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- Asplin, Nina
(författare)
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Women's experiences and reactions when a fetal malformation is detected by ultrasound examination
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Second trimester ultrasound examination among pregnant women in Sweden is almost universal. The detection of a fetal malformation on ultrasound puts health care providers and pregnant women in a difficult and precarious situation. What information and how it is communicated is crucial to women’s decision-making about continuing or terminating at pregnancy. The main aim of this thesis was to describe and analyze women’s experiences and reactions following the detection of a fetal malformation on an ultrasound scan. Methods: Two semi-structured in-depth interviews were performed, with women informed of a fetal malformation following an ultrasound scan. A total of 27 women took part in the first round of interviews: women continuing their pregnancy were interviewed, either in gestational week 30 or three weeks after the diagnosis; those terminating their pregnancy were interviewed two to four weeks after termination (Paper I). A second interview with 11 women who terminated their pregnancy was conducted six months after termination (Paper III). Two questionnaires were also administered. The first, answered by 99 women (Paper II) and comprising 22 study- specific questions along with emotional well-being and socio-demographics variables and medical and obstetric history, was conducted at the same time as the first stage of interviews. The other questionnaire, answered by 56 women incorporated common self- report instruments and was performed three times: first in gestational week 30, and then two respectively six months postpartum (Paper IV). Qualitative data were analyzed through content analysis, and quantitative data were analyzed through descriptive statistics. Results: The timing, duration, and manner of women’s initial counseling and ongoing support were shown to be important in the interaction between women and caregivers. Positive interactions improved the women’s ability to understand the information and fostered feelings of trust and safety, which in turn reduced their anxiety. Most of the women who expected a baby with an abnormality expressed their need for information on several occasions to help them make this difficult decision. They also wished for information from different specialists and continuity of care. These needs were even stronger in women who chose to terminate their pregnancy. We found women continuing their pregnancy to be at high risk of depressive symptoms, major worries, and high anxiety levels, both in mid-pregnancy, and at two months and one year postpartum. Despite these findings, the results of the maternal-fetal attachment scale for women who continued their pregnancy with a fetus diagnosed with a malformation indicated a high level of attachment. Conclusions and Clinical Implications: Effective communication, empathy and compassion, and consistent follow-up routines are important to ensure good treatment and care of this group of women. Taking these results into account may improve caregivers’ ability to counsel these vulnerable patients and to ensure that their needs are properly met.
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| 3. |
- Blom, Helena, 1970-
(författare)
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Violence exposure among Swedish youth
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- BackgroundViolence is a global public health problem and violence among youth is a matter of high priority. Adolescence and young adulthood are important periods for the foundation of future health. Youth victimization may have serious health consequences, making it important to address the occurrence and socio-medical context for possible interventions against violence.AimsTo analyze prevalence, risk patterns and gender differences in emotional, physical, sexual, and multiple-violence victimizations and the associations between violence victimization and sexual ill health, sexual risk behaviors and mental health in Swedish youth.MethodsA cross sectional study using two samples, a national sample from nine youth health centers in Sweden and a population-based sample from a middle-sized Swedish city. The questionnaire included standardized instruments addressing violence exposure (NorAQ), socio-demographics, mental and sexual ill-health and sexual risk behaviors, alcohol and substance use. Proportions and crude and adjusted odds ratios with a 95% CI were calculated.ResultsA total of 2,250 young women and 920 men, aged 15-23, answered the questionnaire at the youth health centers. In upper secondary school, 1,658 women and 1,589 men, aged 15-22, answered the questionnaire.High prevalence rates with gendered differences both in rates and in co-occurrence of different types of violence were found. Women were more often exposed to emotional violence and sexual violence than men, while men were more often physically victimized. For both women and men, violence victimization before the age of 15 was strongly associated with all types of violence victimizations during the past year.Strong associations were found between multiple-violence victimization and poor mental health in both genders. Among the sexually experienced students, consistent associations between lifetime multiple-violence victimization and various sexual ill-health and sexual risk behaviors were found in both genders, except for non-contraceptive use.ConclusionsHigh prevalence of violence victimization in youth and strong associations between victimization, especially multiple victimization, and poor mental and sexual health were found. This needs to be recognized and addressed in social and medical settings.
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- Falk, Gabriella, 1955-
(författare)
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Teenagers´unintended pregnancies and contraception
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Teenage pregnancies are often not intended, and there is a high risk that unintended pregnancies will lead to abortion. The wide-spread availability of Youth Clinics, the subsidizing of contraceptives and the introduction of new and effective contraceptives have failed to lower the abortion rates. The aim of this thesis was to study possible risk groups and to highlight underlying reasons for contraceptive failure.Methods: Study I and II were quantitative studies with the aims of investigating whether teenagers who sought emergency contraception (Paper I) and teenage mothers (Paper II) were at risk for new unintended pregnancies during a 12-month follow-up period.Study III and IV were qualitative studies. The aim in study III was to see how contraceptive use was documented in medical records (MRs) concerning teenagers who had attended for induced abortion. In study IV the aim was to find out reasons for non- use or inconsistent use of contraceptives among teenagers attending for abortion.Results: In study I and II data were collected from medical and antenatal records. The results showed that both groups, despite contraceptive counselling, were at high risk for new unintended pregnancies leading to abortion. Attendance at the postpartum visit was low and 24% of the teenage mothers did not receive any recommendation about using a particular contraceptive method. Within 12 months 25% had a new pregnancy and of these one third led to legal abortion.In Study III two themes were generated from the analysis of the MRs; ‘Contraceptive methods previously used’ and ‘Plan for future contraceptive use’. All MRs did not contain information about contraceptive use. In study IV one theme was generated from the analysis of the interview text: ‘Struggling with feelings of uncertainty and patterns of behaviour’.Conclusion: Teenagers using emergency contraceptive pills and teenage mothers were at high risk for unintended pregnancies. Contraceptive failure in teenagers who have had an abortion may be due to in part to the absence of contraceptive counselling at abortion visits and in part to problems with contraceptive use due to insufficient knowledge and not knowing what do when side-effects occurs.
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- Marions, Lena
(författare)
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Endometrial receptivity and development of new contraceptive methods
- 2001
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Ovulation and endometrial development as well as contraceptive efficacy was studied after treatment with the antiprogestin mifepristone. Mechanism of action after treatment with the gestagen levonorgestrel or mifepristone in doses effective for emergency contraception was also evaluated. Mifepristone binds to the progesterone receptor and blocks the action. The effect in reproductive pathways depends on when the drug is administered and the dose given. Subjects were treated with different doses of mifepristone, 0.5 mg daily, 5mg once weekly or 200 mg as a single dose in early luteal phase. To study the effect of emergency contraception treatment, levonorgestrel 1.5 mg divided into 2 doses or 10 ing mifepristone was administered either 2 days before or 2 days after the luteinizing hormone (LH) surge. An endometrial biopsy was performed during the expected time of implantation (6-8 days after LH surge). Immunohistochemistry and electron microscopy were used for analysis of implantation on markers and ovarian steroid production was followed by daily urine samples. After treatment with 200 ing mifepristone in early luteal phase the expression of the enzymes involved in prostaglandin synthesis, COX-1 and COX-2, was significantly reduced. The expression of integrin subunits alpha4 and beta3, suggested as important for blastocyst implantation, was also reduced. This effect was also shown after administration with 5mg weekly and 0.5 mg daily. When 10 ing mifepristone was administered in early luteal phase no effect on above markers was found however the down regulation of progesterone receptors that normally occur during the expected time of implantation was inhibited. No effect on endometrial development was found after treatment with 1.5 ing levonorgestrel in early luteal phase. Preovulatory treatment with 10 mg mifepristone and also 1.5 mg levonorgestrel suppressed or delayed the LH surge in all subjects. When 5 mg mifepristone was administered once weekly to 17 women during 60 cycles, 3 pregnancies occurred leading to an estimated contraceptive efficacy of 78%. Treatment with 0.5 mg mifepristone daily to 32 women during 141 cycles resulted in 5 pregnancies and an estimated contraceptive efficacy of 85%. In conclusion these results indicate that mifepristone and levonorgestrel in doses effective for emergency contraception mainly affect ovulation and that higher doses of mifepristone i.e. 200 mg show more pronounced effect on endometrial development. These studies also show that mifepristone in low doses that do not affect ovulation significantly reduces pregnancy rate compared to if no contraceptive method is used. However the effect is not sufficient for this regimen to be used on a regular basis.
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- Ugarte Guevara, William J., 1979-
(författare)
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Averting HIV and AIDS epidemic in Nicaragua : Studies of prevalence, knowledge, attitudes, and behavior
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to obtain an understanding of the dynamics of the HIV epidemic by estimating prevalence and exploring the relationship between HIV-related knowledge, attitudes, behavior, and HIV status in Nicaragua. Structured questionnaires were administered to adults from a health and demographic surveillance system in León, Nicaragua (Papers I–III). In-depth interviews and a survey were conducted among men who have sex with men (MSM, Paper IV). Blood sampling for HIV was carried out among 2,204 men and women (Paper I). Bivariate and multivariate analyses, including adjusted prevalence ratio (Papers I, II, IV), factor analysis, Cronbach’s alpha, and hierarchical regression analysis (Paper III) were performed. Thematic analysis was used with qualitative data (Paper IV).The prevalence of HIV in the general population was 0.35% (95% CI, 0.17–0.73). Those who have taken a HIV test were more likely to be females, younger, living in an urban setting, have a higher level of education, be married or cohabiting, and have no religious affiliation. HIV-related knowledge was lower among members of the general population than among MSM. Unprotected sex was reported more times with regular partners than with casual partners. Findings suggested that consistency of condom use and emotional attachment (steady relations) were inversely related. Stigma and discrimination were reported high in the general population; they appeared to be negatively associated with HIV-related knowledge, self-perception of HIV risk, HIV testing, and willingness to disclose HIV status in the event of being HIV-positive. Findings demonstrated an increasing tolerance towards same-sex attractions. MSM have a better understanding of HIV transmission than men and women of the general population. Although seven out of ten MSM and six out of ten women were concerned about becoming infected with HIV, inconsistent condom use was common.This study confirmed that Nicaragua has a low prevalence but high risk for HIV infection and transmission. Results underscore that social, behavioral, and cultural factors contribute to retard progress in achieving the Millennium Development Goals on reducing gender inequality and combating HIV/AIDS. Addressing these challenges depends not only on successful behavior change interventions, but requires a culturally gender-appropriate strategy.
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