| 1. |
- Byass, Peter, et al.
(författare)
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Lessons from History for Designing and Validating Epidemiological Surveillance in Uncounted Populations
- 2011
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 6:8, s. e22897-
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Tidskriftsartikel (refereegranskat)abstract
- Background: Due to scanty individual health data in low- and middle-income countries (LMICs), health planners often use imperfect data sources. Frequent national-level data are considered essential, even if their depth and quality are questionable. However, quality in-depth data from local sentinel populations may be better than scanty national data, if such local data can be considered as nationally representative. The difficulty is the lack of any theoretical or empirical basis for demonstrating that local data are representative where data on the wider population are unavailable. Thus these issues can only be explored empirically in a complete individual dataset at national and local levels, relating to a LMIC population profile. Methods and Findings: Swedish national data for 1925 were used, characterised by relatively high mortality, a low proportion of older people and substantial mortality due to infectious causes. Demographic and socioeconomic characteristics of Sweden then and LMICs now are very similar. Rates of livebirths, stillbirths, infant and cause-specific mortality were calculated at national and county levels. Results for six million people in 24 counties showed that most counties had overall mortality rates within 10% of the national level. Other rates by county were mostly within 20% of national levels. Maternal mortality represented too rare an event to give stable results at the county level. Conclusions: After excluding obviously outlying counties (capital city, island, remote areas), any one of the remaining 80% closely reflected the national situation in terms of key demographic and mortality parameters, each county representing approximately 5% of the national population. We conclude that this scenario would probably translate directly to about 40 LMICs with populations under 10 million, and to individual states or provinces within about 40 larger LMICs. Unsubstantiated claims that local sub-national population data are "unrepresentative" or "only local" should not therefore predominate over likely representativity.
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| 2. |
- Edin, Kerstin, 1952-, et al.
(författare)
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"Keeping up a front" : narratives about intimate partner violence, pregnancy, and antenatal care
- 2010
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Ingår i: Violence against Women. - : Sage Publications. - 1077-8012 .- 1552-8448. ; 16:2, s. 189-206
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Tidskriftsartikel (refereegranskat)abstract
- Nine women who had been subjected to severe intimate partner violence during pregnancy narrated their ambiguous and contradictory feelings and the various balancing strategies they used to overcome their complex and difficult situations. Because allowing anyone to come close posed a threat, the women mostly denied the situation and kept up a front to hide the violence from others. Three women disclosed ongoing violence to the midwives, but only one said such disclosure was helpful. This article highlights the complexity of being pregnant when living with an abusive partner and challenges antenatal care policies from the perspective of pregnant women.
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| 3. |
- Esscher, Annika, 1968-, et al.
(författare)
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Excess mortality in women of reproductive age from low-income countries : a Swedish national register study
- 2013
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Ingår i: European Journal of Public Health. - : Oxford University Press (OUP). - 1101-1262 .- 1464-360X. ; 23:2, s. 274-279
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Tidskriftsartikel (refereegranskat)abstract
- Background: Cause-of-death statistics is widely used to monitor the health of a population. African immigrants have, in several European studies, shown to be at an increased risk of maternal death, but few studies have investigated cause-specific mortality rates in female immigrants. Methods: In this national study, based on the Swedish Cause of Death Register, we studied 27 957 women of reproductive age (aged 15-49 years) who died between 1988 and 2007. Age-standardized mortality rates per 100 000 person years and relative risks for death and underlying causes of death, grouped according to the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, were calculated and compared between women born in Sweden and in low-, middle- and high-income countries. Results: The total age-standardized mortality rate per 100 000 person years was significantly higher for women born in low-income (84.4) and high-income countries (83.7), but lower for women born in middle-income countries (57.5), as compared with Swedish-born women (68.1). The relative risk of dying from infectious disease was 15.0 (95% confidence interval 10.8-20.7) and diseases related to pregnancy was 6.6 (95% confidence interval 2.6-16.5) for women born in low-income countries, as compared to Swedish-born women. Conclusions: Women born in low-income countries are at the highest risk of dying during reproductive age in Sweden, with the largest discrepancy in mortality rates seen for infectious diseases and diseases related to pregnancy, a cause of death pattern similar to the one in their countries of birth. The World Bank classification of economies may be a useful tool in migration research.
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| 4. |
- Esscher, Annika, 1968-, et al.
(författare)
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Maternal mortality in Sweden 1988-2007 : more deaths than officially reported
- 2013
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 92:1, s. 40-46
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To obtain more accurate calculations of maternal and pregnancy-related mortality ratios in Sweden from 1988 to 2007 by using information from national registers and death certificates.DESIGN: A national register-based study, supplemented by a review of death certificates.SETTING:Sweden, 1988 to 2007.POPULATION: The deaths of 27 957 women of reproductive age (15 to 49 years).METHODS:The Swedish Cause of Death Register, Medical Birth Register, and National Patient Register were linked. All women with a diagnosis related to pregnancy in at least one of these registers within one year prior to death were identified. Death certificates were reviewed to ascertain maternal deaths. Maternal mortality ratio, the number of maternal deaths/100 000 live births (excluding and including suicides); and pregnancy-related mortality ratio (number of deaths within 42 days after termination of pregnancy, irrespective of cause of death/100 000 live births) were calculated.MAIN OUTCOME MEASURES:Direct and indirect maternal deaths and pregnancy-related deaths.RESULTS: The maternal mortality ratio in Sweden, based on the current method of identifying maternal deaths, was 3.6. After linking registers and reviewing death certificates, we identified 64% more maternal deaths, resulting in a ratio of 6.0 (or 6.5 if suicides are included). The pregnancy-related mortality ratio was 7.3. A total of 478 women died within a year after being recorded with a diagnosis related to pregnancy.CONCLUSIONS: By including the 123 cases of maternal death identified in this study, the mean maternal mortality ratio from 1988-2007 was 64% higher than reported to the World Health Organization.
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| 5. |
- Esscher, Annika, 1968-, et al.
(författare)
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Suboptimal care and maternal mortality among foreign-born women in Sweden : Maternal death audit with application of the 'migration three delays' model
- 2014
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Ingår i: BMC Pregnancy and Childbirth. - : Springer Science and Business Media LLC. - 1471-2393 .- 1471-2393. ; 14, s. 141-
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Background: Several European countries report differences in risk of maternal mortality between immigrants from low- and middle-income countries and host country women. The present study identified suboptimal factors related to care-seeking, accessibility, and quality of care for maternal deaths that occurred in Sweden from 1988-2010. Methods: A subset of maternal death records (n = 75) among foreign-born women from low- and middle-income countries and Swedish-born women were audited using structured implicit review. One case of foreign-born maternal death was matched with two native born Swedish cases of maternal death. An assessment protocol was developed that applied both the 'migration three delays' framework and a modified version of the Confidential Enquiry from the United Kingdom. The main outcomes were major and minor suboptimal factors associated with maternal death in this high-income, low-maternal mortality context. Results: Major and minor suboptimal factors were associated with a majority of maternal deaths and significantly more often to foreign-born women (p = 0.01). The main delays to care-seeking were non-compliance among foreign-born women and communication barriers, such as incongruent language and suboptimal interpreter system or usage. Inadequate care occurred more often among the foreign-born (p = 0.04), whereas delays in consultation/referral and miscommunication between health care providers where equally common between the two groups. Conclusions: Suboptimal care factors, major and minor, were present in more than 2/3 of maternal deaths in this high-income setting. Those related to migration were associated to miscommunication, lack of professional interpreters, and limited knowledge about rare diseases and pregnancy complications. Increased insight into a migration perspective is advocated for maternity clinicians who provide care to foreign-born women.
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| 6. |
- Fottrell, Edward, et al.
(författare)
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A probabilistic method to estimate the burden of maternal morbidity in resource-poor settings : preliminary development and evaluation
- 2014
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Ingår i: Emerging Themes in Epidemiology. - : BioMed Central (BMC). - 1742-7622. ; 11:1, s. 3-
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Maternal morbidity is more common than maternal death, and population-based estimates of the burden of maternal morbidity could provide important indicators for monitoring trends, priority setting and evaluating the health impact of interventions. Methods based on lay reporting of obstetric events have been shown to lack specificity and there is a need for new approaches to measure the population burden of maternal morbidity. A computer-based probabilistic tool was developed to estimate the likelihood of maternal morbidity and its causes based on self-reported symptoms and pregnancy/delivery experiences. Development involved the use of training datasets of signs, symptoms and causes of morbidity from 1734 facility-based deliveries in Benin and Burkina Faso, as well as expert review. Preliminary evaluation of the method compared the burden of maternal morbidity and specific causes from the probabilistic tool with clinical classifications of 489 recently-delivered women from Benin, Bangladesh and India.RESULTS: Using training datasets, it was possible to create a probabilistic tool that handled uncertainty of women's self reports of pregnancy and delivery experiences in a unique way to estimate population-level burdens of maternal morbidity and specific causes that compared well with clinical classifications of the same data. When applied to test datasets, the method overestimated the burden of morbidity compared with clinical review, although possible conceptual and methodological reasons for this were identified.CONCLUSION: The probabilistic method shows promise and may offer opportunities for standardised measurement of maternal morbidity that allows for the uncertainty of women's self-reported symptoms in retrospective interviews. However, important discrepancies with clinical classifications were observed and the method requires further development, refinement and evaluation in a range of settings.
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| 7. |
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| 8. |
- Hayati, Elli Nur, et al.
(författare)
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'Elastic band strategy' : women's lived experiences of coping with domestic violence in rural Indonesia
- 2013
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Ingår i: Global Health Action. - : Informa UK Limited. - 1654-9716 .- 1654-9880. ; 6, s. 1-12
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Tidskriftsartikel (refereegranskat)abstract
- Background: Experiencing domestic violence is considered a chronic and stressful life event. A theoretical framework of coping strategies can be used to understand how women deal with domestic violence. Traditional values strongly influenced by religious teachings that interpret men as the leaders of women play an important role in the lives of Javanese women, where women are obliged to obey their husbands. Little is known about how sociocultural and psychosocial contexts influence the ways in which women cope with domestic violence. Objective: Our study aimed to deepen our understanding of how rural Javanese women cope with domestic violence. Our objective was to explore how the sociocultural context influences coping dynamics of women survivors of domestic violence in rural Purworejo. Design: A phenomenological approach was used to transform lived experiences into textual expressions of the coping dynamics of women survivors of domestic violence. Results: Experiencing chronic violence ruined the women's personal lives because of the associated physical, mental, psychosocial, and financial impairments. These chronic stressors led women to access external and internal resources to form coping strategies. Both external and internal factors prompted conflicting impulses to seek support, that is, to escape versus remain in the relationship. This strong tension led to a coping strategy that implied a long-term process of moving between actively opposing the violence and surrendering or tolerating the situation, resembling an elastic band that stretches in and out. Conclusions: Women survivors in Purworejo face a lack of institutional support and tend to have traditional beliefs that hamper their potential to stop the abuse. Although the women in this study were educated and economically independent, they still had difficulty mobilizing internal and external support to end the abuse, partly due to internalized gender norms.
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| 9. |
- Högberg, Ulf, 1949-
(författare)
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För tidig förlossning
- 2014. - 1
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Ingår i: Gyn.. - : Liber. - 9789147117253
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 10. |
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| 11. |
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| 12. |
- Olivier, Jocelien D A, et al.
(författare)
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The effects of maternal depression and maternal selective serotonin reuptake inhibitor exposure on offspring
- 2013
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Ingår i: Frontiers in Cellular Neuroscience. - : Frontiers Media SA. - 1662-5102. ; 7, s. 73-
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Forskningsöversikt (refereegranskat)abstract
- It has been estimated that 20% of pregnant women suffer from depression and it is well-documented that maternal depression can have long-lasting effects on the child. Currently, common treatment for maternal depression has been the selective serotonin reuptake inhibitor medications (SSRIs) which are used by 2-3% of pregnant women in the Nordic countries and by up to 10% of pregnant women in the United States. Antidepressants cross the placenta and are transferred to the fetus, thus, the question arises as to whether children of women taking antidepressants are at risk for altered neurodevelopmental outcomes and, if so, whether the risks are due to SSRI medication exposure or to the underlying maternal depression. This review considers the effects of maternal depression and SSRI exposure on offspring development in both clinical and preclinical populations. As it is impossible in humans to study the effects of SSRIs without taking into account the possible underlying effects of maternal depression (healthy pregnant women do not take SSRIs), animal models are of great value. For example, rodents can be used to determine the effects of maternal depression and/or perinatal SSRI exposure on offspring outcomes. Unraveling the joint (or separate) effects of maternal depression and SSRI exposure will provide more insights into the risks or benefits of SSRI exposure during gestation and will help women make informed decisions about using SSRIs during pregnancy.
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| 13. |
- Santosa, Ailiana, 1976-, et al.
(författare)
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Socio-demographic predictors of mortality inequality among Swedish men and women : a longitudinal study
- 2014
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Ingår i: European Journal of Public Health. - : Oxford University Press (OUP). - 1101-1262 .- 1464-360X. ; 24, s. 188-189, s. 188-189
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundDespite increasing life expectancy in many countries, health and mortality inequality exist. This study aimed to assess overall and cardiovascular (CVD) mortality trends among Swedish men and women during 1992-2006, and their association with individual level socio-demographic determinants of mortality inequality.MethodsData were extracted from the Linnaeus Database which consists of register and survey data. A multilevel Poisson regression analysis was used to assess the number and mortality rate, as well as individual level determinants (fixed effects) of overall and CVD deaths for men and women at county level (n = 24) in each 5-year period during 1992-2006. We also assessed the random effect at county level.ResultsA total of 9,098,090 individuals accumulating 115,361,104 person years was included in this study. A significant reduction in overall and CVD mortality rates occurred among Swedish men and women during the study period 1992-2006, with persisting excess male: female mortality. Older age and pensioner, unmarried or widowed individuals, low and middle education levels and employed individuals with low income (the lowest income tertile) were consistently associated with higher mortality rates of overall and CVD mortality in men and women. Individuals with tertiary education level and being immigrant was protective factors for overall mortality, but less so for CVD mortality. The multilevel analysis revealed that about 85% and 80% of the variation of overall and CVD mortality at county level, respectively, could be explained by the individual socio-demographic variables.ConclusionsInequality in overall and CVD mortality still exists among Swedish men and women, and to some extend are influenced by county level determinants. Contextual epidemiology must therefore play a decisive role in understanding social disparities in overall and CVD mortality in Sweden.Key messagesOverall, individual factors played a more important part in understanding the differences of overall and CVD mortality than contextual factors within the same area in men and women in Swedish context.Health policy actions aiming to reduce health inequality should be addressed not only focusing on individual characteristics but also on geographical factors.
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| 14. |
- Ugarte, William J., et al.
(författare)
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Assessing knowledge, attitudes, and behaviors related to HIV and AIDS in Nicaragua : A community-level perspective
- 2013
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Ingår i: Sexual & Reproductive HealthCare. - : Elsevier BV. - 1877-5756 .- 1877-5764. ; 4:1, s. 37-44
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Tidskriftsartikel (refereegranskat)abstract
- Background:Nicaragua's HIV epidemic is concentrated among men who have sex with men.Nevertheless, the increasing number of HIV cases among heterosexuals, high levels of poverty andmigration rates, and incomplete epidemiological data suggest the need to improve the understanding of the epidemic.Objective:To examine the prevalence of HIV-related knowledge, attitudes, and sexual rsik-taking behaviors, and their predictors among the adult population.Methods: A community-based cross-sectional survey was conducted in 2009 among 520 participants ages 15 to 49 from an ongoing Health and Demographic Surveillance System in Nicaragua. Bivariate analysis and adjusted prevalence ratios were use to examine factors associated with HIV-related knowledge, attitudes, and sexual behavior.Results: Contributing factors for risk-taking behaviors included cognitive, psychosocial, and emotional elements. Insufficient knowledge affecting the accurate assessment of HIV risk were low educational level, poverty, and rural origin, especially among females. Recognizing risk was not sufficient to promote safer sex: 90% of the females and 70% of the males who reported being sexually active in the past year did not use condoms during their last sexual encounter. Inconsistent condom use among men was associated with older age, long-term relationships, and lack of awareness about acquiring HIV infection.Conclusions:Interventions to reduce social-structural contextual factors in Nicaragua are needed so that individuals may adopt and maintain HIV risk reduction strategies. Increased gender-specific HIV education and skills-building programs need to be implemented. Sensitive mass media messages may also increase the knowledge of HIV and AIDS, and serve to encourage protective attitudes and behaviors.
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| 15. |
- Ugarte, William J., 1979-, et al.
(författare)
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Measuring HIV- and AIDS-related stigma and discrimination in Nicaragua : Results from a community-based study
- 2013
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Ingår i: AIDS Education and Prevention. - : Guilford Publications. - 0899-9546 .- 1943-2755. ; 25:2, s. 164-178
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Tidskriftsartikel (refereegranskat)abstract
- Psychometric properties of external HIV-related stigma and discrimination scales and their predictors were investigated. A cross-sectional community-based study was carried out among 520 participants using an ongoing health and demographic surveillance system in León, Nicaragua. Participants completed an 18-item HIV stigma scale and 19 HIV and AIDS discrimination-related statements. A factor analysis found that 15 of the 18 items in the stigma scale and 18 of the 19 items in the discrimination scale loaded clearly into five- and four-factor structures, respectively. Overall Cronbach’s alpha of .81 for the HIV stigma scale and .91 for the HIV discrimination scale provided evidence of internal consistency. Hierarchical multiple linear regression analysis identified that females, rural residents, people with insufficient HIV-related transmission knowledge, those not tested for HIV, those reporting an elevated self-perception of HIV risk, and those unwilling to disclose their HIV status were associated with higher stigmatizing attitudes and higher discriminatory actions towards HIV-positive people. This is the first community-based study in Nicaragua that demonstrates that overall HIV stigma and discrimination scales were reliable and valid in a community-based sample comprised of men and women of reproductive age. Stigma and discrimination were reported high in the general population, especially among sub-groups. The findings in the current study suggest Community-based strategies, including the monitoring of stigma and discrimination, and designing and implementing stigma reduction interventions, are greatly needed to reduce inequities and increase acceptance of persons with HIV.
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| 16. |
- Wahlberg, Åsa, 1973-, et al.
(författare)
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Increased risk of severe maternal morbidity (near-miss) among immigrant women in Sweden : a population register-based study
- 2013
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Ingår i: British Journal of Obstetrics and Gynecology. - : Wiley. - 1470-0328 .- 1471-0528. ; 120:13, s. 1605-1612
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE:To determine if immigrant women from low-, middle- and high-income countries have an increased risk of severe maternal morbidity (near-miss) when they deliver in Sweden.DESIGN:Population register-based study.SETTING:Nationwide study including all singleton deliveries (≥28 weeks of gestation) between 1998 and 2007.POPULATION:Women with a near-miss event; all women with a singleton delivery ≥28 weeks of gestation during the same period acted as reference group.METHODS:Near-miss was defined by a combined clinical and management approach with use of International Classification of Diseases, 10th revision codes for severe maternal morbidity. A woman's country of origin was designated as low-, middle- or high-income according to the World Bank Classification of 2009. Unconditional logistic regression models were used in the analysis.MAIN OUTCOME MEASURES:Maternal near-miss frequencies per 1000 deliveries and odds ratios with 95% confidence intervals.RESULTS:There were 914 474 deliveries during the study period and 2655 near-misses (2.9 per 1000 deliveries). In comparison to Swedish-born women, those from low-income countries had an increased risk of near-miss (odds ratio 2.3, 95% confidence interval 1.9-2.8) that was significant in all morbidity groups except for cardiovascular diseases and sepsis. Women from middle- and high-income countries showed no increased risk of near-miss.CONCLUSIONS:Women from low-income countries have an increased risk of maternal near-miss morbidity compared with women born in Sweden. Although the rate is low it should alert healthcare providers.
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| 17. |
- Wallin Lundell, Inger, et al.
(författare)
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Posttraumatic stress among women after induced abortion : a Swedish multi-centre cohort study
- 2013
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Ingår i: BMC Women's Health. - : BioMed Central. - 1472-6874. ; 13, s. Article Number: 52-
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Tidskriftsartikel (refereegranskat)abstract
- Background: Induced abortion is a common medical intervention. Whether psychological sequelae might follow induced abortion has long been a subject of concern among researchers and little is known about the relationship between posttraumatic stress disorder (PTSD) and induced abortion. Thus, the aim of the study was to assess the prevalence of PTSD and posttraumatic stress symptoms (PTSS) before and at three and six months after induced abortion, and to describe the characteristics of the women who developed PTSD or PTSS after the abortion. Methods: This multi-centre cohort study included six departments of Obstetrics and Gynaecology in Sweden. The study included 1457 women who requested an induced abortion, among whom 742 women responded at the three-month follow-up and 641 women at the six-month follow-up. The Screen Questionnaire-Posttraumatic Stress Disorder (SQ-PTSD) was used for research diagnoses of PTSD and PTSS, and anxiety and depressive symptoms were evaluated by the Hospital Anxiety and Depression Scale (HADS). Measurements were made at the first visit and at three and six months after the abortion. The 95% confidence intervals for the prevalence of lifetime or ongoing PTSD and PTSS were calculated using the normal approximation. The chi-square test and the Student's t-test were used to compare data between groups. Results: The prevalence of ongoing PTSD and PTSS before the abortion was 4.3% and 23.5%, respectively, concomitant with high levels of anxiety and depression. At three months the corresponding rates were 2.0% and 4.6%, at six months 1.9% and 6.1%, respectively. Dropouts had higher rates of PTSD and PTSS. Fifty-one women developed PTSD or PTSS during the observation period. They were young, less well educated, needed counselling, and had high levels of anxiety and depressive symptoms. During the observation period 57 women had trauma experiences, among whom 11 developed PTSD or PTSS and reported a traumatic experience in relation to the abortion. Conclusion: Few women developed PTSD or PTSS after the abortion. The majority did so because of trauma experiences unrelated to the induced abortion. Concomitant symptoms of depression and anxiety call for clinical alertness and support.
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| 18. |
- Wallin Lundell, Inger, et al.
(författare)
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The prevalence of posttraumatic stress among women requesting induced abortion
- 2013
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Ingår i: European journal of contraception & reproductive health care. - : Informa Healthcare. - 1362-5187 .- 1473-0782. ; 18:6, s. 480-488
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Tidskriftsartikel (refereegranskat)abstract
- Objectives To describe the prevalence and pattern of traumatic experiences, to assess the prevalence of posttraumatic stress disorder (PTSD) and posttraumatic stress symptoms (PTSS), to identify risk factors for PTSD and PTSS, and to analyse the association of PTSD and PTSS with concomitant anxiety and depressive symptoms in women requesting induced abortion. less thanbrgreater than less thanbrgreater thanMethods A Swedish multi-centre study of women requesting an induced abortion. The Screen Questionnaire - Posttraumatic Stress Disorder was used for research diagnoses of PTSD and PTSS. Anxiety and depressive symptoms were evaluated by the Hospital Anxiety and Depression Scale (HADS). less thanbrgreater than less thanbrgreater thanResults Of the 1514 respondents, almost half reported traumatic experiences. Lifetime-and point prevalence of PTSD were 7% (95% confi dence interval [CI]: 5.8-8.5) and 4% (95% CI: 3.1-5.2), respectively. The prevalence of PTSS was 23% (95% CI: 21.1-25.4). Women who reported symptoms of anxiety or depression when requesting abortion were more likely to have ongoing PTSD or PTSS. Also single-living women and smokers displayed higher rates of ongoing PTSD. less thanbrgreater than less thanbrgreater thanConclusions Although PTSD is rare among women who request an induced abortion, a relatively high proportion suffers from PTSS. Abortion seeking women with trauma experiences and existing or preexisting mental disorders need more consideration and alertness when counselled for termination.
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| 19. |
- Wennberg, Anna Lena, et al.
(författare)
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Women's experiences of dietary advice and dietary changes during pregnancy
- 2013
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Ingår i: Midwifery. - : Elsevier BV. - 0266-6138 .- 1532-3099. ; 29:9, s. 1027-1034
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE:to describe women's experiences of dietary information and the change of dietary habits during pregnancy.DESIGN:a qualitative design was used. In 2007 we conducted six focus group interviews using open-ended questions.SETTINGS: five rural and city antenatal clinics in northern Sweden were includedPARTICIPANTS: twenty-three women in mid-pregnancy participated in groups of three to sevenFINDINGS:three domains were found 'Dietary information gain', 'Reactions to dietary information' and 'Dietary management'. The women had to discover dietary information by themselves, and only when health problems or symptoms occurred did they receive guidance from the midwife. Their reactions to the dietary information were 'being confused', 'feeling fear and guilt' and 'being monitored', summed up in 'being uncertain'. The diet was managed by 'checking food content', 'following bodily signals', 'using common sense', and 'making exceptions', summed up as 'being responsible but with a pinch of salt'.KEY CONCLUSIONS:the women expressed problems with dietary changes, but they could mostly manage them on their own. The pregnant women experienced that the midwives gave dietary information and advice first when problems arise. When struggling with diet, the women experienced confusion, and they had to seek information by themselves.IMPLICATIONS FOR PRACTICE:sources of information about diet during pregnancy were experienced as inconsistent and contradictory. Midwives are important in motivation for healthy lifestyle during pregnancy and with sufficient dietary knowledge and counselling skills they can help pregnant women effect dietary changes by providing guidance and support in early pregnancy.
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| 20. |
- Åmark, H., et al.
(författare)
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Single versus pairwise interpretation of cardiotochography, a comparative study from six Swedish delivery units
- 2014
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Ingår i: Sexual & Reproductive HealthCare. - : Elsevier. - 1877-5756 .- 1877-5764. ; 5:4, s. 195-198
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of the study was to evaluate whether interpreting CTG pairwise brings about a higher level of correctly classified CTG recordings in a non-selected population of midwives and physicians. Study design: A comparative study. Setting: Five delivery units in Stockholm and one delivery unit in Uppsala, with 1589, 3740, 3908, 4539, 6438, and 7331 deliveries in 2011, respectively. Subjects: 536 midwives and physicians classified one randomly selected CTG recording individually followed by a pairwise classification. The pairs consisted of two midwives (119 pairs) or one midwife and one physician (149 pairs), a total of 268 pairs. Main outcome measure: The proportion of individually correctly classified CTG recordings versus the proportion of pairwise correctly classified CTG recordings. Results: The proportion of individually correctly classified CTG's was 75% and the proportion of pairwise correctly classified CTG's was 80% (difference 5%, p = 0.12). Conclusions: There was no statistically significant difference when CTG's were classified pairwise compared to individual classifications. The proportion of individually correctly classified CTG's was high (75%). There were differences in the proportion of correctly classified CTG recordings between the delivery units, indicating potential areas of improvement. © 2014 Elsevier B.V.
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