uu.seUppsala University Publications
Change search
Refine search result
1234567 1 - 50 of 737
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Rows per page
  • 5
  • 10
  • 20
  • 50
  • 100
  • 250
Sort
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
Select
The maximal number of hits you can export is 250. When you want to export more records please use the Create feeds function.
  • 1.
    Aarts, Clara
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Kylberg, Elisabeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Hofvander, Yngve
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Gebre-Medhin, Meharigm
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Growth under privileged conditions of healthy Swedish infants exclusively breastfed from birth to 4-6 months:  a longitudinal prospective study based on daily records of feeding2003In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 92, no 2, p. 145-151Article in journal (Refereed)
    Abstract [en]

    Aim:

    In most studies the methodology used to study growth in relation to breastfeeding patterns cannot ensure that exclusive breastfeeding has in fact occurred since birth. The aim of this study was to investigate the growth of healthy infants in Sweden in whom exclusive breastfeeding for the first 4–6 mo was ascertained through daily feeding records and to compare the results with the World Health Organization (WHO) “12-month breastfed pooled data set” and the Euro-Growth references for exclusively breastfed infants, as well as with the National Center for Health Statistics (NCHS)/WHO reference.

    Methods:

    147 exclusively breastfed infants and 325 non-exclusively breastfed Swedish infants, with a birthweight of ≥3 kg, were included. The mothers had previous breastfed at least one infant for at least 4 mo. Weight was recorded fortnightly and length monthly.

    Results:

    Infants exclusively breastfed since birth showed similar growth in weight and height to that of the non-exclusively breastfed infants. During the first 6 mo of life the growth of exclusively breastfed infants was also similar to that of the infants regularly receiving formula at 12–16 wk of age, mostly in addition to breast milk. The monthly growth increments were fairly similar to those of the “WHO pooled breastfed data set” and the Euro-Growth references for exclusively breastfed infants.

    Conclusion:

    In an affluent society truly exclusively breastfed infants seem to have the same growth during the first half year of life as non-exclusively breastfed infants with a high breastfeeding rate.

  • 2.
    Aarts, Clara
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Kylberg, Elisabeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Hornell, A
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Hofvander, Yngve
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Gebre-Medhin, Mehari
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Greiner, Ted
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    How exclusive is exclusive breastfeeding? A comparison of data since birth with current status data:  2000In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 29, no 6, p. 1041-1046Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    There is no accepted and widely used indicator for exclusive breastfeeding since birth. Indeed, the difference between 'current status' data on exclusive breastfeeding and data on 'exclusive breastfeeding since birth' is rarely recognized. We used data from a longitudinal study to examine this issue.

    METHODS:

    A descriptive longitudinal, prospective study design was used in which 506 mother-infant pairs were included. The mothers completed daily recordings on infant feeding during the first nine months after birth. A research assistant conducted fortnightly home visits with structured interviews. The resulting data on breastfeeding patterns are presented in two different ways: analysis of 'current status' data based on a single 24-hour recording of infant feeding at 2, 4 and 6 months of age, and analysis of data 'since birth', i.e. data on infant feeding for every day, starting from birth until the ages of 2, 4 and 6 months.

    RESULTS:

    A wide discrepancy between the results obtained from the two analyses was found. The difference in the exclusive breastfeeding rate was over 40 percentage points at both 2 and 4 months of age (92% versus 51% at 2 months and 73% versus 30% at 4 months) and 9 percentage points at 6 months (11% versus 1.8%).

    CONCLUSIONS:

    Current status indicators based on a 24-hour period may be inadequate and even misleading for many purposes. We propose that in many studies an indicator called 'exclusive breastfeeding since birth' could be added.

  • 3.
    Abdulcadir, Jasmine
    et al.
    Outpatient Clinic for Women with FGM/C, Department of Obstetric and Gynecology, Geneva University Hospitals.
    Abdulcadir, Omar
    Referral Centre for Preventing and Curing Female Genital Mutilation, Department of Maternal and Child Health, Careggi University Hospital, Florence, Italy.
    Caillet, Martin
    Outpatient Clinic for Women with FGM/C, Department of Obstetric and Gynecology, Geneva University Hospitals.
    Catania, Lucrezia
    Referral Centre for Preventing and Curing Female Genital Mutilation, Department of Maternal and Child Health, Careggi University Hospital, Florence, Italy.
    Cuzin, Béatrice
    Division of Urology and Transplantation, Edouard Herriot Hospital, Lyon, France.
    Essén, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Maternal and Reproductive Health and Migration.
    Foldès, Pierre
    Institute of Reproductive Health, Saint Germain en Laye, Paris, France.
    Johnsdotter, Sara
    Faculty of Health and Society, Malmö University, Malmö, Sweden.
    Johnson-Agbakwu, Crista
    Refugee Women's Health Clinic, Obstetrics & Gynecology, Maricopa Integrated Health System.
    Nour, Nawal
    Global Ob/Gyn and African Women's Health Center, Ambulatory Obstetrics, Office for Multicultural Careers, Division of Global Obstetrics and Gynecology, Brigham and Women's Hospital.
    Ouedraogo, Charlemagne
    University Hospital Yalgado Ouedraogo of Ouagadougou, Ouagadougou, Burkina Faso.
    Warren, Nicole
    Department of Community Public Health Nursing, John Hopkins School of Nursing, Baltimore, MD, USA.
    Wylomanski, Sophie
    Department of Gynecology and Obstetrics, Nantes University Hospital, Nantes, France.
    Clitoral Surgery After Female Genital Mutilation/Cutting2017In: Aesthetic surgery journal, ISSN 1090-820X, E-ISSN 1527-330X, Vol. 37, no 9, p. NP113-NP115Article in journal (Other academic)
  • 4.
    Abdulcadir, Jasmine
    et al.
    Department of Obstetrics and Gynecology, University Hospitals of Geneva, Switzerland.
    Ahmadu, Fuambai Sia
    Catania, Lucrezia
    Essén, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Gruenbaum, Ellen
    Johnsdotter, Sara
    Johnson, Michelle C.
    Johnson-Agbakwu, Crista
    Kratz, Corinne
    Sulkin, Carlos Londoño
    McKinley, Michelle
    Njambi, Wairimu
    Rogers, Juliet
    Shell-Duncan, Bettina
    Shweder, Richard A.
    Human Development, University of Chicago, Illinois.
    Seven things to know about female genital surgeries in Africa2012In: The Hastings center report, ISSN 0093-0334, E-ISSN 1552-146X, Vol. 42, no 6, p. 19-27Article in journal (Refereed)
  • 5.
    Abeid, Muzdalifat
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Department of Obstetrics/Gynecology, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania .
    Muganyizi, Projestine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Department of Obstetrics/Gynecology, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania .
    Massawe, Siriel
    Department of Obstetrics/Gynecology, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania.
    Mpembeni, Rose
    Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania.
    Darj, Elisabeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Axemo, Pia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway .
    Knowledge and attitude towards rape and child sexual abuse - a community-based cross-sectional study in Rural Tanzania2015In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 15, no 1, article id 428Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Violence against women and children is globally recognized as a social and human rights concern. In Tanzania, sexual violence towards women and children is a public health problem. The aim of this study was to determine community knowledge of and attitudes towards rape and child sexual abuse, and assess associations between knowledge and attitudes and socio-demographic characteristics.

    METHODS: A cross-sectional study was undertaken between May and June 2012. The study was conducted in the Kilombero and Ulanga rural districts in the Morogoro Region of Tanzania. Men and women aged 18-49 years were eligible for the study. Through a three-stage cluster sampling strategy, a household survey was conducted using a structured questionnaire. The questionnaire included socio-demographic characteristics, attitudes about gender roles and violence, and knowledge on health consequences of rape. Data were analyzed using the Statistical Package for Social Sciences (SPSS) software, version 21. Main outcome measures were knowledge of and attitudes towards sexual violence. Multivariate analyses were used to assess associations between socio-demographic characteristics and knowledge of and attitudes towards sexual violence.

    RESULTS: A total of 1,568 participants were interviewed. The majority (58.4%) of participants were women. Most (58.3%) of the women respondents had poor knowledge on sexual violence and 63.8% had accepting attitudes towards sexual violence. Those who were married were significantly more likely to have good knowledge on sexual violence compared to the divorced/separated group (AOR = 1.6 (95% CI: 1.1-2.2)) but less likely to have non-accepting attitudes towards sexual violence compared to the single group (AOR = 1.8 (95%CI: 1.4-2.3)). Sex of respondents, age, marital status and level of education were associated with knowledge and attitudes towards sexual violence.

    CONCLUSIONS: Our study showed that these rural communities have poor knowledge on sexual violence and have accepting attitudes towards sexual violence. Increasing age and higher education were associated with better knowledge and less accepting attitudes towards sexual violence. The findings have potentially important implications for interventions aimed at preventing violence. The results highlight the challenges associated with changing attitudes towards sexual violence, particularly as the highest levels of support for such violence were found among women.

  • 6.
    Abeid, Muzdalifat
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Muhimbili University of Health and Allied Sciences, Tanzania.
    Muganyizi, Projestine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Muhimbili University of Health and Allied Sciences, Tanzania.
    Mpembeni, Rose
    Muhimbili University of Health and Allied Sciences, Tanzania.
    Darj, Elisabeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Norwegian University of Science and Technology, Trondheim, Norway.
    Axemo, Pia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    A community-based intervention for improving health-seeking behavior among sexual violence survivors: A controlled before and after design study in rural Tanzania2015In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 8, article id 28608Article in journal (Refereed)
    Abstract [en]

    Background: Despite global recognition that sexual violence is a violation of human rights, evidence still shows it is a pervasive problem across all societies. Promising community intervention studies in the low- and middle-income countries are limited.

    Objective: This study assessed the impact of a community-based intervention, focusing on improving the community’s knowledge and reducing social acceptability of violence against women norms with the goal to prevent and respond to sexual violence.

    Design: The strategies used to create awareness included radio programs, information, education communication materials and advocacy meetings with local leaders. The intervention took place in Morogoro region in Tanzania. The evaluation used a quasi-experimental design including cross-sectional surveys at baseline (2012) and endline (2014) with men and women aged 18-49. Main outcome measures were number of reported rape cases at health facilities and the community’s knowledge and attitudes towards sexual violence.

    Results: The number of reported rape events increased by more than 50% at health facilities during the intervention. Knowledge on sexual violence increased significantly in both areas over the study period (from 57.3% to 80.6% in the intervention area and from 55.5% to 71.9% in the comparison area; p<.001), and the net effect of the intervention between the two areas was statistically significant (6.9, 95% CI 0.2–13.5, p= 0.03). There was significant improvement in most of attitude indicators in the intervention area, but not in the comparison area. However, the intervention had no significant effect in the overall scores of acceptance attitudes in the final assessment when comparing the two areas (-2.4, 95%CI: -8.4 – 3.6, p= 0.42).

    Conclusions: The intervention had an effect on some indicators on knowledge and attitudes towards sexual violence even after a short period of intervention. This finding informs the public health practitioners of the importance of combined strategies in achieving changes.

  • 7.
    Abeid, Muzdalifat
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). MUHAS, Dept Obstet Gynecol, Dar Es Salaam, Tanzania.
    Muganyizi, Projestine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). MUHAS, Dept Obstet Gynecol, Dar Es Salaam, Tanzania.
    Mpembeni, Rose
    MUHAS, Dept Epidemiol & Biostat, Dar Es Salaam, Tanzania.
    Darj, Elisabeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Norwegian Univ Sci & Technol, Dept Publ Hlth & Gen Practice, Trondheim, Norway.
    Axemo, Pia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Evaluation of a training program for health care workers to improve the quality of care for rape survivors: a quasi-experimental design study in Morogoro, Tanzania2016In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 9, article id 31735Article, review/survey (Refereed)
    Abstract [en]

    BACKGROUND:

    Sexual violence against women and children in Tanzania and globally is a human rights violation and a developmental challenge.

    OBJECTIVE:

    The aim of this study was to assess the impact of training health professionals on rape management. The specific objectives were to evaluate the changes of knowledge and attitudes toward sexual violence among a selected population of health professionals at primary health care level.

    DESIGN:

    A quasi-experimental design using cross-sectional surveys was conducted to evaluate health care workers' knowledge, attitude, and clinical practice toward sexual violence before and after the training program. The study involved the Kilombero (intervention) and Ulanga (comparison) districts in Morogoro region. A total of 151 health professionals at baseline (2012) and 169 in the final assessment (2014) participated in the survey. Data were collected using the same structured questionnaire. The amount of change in key indicators from baseline to final assessment in the two areas was compared using composite scores in the pre- and post-interventions, and the net intervention effect was calculated by the difference in difference method.

    RESULTS:

    Overall, there was improved knowledge in the intervention district from 55% at baseline to 86% and a decreased knowledge from 58.5 to 36.2% in the comparison area with a net effect of 53.7% and a p-value less than 0.0001. The proportion of participants who exhibited an accepting attitude toward violence declined from 15.3 to 11.2% in the intervention area but increased from 13.2 to 20.0% in the comparison area.

    CONCLUSIONS:

    Training on the management of sexual violence is feasible and the results indicate improvement in healthcare workers' knowledge and practice but not attitudes. Lessons learned from this study for successful replication of such an intervention in similar settings require commitment from those at strategic level within the health service to ensure that adequate resources are made available.

  • 8.
    Abuelgasim, Khalda
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
     “Who do I turn to?” The experiences of Sudanese women and Eritrean refugee women when trying to access healthcare services in Sudan after being subject to gender-based violence2018Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Aim: To explore the experiences of Sudanese women and Eritrean refugee women in Sudan when seeking healthcare after being subject to gender-based violence.

    Background: In Sudan there is a general assumption that anyone who is subject violence, including gender-based violence, must first go to the police department to file a report and be given “Form Eight”, a legal document, which they must present to the healthcare provider before they receive any care. Without this form healthcare providers are, supposedly, by law not allowed to treat the person. This complicates an already vague system of services for women subject to gender-based violence.

    Methods: A qualitative study using semi-structured interviews of eight Sudanese women and seven Eritrean refugee women. Data was analyzed through a framework analysis (a form of thematic analysis).

    Results: Women had to bring Form Eight before they received any help, this led to a delay in the time to receive care. There was a general lack of cooperation by police officers. Some women feared the consequences of help seeking, apparent amongst those subject to domestic violence and the Eritrean refugee women. Generally, the healthcare provided to these women was inadequate.

    Conclusion: This study concludes the experiences of all the women in this study when seeking healthcare after being subject to gender-based violence were far from international standards. A lot needs to be done in order for women to know the clear answer to the question posed in the title of this study; “Who do I turn to?”.

  • 9.
    Adams, Emma A.
    et al.
    Norwegian Univ Sci & Technol, NTNU, Dept Publ Hlth & Nursing, NO-7491 Trondheim, Norway;Ontario Shores Ctr Mental Hlth Sci, Strateg Initiat, Whitby, ON, Canada.
    Darj, Elisabeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Norwegian Univ Sci & Technol, NTNU, Dept Publ Hlth & Nursing, NO-7491 Trondheim, Norway;St Olavs Univ Hosp, Dept Obstet & Gynecol, Trondheim, Norway.
    Wijewardene, Kumudu
    Univ Sri Jayewardenepura, Fac Med Sci, Dept Community Med Hlth, Nugegoda, Sri Lanka.
    Infanti, Jennifer J.
    Norwegian Univ Sci & Technol, NTNU, Dept Publ Hlth & Nursing, NO-7491 Trondheim, Norway.
    Perceptions on the sexual harassment of female nurses in a state hospital in Sri Lanka: a qualitative study2019In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 12, no 1, article id 1560587Article in journal (Refereed)
    Abstract [en]

    Background:

    Sexual harassment occurs within the nursing profession globally, challenging the health and safety of nurses and the quality and efficiency of health systems. In Sri Lanka, no studies have explored this issue in the health sector; however, female employees face sexual harassment in other workplace settings.

    Objective:

    To explore female nurses' perceptions of workplace sexual harassment in a large state hospital in Sri Lanka.

    Methods:

    This is a qualitative study conducted in an urban, mainly Buddhist and Singhalese context. We invited all female senior and ward nurses working in the hospital to participate in the study. We conducted individual in-depth interviews with four senior nurses and focus group discussions with 29 nurses in three groups.

    Results:

    The nurses described a variety of perceived forms of sexual harassment in the hospital. They discussed patient-perpetrated incidents as the most threatening and the clearest to identify compared with incidents involving doctors and other co-workers. There was significant ambiguity regarding sexual consent and coercion in relationships between female nurses and male doctors, which were described as holding potential for exploitation or harassment. The nurses reported that typical reactions to sexual harassment were passive. Alternatively, they described encountering inaction or victim blaming when they attempted to formally report incidents. They perceived that workplace sexual harassment has contributed to negative societal attitudes about the nursing profession and discussed various informal strategies, such as working in teams, to protect themselves from sexual harassment in the hospital.

    Conclusions:

    Sexual harassment was a perceived workplace concern for nurses in this hospital. To develop effective local prevention and intervention responses, further research is required to determine the magnitude of the problem and explore differences in responses to and consequences of sexual harassment based on perpetrator type and intent, and personal vulnerabilities of the victims, among other factors.

  • 10.
    Adel, Rabie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Challenges facing Pro-life and Pro-choice organisations within Warsaw, Poland2015Independent thesis Advanced level (degree of Master (Two Years)), 180 HE creditsStudent thesis
  • 11. Adeniran, Abosede
    et al.
    Likaka, Andrew
    Knutsson, Anneka
    Costello, Anthony
    Daelmans, Bernadette
    Maliqi, Blerta
    Burssa, Daniel
    Freer, Joseph
    Askew, Ian
    Bowen, Lisa
    Kak, Lily
    McDougall, Lori
    Zaka, Nabila
    Tunçalp, Özge
    Tenhoope-Bender, Petra
    Syed, Shamsuzzoha Babar
    Swartling Peterson, Stefan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Child Health and Nutrition.
    Luchesi, Thiago
    Zeck, Willibald
    Were, Wilson
    Barker, Pierre
    Naimy, Zainab
    Leadership, action, learning and accountability to deliver quality care for women, newborns and children.2018In: Bulletin of the World Health Organization, ISSN 0042-9686, E-ISSN 1564-0604, Vol. 96, no 3, p. 222-224Article in journal (Refereed)
  • 12.
    Adolphson, Katja
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Axemo, Pia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Högberg, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Midwives' experiences of working conditions, perceptions of professional role and attitudes towards mothers in Mozambique2016In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 40, p. 95-101Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: low- and middle-income countries still have a long way to go to reach the fifth Millennium Development Goal of reducing maternal mortality. Mozambique has accomplished a reduction of maternal mortality since the 1990s, but still has among the highest in the world. A key strategy in reducing maternal mortality is to invest in midwifery. AIM: the objective was to explore midwives' perspectives of their working conditions, their professional role, and perceptions of attitudes towards mothers in a low-resource setting. SETTING: midwives in urban, suburban, village and remote areas; working in central, general and rural hospitals as well as health centres and health posts were interviewed in Maputo City, Maputo Province and Gaza Province in Mozambique. METHOD: the study had a qualitative research design. Nine semi-structured interviews and one follow-up interview were conducted and analysed with qualitative content analysis. RESULTS: two main themes were found; commitment/devotion and lack of resources. All informants described empathic care-giving, with deep engagement with the mothers and highly valued working in teams. Lack of resources prevented the midwives from providing care and created frustration and feelings of insufficiency. CONCLUSIONS: the midwives perceptions were that they tried to provide empathic, responsive care on their own within a weak health system which created many difficulties. The great potential the midwives possess of providing quality care must be valued and nurtured for their competency to be used more effectively.

  • 13.
    Ahlberg, Beth Maina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Maternal and Reproductive Health and Migration. Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Sociology.
    Hamed, Sarah
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Sociology.
    Thapar-Björkert, Suruchi
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Government.
    Bradby, Hannah
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Sociology.
    Invisibility of Racism in the Global Neoliberal Era: Implications for Researching Racism in Healthcare2019In: Frontiers in Sociology, ISSN 2297-7775Article in journal (Refereed)
    Abstract [en]

    This paper describes the difficulties of researching racism in healthcare contexts as part of the wider issue of neoliberal reforms in welfare states in the age of global migration. In trying to understand the contradiction of a phenomenon that is historical and strongly felt by individuals and yet widely denied by both institutions and individuals, we consider the current political and socioeconomic context of healthcare provision. Despite decades of legislation against racism, its presence persists in healthcare settings, but data on these experiences is rarely gathered in Europe. National systems of healthcare provision have been subject to neoliberal reforms, where among others, cheaper forms of labor are sought to reduce the cost of producing healthcare, while the availability of services is rationed to contain demand. The restriction both on provision of and access to welfare, including healthcare, is unpopular among national populations. However, the explanations for restricted access to healthcare are assumed to be located outside the national context with immigrants being blamed. Even as migrants are used as a source of cheap labor in healthcare and other welfare sectors, the arrival of immigrants has been held responsible for restricted access to healthcare and welfare in general. One implication of (im)migration being blamed for healthcare restrictions, while racism is held to be a problem of the past, is the silencing of experiences of racism, which has dire consequences for ethnic minority populations. The implications of racism as a form of inequality within healthcare and the circumstances of researching racism in healthcare and its implication for the sociology of health in Sweden are described.

  • 14.
    Ahlberg, Beth Maina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Njoroge, Kezia Muthoni
    School of Health, Community of Education Studies, Northumbria University, Newcastle upon Tyne, UK.
    'Not men enough to rule!': politicization of ethnicities and forcible circumcision of Luo men during the postelection violence in Kenya2013In: Ethnicity and Health, ISSN 1355-7858, E-ISSN 1465-3419, Vol. 18, no 5, p. 454-468Article in journal (Refereed)
    Abstract [en]

    Background

    As a contribution to ongoing research addressing sexual violence in war and conflict situations in the Democratic Republic of Congo, Kenya and Rwanda, this paper argues that the way sexual violence intersects with other markers of identity, including ethnicity and class, is not clearly articulated. Male circumcision has been popularized, as a public health strategy for prevention of HIV transmission, although evidence of its efficacy is disputable and insufficient attention has been given to the social and cultural implications of male circumcision.

    Methods

    This paper draws from media reporting and the material supporting the prosecutor at the International Criminal Court case against four Kenyans accused of crimes against humanity, to explore the postelection violence, especially forcible male circumcision.

    Results

    During the postelection violence in Kenya, women were, as in other conflict situations, raped. In addition, men largely from the Luo ethnic group were forcibly circumcised. Male circumcision among the Gikuyu people is a rite of passage, but when forced upon the Luo men, it was also associated with cases of castration and other forms of genital mutilation. The aim appears to have been to humiliate and terrorize not just the individual men, but their entire communities. The paper examines male circumcision and questions why a ritual that has marked a life-course transition for inculcating ethical analysis of the self and others, became a tool of violence against men from an ethnic group where male circumcision is not a cultural practice.

    Conclusion

    The paper then reviews the persistence and change in the ritual and more specifically, how male circumcision has become, not just a sexual health risk, but, contrary to the emerging health discourse and more significantly, a politicized ethnic tool and a status symbol among the Gikuyu elite. In the view of the way male circumcision was perpetrated in Kenya, we argue it should be considered as sexual violence, with far-reaching consequences for men's physical and mental health.

  • 15.
    Ahrne, Malin
    et al.
    Karolinska Inst, Dept Womens & Childrens Hlth, Tomtebodavagen 18A,8th Floor, SE-17177 Stockholm, Sweden.
    Shytt, Erica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna. Karolinska Inst, Dept Womens & Childrens Hlth, Tomtebodavagen 18A,8th Floor, SE-17177 Stockholm, Sweden;Western Norway Univ Appl Sci, Fac Hlth & Social Sci, Haugesund, Norway.
    Andersson, Ewa
    Karolinska Inst, Dept Womens & Childrens Hlth, Tomtebodavagen 18A,8th Floor, SE-17177 Stockholm, Sweden.
    Small, Rhonda
    Karolinska Inst, Dept Womens & Childrens Hlth, Tomtebodavagen 18A,8th Floor, SE-17177 Stockholm, Sweden;La Trobe Univ, Judith Lumley Ctr, Melbourne, Vic, Australia.
    Adan, Aisha
    Karolinska Inst, Dept Womens & Childrens Hlth, Tomtebodavagen 18A,8th Floor, SE-17177 Stockholm, Sweden.
    Essén, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Maternal and Reproductive Health and Migration.
    Byrskog, Ulrika
    Dalarna Univ, Sch Educ Hlth & Social Studies, Falun, Sweden.
    Antenatal care for Somali-born women in Sweden: Perspectives from mothers, fathers and midwives2019In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 74, p. 107-115Article in journal (Refereed)
    Abstract [en]

    Objective:

    To explore Somali-born parents' experiences of antenatal care in Sweden, antenatal care midwives' experiences of caring for Somali-born parents, and their respective ideas about group antenatal care for Somali-born parents.

    Design:

    Eight focus group discussions with 2-8 participants in each were conducted, three with Somaliborn mothers, two with fathers and three with antenatal care midwives. The transcribed text was analysed using Attride-Stirling's tool "Thematic networks".

    Setting:

    Two towns in mid-Sweden and a suburb of the capital city of Sweden. Participants: Mothers (n = 16), fathers (n = 13) and midwives (n = 7) were recruited using purposeful sampling.

    Findings:

    Somali-born mothers and fathers in Sweden were content with many aspects of antenatal care, but they also faced barriers. Challenges in the midwife-parent encounter related to tailoring of care to individual needs, dealing with stereotypes, addressing varied levels of health literacy, overcoming communication barriers and enabling partner involvement. Health system challenges related to accessibility of care, limited resources, and the need for clear, but flexible routines and supportive structures for parent education. Midwives confirmed these challenges and tried to address them but sometimes lacked the support, resources and tools to do so. Mothers, fathers and midwives thought that language-supported group antenatal care might help to improve communication, provide mutual support and enable better dialogue, but they were concerned that group care should still allow privacy when needed and not stereotype families according to their country of birth.

    Key conclusions:

    ANC interventions targeting inequalities between migrants and non-migrants may benefit from embracing a person-centred approach, as a means to counteract stereotypes, misunderstandings and prejudice. Group antenatal care has the potential to provide a platform for person-centred care and has other potential benefits in providing high-quality antenatal care for sub-groups that tend to receive less or poor quality care. Further research on how to address stereotypes and implicit bias in maternity care in the Swedish context is needed. (c) 2019 The Authors. Published by Elsevier Ltd.

  • 16.
    Ahsan, Rumana
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Association of self-reported different aspects of workplace environment and general wellbeing with maximum workload – A cross- sectional study2018Independent thesis Advanced level (degree of Master (Two Years)), 80 credits / 120 HE creditsStudent thesis
    Abstract [en]

    Introduction

    Cardiovascular disease (CVD) is the leading cause of death globally and similarly in United Kingdom (UK), accounting for 31% and 45% annual deaths respectively. Workplace environment consists of different elements (e.g.- physical and psychosocial environment, intra and extra organizational settings) and interrelationship of employer and employee, playing an important role on workers’ health. Current study aims to identify the association of different aspects of workplace environment and general wellbeing with maximum workload (MW) in a working population in UK.

    Method

    A cross-sectional study has been done including a total of 77,781 working people aged 39 to 72 years old who participated voluntarily in the UK Biobank baseline assessment cohort study. Exposures were selfreported that included information about both physical and psychosocial aspects of workplace environment and general well-being. The outcome variable was maximum workload calculated during electrocardiogram (ECG) stress test. Three different statistical models were tested through ordinal logistic regressions using the SPSS software.

    Results

    No/low health satisfaction was associated with reduction in maximum workload and this association was constant in all analytical model, both in crude (B -0.786, 95% CI -0.825, -0.748) and adjusted models (B -0.866, 95% CI -0.910, -0.823). Other variables regarding different aspects of workplace environment and well-being showed no statistically significant result on the adjusted models.

    Conclusion

    Health satisfaction may be considered as an important determinant of CVD among middle and old-aged working population. Future research required to establish the result and to formulate preventive measures in workplace for better health outcome of workers.

  • 17. Alfvén, T.
    et al.
    Axelson, H.
    Rand, A. L.
    Peterson, S. S.
    Persson, Lars-Åke
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Dödligheten minskar, men fortfarande dör 7 miljoner barn varje år2013In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 110, no 1-2, p. 28-30Article in journal (Refereed)
  • 18. Alfvén, Tobias
    et al.
    Axelson, Henrik
    Lindstrand, Ann
    Peterson, Stefan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Persson, Lars-Ake
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Dödligheten minskar, men fortfarande dör 7 miljoner barn varje år2013In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 110, no 1-2, p. 28-30Article in journal (Other academic)
    Abstract [sv]

    Millenniemål 4 lyder: »Barnadödligheten under de fem första levnadsåren ska minska med två tredjedelar till 2015 jämfört med år 1990«.

    Barnadödligheten minskar i ­stora delar av världen, men inte i tillräckligt snabb takt för att uppnå målet. Den skiljer sig också kraftigt mellan länder och mellan olika grupper inom länderna.

    Sex dödsorsaker står för mer än 90 procent av alla dödsfall före 5 års ålder: neonatal mortalitet, lunginflammation, diarré, ­malaria, mässling och HIV/aids. ­Undernäring beräknas vara ­delorsak till cirka en tredjedel av dessa dödsfall.

    Vi har kunskap och metoder att med kostnadseffektiva lösningar reducera barnadödligheten med två tredjedelar. Fortsatt inter­nationellt samarbete, utökade ­resurser samt lokal, nationell po­litisk vilja krävs för att lyckas.

  • 19.
    Algady, Walid
    et al.
    Univ Leicester, Dept Genet & Genome Biol, Leicester LE1 7RH, Leics, England.
    Louzada, Sandra
    Wellcome Sanger Inst, Cambridge CB10 1SA, England.
    Carpenter, Danielle
    Univ Leicester, Dept Genet & Genome Biol, Leicester LE1 7RH, Leics, England.
    Brajer, Paulina
    Univ Leicester, Dept Genet & Genome Biol, Leicester LE1 7RH, Leics, England.
    Farnert, Anna
    Karolinska Inst, Dept Med Solna, Div Infect Dis, S-17176 Stockholm, Sweden;Karolinska Univ Hosp, Dept Infect Dis, S-17176 Stockholm, Sweden.
    Rooth, Ingegerd
    Natl Inst Med Res, Nyamisati Malaria Res, Dar Es Salaam, Tanzania.
    Ngasala, Billy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Child Health and Nutrition. Muhimbili Univ Hlth & Allied Sci, Dept Parasitol & Med Entomol, Dar Es Salaam, Tanzania.
    Yang, Fengtang
    Wellcome Sanger Inst, Cambridge CB10 1SA, England.
    Shaw, Marie-Anne
    Univ Leeds, Leeds Inst Med Res St Jamess, Leeds LS9 7TF, W Yorkshire, England.
    Hollox, Edward J.
    Univ Leicester, Dept Genet & Genome Biol, Leicester LE1 7RH, Leics, England.
    The Malaria-Protective Human Glycophorin Structural Variant DUP4 Shows Somatic Mosaicism and Association with Hemoglobin Levels2018In: American Journal of Human Genetics, ISSN 0002-9297, E-ISSN 1537-6605, Vol. 103, no 5, p. 769-776Article in journal (Refereed)
    Abstract [en]

    Glycophorin A and glycophorin B are red blood cell surface proteins and are both receptors for the parasite Plasmodium falciparum, which is the principal cause of malaria in sub-Saharan Africa. DUP4 is a complex structural genomic variant that carries extra copies of a glycophorin A-glycophorin B fusion gene and has a dramatic effect on malaria risk by reducing the risk of severe malaria by up to 40%. Using fiber-FISH and Illumina sequencing, we validate the structural arrangement of the glycophorin locus in the DUP4 variant and reveal somatic variation in copy number of the glycophorin B-glycophorin A fusion gene. By developing a simple, specific, PCR-based assay for DUP4, we show that the DUP4 variant reaches a frequency of 13% in the population of a malaria-endemic village in southeastern Tanzania. We genotype a substantial proportion of that village and demonstrate an association of DUP4 genotype with hemoglobin levels, a phenotype related to malaria, using a family-based association test. Taken together, we show that DUP4 is a complex structural variant that may be susceptible to somatic variation and show that DUP4 is associated with a malarial-related phenotype in a longitudinally followed population.

  • 20. Allen, Elizabeth Palchik
    et al.
    Muhwezi, Wilson Winstons
    Henriksson, Dorcus Kiwanuka
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Child Health and Nutrition. Karolinska Institutet, Sweden..
    Mbonye, Anthony Kabanza
    Health facility management and access: a qualitative analysis of challenges to seeking healthcare for children under five in Uganda2017In: Health Policy and Planning, ISSN 0268-1080, E-ISSN 1460-2237, Vol. 32, no 7, p. 934-942Article in journal (Refereed)
    Abstract [en]

    While several studies have documented the various barriers that caretakers of children under five routinely confront when seeking healthcare in Uganda, few have sought to capture the ways in which caretakers themselves prioritize their own barriers to seeking services. To that end, we asked focus groups of caretakers to list their five greatest challenges to seeking care on behalf of children under five. Using qualitative content analysis, we grouped responses according to four categories: (1) geographical access barriers; (2) facility supplies, staffing, and infrastructural barriers; (3) facility management and administration barriers (e.g. health worker professionalism, absenteeism and customer care); and (4) household barriers related to financial circumstances, domestic conflicts with male partners and a stated lack of knowledge about health-related issues. Among all focus groups, caretakers mentioned supplies, staffing and infrastructure barriers most often and facility management and administration barriers the least. Caretakers living furthest from public facilities (8-10 km) more commonly mentioned geographical barriers to care and barriers related to financial and other personal circumstances. Caretakers who lived closest to health facilities mentioned facility management and administration barriers twice as often as those who lived further away. While targeting managerial barriers is vitally important-and increasingly popular among national planners and donors-it should be done while recognizing that alleviating such barriers may have a more muted effect on caretakers who are geographically harder to reach - and by extension, those whose children have an increased risk of mortality. In light of calls for greater equity in child survival programming - and given the limited resource envelopes that policymakers often have at their disposal - attention to the barriers considered most vital among caretakers in different settings should be weighed.

  • 21.
    Allvin, Marie Klingberg
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Maternal and Reproductive Health and Migration.
    Atuhairwe, S
    Cleeve, A
    Byamugisha, J K
    Larsson, Elin C.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Maternal and Reproductive Health and Migration.
    Makenzius, M
    Oguttu, M
    Gemzell-Danielsson, K
    Co-creation to scale up provision of simplified high-quality comprehensive abortion care in East Central and Southern Africa.2018In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 11, no 1, article id 1490106Article in journal (Refereed)
    Abstract [en]

    Universal access to comprehensive abortion care (CAC) is a reproductive right and is essential to reduce preventable maternal mortality and morbidity. In East Africa, abortion rates are consistently high, and the vast majority of all abortions are unsafe, significantly contributing to unnecessary mortality and morbidity. The current debate article reflects and summarises key action points required to continue to speed the implementation of and expand access to CAC in the East, Central, and Southern African (ECSA) health community. To ensure universal access to quality CAC, a regional platform could facilitate the sharing of best practices and successful examples from the region, which would help to visualise opportunities. Such a platform could also identify innovative ways to secure women's access to quality care within legally restrictive environments and would provide information and capacity building through the sharing of recent scientific evidence, guidelines, and training programmes aimed at increasing women's access to CAC at the lowest effective level in the healthcare system. This type of infrastructure for exchanging information and developing co-creation could be crucial to advancing the Sustainable Development Goals 2030 agenda.

  • 22.
    Allwell-Brown, Gbemisola
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Individual and household-level determinants of malaria infection in under-5 children from north-west and southern Nigeria: A cross-sectional comparative study based on the 2015 Nigeria Malaria Indicator Survey2017Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Introduction

    Nigeria has the highest malaria burden worldwide. The 2010 and 2015 Nigeria Malaria Indicator Surveys (NMIS) suggest an improvement in malaria indicators, with the North West zone lagging behind. This study aimed to identify the individual and household-level malaria determinants in north-west and southern Nigeria, using Rapid Diagnostic Testing (RDT) and microscopy for malaria diagnosis.

    Methods

    Data on 3,358 children aged 6-59 months from north-west and southern Nigeria from the 2015 NMIS was used. The two populations were compared using chi-square tests, and logistic regression analysis was done for determinants of malaria infection, based on RDT and microscopic malaria test results.

    Results

    Malaria prevalence by RDT in the north-west and south was 55.8% and 29.2%, respectively (37.0% and 14.9%, respectively by microscopy). In both populations, a higher age, positive RDT in an additional household member and rural residence increased the odds of malaria infection; while higher education of the head of household and greater household wealth lowered the odds of malaria infection. Household clustering of RDT-positive cases appeared to be stronger in the south compared to the north-west. There were no statistically significant differences between the results using RDT or microscopy.

    Conclusion

    Irrespective of the diagnostic tool used, malaria determinants were similar in north-west and southern Nigeria. However, poorer social circumstances were observed in the north-west, and may account for the delayed progress in malaria control in the region. There may be a need to intensify malaria control efforts, particularly in the north-west, while awaiting socio-economic development.

     

  • 23.
    Alm Stävlid, Sofia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    A cross-sectional study on depression, anxiety, and perfectionism in students at Uppsala University and patients at Uppsala University hospital2016Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Introduction Mental illness is one of the largest causes of disability worldwide and it is becoming more prevalent among adolescents. The aim of this thesis was to compare the levels of anxiety and depressive symptoms among students at Uppsala University in relation to patients at the psychiatric department of Uppsala University Hospital, and to see if there was a possible correlation between anxiety and depression and higher levels of perfectionism.

    Methods Students at Uppsala University and patients at Uppsala University hospital participated in the student group and the clinical group of the study (n=93 and n=109 respectively). Data on anxiety and depressive symptoms, and perfectionism traits were collected with questionnaires and analyzed. Linear regression analysis was performed to determine the relationship between perfectionism and anxiety and depression. Independent t-test was used to examine the difference of means between the student group and the clinical group.

    Results The clinical group had a significantly higher mean score in the anxiety and depression scale The same trend could also be seen for all sub scales; anxiety, depression, and perfectionism There was a significant positive association between perfectionism and anxiety and depression.

    Conclusion There was a significant difference in levels of anxiety and depression for the students compared to patients, and a positive association between perfectionism and anxiety and depression. Furthermore, half of the students in the study had scores that would qualify them for psychiatric treatment. This research highlights the need for further research on the mental health of students in Uppsala and Sweden.

  • 24.
    Almblad, Ann-Charlotte
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Child Health and Nutrition.
    Brylid, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Engvall, Gunn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Neuropediatrics/Paediatric oncology.
    Målqvist, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Child Health and Nutrition.
    Increased intensive care admission rate after introduction of Early Detection and Treatment program for Children and the establishment of a pediatric intensive care unit at a tertiary hospital in SwedenIn: Article in journal (Refereed)
    Abstract [en]

    Objective: To evaluate the introduction of an Early Detection and Treatment program- Children (EDT-C) including a paediatric early warning score (PEWS) in relation to admission and length of stay at intensive care unit (ICU). Design: Before-after study utilizing data from the Electronic Patient Record (EPR) system, comparing outcomes over a total time period of 60 months between April 2010 and September 2015. Setting: A Swedish tertiary hospital. Patients: A total of 16,283 paediatric patients were included over the study period. Interventions: EDT-C including PEWS Measurements and Main Results: The following variables were extracted from the EPR data: 1) Admissions to paediatric wards 2) Length of stay at paediatric wards 3) Admissions to intensive care units 4) Length of stay at intensive care unit 5) Diagnosis. Intensive care unit admission increased from 5.0% (440/8746) before to 10.2 % (772/7537) after the introduction of the EDT-C (p<0.01). Mean treatment time at ICU did not change (41.0 vs 48.3 hours, p=0.23). Conclusion: The introduction of EDT-C including PEWS, in conjunction with the establishment of a paediatric intensive care unit at the hospital, resulted in an increased intensive care admittance rate among paediatric in-patients.

  • 25.
    Almblad, Ann-Charlotte
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Målqvist, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Engvall, Gunn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Caring for the Acutely, Severely Ill Child-A Multifaceted Situation with Paradoxical Elements: Swedish Healthcare Professionals' Experiences2016In: Journal of Pediatric Nursing: Nursing Care of Children and Families, ISSN 0882-5963, E-ISSN 1532-8449, Vol. 31, no 5, p. E293-E300Article in journal (Refereed)
    Abstract [en]

    Purpose: The aim of this study was to describe healthcare professionals' experience of caring for acutely, severely ill children in hospital in Sweden.

    Design and Methods: Five focus group interviews were conducted with nurses, nurse assistants and physicians comprising a total of 20 participants. Data were analyzed using qualitative content analysis.

    Results: An overall theme emerged that describes healthcare professionals' experiences as: "being in a multifaceted area of tension with paradoxical elements". The theme is based on three categories: proficiency of the individuals and the team is the fundamental base; interactions are crucial in an area of tension; and wellbeing of the individual is a balance of contradictory emotions. With maintained focus on the ill child, proficiency is the fundamental base, interactions are crucial, and moreover contradictory emotions are described.

    Conclusions: The interplay based on proficiency may influence the assessments and treatments of acutely, severely ill children.

    Practice Implications: Recognizing the multifaceted area of tension with paradoxical elements, practical teamwork exercises, a structured approach, and assessment tools could be a possible way to develop interprofessional team collaboration to improve the care of acutely, severely ill children in order to increase patient safety.

  • 26.
    Almblad, Ann-Charlotte
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Child Health and Nutrition.
    Målqvist, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Child Health and Nutrition.
    Engvall, Gunn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Neuropediatrics/Paediatric oncology.
    From skepticism to assurance and control: Implementation of a patient safety system at a pediatric hospital in Sweden2018In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 11, article id e0207744Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The use of evidence-based practice among healthcare professionals directly correlates to better outcomes for patients and higher professional satisfaction. Translating knowledge in practice and mobilizing evidence-based clinical care remains a continuing challenge in healthcare systems across the world.

    PURPOSE: To describe experiences from the implementation of an Early Detection and Treatment Program for Children (EDT-C) among health care professionals at a pediatric hospital in Sweden.

    DESIGN AND METHODS: Sixteen individual interviews were conducted with physicians, nurses and nurse assistants, which of five were instructors. Data were analyzed with qualitative content analysis.

    RESULTS: An overarching theme was created: From uncertainty and skepticism towards assurance and control. The theme was based on the content of eight categories: An innovation suitable for clinical practice, Differing conditions for change, Lack of organizational slack, Complex situations, A pragmatic implementation strategy, Delegated responsibility, Experiences of control and Successful implementation.

    CONCLUSIONS: Successful implementation was achieved when initial skepticism among staff was changed into acceptance and using EDT-C had become routine in their daily work. Inter-professional education including material from authentic patient cases promotes knowledge about different professions and can strengthen teamwork. EDT-C with evidenced-based material adapted to the context can give healthcare professionals a structured and objective tool with which to assess and treat patients, giving them a sense of control and assurance.

  • 27.
    Almblad, Ann-Charlotte
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Child Health and Nutrition.
    Målqvist, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Child Health and Nutrition.
    Engvall, Gunn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Neuropediatrics/Paediatric oncology.
    From skepticism to assurance and control: implementation of a patient safety system at a pediatric hospital in SwedenIn: Article in journal (Refereed)
  • 28.
    Almblad, Ann-Charlotte
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Child Health and Nutrition.
    Siltberg, Petra
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Neuropediatrics/Paediatric oncology.
    Engvall, Gunn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Neuropediatrics/Paediatric oncology.
    Målqvist, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Child Health and Nutrition.
    Implementation of Pediatric Early Warning Score: Adherence to Guidelines and Influence of Context2018In: Journal of Pediatric Nursing: Nursing Care of Children and Families, ISSN 0882-5963, E-ISSN 1532-8449, Vol. 38, p. 33-39Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To describe data of Pediatric Early Warning Score (PEWS) registrations and to evaluate the implementation of PEWS by examining adherence to clinical guidelines based on measured PEWS, and to relate findings to work context.

    DESIGN AND METHODS: PEWS, as a part of a concept called Early Detection and Treatment-Children (EDT-C) was implemented at three wards at a Children's Hospital in Sweden. Data were collected from the Electronic Patient Record (EPR) retrospectively to assess adherence to guidelines. The Alberta Context Tool (ACT) was used to assess work context among healthcare professionals (n=110) before implementation of EDT-C.

    RESULTS: The majority of PEWS registrations in EPR were low whereas 10% were moderate to high. Adherences to ward-specific guidelines at admission and for saturation in respiratory distress were high whereas adherence to pain assessment was low. There were significant differences in documented recommended actions between wards. Some differences in leadership and evaluation between wards were identified.

    CONCLUSIONS: Evaluation of PEWS implementation indicated frequent use of the tool despite most scores being low. High scores (5-9) occurred 28 times, which may indicate that patients with a high risk of clinical deterioration were identified. Documentation of the consequent recommended actions was however incomplete and there was a large variation in adherence to guidelines. Contextual factors may have an impact on adherence.

    PRACTICE IMPLICATIONS: EDT-C can lead to increased knowledge about early detection of deterioration, strengthen nurses as professionals, optimize treatment and teamwork and thereby increase patient safety for children treated in hospitals.

  • 29. Al-Murani, F.
    et al.
    Aweko, J.
    Nordin, I.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Delobelle, P.
    Kasujja, Fx.
    Östenson, C.-G.
    Peterson, Stefan S.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Daivadanam, Meena
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics. Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Alvesson, HM.
    Community and stakeholders' engagement in the prevention and management of Type 2 diabetes: a qualitative study in socioeconomically disadvantaged suburbs in region Stockholm2019In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 12, no 1, article id 1609313Article in journal (Refereed)
    Abstract [en]

    Background: Community-based approaches have been identified as an effective strategy to address the growing burden of noncommunicable diseases (NCDs) worldwide. However, little is known about community as a concept among people living in socioeconomically disadvantaged settings and stakeholders’ interactions and engagement in NCDs prevention and management.

    Objective: The aim of this study was to understand; (1) the meaning of community among people living in socioeconomically disadvantaged suburbs in Region Stockholm and (2) how communities interact and engage with stakeholders at local and regional levels for the prevention and management of type 2 diabetes (T2D).

    Methods: This qualitative study was conducted in three municipalities in Region Stockholm with a high proportion of migrants. Multiple data collection methods were used, including observations of community activities; interviews with community members, representatives of public authorities and NGOs; and group interviews with healthcare providers. Data were analyzed using content analysis.

    Results: Community was perceived as living in close proximity with shared beliefs, values and resources. Although they recognized its social and cultural diversity, community members focused more on the commonalities of living in their neighborhood and less on their differences in country of birth and languages spoken. Several mismatches between awareness of community needs and the available skills and resources among stakeholders for T2D prevention were identified. Stakeholders expressed awareness of T2D risk and interest in addressing it in a culturally appropriate manner.

    Conclusion: Interaction between the communities and stakeholders was limited, as was engagement in T2D prevention and management. This highlights barriers in the collaboration between community, healthcare institutions and other stakeholders which consequently affect the implementation of preventive interventions. Innovative ways to link the community to the healthcare sector and other local government institutions are needed to build the capacity of health systems for T2D prevention in socioeconomically disadvantaged communities.

  • 30.
    Alosaimi, Abdullah N.
    et al.
    Univ Tampere, Fac Social Sci, Hlth Sci Dept, Tampere 33014, Finland.
    Essén, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Maternal and Reproductive Health and Migration.
    Riitta, Luoto
    Univ Tampere, Fac Social Sci, Hlth Sci Dept, Tampere 33014, Finland.
    Nwaru, Bright I.
    Univ Tampere, Fac Social Sci, Hlth Sci Dept, Tampere 33014, Finland;Univ Gothenburg, Inst Med, Krefting Res Ctr, Gothenburg, Sweden.
    Mouniri, Halima
    Columbia Univ, Averting Maternal Death & Disabil Program, Dept Populat & Family Hlth, Mailman Sch Publ Hlth, New York, NY USA.
    Factors associated with female genital cutting in Yemen and its policy implications2019In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 74, p. 99-106Article in journal (Refereed)
    Abstract [en]

    Background:

    A tremendous number of girls in Yemen are still subjected to female genital cutting (FGC), which carries an increased risk of health complications and violates children's rights. This study describes the prevalence of FGC in four Yemeni provinces and investigates the determinants of FGC.

    Methods:

    We analyzed data from women aged 15 to 49 years who responded to a sub-national household survey conducted in six rural districts of four Yemeni provinces in 2008-2009. Logistic regression was used to estimate the association between individual and household socioeconomic factors and FGC practices and attitudes.

    Results:

    The prevalence of women's FGC was 48% while daughters' FGC was 34%. Almost 45.8% of the women surveyed believe the FGC practice should discontinue. Higher odds of FGC practice and positive attitude towards it were associated with older age, family marriage, and lower tertiles of wealth and education indices. Early marriage was also associated with increased odds of FGC practice (p < 0.01).

    Conclusions:

    Socioeconomic indices and other individual factors associated with FGC are differing and complex. Younger generations of women are more likely to not have FGC and to express negative attitudes towards the tradition. Appropriate strategies to invest in girls' education and women's empowerment with effective engagement of religious and community leaders might support the change of attitudes and practice of FGC in the younger generation.

  • 31.
    Amaratunga, Chanaki
    et al.
    NIAID, Lab Malaria & Vector Res, Div Intramural Res, NIH, Rockville, MD USA.
    Andrianaranjaka, Voahangy Hanitriniaina
    Inst Pasteur Madagascar, Malaria Res Unit, Antananarivo, Madagascar;Univ Antananarivo, Fac Sci, Antananarivo, Madagascar.
    Ashley, Elizabeth
    MOCRU, Yangon, Myanmar;Univ Oxford, Ctr Trop Med & Global Hlth, Oxford, England.
    Bethell, Delia
    Armed Forces Res Inst Med Sci, Bangkok, Thailand.
    Bjorkman, Anders
    Karolinska Inst, Dept Mol Tumor & Cell Biol, Stockholm, Sweden.
    Bonnington, Craig A.
    Shoklo Malaria Res Unit, Mae Sot, Thailand.
    Cooper, Roland A.
    Dominican Univ Calif, Dept Nat Sci & Math, San Rafael, CA USA.
    Dhorda, Mehul
    Univ Oxford, Nuffield Dept Clin Med, Ctr Trop Med, WWARN, Oxford, England.
    Dondorp, Arjen
    Univ Oxford, Nuffield Dept Clin Med, Ctr Trop Med, WWARN, Oxford, England;Mahidol Univ, Fac Trop Med, Mahidol Oxford Res Unit, Bangkok, Thailand.
    Erhart, Annette
    ITM Antwerp, Dept Publ Hlth, Antwerp, Belgium;Inst Trop Med, MRC Unit Gambia, Fajara, Gambia;Inst Trop Med, MRC Unit Gambia, Fajara, Gambia.
    Fairhurst, Rick M.
    NIAID, Lab Malaria & Vector Res, Div Intramural Res, NIH, Rockville, MD USA.
    Faiz, Abul
    Dev Care Fdn, Dhaka, Bangladesh.
    Fanello, Caterina
    Univ Oxford, Nuffield Dept Clin Med, Ctr Trop Med, Oxford, England;Mahidol Oxford Res Unit, Bangkok, Thailand.
    Fukuda, Mark M.
    Armed Forces Res Inst Med Sci, Bangkok, Thailand.
    Guerin, Philippe
    Univ Oxford, Nuffield Dept Clin Med, Ctr Trop Med, WWARN, Oxford, England.
    van Huijsduijnen, Rob Hooft
    Med Malaria Venture, Geneva, Switzerland.
    Hien, Tran Tinh
    Hong, N. V.
    Natl Inst Malariol Parasitol & Entomol, Hanoi, Vietnam.
    Htut, Ye
    Dept Med Res, Yangon, Myanmar.
    Huang, Fang
    Chinese Ctr Dis Control & Prevent, Natl Inst Parasit Dis, Shanghai, Peoples R China.
    Humphreys, Georgina
    Univ Oxford, Nuffield Dept Clin Med, Ctr Trop Med, WWARN, Oxford, England.
    Imwong, Mallika
    Mahidol Univ, Fac Trop Med, Dept Mol Trop Med & Genet, Bangkok, Thailand;Mahidol Univ, Fac Trop Med, Mahidol Oxford Trop Med Res Unit, Bangkok, Thailand.
    Kennon, Kalynn
    Univ Oxford, Nuffield Dept Clin Med, Ctr Trop Med, WWARN, Oxford, England.
    Lim, Pharath
    NIAID, Lab Malaria & Vector Res, Div Intramural Res, NIH, Rockville, MD USA.
    Lin, Khin
    Dept Med Res, Pyin Oo Lwin Branch, Anesakhan, Myanmar.
    Lon, Chanthap
    Armed Forces Res Inst Med Sci, Bangkok, Thailand.
    Mårtensson, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Mayxay, Mayfong
    Lao Oxford Mahosot Hospital, Wellcome Trust Res Unit, LOMWRU, Viangchan, Laos;Univ Hlth Sci, Minist Hlth, Fac Postgrad Studies, Viangchan, Laos;Churchill Hosp, Nuffield Dept Med, Ctr Trop Med & Global Hlth, Oxford, England.
    Mokuolu, Olugbenga
    Univ Ilorin, Coll Hlth Sci, Dept Paediat & Child Hlth, Ilorin, Nigeria;Univ Ilorin, Teaching Hosp, Ctr Malaria & Other Trop Dis Care, Ilorin, Nigeria.
    Morris, Ulrika
    Karolinska Inst, Dept Mol Tumor & Cell Biol, Stockholm, Sweden.
    Ngasala, Billy E.
    Muhimbili Univ Hlth & Allied Sci, Dept Parasitol & Med Entomol, Dar Es Salaam, Tanzania.
    Amambua-Ngwa, Alfred
    Inst Trop Med, MRC Unit Gambia, Fajara, Gambia.
    Noedl, Harald
    Med Univ Vienna, Inst Specif Prophylaxis & Trop Med, Vienna, Austria.
    Nosten, Francois
    Shoklo Malaria Res Unit, Mae Sot, Thailand;Univ Oxford, Nuffield Dept Clin Med, Ctr Trop Med, Oxford, England;Mahidol Univ, Fac Trop Med, Mahidol Oxford Trop Med Res Unit, Bangkok, Thailand.
    Onyamboko, Marie
    Mahidol Oxford Res Unit, Bangkok, Thailand;Kinshasa Sch Publ Hlth, Kinshasa, DEM REP CONGO.
    Phyo, Aung Pyae
    Univ Oxford, Nuffield Dept Clin Med, Ctr Trop Med, Oxford, England;Mahidol Univ, Fac Trop Med, Mahidol Oxford Trop Med Res Unit, Bangkok, Thailand.
    Plowe, Christopher V.
    Duke Univ, Duke Global Hlth Inst, Durham, NC USA.
    Pukrittayakamee, Sasithon
    Mahidol Univ, Dept Clin Trop Med, Bangkok, Thailand;Royal Soc Thailand, Bangkok, Thailand.
    Randrianarivelojosia, Milijaona
    Inst Pasteur Madagascar, Malaria Res Unit, Antananarivo, Madagascar;Univ Toliara, Fac Sci, Toliara, Madagascar.
    Rosenthal, Philip J.
    Univ Calif San Francisco, Dept Med, San Francisco, CA 94143 USA;Univ Calif San Francisco, Div HIV Infect Dis & Global Med, San Francisco, CA 94143 USA.
    Saunders, David L.
    Armed Forces Res Inst Regenerat Med, Bangkok, Thailand;US Army Med Mat Dev Act, Ft Detrick, MD USA.
    Sibley, Carol Hopkins
    Univ Oxford, Nuffield Dept Clin Med, Ctr Trop Med, WWARN, Oxford, England;Univ Washington, Dept Genome Sci, Seattle, WA 98195 USA.
    Smithuis, Frank
    Myanmar Oxford Clin Res Unit, Yangon, Myanmar.
    Spring, Michele D.
    Armed Forces Res Inst Med Sci, Dept Immunol & Med, Bangkok, Thailand.
    Sondo, Paul
    Univ Oxford, Nuffield Dept Clin Med, Ctr Trop Med, WWARN, Oxford, England;CRUN, Ouaga, Burkina Faso.
    Sreng, Sokunthea
    Natl Ctr Parasitol Entomol & Malaria Control, Phnom Penh, Cambodia.
    Starzengruber, Peter
    Med Univ Vienna, Inst Specif Prophylaxis & Trop Med, Vienna, Austria;Med Univ Vienna, Dept Lab Med, Div Clin Microbiol, Vienna, Austria.
    Stepniewska, Kasia
    Univ Oxford, Ctr Trop Med & Global Hlth, WWARN, Oxford, England.
    Suon, Seila
    Natl Ctr Parasitol Entomol & Malaria Control, Phnom Penh, Cambodia.
    Takala-Harrison, Shannon
    Univ Maryland, Sch Med, Inst Global Hlth, Div Malaria Res, Baltimore, MD 21201 USA.
    Thriemer, Kamala
    Inst Trop Med, Antwerp, Belgium;Menzies Sch Hlth Res, Darwin, NT, Australia.
    Thuy-Nhien, Nguyen
    Tun, Kyaw Myo
    Myanmar Oxford Clin Res Unit, Yangon, Myanmar;Def Serv Med Acad, Yangon, Myanmar.
    White, Nicholas J.
    Mahidol Univ, Fac Trop Med, Mahidol Oxford Res Unit, Bangkok, Thailand;Univ Oxford, Nuffield Dept Clin Med, Ctr Trop Med, Oxford, England.
    Woodrow, Charles
    Mahidol Univ, Fac Trop Med, Mahidol Oxford Res Unit, Bangkok, Thailand;Univ Oxford, Nuffield Dept Clin Med, Ctr Trop Med, Oxford, England.
    Association of mutations in the Plasmodium falciparum Kelch13 gene (Pf3D7_1343700) with parasite clearance rates after artemisinin-based treatments: a WWARN individual patient data meta-analysis2019In: BMC Medicine, ISSN 1741-7015, E-ISSN 1741-7015, Vol. 17, p. 1-20, article id 1Article in journal (Refereed)
    Abstract [en]

    Background: Plasmodium falciparum infections with slow parasite clearance following artemisinin-based therapies are widespread in the Greater Mekong Subregion. A molecular marker of the slow clearance phenotype has been identified: single genetic changes within the propeller region of the Kelch13 protein (pfk13; Pf3D7_1343700). Global searches have identified almost 200 different non-synonymous mutant pfk13 genotypes. Most mutations occur at low prevalence and have uncertain functional significance. To characterize the impact of different pfk13 mutations on parasite clearance, we conducted an individual patient data meta-analysis of the associations between parasite clearance half-life (PC1/2) and pfk13 genotype based on a large set of individual patient records from Asia and Africa.

    Methods: A systematic literature review following the PRISMA protocol was conducted to identify studies published between 2000 and 2017 which included frequent parasite counts and pfk13 genotyping. Four databases (Ovid Medline, PubMed, Ovid Embase, and Web of Science Core Collection) were searched. Eighteen studies (15 from Asia, 2 from Africa, and one multicenter study with sites on both continents) met inclusion criteria and were shared. Associations between the log transformed PC1/2 values and pfk13 genotype were assessed using multivariable regression models with random effects for study site.

    Results: Both the pfk13 genotypes and the PC1/2 were available from 3250 (95%) patients (n=3012 from Asia (93%), n=238 from Africa (7%)). Among Asian isolates, all pfk13 propeller region mutant alleles observed in five or more specific isolates were associated with a 1.5- to 2.7-fold longer geometric mean PC1/2 compared to the PC1/2 of wild type isolates (all p≤0.002). In addition, mutant allele E252Q located in the P. falciparum region of pfk13 was associated with 1.5-fold (95%CI 1.4-1.6) longer PC1/2. None of the isolates from four countries in Africa showed a significant difference between the PC1/2 of parasites with or without pfk13 propeller region mutations.Previously, the association of six pfk13 propeller mutant alleles with delayed parasite clearance had been confirmed. This analysis demonstrates that 15 additional pfk13 alleles are associated strongly with the slow-clearing phenotype in Southeast Asia.

    Conclusion: Pooled analysis associated 20 pfk13 propeller region mutant alleles with the slow clearance phenotype, including 15 mutations not confirmed previously.

  • 32.
    Amiot, Ikraam
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Coping strategies of men who have been sexually abused in childhood: A qualitative metasynthesis2019Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Estimates on the prevalence of childhood sexual abuse on boys vary from 8% to 35% globally. These figures are known to be well below the actual numbers that are believed to be much higher than those found in official data. Most cases of childhood sexual abuse are never reported, boys are less likely to report sexual abuse and if they ever do, they do so up to 10-20 years later than girls with similar experiences. This metasynthesis adds to the scarce qualitative literature on coping of male victims. It brings together the types of coping strategies men with histories of childhood sexual abuse use and allows for deeper understanding on how men cope with childhood sexual abuse.

    Aim: To explore coping strategies used by men who have been affected by childhood sexual abuse 

    Method: A qualitative metasynthesis

    Findings: Men affected by childhood sexual abuse reported the use of several coping strategies throughout their lives. These coping strategies were adapted to changes in their social environment. Meaningful inter-personal relationships were found to influence which coping strategies victims would resort to. Not all men felt affected by their experiences of childhood sexual abuse and some reject to be labelled as victims, while others felt empowered by the recognition of their victimhood.

    Conclusion: Men reported using similar coping strategies in different settings, but with different outcomes. Social support and social awareness about male victimisation were found to affect coping strategies used by men who have been affected by childhood sexual abuse.

  • 33.
    Andersson, Maria Eva
    et al.
    Department of Infectious Diseases, University of Gothenburg , Gothenburg , Sweden.
    Elfving, Kristina
    Department of Infectious Diseases, University of Gothenburg , Gothenburg , Sweden.; Univ Gothenburg, Dept Pediat, Gothenburg, Sweden..
    Shakely, Deler
    Department of Medicine, Kungälv Hospital, Sweden.; Karolinska Institutet, Malaria Res, Dept Microbiol Tumor & Cell Biol, Stockholm, Sweden..
    Nilsson, Staffan
    Chalmers University of Technology, Gothenburg, Sweden.
    Msellem, Mwinyi
    Zanzibar Malaria Elimination Programme, Ministry of Health, Tanzania.
    Trollfors, Birger
    Department of Pediatrics, University of Gothenburg, Gothenburg, Sweden.
    Mårtensson, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Björkman, Anders
    Malaria Research, Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm.
    Lindh, Magnus
    Department of Infectious Diseases, University of Gothenburg , Gothenburg , Sweden.
    Rapid Clearance and Frequent Reinfection With Enteric Pathogens Among Children With Acute Diarrhea in Zanzibar.2017In: Clinical Infectious Diseases, ISSN 1058-4838, E-ISSN 1537-6591, Vol. 65, no 8, p. 1371-1377Article in journal (Refereed)
    Abstract [en]

    Background: Acute infectious gastroenteritis is an important cause of illness and death among children in low-income countries. In addition to rotavirus vaccination, actions to improve nutrition status, sanitation, and water quality are important to reduce enteric infections, which are frequent also among asymptomatic children. The aim of this study was to investigate if the high prevalence of these infections reflects that they often are not cleared properly by the immune response or rather is due to frequent pathogen exposure.

    Methods: Rectal swabs were collected at time of acute diarrhea and 14 days later from 127 children, aged 2-59 months and living in rural Zanzibar, and were analyzed by real-time polymerase chain reaction targeting multiple pathogens.

    Results: At baseline, detection rates >20% were found for each of enterotoxigenic Escherichia coli, Shigella, Campylobacter, Cryptosporidium, norovirus GII, and adenovirus. At follow-up, a large proportion of the infections had become cleared (34-100%), or the pathogen load reduced, and this was observed also for agents that were presumably unrelated to diarrhea. Still, the detection frequencies at follow-up were for most agents as high as at baseline, because new infections had been acquired. Neither clearance nor reinfection was associated with moderate malnutrition, which was present in 21% of the children.

    Conclusions: Children residing in poor socioeconomic conditions, as in Zanzibar, are heavily exposed to enteric pathogens, but capable of rapidly clearing causative and coinfecting pathogens.

  • 34.
    Andersson, Maria
    et al.
    Univ Gothenburg, Dept Infect Dis, Guldhedsgatan 10B, S-41346 Gothenburg, Sweden.
    Kabayiza, Jean-Claude
    Univ Rwanda, Dept Pediat, Kigali, Rwanda.
    Elfving, Kristina
    Univ Gothenburg, Dept Infect Dis, Guldhedsgatan 10B, S-41346 Gothenburg, Sweden.
    Nilsson, Staffan
    Chalmers Univ Technol, Gothenburg, Sweden.
    Msellem, Mwinyi I.
    Minist Hlth, Zanzibar Malaria Eliminat Programme ZAMEP, Zanzibar, Tanzania.
    Mårtensson, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Bjorkman, Anders
    Karolinska Inst, Dept Microbiol Tumor & Cell Biol, Malaria Res, Stockholm, Sweden.
    Bergstrom, Tomas
    Univ Gothenburg, Dept Infect Dis, Guldhedsgatan 10B, S-41346 Gothenburg, Sweden.
    Lindh, Magnus
    Univ Gothenburg, Dept Infect Dis, Guldhedsgatan 10B, S-41346 Gothenburg, Sweden.
    Coinfection with Enteric Pathogens in East African Children with Acute Gastroenteritis-Associations and Interpretations2018In: American Journal of Tropical Medicine and Hygiene, ISSN 0002-9637, E-ISSN 1476-1645, Vol. 98, no 6, p. 1566-1570Article in journal (Refereed)
    Abstract [en]

    Enteric coinfections among children in low-income countries are very common, but it is not well known if specific pathogen combinations are associated or have clinical importance. In this analysis, feces samples from children in Rwanda and Zanzibar less than 5 years of age, with (N = 994) or without (N = 324) acute diarrhea, were analyzed by realtime polymerase chain reaction targeting a wide range of pathogens. Associations were investigated by comparing codetection and mono-detection frequencies for all pairwise pathogen combinations. More than one pathogen was detected in 840 samples (65%). A negative association (coinfections being less common than expected from probability) was observed for rotavirus in combination with Shigella, Campylobacter, or norovirus genogroup II, but only in patients, which is statistically expected for agents that independently cause diarrhea. A positive correlation was observed, in both patients and controls, between Ct (threshold cycle) values for certain virulence factor genes in enteropathogenic Escherichia coli (EPEC) (eae and bfpA) and toxin genes in enterotoxigenic E. coli (eltB and estA), allowing estimation of how often these genes were present in the same bacteria. A significant positive association in patients only was observed for Shigella andEPEC-eae, suggesting that this coinfection might interact in a manner that enhances symptoms. Although interaction between pathogens that affect symptoms is rare, this work emphasizes the importance and difference in interpretation of coinfections depending on whether they are positively or negatively associated.

  • 35.
    Andersson, Ola
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Child Health and Nutrition.
    Between the sheets - or how to keep babies warm2018In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 107, no 8, p. 1300-1301Article in journal (Other academic)
  • 36.
    Andersson, Ola
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    The transition to extra-uterine life by extremely preterm infants: handle with care2016In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 105, no 4, p. 337-338Article in journal (Other academic)
  • 37.
    Andersson, Ola
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Department of Research and Development, Region Halland, Sweden.
    Hellström-Westas, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Domellöf, Magnus
    Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden.
    Elective caesarean: does delay in cord clamping for 30 s ensure sufficient iron stores at 4 months of age? A historical cohort control study2016In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, no 11, article id e012995Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To compare iron stores in infants born after elective caesarean section (CS) and a 30 s delay of umbilical cord clamping with those born vaginally after early (≤10 s) or delayed (≥180 s) cord clamping.

    DESIGN: Prospective observational study with historical control.

    SETTING: Swedish county hospital.

    POPULATION: 64 infants born after elective CS were compared with a historical control of 166 early clamped and 168 delayed clamped after vaginal birth.

    METHODS: Blood and iron status were measured in blood samples collected at birth, 48-96 hours after birth, 4 and 12 months of age.

    PRIMARY AND SECONDARY OUTCOME MEASURES: Ferritin at 4 months of age was the primary outcome, second outcome measures were other indicators of iron status, and haemoglobin, at 4 and 12 months of age, as well as respiratory distress at 1 and 6 hours after birth.

    RESULTS: At 4 months infants born by elective CS had better iron status than those born vaginally subjected to early cord clamping, shown by higher adjusted mean difference of ferritin concentration (39 µg/L (95% CI 10 to 60)) and mean cell volume (1.8 fL (95% CI 0.6 to 3.0)); and lower levels of transferrin receptors (-0.39 mg/L (95% CI -0.69 to -0.08)). No differences were seen between infants born after elective CS and delayed clamped vaginally born infants at 4 months. No differences were found between groups at 12 months of age.

    CONCLUSIONS: Waiting to clamp the umbilical cord for 30 s after elective CS results in higher iron stores at 4 months of age compared with early cord clamping after vaginal birth, and seems to ensure iron status comparable with those achieved after 180 s delayed cord clamping after vaginal birth.

  • 38.
    Aneblom, Gunilla
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Stålsby Lundborg, Cecilia
    Carlsten, Anders
    Eurenius, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Tydén, Tanja
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Emergency contraceptive pills over-the-counter: practices and attitudes of pharmacy and nurse-midwife providers2004In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 55, no 1, p. 129-135Article in journal (Refereed)
    Abstract [en]

    Deregulation of emergency contraceptive pills (ECP) has led to pharmacy staff becoming a new provider group of ECP, together with nurse-midwives, who are already experienced in prescribing contraceptives. This postal questionnaire survey aimed to assess practices and attitudes towards ECP and the over-the-counter (OTC)-availability among pharmacy staff (n=237) and nurse-midwives (n=163). The overall response rate was 89%. Both study groups were positive to ECP and the OTC-availability and the vast majority agreed that sexually active women should be aware of ECP and that routine information about ECP should be included in contraceptive counseling. Verbal information on all aspects of ECP to clients was reported more often by nurse-midwives than by pharmacy staff. Both groups supported collaboration between providers. Our findings suggest that further collaboration between pharmacies and family planning clinics should be encouraged to ensure a competent and client-friendly provision of ECP.

  • 39.
    Arifeen, Shams El
    et al.
    Int Ctr Diarrhoeal Dis Res Icddr B, Dhaka, Bangladesh.
    Ekström, Eva-Charlotte
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Child Health and Nutrition.
    Frongillo, Edward A
    Univ South Carolina, Arnold Sch Publ Hlth, Dept Hlth Promot Educ & Behav, Columbia, SC USA.
    Hamadani, Jena
    Int Ctr Diarrhoeal Dis Res Icddr B, Dhaka, Bangladesh.
    Khan, Ashraful Islam
    Int Ctr Diarrhoeal Dis Res Icddr B, Dhaka, Bangladesh.
    Naved, Ruchira T
    Int Ctr Diarrhoeal Dis Res Icddr B, Dhaka, Bangladesh.
    Rahman, Anisur
    Int Ctr Diarrhoeal Dis Res Icddr B, Dhaka, Bangladesh.
    Raqib, Rubhana
    Int Ctr Diarrhoeal Dis Res Icddr B, Dhaka, Bangladesh.
    Rasmussen, Kathleen M
    Cornell Univ, Div Nutr Sci, Ithaca, NY 14853 USA.
    Ekholm Selling, Katarina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Child Health and Nutrition.
    Wagatsuma, Yukiko
    Univ Tsukuba, Dept Med, Tsukuba, Ibaraki, Japan.
    Persson, Lars-Åke
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Child Health and Nutrition. London Sch Hyg & Trop Med, Dept Dis Control, London, England.
    Cohort Profile: The Maternal and Infant Nutrition Interventions in Matlab (MINIMat) Cohort in Bangladesh2018In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 47, no 6, p. 1737-1738eArticle in journal (Refereed)
  • 40.
    Arousell, J.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Maternal and Reproductive Health and Migration.
    Carlbom, A.
    Malmö Univ, Fac Hlth & Soc, Malmö, Sweden.
    Larsson, Elin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Maternal and Reproductive Health and Migration.
    Johnsdotter, S.
    Malmö Univ, Fac Hlth & Soc, Malmö, Sweden.
    Essén, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Maternal and Reproductive Health and Migration.
    Unintended consequences of gender equality promotion in Swedish contraceptive counselling2018In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, no Supplement: 1, p. 105-105Article in journal (Other academic)
  • 41.
    Arousell, Jonna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Maternal and Reproductive Health and Migration.
    Carlbom, A.
    Malmö Univ, Fac Hlth & Soc, Malmö, Sweden..
    Essén, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Maternal and Reproductive Health and Migration.
    Is multiculturalism bad for swedish abortion care?: Exploring the diversity of religious counselling in public healthcare institutions2018In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, no 1, p. 122-122Article in journal (Other academic)
    Abstract [en]

    Background:

    Sweden has one of the most liberal abortion laws in the world, granting women extensive rights to make autonomous reproductive decisions. At the same time, Swedish policy-makers are keen to protect society’s religious diversity. This ambition is reflected in decisions to grant religious leaders the possibility to provide ‘spiritual care’ in public hospitals. Through interviews with religious representatives in public healthcare institutions, we asked: In what ways would they counsel a religious woman who is seeking their advice about abortion? And how does this advice correspond with Swedish policies on, and provision of, abortion care?

    Methods:

    Individual interviews were conducted with religious representatives of the Swedish Church, the Catholic Church, and the Buddhist and Muslim communities. Interviews took place in 2016 and 2017.

    Findings:

    We found that informants saw it as their obligation to provide religious people with abortion advice according to religious norms, giving them limited opportunities to harmonise the content of their counselling with Swedish healthcare laws or regulations. Most informants argued that it was their responsibility to inform women about the wrongdoing of terminating a pregnancy, and to provide suggestions about how women could mitigate the sin in order to gain God’s forgiveness.

    Conclusion:

    Informants appeared inclined to deliver religious recommendations on abortion that were more conservative than what is established in the Swedish Abortion Act.

    Main messages:

    • ‘Spiritual care’ in the question of abortion favours the delivery of religious norms at the possible expense of women’s right to non-judgmental abortion counselling.

    • ‘Spiritual care’ is now an integral part of Swedish healthcare institutions. A critical discussion is needed about the extent to which such services should be in compliance with Swedish laws and public health aims on abortion.

  • 42.
    Arousell, Jonna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Maternal and Reproductive Health and Migration.
    Carlbom, A.
    Malmö Univ, Fac Hlth & Soc, Malmö, Sweden..
    Johnsdotter, S.
    Malmö Univ, Fac Hlth & Soc, Malmö, Sweden..
    Essén, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Maternal and Reproductive Health and Migration.
    Are 'Low Socioeconomic Status' and 'Religiousness' barriers to minority women's contraceptive use in Sweden and Denmark?: A qualitative interrogation of a common argument in health research2018In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, p. 121-121Article in journal (Other academic)
  • 43.
    Arousell, Jonna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Maternal and Reproductive Health and Migration.
    Carlbom, Aje
    Malmo Univ, Fac Hlth & Soc, S-20506 Malmo, Sweden.
    Johnsdotter, Sara
    Malmo Univ, Fac Hlth & Soc, S-20506 Malmo, Sweden.
    Essén, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Maternal and Reproductive Health and Migration.
    Are 'low socioeconomic status' and 'religiousness' barriers to minority women's use of contraception? A qualitative exploration and critique of a common argument in reproductive health research2019In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 75, p. 59-65Article in journal (Refereed)
    Abstract [en]

    Objective: 'Low socioeconomic status' and 'religiousness' appear to have gained status as nearly universal explanatory models for why women in minority groups are less likely to use contraception than other women in the Scandinavian countries. Through interviews with pious Muslim women with immigrant background, living in Denmark and Sweden, we wanted to gain empirical insights that could inform a discussion about what 'low socioeconomic status' and 'religiousness' might mean with regard to women's reproductive decisions.

    Design: Semi-structured interviews were conducted in Denmark and Sweden between 2013 and 2016.

    Findings: We found that a low level of education and a low income were not necessarily obstacles for women's use of contraception; rather, these were strong imperatives for women to wait to have children until their life circumstances become more stable. Arguments grounded in Islamic dictates on contraception became powerful tools for women to substantiate how it is religiously appropriate to postpone having children, particularly when their financial and emotional resources were not yet established.

    Conclusion: We have shown that the dominant theory that 'low socioeconomic status' and 'religiousness' are paramount barriers to women's use of contraception must be problematized. When formulating suggestions for how to provide contraceptive counseling to women in ethnic and religious minority groups in Denmark and Sweden, one must also take into account that factors such as low financial security as well as religious convictions can be strong imperatives for women to use contraception.

    Implications for practice: This study can help inform a critical discussion about the difficulties of using broad group-categorizations for understanding individuals' health-related behavior, as well as the validity of targeted interventions towards large heterogeneous minority groups in Scandinavian contraceptive counseling.

  • 44.
    Arousell, Jonna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Maternal and Reproductive Health and Migration.
    Carlbom, Aje
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Maternal and Reproductive Health and Migration.
    Johnsdotter, Sara
    Faculty of Health and Society, Malmö University.
    Essén, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Maternal and Reproductive Health and Migration.
    Does Religious Counselling on Abortion Comply with Sweden’s ‘Women‑Friendly’ Abortion Policies?: A Qualitative Exploration Among Religious Counsellors2019In: Sexuality & Culture, ISSN 1095-5143, E-ISSN 1936-4822, p. 1-20Article in journal (Refereed)
    Abstract [en]

    The abortion discourse in Sweden is marked by historically liberal ideals about women’s inviolable right to make autonomous reproductive decisions. However, to respond to the increase in cultural and religious pluralism building up over several decades, religious organizations have been given opportunities to provide so-called spiritual care in affiliation with Swedish hospitals since the 1980s. In this study we asked: in what ways do religious counsellors, affiliated with Swedish hospitals, construct their ideas on abortion, and how well do their ideas comply with Sweden’s ‘women-friendly’ abortion policies? Through interviews with Protestant, Catho-lic, Muslim, and Buddhist religious counsellors, we wanted to empirically test the presumption underlying the decisions to grant space to religious actors in Swedish healthcare, i.e., that religious counselling serves to complement existing services. We found that it cannot be expected that religious advice on abortion will always comply with Swedish abortion law and with the women-friendly abortion policy that the Swedish state seeks to impose. When policy-makers open up possibilities for diverse norms on abortion to manifest in close affiliation with healthcare institutions, they must be aware that some religious counsellors argue that only God—and not the woman herself—can decide whether a woman can terminate a pregnancy. We argue that the findings in this study speaks to what researchers have referred to as the “diversity-equality paradox”, which highlights the tension between the promotion of religious ideas on abortion on the one hand and the promotion of liberal ideas about women’s reproductive freedom on the other.

  • 45.
    Arousell, Jonna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Carlbom, Aje
    Malmo Univ, Fac Hlth & Soc, Social Anthropol, Malmo, Sweden.
    Johnsdotter, Sara
    Malmo Univ, Fac Hlth & Soc, Med Anthropol, Malmo, Sweden.
    Larsson, Elin C.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Essén, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Unintended Consequences of Gender Equality Promotion in Swedish Multicultural Contraceptive Counseling: A Discourse Analysis.2017In: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, Vol. 27, no 10, p. 1518-1528Article in journal (Refereed)
    Abstract [en]

    In this article, we explore how reproductive health care providers in Sweden, a country often described as one of the most gender-equal countries in the world, incorporate gender equality ideals in multicultural contraceptive counseling. In the tension between gender equality promotion on one hand and respect for cultural diversity and individualized care on the other, we will demonstrate that values of gender equality were often given priority. This is not necessarily undesirable. Nevertheless, our proposal is that the gender equality ideology may inhibit providers' ability to think differently about issues at stake in contraceptive counseling, which may negatively influence women's possibilities to obtain adequate support. At the end of the article, we suggest how health care providers' reflexivity might be used as a working tool for increased awareness about the taken-for-granted cultural norms that exist in their clinical milieu.

  • 46.
    Arousell, Jonna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Maternal and Reproductive Health and Migration.
    Essén, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Johnsdotter, Sara
    Department of Social Work, Malmö University.
    Carlbom, Aje
    Department of Social Work, Malmö University.
    Modes of Governing: A Foucaultian Perspective on Encounters between Healthcare Providers and Muslim Women in Swedish Reproductive HealthcareManuscript (preprint) (Other academic)
    Abstract [en]

    There are probably few groups of patients in Sweden today that arouse as much associations and thoughts as do Muslims from the Middle East. The core dilemma in much of these discussions is whether healthcare providers should adjust the provision of care to Muslims’ divergent religious preferences, or if they would be better off to treat Muslims in the same way as other patients. These debates are often entangled with both a concern about politics of equality (i.e. ambitions to treat everyone the same) and politics of diversity (i.e. to treatpeople from ethnic and religious minority groups differently). Inspired by Foucault’s concept of governmentality, we in this study intended to explore the principles of ‘equality’ and 'diversity’ as governing tools for the shaping of healthcare providers and patients’ conduct. We found that although these governing tools are presented as non-conflicting in health policies, there seems to be an often-present trade-off between diversity and equality ideals in their practical implementation. When these policies are assigned meaning and implemented inpractice, they appear to generate unforeseeable consequences, both for healthcare providers and for the patients. It thus appears that the policies that were introduced with the intention of improving the structure of multicultural care encounters, in some cases, had an opposite effect.

  • 47.
    Arvidsson, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Challenges of transnational parenthood: Exploring different perspectives of surrogacy in Sweden and India2019Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Transnational surrogacy challenges traditional norms of parenthood, especially motherhood; additionally, it is viewed as the exploitation of poor women. The overall aim of this thesis was to shed light on the consequences of an unregulated situation on surrogacy in the Swedish and Indian contexts, and to give different perspectives on surrogacy and the surrogate. The experiences of using transnational surrogacy and the consequences of using this reproductive method in a context of a largely unregulated situation had rarely been explored at the start of the study. Between 2012 and 2015, qualitative interviews were conducted with commissioning parents in Sweden who used transnational surrogacy mainly in India, as well as with social workers in Sweden, who have handled cases regarding the legal recognition of parenthood. To capture a non-western perspective on surrogacy, the views of women and men in different social strata in Assam, India were explored through individual interviews and focus group discussions. At the start of the project, India was the most common country to turn to for surrogacy. The results reveal that both commissioning parents and social workers needed to navigate inadequate parental legislation, with the result that commissioning parents felt questioned as parents. Social workers tried to balance the protection of the surrogate’s rights with the child’s best interest. The ethical aspects made the users of surrogacy ambivalent, and, for social workers, it resulted in further reluctance to handle legal parenthood cases. However, from an Assamese point of view, no ethical considerations were expressed; instead, the surrogate would either be stigmatized for her act and seen as though she was “selling her child,” or seen as a woman doing a noble act, helping a childless couple. All the informants demonstrated a pragmatic view of legal parenthood, but the current legal situation in Sweden limits the scope to act as parents in relation to society, because of the length of time it takes to be recognized as legal parents. This comes with a risk for children. From the perspective of reproductive justice, a clearer regulation on surrogacy, and kinship rules that are more adjusted to the current family practice, are needed. Additionally, to limit the risks for all parties involved in the surrogacy process, a more transparent surrogacy process is needed.

    List of papers
    1. Views of Swedish commissioning parents relating to the exploitation discourse in using transnational surrogacy
    Open this publication in new window or tab >>Views of Swedish commissioning parents relating to the exploitation discourse in using transnational surrogacy
    2015 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 5, article id e0126518Article in journal (Refereed) Published
    Abstract [en]

    Transnational surrogacy, when people travel abroad for reproduction with the help of a surrogate mother, is a heavily debated phenomenon. One of the most salient discourses on surrogacy is the one affirming that Westerners, in their quest for having a child, exploit poor women in countries such as India. As surrogacy within the Swedish health care system is not permitted, Swedish commissioning parents have used transnational surrogacy, and the majority has turned to India. This interview study aimed to explore how commissioning parents negotiate the present discourses on surrogacy. Findings from the study suggest that the commissioning parents' views on using surrogacy are influenced by competing discourses on surrogacy represented by media and surrogacy agencies. The use of this reproductive method resulted, then, in some ambiguity. Although commissioning parents defy the exploitation discourse by referring to what they have learnt about the surrogate mother's life situation and by pointing at the significant benefits for her, they still had a request for regulation of surrogacy in Sweden, to better protect all parties involved. This study, then, gives a complex view on surrogacy, where the commissioning parents simultaneously argue against the exploitation discourse but at the same time are uncertain if the surrogate mothers are well protected in the surrogacy arrangements. Their responses to the situation endorse the need for regulation both in Sweden and India.

    National Category
    Obstetrics, Gynecology and Reproductive Medicine
    Identifiers
    urn:nbn:se:uu:diva-253219 (URN)10.1371/journal.pone.0126518 (DOI)000356768100126 ()25955178 (PubMedID)
    Available from: 2015-05-25 Created: 2015-05-25 Last updated: 2019-06-19Bibliographically approved
    2. Gauging the interests of birth mother and child: a qualitative study of Swedish social workers' experiences of transnational gestational surrogacy
    Open this publication in new window or tab >>Gauging the interests of birth mother and child: a qualitative study of Swedish social workers' experiences of transnational gestational surrogacy
    2016 (English)In: European Journal of Social Work, ISSN 1369-1457, E-ISSN 1468-2664, Vol. 21, no 1, p. 86-99Article in journal (Refereed) Published
    Abstract [en]

    There are few studies on how social workers deal with cases regarding transnational surrogacy. Our study intends to contribute to filling this gap. In Sweden, surrogacy as an assisted reproductive technology method is not permitted. As a result, many prospective parents have turned abroad, mainly to India, for surrogacy. There are no laws regulating surrogacy in Sweden, and difficulties have arisen in establishing legal parenthood when the parents return with the child. This qualitative interview study with social workers found that legal uncertainty and ethical issues surrounded their handling. With no guidelines, the constructions of parenthood will continue to depend on individual social workers' conflicting views on how to best meet the surrogate mother’s interest and the best interest of the child. Regulationis thus needed to better protect those involved and minimize the contingent aspects of legal handling by individual officials.

    Keywords
    Legal parenthood, Sweden, social workers, transnational commercial surrogacy, construction
    National Category
    Social Work Obstetrics, Gynecology and Reproductive Medicine
    Identifiers
    urn:nbn:se:uu:diva-307959 (URN)10.1080/13691457.2016.1256869 (DOI)000417767400008 ()
    Available from: 2016-11-23 Created: 2016-11-23 Last updated: 2019-06-27Bibliographically approved
    3. Surrogate mother – praiseworthy or stigmatized: a qualitative study on perceptions of surrogacy in Assam, India
    Open this publication in new window or tab >>Surrogate mother – praiseworthy or stigmatized: a qualitative study on perceptions of surrogacy in Assam, India
    2017 (English)In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, no 1, article id 1328890Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND: Surrogacy is a reproductive practice that has been strongly marketed in India as a solution for childless couples. As a result, the number of surrogacy clinics is increasing. Meanwhile, a global discourse on surrogacy, originating from a Western perspective, has characterized surrogacy as being exploitative of women in low-income settings, where poverty drives them to become surrogate mothers.

    OBJECTIVE: This study explored perspectives on surrogacy from men and women in Assam, an Indian state known to be a low-income setting. Surrogacy arrangements in Assam are still uncommon. It can be expected that the dominant global discourses on surrogacy will be unfamiliar to the general population, and the objective was also to position the results within the divergent global discourses of surrogacy.

    METHODS:  In order to explore local views on surrogacy, we conducted individual interviews and focus group discussions with people from various socioeconomic groups in Assam.

    RESULTS: Our findings reveal that people in Assam perceive surrogacy as a good option for a childless couple, as it would result in a child who is a 'blood' relation - something highly desirable for sociocultural reasons. However, the part played by the surrogate mother complicates local views on surrogacy. Most people consider payment to the surrogate mother contrary to societal norms. A surrogate mother is also often judged in a moral light, either as a 'bad mother' for selling her child, or as a 'noble woman' who has helped a childless couple and deserves payment for her services.

    CONCLUSIONS: In order to decrease the stigmatization of women, a regulatory policy is needed that will take into account the complex understandings of surrogacy and perceptions of surrogate mothers in Indian society. In policy, the possible effect of the dominant exploitation discourse needs to be modulated by local understandings of this reproduction method.

    Keywords
    Childlessness, in-vitro fertilization (IVF) surrogacy, low-income setting, motherhood, stigmatization, surrogate mother
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-327390 (URN)10.1080/16549716.2017.1328890 (DOI)000403498600001 ()28604252 (PubMedID)
    Available from: 2017-08-10 Created: 2017-08-10 Last updated: 2019-06-19Bibliographically approved
    4. Being questioned as parents: An interview studywith Swedish commissioning parents usingtransnational surrogacy
    Open this publication in new window or tab >>Being questioned as parents: An interview studywith Swedish commissioning parents usingtransnational surrogacy
    2019 (English)In: Reproductive Biomedicine and Society Online, E-ISSN 2405-6618, Vol. 8, p. 23-31Article in journal (Refereed) Published
    Abstract [en]

    This study sought to explore how Swedish parents who had commissioned surrogacy abroad experienced the process ofparenthood recognition. The study consisted of in-depth interviews with five couples and 10 individuals representing 10 additionalcouples who had used surrogacy abroad, mainly in India. The construction of motherhood and fatherhood in the Swedish systemcontradicts how parenthood is defined in the surrogacy process. This study found that the formal recognition of parenthood involved acomplex and frustrating process where the presumption of fatherhood and step-child adoption as grounds for parenthood makepeople feel questioned as parents, negatively affecting parental welfare. Policy makers need to take into account the consequencesof an unregulated situation regarding surrogacy, and focus more on the child–parent relationship when regulating surrogacy.

    Keywords
    assisted reproduction, commissioning parents, transnational surrogacy, parenthood, Sweden, India
    National Category
    Clinical Medicine
    Research subject
    Obstetrics and Gynaecology
    Identifiers
    urn:nbn:se:uu:diva-382882 (URN)org/10.1016/j.rbms.2018.08.001 (DOI)
    Available from: 2019-05-05 Created: 2019-05-05 Last updated: 2019-06-19
  • 48.
    Arvidsson, Anna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Johnsdotter, Sara
    Department of Social Work, Malmö University, Malmö, Sweden.
    Emmelin, Maria
    Department of Clinical Sciences, Division of Social Medicine and Global Health, Lund University, Lund, Sweden.
    Essén, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Gauging the interests of birth mother and child: a qualitative study of Swedish social workers' experiences of transnational gestational surrogacy2016In: European Journal of Social Work, ISSN 1369-1457, E-ISSN 1468-2664, Vol. 21, no 1, p. 86-99Article in journal (Refereed)
    Abstract [en]

    There are few studies on how social workers deal with cases regarding transnational surrogacy. Our study intends to contribute to filling this gap. In Sweden, surrogacy as an assisted reproductive technology method is not permitted. As a result, many prospective parents have turned abroad, mainly to India, for surrogacy. There are no laws regulating surrogacy in Sweden, and difficulties have arisen in establishing legal parenthood when the parents return with the child. This qualitative interview study with social workers found that legal uncertainty and ethical issues surrounded their handling. With no guidelines, the constructions of parenthood will continue to depend on individual social workers' conflicting views on how to best meet the surrogate mother’s interest and the best interest of the child. Regulationis thus needed to better protect those involved and minimize the contingent aspects of legal handling by individual officials.

  • 49.
    Arvidsson, Anna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Johnsdotter, Sarah
    Faculty of Health and Society, Malmö University.
    Emmelin, Maria
    Department of Clinical Sciences, Division of Social Medicine and Global Health, Lund University.
    Essén, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Maternal and Reproductive Health and Migration.
    Being questioned as parents: An interview studywith Swedish commissioning parents usingtransnational surrogacy2019In: Reproductive Biomedicine and Society Online, E-ISSN 2405-6618, Vol. 8, p. 23-31Article in journal (Refereed)
    Abstract [en]

    This study sought to explore how Swedish parents who had commissioned surrogacy abroad experienced the process ofparenthood recognition. The study consisted of in-depth interviews with five couples and 10 individuals representing 10 additionalcouples who had used surrogacy abroad, mainly in India. The construction of motherhood and fatherhood in the Swedish systemcontradicts how parenthood is defined in the surrogacy process. This study found that the formal recognition of parenthood involved acomplex and frustrating process where the presumption of fatherhood and step-child adoption as grounds for parenthood makepeople feel questioned as parents, negatively affecting parental welfare. Policy makers need to take into account the consequencesof an unregulated situation regarding surrogacy, and focus more on the child–parent relationship when regulating surrogacy.

  • 50.
    Arvidsson, Anna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Vauquline, Polly
    Department of Women's Studies, Gauhati University, Guwahati, India.
    Johnsdotter, Sara
    Faculty of Health and Society, Malmö University, Sweden.
    Essén, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Surrogate mother – praiseworthy or stigmatized: a qualitative study on perceptions of surrogacy in Assam, India2017In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, no 1, article id 1328890Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Surrogacy is a reproductive practice that has been strongly marketed in India as a solution for childless couples. As a result, the number of surrogacy clinics is increasing. Meanwhile, a global discourse on surrogacy, originating from a Western perspective, has characterized surrogacy as being exploitative of women in low-income settings, where poverty drives them to become surrogate mothers.

    OBJECTIVE: This study explored perspectives on surrogacy from men and women in Assam, an Indian state known to be a low-income setting. Surrogacy arrangements in Assam are still uncommon. It can be expected that the dominant global discourses on surrogacy will be unfamiliar to the general population, and the objective was also to position the results within the divergent global discourses of surrogacy.

    METHODS:  In order to explore local views on surrogacy, we conducted individual interviews and focus group discussions with people from various socioeconomic groups in Assam.

    RESULTS: Our findings reveal that people in Assam perceive surrogacy as a good option for a childless couple, as it would result in a child who is a 'blood' relation - something highly desirable for sociocultural reasons. However, the part played by the surrogate mother complicates local views on surrogacy. Most people consider payment to the surrogate mother contrary to societal norms. A surrogate mother is also often judged in a moral light, either as a 'bad mother' for selling her child, or as a 'noble woman' who has helped a childless couple and deserves payment for her services.

    CONCLUSIONS: In order to decrease the stigmatization of women, a regulatory policy is needed that will take into account the complex understandings of surrogacy and perceptions of surrogate mothers in Indian society. In policy, the possible effect of the dominant exploitation discourse needs to be modulated by local understandings of this reproduction method.

1234567 1 - 50 of 737
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf