Submitted by Ana Lúcia Torres (bfmhuap@gmail.com) on 2017-11-13T14:19:06Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao Josy Pinho.pdf: 1226133 bytes, checksum: eb4114659ac7eea459d334e4f15bb04f (MD5) / Approved for entry into archive by Ana Lúcia Torres (bfmhuap@gmail.com) on 2017-11-13T14:19:16Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao Josy Pinho.pdf: 1226133 bytes, checksum: eb4114659ac7eea459d334e4f15bb04f (MD5) / Made available in DSpace on 2017-11-13T14:19:16Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao Josy Pinho.pdf: 1226133 bytes, checksum: eb4114659ac7eea459d334e4f15bb04f (MD5) Previous issue date: 2017 / Viva Rio / Objetivo: Análise da morbidade materna grave (near miss materno), por meio de revisão sistemática de estudos no Brasil. Métodos: Foram examinados estudos que relataram dados quantitativos, causas e fatores associados à morbidade materna grave (near miss materno). A busca foi feita pelos sites MEDLINE e LILACS, sendo as palavras-chave: maternal near miss or severe maternal morbidity and Brazil. Foram extraídos dados utilizando-se um protocolo pré-definido (autor, ano, desenho do estudo, população estudada, cenário e contexto, análise estatística, critérios de near miss e resultados). A razão de near miss e os indicadores derivados foram descritos ou estimados, quando não relatados. Resultados: Identificamos 55 estudos, a maioria de desenho transversal (32). Predominaram estudos (40) de base hospitalar (local ou nacional); outros usaram sistemas de informação de saúde ou pesquisas nacionais de saúde. Diferentes definições e terminologias para “near miss” foram adotadas. A Razão de near miss materno variou de 2,4/ 1000 NV a 188,4/ 1000 NV, dependendo dos critérios e do cenário epidemiológico. O índice de mortalidade near miss materno variou entre 3,3% e 32,2%. Doenças hipertensivas e hemorrágicas foram as morbidades mais comuns. As causas indiretas vêm aumentando nos últimos anos. A ausência de cuidados pré-natais e outras demoras nos cuidados de saúde foram associados ao near miss, como também fatores sociodemográficos (cor da pele não branca, adolescência/ idade≥35 anos, baixo nível de escolaridade). Conclusão: O near miss materno no Brasil está associado a iniquidades e demoras na assistência à saúde. Existem grandes diferenças entre as regiões e de acordo com a classificação/ definição usada nos estudos. Os casos de near miss devem ser monitorados rotineiramente em unidades de saúde. Pesquisas futuras sobre casos de near miss materno devem usar os critérios da OMS e expandir o conceito de morbidade materna / Objective: Analysis of severe maternal morbidity (maternal near miss), through systematic review of studies in Brazil. Methods: We examined studies that reported quantitative data, causes, and associated factors on severe maternal morbidity (maternal near miss). The search was through MEDLINE and LILACS, and keywords were: maternal near miss or severe maternal morbidity and Brazil. We extracted data, using a pre-defined protocol (author, year, study design, population studied, setting and context, statistical analysis, criteria of near miss, and results). Near miss ratios, and near miss indicators were described or estimated, when not reported. Results: We identified 55 studies, mainly cross-sectional (32). Most of them (35) were health facility-based (local or national); others used health information systems or national health surveys. Different definitions and terminologies for maternal near miss were adopted. Near miss ratio ranged from 2,4/1000 LB to 188,4/1000 LB, depending on criteria and epidemiological scenario. Mortality index for maternal near miss ranged from 3.3%-32.2%. Hypertensive diseases and hemorrhage were the commonest morbidities. Indirect causes have been increasing in last years. Absence of prenatal care and other delays in health care were associated with near miss, as sociodemographic factors (skin color, adolescence and age > 35 years, low educational level). Conclusion: Maternal near miss in Brazil is associated with health iniquities and delays in health care. Large differences exist between regions and depending on the classification/setting of the studies. Near miss cases should be surveyed routinely in health facilities. Future research on maternal near misses should use WHO criteria and expand the concept of maternal morbidity

Syfte – Syftet med denna studie är att kartlägga hur digitala tidsbokningar i sjukvården används i nuläget, identifiera brister och ta fram förbättringsförslag för att skapa en effektivare tidsbokningsprocess. För att uppfylla syftet har tre frågeställningar formulerats: 1. Hur används digitala tidsbokningar i nuläget? 2. Vilka brister finns det i den digitala tidsbokningsprocessen som påverkar effektiviteten? 3. Hur kan den nuvarande digitala tidsbokningsprocessen effektiviseras? Metod – För att kunna uppnå studiens syfte har en fallstudie genomförts på kvinnohälsovården i Jönköping. Fallstudien bestod utav deltagande observationer och dokumentstudier. Även en litteraturstudie har genomförts vilket har legat till grund för det teoretiska ramverket som använts för analys av empiriska data. Resultat – I studien framkom det att kvinnohälsovården till viss del använder sig av digitala tidsbokningar. Fyra brister identifieras i tidsbokningsprocessen som påverkade effektiviteten. Dessa var schemaläggning, begränsat utbud på 1177, bristande användning av prognoser samt samordning. Efter att dessa brister identifierats kunde tre förbättringsförslag formuleras med syfte till att effektivisera tidsbokningsprocessen. Det första förbättringsförslaget gäller ett utökat utbud av tillgängliga tider på 1177. Det andra förbättringsförslaget handlar om hur prognoser kan användas i större utsträckning vid schemaläggning och planering av tillgängliga tider på 1177. Slutligen handlar det tredje förbättringsförslaget om hur en större samordning kan bidra till minskad tid för administration för barnmorskorna. Implikationer – I studien har brister identifierats och förbättringsförslag har tagits fram gällande hur tidsbokningsprocessen ska effektiviseras. Genom användning av förbättringsförslagen kan verksamheten bli mer samordnad och med hjälp av prognoser kunna tillgodose den efterfrågan som finns. Förbättringsförslagen skulle innebära nya arbetsrutiner för kvinnohälsovården. Ingen ny teori har skapats utifrån studien då den är baserad på redan existerande teori. Begränsningar – Studien utfördes endast på ett fallföretag vilket kan påverka studiens generaliserbarhet. Förbättringsförslagen gällande hur tidsbokningsprocessen kan effektiviseras har enbart beskrivits på ett teoretiskt plan och inte testats i praktiken. Studien har även främst varit av kvalitativ karaktär vilket medför att inga mätningar har gjorts gällande hur förbättringsförslagen har bidragit till en effektivare tidsbokningsprocess. / Purpose – The purpose with this study is to chart the using of digital appointment bookings in the health care, identify deficits and to generate suggestions for improvements for a more efficient process regarding appointment bookings. To fulfil the purpose three research questions have been formulated: 1. How are digital appointment bookings currently being used? 2. What deficits are there in the digital appointment booking process that affects the efficiency? 3. In what way can the current digital appointment booking process be more efficient? Method – To be able to fulfil the purpose a case study was conducted at women’s health care in Jönköping. The case study consisted of participatory observations and document studies. A literature review was also conducted to establish the theoretical framework that was used to analyze the empirical data. Findings – The study showed that digital appointment bookings are partly being used in the women’s health care. Four deficits that affected the appointment booking process were identified. The deficits were scheduling, a limited supply of appointments at 1177, limited using of forecasts in the scheduling and planning of appointments and lack of coordination. Once these deficits were identified, three suggestions for improvements to a more efficient appointment booking process were formulated. The first suggestion was to extend the supply of appointments at 1177. The second suggestion was regarding how forecasts can be used for scheduling and planning of appointments at 1177 in a greater extent. Lastly, the third suggestion mentioned how a greater use of coordination can contribute to reduced administration for the midwives. Implications – The study identified deficits and suggestions for improvements regarding how the appointment booking process can become more efficient. By using the suggestions, the organization can become more coordinated and by using forecasts be able to meet the demand. The suggestions for improvements would lead to new work procedures for the women´s health care. No additional research has been developed through this study as it was based on already existing theories. Limitations – the study was only executed at one case company which can affect how generalized the results are. The suggestions for improvement regarding how the appointment booking process can become more efficient are only described in the theory and have not been tested in the reality. The study has mainly been a qualitative research which means that no measurements has been performed regarding on how the suggestions for improvements would lead to a more efficient appointment booking process.

This study examines the accessibility and barriers that Polish immigrants face in public gynecological care in Sweden and explains their attitudes towards and frequency of gynecological visits. To understand attitudes of the research group, the study explores their knowledge about basic gynecological health topics such as Pap and HPV tests, HPV infections and vaccinations. Qualitative ethnographic methods were used in this research. Thirteen semi-structured interviews were conducted with 25 to 45-year old Polish women living in Stockholm, Sweden. Analysis was performed using descriptive and theoretical approaches. The results indicate several barriers to fully adapt to the Swedish healthcare system for Polish women. The barriers included the lack of understanding of how Swedish gynecological care works (division of specializations), problems in finding specialist care, an insufficient number of specialists, a lack of information in English or Polish, and a limited amount of knowledge among study participants about HPV tests and vaccinations. The adaptation of Polish immigrants to the Swedish system and their level of trust is influenced by their first experiences in Sweden, health literacy, experiences with the Polish private gynecological system, and the attitudes of partners and family with Swedish backgrounds or those who have long term experiences in Sweden.

Bakgrund: Premenstruell dysforisk störning (PMDS) är en allvarlig form av premenstruellt syndrom (PMS) som drabbar 3–8% av kvinnor i reproduktiv ålder. Emotionell dysreglering är kardinalsymptom för PMDS. Orsaken är ännu ej är helt klarlagd, men troligen råder hormonell överkänslighet i centrala nervsystemet. Identifikation, bemötande och omvårdnad från hälso- och sjukvårdspersonal är avgörande för bibehållen livskvalitet. Syfte: Syftet är att undersöka kvinnors upplevelser av premenstruell dysforisk störning. Metod: Litteraturöversikt med kvalitativ metod och induktiv ansats. Artikelsökningen gjordes i databaserna MEDLINE, CINAHL och PsycInfo. Tolv artiklar från år 2006–2022 inkluderades i resultatet. Fribergs dataanalysmodell användes. Resultat: I resultatet framkom två huvudteman; Begränsningar till följd av PMDS samt försök att hantera PMDS, vilka underbyggdes av sex subteman. Slutsats: Till följd av PMDS upplevdes sociala, känslomässiga, utbildnings- och yrkesmässiga begränsningar. Kvinnor försökte hantera livet med PMDS på olika sätt. Vikten av att såväl kvinnor själva som hälso- och sjukvårdspersonal besitter kunskap om PMDS var avgörande för att undvika onödigt lidande och försämrad livskvalité. / Background: Premenstrual Dysphoric Disorder (PMDD) is a severe type of Premenstrual Syndrome (PMS) affecting 3–8% of women at reproductive age. Emotional dysregulation is the primary symptom for PMDD. The cause is not yet entirely confirmed but probably it is due to hormonal oversensitivity in the central nervous system. Health professionals' identification, respond and nursing is crucial in order to substantiate women's perceived quality of life. Aim: The aim is to describe women’s experiences of premenstrual dysphoric disorder. Method: A literature review with qualitative method and inductive research approach. The result was based on twelve articles from year 2006-2022 which underwent examination according to templates from Friberg’s analysis model. Result: Two main themes were identified as Limitations due to PMDD and women’s ways of handling the life with PMDD. Those were supported by 6 sub-themes. Conclusion: Social, emotional, educational and work-related limitations due to PMDD were presented along with women´s different ways of trying to handle their life with PMDD. It was found highly important that both women themselves and health professionals have knowledge about PMDD in order to avoid unnecessary suffering and negatively affected quality of life.

The polycystic ovary syndrome (PCOS) affects women or people with female reproductive organs negatively, by irregular periods, difficulties in getting pregnant, and excessive hair growth. The symptoms can be eased by taking on habits of regular physical exercise and a balanced diet. Taking on new habits is however a challenging task. This thesis aims at harnessing the affordances (if any) that the design of gamification in a mobile application for women with PCOS could bring. The theoretical lens of self-determination theory has been used to underpin the design of gamification elements that can engage the users of an app. After creating designs and implementations in the app, evaluations were made with 29 participants through surveys and interviews. The results from the user evaluations show that participants’ thoughts on features and elements differed and that they were interested in them being designed in different ways. Designing an app that allows the user flexibility was desirable, and even viewed as motivational. Another take is that one should be careful in designing elements in a health app that uses comparing elements of gamification, since it can generate negative feelings such as anxiety. In the future, it would be interesting to include more features in the app and let users test it for a longer time to see if that would have a significant impact on the user engagement, and if habits could form for a better well-being. / Polycystiskt ovarialsyndrom (PCOS) påverkar kvinnor eller människor med kvinnliga reproduktiva organ negativt, genom oregelbunden mens, svårigheter i att bli gravid, och ökad hårväxt. Symptomen kan lindras genom regelbunden fysisk aktivitet och en balanserad kost. Att skaffa nya vanor är en utmaning. Det här examensarbetet har i syfte att se vilka möjligheter (om några) som en design av spelifiering i en mobilapp för kvinnor med PCOS kan ge. Linsen av självbestämmande teorin har använts för att stödja designen av spelifiering element som kan engagera app användare. Utvärderingar gjordes med 29 deltagare i form av enkäter samt intervjuer efter att ha skapat designer samt gjort implementationer i appen. Resultaten, baserade på deltagar utvärderingarna, visar på att användarnas tankar kring funktioner och element skilde sig åt samt att de var intresserade i olika designer för dessa. Att designa en app som erbjuder användaren flexibilitet var önskvärt, och sågs även som motiverande. En annan insikt är att designa delar av en hälsoapp som använder sig av spelifiering element där man jämför sig med andra bör ske med omsorg, då det kan medföra användaren med negativa känslor såsom ångest. Vidare vore det intressant att inkludera fler funktioner i appen och låta användare testa den en längre period för att se om det skulle ha en signifikant påverkan på användarnas engagemang, samt om vanor kunde skapas för ett bättre välbefinnande.

Unintended and unwanted pregnancies are major reproductive health problems impacting negatively on women’s health globally. When faced with these pregnancies, many women choose termination of pregnancy (TOP) as their recourse. The purpose of the study was to explore and describe physical, psychological and social implications of TOP on the woman’s health. A qualitative and descriptive research design was used. The population comprised women who had TOP three months to one year before the study and were willing to participate in the study. A non-probability purposive sampling was used to select participants for the study. In-depth phenomenological interviews were used for data collection until data saturation was reached with 20 participants. The findings reveal that women had psychological, physical and social implications after TOP which impacted negatively on their health. Recommendations were made to improve the services of women choosing to terminate a pregnancy to lessen negative implications. / Health Studies / M.A. (Health Studies)

Text in English / Intimate Partner Violence (IPV) is a major problem among women of child-bearing age in Uganda. This study explored the IPV experiences of women living in urban slums and their health needs in order to assist in developing strategies to prevent and respond to IPV. This was a cross-sectional explanatory study using a mixed methods approach among women aged 20-45 years in Kabalagala slums, Kampala, Uganda. The quantitative survey data was collected using a structured questionnaire while qualitative data was collected using in-depth interviews. Quantitative data were collected from a random sample of 372 women and qualitative data from a purposive sample of 48 women with IPV experiences. The quantitative data was analysed using STATA (version 11), and the qualitative data was coded and analysed manually into thematic content. The study revealed a high overall lifetime prevalence of IPV. The different IPV forms prevalent in the study population included psychological (99.7%), economic (93%), physical (92%) and sexual (88%). Physical violence in the last one year was 91%. The qualitative findings revealed the manifestations of IPV in this context. Furthermore, the physical and psychological health impacts of IPV included but were not limited to injuries; chronic pain and complications; HIV infection; low self-esteem; stress and fear of death, and loss of relationships. The researcher proposed three strategies to prevent and respond to IPV, namely implementing economic empowerment and poverty reduction programmes for women; strengthening the legal and justice system to respond appropriately to the problem of IPV, and improving the social and institutional support including training of health workers to prevent and respond to IPV. The proposed regulation of substance and alcohol use would also contribute to reducing IPV prevalence and scaling-up the response. / Health Studies / D. Litt. et Phil. (Health Studies)

Text in English / Intimate Partner Violence (IPV) is a major problem among women of child-bearing age in Uganda. This study explored the IPV experiences of women living in urban slums and their health needs in order to assist in developing strategies to prevent and respond to IPV. This was a cross-sectional explanatory study using a mixed methods approach among women aged 20-45 years in Kabalagala slums, Kampala, Uganda. The quantitative survey data was collected using a structured questionnaire while qualitative data was collected using in-depth interviews. Quantitative data were collected from a random sample of 372 women and qualitative data from a purposive sample of 48 women with IPV experiences. The quantitative data was analysed using STATA (version 11), and the qualitative data was coded and analysed manually into thematic content. The study revealed a high overall lifetime prevalence of IPV. The different IPV forms prevalent in the study population included psychological (99.7%), economic (93%), physical (92%) and sexual (88%). Physical violence in the last one year was 91%. The qualitative findings revealed the manifestations of IPV in this context. Furthermore, the physical and psychological health impacts of IPV included but were not limited to injuries; chronic pain and complications; HIV infection; low self-esteem; stress and fear of death, and loss of relationships. The researcher proposed three strategies to prevent and respond to IPV, namely implementing economic empowerment and poverty reduction programmes for women; strengthening the legal and justice system to respond appropriately to the problem of IPV, and improving the social and institutional support including training of health workers to prevent and respond to IPV. The proposed regulation of substance and alcohol use would also contribute to reducing IPV prevalence and scaling-up the response. / Health Studies / D. Litt. et Phil. (Health Studies)