| 3641. |
- Koo Andersson, Melinda, et al.
(författare)
-
Implementation of reproductive life planning (RLP) in primary health care supported by an evidence-based website
- 2020
-
Ingår i: European journal of contraception & reproductive health care. - : TAYLOR & FRANCIS LTD. - 1362-5187 .- 1473-0782. ; 25:1, s. 1-7
-
Tidskriftsartikel (refereegranskat)abstract
- Objectives: The aims of the study were to evaluate how well the reproductive life plan (RLP) tool was implemented in practice and explore the utility of the website for patient counselling. Methods: A cross-sectional study was conducted in 2018, in which 73 midwives in primary health care were asked to use the RLP tool and the website in their daily practice. Three months later, participants answered a questionnaire, based on normalisation process theory (NPT), about their implementation experience. Results: The response rate was 73% (n = 53). The mean length of midwifery experience was 15 years. Almost all respondents (89%) reported a positive attitude towards the tool and the website and their ability to use them in practice. The majority agreed to all statements about implementation of the RLP, according to NPT. Use of the RLP also made it easier for midwives to support clients in forming reproductive goals (85%, n = 45), give family planning advice (81%, n = 43), give advice about how to improve health before pregnancy (85%, n = 45) and give advice about how to preserve fertility (89%, n = 47). Nine out of ten respondents said they would recommend the website to other midwives. Conclusion: The RLP was well implemented among the respondents and the majority considered the website to be a useful tool. Long-term studies are needed to further elucidate the effects of the RLP on changes in health behaviour and pregnancy outcomes.
|
|
| 3642. |
- Korjagina, Marta, et al.
(författare)
-
Prevalence of adverse pregnancy outcomes after exposure to interferon beta prior to or during pregnancy in women with MS : Stratification by maternal and newborn characteristics in a register-based cohort study in Finland and Sweden
- 2020
-
Ingår i: Multiple Sclerosis and Related Disorders. - : Elsevier. - 2211-0348 .- 2211-0356. ; 48
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Previous studies reported no increase in the prevalence of adverse pregnancy outcomes after exposure to interferon-beta (IFN-beta). However, no study has investigated if the prevalence of these outcomes after IFN-beta exposure is modified by maternal and newborn characteristics. Our objective was to describe the stratified prevalence of adverse pregnancy outcomes among women with multiple sclerosis (MS) exposed only to IFN-beta or unexposed to any MS disease modifying drugs (MSDMDs).METHODS: This population-based cohort study using Finnish (1996-2014) and Swedish (2005-2014) register data included pregnancies of women with MS exposed only to IFN-beta 6 months before or during pregnancy (n=718) or unexposed to MSDMDs (n=1397). The outcome prevalences were described stratified by maternal and newborn characteristics, with 95% confidence intervals (CIs). Confounder-adjusted analyses were performed if the prevalence results indicated modified effect of IFN-beta in specific strata.RESULTS: The stratified analysis indicated that the prevalence of serious (anomaly or stillbirth) and other adverse pregnancy outcomes was similar among the exposed and unexposed, with no statistically significant difference. Among women treated for MS >5 years, serious adverse pregnancy outcomes occurred in 4.3% (95%CI: 1.9-8.3%) of pregnancies exposed only to IFN-beta 6 months before or during pregnancy and in 2.7% (95%CI: 1.2-5.0%) of unexposed pregnancies. The confounder adjusted analyses did not support the hypothesis that MS treatment duration before pregnancy would modify the risk of adverse pregnancy outcomes after exposure to IFN-beta 6 months before or during pregnancy.CONCLUSION: The prevalence of adverse pregnancy outcomes was not increased after IFN-beta exposure, when pregnancies of women with MS were stratified by maternal and newborn characteristics. The stratified results were similar to the unstratified results in the same population.
|
|
| 3643. |
- Kornaros, Katarina, et al.
(författare)
-
A hermeneutic study of integrating psychotherapist competence in postnatal Child Health Care : Parents' perspectives
- 2020
-
Ingår i: Infant Mental Health Journal. - : Wiley. - 0163-9641 .- 1097-0355. ; 41:1, s. 108-125
-
Tidskriftsartikel (refereegranskat)abstract
- A child's emotional and social development depends on the parents' provision of optimal support. Many parents with perinatal distress experience difficulties in mastering parenthood and seek help from professionals within primary healthcare. A clinical project was launched in Stockholm, where psychodynamic psychotherapists provided short-term consultations at Child Health Centers. This study qualitatively explored parents' experiences of perinatal distress and of receiving help by nurses and therapists in the project. Thirteen parents were interviewed, and their responses were analyzed with a hermeneutical method. Three main themes crystallized; accessibility of psychological help and detection of emotional problems; experiences of therapy at the Child Health Center; and the therapists' technique. Parents were also clustered into three so-called ideal types: the insecure; parents in crisis; and parents with lifelong psychological problems. Parents experienced obstacles in accessing psychological care within primary healthcare. Psychotherapists with a holistic family perspective and who managed to oscillate between insight-promoting and supportive interventions were especially appreciated. Patient categories who benefitted from insight promotion and support, respectively, were identified.
|
|
| 3644. |
- Kornaros, Katarina, et al.
(författare)
-
A hermeneutic study of integrating psychotherapist competence in postnatal child health care : Nurses' perspectives
- 2018
-
Ingår i: BMC Nursing. - : Springer Science and Business Media LLC. - 1472-6955 .- 1472-6955. ; 17
-
Tidskriftsartikel (refereegranskat)abstract
- Background: There is a considerable prevalence of and an increasing attention to emotional problems in families with infants. Yet, knowledge is scant of how to create efficient and accessible mental health services for this population. The study qualitatively explored public health nurses' conceptions of a clinical project, in which psychotherapists provided short-term consultations and supervisions for nurses at Child Health Centres in Stockholm.Methods: In-depth interviews with fifteen nurses. The guideline of the interviews contained open-ended questions that were analysed applying a hermeneutical approach.Results: Four main themes crystallized; The nurses' conceptions of their psychosocial work, Trespassing on another professional role, Interprofessional collaboration at the Child Health Centre, and The nurses' conceptions of the psychotherapist's function. In a second step, an analysis that clustered the nurses' attitudes towards handling mental health problems yielded one last theme with three "Ideal types"; nurses who expressed "I don't want to", "I want to but I cannot", and "I want to and I can" (take care of families' emotional problems at the CHC).Conclusion: The nurses appreciated the easy referral and accessibility to the psychotherapists, and the possibilities of learning more about perinatal mental illness and parent-infant interactions. For a successful cooperation with the nurses, the therapist should be a team member, be transparent about his/her work, and give feedback about cases in treatment. The study also shows how the organization needs to clarify its guidelines and competence to improve psychological child health care. The paper suggests improvements for an integrated perinatal mental health care.
|
|
| 3645. |
- Korszun, P, et al.
(författare)
-
Doppler velocimetry for predicting outcome of pregnancies with decreased fetal movements
- 2002
-
Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 81:10, s. 926-930
-
Tidskriftsartikel (refereegranskat)abstract
- Aim. The aim of this study was to evaluate umbilical artery (UA) and uterine artery (Ut.A) Doppler velocimetry in a low-risk pregnancy group with decreased fetal movements. Material and methods. Eight hundred and eighty-eight women were examined because of decreased fetal movements. All fetuses were alive on maternal admission. In all cases, UA and Ut.A Doppler velocimetries were performed, as well as a nonstress test (NST). The managing clinician was informed only of the UA Doppler. Results. In the group of 135 women who gave birth within 2 days, UA velocimetry was abnormal in seven fetuses. In 11 cases, Ut.A vascular resistance was abnormal and in 18 cases 'notch' was stated. There were 19 emergency sections in this group. Signs of increased placental vascular resistance were correlated with need for operational delivery because of fetal distress. Among the remaining 753 women who delivered after more than 2 days after examination, UA velocimetry showed abnormality in five fetuses. In 42 cases the Ut.A pulsatility index was abnormal and in 118 cases an early end diastolic 'notch' was present. There was one perinatal death in this group. Conclusions. Decreased fetal movement perception by mothers should be taken seriously. Abnormal placental Doppler was an infrequent finding in these low-risk pregnancies. However, adding UA and Ut.A Doppler velocimetries to conventional NST surveillance might be reassuring for managing clinicians.
|
|
| 3646. |
- Kostrzewska, Ama, et al.
(författare)
-
Effect of nitric oxide on responses of the human uterine arteries to vasopressin
- 2008
-
Ingår i: Vascular Pharmacology. - : Elsevier BV. - 1537-1891. ; 48:1, s. 9-13
-
Tidskriftsartikel (refereegranskat)abstract
- Nitric oxide (NO) is known to be an important relaxant of contractile activity in various muscles including the human uterine arteries. It has been suggested that NO plays a role in modulation of vascular action of arginin vasopressin (AVP), a strong vasoconstrictor of the human uterine arteries. Therefore, the purposes of this study were to investigate an involvement of endogenous NO in regulation of responses of the human intrauterine arteries to AVP and examine the effect of exogenous NO on contractions of the human intrauterine arteries evoked by AVP. Pretreatment of the artery rings with L-NA, an inhibitor of NO synthase significantly increased the resting force and enhanced the artery responses to AVP. The opposite effect has been observed after administration of 10(-6) mol/L sodium nitroprusside (SNP). Pretreatment of the artery rings with 10(-7) M CTX, a blocker of Ca2+-sensitive potassium channels with large conductance, did not change significantly their responses to ANT. Glibenclamide (1.5 10(-6) mol/L), a blocker of ATP-dependent potassium channels and apamin (10(-8) M), a specific blocker of Ca2+-sensitive potassium channels with small conductance strongly enhanced the maximum responses of the artery rings to AVP. Pretreatment with CTX significantly decreased the relaxation induced by SNP while apamin attenuated the sensitivity to SNP resulted in rightward shift of the concentration-response curve to SNP. In conclusion, this study indicates that: NO plays a role in regulation of both the vascular tone of the human intramyometrial arteries and their response to AVP. Ca2+-sensitive K+ channels with small and large conductance are involved in the SNP-induced relaxation of these arteries. The pathways of this relaxation cannot be sufficiently explained at this moment and need further investigation. (C) 2007 Elsevier Inc. All rights reserved.
|
|
| 3647. |
- Kotrotsou, Maria, et al.
(författare)
-
The current place of tubal surgery in the management of subfertility.
- 2012
-
Ingår i: Human fertility (Cambridge, England). - : Informa UK Limited. - 1742-8149 .- 1464-7273. ; 15:2, s. 75-81
-
Tidskriftsartikel (refereegranskat)abstract
- Treatment of tubal disease can be challenging and complex. It requires accurate assessment of the extent of disease and evaluation of all fertility parameters. Although traditionally treatment involved salpingectomy or IVF or a combination of the two, less invasive treatment options may prove beneficial. We evaluated the various diagnostic tools for disease assessment and the treatment options available.
|
|
| 3648. |
- Kovacevic, A., et al.
(författare)
-
Fetal aortic valvuloplasty : investigating institutional bias in surgical decision-making
- 2014
-
Ingår i: Ultrasound in Obstetrics and Gynecology. - : Wiley. - 0960-7692 .- 1469-0705. ; 44:5, s. 538-544
-
Tidskriftsartikel (refereegranskat)abstract
- Objectives Fetal aortic valvuloplasty may prevent the progression of aortic stenosis to hypoplastic left heart syndrome and allow biventricular rather than univentricular postnatal treatment. This study aimed to investigate whether blinded simulation of a multidisciplinary team approach aids interpretation of multicenter data to uncover institutional bias in postnatal decision-making following fetal cardiac intervention for aortic stenosis. Methods The study included 109 cases of prenatally diagnosed aortic stenosis from 13 European countries, of which 32 had undergone fetal cardiac intervention. The multidisciplinary team, blinded to fetal cardiac intervention, institutional location and postnatal treatment, retrospectively assigned a surgical pathway (biventricular or univentricular) based on a review of recorded postnatal imaging and clinical characteristics. The team's decisions were the numerical consensus of silent voting, with case review when a decision was split. Funnel plots showing concordance between the multidisciplinary team and the local team's surgical choice (first pathway) and with outcome (final pathway) were created. Results In 105 cases the multidisciplinary team reached a consensus decision regarding the surgical pathway, with no decision in four cases because the available imaging records were inadequate. Blinded multidisciplinary team consensus for the first pathway matched the decision of the surgical center in 93/105 (89%) cases, with no difference in agreement between those that had undergone successful fetal cardiac intervention (n= 32) and no (n= 74) or unsuccessful (n= 3) valvuloplasty (no fetal cardiac intervention) (kappa = 0.73 (95% CI, 0.38-1.00) vs 0.74 (95% CI, 0.51-0.96)). However, funnel plots comparing multidisciplinary team individual decisions with those of the local teams displayed more discordance (meaning biventricular-univentricular conversion) for the final surgical pathway following fetal cardiac intervention than they did for cases without such intervention (36/74 vs 34/130; P = 0.002), and identified one outlying center. Conclusions The use of a blinded multidisciplinary team to simulate decision-making and presentation of data in funnel plots may assist in the interpretation of data submitted to multicenter studies and permit the identification of outliers for further investigation. In the case of aortic stenosis, a high level of agreement was observed between the multidisciplinary team and the surgical centers, but one outlying center was identified.
|
|
| 3649. |
- Krebs, L, et al.
(författare)
-
Long-term outcome in term breech infants with low Apgar score--a population-based follow-up
- 2001
-
Ingår i: European Journal of Obstetrics, Gynecology, and Reproductive Biology. - 0301-2115. ; 100:1, s. 5-8
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate the relation between low Apgar score in breech infants and handicap in childhood. STUDY DESIGN: A case-control study. A questionnaire to mothers of 323 non-malformed, singleton infants delivered in breech presentation at term, 105 cases with Apgar score below 7 at 5 min and 218 controls. RESULTS: Four cases (4.6%) and one control (0.5%) had cerebral palsy. In infants without cerebral palsy, speech/language problems were more frequent than controls (10.6 versus 3.2%) (P=0.02). There were no differences in rates of deficits in attention, motor control and perception (DAMP), epilepsy, cognitive developmental delay or learning disabilities. Absence of any handicap or disability was reported in 65 cases (75%) compared to 172 controls (92%) (OR: 3.9; 95% CI: 1.9-7.9). CONCLUSION: Even though low Apgar score indicates an increased risk of neurological sequelae, most (75%) breech infants with low Apgar score are without a handicap/disability at follow-up.
|
|
| 3650. |
- Kremer, Christine, et al.
(författare)
-
European Stroke Organisation guidelines on stroke in women : Management of menopause, pregnancy and postpartum
- 2022
-
Ingår i: European Stroke Journal. - : SAGE Publications. - 2396-9873 .- 2396-9881. ; 7:2
-
Tidskriftsartikel (refereegranskat)abstract
- Pregnancy, postpartum and menopause are regarded as periods women are more vulnerable to ischaemic events. There are conflicting results regarding stroke risk and hormone replacement therapy (HRT) during menopause. Stroke in pregnancy is generally increasing with serious consequences for mother and child; therefore, recommendations for acute treatment with intravenous thrombolysis (IVT) and/or mechanical thrombectomy (MT) are needed. The aim of this guideline is to support and guide clinicians in treatment decisions in stroke in women. Following the “Grading of Recommendations and Assessment, Development and Evaluation (GRADE)” approach, the guidelines were developed according to the European Stroke Organisation (ESO) Standard Operating Procedure. Systematic reviews and metanalyses were performed. Based on available evidence, recommendations were provided. Where there was a lack of evidence, an expert consensus statement was given. Low quality of evidence was found to suggest against the use of HRT to reduce the risk of stroke (ischaemic and haemorrhagic) in postmenopausal women. No data was available on the outcome of women with stroke when treated with HRT. No sufficient evidence was found to provide recommendations for treatment with IVT or MT during pregnancy, postpartum and menstruation. The majority of members suggested that pregnant women can be treated with IVT after assessing the benefit/risk profile on an individual basis, all members suggested treatment with IVT during postpartum and menstruation. All members suggested treatment with MT during pregnancy. The guidelines highlight the need to identify evidence for stroke prevention and acute treatment in women in more vulnerable periods of their lifetime to generate reliable data for future guidelines.
|
|
