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Sökning: WFRF:(Sydsjö Gunilla 1956 )

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1.
  • Claesson, Ing-Marie, 1953-, et al. (författare)
  • Weight gain restriction for obese pregnant women : A case-control intervention study
  • 2008
  • Ingår i: British Journal of Obstetrics and Gynecology. - : Wiley. - 1470-0328 .- 1471-0528. ; 115:1, s. 44-50
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: To minimise obese women's total weight gain during pregnancy to less than 7 kg and to investigate the delivery and neonatal outcome. Design: A prospective case-control intervention study. Setting: Antenatal care clinics in the southeast region of Sweden. Population: One hundred fifty-five pregnant women in an index group and one hundred ninety-three women in a control group. Methods: An intervention programme with weekly motivational talks and aqua aerobic classes for obese pregnant women. Main outcome measures: Weight gain in kilograms, delivery and neonatal outcome. Results: The index group had a significantly lower weight gain during pregnancy compared with the control group (P < 0.001). The women in the index group weighed less at the postnatal check-up compared with the weight registered in early pregnancy (P < 0.001). The percentage of women in the index group who gained less than 7 kg was greater than that of women in the control group who gained less than 7 kg (P = 0.003). The percentage of nulliparous women in this group was greater than that in the control group (P = 0.018). In addition, the women in the index group had a significantly lower body mass index at the postnatal check-up, compared with the control group (P < 0.001). There were no differences between the index group and the control group regarding birthweight, gestational age and mode of delivery. Conclusion: The intervention programme was effective in controlling weight gain during pregnancy and did not affect delivery or neonatal outcome.
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2.
  • Gunnervik, Christina, 1953-, et al. (författare)
  • Attitudes towards cesarean section in a nationwide sample of obstetricians and gynecologists
  • 2008
  • Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 87:4, s. 438-444
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective. The Swedish cesarean section (CS) rate has increased dramatically over the last decades, but remains relatively low compared to several other countries in the Western world. The reasons for this continuous increase are multifactorial and difficult to investigate. That pregnant women are demanding CS more frequently does not appear to be the major explanatory factor for the increasing CS rate. Since Swedish CS rates are relatively low, it is important to study attitudes to CS in a nationwide population of Swedish obstetricians and gynecologists in order to determine the possible concerns of this group. Methods. In 2006, a study-specific questionnaire was created and posted to Swedish obstetricians and gynecologists. In total, 1,280 obstetricians and gynecologists received a questionnaire and replied with a response rate of 66%. Results. In general, older and longer work experience physicians had a more positive attitude towards providing CS on maternal request or elective CS for women who fear vaginal delivery. In addition, these colleagues were more positive in expressing their belief that elective CS is as safe as vaginal delivery for the mother and her child. The main difference between female and male physicians was that males were more positive toward providing CS on maternal request (p<0.001). Conclusion. We have shown that female physicians differ from their male colleagues in their attitudes toward providing CS on maternal request. Female physicians were more reluctant than males to provide CS on maternal request. © 2008 Taylor & Francis.
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3.
  • Kassymova, Gulnara, 1972-, et al. (författare)
  • Effect of nurse-led telephone follow-up on postoperative symptoms and analgesics consumption after benign hysterectomy : a randomized, single-blinded, four-arm, controlled multicenter trial
  • 2023
  • Ingår i: Archives of Gynecology and Obstetrics. - : Springer Heidelberg. - 0932-0067 .- 1432-0711. ; 307:2, s. 459-471
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose The study aimed to determine if planned telephone follow-up, especially when adding structured, oriented coaching, reduces the intensity of postoperative symptoms and decreases analgesics consumption after benign hysterectomy. Methods A randomized, single-blinded, four-armed, controlled multicenter trial of 525 women scheduled for hysterectomy was conducted in 5 hospitals in the southeast health region of Sweden. The women were allocated 1:1:1:1 into four follow-up models: (A) no telephone follow-up (control group); (B) one planned, structured, telephone follow-up the day after discharge; (C) as B but with additional telephone follow-up once weekly for 6 weeks; and (D) as C but with oriented coaching telephone follow-up on all occasions. Postoperative symptoms were assessed using the Swedish Postoperative Symptoms Questionnaire. Analgesic consumption was registered. Unplanned telephone contacts and visits were registered during the 6 weeks of follow-up. Results In total, 487 women completed the study. Neither pain intensity, nor symptom sum score or analgesic consumption differed between the intervention groups. Altogether, 224 (46.0%) women had unplanned telephone contacts and 203 (41.7%) had unplanned visits. Independent of intervention, the women with unplanned telephone contacts had higher pain intensity and symptom sum scores, particularly if an unplanned telephone contact was followed by a visit, or an unplanned visit was preceded by an unplanned telephone contact. Conclusion Telephone follow-up did not seem to affect recovery regarding symptoms or analgesic consumption after benign hysterectomy in an enhanced recovery after surgery (ERAS) setting. Unplanned telephone contacts and visits were associated with more postoperative symptoms, especially pain. Trial registration The study is registered in ClinicalTrial.gov: NCT01526668 retrospectively from January 27; 2012. Date of enrolment of first patient: October 11; 2011.
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4.
  • Kassymova, Gulnara, 1972-, et al. (författare)
  • The Effect of Follow-Up Contact on Recovery After Benign Hysterectomy: A Randomized, Single-Blinded, Four-Arm, Controlled Multicenter Trial
  • 2021
  • Ingår i: Journal of Women's Health. - : MARY ANN LIEBERT, INC. - 1540-9996 .- 1931-843X. ; 30:6, s. 872-881
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The objective of this trial was to analyze the effect of follow-up programs using standard follow-up protocol and structured coaching on recovery after hysterectomy in an enhanced recovery after surgery setting. Materials and Methods: A randomized, four-armed, single-blinded, controlled multicenter trial comprising 487 women was conducted at five hospitals in the southeast region of Sweden. The women were allocated (1:1:1:1) to Group A: no planned follow-up contact; Group B: a single, planned, structured, broadly kept, follow-up telephone contact with the research nurse the day after discharge; Group C: planned, structured, broadly kept follow-up telephone contact with the research nurse the day after discharge and then once weekly for 6 weeks; and Group D: as Group C, but with planned, structured, coaching telephone contact. Recovery was assessed by the health-related quality of life (HRQoL) questionnaires EuroQoL-5 Dimension with three levels (EQ-5D-3L) and Short-Form-Health Survey with 36 items (SF-36) and duration of sick leave. Results: Neither the recovery of HRQoL as measured by the EQ-5D-3L and the SF-36 nor the duration of sick leave (mean 26.8-28.1 days) differed significantly between the four intervention groups. Irrespective of mode of follow-up contact used, the women had recovered to their baseline EQ-5D-3L health index 4 weeks after surgery. The occurrence of unplanned telephone contact was significantly lower (by nearly 30%) in the women who had structured coaching. Conclusion: Follow-up contact, including coaching, did not seem to expedite the postoperative recovery in HRQoL or reduce the sick leave after hysterectomy, but the coaching seemed to reduce unplanned telephone contact with the health care services. ClinicalTrial.gov (NCT01526668).
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5.
  • Kassymova, Gulnara, 1972- (författare)
  • The impact of postoperative telephone follow-up contacts on recovery after benign hysterectomy : with emphasis on health-related quality of life, postoperative symptoms, and health economics
  • 2023
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • BackgroundThe course of a postoperative recovery is important for both patient and healthcare services. Efforts to expedite and improve recovery in a safe and cost-effective manner are therefore highly desirable from the perspective of both parties. Telephone follow-up (TFU) has been suggested as a way to improve postoperative recovery and reduce the burden of the healthcare service. This thesis intends to investigate these issues. The overall purpose of the thesis was twofold: to evaluate the effects of nurse-led TFU contacts on the recovery after benign hysterectomy, and to make a health economic analysis of TFU. The specific aims of the thesis were a) to evaluate whether TFU, particularly when combined with structured-oriented coaching, facilitated postoperative recovery in terms of health-related quality of life (HRQoL), the duration of sick leave, and the occurrence of unplanned telephone contacts (uTCs) and unplanned visits (uVs) in the postoperative period, b) to determine if the TFUs affected postoperative symptoms and the consumption of analgesics, c) to analyze whether symptoms of anxiety and depression, and low stress-coping capacity had an impact on the effect of TFU on recovery and the occurrence of uTCs and uVs, and d) to provide a health economic evaluation of the TFU from the healthcare and societal perspectives. By addressing these aims, the intention of the thesis was to contribute with important knowledge to the existing sparse body of science concerning clinical outcomes after nurse-led TFUs and their impact on recovery outcomes after benign hysterectomy. Material and methodsA four-armed, semi-blinded, randomized controlled trial was conducted at the departments of obstetrics and gynecology in five public hospitals in the southeast health region of Sweden from October 2011 to May 2017. The study comprised 487 women between 18 and 60 years old who underwent abdominal or vaginal hysterectomy for benign gynecological conditions. The treatments to be investigated were different nurse-led TFU models and consisted of four groups: Group A had no planned follow-up contact with the healthcare service after discharge (control group); Group B had one planned, structured TFU session with the research nurse (RN) on the day after discharge; Group C had a planned, structured TFU session with the RN on the day after discharge and then once weekly for six weeks; and Group D had a planned, structured, oriented coaching TFU session with the RN on the day after discharge and then once weekly for six weeks. The specific content of the TFUs in Groups B and C, as well as the oriented coaching TFU model in Group D, were outlined in the study. Demographic and clinical data relevant to the study were collected prospectively. Sick leave duration, analgesic consumption, uTC, and uV were recorded from discharge until the six-week follow-up visit with the RN. HRQoL was measured by means of the EuroQoL-5 Dimension with three levels and the Short Form Health Survey with 36 items. Psychological distress was evaluated using the Hospital Anxiety and Depression Scale and the Stress-Coping Inventory. Postoperative symptoms were assessed using the Swedish Postoperative Symptoms Questionnaire. The health economics were evaluated using a cost minimization analysis. The estimation of hospital costs was based on the principles of the Cost Per Patient (CPP) method and the prices from the CPP list for 2022 from the University Hospital in Linköping were applied. ResultsRegardless of the TFU model, women achieved baseline levels of HRQoL four weeks after surgery and no difference was seen between the intervention groups in the trajectory of recovery of HRQoL. The duration of sick leave was similar across all intervention groups, ranging from 26.8 to 28.1 days. There were no significant differences in the trajectory of the intensity of postoperative symptoms or analgesic consumption between the intervention groups. Approximately 46% of the women had uTC and 45% had uV. The oriented coaching TFU was associated with a 33% lower occurrence of uTC compared with other TFU models. Women who had uTC reported higher levels of pain intensity and sum scores of postoperative symptoms, especially when the uTC was followed by a uV. Symptoms of depression, anxiety, and low stress coping capacity did not affect the effects of the TFU models on recovery trajectories, although there were strong associations between symptoms of anxiety, depression and low stress-coping capacity and all recovery measures. In addition, uTCs were more frequent among women with anxiety. The total costs per patient more than doubled in the groups with repeated TFUs compared with the group with no TFU. The coaching TFU group had lower costs for informal care. ConclusionsNurse-led TFU after benign hysterectomy in the form used in the present study did not expedite or improve the postoperative recovery concerning HRQoL, sick leave duration postoperative symptoms, or analgesic consumption. However, nurse-led TFU with structured coaching reduced the occurrence of uTC to healthcare providers, but not uVs. Symptoms of anxiety increased the occurrence of uTC and pain seemed to be a significant cause of both uTCs and uVs, The effect of the TFU on the recovery did not seem to be affected by the psychological state of proneness to anxiety, depression, or low stress-coping capacity. Nurse-led TFUs were cost-driving for the healthcare systems and can be seen as an inefficient use of healthcare resources. 
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6.
  • Larsson, Caroline, 1972-, et al. (författare)
  • Obstetricians' attitudes and opinions on sickness absence and benefits during pregnancy
  • 2006
  • Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 85:2, s. 165-170
  • Tidskriftsartikel (refereegranskat)abstract
    • Background . In Sweden, sick leave is taken more frequently by pregnant women than by nonpregnant women. This led us to ask if the taking of sick leave during pregnancy could possibly be explained by attitudes to sickness absence held among obstetricians working in antenatal care. Methods . All obstetricians ( n =45) engaged in public antenatal care and at work in May 2001 in seven hospitals in South Eastern Sweden were asked to anonymously respond to questions/statements concerning their work, 87% participated. The results were presented as percent (the median value) on a visual analog scale. Results . In 60% of all contacts with pregnant women issues such as working conditions, sickness absence or benefit programs were discussed besides the actual pregnancy. In 46% the obstetricians stated that they could not exactly pinpoint a correct medical diagnosis motivating a sickness certificate asked for by the pregnant woman. As the majority of the obstetricians (74%) often did not like to conform to the pregnant women's wishes, unpleasant situations were not uncommon (56%). A conflict was experienced in the dual role that the obstetrician had as the patient's confidant on the one hand and as a representative or gatekeeper for the social security system on the other. Male and female obstetricians did not differ in their opinions on their handling of pregnant women with regard to taking sick leave but for one issue, back pain. Conclusions . The high degree of work dealing with sickness absence and social benefits at the Antenatal Care Centers seems to have a negative effect on the obstetrician's evaluation of their work environment. The obstetricians' opinion is that pregnant women are sick-listed too frequently, but obstetricians comply as a rule to the women's wishes in order to avoid conflict. © 2006 Taylor & Francis.
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9.
  • Sydsjö, Adam, 1940-, et al. (författare)
  • Influence of obesity on the use of sickness absence and social benefits among pregnant working women
  • 2007
  • Ingår i: Public Health. - : Allan Press Inc.. - 0033-3506 .- 1476-5616. ; 121:9, s. 656-662
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: To evaluate if obesity in early pregnancy has any possible impact on the capacity of pregnant women to engage in gainful employment.Methods: Register data from a database on sickness absence and pregnancy benefit and parental benefit claims were combined with type of occupation and body mass index (BMI) for 693 women consecutively delivered during the course of one year at a county hospital in Sweden.Results: The results showed the Lowest BMI among women who had administrative jobs and the highest BMI in women who undertook more burdensome and heavy types of manual work. A significant increase in BMI was also seen among those pregnant women who were registered as unemployed. The finding that in the manual types of occupation, obese pregnant women took almost twice as many days of leave provided by the parental benefit programme as did women with a BMI of < 25, indicates that obese pregnant women perhaps do not have the same physical endurance required to manage the combined demands of work and pregnancy. No differences were found with regard to sickness absence between obese women and pregnant women with normal BMI; however, differences were found between different occupational groups.Conclusions: Our study indicates that a woman's BMI at the beginning of pregnancy is associated with her occupational status. Obesity among pregnant women may well be used as a psychosociat indicator as obesity correlates with social and economic problems. Any planned weight reduction programme in antenatal, care must therefore consider this important psychosociat aspect. (c) 2006 The Royal Institute of Public Health. Published by Elsevier Ltd. All rights reserved.
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10.
  • Sydsjö, Adam, 1940-, et al. (författare)
  • Influence of pregnancy-related diagnoses on sick-leave data in women aged 16-44
  • 2001
  • Ingår i: Journal of Womens Health & Gender-Based Medicine. - : Mary Ann Liebert Inc. - 1524-6094 .- 2168-7722. ; 10:7, s. 707-714
  • Tidskriftsartikel (refereegranskat)abstract
    • Data on sickness absence frequently are used as a measure of morbidity and its social consequences in the employed population. The effects of sickness absence, as well as any possible differences in diagnoses among pregnant women as compared the sick leave data among the total population of women in fertile age have so far not been studied. The aim of this study was to investigate the relative contribution of pregnant women to the level of sickness absence, in general and in different diagnostic groups, as well as the extent to which sick-listed pregnant women can be identified through diagnoses on sickness certificates. In a cross-sectional study of all sick leave insured women aged 16-44 years (n=24,481) in Link÷ping, Sweden (117,000 inhabitants), data from two population-based research registers were used, one of sickness absence for the whole population, one of sickness absence among pregnant women in the same population and year. Pregnant women (5%) had a significantly higher cumulative incidence of sickness absence (0.64) compared with all women (0.18) and accounted for 20% of the women listed as absent because of sickness. The duration of the sickness absence was also significantly longer among pregnant women, 44.8 days compared with 9.7 days among all women. Practically all diagnoses among pregnant women were related to pregnancy or back pain (93%). When using diagnoses on the sickness certificates, only 46% of all sick-listed pregnant women could be identified, suggesting methodological difficulties in studies on sickness absence. Studies on sickness absence among women of fertile age should also contain information on the proportion of sick-listed pregnant women, as a small proportion of pregnant women may have a deep impact on the results and conclusions among all women.
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11.
  • Sydsjö, Adam, 1940-, et al. (författare)
  • Influence of rest during pregnancy on birth weight in working women
  • 2006
  • Ingår i: Obstetrics and Gynecology. - 0029-7844 .- 1873-233X. ; 107:5, s. 991-996
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: Birth weight in Sweden has increased during the past decades. We investigated whether rest provided by the combination of time off from work and social benefits among working pregnant women contributed to the observed changes. METHOD: A total of 7,459 consecutively delivered women in 1978, 1986, 1992, and 1997 at 2 delivery wards in southeastern Sweden were studied. RESULTS: Between 1978 and 1997, the average birth weight among the children of the women studied increased from 3,484 to 3,566 grams (P < .001). The increase in weight was most evident among infants born to women who were employed during pregnancy. The use of social benefits and increased rest during pregnancy did not significantly influence birth weight (P = .107), even after adjustment for gestational length, parity, smoking, age, and occupation. CONCLUSION: The continuous increase in infants' birth weight among pregnant women in this study did not correlate with rest periods in the form of leave supported by social benefit programs. The effects of social benefit programs on pregnancy outcome may thus be overrated and merits further research. © 2006 by The American College of Obstetricians and Gynecologists. Published by Lippincott Williams & Wilkins.
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12.
  • Sydsjö, Gunilla, 1956-, et al. (författare)
  • Newly delivered women's evaluation of personal health status and attitudes towards sickness absence and social benefits
  • 2002
  • Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 81:2, s. 104-111
  • Tidskriftsartikel (refereegranskat)abstract
    • Background. Unexpectedly high rates of sickness absence have been observed among pregnant women. No clear medical causes for illnesses reported as the basis for sick leave have yet been identified with certainty. An explanation proposed is the pregnant women's own attitudes towards their own states of well being during pregnancy. The aim of this study was to investigate the validity of this hypothesis. Methods. All of the 384 women who were delivered at the University Hospital during a 2-month period were asked to answer a questionnaire anonymously. Information was sought concerning sickness absence and the use of parental benefits. In addition, questions were asked about working conditions and about each mother's own estimate of her level of 'well being'. The women's attitudes towards work absence due to illness and towards social benefit programs were registered. Results. Forty-three per cent of the women stated that they had been on sick leave during pregnancy. The main reason for sick leave was reported back pain. Seventy-four per cent of the women who were on sick leave stated, nevertheless, that they had been in 'good' or 'excellent' health during pregnancy. Of the 149 women who did not take sick leave, 10 reported being in 'bad' or 'very bad' health during pregnancy. 4.3% of the women stated that they had considered themselves to be ill due to an obstetric condition. Conclusion. In addition to actual disease and severe discomfort, certain social conditions and attitudes as well, are likely to explain the increase of pregnant women on sick leave.
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13.
  • Sydsjö, Gunilla, 1956-, et al. (författare)
  • Relationships and parenthood in couples after assisted reproduction and in spontaneous primiparous couples : A prospective long-term follow-up study
  • 2002
  • Ingår i: Human Reproduction. - 0268-1161 .- 1460-2350. ; 17:12, s. 3242-3250
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The aim of this study was to analyse relationships and parenthood in primiparous IVF couples and spontaneous primiparous couples. Method: In total, 110 consecutive IVF couples were studied. The control group was matched for women's age and selected out of the total spontaneous pregnant population in the study area. Questionnaires and semi-structured telephone interviews were used to gain information about sociodemographic data, couples' relationships, and the children's health, temperament and behaviour. Obstetrical variables concerning the course and outcome of pregnancy and delivery as well as the health status of the new-borns were obtained from standardized antenatal care and delivery files. Results: There weere no differences concerning gestational age, mode of delivery or neonatal health between the two groups. The IVF couples were more stable over time - from pregnancy until the child was 1 year old - in their relationship, while the control group experienced a decrease in marital satisfaction. The children in the IVF group were assessed by their parents as being more regular/habitual, sensitive and manageable than the control children. Conclusion: The differences present between the groups were in favour of the IVF families, and the effects of the infertility crisis were not notable when the children were 1 year old.
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14.
  • Sydsjö, Gunilla, 1956-, et al. (författare)
  • Relationships in couples after failed IVF treatment : A prospective follow-up study
  • 2005
  • Ingår i: Human Reproduction. - : Oxford University Press (OUP). - 0268-1161 .- 1460-2350. ; 20:7, s. 1952-1957
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: There are few studies of couples that analyse satisfaction with treatment, adoption plans and relationships in couples after unsuccessful IVF. Methods: ENRICH marital inventory was used to describe marital dynamics and to gain information about treatment and adoption plans. A specially designed questionnaire was used. Of the 51 couples without previous children who were asked to participate after their first failed IVF cycle, 45 participated. The next stage of the study was carried out when the couples had reached the 6 months point after the first IVF cycle, and the last stage after the couples had been through one to three treatments, 1 1/2 years after the last treatment. Results: The couples displayed a stable relationship from the start as well as 1 year after the last IVF cycle. The vast majority of the couples had decided to go through with an adoption. Seventy-three percent of the women were interested in more IVF treatment compared to 33% of the men. Conclusion: The stresses associated with IVF treatment did not have a negative impact on the couples' appreciation of their relationships during and after the treatment period. After treatment had been completed, the couples seemed to have reoriented themselves toward other solutions to childlessness.
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16.
  • Armuand, Gabriela, et al. (författare)
  • Attitudes among paediatric healthcare professionals in Sweden towards sperm donation to single women : a survey study
  • 2020
  • Ingår i: Fertility research and practice. - : BioMed Central. - 2054-7099. ; 6
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The number of families conceived through sperm donation to single women is increasing. However, there is limited knowledge about health care professionals' attitudes towards solo-mothers by choice, and there is some indication that professionals' personal opinions influence their care of individuals who use alternate ways to build a family. The primary aim of the study was to investigate attitudes towards, and experiences of, families following sperm donation to single women among healthcare professionals working in primary child healthcare.Methods: Between April and November 2016 a total of 712 physicians, registered nurses and psychologists working within primary healthcare in Sweden were invited to participate in a cross-sectional online survey study. The study-specific questionnaire contained the following four domains: Attitudes towards legalization and financing, Attitudes towards the family and the child's health, Clinical experience and Knowledge about sperm donation to single women.Results: The majority of the participants were positive or neutral towards sperm donation being allowed to single women in Sweden. However, one third believed that children risk worse mental health and social stigma. Half of healthcare professionals had own clinical experience of caring for solo-mothers by choice and their children, and of these one third perceived that these families had more need of support than other parents. One out of four indicated that they did not have sufficient knowledge to be able to provide adequate care to these families.Conclusions: The present results indicate that while there was a relatively large support for sperm donation being allowed to single women in Sweden among health care professionals, many expressed concerns about the child's health, as well as low confidence in their knowledge about the specific needs in this patient group. There is a need for educational interventions targeted to healthcare professionals in primary child healthcare in order to provide adequate care to solo-mothers by choice and their children.
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17.
  • Druvefors, Emma, 1985- (författare)
  • Fertility in Inflammatory Bowel Disease
  • 2023
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Inflammatory bowel diseases (IBD) often present in adolescence or early adulthood and is thus frequently diagnosed in men and women in their reproductive age. Previous population-based studies of fertility in patients with IBD are scarce.From the Swedish National Patient Register (NPR) all patients diagnosed with IBD of fertile age between 1964–2014 were identified. Statistics Sweden identified a matched reference cohort (ratio 1:5) from the general population matched for sex, age and place of birth. Children born were identified through the Medical Birth Register and the Swedish Multigeneration Register. For subgroup analyses information about medication was collected through Medical Drug Register and information about socioeconomic status from Longitudinal Integrated Database for Health Insurance and Labour Market Studies. From the SWedish Inflammatory Bowel disease quality REGister (SWIBREG) a cohort of women with UC who underwent colectomy 2000–2020 was identified. Demographic data from SWIBREG and information from a study specific questionnaire regarding reproductive history and voluntary childlessness were analysed.From the NPR 27,331 women and 29,104 men with IBD were identified, corresponding to 272,793 matched individuals.The fertility rate in women with IBD was 1.52 (standard deviation [SD] 1.22) births per 1000 person-years, compared with 1.62 (SD 1.28) (p <0.001) in the matched reference cohort. Fertility was negatively affected mainly in women with Crohn's disease (CD) and IBD-unclassified (IBD-U) and to a lesser extent in ulcerative colitis (UC). Disease activity, bowel resections and, in the case of CD, also perianal disease further adversely affected fertility. For women with UC and IBD-U, but not for women with CD, fertility improved throughout the study period. Contraceptive use was higher in female IBD patients, both before and after the diagnosis.In total 2,989 women underwent colectomy during the study period. Reconstruction with ileal pouch anal anastomosis (IPAA) and ileorectal anastomosis (IRA) was used to about the same extent in UC and IBD-U, although this was rare in CD. Compared with the matched reference cohort, women with IBD had lower fertility overall after colectomy (HR 0.65, CI 0.61–0.69), with least impact for operations that left the rectum intact (HR 0.79, CI 0.70–0.90). When the comparison was made within the group of patients undergoing colectomy, fertility in female patients remained nearly unaffected after IRA in all subtypes of IBD, but was impaired after IPAA, especially in UC (HR 0.67 CI 0.50–0.88), and after completion proctectomy in all subtypes of IBD (CD 0.61 CI 0.38–0.96), UC HR 0.65, CI 0.49–0.85 and IBD-U0.68, 0.55–0.85).The survey regarding reproductive behavior after colectomy was completed by 214 (73%) out of 294 eligible women identified in SWIBREG. The desire to have children was negatively affected by disease onset in 59% of the women, colectomy in 44% and by reconstruction in 37%. Altogether, 39% women with UC estimated that they chose to have fewer children in the end because of the disease, but only 10% expressed that the disease made them completely restrain from having children. On the contrary 37% of the women reported that they had experienced difficulties to conceive and 19% expressed that they could not conceive at all. Of the women undergoing reconstruction post colectomy, 37% reported that the choice of reconstruction method was influenced by their desire to have children. Difficulty conceiving was more commonly reported after reconstruction with IPAA (odds ratio [OR] 5.54) than IRA (OR 2.57).Men with IBD also had lower fertility rate compared with the matched reference population, although the impact on parity was limited; 1.28 (SD 1.27) versus 1.35 (SD 1.31) (p < 0.001). Fertility in men was nevertheless impaired in all IBD subtypes. The disease severity measured as order of hospital admissions (UC and IBD-U), intensity of medical treatment (CD), and bowel surgery (IBD-U) were further associated with impaired fertility in men. In the 3,771 men undergoing colectomy during the study period, fertility was only marginally (HR 0.89, CI 0.85–0.94) impaired, regardless of reconstruction.In conclusion, women with IBD have only slightly reduced fertility rates compared with the matched reference population with some exceptions. In non-surgically treated patients, the impact was most pronounced in female patients with CD. Women post colectomy have a particularly marked impact on fertility independent of IBD subtype. Bowel reconstruction with IPAA and proctectomy had a pronounced negative impact on fertility, while fertility was not further affected after IRA. More than half of the women with UC post colectomy reported that developing UC has affected their desire to have children, but difficulty to conceiving is also commonly reported. The impact of IBD in men was only minor.
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18.
  • Hammar, Mats, 1950-, et al. (författare)
  • A long-term follow-up study of men born with very low birth weight and their reproductive hormone profile
  • 2018
  • Ingår i: Systems biology in reproductive medicine. - : Taylor & Francis. - 1939-6376 .- 1939-6368. ; 64:3, s. 207-215
  • Tidskriftsartikel (refereegranskat)abstract
    • Environmental factors during the fetal period may adversely affect reproductive functions in men being born with very low birth weight (VLBW, <1500 g). The objective of this prospective, controlled cohort study was to investigate if VLBW men have an altered reproductive hormone profile compared with men born at term. The study group initially consisted of all VLBW boys live-born between 1 February 1987 and 30 April 1988 in the south-east region of Sweden (n = 47). A control child was chosen born at term, at the same hospital, with the same parity, without malformations, and next in order after each VLBW child who survived the first four weeks (n = 45). The present follow-up was performed when the men were 26-28 years of age and included measurements of serum hormone levels, hair testosterone concentration, and anthropometric data. Also life-style questionnaires were collected from 26 VLBW men and 19 controls. The VLBW group (n = 26) had higher median levels of serum estradiol, 84.5 pmol/L than controls (n = 19), 57.5 pmol/L (p = 0.008). There was no significant correlation between serum estradiol and BMI (r = 0.06, p = 0.74). There were no differences in other hormone levels or the reproductive pattern between the groups. In conclusion, even though there was a statistically significant difference in estradiol levels between the groups, both groups had low normal mean levels of questionable clinical significance. The reproductive pattern was similar in the two groups and in this study being born VLBW does not seem to affect these measured aspects of reproduction.ABBREVIATIONS: ADHD: attention deficit hyperactive disorder; AGA: average for gestational age; BMI: body mass index; CP: cerebral palsy; DHT: dihydrotestosterone; FSH: follicle stimulating hormone; LBW: low birth weight; LH: luteinizing hormone; SAD: sagittal abdominal diameter; SGA: small for gestational age; SHBG: sex hormone binding globulin; TSH: thyroid stimulating hormone; T3: triiodothyronine; T4: thyroxin; VLBW: very low birth weight.
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19.
  • Isaksson, Stina, et al. (författare)
  • Managing absence and presence of child-parent resemblance : a challenge for heterosexual couples following sperm donation
  • 2019
  • Ingår i: Reproductive biomedicine & society online. - : Elsevier BV. - 2405-6618. ; 8, s. 38-46
  • Tidskriftsartikel (refereegranskat)abstract
    • This qualitative interview study sought to gather and better understand heterosexual parents' experiences of managing resemblance and non-resemblance between child and parent in an identity-release donor programme. The study is part of the prospective longitudinal Swedish Study on Gamete Donation (SSGD), including all fertility clinics performing gamete donation in Sweden. A sample of participants in the SSGD, consisting of 30 heterosexual parents with children aged 7-8 years following identity-release sperm donation, participated in individual semi-structured interviews. This study concerns a secondary analysis of the interview data. The results show how donor-conceiving parents experience the presence and absence of child-parent resemblance, and how they navigate between the importance of genetic connectedness and of 'doing parenthood' through social interactions. The analysis resulted in three categories: 'resemblance through nature or nurture', 'non-resemblance brings the donor to the front' and 'feelings about and coping with resemblance talk'. The first two categories deal with the intrapersonal aspects of physical and non-physical resemblance, while the last category includes aspects of resemblance in relation to persons outside the core family. The presence or absence of parent-child resemblance regarding both physical and non-physical characteristics appears to constitute a considerable challenge for heterosexual couples with school-aged children following sperm donation.
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20.
  • Johansson, Torsten, et al. (författare)
  • Incidence of Perthes disease in children born between 1973 and 1993: A Swedish nationwide cohort study of 2.1 million individuals
  • 2017
  • Ingår i: Acta Orthopaedica. - : TAYLOR & FRANCIS LTD. - 1745-3674 .- 1745-3682. ; 88:1, s. 96-100
  • Tidskriftsartikel (refereegranskat)abstract
    • Background and purpose - The incidence of Perthes disease as reported in the literature varies widely between and within countries. The etiology of the disease is still unknown. Both environmental and genetic factors have been suggested to play a part in either causing the disease or increasing the susceptibility of an individual. We determined the incidence of Perthes disease in Sweden and investigated possible relationships to parental socioeconomic status, ethnicity, marital status, mothers age when giving birth, parity, number of siblings, and smoking habits. Patients and methods - Six Swedish population-based registers were used, together covering all children born in Sweden from 1973 through 1993. Results - The incidence of Perthes disease in Sweden was 9.3 per 100,000 subjects. The ratio between boys and girls was 3.1:1. The educational level of the father and the mother of a child with Perthes disease was lower than in the controls. The incidence was lower when the fathers were in the highest income bracket (above the 90(th) percentile). A higher proportion of parents of Nordic lineage had children with Perthes disease than parental pairs with one or both who were not of such lineage. Interpretation - This study confirms that there is an association between the incidence of Perthes disease and the socioeconomic status of the parents.
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21.
  • Josefsson, Ann, 1958-, et al. (författare)
  • Temperament and character in women with postpartum depression
  • 2007
  • Ingår i: Archives of Women's Mental Health. - : Springer Science and Business Media LLC. - 1434-1816 .- 1435-1102. ; 10:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: To investigate whether women with postpartum depression differ in personality traits from healthy postpartum women, healthy controls from the normal Swedish population and non-postpartum women with major depression. Methods: Forty-five women with postpartum depression were compared with 62 healthy postpartum women, 62 age-matched, healthy, non-postpartum women from a normal sample and 74 non-postpartum women with major depression from a clinical sample. The edinburgh postnatal depression scale was used in order to screen for postpartum depression. A clinical diagnostic interview was done including a rating with the Montgomery-Asberg depression rating scale. Personality i.e. temperament and character was measured by the temperament and character inventory. Results: Harm avoidance (HA) was higher (p < 0.001) and self-directedness (SD) scored lower (p < 0.001) in women with postpartum depression compared to healthy postpartum women. These differences were the most important differences between these two groups. Women with postpartum depression scored lower (p = 0.001) in cooperativeness (CO) and higher (p = 0.019) in self-transcendence (ST) compared to healthy postpartum women. Women with postpartum depression scored overall similar to women with major depression. Conclusion: High HA and low SD can be seen as vulnerability factors for developing a depression and especially in a stressful situation as childbirth. © 2006 Springer-Verlag.
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22.
  • Kangoum, Abdul-Almawla, 1949-, et al. (författare)
  • Prevalence of female genital mutilation among African women resident in the Swedish county of Östergötland
  • 2004
  • Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 83:2, s. 187-190
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives. To establish the prevalence of female genital mutilation (FGM) among African women resident in the Swedish County of Östergötland and assess the types of FGM. Material and methods. Three hundred and four African women aged ≥ 18 years were domiciled in Östergötland by the end of 1998. The women were invited by letter. A socio-cultural questionnaire designed to give an overall picture of FGM within a socioeconomic context, and also to invite the women to an interview and examination, was sent to all African women in the county of Östergötland. Women who gave their consent (n = 63) underwent a gynecologic examination. Results. The response rate was 84%. According to the questionnaire, 68% of all the African women were genitally mutilated. The clinical examination revealed that 39 women (62%) were mutilated, 17 of them (44%) had undergone removal of part or all external genitalia and stitching ('infibulation'), 26% had undergone removal of the prepuce of the clitoris ('prepucectomy'), 23% had undergone various cultural practices on the external genitalia, and 7.7% excision of the clitoris with partial or total removal of labia minora ('clitoridectomy'). Conclusion. The influx of immigrants to Sweden and the other Scandinavian countries from cultures where FGM is practiced, requires that physicians and other health professionals familiarize themselves with the practice and the cultural beliefs underlying it. Sensitivity to the needs of these women as well as attention to the potential physical hazards posed by the practice are important factors in care.
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23.
  • Kjellberg, Svante, 1946-, et al. (författare)
  • Knowledge of and attitudes towards infertility held by members of two county councils in Sweden
  • 2000
  • Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 79:11, s. 1015-1020
  • Tidskriftsartikel (refereegranskat)abstract
    • Background. To investigate Swedish county council members knowledge of the laws regulating infertility treatment, their understanding of the suggestions put forward in the report 'Priorities in Health Care' and their attitudes towards infertility. Methods. All members (n= 182) of the 1998 county councils of Linkoping and Jonkoping were asked to participate in the study. In total, 153 answered the questionnaire. Results. Different age groups did not show different levels of knowledge. Similarly, there was no significant difference between men and women concerning their knowledge of infertility laws. Furthermore, those committee members who were very positive towards infertility treatment did not have any better knowledge of such treatment than those who were less positive. The men and women who themselves had previously had or were dealing with infertility problems at the time of the survey (12 per cent) displayed the same level of knowledge as the other council members. They also expressed similar attitudes. The members showed very little familiarity with the priority groups suggested in the report from the Health Care Priority Committee. For example, only 18 per cent knew that this committee in priority group III placed infertility treatment and investigation. 31.3 per cent answered that infertility was placed in group V, a group that does not exist. The majority stated that they had a positive attitude towards the treatment of infertility. This is indicated, for example, by their rejection of the statement 'it's [infertility is] a luxury problem'. Conclusions. The relative lack of knowledge of Swedish law and of the report from the Health Care Priority Committee might lead to a lower level of commitment to dealing with the problems that infertile couples face than if the members were better informed. In other words, this lack of knowledge might influence the decisions of the county council members.
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24.
  • Lampic, Claudia, 1964-, et al. (författare)
  • National survey of donor-conceived individuals who requested information about their sperm donor-experiences from 17 years of identity releases in Sweden
  • 2022
  • Ingår i: Human Reproduction. - : Oxford University Press (OUP). - 0268-1161 .- 1460-2350. ; 37:3, s. 510-521
  • Tidskriftsartikel (refereegranskat)abstract
    • STUDY QUESTION What characterizes the group of donor-conceived (DC) individuals who request information about their identity-release sperm donor in Sweden, and what are their experiences of disclosure, information receipt and donor contact? SUMMARY ANSWER Following three decades of identity-release donation in Sweden, few DC individuals have requested donor information with varying experiences of information receipt and donor contact. WHAT IS KNOWN ALREADY In 1985, Sweden was the first country worldwide to enact legislation that gave DC individuals the right to obtain identifying information about their donor. Since then, identity-release gamete donation has become available in many countries but there is limited knowledge about the individuals who request donor information. STUDY DESIGN, SIZE, DURATION A nation-wide cross-sectional survey study was performed at all seven University hospitals that provided donation treatment in Sweden during 1985-2002. During this period only donor insemination to heterosexual couples was permitted. Inclusion criteria were being 18 years of age or older, conceived with donor sperm and having requested information about the donor by December 2020. Recruitment was performed during 2016-2020. PARTICIPANTS/MATERIALS, SETTING, METHODS A total of 60 individuals had requested information about their donor. Of these, 53 were approached and 40 individuals, representing 34 families, accepted study participation (75% response rate). Participants completed a postal survey with the WHO-10 well-being index and study-specific questions about experiences of disclosure, motivations for requesting donor information, receipt of information, as well as intentions and experiences of donor contact. Independent t-test and chi-square tests were used to compare ratings of participants with early and late disclosure. MAIN RESULTS AND ROLE OF CHANCE Of similar to 900 DC individuals who had reached adult age, a total of 60 (approximate to 7%) had requested information about the donor. Most of the 40 study participants (78%) made their requests within 2 years after reaching 18 years of age, or following disclosure at later ages (up to 32 years). Several participants had adult DC siblings in the family who had not requested any donor information. All except five participants received identifying information about the donor from the clinic. However, some donors had died or lacked contact information. Among those participants who were able to contact their donor, 41% had done so at the time of the study, while a third of the participants were unsure about potential contact. Several had met the donor in person and a few were in regular contact. About half of the participants had been informed about their donor conception in adolescence or adulthood (age 12-32), and there were significant differences between participants based on age at disclosure. Compared to those with early disclosure, participants with late disclosure were significantly more likely to be dissatisfied with the timing of their disclosure (P = 0.021), to react with negative emotions (P < 0.001), and to subsequently contact the donor (P = 0.047). LIMITATIONS, REASONS FOR CAUTION The limited population available for inclusion resulted in a small sample size, despite a high response rate. In addition, men's lower participation rate must be taken into consideration when interpreting the results. WIDER IMPLICATIONS OF THE FINDINGS The small number of individuals requesting information about their identity-release sperm donor is surprising. While not all DC individuals appear to be interested in donor information, it is reasonable to assume that some are unaware of their donor conception and thus unable to make informed decisions regarding their genetic origins. During the coming years, young women and men in many countries will become eligible to access identifying information about their donor. In order to meet the needs of these individuals, and to support positive outcomes for all involved parties, it is essential that adequate protocols and resources are developed. STUDY FUNDING/COMPETING INTEREST Financial support from The Swedish Research Council. There are no conflicts of interest to declare.
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25.
  • Larsson, Caroline, et al. (författare)
  • Health, sociodemographic data, and pregnancy outcome in women with antepartum depressive symptoms
  • 2004
  • Ingår i: Obstetrics and Gynecology. - 0029-7844 .- 1873-233X. ; 104:3, s. 459-466
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: To study whether women with antepartum depression have an increased risk for adverse perinatal outcome. METHODS: From a sample of 1,489 women, an index group (n = 259) of all women with depressive symptoms on the Edinburgh Postnatal Depression Scale in gestational week 35-36 was selected. Two hundred fifty-nine women with no depressive symptoms on the Edinburgh Postnatal Depression Scale antepartum or postpartum were randomly chosen as the reference group. Medical, gynecologic, and obstetric history, sodoeconomic status, pregnancy, and perinatal data were collected from standardized medical records for all women. RESULTS: Women with antepartum depressive symptoms were more often multiparas with a history of earlier obstetric complications. Complications during the present pregnancy were more frequent in the antepartum-depressed group of women. There were no differences concerning outcome of delivery, puerperium, and neonatal health between the index and reference groups. Forty-six percent of the women with antepartum depressive symptoms had depressive symptoms at 6-8 weeks or 6 months postpartum or both. CONCLUSION: Women depressed during pregnancy constitute a group without an increased risk for adverse obstetric or neonatal outcome but with a high risk for postpartum depressive symptoms.
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26.
  • Leeb-Lundberg, Sara, et al. (författare)
  • Helping parents to tell their children about the use of donor insemination (DI) and determining their opinions about open-identity sperm donors
  • 2006
  • Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 85:1, s. 78-81
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective. To look at the level of compliance with Swedish law whether or not parents intend to tell their child about donor insemination. We also wanted to look at the parents' attitudes towards open-identity sperm donors and at relationships within the family. Method. All parents who were treated and gave birth to a child through donor insemination from 1997 to 2003 were included in the study. Sixteen of 20 couples (80%) were willing to take part in an interview, where the men and women were interviewed separately. The children of these couples had an average age of 2.9 years. Results. Three of the 16 couples had told their child about donor insemination and 9 couples intended to tell the child when he/she was older. Thus 12 couples (75%) had disclosed or planned to inform their child in the future. Fourteen of 16 couples had told others about the donor insemination. The majority (20 of 31 individuals) had a positive attitude towards open-identity for sperm donors and 21 of 31 would have chosen an open-identity sperm donor if they had had the choice between that and an anonymous donor. All the parents felt they had an equal relationship with their child. Conclusion. Couples who conceived a child through donor insemination are open about the donor insemination, both to other people in their surroundings and in their intention to tell the child. These families seem to be functioning well with relaxed attitudes towards the donor insemination process. © 2006 Taylor & Francis.
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27.
  • Leijon, Ingemar, 1942-, et al. (författare)
  • God prognos för unga vuxna med mycket låg födelsevikt [Follow-up study of very low birthweight children in Sweden at the age of 27-28]
  • 2020
  • Ingår i: Läkartidningen. - Stockholm, Sweden : Sveriges Läkarförbund. - 0023-7205 .- 1652-7518. ; 117
  • Tidskriftsartikel (refereegranskat)abstract
    • Studies show that very low birthweight can be an important risk factor for mental problems, disturbed fertility and neuroendocrine dysregulation. In a regional long-term study 56 of 86 adult individuals 27 to 28 years of age with a very low birthweight were compared with normal birthweight controls. Analyses of self-reported mental health, socio-demographic factors, sex hormone levels, and hair cortisol levels showed no significant differences between the groups. However, in order to analyse subgroups with different risk factors from the newborn period or children with a variety of social background factors, larger patient groups are needed.
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28.
  • Leijon, Ingemar, 1942-, et al. (författare)
  • Self-reported mental health and cortisol activity at 27-28 years of age in individuals born with very low birthweight
  • 2020
  • Ingår i: Acta Paediatrica. - : Wiley-Blackwell Publishing Inc.. - 0803-5253 .- 1651-2227. ; 109:5, s. 948-958
  • Tidskriftsartikel (refereegranskat)abstract
    • AimTo assess mental health outcomes of very low birthweight (VLBW, <1500 g) subjects to adulthood and to examine salivary cortisol and hair cortisol levels and their relation to birth characteristics and mental health.MethodsA Swedish regional cohort of 56 VLBW subjects and 55 full‐term controls were assessed at the ages 27‐28 with adult self‐reported scales and the mean of 2 days diurnal salivary cortisol and hair cortisol. The cohorts had been assessed at 15 years of age with youth self‐reported scales.ResultsThere were no differences between the groups in youth self‐reported scales and adult self‐reported scores. The 24 participating VLBW girls scored lower on youth self‐reported scales externalising and total problem scores than the control girls. In adulthood, the 21 participating VLBW women had significantly higher morning concentrations of salivary cortisol than control women, P = .014. No significant associations were found between cortisol concentrations and adult self‐reported scales internalising, externalising and total scores.ConclusionSelf‐reported mental health in VLBW subjects was comparable with normal birthweight controls indicating a satisfying transition from adolescence to adulthood. VLBW females had higher morning salivary cortisol concentrations, suggesting a gender difference. We found no correlations between cortisol and mental health.
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29.
  • Leijon, Ingemar, 1942-, et al. (författare)
  • Use of healthcare resources, family function, and socioeconomic support during the first four years after preterm birth
  • 2003
  • Ingår i: Archives of Disease in Childhood. - 0003-9888 .- 1468-2044. ; 88:5
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: To assess the use of healthcare resources for preterm infants and to evaluate family function and socioeconomic support in a defined population from birth to 4 years of age. Methods: In a prospective case-control study, 39 singleton preterm infants without prenatal abnormalities born during an 18 month period were studied together with their families. The population consisted of 19 very preterm infants (less than 32 weeks) and 20 randomised moderate preterm infants (32-35 weeks), and the control group comprised 39 full term infants. Contacts with medical services, child health services, and the social welfare system were registered, and family function and life events were studied. Results: The preterm children were more often readmitted to hospital (odds ratio (OR) 6.6, 95% confidence interval (CI) 2.0 to 22.1) and had more outpatient attendances (OR 5.6, 95% CI 2.1 to 15.0) during their first year of life. Mothers in the preterm group more often used temporary parental allowance than the control mothers (p < 0.001). The number of contacts with the child health services and the social welfare system did not differ significantly from the controls. Neither was there any significant difference with regard to family function or life events at 4 years of age. Conclusions: A large proportion of the premature children used specialist care during the first years of life. However, the families of the preterm infants were socially well adapted up to four years after birth compared with the control families.
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30.
  • Lennmarken, Claes, 1948-, et al. (författare)
  • Psychological consequences of awareness and their treatment
  • 2007
  • Ingår i: Best Practice & Research. - : Elsevier BV. - 1521-6896 .- 1532-169X. ; 21:3, s. 357-367
  • Tidskriftsartikel (refereegranskat)abstract
    • Intraoperative awareness with subsequent recall is a rare but serious complication with an incidence of 0.1-0.2%. In approximately one third of the patients who have experienced awareness, late severe psychiatric sequelae may develop. The psychiatric symptoms in these patients fulfil the diagnostic criteria for post traumatic stress disorder. To prevent awareness as a negative outcome after anaesthesia, a thorough perioperative management of anaesthesia is necessary. The definite risk for post traumatic stress disorder following awareness indicates the necessity of postoperative clinical routines to identify awareness patients. The problem must be acknowledged. Professional psychiatric assessment and follow up should constitute standard practice. The treatments of choice are Eye Movement Desensitisation Reprocessing and Cognitive Behaviour Therapy. © 2007 Elsevier Ltd. All rights reserved.
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31.
  • Liffner, Susanne, 1974- (författare)
  • Infertility in Men in Relation to Their Birth Characteristics
  • 2021
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Background: About 10-15 % of couples worldwide suffer from infertility, the inability to achieve a pregnancy after more than 12 months of unprotected intercourse. Causes can be related to female factors, male factors, or both. In about 20 % of the couples, the cause remains unexplained. Male factor infertility is based on semen sample evaluation and is defined as poor semen quantity or quality, preferably in two or more samples. When assisted reproductive technology (ART) is considered for a couple with male factor infertility, intra-cytoplasmic sperm injection (ICSI) where the sperm is injected into the oocyte, is often needed to achieve embryo development.Men born small for gestational age (SGA), with low birth weight (LBW, £2,5000g) and/or prematurely (before the 37th gestational week) do not become fathers as often as men born with appropriate size for gestational age (AGA) at term. The aims of the present thesis were to investigate if this lower likelihood to become a father for men born SGA, preterm, or with low birth weight could be related to an increased risk of male factor infertility, if ICSI and sperm donation more often were needed and if the chance of conceiving by ART was lower than in men born AGA. An additional aim was to investigate if sperm DNA damage was more common in men born SGA compared with men born with normal size for gestational age.Material and Methods: Paper I and II were based on retrospective case control studies on men becoming fathers by ART in study I, and infertile men, patients at the Centre of Reproductive Medicine, University Hospital, Linköping, Sweden (RMC), in study II. Paper III was based on a cohort study on all men born in Sweden between 1973 and 1993. All three studies used data from national registers held by the National Board of Health and Welfare and Statistics Sweden. Study III also used information from the Swedish National Quality Register of Assisted Reproduction.Paper IV was based on a case series study of sperm DNA fragmentation in infertile patients and sperm donors at RMC, where two different methods of measuring sperm DNA fragmentation were compared, Halosperm® (easier to perform) and Sperm Chromatin Structure Assay (reference method). Paper V was based on a cohort study of men undergoing ART at RMC. The proportion of sperm with DNA fragmentation was compared between men born SGA and men born AGA.Results and conclusions: Men becoming fathers after ART were more often born with low birth weight than men conceiving naturally. Men becoming fathers after ICSI, presuming a poor semen sample, were more often born SGA than men conceiving by conventional IVF, or conceiving without treatment. ICSI had to be performed in 63% of men born SGA but only in 45% of men born AGA. Men with male factor infertility were more often born SGA or with LBW than men with female factor infertility, or when the infertility was unexplained. The results after ART were not affected by birth weight or size at birth.The likelihood of becoming a father was lower for men born SGA or with LBW compared with men born with normal birth weight. These men were also more often single (never married or with a registered partner) and had a higher risk of being born with undescended testicles, which increases the risk of infertility. Men born SGA more often needed ICSI or sperm donation.The two different methods to analyse sperm DNA fragmentation had high correlation and agreement, and Halosperm® could be considered a reliable and more easily handled method in the clinical setting. The median proportion of sperm with DNA fragmentation were higher for men born SGA (16.6%) compared with men born AGA (6.4%). The result was not statistically significant as the absolute number of men born SGA was much smaller than expected in this sample of 550 men. Larger studies are needed to confirm the hypothesis that DNA fragmentation contributes to a lower likelihood to become a father in men born SGA.
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32.
  • Liffner, Susanne, et al. (författare)
  • Men becoming fathers by intracytoplasmic sperm injection were more often born small for gestational to age
  • 2017
  • Ingår i: Asian Journal of Andrology. - : MEDKNOW PUBLICATIONS & MEDIA PVT LTD. - 1008-682X .- 1745-7262. ; 19:1, s. 103-106
  • Tidskriftsartikel (refereegranskat)abstract
    • Being born with nonoptimal birth characteristics decreases the chance of becoming a father. Urogenital malformations as well as metabolic syndrome are more common in men born small for gestational age (SGA) and could be contributing factors to the reduced fertility rate seen in these men. It could imply that men becoming fathers by assisted reproductive technology (ART) more often are born with low birth weight (LBW), preterm, and/or SGA than men conceiving without treatment and also that men where intracytoplasmic sperm injection (ICSI) had to be performed more often are born with nonoptimal birth characteristics than men where conventional in vitro fertilization (IVF) successfully could be used. In this retrospective, case-control study using Swedish national registers, we compared the birth characteristics of 1206 men who have become fathers by ART with a control group consisting of age-matched men who became fathers without treatment. The differences in birth characteristics between men becoming fathers by IVF and ICSI were also assessed. For men becoming fathers by ART, OR of being born with LBW was 1.66 (95% CI = 1.17-2.36) compared with fathers who conceived without treatment. OR of being born prematurely was 1.32 (95% CI = 1.00-1.77). Men becoming fathers via ICSI had a doubled increased likelihood of being born SGA compared with men who became fathers via IVF (OR = 2.12; 95% CI = 1.17-3.83). In conclusion, we have found that men becoming fathers by ICSI treatments had more often been born SGA than men becoming fathers by conventional IVF.
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33.
  • Lindell Pettersson, Malin, 1979- (författare)
  • Women giving birth at an advanced age and their children : obstetric and neonatal outcomes, health and social support
  • 2022
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Postponement of parenthood is an increasing trend in Western societies today. Delaying motherhood to a later time in life increases the use of assisted reproduction technology (ART), and the risk for adverse obstetric and neonatal outcomes. Along with postponement of motherhood, the number of women requesting treatment to become solo mothers has increased. The aim of the present thesis was to evaluate the obstetric outcomes and morbidity among mothers and their children, and the association of these outcomes with advanced maternal age, single status and the use of ART.Data from the Medical Birth Register (MBR) pertaining to pregnancy, childbirth and neonatal outcomes were retrieved. In total, 37,558 mothers aged ≥ 40 years formed the index group, which was divided into two subgroups, mothers 40-44 years of age and mothers aged ≥ 45, and compared to a control group of 71,472 mothers age ≤ 39 years (Study I). To investigate the mothers’ morbidity up to five years prior to, and up to five years after childbirth (study II), and their children’s morbidity up to five years of age (study III), data from the MBR and the National Patient Register (NPR) on Swedish women giving birth during 2007-2008 and their children were retrieved. The index group comprised 8203 mothers ≥ 40 years, and the control group comprised 15,569 mothers ≤ 39 years and their children. Diagnosis and number of inpatient and outpatient visits in hospital specialized care units were studied as well as mode of conception i.e., using ART or spontaneously conceived. Civil status, defined as single or cohabiting/married, was also investigated. In study IV, 207 single women accepted for treatment with donor sperm were compared with 256 cohabiting women treated with IVF with their own gametes. The women’s sociodemographic data, their descriptions of their social networks, as well as self-assessment of their social support were investigated through a questionnaire.The results showed an increased risk for an adverse pregnancy outcome in older mothers and the children were more often born preterm, with low birthweight or were small-for-gestational age. In addition, the older mothers had more often used ART, and were more likely to be single, to use less tobacco and to have a higher BMI compared to younger women. Also, the results indicated an increased risk for morbidity among older women, both before and after pregnancy, compared to the younger women. Women of both age groups who had used ART to conceive also had higher morbidity than women who conceived spontaneously. Among mothers and children, morbidity was significantly higher in both mother and child when the mother was single at the time of pregnancy. Children born to older mothers were more often diagnosed with conditions diagnosed in the perinatal period and with congenital malformations, deformations and chromosomal abnormalities compared with children born to younger mothers.Solo women who were to be treated with sperm donation were older compared to cohabiting women. Solo women more often had a higher level of education and full-time employment, and were in a profession with a higher salary compared with cohabiting women. Solo women expected to receive much help, primarily from a parent but also from friends.The significantly increased risk for adverse outcomes in pregnancy and childbirth associated with advanced maternal age and the diagnoses their children were more likely to receive during the first five years of life is perhaps small but will have an impact on the individual. Single parenthood is historically associated with social and economic disadvantages. The results are in part promising concerning the sociodemographic characteristics of solo-mothers-to-be and their high levels of perceived social support. However, the potential risk for long-term morbidity in children born to advanced aged mothers, in combination with maternal single civil status and use of ART, is important to follow closely to provide proper and adequate support and health care to these mothers and their children.
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34.
  • Martinez, Cristina A., et al. (författare)
  • Prenatal stress, anxiety and depression alter transcripts, proteins and pathways associated with immune responses at the maternal-fetal interface
  • 2022
  • Ingår i: Biology of Reproduction. - : Oxford University Press. - 0006-3363 .- 1529-7268. ; 106:3, s. 449-462
  • Tidskriftsartikel (refereegranskat)abstract
    • During pregnancy, the immune system is modified to allow developmental tolerance of the semi-allogeneic fetus and placenta to term. Pregnant women suffering from stress, anxiety, and depression show dysfunctions of their immune system that may be responsible for fetal and/or newborn disorders, provided that placental gene regulation is compromised. The present study explored the effects of maternal chronic self-perceived stress, anxiety, and depression during pregnancy on the expression of immune-related genes and pathways in term placenta. Pregnancies were clinically monitored with the Beck Anxiety Inventory (BAI) and Edinburgh Postnatal Depression Scale (EPDS). A cutoff threshold for BAI/EPDS of 10 divided patients into two groups: Index group (>10, n = 11) and a Control group (<10, n = 11), whose placentae were sampled at delivery. The placental samples were subjected to RNA-Sequencing, demonstrating that stress, anxiety, and depression during pregnancy induced a major downregulation of placental transcripts related to immune processes such as T-cell regulation, interleukin and cytokine signaling, or innate immune responses. Expression differences of main immune-related genes, such as CD46, CD15, CD8 alpha & beta ILR7 alpha, and CCR4 among others, were found in the Index group (P < 0.05). Moreover, the key immune-like pathway involved in humoral and cellular immunity named "Primary immunodeficiency" was significantly downregulated in the Index group compared with Controls. Our results show that mechanisms ruling immune system functions are compromised at the maternal-fetal interface following self-perceived depressive symptoms and anxiety during pregnancy. These findings may help unveil mechanisms ruling the impact of maternal psychiatric symptoms and lead to new prevention/intervention strategies in complicated pregnancies. Summary Sentence Mechanisms ruling immune system functions are compromised at the maternal-fetal interface following self-perceived depressive symptoms and anxiety during pregnancy.
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35.
  • Möller, Louise, 1989- (författare)
  • Health, obstetric outcomes and reproduction in women with vulvar pain or primary fear of childbirth
  • 2019
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Fear of childbirth (FOC) is common and affects approximately 5-20 % of all pregnant women. FOC is associated with giving birth by caesarean section on maternal request (CSMR). The rate of caesarean sections (CS) and CSMR has increased during the last decades. To decrease these women’s fear, the rate of CSMR and to promote a more positive birth experience, many treatments for FOC have been evaluated. In Sweden, the treatment is individualized and given by obstetricians, midwives, psychologists or psychotherapists in the specialist care.Women with FOC suffer more often from psychiatric illness and rate their general health as less good, which is important to consider when counselling these women and deciding on mode of delivery. Little is known about the long term obstetric and reproductive outcomes for women with FOC. Therefore, the aim of the studies on which this thesis is based was to compare psychiatric care before and after childbirth in women giving birth by CSMR to women giving birth by other modes of delivery and to follow the subsequent obstetric and reproductive outcomes in women receiving counselling for FOC in their first childbirth. Furthermore, we hypothesized that women with localized provoked vulvodynia (LPV) and/or vaginismus might fear vaginal childbirth and little is known about their reproduction and obstetric outcomes which is why we investigated the parity and obstetric outcomes in women diagnosed with LPV/vaginismus before first childbirth.Based on data linked from several Swedish National registers, the prevalence of psychiatric in- and outpatient care before (paper I) and after first childbirth (paper II) was compared in primiparae giving birth by CSMR to primiparae giving birth by other modes of delivery. The prevalence of psychiatric disorders was found to be significantly higher in women giving birth by CSMR, indicating a severe burden of psychiatric illness in these women.In paper III, also based on data from several Swedish National registers, a diagnosis of LPV/vaginismus before childbirth was shown to decrease the odds of giving birth. When giving birth these women had an increased risk of CS, especially CSMR. This could possibly indicate FOC in these women. Further, women with vaginismus had an increased risk of pelvic floor injuries.Paper IV was a follow-up study of women who received counselling for FOC in their first pregnancy leading to parturition. It was based on data from medical records and a questionnaire. The women were followed 7-14 years after their first childbirth. Women treated for FOC more often gave birth by CS, rated their first birth experience as less positive and more often required counselling for FOC in their subsequent pregnancies compared to women without FOC in their first pregnancy. There were no significant differences in the rate of complications during pregnancy and childbirth compared to the other women. Women treated for FOC less often gave birth more than twice. Despite being given counselling and being exposed to childbirth almost one in five women felt fearful towards childbirth 7-14 years after the first childbirth.In conclusion, women with FOC are a vulnerable group suffering from a significant burden of psychiatric illness. FOC is not easily treated; many women require counselling in subsequent pregnancies and many still fear childbirth after the childbearing years. Furthermore, LPV/vaginismus is a risk factor for giving birth by CSMR, possibly indicating FOC, and these women are less likely to give birth. Our study shows it is important not only to address sexual function in these women but reproductive function as well. Further studies are needed to establish how to optimize their care regarding fertility, antenatal, obstetric and post-partum care.
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36.
  • Paulin, Johan, 1979-, et al. (författare)
  • Using the theory of planned behavior to predict parents' disclosure of donor conception to their children : a longitudinal study
  • 2024
  • Ingår i: Human Reproduction. - : Oxford University Press. - 0268-1161 .- 1460-2350. ; 39:6, s. 1247-1255
  • Tidskriftsartikel (refereegranskat)abstract
    • STUDY QUESTION: Can the application of the theory of planned behavior (TPB) help predict heterosexual parents' disclosure of donor conception to their children?SUMMARY ANSWER: Parents with a stronger will to act in accordance with social norms favoring disclosure were more likely to start the disclosure process within the next 5-9 years.WHAT IS KNOWN ALREADY: In contrast to single mothers by choice and same-sex couples, heterosexual couples need to make an active decision to disclose their use of donor conception to their child. While disclosure at an early age is encouraged by international guidelines, many heterosexual-couple parents struggle with this. A previous study has found an association between parental scores of TPB factors and disclosure intention, but so far, no study has applied the TPB to predict parents' disclosure behavior.STUDY DESIGN, SIZE, DURATION: The present study is based on the fourth and fifth waves of data collection (T4 and T5) in a nation-wide longitudinal study. Participating parents had conceived through identity-release oocyte donation (n = 68, response rate 65%) and sperm donation (n = 62, response rate 56%) as part of a heterosexual couple. PARTICIPANTS/MATERIALS, SETTING, METHODS: The present study is part of the prospective longitudinal Swedish Study on Gamete Donation (SSGD). Consecutive recruitment of couples starting oocyte or sperm donation treatment was conducted at all seven fertility clinics providing gamete donation in Sweden during a 3-year period (2005-2008). Participants were requested to complete postal surveys at five time points. The present study includes heterosexual-couple parents following oocyte or sperm donation who participated at the two latest time points when their children were 7-8 years old (T4), and 13-17 years old (T5). At T4, participants completed the study-specific TPB Disclosure Questionnaire (TPB-DQ) measuring attitudes and intentions to disclose the donor conception to the child, and disclosure behavior was assessed at both T4 and T5. Data from those participants who had not yet disclosed at T4 were analyzed using survival analysis with Cox regressions. MAIN RESULTS AND THE ROLE OF CHANCE: Forty participants had not disclosed the donor conception to their children at T4 and, out of these, 13 had still not disclosed at T5. We found a significant association between scores of the TPB factor Subjective norms at T4 and their subsequent disclosure behavior at T5 (HR = 2.019; 95% CI: 1.36-3.01). None of the other factors were significantly associated with disclosure behavior.LIMITATIONS, REASONS FOR CAUTION: The present study concerns heterosexual-couple parents with children conceived following treatment with gametes from open-identity donors, which limits the generalizability of our findings to other groups and contexts. Other limitations include the risk of systematic attrition due to the longitudinal study design and decreased statistical power due to few participants.WIDER IMPLICATIONS OF THE FINDINGS: Our findings highlight the importance of perceived subjective norms for parents' disclosure behavior and indicate that the co-parent's opinion about disclosure is of particular relevance in this regard. Counselors should focus on supporting prospective parents to initiate and maintain a healthy and open dialogue about concerns around building a family with donor conception.
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37.
  • Paulin, Johan, et al. (författare)
  • Using the theory of planned behavior to predict parents' disclosure of donor conception to their children: a longitudinal study
  • 2024
  • Ingår i: Human Reproduction. - : OXFORD UNIV PRESS. - 0268-1161 .- 1460-2350.
  • Tidskriftsartikel (refereegranskat)abstract
    • STUDY QUESTION Can the application of the theory of planned behavior (TPB) help predict heterosexual parents' disclosure of donor conception to their children?SUMMARY ANSWER Parents with a stronger will to act in accordance with social norms favoring disclosure were more likely to start the disclosure process within the next 5-9 years.WHAT IS KNOWN ALREADY In contrast to single mothers by choice and same-sex couples, heterosexual couples need to make an active decision to disclose their use of donor conception to their child. While disclosure at an early age is encouraged by international guidelines, many heterosexual-couple parents struggle with this. A previous study has found an association between parental scores of TPB factors and disclosure intention, but so far, no study has applied the TPB to predict parents' disclosure behavior.STUDY DESIGN, SIZE, DURATION The present study is based on the fourth and fifth waves of data collection (T4 and T5) in a nation-wide longitudinal study. Participating parents had conceived through identity-release oocyte donation (n = 68, response rate 65%) and sperm donation (n = 62, response rate 56%) as part of a heterosexual couple.PARTICIPANTS/MATERIALS, SETTING, METHODS The present study is part of the prospective longitudinal Swedish Study on Gamete Donation (SSGD). Consecutive recruitment of couples starting oocyte or sperm donation treatment was conducted at all seven fertility clinics providing gamete donation in Sweden during a 3-year period (2005-2008). Participants were requested to complete postal surveys at five time points. The present study includes heterosexual-couple parents following oocyte or sperm donation who participated at the two latest time points when their children were 7-8 years old (T4), and 13-17 years old (T5). At T4, participants completed the study-specific TPB Disclosure Questionnaire (TPB-DQ) measuring attitudes and intentions to disclose the donor conception to the child, and disclosure behavior was assessed at both T4 and T5. Data from those participants who had not yet disclosed at T4 were analyzed using survival analysis with Cox regressions.MAIN RESULTS AND THE ROLE OF CHANCE Forty participants had not disclosed the donor conception to their children at T4 and, out of these, 13 had still not disclosed at T5. We found a significant association between scores of the TPB factor Subjective norms at T4 and their subsequent disclosure behavior at T5 (HR = 2.019; 95% CI: 1.36-3.01). None of the other factors were significantly associated with disclosure behavior.LIMITATIONS, REASONS FOR CAUTION The present study concerns heterosexual-couple parents with children conceived following treatment with gametes from open-identity donors, which limits the generalizability of our findings to other groups and contexts. Other limitations include the risk of systematic attrition due to the longitudinal study design and decreased statistical power due to few participants.WIDER IMPLICATIONS OF THE FINDINGS Our findings highlight the importance of perceived subjective norms for parents' disclosure behavior and indicate that the co-parent's opinion about disclosure is of particular relevance in this regard. Counselors should focus on supporting prospective parents to initiate and maintain a healthy and open dialogue about concerns around building a family with donor conception.STUDY FUNDING/COMPETING INTEREST(S) The study was funded by the Swedish Research Council. The authors have no competing interests to declare.TRIAL REGISTRATION NUMBER N/A.
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38.
  • Skoog Svanberg, Agneta, et al. (författare)
  • Attitudes towards gamete donation among Swedish gynaecologists and obstetricians
  • 2008
  • Ingår i: Human Reproduction. - : Oxford University Press (OUP). - 0268-1161 .- 1460-2350. ; 23:4, s. 904-911
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Assisted reproductive technology (ART) legislation in Sweden has undergone a gradual transformation from being fairly restrictive when first introduced to becoming more permissive in recent years. Regarding gamete donation, Sweden became the first country to pass legislation about disclosure by establishing a child's right to find out the identity of the gamete donor once the child has reached maturity. Our aim was to investigate attitudes towards gamete donation among Swedish gynaecologists and obstetricians. METHODS: A questionnaire was mailed to all gynaecologists and obstetricians listed from a commercial register of all working in Sweden. Among 1230 eligible gynaecologists/obstetricians, 854 (69%) answered the questionnaire. RESULTS: In general, the majority of Swedish gynaecologists/obstetricians had positive attitudes towards gamete donation. Although a majority advocated openness regarding informing the child that he or she was conceived by making use of gamete donation, similar to 40% opposed allowing the child to receive any information about the donor when the child has reached maturity. Even though Swedish legislation has allowed sperm donation to lesbian couples since July 2005, one-third of the gynaecologists/obstetricians opposed donation to lesbians. CONCLUSIONS: The results indicate that the gynaecologists'/obstetricians' negative attitudes towards disclosure may influence patients' ability to discuss their thoughts and feelings about donation. This may also have a negative impact on donor recruitment as well as on the extent of methods made accessible within ART.
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39.
  • Skoog Svanberg, Agneta, 1958-, et al. (författare)
  • Psychosocial aspects of identity-release gamete donation - perspectives of donors, recipients, and offspring
  • 2020
  • Ingår i: Upsala Journal of Medical Sciences. - : Uppsala Medical Society. - 0300-9734 .- 2000-1967. ; 125:2, s. 175-182
  • Forskningsöversikt (refereegranskat)abstract
    • Donor conception creates families with varying genetic linkage between family members. This may have short-term as well as lifelong psychosocial consequences for all involved. Gamete donors have traditionally been anonymous to recipients and offspring, but there is a growing trend towards identity-release donor programmes that give offspring the right to obtain the donor's identity. This review aims to provide an overview of the perspectives of donors and recipients and offspring involved in identity-release donation. The results show that both oocyte and sperm donors have primarily altruistic motives, and recipients, in particular lesbian and single women, are generally open about the donation to their offspring. The few existing studies on offspring perspectives indicate that those who are aware of their donor conception appear to be interested in contact with the donor, and most donors are open to such contact. Investigations of donors and recipients indicate a need for more counselling and support to manage family life with varying genetic linkage within and outside the family unit. This includes preparing for and managing future contact between the donor and his/her family and donor offspring and their family, as well as between donor siblings and their respective families.
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40.
  • Svedin, Carl Göran, et al. (författare)
  • Mental health, behaviour problems and incidence of child abuse at the age of 16 years : A prospective longitudinal study of children born at psychosocial risk
  • 2005
  • Ingår i: European Child and Adolescent Psychiatry. - : Springer Science and Business Media LLC. - 1018-8827 .- 1435-165X. ; 14:7, s. 386-396
  • Tidskriftsartikel (refereegranskat)abstract
    • Of the 1,575 pregnant women registered at the public Antenatal Health Care Service in the city of Linköping, Sweden during 1983, an index group of 78 women was identified that met specific well-defined psychosocial risk criteria related to drug addiction, mental insufficiency, and particular social circumstances of possible relevance to problems of pregnancy and early child development. A further 78 pregnant women who did not meet the inclusion criteria were used as a reference group. The present study is a 16-year follow-up in which 43 (57%) of the original index children and 63 (82%) of the original reference children were examined on indices of mental health, and the presence of child abuse. Their mental health was assessed with the Child Behaviour Checklist (CBCL) completed by the mothers and the Youth Self-Report (YSR) completed by the adolescents. The incidence of child abuse and Social Welfare interventions was obtained from Social Welfare records. The index children, especially the boys, displayed significantly poorer mental health as assessed by both CBCL (p<0.05) and YSR (p<0.02). Being an index child increased the odds ratio 16-27 times for different Social Welfare interventions, and child abuse had been investigated in 27% of the index children compared to 1% of the reference children. © Steinkopff Verlag 2005.
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41.
  • Sydsjö, Gunilla, 1956-, et al. (författare)
  • Evaluation of risk factors' importance on adverse pregnancy and neonatal outcomes in women aged 40 years or older
  • 2019
  • Ingår i: BMC Pregnancy and Childbirth. - : BioMed Central. - 1471-2393 .- 1471-2393. ; 19:1
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Women of advanced age (40 years or older) are generally, at risk for pregnancy and delivery related problems. In addition, there is limited knowledge on being of advanced age and having been given Assisted Reproductive Treatment (ART) and its association with negative obstetric outcomes. Therefore, data from the Swedish Medical Birth Register was used to investigate pregnancy and neonatal outcomes for women aged 40 or more who had given birth. The secondary aim was to compare the obstetric outcomes of women who had used ART and women who had not undergone ART while adjusting for marital status across the age groups.METHOD: Women of advanced age who had given birth in Sweden during 2007-2012 formed the index group, n = 37,558; a reference group of women comprised 71,472 women under the age of 40. An additional subgroup of women aged 45 or older when giving birth was also formed, n = 2229. The obstetric and neonatal data for all the women was derived from national register data.RESULTS: Women of advanced age were more often single, had undergone ART, and more often experienced adverse obstetric outcomes than did younger women. The neonate's health was also more often adversely affected expressed as being born with low birth weight and Small for Gestational Age (SGA), having lower Apgar scores, and having more health problems during the first week compared to the reference group.CONCLUSIONS: Women who are approaching the upper limit of fecundity are at greater risk for having children who are preterm and SGA. The adverse effects of being preterm and SGA may have negative long-term effects, not only on the children but also on the mothers. This needs to be addressed more frequently in a clinical setting when advising women of all ages on pregnancy and ART treatment.
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42.
  • Sydsjö, Gunilla, 1956-, et al. (författare)
  • Life development for 20 pairs of children with and without psychosocial problems - A 16-year-long study with follow-up
  • 2007
  • Ingår i: Nordic Journal of Psychiatry. - : Informa UK Limited. - 1502-4725 .- 0803-9488. ; 61:1, s. 19-26
  • Tidskriftsartikel (refereegranskat)abstract
    • The objective of the study was to describe 20 matched pairs of children born to psychosocial risk mothers who have been followed from early pregnancy through their first 16 years of life. Interviews and standardized behavior measurements with a focus on the children's development were used. When considering the overall data from the different measurements done over the 16-year study period, the study group has significantly more negative results. Nine of the families in the study group had been investigated for abuse, neglect and inadequate parenting during the 16 years. In the rest of the 11 families from the study group, two siblings had been placed in foster care because of maltreatment. The study group mothers' characteristics from the start had a significantly negative impact on the children's behavior and mental health throughout their lives and when they reached 16 years.
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43.
  • Sydsjö, Gunilla, 1956-, et al. (författare)
  • Nurses promote openness regarding the genetic origins after gamete donation
  • 2007
  • Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 96:10, s. 1500-1504
  • Tidskriftsartikel (refereegranskat)abstract
    • AIM: To study attitudes and knowledge concerning different aspects of sperm and oocyte donation among paediatric nurses at child health care centres (CHCs) in Sweden. METHOD: A study-specific questionnaire, to be completed anonymously, was sent to 188 nurses, 141 of whom (75%) responded. RESULTS: The majority of the respondents (62%) stated that they had no professional experience of families created with the help of a donor. A majority (53%) stated that they had good knowledge of the procedure followed in sperm donation, whereas 43% stated that they had good knowledge of the procedure of oocyte donation. More than 80% agreed that the parents should be honest with their child with regard to the child's genetic origin. Among the respondents who were in favour of disclosure, the preferred age for informing the child varied between 0 to 19 years (mean 7.2, SD 5.7). CONCLUSION: We conclude that the nurses working in CHCs need guidance and information about gamete donation in order to be able to support parents in the disclosure of information to their children and also how to inform or withhold information to significant others in their surrounding milieu.
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44.
  • Sydsjö, Gunilla, 1956-, et al. (författare)
  • Period prevalence and types of psychosocial risk factors in pregnant women in an urban Swedish community
  • 2003
  • Ingår i: International Journal of Social Welfare. - : Wiley. - 1369-6866 .- 1468-2397. ; 12:4, s. 302-306
  • Tidskriftsartikel (refereegranskat)abstract
    • During a three-year period a total population of pregnant women attending antenatal clinics in Link÷ping, Sweden was screened for being at psychosocial risk. The prevalence of different psychosocial risk factors was compared with the corresponding prevalence in women referred to and accepting or declining to take part in a specialised training programme at a parent-baby clinic. In general, the present study showed that there was a constant proportion of about 4-5% of pregnant women with psychosocial risk factors. Psychiatric problems and social problems of relevance for pregnancies/parenthood were about equally frequent (i.e. 44 and 45%), while drug-addiction problems were at 11%. Only one in three women with risk factors were eventually referred to the parent-baby clinic, and every second woman referred finally took part in the programme. With the knowledge that an early intervention in families with psychosocial risk factors may alleviate some adverse or disadvantageous developments in children, it is a challenge to identify and to motivate these women to enrol in various support and training programmes. There are still too few pregnant women at risk who are ready to accept the further support that they may need, and the rationale for their reluctance must be better known.
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45.
  • Sydsjö, Gunilla, 1956-, et al. (författare)
  • Psychosocial risk mothers : Early mother-child interaction and behavioural disturbances in children at 8 years of age
  • 2001
  • Ingår i: Journal of Reproductive and Infant Psychology. - : Informa UK Limited. - 0264-6838 .- 1469-672X. ; 19:2, s. 135-146
  • Tidskriftsartikel (refereegranskat)abstract
    • Mother-child interaction in a group of women with psychosocial risks, identified during pregnancy, was assessed at birth, when the infants were 6 months old, and again when they were 18 months old. Presence of behavioural disturbances in the children was assessed when they were 8 years of age. The at-risk index group was comprised of 45 mothers and their children, with the risk criteria consisting of alcohol/drug abuse, psychiatric problems, and disadvantageous social circumstances. Another 57 mother-child pairs lacking in risk criteria comprised a reference group. Most aspects of mother-child interaction were shown to be significantly poorer in the index group than in the reference group at the three points of assessment during infancy. At 8 years of age, the index children, especially the boys, were found to display significantly more behavioural disturbances than the reference children. A significant correlation was also found in the index group, but not in the reference group, between the quality of mother-infant interaction at birth and the extent of behavioural disturbance in children at 8 years of age. Overall, the results suggest that identification can be made, even during pregnancy, of children who are at risk of poor interaction with mothers during infancy and at risk of behavioural problems later in development.
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46.
  •  
47.
  • Sydsjö, Gunilla, 1956- (författare)
  • Psykosociala riskgraviditeter och deras utfall
  • 1992
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • The present study describes a prospective survey of an index-group of78 pregnant women, who during pregnancy met with certain arbitrarily selected, but well defined criteria associated with drug addiction, moderate mental insufficiency or particular social circumstances of possible relevance to the course of pregnancy and early child development. For comparison, a referencegroup of 78 pregnant women who did not meet the present inclusion criteria, were studied in equal detail. The two groups of women were derived out of a total number of 1575 pregnant women who during the year 1983 registered at the public Antenatal Health Care Service in the community of Linköping. The two groups of women were followed and compared until their children were four years old. By means of repeated personal, semistructured interviews with all the women, together with standardized observations of the women and their children and collection of a range of social, economic, medical,obstetrical and neonatal data, the duration and outcome of pregnancy in relation to the need for medical antenatal care and social wellfare was illustrated in some detail. Furthermore, the psychosocial conditions of the pregnant women, apparent during early pregnancy were related to the development of the interaction and relationship between mother and child as observed during the first 18 months as well as to the somatic and psycho-motor development of the child at four years of age.In summary, at least five per cent of all pregnant women in the community of Linköping were found, already during early pregnancy, to be characterized by drug addiction, suffering from modefate mental insufficiency symptoms or being associated with one or more defined social attributes thought to be of relevance to the course of pregnancy and early child development. These women, when compared to the reference group of pregnant women, were eventually found to require a significantly increased amount of medical attention and social wellfare during pregnancy. However, no significant differences were observed between the groups regarding duration and outcome of pregnancy, thestates of the neonates or the somatic wellbeing of mother and child postnatally.With the beginning soon after delivery, the indexchildren appeared to run a considerably increased risk for an unfavourable somatic as well as psycho-motor development during their ftrst four years of life, as compared to the reference children.It is obvious that present efforts and routines with regard to antenatal medical and social care, at least as presendy practised in Linköping, Sweden, are consistent with regular obstetric courses and outcomes of pregnancies in general in women stigmatized by certain impaired psychosocial conditions. However, if we are to prevent and eventually eliminate the significantly increased risks for an unfavourable somatic and psycho-motor development of the children of these women, we mustprobably introduce complementary elements of an educational and socially reassuring type in the Antenatal Health Care Service.
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48.
  • Thorup, Emilia, et al. (författare)
  • Same-sex mothers' experiences of equal treatment, parenting stress and disclosure to offspring : a population-based study of parenthood following identity-release sperm donation
  • 2022
  • Ingår i: Human Reproduction. - : Oxford University Press. - 0268-1161 .- 1460-2350. ; 37:11, s. 2589-2598
  • Tidskriftsartikel (refereegranskat)abstract
    • STUDY QUESTION: What are the experiences of same-sex mothers following identity-release sperm donation regarding equal treatment in society, parenting stress and disclosure to child?SUMMARY ANSWER: Mothers predominantly reported equal treatment in society, low levels of parenting stress and early disclosure of the donor conception to the child, and half of the couples had also informed the child of his/her right to obtain the donor's identity.WHAT IS KNOWN ALREADY: The number of two-mother families is increasing, and previous studies have reported about challenges related to heteronormativity, discrimination and the status of the non-birth mother. Same-sex mothers have been found to disclose the child's donor conception earlier than different-sex parents, but little is known regarding disclosure of the child's right to obtain identifying information about the donor.STUDY DESIGN, SIZE, DURATION: The present study concerns the fourth wave of data collection of a nation-wide longitudinal study. A total of 143 same-sex mothers (73% response rate) following identity-release sperm donation completed individual surveys when their donor-conceived child had reached age 7. These women represent a total of 82 couples who had undergone sperm donation treatment.PARTICIPANTS/MATERIALS, SETTING, METHODS: The study is part of the longitudinal Swedish Study on Gamete Donation (SSGD). Couples accepted for gamete donation treatment at seven Swedish University hospitals were recruited between 2005 and 2008 and were requested to complete postal surveys during four waves of data collection. The present study sample includes same-sex mothers who completed a survey when their donor-conceived child had reached 7 years of age. Data were collected with the Swedish Parenting Stress Questionnaire (SPSQ), and study-specific items on experiences of treatment in society and disclosure behavior. Group comparisons (birth mothers vs non-birth mothers) were conducted using Chi2-tests, independent t-tests and Mann–Whitney U-tests, and written comments provided for open-response items were analyzed by qualitative content analysis.MAIN RESULTS AND ROLE OF CHANCE: The mothers were generally open about the child's donor conception and the large majority (>80%) reported being treated positively and in the same way as other parents. However, satisfaction with treatment in health care settings was significantly lower than that reported in contacts with the child's school and recreational activities (P < 0.001) and open-response comments indicate that this may be related predominantly to heteronormative language and assumptions. Birth mothers and non-birth mothers reported similar treatment in society and similar levels of parenting stress. All but one couple had already talked with their 7-year-old child about his/her conception with donor sperm. Half of the couples had also informed the child about his/her opportunity to obtain identifying information about the donor, and remaining couples planned later disclosure. Children's reactions were generally described as neutral, positive or characterized by interest and curiosity.LIMITATIONS, REASONS FOR CAUTION: The present study was performed within the context of the Swedish legislation on identity-release donation, which limits the generalizability to same-sex couples using anonymous or known sperm donors. Although no evidence of attrition bias was found, it is possible that those couples who initially declined participation in the SSGD (23%) or dropped out at the fourth wave of data collection (27%) differ from the study sample in terms of variables that we were unable to control for.WIDER IMPLICATION OF THE FINDINGS: The present finding that most same-sex mothers in a population-based sample experience equal treatment in society is encouraging and validates previous results from predominantly qualitative studies. Nevertheless, the fact that a subgroup experiences discrimination and less favorable treatment indicates that further action is needed, particularly in child health care settings. The present study is the first to report on the timing of parents' disclosure of the child's right to identifying donor information and suggests that disclosure during preschool ages is feasible and does not appear to be related to negative consequences. In view of the increased availability and use of identity-release donation, there is a pressing need to investigate parents' intentions, behaviors and needs with regard to talking with their child about his/her opportunity to obtain the donor’s identity.
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49.
  • Tordön, Rikard, Doktorand, 1969-, et al. (författare)
  • Background, experience of abuse, and mental health among adolescents in out-of-home care : a cross-sectional study of a Swedish high school national sample
  • 2019
  • Ingår i: Nordic Journal of Psychiatry. - : Taylor & Francis. - 0803-9488 .- 1502-4725. ; 73:1, s. 16-23
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: To compare experiences for adverse events, especially sexual abuse, and mental health in a group of high school students in out-of-home care with a representative sample of peers of the same age and similar educational attainment living with their parents. Materials and methods: A sample of 5839 students in the third year of Swedish high school, corresponding to a response rate of 59.7%, answered a study specific questionnaire. Data from 41 students living in out-of-home care were compared with data from peers not in out-of-home care in a cross-sectional analyze. Results: Students in out-of-home care had more often an immigrant background and a non-heterosexual orientation, had more often experienced physical and penetrative sexual abuse, and more often sought healthcare for mental problems. Disclosure of sexual abuse was less common, and acts of persuasion or adults' use of their social position was more common among students in out-of-home care. Conclusions: Even where the protective factor 'senior educational attainment' is present, risks for abuse and poor mental health are evident for adolescents in out-of-home care. Disclosure of adversity, when it has occurred, ought to be higher among these adolescents with regular contact with social services, but our findings indicate tendencies for the opposite. We therefore suggest routines to be established to screen for adverse life events and mental health actively, along with general and systematic assessments of adversity and mental health during care.
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50.
  • Tordön, Rikard, Doktorand, 1969- (författare)
  • Health, Experienced Support and School Performance among Children in Out-of-home care
  • 2020
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Children in out-of-home care (OHC) have higher risks for developing poorer health and school achievement, being subjected to more abuse experiences, as well as negative long-term outcomes related to occupational performance, socioeconomic status, addiction, and criminality. Research related to OHC children is fragmented and the effects of interventions are under-studied.This thesis aimed to explore health, abuse, support, and preconditions for school among children in OHC and to assess changes after an intervention targeting foster children’s school performance.Paper I compared OHC pupils in last year high school to non-OHC peers in a national survey with 5 839 pupils. The study showed that risks of abuse and poor mental health are evident for adolescents in out-of-home care. Also, results indicated a lower disclosure rate of sexual abuse, particularly to police or social services.Paper II compared OHC pupils to peers in birth parent care by analyzing responses in four consecutive year surveys in a regional sample comprising 23 798 pupils in 8th-year compulsory and 2nd-year high school. Responses from the 311 pupils in OHC showed poorer outcomes than did birth-parent care peers in perceived satisfaction with social life and relations, trust to other persons in different relations, abuse experiences online, and sense of security in the school and at home. These results also applied when compared to a subset of pupils living with a single birth parent.Paper III analyzed prospective test and questionnaire data of intelligence, adaptive behavior, mathematics, literacy skills, and psychosocial wellbeing from 856 children in foster care. Results revealed poorer preconditions for school performance of between 0.5 and 1.0 standard deviations below age-standardized norms. The analysis also provided results regarding different intelligence domains, where working memory showed the lowest scores while perceptual functioning were close to norms. Boys generally scored poorer than girls except in mathematics.Paper IV explored the effects of a school-based intervention, Skolfam, on a subset of Paper III cohort (n= 475). Results showed improved skills in higher-order cognitive executive functions such as reading comprehension, sentence chains, mathematics, and intelligence. For less complex cognitive functions, affective functioning or psychosocial symptoms, no improvements were seen, except for reduced hyperactivity.Conclusion: The studies confirm that children in OHC have poorer mental health, are less satisfied with social life, have more adverse experiences both online and in real life and have poorer preconditions for school performance than do non-OHC peers. Importantly, Skolfam intervention can partially enhance preconditions for school performance. Further studies on longitudinal risk, with a design to identify specific protective factors, development of school-related competencies and ways to support OHC children in school are needed.
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