| 1. |
- Lundin, Cecilia, et al.
(författare)
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Hormonal Contraceptive Use and Risk of Depression Among Young Women With Attention-Deficit/Hyperactivity Disorder
- 2023
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Ingår i: Journal of the American Academy of Child and Adolescent Psychiatry. - : Elsevier BV. - 0890-8567 .- 1527-5418. ; 62:6, s. 665-674
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Women with attention-deficit/hyperactivity disorder (ADHD) have an increased risk of becoming teenage mothers. Adverse effects of hormonal contraception (HC), including depression, may affect adherence to user-dependent contraception and increase the risk for unplanned pregnancies and teenage births in women with ADHD. The current study analyzed whether girls and young women with ADHD are at increased risk for depression during HC use compared with women without ADHD.Method: A linkage of Swedish national registers covering 29,767 girls and young women with ADHD aged 15 to 24 years and 763,146 without ADHD provided measures of ADHD and depression diagnoses (International Classification of Diseases [ICD] code) and prescription of stimulant medication, HC, and antidepressant medication (Anatomical Therapeutic Chemical [ATC] code). Cox regression models applying an interaction term (ADHD diagnosis x HC use) evaluated the excess risk of HC-induced depression in women with ADHD.Results: Women with ADHD had a 3-fold higher risk of developing depression, irrespective of HC use (adjusted hazard ratio [aHR] = 3.69, 95% CI = 3.60-3.78). Oral combined HC users with ADHD had a 5 times higher risk of depression compared with women without ADHD who were not using oral combined HC (aHR = 5.19, 95% CI = 4.94-5.47), anda 6 times higher risk in comparison with women without ADHD who were on oral combined HC (aHR = 6.10 (95% CI = 5.79-6.43). The corresponding risk of depression in women with ADHD who used a progestogen-only pill (aHR = 5.00, 95% CI = 4.56-5.49). The risk of developing depression when using non-oral HC was similarly moderately increased in both groups.Conclusion: Girls and young women with ADHD have an increased risk of developing depression when using oral HC compared with their un-affected peers. Information on risks with HCs as well as potential benefits with long-acting reversible contraceptives needs to be an integrated part of the shared decision making and contraception counseling for young women with ADHD.
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| 2. |
- Döhlen Wedin, Anna
(författare)
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The planner's dilemma : An ethical investigation of adaptation to sea level rise
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This is a thesis on the ethics of adaptation to sea level rise, with a focus on proactive adaptation planning. The research, which has been conducted within a transdisciplinary research project, takes a bottom-up approach to applied ethics, and has been conducted in close collaboration withadaptation planners and other project partners. The thesis consists of an introductory chapter which includes broader methodological concerns, and an overview of scientific and theoretical issues that are considered as relevant background to the broader research topic, as well as five articles.Article 1: Departing from an interview study with planners working with adaptation to sea level rise in Sweden, a typology of ethical issuesis presented. It is shown that planners have to deal with input-oriented, process-oriented, and outcome-oriented ethical issues, and that knowledge of these can contribute to ethical adaptation policy.Article 2: Responsibility of adaptation to sea level rise is often assigned to local planners. But what does it mean to be responsible? Departing from the idea of professional virtues, three codes of ethics for planners are analysed to extract aspirational characteristics for planners. The identified virtues are put in relation to central challenges of adaptation, where five virtues stand out as central to the understanding of what it means to be responsible in adaptation to sea level rise.Article 3: A method building on Value Sensitive Design (VSD) and scenario planning is developed and applied to address the challenge of integrating ethics when planning for uncertainty over long time-horizons, in the context of adaptation to sea level rise. The method iscalled VSSP and consists of three steps for scenario development and three steps for value investigations. The application resulted in insights on aspects important for an ethical long-term adaptation to sea levelrise.Article 4: Climate change and adaptation to climate change tend to have disproportionately negative impacts on women. An analysis of what a gender-sensitive adaptation planning needs to address is conducted, and the potential of VSSP as an approach for promoting gender equality in long-term adaptation planning is investigated.Article 5: The concept of feasibility, as it is used in the climate change context, is discussed. It is found that common uses of the term fail to capture what is meant by feasibility, and that this can have significant consequences for practical deliberation on climate policy. The conditional probability account of feasibility, as discussed in political theory, is suggested as a preferable account for feasibility in the climate change discourse.In all, the thesis explores a range of ethical topics of relevance in the context of planning for a sustainable adaptation to sea level rise. It bridges practical experiences and concerns with insights from the fields of climate ethics, decision theory, philosophy of technology, and political philosophy, to mention a few. In doing this, the thesis contributes to thegrowing field of ethics of climate change adaptation, with results that can be of interest to both philosophers, planners, and others working with adaptation genrally and adaptation to sea level rise specifically.
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| 3. |
- Grundström, Hanna, 1982-, et al.
(författare)
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Demographic and clinical characteristics determining patient-centeredness in endometriosis care
- 2023
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Ingår i: Archives of Gynecology and Obstetrics. - : Springer. - 0932-0067 .- 1432-0711. ; 307, s. 1047-1055
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The primary aim of this study was to assess patient-centeredness of endometriosis care in a national sample of Swedish women with endometriosis. The secondary aims were to assess the importance of different dimensions of endometriosis care and to analyze demographic and clinical determinants associated with the experience of patient-centeredness.Methods: This cross-sectional study included 476 women with confirmed endometriosis. An invitation to participate was sent to 1000 randomly selected women aged ≥ 18 years having any endometriosis diagnosis and who had visited a gynecological clinic due to endometriosis problems any time during the past five years. Participants were recruited from ten different-sized gynecology clinics all over Sweden. The invitation letter had a link to the digital survey, which consisted of demographic and clinical questions, and the ENDOCARE questionnaire (ECQ). ECQ measures experiences, importance and patient-centeredness of ten dimensions of endometriosis care. Univariate and multiple regression analyses were used to analyze which patient-specific demographic and clinical determinants were associated with the experience of patient-centeredness.Results: The response rate was 48%. The results indicate that Swedish women with endometriosis experience low patient-centeredness and rate relational aspects with healthcare professionals as the most important aspects of care. Having a gynecologist with patient responsibility was an independent predictor for high patient-centeredness.Conclusion: Women with endometriosis in Sweden experience low patient-centeredness, reflecting the urgent need for improvement. More effort should be given to develop the relational aspects of care. Women with endometriosis should have a responsible gynecologist to care for treatment and follow-up.
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| 4. |
- Grundström, Hanna, 1982-, et al.
(författare)
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Psychometric evaluation of the Swedish version of the 30-item endometriosis health profile (EHP-30)
- 2020
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Ingår i: BMC Women's Health. - : BMC. - 1472-6874. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: The 30-Item Endometriosis Health Profile (EHP-30) is a specific instrument measuring quality of life among women with endometriosis. Although the Swedish version of EHP-30 is widely used in research and clinical settings, it has not yet been evaluated psychometrically. Ensuring validity and reliability is of most importance when using translated instruments. Therefore, the aim of the study was to evaluate the psychometric properties of the Swedish version of the EHP-30. Methods: This study was conducted at a Swedish referral university hospital specializing in endometriosis. Data collection was performed in January 2013. The EHP-30 was sent to 369 randomly selected women with a laparoscopy-verified endometriosis diagnosis. The psychometric evaluation included evaluation of data completeness, score distributions, floor and ceiling effects, internal consistency, factor analysis and test-retest reliability. Results: Out of the 211 women with endometriosis who answered the questionnaire, 128 were native Swedish speakers who had experienced symptoms of endometriosis during the past 4 weeks, and were included in the psychometric evaluation. Data completeness was 99.5%. The highest median score was found in the Control and Powerlessness subscale, and lowest in Pain. Distributions towards ill health were found in all subscales except for the pain subscale, but there were no noteworthy floor or ceiling effects. Internal consistency was good (Cronbach's alpha 0.83-0.96). Factor analysis could roughly confirm three of the five subscales. The test-rest analysis showed good reliability. Scores were systematically lower during the second measurement. Conclusions: We conclude that the Swedish version of EHP-30 is a valid and reliable instrument to measure health-related quality of life in women with endometriosis. It is understandable, acceptable and usable and can be recommended for use in clinical daily routines and for research purposes.
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| 5. |
- Grundström, Hanna, et al.
(författare)
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Translation, Cross-Cultural Adaptation, and Psychometric Evaluation of the Swedish Version of ENDOCARE : An Instrument to Measure Patient Centeredness of Endometriosis Care
- 2021
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Ingår i: Gynecologic and Obstetric Investigation. - : S. Karger AG. - 0378-7346 .- 1423-002X. ; 86:3, s. 283-292
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The need for quality improvement within endometriosis healthcare is widely acknowledged. The ENDOCARE questionnaire (ECQ) measures patient centeredness of endometriosis care. The aims of this study were (1) to translate and culturally adapt ECQ into Swedish, (2) to evaluate validity (construct validity), and (3) to measure reliability (internal consistency and test-retest reliability).Design: This is a cross-sectional randomized study.Participants, Setting, and Methods: ECQ was first translated according to a well-established guideline and was thereafter sent to 500 randomly selected women with endometriosis, who had visited participating clinics during the past 3 years. The first 150 women who returned their questionnaires were immediately sent the same questionnaire again. The ECQ consists of 3 parts. The first part contains demographic and clinical questions, while part II has 38 items that are answered according to 2 aspects: percentage of negative experience of care and mean personal importance. A patient-centeredness score (PCS) is calculated based on these 2 aspects. The items are also divided into 10 dimensions of care. Part III is a grading of overall experience and an open-ended question on any missing aspect in the questionnaire.Results: A total of 187 native Swedish-speaking women participated. Data completeness was high (>90%). The overall PCS median was 3.5. The highest median PCS was found in the dimension regarding endometriosis clinic staff and the lowest in emotional support and alleviation of fear and anxiety and the involvement of significant others. Factor analysis could roughly confirm 2 of the 10 dimensions. The Cronbach's alpha coefficient for PCS ranged from 0.35 to 0.73. The test-rest analysis showed acceptable reliability.Limitations: The most important limitation was the relatively low participation rate and the risk of recall bias. It is likely that women gave their answers based on their most recent experiences.Conclusions: Overall, our results indicate that the Swedish version of the ECQ is a usable instrument to measure patient centeredness in endometriosis care, but due to the unstable factor analysis, conclusions based on the dimensions should be made with caution.
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| 6. |
- Kanyama, Annika Carlsson, et al.
(författare)
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"The Greatest Benefit Is to Think Differently" : Experiences of Developing and Using a Web-Based Tool for Decision-Making under Deep Uncertainty for Adaptation to Sea Level Rise in Municipalities
- 2024
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Ingår i: Sustainability. - : MDPI. - 2071-1050. ; 16:5
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Tidskriftsartikel (refereegranskat)abstract
- The need for handling the deep uncertainty surrounding the future climate has led to various novel and robust approaches for decision-making under deep uncertainty (DMDU) when adapting to climate change. Here, an online and self-explanatory web-based tool was developed and tested with civil servants from five municipalities in Sweden challenged by rising sea levels. The municipalities used the tool by themselves and were then interviewed about the usability of the tool, the perceived urgency of climate change adaptation, and the possibilities for municipalities for handling the flexible solutions that are at the core of DMDU. Results were that the civil servants reported that the urgency of climate change adaptation has increased, that the tool changed their perspectives compared to traditional planning methods, and that changes in laws and regulations to accommodate decisions about flexible solutions were recommended.
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| 7. |
- Metzger, Jonathan, 1978-, et al.
(författare)
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The flexibility gamble : challenges for mainstreaming flexible approaches to climate change adaptation
- 2021
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Ingår i: Journal of Environmental Policy and Planning. - : Informa UK Limited. - 1523-908X .- 1522-7200.
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Tidskriftsartikel (refereegranskat)abstract
- Adaptive and flexible approaches based on implementing different measures as new information emerges have been proposed as a way of enabling robustness towards uncertain future climate change. However, the success of flexible approaches in practice depends on the stability of the relevant organizational landscapes. In this paper, we draw upon key insights from the institutional theories of organizations and research on public administration and climate adaptation in Sweden. We argue that potential organizational instabilities pose a substantial challenge for the mainstreaming of flexible approaches to climate adaptation. Given the unstable character of the relevant organizational landscape in a very stable country such as Sweden, it seems reasonable to also seriously doubt the capacity of the relevant authorities in less stable countries to carry out a great number of monitoring-intensive, and hence attention-demanding, adaptive governance processes over time. Based on our results we argue that it is perilous to simply assume that flexible approaches to climate adaptation will lead to greater robustness.
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| 8. |
- Niemeyer Hultstrand, Jenny, et al.
(författare)
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Hormonal contraception and risk of breast cancer and breast cancer in situ among Swedish women 15-34 years of age : A nationwide register-based study
- 2022
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Ingår i: The Lancet Regional Health. - : Elsevier. - 2666-7762. ; 21
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Tidskriftsartikel (refereegranskat)abstract
- Background: Evidence on a possible association between newer hormonal contraceptives (HC) and risk of breast cancer remains inconclusive, especially as concerns progestogen-only methods.Methods: In this nationwide prospective cohort study, all Swedish women aged 15-34 at study start on January 1st 2005, or who turned 15 years during the study period, were followed until December 31st 2017. Using information from seven National Registers, we assessed the risk ratio of developing breast cancer and breast cancer in situ in relation to different HC using Poisson regression. We adjusted the analyses for several known confounders of breast cancer.Findings: This cohort included 1.5 million women providing more than 14 million person-years. During the study period, 3842 women were diagnosed with breast cancer. Compared with never users of any HC, we found no increased risk of developing breast cancer among current users of any combined HC, IRR 1.03 (0.91-1.16), whereas current users of progestogen-only methods had an increased risk of developing breast cancer, IRR 1.32 (1.20-1.45). Across all types of HC, the risk of developing breast cancer appeared to be highest the first five years of use (combined HC IRR 1.39 (1.14-1.69); progestogen-only methods IRR 1.74 (1.44-2.10). The risk disappeared ten years after the women stopped using HC. The absolute risk of breast cancer per 100,000 women-years was 22.4 for never users, 10.9 for current users of combined HC, and 29.8 for current users of progestogen-only methods.Interpretation: Current use of progestogen-only methods is associated with a small increased risk of developing breast cancer, whereas we could only detect an increased risk among users of combined HC during the first five years of use. This may partly be explained by a selective prescription of progestogen-only methods to women with risk factors for breast cancer, like smoking or obesity. As the absolute risk of breast cancer was small, the many health benefits associated with HC must also be taken into account in contraceptive counselling.
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| 9. |
- Osterroos, Anna, et al.
(författare)
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Associations between capillary glucose during pregnancy and childhood growth to the age of five : a cohort study
- 2022
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Ingår i: Scientific Reports. - : NATURE PORTFOLIO. - 2045-2322. ; 12:1
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Tidskriftsartikel (refereegranskat)abstract
- The objective of this study was to evaluate the relationship between random capillary glucose levels in healthy pregnant women and infant size at birth and childhood growth to the age of five years. This population-based cohort study comprised 10,937 healthy mother-child dyads. Data on highest maternal random capillary glucose level during pregnancy and sequential anthropometric data on their children during the first five years of life were gathered from the Uppsala County Mother and Child Cohort. Statistical analyses were performed with linear regression and linear mixed effect regression models. We found that higher glucose level during pregnancy was associated with higher weight z-score (beta 0.10, 95% confidence interval (CI) 0.08-0.11), length z-score (beta 0.05, 95% CI 0.03-0.07) and BMI z-score (beta 0.09, 95% CI 0.07-0.12) at birth, adjusted for maternal BMI and country of birth, smoking during pregnancy and parity. The association did not remain at 11/2, 3, 4 and 5 years of age. There was a positive relationship between higher glucose level during pregnancy and a decrease in weight z-score, height z-score and BMI z-score from birth to 5 years of age. In conclusion, higher random capillary glucose levels in pregnant healthy women were associated with greater infant size at birth, as well as decreased growth velocity in early childhood.
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| 10. |
- Pulkkinen, Karoliina, et al.
(författare)
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The value of values in climate science
- 2022
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Ingår i: Nature Climate Change. - : Springer Nature. - 1758-678X .- 1758-6798. ; 12:1, s. 4-6
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Tidskriftsartikel (refereegranskat)
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