than the controls (p=0.02). No harms were reported. Conclusions: The school-based intervention had favourable effects on the beliefs about primary prevention of HPV, and increased the HPV vaccination rates in a diverse population of adolescents.

Keyword
adolescents, HPV, prevention, randomised control trial, school-based
National Category
Public Health, Global Health, Social Medicine and Epidemiology Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-263257 (URN)10.1136/bmjopen-2015-009875 (DOI)000369993900136 ()
Funder
Swedish Cancer Society, 130744
Available from: 2015-09-30 Created: 2015-09-29 Last updated: 2017-12-01Bibliographically approved
Ehrsson, Y. T., Stenhammar, C., Rosenblad, A., Åkerud, H., Larsson, M. & Tydén, T. (2016). Self-reported sexually transmitted infections among female university students.. Upsala Journal of Medical Sciences, 121(1), 45-49.
Open this publication in new window or tab >>Self-reported sexually transmitted infections among female university students.
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2016 (English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 121, no 1, p. 45-49Article in journal (Refereed) Published
Abstract [en]

AIM: To investigate the occurrence of self-reported sexually transmitted infections (STIs) and associated factors among female university students requesting contraceptive counselling.

MATERIAL AND METHODS: Cross-sectional study. Female university students (n = 353) completed a waiting-room questionnaire in connection with contraceptive counselling at a Student Health Centre in Uppsala, Sweden.

RESULTS: Ninety-three (26.3%) female students had experienced an STI. The three most frequently reported STIs were chlamydia trachomatis, condyloma, and genital herpes. The experience of an STI was significantly associated with the total number of sexual partners (OR 1.060, 95% CI 1.030-1.091, P < 0.001), being heterosexual (OR 4.640, 95% CI 1.321-16.290, P = 0.017), having experienced an abortion (OR 2.744, 95% CI 1.112-6.771, P = 0.028), not being HPV-vaccinated (OR 2.696, 95% CI 1.473-4.935, P = 0.001), and having had intercourse on first night without using a condom (OR 2.375, 95% CI 1.182-4.771, P = 0.015).

CONCLUSIONS: Contraceptive counselling should also include information about primary and secondary prevention of STI, such as the importance of correct use of a condom and STI testing, to prevent a further spread of STIs.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-266530 (URN)10.3109/03009734.2015.1093568 (DOI)000372123700007 ()26489857 (PubMedID)
Available from: 2015-11-10 Created: 2015-11-10 Last updated: 2017-12-01Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-2172-6527

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