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  • 51.
    Mocumbi, Sibone
    et al.
    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), Obstetrics and Reproductive Health Research. Univ Eduardo Mondlane, Fac Med, Maputo, Mozambique.
    Boene, H.
    Manhica Hlth Res Ctr CISM, Manhica, Mozambique.
    Munguambe, K.
    Univ Eduardo Mondlane, Fac Med, Maputo, Mozambique; Manhica Hlth Res Ctr CISM, Manhica, Mozambique.
    Högberg, Ulf
    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), Obstetrics and Reproductive Health Research. Uppsala Univ, Dept Womens & Childrens Hlth, Uppsala, Sweden..
    Hanson, C.
    Karolinska Inst, Dept Publ Hlth, Stockholm, Sweden.
    Bergström, 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).
    Sevene, E.
    Univ Eduardo Mondlane, Fac Med, Maputo, Mozambique; Manhica Hlth Res Ctr CISM, Manhica, Mozambique.
    Obstetric fistulae in southern Mozambique, incidence, risk factors and obstacles for care2017In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 124, no S1, p. 49-49Article in journal (Other academic)
  • 52.
    Mocumbi, Sibone
    et al.
    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), Obstetrics and Reproductive Health Research. Univ Eduardo Mondlane UEM, Fac Med, Dept Obstet & Gynaecol, Av Agostinho Neto 679, Maputo 1100, Mozambique..
    Hanson, Claudia
    Karolinska Inst, Dept Publ Hlth Sci, Tomtebodavagen 18A,Plan 4, Stockholm, Sweden.;London Sch Hyg & Trop Med, Dept Dis Control, Keppel St, London WC1E 7HT, England..
    Högberg, Ulf
    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), Obstetrics and Reproductive Health Research.
    Boene, Helena
    CISM, Rua 12,Vila Manhica, Manhica 1121, Mozambique..
    von Dadelszen, Peter
    Kings Coll London, Global Womens Hlth, London, England..
    Bergström, 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), International Child Health and Nutrition. UCL, Inst Global Hlth, Gower St, London WC1E 6BT, England..
    Munguambe, Khtia
    UEM, Fac Med, Dept Publ Hlth, Av Salvador Allende 702 R-C, Maputo, Mozambique..
    Sevene, Esperanca
    UEM, Fac Med, Clin Pharmacol, Dept Physiol Sci, Av Salvador Allende 702 R-C, Maputo, Mozambique..
    Obstetric fistulae in southern Mozambique: incidence, obstetric characteristics and treatment2017In: Reproductive Health, ISSN 1742-4755, E-ISSN 1742-4755, Vol. 14, article id 147Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Obstetric fistula is one of the most devastating consequences of unmet needs in obstetric services. Systematic reviews suggest that the pooled incidence of fistulae in community-based studies is 0.09 per 1000 recently pregnant women; however, as facility delivery is increasing, for the most part, in Africa, incidence of fistula should decrease. Few population-based studies on fistulae have been undertaken in Sub-Saharan Africa, including Mozambique. This study aimed to estimate the incidence of obstetric fistulae in recently delivered mothers, and to describe the clinical characteristics and care, as well as the outcome, after surgical repair.

    METHODS: We selected women who had delivered up to 12 months before the start of the study (June, 1st 2016). They were part of a cohort of women of reproductive age (12-49 years), recruited from selected clusters in rural areas of Maputo and Gaza provinces, Southern Mozambique, who were participating in an intervention trial (the Community Level Interventions for Pre-eclampsia trial or CLIP trial). Case identification was completed by self-reported constant urine leakage and was confirmed by clinical assessment. Women who had confirmed obstetric fistulae were referred for surgical repair. Data were entered into a REDCap database and analysed using R software.

    RESULTS: Five women with obstetric fistulae were detected among 4358 interviewed, giving an incidence of 1.1 per 1000 recently pregnant women (95% CI 2.16-0.14). All but one had Caesarean section and all of the babies died. Four were stillborn, and one died very soon after birth. All of the patients identified and reached the primary health facility in reasonable time. Delays occurred in the care: in diagnosis of obstructed labour, and in the decision to refer to the secondary or third-level hospital. All but one of the women were referred to surgical repair and the fistulae successfully closed.

    CONCLUSION: This population-based study reports a high incidence of obstetric fistulae in an area with high numbers of facility births. Few first and second delays in reaching care, but many third delays in receiving care, were identified. This raises concerns for quality of care.

  • 53.
    Mocumbi, Sibone
    et al.
    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), Obstetrics and Reproductive Health Research. UEM, Fac Med, Dept Obstet & Gynaecol, Av Salvador Allende 702, Maputo 1100, Mozambique.
    Högberg, Ulf
    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), Obstetrics and Reproductive Health Research.
    Lampa, Erik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Sacoor, Charfudin
    CISM, Rua 12, Manhica, Mozambique.
    Vala, Anifa
    CISM, Rua 12, Manhica, Mozambique.
    Bergström, 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). UCL, Inst Global Hlth, Gower St, London WC1E 6BT, England.
    von Dadelszen, Peter
    Kings Coll London, Fac Life Sci & Med, Sch Life Course Sci, Dept Women & Childrens Hlth, 1 Lambeth Palace Rd, London SE1 7EU, England.
    Munguambe, Khatia
    CISM, Rua 12, Manhica, Mozambique;Univ Eduardo Mondlane, Fac Med, Dept Publ Hlth, Av Salvador Allende 702 R-C, Maputo, Mozambique.
    Hanson, Claudia
    Karolinska Inst, Dept Publ Hlth Sci, Tomtebodavagen 18A,Plan 4, Stockholm, Sweden;London Sch Hyg & Trop Med, Dept Dis Control, Keppel St, London WC1E 7HT, England.
    Sevene, Esperanca
    CISM, Rua 12, Manhica, Mozambique;Univ Eduardo Mondlane, Fac Med, Dept Physiol Sci, Clin Pharmacol, Av Salvador Allende 702 R-C, Maputo, Mozambique.
    Macete, Eusebio
    Amose, Felizarda
    Pires, Rosa
    Nhamirre, Zefanias
    Macamo, Marta
    Matavele, Analisa
    Vilanculo, Faustino
    Nhancolo, Ariel
    Cutana, Silvestre
    Mandlate, Ernesto
    Macuacua, Salesio
    Bique, Cassimo
    Maculuve, Sonia
    Biz, Ana Ilda
    Mulungo, Dulce
    Augusto, Orvalho
    Filimone, Paulo
    Nobela, Vivalde
    Tchavana, Corsino
    Nkumbula, Claudio
    Payne, Beth
    Vidler, Marianne
    Sharma, Sumedha
    Li, Jing (Larry)
    Lee, Tang
    Tu, Domena
    Dube, Alison
    Bone, Jeffrey
    Dunsmuir, Dustin
    Madhavan, Meera
    Mothers' satisfaction with care during facility-based childbirth: a cross-sectional survey in southern Mozambique2019In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 19, no 1, article id 303Article in journal (Refereed)
    Abstract [en]

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

  • 54.
    Mocumbi, Sibone
    et al.
    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), Obstetrics and Reproductive Health Research. Department of Obstetrics and Gynaecology, Faculty of Medicine, Universidade Eduardo Mondlane (UEM), Maputo, Mozambique.
    McKee, Kevin
    Munguambe, Khátia
    Chiau, Rogério
    Högberg, Ulf
    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), Obstetrics and Reproductive Health Research.
    Hanson, Claudia
    Wallin, Lars
    Sevene, Esperança
    Bergström, 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), International Child Health and Nutrition. Institute for Global Health, University College London, London, UK.
    Ready to deliver maternal and newborn care?: Health providers' perceptions of their work context in rural Mozambique2018In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 11, no 1, article id 1532631Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Deficiencies in the provision of evidence-based obstetric care are common in low-income countries, including Mozambique. Constraints relate to lack of human and financial resources and weak health systems, however limited resources alone do not explain the variance. Understanding the healthcare context ahead of implementing new interventions can inform the choice of strategies to achieve a successful implementation. The Context Assessment for Community Health (COACH) tool was developed to assess modifiable aspects of the healthcare context that theoretically influence the implementation of evidence.

    OBJECTIVES: To investigate the comprehensibility and the internal reliability of COACH and its use to describe the healthcare context as perceived by health providers involved in maternal care in Mozambique.

    METHODS: A response process evaluation was completed with six purposively selected health providers to uncover difficulties in understanding the tool. Internal reliability was tested using Cronbach's α. Subsequently, a cross-sectional survey using COACH, which contains 49 items assessing eight dimensions, was administered to 175 health providers in 38 health facilities within six districts in Mozambique.

    RESULTS: The content of COACH was clear and most items were understood. All dimensions were near to or exceeded the commonly accepted standard for satisfactory internal reliability (0.70). Analysis of the survey data indicated that items on all dimensions were rated highly, revealing positive perception of context. Significant differences between districts were found for the Work culture, Leadership, and Informal payment dimensions. Responses to many items had low variance and were left-skewed.

    CONCLUSIONS: COACH was comprehensible and demonstrated good reliability, although biases may have influenced participants' responses. The study suggests that COACH has the potential to evaluate the healthcare context to identify shortcomings and enable the tailoring of strategies ahead of implementation. Supplementing the tool with qualitative approaches will provide an in-depth understanding of the healthcare context.

  • 55.
    Namatovu, Fredinah
    et al.
    Umea Univ, Dept Publ Hlth & Clin Med Epidemiol & Global Hlth, SE-90187 Umea, Sweden..
    Olsson, Cecilia
    Umea Univ, Dept Food & Nutr, SE-90187 Umea, Sweden..
    Lindkvist, Marie
    Umea Univ, Dept Publ Hlth & Clin Med Epidemiol & Global Hlth, SE-90187 Umea, Sweden..
    Myleus, Anna
    Umea Univ, Dept Publ Hlth & Clin Med Epidemiol & Global Hlth, SE-90187 Umea, Sweden..
    Högberg, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology. Umea Univ, Dept Publ Hlth & Clin Med Epidemiol & Global Hlth, SE-90187 Umea, Sweden..
    Ivarsson, Anneli
    Umea Univ, Dept Publ Hlth & Clin Med Epidemiol & Global Hlth, SE-90187 Umea, Sweden..
    Sandström, Olof
    Umea Univ, Dept Clin Sci, Pediat, SE-90187 Umea, Sweden..
    Maternal and perinatal conditions and the risk of developing celiac disease during childhood2016In: BMC Pediatrics, ISSN 1471-2431, E-ISSN 1471-2431, Vol. 16, article id 77Article in journal (Refereed)
    Abstract [en]

    Background: Celiac disease (CD) is increasing worldwide, which might be due to the changing environmental and lifestyle exposures. We aimed to explore how conditions related to maternity, delivery and the neonatal period influence CD onset during childhood. Methods: Using Sweden's national registers we had access to information on 1 912 204 children born between 1991 and 2009, 6 596 of whom developed CD before 15 years of age. Logistic regression analyses were performed to determine how CD is associated with maternity, delivery and the neonatal period. Results: Regardless of sex, a reduction in CD risk was observed in children born to mothers aged >= 35 years (odds ratio [OR] 0.8; 95 % confidence interval [CI] 0.7-0.9) and with high maternal income (OR 0.9; 95 % CI 0.8-0.9). Being a second-born child, however, was positively associated with CD. Among boys, elective caesarean delivery increased the risk of CD (OR 1.2; 95 % CI 1.0-1.4), while maternal overweight (OR 0.9; 95 % CI 0.8-0.9), premature rupture of the membrane (OR 0.4; 95 % CI 0.2-0.8) and low birth weight showed a negative association. Girls had an increased CD risk compared to boys and in girls the risk was increased by repeated maternal urinary tract infections (OR 1.1; 95 % CI 1.0-1.2). Conclusions: Elective caesarean delivery and repeated maternal urinary tract infections during pregnancy are associated with increased risk of CD onset during childhood, suggesting the role of dysbiosis during early life. High maternal age and high income reduced the risk of CD, which might be due to infant-feeding practices and life style.

  • 56. Nyström, Monica E.
    et al.
    Westerlund, Anna
    Hoog, Elisabet
    Millde-Luthander, Charlotte
    Högberg, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Grunewald, Charlotta
    Healthcare system intervention for prevention of birth injuries: process evaluation of self-assessment, peer review, feedback and agreement for change2012In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 12, p. 274-Article, review/survey (Refereed)
    Abstract [en]

    Background: Patient safety is fundamental in high quality healthcare systems but despite an excellent record of perinatal care in Sweden some children still suffer from substandard care and unnecessary birth injuries. Sustainable patient safety improvements assume changes in key actors' mental models, norms and culture as well as in the tools, design and organisation of work. Interventions positively affecting team mental models on safety issues are a first step to enhancing change. Our purpose was to study a national intervention programme for the prevention of birth injuries with the aim to elucidate how the main interventions of self-assessment, peer review, feedback and written agreement for change affected the teams and their mental model of patient safety, and thereby their readiness for change. Knowledge of relevant considerations before implementing this type of patient safety intervention series could thereby be increased. Methods: Eighty participants in twenty-seven maternity units were interviewed after the first intervention sequence of the programme. A content analysis using a priori coding was performed in order to relate results to the anticipated outcomes of three basic interventions: self-assessment, peer review and written feedback, and agreement for change. Results: The self-assessment procedure was valuable and served as a useful tool for elucidating strengths and weaknesses and identifying areas for improvement for a safer delivery in maternity units. The peer-review intervention was appreciated, despite it being of less value when considering the contribution to explicit outcome effects (i.e. new input to team mental models and new suggestions for actions). The feedback report and the mutual agreement on measures for improvements reached when signing the contract seemed exert positive pressures for change. Conclusions: Our findings are in line with several studies stressing the importance of self-evaluation by encouraging a thorough review of objectives, practices and outcomes for the continuous improvement of an organisation. Even though effects of the peer review were limited, feedback from peers, or other change agents involved, and the support that a clear and well-structured action plan can provide are considered to be two important complements to future self-assessment procedures related to patient safety improvement.

  • 57.
    Olivier, Jocelien D A
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Åkerud, Helena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Kaihola, Helena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Pawluski, J. L.
    GIGA-Neurosciences, University of Liège, Liège, Belgium.
    Skalkidou, Alkistis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Högberg, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Sundström Poromaa, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    The effects of maternal depression and maternal selective serotonin reuptake inhibitor exposure on offspring2013In: Frontiers in Cellular Neuroscience, ISSN 1662-5102, E-ISSN 1662-5102, Vol. 7, p. 73-Article, review/survey (Refereed)
    Abstract [en]

    It has been estimated that 20% of pregnant women suffer from depression and it is well-documented that maternal depression can have long-lasting effects on the child. Currently, common treatment for maternal depression has been the selective serotonin reuptake inhibitor medications (SSRIs) which are used by 2-3% of pregnant women in the Nordic countries and by up to 10% of pregnant women in the United States. Antidepressants cross the placenta and are transferred to the fetus, thus, the question arises as to whether children of women taking antidepressants are at risk for altered neurodevelopmental outcomes and, if so, whether the risks are due to SSRI medication exposure or to the underlying maternal depression. This review considers the effects of maternal depression and SSRI exposure on offspring development in both clinical and preclinical populations. As it is impossible in humans to study the effects of SSRIs without taking into account the possible underlying effects of maternal depression (healthy pregnant women do not take SSRIs), animal models are of great value. For example, rodents can be used to determine the effects of maternal depression and/or perinatal SSRI exposure on offspring outcomes. Unraveling the joint (or separate) effects of maternal depression and SSRI exposure will provide more insights into the risks or benefits of SSRI exposure during gestation and will help women make informed decisions about using SSRIs during pregnancy.

  • 58.
    Palm, Anna
    et al.
    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), Obstetric research.
    Danielsson, Ingela
    Umea Univ, Dept Clin Sci, Obstet & Gynaecol, SE-90187 Umea, Sweden..
    Högberg, Ulf
    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), Obstetric research.
    Norbergh, Karl-Gustav
    Mid Sweden Univ, Fac Human Sci, Dept Nursing Sci, SE-85170 Sundsvall, Sweden..
    How do youth with experience of violence victimization and/or risk drinking perceive routine inquiry about violence and alcohol consumption in Swedish youth clinics?: A qualitative study2017In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 13, p. 51-57Article in journal (Refereed)
    Abstract [en]

    Objective: To explore perceptions and experiences among youth who underwent structured questions about violence victimization and alcohol consumption when visiting Swedish youth clinics.

    Methods: This study is part of a larger research project examining the effect of including routine inquiry about violence victimization and alcohol consumption for youth visiting youth clinics. Fifteen youth with experiences of victimization and/or risk drinking (AUDIT-C >= 5) were interviewed. Content analysis was used.

    Results: The findings were grouped into three main categories: The first; "Disclosure talking about violence" reflected the participants' experiences of being asked about victimization. Participants were in favor of routine inquiry about violence victimization, even when questions caused distress. The questions helped participants reflect on prior victimization and process what had happened to them. The second; "Influence on the life situation" demonstrated that many of the participants still were effected by prior victimization, but also how talking about violence sometimes led to the possibility of initiating change such as leaving a destructive relationship or starting therapy. In the third; "One's own alcohol consumption in black and white" participants considered it natural to be asked about alcohol consumption. However, most participants did not consider their drinking problematic, even when told they exceeded guidelines. They viewed risk drinking in terms of immediate consequences rather than in quantity or frequency of alcohol intake.

    Conclusion: Routine inquiry about violence victimization and risk drinking at youth clinics was well received. Questions about violence helped participants to interpret and process prior victimization and sometimes initiated change.

  • 59.
    Palm, Anna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology. Sundsvall Hosp, Dept Obstet & Gynaecol, S-85643 Sundsvall, Sweden.
    Danielsson, Ingela
    Umea Univ, Dept Clin Sci Obstet & Gynaecol, Umea, Sweden.
    Skalkidou, Alkistis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Olofsson, Niclas
    Linkoping Univ, Dept Med & Hlth, Div Social Med & Publ Hlth Sci, Linkoping, Sweden.
    Högberg, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Violence victimisation: a watershed for young women's mental and physical health2016In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 26, no 5, p. 861-867Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The association between victimisation and adverse health in children is well established but few studies have addressed the effect of victimisation, especially multiple victimisations, in older adolescents and young adults. The aim of this study was to assess self-reported health in young women (15-22 years) victimised to one or more types of violence, compared with non-victimised.  METHODS: Young women visiting youth health centres in Sweden answered a questionnaire constructed from standardised instruments addressing violence victimisation (emotional, physical, sexual and family violence), socio-demographics, substance use and physical and mental health. Adjusted odds ratio (AOR) with 95% confidence interval (CI) and attributable risk (AR) were assessed.  RESULTS: Of 1051 women (73% of eligible women), 25% were lifetime victims of one type of violence and 31% of two or more types of violence. Sexual-minority young women were more victimised than heterosexual women. Violence victimisation increased the risk for adverse health outcomes, especially evident for those multiply victimised. Victims of two or more types of violence had AOR 11.8 (CI 6.9-20.1) for post-traumatic stress symptoms, 6.3 (CI 3.9-10.2) for anxiety symptoms and 10.8 (CI 5.2-22.5) for suicide ideation. The AR of victimisation accounted for 41% of post-traumatic stress symptoms, 30% of anxiety symptoms and 27% of suicide ideation. Stratified analyses showed that lower economic resources did not influence health negatively for non-victimised, whereas it multiplicatively reinforced ill-health when combined with violence victimisation.  CONCLUSION: Violence victimisation, and particularly multiple victimisations, was strongly associated with mental ill-health in young women, especially evident in those with low economic resources.

  • 60.
    Salazar, Mariano
    et al.
    Center for Demography and Health Research, Nicaraguan National Autonomous University, León, Nicaragua.
    Högberg, Ulf
    Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Sweden.
    Valladares, Eliette
    Center for Demography and Health Research, Nicaraguan National Autonomous University, León, Nicaragua.
    Ohman, Ann
    Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Sweden.
    The supportive process for ending intimate partner violence after pregnancy: the experience of Nicaraguan women.2012In: Violence against Women, ISSN 1077-8012, E-ISSN 1552-8448, Vol. 18, no 11, p. 1257-78Article in journal (Refereed)
    Abstract [en]

    This grounded theory study found that Nicaraguan mothers exposed to intimate partner violence (IPV) during pregnancy eventually acted to protect their children and themselves. They experienced ending abuse as an empowerment process characterized by a cognitive change in women's attitudes toward partner abuse and the emergence of help-seeking strategies that lead to ending violence with or without ending the relationship. This process was facilitated by a supportive environment that challenged abusive behaviors as well as being asked about abuse during their last pregnancy. Although environmental changes can facilitate ending abuse, Nicaragua's public institutions must be strengthened to reach women in need.

  • 61.
    Salazar, Mariano
    et al.
    Center for Demography and Health Research, Nicaraguan National Autonomous University, León, Nicaragua.
    Högberg, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Valladares, Eliette
    Center for Demography and Health Research, Nicaraguan National Autonomous University, León, Nicaragua.
    Persson, Lars-Åke
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Intimate partner violence and early child growth: a community-based cohort study in Nicaragua2012In: BMC Pediatrics, ISSN 1471-2431, E-ISSN 1471-2431, Vol. 12, p. 82-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    This study analyses whether a mother's exposure to different forms of Intimate Partner Violence (IPV) during pregnancy was associated with the index child linear growth, and whether these associations were modified by the gender of the child.

    METHODS:

    A pregnancy cohort of 478 women in Leon, Nicaragua, resulted in 461 live births. From this group, 81% (375/461) children were available for anthropometric follow-up at 40 to 46 months. Analysis of covariance (ANCOVA) was used to assess the association between IPV and height-for-age Z-scores, adjusting for confounding factors.

    RESULTS:

    Sixty-three percent (236/375) of the mothers had been exposed to some form of IPV during pregnancy (emotional, physical, sexual or controlling behavior). After adjustment for confounding factors, maternal exposure to any IPV during pregnancy was associated with 0.24 lower mean height-for-age Z-scores (p = 0.02). A separate analysis of each IPV type showed that emotional, physical or sexual IPV during pregnancy were not significantly associated with lower mean height-for-age Z-scores, whereas ever exposure to controlling behavior by the father of the child was related to 0.29 lower mean height-for-age Z-scores (p < 0.01) When stratified by gender, these associations remained significant only for young girls.

    CONCLUSIONS:

    This study has contributed to the growing amount of evidence pointing to the pervasive effect of different forms of IPV on child health. Our study highlights the relevance of maternal autonomy for linear child growth, especially for young girls in the Nicaraguan context.

  • 62.
    Salazar, Mariano
    et al.
    Center for Demography and Health Research, Nicaraguan National Autonomous University, León, Nicaragua.
    Valladares, Eliette
    Högberg, Ulf
    Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Sweden.
    Questions about intimate partner violence should be part of contraceptive counselling: findings from a community-based longitudinal study in Nicaragua2012In: Journal of family planning and reproductive health care, ISSN 1471-1893, E-ISSN 2045-2098, Vol. 38, no 4, p. 221-228Article in journal (Refereed)
    Abstract [en]

    Background and methodology The study aim was to examine whether exposure to intimate partner violence (IPV) was associated with reversible contraceptive use in ever-pregnant partnered women. The authors conducted a longitudinal panel study in Leon municipality, Nicaragua. At baseline (2002-2003), 478 pregnant women were interviewed and 398 were available for questioning about contraceptive use 40-47 months after childbirth. IPV was assessed at baseline and follow-up, with women classified as never abused, ending abuse, continued abuse or new abuse. Reversible contraceptive use was defined as women using any form of contraception apart from sterilisation. Adjusted odds ratios (AORs) were used to assess the association between reversible contraceptive use, IPV patterns and IPV exposures at follow-up. Results Eighty percent of the women were not pregnant and with a partner at follow-up. Half were using reversible contraceptives and 28% were sterilised. Women exposed to a continued abuse pattern (AOR 2.50, 95% CI 1.04-5.99), and those exposed to emotional (AOR 2.80, 95% CI 1.32-5.95), physical (AOR 3.60, 95% CI 1.15-11.10) or any IPV at follow-up (AOR 2.59, 95% CI 1.24-5.40) had higher odds of reversible contraceptive use than those not exposed, even after adjusting for demographic factors. No significant differences in the type of reversible contraceptive used were found between women exposed or not to IPV. Discussion and conclusions IPV exposure was associated with more reversible contraceptive use. Abuse inquiring at health facilities providing contraceptives should be implemented to identify women exposed to IPV and provide adequate support.

  • 63. Santosa, A
    et al.
    Rocklöv, J
    Högberg, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Byass, P
    Socio-demographic predictors of mortality inequality among Swedish men and women: a longitudinal study2014In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 24, p. 188-189Article in journal (Refereed)
    Abstract [en]

    Background

    Despite increasing life expectancy in many countries, health and mortality inequality exist. This study aimed to assess overall and cardiovascular (CVD) mortality trends among Swedish men and women during 1992-2006, and their association with individual level socio-demographic determinants of mortality inequality.

    Methods

    Data were extracted from the Linnaeus Database which consists of register and survey data. A multilevel Poisson regression analysis was used to assess the number and mortality rate, as well as individual level determinants (fixed effects) of overall and CVD deaths for men and women at county level (n = 24) in each 5-year period during 1992-2006. We also assessed the random effect at county level.

    Results

    A total of 9,098,090 individuals accumulating 115,361,104 person years was included in this study. A significant reduction in overall and CVD mortality rates occurred among Swedish men and women during the study period 1992-2006, with persisting excess male: female mortality. Older age and pensioner, unmarried or widowed individuals, low and middle education levels and employed individuals with low income (the lowest income tertile) were consistently associated with higher mortality rates of overall and CVD mortality in men and women. Individuals with tertiary education level and being immigrant was protective factors for overall mortality, but less so for CVD mortality. The multilevel analysis revealed that about 85% and 80% of the variation of overall and CVD mortality at county level, respectively, could be explained by the individual socio-demographic variables.

    Conclusions

    Inequality in overall and CVD mortality still exists among Swedish men and women, and to some extend are influenced by county level determinants. Contextual epidemiology must therefore play a decisive role in understanding social disparities in overall and CVD mortality in Sweden.

    Key messages

    • Overall, individual factors played a more important part in understanding the differences of overall and CVD mortality than contextual factors within the same area in men and women in Swedish context.

    • Health policy actions aiming to reduce health inequality should be addressed not only focusing on individual characteristics but also on geographical factors.

  • 64. Santosa, Ailiana
    et al.
    Rocklov, Joacim
    Högberg, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Byass, Peter
    Achieving a 25% reduction in premature non-communicable disease mortality: the Swedish population as a cohort study2015In: BMC Medicine, ISSN 1741-7015, E-ISSN 1741-7015, Vol. 13, article id 65Article in journal (Refereed)
    Abstract [en]

    Background: The 2012 World Health Assembly set a target for Member States to reduce premature non-communicable disease (NCD) mortality by 25% over the period 2010 to 2025. This reflected concerns about increasing NCD mortality burdens among productive adults globally. This article first considers whether the WHO target of a 25% reduction in the unconditional probability of dying between ages of 30 and 70 from NCDs (cardiovascular diseases, cancer, diabetes, or chronic respiratory diseases) has already taken place in Sweden during an equivalent 15-year period. Secondly, it assesses which population sub-groups have been more or less successful in contributing to overall changes in premature NCD mortality in Sweden. Methods: A retrospective dynamic cohort database was constructed from Swedish population registers in the Linnaeus database, covering the entire population in the age range 30 to 69 years for the period 1991 to 2006, which was used directly to measure reductions in premature NCD mortality using a life table method as specified by the WHO. Multivariate Poisson regression models were used to assess the contributions of individual background factors to decreases in premature NCD mortality. Results: A total of 292,320 deaths occurred in the 30 to 69 year age group during the period 1991 to 2006, against 70,768,848 person-years registered. The crude all-cause mortality rate declined from 5.03 to 3.72 per 1,000 person-years, a 26% reduction. Within this, the unconditional probability of dying between the ages of 30 and 70 from NCD causes as defined by the WHO fell by 30.0%. Age was consistently the strongest determinant of NCD mortality. Background determinants of NCD mortality changed significantly over the four time periods 1991-1994, 1995-1998, 1999-2002, and 2003-2006. Conclusions: Sweden, now at a late stage of epidemiological transition, has already exceeded the 25% premature NCD mortality reduction target during an earlier 15-year period. This should be encouraging news for countries currently implementing premature NCD mortality reduction programmes. Our findings suggest, however, that it may be difficult for Sweden and other late-transition countries to reach the current 25 x 25 target, particularly where substantial premature mortality reductions have already been achieved.

  • 65. Santosa, Ailiana
    et al.
    Wall, Stig
    Fottrell, Edward
    Högberg, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Byass, Peter
    The development and experience of epidemiological transition theory over four decades: a systematic review2014In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, no SI, p. 56-71Article, review/survey (Refereed)
    Abstract [en]

    Background: Epidemiological transition (ET) theory, first postulated in 1971, has developed alongside changes in population structures over time. However, understandings of mortality transitions and associated epidemiological changes remain poorly defined for public health practitioners. Here, we review the concept and development of ET theory, contextualising this in empirical evidence, which variously supports and contradicts the original theoretical propositions. Design: A Medline literature search covering publications over four decades, from 1971 to 2013, was conducted. Studies were included if they assessed human populations, were original articles, focused on mortality and health or demographic or ET and were in English. The reference lists of the selected articles were checked for additional sources. Results: We found that there were changes in emphasis in the research field over the four decades. There was an increasing tendency to study wide-ranging aspects of the determinants of mortality, including risk factors, lifestyle changes, socio-economics, and macro factors such as climate change. Research on ET has focused increasingly on low-and middle-income countries rather than industrialised countries, despite its origins in industrialised countries. Countries have experienced different levels of progress in ET in terms of time, pace, and underlying mechanisms. Elements of ET are described for many countries, but observed transitions have not always followed pathways described in the original theory. Conclusions: The classic ET theory largely neglected the critical role of social determinants, being largely a theoretical generalisation of mortality experience in some countries. This review shows increasing interest in ET all over the world but only partial concordance between established theory and empirical evidence. Empirical evidence suggests that some unconsidered aspects of social determinants contributed to deviations from classic theoretical pathways. A better-constructed, revised ET theory, with a stronger basis in evidence, is needed.

  • 66.
    Santosa, Ailiana
    et al.
    Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Sweden.
    Öhman, Ann
    Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Sweden.
    Högberg, Ulf
    Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Sweden.
    Stenlund, Hans
    Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Sweden.
    Hakimi, Mohammad
    Centre for Reproductive Health, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia.
    Ng, Nawi
    Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Sweden.
    Cross-Sectional Survey of Sexual Dysfunction and Quality of Life among Older People in Indonesia2011In: Journal of Sexual Medicine, ISSN 1743-6095, Vol. 8, no 6, p. 1594-1602Article in journal (Refereed)
    Abstract [en]

    Introduction. The burden of sexual dysfunction among older people in many low- and middle-income countries is not well known. Understanding sexual dysfunction among older people and its impact on quality of life is essential in the design of appropriate health promotion programs. Aims. To assess levels of sexual function and their association with quality of life while controlling for different sociodemographic determinants and chronic diseases among men and women over 50 years of age in rural Indonesia. Methods. A cross-sectional study was conducted in the Purworejo District, Central Java, Indonesia in 2007. The study involved 14,958 men and women over 50 years old. The association between sexual dysfunction and quality of life after controlling for potential confounders (e.g., sociodemographic determinants and self-reported chronic diseases) was analyzed by multivariable logistic regression. Main Outcome Measures. Self-reported quality of life. Results. Older men more commonly reported sexual activity, and sexual problems were more common among older women. The majority of older men and women reported their quality of life as good. Lack of sexual activity, dissatisfaction in sexual life, and presence of sexual problems were associated with poor self-reported quality of life in older men after adjustment for age, marital status, education, and history of chronic diseases. A presence of sexual problems was the only factor associated with poor self-reported quality of life in women. Being in a marital relationship might buffer the effect of sexual problems on quality of life in men and women. Conclusion. Sexual dysfunction is associated with poor quality of life among older people in a rural Javanese setting. Therefore, promotion of sexual health should be an integral part of physical and mental health campaigns in older populations. Santosa A, Ohman A, Hogberg U, Stenlund H, Hakimi M, and Ng N. Cross-sectional survey of sexual dysfunction and quality of life among older people in Indonesia. J Sex Med 2011;8:1594-1602.

  • 67.
    Tinglöf, Soile
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Högberg, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Wallin Lundell, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Skoog Svanberg, Agneta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Exposure to violence among women with unwanted pregnancies is associated with post-traumatic stress disorder, symptoms of anxiety and depression2015In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 6, no 2, p. 50-53Article in journal (Refereed)
    Abstract [en]

    Aim

    The objective was to examine lifetime exposure to violence, physical and sexual, among women seeking termination of pregnancy (TOP) and its association with socio-demographic factors, PTSD, symptoms of anxiety and depression.

    Design

    The design of the study was a Swedish multi-centre study targeting women requesting TOP.

    Methods

    All women requesting TOP with a gestational length less than 12 pregnancy weeks were approached for participation in the study. The questionnaire comprised the following research instruments: Screen Questionnaire-Post traumatic Stress Disorder (SQ-PTSD) and Hospital Anxiety and Depression Scale (HADS). The response rate was 57% and the final sample was 1514 women. Descriptive and analytic statistics were applied.

    Results

    Lifetime exposure to violence was common among women seeking abortion. Exposure to violence was associated with low education, single marital status, smoking and high alcohol consumption. Exposure to violence was associated with the occurrence of signs of PTSD and symptoms of anxiety and depression. Among those having PTSD, all had been exposed to sexual violence and almost all had been exposed to physical violence, while for those with symptoms of anxiety and depression almost half had been exposed to either physical or sexual violence.

    Conclusion

    Exposure to physical and sexual abuse was common among women requesting TOP, and was strongly associated with the occurrence of PTSD, symptoms of anxiety and depression. This underscores the importance for health professionals to recognize and offer support to those women exposed to violence.

  • 68. Tornell, S.
    et al.
    Ekeus, C.
    Hultin, M.
    Hakansson, S.
    Thunberg, J.
    Högberg, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Low Apgar score, neonatal encephalopathy and epidural analgesia during labour: a Swedish registry-based study2015In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 59, no 4, p. 486-495Article in journal (Refereed)
    Abstract [en]

    BackgroundMaternal intrapartum fever (MF) is associated with neonatal sequelae, and women in labour who receive epidural analgesia (EA) are more likely to develop hyperthermia. The aims of this study were to investigate if EA and/or a diagnosis of MF were associated to adverse neonatal outcomes at a population level. MethodsPopulation-based register study with data from the Swedish Birth Register and the Swedish National Patient Register, including all nulliparae (n=294,329) with singleton pregnancies who gave birth at term in Sweden 1999-2008. Neonatal outcomes analysed were Apgar score (AS)<7 at 5min and ICD-10 diagnosis of neonatal encephalopathy (e.g. convulsions or neonatal cerebral ischaemia). Multivariate logistic regression was used to calculate adjusted odds ratios (AOR) with 95% confidence intervals (CI). ResultsEA was used in 44% of the deliveries. Low AS or encephalopathy was found in 1.26% and 0.39% of the children in the EA group compared with 0.80% and 0.29% in the control group. In multivariate analysis, EA was associated with increased risk with low AS, AOR 1.27 (95% CI 1.16-1.39), but not with diagnosis of encephalopathy, 1.11 (0.96-1.29). A diagnosis of MF was associated with increased risk for both low AS, 2.27 (1.71-3.02), and of neonatal encephalopathy, 1.97 (1.19-3.26). ConclusionDiagnosis of MF was associated with low AS and neonatal encephalopathy, whereas EA was only associated with low AS and not with neonatal encephalopathy. The found associations might be a result of confounding by indication, which is difficult to assess in a registry-based population study.

  • 69.
    Ugarte, William 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).
    Högberg, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Valladares Cardoza, Eliette
    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).
    Measuring HIV- and AIDS-related stigma and discrimination in Nicaragua: Results from a community-based study2013In: AIDS Education and Prevention, ISSN 0899-9546, E-ISSN 1943-2755, Vol. 25, no 2, p. 164-178Article in journal (Refereed)
    Abstract [en]

    Psychometric properties of external HIV-related stigma and discrimination scales and their predictors were investigated. A cross-sectional community-based study was carried out among 520 participants using an ongoing health and demographic surveillance system in León, Nicaragua. Participants completed an 18-item HIV stigma scale and 19 HIV and AIDS discrimination-related statements. A factor analysis found that 15 of the 18 items in the stigma scale and 18 of the 19 items in the discrimination scale loaded clearly into five- and four-factor structures, respectively. Overall Cronbach’s alpha of .81 for the HIV stigma scale and .91 for the HIV discrimination scale provided evidence of internal consistency. Hierarchical multiple linear regression analysis identified that females, rural residents, people with insufficient HIV-related transmission knowledge, those not tested for HIV, those reporting an elevated self-perception of HIV risk, and those unwilling to disclose their HIV status were associated with higher stigmatizing attitudes and higher discriminatory actions towards HIV-positive people. This is the first community-based study in Nicaragua that demonstrates that overall HIV stigma and discrimination scales were reliable and valid in a community-based sample comprised of men and women of reproductive age. Stigma and discrimination were reported high in the general population, especially among sub-groups. The findings in the current study suggest Community-based strategies, including the monitoring of stigma and discrimination, and designing and implementing stigma reduction interventions, are greatly needed to reduce inequities and increase acceptance of persons with HIV.

  • 70.
    Ugarte, William 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).
    Högberg, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Valladares, Eliette
    Essén, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Assessing knowledge, attitudes, and behaviors related to HIV and AIDS in Nicaragua: A community-level perspective2013In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 4, no 1, p. 37-44Article in journal (Refereed)
    Abstract [en]

    Background:

    Nicaragua's HIV epidemic is concentrated among men who have sex with men.Nevertheless, the increasing number of HIV cases among heterosexuals, high levels of poverty andmigration rates, and incomplete epidemiological data suggest the need to improve the understanding of the epidemic.

    Objective:

    To examine the prevalence of HIV-related knowledge, attitudes, and sexual rsik-taking behaviors, and their predictors among the adult population.

    Methods:

    A community-based cross-sectional survey was conducted in 2009 among 520 participants ages 15 to 49 from an ongoing Health and Demographic Surveillance System in Nicaragua. Bivariate analysis and adjusted prevalence ratios were use to examine factors associated with HIV-related knowledge, attitudes, and sexual behavior.

    Results:

    Contributing factors for risk-taking behaviors included cognitive, psychosocial, and emotional elements. Insufficient knowledge affecting the accurate assessment of HIV risk were low educational level, poverty, and rural origin, especially among females. Recognizing risk was not sufficient to promote safer sex: 90% of the females and 70% of the males who reported being sexually active in the past year did not use condoms during their last sexual encounter. Inconsistent condom use among men was associated with older age, long-term relationships, and lack of awareness about acquiring HIV infection.

    Conclusions:

    Interventions to reduce social-structural contextual factors in Nicaragua are needed so that individuals may adopt and maintain HIV risk reduction strategies. Increased gender-specific HIV education and skills-building programs need to be implemented. Sensitive mass media messages may also increase the knowledge of HIV and AIDS, and serve to encourage protective attitudes and behaviors.

  • 71. Valladares, Eliette
    et al.
    Ugarte, William J
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    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).
    Högberg, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Morgan, Douglas
    Center for Functional Gastrointestinal and motility disorders, University of North Carolina.
    HIV community prevalence and testing practices in León, NicaraguaManuscript (preprint) (Other academic)
    Abstract [en]

    Our objective was to determine the HIV prevalence, testing practices, and HIV-related behaviors in a general population sample in the municipality of Leon, Nicaragua. We performed a cross-sectional community-based study of 2,204 males and females ages 18 to 69, from a health and demographic surveillance system. A behavior survey and blood sampling for HIV were also carried out. Seven of 1,960 individuals who provided biological samples (0.35%; CI 0.18–0.67) were HIV positive. The predicted prevalence of HIV among non-participants was about 11% higher than the observed prevalence but it was not significantly different. The major obstacle to HIV testing seemed to be the fear of being diagnosed HIV positive. This is the first study to determine HIV prevalence among the general population in Nicaragua. Our findings confirmed that this population has a low prevalence but high risk for HIV infection. Prevention strategies are essential to maintain this figure.

  • 72.
    Wahlberg, Åsa
    et al.
    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), Obstetrics and Reproductive Health Research. Department of Gynecology and Obstetrics, Skåne University Hospital, Malmö, Sweden.
    Andreen Sachs, Magna
    LIME/Medical Management Centre, Karolinska Institute, Sweden.
    Bergh Johannesson, Kerstin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Hallberg, Gunilla
    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), Gynecological endocrinology. Department of Gynecology and Obstetrics, Akademiska Hospital, Uppsala, Sweden.
    Jonsson, Maria
    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), Clinical Obstetrics. Department of Gynecology and Obstetrics, Akademiska Hospital, Uppsala, Sweden.
    Skoog Svanberg, Agneta
    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), Reproductive Health.
    Högberg, Ulf
    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), Obstetrics and Reproductive Health Research.
    Self-reported exposure to severe events on the labour ward among Swedish midwives and obstetricians: A cross-sectional retrospective study2017In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 65, p. 8-16Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The process of delivery entails potentially traumatic events in which the mother or child becomes injured or dies. Midwives and obstetricians are sometimes responsible for these events and can be negatively affected by them as well as by the resulting investigation or complaints procedure (clinical negligence).

    OBJECTIVE: To assess the self-reported exposure rate of severe events among midwives and obstetricians on the delivery ward and the cumulative risk by professional years and subsequent investigations and complaints.

    DESIGN: Cross-sectional survey.

    PARTICIPANTS: Members of the Swedish Association of Midwives (SFB) and the Swedish Society of Obstetrics and Gynaecology (SFOG).

    METHODS: A questionnaire covering demographic characteristics, experiences of self-reported severe events on the delivery ward, and complaints of medical negligence was developed. Potential consequences of the complaint was not reported. A severe event was defined as: 1) the death of an infant due to delivery-related causes during childbirth or while on the neonatal ward; 2) an infant being severely asphyxiated or injured at delivery; 3) maternal death; 4) very severe or life threatening maternal morbidity; or 5) other stressful events during delivery, such as exposure to violence or aggression.

    RESULTS: The response rate was 39.9% (n=1459) for midwives and 47.1% (n=706) for obstetricians. Eighty-four percent of the obstetricians and almost 71% of responding midwives had experienced one or more self-reported severe obstetric event with detrimental consequences for the woman or the new-born. Fourteen percent of the midwives and 22.4% of the obstetricians had faced complaints of medical negligence from the patient or the family of the patient.

    CONCLUSIONS: A considerable proportion of midwives and obstetricians will, in the course of their working life, experience severe obstetric events in which the mother or the new-born is injured or dies. Preparedness for such exposure should be part of the training, as should managerial and peer support for those in need. This could prevent serious consequences for the health care professionals involved and their subsequent careers.

  • 73.
    Wahlberg, Åsa
    et al.
    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), Obstetrics and Reproductive Health Research. Department of Obstetrics and Gynaecology, Ystad Hospital, Sweden.
    Högberg, Ulf
    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), Obstetrics and Reproductive Health Research.
    Emmelin, Maria
    Department of Social Medicine and Global Health, Lund University, Sweden.
    The erratic pathway to regaining a professional self-image after an obstetric work-related trauma: A grounded theory study2019In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 89, p. 53-61Article in journal (Refereed)
    Abstract [en]

    Background: It is known that healthcare providers might be affected by severe medical events in which patients are badly hurt. In birth care, escalating situations can result in death or injury to a mother or new-born child.

    Objective: To explore the process that Swedish midwives and obstetricians go through after a severe event in the maternity unit.

    Design: A modified Constructivist Grounded Theory analysis, based on fourteen in-depth interviews with birth care professionals.

    Participants: Seven midwives and seven obstetricians.

    Results: A core category, 'regaining of a professional self-image', was constructed and interpreted as being constituted of six main categories illustrating a frequently erratic pathway to the regaining of a professional self-image. The process included a search for external acceptance for the re-establishment of belongingness by obtaining corroboration from the woman, work colleagues and manager, and the medico-legal system.

    Media exposure was invariably seen as something negative. Internal processes involved coping with emotions of guilt and shame and the vulnerability that the work entails, as well as contemplating future work. The possibility to fully regain one's professional self-image depended on having a sense of confidence and an urge to support others in similar situations by sharing gained insights. However, the process could also result in reconsidering one's professional self-image by setting up boundaries, creating a better work-life balance, or creating mental back-up plans in case of similar recurrences. For others, the process led to a change of professional identity and a search for roles away from emergency obstetrics or the specialty as such.

    Conclusions: Many midwives and obstetricians will experience severe obstetric events that might affect them, sometimes severely. The vulnerability that healthcare professionals are exposed to should not be underestimated and preparedness in terms of collegial support, as well as an awareness in the workplace of how badly affected employees might be, is important. Growth as well as leaving birth care can be the results of the process following a severe event.

  • 74.
    Wahlberg, Åsa
    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).
    Rööst, Mattias
    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).
    Haglund, Bengt
    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, 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).
    Increased risk of severe maternal morbidity (near-miss) among immigrant women in Sweden: a population register-based study2013In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 120, no 13, p. 1605-1612Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    To determine if immigrant women from low-, middle- and high-income countries have an increased risk of severe maternal morbidity (near-miss) when they deliver in Sweden.

    DESIGN:

    Population register-based study.

    SETTING:

    Nationwide study including all singleton deliveries (≥28 weeks of gestation) between 1998 and 2007.

    POPULATION:

    Women with a near-miss event; all women with a singleton delivery ≥28 weeks of gestation during the same period acted as reference group.

    METHODS:

    Near-miss was defined by a combined clinical and management approach with use of International Classification of Diseases, 10th revision codes for severe maternal morbidity. A woman's country of origin was designated as low-, middle- or high-income according to the World Bank Classification of 2009. Unconditional logistic regression models were used in the analysis.

    MAIN OUTCOME MEASURES:

    Maternal near-miss frequencies per 1000 deliveries and odds ratios with 95% confidence intervals.

    RESULTS:

    There were 914 474 deliveries during the study period and 2655 near-misses (2.9 per 1000 deliveries). In comparison to Swedish-born women, those from low-income countries had an increased risk of near-miss (odds ratio 2.3, 95% confidence interval 1.9-2.8) that was significant in all morbidity groups except for cardiovascular diseases and sepsis. Women from middle- and high-income countries showed no increased risk of near-miss.

    CONCLUSIONS:

    Women from low-income countries have an increased risk of maternal near-miss morbidity compared with women born in Sweden. Although the rate is low it should alert healthcare providers.

  • 75.
    Wahlberg, Åsa
    et al.
    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), Obstetrics and Reproductive Health Research. Skane Univ Hosp, Dept Obstet & Gynaecol, Malmo, Sweden..
    Sachs, M. Andreen
    Karolinska Inst, LIME Med Management Ctr, Stockholm, Sweden.
    Bergh Johannesson, Kerstin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Hallberg, Gunilla
    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), Gynecological endocrinology. Akad Hosp, Dept Obstet & Gynaecol, Uppsala, Sweden.
    Jonsson, Maria
    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), Clinical Obstetrics. Akad Hosp, Dept Obstet & Gynaecol, Uppsala, Sweden..
    Skoog Svanberg, Agneta
    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), Reproductive Health.
    Högberg, Ulf
    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), Obstetrics and Reproductive Health Research.
    Post-traumatic stress symptoms in Swedish obstetricians and midwives after severe obstetric events: a cross-sectional retrospective survey2017In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 124, no 8, p. 1264-1271Article in journal (Refereed)
    Abstract [en]

    Objective: To examine post-traumatic stress reactions among obstetricians and midwives, experiences of support and professional consequences after severe events in the labour ward.

    Design: Cross-sectional online survey from January 7 to March 10, 2014.

    Population: Members of the Swedish Society of Obstetrics and Gynaecology and the Swedish Association of Midwives.

    Methods: Potentially traumatic events were defined as: the child died or was severely injured during delivery; maternal near-miss; maternal mortality; and other events such as violence or threat. The validated Screen Questionnaire Posttraumatic Stress Disorder (SQ-PTSD), based on DSM-IV (1994) 4th edition, was used to assess partial post-traumatic stress disorder (PTSD) and probable PTSD.

    Main outcome measures: Partial or probable PTSD.

    Results: The response rate was 47% for obstetricians (n = 706) and 40% (n = 1459) for midwives. Eighty-four percent of the obstetricians and 71% of the midwives reported experiencing at least one severe event on the delivery ward. Fifteen percent of both professions reported symptoms indicative of partial PTSD, whereas 7% of the obstetricians and 5% of the midwives indicated symptoms fulfilling PTSD criteria. Having experienced emotions of guilt or perceived insufficient support from friends predicted a higher risk of suffering from partial or probable PTSD. Obstetricians and midwives with partial PTSD symptoms chose to change their work to outpatient care significantly more often than colleagues without these symptoms.

    Conclusions: A substantial proportion of obstetricians and midwives reported symptoms of partial or probable PTSD after severe traumatic events experienced on the labour ward. Support and resilience training could avoid suffering and consequences for professional carers.

  • 76.
    Wallin Lundell, Inger
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Frans, Örjan
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Helstrom, L.
    Högberg, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Moby, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Nyberg, S.
    Poromaa, Inger Sundström
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Sydsjö, G.
    Ohman, S. G.
    Östlund, I
    Svanberg, Agneta Skoog
    Post-traumatic stress disorder among women requesting induced termination of pregnancy: a Swedish multi-centre study2012In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 119, no S2, p. 2-2Article in journal (Other academic)
  • 77.
    Wallin Lundell, Inger
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology. Sophiahemmet University, Stockholm, Sweden.
    Georgsson Öhman, Susanne
    Sophiahemmet University, Stockholm, Sweden.
    Frans, Örjan
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Helström, Lotti
    Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden.
    Högberg, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Nyberg, Sigrid
    Sundström Poromaa, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Sydsjö, Gunilla
    Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Sweden.
    Östlund, Ingrid
    Department of Obstetrics and Gynaecology, Örebro University Hospital, Sweden.
    Svanberg, Agneta Skoog
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Posttraumatic stress among women after induced abortion: a Swedish multi-centre cohort study2013In: BMC Women's Health, ISSN 1472-6874, E-ISSN 1472-6874, Vol. 13, p. 52-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Induced abortion is a common medical intervention. Whether psychological sequelae might follow induced abortion has long been a subject of concern among researchers and little is known about the relationship between posttraumatic stress disorder (PTSD) and induced abortion. Thus, the aim of the study was to assess the prevalence of PTSD and posttraumatic stress symptoms (PTSS) before and at three and six months after induced abortion, and to describe the characteristics of the women who developed PTSD or PTSS after the abortion.

    METHODS:

    This multi-centre cohort study included six departments of Obstetrics and Gynaecology in Sweden. The study included 1457 women who requested an induced abortion, among whom 742 women responded at the three-month follow-up and 641 women at the six-month follow-up. The Screen Questionnaire-Posttraumatic Stress Disorder (SQ-PTSD) was used for research diagnoses of PTSD and PTSS, and anxiety and depressive symptoms were evaluated by the Hospital Anxiety and Depression Scale (HADS). Measurements were made at the first visit and at three and six months after the abortion. The 95% confidence intervals for the prevalence of lifetime or ongoing PTSD and PTSS were calculated using the normal approximation. The chi-square test and the Student's t-test were used to compare data between groups.

    RESULTS:

    The prevalence of ongoing PTSD and PTSS before the abortion was 4.3% and 23.5%, respectively, concomitant with high levels of anxiety and depression. At three months the corresponding rates were 2.0% and 4.6%, at six months 1.9% and 6.1%, respectively. Dropouts had higher rates of PTSD and PTSS. Fifty-one women developed PTSD or PTSS during the observation period. They were young, less well educated, needed counselling, and had high levels of anxiety and depressive symptoms. During the observation period 57 women had trauma experiences, among whom 11 developed PTSD or PTSS and reported a traumatic experience in relation to the abortion.

    CONCLUSION:

    Few women developed PTSD or PTSS after the abortion. The majority did so because of trauma experiences unrelated to the induced abortion. Concomitant symptoms of depression and anxiety call for clinical alertness and support.

  • 78.
    Wallin Lundell, Inger
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Georgsson Öhman, Susanne
    Karolinska Institutet.
    Sundström Poromaa, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Högberg, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Sydsjö, Gunilla
    Linköpings universitet .
    Svanberg, Agneta Skoog
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    How do women perceive abortion care: A study focusing on healthy women and those with mental and posttraumatic stress2015In: European journal of contraception & reproductive health care, ISSN 1362-5187, E-ISSN 1473-0782, Vol. 20, no 3, p. 211-222Article in journal (Refereed)
    Abstract [en]

    Objectives To identify perceived deficiencies in the quality of abortion care among healthy women and those with mental stress. Methods This multi-centre cohort study included six obstetrics and gynaecology departments in Sweden. Posttraumatic stress (PTSD/PTSS) was assessed using the Screen Questionnaire-Posttraumatic Stress Disorder; anxiety and depressive symptoms, using the Hospital Anxiety Depression Scale; and abortion quality perceptions, using a modified version of the Quality from the Patient's Perspective questionnaire. Pain during medical abortion was assessed in a subsample using a visual analogue scale. Results Overall, 16% of the participants assessed the abortion care as being deficient, and 22% experienced intense pain during medical abortion. Women with PTSD/PTSS more often perceived the abortion care as deficient overall and differed from healthy women in reports of deficiencies in support, respectful treatment, opportunities for privacy and rest, and availability of support from a significant person during the procedure. There was a marginally significant difference between PTSD/PTSS and the comparison group for insufficient pain alleviation. Conclusions Women with PTSD/PTSS perceived abortion care to be deficient more often than did healthy women. These women do require extra support, relatively simple efforts to provide adequate pain alleviation, support and privacy during abortion may improve abortion care.

  • 79.
    Wallin Lundell, Inger
    et al.
    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), Reproductive Health. Sophiahemmet Univ, Box 5605, SE-11486 Stockholm, Sweden.
    Sundström Poromaa, Inger
    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), Reproductive Health.
    Ekselius, L
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Georgsson, Susanne
    Sophiahemmet Univ, Box 5605, SE-11486 Stockholm, Sweden.; Karolinska Inst, Dept Clin Sci Intervent & Technol, SE-17177 Stockholm, Sweden..
    Frans, Örjan
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Helström, Lotti
    Karolinska Inst, Dept Clin Sci & Educ, SE-11883 Stockholm, Sweden.
    Högberg, Ulf
    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), Obstetric research.
    Skoog Svanberg, Agneta
    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), Reproductive Health.
    Neuroticism-related personality traits are associated with posttraumatic stress after abortion: findings from a Swedish multi-center cohort study2017In: BMC Women's Health, Vol. 17, article id 96Article in journal (Refereed)
    Abstract [en]

    Background: Most women who choose to terminate a pregnancy cope well following an abortion, although some women experience severe psychological distress. The general interpretation in the field is that the most consistent predictor of mental disorders after induced abortion is the mental health issues that women present with prior to the abortion. We have previously demonstrated that few women develop posttraumatic stress disorder (PTSD) or posttraumatic stress symptoms (PTSS) after induced abortion. Neuroticism is one predictor of importance for PTSD, and may thus be relevant as a risk factor for the development of PTSD or PTSS after abortion. We therefore compared Neuroticism-related personality trait scores of women who developed PTSD or PTSS after abortion to those of women with no evidence of PTSD or PTSS before or after the abortion.

    Methods: A Swedish multi-center cohort study including six Obstetrics and Gynecology Departments, where 1294 abortion-seeking women were included. The Screen Questionnaire-Posttraumatic Stress Disorder (SQ-PTSD) was used to evaluate PTSD and PTSS. Measurements were made at the first visit and at three and six month after the abortion. The Swedish universities Scales of Personality (SSP) was used for assessment of Neuroticism-related personality traits. Multiple logistic regression analyses were performed to investigate the risk factors for development of PTSD or PTSS post abortion.

    Results: Women who developed PTSD or PTSS after the abortion had higher scores than the comparison group on several of the personality traits associated with Neuroticism, specifically Somatic Trait Anxiety, Psychic Trait Anxiety, Stress Susceptibility and Embitterment. Women who reported high, or very high, scores on Neuroticism had adjusted odds ratios for PTSD/PTSS development of 2.6 (CI 95% 1.2-5.6) and 2.9 (CI 95% 1.3-6.6), respectively.

    Conclusion: High scores on Neuroticism-related personality traits influence the risk of PTSD or PTSS post abortion. This finding supports the argument that the most consistent predictor of mental disorders after abortion is pre-existing mental health status.

  • 80.
    Wallin Lundell, Inger
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Sundström Poromaa, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Ekselius, Lisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Georgsson Öhman, Susanne
    Karolinska Institutet.
    Frans, Örjan
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Helström, Lotti
    Karolinska Institutet.
    Högberg, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Sydsjö, Gunilla
    Linköpings universitet .
    Svanberg, Agneta Skoog
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Neuroticism-related personality traits are associated with post-abortion posttraumatic stress2014In: Archives of Women's Mental Health, ISSN 1434-1816, E-ISSN 1435-1102Article in journal (Other academic)
  • 81.
    Wallin Lundell, Inger
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Sundström Poromaa, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Frans, Örjan
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Helström, Lotti
    Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden.
    Högberg, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Moby, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Nyberg, Sigrid
    Department of Clinical Sciences Obstetrics and Gynaecology Umeå University, Sweden.
    Sydsjö, Gunilla
    Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Sweden.
    Georgsson Öhman, Susanne
    Sophiahemmet University, Stockholm, Sweden.
    Ostlund, Ingrid
    Department of Obstetrics and Gynaecology, Örebro University Hospital, Sweden.
    Svanberg, Agneta Skoog
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    The prevalence of posttraumatic stress among women requesting induced abortion2013In: European journal of contraception & reproductive health care, ISSN 1362-5187, E-ISSN 1473-0782, Vol. 18, no 6, p. 480-488Article in journal (Refereed)
    Abstract [en]

    Objectives To describe the prevalence and pattern of traumatic experiences, to assess the prevalence of posttraumatic stress disorder (PTSD) and posttraumatic stress symptoms (PTSS), to identify risk factors for PTSD and PTSS, and to analyse the association of PTSD and PTSS with concomitant anxiety and depressive symptoms in women requesting induced abortion. Methods A Swedish multi-centre study of women requesting an induced abortion. The Screen Questionnaire - Posttraumatic Stress Disorder was used for research diagnoses of PTSD and PTSS. Anxiety and depressive symptoms were evaluated by the Hospital Anxiety and Depression Scale (HADS). Results Of the 1514 respondents, almost half reported traumatic experiences. Lifetime- and point prevalence of PTSD were 7% (95% confidence interval [CI]: 5.8-8.5) and 4% (95% CI: 3.1-5.2), respectively. The prevalence of PTSS was 23% (95% CI: 21.1-25.4). Women who reported symptoms of anxiety or depression when requesting abortion were more likely to have ongoing PTSD or PTSS. Also single-living women and smokers displayed higher rates of ongoing PTSD. Conclusions Although PTSD is rare among women who request an induced abortion, a relatively high proportion suffers from PTSS. Abortion seeking women with trauma experiences and existing or preexisting mental disorders need more consideration and alertness when counselled for termination.

  • 82.
    Wennberg, Anna Lena
    et al.
    Department of Nursing, Umeå University, Sweden.
    Lundqvist, Anette
    Department of Public Health and Clinical Medicine, University Hospital, Umeå, Sweden.
    Högberg, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Sandström, Herbert
    Department of Public Health and Clinical Medicine, University Hospital, Umeå, Sweden.
    Hamberg, Katarina
    Department of Public Health and Clinical Medicine, University Hospital, Umeå, Sweden.
    Women's experiences of dietary advice and dietary changes during pregnancy2013In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 29, no 9, p. 1027-1034Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    to describe women's experiences of dietary information and the change of dietary habits during pregnancy.

    DESIGN:

    a qualitative design was used. In 2007 we conducted six focus group interviews using open-ended questions.

    SETTINGS:

    five rural and city antenatal clinics in northern Sweden were included

    PARTICIPANTS:

    twenty-three women in mid-pregnancy participated in groups of three to seven

    FINDINGS:

    three domains were found 'Dietary information gain', 'Reactions to dietary information' and 'Dietary management'. The women had to discover dietary information by themselves, and only when health problems or symptoms occurred did they receive guidance from the midwife. Their reactions to the dietary information were 'being confused', 'feeling fear and guilt' and 'being monitored', summed up in 'being uncertain'. The diet was managed by 'checking food content', 'following bodily signals', 'using common sense', and 'making exceptions', summed up as 'being responsible but with a pinch of salt'.

    KEY CONCLUSIONS:

    the women expressed problems with dietary changes, but they could mostly manage them on their own. The pregnant women experienced that the midwives gave dietary information and advice first when problems arise. When struggling with diet, the women experienced confusion, and they had to seek information by themselves.

    IMPLICATIONS FOR PRACTICE:

    sources of information about diet during pregnancy were experienced as inconsistent and contradictory. Midwives are important in motivation for healthy lifestyle during pregnancy and with sufficient dietary knowledge and counselling skills they can help pregnant women effect dietary changes by providing guidance and support in early pregnancy.

12 51 - 82 of 82
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