| 1. |
- Adolfsson, Ann-Sofie, et al.
(författare)
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Applicability of general grief theory to Swedish women’s experiences after early miscarriage, with factor analysis of Bonanno´s taxonomy, using the Perinatal Grief Scale.
- 2010
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Ingår i: Upsala Journal of Medical Sciences. - : Uppsala Medical Society. - 0300-9734 .- 2000-1967. ; 115:3, s. 201-209
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Tidskriftsartikel (refereegranskat)abstract
- Background. Grief is a normal phenomenon but showing great variation depending on cultural and personal features. Bonanno and Kaltman have nonetheless proposed five aspects of normal grief. The aim of this study was to investigate if women with miscarriage experience normal grief. Material and methods. Content analyses of 25 transcribed conversations with women 4 weeks after their early miscarriages were classified depending on the meaning-bearing units according to Bonanno and Kaltman's categories. In the factor analyses, these categories were compared with the Perinatal Grief Scale and women's age, number of children and number of miscarriages, and gestational weeks. Results. Women with miscarriage fulfill the criteria for having normal grief according to Bonanno and Kaltman. All of the 25 women had meaning-bearing units that were classified as cognitive disorganization, dysphoria, and health deficits, whereas disrupted social and occupational functioning and positive aspects of bereavement were represented in 22 of 25 women. From the factor analysis, there are no differences in the expression of the intensity of the grief, irrespective of whether or not the women were primiparous, younger, or had suffered a first miscarriage. Conclusion. Women's experience of grief after miscarriage is similar to general grief after death. After her loss, the woman must have the possibility of expressing and working through her grief before she can finish her pregnancy emotionally. The care-giver must facilitate this process and accept that the intensity of the grief is not dependent on the woman's age, or her number of earlier miscarriages.
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| 2. |
- Berg, Marie, 1955, et al.
(författare)
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Person-centered web support to women with type 1 diabetes in pregnancy early motherhood : the development process
- 2013
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Ingår i: Diabetes Technology & Therapeutics. - : Mary Ann Liebert. - 1520-9156 .- 1557-8593. ; 15:1, s. 20-25
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Tidskriftsartikel (refereegranskat)abstract
- Background: Pregnancy and early motherhood are extraordinarily demanding periods for women with type 1 diabetes, who therefore need optimal support. This article describes the process of developing person-centered Web-based support for women with type 1 diabetes during the period of pregnancy through early motherhood. Important aspects of perrsoncenteredness are a broader scope of medicine, viewing the patient as a person, shared decision-making to accomplish a therapeutic alliance, and the role of documentation.Materials and Methods: A participatory design was used in the development process to capture the target group’s knowledge, experiences, and needs, and a systematic process map for Web-based support was used to describe the process.Results: Content and layout in the Web support were developed collaboratively by project managers, advisory and scientific reference groups, technical producers, and representatives for the target group. Based on needs assessment and evidence synthesis, three main components of complementary Web-based support were identified: (1) specific information about pregnancy, childbirth, and early motherhood in relation to type 1 diabetes; (2) a self-care diary, including a device for documenting and evaluating blood glucose levels, insulin doses, food intake, physical activities, and overall well-being; and (3) a forum for communication between women with type 1 diabetes in the childbearing period.Conclusions: Using a perspective of person-centered care, a participatory design and the process map were fruitful for developing person-centered Web support for self-care and self-learning. The developed Web support product will be evaluated in a randomized controlled trial and further developed based on this result.
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| 3. |
- Eriksson, Katarina, et al.
(författare)
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The prevalence of BV in the population on the Åland Islands during a 15-year period
- 2010
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Ingår i: Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS). - Malden, USA : John Wiley & Sons. - 0903-4641 .- 1600-0463. ; 118:11, s. 903-908
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the study was to describe the prevalence and age distribution of bacterial vaginosis (BV) during an observation period of 15 years in a population study with cross-sectional samples of adult women living on the Åland Islands. The Åland Islands form an archipelago in the Baltic Sea and are a province of Finland. Every fifth year, specific age groups in the adult female population are invited to participate in a screening program for early diagnosis of cervical cancer using a papanicolaou (PAP)-stained vaginal smear. Women in the age groups of 20, 25, 30, 35, 40, 45, 50, 55, and 60 years are called each year. BV diagnosis of the PAP-stained smears uses the classification according to Nugent. The PAP-stained smears from the screening program of cervical cancer 1993, 1998, 2003, and 2008 were used in this study. A total of 3456 slides were investigated and 271 women could be followed for the 15-year observation period. The prevalence of BV declined from 15.6% in 1993 to 8.6% in 2008. The highest prevalence occurred among the age groups of 35 and 50 years. Among the 271 women who could be followed for the 15-year observation period, two-third showed normal/intermediate flora and one-third were infected with BV at least once. As this is a cross-sectional population study spanning 15 years, the prevalence of BV in the female adult population of the Åland Islands can be estimated. The prevalence has declined between 1993 and 2008 from 15.6% to 8.6%.
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| 4. |
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| 5. |
- Wojnar, Danuta M., et al.
(författare)
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Confronting the inevitable : a conceptual model of miscarriage for use in clinical practice and research
- 2011
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Ingår i: Death Studies. - : Routledge. - 0748-1187 .- 1091-7683. ; 35:6, s. 536-558
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Tidskriftsartikel (refereegranskat)abstract
- In spite of scientific evidence that miscarriage has negative psychological consequences for many individuals and couples, silence and dismissal continue to surround this invisible loss in North American culture and beyond. The grief and sorrow of miscarriage has important implications for clinical practice. It indicates a need for therapeutic interventions delivered in a caring, compassionate, and culturally sensitive manner. This research, based on data from 3 phenomenological investigations conducted with 42 women from diverse geographical locations, sexual orientations, and cultural backgrounds offers a theoretical framework for addressing miscarriage in clinical practice and research.
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| 6. |
- Eriksson, Katarina
(författare)
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Bacterial Vaginosis : Diagnosis, Prevalence, and Treatment
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Bacterial Vaginosis (BV) is a disorder of unknown etiology, characterized by a foul smelling vaginal discharge, loss or reduction of the normal vaginal Lactobacilli, and overgrowth of other anaerobic bacteria. Thus, it presents a formidable problem for clinicians as well as microbiologists researching its etiology, clinical course, treatment, and epidemiology. The present work focuses on the unresolved issues of the epidemiology and treatment of BV in order to provide valid methods for treatment studies of this condition and to describe the prevalence of BV in defined populations.The first study validates the use of PAP-stained smears in the diagnosis of BV. The study assesses the methods of Amsel’s clinical criteria and Nugent criteria on Gram-stain smears, against Pap-stained smears and also validates different observers. The result shows that the PAP-staining of vaginal smears is a good method in BV diagnosis; the kappa value is 0.86 (interobserver weighted kappa index) compared to 0.81 for Gram-stained smears, and 0.70 for rehydrated air-dried smears using the mean Nugent score as the criterion standard. This enables population based studies on archived PAP-stained smears from the screening of cervical cancer.In the second study, we use the knowledge gained from study one to investigate the prevalence of BV in a cohort from the population of Åland. The prevalences of BV on the Åland Islands were: 15.6 %, 11.9 %, 8.7 %, and 8.6% in 1993, 1998, 2003, and 2008, respectively. This means that the prevalence of BV decreased between1993-2008 from 15.6% to 8.6%. The confidence intervals are not overlapping, thus indicating a significant decrease in prevalence from 1993 to 2008.The third study is a prospective, double-blind placebo controlled treatment study of BV. After conventional treatment with clindamycin, the patients were treated with adjuvant treatment of Lactobacilli-loaded tampons or placebo. The study showed no differences between the treatment and the placebo group, indicating that the tampon does not work at all. There are a variety of possible explanations for the result, which are analyzed in this thesis.The fourth study aimed to evaluate whether clindamycin is retained for a long time in the vaginal mucosa, thus disturbing the Lactobacilli in an attempt to reimplant Lactobacilli in the probiotic treatment studies. In conventional treatment, it is also useful to know whether clindamycin is retained, especially when considering the pressure from antibiotics on the antimicrobial sensitivity pattern. In the study, we found that the clindamycin disappears rapidly.Conclusion: BV research requires effort from many different scientific disciplines and the riddle of this condition and its treatment can only be resolved by concerted actions in research and treatment. The vision for the future includes, among other factors, better molecular biology based diagnostic tools, and knowledge of population based bacterial floras.
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| 7. |
- Linden, Karolina, 1982, et al.
(författare)
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A woman-centered web-support program during pregnancy and early motherhood for women with type 1 diabetes
- 2014
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Ingår i: The International Confederation of Midwives. ICM 30th Triennial Congress. 1-5 June 2014 Prague, Czech Republic.
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Konferensbidrag (refereegranskat)abstract
- Background: Midwives have the responsibility to strengthen normal birth and promote breastfeeding; this challenge also includes women with chronic illness, such as type 1 diabetes. The transition to motherhood in pregnant women with type 1 diabetes is influenced by their constant struggle to achieve normoglycemia and negative feelings such as stress, anxiety and hopelessness are present. Aim: To describe the design of a woman-centered web-support for pregnant women and new mothers with type 1 diabetes. Method: A web-support has been developed using participatory design. A research project management group had the responsibility of steering the project forward. Different stakeholders including, midwifery, medical, nursing and target group expertise participated in the development. The web-support is implemented through a randomized controlled trial. Result: The developed web-support consists of three parts: 1) Specific information about pregnancy, childbirth, and early motherhood in relation to type 1 diabetes, where the challenge is to balance the core values of normal childbearing with diabetes related issues. 2) A self-care diary, including a device for documenting and evaluating blood glucose levels, insulin doses, food intake and physical activities. This enables the woman to keep in control of her own health. 3) A forum for peer support through communication between women and mothers in pregnancy and early motherhood. This enables sharing of similar experiences and of strategies to handle daily life. Clinical relevance: Well-being in terms of joy of childbearing, birth and motherhood could be achieved by addressing diabetes related health risks and complications in a manner that emphasizes the normality of being pregnant, giving birth and breastfeeding. A balancing act between focusing on potential risks and normal pregnancy related processes.
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| 8. |
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| 9. |
- Linden, Karolina, 1982, et al.
(författare)
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Study protocol for evaluating a web-support program with a control group for pregnant women and new mothers with type 1 diabetes mellitus.
- 2013
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Ingår i: 7th International DIP Symposium - Diabetes, Hypertension, Metabolic syndrome & Pregnancy. Florence, Italy, March 13-16, 2013.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background In the struggle to achieve normoglycemia during pregnancy, women with type 1 diabetes mellitus (T1D) alternate between mastering their situation and feeling enslaved. Caregivers not only have the responsibility of optimising the women’s biological probability of delivering healthy children, but also of supporting them during their transition to motherhood. In order to establish breastfeeding and simultaneously control blood glucose, the mothers require extended post-partum support. The aim was to describe the study design of an on-going randomized controlled trial evaluating a web-support program for pregnant women and new mothers with T1D. Methods The developed web-based support is being implemented through a randomized controlled trial in which women with T1D in early pregnancy are randomized to either web-based support in addition to usual care (IG) or usual care (CG). A sample size of 160 is required based on the two primary outcomes: a general wellbeing scale (W-BQ12) and a diabetes empowerment scale (SWE-DES) to reach a statistical power of 80% with a significance level of 0.05. Results The web-support consists of evidence-based information, person-centred self-care diaries and an online social community. Outcomes will be measured in early pregnancy (baseline), about five weeks before expected partus and at two and six months after partus. Conclusion The unique contribution of this project is the development of a specially designed web application for mothers with T1D which is expected to increase the women’s personal resources, including knowledge, and thereby strengthen their autonomy during pregnancy, breastfeeding and early motherhood.
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