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Wahlberg, Å., Högberg, U. & Emmelin, M. (2020). Left alone with the emotional surge - A qualitative study of midwives' and obstetricians' experiences of severe events on the labour ward. Sexual & Reproductive HealthCare, 23, Article ID 100483.
Open this publication in new window or tab >>Left alone with the emotional surge - A qualitative study of midwives' and obstetricians' experiences of severe events on the labour ward
2020 (English)In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 23, article id 100483Article in journal (Refereed) Published
Abstract [en]

Background: Working on the labour ward entails being responsible for severe events during which a mother or baby may be injured or may die. Such events might affect decision-making, team-working, capacity for empathy, and patient safety.

Aim: To explore midwives' and obstetricians' experiences, reactions and interpretations of being part of a severe event on the labour ward.

Design: A qualitative study using content analysis of in-depth interviews.

Participants: Fourteen Swedish healthcare providers: seven midwives, and seven obstetricians.

Methods: Qualitative content analysis was used to describe and interpret the manifest and latent meaning of the interview text, while remaining close to participants' lived experiences.

Results: The overarching theme "Left alone with the emotional surge" was developed around three subthemes, supported by categories and subcategories. Professionals identified factors that had contributed to the course of events that made them perceive that they had been "acting within an illusory system of control and safety". When the severity of the situation became clear, "cognitive and emotional discordance was experienced", and, in the aftermath, the professionals described a "search for internal and external redemption" related to strong emotions of being left alone.

Conclusions: Facing severe obstetric events entails exposure to emotionally demanding situations and hence joint vulnerability. Midwives and obstetricians described a sense of loneliness and perceptions of insecurity regarding the organisational system, managers and colleagues, following a complex, severe event with a woman or her baby during childbirth.

Place, publisher, year, edition, pages
ELSEVIER IRELAND LTD, 2020
Keywords
Adverse event, Midwife, Obstetrician, Second victim, Severe event, Teamwork
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-408933 (URN)10.1016/j.srhc.2019.100483 (DOI)000520945600006 ()31810050 (PubMedID)
Available from: 2020-04-27 Created: 2020-04-27 Last updated: 2020-04-27Bibliographically approved
Palm, A., Högberg, U., Olofsson, N., Skalkidou, A. & Danielsson, I. (2020). No Differences in Health Outcomes After Routine Inquiry About Violence Victimization in Young Women: A Randomized Controlled Study in Swedish Youth Health Centers. Journal of Interpersonal Violence, 35(1-2), 77-99
Open this publication in new window or tab >>No Differences in Health Outcomes After Routine Inquiry About Violence Victimization in Young Women: A Randomized Controlled Study in Swedish Youth Health Centers
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2020 (English)In: Journal of Interpersonal Violence, ISSN 0886-2605, E-ISSN 1552-6518, Vol. 35, no 1-2, p. 77-99Article in journal (Refereed) Published
Abstract [en]

Youth is a period in life when the risk of violence victimization is high and association between victimization and ill health is well established. Youth rarely reveal violence victimization to health professionals if not directly asked but favor health professionals asking about victimization. The study’s primary aim was to examine health outcomes in young women being routinely asked about violence victimization and offered subsequent support, compared with controls, at 12-month follow-up. Secondary aims were to examine to what extent routine inquiry altered the consultation and re-victimization rates during the study period. A randomized controlled intervention study was conducted at Swedish youth health centers. Participants assigned to the intervention group were asked structured questions about violence. Victimized participants received empowering strategies and were offered further counseling. Participants in the control group completed questionnaires about victimization after the visit. Both groups answered questions about sociodemographics and health, constructed from validated instruments. A questionnaire was administered to all participants 12 months after baseline. Of 1,445 eligible young women, 1,051 (73%) participated, with 54% of the participants completing the 12-month follow-up. Lifetime violence victimization was reported by 53% in the intervention group and 60% in the control group, ns. There were no significant differences in health outcomes, between baseline and 12-month follow-up, within either group or between groups. Re-victimization rates were 16% in the intervention group and 12% in the control group, ns. Of victimized young women in the intervention group, 14% wanted and received further counseling. Routine inquiry about violence victimization and empowering strategies were feasible within ordinary consultations at youth health centers but did not demonstrate improved health outcomes at 12-month follow-up compared with controls. Questions about violence led to a high degree of disclosure, and 14% of victimized young women in the intervention group received further counseling as a result.

Keywords
violence victim, youth, screening, health, randomized controlled trial, treatment outcome
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-307391 (URN)10.1177/0886260516681878 (DOI)000503281100004 ()27909178 (PubMedID)
Funder
The Swedish Crime Victim Compensation and Support Authority
Note

Title in thesis list of papers: No differences in health outcomes after routine inquiry into violence victimization in young women – A randomized controlled study in Swedish youth health centers

Available from: 2016-11-14 Created: 2016-11-14 Last updated: 2020-02-25Bibliographically approved
Boene, H., Mocumbi, S., Högberg, U., Hanson, C., Valá, A., Bergström, A., . . . Munguambe, K. (2020). Obstetric fistula in southern Mozambique: a qualitative study on women’s experiences of care pregnancy, delivery and post-partum. Reproductive Health, 17, Article ID 21.
Open this publication in new window or tab >>Obstetric fistula in southern Mozambique: a qualitative study on women’s experiences of care pregnancy, delivery and post-partum
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2020 (English)In: Reproductive Health, ISSN 1742-4755, E-ISSN 1742-4755, Vol. 17, article id 21Article in journal (Refereed) Published
Abstract [en]

Background: Obstetric fistula is still common in low- and middle-income countries (LMIC) despite the on-going shift to increased facility deliveries in the same settings. The social behavioural circumstances in which fistula, as well as its consequences, still occur are poorly documented, particularly from the perspective of the experiences of women with obstetric fistula. This study sought to describe women’s experiences of antenatal, partum and post-partum care in southern Mozambique, and to pinpoint those experiences that are unique to women with fistula in order to understand the care-seeking and care provision circumstances which could have been modified to avoid or mitigate the onset or consequences of fistula.

Methods: This study took place in Maputo and Gaza provinces, southern Mozambique, in 2016–2017. Qualitative data were collected through in-depth interviews conducted with 14 women with positive diagnoses of fistula and an equal number of women without fistula. All interviews were audio-recorded and transcribed verbatim prior to thematic analysis using NVivo11.

Results: Study participants had all attended antenatal care (ANC) visits and had prepared for a facility birth. Prolonged or obstructed labour, multiple referrals, and delays in receiving secondary and tertiary health care were common among the discourses of women with fistula. The term “fistula” was rarely known among participants, but the condition (referred to as “loss of water” or “illness of spillage”) was recognised after being prompted on its signs and symptoms. Women with fistula were invariably aware of the links between fistula and poor birth assistance, in contrast with those without fistula, who blamed the condition on women’s physiological and behavioural characteristics.

Conclusion: Although women do seek antenatal and peri-partum care in health facilities, deficiencies and delays in birth assistance, referral and life-saving interventions were commonly reported by women with fistula. Furthermore, weaknesses in quality of care, not only in relation to prevention, but also the resolution of the damage, were evident. Quality improvement of birth care is necessary, both at primary and referral level. There is a need to increase awareness and develop guidelines for prevention, early detection and management of obstetric fistula, including early postpartum treatment, availability of fistula repair for complex cases, and rehabilitation, coupled with the promotion of community consciousness of the problem.

Keywords
obstetric fistula, women’s experiences, quality of care, Mozambique.
National Category
Public Health, Global Health, Social Medicine and Epidemiology Obstetrics, Gynecology and Reproductive Medicine
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-380579 (URN)10.1186/s12978-020-0860-0 (DOI)000511996900002 ()32005268 (PubMedID)
Note

Title in dissertation list of papers: Obstetric fistula in southern Mozambique: a qualitative study on women’s experiences and perspectives

Available from: 2019-03-29 Created: 2019-03-29 Last updated: 2020-03-23Bibliographically approved
Högberg, U., Squier, W., Andersson, J., Högberg, G., Fellman, V., Thiblin, I. & Wester, K. (2019). Do inter-country differences in the frequency of abusive head trauma reflect different proportions of overdiagnosis of abuse or true differences of abuse?. Journal of Epidemiology
Open this publication in new window or tab >>Do inter-country differences in the frequency of abusive head trauma reflect different proportions of overdiagnosis of abuse or true differences of abuse?
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2019 (English)In: Journal of Epidemiology, ISSN 0917-5040, E-ISSN 1349-9092Article in journal (Refereed) Epub ahead of print
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-404735 (URN)10.2188/jea.JE20190066 (DOI)31178472 (PubMedID)
Available from: 2020-02-26 Created: 2020-02-26 Last updated: 2020-02-26
Gunnarsdóttir, J., Akhter, T., Högberg, U., Cnattingius, S. & Wikström, A.-K. (2019). Elevated diastolic blood pressure until mid-gestation is associated with preeclampsia and small-for-gestational-age birth: a population-based register study. BMC Pregnancy and Childbirth, 19, 1-8, Article ID 186.
Open this publication in new window or tab >>Elevated diastolic blood pressure until mid-gestation is associated with preeclampsia and small-for-gestational-age birth: a population-based register study
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2019 (English)In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 19, p. 1-8, article id 186Article in journal (Refereed) Published
Abstract [en]

Background: Gestational hemodynamic adaptations, including lowered blood pressure (BP) until mid-gestation, might benefit placental function. We hypothesized that elevated BP from early to mid-gestation increases risks of preeclampsia and small-for-gestational-age birth (SGA), especially in women who also deliver preterm (< 37 weeks). Methods: In 64,490 healthy primiparous women, the change in systolic and diastolic BP from early to midgestation was categorized into lowered (≥ 0 mmHg decreased), and elevated (≥ 1 mmHg increase). Women with chronic hypertension, chronic renal disease, pre-gestational diabetes and systemic lupus erythematosus were excluded. Risks of preeclampsia and SGA birth were estimated by logistic regression, presented with adjusted odds ratio (aOR) and 95% confidence intervals (CI). Further, the effect of BP change in combination with stage 1 hypertension (systolic BP 130–139 mmHg or diastolic BP 80–89 mmHg) in early gestation was estimated. Results: Compared to women with lowered diastolic BP from early to mid-gestation, those with elevated diastolic BP had increased risks of preeclampsia (aOR: 1.8 [1.6–2.0]) and SGA birth (aOR: 1.3 [1.2–1.5]). The risk estimates were higher for preeclampsia and SGA when combined with preterm birth (aORs: 2.2 [1.8–2.8] and 2.3 [1.8–3.0], respectively). The highest rate of preeclampsia (9.9%) was seen in women with stage 1 hypertension in early gestation and a diastolic BP that was elevated until mid-gestation. This was three times the risk, compared to women with normal BP in early gestation and a diastolic BP that was decreased until mid-gestation. The association between elevated systolic BP from early to mid-gestation and preeclampsia was weak, and no significant association was found between changes in systolic BP and SGA births. Conclusion: Elevated diastolic BP from early to mid-gestation was associated with increased risks of preeclampsia and SGA, especially for women also delivering preterm. The results may imply that the diastolic BP starts to increase around mid-gestation in women later developing placental dysfunction disorders

Keywords
Blood pressure, Preeclampsia, Foetal growth restriction, Small-for-gestational-age
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-320672 (URN)10.1186/s12884-019-2319-2 (DOI)000469343400003 ()31138157 (PubMedID)
Funder
Swedish Research Council, 2014–3561Stockholm County Council, 20150118, SCThe Karolinska Institutet's Research Foundation
Available from: 2017-04-23 Created: 2017-04-23 Last updated: 2019-06-24Bibliographically approved
Högberg, U., Andersson, J., Högberg, G. & Thiblin, I. (2019). High Risk of Bias in a Systematic Review of Rib Fractures and Abuse by Paine et al (2019).. Pediatric emergency care
Open this publication in new window or tab >>High Risk of Bias in a Systematic Review of Rib Fractures and Abuse by Paine et al (2019).
2019 (English)In: Pediatric emergency care, ISSN 0749-5161, E-ISSN 1535-1815Article in journal (Refereed) Epub ahead of print
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-404733 (URN)10.1097/PEC.0000000000001832 (DOI)30964848 (PubMedID)
Available from: 2020-02-26 Created: 2020-02-26 Last updated: 2020-02-26
Högberg, U., Sennerstam, R., Wester, K., Högberg, G., Andersson, J. & Thiblin, I. (2019). Medical diagnoses among infants at entry in out-of-home care: A Swedish population-register study.. Health science reports, 2(8), Article ID e133.
Open this publication in new window or tab >>Medical diagnoses among infants at entry in out-of-home care: A Swedish population-register study.
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2019 (English)In: Health science reports, ISSN 2398-8835, Vol. 2, no 8, article id e133Article in journal (Refereed) Published
Abstract [en]

Background and aims: Identification of child abuse involves a medical investigation and assessment of problems related to social environment and upbringing and might necessitate out-of-home care. The objective of this study was to analyse infants placed in out-of-home care in Sweden by incidence, medical diagnoses, and perinatal factors.

Methods: This was a population-based register study of infants born in Sweden 1997 to 2014. Data were retrieved from registers at the Swedish National Board of Health and Welfare and Statistics Sweden. Outcome measures were out-of-home care categories: (a) "Problems Related to Social Environment/Upbringing", (b) "Abuse diagnoses without SDH (subdural haemorrhage), RH (retinal haemorrhage), rib fracture, or long bone fracture", and (c) "SDH, RH, rib fracture, or long bone fracture." As a reference population, we randomly selected infants without medical diagnoses born the same year.

Results: Overall incidence of out-of-home care was 402 per 100 000. For subcategories (a), (b), and (c), the incidences were 14.8 (n = 273), 3.77 (n = 70), and 9.83 (n = 182) per 100 000, respectively. During the study period, the first remained unchanged; the latter two have been increasing. Compared with other reasons for out-of-home care, children in category (c), "SDH, RH, rib fracture, or long bone fracture", had increased odds of being boys (adjusted odds ratio [aOR] 1.60; 95% confidence interval [CI], 1.08-2.38) and decreased odds of having a mother being single (aOR 0.49; 95% CI, 0.32-0.75) and a smoker (aOR 0.60; 95% CI, 0.37-0.96). Compared with the reference population, children in this category were more often twin born (7.7% versus 2.8%), preterm (18.5% versus 5.5%), and small-for-gestational age (5.2% versus 2.1%).

Conclusion: SDH, RH, rib fracture, or long bone fracture constitute a minor part of medical diagnoses for infants entered in out-of-home care, but have been increasing, both in numbers and proportion. Overdiagnosis of abuse might be a possible reason but cannot be ascertained by this study design.

Keywords
evidence‐based practice, infant welfare, medical errors, out‐of‐home care, shaken baby syndrome
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-404736 (URN)10.1002/hsr2.133 (DOI)31463369 (PubMedID)
Available from: 2020-02-26 Created: 2020-02-26 Last updated: 2020-02-26
Mocumbi, S., Högberg, U., Lampa, E., Sacoor, C., Vala, A., Bergström, A., . . . Madhavan, M. (2019). Mothers' satisfaction with care during facility-based childbirth: a cross-sectional survey in southern Mozambique. BMC Pregnancy and Childbirth, 19(1), Article ID 303.
Open this publication in new window or tab >>Mothers' satisfaction with care during facility-based childbirth: a cross-sectional survey in southern Mozambique
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2019 (English)In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 19, no 1, article id 303Article in journal (Refereed) Published
Abstract [en]

Background Client satisfaction is an essential component of quality of care. Health system factors, processes of care as well as mothers' characteristics influence the extent to which care meets the expectations of mothers and families. In our study, we specifically aimed to address the mothers' experiences of, and satisfaction with, care during childbirth. Methods A population-based cross-sectional study, using structured interviews with published sequences of questions assessing satisfaction, including 4358 mothers who gave birth during the 12 months before June 2016 to estimate satisfaction with childbirth care. Regression analysis was used to determine the predictors of client satisfaction. Results Most mothers (92.5%) reported being satisfied with care during childbirth and would recommend that a family member to deliver at the same facility. Specifically, 94.7% were satisfied with the cleanliness of the facility, 92.0% reported being satisfied with the interaction with the healthcare providers, but only 49.8% felt satisfied with the assistance to feed their baby. Mothers who had negative experiences during the process of care, such as being abandoned when needing help, disrespect, humiliation, or physical abuse, reported low levels of satisfaction when compared to those who had not had such experiences (68.5% vs 93.5%). Additionally, they reported higher levels of dissatisfaction (20.1% vs 2.1%). Regression analysis revealed that mothers who gave birth in primary level facilities tended to be more satisfied than those who gave birth in hospitals, and having a companion increased, on average, the overall satisfaction score, with 0.06 in type II health centres (CI 0.03-0.10) and with 0.05 in type I health centres (CI - 0.02 - 0.13), compared to - 0.01(CI -0.08 - 0.07) in the hospitals, irrespective of age, education and socio-economic background. Conclusion Childbirth at the primary level facilities contributes to the level of satisfaction. The provision of childbirth care should consider women's preferences and needs, including having a companion of choice. We highlight the challenge in balancing safety of care versus satisfaction with care and in developing policies on the optimum configuration of childbirth care. Interventions to improve the interaction with providers and the provision of respectful care are recommended.

Place, publisher, year, edition, pages
BMC, 2019
Keywords
Satisfaction with care, Experiences of care, Facility-based childbirth
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-398861 (URN)10.1186/s12884-019-2449-6 (DOI)000482898900002 ()31426758 (PubMedID)
Available from: 2019-12-11 Created: 2019-12-11 Last updated: 2019-12-11Bibliographically approved
Högberg, U., Winbo, J. & Fellman, V. (2019). Population-based register study of children born in Sweden from 1997 to 2014 showed an increase in rickets during infancy. Acta Paediatrica, 108(11), 2034-2040
Open this publication in new window or tab >>Population-based register study of children born in Sweden from 1997 to 2014 showed an increase in rickets during infancy
2019 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 108, no 11, p. 2034-2040Article in journal (Refereed) Published
Abstract [en]

Aim: This population-based study assessed the incidence of rickets in infants up to age of one born in Sweden from 1997 to 2014. We also examined maternal and perinatal factors and co-morbidity.

Methods: We used Swedish National Board of Health and Welfare registers and data from Statistics Sweden. The outcome measure was an International Classification of Diseases, Tenth Revision, code for rickets.

Results: There were 273 cases of rickets, with an incidence of 14.7 per 100 000 and a 10-fold incidence increase between 1997 and 2014. The majority (78.4%) were born preterm, half were small-for-gestational age (SGA) (birthweight <10th percentile), 4.8% were born to Asian-born mothers and 3.5% to African-born mothers. The adjusted odds ratios by birth week were 182 (95% CI: 121-272) before 32 weeks and 10.8 (95% CI: 6.72-17.4) by 32-36 weeks. Preterm infants with necrotising enterocolitis had very high odds for rickets and so did SGA term-born infants and those born to African-born mothers. The odds for rickets among preterm infants increased considerably during the later years.

Conclusion: Rickets increased 10-fold in Sweden from 1997 to 2014 and was mainly associated with prematurity, SGA and foreign-born mothers. Possible reasons may include increased preterm survival rates and improved clinical detection and registration.

Place, publisher, year, edition, pages
WILEY, 2019
Keywords
Incidence, Infants, Metabolic bone disease, Rickets, Vitamin D deficiency
National Category
Pediatrics
Identifiers
urn:nbn:se:uu:diva-396436 (URN)10.1111/apa.14835 (DOI)000489595000015 ()31050835 (PubMedID)
Available from: 2019-11-05 Created: 2019-11-05 Last updated: 2019-11-05Bibliographically approved
Lindström, L., Wikström, A.-K., Bergman, E., Mulic-Lutvica, A., Högberg, U., Ahlsson, F. & Lundgren, M. (2019). Postnatal growth in children born small for gestational age with and without smoking mother. Pediatric Research, 85(7), 961-966
Open this publication in new window or tab >>Postnatal growth in children born small for gestational age with and without smoking mother
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2019 (English)In: Pediatric Research, ISSN 0031-3998, E-ISSN 1530-0447, Vol. 85, no 7, p. 961-966Article in journal (Refereed) Published
Abstract [en]

Background: Maternal smoking impairs fetal growth; however, if postnatal growth differs between children born small for gestational age (SGA) with smoking and non-smoking mother is unknown.

Methods: Cohort-study of term born children born appropriate for gestational age with non-smoking mother (AGA-NS, n=30,561), SGA (birthweight <10th percentile) with smoking mother (SGA-S, n=171) or SGA with non-smoking mother (SGA-NS, n=1761). Means of height and weight measurements, collected at birth, 1.5, 3, 4 and 5 years, were compared using a generalized linear mixed effect model. Relative risks of short stature (<10th percentile) were expressed as adjusted risk ratios (aRR).

Results: At birth, children born SGA-S were shorter than SGA-NS, but they did not differ in weight. At 1.5 years, SGA-S had reached the same height as SGA-NS. At 5 years, SGA-S were 1.1 cm taller and 1.2 kg heavier than SGA-NS. Compared with AGA-NS, SGA-S did not have increased risk of short stature at 1.5 or 5 years, while SGA-NS had increased risk of short stature at both ages; aRRs 3.0 (95% CI 2.6;3.4) and 2.3 (95% CI 2.0;2.7), respectively.

Conclusions: Children born SGA-S have a more rapid catch-up growth than SGA-NS. This may have consequences for metabolic and cardiovascular health in children with smoking mothers.

National Category
Obstetrics, Gynecology and Reproductive Medicine Pediatrics
Identifiers
urn:nbn:se:uu:diva-374779 (URN)10.1038/s41390-019-0352-5 (DOI)000468524800013 ()30808020 (PubMedID)
Funder
Swedish Research Council, 2014-3561
Available from: 2019-01-24 Created: 2019-01-24 Last updated: 2019-09-05Bibliographically approved
Projects
Publicering: Vita rockar och bruna skjortor ? nazimedicinen och läkare på flykt [2009-02146_Forte]; Umeå University
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-2121-7511

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