| 1. |
- Thorgeirsdottir, Lilja, et al.
(författare)
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Study protocol: establishment of a multicentre pre-eclampsia database and biobank in Sweden: GO PROVE and UP MOST, a prospective cohort study
- 2021
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 11:11
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Introduction Pre-eclampsia, a multisystem disorder in pregnancy, is one of the most common causes of maternal morbidity and mortality worldwide. However, we lack methods for objective assessment of organ function in pre-eclampsia and predictors of organ impairment during and after pre-eclampsia. The women’s and their partners’ experiences of pre-eclampsia have not been studied in detail. To phenotype different subtypes of the disorder is of importance for prediction, prevention, surveillance, treatment and follow-up of pre-eclampsia.The aim of this study is to set up a multicentre database and biobank for pre-eclampsia in order to contribute to a safer and more individualised treatment and care.Methods and analysis This is a multicentre cohort study. Prospectively recruited pregnant women ≥18 years, diagnosed with pre-eclampsia presenting at Sahlgrenska University Hospital, Uppsala University Hospital and at Södra Älvsborgs Hospital, Sweden, as well as normotensive controls are eligible for participation. At inclusion and at 1-year follow-up, the participants donate biosamples that are stored in a biobank and they are also asked to participate in various organ-specific evaluations. In addition, questionnaires and interviews regarding the women’s and partner’s experiences are distributed at follow-up.Ethics and dissemination By creating a database and biobank, we will provide the means to explore the disorder in a broader sense and allow clinical and laboratory discoveries that can be translated to clinical trials aiming at improved care of women with pre-eclampsia. Further, to evaluate experiences and the psychological impact of being affected by pre-eclampsia can improve the care of pregnant women and their partners. In case of incidental pathological findings during examinations performed, they will be handled in accordance with clinical routine. Data are stored in a secure online database. Biobank samples are identified through the women’s personal identification number and pseudonymised after identification in the biobank before analysis.This study was approved by the regional ethical review board in Gothenburg on 28 December 2018 (approval number 955-18) and by the Swedish Ethical Review Authority on 27 February 2019 (approval number 2019-00309).
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| 2. |
- Carlsson, Ylva, 1975, et al.
(författare)
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COVID-19 in Pregnancy and Early Childhood (COPE): study protocol for a prospective, multicentre biobank, survey and database cohort study.
- 2021
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Ingår i: BMJ open. - : BMJ. - 2044-6055. ; 11:9
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Tidskriftsartikel (refereegranskat)abstract
- There is limited knowledge on how the SARS-CoV-2 affects pregnancy outcomes. Studies investigating the impact of COVID-19 in early pregnancy are scarce and information on long-term follow-up is lacking.The purpose of this project is to study the impact of COVID-19 on pregnancy outcomes and long-term maternal and child health by: (1) establishing a database and biobank from pregnant women with COVID-19 and presumably non-infected women and their infants and (2) examining how women and their partners experience pregnancy, childbirth and early parenthood in the COVID-19 pandemic.This is a national, multicentre, prospective cohort study involving 27 Swedish maternity units accounting for over 86000 deliveries/year. Pregnant women are included when they: (1) test positive for SARS-CoV-2 (COVID-19 group) or (2) are non-infected and seek healthcare at one of their routine antenatal visits (screening group). Blood, as well as other biological samples, are collected at different time points during and after pregnancy. Child health up to 4years of age and parent experience of pregnancy, delivery, early parenthood, healthcare and society in general will be examined using web-based questionnaires based on validated instruments. Short- and long-term health outcomes will be collected from Swedish health registers and the parents' experiences will be studied by performing qualitative interviews.Confidentiality aspects such as data encryption and storage comply with the General Data Protection Regulation and with ethical committee requirements. This study has been granted national ethical approval by the Swedish Ethical Review Authority (dnr 2020-02189 and amendments 2020-02848, 2020-05016, 2020-06696 and 2021-00870) and national biobank approval by the Biobank Väst (dnr B2000526:970). Results from the project will be published in peer-reviewed journals.NCT04433364.
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| 3. |
- Siira, Elin, 1987-, et al.
(författare)
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Intersectionality in nursing research : A systematic review
- 2023
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Ingår i: Nursing Open. - Chichester, West Sussex : Wiley-Blackwell Publishing Inc.. - 2054-1058. ; 10:12, s. 7509-7527
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Forskningsöversikt (refereegranskat)abstract
- Aim: This systematic literature review aimed to identify, appraise and synthesize available research studies that apply intersectionality in nursing research. Design: Systematic review. Data Sources: Empirical and theoretical nursing studies published before February 2022 were identified from the PubMed and CINAHL databases. Studies were eligible for inclusion if they substantially covered the topics of intersectionality and nursing, had undergone peer-review, and were written in English. Review Methods: The PRISMA 2020 statement for reporting systematic reviews was used to report findings. The Joanna Briggs Institute Critical Appraisal tools were used to assess the quality of the included research studies. Results: Out of 331 identified studies, 60 studies were substantially about nursing and intersectionality, and were included in the review. There are a myriad of ways that the concept of intersectionality has been adopted in nursing research. Furthermore, there was great heterogeneity in the definition and application of the concept of intersectionality, and only a few studies were empirical. Conclusion: There is a need for robust and clear framing of how the concept of intersectionality is defined and understood in nursing research. There is also a need for more empirical research effectively adopting the concept of intersectionality to enhance our understanding of how health inequities operate within the field of nursing. No Patient or Public Contribution: No patients, service users, caregivers or members of the public were involved in this work. © 2023 The Authors. Nursing Open published by John Wiley & Sons Ltd.
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| 4. |
- Thorgeirsdottir, Lilja, et al.
(författare)
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Partners upplevelse av preeklampsi
- 2023
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Ingår i: Konferens Reproduktiv hälsa 2023.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)
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| 5. |
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| 6. |
- Adolfsson, Annsofie, 1960-, et al.
(författare)
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A web-based support for pregnant women and new mothers with type 1 diabetes mellitus in Sweden (MODIAB-Web) : study protocol for arandomized controlled trial
- 2014
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Ingår i: Trials. - : Springer Science and Business Media LLC. - 1745-6215. ; 15, s. 513-
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Background: Women with type 1 diabetes face particular demands in their lives in relation to childbearing. During pregnancy, in order to optimize the probability of giving birth to a healthy child, their blood glucose levels need to be as normal as possible. After childbirth, they experience a 'double stress': in addition to the ordinary challenges they face as new mothers, they also need to focus on getting their blood glucose levels normal. To improve self-management of diabetes and overall well-being in women with type 1 diabetes, a person-centered web-based support was designed to be tested in a randomized controlled trial (RCT) to be used during pregnancy and early motherhood. This protocol outlines the design of this RCT, which will evaluate the effectiveness of the specially designed web-based support for mothers with type 1 diabetes in Sweden.Methods: The study is designed as an RCT. The web support consists of three parts: 1) evidence-based information, 2) a self-care diary, and 3) communication with peers. The primary outcome is general well-being evaluated with the Well-Being Questionnaire short version (W-BQ12) and diabetes management evaluated with the Diabetes Empowerment Scale, short version (SWE-DES). Women attending six hospital-based antenatal care centers in Sweden are invited to participate. The inclusion period is November 2011 to late 2014. The allocation of participants to web support (intervention group) and to usual care (control group) is equal (1:1). In total, 68 participants in each group will be needed to reach a statistical power of 80% with significance level 0.05.Discussion: The web support is expected to strengthen the women's personal capacity and autonomy during pregnancy, breastfeeding, and early motherhood, leading to optimal well-being and diabetes management.
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| 7. |
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| 8. |
- Berg, Marie, 1955, et al.
(författare)
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Web-Based Intervention for Women With Type 1 Diabetes inPregnancy and Early Motherhood : Critical Analysis of Adherenceto Technological Elements and Study Design
- 2018
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Ingår i: Journal of Medical Internet Research. - : JMIR Publications. - 1438-8871. ; 20:5
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Tidskriftsartikel (refereegranskat)abstract
- Background: Numerous Web-based interventions have been implemented to promote health and health-related behaviors inpersons with chronic conditions. Using randomized controlled trials to evaluate such interventions creates a range of challenges, which in turn can influence the study outcome. Applying a critical perspective when evaluating Web-based health interventions is important.Objective: The objective of this study was to critically analyze and discuss the challenges of conducting a Web-based health intervention as a randomized controlled trial.Method: The MODIAB-Web study was critically examined using an exploratory case study methodology and the framework for analysis offered through the Persuasive Systems Design model. Focus was on technology, study design, and Web-based support usage, with special focus on the forum for peer support. Descriptive statistics and qualitative content analysis were used.Results: The persuasive content and technological elements in the design of the randomized controlled trial included all four categories of the Persuasive Systems Design model, but not all design principles were implemented. The study duration was extended to a period of four and a half years. Of 81 active participants in the intervention group, a maximum of 36 women were simultaneously active. User adherence varied greatly with a median of 91 individual log-ins. The forum for peer support was used by 63 participants. Although only about one-third of the participants interacted in the forum, there was a fairly rich exchange of experiences and advice between them. Thus, adherence in terms of social interactions was negatively affected by limited active participation due to prolonged recruitment process and randomization effects. Lessons learned from this critical analysis are that technology and study design matter and might mutually influence each other. In Web-based interventions, the use of design theories enables utilization of the full potential of technology and promotes adherence. The randomization element in a randomized controlled trial design can become a barrier to achieving a critical mass of user interactions in Web-based interventions, especially when social support is included. For extended study periods, the technology used may need to be adapted in line with newly available technical options to avoid the risk of becoming outdated in the user realm, which in turn might jeopardize study validity in terms of randomized controlled trial designs.Conclusions: On the basis of lessons learned in this randomized controlled trial, we give recommendations to consider when designing and evaluating Web-based health interventions.
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| 9. |
- Bogren, Malin, 1970, et al.
(författare)
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Impact of the Helping Mothers Survive Bleeding After Birth learning programme on care provider skills and maternal health outcomes in low-income countries — An integrative review
- 2021
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Ingår i: Women and Birth. - : Elsevier BV. - 1871-5192 .- 1878-1799. ; 34:5, s. 425-434
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Forskningsöversikt (refereegranskat)abstract
- © 2020 The Author(s) Background: To improve maternal health outcomes, highly competent healthcare providers are needed. One strategy used to improve performance among healthcare providers is simulation-based learning. An integrative review was designed with the aim of synthesising available research on Helping Mothers Survive (HMS), a learning programme used in low-income countries, and its impact on care provider skills and maternal health outcomes. Method: A systematic search was conducted in June 2020 in CINAHL, PubMed, Scopus, and Web of Science. All stages of inclusion, quality assessment, and data extraction were done independently by four reviewers. A narrative synthesis was used for the outcomes of care provider skills and knowledge, as well as maternal health outcomes. Findings: The search identified 50 articles, 22 of which were excluded due to being duplicates, 16 based on their title and abstract, and two based on their full text. Eleven papers were included in the synthesis: eight quantitative, two qualitative, and one mixed-method study, originating from India, Malawi, Tanzania, Uganda, and Zanzibar. The Helping Mothers Survive-Bleeding After Birth (HMS-BAB) learning programme was found to have a positive impact on care providers’ competencies and maternal health outcomes, with a reduced number of postpartum haemorrhages and a reduction in maternal mortality. Conclusion: The HMS-BAB learning programme has the potential to increase competence among care providers and improve maternal health outcomes in low-income settings. A successful use of the programme to maintain improved care routines for mothers requires multi-professional teams, facility readiness, a low-dose high-frequency approach, a local coordinator, and accountability and ownership.
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| 10. |
- Chertok, Ilana Azulay, et al.
(författare)
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Factors associated with exclusive breastfeeding at discharge during the COVID-19 pandemic in 17 WHO European Region countries.
- 2022
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Ingår i: International breastfeeding journal. - : Springer Science and Business Media LLC. - 1746-4358. ; 17:1
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Tidskriftsartikel (refereegranskat)abstract
- Exclusive breastfeeding is the optimal infant nutrition, providing infants immunoprotection against many diseases including SARS-CoV-2 infection. Restrictions during the COVID-19 pandemic may have negatively affected breastfeeding practices inmaternity care facilities. The aims of the study were to examine exclusive breastfeeding rates at discharge over time and to identify factors associated with exclusive breastfeeding during the pandemic.A cross-sectional survey was conducted among mothers who gave birth in a maternity care facility in the World Health Organization (WHO) European Region countries during the COVID-19 pandemic. The socio-ecological model was employed to examine intrapersonal, interpersonal, organizational, and community/society factors associated with maternal report of exclusive breastfeeding at the time of discharge.There were 26,709 participating mothers from 17 European Region countries who were included in the analysis. Among the mothers, 72.4% (n=19,350) exclusively breastfed and 27.6% (n=7,359) did not exclusively breastfeed at discharge. There was an overall decline in exclusive breastfeeding rates over time (p=0.015) with a significantly lower rate following the publication of the WHO breastfeeding guidelines on 23 June 2020 (AOR 0.88; 95% CI 0.82, 0.94). Factors significantly associated with exclusive breastfeeding outcomes in the logistic regression analysis included maternal age, parity, education, health insurance, mode of birth, inadequate breastfeeding support, lack of early breastfeeding initiation, lack of full rooming-in, birth attendant, perceived healthcare professionalism and attention, facility room cleanliness, timing of birth, and location of birth.Results from the study indicate the decline in exclusive breastfeeding rates in the WHO European Region during the COVID-19 pandemic. Using the socio-ecological model to identify factors associated with breastfeeding outcomes facilitates an integrated and holistic approach to address breastfeeding needs among women across the region. These findings demonstrate the need to augment breastfeeding support and to protect exclusive breastfeeding among mother-infant dyads, in an effort to reverse the declining exclusive breastfeeding rates. The study highlights the need to educate mothers and their families about the importance of exclusive breastfeeding, reduce maternal-infant separation, increase professional breastfeeding support, and follow evidence-based practice guidelines to promote breastfeeding in a comprehensive and multi-level manner.Clinical Trials NCT04847336.
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| 11. |
- Costa, Raquel, et al.
(författare)
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Quality of maternal and newborn care around the time of childbirth for migrant versus nonmigrant women during the COVID-19 pandemic: Results of the IMAgiNE EURO study in 11 countries of the WHO European region.
- 2022
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Ingår i: International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. - : Wiley. - 1879-3479 .- 0020-7292. ; 159:Suppl 1, s. 39-53
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Tidskriftsartikel (refereegranskat)abstract
- To describe the perception of quality of maternal and newborn care (QMNC) around the time of childbirth among migrant and nonmigrant women in Europe.Women who gave birth at a health facility in 11 countries of the WHO European Region from March 2020 to July 2021 were invited to answer an online questionnaire including demographics and childbirth experience. Data were analyzed and compared for 1781 migrant and 20653 nonmigrant women.Migrant women who experienced labor perceived slightly more difficulties in attending routine antenatal visits (41.2% vs 39.4%; P=0.001), more barriers in accessing facilities (32.9% vs 29.9%; P=0.001), lack of timely care (14.7% vs 13.0%; P=0.025), inadequate room comfort and equipment (9.2% vs 8.5%; P=0.004), inadequate number of women per room (9.4% vs 8.6%; P=0.039), being prevented from staying with their baby as they wished (7.8% vs 6.9%; P=0.011), or suffering abuse (14.5% vs 12.7%; P=0.022) compared with nonmigrant women. For women who had a prelabor cesarean, migrant women were more likely not to receive pain relief after birth (16.8% vs.13.5%; P=0.039) and less likely to provide informal payment (1.8% vs 4.4%; P=0.005) compared with nonmigrant women. Overall, the QMNC index was not significantly different for migrant compared with nonmigrant women.Gaps in overall QMNC were reported by both migrant and nonmigrant women, with improvements to healthcare necessary for all.
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| 12. |
- Englund-Ögge, Linda, et al.
(författare)
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Glycemic control assessed by continuous glucose monitoring during pregnancy in women with type 1 diabetes and its association with preeclampsia, an observational Swedish cohort study
- 2024
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Ingår i: ACTA OBSTETRICIA ET GYNECOLOGICA SCANDINAVICA. - 0001-6349 .- 1600-0412. ; 103:7, s. 1426-1436
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Tidskriftsartikel (refereegranskat)abstract
- IntroductionWomen with type 1 diabetes have an increased risk of preeclampsia (PE), but it is not fully understood if degree of glycemic control is associated with this risk. The aim of this study was to assess glycemic control during pregnancy analyzed by continuous glucose monitoring (CGM) in women with and without PE and to investigate if glycemic control is associated with increased risk of PE.Material and MethodsA total of 120 pregnant Swedish women with type 1 diabetes using CGM were included. Background factors and pregnancy outcomes were collected from medical records. CGM data were collected via the internet-based platform Diasend. Mean glucose, standard deviation of mean glucose, percentage of time in target, time below target, and time above target were presented for each trimester in women who did or did not develop PE. Associations between CGM-derived metrics and PE were analyzed with logistic regression and adjusted for confounders.ResultsTwenty-two women (18.3%) developed PE. There were no significant differences in maternal characteristics between women with and without PE. Glycemic control improved in each trimester but was suboptimal in both groups. Time in target increased from 59% in the non-PE group and 54% in the PE group in the first trimester to 65% in both groups in the third trimester. There were no significant associations between glycemic control and PE after adjustment for confounders.ConclusionsDegree of glycemic control during pregnancy assessed by CGM was not associated with development of PE in women with type 1 diabetes. However, more research is needed to understand the role of glycemic control in relation to development of PE. This study showed that women with diabetes improved their glycemic control during pregnancy; however, there were no significant differences in glycemic control in women developing preeclampsia compared to women who did not develop preeclampsia. Larger studies are needed.image
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| 13. |
- Göransson, Malin, et al.
(författare)
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“If I blink twice everything is OK” – A qualitative study of Swedish midwives’ strategies for supporting birthing women while working in full personal protective equipment
- 2024
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Ingår i: Women and Birth. - 1871-5192 .- 1878-1799.
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Tidskriftsartikel (refereegranskat)abstract
- Problem: Midwives all over the world have had to adapt to the use of personal protective equipment (PPE) during the COVID-19 pandemic. The issue of how they managed to support birthing women, despite the use of PPE, has been insufficiently studied. Background: Midwives support birthing women in one of their most life-changing situations. Having COVID-19 at the time of childbirth makes birthing women even more vulnerable. PPE has been shown to impact the ability of providing support to birthing women. Aim: To describe midwives’ strategies for supporting birthing women while working in full PPE Methods: A qualitative study based on focus group discussons with Swedish midwives. Data were analysed by inductive content analysis. Findings: To support birthing women while in full PPE, the midwives adapted existing working methods, increased collaboration with colleagues, unveiled, adapted to the requirements for contagion prevention, addressed women's concern for the midwife and maintained focus on the birth while remaining mindful of the risk of contagion. Discussion: Midwives adopted strategies in order to uphold provision of support to the birthing women, as well as to address contextual factors related to PPE that hinder provision of support. Conclusion: The respective effects of different PPE types and models on the birth experience should be explored. Explicit strategies for supporting birthing women while working in full PPE must be created and discussed among midwives.
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| 14. |
- Jansson, Sofia, et al.
(författare)
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The implementation process of the Confident Birth method in Swedish antenatal education: opportunities, obstacles and recommendations.
- 2021
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Ingår i: Health promotion international. - : Oxford University Press (OUP). - 1460-2245. ; 36:3, s. 649-659
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Tidskriftsartikel (refereegranskat)abstract
- Antenatal clinics in western Sweden have recently invested in a birth method called Confident Birth. In this study, we investigate midwives' and first line managers' perceptions regarding the method, and identify opportunities and obstacles in its implementation. Semi-structured individual interviews were conducted with ten midwives and five first line managers working in 19 antenatal clinics in western Sweden. The Consolidated Framework for Implementation Research was used in a directed content analysis approach. Intervention Characteristics-such as perceptions about the Confident Birth method-were found to have equipped the midwives with coping strategies that were useful for expecting parents during birth. Outer Setting-the method was implemented to harmonize the antenatal education, and provided a mean for a birth companionship of choice. Inner setting-included time-consuming preparations and insufficient information at all levels, which affected the implementation. Characteristics of individuals-, such as knowledge and believes in the method, where trust in the method was seen as an opportunity, while long experience of teaching other birth preparatory methods, affected how the Confident Birth method was perceived. Process-such as no strategy for ensuring that the core of the method remained intact or plans for guiding its implementation were major obstacles to successful implementation. The findings speak to the importance of adequate planning, time, information and communication throughout the process to have a successful implementation. Based on lessons learned from this study, we have developed recommendations for successful implementation of interventions, such as the Confident Birth, in antenatal care settings.
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| 15. |
- Lazzerini, Marzia, et al.
(författare)
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Rates of instrumental vaginal birth and cesarean and quality of maternal and newborn health care in private versus public facilities: Results of the IMAgiNE EURO study in 16 countries.
- 2022
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Ingår i: International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. - : Wiley. - 1879-3479 .- 0020-7292. ; 159:Suppl 1, s. 22-38
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Tidskriftsartikel (refereegranskat)abstract
- To explore the quality of maternal and newborn care (QMNC) during the COVID-19 pandemic by facility type among 16 European countries, comparing rates of instrumental vaginal birth and cesarean.Women who gave birth in the WHO European Region from March 1, 2020, to February 7, 2022, answered a validated online questionnaire. Rates of instrumental birth, instrumental vaginal birth, and cesarean, and a QMNC index were calculated for births in public versus private facilities.Responses from 25 206 participants were analyzed. Women giving birth in private compared with public facilities reported significantly more frequent total cesarean (32.5% vs 19.0%; aOR 1.70; 95% CI 1.52-1.90), elective cesarean (17.3% vs 7.8%; aOR 1.90; 95% CI 1.65-2.19), and emergency cesarean before labor (7.4% vs 3.9%; aOR 1.39; 95% CI 1.14-1.70) (P <0.001 for all comparisons), with analyses by country confirming these results. QMNC index results were heterogeneous across countries and regions in the same country and were largely affected by geographical distribution of regions rather than by type of facility alone.The study confirms that births in private facilities have higher odds of cesarean. It also suggests that QMNC should be closely monitored in all facilities to achieve high-quality care, independent of facility type or geographical distribution.NCT04847336.
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| 16. |
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| 17. |
- Linden, Karolina, 1982, et al.
(författare)
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A woman-centered web-support program during pregnancy and early motherhood for women with type 1 diabetes
- 2014
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Ingår i: The International Confederation of Midwives. ICM 30th Triennial Congress. 1-5 June 2014 Prague, Czech Republic.
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Konferensbidrag (refereegranskat)abstract
- Background: Midwives have the responsibility to strengthen normal birth and promote breastfeeding; this challenge also includes women with chronic illness, such as type 1 diabetes. The transition to motherhood in pregnant women with type 1 diabetes is influenced by their constant struggle to achieve normoglycemia and negative feelings such as stress, anxiety and hopelessness are present. Aim: To describe the design of a woman-centered web-support for pregnant women and new mothers with type 1 diabetes. Method: A web-support has been developed using participatory design. A research project management group had the responsibility of steering the project forward. Different stakeholders including, midwifery, medical, nursing and target group expertise participated in the development. The web-support is implemented through a randomized controlled trial. Result: The developed web-support consists of three parts: 1) Specific information about pregnancy, childbirth, and early motherhood in relation to type 1 diabetes, where the challenge is to balance the core values of normal childbearing with diabetes related issues. 2) A self-care diary, including a device for documenting and evaluating blood glucose levels, insulin doses, food intake and physical activities. This enables the woman to keep in control of her own health. 3) A forum for peer support through communication between women and mothers in pregnancy and early motherhood. This enables sharing of similar experiences and of strategies to handle daily life. Clinical relevance: Well-being in terms of joy of childbearing, birth and motherhood could be achieved by addressing diabetes related health risks and complications in a manner that emphasizes the normality of being pregnant, giving birth and breastfeeding. A balancing act between focusing on potential risks and normal pregnancy related processes.
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| 18. |
- Linden, Karolina, 1982, et al.
(författare)
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Being in the shadow of the unknown — Swedish women's lived experiences of pregnancy during the COVID-19 pandemic, a phenomenological study
- 2022
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Ingår i: Women and Birth. - : Elsevier BV. - 1871-5192 .- 1878-1799. ; 35:5, s. 440-446
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Tidskriftsartikel (refereegranskat)abstract
- Background: The COVID-19 pandemic has had a profound effect on the emotional well-being of expecting mothers. Sweden's unique strategy for managing COVID-19 involved no national lockdown. Emphasis was instead placed on limiting crowding and asking citizens to practice social distancing measures. Aim: To gain a deeper understanding of how women not infected by SARS-CoV-2 experienced pregnancy during the COVID-19 pandemic in Sweden. Methods: This was a qualitative study with a reflective lifeworld approach. Fourteen women that had not contracted COVID-19 and who were pregnant during the first and second wave of the pandemic were interviewed. Data were analysed with a phenomenological reflective lifeworld approach. Findings: The essence of the women's experiences of being pregnant during the COVID-19 pandemic was best described as being in the shadow of the unknown, where the COVID-19 pandemic could at times totally overshadow the experience of being pregnant, while at other times, rays of sunlight pierced through the clouds. The experience was characterised by having to deal with the uncertainties caused by the pandemic and feelings of being in an information echo. Women felt socially isolated and had to face maternal check-ups without the support of their partners. There was, however, a strong trust in maternal health-care services despite the lack of information available. Conclusion: Being in the shadow of the unknown represents the uncertainties posed by the COVID-19 pandemic on the experience of pregnancy. Sufficient information, a companion of choice and screening for emotional well-being are important factors in maternity care during pandemics. © 2021 The Author(s)
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| 19. |
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| 20. |
- Linden, Karolina, 1982, et al.
(författare)
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Initial Validation of the Diabetes and Breastfeeding Management Questionnaire (DBM-Q)
- 2020
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Ingår i: International Journal of Environmental Research and Public Health. - Basel, Switzerland : MDPI. - 1661-7827 .- 1660-4601. ; 17:9
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Tidskriftsartikel (refereegranskat)abstract
- Women with pre-gestational diabetes face additional challenges after birth as they struggle with breastfeeding and managing unpredictable blood glucose levels. The aim of this study is to validate the Diabetes and Breastfeeding Management Questionnaire (DBM-Q). In total, 142 mothers with type 1 diabetes mellitus answered the questionnaire, which initially consisted of 11 items. The response rate was 82.5% (n = 128) at two months, and 88.4% (n = 137) at six months postpartum. The measurement properties of the Diabetes and Breastfeeding Management Questionnaire were tested according to the Rasch measurement theory (RMT). One item showed both disordered thresholds and several model misfits and was removed. Two items showed disordered thresholds which were resolved by collapsing response categories. This resulted in a 10-item questionnaire with all the fit residuals within the range of +2.5, minor significant dierential item functioning, well-targeted items and a person separation index of 0.73. Evaluating the DBM-Q according to the RMT is a strength, as it evaluates data against strict measurement criteria. This study provides an initial validation of the questionnaire. The DBM-Q shows good measurement properties for measuring diabetes and breastfeeding management postpartum in women with pre-gestational diabetes. Further studies are needed to identify cutos for when professional support is needed.
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| 21. |
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| 22. |
- Linden, Karolina, 1982, et al.
(författare)
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Person-centred web-based support in pregnancy and early motherhood for women with Type 1 Diabetes Mellitus : a randomized controlled trial
- 2018
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Ingår i: Diabetic Medicine. - : Wiley-Blackwell. - 0742-3071 .- 1464-5491. ; 5:2, s. 232-241
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Tidskriftsartikel (refereegranskat)abstract
- Aims: To report results from and explore use of a multicentre, parallel-group, unblinded, randomized controlled trial testing the effectiveness in terms of well-being and diabetes management of a person-centred, web-based support programme for women with Type 1 diabetes, in pregnancy and postpartum.Methods: Between 2011 and 2014, 174 pregnant women with Type 1 diabetes were randomly allocated (1:1) to web-based support and standard care (intervention group, n=83), or standard care (control group, n=91). The web-based support consisted of evidence-based information; a self-care diary for monitoring of daily activities; and peer support in a discussion forum. The primary outcomes (mean difference, measured at 6 months after childbirth) were well-being and diabetes management.Results: No differences were found with regard to the primary outcome measure scores for general well-being [1.04 (95% CI -1.28 to 3.37); P= 0.68] and self-efficacy of diabetes management [0.076 (95% CI -0.123 to 0.275); P= 0.75], after adjustment for baseline differences in the insulin administration method, nor with regard to the secondary outcome measures.Conclusions: At 6 months after childbirth, the web-based support plus standard care was not superior to standard care in terms of general well-being or self-efficacy of diabetes management. This might be explained by the low number of participants who had a high activity level. Few simultaneously active participants in the web-based programme and stressors in motherhood and diabetes postpartum were the main barriers to its use. Further intervention studies that offer web-based support are needed, with lessons learned from the present study.
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| 23. |
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| 24. |
- Linden, Karolina, 1982, et al.
(författare)
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Study protocol for evaluating a web-support program with a control group for pregnant women and new mothers with type 1 diabetes mellitus.
- 2013
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Ingår i: 7th International DIP Symposium - Diabetes, Hypertension, Metabolic syndrome & Pregnancy. Florence, Italy, March 13-16, 2013.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background In the struggle to achieve normoglycemia during pregnancy, women with type 1 diabetes mellitus (T1D) alternate between mastering their situation and feeling enslaved. Caregivers not only have the responsibility of optimising the women’s biological probability of delivering healthy children, but also of supporting them during their transition to motherhood. In order to establish breastfeeding and simultaneously control blood glucose, the mothers require extended post-partum support. The aim was to describe the study design of an on-going randomized controlled trial evaluating a web-support program for pregnant women and new mothers with T1D. Methods The developed web-based support is being implemented through a randomized controlled trial in which women with T1D in early pregnancy are randomized to either web-based support in addition to usual care (IG) or usual care (CG). A sample size of 160 is required based on the two primary outcomes: a general wellbeing scale (W-BQ12) and a diabetes empowerment scale (SWE-DES) to reach a statistical power of 80% with a significance level of 0.05. Results The web-support consists of evidence-based information, person-centred self-care diaries and an online social community. Outcomes will be measured in early pregnancy (baseline), about five weeks before expected partus and at two and six months after partus. Conclusion The unique contribution of this project is the development of a specially designed web application for mothers with T1D which is expected to increase the women’s personal resources, including knowledge, and thereby strengthen their autonomy during pregnancy, breastfeeding and early motherhood.
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| 25. |
- Linden, Karolina, 1982, et al.
(författare)
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Web-based information for pregnant women and new mothers with type 1 diabetes- a description of the development process
- 2012
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Ingår i: BMC Medical informatics and decision making. - : Springer Science and Business Media LLC. - 1472-6947. ; 12:1
-
Tidskriftsartikel (refereegranskat)abstract
- Abstract Background: This paper describes the process of developing specifically designed web-based maternity information for women with type 1 diabetes. Methods: A participatory design was used and the information was evaluated in seven stages by researchers, professional experts and users. All steps of the development process were noted in an online logbook. Results: The information developed gradually and its contents were reviewed by nurse-midwives, nurses and physicians specializing in different key areas including diabetes care, paediatrics, obstetrics and breastfeeding, a clinical dietician and mothers with type 1 diabetes. The draft was reviewed in regard to its cultural suitability and the information material was adjusted to meet quality criterions. Finally, the text was adapted for a lay audience. Conclusions: Using participatory design required time and resources, however; it proved a functional way of producing appropriate information for the target group.
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| 26. |
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| 27. |
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| 28. |
- Linden, Karolina, 1982, et al.
(författare)
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Well-Being and Diabetes Management in Early Pregnant Women with Type 1 Diabetes Mellitus
- 2016
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Ingår i: International Journal of Environmental Research and Public Health. - Basel, Switzerland : MDPI AG. - 1660-4601 .- 1661-7827. ; 13:8
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Tidskriftsartikel (refereegranskat)abstract
- This paper explores well-being and diabetes management in women with type 1 diabetes mellitus (DM) in early pregnancy and investigates associations among perceived well-being, diabetes management, and maternal characteristics. Questionnaires were answered by 168 Swedish women. Correlation analyses were conducted with Spearman's correlation coefficient (r(s)). The women reported relatively high scores of self-efficacy in diabetes management (SWE-DES-10: 3.91 (0.51)) and self-perceived health (excellent (6.5%), very good (42.3%), good (38.7%), fair (11.3%) and poor (1.2%)). Moderate scores were reported for general well-being (WBQ-12: 22.6 (5.7)) and sense of coherence (SOC-13: 68.9 (9.7), moderate/low scores for hypoglycemia fear (SWE-HFS 26.6 (11.8)) and low scores of diabetes-distress (SWE-PAID-20 27.1 (15.9)). A higher capability of self-efficacy in diabetes management showed positive correlations with self-perceived health (r(s) = 0.41, p < 0.0001) and well-being (r(s) = 0.34, p < 0.0001) as well as negative correlations with diabetes distress (r(s) = 0.51, p < 0.0001) and hypoglycemia worries (r(s) = 0.27, p = 0.0009). Women with HbA1c levels of <= 48 mmL/mol scored higher in the subscales "goal achievement" in SWE-DES (p = 0.0028) and "comprehensibility" in SOC (p = 0.016). Well-being and diabetes management could be supported by strengthening the women's capability to achieve glycemic goals and their comprehensibility in relation to the treatment. Further studies are needed to test this.
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| 29. |
- Linden, Karolina, 1982, et al.
(författare)
-
Well-being, diabetes management and breastfeeding in mothers with type 1 diabetes – An explorative analysis
- 2018
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Ingår i: Sexual and Reproductive Healthcare. - : Elsevier BV. - 1877-5756 .- 1877-5764. ; 15, s. 77-82
-
Tidskriftsartikel (refereegranskat)abstract
- Objectives The aim was to explore and investigate associations between well-being, diabetes management and breastfeeding in mothers with type 1 diabetes mellitus (T1DM) up to six months postpartum. Methods An explorative analysis of self-reported questionnaires measuring general well-being, sense of coherence, self-efficacy of diabetes management and experiences of diabetes management during breastfeeding, which were distributed to 155 mothers with T1DM at two months and at six months after childbirth. The questionnaires were answered by 128 (82.5%) at two months and 137 (88.4%) at six months after birth. Statistical analysis included; descriptive statistics, Wilcoxon sign-rank test, sign test and Spearman's correlation coefficient (rs). Results The majority of the mothers had fairly high levels of general well-being and diabetes management but a quarter had a low sense of coherence at both two and six months after birth. A weak association was found between more unstable blood glucose levels and lower general well-being at two months postpartum, but no other associations with erratic glycaemia was found. Those with lower grades of general well-being and sense of coherence had a higher need of professional support to manage their diabetes than they were offered, at both two and six months. Conclusion To develop more optimal care routines for mothers with T1DM after childbirth, further studies are needed to identify those most in need of additional support. © 2017 The Authors
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| 30. |
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| 31. |
- Linden, Karolina, 1982
(författare)
-
Women with type 1 diabetes during pregnancy and postpartum Well-being and diabetes management
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Type 1 diabetes mellitus (T1DM) is associated with increased medical risks during pregnancy and birth. To minimize the risks and increase the possibility of a healthy offspring, blood glucose levels near normal are required. This puts women with T1DM in a vulnerable situation in relation to pregnancy and childbirth, as it demands high levels of diabetes management. The overall aim was to investigate well-being and diabetes management in women with T1DM during pregnancy and in the first six months postpartum. Studies I, II and III mainly report on patient-reported outcome measures in terms of questionnaires. Studies I and III have an observational design and Study II was a randomized controlled trial. Study IV used a case study design and analysed data with both quantitative and qualitative methods. In Study I, well-being and diabetes management in early pregnancy was explored. A higher degree of diabetes management correlated positively with self-perceived health and well-being and with less worry about diabetes distress and hypoglycemia. In Study II, a web-based support program during pregnancy and up to six months after childbirth was evaluated. The findings suggest that the web-based support and standard care was not superior to standard care alone in terms of general well-being or self-efficacy of diabetes management at six months postpartum and that few participants had a high activity level. In Study III, associations between well-being, diabetes management and breastfeeding postpartum were investigated. Participants with lower scores of general well-being and sense of coherence expressed a need for more professional support to manage their diabetes than they were offered. In Study IV, adherence to technological elements and study design in a web-based intervention were critically analysed. The results highlight that technology and study design matter and might mutually influence each other. The findings confirm that well-being and diabetes management are closely linked during the childbearing period. Means of identifying a more vulnerable group of women with T1DM during pregnancy and new approaches to professional support after childbirth are needed.
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| 32. |
- Markstedt, Elias, et al.
(författare)
-
Hur upplever gravida och deras partners Covid-19 pandemin?
- 2020
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Att bli gravid och föda barn är livsomvälvande händelser. I arbetet med att förhindra smittspridningen har restriktioner införts på mödravårdscentraler och sjukhus, och för de många gravida har detta inneburit att mödrar inte fått ha med sig partners till ultraljud eller andra vårdbesök, att föräldra- och förlossningskurser ställts in, att partners med förkylningssymtom inte fått delta vid förlossning och att partnern på vissa sjukhus inte fått följa med till BB efter förlossningen. Med denna vetskap kan vi anta att gravida mödrar och deras partners är mer oroliga för coronaviruset, tänker oftare på det och dess konsekvenser, samt upplever sig mer påverkade av pandemin än den genomsnittlige individen. I den här rapporten visar vi hur utsatta de gravida och deras partners upplever att de är under pandemin och hur deras upplevelser ser ut i jämförelse med andra gruppers upplevda utsatthet. Till vår hjälp har vi resultat från SOM-undersökningen om coronaviruset 2020 samt Graviditetspanelen, som genomförs inom ramen för forskningsprogrammet Gothenburg Research Program on Pregnancy and Politics (PregDem)
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| 33. |
- Miani, Céline, et al.
(författare)
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Individual and country-level variables associated with the medicalization of birth: Multilevel analyses of IMAgiNE EURO data from 15 countries in the WHO European region.
- 2022
-
Ingår i: International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. - : Wiley. - 1879-3479 .- 0020-7292. ; 159:Suppl 1, s. 9-21
-
Tidskriftsartikel (refereegranskat)abstract
- To investigate potential associations between individual and country-level factors and medicalization of birth in 15 European countries during the COVID-19 pandemic.Online anonymous survey of women who gave birth in 2020-2021. Multivariable multilevel logistic regression models estimating associations between indicators of medicalization (cesarean, instrumental vaginal birth [IVB], episiotomy, fundal pressure) and proxy variables related to care culture and contextual factors at the individual and country level.Among 27173 women, 24.4% (n=6650) had a cesarean and 8.8% (n=2380) an IVB. Among women with IVB, 41.9% (n=998) reported receiving fundal pressure. Among women with spontaneous vaginal births, 22.3% (n=4048) had an episiotomy. Less respectful care, as perceived by the women, was associated with higher levels of medicalization. For example, women who reported having a cesarean, IVB, or episiotomy reported not feeling treated with dignity more frequently than women who did not have those interventions (odds ratio [OR] 1.37; OR 1.61; OR 1.51, respectively; all: P<0.001). Country-level variables contributed to explaining some of the variance between countries.We recommend a greater emphasis in health policies on promotion of respectful and patient-centered care approaches to birth to enhance women's experiences of care, and the development of a European-level indicator to monitor medicalization of reproductive care.
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| 34. |
- Naurin, Elin, 1975, et al.
(författare)
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Does transition to parenthood affect gender traits? The Effect of Pregnancy on Perceived Female and Male Traits
- 2019
-
Ingår i: NJF Congress 2019 Abstract Book.
-
Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background Gendered identities are strengthened during pregnancy and the early phases of parenthood; women feel more female and men more male. Gendered cultural narratives that further emphasize disparities in parenting roles between the sexes embed this transition period. However, it has been argued that it is the social practice of mothering, rather than the bodily or emotional experience or pregnancy and childbirth, which yield a traditionalizing influence on women’s gender ideologies. There is reason to believe that the effects of pregnancy and childbirth is less apparent in contexts with strong welfare state support for the parents and where gender equality is a societal norm. Methods The data was collected from a subset of the large-scale Swedish Citizen Panel consisting of pregnant respondents or respondents who identify themselves as partners to someone who is pregnant. At two time points, these respondents were asked about the extent to which they have “female” and “male traits”. The methodological approach was to explore pregnancy and childbirth as a process and study respondents over time; to compare pregnant women to partners of pregnant women and to compare pregnant women and partners of pregnant women to individuals in the panel who do not become pregnant during the studied period. Data was analyzed by fixed effects panel regression. Findings Data from 2445 respondents was analyzed. No statistical significant changes in perceived gender traits were found in the respondents’ answers between pre-pregnancy and pregnancy; pregnancy and being having an infant <6 months of age; or being a parent of an infant < 6 months of age and having a child > 6 months of age. With the exception that men expressed that they had somewhat less female traits postpartum (-0.3, p<0.05). Conclusion Self-perceptions of gendered traits are mainly stable over pregnancy and early parenthood in this Swedish sample.
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| 35. |
- Naurin, Elin, 1975, et al.
(författare)
-
Does transition to parenthood affect gender traits? The effect of pregnancy on perceived female and male traits
- 2021
-
Ingår i: European Journal of Politics and Gender. - 2515-1088 .- 2515-1096. ; 4:1, s. 135-150
-
Tidskriftsartikel (refereegranskat)abstract
- Key messages We study the effect of a gendered life event on changes in gender identity during adulthood. Pregnant women and partners of pregnant women are followed over time, with pre- and post-test measures of gender identity. While pregnancy and childbirth are often seen as reinforcing feminine identity, we expect only small changes in a gender-equal society like Sweden. Results show that gender identity is stable during pregnancy and around childbirth for Swedish women and men.
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| 36. |
- Naurin, Elin, 1975, et al.
(författare)
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Pregnant under the pressure of a pandemic: a large-scale longitudinal survey before and during the COVID-19 outbreak
- 2021
-
Ingår i: European Journal of Public Health. - : Oxford University Press (OUP). - 1101-1262 .- 1464-360X. ; 31:1, s. 7-13
-
Tidskriftsartikel (refereegranskat)abstract
- Background One of the groups that is most vulnerable to the COVID-19 pandemic is pregnant women. They cannot choose to refrain from care; they and their children are at risk of severe complications related to the virus; and they lose comfort and support as clinics prohibit their partners and as societal restrictions demand isolation from friends and relatives. It is urgent to study how this group is faring during the pandemic and we focus here on their health-related worries. Methods A longitudinal survey at a Swedish hospital starting six months before (16 September 2019) and continuing during the COVID-19 outbreak (until 25 August 2020). 6,941 pregnant women and partners of diverse social backgrounds were recruited. 96 percent of birth-giving women in the city take early ultrasounds where recruitment took place. 62 percent of the women with an appointment and 51 percent of their partners gave consent to participate. Results Pregnant women experienced dramatically increased worries for their own health, as well as for their partner’s and their child’s health in the beginning of the pandemic. The worries remained at higher than usual levels throughout the pandemic. Similar, but less dramatic changes, were seen among partners. Conclusions There is a need for heightened awareness of pregnant women’s and partners’ health-related worries as a consequence of the COVID-19 pandemic. Related feelings such as anxiety have been linked to adverse pregnancy outcome and might have long-term effects. The health care system needs to prepare for follow-up visits with these families.
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| 37. |
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| 38. |
- Olander, Petrus, 1984, et al.
(författare)
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The impact of exclusion due to COVID-19 restrictions on partners' satisfaction with Swedish hospital postnatal ward care: A multi-methods approach
- 2024
-
Ingår i: BIRTH-ISSUES IN PERINATAL CARE. - 0730-7659 .- 1523-536X.
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundTo prevent the spread of SARS-CoV-2, hospitals around the world adopted protocols that, in varying ways, resulted in the exclusion of partners from hospital postnatal care wards. The objective of this study was to examine the effect this exclusion had on partners' satisfaction with postnatal care.MethodsAn online survey (the Swedish Pregnancy Panel) including free-text comments was conducted before and during the first wave of the COVID-19 pandemic; partners of pregnant women were recruited at an early ultrasound appointment and followed until 2 months after childbirth. Data were linked to the Swedish Pregnancy Register.ResultsThe survey was completed by 524 partners of women who gave birth during the pandemic and 203 partners of women who gave birth before. Partners' satisfaction with hospital postnatal care dropped 29.8 percent (-0.94 OLS, 95% CI = -1.17 to -0.72). The drop was largest for partners of first-time mothers (-1.40 OLS, 95% CI = -1.69 to -1.11), but unrelated to clinical outcomes such as mode of birth and most social backgrounds, except higher income. The qualitative analysis showed that partners (1) felt excluded as partners and parents, (2) thought the strain on staff led to deficiencies in the care provided, and (3) perceived the decision about partner restrictions as illogical.ConclusionsThe exclusion of partners from the hospital postnatal wards clearly impaired satisfaction with care, and partners of first-time mothers were particularly affected. Planning for future restrictions on partners from hospital wards should factor in these consequences. image
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| 39. |
- Thorgeirsdottir, Lilja, et al.
(författare)
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The experience of being a partner to a childbearing woman whose pregnancy is complicated by pre-eclampsia : A Swedish qualitative study
- 2023
-
Ingår i: Sexual & Reproductive HealthCare. - : Elsevier BV. - 1877-5756 .- 1877-5764. ; 36
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Pre-eclampsia affects 3-5% of all pregnant women and is among the leading causes of maternal morbidity and mortality as well as iatrogenic preterm birth worldwide. Little is known about the experience of partners of women whose pregnancy is complicated by pre-eclampsia.Aim: To describe partners' experience of having a spouse whose pregnancy was complicated by pre-eclampsia.Methods: A qualitative study with in-depth interviews. Eight partners of women whose pregnancy was complicated by pre-eclampsia were interviewed and data were analysed using content analysis.Findings: Partners found themselves in an unfamiliar and unexpected situation. They experienced an information gap in which they tried to make sense of the situation by interpreting subtle signs. The situation left them feeling emotionally stretched, feeling like an outsider while trying to provide support for their extended family. The partners experienced a split focus after the baby was born, prioritising the baby while worrying about their spouse. Post-partum, they expressed needing time to process and heal after childbirth. A need for professional support was highlighted and concerns about a future pregnancy were voiced.Conclusion: Having a spouse who is diagnosed with pre-eclampsia is challenging and overwhelming. Our findings imply a need to develop a model of care for women with pre-eclampsia that includes their partner, i.e., the other parent.
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| 40. |
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| 41. |
- Veje, Malin, et al.
(författare)
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Working conditions for healthcare workers at a Swedish university hospital infectious disease department during the COVID-19 pandemic: barriers and facilitators to maintaining employee wellbeing.
- 2023
-
Ingår i: Frontiers in psychology. - 1664-1078. ; 14
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Tidskriftsartikel (refereegranskat)abstract
- Healthcare workers (HCWs) at infectious disease departments have held the frontline during the COVID-19 pandemic. This study aimed to identify barriers and facilitators to maintaining the employees' wellbeing that may be used to increase preparedness for future pandemics within ID Departments.In September 2020, a web-based survey on demographics and work environment was distributed to all HCWs at the Infectious Disease Department at Sahlgrenska University Hospital. Results were compared with a pre-COVID-19 survey from October 2019. A quantitative analysis of the overall effects of the pandemic on the working conditions of HCWs was conducted; in addition, a qualitative content analysis of open-ended responses was performed.In total, 222 and 149 HCWs completed the pre-COVID-19 and COVID-19 surveys (84 and 54% response rate), respectively. Overall, we found significant changes regarding increased workload, lack of emotional support in stressful work situations, and inability to recover after shifts. These factors correlated both with younger age and concern of becoming infected. The open-ended answers (n=103, 69%) revealed five generic categories (Workload; Organizational support; Worry and ethical stress; Capability; and Cooperation and unity) with a total of 14 identified factors representing plausible individual and organizational-level barriers or facilitators to sustained employee wellbeing.Younger HCWs as well as those expressing worries about contracting the infection were found to be particularly affected during the COVID-19 pandemic and these groups may require additional support in future outbreaks. Factors both increasing and decreasing the pandemic-induced negative health consequences for HCWs were identified; this knowledge may be utilized in the future.
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| 42. |
- Vikner, Pia, 1981, et al.
(författare)
-
Att diagnostiseras med graviditetsdiabetes - påverkar det upplevelsen av graviditet, förlossning och amning?
- 2023
-
Ingår i: Konferens Reproduktiv Hälsa 2023.
-
Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Graviditetsdiabetes uppkommer på grund av en ökad insulinresistens hos den gravida kvinnan. Sedan 2013 förespråkar WHO striktare diagnoskriterier för graviditetsdiabetes vilka även Socialstyrelsen rekommenderar sedan 2015. Trots rekommendationen används olika diagnoskriterier runtom i Sverige och förekomsten av graviditetsdiabetes varierar stort, allt från 1–22% (nationellt 6,2%). Att få diagnosen graviditetsdiabetes kan upplevas stigmatiserande och medföra ett ökat fokus på risker, övervakning och medicinska interventioner. Hur detta påverkar kvinnans upplevelse av graviditet, förlossning och amning är inte tillräckligt studerat. Syftet med studien är att undersöka om diagnosen graviditetsdiabetes påverkar kvinnans tillit till egen förmåga och känsla av sammanhang, hennes förlossningsupplevelse och tillit till egen förmåga att amma. Studien är en del av multicenterstudien CDC4G (ISRCTN 41918550) och förlossningsklinikerna i Örebro, Lund, Uppsala, Göteborg och Falun deltar. De kvinnor som enligt lokala riktlinjer för screening planeras för oralt glukostoleranstest (OGTT), kan tillfrågas om medverkan. Studien har etiktillstånd (2019–02080, 2020-00122). Studien pågår med insamling av enkäter som mäter känsla av sammanhang (SOC-13), tilltro till egen förmåga (GSE), förlossningsupplevelse (CEQ2) och tillit till egen förmåga att amma (BSE). Mätningarna sker före OGTT samt cirka åtta veckor postpartum. Jämförande analyser kommer att göras mellan svarande kvinnor som fått diagnosen (studiegrupp) med de som inte fått diagnosen (kontrollgrupp). Då diagnoskriterierna varierar på studieorterna kommer en andra kontrollgrupp bestå av kvinnor som inte fick diagnosen men vars resultat från OGTT överskred de rekommenderade diagnoskriterierna från Socialstyrelsen. Resultatet kommer att ge en ökad förståelse för om diagnosen graviditetsdiabetes påverkar kvinnans känsla av sammanhang och tilltro till egen förmåga under graviditet och amning samt fylla kunskapsluckan om diagnosen påverkar kvinnans förlossningsupplevelse. Slutsatserna kan bli ett viktigt bidrag i diskussionen om när och hur diagnosen graviditetsdiabetes ska användas under graviditet.
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| 43. |
- Vikner, Pia, 1981, et al.
(författare)
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En utvärdering av egenmonitorering i vården av gravida kvinnor med diabetes
- 2023
-
Ingår i: Konferens Reproduktiv Hälsa 2023.
-
Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Integrerad egenmonitorering i vården har, med covid-19-pandemin som katalysator, genomgått en revolutionerande utveckling. Vårdformen sprids alltmer och har potential att göra vården mer effektiv, tillgänglig och individanpassad. För gravida kvinnor med läkemedelsbehandlad diabetes (typ 1-, typ 2- och graviditetsdiabetes) är tät uppföljning avgörande för den medicinska säkerheten. Under år 2020 och 2021 införde Specialistmödravården på Sahlgrenska universitetssjukhuset i Göteborg egenmonitorering i vården av patientgruppen. Införandet av integrerad egenmonitorering har resulterat i att kvinnorna nu följer Mödrahälsovårdens basprogram för fysiska graviditetsbesök. Resterande uppföljning sker digitalt. Den integrerade egenmonitoreringen ska nu utvärderas vetenskapligt. Intervention består av: kontroll av blodtryck, äggvita i urinen och ett välmåendeformulär och CTG från hemmet samt möjlighet till digital uppföljning via digitala vårdmöten och chattfunktioner. Syftet med utvärderingen är att undersöka faktorer som påverkade implementeringen av egenmonitorering i vården av gravida kvinnor med läkemedelsbehandlad diabetes samt följa medicinsk utfall efter implementeringen av egenmonitoreringen. Utvärderingen kommer göras i enlighet med UK Medical Research Council riktlinjer för processutvärdering av komplexa interventioner. Patienter, medarbetare, chefer och verksamhetsledare kommer intervjuas med semistrukturerade intervjuer. Jämförelse av medicinska utfall fyra år före och fyra år efter implementeringen av egenmonitorering (ca 800 kvinnor). Utvärderingen förväntas ge ökad kunskap kring hur implementering av integrerad egenmonitorering kan införas i andra verksamheter, om integrerad egenmonitorering är en säker vårdform för patientgruppen och om vårdformen accepteras av de gravida kvinnorna.
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| 44. |
- Wadell, M., et al.
(författare)
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Challenges imposed by the COVID-19 pandemic on the Obstetrics and Gynecology residency program: a mixed-methods Swedish survey in the COPE Staff cohort study
- 2022
-
Ingår i: Bmc Medical Education. - : Springer Science and Business Media LLC. - 1472-6920. ; 22:1
-
Tidskriftsartikel (refereegranskat)abstract
- Background To outline how the training program and work situation of residents in Obstetrics and Gynecology (OB-GYN) was affected by the pandemic and to illuminate how residents experienced these changes. Methods As part of the COVID-19 in Pregnancy and Early Childhood Staff (COPE Staff) cohort study, between January and May 2021, all participating residents were invited to answer a 28-question online Resident Survey focusing on their specialist education, work situation and experiences during the COVID-19 pandemic. Descriptive statistics were given in percentages for categorical variables and means and standard deviations (SD) for continuous variables. Univariate comparative analyses were performed with the use of the Pearson's Chi-2-test for dichotomous data. The association between residents' worry about the quality and length of their specialist training, with extra clinical hours and transfer to other healthcare institutions were assessed by multivariate logistic regression. Free text responses were analyzed by content analysis. Results Of the 162 participating OB-GYN residents, 69% expressed concern that the pandemic would have a negative impact on their training. Ninety-five (95%) reported cancellation/postponement of educational activities, 70% performed fewer surgeries and 27% had been transferred to other healthcare institutions where about half reported having gained more general knowledge as a physician. Working extra clinical hours was reported by 69% (7.4 +/- 5.3 hours per week) and 14% had considered changing their profession due to the pandemic. Senior residents, compared to junior residents, more often experienced cancelled/postponed clinical rotations (30% vs 15%, P=0.02) and reported performing fewer surgeries (P=0.02). The qualitative analysis highlighted the lack of surgical procedural training as a major concern for residents. Conclusion The COVID-19 pandemic has strongly impacted the training program and work situation of OB-GYN residents in Sweden. Residents were concerned over the negative impact of the pandemic on their training program and senior residents reported more missed educational opportunities as compared to junior residents. Program directors, head of institutions and clinical supervisors can use the problem areas pinpointed by this study to support residents and compensate for missed educational opportunities. While hands-on-training and operating time cannot be compensated for, the authors hope that the findings of the study can help develop new strategies to minimize the negative impact of the current and future pandemics on resident education and work situation.
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| 45. |
- Zheng, Lucy R., et al.
(författare)
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A Longitudinal Dyadic Study of Six Leisure Activities in Swedish Couples During the Transition to Parenthood
- 2023
-
Ingår i: Sex Roles. - : Springer Science and Business Media LLC. - 0360-0025 .- 1573-2762. ; 88, s. 210-224
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Tidskriftsartikel (refereegranskat)abstract
- Parents are not only caregivers to their children; they also have leisure routines that can impact their own well-being. However, little is known about how leisure activities change within the context of a couple during the transition to parenthood. This study uses latent growth curve models and data from the Swedish Pregnancy Panel to examine how often 918 first-time, heterosexual couples participated in six leisure activities from around pregnancy week 19 to one year postpartum. Compared to fathers, mothers less frequently exercised and listened to news, and more frequently read newspapers, spent time for themselves, and spent time with friends. Over time, mothers increased their frequency of praying to God and decreased spending time for themselves and with friends. Fathers decreased frequency of exercise. Within couples, there was a positive correlation between mothers' and fathers' frequency of engaging in leisure activities, although most changes over time were not associated. Our finding that two individuals within a couple may change their leisure activities independently of each other during the transition to parenthood can help healthcare professionals and researchers prepare expectant couples for upcoming changes (or lack thereof) and promote parent well-being. Our findings also highlight the possibility that in contexts with more state support for families, parenthood may not exacerbate gender gaps in leisure.
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| 46. |
- Zheng, Lucy R., et al.
(författare)
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Expectant parents’ emotions evoked by pregnancy: A longitudinal dyadic analysis of couples in the Swedish Pregnancy Panel
- 2022
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Ingår i: Social Science and Medicine. - : Elsevier BV. - 0277-9536 .- 1873-5347. ; 312
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Tidskriftsartikel (refereegranskat)abstract
- Rationale: Holistic antenatal care requires knowledge of individuals’ emotional response to pregnancy. Little is known about how a pregnant woman and her partner influence each other emotionally during a pregnancy. Objective: This study examines six discrete emotions that expectant couples experience during pregnancy, how these emotions change mid-to late-pregnancy, and whether the partners’ emotional responses influence each other. Methods: A longitudinal dyadic study where pregnant women and their partners (1432 couples) rated the extent to which the pregnancy evoked joy, strength, security, worry, shame, and anger at pregnancy week 12–19, 22–24, and 36. Latent curve models with structured residuals identify levels of and change in these emotions over time, while accounting for between- and within-couple variance. Results: Pregnancy evoked mainly joy, strength, security, and worry, and lower levels of anger and shame. Pregnant women and partners felt similar levels of joy, strength, and security, but pregnant women felt more worry, shame, and anger. There was little to no mean-level change in all six measured emotions evoked by pregnancy (between-couple change), and no reciprocal effects between the partners (within-couple change). Conclusions: Emotions in mid-pregnancy were also felt in late pregnancy. Furthermore, the pregnant woman and her partner have individual emotional trajectories. The results can assist healthcare professionals and researchers target interventions to expectant mothers and partners, specifically by understanding emotional response to pregnancy as a stable confound and by not approaching the couple as one emotional unit.
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| 47. |
- Åkerström, Magnus, 1981, et al.
(författare)
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The COPE Staff study : Study description and initial report regarding job satisfaction, work-life conflicts, stress, and burnout among Swedish maternal and neonatal healthcare workers during the COVID-19 pandemic
- 2023
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Ingår i: International Journal of Gynecology & Obstetrics. - : John Wiley & Sons. - 0020-7292 .- 1879-3479. ; 162:3, s. 989-997
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveTo describe the study design of the COPE Staff cohort study on working conditions for maternal and neonatal healthcare workers (MNHCWs), and present baseline data regarding job satisfaction, work-life conflicts, stress, and burnout. MethodsBetween January and April 2021, 957 MNHCWs (administrative and medical staff) completed a baseline survey. Average levels of job satisfaction, work-life conflicts, stress, and burnout, and associations to perceived workload were assessed. ResultsThe average levels of job satisfaction, work-life conflicts, stress, and burnout were 68.6 (95% confidence interval [CI] 64.3-72.8), 42.6 (95% CI 37.3-48.0), 42.0 (95% CI 37.7-46.3), and 1.9 (95% CI 1.6-2.2), respectively. The respondents scoring above critical values indicating clinical burnout ranged between 3% and 18%, respectively, for the four burnout sub-dimensions. Women reported significantly higher levels of stress and burnout. Younger participants had lower job satisfaction and higher levels of work-life conflicts, stress, and burnout. Higher perceived workload was significantly associated with lower job satisfaction levels and higher levels of work-life conflicts, stress, and burnout. ConclusionsOur results indicate associations between MNHCWs perceived workload and job satisfaction, work-life conflicts, stress, and burnout during the COVID-19 pandemic. Eighteen percent scored above critical values for exhaustion.
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| 48. |
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| 49. |
- Åkerström, Magnus, 1981, et al.
(författare)
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Working conditions for hospital-based maternity and neonatal health care workers during extraordinary situations-A pre-/post COVID-19 pandemic analysis and lessons learned
- 2022
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Ingår i: Sexual & Reproductive HealthCare. - : Elsevier BV. - 1877-5756. ; 33
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of this study was to investigate how the changed work routines during the COVID-19 pandemic has been affecting the working environment for hospital-based maternity and neonatal health care workers, and to identify preventive measures to be used in future situations when health care organizations are under pressure. Methods: All maternity and neonatal health care workers in a Swedish university hospital were surveyed during October 2019 and September 2020. The data was analyzed by document analysis of implemented changes in working routines, a quantitative analysis of the overall effects on the working conditions, and a qualitative analysis of open-ended responses. Results: A total of 660 maternity and neonatal health care workers completed the pre-COVID-19 survey (74% response rate) and 382 the COVID-19 survey (35% response rate). Lack of personal protective equipment, worry about becoming infected, uncertainty whether implemented changes were enough, and challenges in commu-nicating updated routines had negative effects on maternity and neonatal health care workers' working condi-tions. Team spirit and feeling valued by peers had a positive effect. Conclusions: Results suggest that negative effects on maternity and neonatal health care workers' health can partly be prevented in future critical situations by creating a work climate that acknowledges the employees' worry about being infected, securing adequate pre-conditions for managers, creating a strong psychosocial safety climate and systematically improving the working conditions for the maternity and neonatal health care workers, as well as maintaining the positive perceived effects of increased team spirit and feeling valued by peers.
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