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1.	Mbekenga, Columba K, 1972- (författare) Striving to Promote Family Health after Childbirth : Studies in Low-Income Suburbs of Dar es Salaam, Tanzania 2011 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract Deeper understanding of family health and support after childbirth from the perspective of first-time parents and their informal support network is needed. Postpartum experiences and health concerns of first-time mothers and fathers and, discourses on sexuality and informal support after childbirth were explored in low-income, suburban areas in Ilala, Dar es Salaam, Tanzania. Individual qualitative interviews with first-time mothers (n=10) and fathers (n=10), and 14 focus group discussions with first-time parents (n=40) and informal support persons (n=42) provided the data, which were analyzed through qualitative content and discourse analysis. First-time parents’ areas of concern were newborn care and hygiene, infant feeding, handling crying infant, maternal nutrition and hygiene, uncertain body changes for the mother and, sexuality. The mothers were burdened with caring responsibilities and fathers felt neglected and excluded from the care of the mother and infant after childbirth, both by the families and the health care system. Sexuality after childbirth created tension between new parents due to the understanding that abstinence would protect child health during the breastfeeding period, which could be several years. Women’s adherence to sexual abstinence was more emphasized compared to men’s. Men’s engagement with other sex partners and the risk of contraction HIV was a threat to family health. First-time parents drew on support from both informal and formal sources. Informal support networks played a major role in providing information, materials, guidance and supervision while conveying stereotypic gender norms. Contradictions in the messages to parents within and between the support systems created uncertainties that might have negative implications for family health. Poor parents and those who did not adherence to the social norms were less likely to get informal support than others were. There is a need for information and practical guidance on basic aspects of care for the mother and infant, male involvement, and the importance of social support to first-time parents, as new parents face physical, social and relational challenges after childbirth. The link between the health care system and informal networks need to be strengthened to enable them to complement each other in promoting family health after child health.
2.	Abeid, Muzdalifat, et al. (författare) A community-based intervention for improving health-seeking behavior among sexual violence survivors: A controlled before and after design study in rural Tanzania 2015 Ingår i: Global Health Action. - : Informa UK Limited. - 1654-9716 .- 1654-9880. ; 8 Tidskriftsartikel (refereegranskat)abstract Background: Despite global recognition that sexual violence is a violation of human rights, evidence still shows it is a pervasive problem across all societies. Promising community intervention studies in the low- and middle-income countries are limited.Objective: This study assessed the impact of a community-based intervention, focusing on improving the community’s knowledge and reducing social acceptability of violence against women norms with the goal to prevent and respond to sexual violence.Design: The strategies used to create awareness included radio programs, information, education communication materials and advocacy meetings with local leaders. The intervention took place in Morogoro region in Tanzania. The evaluation used a quasi-experimental design including cross-sectional surveys at baseline (2012) and endline (2014) with men and women aged 18-49. Main outcome measures were number of reported rape cases at health facilities and the community’s knowledge and attitudes towards sexual violence.Results: The number of reported rape events increased by more than 50% at health facilities during the intervention. Knowledge on sexual violence increased significantly in both areas over the study period (from 57.3% to 80.6% in the intervention area and from 55.5% to 71.9% in the comparison area; p<.001), and the net effect of the intervention between the two areas was statistically significant (6.9, 95% CI 0.2–13.5, p= 0.03). There was significant improvement in most of attitude indicators in the intervention area, but not in the comparison area. However, the intervention had no significant effect in the overall scores of acceptance attitudes in the final assessment when comparing the two areas (-2.4, 95%CI: -8.4 – 3.6, p= 0.42).Conclusions: The intervention had an effect on some indicators on knowledge and attitudes towards sexual violence even after a short period of intervention. This finding informs the public health practitioners of the importance of combined strategies in achieving changes.
3.	Abeid, Muzdalifat, 1973-, et al. (författare) Community perceptions of rape and child sexual abuse : a qualitative study in rural Tanzania 2014 Ingår i: BMC International Health and Human Rights. - 1472-698X. ; 14, s. 23- Tidskriftsartikel (refereegranskat)abstract Background: Rape of women and children is recognized as a health and human rights issue in Tanzania and internationally. Exploration of the prevailing perceptions in rural areas is needed in order to expand the understanding of sexual violence in the diversity of Tanzania's contexts. The aim of this study therefore was to explore and understand perceptions of rape of women and children at the community level in a rural district in Tanzania with the added objective of exploring those perceptions that may contribute to perpetuating and/or hindering the disclosure of rape incidences. Methods: A qualitative design was employed using focus group discussions with male and female community members including religious leaders, professionals, and other community members. The discussions centered on causes of rape, survivors of rape, help-seeking and reporting, and gathered suggestions on measures for improvement. Six focus group discussions (four of single gender and two of mixed gender) were conducted. The focus group discussions were recorded, transcribed verbatim, and analyzed using manifest qualitative content analysis. Results: The participants perceived rape of women and children to be a frequent and hidden phenomenon. A number of factors were singled out as contributing to rape, such as erosion of social norms, globalization, poverty, vulnerability of children, alcohol/drug abuse and poor parental care. Participants perceived the need for educating the community to raise their knowledge of sexual violence and its consequences, and their roles as preventive agents. Conclusions: In this rural context, social norms reinforce sexual violence against women and children, and hinder them from seeking help from support services. Addressing the identified challenges may promote help-seeking behavior and improve care of survivors of sexual violence, while changes in social and cultural norms are needed for the prevention of sexual violence.
4.	Abeid, Muzdalifat, 1973-, et al. (författare) Evaluation of a training program for health care workers to improve the quality of care for rape survivors : a quasi-experimental design study in Morogoro, Tanzania 2016 Ingår i: Global Health Action. - : Informa UK Limited. - 1654-9716 .- 1654-9880. ; 9 Forskningsöversikt (refereegranskat)abstract BACKGROUND:Sexual violence against women and children in Tanzania and globally is a human rights violation and a developmental challenge.OBJECTIVE:The aim of this study was to assess the impact of training health professionals on rape management. The specific objectives were to evaluate the changes of knowledge and attitudes toward sexual violence among a selected population of health professionals at primary health care level.DESIGN:A quasi-experimental design using cross-sectional surveys was conducted to evaluate health care workers' knowledge, attitude, and clinical practice toward sexual violence before and after the training program. The study involved the Kilombero (intervention) and Ulanga (comparison) districts in Morogoro region. A total of 151 health professionals at baseline (2012) and 169 in the final assessment (2014) participated in the survey. Data were collected using the same structured questionnaire. The amount of change in key indicators from baseline to final assessment in the two areas was compared using composite scores in the pre- and post-interventions, and the net intervention effect was calculated by the difference in difference method.RESULTS:Overall, there was improved knowledge in the intervention district from 55% at baseline to 86% and a decreased knowledge from 58.5 to 36.2% in the comparison area with a net effect of 53.7% and a p-value less than 0.0001. The proportion of participants who exhibited an accepting attitude toward violence declined from 15.3 to 11.2% in the intervention area but increased from 13.2 to 20.0% in the comparison area.CONCLUSIONS:Training on the management of sexual violence is feasible and the results indicate improvement in healthcare workers' knowledge and practice but not attitudes. Lessons learned from this study for successful replication of such an intervention in similar settings require commitment from those at strategic level within the health service to ensure that adequate resources are made available.
5.	Abeid, Muzdalifat, 1973-, et al. (författare) Knowledge and attitude towards rape and child sexual abuse - a community-based cross-sectional study in Rural Tanzania 2015 Ingår i: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 15:1 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Violence against women and children is globally recognized as a social and human rights concern. In Tanzania, sexual violence towards women and children is a public health problem. The aim of this study was to determine community knowledge of and attitudes towards rape and child sexual abuse, and assess associations between knowledge and attitudes and socio-demographic characteristics.METHODS: A cross-sectional study was undertaken between May and June 2012. The study was conducted in the Kilombero and Ulanga rural districts in the Morogoro Region of Tanzania. Men and women aged 18-49 years were eligible for the study. Through a three-stage cluster sampling strategy, a household survey was conducted using a structured questionnaire. The questionnaire included socio-demographic characteristics, attitudes about gender roles and violence, and knowledge on health consequences of rape. Data were analyzed using the Statistical Package for Social Sciences (SPSS) software, version 21. Main outcome measures were knowledge of and attitudes towards sexual violence. Multivariate analyses were used to assess associations between socio-demographic characteristics and knowledge of and attitudes towards sexual violence.RESULTS: A total of 1,568 participants were interviewed. The majority (58.4%) of participants were women. Most (58.3%) of the women respondents had poor knowledge on sexual violence and 63.8% had accepting attitudes towards sexual violence. Those who were married were significantly more likely to have good knowledge on sexual violence compared to the divorced/separated group (AOR = 1.6 (95% CI: 1.1-2.2)) but less likely to have non-accepting attitudes towards sexual violence compared to the single group (AOR = 1.8 (95%CI: 1.4-2.3)). Sex of respondents, age, marital status and level of education were associated with knowledge and attitudes towards sexual violence.CONCLUSIONS: Our study showed that these rural communities have poor knowledge on sexual violence and have accepting attitudes towards sexual violence. Increasing age and higher education were associated with better knowledge and less accepting attitudes towards sexual violence. The findings have potentially important implications for interventions aimed at preventing violence. The results highlight the challenges associated with changing attitudes towards sexual violence, particularly as the highest levels of support for such violence were found among women.
6.	Adams, Emma A., et al. (författare) Perceptions on the sexual harassment of female nurses in a state hospital in Sri Lanka : a qualitative study 2019 Ingår i: Global Health Action. - : Informa UK Limited. - 1654-9716 .- 1654-9880. ; 12:1 Tidskriftsartikel (refereegranskat)abstract Background: Sexual harassment occurs within the nursing profession globally, challenging the health and safety of nurses and the quality and efficiency of health systems. In Sri Lanka, no studies have explored this issue in the health sector; however, female employees face sexual harassment in other workplace settings.Objective:To explore female nurses' perceptions of workplace sexual harassment in a large state hospital in Sri Lanka.Methods:This is a qualitative study conducted in an urban, mainly Buddhist and Singhalese context. We invited all female senior and ward nurses working in the hospital to participate in the study. We conducted individual in-depth interviews with four senior nurses and focus group discussions with 29 nurses in three groups.Results:The nurses described a variety of perceived forms of sexual harassment in the hospital. They discussed patient-perpetrated incidents as the most threatening and the clearest to identify compared with incidents involving doctors and other co-workers. There was significant ambiguity regarding sexual consent and coercion in relationships between female nurses and male doctors, which were described as holding potential for exploitation or harassment. The nurses reported that typical reactions to sexual harassment were passive. Alternatively, they described encountering inaction or victim blaming when they attempted to formally report incidents. They perceived that workplace sexual harassment has contributed to negative societal attitudes about the nursing profession and discussed various informal strategies, such as working in teams, to protect themselves from sexual harassment in the hospital.Conclusions:Sexual harassment was a perceived workplace concern for nurses in this hospital. To develop effective local prevention and intervention responses, further research is required to determine the magnitude of the problem and explore differences in responses to and consequences of sexual harassment based on perpetrator type and intent, and personal vulnerabilities of the victims, among other factors.
7.	August, Furaha, et al. (författare) Birth preparedness and complication readiness - a qualitative study among community members in rural Tanzania 2015 Ingår i: Global Health Action. - : Informa UK Limited. - 1654-9716 .- 1654-9880. ; 8, s. 1-U12 Tidskriftsartikel (refereegranskat)abstract Background: Birth preparedness and complication readiness (BP/CR) strategies are aimed at reducing delays in seeking, reaching, and receiving care. Counselling on birth preparedness is provided during antenatal care visits. However, it is not clear why birth preparedness messages do not translate to utilisation of facility delivery. This study explores the perceptions, experiences, and challenges the community faces on BP/CR. Design: A qualitative study design using Focused Group Discussions was conducted. Twelve focus group discussions were held with four separate groups: young men and women and older men and women in a rural community in Tanzania. Qualitative content analysis was used to analyse the data. Results: The community members expressed a perceived need to prepare for childbirth. They were aware of the importance to attend the antenatal clinics, relied on family support for practical and financial preparations such as saving money for costs related to delivery, moving closer to the nearest hospital, and also to use traditional herbs, in favour of a positive outcome. Community recognised that pregnancy and childbirth complications are preferably treated at hospital. Facility delivery was preferred; however, certain factors including stigma on unmarried women and transportation were identified as hindering birth preparedness and hence utilisation of skilled care. Challenges were related to the consequences of poverty, though the maternal health care should be free, they perceived difficulties due to informal user fees. Conclusions: This study revealed community perceptions that were in favour of using skilled care in BP/CR. However, issues related to inability to prepare in advance hinder the realisation of the intention to use skilled care. It is important to innovate how the community reinforces BP/CR, such as using insurance schemes, using community health funds, and providing information on other birth preparedness messages via community health workers.
8.	August, Furaha, 1973-, et al. (författare) Community Health workers can improve male involvement in maternal health : Evidence from rural Tanzania 2016 Ingår i: Global Health Action. - : Informa UK Limited. - 1654-9716 .- 1654-9880. ; 9 Tidskriftsartikel (refereegranskat)abstract BACKGROUND:Male involvement in maternal health is recommended as one of the interventions to improve maternal and newborn health. There have been challenges in realising this action, partly due to the position of men in society and partly due to health system challenges in accommodating men. The aim of this study was therefore to evaluate the effect of Home Based Life Saving Skills training by community health workers on improving male involvement in maternal health in terms of knowledge of danger signs, joint decision-making, birth preparedness, and escorting wives to antenatal and delivery care in a rural community in Tanzania.DESIGN:A community-based intervention consisting of educating the community in Home Based Life Saving Skills by community health workers was implemented using one district as the intervention district and another as comparison district. A pre-/post-intervention using quasi-experimental design was used to evaluate the effect of Home Based Life Saving Skills training on male involvement and place of delivery for their partners. The effect of the intervention was determined using difference in differences analysis between the intervention and comparison data at baseline and end line.RESULTS:The results show there was improvement in male involvement (39.2% vs. 80.9%) with a net intervention effect of 41.1% (confidence interval [CI]: 28.5-53.8; p <0.0001). There was improvement in the knowledge of danger signs during pregnancy, childbirth, and postpartum periods. The proportion of men accompanying their wives to antenatal and delivery also improved. Shared decision-making for place of delivery improved markedly (46.8% vs. 86.7%), showing a net effect of 38.5% (CI: 28.0-49.1; p <0.0001). Although facility delivery for spouses of the participants improved in the intervention district, this did not show statistical significance when compared to the comparison district with a net intervention effect of 12.2% (95% CI: -2.8-27.1: p=0.103).CONCLUSION:This community-based intervention employing community health workers to educate the community in the Home Based Life Saving Skills programme is both feasible and effective in improving male involvement in maternal healthcare.
9.	August, Furaha, 1973- (författare) Effect of Home Based Life Saving Skills education on knowledge of obstetric danger signs, birth preparedness, utilization of skilled care and male involvement : A Community-based intervention study in rural Tanzania 2016 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract Use of skilled care during antenatal visits and delivery is recommended to address the burden of maternal mortality. However there are few facility deliveries and insufficient knowledge of danger signs, especially in rural Tanzania. The aim of this thesis was to explore the perceptions and challenges that the community faces while preparing for childbirth and to evaluate an intervention of the Home Based Life Saving Skills education programme on knowledge of danger signs, facility delivery and male involvement when delivered by rural community health workers in Tanzania.In Paper I, Focus Group Discussions explored the perceptions and challenges that the community encounters while preparing for childbirth. Structured questionnaires assessed men’s knowledge of danger signs and birth preparedness and complication readiness in Paper II. The effect of the Home Based Life Saving Skills education programme in the community was assessed with a before-and-after evaluation in two districts; one intervention and one comparison. Paper III assessed the effect of the programme on knowledge of danger signs and birth preparedness and facility delivery among women, while Paper IV evaluated its effect on male involvement.The community perceived that all births must be prepared for and that obstetric complication demands hospital care; hence skilled care was favoured. Men’s knowledge of danger signs was limited; only 12% were prepared for childbirth and complications. Preparedness was associated with knowledge of obstetric complications (AOR=1.4 95% CI 1.8 – 2.6). The intervention showed women utilizing antenatal care (four visits) significantly more (43.4 vs 67.8%) with a net effect of 25.3% (95% CI: 16.9 – 33.2; p < .0001). The use of facility delivery improved in the intervention area (75.6 vs 90.2%; p = 0.0002), but with no significant net effect 11.5% (95% CI: -5.1 – 39.6; p = 0.123) when comparing the two districts. Male involvement improved (39.2% vs 80.9%) with a net intervention effect of 41.1% (CI: 28.5 – 53.8; p < .0001). Improvements were demonstrated in men’s knowledge level, in escorting partners for antenatal care and delivery, making birth preparations, and shared decision-making.The intervention, in educating this rural community, is effective in improving knowledge, birth preparedness, male involvement and use of skilled care.
10.	August, Furaha, 1973-, et al. (författare) Effectiveness of the Home Based Life Saving Skills training by community health workers on knowledge of danger signs, birth preparedness, complication readiness and facility delivery, among women in Rural Tanzania 2016 Ingår i: BMC Pregnancy and Childbirth. - : Springer Science and Business Media LLC. - 1471-2393 .- 1471-2393. ; 16 Tidskriftsartikel (refereegranskat)
11.	August, Furaha, 1973-, et al. (författare) Men's Knowledge of Obstetric Danger Signs, Birth Preparedness and Complication Readiness in Rural Tanzania 2015 Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 10:5, s. e0125978- Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Men's involvement in reproductive health is recommended. Their involvement in antenatal care service is identified as important in maternal health. Awareness of obstetric danger signs facilitates men in making a joint decision with their partners regarding accessing antenatal and delivery care. This study aims to assess the level of knowledge of obstetric complications among men in a rural community in Tanzania, and to determine their involvement in birth preparedness and complication readiness.METHODS: A cross-sectional survey was conducted where 756 recent fathers were invited through a two-stage cluster sampling procedure. A structured questionnaire was used to collect socio-demographic characteristics, knowledge of danger signs and steps taken on birth preparedness and complication readiness. Data were analyzed using bivariate and multivariable logistic regression to determine factors associated with being prepared, with statistically significant level at p<0.05.RESULTS: Among the invited men, 95.9% agreed to participate in the community survey. Fifty-three percent could mention at least one danger sign during pregnancy, 43.9% during delivery and 34.6% during the postpartum period. Regarding birth preparedness and complication readiness, 54.3% had bought birth kit, 47.2% saved money, 10.2% identified transport, 0.8% identified skilled attendant. In general, only 12% of men were prepared. Birth preparedness was associated with knowledge of danger signs during pregnancy (AOR = 1.4, 95% CI: 1.8-2.6). It was less likely for men living in the rural area to be prepared (AOR=0.6, 95% CI; 0.5-0.8).CONCLUSION: There was a low level of knowledge of obstetric danger signs among men in a rural district in Tanzania. A very small proportion of men had prepared for childbirth and complication readiness. There was no effect of knowledge of danger signs during childbirth and postpartum period on being prepared. Innovative strategies that increase awareness of danger signs as well as birth preparedness and complication readiness among men are required. Strengthening counseling during antenatal care services that involve men together with partners is recommended.
12.	Aune, Anders, et al. (författare) Bilirubin estimates from smartphone images of newborn infants' skin correlated highly to serum bilirubin levels. 2020 Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 109:12, s. 2532-2538 Tidskriftsartikel (refereegranskat)abstract AIM: Neonatal jaundice is an important cause of morbidity and mortality, and identifying the condition remains a challenge. This study evaluated a novel method of estimating bilirubin levels from colour-calibrated smartphone images.METHODS: A cross-sectional prospective study was undertaken at two hospitals in Norway from February 2017 to March 2019, with standardised illumination at one hospital and non-standardised illumination at the other hospital. Healthy term-born infants with a normal birthweight were recruited up to 15 days of age. The main outcome measures were bilirubin estimates from digital images, plus total bilirubin in serum (TSB) and transcutaneous bilirubin (TcB).RESULTS: Bilirubin estimates were performed for 302 newborn infants, and 76 had severe jaundice. The correlation between the smartphone estimates and TSB was measured by Pearson's r and was .84 for the whole sample. The correlation between the image estimates and TcB was 0.81. There were no significant differences between the hospitals. Sensitivity was 100%, and specificity was 69% for identifying severe jaundice of more than 250 µmol/L.CONCLUSION: A smartphone-based tool that estimated bilirubin levels from digital images identified severe jaundice with high sensitivity and could provide a screening tool for neonatal jaundice.
13.	Aune, Anders, et al. (författare) Response to letter to the editor 2020 Ingår i: Acta Paediatrica. - : WILEY. - 0803-5253 .- 1651-2227. ; 109:12, s. 2823-2823 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
14.	Axemo, Pia, et al. (författare) Training university teachers and students in Sri Lanka on Gender Based Violence: testing of a participatory training program 2018 Ingår i: MedEdPublisher. - : F1000 Research Ltd. - 2312-7996. Tidskriftsartikel (refereegranskat)abstract In all societies, violence is a social problem and violation of human rights. Changing attitudes and behaviors, which accept violence atindividual and societal levels are key components in prevention strategies.The aim of this study was to produce educational material on Gender Based Violence (GBV). A participatory study design including educators and university students was used to create four teaching modules. The teaching was evaluated by descriptive surveys before andafter the training and focus group discussions followed the training session. The questionnaire covered attitudes to gender, violence and laws. One hundred eleven teachers and 25 students representing different faculties and universities participated in separate workshops in three Sri Lankan universities. The students lacked knowledge of the meaning of GBV, consequences and existing laws. Women held more gender-equitable attitudes. Both women and men favoured equal participation of work and decision in the households. Male undergraduates showed less accepting attitudes toward rape or blaming women for rape Three categories emerged after the FGDs; Maketraining module compulsory and teacher led; Mind your own business; What can be done.The newly prepared and context specific material was well-received by educators and students and they provided valuable inputs, which improved the educational modules.
15.	Bremnes, Hanna Stromholt, et al. (författare) Challenges in day-to-day midwifery practice : a qualitative study from a regional referral hospital in Dar es Salaam, Tanzania 2018 Ingår i: Global Health Action. - : TAYLOR & FRANCIS LTD. - 1654-9716 .- 1654-9880. ; 11:1 Tidskriftsartikel (refereegranskat)abstract Background: Maternal and infant mortality rates in Tanzania have decreased over the past decades, but remain high. One of the challenges the country faces, is the lack of skilled health care workers. High fertility rates make midwives and their patients particularly susceptible to stress as a result of understaffing.Objective: This paper explores the challenges midwives face in their day-to-day practice at a regional referral hospital in Tanzania, and investigates which measures the midwives themselves find necessary to implement to improve their situation.Methods: A qualitative study design with focus group discussions (FGDs) was employed to explore which challenges the midwives experienced. Each focus group consisted of five to six midwives. A FGD topic guide covering challenges, consequences, motivation, ideal situation and possible solutions was used. These data were analyzed using Systematic Text Condensation.Results: A total of 28 Midwives, six men and 22 women, participated in five FGDs. Four categories emerged from the collected material: Feelings of demoralization, shortage of resources, societal challenges and personal struggles. A feeling of demoralization was especially prevalent and was caused by a lack of support from the leaders and little appreciation from the patients. Shortage of resources, and shortage of personnel in particular, was also highlighted as it led to an excessive workload resulting in difficulties with providing adequate care. These difficulties were intensified by lack of equipment, facilities and a non-optimal organization of the healthcare system.Conclusion: The challenges revealed during the FGDs prevent the midwives from providing sufficient midwifery care. To improve the situation, measures such as supportive leadership, reduction of workload, increasing availability of equipment and increasing knowledge of reproductive health in society, should be taken.
16.	Brolin Ribacke, Kim J, et al. (författare) The Impact of the West Africa Ebola Outbreak on Obstetric Health Care in Sierra Leone. 2016 Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 11:2 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: As Sierra Leone celebrates the end of the Ebola Virus Disease (EVD) outbreak, we can begin to fully grasp its impact on already weak health systems. The EVD outbreak in West Africa forced many hospitals to close down or reduce their activity, either to prevent nosocomial transmission or because of staff shortages. The aim of this study is to assess the potential impact of EVD on nationwide access to obstetric care in Sierra Leone.METHODS AND FINDINGS: Community health officers collected weekly data between January 2014-May 2015 on in-hospital deliveries and caesarean sections (C-sections) from all open facilities (public, private for-profit and private non-profit sectors) offering emergency obstetrics in Sierra Leone. This was compared to official data of EVD cases per district. Logistic and Poisson regression analyses were used to compute risk and rate estimates. Nationwide, the number of in-hospital deliveries and C-sections decreased by over 20% during the EVD outbreak. The decline occurred early on in the EVD outbreak and was mainly attributable to the closing of private not-for-profit hospitals rather than government facilities. Due to difficulties in collecting data in the midst of an epidemic, limitations of this study include some missing data points.CONCLUSIONS: Both the number of in-hospital deliveries and C-sections substantially declined shortly after the onset of the EVD outbreak. Since access to emergency obstetric care, like C-sections, is associated with decreased maternal mortality, many women are likely to have died due to the reduced access to appropriate care during childbirth. Future research on indirect health effects of health system breakdown should ideally be nationwide and continue also into the recovery phase. It is also important to understand the mechanisms behind the deterioration so that important health services can be reestablished.
17.	Colombini, Manuela, et al. (författare) Agenda setting and framing of gender-based violence in Nepal : how it became a health issue. 2016 Ingår i: Health Policy and Planning. - : Oxford University Press (OUP). - 0268-1080 .- 1460-2237. ; 31:4, s. 493-503 Tidskriftsartikel (refereegranskat)abstract Gender-based violence (GBV) has been addressed as a policy issue in Nepal since the mid 1990s, yet it was only in 2010 that Nepal developed a legal and policy framework to combat GBV. This article draws on the concepts of agenda setting and framing to analyse the historical processes by which GBV became legitimized as a health policy issue in Nepal and explored factors that facilitated and constrained the opening and closing of windows of opportunity. The results presented are based on a document analysis of the policy and regulatory framework around GBV in Nepal. A content analysis was undertaken. Agenda setting for GBV policies in Nepal evolved over many years and was characterized by the interplay of political context factors, actors and multiple frames. The way the issue was depicted at different times and by different actors played a key role in the delay in bringing health onto the policy agenda. Women's groups and less powerful Ministries developed gender equity and development frames, but it was only when the more powerful human rights frame was promoted by the country's new Constitution and the Office of the Prime Minister that legislation on GBV was achieved and a domestic violence bill was adopted, followed by a National Plan of Action. This eventually enabled the health frame to converge around the development of implementation policies that incorporated health service responses. Our explicit incorporation of framing within the Kindgon model has illustrated how important it is for understanding the emergence of policy issues, and the subsequent debates about their resolution. The framing of a policy problem by certain policy actors, affects the development of each of the three policy streams, and may facilitate or constrain their convergence. The concept of framing therefore lends an additional depth of understanding to the Kindgon agenda setting model.
18.	Darj, Elisabeth, 1953-, et al. (författare) Barriers and facilitators to cervical cancer screening in Nepal : A qualitative study 2019 Ingår i: Sexual & Reproductive HealthCare. - : ELSEVIER IRELAND LTD. - 1877-5756 .- 1877-5764. ; 20, s. 20-26 Tidskriftsartikel (refereegranskat)abstract Objectives: Despite being preventable, cervical cancer remains the most common cancer among women in Nepal, a country where there is no nationwide screening programme. Hence, the objective was to investigate and better understand Nepali women's perceptions on barriers to participation in cervical cancer screening and what might facilitate their participation. Methods: A qualitative study design with focus group discussions was employed and women were purposively invited. The interviews were tape-recorded, transcribed verbatim, and analysed using manifest content analysis. Findings: Women had misconceptions about the screening and low levels of knowledge. Sociocultural barriers, service providers' behaviour, geographical challenges, and limited finances were all perceived as obstacles to attending screening centres. Facilitating factors, such as participation in awareness programmes and support from family and women's groups, may convince women to attend screening clinics. Conclusions: The findings contribute information on Nepalese women's perceptions of cervical cancer screening. They may serve to support the Government of Nepal's promotion of cervical cancer screening and treatment as a right for all Nepali women, whenever necessary.
19.	Darj, Elisabeth (författare) Brädan 2004 Ingår i: Läkartidningen. ; 101:43, s. 3342-3346 Tidskriftsartikel (refereegranskat)
20.	Darj, Elisabeth, et al. (författare) Clinical and endometrial effects of oestradiol and progesterone in postmenopausal women 1991 Ingår i: Maturitas. - 0378-5122 .- 1873-4111. ; 13, s. 109-115 Tidskriftsartikel (refereegranskat)
21.	Darj, Elisabeth, et al. (författare) Effects on lipids and lipoproteins in women treated with estradiol and progesterone 1992 Ingår i: Maturitas. - 0378-5122 .- 1873-4111. ; 15, s. 209- Tidskriftsartikel (refereegranskat)
22.	Darj, Elisabeth, et al. (författare) Engelsk undervisning stimulerar och hämma : Klinisk grundkurs som del i EU-projekt 1997 Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 94:3, s. 126-128 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
23.	Darj, Elisabeth, 1953-, et al. (författare) 'Even though a man takes the major role, he has no right to abuse' : future male leaders' views on gender-based violence in Sri Lanka 2017 Ingår i: Global Health Action. - : Informa UK Limited. - 1654-9716 .- 1654-9880. ; 10:1 Tidskriftsartikel (refereegranskat)abstract Background: Distinct gender roles influence gender inequality and build the foundation for gender-based violence. Violence against women is a major public health problem in all societies, and a violation of human rights. Prevalence surveys on gender-based violence have been published from Sri Lanka, but qualitative studies on men's perceptions are lacking. Objectives: The aim of this study was to explore young educated Sri Lankan men's perceptions of violence against women. Methods: Seven focus-group discussions were held. Men at the end of their university studies were purposefully selected. A topic guide was used, covering various scenarios of violence against women. Qualitative content analysis was carried out. Results: Four categories were developed through the analytic process: fixed gender roles patriarchal values are accepted in society, female mobility control, and slowly changing attitudes; violence not accepted but still exists - sexual harassment exists everywhere, different laws for different people, female tolerance of violence, and men's right to punish; multiple factors cause violence - alcohol, violent behavior is inherited, violence culturally accepted, low education, and lack of communication; and prevention of violence against women - both parents must engage and socialize girls and boys equally, life skills education, premarital counselling, working places value clarification, and more women in politics and boards are suggested. Conclusions: Medical and management students, possible future male leaders of the country, have suggestions of prevention strategies in life skills to reduce gender-based violence and to increase knowledge of health consequences with the aim of changing attitudes.
24.	Darj, Elisabeth, et al. (författare) Insulin-like growth factor binding protein-1, a quick way to detect amniotic fluid 1998 Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 77:3, s. 295-297 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: The detection of premature rupture of membranes (PROM) is essential to the management of pregnancy. Various tests, all with different limitations, have been used to diagnose PROM. Insulin-like growth factor binding protein-1 (IGFBP-1) is present in an essentially higher concentration in amniotic fluid, than in serum, cervical mucous, urine and seminal plasma. A commercial kit, with monoclonal antibodies to IGFBP-1 attached to a stick, is available. The aim of this study was to investigate whether a rapid dipstick test could confirm or exclude the presence of amniotic fluid. METHODS: A multicenter study, involving six departments of obstetrics and gynecology in Sweden, was designed to evaluate the new dipstick technique of diagnosing the presence of amniotic fluid in the vagina. One hundred and seventy-four women were examined. Forty-six women with obvious PROM, 29 women without PROM and 99 women with suspected PROM. RESULTS: Forty-four out of forty-six women with obvious PROM had a positive PROM-TEST. Twenty-seven out of twenty-nine women without PROM had a negative PROM-TEST, giving a sensitivity of 95.7% and a specificity of 93.1%. Among the women with suspected rupture of membranes, the sensitivity was 70.8%, the specificity 88.2% and the positive predictive value (PPV) 92%. CONCLUSION: IGFBP is present in high concentration in amniotic fluid. The dipstick test with monoclonal antibodies to IGFBP-1 is rapid and has a high PPV, sensitivity and specificity. It is a useful complement to the existing arsenal of tests to detect PROM.
25.	Darj, Elisabeth, et al. (författare) Ki-67 Immunostaining of endometrial biopsies with special reference to hormone replacement therapy 1995 Ingår i: Gynecologic and Obstetric Investigation. - 0378-7346 .- 1423-002X. ; 39:2, s. 120-124 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: The purpose of this investigation was to evaluate the Ki-67 immunostaining method on formalin-fixed, paraffin-embedded endometrium and to use the method on endometrial biopsies from 30 postmenopausal women treated with 2 mg estradiol and different doses of natural micronized progesterone (50, 100 or 200 mg). METHODS: Two technicians prepared the immunostaining of slides from each of 12 endometrial specimens and 3 different observers estimated the Ki-67 immunostaining. One observer estimated all the slides 3 times on different occasions. The percentage of immunopositive nuclei in glandular epithelium was evaluated. RESULTS: The dominating component of variation for this method was between observers, with a median standard deviation of 20%. A total median variation including all components rendered a standard deviation of 23%. No significant effects of different technicians, preparations, or from the same observer on different occasions were found. In the major part of the biopsies from women on hormone replacement therapy (HRT), only 0-10% of the glandular epithelium was Ki-67 stained. CONCLUSION: Ki-67 immunostaining is an adequate technique to use when evaluating the effects of HRT on the endometrium. The main source of variation is between observers and not the technique of preparing the slides.
26.	Darj, Elisabeth (författare) Kortare kö och bättre arbetsmiljö! 2003 Ingår i: Läkartidningen. ; :37, s. 2847-2851 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
27.	Darj, Elisabeth, et al. (författare) Liver metabolism during treatment with estradiol and progesterone 1993 Ingår i: Gynecological Endocrinology. - : Informa UK Limited. - 0951-3590 .- 1473-0766. ; 7:2, s. 111-114 Tidskriftsartikel (refereegranskat)abstract Serum concentrations of sex hormone-binding globulin (SHBG), corticosteroid binding globulin (CBG), ceruloplasmin, lipoprotein A and liver enzymes were measured in 30 postmenopausal women treated with 2 mg micronized 17 beta-estradiol daily and micronized progesterone orally in doses of 50, 100 and 200 mg daily, as progestogen supplementation. The treatment lasted for 4 months. The serum levels of SHBG and CBG increased during treatment and a weak association between progesterone dosage and CBG was observed. Levels of lipoprotein A and liver enzymes did not change. It is concluded that micronized natural progesterone is an attractive means of progesterone supplementation in postmenopausal hormone replacement therapy without any liver-related side-effects.
28.	Darj, Elisabeth, et al. (författare) Mödrahälsovården utnyttjas inte av alla gravida kvinnor : Språksvårigheter och rädsla för undersökningen vanliga orsaker 2002 Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 99:1, s. 41-44 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract A study within a multinational collaborative study (Barriers and Incentives to Prenatal Care in Europe) showed that out of 3 278 women in Sweden who delivered during a 12-month study period, 5 % had registered late (after 15 gestational weeks) at the prenatal care centre or had visited the centre less than three times. Compared to the control group, these women were more likely to be young, single, multipara, immigrant, not fully employed, or having an unplanned pregnancy. The results indicate that their contact with prenatal services could be facilitated by access to interpreters and by transcultural competence among centre staff .
29.	Darj, Elisabeth, et al. (författare) Natural micronized progesterone orally administered in postmenopausal hormone replacement therapy 1995 Ingår i: European Menopause Journal. - 1381-2858. ; 2, s. 16- Tidskriftsartikel (refereegranskat)
30.	Darj, Elisabeth (författare) Oral progesterone opposing postmenopausal estrogen replacement therapy 1994 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)
31.	Darj, Elisabeth (författare) Oral progesterone opposing postmenopausal estrogen replacement therapy 1995 Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 74:5, s. 404-405 Tidskriftsartikel (refereegranskat)
32.	Darj, Elisabeth, 1953-, et al. (författare) Pharmacists' perception of their challenges at work, focusing on antimicrobial resistance : a qualitative study from Bangladesh 2019 Ingår i: Global Health Action. - : TAYLOR & FRANCIS LTD. - 1654-9716 .- 1654-9880. ; 12 Tidskriftsartikel (refereegranskat)abstract Background: The indiscriminate use of antimicrobial medicines has contributed to the development of microorganisms' resistance to antibiotics. Antimicrobial resistance (AMR) is a major global health problem and is most acute in countries that have a weak health care and regulatory system and a high burden of infectious diseases, such as Bangladesh. Due to shortages of physicians available to diagnose and prescribe appropriate antibiotics, people with ailments in Bangladesh are forced to contact various types of health care services, including retail pharmacies, that lack supervision by qualified medical personnel. It is unknown how pharmacists perceive the AMR situation and the related challenges they face. Objective: The aim of the study was to understand retail pharmacist's perceptions regarding AMR. Method: A qualitative study design was used, and in-depth interviews were held with retail pharmacists in Dhaka. Results: The participants demonstrated a variety of concerns regarding AMR. They considered that self-medication, old prescriptions, lack of regulations and supervision, and readily available antibiotics were the main factors that contributed to the misuse of antimicrobial medicines and the development of AMR. Conclusions: To control the further spread of AMR in Bangladesh, there is a need to work at several levels of the health system simultaneously. Initiatives could include establishment of the 'Model Pharmacy' programme nationwide, increasing and widening the focus on AMR in pharmacists' education, ensuring the implementation of government guidelines on AMR, increasing public awareness of the consequences of antimicrobial use, and surveillance and monitoring of regulations and progress. A multipronged strategy is necessary not only for better AMR control but also for investment in a system that is well equipped to provide equitable care in the face of both existing and new health challenges.
33.	Darj, Elisabeth (författare) Sorg och omsorg 2001 Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 98:24, s. 2942-2943 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
34.	Darj, Elisabeth, et al. (författare) STI-prevalence and differences in social background and sexual behavior among urban and rural young women in Uganda 2010 Ingår i: Sexual & Reproductive HealthCare. - : Elsevier BV. - 1877-5756 .- 1877-5764. ; 1:3, s. 111-115 Tidskriftsartikel (refereegranskat)abstract Background: Adolescents in Uganda carry a heavy burden of reproductive health problems. Different environment creates different problems.Objectives: To study the prevalence of STI and to compare social and behavioral risk factors for Neisseria gonorrhoea (NG) and Chlamydia trachomatis (CT) among sexually experienced young women in one urban and one rural area in Uganda.Methods: Consenting, sexually experienced women, below 20 years, visiting two different youth clinics were asked about social background, genital symptoms and sexual experiences. Vaginal samples were taken for NG and CT and analyzed by PCR.Results: The prevalence of NG and/or CT was 20 (6.8%) in the urban and 23 (7.8%) in the rural study site, a non-significant difference. The rural women were often in marital union, 25.3% compared to 12.2% of the urban women (OR 2.4, 95% CI 1.6-3.8) and had experienced more pregnancies and had more children. Their partners were often more than 10 years older. More urban women (42.2%) knew their HIV status compared to rural women (16.2%), OR 2.1 (1.6–2.7), reported more condom use and more sexual partners.Conclusions: Marital status and few sexual partners does not appear to protect young rural women from sexually transmitted infections (STIs), implying that male sexual behavior may have an important impact on women’s risk to be infected.
35.	Darj, Elisabeth, 1953-, et al. (författare) "The fairer the better?" : Use of potentially toxic skin bleaching products 2015 Ingår i: African Health Sciences. - : African Journals Online (AJOL). - 1680-6905 .- 1729-0503. ; 15:4, s. 1074-1080 Tidskriftsartikel (refereegranskat)abstract Background:Skin bleaching is a widespread phenomenon in spite of their potentially toxic health effects.Objectives:This study aimed to determine if such products are used in Sweden in particular by pregnant women, furthermore to explore immigrant women’s view skin bleaching.Methods:455 pregnant women completed a questionnaire, which were statistically analysed. Focus groups and individual interviews were conducted with immigrant women, content analysis was used to assess the data.Results:Skin bleaching products were used by 2.6% of pregnant women, significantlly more by women born in non-European countries. Motivating factors were associated with the concept of beauty together with social and economic advantages. The women had low awareness of the potential health risks of the products. Regulations on the trade of skin bleaching products have not effectively reduced the availability of the products in Sweden nor the popularity of skin bleaching.Conclusion:There is need for further research especially among pregnant women and possible effects on newborns. Products should be tested for toxicity. Public health information should be developed and health care providers educated and aware of this practice, due to their potential negative health implications.
36.	Darj, Elisabeth, et al. (författare) The prophylactic effect of doxycycline on postoperative infection rate after first-trimester abortion 1987 Ingår i: Obstetrics and Gynecology. - 0029-7844 .- 1873-233X. ; 70:5, s. 755-758 Tidskriftsartikel (refereegranskat)abstract A prospective double-blind study was performed to evaluate the effect of prophylactic antibiotic treatment before induced abortion. Eight hundred consecutive women admitted for first-trimester abortion, without signs of genital infection or antibiotic use in the last three weeks, were included in the study. Doxycycline 400 mg or placebo was given as a single oral dose ten to 12 hours before vacuum aspiration. Ninety-one women (11.8%) returned to the hospital with suspected complications. Thirty-two of these women were diagnosed as having pelvic inflammatory disease, eight of whom (2.1%) had received doxycycline before the abortion and 24 of whom (6.2%) had received placebo, a statistically significant difference (P less than .01). A history of pelvic inflammatory disease increased the risk of developing it again after an abortion.
37.	Darj, Elisabeth, et al. (författare) Ultrasonographic blood flow measurement in the carotid arteries in postmenopausal women 1999 Ingår i: Gynecologic and Obstetric Investigation. - : S. Karger AG. - 0378-7346 .- 1423-002X. ; 47:1, s. 20-25 Tidskriftsartikel (refereegranskat)abstract OBJECTIVES: The aim of the present study was to evaluate blood flow in postmenopausal women on hormone replacement therapy (HRT) compared to controls. Blood flow was ultrasonographically measured in the great arteries of the neck instead of in the vessels of the internal genital organs. METHODS: Fifty healthy women with climacteric complaints, at least 6 months postmenopausal, participated in the study. They were randomly divided into two groups. One group received 2 mg estradiol (E2) for 12 days, continued with 2 mg E2 and 1 mg norethisterone acetate for 10 days, followed by 1 mg E2 for 6 days, cyclically during 6 months. The other group received placebo tablets the first 3 months and the same HRT as the first group for the last 3 months. Blood flow was measured ultrasonographically by color flow pulsed Doppler in the common (CCA), internal (ICA) and external (ECA) carotid arteries, before the start of the study, after 3 and 6 months of therapy. RESULTS: CCA and ICA, both low resistance vessels, and ECA, a high resistance vessel, and their waveforms were identified. Pulsatility index did not decrease statistically significant (p > 0.05) in any of the great vessels during 6 months of HRT in this study. There were no differences in blood flow between the HRT-treated group compared to control group during 3 months of therapy, except for the right ECA (p = 0.04). CONCLUSION: The difference in blood flow and wave-forms of the major arteries of the neck were clearly shown, but HRT did not have any important impact on the blood flow in this study. No difference was shown concerning blood flow between the two groups of postmenopausal women, on active therapy or placebo.
38.	Darj, Elisabeth, et al. (författare) Ungdomars syn på kondomanvändning 2003 Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 100:44, s. 3510-3516 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract Seven out of ten of the adolescents included in the study had experienced unsafe sex with a new partner. Afterwards, 48 % worried about STD and 31 % worried about pregnancy.Teenagers calculate the risk of contracting STD from the looks and the reputation of a new partner.Young women and men agree, that both share responsibility for the use of condoms, but more often the young women initiate the use of condoms.Many participants found it more embarrassing to buy condoms than to use them.The participants hoped for improved education in schools and less expensive condoms. The adolescents possessed good knowledge concerning how to protect themselves, but changes in attitudes are needed. School and youth clinics play important roles in this process.
39.	Darj, Elisabeth, et al. (författare) Very early discharge from hospital after normal deliveries 2000 Ingår i: Upsala Journal of Medical Sciences. - : Uppsala Medical Society. - 0300-9734 .- 2000-1967. ; 105:1, s. 57-66 Tidskriftsartikel (refereegranskat)abstract The aim of the present study was to investigate, in a descriptive study, how healthy women experienced early discharge from hospital, 6-12 hours, after normal deliveries. Expecting couples were prepared for early discharge during pregnancy. The women delivered at the University Hospital in Uppsala. All infants had two obligatory medical examinations, one before leaving the hospital and one for metabolic screening after four or five days. Both mothers and infants received postpartum care at home by midwives. One hundred and three women participated and answered a questionnaire four to five days after delivery. Twenty of the women were additionally interviewed by telephone four months after delivery. The average length of stay at the hospital after delivery was 8 hours. The families had, on average, 1.9 visits at home. All women considered that they had received sufficient care and advice from the midwives, although 40 percent felt uncertainty about something in the postpartum period. Questions frequently raised concerned breast-feeding. Two infants were readmitted to hospital due to mild neonatal hyperbilirubinemia. All but three women wanted to repeat very early discharge after a future uncomplicated delivery. Ninety-five percent of the women were still breast-feeding after four months. We conclude, that antenatal preparation and a well-organised, adequate postpartum home-care is of the greatest importance, to establish safe early discharge after uncomplicated deliveries. This concept of early discharge from hospital, with midwifery home care provided, is safe and appreciated by the new parents.
40.	Edvardsson, Kristina, et al. (författare) Norwegian obstetricians' experiences of the use of ultrasound in pregnancy management : a qualitative study 2018 Ingår i: Sexual & Reproductive HealthCare. - : Elsevier. - 1877-5756 .- 1877-5764. ; 15, s. 69-76 Tidskriftsartikel (refereegranskat)abstract Objective: To explore obstetricians' experiences and views of the use of obstetric ultrasound in clinical management of pregnancy. Methods: A qualitative interview study was undertaken in 2015 with obstetricians (N = 20) in Norway as part of the CROss Country Ultrasound Study (CROCUS). Results: Three categories developed during analyses. 'Differing opinions about ultrasound and prenatal diagnosis policies' revealed divergent views in relation to Norwegian policies for ultrasound screening and prenatal diagnosis. Down syndrome screening was portrayed as a delicate and frequently debated issue, with increasing ethical challenges due to developments in prenatal diagnosis. 'Ultrasound's influence on the view of the fetus' illuminated how ultrasound influenced obstetricians' views of the fetus as a 'patient' and a 'person'. They also saw ultrasound as strongly influencing expectant parents' views of the fetus, and described how ultrasound was sometimes used as a means of comforting women when complications occurred. The complexity of information and counselling' revealed how obstetricians balanced the medical and social aspects of the ultrasound examination, and the difficulties of 'delivering bad news' and counselling in situations of uncertain findings. Conclusion: This study highlights obstetricians' experiences and views of ultrasound and prenatal diagnosis in Norwegian maternity care and the challenges associated with the provision of these services, including counselling dilemmas and perceived differences in expectations between caregivers and expectant parents. There was notable diversity among these obstetricians in relation to their support of, and adherence to Norwegian regulations about the use of ultrasound, which indicates that the care pregnant women receive may vary accordingly.
41.	Ekstrand, Maria, et al. (författare) Advance provision of emergency contraceptive pills reduces treatment delay : a randomized controlled trial among Swedish teenage girls 2008 Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 87:3, s. 354-359 Tidskriftsartikel (refereegranskat)abstract OBJECTIVE: To evaluate an intervention involving advance provision of emergency contraceptive pills (ECP) to Swedish teenage girls. MATERIAL AND METHODS: Some 420 girls aged 15-19, requesting ECP at a local youth clinic were randomly assigned to intervention group (IG) (n=214) or control group (CG) (n=206). Both groups received ECP on request. The IG received one extra dose of ECP, condoms and an information leaflet regarding ECP and condom use. Main outcome measures were differences between IG and CG regarding ECP use, time span between unprotected intercourse and ECP intake, contraceptive use, and sexual risk taking. Questionnaires were completed at the initial visit, and the girls were followed up by structured telephone interviews 3 and 6 months later. RESULTS: At the 3-month follow-up, girls in the IG were almost twice as likely to have used ECP compared to girls in the CG (IG: 24.0%, CG: 13%, p=0.02), and they used it sooner after unprotected intercourse (mean time IG: 13.61 h, CG: 25.47 h, p=0.007). Significant differences persisted 6 months after the intervention (ECP use IG: 31%, CG: 19%, p=0.01; and mean time IG: 15.59 h, CG: 26.38 h, p=0.006). No significant differences were found in the use of regular hormonal contraceptives or condoms at either follow-up. About 40% of the girls in both groups had risked pregnancy during the follow-up period, but only half of these had used ECP. CONCLUSIONS: This intervention shortened the time interval from unprotected intercourse to pill intake without jeopardising contraceptive use and without increasing sexual risk taking.
42.	Ekstrand, Maria, et al. (författare) An illusion of power : Qualitative Perspectives On Abortion Decision-Making Among Teenage Women In Sweden 2009 Ingår i: Perspectives on sexual and reproductive health. - : Guttmacher Institute. - 1538-6341 .- 1931-2393. ; 41:3, s. 173-180 Tidskriftsartikel (refereegranskat)abstract CONTEXT:Swedish law permits abortion at the request of a pregnant woman untilthe 18th week of gestation. However, the extent to which the decision istruly the woman's own is subject to debate; women are often influenced,directly or indirectly, by the attitudes of their partners, family andfriends or by social norms. METHODS: Individual in-depth interviewsabout the pregnancy and the abortion decision were conducted 3-4 weekspostabortion with 25 women aged 16-20 at different periods in 2003, 2005and 2007. Interviews were audio-taped, transcribed verbatim andanalyzed using latent content analysis. RESULTS: The main reasons forunplanned pregnancy were underestimation of pregnancy risk andinconsistent contraceptive use. Pregnancy prevention was perceived asthe woman's responsibility. The abortion decision was accompanied bymixed emotions, and was seen as a natural yet difficult choice. Socialnorms and the negative attitudes of family and friends stronglyinfluenced the decision. Partners and parents were regarded as the mostimportant sources of support. After the abortion, the women feltpressured by contraceptive counselors to use highly effectivecontraceptives despite their previous negative experiences or worriesabout side effects. CONCLUSIONS: Swedish teenagers' basic right todecide whether to have an abortion may be limited by societal norms anddisapproval of teenage childbearing. Given the perception that women areresponsible for contraception, programs need to emphasize thatpregnancy prevention is a shared responsibility; greater efforts toinclude males in prevention practices are needed.
43.	Ekstrand, Maria, et al. (författare) Preventing pregnancy : A girls' issue. Seventeen-year-old Swedish boys' perceptions on abortion, reproduction and use of contraception 2007 Ingår i: European journal of contraception & reproductive health care. - : Informa UK Limited. - 1362-5187 .- 1473-0782. ; 12:2, s. 111-118 Tidskriftsartikel (refereegranskat)abstract Objective To gain deeper understanding of how teenage males view abortion, adolescent fatherhood, sexual behavior, and use of contraception. Method We conducted six focus-group interviews with 17-year-old boys (n 1⁄4 40). The interviews were tape-recorded, transcribed verbatim, and analyzed using manifest content analysis. Results Adolescent fatherhood was considered to be a catastrophe and abortion a moral dilemma. Most participants agreed that the unrestricted right to decide on abortion rests upon the girl, but some were frustrated by not having any legal right to influence the decision. Contraceptive failure was viewed as common and mainly due to the influence of alcohol or in relation to unplanned sex. Boys perceived girls as having a greater responsibility in avoiding pregnancy, and they often put a blind trust in the girls’ use of hormonal contraceptives or initiation of emergency contraception. Several groups had insufficient knowledge about fetal development and other aspects of reproduction. Many were unsatisfied with the sex education they had received at school, but still considered it to be an important counterweight to other sources of information concerning sex, such as pornography. Conclusion Equal responsibility among boys and girls regarding reproductive issues is still a challenge, but nevertheless an important key to the prevention of unwanted pregnancies.
44.	Ekstrand, Maria, 1977- (författare) Sexual Risk Taking : – Perceptions of Contraceptive Use, Abortion, and Sexually Transmitted Infections Among Adolescents in Sweden 2008 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract The overall aim of this thesis was to inestigate Swedish adolescents' perceptions and behaviours regarding sexual risk taking. Specific objectives were to explore teenagers' perceptions of contraceptive use, unintended pregnancy, and abortion; teenage girls' experiences of decision making process and support connected to abortion; and male adolescents' perceptions of sexual risk taking and barriers to practicing safe sex. Another objective was to evaluate the effect of advance provision of emergency contraceptive pills to teenage girls. The methodologies included focus group discussions, in-depth interviews, and a randomized controlled trial. Among the adolescents in our studies, teenage parenthood was generally viewed as a "catastrophe", and the majority expressed supportive attitudes towards abortion (studies I-IV). Occasions of failure to use contraceptives were common, especially when sex was unplanned (studies I-V). Pregnancy prevention was perceived as the woman's responsibility. However, many girls were reluctant about using homonal contraceptives due to worries about negative side effects (I, III). Initiating condom use was difficult for girls, as well as for boys, for a number of reasons (I-IV): fear of ruining an intimate situation, associations with disease, distrust, pleasure reduction, and (for the boys) the fear of loosing one's erection. Males generally perceived personal and partner-related risks connected to unprotected intercourse as low. Few males were worried that an unintended pregnancy would be carried to term, and the majority would urge the girl towards abortion if she seemed ambivalent (II, IV). Girls viewed the abortion decision as a natural, yet difficult choice, strongly influenced by attitudes of partners, parents, peers and societal norms (III). Teenage girls provided with emergency contraceptive pills in advance used it more frequently and sooner after unprotected intercourse compared with controls, without jeopardising regular contraceptive use (V).
45.	Ekstrand, Maria, et al. (författare) Twelve-month follow-up of advance provision of emergency contraception among teenage girls in Sweden-a randomized controlled trial 2013 Ingår i: Upsala Journal of Medical Sciences. - : Uppsala Medical Society. - 0300-9734 .- 2000-1967. ; 118:4, s. 271-275 Tidskriftsartikel (refereegranskat)abstract Objective. The objective of this study was to evaluate the effect of an intervention with advance provision of emergency contraceptive pills (ECP), condoms, and extended information to a targeted group of teenage girls, compared with a control group, 12 months after intervention. Material and methods. A randomized controlled trial among 420 girls, 15-19 years old, requesting emergency contraception at a youth clinic in Sweden was carried out. Data were collected by a questionnaire at the initial visit and structured telephone interviews 12 months after enrolment. Differences between the intervention group and the control group regarding ECP use, time interval from unprotected intercourse to ECP intake, contraceptive use, and sexual risk-taking were analysed. Results. One year after the intervention 62% of the girls could be reached for follow-up. The girls in the intervention group reported a shorter time interval (mean 15.3 hours) from unprotected intercourse to ECP intake compared to the control group (mean 25.8 hours) (p = 0.019), without any evidence of decreased use of contraceptives or increased sexual risk-taking. Conclusion. Even up to 12 months following the intervention, advance provision of ECP at one single occasion, to a specific target group of adolescent girls, shortens the time interval from unprotected intercourse to pill intake, without jeopardizing contraceptive use or increasing sexual risk-taking. Considering the clinical relevance of these results, we suggest that advance provision of ECP could be implemented as a routine preventive measure for this target group.
46.	Graner, Sophie, 1971- (författare) Reproductive outcomes in rural Vietnam. Perspectives and experiences by pregnant women and health care professionals on pregnancy promotion and maternal health care. 2010 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract Background Reproductive health and health events associated with pregnancy including induced abortions are among the most important factors for the health of fertile women. Adverse outcomes have an impact on women’s reproductive health and their overall health as well as the health of their offspring. Pregnancy and child bearing take place within a cultural context. Risk factors for adverse pregnancy outcomes depend on factors both associated with the individual woman as well as contextual factors. Aims This thesis investigates reproductive health indicators and their determinants for women in a rural district in Vietnam with special focus on adverse pregnancy outcomes and their determinants. In addition, this thesis explores the perspectives and experiences among pregnant women and health care professionals on maternal health care in Vietnam and risks during pregnancy and delivery. Methods The studies used quantitative and qualitative methods. In the quantitative studies a total of 4,396 women reporting 5,838 pregnancies, and 5,521 infants were included. Parametric and non parametric tests and univariate and multivariate logistic regression analysis was performed. For the estimation of small for gestational age a population-specific reference curve was constructed based on the mean birth weight at term in the study population. In the qualitative studies data were collected from eight focus group discussions, four with pregnant women and four with health care professionals. Manifest and latent content analysis was applied. Main findings Women belonging to an ethnic minority or women giving birth at home were at increased risk of stillbirth. The risk of induced abortion increased with maternal age. Neonatal mortality was estimated to 11.6 per 1000 live births and perinatal mortality to 25.0 per 1000 births. The prevalence of small for gestational age was estimated to 6.4%. Risk factors for small for gestational age included women in farming occupations and post-term birth. There was a marked decrease in perinatal mortality after 33 weeks of gestation. Contextual conditions influenced both pregnant women’s use of maternal health care and the performance of the health care professionals. The use of maternal health care was influenced by economical conditions as well as cultural norms that impeded women’s autonomy. Structural constraints included inadequate financing of the health system, including lack of staff, insufficient professional re-training, and inadequate equipment. Pregnant women in rural Vietnam created a strategy to promote a healthy pregnancy through lifestyle adjustments, gathering of information, and seeking timely medical care. Insights in pregnancy-related conditions were sought from various sources and were influenced both by Vietnamese traditions and modern medical knowledge. Conclusions Knowledge about pregnancy complications and their related signs and symptoms, and a high confidence in the maternal health care probably contribute to the relatively good maternal health status and pregnancy outcomes in Vietnam. To improve perinatal and neonatal outcomes there is a need to ensure access for all pregnant women to delivery units with surgical capacity in case of an obstetrical emergency. Also, a higher proportion of premature infants need to be born at units with access to neonatal care. This may be achieved by an improved system for referral including capacity of medical care during transportation. Other desirable improvements include antenatal identification of small for gestational age foetuses. In our study the induced abortion rate increased with maternal age and was highest among married women, indicating that induced abortions may be used as a method for family planning. The cultural norms in Vietnam limit women’s autonomy and reduce their possibility to make independent decisions about their reproductive health. Our studies emphasize the importance of adequate access for all women to maternal health care adjusted for their individual needs. A better understanding is needed of context-specific factors that influence couples’ choice of family planning methods, place of birth, and maternal health care. The communication between pregnant women and health care professionals needs further investigation. This knowledge is essential in order to develop reproductive health services that are accessible, acceptable and affordable to all.
47.	Johansson, Katarina, et al. (författare) First-time parents' experiences of home-based postnatal care in Sweden 2010 Ingår i: Upsala Journal of Medical Sciences. - : Informa Healthcare. - 0300-9734 .- 2000-1967. ; 115:2, s. 131-137 Tidskriftsartikel (refereegranskat)abstract Aim. To gain a deeper understanding of first-time parents’ experiences of early discharge from hospital after delivery andhome-based postnatal care.Material and methods. The study was comprised of focus group interviews, interviews with couples and with fathers. Twentyoneparents participated. Inclusion criteria: healthy women who have given birth to their first child after a normal pregnancyand delivery, the women’s partners, healthy and full term babies, Swedish-speaking, discharge from the delivery ward within24 hours, resident in the Uppsala community, the parents cohabited at the time of the delivery. The material was analysed byqualitative content analysis.Results. Three themes emerged: The family’s strategy, which describes the family’s expectations of postnatal care and theirexperiences of the real situation. Some are flexible concerning going home early, and others have decided in advance. Selfrelianceand strength, which explores the parents’ feelings of security and uncertainty, freedom and independence, and sharedresponsibility. Breast-feeding is described as the ‘main thing’, an interactive learning process. Professional support in the homesummarizes the parents’ experience of the midwife’s support at home. While conflicting feelings may be revealed during thefirst days, the midwife confirms their new roles as parents. The midwife is seen as a support and adviser to the parents.Conclusion. This study shows that parents welcome home-based postnatal care with professional support from midwives. Weconclude that this care suits healthy families. We think it will be more important in the future to discriminate between healthyfamilies and those in need of hospital care, than to focus on the moment when they leave the hospital, early or late.
48.	Johansson, Martin M., 1976-, et al. (författare) Novel Y-Chromosome Long Non-Coding RNAs Expressed in Human Male CNS During Early Development 2019 Ingår i: Frontiers in Genetics. - : Frontiers Media S.A.. - 1664-8021. ; 10 Tidskriftsartikel (refereegranskat)abstract Global microarray gene expression analyses previously demonstrated differences in female and male embryos during neurodevelopment. In particular, before sexual maturation of the gonads, the differences seem to concentrate on the expression of genes encoded on the X- and Y-chromosomes. To investigate genome-wide differences in expression during this early developmental window, we combined high-resolution RNA sequencing with qPCR to analyze brain samples from human embryos during the first trimester of development. Our analysis was tailored for maximum sensitivity to discover Y-chromosome gene expression, but at the same time, it was underpowered to detect X-inactivation escapees. Using this approach, we found that 5 out of 13 expressed gametolog pairs showed unbalanced gene dosage, and as a consequence, a male-biased expression. In addition, we found six novel non-annotated long non-coding RNAs on the Y-chromosome with conserved expression patterns in newborn chimpanzee. The tissue specific and time-restricted expression of these long non-coding RNAs strongly suggests important functions during central nervous system development in human males.
49.	Johansson, Martin, 1976-, et al. (författare) Spatial sexual dimorphism of X and Y homolog gene expression in the human central nervous system during early male development 2016 Ingår i: Biology of Sex Differences. - : Springer Science and Business Media LLC. - 2042-6410. ; 7 Tidskriftsartikel (refereegranskat)abstract Background: Renewed attention has been directed to the functions of the Y chromosome in the central nervous system during early human male development, due to the recent proposed involvement in neurodevelopmental diseases. PCDH11Y and NLGN4Y are of special interest because they belong to gene families involved in cell fate determination and formation of dendrites and axon. Methods: We used RNA sequencing, immunocytochemistry and a padlock probing and rolling circle amplification strategy, to distinguish the expression of X and Y homologs in situ in the human brain for the first time. To minimize influence of androgens on the sex differences in the brain, we focused our investigation to human embryos at 8-11 weeks post-gestation. Results: We found that the X- and Y-encoded genes are expressed in specific and heterogeneous cellular sub-populations of both glial and neuronal origins. More importantly, we found differential distribution patterns of X and Y homologs in the male developing central nervous system. Conclusions: This study has visualized the spatial distribution of PCDH11X/Y and NLGN4X/Y in human developing nervous tissue. The observed spatial distribution patterns suggest the existence of an additional layer of complexity in the development of the male CNS.
50.	Lind, Anna-Britta, et al. (författare) Gene expression of cytochrome P450 1B1 and 2D6 in leukocytes in human pregnancy 2003 Ingår i: Pharmacology and Toxicology. - : Wiley. - 0901-9928 .- 1600-0773. ; 92:6, s. 295-9 Tidskriftsartikel (refereegranskat)abstract We investigated the influence of human pregnancy on gene expression of two cytochrome P450 enzymes in white blood cells. Cytochrome P450 1B1 (CYP1B1) catalyses oestradiol 4-hydroxylation, and may participate in the endocrine regulation of oestrogens. Cytochrome P450 2D6 (CYP2D6) metabolises many commonly used drugs, and previous studies have suggested that it is induced during pregnancy. CYP1B1 and CYP2D6 were therefore considered to be of interest in human pregnancy. As it is not ethically possible to take liver biopsies from healthy mothers during pregnancy, easily accessible cells that express the genes were used as a surrogate tissue. White blood cells were collected from eighteen pregnant women, and were used to measure CYP1B1 and CYP2D6 ribonucleic acid (RNA). The analysis was repeated after pregnancy, the women, thus, serving as their own controls. Real-time reverse transcriptase - polymerase chain reaction methods were used with 18S ribosomal RNA as an internal control. A slight, but not significant, increase in gene activity of CYP1B1 was detected during pregnancy. Expression of CYP2D6 in blood was extremely low, and induction of CYP2D6 during pregnancy could not be confirmed. In conclusion, gene expression of CYP1B1 and CYP2D6 in leukocytes was not significantly up-regulated in the third trimester of pregnancy, but a trend indicating an altered metabolism during pregnancy was detected.

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