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| 4. |
- Allbrand, Marianne, 1958-, et al.
(författare)
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Expression of genes involved in inflammation and growth : does sampling site in human full-term placenta matter?
- 2019
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Ingår i: Journal of Perinatal Medicine. - : Walter de Gruyter. - 0300-5577 .- 1619-3997. ; 47:5, s. 539-546
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate the placental gene expression of substances in the inflammatory cascade and growth factors at nine different well-defined sampling sites in full-term placentas from 12 normal weight healthy non-smoking women with an uncomplicated singleton pregnancy.Methods: All placentas (six girls and six boys) were delivered vaginally. Quantitative real-time polymerase chain reaction was used to analyze toll receptor-2 and -4, interleukin-6 and -8, tumor necrosis factor-α, leptin, ghrelin, insulin-like growth factor-1 and -2, hepatocyte growth factor, hepatocyte growth factor receptor and insulin receptor (IR).Results: The leptin gene and the IR gene showed higher expression in lateral regions near the chorionic plate compared to central regions near the basal plate (P = 0.028 and P = 0.041, respectively).Conclusion: Our results suggest that the sampling site may influence the gene expression for leptin and IR in placental tissue obtained from full-term normal pregnancies. We speculate that this may be due to differences in placental structure and perfusion and may be important when future studies are designed.
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| 5. |
- Allbrand, Marianne, 1958-, et al.
(författare)
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Placental gene expression of inflammatory markers and growth factors : a case control study of obese and normal weight women
- 2015
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Ingår i: Journal of Perinatal Medicine. - : Walter de Gruyter. - 0300-5577 .- 1619-3997. ; 43:2, s. 159-164
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To survey the placental gene expression of inflammatory markers and growth factors in non-smoking obese women with an uncomplicated pregnancy without associated morbidity and delivery at term compared with normal weight women.Methods: Placental tissue samples from 32 obese women (body mass index, BMI >= 35.0 kg/m(2)) were compared with samples from 94 normal weight women (BMI 18.5-25.0 kg/m(2)) matched for age (+/- 1 year), gestational age (+/- 3 days), parity and mode of delivery. Semi-quantitative reverse transcription polymerase chain reaction (RT-PCR) was used to analyse toll receptor-2 and -4, interleukin-6 and -8, tumour necrosis factor-alpha, leptin, adiponectin, insulin-like growth factor-1 and -2, hepatocyte growth factor, hepatocyte growth factor receptor and insulin receptor.Results: There was no significant difference in gene expression in placental tissue samples from obese and normal weight women.Conclusion: We found no difference in the occurrence of inflammatory marker and growth factor mRNA levels in placental tissue samples from a large group of obese women without associated morbidity and with healthy infants compared to a closely matched control group of healthy normal weight women. Compared with the previous studies, this anomalous finding may be explained by the absence of associated morbidity in the obese women in our study.
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| 6. |
- Jansson, Markus, 1982-, et al.
(författare)
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Cost-effectiveness of antibiotic prophylaxis in elective cesarean section
- 2018
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Ingår i: Cost Effectiveness and Resource Allocation. - : BMC. - 1478-7547. ; 16
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Tidskriftsartikel (refereegranskat)abstract
- Background: The proportion of pregnant women delivered by cesarean section has increased steadily during the past three decades. The risk of infection is 10-fold augmented after elective cesarean section compared to vaginal delivery. Antibiotic prophylaxis may reduce endometritis by 62% and superficial wound infection by 38% after elective cesarean section. International guidelines recommend antibiotic prophylaxis in elective cesarean section, but this procedure is not routinely followed in Sweden. Studies of costs of antibiotic prophylaxis in cesarean section show conflicting results and are based on substantially different incidence of postoperative infections. No study of costs of antibiotic prophylaxis in elective cesarean section in a Swedish or Nordic context has been pursued. The aim of this study was to investigate if antibiotic prophylaxis is cost-reducing in elective cesarean section in orebro County, Sweden.Methods: All women undergoing elective cesarean in the Region orebro County health care system during 2011-2012 were eligible for inclusion. Postoperative infections and risk factors for infections were registered. A hypothetical situation in which all participants had received antibiotic prophylaxis was compared to the actual situation, in which none of them had received antibiotic prophylaxis. The reduction in the risk of postoperative infections resulting from antibiotic prophylaxis was based on a meta-analysis. Costs for in-patient care of postoperative infections were extracted from the accounting system, and costs for out-patient care were calculated according to standard costs. Costs for antibiotic prophylaxis were calculated and compared with the cost reduction that would be implied by the introduction of such prophylaxis.Results: The incidences of deep and superficial surgical site infection were 3.5% and 1.3% respectively. Introduction of antibiotic prophylaxis would reduce health care costs by 31 Euro per cesarean section performed (95% credible interval 4-58 Euro). The probability of cost-saving was 99%.Conclusions: Antibiotic prophylaxis in elective cesarean section is cost-reducing in this health care setting. Our results indicate that the introduction of antibiotic prophylaxis in elective cesarean section can also be cost-saving in low infection rate settings.Trial registration Ethical approval was given by the Regional Ethical Review Board in Uppsala (registration number 2013/484).
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| 7. |
- Jansson, Markus, 1982-, et al.
(författare)
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Development and validation of a protocol for documentation of obstetric perineal lacerations
- 2019
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Ingår i: International Urogynecology Journal. - : Springer. - 0937-3462 .- 1433-3023. ; 30:12, s. 2069-2076
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION AND HYPOTHESIS: The aim of this study was to develop a new protocol for documentation of perineal lacerations and to validate the latter against the most common obstetric record system in Sweden. The hypothesis was that the new protocol would render more complete data on perineal lacerations than the current documentation method.METHODS: A protocol for documentation of perineal lacerations was developed to be sufficiently comprehensive to serve research purposes. All women delivering their first child vaginally from 13 October 2015 to 1 February 2016 at Örebro University Hospital were eligible for the validation study. Perineal lacerations were documented using the protocol in parallel with the regular obstetric record system (ObstetriX). Cross tabulations were used to compare the coverage regarding perineal lacerations between the two documentation methods. McNemar's test was used to evaluate systematic differences between the methods.RESULTS: A total of 187 women were included. The coverage of documentation regarding perineal laceration was significantly higher (p < 0.001) in the new protocol (89%) compared with ObstetriX (18%). Incidence of second-degree perineal tears was 26% according to the new protocol and 11% according to ObstetriX. The incidence of third-degree perineal tears A, B, and C was 2.7%, 2.1%, and 2.1%, respectively, according to the new protocol, and 3.2%, 2.7%, and 1.1% according to ObstetriX.CONCLUSIONS: This validation study of a new documentation protocol showed that it delivered significantly more comprehensive information regarding perineal lacerations than the most common obstetric record system in Sweden.
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| 8. |
- Jansson, Markus, 1982-, et al.
(författare)
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Development and Validation of a Protocol for Documentation of Obstetric Perineal Lacerations
- 2018
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Konferensbidrag (refereegranskat)abstract
- Introduction and hypothesis: The aim of this study was to develop a new protocol for documentation of perineal lacerations and to validate the latter against the most common obstetric record system in Sweden. The hypothesis was that the new protocol would render more complete data on perineal lacerations than the current documentation method. Methods: A protocol for documentation of perineal lacerations was developed to be sufficiently comprehensive to serve research purposes. All women delivering their first child vaginally from 13 October 2015 to 1 February 2016 at Örebro University Hospital were eligible for the validation study. Perineal lacerations were documented using the protocol in parallel with the regular obstetric record system (ObstetriX). Cross tabulations were used to compare the coverage regarding perineal lacerations between the two documentation methods. McNemar's test was used to evaluate systematic differences between the methods. Results: A total of 187 women were included. The coverage of documentation regarding perineal laceration was significantly higher (p < 0.001) in the new protocol (89%) compared with ObstetriX (18%). Incidence of second-degree perineal tears was 26% according to the new protocol and 11% according to ObstetriX. The incidence of third-degree perineal tears A, B, and C was 2.7%, 2.1%, and 2.1%, respectively, according to the new protocol, and 3.2%, 2.7%, and 1.1% according to ObstetriX. Conclusions: This validation study of a new documentation protocol showed that it delivered significantly more comprehensive information regarding perineal lacerations than the most common obstetric record system in Sweden.
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| 9. |
- Kunovac Kallak, Theodora, et al.
(författare)
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Vaginal Gene Expression During Treatment With Aromatase Inhibitors
- 2015
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Ingår i: Clinical Breast Cancer. - : CIG MEDIA GROUP. - 1526-8209 .- 1938-0666. ; 15:6, s. 527-535.e2
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Tidskriftsartikel (refereegranskat)abstract
- Vaginal gene expression in aromatase inhibitor-treated women was compared with postmenopausal control women treated with vaginal estrogen therapy. Vaginal tissue from aromatase inhibitor-treated women had low expression of genes involved in cell differentiation, proliferation, and cell adhesion, and associated with vaginal discomfort. The presence of vaginal aromatase suggests that this is the result of local and systemic aromatase inhibition.Background: Aromatase inhibitor (AI) treatment suppresses estrogen biosynthesis and causes genitourinary symptoms of menopause such as vaginal symptoms, ultimately affecting the quality of life for many postmenopausal women with breast cancer. Thus, the aim of this study was to examine vaginal gene expression in women during treatment with AIs compared with estrogen-treated women. The secondary aim was to study the presence and localization of vaginal aromatase.Patients and Methods: Vaginal biopsies were collected from postmenopausal women treated with AIs and from age-matched control women treated with vaginal estrogen therapy. Differential gene expression was studied with the Affymetrix Gene Chip Gene 1.0 ST Array (Affymetrix Inc, Santa Clara, CA) system, Ingenuity pathway analysis, quantitative real-time polymerase chain reaction, and immunohistochemistry.Results: The expression of 279 genes differed between the 2 groups; AI-treated women had low expression of genes involved in cell differentiation, proliferation, and cell adhesion. Some differentially expressed genes were found to interact indirectly with the estrogen receptor alpha. In addition, aromatase protein staining was evident in the basal and the intermediate vaginal epithelium layers, and also in stromal cells with a slightly stronger staining intensity found in AI-treated women.Conclusion: In this study, we demonstrated that genes involved in cell differentiation, proliferation, and cell adhesion are differentially expressed in AI-treated women. The expression of vaginal aromatase suggests that this could be the result of local and systemic inhibition of aromatase. Our results emphasize the role of estrogen for vaginal cell differentiation and proliferation and future drug candidates should be aimed at improving cell differentiation and proliferation.
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| 10. |
- Megeus, Veronika, 1983, et al.
(författare)
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Hand Contamination, Cross-Transmission, and Risk-Associated Behaviors: An Observational Study of Team Members in ORs
- 2015
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Ingår i: AORN Journal. - : Wiley. - 0001-2092. ; 102:6
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Tidskriftsartikel (refereegranskat)abstract
- Team members in ORs have frequent hand contact with many surfaces and sites during high workload, thus increasing the risk for microorganism cross-transmission. This study aimed at identifying risks for hand contamination and microorganism cross-transmission during invasive procedures in ORs. We carried out observations during 22 daytime sessions and analyzed data using qualitative content analysis. The results revealed that clinicians’ hands may be contaminated by self-contamination, via objects, or by touching the patient. Contamination may occur before, during, or directly after performing an invasive procedure requiring the use of aseptic technique, which risks cross-transmitting microorganisms. The results of the study contribute detailed knowledge about risk-associated activities and behaviors in relation to performing invasive procedures in the OR. This knowledge provides clinicians, managers, and educators with specific information that can be used in nursing and medical education and in quality improvement projects aimed at improving hand hygiene routines and enhancing aseptic technique.
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| 11. |
- Megeus, Veronika, 1983, et al.
(författare)
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Hand hygiene and aseptic techniques during routine anesthetic care - observations in the operating room.
- 2015
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Ingår i: Antimicrobial resistance and infection control. - : Springer Science and Business Media LLC. - 2047-2994. ; 5:4
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Tidskriftsartikel (refereegranskat)abstract
- More knowledge is needed about task intensity in relation to hand hygiene in the operating room during anesthetic care in order to choose effective improvement strategies. The aim of this study was to explore the indications and occurrence of hand hygiene opportunities and the adherence to hand hygiene guidelines during routine anesthetic care in the operating room.
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| 12. |
- Nilsson, Marie, 1966-, et al.
(författare)
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Coexisting needs : paradoxes in collegial reflection—the development of a pragmatic method for reflection
- 2017
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Ingår i: Education Research International. - 2090-4002 .- 2090-4010. ; 2017
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Tidskriftsartikel (refereegranskat)abstract
- This paper addresses a feasibility study of a method for recurrent collegial reflection. A qualitative approach, using a participatory research design, was adopted. The collegial reflection was implemented in a school, in a middle-sized municipality in southern Sweden, with 21 teachers participating in the intervention. Data collection included digital recordings of collegial reflection, open questions by mail, and individual interviews. Findings indicated one major theme, paradoxes in the design of the collegial reflection, and three categories: wanting to decide and wanting to be guided; meeting each other as teachers and/or as persons; and looking for the safe and/or looking for the new. Before implementing the method in another context, management needs to appreciate these contradictory experiences, allow for voluntary participation, address participants’ expectations, and allocate time and tasks. This study implicates that collegial reflection may contribute to teachers’ professional development, and it is thereby relevant to teachers’ classroom practice and pupils’ learning. We conclude that, by creating a structure which supports teachers’ collegial reflection, the school may function as a supportive environment, which may contribute to teacher retention.
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| 13. |
- Rönnberg, AnnKristin, 1967-, et al.
(författare)
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Effects on postpartum weight retention after antenatal lifestyle intervention : a secondary analysis of a randomized controlled trial
- 2016
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley-Blackwell. - 0001-6349 .- 1600-0412. ; 95:9, s. 999-1007
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: High weight retention after pregnancy is related to an increased risk of future obesity. The objective was to evaluate if an antenatal intervention, compared to standard care, could reduce postpartum weight retention (PPWR).Material and methods: Women with body mass index >19, age ≥18 years, knowledge of Swedish, and pregnancy ≤16 weeks' gestation were randomized. Standard care was compared to a composite intervention including a personalized weight graph, education on recommended weight gain, prescription of exercise, and monitoring of weight until one year after delivery. Mean (kg) PPWR was compared between the groups and risk estimates (odds ratio) for excessive weight retention were calculated.Results: Of 445 women randomized, 267 remained for analysis at ≤16 weeks postpartum and 168 at one year postpartum. The intervention group had a significantly lower mean PPWR at ≤16 weeks (1.81 kg (standard deviation, SD, 4.52) vs. 3.19 kg (SD 4.77), p=0.016). At one year postpartum, mean retention was still 0.7 kg lower in the intervention group (0.30 kg (SD 5.52) vs. 1.00 kg (SD 5.46)), the difference was not statistically significant (p=0.414). Gestational weight gain above Institute of Medicine recommendations was a significant risk factor for excessive weight retention (>5 kg) one year after delivery (OR 2.44; 95% CI; 1.08-5.52, p=0.029).Conclusions: A composite lifestyle intervention during pregnancy reduced short-term weight retention, but the effect of the intervention did not remain at one year postpartum. A gestational weight gain above Institute of Medicine recommendations increases the risk of excessive long-term weight retention.
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| 14. |
- Rönnberg, AnnKristin, 1967-, et al.
(författare)
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Intervention during pregnancy to reduce excessive gestational weight gain : a randomised controlled trial
- 2015
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Ingår i: British Journal of Obstetrics and Gynecology. - : Wiley. - 1470-0328 .- 1471-0528. ; 122:4, s. 537-544
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To evaluate if a feasible, low-cost intervention could decrease the percentage of women gaining weight above the Institute of Medicine (IOM) recommendations on gestational weight gain (GWG) compared with standard maternity care.Design: A randomised controlled interventional design.Setting: Antenatal clinics (n=14) in orebro county, Sweden, participated.Population: Healthy women with a body mass index (BMI) 19kg/m(2), age 18years and adequate knowledge of Swedish language who signed in for maternity care at 16weeks of gestation.Methods: Standard care was compared with a composite intervention consisting of education on recommended GWG according to IOM, application of personalised weight graph, formalised prescription of exercise and regular monitoring of GWG at every antenatal visit.Outcome: The proportion of women gaining weight above IOM guidelines (1990) and mean GWG (kg) was compared between groups.Results: In all, 445 women were randomised and 374 women remained for analysis after delivery. A majority of the women analysed were normal weight (72%). The intervention reduced the proportion of women who exceeded the IOM guidelines (41.1% versus 50.0%). The reduction was, however, not statistically significant (P=0.086). Mean GWG was significantly lower among women receiving the intervention, 14.2kg (SD 4.4) versus 15.3kg (SD 5.4) in the standard care group (P=0.029).Conclusions: The low-cost intervention programme tested did significantly reduce the mean GWG but the proportion of women who exceeded the IOM recommendations for GWG was not significantly lower. ClinicalTrials.gov Id NCT00451425
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| 15. |
- Rönnberg, Ann-Kristin, 1967-, et al.
(författare)
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Effects of an antenatal lifestyle intervention on offspring obesity : a 5-year follow-up of a randomized controlled trial
- 2017
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : John Wiley & Sons. - 0001-6349 .- 1600-0412. ; 96:9, s. 1093-1099
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Strategies to limit excessive maternal gestational weight gain could also have positive health effects for the offspring. This study informs us on the effect of an antenatal lifestyle intervention on offspring body mass index (BMI) trajectory until age five.Material and methods: A secondary analysis of a randomized controlled trial aimed at reducing gestational weight gain, set in Orebro, Sweden (Clinical Trials.gov Id NCT00451425). Offspring were followed with standardized measures of weight and height until age five. Mean BMI z-score and proportion (%) of over- and undernutrition (BMI z-score > 2 standard deviations) was compared between groups. Risk estimates for obesity at age five were analyzed in relation to maternal gestational weight gain and prepregnancy BMI as a secondary outcome.Results: We analyzed 374 children at birth and 300 at age five. No significant difference in mean BMI z-score was seen at birth (0.68 (I) vs 0.56 (C), p = 0.242) or at age five (0.34 (I) vs 0.26 (C), p = 0.510) and no significant difference in proportion of over- or undernutrition was seen. Excessive maternal gestational weight gain was an independent risk factor for offspring obesity at birth (OR = 4.51, p < 0.001) but not at age five. Maternal obesity was an independent risk factor for offspring obesity at age five (OR = 4.81, p = 0.006).Conclusions: Our composite antenatal lifestyle intervention did not significantly reduce the risk of obesity in offspring up until age five.
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| 16. |
- Wahman, Kerstin, et al.
(författare)
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Translation and validation of two International Spinal Cord Injury (SCI) Data Sets : a modified process
- 2019
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Ingår i: Spinal Cord Series and Cases. - : Springer Nature. - 2058-6124. ; 5:1
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Tidskriftsartikel (refereegranskat)abstract
- Study design: A descriptive design was used of a reflective process of problem solving among individuals working together to improve the process of translating.Setting: Sweden.Objectives: The aim of this study was to describe a modified process for translation and validation of the International Spinal Cord Injury (SCI) Quality of Life (QoL) and Activity and Participation (A&P) Basic Data Sets from English into Swedish.Methods: The process of translation followed the Executive Committee for the International SCI Standards and Data Sets (ECSCI) recommendations. The initial translation was performed by translators. Experts in SCI were then assembled to scrutinize the translations and to reach a consensus for defining a final version.Results: The whole process was time consuming. To save time in future translations, the start-up planning is of great importance. To identify appropriate participants with knowledge and interest to be part of the project is crucial. In addition, the consensus meetings, when scrutinizing the translated International SCI Data Sets, should be well prepared and structured. We identified a few steps that could make the process more efficient.Conclusions: By adding a few steps as well as defining the role of a project coordinator, we believe that future translations of the International SCI Data Sets for non-English-speaking countries could be facilitated.
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| 17. |
- Wijk, Lena, 1971-
(författare)
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Enhanced Recovery After Hysterectomy
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Objectives: To study recovery after hysterectomy under Enhanced Recovery After Surgery (ERAS) care, and in relation to different operation techniques.Materials and Methods: An observational study was conducted comparing 85 patients undergoing hysterectomy with ERAS care to 120 patients immediately before establishing ERAS. In a prospective cohort study of 121 consecutive patients undergoing hysterectomy, the outcome was compared for patients with malignant versus benign indications. The main outcome measure was length of stay (LOS). A randomised controlled trial (RCT) of 20 women scheduled for hysterectomy compared robot-assisted laparoscopic with abdominal hysterectomy in terms of the development of insulin resistance, inflammatory reactions, and clinical recovery, and examined the relation to hormonal status. All studies were conducted in 2011--2015, at the Department of Obstetrics and Gynaecology, Örebro University Hospital, Sweden.Results: Implementation of a structured ERAS protocol significantly reduced LOS compared to non-ERAS care. The effect was similar between patients with malignant and benign indications for surgery. No difference in complications was found. There was no difference in development of insulin resistance between robotic and abdominal technique, but clinical outcomes and inflammatory responses significantly favoured robot-assisted hysterectomy. Female sex hormone status was associated with the development of insulin resistance.Conclusions: Recovery after hysterectomy can be influenced. ERAS care seems to be effective and safe. Clinical outcome can also be influenced by operational technique. Hysterectomy triggers a stress reaction in both the metabolic and the inflammatory system. It remains unclear why the reduced inflammatory reaction and favourable clinical outcome in robotic surgery were not mirrored by less insulin resistance. This could not be explained by female sex hormone status.
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| 18. |
- Wijk, Lena, 1971-, et al.
(författare)
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Enhanced Recovery after Surgery Protocol in Abdominal Hysterectomies for Malignant versus Benign Disease
- 2016
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Ingår i: Gynecologic and Obstetric Investigation. - Basel : S. Karger. - 0378-7346 .- 1423-002X. ; 81:5, s. 461-467
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Tidskriftsartikel (refereegranskat)abstract
- Background: The enhanced recovery after surgery (ERAS) protocol combines unimodal evidence-based interventions aiming to enhance recovery after surgery and reduce length of stay (LOS). We introduced an ERAS protocol in gynecological surgery and compared outcomes after hysterectomies performed for malignant vs. benign indications.Methods: This prospective cohort study was conducted at the Department of Obstetrics and Gynecology, Örebro University Hospital, Sweden, among 121 consecutive patients undergoing abdominal hysterectomy and salpingo-oophorectomy for malignant (n = 40) or benign (n = 81) indications between 2012 and 2014. Clinical data were prospectively collected and extracted from the patient records and from a specific database. The primary outcomes were LOS and proportion of patients achieving target LOS (2 days).Results: Patients operated for malignant vs. benign disease did not differ significantly in terms of LOS (2 (1-5) vs. 2 (1-11) days; p = 0.505), proportion discharged at target LOS (62 vs. 69%; p = 0.465; OR 0.74, 95% CI 0.3-1.6), complications (2 vs. 7% in primary stay, 8 vs. 11% within 30 days after discharge), re operations (0 vs. 2%), or readmissions (2 vs. 1%).Conclusion: The ERAS protocol may be equally applicable to patients undergoing hysterectomy either for a malignant or for a benign disease.
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| 19. |
- Wijk, Lena, 1971-, et al.
(författare)
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Female sex hormones in relation to insulin resistance after hysterectomy : A pilot study
- 2019
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Ingår i: Clinical Nutrition. - : Churchill Livingstone. - 0261-5614 .- 1532-1983. ; 38:6, s. 2721-2726
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND & AIM: Surgery causes development of insulin resistance. Women undergoing hysterectomy have different female sex hormonal status, ranging from premenopausal to postmenopausal. The aim of the study was to explore the relation between the female sex hormones and insulin resistance (IR%) after hysterectomy.METHODS: A secondary analysis from a randomised controlled single-centre study at the Department of Obstetrics and Gynaecology, Örebro University Hospital, Sweden. Twenty women were randomised to robot-assisted laparoscopic or abdominal hysterectomy. Blood were drawn before and after surgery for measurement of oestrogens, progesterone, and gonadotropins alongside determination of insulin sensitivity using the hyperinsulinemic normolycaemic clamp.RESULTS: Female sex hormonal status was not correlated to insulin sensitivity before operation. Premenopausal women developed more IR% than postmenopausal women (p = 0.012). Premenopausal women also showed a significant decrease in absolute levels of oestradiol (E2) (p = 0.016), and the relative decrease in E2 from preoperative to postoperative values (E2%) was significantly higher (p = 0.001). There was a significant positive correlation in the entire study population between E2% and IR% (r = 0.72, p = 0.001, r2 0.51) that remained when adjusted for age (p = 0.028), BMI (p = 0.001), and preoperative insulin sensitivity (p = 0.011) separately.CONCLUSIONS: Premenopausal women developed a higher degree of postoperative insulin resistance that was associated with a parallel relative change in oestradiol levels compared with the postmenopausal women. It remains unclear whether these are independent phenomena in the overall stress response or whether a causal relationship exists.
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| 20. |
- Wijk, Lena, 1971-, et al.
(författare)
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Metabolic and inflammatory responses and subsequent recovery in robotic versus abdominal hysterectomy : A randomised controlled study
- 2018
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Ingår i: Clinical Nutrition. - : Elsevier. - 0261-5614 .- 1532-1983. ; 37:1, s. 99-106
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND & AIMS: Surgery causes inflammatory and metabolic responses in the body. The aim of the study was to investigate whether robotic-assisted total laparoscopic hysterectomy induces less insulin resistance than abdominal hysterectomy, and to compare inflammatory response and clinical recovery between the two techniques.METHODS: A randomised controlled study at the Department of Obstetrics and Gynaecology, Örebro University Hospital, Sweden. Twenty women scheduled for a planned total hysterectomy with or without salpingo-oophorectomy between October 2014 and May 2015, were randomly allocated to robotic-assisted total laparoscopic hysterectomy or abdominal hysterectomy. Insulin resistance after surgery was measured by the hyperinsulinemic normoglycaemic clamp method, inflammatory response measured in blood samples, and clinical recovery outcomes registered.RESULTS: There were no differences in development of insulin resistance between the robotic group and the abdominal group (mean ± SD: 39% ± 22 vs. 40% ± 19; p = 0.948). The robotic group had a significantly shorter hospital stay (median 1 vs. 2 days; p = 0.005). Inflammatory reaction differed; in comparison to the robotic group, the abdominal group showed significantly higher increases in serum interleukin 6 levels, white blood cell count and cortisol from preoperative values to postoperative peak values.CONCLUSIONS: Robotic laparoscopic surgery reduced inflammatory responses and recovery time, but these changes were not accompanied by decreased insulin resistance.CLINICAL TRIAL REGISTRATION: www.ClinicalTrials.gov Identifier no NCT02291406.
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| 21. |
- Wijk, Lena, 1971-, et al.
(författare)
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Robotic versus abdominal hysterectomy; metabolic and inflammatory responses and subsequent recovery : A randomised controlled study
- 2016
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Ingår i: Clinical Nutrition ESPEN. - : Elsevier. - 2405-4577. ; 12
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The aim was to study if robotic assisted total hysterectomy (RTLH) would induce less insulin resistance than abdominal hysterectomy (AH). In addition, inflammatory response and clinical recovery were compared.Methods: We conducted a randomised controlled study at the Department of Obstetrics & Gynaecology, Örebro University Hospital; Sweden. Twenty women scheduled for a planned total hysterectomy with or without salpingo-oophorectomy, between October 2014 and May 2015, were randomly allocated to robotic assisted laparoscopic hysterectomy or abdominal hysterectomy. Insulin resistance after surgery was measured by the hyperinsulinemic normoglycemic clamp method. Inflammatory response was measured in blood samples and clinical recovery outcomes registered.Results: There were no differences in development of insulin resistance (mean ± SD) for robotic group (39±22%) vs abdominal group (40±19%; p=0.948). The robotic group had a significantly shorter hospital stay (median 1 vs. 2 days, p=0.005). Inflammatory reaction differed in form of significantly greater increase in serum interleukin 6 levels and white blood cell count, from preoperative value to postoperative peak value, in abdominal group compared with robotic group.Conclusion: Robotic assisted hysterectomy reduced inflammatory responses and recovery time but these changes were not accompanied by less insulin resistance.
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| 22. |
- Wätterbjörk, Inger, 1955-, et al.
(författare)
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Decision-making process of prenatal screening described by pregnant women and their partners
- 2015
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Ingår i: Health Expectations. - : Wiley-Blackwell. - 1369-6513 .- 1369-7625. ; 18:5, s. 1582-1592
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Tidskriftsartikel (refereegranskat)abstract
- Background: Pregnant women are often faced with having to decide about prenatal screening for Down’s syndrome. However,the decision to participate in or refrain from prenatal screening can be seen as an important decision not only for the pregnant woman but also for both the partners.Objective: The aim of this study was to explore the couples’ processes of decision making about prenatal screening.Methods: A total of 37 semi-structured interviews conducted at two time points were analysed using the interpretive description.Setting: The study was carried out in Maternal health-care centres,Örebro County Council, Sweden.Participants: Fifteen couples of different ages and with different experiences of pregnancy and childbirth were interviewed.Results: Three different patterns of decision making were identified. For the couples in The open and communicative decision-making process’, the process was straightforward and rational, and the couples discussed the decision with each other. ‘The closed and personal decision-making process’ showed an immediate and non-communicative decision making where the couples decided each for themselves. The couples showing ‘The searching and communicative decision-making process’ followed an arduous road in deciding whether to participate or not in prenatal screening and how to cope with the result.Conclusions: The decision-making process was for some couples a fairly straightforward decision, while for others it was a more complex process that required a great deal of consideration.
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| 23. |
- Wätterbjörk, Inger, 1955-, et al.
(författare)
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Reasons for declining extended information visit on prenatal screening among pregnant women and their partners
- 2015
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Ingår i: Prenatal Diagnosis. - : Wiley-Blackwell. - 0197-3851 .- 1097-0223. ; 35:12, s. 1232-1237
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Tidskriftsartikel (refereegranskat)abstract
- Objective: A two-step model on information on prenatal screening consists of brief information at the first visit at the Maternal Health Care Centre and an offer of extended information at a separate visit. There is a lack of knowledge why some pregnant women and their partners refrain from the extended information visit. The aim of this study was to explore their reasonsMethod: Eight qualitative interviews were analysed using Interpretive Description.Results: In the first theme “From an individual view”, the interviewees saw the invitation from their own points of view. They refrained because they did not want to receive any more information or had taken an individual position against chromosomal testing. In the theme, “From a societal view”, the interviewees perceived the offer as part of a societal view on prenatal screening that they could not support.Conclusion: The findings shows that these interviewees' reasons of declining an extended information visit are multidimensional and influenced by different views, from both an individual perspective and a more societal one. Health care professionals should be aware that some persons could have a different view on health care services and could be reluctant to accept offered services.
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