Diss. (sammanfattning) Stockholm : Karol. inst., 2001. / Härtill 5 uppsatser.

Bakgrund: Triage är en av sjuksköterskans uppgifter på vårdcentral som bland annat innebär att hon skall bedöma och ta beslut om behov när en kvinna söker vård för gynekologiska problem. Många gynekologiska åkommor är av diffus karaktär och det finns många diagnoser vars symtom överensstämmer med gynekologiska. Kvinnor med gynekologiska problem kan ha svårt att redogöra för sin sjukdomsbild och kan vara motvilliga till att söka vård, detta utgör hinder för den triagerande sjuksköterskan. Syfte: Syftet med studien var att undersöka sjuksköterskors erfarenheter av att triagera kvinnor med gynekologiska problem. Metod: En intervjustudie utfördes och analyserades med innehållsanalys. Resultat: Sjuksköterskorna hade erfarenhet av att det fanns svårigheter att följa riktlinjer och att triagera per telefon. Krav på remiss resulterade i långa vårdköer och det fanns sociokulturella utmaningar relaterat till att samtala om gynekologiska problem. Språk kunde vara ett hinder vid triage, särskilt via telefon. Sjuksköterskorna var i behov av kompetensutveckling för att fördelaktigt kunna utföra arbetet med att triagera. Resultatet visade även att informanterna upplevt ett behov av kompetensutveckling. Konklusion: De svårigheter som sjuksköterskorna erfarit genom att arbeta med att triagera kvinnor med gynekologiska problem var att förhålla sig till organisatoriska villkor, sociokulturella utmaningar, kompetensbrist att bedöma symtom samt och detta pekade på ett behov av kompetensutveckling hos sjuksköterskor som ej har tillgång till konsultation med gynekolog samt revision av regionala riktlinjer och organisatoriska villkor på vårdcentraler i Malmö. / Background: Triage is one of the nurse's duties at the health center which among other things means that she must assess and make decisions when a woman seeks treatment for gynecological problems. Many gynecological disorders are diffuse and there are many diagnoses whose symptoms are consistent with gynecological symptoms. Women with gynecological problems may find it difficult to explain their illness and may be reluctant to seek care, this constitutes an obstacle for the nurse. Aim: The aim of this study was to investigate the nurses' experiences in triage of women with gynecological problems. Method: An interview study was performed and analyzed with content analysis. Results: The nurses had experienced that there were difficulties to follow the guidelines and make decisions over the telephone. Referral requirement resulting in long waiting lists and sociocultural challenges related to talk about gynecological problems. Language can be a barrier in triage, especially over the telephone. The nurses were in need of skills to advantageously carry out the work with triage of women. The nurses had also learned that they needed a development of skills. Conclusion: The difficulties the nurses learned by working with triage of women with gynecological problems is that it is related to the organizational conditions, sociocultural challenges, to assessing symptoms and the lack of competence. This points to a need for development of skills of nurses who do not have access to consultation with a gynecologist, audited guidelines and organizational conditions of health centers in Malmö.

ABSTRACT Background: In the late 1980s the possibility was raised that periodontal infections could constitute maternal infections so it could influence adversely birth outcomes. Adversely birth outcomes such as preterm infants (born before 37 weeks of gestation). Low birth weight (LBW) (<2500g) is also usual with preterm infants. Transient bacteraemia commonly occurs in subjects with inflamed gingiva (Kinane et al. 2005) and may reach the tissues of the placenta, which could cause inflammatory impetus for labour induction  Aim: The aim of this study was to review published articles during the last ten years to summarize the current research field to elucidate if there is an association between periodontitis and some adverse birth outcomes, specifically low birth weight, pre-eclampsia and pre-term birth. Methods: A literature search was conducted in the database PubMed with the aim to find published articles in which the association between periodontitis and adverse birth outcomes was examined. Human clinical studies that were published within the last ten years, had an abstract available and a minimum of 200 subjects were included. Studies published before 2012 were excluded. Results: Results of the primary search presented 280 articles. Twentyone of these articles fulfilled the inclusion criteria. Two thirds of the included studies could show an association between periodontitis and adverse birth outcomes.  Conclusions: Within the limitations of this paper there is very likely to be an association between periodontitis and adverse birth outcomes in some populations, and under some conditions such as diagnostic criteria for periodontitis.

<p><strong>Bakgrund:</strong> Sexualitet hos äldre är precis som hos yngre en viktig del av livskvaliteten. Den sexuella förmågan och de sexuella behoven fortsätter långt upp i åren. Ett aktivt sexualliv har visat sig vara bra för välbefinnandet.</p><p><strong>Syfte: </strong>Syftet var att undersöka vilka faktorer som har en positiv påverkan på äldre kvinnors sexuella välbefinnande.</p><p><strong>Metod: </strong>En kvantitativ metod har används på ett redan insamlat datamaterial. Detta material består av omfattande enkäter som samlades in under åren 2000-2003. Huvudvariabel sexuellt välbefinnande har testats mot flera relevanta variabler. Analysmetoderna som användes var Chi-square test, univariat analys och slutligen en multivariat analys. Vi har valt att titta på den positiva odds kvoten, det vill säga vad som påverkar det sexuella välbefinnandet positivt.</p><p><strong>Resultat:</strong> Av den undersökta populationen skattade 25 % av kvinnorna att de hade ett bra sexuellt välbefinnande. Studien visade ett starkt samband mellan att känna sig uppskattad i hemmet och att vara nöjd med sitt sexuella välbefinnande. Att vara nöjd med sin kropp var en positiv faktor för det sexuella välbefinnandet. Signifikans fanns också för att ha ett bra humör, att vara icke rökare och att inte ha passerat menopaus.</p> / <p><strong>Background</strong>: Sexuality among older persons are just as important to quality of life as it is to younger people. The sexual ability and sexual needs will continue up in years. An active sex life is good for the sexual satisfaction.</p><p><strong>Objective:</strong> The objective was to examine factors that have a positive impact on older women's sexual satisfaction.</p><p><strong>Method:</strong> A quantitative method was used on already collected material, consisting of extensive surveys collected during the years of 2000-2003. The main variable sexual satisfaction has been tested against several relevant variables. The analytical methods used were chi-square test, univariate analysis and finally a multivariate analysis. We chose to examine the positive odds ratio, (POR), that affects the sexual satisfaction positively. <strong>Results:</strong> Among the respondents 25% estimated that they had very good sexual satisfaction. The results indicates to be appreciated at home and happy with ones own body affected the sexual satisfaction positively. Having a good mood and not have passed menopause also have a positive affect of the older womens sexual satisfaction.</p>

Internationally as well as in Sweden, efforts for improvement in gynaecological surgery in recent decades have mainly focused on three new treatment concepts: (1) Use of minimally invasive procedures: since there is an interdependency between the extent of surgical trauma and the risk for adverse outcome, increased use of supposedly atraumatic endoscopic procedures has revolutionized several aspects of surgical care (2) A multimodal approach to eliminate harmful procedures in the peri-operative process based on evidence-based principles (3) Introduction of implants to support damaged tissue with synthetic mesh in incontinence and pelvic organ prolapse patients. Research question 1: Is introduction of a minimally invasive operation enough per se or is the measured improvement mediated by elimination of harmful procedures in the perioperative process? Findings: Our study (Paper I) indicates that by applying a multimodal intervention programme for the pre- and postoperative care of patients undergoing supravaginal hysterectomy, the surgical procedure per se is of less importance than generally considered. Patient-related parameters such as length of postoperative hospital stay, number of days at home with need of painkillers, number of days before return to normal activities, and patient satisfaction did not differ between patients undergoing the laparoscopic procedure and patients undergoing abdominal supravaginal hysterectomy. When evaluating a new and presumably improved operative procedure against an established standard procedure, it is mandatory and of fundamental importance that the two methods are aligned in terms of perioperative care provided. Research question 2: Under which circumstances can it be assumed that a new surgical procedure showing promising efficacy in one setting can be reproduced with similar results in a different clinical setting (Paper I)? Findings: The operating surgeons concluded that, in their hands and under local conditions, laparoscopic technique for supravaginal hysterectomy was not superior to traditional open hysterectomy and stopped using laparoscopic technique. It seems necessary, prior to routine use, to monitor, using scientific tools, whether the advantages described in the literature are achievable under local conditions. Research question 3: Do expected advantages of implants outweigh the unwanted effects and complications caused by implants in operations for recurrent cystocele (Paper II)? Findings: Mesh has better durability but more (minor) complications. It is not possible to determine whether mesh is "generally better" than native tissue operation. Some may focus on the improved durability, others on the increased risks. The surgeon must make a risk assessment for each individual case. The patient must be sufficiently informed to understand the risks and make a personal, informed decision whether she wants an augmentation by implant. Essential for this process is a clear, comprehensible picture of both desired and unwanted effects of the planned surgery. In this context, studies like ours might be of use.

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.

<p>Hysterektomi är ett kirurgiskt ingrepp där man opererar bort livmodern på kvinnor där en genital rubbning uppkommit. Syftet med detta arbete var att ge en klarare bild om hur kvinnor upplever detta ingrepp samt hur vårdpersonalen skall bemöta och kunna ge kvinnan stöd om så skulle behövas. Syftet med studien var att genom en litteraturstudie belysa kvinnors upplevelser av hysterektomi samt behov av stöd. En systematisk litteraturstudie gjordes där tretton vetenskapliga studier har inkluderats. Resultatet presenteras i två huvudkategorier, kvinnors upplevelser vid hysterektomi samt kvinnors behov av stöd. Båda kategorierna innefattade underkategorier vilka var livskvalitet, sexualitet, stöd samt information. Resultatet visade på att större delen av kvinnorna som genomgått hysterektomi var nöjda med ingreppet, då ett stort handikapp de dragits med en lång tid lättade eller försvann helt. Kvinnorna saknade information om tiden efter operationen. Information har en stor betydelse av hur kvinnorna upplever hysterektomi. Sammanfattningsvis är det viktigt att sjukvårdspersonal har den kunskapen att ge rätt information vid rätt tillfälle. För att hjälpa de kvinnor som skall genomgå hysterektomi bör vårdpersonalen även kunna vara ett stöd, så att sjukhusvistelsen blir en god upplevelse för dessa kvinnor.</p>

Women afflicted with cervical cancer who have the highest morbidity and mortality rates have been the least likely to be screened. The overall aim of this research project was to investigate non-attendance in a cervical cancer screening (CCS) program among women with no registered cervical smear during the previous five years. Both quantitative (I,III) and qualitative methods (II) as well as costeffectiveness analysis (IV) were used in this research project. In Kalmar County women (aged 23-65 years) are invited to CCS every third year. All cervical smears taken both in opportunistic and organised CCS are coordinated in a register called Sympathy. The coverage is 88.4 %. From Sympathy, a random sample of 400 women served as a study group and another 400 women as a control group (III,IV). From the study group, 133 women participated in study I and 14 women in study II. Data was collected by telephone interviews based on a questionnaire (I), qualitative face-to-face interviews (II), questionnaire, promotive efforts and outcome (III), costs and effectiveness (IV). Quantitative data was analysed by descriptive and analytic statistics (I,III), qualitative data was analysed by content analysis. In study IV, cost-effectiveness analysis was used. The women believed that CCS was a good idea for all other women, but tended to refer to various circumstances resulting in their own non-attendance. One of the most common reasons for non-attendance was the feeling of being healthy. The women prioritized family and work commitments, and the invitation to attend CCS was sometimes experienced as a stressful disturbance. The feeling of discomfort was related to the gynaecologic examination, or to health care visits in general (I,II). Of 133 women, 120 could consider having a cervical smear taken and their two most common requirements for doing so were to be assured they would be treated in a friendly way (19%) and to find a suitable time (18%) for having the cervical smear. Fifty women wanted to be helped to have a cervical smear taken. Promotive efforts ranged from making a simple telephone call to arranging an appointment time to a combination of promotive efforts including repeated encounters in order to create a trusting relationship with respect to taking the smear. In the study group, 29.5% (n=118) had a registered cervical smear at follow-up compared to 18.5% (n=74) in the control group, (p&lt;0.001) (III). In the study group, the cost per cervical smear taken was 66.87 €, and in the control group it was 16.62 €. The incremental cost per additional cervical smear taken was 151.36 € (IV). In conclusion, women’s reasons for not attending CCS are complex and are influenced by both present and earlier circumstances. In settings with high coverage, further contact in order to promote women’s attendance at CCS seems to be associated with high costs in relation to the number of additional cervical smears taken. / On the day of the defence data the status of article I was: In press; article II: Submitted; article II: Accepted and artile IV: In press.

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders among women of childbearing age and is associated with a number of metabolic disturbances. It has been hypothesised these women carry an increased risk of developing cardiovascular diseases (CVD) with advancing age. The first aim of this thesis was to establish the prevalence of PCOS-related symptoms in Northern Sweden. The Northern part of the WHO MONICA project was used for this purpose. Based on self-reported menstrual disturbances and hirsutism together with biochemical analyses of free androgen index, the estimated prevalence of PCOS in Northern Sweden was 4.8%, which corresponded with previous prevalence studies. Disturbances in the fibrinolytic system are predictors of future cardiovascular events and measurements of plasminogen activator inhibitor 1 (PAI-1) activity and tissue plasminogen activator (tPA) mass concentration may be used to assess fibrinolytic activity in women with PCOS. From the findings, over-weight women with PCOS had impaired fibrinolysis, especially if they displayed objective biochemical markers of hyperandrogenism. Conversely, lean women with PCOS, displayed no signs of disturbed fibrinolysis. The adipose tissue is an active endocrine organ that produces and releases hormones, pro- and anti-inflammatory cytokines, and chemoattractant cytokines. Proinflammatory molecules produced by adipose tissue can be active participants in the development of insulin resistance and the increased risk of cardiovascular disease associated with obesity. The findings suggested being overweight, rather than the PCOS diagnosis per se, was the main explanatory variable for elevated adipose tissue inflammation in PCOS patients. Weight reduction is the primary target for intervention in overweight and obese women with PCOS. When this thesis was planned, no placebo-controlled trials on anti-obesity drugs in women with PCOS had been conducted. Sibutramine in combination with lifestyle intervention resulted in significant weight reduction in overweight women with PCOS. In addition to the weight loss, sibutramine appeared to have a beneficial effect on metabolic and cardiovascular risk factors.

Introduction: Obesity is a growing global public health problem and is as prevalent among pregnant women as in the general population. It is well known that obese women have an increased risk for several complications during pregnancy and delivery and this is also true for the neonate. Excessive gestational weight gain among obese women seems to further increase these risks for adverse outcomes. It has not been known up to the time of this study whether a behavioral intervention program designed for obese pregnant women could result in a reduction of gestational weight gain. Aim: The overall aim of the present thesis was to study the effect of an intervention program designed to control weight gain among obese pregnant women during pregnancy and to then observe the outcomes of their pregnancies. In addition we wanted to learn if this behavioral intervention program could result in a weight gain of less than seven kilograms. Material and methods: The intervention group consisted of 155 obese (BMI &gt;30 kg/m2) pregnant women at the antenatal care clinic (ANC) in Linköping; the control group consisted of 193 obese pregnant women in two other cities. The women in the intervention group were offered, in addition to regular care at the ANC, motivational interviewing in weekly visits to support them in making this behavioral change. They were also offered aqua aerobic class once or twice a week. The women in the control group attended the routine antenatal program in their respective ANCs. Outcome measures were: weight in kg, pregnancy-, delivery and neonatal outcomes, prevalence of anxiety- and depressive symptoms and attitudes and experiences of participating in an intervention program. Results: The women in the intervention group had a significantly lower gestational weight gain and also had a lower postnatal weight than the women in the control group. The percentage of women in the intervention group who gained &lt;7 kg was greater than the percentage in the control group. There were no differences between the two groups in pregnancy-, delivery- and neonatal outcomes. In addition, there was no difference in prevalence of symptoms of anxiety and depressions between the intervention- and control group and the gestational weight gain did not have any effect on symptoms of depression or anxiety. The women in the intervention group with gestational weight gain &lt;7 kg, weighed less at the two years follow-up than the women in the control group. Most of the women who participated in the intervention program expressed positive attitudes and were positive towards their experiences with the intervention program and their efforts to manage the gestational weight gain. Conclusion: The intervention program was effective in controlling weight gain during pregnan-cy and did not change the pregnancy, delivery or neonatal outcomes or the prevalence of anxie-ty- and depressive symptoms. The group with a gestational weight gain &lt;7 kg showed the same distribution of complications as the group with a higher weight gain. The intervention program seems to influence the development of weight in a positive direction up to two years after childbirth. The women were also satisfied with their participation in the intervention program.