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  • 1.
    Abusabeib, Abdelrahman
    et al.
    Department of General Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    Bhat, Harun
    Weill Cornell Medicine in Qatar, Doha, Qatar.
    El Ansari, Walid
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar / College of Medicine, Qatar University, Doha, Qatar.
    Al Hassan, Mohamed S.
    Department of General Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    Abdelaal, Abdelrahman
    Department of General Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    Right ectopic paraesophageal parathyroid adenoma with refractory hypercalcemia in pregnancy: A case report and review of the literature2020In: International Journal of Surgery Case Reports, E-ISSN 2210-2612, Vol. 77, p. 229-234Article, review/survey (Refereed)
    Abstract [en]

    Introduction: Ectopic parathyroid adenoma is rare during pregnancy but poses multiple challenges in treatment. It presents as primary hyperparathyroidism which leads to symptoms and complications of hypercalcemia in both the mother and fetus. Presentation of case: A 38-year-old Sudanese female presented with diffuse bone pain and polyuria. Laboratory investigations revealed elevated serum calcium and parathyroid hormone. Ultrasound of the neck did not show any abnormal lesion, however 99mTc-sestamibi scan showed a right sided parathyroid adenoma, and an earlier CT scan showed the adenoma to be in an ectopic paraesophageal position. Focused surgical neck exploration was done, and the ectopic parathyroid adenoma was excised. Discussion: Preoperative localization of the ectopic parathyroid adenoma allows for a focused surgical procedure. Ultrasound is the safest during pregnancy, but 99mTc-sestamibi and CT scan may be necessary if ultrasound or initial bilateral neck exploration do not detect any adenoma. Mild elevations in maternal serum calcium can have detrimental effects on the fetus which suggests that a surgical approach may be necessary in the majority of cases. Conclusions: Ectopic parathyroid adenoma is rare during pregnancy and is detrimental to both the mother and fetus. Preoperative localization allows for a focused surgery which is a definitive treatment and can safely be performed during the 2nd trimester of pregnancy. 

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  • 2.
    Adolfsson, Annsofie
    et al.
    University of Skövde, School of Life Sciences. Department of Obstetrics and Gynecology, Central Hospital Skövde.
    Tullander-Tjörnstrand, Karin
    Department of Obstetrics and Gynecology, Central Hospital Skövde.
    Larsson, Per-Göran
    University of Skövde, School of Life Sciences. Department of Obstetrics and Gynecology, Central Hospital Skövde.
    Decreased need for emergency services after changing management for suspected miscarriage2011In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 90, no 8, p. 921-923Article in journal (Refereed)
    Abstract [en]

    We investigated the effect of a changed routine to identify women with a nonviable pregnancy, in order to utilize health care resources more efficiently during office hours rather than relying on emergency care services. From hospital register data about where and when women with miscarriages were treated, there was a significant trend during a nine-year period for miscarriages to be more rarely diagnosed (p-value<0.001) in the emergency ward after office hours. The proportion of miscarriages that were diagnosed and handled at the emergency ward decreased from 31% in 2001 to 17% in 2009. Furthermore, the number of women showing up with bleeding at the emergency ward, but who also had a normal viable pregnancy, declined during the same period (p-value<0.01). Women with suspected miscarriage benefit from structured information and standardized management and can effectively be scheduled for day-time assessment including ultrasound with a concomitant reduced need for emergency services.

  • 3.
    Agder, Terese
    et al.
    University of Skövde, School of Health Sciences.
    Bobeck, Sabina
    University of Skövde, School of Health Sciences.
    Kvinnors kunskap och förståelse om hemförlossning i Sverige: En kvalitativ hermeneutisk textanalys2021Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Research shows that the choice of place of birth is important for the woman's birth experience. Home birth in a low-risk pregnancy is a safe alternative to giving birth in a hospital, however, interest in home birth is low in Sweden. In order for women to be able to make an active choice, an awareness of the alternatives available is required. The authors ask themselves whether women in Sweden know that home birth exists. Aim: To shed light on women's knowledge and understanding of home birth in Sweden. Aim: To shed light on women's knowledge and understanding of home birth in Sweden. Method: Questionguide analyzed with a qualitative hermeneutic text analysis. Results: Knowledge about home birth has been shown to vary. The result shows 4 main themes and 8 sub-themes. The main themes consist of "Women's interest in home birth varies", "The importance of information for decision-making", "Obstacles to home birth in Sweden" and "Home birth as a right".Conclusion: The study shows that there is risk that women do not know that homebirth exists. It also shows greater obstacles to the possibility of making an active choice of place of birth and undergoing a homebirth. 

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  • 4.
    Aleter, Ammar
    et al.
    Department of General Surgery, Hamad General Hospital, Doha, Qatar.
    El Ansari, Walid
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Surgery, Hamad General Hospital, Doha, Qatar / College of Medicine, Qatar University, Doha, Qatar.
    Incidental appendiceal mucinous neoplasm mimicking a left adnexal mass: A case report2020In: International Journal of Surgery Case Reports, E-ISSN 2210-2612, Vol. 74, p. 132-135Article in journal (Refereed)
    Abstract [en]

    Introduction: Appendiceal mucinous neoplasm is a rare type of appendiceal tumors which can present in a variety of symptoms and is difficult to diagnose. Preoperative diagnosis depends mainly on diagnostic imaging such as ultrasonography and computerized tomography (CT) scan. This uncommon case report discusses an appendiceal mucinous neoplasm mimicking a left adnexal mass on presentation, physical examination and diagnostic imaging findings. Presentation of case: This is a 61-year-old female found to have a large left adnexal mass during follow up ultrasonography. The patient refused further imaging, and during laparotomy, she was found to have an appendicular mucocele with normal left and right ovaries. Discussion: Appendectomy was done and the final pathology came as appendiceal mucinous neoplasm. Her post-operative course and 3 years follow up were uneventful. Conclusions: The equivocal signs and symptoms along with the anatomical position of appendiceal mucocele makes it difficult to diagnose and can mimic other types of tumors. Therefore, it should be considered in the deferential diagnosis of lower abdominal and pelvic masses. 

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  • 5.
    Andersson, Annica
    et al.
    University of Skövde, School of Health Sciences.
    Stolt, Zarah
    University of Skövde, School of Health Sciences.
    Möjligheter och hinder för amningsrådgivning på BVC-mottagning: BVC-sjuksköterskors perspektiv2021Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Breastfeeding has many health-, economical and ecological benefits for child, parents and society, but statistics of breastfeeding are declining and are often due to insufficient breastfeeding support. Aim of the study: to examine child health care nurses’ possibilities and hindrance for breastfeeding counselling. Method: This study was conducted using Critical Incident as a method. Six child healthcare nurses in Sweden were interviewed about their experiences of providing breastfeeding advice. Results: The result was divided into two main incidents based on the aim, - possibilities and hindrance, with several behaviours that could affect the incidents. Under Possiblities a sensitivity for the woman’s needs, to be able to give simple breastfeeding advice, having time to give it and look for support when needed was seen. Behaviours that was a hindrance for breastfeeding counselling was a lack of sensitivity for the woman’s and child’s needs, to not have deeper knowledge or time, to not cooperate with others or not provide preparatory courses for parents. Conclusion: To create possibilities for individual breastfeeding counselling a sensitivity for the woman’s and child’s needs is essential, to have an understanding of the expectations the woman has and to have enough knowledge and time. Hindrance for breastfeeding counselling is a lack of sensitivity for the woman’s needs, difficulties to give evidence based information and not enough time. Cooperation between the different facilities and to follow the recommendations are potentials for improvement to strengthen the breastfeeding counselling. 

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  • 6.
    Andersson, Ida-Maria
    et al.
    University of Skövde.
    Nilsson, Sandra
    University of Skövde.
    Adolfsson, Annsofie
    University of Skövde, School of Life Sciences.
    How women who have experienced one or more miscarriages manage their feelings and emotions when they become pregnant again: a qualitative interview study2012In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 26, no 2, p. 262-270Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this study was to investigate how women who have experienced one or more miscarriages manage their feelings when they become pregnant again.

    Method:  Individual qualitative interviews were conducted with 16 women who were pregnant again after experiencing one or more miscarriages. The interviews were analysed using qualitative content analysis with an inductive approach.

    Results: The analysis of the material ended up in five categories: distancing herself from her pregnancy, focusing on her pregnancy symptoms, searching for confirming information, asking for ultrasound examination and asking for professional and social support. Because of their past experience with miscarriage, it could be painful to have another pregnancy terminate in disappointment. Therefore, the women manage their feelings by distancing themselves from their pregnancies. Simultaneously, they are managing their emotions by seeking affirmation that their current pregnancy is normal.

    Conclusion: Generally speaking, women manage their emotions by themselves. They feel isolated with their worries and concerns, and they are in need of the support provided from their intimate circle of friends and family as well as from the staff of the maternity health care ward. Unfortunately, the women do not feel that they get the support they need from the staff, instead they have to rely on their friends, family and partners to help them manage their emotions.

  • 7.
    Bark, Charlotte
    et al.
    University of Skövde, School of Health Sciences.
    Dahlén, Carl
    University of Skövde, School of Health Sciences.
    Ingen talar om det, men jag gör: Barnmorskors upplevelser av att stödja kvinnors sexuella hälsa i relation till en hysterektomi2020Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Världshälsoorganisationen beskriver sexualiteten som en central aspekt genom hela livet, det är en del av att vara människa. En hysterektomi innebär att kvinnans livmoder tas bort, vilket kan påverka kvinnans sexuella hälsa. Forskning visar att kvinnor har ett stort behov av stöd vid en hysterektomi. Dock finns en brist i att följa upp och stötta kvinnor i olika frågor angående den sexuella hälsan.Syfte: Barnmorskors upplevelser i att stödja kvinnors sexuella hälsa i relation till en hysterektomi.Metod: En kvalitativ innehållsanalys med induktiv ansats där nio barnmorskor intervjuats.Resultat: Barnmorskors upplevelser i att stötta och samtala med kvinnor i relation till en hysterektomi är viktigt. Vissa kvinnor är mer öppna än andra och det är en utmaning i att kunna ge stöd. Tidsbrist i organisationen ses som ett hinder. Stress och bristen på barnmorskekollegor gör att viktig information till kvinnor om den sexuella hälsan inte ges.Konklusion: En hysterektomi kan påverka kvinnors livskvalitet och samliv. I resultatet framkom att vissa barnmorskor informerar vid behov. En del barnmorskor informerar oavsett om de upplever att kvinnor har behov utav det eller inte. Utgår barnmorskorna utifrån sig själva? Hur kan det påverka vården och vilket stöd kvinnor får i den sexuella hälsan.

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  • 8.
    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.

  • 9.
    Blixt, Ingrid
    et al.
    Department of Obstetrics and Gynaecology, Mälarhospital, Eskilstuna, Sweden.
    Mårtensson, Lena B.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Ekström, Anette C.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Process-oriented training in breastfeeding for health professionals decreases women’s experiences of breastfeeding challenges2014In: International Breastfeeding Journal, ISSN 1746-4358, E-ISSN 1746-4358, Vol. 9, no 1, article id 15Article in journal (Refereed)
    Abstract [en]

    Background: The World Health Organization recommends promoting exclusive breastfeeding for six months. Women much too often end breastfeeding earlier than they planned, but women who continue to breastfeed despite problems more often experience good support and counselling from health professionals. The aim in this study was to evaluate the effects of a process-oriented training in breastfeeding support counselling for midwives and child health nurses, in relation to women’s satisfaction with breastfeeding counselling, problems with insufficient breast milk, pain or nipple sores in relation to exclusive breastfeeding shorter or longer than 3 months.

    Methods: An intervention through process-oriented training for health professionals regarding support in childbearing and breastfeeding took part in the south west of Sweden. The present study was performed in Sweden, in 2000- 2003. Ten municipalities were paired, and within each pair, one was randomly assigned to the group of five intervention (IG) municipalities and one to the group of five control municipalities. Primiparas (n=540) were asked to participate in a longitudinal study to evaluate the care they received. A survey was distributed at 3 days, 3 months and 9 months postpartum. Data collection for control group A (n=162) started before the intervention was initiated. Data for control group B (n=172) were collected simultaneously with the intervention group (IG) (n=206).Women were also divided into two groups depending on whether they exclusive breastfed < 3 months or ≥ 3 months.

    Results: Women in IG were more satisfied with the breastfeeding counselling (p=0.008) and felt the breastfeeding counselling was more coherent (p=0.002) compared with control groups, when the exclusively breastfeeding was < 3 months. In addition fewer women in the IG, among the group exclusively breastfeeding < 3 months, had problems with insufficient breast milk compared to the control groups (p=0.01).

    Conclusion: A process-oriented training for health professionals in support influenced women's ability to solve breastfeeding problems such as the experience of insufficient breast milk production. Women with exclusive breastfeeding lasting ≥ 3 months more often had breastfeeding duration in conformity with their planned breastfeeding duration, compared with women who had breastfeeding duration < 3 months.

    Trial registration: ACTRN12611000354987

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  • 10.
    Blixt, Ingrid
    et al.
    University of Skövde, School of Health and Education. Mälarsjukhuset Eskilstuna / Centrum för klinisk forskning i Sörmland, Uppsala universitet.
    Mårtensson, Lena
    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.
    Utbildning minskar amningsproblem2014In: Amningsnytt, ISSN 1102-7207, no 4, p. 4-5Article in journal (Other (popular science, discussion, etc.))
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  • 11.
    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.

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  • 12.
    Bäckström, Caroline A.
    et al.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    Carlén, Kristina
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    Larsson, Viveca
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    Mårtensson, Lena Birgitta
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). School of Nursing, Midwifery and Social Work, Faculty of Health and Rehabilitation Sciences, The University of Queensland, Australia.
    Thorstensson, Stina
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    Berglund, Marina
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    Larsson, Therese
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    Bouwmeester, Björn
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). School of Health Sciences, University of Skövde, Sweden.
    Wilhsson, Marie
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). School of Health Sciences, University of Skövde, Sweden.
    Larsson, Margaretha
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    Expecting parents’ use of digital sources in preparation for parenthood in a digitalised society – a systematic review2022In: Digital Health, E-ISSN 2055-2076, Vol. 8, article id 20552076221090335Article, review/survey (Refereed)
    Abstract [en]

    Background

    In today's society, people are experiencing the rapid development of digitalisation. Expecting parents may have difficulties evaluating the information online; they are not always sure which sources of information are trustworthy, and this exacerbates their feelings of anxiety. More research is needed to broaden the knowledge about how their use of digital sources may influence their health.

    Question

    The focus of this study was to explore expecting parents’ use of digital sources and how this influences their health during pregnancy.

    Methods

    A systematic review covered the thematic analysis of 39 articles.

    Findings

    The analysis resulted in the following theme: The digitalised society involves both opportunities and challenges, and expecting parents express a need for a variety of digital sources to improve their health, and sub-themes: Digital sources could promote parents’ health and well-being in a digitalised society; Consuming digital health information facilitates understanding, different feelings and social connections; and A variety of digital sources may facilitate parental identification and adaption to parenthood.

    Conclusion

    Different digital sources in our digitalised society mean access to information and opportunities to extend social connections for expecting parents. This can promote their ability to understand and adapt to parenthood, as well as to improve their health and well-being and make the parental transition. However, professional support during face-to-face consultations cannot always be exchanged to digital sources. It is important to base digital sources devoted to expecting parents and digitalisation overall on multi-sectorial collaborations and coordination between different organisations and the digital sources they provide.

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  • 13.
    Bäckström, Caroline A.
    et al.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Caring Science, University of Borås, Sweden.
    Knez, Rajna
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Skaraborg Hospital, Skövde, Sweden.
    Fahlgren, M.
    Skaraborg Hospital, Skövde, Sweden.
    Synnergren, M.
    Skaraborg Hospital, Skövde, Sweden.
    Larsson, Viveca
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    In the need of a digital cicerone in healthcare? – Guidance for parents2022In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 22, no 1, article id 863Article in journal (Refereed)
    Abstract [en]

    Objective: To explore parents’ experiences using digital tools in relation to pregnancy, labor and birth, and the child’s first 18 months. Background: Parents find relevant information using digital healthcare tools, material obtained from professionals, as well as personal opinions and experiences that vary in quality. Method: Fifteen parents were interviewed and data were analyzed beginning with content analysis and followed by thematic analysis. Results: The main theme was insecurity and responsibility for own choices and knowledge. Parents use digital tools to take responsibility for their insecurity and need for knowledge when entering parenthood. Conclusion: The parents’ experiences highlighted that (1) insecurity can be both eased and enhanced using digital tools, (2) they took responsibility for feelings of insecurity and the search for knowledge, and (3) they needed knowledge to make the right choices and feel secure that these choices are made in the best interest of their new family. 

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  • 14.
    Carlsson, Ing-Marie
    et al.
    Halmstad Univ, Sch Social & Hlth Sci, SE-30118 Halmstad, Sweden / Univ Orebro, Sch Hlth & Med Sci, SE-70182 Orebro, Sweden / Halmstad Cty Hosp, SE-30185 Halmstad, Sweden .
    Ziegert, Kristina
    Halmstad Univ, Sch Social & Hlth Sci, SE-30118 Halmstad, Sweden .
    Sahlberg-Blom, Eva
    Univ Örebro, Sch Hlth & Med Sci, SE-70182 Örebro, Sweden .
    Nissen, Eva
    University of Skövde, School of Life Sciences.
    Maintaining power: Women's experiences from labour onset before admittance to maternity ward2012In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 28, no 1, p. 86-92Article in journal (Refereed)
    Abstract [en]

    Background: in Sweden pregnant women are encouraged to remain at home until the active phase of labour. Recommendation is based on evidence, that women who seek care and are admitted in the latent phase of labour are subjected to more obstetric interventions and suffer more complications than women who remain at home until the active phase of labour. The aim of this study was to obtain a deeper understanding of how women, who remain at home until the active phase of labour, experience the period from labour onset until admission to labour ward. Method: interviews were conducted with 19 women after they had given birth to their first child. A Constructivist Grounded theory method was used. Findings: 'Maintaining power' was identified as the core category, explaining the women's experience of having enough power, when the labour started. Four related categories: to share the experience with another', to listen to the rhythm of the body', to distract oneself and to be encased in a glass vessel', explained how the women coped and thereby maintained power. Conclusions: the first time mothers in this study, who managed to stay at home during the latent phase of labour, had a sense of power that was expressed as a driving force towards the birth, a bodily and mental strength and the right to decide over their own bodies. This implies that women who maintain power have the ability to make choices during the birth process. The professionals need to be sensitive, supportive and respectful to women's own preferences in the health-care encounter, to promote the existing power throughout the birthing process. (C) 2010 Elsevier Ltd. All rights reserved.

  • 15.
    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.

  • 16.
    Ehn, Bodil
    et al.
    Department of Obstetrics and Gynecology, Hospital of Karlskrona, Kvinnokliniken, Blekingesjukhuset, Karlskrona, Sweden.
    Anderberg, Peter
    Blekinge Institute of Technology, BTH, Karlskrona Blekinge tekniska högskola, Karlskrona, Sweden.
    Sanmartin Berglund, Johan
    Blekinge Institute of Technology, BTH, Karlskrona Blekinge tekniska högskola, Karlskrona, Sweden.
    Lilje, Stina
    Karolinska Institutet, Stockholm, Sweden.
    The process of opting for female permanent contraception: A qualitative study of women's experiences in Sweden2021In: Contraception, ISSN 0010-7824, E-ISSN 1879-0518, Vol. 103, no 1, p. 48-52Article in journal (Refereed)
    Abstract [en]

    Objectives: We aimed to explore Swedish women's decision-making experiences regarding permanent contraception. Study design: In this study, we included 17 women aged 30–48 who were scheduled to undergo female permanent contraceptive procedures. We conducted semistructured interviews using two broad open-ended questions. We analyzed these data using systematic text condensation based on the principles of psychological phenomenological analysis. Results: The interviewees experienced no counseling or support from health care workers regarding permanent contraception until they specifically asked for it. Participants reported that they themselves place the responsibility of permanent contraception solely on women. Consequently, our participants described feeling hesitancy and ambivalence in the process of deciding to have the procedure. Once the decision was made and the women were on the waiting lists for surgery, they experienced relief and empowerment. Conclusions: Our findings suggest that health care providers in Sweden miss opportunities to support patient-centered decision-making regarding permanent contraception. This study indicates that women make deliberate and considered decisions regarding permanent contraception and are best positioned to know when the procedure should take place in their reproductive lives. Implication statements: Health care professionals should discuss permanent contraception as an option with all women desiring contraception to allow them to decide if that method is right for them. © 2020 Elsevier Inc.

  • 17.
    Ekström, Anette
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Abrahamsson, Hanna
    Department of Obstetrics and Gynecology, Central Hospital, Skövde, Sweden.
    Eriksson, Rose-Marie
    Department of Obstetrics and Gynecology, Central Hospital, Skövde, Sweden.
    Mårtensson, Lena B.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Women’s use of nipple shields - their influence on breastfeeding duration after a process-oriented education for health professionals2014In: Breastfeeding Medicine, ISSN 1556-8253, E-ISSN 1556-8342, Vol. 9, no 9, p. 458-466Article in journal (Refereed)
    Abstract [en]

    Aim: This study investigated if a process-oriented training for health professionals will influence women's use and reasons for using a nipple shield, the baby's weight, and the duration of breastfeeding.

    Materials and Methods: An intervention was performed for health professionals that included a process-oriented training program on breastfeeding support. Primiparas living in either the intervention municipality or in a control municipality were asked to participate in a longitudinal study to evaluate the care given. Data collection for control group A (CGA) (n=162) started before the intervention was initiated. Data for control group B (CGB) (n=172) were collected simultaneously with those for the intervention group (IG) (n=206). The mothers responded to questionnaires at 3 days, at 3 months, and at 9 months postpartum.

    Results: The mothers' use of nipple shields related to the finding that if the women had a higher body mass index in the beginning of the pregnancy, the babies had difficulty in grasping over the nipple, and the mothers had pain or wound on the nipple. For the mothers in the IG group, there was no significant difference if they had used nipple shields or not in relation to breastfeeding duration. In contrast, the mothers in the control groups had a significant shorter breastfeeding duration if they had used nipple shields. In the IG, there were no significant difference between the use of nipple shields and the babies' weights at 3 or 9 months. The babies of women in the CGB who used nipple shields had a significantly lower weight at 3 months than the babies of those who did not use nipple shields (p=0.02).

    Conclusions: A process-oriented training in breastfeeding counseling prolongs the duration of breastfeeding for women with breastfeeding problems, where the problems are remedied by the use of nipple shields.

  • 18.
    Ekström, Linnéa
    et al.
    Karolinska Institute, Stockholm, Sweden.
    Adolfsson, Annsofie
    Department of Obstetrics and Gynaecology, Skaraborg Hospital, Skövde, Sweden / School of Health and Medical Sciences, University of Örebro, Örebro, Sweden.
    Ericson, Henrik
    University of Skövde, School of Life Sciences. University of Skövde, The Systems Biology Research Centre.
    Poutakidis, Georgios
    Department of Obstetrics and Gynaecology, Skaraborg Hospital, Skövde, Sweden.
    Charonis, Georgios
    Department of Obstetrics and Gynaecology, University of Linköping, Linköping, Sweden / Mitera General and Maternity Hospital, Athens, Greece.
    Larsson, Per-Göran
    Department of Obstetrics and Gynaecology, Skaraborg Hospital, Skövde, Sweden.
    Vaginal flora and urinary and vaginal group B streptococci in early pregnancy2013In: Gynecology, ISSN 2052-6210, Vol. 1, article id 6Article in journal (Refereed)
    Abstract [en]

    Background: Bacterial vaginosis (BV) is a risk factor for premature birth and group B streptococci (GBS) colonizing the vagina are etiological agents of neonatal infections. Significant growth of GBS in the vagina has been assumed to be detectable through urinary culture. The aim was to investigate the correlation between BV and the presence of GBS in qualitative vaginal or quantitative urinary culture, since this could predict a higher risk for perinatal morbidity. Design and setting: A consecutive prospective study of women in early pregnancy included 3101 women between 2007 and 2010, in a region of south-western Sweden. Methods: Vaginal and urine samples were obtained from women in early pregnancy at maternity health care clinics. BV was diagnosed according to the Ison/Hay classification. GBS in urine were detected in amounts as low as 100 CFU/ml. Vaginal culturing for GBS was obtained from a selected group of 481 women. Results: There was no difference in the prevalence of GBS in the urine among women with BV compared with women with lactobacilli flora (OR 0.7; 95% CI 0.4-1.1). Vaginal presence of GBS was found among 17.3% of women with BV and among 23.5% of women with lactobacilli flora (OR 0.7; 95% CI 0.3-1.4). Among the 105 women who had vaginal GBS, the urine culture of GBS was positive in only 21.9% of cases. Conclusions: Even though women with BV. have much higher concentration of bacteria in the vagina, they do not necessarily have more GBS in the vagina or urine. The modest correlation between positive vaginal culture and positive urine culture of GBS question the value of urinary culture for detection of vaginal GBS.

  • 19.
    Elbardisi, Haitham
    et al.
    Department of Urology, Hamad Medical Corporation, Doha, Qatar / Department of Urology, Weill Cornell Medicine-Qatar, Doha, Qatar.
    El Ansari, Walid
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar / College of Medicine, Qatar University, Doha, Qatar.
    Majzoub, Ahmad
    Department of Urology, Hamad Medical Corporation, Doha, Qatar / Department of Urology, Weill Cornell Medicine-Qatar, Doha, Qatar / American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.
    Arafa, Mohamad
    Department of Urology, Hamad Medical Corporation, Doha, Qatar / Department of Urology, Weill Cornell Medicine-Qatar, Doha, Qatar / American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA / Department of Andrology, Cairo University, Egypt.
    Does varicocelectomy improve semen in men with azoospermia and clinically palpable varicocele?2020In: Andrologia, ISSN 0303-4569, E-ISSN 1439-0272, Vol. 52, no 2, article id e13486Article in journal (Refereed)
    Abstract [en]

    The effectiveness of varicocelectomy in nonobstructive azoospermia is controversial. The current study assessed the efficacy of microsurgical subinguinal varicocelectomy in nonobstructive azoospermic men with palpable varicocele and to evaluate predictive parameters of outcome. We reviewed the records of 723 patients who had microsurgical varicocelectomy and diagnostic testicular biopsy between 2012 and 2016 at a tertiary medical centre. Data pertaining to the physical, laboratory (semen analysis and hormonal profile) and histopathology features were examined, exploring the predictors of improvement in semen analysis post-varicocelectomy. In total, 42 patients with mean age 35.71 +/- 6.35 years were included. After a mean varicocelectomy follow-up of 6.7 months, motile spermatozoa in the ejaculate could be observed in 11 patients (26.2). Out of all the factors examined, only testicular histopathology significantly predicted post-varicocelectomy outcome, where 8/11 patients exhibited hypospermatogenesis, and 3/11 Sertoli cell-only regained spermatozoa in semen. Microsurgical varicocelectomy in nonobstructive azoospermic men with clinically palpable varicocele can result in sperm appearance in the ejaculate with the highest success expected in hypospermatogenesis.

  • 20.
    Forsberg, Catarina
    et al.
    University of Skövde, School of Health Sciences.
    Käll, Emma
    University of Skövde, School of Health Sciences.
    ”Vi räcker inte till”: Barnmorskors upplevelser av att ge stöd till föräldrarna på BB under covid-19 pandemin2021Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: After giving birth, the new family can receive care and support in a maternity-ward. Parenting is encouraged through support from the maternity-ward after the birth. By the end of the year 2019, the world was affected by Covid-19. Virus entailed restrictions at the maternity-ward, which resulted in protective equipment and partner restrictions. Covid-19´s restrictions have prevented the support. This topic is relatively unexplored and there are few studies in the field. Aim: To explore how midwives in Swedish maternity-ward experience to support parents during the ongoing pandemic. Method: The method is a qualitative content analysis with an inductive approach. Eleven midwives were interviewed individually. Result: The theme that emerged was: Protective equipment and visiting restrictions requires ingenuity and affects midwives professional support at maternity-ward. The results presented in two categories: The midwifes needs to adapt professional support according to the Covid-19 pandemic restrictions & how the Covid-19 Pandemic affects the conditions for providing support negatively. Conclusion: Midwives have had to increase their support to the mothers in various ways and be inventive in reaching the whole family. Midwives have also experienced the support as insufficient and limited by high workload and the use of protective equipment. 

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  • 21.
    Handlin, Linda
    University of Skövde, School of Life Sciences. University of Skövde, The Systems Biology Research Centre. Swedish University of Agricultural Sciences, Department of Animal Environment and Health, Skara, Sweden.
    Human-Human and Human-Animal Interaction: Some Common Physiological and Psychological Effects2010Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The aim of the present thesis was to investigate hormonal and physiological effects in mothers during a breastfeeding session and in dogs and their owners in response to short-term interaction. In study one, sixty-six mothers receiving either exogenous oxytocin infusion and/or epidural analgesia (EDA) during labor or intramuscular oxytocin injection post partum were studied. Oxytocin, prolactin, adrenocorticotrophic hormone (ACTH) and cortisol levels, as well as blood pressure were measured during a breastfeeding session two days after birth. In response to breastfeeding two days after birth, the mothers displayed a pulsatile release of oxytocin and increasing prolactin levels. In addition, the activity in the HPA-axis was reduced and maternal blood pressure decreased. The results also show that EDA administration in combination with oxytocin during labor resulted insignificantly lower oxytocin levels and higher cortisol levels, as well as higher bloodpressure in response to breastfeeding two days after birth, compared to EDA administration alone. In addition, oxytocin infusions dose-dependently lowered the mothers’ endogenous oxytocin levels two days after birth. In study two, ten female dog owners and their male Labrador dogs participated, together with ten controls. Their levels of oxytocin, cortisol and insulin, as well as their heart rate, were measured. The connection between the quality of the dogowner relationship and hormone levels was also explored. Short-term interaction between dogs and their owners resulted in oxytocin release in both species and their cortisol levels and heart rate were also affected. Oxytocin levels and positive attitudes regarding the dog-owner relationship were positively correlated. In conclusion, both human-human and human-animal interactions induce oxytocin release and promote oxytocin mediated effects, such as decreasing cortisol levels and blood pressure. In addition, social interaction and oxytocin levels arepositively related.

  • 22.
    Hutton, Eileen
    et al.
    McMaster University, Hamilton, Canada.
    Mårtensson, Lena
    University of Skövde, School of Life Sciences.
    Waterinjectie stilt bevallingspijn2013In: Medisch Contact, ISSN 0025-8245, Vol. 68, no 38, p. 1894-1897Article in journal (Other (popular science, discussion, etc.))
  • 23.
    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.

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  • 24.
    Ingridsdottir, Micaela
    et al.
    University of Skövde, School of Health Sciences.
    Wennberg, Jenny
    University of Skövde, School of Health Sciences.
    Kvinnors upplevelse av episiotomi: En kvalitativ fenomenologisk intervjustudie2021Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Episiotomy is a cut through the vagina and perineum during childbirth, which is performed, for example, to speed up labor. The procedure was previously performed routinely but has in recent years been criticized, because the procedure often causes unnecessary problems for the women. Aim: The aim of the study was to investigate women's experiences of episiotomy since there is little research on this, especially in Sweden. Method: A qualitative interview study with semi-structured interviews was conducted with a phenomenological method and an inductive approach. Informants were sought through convenience selection, via a group on social media. Results: The results show that the women have experienced the episiotomy and the surrounding circumstances as very negative. The women emphasize that a lack of information from the staff led to a feeling of being in a vulnerable position and not being involved in the decision regarding the episiotomy. Conclusion: The women experienced many negative feelings about the procedure and had no participation when the decision on episiotomy was made. Since the women did not get a chance to give their consent to the procedure it has been difficult for them to process the incident afterwards.

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  • 25.
    Johansson, Matilda
    et al.
    University of Skövde, School of Health Sciences.
    Juliusson, Sandra
    University of Skövde, School of Health Sciences.
    Kvinnors upplevelser av induktion som genomförts på grund av humanitära skäl: En kvalitativ studie baserad på bloggar2020Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: The amount of inductions in Sweden increases as the birth clinics are restrictive with inductions that isn’t related to medical indications in order to decrease risk for complications. Women that undergoes induction has increased risk for a negative birth experience. Participation helps to a feeling of control and the midwife needs to support women’s individual unique needs. Aim: To describe women’s experience of induction which is founded on humanitarian reasons. Method: A qualitative method with inductive approach was applied. Data was gathered on the Internet and 11 blogs was included and analysed with help of qualitative content analysis. Result: The analysis concluded in one theme: Induction feels like an emotional rollercoaster from start to beginning. The result is presented in four categories and ten subcategories. Conclusion: The women had a large need for acknowledgement and support from the midwife who needs to be responsive to the unique needs. A strong misbelief to their own body is described and the hope lays to the care’s interventions. Even though the induction can be long-spun and painful the woman can get a positive birth experience if she experienced support, participation and security.

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  • 26.
    Laanterä, Sari
    et al.
    University of Eastern Finland.
    Pietilä, Anna-Maija
    University of Eastern Finland.
    Ekström, Anette
    University of Skövde, School of Life Sciences.
    Pölkki, Tarja
    University of Oulu, Finland.
    Confidence in Breastfeeding Among Pregnant Women2012In: Western Journal of Nursing Research, ISSN 0193-9459, E-ISSN 1552-8456, Vol. 34, no 7, p. 933-951Article in journal (Refereed)
    Abstract [en]

    Little is known about prenatal breastfeeding confidence, although such knowledge is necessary for developing the content of counseling and tailoring it for individuals. The purpose of this study was to describe women’s prenatal breastfeeding confidence and how their sociodemographic characteristics, breastfeeding knowledge, and attitudes relate to it. The electronic confidence scale was used in data collection, and 123 Finnish women filled in the questionnaire. The mean confidence score was 83.88 when the maximum possible score was 120. Confidence scores varied when parity, breastfeeding knowledge, and attitudes were involved. Variables regarding breastfeeding as difficult, regarding breastfeeding as exhausting, and parity explained 38.1% of the variation of the breastfeeding confidence scores. Pregnant women need information about managing potential breastfeeding problems and the physiology of breastfeeding. Interventions designed to promote breastfeeding confidence need to be focused on primiparas and women with a lack of breastfeeding knowledge.

  • 27.
    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.

  • 28.
    Lee, Nigel
    et al.
    School of Nursing, Midwifery and Social Work, University Of Queensland, St Lucia, Australia / Mater Research Institute and School of Nursing, Midwifery and Social Work, University of Queensland, Australia.
    Gao, Yu
    Molly Wardaguga Research Centre, Charles Darwin University, Brisbane, Australia / Mater Research Institute and School of Nursing, Midwifery and Social Work, University of Queensland, Australia.
    Collins, Sally L.
    Nuffield Department of Women’s and Reproductive Health, University of Oxford, United Kingdom / Oxford University Hospitals NHS Foundation Trust, United Kingdom.
    Mårtensson, Lena B.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    Randall, Wendy
    Oxford University Hospitals NHS Foundation Trust, United Kingdom.
    Rowe, Toni-Marie
    Women’s and Children’s Health Network, Adelaide, South Australia.
    Kildea, Sue
    Molly Wardaguga Research Centre, Charles Darwin University, Brisbane, Australia / Mater Research Institute and School of Nursing, Midwifery and Social Work, University of Queensland, Australia.
    Caesarean delivery rates and analgesia effectiveness following injections of sterile water for back pain in labour: A multicentre, randomised placebo controlled trial2020In: eClinicalMedicine, E-ISSN 2589-5370, Vol. 25, article id 100447Article in journal (Refereed)
    Abstract [en]

    Background

    About a third of women experience severe back pain during labour. Injecting small volumes of intracutaneous sterile water into the lumbar region can be used to relieve this pain, however the procedure is controversial and previous reviews call for high quality trials to establish efficacy. We evaluated the impact on birth outcomes and analgesic effects of sterile water injections.

    Methods

    A multicentre, double-blind trial undertaken between December 2012 and December 2017 in one British and 15 Australian maternity units. Women experiencing severe back-pain in labour were assigned (1:1) by an independently generated randomisation schedule stratified by site to injections of either sterile water or saline placebo. Participants and caregivers were blinded to group allocation. The primary outcome was caesarean delivery rate. Main secondary outcomes included at least 30% or 50% reduction in self-reported pain scores at 30, 60 and 90 minutes after treatment. Intention to treat analysis were used and the level of significance for the multiple clinical outcomes was set at p<0.001 with the Bonferroni correction applied. The study is registered with the ACTRN Registry number, ACTRN1261100022195

    Findings

    Between December 9, 2012, and December 15, 2017, 1166 women were recruited and randomised: 587 women received sterile water injections (SWI) and 579 a saline placebo. Seven women in the SWI group and 12 in the placebo group were excluded as consent was not completed, leaving 580 and 567, respectively, included in the analysis. The proportions of caesarean delivery were 17·1% (82 of 580) in the SWI group and 14·8% (82 of 567) in the placebo (RR 1·16, 95% CI 0·88–1.51; p = 0·293). At 30 min post treatment 60·8% (330 of 543) of women in the SWI group reported a 30% reduction in self-reported pain compared to 31·4% (163 of 520) placebo (RR 1·94, 95% CI 1·68–2·24; p=<0·001) and 43·3% (235 of 534) SWI reported a 50% reduction versus 18·1% (94 of 520) placebo (RR 2·39, 95% CI 1·95–2·94; p=<0·001). The analgesic effect of SWI compared to placebo remained significant at 60 and 90 min post-treatment. There were no significant differences in other maternal or neonatal outcomes.

    Interpretation

    Compared to placebo, injections of sterile water did not reduce rates of caesarean delivery. For the main secondary outcome of pain relief the intervention did result in significantly more women reporting at least 30% and 50% reduction in pain for up to 90 min. Water injections have no effect on birth outcomes though can be an effective treatment for the relief of labour-related back pain.

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  • 29.
    Lee, Nigel
    et al.
    School of Nursing Midwifery and Social Work, University of Queensland, St Lucia, QLD, Australia.
    Gao, Yu
    Molly Wardaguga Research Centre, College of Nursing & Midwifery, Charles Darwin University, Brisbane, QLD, Australia.
    Mårtensson, Lena B.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    Callaway, Leonie
    Women’s and Newborn Services, Royal Brisbane and Women’s Hospital, Herston, QLD, Australia.
    Barnett, Belinda
    School of Nursing Midwifery and Social Work, University of Queensland, St Lucia, QLD, Australia.
    Kildea, Sue
    Molly Wardaguga Research Centre, College of Nursing & Midwifery, Charles Darwin University, Sadadeen, Alice Springs, Australia.
    Sterile water injections for relief of labour pain (the SATURN trial): study protocol for a randomised controlled trial2022In: Trials, E-ISSN 1745-6215, Vol. 23, no 1, article id 155Article in journal (Refereed)
    Abstract [en]

    Background: Up to 80% of women use some form of pharmacological analgesia during labour and birth. The side effects of pharmacological agents are often incompatible with the concurrent use of non-pharmacological pain-relieving strategies, such as water immersion, ambulation and upright positioning, or may have negative effects on both the mother and foetus. Sterile water injections given into the skin of the lumbar region have been demonstrated to reduce back pain during labour. However, the injections given for back pain have no effect on abdominal contraction pain. The analgesic efficacy of sterile water injections for abdominal pain during childbirth is unknown. The injections cause an immediate, brief but significant pain that deters some women from using the procedure. This study aims to investigate the use of water injections given intradermally into the abdomen to relieve labour contraction pain. A vapocoolant spray will be applied to the skin immediately prior to the injections to reduce the injection pain. Methods: In this pragmatic, placebo-controlled trial, 154 low-risk women in labour at term with a labour pain score ≥ 60 on a 100-ml visual analogue scale (VAS) will be randomly allocated to receive either six injections of sterile water or a sodium chloride 0.9% solution as a placebo (0.1–0.3 ml per injection). Three injections are given along the midline from the fundus to the supra-pubis and three laterally across the supra-pubis. The primary outcome will be the difference in VAS score 30 min post-injection between the groups. Secondary outcomes include VAS score of the injection pain on administration, VAS score of labour pain at 60 and 90 min and maternal and neonatal birth outcomes. Discussion: Access to effective pain relief during labour is fundamental to respectful and safe maternity care. Pharmacological analgesics should support rather than limit other non-pharmacological strategies. Sterile water injections have the potential to provide an alternative form of labour pain relief that is easy to administer in any labour and birth setting and is compatible with other non-pharmacological choices. Trial registration: ANZCTR ACTRN12621001036808. Registered on 05 August 2021. 

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  • 30.
    Lee, Nigel
    et al.
    School of Nursing Midwifery and Social Work, University of Queensland, St Lucia, Queensland, Australia.
    Leiser, Bernadette
    Central Coast Local Health District, Holden Street, Gosford, Australia .
    Halter-Wehrli, Yvonne
    North Sydney Local Health District, Mona Vale, NSW, Australia.
    Mårtensson, Lena B.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). School of Nursing Midwifery and Social Work, University of Queensland, St Lucia, Queensland, Australia.
    Gao, Yu
    Molly Wardaguga Research Centre, College of Nursing & Midwifery, Charles Darwin University, Brisbane, Queensland, Australia.
    Kildea, Sue
    Molly Wardaguga Research Centre, College of Nursing & Midwifery, Charles Darwin University, Brisbane, Queensland, Australia.
    A comparison of two versus four sterile water injections for the relief of back pain in labour: A multicentre randomised equivalence trial2022In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 35, no 6, p. e556-e562Article in journal (Refereed)
    Abstract [en]

    Background

    Recent trials demonstrated the safety and efficacy of sterile water injections to provide relief from labour back pain. While four injections is the most common approach variations in technique, such as employing two injections, are also used.

    Aim

    To determine if the analgesic effect of two sterile water injections is clinically equivalent to four.

    Methods

    238 women in labour with a Visual Analogue Scale pain score (VAS) of 70 millimetres (mm) (0 = no pain; 100 = worst pain imaginable) were randomised to two or four sterile water injections. The primary outcome was pain measured on a VAS at 30 min post treatment. A priori margin of equivalence was set at ±10 mm. Secondary outcomes included the likelihood of achieving an at least 30% and 50% reduction in pain, birth and neonatal outcomes.

    Results

    At 30 min post-injection the difference in VAS scores between the techniques was −5.97 (95% Confidence Interval [CI] −13.18–1.22). As the lower end of the CI exceeds the margin of −10 mm equivalence was not demonstrated. Both techniques achieved an at least 30% reduction in pain in over 75% of participants though duration of effect was longer in the four injection group. There was no difference in other birth related secondary outcomes.

    Conclusion

    Four injections provided a margin of benefit over two injections in level and duration of analgesia.DiscussionFour injections remains the technique of choice though two injections still provided significant pain relief and would be suitable where it was not possible or desirable to provide four.

  • 31.
    Lee, Nigel
    et al.
    Level 3 Chamberlain Building/School of Nursing Midwifery and Social Work, University of Queensland, St Lucia, Queensland, Australia.
    Mårtensson, Lena B.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Level 3 Chamberlain Building/School of Nursing Midwifery and Social Work, University of Queensland, St Lucia, Queensland, Australia.
    Sterile water injections for management of renal colic pain: a systematic review2022In: Scandinavian Journal of Urology, ISSN 2168-1805, Vol. 56, no 3, p. 255-263Article, review/survey (Refereed)
    Abstract [en]

    Background

    Since the 1950s a small number of centres have used sterile water injections (SWI) to treat renal colic pain. We undertook this review to determine the efficacy of SWI to manage the pain of renal colic.

    Methods

    We searched the electronic databases PubMed, Cochrane Central Register, CINAHL, and Scopus from database inception to 7 November 2021 for randomized controlled trials that met the inclusion criteria.

    Results

    Six trials were included in the review (n = 894 patients). Two placebo controlled trials were included in the meta-analysis. Other trials compared SWI to Diclofenac, Morphine, or oral Paracetamol. The overall quality of the trial was low. Compared to a placebo SWI demonstrated a significant reduction in self-reported pain at 30 min (Mean difference [MD] = −4.68, 95% Confidence Interval [CI] = −5.21, −4.15. p < 0.001, I2 = 0%) and at or beyond 60 min post-injection (MD = −5.34 95% CI = −5.85, −4.82, p ≤ 0.001, I2 = 0%). Pain relief provided by SWI was significantly better than oral paracetamol and equivalent to Diclofenac and Morphine. No significant side-effects were attributed to SWI use in any trials.

    Discussion/conclusion

    SWI could be a suitable alternative for management of renal colic pain where alternatives such as non-steroidal anti-inflammatory and opioid drugs are either unavailable or contraindicated. However, further research is required to establish the role of SWI in renal colic pain management.

  • 32.
    Lee, Nigel
    et al.
    Mater Medical Research Institute, Mater Health Services, Brisbane, QLD, Australia / Faculty of Health Sciences, Australian Catholic University, Brisbane, QLD, Australia.
    Mårtensson, Lena B.
    University of Skövde, School of Life Sciences.
    Homer, Caroline
    Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.
    Webster, Joan
    Centre for Clinical Nursing, Royal Brisbane and Women's Hospital, Herston, QLD, Australia.
    Gibbons, Kristen
    Mater Medical Research Institute, Mater Health Services, Brisbane, QLD, Australia.
    Stapleton, Helen
    Mater Medical Research Institute, Mater Health Services, Brisbane, QLD, Australia / Faculty of Health Sciences, Australian Catholic University, Brisbane, QLD, Australia.
    Dos Santos, Natalie
    Mater Medical Research Institute, Mater Health Services, Brisbane, QLD, Australia / Faculty of Health Sciences, Australian Catholic University, Brisbane, QLD, Australia.
    Beckmann, Michael
    Mater Medical Research Institute, Mater Health Services, Brisbane, QLD, Australia.
    Gao, Yu
    University Centre for Rural Health, University of Sydney, Lismore, NSW, Australia.
    Kildea, Sue
    Mater Medical Research Institute, Mater Health Services, Brisbane, QLD, Australia / Faculty of Health Sciences, Australian Catholic University, Brisbane, QLD, Australia.
    Impact on Caesarean section rates following injections of sterile water (ICARIS): a multicentre randomised controlled trial2013In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 13, article id 105Article in journal (Refereed)
    Abstract [en]

    Background: Sterile water injections have been used as an effective intervention for the management of back pain during labour. The objective of the current research is to determine if sterile water injections, as an intervention for back pain in labour, will reduce the intrapartum caesarean section rate. Methods/design: Design: A double blind randomised placebo controlled trial Setting: Maternity hospitals in Australia Participants: 1866 women in labour, >= 18 years of age who have a singleton pregnancy with a fetus in a cephalic presentation at term (between 37 + 0 and 41 + 6 weeks gestation), who assess their back pain as equal to or greater than seven on a visual analogue scale when requesting analgesia and able to provide informed consent. Intervention: Participants will be randomised to receive either 0.1 to 0.3 millilitres of sterile water or a normal saline placebo via four intradermal injections into four anatomical points surrounding the Michaelis' rhomboid over the sacral area. Two injections will be administered over the posterior superior iliac spine (PSIS) and the remaining two at two centimetres posterior, and one centimetre medial to the PSIS respectively. Main outcome measure: Proportion of women who have a caesarean section in labour. Randomisation: Permuted blocks stratified by research site. Blinding (masking): Double-blind trial in which participants, clinicians and research staff blinded to group assignment. Funding: Funded by the National Health and Medical Research Council Trial registration: Australian New Zealand Clinical Trials Registry (No ACTRN12611000221954). Discussion: Sterile water injections, which may have a positive effect on reducing the CS rate, have been shown to be a safe and simple analgesic suitable for most maternity settings. A procedure that could reduce intervention rates without adversely affecting safety for mother and baby would benefit Australian families and taxpayers and would reduce requirements for maternal operating theatre time. Results will have external validity, as the technique may be easily applied to maternity populations outside Australia. In summary, the results of this trial will contribute High level evidence on the impact of SWI on intrapartum CS rates and provide evidence of the analgesic effect of SWI on back pain.

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  • 33.
    Lee, Nigel
    et al.
    Australian Catholic University, Qld 4014, Australia.
    Mårtensson, Lena B.
    University of Skövde, School of Life Sciences.
    Kileda, Sue
    Australian Catholic University, Qld 4014, Australia ; Mater Medical Research Institute, Qld 4101, Australia.
    Cross sectional study of Australian midwives knowledge and use of sterile water injections for pain relief in labour2012In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 25, no 4, p. e75-e80Article in journal (Refereed)
    Abstract [en]

    Background: The effectiveness of sterile water injections (SWI) to relieve back pain in labour is supported by a number of randomised controlled trials. Although the procedure is available in a number of Australian maternity units, there is no information regarding the use of SWI by midwives, in terms of knowledge and availability, clinical application or technique used. Neither is there any data on midwives who do not use SWI nor the specific challengers and barriers encountered by midwives introducing SWI.

    Method: An invitation to participate in an online survey was emailed to 4700 members of the Australian College of Midwives (ACM) and 484 members of CRANAplus (Remote Health Organisation). Nine hundred and seventy midwives completed the survey (19%).

    Results: Four hundred and seven (42.5%) midwives currently used SWI in their practice and five hundred and fifty-one (57.5%) indicated they did not. Eighty-six percent (n = 478/548) indicated they would consider using SWI and 90% (n = 500/547) were interested in obtaining further information about SWI. The main reasons cited for not using SWI was the lack of a policy or guideline (n = 271, 57.5%) and being unable to access workshops or resource material (n = 68, 14.4%).

    Conclusion: This study indicates that SWI is not being used by the majority of midwives participating in the study, although there is a strong desire by midwives to learn about and explore its use. Greater access to information and workshops on SWI is highlighted. In response to the findings of this survey the authors are currently developing an online resource and training to support units to introduce SWI.

  • 34.
    Leinweber, Julia
    et al.
    Institute of Midwifery, Charité—University Medicine Berlin, Germany.
    Fontein-Kuipers, Yvonne
    School of Midwifery, Health and Social Work, University College Antwerp, Belgium ; Edinburgh Napier University, School of Health and Social Care, Edinburgh, United Kingdom.
    Karlsdottir, Sigfridur I.
    School of Health Sciences, University of Akureyri, Iceland.
    Ekström-Bergström, Anette
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Health Sciences, University West, Trollhättan, Sweden.
    Nilsson, Christina
    Munkebäck Antenatal Clinic, Region Västra Götaland, Gothenburg, Sweden.
    Stramrood, Claire
    Department of Obstetrics and Gynaecology, OLVG Hospital, Amsterdam, The Netherlands.
    Thomson, Gill
    Maternal and Infant Nutrition & Nurture Unit, School of Community Health & Midwifery, University of Central Lancashire, Preston, United Kingdom.
    Developing a woman-centered, inclusive definition of positive childbirth experiences: A discussion paper2023In: Birth, ISSN 0730-7659, E-ISSN 1523-536X, Vol. 50, no 2, p. 362-383Article in journal (Refereed)
    Abstract [en]

    Introduction A positive childbirth experience promotes women’s health, both during and beyond the perinatal period. Understanding what constitutes a positive childbirth experience is thus critical to providing high-quality maternity care. Currently, there is no clear, inclusive, woman-centered definition of a positive childbirth experience to guide practice, education, and research.

    Aim To formulate an inclusive woman-centered definition of a positive childbirth experience.

    Methods A six-step process was undertaken: (a) Key concepts associated with a positive childbirth were derived from a rapid literature review; (b) The key concepts were used by interdisciplinary experts in the author group to create a draft definition; (c) The draft definition was presented to clinicians and researchers during a European research meeting on perinatal mental health; (d) The authors integrated the expert feedback to refine the working definition; (e) A revised definition was shared with women from consumer groups in six countries to confirm its face validity; and (f) A final definition was formulated based on the women’s feedback (n = 42).

    Results The following definition was formulated: “A positive childbirth experience refers to a woman’s experience of interactions and events directly related to childbirth that made her feel supported, in control, safe, and respected; a positive childbirth can make women feel joy, confident, and/or accomplished and may have short and/or long-term positive impacts on a woman’s psychosocial well-being.”

    Conclusions This inclusive, woman-centered definition highlights the importance of provider interactions for facilitating a positive childbirth experience. Feeling supported and having a sense of control, safety, and respect are central tenets. This definition could help to identify and validate positive childbirth experience(s), and to inform practice, education, research, advocacy, and policy-making.

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  • 35.
    Lilja, Gunilla
    et al.
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden .
    Edhborg, Maigun
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden .
    Nissen, Eva
    University of Skövde, School of Life Sciences.
    Depressive mood in women at childbirth predicts their mood and relationship with infant and partner during the first year postpartum2012In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 26, no 2, p. 245-253Article in journal (Refereed)
    Abstract [en]

    Depressive mood in women at childbirth predicts their mood and relationship with infant and partner during the first year postpartum Background: Although many studies have reported negative impact of maternal depressive symptoms on family relations, few studies have explored whether or not early depressive symptoms influence interfamily relationships. The aim was to describe first-time mothers feelings for their infant and partner during the first postpartum year in relation to maternal depressive symptoms. Research questions were addressed about: What is the prevalence of maternal depressive symptoms 10 days postpartum? How does maternal depressive symptoms on day 10 relate to her mood and feelings for the infant and partner at days 3 and 10, and at 6 and 12 months postpartum? Methods: A longitudinal study with first-time mothers, normal pregnancies, giving birth to healthy babies participated in the study; altogether, n = 419. Depressive symptoms were measured by Edinburgh Postnatal Depression Scale (EPDS) at 3 and 10 days. Additional questionnaires assessing the womans mood and relationship with her infant and partner were filled out at days 3 and 10, and at 6 and 12 months postpartum. Results: Twenty-two per cent of the women scored high on EPDS on day 10 postpartum. In addition, low mood seemed to remain prevalent over the babys first year, as confirmed by the mood scale at 6 and 12 months postpartum. Women with depressive symptoms showed less closeness, warmth and confidence as measured by the infant and partner relationship scales over the first year. Mothers with a high EPDS score on day 3 scored less optimal on the relationship scale to the infant at days 3 and 10, but not 6 or 12 months postpartum. Conclusions: To screen women for depressive symptoms, 10 days postpartum seems to be predictive of maternal assessment of maternalinfant relationship throughout the first year and enables early intervention.

  • 36.
    Lycke, Maria
    et al.
    Department of Obstetrics and Gynecology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg and Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Ulfenborg, Benjamin
    University of Skövde, School of Bioscience. University of Skövde, Systems Biology Research Environment.
    Malchau Lauesgaard, Jacob
    Department of Obstetrics and Gynecology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg and Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Kristjansdottir, Björg
    Department of Obstetrics and Gynecology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg and Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Sundfeldt, Karin
    Department of Obstetrics and Gynecology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg and Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Consideration should be given to smoking, endometriosis, renal function (eGFR) and age when interpreting CA125 and HE4 in ovarian tumor diagnostics2021In: Clinical Chemistry and Laboratory Medicine, ISSN 1434-6621, E-ISSN 1437-4331, Vol. 59, no 12, p. 1954-1962Article in journal (Refereed)
    Abstract [en]

    To evaluate the impact of different biologic, histopathologic and lifestyle factors on serum levels of human epididymis protein 4 (HE4) and Cancer antigen 125 (CA125) in the diagnostic work up of women with an ovarian cyst or pelvic tumor. The statistical evaluation was performed on a population of 445 women diagnosed with a benign ovarian disease, included in a large Swedish multicenter trial (ClinicalTrials.gov NCT03193671). Multivariable logistic regression analyses were performed to distinguish between the true negatives and false positives through adjusting for biologic, histopathologic and lifestyle factors on serum samples of CA125 and HE4 separately. The likelihood ratio test was used to determine statistical significance and Benjamini-Hochberg correction to adjust for multiple testing. A total of 31% of the women had false positive CA125 but only 9% had false positive results of HE4. Smoking (OR 6.62 95% CI 2.93-15.12) and impaired renal function, measured by eGFR (OR 0.18 95% CI 0.08-0.39), were independently predictive of falsely elevated serum levels of HE4. Endometriosis was the only variable predictive of falsely elevated serum levels of CA125 (OR 7.96 95% CI 4.53-14.39). Age correlated with increased serum levels of HE4. Smoking, renal failure, age and endometriosis are factors that independently should be considered when assessing serum levels of HE4 and CA125 in women with an ovarian cyst or pelvic mass to avoid false indications of malignant disease. 

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  • 37.
    Majzoub, Ahmad
    et al.
    Department of Urology, Hamad Medical Corporation, Doha, Qatar / Department of Urology, Weill Cornell Medicine-Qatar, Doha, Qatar.
    Arafa, Mohamed
    Department of Urology, Hamad Medical Corporation, Doha, Qatar / Department of Urology, Weill Cornell Medicine-Qatar, Doha, Qatar / Department of Andrology, Cairo University, Egypt.
    El Ansari, Walid
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Surgery, Hamad Medical Corporation, Doha, Qatar / College of Medicine, Qatar University, Doha, Qatar.
    Mahdi, Mohammed
    Department of Urology, Hamad Medical Corporation, Doha, Qatar.
    Agarwal, Ashok
    Department of Urology, Glickman Urology and Kidney Institute, Cleveland Clinic Foundation, OH, United States.
    Al-Said, Sami
    Department of Urology, Hamad Medical Corporation, Doha, Qatar / Department of Urology, Weill Cornell Medicine-Qatar, Doha, Qatar.
    Elbardisi, Haitham
    Department of Urology, Hamad Medical Corporation, Doha, Qatar / Department of Urology, Weill Cornell Medicine-Qatar, Doha, Qatar.
    Correlation of oxidation reduction potential and total motile sperm count: its utility in the evaluation of male fertility potential2020In: Asian Journal of Andrology, ISSN 1008-682X, E-ISSN 1745-7262, Vol. 22, no 3, p. 317-322Article in journal (Refereed)
    Abstract [en]

    Oxidative stress (OS) is detrimental to sperm functions, and the oxidation reduction potential (ORP) is a good measure of OS as it considers the balance between oxidants and reductants. Total motile sperm count (TMSC) is viewed as the single most important semen analysis parameter that can predict male infertility severity, and its correlation with ORP has never been undertaken. The objectives of this study were to assess the correlation between ORP and TMSC, to identify the ORP cutoff value based on the TMSC result, and to compare this cutoff value with previously reported ORP cutoff values in literature. One thousand one hundred and sixty-eight infertile patients and 100 fertile controls were enrolled. Demographic and semen data of the participants were retrieved and analyzed. Wilcoxon's rank-sum test compared variables between infertile men and fertile controls; Spearman's correlation assessed the static ORP (sORP)-TMSC relationship for the whole sample and among each group individually. Using a 20×106TMSC threshold, receiver operator characteristic (ROC) analysis determined the sORP cutoff associated with the highest predictive values. TMSC was significantly negatively correlated with sORP across all participants (r = 0.86, P < 0.001), among infertile patients (r = 0.729, P < 0.001), and among fertile controls (r = 0.53, P < 0.001). A 20-million TMSC threshold determined an sORP cutoff value of 2.34 mV/106sperm/ml to be associated with 82.9% sensitivity, 82.8% specificity, 91.5% positive predictive value (PPV), 68.5% negative predictive value (NPV), and 82.9% overall accuracy. Compared with previously reported cutoff values in searched literature, the 2.34 mV/106sperm/ml cutoff value identified in our study yielded the highest overall diagnostic accuracy in the evaluation of infertile men.

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  • 38.
    Manti, Maria
    et al.
    Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
    Pui, Han-Pin
    Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden / Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden.
    Edström, Sonja
    Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
    Risal, Sanjiv
    Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
    Lu, Haojiang
    Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
    Lindgren, Eva
    Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
    Ohlsson, Claes
    Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.
    Jerlhag, Elisabet
    Department of Pharmacology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden.
    Benrick, Anna
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden.
    Deng, Qiaolin
    Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden / Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden.
    Stener-Victorin, Elisabet
    Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
    Excess of ovarian nerve growth factor impairs embryonic development and causes reproductive and metabolic dysfunction in adult female mice2020In: The FASEB Journal, ISSN 0892-6638, E-ISSN 1530-6860, Vol. 34, no 11, p. 14440-14457Article in journal (Refereed)
    Abstract [en]

    Nerve growth factor (NGF) is critical for the development and maintenance of the peripheral sympathetic neurons. NGF is also involved in the ovarian sympathetic innervation and in the development and maintenance of folliculogenesis. Women with the endocrine disorder, polycystic ovary syndrome (PCOS), have an increased sympathetic nerve activity and increased ovarian NGF levels. The role of ovarian NGF excess in the PCOS pathophysiology and in the PCOS-related features is unclear. Here, using transgenic mice overexpressesing NGF in the ovarian theca cells (17NF mice), we assessed the female embryonic development, and the reproductive and metabolic profile in adult females. Ovarian NGF excess caused growth restriction in the female fetuses, and a delayed gonocyte and primary oocyte maturation. In adulthood, the 17NF mice displayed irregular estrous cycles and altered ovarian expression of steroidogenic and epigenetic markers. They also exhibited an increased sympathetic output with increased circulating dopamine, and metabolic dysfunction reflected by aberrant adipose tissue morphology and function, impaired glucose metabolism, decreased energy expenditure, and hepatic steatosis. These findings indicate that ovarian NGF excess leads to adverse fetal development and to reproductive and metabolic complications in adulthood, mirroring common features of PCOS. This work provides evidence that NGF excess may be implicated in the PCOS pathophysiology. 

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  • 39.
    Manti, Maria
    et al.
    Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm.
    Stener-Victorin, Elisabet
    Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm.
    Benrick, Anna
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg.
    Skeletal Muscle Immunometabolism in Women With Polycystic Ovary Syndrome: A Meta-Analysis2020In: Frontiers in Physiology, E-ISSN 1664-042X, Vol. 11, article id 573505Article, review/survey (Refereed)
    Abstract [en]

    Polycystic ovary syndrome (PCOS) is an endocrine and metabolic disorder affecting up to 15% of women at reproductive age. The main features of PCOS are hyperandrogenism and irregular menstrual cycles together with metabolic dysfunctions including hyperinsulinemia and insulin resistance and a 4-fold increased risk of developing type 2 diabetes. Despite the high prevalence the pathophysiology of the syndrome is unclear. Insulin resistance in women with PCOS likely affect the skeletal muscle and recently it was demonstrated that changes in DNA methylation affects the gene expression in skeletal muscle that in part can explain their metabolic abnormalities. The objective of this work was to combine gene expression array data from different datasets to improve statistical power and thereby identify novel biomarkers that can be further explored. In this narrative review, we performed a meta-analysis of skeletal muscle arrays available from Gene Expression Omnibus and from publications. The eligibility criteria were published articles in English, and baseline (no treatment) skeletal muscle samples from women with PCOS and controls. The R package Metafor was used for integration of the datasets. One hundred and fourteen unique transcripts were differentially expressed in skeletal muscle from women with PCOS vs. controls (q < 0.05), 87% of these transcripts have not been previously identified as altered in PCOS muscle. ING2, CDKAL1, and AKTIP had the largest differential increase in expression, and TSHZ2, FKBP2, and OCEL1 had the largest decrease in expression. Two genes, IRX3 and CDKAL1 were consistently upregulated (q < 0.05) in the individual analyses and meta-analysis. Based on the meta-analysis, we identified several dysregulated immunometabolic pathways as a part of the molecular mechanisms of insulin resistance in the skeletal muscle of women with PCOS. The transcriptomic data need to be verified by functional analyses as well as proteomics to advance our understanding of PCOS specific insulin resistance in skeletal muscle.

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  • 40.
    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.

  • 41.
    Mårtensson, Lena B.
    et al.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    Gunnarsson, Britt-Marie
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    Karlsson, Sandra
    School of Health and Welfare, Jönköping University, Sweden.
    Lee, Nigel
    School of Nursing, Midwifery and Social Work University of Queensland, St Lucia, Australia.
    Bergh, Ingrid
    University of Skövde, School of Health Sciences.
    Effect of topical local anaesthesia on injection pain associated with administration of sterile water injections - a randomized controlled trial2022In: BMC Anesthesiology, ISSN 1471-2253, E-ISSN 1471-2253, Vol. 22, no 1, article id 35Article in journal (Refereed)
    Abstract [en]

    Background

    Sterile water injections can provide effective pain relief during childbirth, particularly for low back pain related to childbirth. However, the pain associated administering the injections can negatively impact women’s impressions of the procedure. It may discourage women from considering repeat doses despite the quality of analgesia experienced. Determining strategies to reduce the pain related to the administration of sterile water injections would improve the acceptability of the technique. Therefore, the aim of this study was to evaluate the effect of topical local anesthesia on the pain associated with administration of sterile water injections.

    Methods

    The study was designed as a multi-arm single-blind, randomized, controlled trial and 120 female healthy students were randomly divided according to one of four groups. The Intervention group received sterile water injections with topical local anesthesia. Control group 1 received sterile water injections without topical local anesthesia, control group 2 received injections of isotonic saline 0.9% with topical local anesthesia and control group 3 received injections of isotonic saline 0.9% without topical local anesthesia. Pain Immediately after the injections and subsidence in pain were recorded using a visual analogue scale. Sensations in the injection area were reported 15 min and the day after the injections.

    Results

    The main finding of this study was that local anesthesia with EMLA® reduces the pain associated with the administration of intracutaneous sterile water injections. There was a significant difference in the self-assessed pain score immediately following the injections between the control (73.3 mm) and intervention groups (50.0 mm), p = 0.001. No adverse side effects were reported.

    Conclusion

    Local anesthesia with EMLA® reduces the pain associated with intracutaneous administration of sterile water injections.

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  • 42.
    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.

  • 43.
    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.

  • 44.
    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.

  • 45.
    Norelius, Frida
    et al.
    University of Skövde, School of Health Sciences.
    Scarlini, Hanna
    University of Skövde, School of Health Sciences.
    Att möta en främmande värld ensam: Kvinnors upplevelser av sin vårdtid i samband med barnafödande under pågående Covid-19 pandemi2021Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Women is affected by the Covid-19 pandemic that contributed to changes in health care during childbirth and postnatal. Research has shown that the pandemic had negatively affected women´s mental health. There is concern among women about getting symptoms or being infected with Covid-19 and fear that the midwife would not want to care for them. To increase knowledge about how women experience their hospital stay in connection with childbearing during ongoing pandemic, more research is needed. Aim: To describe women´s experiences of their hospital stay in connection with childbearing during ongoing Covid-19 pandemic. Method: Qualitative content analysis with an inductive approach. Semistructured individual interviews were conducted with 10 women who gave birth during Covid-19 pandemic. Results: Data analysis resulted in one theme, three categories and nine subcategories. The overall theme that emerged was following: ”Covid-19 pandemic contributed to feelings of loneliness and abandonment as well as an increased need for support and security” and categories: ”Partner´s supportive role and opportunity for participation”, ”Health professionals supportive role” and ”The importance of the care environment”. Conclusion: Presence of the partner is important for women to feel support and security. There is an increased need for attendance, communication and information from midwives.

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  • 46.
    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.

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  • 47.
    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. University of Skövde, The Systems Biology Research Centre. 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, 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.

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  • 48.
    Pendharkar, Sonal
    et al.
    Karolinska University Hospital, Sweden.
    Magopane, Tebogo
    Chris Hani Baragwanath Hospital, South Africa.
    Larsson, Per-Göran
    University of Skövde, School of Life Sciences. University of Skövde, The Systems Biology Research Centre. Department of Obstetrics and Gynaecology, Skaraborg Hosptial, Skövde.
    de Bruyn, Guy
    Chris Hani Baragwanath Hospital, South Africa.
    Gray, Glenda E.
    Chris Hani Baragwanath Hospital, South Africa.
    Hammarstrom, Lennart
    Karolinska University Hospital, Sweden.
    Marcotte, Harold
    Karolinska University Hospital, Sweden / Karolinska Institute, Sweden.
    Identification and characterisation of vaginal lactobacilli from South African women2013In: BMC Infectious Diseases, E-ISSN 1471-2334, Vol. 13, article id 43Article in journal (Refereed)
    Abstract [en]

    Background: Bacterial vaginosis (BV), which is highly prevalent in the African population, is one of the most common vaginal syndromes affecting women in their reproductive age placing them at increased risk for sexually transmitted diseases including infection by human immunodeficiency virus-1. The vaginal microbiota of a healthy woman is often dominated by the species belonging to the genus Lactobacillus namely L. crispatus, L. gasseri, L. jensenii and L. iners, which have been extensively studied in European populations, albeit less so in South African women. In this study, we have therefore identified the vaginal Lactobacillus species in a group of 40 African women from Soweto, a township on the outskirts of Johannesburg, South Africa. Methods: Identification was done by cultivating the lactobacilli on Rogosa agar, de Man-Rogosa-Sharpe (MRS) and Blood agar plates with 5% horse blood followed by sequencing of the 16S ribosomal DNA. BV was diagnosed on the basis of Nugent scores. Since some of the previous studies have shown that the lack of vaginal hydrogen peroxide (H2O2) producing lactobacilli is associated with bacterial vaginosis, the Lactobacillus isolates were also characterised for their production of H2O2. Results: Cultivable Lactobacillus species were identified in 19 out of 21 women without BV, in three out of five women with intermediate microbiota and in eight out of 14 women with BV. We observed that L. crispatus, L. iners, L. jensenii, L. gasseri and L. vaginalis were the predominant species. The presence of L. crispatus was associated with normal vaginal microbiota (P = 0.024). High level of H2O2 producing lactobacilli were more often isolated from women with normal microbiota than from the women with BV, although not to a statistically significant degree (P = 0.064). Conclusion: The vaginal Lactobacillus species isolated from the cohort of South African women are similar to those identified in European populations. In accordance with the other published studies, L. crispatus is related to a normal vaginal microbiota. Hydrogen peroxide production was not significantly associated to the BV status which could be attributed to the limited number of samples or to other antimicrobial factors that might be involved.

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  • 49.
    Rilby, Linda
    et al.
    Department of Obstetrics and Gynecology, Sahlgrenska University Hospital/Östra, Sweden.
    Jansson, Solveig
    Department of Obstetrics and Gynecology, Sahlgrenska University Hospital/Östra, Sweden.
    Lindblom, Britta
    Department of Obstetrics and Gynecology, Sahlgrenska University Hospital/Östra, Sweden.
    Mårtensson, Lena B.
    University of Skövde, School of Life Sciences.
    A Qualitative Study of Women's Feelings About Future Childbirth: Dread and Delight2012In: Journal of midwifery & women's health, ISSN 1526-9523, E-ISSN 1542-2011, Vol. 57, no 2, p. 120-125Article in journal (Refereed)
    Abstract [en]

    Introduction: There is extensive knowledge about expectations of and thoughts about childbirth among women who have not given birth. When it comes to women who have given birth to at least 1 child, on the other hand, knowledge about their expectations for a future birth is limited. The purpose of this study is thus to describe the emotions of this group concerning future childbirth. Methods: Participants were 908 women in Sweden who had given birth to at least 1 child. This study is based on responses to the following request in the questionnaire sent out to women 4 to 7 years after they had given birth vaginally: "Please describe your feelings when you think about giving birth in the future." Results: One-third of the women responded that they were mostly frightened of future childbirth, while the remaining two-thirds had mostly positive feelings. The qualitative analysis resulted in 3 categories and 8 subcategories and an overall theme: a mixture of dread and delight. Even with negative feelings/fears about future childbirth, many women want to give birth to more children. Discussion: Despite experiences of severe pain or complications during a previous birth, many women nonetheless looked forward to future childbirth, primarily since they were motivated by having another child and encouraged by having been given good support by the midwife.

  • 50.
    Risal, Sanjiv
    et al.
    Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
    Li, Congru
    Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden ; Center of Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China.
    Luo, Qing
    Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
    Fornes, Romina
    Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden ; Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden.
    Lu, Haojiang
    Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
    Eriksson, Gustaw
    Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
    Manti, Maria
    Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
    Ohlsson, Claes
    Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden ; Department of Drug Treatment, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Lindgren, Eva
    Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
    Crisosto, Nicolas
    Endocrinology and Metabolism Laboratory, West Division, School of Medicine, University of Chile, Santiago, Chile ; Endocrinology Unit, Department of Medicine, Clínica Alemana de Santiago, Faculty of Medicine, Clinica Alemana, Universidad del Desarrollo, Santiago, Chile.
    Maliqueo, Manuel
    Endocrinology and Metabolism Laboratory, West Division, School of Medicine, University of Chile, Santiago, Chile.
    Echiburú, Barbara
    Endocrinology and Metabolism Laboratory, West Division, School of Medicine, University of Chile, Chile.
    Recabarren, Sergio
    Laboratory of Animal Physiology and Endocrinology, Faculty of Veterinary Sciences, University of Concepción, Chillán, Chile.
    Petermann, Teresa Sir
    Endocrinology and Metabolism Laboratory, West Division, School of Medicine, University of Chile, Chile.
    Benrick, Anna
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden.
    Brusselaers, Nele
    Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden ; Global Health Institute, Antwerp University, Belgium.
    Qiao, Jie
    Center of Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China.
    Deng, Qiaolin
    Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden ; Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden.
    Stener-Victorin, Elisabet
    Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
    Transgenerational transmission of reproductive and metabolic dysfunction in the male progeny of polycystic ovary syndrome2023In: Cell Reports Medicine, E-ISSN 2666-3791 , Vol. 4, no 5, article id 101035Article in journal (Refereed)
    Abstract [en]

    The transgenerational maternal effects of polycystic ovary syndrome (PCOS) in female progeny are being revealed. As there is evidence that a male equivalent of PCOS may exists, we ask whether sons born to mothers with PCOS (PCOS-sons) transmit reproductive and metabolic phenotypes to their male progeny. Here, in a register-based cohort and a clinical case-control study, we find that PCOS-sons are more often obese and dyslipidemic. Our prenatal androgenized PCOS-like mouse model with or without diet-induced obesity confirmed that reproductive and metabolic dysfunctions in first-generation (F1) male offspring are passed down to F3. Sequencing of F1–F3 sperm reveals distinct differentially expressed (DE) small non-coding RNAs (sncRNAs) across generations in each lineage. Notably, common targets between transgenerational DEsncRNAs in mouse sperm and in PCOS-sons serum indicate similar effects of maternal hyperandrogenism, strengthening the translational relevance and highlighting a previously underappreciated risk of transmission of reproductive and metabolic dysfunction via the male germline. 

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