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  • 1.
    Bergh, Ingrid H. E.
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Johansson, Anna
    Univ Hosp Örebro, Dept Obstet, Örebro, Sweden.
    Bratt, Annelie
    Skaraborgs Hosp, Dept Obstet & Gynecol, Skövde, Sweden.
    Ekström, Anette
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Mårtensson, Lena B.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Assessment and documentation of women's labour pain: A cross-sectional study in Swedish delivery wards2015In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 28, no 2, p. E14-E18Article in journal (Refereed)
    Abstract [en]

    Background: A woman's pain during labour plays a dominant role in childbirth. The midwife's role is to assess the degree of pain experienced during labour. When professionals respond to labour pain with acknowledgement and understanding, the woman's sense of control and empowerment is increased, which could contribute to a positive experience of childbirth. The aim of this study is to describe how labour pain in Swedish delivery wards is assessed and documented. Methods: This quantitative descriptive study was designed as a national survey performed through telephone interviews with the representatives of 34 delivery wards in Sweden. Results and conclusion: The majority of the participating delivery wards assessed and documented women's labour pain, but in an unstructured manner. The wards differed in how the assessments and documentation were performed. In addition, almost all the delivery wards that participated in the survey lacked guidelines for the assessment and documentation of the degree of pain during labour. The findings also showed that the issue of labour pain was sometimes discussed in the delivery wards, but not in a structured or consistent way. (C) 2015 Australian College of Midwives. Published by Elsevier Australia (a division of Reed International Books Australia Pty Ltd). All rights reserved.

  • 2.
    Borgström, Juliana
    University of Skövde, School of Bioscience.
    Cyclical Women: Menstrual Cycle Effects on Mood and Neuro-Cognitive Performance2019Independent thesis Basic level (degree of Bachelor), 15 credits / 22,5 HE creditsStudent thesis
    Abstract [en]

    During roughly forty years of a woman’s life-span, the fertile female human body prepares itself monthly for the possibility of pregnancy. Science has shown that the fluctuation of the sex steroids progesterone and estrogen have a crucial role in the female body's physiology, determining the menstrual cycle and its general phases. This biological dance of hormones governing the cycle influences a lot of physical, mental and cognitive aspects of life for a fertile ovulating woman. Although the question of whether these changes also affect women's cognitive performance is still unclear, some evidence has been gathered that could bring us closer to answers. Recent research findings show that this hormonal interplay might have a significant role in cognitive and psychological development - modulating brain activity, cognitive performance, higher cognition, emotional status, sensory processing, appetite and more. This thesis aims to uncover to what extent the menstrual cycle affects brain functions, neurobiology, mood, well-being and cognitive performance in menstruating cisgender women.

  • 3.
    Cedermark, Ulrika
    University of Skövde, School of Life Sciences.
    Förstagångsmammor, Amning och deras upplevelse av Amningsstöd2013Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    The health benefits of breastfeeding are well documented and guidelines for infant feeding have supported exclusive breastfeeding during the first 6 months. The breastfeeding prevalence has decreased in Sweden during the last ten years. The aim with this study was to find out if primaparous mothers could breastfeed as long as they had planned to do, reasons for stopping breastfeeding and how the mothers had perceived breastfeeding support, especially the support from the child health care. A questionnaire was sent out to 65 primiparous women and 35 mothers participated in the study. Almost half of the mothers had stopped breastfeeding earlier than they wanted to do. The result showed that many mothers looked for support in their own social network. The support from antenatal care, delivery and maternity ward, child health care was important in initiating breastfeeding as well as to maintain breastfeeding. There is a need of more education in breastfeeding and breast milk to health professionals and breastfeeding supporters to be able to support those mothers who want to breastfeed their babies.

  • 4.
    Hörnberg, Frida
    et al.
    University of Skövde, School of Health and Education.
    Nyblom, Frida
    University of Skövde, School of Health and Education.
    Sex- och samlevnadsundervisning till ungdomar: Barnmorskors erfarenheter2019Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Forskning har visat att ungdomarna är missnöjda med den sex- och

    samlevnadsundervisning som idag finns att tillgå. Det sexuella beteendet har förändrats

    genom tiderna och det har visat sig vara tidskrävande samt svårt att bedriva undervisningen på grund av bristen på barnmorskor.

    Syfte: Att belysa ungdomsmottagnings-barnmorskornas erfarenheter av sex- och samlevnadsundervisning till ungdomar.

    Metod: I studien genomfördes intervjuer med sex barnmorskor verksamma på olika ungdomsmottagningar i Västra Götaland. Datamaterialet analyserades med hjälp av kvalitativ innehållsanalys.

    Resultat: I resultatet framkom fyra teman och åtta subteman; Främja en positiv syn på

    sexualiteten bland ungdomarna; Ungdomarnas okunskap kan leda till ett riskbeteende;

    Grundskolans sex- och samlevnadsundervisning möter inte ungdomarnas behov; Betydelsen

    av utåtriktat arbete. Konklusion: Resultatet visar att den sex- och samlevnadsundervisning

    som idag erbjuds till ungdomarna är bristande. Barnmorskorna ger tydliga förslag på hur sex och samlevnadsundervisningen kan integreras i grundämnena. Genom att ungdomarna får

    tillgång till den undervisning de är i behov ökar deras kunskap vilket genererar i en positiv

    sexualitet.

  • 5.
    Landegren, Nils
    et al.
    Department of Medicine (Solna), Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden / Department of Medical Sciences, Science for Life Laboratory, Uppsala University, Uppsala, Sweden.
    Sharon, Donald
    Department of Genetics, Stanford University, CA, USA / Department of Molecular, Cellular, and Developmental Biology, Yale University, New Haven, CT 06511, USA.
    Shum, Anthony K.
    Division of Pulmonary and Critical Care, Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA.
    Khan, Imran S.
    Diabetes Center, University of California San Francisco, San Francisco, CA 94143, USA.
    Fasano, Kayla J.
    Diabetes Center, University of California San Francisco, San Francisco, CA 94143, USA.
    Hallgren, Åsa
    Department of Medicine (Solna), Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden / Department of Medical Sciences, Science for Life Laboratory, Uppsala University, Uppsala, Sweden.
    Kampf, Caroline
    Department of Immunology, Genetics, and Pathology, Uppsala University, Uppsala, Sweden.
    Freyhult, Eva
    Cancer Pharmacology and Computational Medicine, Department of Medical Sciences, Bioinformatics Infrastructure for Life Sciences, Science for Life Laboratory, Uppsala University, Uppsala, Sweden.
    Ardesjö-Lundgren, Brita
    Department of Animal Breeding and Genetics, Swedish University of Agricultural Sciences, Uppsala, Sweden.
    Alimohammadi, Mohammad
    Department of Medicine (Solna), Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden / Department of Medical Sciences, Science for Life Laboratory, Uppsala University, Uppsala, Sweden / Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Rathsman, Sandra
    Department of Laboratory Medicine/Microbiology, Örebro University Hospital, Örebro, Sweden.
    Ludvigsson, Jonas F.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Lundh, Dan
    University of Skövde, School of Bioscience. University of Skövde, Health and Education.
    Motrich, Ruben
    Centro de Investigaciones en Bioquímica Clínica e Inmunología, Departamento de Bioquímica Clínica, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba 5000, Argentina.
    Rivero, Virginia
    Centro de Investigaciones en Bioquímica Clínica e Inmunología, Departamento de Bioquímica Clínica, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba 5000, Argentina.
    Fong, Lawrence
    University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA 94115, USA.
    Giwercman, Aleksander
    Molecular Reproduction Research, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
    Gustafsson, Jan
    Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
    Perheentupa, Jaakko
    The Hospital for Children and Adolescents, University of Helsinki, Helsinki 00029, Finland.
    Husebye, Eystein S.
    Department of Clinical Science, University of Bergen, and Department of Medicine, Haukeland University Hospital, Bergen 5020, Norway.
    Anderson, Mark S.
    Diabetes Center, University of California San Francisco, San Francisco, CA 94143, USA.
    Snyder, Michael
    Department of Genetics, Stanford University, Stanford 94305, CA, USA.
    Kämpe, Olle
    Department of Medicine (Solna), Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden / Department of Medical Sciences, Science for Life Laboratory, Uppsala University, Uppsala, Sweden.
    Transglutaminase 4 as a prostate autoantigen in male subfertility2015In: Science Translational Medicine, ISSN 1946-6234, E-ISSN 1946-6242, Vol. 7, no 292, article id 292ra101Article in journal (Refereed)
    Abstract [en]

    Autoimmune polyendocrine syndrome type 1 (APS1), a monogenic disorder caused by AIRE gene mutations, features multiple autoimmune disease components. Infertility is common in both males and females with APS1. Although female infertility can be explained by autoimmune ovarian failure, the mechanisms underlying male infertility have remained poorly understood. We performed a proteome-wide autoantibody screen in APS1 patient sera to assess the autoimmune response against the male reproductive organs. By screening human protein arrays with male and female patient sera and by selecting for gender-imbalanced autoantibody signals, we identified transglutaminase 4 (TGM4) as a male-specific autoantigen. Notably, TGM4 is a prostatic secretory molecule with critical role in male reproduction. TGM4 autoantibodies were detected in most of the adult male APS1 patients but were absent in all the young males. Consecutive serum samples further revealed that TGM4 autoantibodies first presented during pubertal age and subsequent to prostate maturation. We assessed the animal model for APS1, the Aire-deficient mouse, and found spontaneous development of TGM4 autoantibodies specifically in males. Aire-deficient mice failed to present TGM4 in the thymus, consistent with a defect in central tolerance for TGM4. In the mouse, we further link TGM4 immunity with a destructive prostatitis and compromised secretion of TGM4. Collectively, our findings in APS1 patients and Aire-deficient mice reveal prostate autoimmunity as a major manifestation of APS1 with potential role in male subfertility.

  • 6.
    Mårtensson, Lena
    University of Skövde, School of Life Sciences.
    Sterile water injections and acupuncture as treatment for labour pain2006Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Most women experience pain during labour. Complementary pain relief methods such as sterile water injections and acupuncture are two alternatives for the child birthing women. The lack of knowledge about the use of these methods in clinical practice creates the need to develop and evaluate them.

    Aims and methods: To elucidate whether the new subcutaneous method of administering sterile water, as well as the previously described intracutaneous injection method, were effective for the relief of labour pain. Ninety-nine women in labour were randomized to either intracutaneous- , subcutaneous injections of sterile water or to placebo (Paper I). To investigate if there was any difference in perceived pain between the intracutaneous and subcutaneous techniques during injection of sterile water. One hundred female volunteers were given injections with both techniques in a cross-over trial (Paper II). To elucidate the clinical use of acupuncture and sterile water injections as pain relief and relaxation during childbirth in Swedish delivery wards. Five hundred and sixty-five midwives answered a questionnaire about their use of these methods (Paper III). To elucidate if there were any differences between acupuncture and sterile water injections in terms of pain relief and relaxation during labour. One hundred and twenty-eight pregnant women in childbirth were randomized to either sterile water injections or acupuncture (Paper IV).

    Results: Paper I: VAS pain scores were significantly lower in both treatment groups 10 minutes (p=0.001) and 45 minutes (p=0.005) after treatment, compared with the placebo group. Paper II: subcutaneous injections were still perceived as less painful than intracutaneous injections after trial, day and injection location were taken into consideration (p<0.001). Paper III: the midwives’ estimated frequency of administration of acupuncture was much higher than that of sterile water injections, 25 % versus 2 %. The intracutaneous injection technique was more common in clinical practice than the subcutaneous technique. Sterile water injections were used exclusively for pain relief during labour while acupuncture was used for both pain relief and relaxation during labour. Paper IV: women given sterile water injections experience significantly less labour pain and a higher degree of relaxation in labour, compared to women given acupuncture (p<0.001).

    Conclusions: The results indicate that the subcutaneous injection technique is preferable when using sterile water injections for low back pain during labour. Sterile water injections seem to provide more pain relief and a higher degree of relaxation, compared to acupuncture. However, acupuncture is a more common pain relief method in clinical practice.

  • 7.
    Mårtensson, Lena
    et al.
    University of Skövde, School of Life Sciences.
    Nyberg, Karin
    Department of Health Sciences, University of Göteborg, Sweden.
    Wallin, Gunnar
    Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Sweden.
    Subcutaneous versus intracutaneous injections of sterile water for labour analgesia: a comparison of perceived pain during administration2000In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 107, no 10, p. 1248-1251Article in journal (Refereed)
    Abstract [en]

    Objective To investigate whether, during injections of sterile water, there is any difference in perceived pain between intracutaneous and subcutaneous injections.

    Design Blind controlled trial with cross-over design.

    Setting Göteborg and Skövde, Sweden.

    Participants One hundred healthy female volunteers.

    Methods The women were randomised into two groups and subjected to two trials, within one week of each other. During the first trial one group ( n= 50 ) received the intracutaneous injection first, followed by the subcutaneous injection. The second group ( n= 50 ) was given the subcutaneous injection first, followed by intracutaneous injection. In both groups all the injections were given in reverse order during the second trial.

    Main outcome measures Experienced pain during the administration of sterile water injections, measured by visual analogue scale.

    Results The analysis showed intracutaneous injections to be significantly more painful than subcutaneous injections, even after adjusting for injection day and for left/right site of injection (mean 60.8 vs 41.3,  P < 0.001 ).

    Conclusions The findings suggest that the less painful subcutaneous injection technique should be used.

  • 8.
    Mårtensson, Lena
    et al.
    University of Skövde, School of Life Sciences.
    Stener-Victorin, Elisabet
    Univ Gothenburg, Sahlgrenska Acad, Inst Neurosci Physiol Endocrinol, Gothenburg, Sweden.
    Wallin, Gunnar
    Univ Gothenburg, Sahlgrenska Acad, Dept Obstet & Gynecol, Gothenburg, Sweden.
    Acupuncture versus subcutaneous injections of sterile water as treatment for labour pain2008In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 87, no 2, p. 171-177Article in journal (Refereed)
    Abstract [en]

    Two methods for pain relief and relaxation during labour are sterile water injections and acupuncture. In several studies, sterile water injections have been shown to provide good pain relief, particularly for low back pain during labour. The acupuncture studies for pain relief during labour are not as concordant. Therefore, the aim of this study was to explore if there were any differences between acupuncture and sterile water injections regarding pain relief and relaxation during labour. METHODS: A randomised controlled trial. Some 128 pregnant women at term were randomly assigned to receive acupuncture (n=62) or sterile water injections (n=66). The primary endpoint was to compare the differences between pre-treatment pain levels and maximum pain in the 2 groups. RESULTS: The main results of this study were that sterile water injections yielded greater pain relief (p<0.001) during childbirth compared to acupuncture. The secondary outcome showed that women in the sterile water group had a higher degree of relaxation (p<0.001) compared to the acupuncture group. The women's own assessment of the effects also favoured sterile water injections (p<0.001). There were no significant differences regarding requirements for additional pain relief after treatment between the 2 groups. CONCLUSIONS: Women given sterile water injection experience less labour pain compared to women given acupuncture.

  • 9.
    Mårtensson, Lena
    et al.
    University of Skövde, School of Life Sciences.
    Wallin, Gunnar
    Dept. of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Labour pain treated with cutaneous injections of sterile water: a randomised controlled trial1999In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 106, no 7, p. 633-637Article in journal (Refereed)
    Abstract [en]

    Objective To evaluate the relief of pain in labour with subcutaneous and intracutaneous injections of sterile water, compared with placebo.

    Design Randomised controlled trial.

    Setting Labour ward with approximately 3000 deliveries annually in a suburban area near Gothenburg, Sweden.

    Participants Ninety-nine pregnant women at term, requiring pain relief for severe lower back pain during the first stage of labour. The women were randomised to receive four injections of 0.1 mL sterile water (without salt) intracutaneously ( n= 33 ), four injections of 0.5 mL sterile water subcutaneously ( n= 33 ) or placebo treatment ( n= 33 ).

    Main outcome measures Reduction of labour pain measured by visual analogue scale.

    Results The median visual analogue scale pain score for labour pain was significantly lower compared with initial values in the two study groups and compared with placebo at 10 and 45 minutes after treatment. The median reductions in visual analogue scores after 10 minutes were 5.0 cm and 4.5 cm in the intracutaneous and subcutaneous injection groups, respectively; women in the placebo group scored a median reduction of 1.7 cm. After 45 minutes the median reductions in the visual analogue scores were 4.9 cm and 4.0 cm in the intracutaneous and subcutaneous injection groups, respectively, compared with 1.0 cm for women in the placebo group. No significant differences in analgesic effect or pain experienced during administration were found between the two study groups.

    Conclusion The new subcutaneous method of administering sterile water, as well as the earlier described intracutaneous injection method, were effective for the relief of pain in labour.

  • 10.
    Nygren, Maria
    et al.
    University of Skövde, School of Life Sciences.
    Trojette, Faten
    University of Skövde, School of Life Sciences.
    KVINNORS UPPLEVELSER AV STÖD VID MISSFALL: En litteraturöversikt2009Independent thesis Basic level (university diploma), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    A miscarriage is a big and chaotic event in a woman's life. During this time caregiver has an important role in how women cope with their situation and how they move forward. The purpose of this literature review was to highlight women’s experiences of support at miscarriage. This can help nurses to better understand the woman in her situation in a miscarriage. The method was a literature review according to Friberg (2006). Nine scientific articles formed the base of the review. The results revealed two main areas: emotional support and practical assistance with five different sub-areas: social assistance, professional support, treatment and attitude, follow up and information. It appeared both positive and negative experiences of the provided care. The support and care provided by nurses at an miscarriage should be as good as possible with the idea that each case is individual and unique. This by listening to what the women need and shaping health care for her.

  • 11.
    Pendharkar, Sonal
    et al.
    Karolinska institutet, Stockholm, Sweden.
    Brandsborg, Erik
    Bifodan AS, Hundested, Denmark.
    Hammarström, Lennart
    Karolinska Institutet, Stockholm, Sweden.
    Marcotte, Harold
    Karolinska Institutet, Stockholm, Sweden.
    Larsson, Per-Göran
    University of Skövde, School of Bioscience. Department of Obstetrics and Gynaecology Kärnsjukhuset, Skaraborg hospital, Skövde, Sweden.
    Vaginal colonisation by probiotic lactobacilli and clinical outcome in women conventionally treated for bacterial vaginosis and yeast infection2015In: BMC Infectious Diseases, ISSN 1471-2334, E-ISSN 1471-2334, Vol. 15, p. 1-12, article id 255Article in journal (Refereed)
    Abstract [en]

    Background: The aim of this study was to investigate the colonisation by lactobacilli and clinical outcome in women with bacterial vaginosis (BV) and recurrent vulvovaginal candidiasis (R-VVC) receiving antibiotic or anti-fungal treatment in combination with the probiotic EcoVag(R) capsules. Methods: A total of 40 Scandinavian women diagnosed with BV or VVC on the basis of Amsel's criteria or clinical symptoms were consecutively recruited in two pilot open label clinical trials. In trial I, women with BV were treated with clindamycin and metronidazole followed by vaginal EcoVag(R) capsules, containing Lactobacillus rhamnosus DSM 14870 and Lactobacillus gasseri DSM 14869, for 5 consecutive days after each antibiotic treatment. In trial II, women were recruited in three groups as follows: women with BV receiving clindamycin and metronidazole treatment together with a prolonged administration of EcoVag(R) (10 consecutive days after each antibiotic treatment followed by weekly administration of capsules for next four months), women with R-VVC receiving extended fluconazole and EcoVag(R) treatment, and women receiving extended fluconazole treatments only. The difference in frequency of isolation of EcoVag(R) strains or other lactobacilli between groups was compared by Fisher's exact test. Results: The 6-month cure rate for BV was 50 % in trial I while both the 6- and 12-month cure rates were 67 % in trial II. The 6- and 12-month cure rates for VVC were 100 % and 89 % in women receiving fluconazole and EcoVag(R), and 100 % and 70 % in women receiving fluconazole only. The frequency of isolation of any Lactobacillus species during the course of the study was associated with cure of BV in trial I and II, whereas the frequency of isolation of EcoVag(R) strains was significantly associated with the cure of BV in trial II only. As previously observed, a change in sexual partner was associated with relapse of BV with an Odds ratio of 77 (95 % CI: 2.665 to 2225). Conclusions: The study suggests that the treatment with antibiotics or anti-fungal medication in combination with EcoVag(R) capsules provide long-term cure against BV and R-VVC as compared to previous reports.

  • 12.
    Scheynius, Hanna
    et al.
    University of Skövde, School of Life Sciences.
    Lager, Josefin
    University of Skövde, School of Life Sciences.
    Kvinnors upplevelser av stöd från barnmorskor i samband medmedicinsk hemabort: en kvalitativ studie2010Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Medical abortion means termination of pregnancy in a pharmacological way, it can beperformed until the ninth week of pregnancy. Abortion at home means that women completea medical abortion in their homes, it has been allowed in Sweden since 2004. Previous studiesillustrate that women experience abortion at home as more natural than abortion performed athospital. Support can be seen from four different dimensions; informational, instrumental,emotional and appraisal. The aim of the study was to describe women’s experiences ofsupport from midwives in connection to induced medical abortion at home. The method usedis qualitative content analysis with an inductive approach. The collecting of data has beenmade through a questionnaire with open questions. Six women chose to participate in thestudy. The result was divided into six categories and one theme. The result shows that eventhough the women feel vulnerable, they are satisfied with the support they are offered. Thewomen feel that they are well informed, involved and safe; they appreciate the call from themidwife during the day of the abortion, also that the hospital can be reached day and night.

  • 13.
    Skalkidou, Alkistis
    et al.
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Sundström Poromaa, Inger
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Iliadis, Stavros I.
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Huizink, Anja
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Section of Clinical Developmental Psychology, Vrije Universiteit Amsterdam, Netherlands.
    Hellgren, Charlotte
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Freyhult, Eva
    Department of Medical Science, National Bioinformatics Infrastructure Sweden, Science for Life Laboratory, Uppsala University, Uppsala, Sweden.
    Comasco, Erika
    Department of Neuroscience, Science for Life Laboratory, Uppsala University, Uppsala, Sweden.
    Stress-related genetic polymorphisms in association with peripartum depression symptoms and stress hormones: A longitudinal population-based study2019In: Psychoneuroendocrinology, ISSN 0306-4530, E-ISSN 1873-3360, Vol. 103, p. 296-305Article in journal (Refereed)
    Abstract [en]

    Individual differences in the response of the stress system to hormonal changes during pregnancy and the postpartum period render some women susceptible to developing depression. The present study sought to investigate peripartum depression and stress hormones in relation to stress-related genotypes. The Edinburgh Postnatal Depression Scale was used to assess peripartum depressive symptoms in a sample of 1629 women, followed from pregnancy week seventeen to six months postpartum. Genotypes of ninety-four haplotype-tag single nucleotide polymorphisms (SNPs) in sixteen genes of the hypothalamus-pituitary-adrenal axis pathway were analyzed and data on psychosocial and demographic factors was collected. In sub-studies, salivary cortisol awakening response in gestational week 35–39, salivary evening cortisol levels in gestational week 36 and postpartum week 6, and blood cortisol and cortisone levels in gestational week 35–39 were analyzed. SNP-set kernel association tests were performed at the gene-level, considering psychosocial and demographic factors, followed by post-hoc analyses of SNPs of significant genes. Statistically significant findings at the 0.05 p-level included SNPs in the hydroxysteroid 11-beta dehydrogenase 1 (HSD11B1) gene in relation to self-rated depression scores in postpartum week six among all participants, and serpin family A member 6 (SERPINA6) gene at the same time-point among women with de novo onset of postpartum depression. SNPs in these genes also associated with stress hormone levels during pregnancy. The present study adds knowledge to the neurobiological basis of peripartum depression by systematically assessing SNPs in stress-regulatory genes and stress-hormone levels in a population-based sample of women. © 2019 Elsevier Ltd

  • 14.
    Theurich, Melissa Ann
    et al.
    LMU - Ludwig-Maximilians-Universität Munich, Div. Metabolic and Nutritional Medicine, Dr. von Hauner Children's Hospital, Munich, Germany.
    Davanzo, Riccardo
    Department of Mother and Child Health, ASM-Matera and Task Force on Breastfeeding, MOH, Rome, Italy.
    Busck-Rasmussen, Marianne
    Danish Committee for Health Education, Copenhagen, Denmark.
    Díaz-Gómez, N. Marta
    Instituto de Tecnologías Biomédicas (ITB) and Centro de Investigaciones Biomédicas de Canarias (CIBICAN), Universidad de La Laguna, Spain.
    Brennan, Christine
    Breastfeeding Promotion Foundation, Bern, Switzerland.
    Kylberg, Elisabeth
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Bærug, Anne
    Norwegian National Advisory Unit on Breastfeeding, Oslo, Norway.
    McHugh, Laura
    Health Service Executive, Ennis, Ireland.
    Weikert, Cornelia
    German Federal Institute for Risk Assessment, Department of Food Safety, Berlin, Germany.
    Abraham, Klaus
    German Federal Institute for Risk Assessment, Department of Food Safety, Berlin, Germany.
    Koletzko, Berthold
    LMU - Ludwig-Maximilians-Universität Munich, Div. Metabolic and Nutritional Medicine, Dr. von Hauner Children's Hospital, Munich, Germany.
    Breastfeeding Rates and Programs in Europe: A Survey of 11 National Breastfeeding Committees and Representatives2019In: Journal of Pediatric Gastroenterology and Nutrition - JPGN, ISSN 0277-2116, E-ISSN 1536-4801, Vol. 68, no 3, p. 400-407Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Among the world's regions, the WHO European Region has the lowest rates of exclusive breastfeeding at age 6 months with around 25%. Low rates and early cessation of breastfeeding have important adverse health consequences for women, infants and young children. Protecting, promoting and supporting breastfeeding are a public health priority.

    OBJECTIVES: National breastfeeding data and monitoring systems among selected European countries and the WHO European Region are compared. Mechanisms for the support, protection and promotion of breastfeeding are reviewed and successes and challenges in implementation of national programs are presented.

    METHODS: National representatives of national breastfeeding committees and initiatives in eleven European countries, including Belgium, Croatia, Denmark, Germany, Ireland, Italy, The Netherlands, Norway, Spain, Sweden and Switzerland, participated in a standardized survey. Results are evaluated and compared in a narrative review.

    RESULTS: Variation exists in Europe on breastfeeding rates, methodology for data collection and mechanisms for support, protection and promotion of breastfeeding. Directly after birth, between 56 and 98 % of infants in all countries were reported to receive any human milk, and at 6 months 38-71% and 13-39 % of infants to be breastfed or exclusively breastfed, respectively. National plans addressing breastfeeding promotion, protection and support exist in 6 of the 11 countries.

    CONCLUSIONS: National governments should commit to evidence-based breastfeeding monitoring and promotion activities, including financial and political support, to improve breastfeeding rates in the Europe. Renewed efforts for collaboration between countries in Europe, including a sustainable platform for information exchange, are needed.

  • 15.
    Thorstensson, Stina
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Claesson, Amanda
    Mölndal labour ward, Sahlgrenska University Hospital, Göteborg, Sweden.
    Packalen, Anna
    Kvinnokliniken, Skaraborgs Sjukhus Skövde, Sweden.
    Hertfelt Wahn, Elisabeth
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Ekström, Anette
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Validating the Mother-to-Infant Relation and Feelings' scale by first-time mothers' descriptions three months after birth2014In: Journal of Women's Health, Issues & Care, ISSN 2325-9795, Vol. 3, no 6, article id 1000173Article in journal (Refereed)
  • 16.
    Uvnäs-Moberg, Kerstin
    et al.
    University of Agriculture (SLU), Uppsala, Sweden.
    Ekström-Bergström, Anette
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Department of Health Sciences, University West, Trollhättan, Sweden.
    Berg, Marie
    Institute of Health and Care Sciences, University of Gothenburg, Sweden / Centre for Person-Centred Care, University of Gothenburg, Sweden.
    Buckley, Sarah
    School of Public Health, University of Queensland, Brisbane, Australia.
    Pajalic, Zada
    Faculty of Health Sciences, Oslo and Akershus University, College of Applied Sciences, Oslo, Norway.
    Hadjigeorgiou, Eleni
    Faculty of Health Sciences, Cyprus, University of Technology, Limassol, Cyprus.
    Kotłowska, Alicja
    Faculty of Health Sciences with Subfaculty of Nursing, Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, Gdańsk, Poland.
    Lengler, Luise
    Midwifery Research and Education Unit, Hannover Medical School, Hannover, Germany.
    Kielbratowska, Bogumila
    Faculty of Medical Sciences, Medical University of Gdańsk, Gdańsk, Poland.
    Leon-Larios, Fatima
    Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain.
    Magistretti, Claudia Meier
    Department of Social Work Center for Health Promotion and Social Participation, Lucerne University of Applied Sciences and Arts, Luzern, Switzerland.
    Downe, Soo
    Research in Childbirth and Health (ReaCH) Group, University of Central Lancashire, Preston, United Kingdom.
    Lindström, Bengt
    Norwegian University of Science and Technology, Trondheim, Norway.
    Dencker, Anna
    Institute of Health and Care Sciences, University of Gothenburg, Sweden / Centre for Person-Centred Care, University of Gothenburg, Sweden.
    Maternal plasma levels of oxytocin during physiological childbirth: A systematic review with implications for uterine contractions and central actions of oxytocin2019In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 19, no 1, article id 285Article, review/survey (Refereed)
    Abstract [en]

    Background: Oxytocin is a key hormone in childbirth, and synthetic oxytocin is widely administered to induce or speed labour. Due to lack of synthetized knowledge, we conducted a systematic review of maternal plasma levels of oxytocin during physiological childbirth, and in response to infusions of synthetic oxytocin, if reported in the included studies. Methods: An a priori protocol was designed and a systematic search was conducted in PubMed, CINAHL, and PsycINFO in October 2015. Search hits were screened on title and abstract after duplicates were removed (n = 4039), 69 articles were examined in full-text and 20 papers met inclusion criteria. As the articles differed in design and methodology used for analysis of oxytocin levels, a narrative synthesis was created and the material was categorised according to effects. Results: Basal levels of oxytocin increased 3-4-fold during pregnancy. Pulses of oxytocin occurred with increasing frequency, duration, and amplitude, from late pregnancy through labour, reaching a maximum of 3 pulses/10 min towards the end of labour. There was a maximal 3- to 4-fold rise in oxytocin at birth. Oxytocin pulses also occurred in the third stage of labour associated with placental expulsion. Oxytocin peaks during labour did not correlate in time with individual uterine contractions, suggesting additional mechanisms in the control of contractions. Oxytocin levels were also raised in the cerebrospinal fluid during labour, indicating that oxytocin is released into the brain, as well as into the circulation. Oxytocin released into the brain induces beneficial adaptive effects during birth and postpartum. Oxytocin levels following infusion of synthetic oxytocin up to 10 mU/min were similar to oxytocin levels in physiological labour. Oxytocin levels doubled in response to doubling of the rate of infusion of synthetic oxytocin. Conclusions: Plasma oxytocin levels increase gradually during pregnancy, and during the first and second stages of labour, with increasing size and frequency of pulses of oxytocin. A large pulse of oxytocin occurs with birth. Oxytocin in the circulation stimulates uterine contractions and oxytocin released within the brain influences maternal physiology and behaviour during birth. Oxytocin given as an infusion does not cross into the mother's brain because of the blood brain barrier and does not influence brain function in the same way as oxytocin during normal labour does. 

  • 17.
    Uvnäs-Moberg, Kerstin
    et al.
    Department of Animal Environment and Health, Swedish University of Agricultural Sciences, Skara, Sweden.
    Handlin, Linda
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Kendall-Tackett, Kathleen
    Texas Tech University School of Medicine, Amarillo, TX, USA.
    Petersson, Maria
    Department of Molecular Medicine and Surgery, Endocrine and Diabetes Unit, Karolinska Institutet, Sweden.
    Oxytocin is a principal hormone that exerts part of its effects by active fragments2019In: Medical Hypotheses, ISSN 0306-9877, E-ISSN 1532-2777, Vol. 133, p. 1-9, article id 109394Article in journal (Refereed)
    Abstract [en]

    Oxytocin is a nonapeptide consisting of a cyclic six amino-acid structure and a tail of three amino acids. It was originally known for its ability to induce milk ejection and to stimulate uterine contractions. More recently, oxytocin has been shown to stimulate social behaviors, and exert pain-relieving, anti-stress/anti-inflammatory and restorative effects. We hypothesize that oxytocin is a principal hormone that, in part, exerts its effects after degradation to active fragments with more specific effect profiles. Experimental findings on rats show that administered oxytocin exerts biphasic effects. For example, after an initial increase in pain threshold, a second more long-lasting increase follows. Blood pressure and cortisol levels initially increase and then reverse into a long-lasting decrease in blood pressure and cortisol. Whereas the initial effects are, the second-phase effects are not blocked by an oxytocin antagonist, but by an opioid mu-antagonist and by an alpha 2-adrenoreceptor antagonist, respectively, suggesting that other receptors are involved. Repeated administration of oxytocin induces multiple anti-stress effects, which are mediated by alpha 2-adrenoreceptors. Repeated administration of linear oxytocin and linear oxytocin fragments with a retained C-terminal reduce spontaneous motor activity, a sedative or anti-stress effect, suggesting that alpha 2-adrenoreceptors have been activated. In contrast, linear mid-fragments stimulate motor activity. Low-intensity stimulation of cutaneous nerves in rats, as well as breastfeeding and skin-to-skin contact between mothers and babies, trigger immediate anti-stress effects. Some of these effects are likely caused by open ring/linear C-terminal fragments activating alpha 2-adrenoreceptors. Oxytocin fragments may be pre-formed and released in the brain or created by metabolic conversion of the principal hormone oxytocin in the central nervous system. Oxytocin and its fragments may also be released from peripheral sites, such as peripheral nerves, the gastrointestinal tract, and blood vessels in response to decreased sympathetic or increased parasympathetic nervous tone. Smaller fragments of oxytocin produced in the periphery may easily pass the blood-brain barrier to induce effects in the brain. In conclusion, oxytocin is linked to many different, sometimes opposite effects. The intact cyclic molecule may act to initiate social interaction and associated psychophysiological effects, whereas linear oxytocin and C-terminal fragments may induce relaxation and anti-stress effects following social interaction. In this way, the principal hormone oxytocin and its fragments may take part in a behavioral sequence, ranging from approach and interaction to calm and relaxation. Linear fragments, with an exposed cysteine-residue, may exert anti-inflammatory and antioxidant effects and thereby contribute to the health-promoting effects of oxytocin. 

  • 18.
    Vixner, Linda
    et al.
    Department of Women’s and Children’s Health, Division of Reproductive Health, Karolinska Institutet, Stockholm, Sweden / School of Health and Social Studies, Dalarna University, Sweden.
    Mårtensson, Lena
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Schytt, Erica
    Department of Women’s and Children’s Health, Division of Reproductive Health, Karolinska Institutet, Sweden / Centre for Clinical Research Dalarna, Falun, Sweden.
    Acupuncture with manual and electrical stimulation for labour pain: a two month follow up of recollection of pain and birth experience2015In: BMC Complementary and Alternative Medicine, ISSN 1472-6882, E-ISSN 1472-6882, Vol. 15, no 1, article id 180Article in journal (Refereed)
  • 19.
    Vixner, Linda
    et al.
    Department of Women’s and Children’s Health, Division of Reproductive Health, Karolinska Institutet, Stockholm, Sweden / School of Health and Social Studies, Dalarna University, Falun, Sweden.
    Schytt, Erica
    Department of Women’s and Children’s Health, Division of Reproductive Health, Karolinska Institutet, Stockholm, Sweden / Centre for Clinical Research Dalarna, Falun, Sweden.
    Stener-Victorin, Elisabet
    Department of Physiology, Sahlgrenska Academy, Institute of Neuroscience and Physiology, University of Gothenburg, Sweden.
    Waldenström, Ulla
    Department of Women’s and Children’s Health, Division of Reproductive Health, Karolinska Institutet, Stockholm, Sweden.
    Pettersson, Hans
    Department of Clinical Science and Education, Södersjukhuset Karolinska Institutet, Stockholm, Sweden.
    Mårtensson, Lena B.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Acupuncture with manual and electrical stimulation for labour pain: a longitudinal randomised controlled trial2014In: BMC Complementary and Alternative Medicine, ISSN 1472-6882, E-ISSN 1472-6882, Vol. 14, article id 187Article in journal (Refereed)
    Abstract [en]

    Background: Acupuncture is commonly used to reduce pain during labour despite contradictory results. The aim of this study is to evaluate the effectiveness of acupuncture with manual stimulation and acupuncture with combined manual and electrical stimulation (electro-acupuncture) compared with standard care in reducing labour pain. Our hypothesis was that both acupuncture stimulation techniques were more effective than standard care, and that electro-acupuncture was most effective.

    Methods: A longitudinal randomised controlled trial. The recruitment of participants took place at the admission to the labour ward between November 2008 and October 2011 at two Swedish hospitals . 303 nulliparous women with normal pregnancies were randomised to: 40 minutes of manual acupuncture (MA), electro-acupuncture (EA), or standard care without acupuncture (SC). Primary outcome: labour pain, assessed by Visual Analogue Scale (VAS). Secondary outcomes: relaxation, use of obstetric pain relief during labour and post-partum assessments of labour pain. The sample size calculation was based on the primary outcome and a difference of 15 mm on VAS was regarded as clinically relevant, this gave 101 in each group, including a total of 303 women.

    Results: Mean estimated pain scores on VAS (SC: 69.0, MA: 66.4 and EA: 68.5), adjusted for: treatment, age, education, and time from baseline, with no interactions did not differ between the groups (SC vs MA: mean difference 2.6, 95% confidence interval [CI] -1.7-6.9 and SC vs EA: mean difference 0.6 [95% CI] -3.6-4.8). Fewer number of women in the EA group used epidural analgesia (46%) than women in the MA group (61%) and SC group (70%) (EA vs SC: odds ratio [OR] 0.35; [95% CI] 0.19-0.67).

    Conclusions: Acupuncture does not reduce women’s experience of labour pain, neither with manual stimulation nor with combined manual and electrical stimulation. However, fewer women in the EA group used epidural analgesia thus indicating that the effect of acupuncture with electrical stimulation may be underestimated.

    These findings were obtained in a context with free access to other forms of pain relief.

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