| 11. |
- Eriksson, Katarina
(författare)
-
Bacterial Vaginosis : Diagnosis, Prevalence, and Treatment
- 2011
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Bacterial Vaginosis (BV) is a disorder of unknown etiology, characterized by a foul smelling vaginal discharge, loss or reduction of the normal vaginal Lactobacilli, and overgrowth of other anaerobic bacteria. Thus, it presents a formidable problem for clinicians as well as microbiologists researching its etiology, clinical course, treatment, and epidemiology. The present work focuses on the unresolved issues of the epidemiology and treatment of BV in order to provide valid methods for treatment studies of this condition and to describe the prevalence of BV in defined populations.The first study validates the use of PAP-stained smears in the diagnosis of BV. The study assesses the methods of Amsel’s clinical criteria and Nugent criteria on Gram-stain smears, against Pap-stained smears and also validates different observers. The result shows that the PAP-staining of vaginal smears is a good method in BV diagnosis; the kappa value is 0.86 (interobserver weighted kappa index) compared to 0.81 for Gram-stained smears, and 0.70 for rehydrated air-dried smears using the mean Nugent score as the criterion standard. This enables population based studies on archived PAP-stained smears from the screening of cervical cancer.In the second study, we use the knowledge gained from study one to investigate the prevalence of BV in a cohort from the population of Åland. The prevalences of BV on the Åland Islands were: 15.6 %, 11.9 %, 8.7 %, and 8.6% in 1993, 1998, 2003, and 2008, respectively. This means that the prevalence of BV decreased between1993-2008 from 15.6% to 8.6%. The confidence intervals are not overlapping, thus indicating a significant decrease in prevalence from 1993 to 2008.The third study is a prospective, double-blind placebo controlled treatment study of BV. After conventional treatment with clindamycin, the patients were treated with adjuvant treatment of Lactobacilli-loaded tampons or placebo. The study showed no differences between the treatment and the placebo group, indicating that the tampon does not work at all. There are a variety of possible explanations for the result, which are analyzed in this thesis.The fourth study aimed to evaluate whether clindamycin is retained for a long time in the vaginal mucosa, thus disturbing the Lactobacilli in an attempt to reimplant Lactobacilli in the probiotic treatment studies. In conventional treatment, it is also useful to know whether clindamycin is retained, especially when considering the pressure from antibiotics on the antimicrobial sensitivity pattern. In the study, we found that the clindamycin disappears rapidly.Conclusion: BV research requires effort from many different scientific disciplines and the riddle of this condition and its treatment can only be resolved by concerted actions in research and treatment. The vision for the future includes, among other factors, better molecular biology based diagnostic tools, and knowledge of population based bacterial floras.
|
|
| 12. |
- Kihlgren, Annica, 1957-, et al.
(författare)
-
Psychometric evaluation of the Decision Support System (DSS) for municipal nurses encountering health deterioration among older adults
- 2024
-
Ingår i: BMC Geriatrics. - : BMC. - 1471-2318. ; 24:1
-
Tidskriftsartikel (refereegranskat)abstract
- Background: A valid and reliable tool is crucial for municipal registered nurses (RNs) to make quick decisions in older adults who show rapid signs of health deterioration. The aim of this study was to investigate the psychometric properties of the Decision Support System (DSS) among older adults in the municipal healthcare system.Methods: Firstly, we utilized the Rasch dichotomous model to analyze the DSS assessments (n=281) that were collected from municipal RNs working with older adults in the municipal healthcare system. We examined the properties of the DSS in terms of its unidimensionality, item fit, and separation indices. Secondly, to investigate inter-rater agreement in using the DSS, four experienced municipal RNs used the DSS to assess 60 health deterioration scenarios presented by one human patient simulators. The 60 DSS assessments were then analyzed using the ICC (2,1), percentage agreement, and Cohen kappa statistics.Results: The sample of older adults had a mean age of 82.8 (SD 11.7). The DSS met the criteria for unidimensionality, although two items did not meet the item fit statistics when all the DSS items were analyzed together. The person separation index was 0.47, indicating a limited level of separation among the sample. The item separation index was 11.43, suggesting that the DSS has good ability to discriminate between and separate the items. At the overall DSS level, inter-rater agreements were good according to the ICC. At the individual DSS item level, the percentage agreements were 75% or above, while the Cohen kappa statistics ranged from 0.46 to 1.00.Conclusions: The Rasch analysis revealed that the psychometric properties of the instrument were acceptable, although further research with a larger sample size and more items is needed. The DSS has the potential to assist municipal RNs in making clinical decisions regarding health deterioration in older adults, thereby avoiding unnecessary emergency admistion and helping.
|
|
| 13. |
|
|
| 14. |
- Linden, Karolina, 1982, et al.
(författare)
-
A woman-centered web-support program during pregnancy and early motherhood for women with type 1 diabetes
- 2014
-
Ingår i: The International Confederation of Midwives. ICM 30th Triennial Congress. 1-5 June 2014 Prague, Czech Republic.
-
Konferensbidrag (refereegranskat)abstract
- Background: Midwives have the responsibility to strengthen normal birth and promote breastfeeding; this challenge also includes women with chronic illness, such as type 1 diabetes. The transition to motherhood in pregnant women with type 1 diabetes is influenced by their constant struggle to achieve normoglycemia and negative feelings such as stress, anxiety and hopelessness are present. Aim: To describe the design of a woman-centered web-support for pregnant women and new mothers with type 1 diabetes. Method: A web-support has been developed using participatory design. A research project management group had the responsibility of steering the project forward. Different stakeholders including, midwifery, medical, nursing and target group expertise participated in the development. The web-support is implemented through a randomized controlled trial. Result: The developed web-support consists of three parts: 1) Specific information about pregnancy, childbirth, and early motherhood in relation to type 1 diabetes, where the challenge is to balance the core values of normal childbearing with diabetes related issues. 2) A self-care diary, including a device for documenting and evaluating blood glucose levels, insulin doses, food intake and physical activities. This enables the woman to keep in control of her own health. 3) A forum for peer support through communication between women and mothers in pregnancy and early motherhood. This enables sharing of similar experiences and of strategies to handle daily life. Clinical relevance: Well-being in terms of joy of childbearing, birth and motherhood could be achieved by addressing diabetes related health risks and complications in a manner that emphasizes the normality of being pregnant, giving birth and breastfeeding. A balancing act between focusing on potential risks and normal pregnancy related processes.
|
|
| 15. |
|
|
| 16. |
- Linden, Karolina, 1982, et al.
(författare)
-
Study protocol for evaluating a web-support program with a control group for pregnant women and new mothers with type 1 diabetes mellitus.
- 2013
-
Ingår i: 7th International DIP Symposium - Diabetes, Hypertension, Metabolic syndrome & Pregnancy. Florence, Italy, March 13-16, 2013.
-
Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background In the struggle to achieve normoglycemia during pregnancy, women with type 1 diabetes mellitus (T1D) alternate between mastering their situation and feeling enslaved. Caregivers not only have the responsibility of optimising the women’s biological probability of delivering healthy children, but also of supporting them during their transition to motherhood. In order to establish breastfeeding and simultaneously control blood glucose, the mothers require extended post-partum support. The aim was to describe the study design of an on-going randomized controlled trial evaluating a web-support program for pregnant women and new mothers with T1D. Methods The developed web-based support is being implemented through a randomized controlled trial in which women with T1D in early pregnancy are randomized to either web-based support in addition to usual care (IG) or usual care (CG). A sample size of 160 is required based on the two primary outcomes: a general wellbeing scale (W-BQ12) and a diabetes empowerment scale (SWE-DES) to reach a statistical power of 80% with a significance level of 0.05. Results The web-support consists of evidence-based information, person-centred self-care diaries and an online social community. Outcomes will be measured in early pregnancy (baseline), about five weeks before expected partus and at two and six months after partus. Conclusion The unique contribution of this project is the development of a specially designed web application for mothers with T1D which is expected to increase the women’s personal resources, including knowledge, and thereby strengthen their autonomy during pregnancy, breastfeeding and early motherhood.
|
|
