| 1. |
- Reinius, Maria, et al.
(författare)
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Towards a new understanding of HIV-related stigma in the era of efficient treatment : A qualitative reconceptualization of existing theory
- 2021
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Ingår i: Journal of Advanced Nursing. - : John Wiley & Sons. - 0309-2402 .- 1365-2648. ; 77:5, s. 2472-2480
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Tidskriftsartikel (refereegranskat)abstract
- AimTo further develop Earnshaw and Chaudoir's HIV stigma framework by describing the experiences of HIV-related stigma among people living with viral suppression in a context where HIV is well controlled and to investigate how these experiences correspond to the stigma mechanisms of the framework.DesignQualitative study using interviews and a framework approach to analysis.MethodsPeople living with virally suppressed HIV in Sweden were recruited through an outpatient clinic and interviewed about their experiences of social aspects of living with HIV. The interviews were audio recorded, transcribed and analysed using a framework approach.ResultsFifteen participants (eight women and seven men, aged 30–64 years) were interviewed from March to September 2017. They described stigma around HIV as a barrier in many situations. Anticipated and enacted stigma were found to be more complex than is described in the existing literature. Being labelled as a person with HIV was found to be an important and persistent part of the stigma experience. Disclosure was found to be context-related and a result of a process of negotiating and weighing the relevance of disclosing HIV, perceiving HIV as a private matter and feeling a responsibility to disclose one's HIV status to others. An important reason for nondisclosure was to avoid being labelled with HIV, which would then become their most defining feature.ConclusionsThe HIV stigma framework could benefit from revision for people living with virally suppressed HIV.ImplicationsThe present findings, which indicate the role of health professionals in relation to disclosure and labelling, may guide nurses and other healthcare personnel in providing counselling and support for people who live with virally suppressed HIV and experience stigma.
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| 2. |
- Anandavadivelan, Poorna, et al.
(författare)
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Cultural adaptation and psychometric evaluation of the Swedish version of the Reproductive Concerns After Cancer (RCAC) scale
- 2020
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Ingår i: Health and Quality of Life Outcomes. - : BMC. - 1477-7525. ; 18:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundReproductive concerns are common among young cancer survivors and include worries related to different aspects of fertility and parenthood. The Reproductive Concerns After Cancer (RCAC) scale is an 18-item scale with six dimensions, developed to capture a variety of such concerns. The aim of the present study was to describe the cultural adaptation of the RCAC scale into Swedish and evaluate its psychometric properties among young women who have undergone treatment for cancer.MethodsThe RCAC was forward translated from English into Swedish and assessed for cultural adaptation based on a two-panel approach followed by cognitive interviews with the target group. For the psychometric evaluation, a Swedish cohort of 181 female young adult breast cancer survivors completed a survey including the RCAC scale approximately 1.5years post-diagnosis. Psychometric properties were examined by analyses of construct validity (confirmatory factor analysis and convergent validity), data quality (score distribution, floor and ceiling effects), reliability and known-groups validity.ResultsThe confirmatory factor analysis yielded an acceptable fit (RMSEA 0.08, SRMR 0.09, CFI 0.92). Convergent validity was demonstrated by a negative correlation of moderate size (-0.36) between the RCAC total score and the emotional function scale of the EORTC QLQ-C30. Reliability measured with Revelle Omega total was satisfactory (0.73-0.92) for five of the dimensions, and poor for the dimension Becoming pregnant (Revelle Omega total=0.60); Cronbach's alpha showed a similar pattern. Known-groups validity was indicated by significant RCAC mean score differences (MD), reflecting more concerns among women with a certain (MD 4.56 [95% CI 3.13 to 5.99]) or uncertain (MD 3.41 [95% CI 1.68 to 5.14]) child wish compared to those with no wish for (additional) children.ConclusionThe translation and cultural adaptation of the Swedish RCAC has resulted in a scale demonstrating construct and known-groups validity, and satisfactory reliability for five of six dimensions. The dimension Becoming pregnant showed non-optimal internal consistency and should undergo further evaluation. The Swedish RCAC is recommended to be used in research settings for measurement of concerns related to fertility and parenthood in young women with cancer.
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| 3. |
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| 4. |
- Elmlund, Louise
(författare)
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QCM-based sensing using biological and biomimetic interfaces
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The objective of this thesis was to explore novel approaches for studying molecular recognition at biological and biomimetic surfaces using the quartz crystal microbalance (QCM) biosensor technique. The first two papers focused on the synthesis and study of biotin selective polymer films prepared using the molecularly imprinted polymer (MIP) technique. Control over polymer structure is of importance for sensor reproducibility and sensitivity, and was addressed in Paper I where a simple strategy for fabricating uniform thin biotin imprinted polymer films was employed. In Paper II the binding of biotin moieties to thin (3-5 nm) biomimetic polymer films was examined and consequences for sensor performance discussed. The potential for using QCM as a tool for assessing the binding of small peptides derived from phage display screening was presented Paper III. Here, screening of a phage peptide library against immobilized adenine resulted in candidate peptides that were studied using this technique. In Paper IV a whole cell-based biosensor was developed for studying interactions with cell membrane-incorporated targets. Epithelial cancer cells, SKOV3, were attached to QCM sensor chips and the binding of the monoclonal antibody HerceptinTM was studied. This approach demonstrates the potential of using QCM to study binding to membrane-incorporated targets, an alternative to assays based upon immobilized receptor structures lacking their natural context.
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| 5. |
- Micaux, Claire, et al.
(författare)
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Efficacy of a Web-Based Psychoeducational Intervention for Young Adults with Fertility-Related Distress following Cancer (Fex-Can) : Randomized Controlled Trial
- 2022
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Ingår i: JMIR Cancer. - : JMIR Publications. - 2369-1999. ; 8:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Threatened fertility following cancer diagnosis in the reproductive age may severely impact emotional and psychosocial well-being in survivorship. Effective web-based interventions for fertility-related distress have been lacking.Objective: This study aims to test whether the Fertility and Sexuality following Cancer (Fex-Can) intervention is superior to standard care in reducing fertility-related distress and related psychosocial outcomes in young adults with cancer.Methods: This randomized controlled trial evaluated a 12-week, web-based, automated self-help intervention for fertility-related distress following cancer—Fex-Can Fertility. Individuals were identified via Swedish national quality registries, and those reporting fertility-related distress 1.5 years after diagnosis were invited. A total of 100 women and 24 men (aged 19-40 years) answered self-administered surveys at baseline (T0), directly after the intervention (T1), and 3 months later (T2). The main outcome was fertility-related distress, which was measured by using the 6-dimension Reproductive Concerns After Cancer (RCAC) scale. The secondary outcomes were health-related quality of life (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire), emotional distress (Hospital Anxiety and Depression Scale), fertility-related knowledge, and fertility self-efficacy. In addition, the intervention group (IG) reported self-perceived changes in problems related to fertility after cancer (T1). 2-tailed t tests and linear mixed models, including intention-to-treat and subgroup analyses, were performed to compare the effects of the intervention with those of standard care.Results: Although 62% (31/50) of the participants in the IG stated that their concerns about fertility were fewer after the intervention, there were few statistically significant group differences in the main outcome (RCAC) at T1 and T2. Compared with controls, the IG rated lower distress concerning the dimension child’s health at T2 (P=.003; effect size [ES]=0.64). This difference was maintained when adding group and time interactions (intention-to-treat: P=.003; ES=0.58). The IG also had better self-perceived cancer-related fertility knowledge at T1 (P=.05; ES=0.35) and T2 (P=.01; ES=0.42) than the control group. Subgroup analyses based on dose or adherence and baseline RCAC scores did not substantially alter these results. Overall, the use of the web-based program was low.Conclusions: The Fex-Can intervention had small to moderate positive effects on cancer-related fertility knowledge and distress related to child’s health. The lack of group differences in other dimensions of fertility distress and related secondary outcomes contrasted with reports on self-perceived improvement after the intervention. The Fex-Can Fertility program may be a useful complement to routine psychosocial support in the clinical care of young women and men with cancer.
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| 6. |
- Sinai, Cave, et al.
(författare)
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Exposure to interpersonal violence and risk of post-traumatic stress disorder among women with borderline personality disorder
- 2018
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Ingår i: Psychiatry Research. - : ELSEVIER IRELAND LTD. - 0165-1781 .- 1872-7123. ; 262, s. 311-315
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Tidskriftsartikel (refereegranskat)abstract
- Background: This study aims to determine the validity of the Karolinska Interpersonal Violence Scale (KIVS), as a screening tool for PTSD, among women with borderline personality disorder (BPD) and severe suicidal behavior. Method: 106 women with BPD and at least two suicide attempts were assessed with the KIVS for exposure to interpersonal violence as a child and as an adult. The screening ability of the KIVS for the diagnosis of PTSD was analyzed using receiver operating characteristic curve analysis. Results: PTSD diagnosis was valid for 61 (58%) women with BPD. The KIVS exposure of lifetime interpersonal violence, displayed fair accuracy of predicting diagnosis of PTSD (area under the curve 0.79, confidence interval [0.71, 0.88]) and performed well (sensitivity 0.90 and specificity 0.62), with a cut-off score of 4 (range 0-10). Poly-traumatization was not significantly related to PTSD diagnosis as compared to single traumatization, whereas sexual victimization was significantly more prevalent in women with PTSD diagnosis, as compared to other types of traumatic events. Conclusion: A score of 4 or more on the KIVS exposure to interpersonal lifetime violence presents well as a screening instrument for risk of PTSD, among women with BPD.
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| 7. |
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| 8. |
- Wiklander, Maria
(författare)
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Attempted suicide and shame
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- A suicide attempt constitutes not only a risk factor for suicide, but also an expression of human suffering. As therapists, physicians and caring personnel we have an opportunity to reach out to this suffering individual and offer help. However, suicidal individuals often decline psychiatric follow-up or drop out of treatment prematurely. An improved understanding of these patients’ needs and problems may enhance our capability to treat them. This thesis is focusing on attempted suicide patients’ experiences. In the first study, eighteen patients were interviewed about their experiences of psychiatric inpatient treatment after a suicide attempt. Mixed feelings of relief and shame were common. Since shame is an emotion that triggers avoidance behaviors, and thus could lead to help negation, non-attendance and treatment drop-out, the following studies focused on shame in attempted suicide patients. The second study explored the shame theme in the interviews from the first study. The finding of shame with qualitative method also raised the question whether suicide attempters were generally shame-prone, that is, if suicide attempters in common were inclined to react with shame. A self-rating scale of shame-proneness, the Test of Self-Conscious Affect (TOSCA), was translated into Swedish and used as measurement of shame in the last two studies. In the third study, the propensity to shame in suicide attempters was compared with shame-proneness in non-suicidal psychiatric patients and healthy controls. In the fourth study, the TOSCA results of a small group of individuals who completed suicide were explored. The interviews with attempted suicide patients (study I and II) indicated that shame was common after a suicide attempt; thirteen out of eighteen participants described feelings and behaviors that were interpreted as shame reactions. Most women and two thirds of the men described shame reactions in the interviews. In the investigation of shame-proneness in groups of suicide attempters and non-suicidal controls, a more complex pattern emerged. Large gender differences in shame-proneness were found among the attempted suicide patients (but also among the non-suicidal controls). Female suicide attempters with borderline personality disorder (BPD) had the highest shame scores, while male suicide attempters (without BPD) had the lowest shame scores in the study. Shame-proneness among patients was also investigated with multiple regressions. It was found that shame-proneness in these samples of psychiatric patients was predicted by BPD and depression severity (but not by suicidality) in women, and level of depression and non-suicidality in men. Our studies indicated that shame reactions after attempted suicide are common, but that shame-proneness in everyday life is not typical for all groups of suicide attempters. A small group of suicide attempters who subsequently committed suicide did not differ in shame-proneness, from suicide attempters who were alive.
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| 9. |
- Wiklander, Maria, et al.
(författare)
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Feasibility of a self-help web-based intervention targeting young cancer patients with sexual problems and fertility distress
- 2017
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Ingår i: Supportive Care in Cancer. - : Springer. - 0941-4355 .- 1433-7339. ; 25:12, s. 3675-3682
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The purpose of the study is to evaluate the feasibility of a self-help web-based intervention to alleviate sexual problems and fertility distress in adolescents and young adults with cancer.METHODS: Twenty-three persons with cancer (19 women and 4 men, age 18-43, 1-5 years post-diagnosis of lymphoma, breast, gynecologic, central nervous system, or testicular cancer) were recruited to test a 2-month web-based program targeting sexual problems or fertility distress. The programs were organized in modules with educational and behavior change content, including texts, illustrations, exercises, and video vignettes. The program also included a discussion forum and an "ask the expert" forum. In addition, the sexuality program offered two telephone consultations. Feasibility (regarding demand, acceptability, preliminary efficacy, and functionality) was evaluated with the website system data, telephone interviews, continuous online evaluations, and study-specific measures.RESULTS: Fifteen participants completed four modules or more. Most of the program features were used and well accepted by these "committed users." The web-based format enabled flexible use by participants with diverse needs. Preliminary efficacy was indicated by self-reported increased knowledge and skill in handling sexual problems and fertility distress. The website was easy to use and functioned well technically.CONCLUSIONS: The present study indicated that this web-based intervention was feasible for adolescents and young adults with cancer. The effectiveness of the intervention in decreasing sexual problems and fertility distress will be tested in a population-based randomized controlled trial for adolescents and young adults with cancer.TRIAL REGISTRATION: ISRCTN36621459.
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| 10. |
- Wiklander, Maria, et al.
(författare)
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Shame-proneness in attempted suicide patients
- 2012
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Ingår i: BMC Psychiatry. - 1471-244X. ; 12, s. 50-
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: It has been suggested that shame may be an important feature in suicidal behaviors. The disposition to react with shame, "shame-proneness", has previously not been investigated in groups of attempted suicide patients. We examined shame-proneness in two groups of attempted suicide patients, one group of non-suicidal patients and one group of healthy controls. We hypothesized that the attempted suicide patients would be more shame-prone than non-suicidal patients and healthy controls.METHODS: The Test of Self-Conscious Affect (TOSCA), which is the most used measure of shame-proneness, was completed by attempted suicide patients (n = 175: 105 women and 3 men with borderline personality disorder [BPD], 45 women and 22 men without BPD), non-suicidal psychiatric patients (n = 162), and healthy controls (n = 161). The participants were convenience samples, with patients from three clinical research projects and healthy controls from a fourth research project. The relationship between shame-proneness and attempted suicide was studied with group comparisons and multiple regressions. Men and women were analyzed separately.RESULTS: Women were generally more shame-prone than men of the same participant group. Female suicide attempters with BPD were significantly more shame-prone than both female suicide attempters without BPD and female non-suicidal patients and controls. Male suicide attempters without BPD were significantly less shame-prone than non-suicidal male patients. In multiple regressions, shame-proneness was predicted by level of depression and BPD (but not by attempted suicide) in female patients, and level of depression and non-suicidality in male patients.CONCLUSIONS: Contrary to our hypothesis and related previous research, there was no general relationship between shame-proneness and attempted suicide. Shame-proneness was differentially related to attempted suicide in different groups of suicide attempters, with significantly high shame-proneness among female suicide attempters with BPD and a negative relationship between shame-proneness and attempted suicide among male patients. More research on state and trait shame in different groups of suicidal individuals seems clinically relevant.
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