| 81. |
- Kilander, Helena, et al.
(author)
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Developing contraceptive services for immigrant women postpartum : a case study of a quality improvement collaborative in Sweden
- 2022
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In: BMC Health Services Research. - : BioMed Central (BMC). - 1472-6963. ; 22:1
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Journal article (peer-reviewed)abstract
- Background: Immigrant women use less effective contraceptive methods and have a higher risk of unintended pregnancies. Maternal health care services offer a central opportunity to strengthen contraceptive services, especially among immigrants. This study aimed to evaluate a Quality Improvement Collaborative QIC. Its objective was to improve contraceptive services for immigrant women postpartum, through health care professionals’ (HCPs) counselling and a more effective choice of contraceptive methods.Methods: The pilot study was designed as an organisational case study including both qualitative and quantitative data collection and analysis. Midwives at three maternal health clinics (MHCs) in Stockholm, Sweden participated in a QIC during 2018–2019. In addition, two recently pregnant women and a couple contributed user feedback. Data on women’s choice of contraceptive method at the postpartum visit were registered in the Swedish Pregnancy Register over 1 year.Results: The participating midwives decided that increasing the proportion of immigrant women choosing a more effective contraceptive method postpartum would be the goal of the QIC. Evidence-based changes in contraceptive services, supported by user feedback, were tested in clinical practice during three action periods. During the QIC, the proportion of women choosing a more effective contraceptive method postpartum increased at an early stage of the QIC. Among immigrant women, the choice of a more effective contraception increased from 30 to 47% during the study period. Midwives reported that their counselling skills had developed due to participation in the QIC, and they found using a register beneficial for evaluating women’s choice of contraceptive methods.Conclusions: The QIC, supported by a register and user feedback, helped midwives to improve their contraceptive services during the pregnancy and postpartum periods. Immigrant women’s choice of a more effective contraceptive method postpartum increased during the QIC. This implies that a QIC could increase the choice of a more effective contraception of postpartum contraception among immigrants.
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| 82. |
- Kilander, Helena, et al.
(author)
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IMplementing best practice post-partum contraceptive services through a quality imPROVEment initiative for and with immigrant women in Sweden (IMPROVE it) : a protocol for a cluster randomised control trial with a process evaluation
- 2023
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In: BMC Public Health. - : BioMed Central (BMC). - 1471-2458. ; 23:1
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Journal article (peer-reviewed)abstract
- Background: Immigrant women’s challenges in realizing sexual and reproductive health and rights (SRHR) are exacerbated by the lack of knowledge regarding how to tailor post-partum contraceptive services to their needs. Therefore, the overall aim of the IMPROVE-it project is to promote equity in SRHR through improvement of contraceptive services with and for immigrant women, and, thus, to strengthen women’s possibility to choose and initiate effective contraceptive methods post-partum.Methods: This Quality Improvement Collaborative (QIC) on contraceptive services and use will combine a cluster randomized controlled trial (cRCT) with a process evaluation. The cRCT will be conducted at 28 maternal health clinics (MHCs) in Sweden, that are the clusters and unit of randomization, and include women attending regular post-partum visits within 16 weeks post birth. Utilizing the Breakthrough Series Collaborative model, the study’s intervention strategies include learning sessions, action periods, and workshops informed by joint learning, co-design, and evidence-based practices. The primary outcome, women’s choice of an effective contraceptive method within 16 weeks after giving birth, will be measured using the Swedish Pregnancy Register (SPR). Secondary outcomes regarding women’s experiences of contraceptive counselling, use and satisfaction of chosen contraceptive method will be evaluated using questionnaires completed by participating women at enrolment, 6 and 12 months post enrolment. The outcomes including readiness, motivation, competence and confidence will be measured through project documentation and questionnaires. The project’s primary outcome involving women’s choice of contraceptive method will be estimated by using a logistic regression analysis. A multivariate analysis will be performed to control for age, sociodemographic characteristics, and reproductive history. The process evaluation will be conducted using recordings from learning sessions, questionnaires aimed at participating midwives, intervention checklists and project documents.Discussion: The intervention’s co-design activities will meaningfully include immigrants in implementation research and allow midwives to have a direct, immediate impact on improving patient care. This study will also provide evidence as to what extent, how and why the QIC was effective in post-partum contraceptive services.Trial registration: NCT05521646, August 30, 2022.
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| 83. |
- Koch, M., et al.
(author)
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Effect of education intervention on the quality and long-term outcomes of root canal treatment in general practice
- 2015
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In: International Endodontic Journal. - : Wiley-Blackwell. - 0143-2885 .- 1365-2591. ; 48:7, s. 680-689
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Journal article (peer-reviewed)abstract
- Aim: To compare the technical quality and long-term outcomes of root canal treatment by general practitioners of a Swedish Public Dental Service, before and after an endodontic education including Ni-Ti rotary technique (NiTiR).Methodology: A random sample was compiled, comprising one root filled tooth from each of 830 patients, treated by 69 general practitioners participating in the education: 414 teeth root filled in 2002, pre-education, using primarily stainless steel instrumentation and filling by lateral compaction, and 416 teeth root filled post-education (2005), using mainly NiTiR and single-cone obturation. Follow-up radiographs taken in 2009 were evaluated alongside immediate post-filling radiographs from 2002 to 2005. The density and length of the root fillings were registered. Periapical status was assessed by the Periapical Index (PAI), using two definitions of disease: apical periodontitis (AP) (PAI 3 + 4 + 5) and definite AP (PAI 4 + 5). Tooth survival was registered. Root fillings pre- and post-education were compared using chi-square and Fisher's exact tests. Crude extraction rates per 100 years were calculated for comparison of tooth survival. Explanatory variables (type of tooth, root filling quality, periapical status, marginal bone loss, type and quality of coronal restoration) in relation to the dependent variable (AP at follow-up) were analysed by multivariable logistic regression.Results: Follow-up data were available for 229 (55%) of teeth treated pre-and 288 (69%) treated post-education: both tooth survival (P < 0.001) and root filling quality were significantly higher (P < 0.001) in the latter. However, there was no corresponding improvement in periapical status. Both preand post-education, root fillings with definite AP on completion of treatment had significantly higher odds of AP or definite AP at follow-up. For teeth treated post-education, inadequate root filling quality was significantly associated with AP at follow-up.Conclusions: Despite a higher tooth survival rate and a significant improvement in technical quality of root fillings after the education, there was no corresponding improvement in periapical status.
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| 84. |
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Korsvägar. En antologi om möten mellan unga och institutioner förr och nu
- 1995
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Editorial collection (other academic/artistic)abstract
- Vad är det som händer ute på de olika institutioner där barn och ungdomar tillbringar stora delar av sina liv? Varför vill vuxna i till exempel skolan en sak, medan de unga vanligen är intresserade av någonting helt annat? Det är sådana frågor som Korsvägar försöker ge svar på. Bokens titel syftar på de ibland konfliktfyllda möten som sker mellan barn, ungdomar och vuxna. De olika artiklarna vill synliggöra spelet mellan unga och olika institutioner utifrån de ungas perspektiv. Likaså studeras hur de vuxnas ideal om den goda barn- och ungdomstiden förändrats under de senaste hundra åren och hur ungdomarna förhållit sig till detta.
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| 85. |
- Lagerstrand, Kerstin M, et al.
(author)
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Treatment decision in a 4-year-old-boy with left ventricular outpouching after advanced hemodynamical flow evaluation with 4Dflow CMR: A case report.
- 2022
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In: Frontiers in pediatrics. - : Frontiers Media SA. - 2296-2360. ; 10
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Journal article (peer-reviewed)abstract
- Background: The present study presents a diagnostic course for the characterization of a congenital left ventricular outpouching (LVO) in a 4-year-old boy with severe neonatal heart failure, evaluating the added value of cardiac magnetic resonance (CMR) 4Dflow. Case presentation: A boy, born at full term, presented with heart failure immediately after birth. Echocardiography showed dilated left ventricle with poor function and LVO was initially interpreted as an aneurysm. No infection, inflammation, or other cause for heart failure was found. With intensive medical treatment, the heart function returned to normal, and eventually, all medication was terminated. At follow-up, surgical treatment of the LVO was discussed but after CMR 4Dflow, a thorough evaluation of the function of the left ventricle as well as the LVO was possible and the LVO was determined a double-chambered left ventricle with a good prognosis. Conclusions: The present case demonstrates the clinical usability of CMR 4Dflow for improved decision-making and risk assessment, revealing advanced hemodynamic flow patterns with no need for operation.
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| 86. |
- Larsson, E., et al.
(author)
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The Swedish study on improved contraceptive counselling for immigrant women postpartum
- 2020
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In: European Journal of Public Health. - : Oxford University Press. - 1101-1262 .- 1464-360X. ; 30:Supplement_5
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Journal article (other academic/artistic)abstract
- Contraceptive choices postpartum have not previously been studied in Sweden. Being foreign born is a risk factor for induced abortion. Improving postpartum contraceptive counseling could potentially fulfill unmet needs for contraception.This is an organizational case study using a Quality Improvement Collaborative (QIC) within the regular healthcare setting at 3 maternal health clinics in Stockholm. The active phase of the study was Sep2018-Sep2019. Quantitative and qualitative methods were combined. Routine registration of choice of postpartum contraception was introduced at the clinics and analyzed focusing on Swedish born and foreign-born women. Midwives and researchers met continuously, and during the active phase every 2-3 months in learning seminars with around 20 participants. During the learning seminars PDSA-cycles were used and areas of improvements for continuous performance measures were chosen. The midwives decided on and tested multiple evidence-based changes in contraceptive counselling and services during action periods. Goals were set and competency building in areas chosen by the midwifes were held. In addition, both foreign- and Swedish born women gave their input to the improvement areas. Qualitative data was analyzed through content analysis from field notes and verbatim transcripts.Preliminary results show that the proportion of women choosing an effective contraceptive method (SARC or LARC) among immigrant women increased from 40% to 55% when comparing the start and the end of the project. The midwives reported how they had changed their approach when counselling women who were skeptical about contraception and tried to find a new way to meet women's needs.As much as the QIC showed positive results, it was a small-scale study in 3 clinics in one geographical area. A larger study to determine and explain the effectiveness of QIC on the proportion of immigrant women choosing an effective contraceptive method postpartum is planned for 2021-2024.
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| 87. |
- Lennell, Anne, et al.
(author)
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Alcohol-based hand-disinfection reduced children's absence from Swedish day care centers
- 2008
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In: Acta Paediatrica. - Oslo : Taylor & Francis. - 0803-5253 .- 1651-2227. ; 97:12, s. 1672-1680
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Journal article (peer-reviewed)abstract
- Aim: To determine if the use of alcohol-based hand-disinfection as a complement to regular hand washing at daycare centers (DCCs) can reduce the childhood rate of absenteeism. Methods: Children aged 0–6 years attending DCC were studied in a cluster randomized controlled trial during 30 weeks. Thirty matched pairs of DCCs were included in the study, where one of the DCCs was randomized to intervention and the other to control within each pair. The intervention consisted in children and staff using alcohol-based oily disinfectant gel containing 70% ethanol after regular hand washing. The main outcome was the rate of episodes of absence from DCC due to infection. A regression model was fitted at the individual level and controlling several possible confounders for illness. Absences were reported by the parents. Results: Differences in missing absence reports between the two groups led to only evaluating those 29 DCCs (1431 children) that were able to provide complete reports. In the multivariate regression, the intervention significantly reduced the rate of absenteeism of a child by 12% compared to a child in a control DCC (IRR 95% CI: 0.799–0.965).
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| 88. |
- Lindqvist, Gunilla, et al.
(author)
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Informal home caregiving in a gender perspective : A selected literature review
- 2004
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In: Vård i Norden. - 0107-4083 .- 1890-4238. ; 24:4, s. 26-30
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Journal article (peer-reviewed)abstract
- An informal home caregiver is a person (family member or friends) who takes care of or participates to some degree in the care of a person in the home. This study provides a selected review of literature published 1982-2003 of the informal home caregiving from a gender perspective. A computer-aided search using MEDLINE and CINAHL was carried out. The final number of articles was 45. The main findings were that there are differences in informal caregiving due to gender. Gender differences were found in categories such as affected lifeworld, health problems, managing ability and caregivers experience from caring for a care receiver with different diseases. It is of importance that the informal caregiver is involved in the planning and that a planning act takes place. If society involves the informal home caregiver we can avoid the caregiver being the hidden victim of illness and disability. It is known that burdensome caregiving can result in encroachment due to exhaustion.
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| 89. |
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| 90. |
- Magnusson, Kerstin, et al.
(author)
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Effect of dentifrices with antimicrobial agents on mutans streptococci in saliva and approximal dental plaque in orthodontic patients.
- 2007
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In: Oral health & preventive dentistry. - 1602-1622. ; 5:3, s. 223-7
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Journal article (peer-reviewed)abstract
- PURPOSE: The aim of the present investigation was to study the effect of daily use of fluoride dentifrices containing various antimicrobial agents on mutans streptococci (MS) in saliva and approximal dental plaque. MATERIALS AND METHODS: Fifty-nine healthy adolescents, 12-14 years old, undergoing orthodontic treatment with fixed appliances and harbouring high levels of MS in saliva and preferably also in interdental plaque, were randomly distributed into four groups, using dentifrices with: 1) zinc lactate (n = 16), 2) amine fluoride-stannous fluoride (n = 13), 3) triclosan (n = 15), and 4) no antimicrobial agent (control; n = 15). Changes of MS scores versus baseline were determined after 1, 3 and 6 months, using the Dentocult SM Strip mutans test. RESULTS: At the 6-month sampling occasion, the subjects using dentifrice with either amine fluoride-stannous fluoride or triclosan showed a tendency to lower MS scores in interdental plaque (p < 0.05). In saliva and in the 1- and 3-month plaque samples, no changes of MS were detected in any of the four groups. CONCLUSION: This 6-month clinical study showed that dentifrices with various antimicrobial agents only result in small or no changes of the MS scores in saliva and approximal dental plaque in orthodontic patients.
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