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- Berg, Marie, 1955, et al.
(författare)
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Web-Based Intervention for Women With Type 1 Diabetes inPregnancy and Early Motherhood : Critical Analysis of Adherenceto Technological Elements and Study Design
- 2018
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Ingår i: Journal of Medical Internet Research. - : JMIR Publications. - 1438-8871. ; 20:5
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Tidskriftsartikel (refereegranskat)abstract
- Background: Numerous Web-based interventions have been implemented to promote health and health-related behaviors inpersons with chronic conditions. Using randomized controlled trials to evaluate such interventions creates a range of challenges, which in turn can influence the study outcome. Applying a critical perspective when evaluating Web-based health interventions is important.Objective: The objective of this study was to critically analyze and discuss the challenges of conducting a Web-based health intervention as a randomized controlled trial.Method: The MODIAB-Web study was critically examined using an exploratory case study methodology and the framework for analysis offered through the Persuasive Systems Design model. Focus was on technology, study design, and Web-based support usage, with special focus on the forum for peer support. Descriptive statistics and qualitative content analysis were used.Results: The persuasive content and technological elements in the design of the randomized controlled trial included all four categories of the Persuasive Systems Design model, but not all design principles were implemented. The study duration was extended to a period of four and a half years. Of 81 active participants in the intervention group, a maximum of 36 women were simultaneously active. User adherence varied greatly with a median of 91 individual log-ins. The forum for peer support was used by 63 participants. Although only about one-third of the participants interacted in the forum, there was a fairly rich exchange of experiences and advice between them. Thus, adherence in terms of social interactions was negatively affected by limited active participation due to prolonged recruitment process and randomization effects. Lessons learned from this critical analysis are that technology and study design matter and might mutually influence each other. In Web-based interventions, the use of design theories enables utilization of the full potential of technology and promotes adherence. The randomization element in a randomized controlled trial design can become a barrier to achieving a critical mass of user interactions in Web-based interventions, especially when social support is included. For extended study periods, the technology used may need to be adapted in line with newly available technical options to avoid the risk of becoming outdated in the user realm, which in turn might jeopardize study validity in terms of randomized controlled trial designs.Conclusions: On the basis of lessons learned in this randomized controlled trial, we give recommendations to consider when designing and evaluating Web-based health interventions.
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| 3. |
- Lindahl, Hannes, et al.
(författare)
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IL-22 Binding Protein Promotes the Disease Process in Multiple Sclerosis
- 2019
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Ingår i: Journal of Immunology. - : AMER ASSOC IMMUNOLOGISTS. - 0022-1767 .- 1550-6606. ; 203:4, s. 888-898
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Tidskriftsartikel (refereegranskat)abstract
- Genome-wide association studies have mapped the specific sequence variants that predispose for multiple sclerosis (MS). The pathogenic mechanisms that underlie these associations could be leveraged to develop safer and more effective MS treatments but are still poorly understood. In this article, we study the genetic risk variant rs17066096 and the candidate gene that encodes IL-22 binding protein (IL-22BP), an antagonist molecule of the cytokine IL-22. We show that monocytes from carriers of the risk genotype of rs17066096 express more IL-22BP in vitro and cerebrospinal fluid levels of IL-22BP correlate with MS lesion load on magnetic resonance imaging. We confirm the pathogenicity of IL-22BP in both rat and mouse models of MS and go on to suggest a pathogenic mechanism involving lack of IL-22-mediated inhibition of T cell-derived IFN-gamma expression. Our results demonstrate a pathogenic role of IL-22BP in three species with a potential mechanism of action involving T cell polarization, suggesting a therapeutic potential of IL-22 in the context of MS.
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| 5. |
- Linden, Karolina, 1982, et al.
(författare)
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Person-centred web-based support in pregnancy and early motherhood for women with Type 1 Diabetes Mellitus : a randomized controlled trial
- 2018
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Ingår i: Diabetic Medicine. - : Wiley-Blackwell. - 0742-3071 .- 1464-5491. ; 5:2, s. 232-241
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Tidskriftsartikel (refereegranskat)abstract
- Aims: To report results from and explore use of a multicentre, parallel-group, unblinded, randomized controlled trial testing the effectiveness in terms of well-being and diabetes management of a person-centred, web-based support programme for women with Type 1 diabetes, in pregnancy and postpartum.Methods: Between 2011 and 2014, 174 pregnant women with Type 1 diabetes were randomly allocated (1:1) to web-based support and standard care (intervention group, n=83), or standard care (control group, n=91). The web-based support consisted of evidence-based information; a self-care diary for monitoring of daily activities; and peer support in a discussion forum. The primary outcomes (mean difference, measured at 6 months after childbirth) were well-being and diabetes management.Results: No differences were found with regard to the primary outcome measure scores for general well-being [1.04 (95% CI -1.28 to 3.37); P= 0.68] and self-efficacy of diabetes management [0.076 (95% CI -0.123 to 0.275); P= 0.75], after adjustment for baseline differences in the insulin administration method, nor with regard to the secondary outcome measures.Conclusions: At 6 months after childbirth, the web-based support plus standard care was not superior to standard care in terms of general well-being or self-efficacy of diabetes management. This might be explained by the low number of participants who had a high activity level. Few simultaneously active participants in the web-based programme and stressors in motherhood and diabetes postpartum were the main barriers to its use. Further intervention studies that offer web-based support are needed, with lessons learned from the present study.
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| 6. |
- Linden, Karolina, 1982, et al.
(författare)
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Well-Being and Diabetes Management in Early Pregnant Women with Type 1 Diabetes Mellitus
- 2016
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Ingår i: International Journal of Environmental Research and Public Health. - Basel, Switzerland : MDPI AG. - 1660-4601 .- 1661-7827. ; 13:8
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Tidskriftsartikel (refereegranskat)abstract
- This paper explores well-being and diabetes management in women with type 1 diabetes mellitus (DM) in early pregnancy and investigates associations among perceived well-being, diabetes management, and maternal characteristics. Questionnaires were answered by 168 Swedish women. Correlation analyses were conducted with Spearman's correlation coefficient (r(s)). The women reported relatively high scores of self-efficacy in diabetes management (SWE-DES-10: 3.91 (0.51)) and self-perceived health (excellent (6.5%), very good (42.3%), good (38.7%), fair (11.3%) and poor (1.2%)). Moderate scores were reported for general well-being (WBQ-12: 22.6 (5.7)) and sense of coherence (SOC-13: 68.9 (9.7), moderate/low scores for hypoglycemia fear (SWE-HFS 26.6 (11.8)) and low scores of diabetes-distress (SWE-PAID-20 27.1 (15.9)). A higher capability of self-efficacy in diabetes management showed positive correlations with self-perceived health (r(s) = 0.41, p < 0.0001) and well-being (r(s) = 0.34, p < 0.0001) as well as negative correlations with diabetes distress (r(s) = 0.51, p < 0.0001) and hypoglycemia worries (r(s) = 0.27, p = 0.0009). Women with HbA1c levels of <= 48 mmL/mol scored higher in the subscales "goal achievement" in SWE-DES (p = 0.0028) and "comprehensibility" in SOC (p = 0.016). Well-being and diabetes management could be supported by strengthening the women's capability to achieve glycemic goals and their comprehensibility in relation to the treatment. Further studies are needed to test this.
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| 7. |
- Linden, Karolina, 1982, et al.
(författare)
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Well-being, diabetes management and breastfeeding in mothers with type 1 diabetes – An explorative analysis
- 2018
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Ingår i: Sexual and Reproductive Healthcare. - : Elsevier BV. - 1877-5756 .- 1877-5764. ; 15, s. 77-82
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Tidskriftsartikel (refereegranskat)abstract
- Objectives The aim was to explore and investigate associations between well-being, diabetes management and breastfeeding in mothers with type 1 diabetes mellitus (T1DM) up to six months postpartum. Methods An explorative analysis of self-reported questionnaires measuring general well-being, sense of coherence, self-efficacy of diabetes management and experiences of diabetes management during breastfeeding, which were distributed to 155 mothers with T1DM at two months and at six months after childbirth. The questionnaires were answered by 128 (82.5%) at two months and 137 (88.4%) at six months after birth. Statistical analysis included; descriptive statistics, Wilcoxon sign-rank test, sign test and Spearman's correlation coefficient (rs). Results The majority of the mothers had fairly high levels of general well-being and diabetes management but a quarter had a low sense of coherence at both two and six months after birth. A weak association was found between more unstable blood glucose levels and lower general well-being at two months postpartum, but no other associations with erratic glycaemia was found. Those with lower grades of general well-being and sense of coherence had a higher need of professional support to manage their diabetes than they were offered, at both two and six months. Conclusion To develop more optimal care routines for mothers with T1DM after childbirth, further studies are needed to identify those most in need of additional support. © 2017 The Authors
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| 8. |
- Linden, Karolina, 1982
(författare)
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Women with type 1 diabetes during pregnancy and postpartum Well-being and diabetes management
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Type 1 diabetes mellitus (T1DM) is associated with increased medical risks during pregnancy and birth. To minimize the risks and increase the possibility of a healthy offspring, blood glucose levels near normal are required. This puts women with T1DM in a vulnerable situation in relation to pregnancy and childbirth, as it demands high levels of diabetes management. The overall aim was to investigate well-being and diabetes management in women with T1DM during pregnancy and in the first six months postpartum. Studies I, II and III mainly report on patient-reported outcome measures in terms of questionnaires. Studies I and III have an observational design and Study II was a randomized controlled trial. Study IV used a case study design and analysed data with both quantitative and qualitative methods. In Study I, well-being and diabetes management in early pregnancy was explored. A higher degree of diabetes management correlated positively with self-perceived health and well-being and with less worry about diabetes distress and hypoglycemia. In Study II, a web-based support program during pregnancy and up to six months after childbirth was evaluated. The findings suggest that the web-based support and standard care was not superior to standard care alone in terms of general well-being or self-efficacy of diabetes management at six months postpartum and that few participants had a high activity level. In Study III, associations between well-being, diabetes management and breastfeeding postpartum were investigated. Participants with lower scores of general well-being and sense of coherence expressed a need for more professional support to manage their diabetes than they were offered. In Study IV, adherence to technological elements and study design in a web-based intervention were critically analysed. The results highlight that technology and study design matter and might mutually influence each other. The findings confirm that well-being and diabetes management are closely linked during the childbearing period. Means of identifying a more vulnerable group of women with T1DM during pregnancy and new approaches to professional support after childbirth are needed.
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| 9. |
- Naurin, Elin, 1975, et al.
(författare)
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Does transition to parenthood affect gender traits? The Effect of Pregnancy on Perceived Female and Male Traits
- 2019
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Ingår i: NJF Congress 2019 Abstract Book.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background Gendered identities are strengthened during pregnancy and the early phases of parenthood; women feel more female and men more male. Gendered cultural narratives that further emphasize disparities in parenting roles between the sexes embed this transition period. However, it has been argued that it is the social practice of mothering, rather than the bodily or emotional experience or pregnancy and childbirth, which yield a traditionalizing influence on women’s gender ideologies. There is reason to believe that the effects of pregnancy and childbirth is less apparent in contexts with strong welfare state support for the parents and where gender equality is a societal norm. Methods The data was collected from a subset of the large-scale Swedish Citizen Panel consisting of pregnant respondents or respondents who identify themselves as partners to someone who is pregnant. At two time points, these respondents were asked about the extent to which they have “female” and “male traits”. The methodological approach was to explore pregnancy and childbirth as a process and study respondents over time; to compare pregnant women to partners of pregnant women and to compare pregnant women and partners of pregnant women to individuals in the panel who do not become pregnant during the studied period. Data was analyzed by fixed effects panel regression. Findings Data from 2445 respondents was analyzed. No statistical significant changes in perceived gender traits were found in the respondents’ answers between pre-pregnancy and pregnancy; pregnancy and being having an infant <6 months of age; or being a parent of an infant < 6 months of age and having a child > 6 months of age. With the exception that men expressed that they had somewhat less female traits postpartum (-0.3, p<0.05). Conclusion Self-perceptions of gendered traits are mainly stable over pregnancy and early parenthood in this Swedish sample.
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