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Kabwama SN, Wanyenze RK, Razaz N, Ssenkusu JM, Alfvén T, Lindgren H. How interventions to maintain services during the COVID-19 pandemic strengthened systems for delivery of maternal and child health services: a case-study of Wakiso District, Uganda. Glob Health Action 2024; 17:2314345. [PMID: 38381458 PMCID: PMC10883101 DOI: 10.1080/16549716.2024.2314345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 01/31/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Health systems are resilient if they absorb, adapt, and transform in response to shocks. Although absorptive and adaptive capacities have been demonstrated during the COVID-19 response, little has been documented about their transformability and strengthened service delivery systems. We aimed to describe improvements in maternal and child health service delivery as a result of investments during the COVID-19 response. METHODS This was a descriptive case study conducted in Wakiso District in central Uganda. It included 21 nurses and midwives as key informants and 32 mothers in three focus group discussions. Data were collected using an interview guide following the Systems Engineering Initiative for Patient Safety theoretical framework for service delivery. RESULTS Maternal and child health service delivery during the pandemic involved service provision without changes, service delivery with temporary changes and outcomes, and service delivery that resulted into sustained changes and outcomes. Temporary changes included patient schedule adjustments, community service delivery and negative outcomes such as increased workload and stigma against health workers. Sustained changes that strengthened service delivery included new infrastructure and supplies such as ambulances and equipment, new roles involving infection prevention and control, increased role of community health workers and outcomes such as improved workplace safety and teamwork. CONCLUSIONS In spite of the negative impact the COVID-19 pandemic had on health systems, it created the impetus to invest in system improvements. Investments such as new facility infrastructure and emergency medical services were leveraged to improve maternal and child health services delivery. The inter-departmental collaboration during the response to the COVID-19 pandemic resulted into an improved intra-hospital environment for other service delivery. However, there is a need to evaluate lessons beyond health facilities and whether these learnings are deliberately integrated into service delivery. Future responses should also address the psychological and physical impacts suffered by health workers to maintain service delivery.
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Affiliation(s)
- Steven Ndugwa Kabwama
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Community Health and Behavioral Sciences, Makerere University School of Public Health, Kampala, Uganda
| | - Rhoda K Wanyenze
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - Neda Razaz
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - John M Ssenkusu
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | - Tobias Alfvén
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Paediatric Public Health Department, Sachs' Children and Youth Hospital, Stockholm, Sweden
| | - Helena Lindgren
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Department of Health Promotion, Sophiahemmet University, Stockholm, Sweden
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Lindgren H, Liu X, Sjöstedt A. Francisella tularensis-specific antibody levels in sera from Swedish patients with suspected tularemia during a 13-year period. Front Cell Infect Microbiol 2024; 14:1381776. [PMID: 38628552 PMCID: PMC11018962 DOI: 10.3389/fcimb.2024.1381776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 03/20/2024] [Indexed: 04/19/2024] Open
Abstract
Introduction For a majority of tularemia patients, serology is the basis for the diagnosis. The aim of this study was to perform an analysis of the samples analyzed at a Swedish reference laboratory for the presence of Francisella tularensis-specific antibody levels in sera from individuals with suspected tularemia. Annual and monthly variations of the total number of samples and proportions of positive samples were analyzed, as well as the influence of age and gender. Methods We performed a retrospective analysis of the presence of F. tularensis-specific antibodies in serological samples from patients with suspected tularemia analyzed during the period 2010 - 2022 at the University Hospital of Umeå in Sweden, a national reference laboratory, by use of various statistical methods. In total, some 15,100 serum samples had been analyzed for the presence of IgG and IgM antibodies by ELISA during the 13-year period. Results Overall, there were higher number of samples with IgG positive or borderline titers, 2,522 and 921, respectively, than with IgM positive or borderline titers, 1,802 and 409, respectively. Repeated samples were obtained from some 1,930 individuals and approximately a third of the cases, which were initially seronegative, had seroconverted when resampled. Peak number of monthly samples were recorded in August and September, > 3,000. Annual numbers varied greatly and peak numbers were observed in 2015 and 2019, 1,832 and 2,250, respectively, whereas some other years the numbers were 700 - 800. There was also much variation in the annual and monthly percentages of positive samples and they varied between less than 10% to greater than 20%. The highest percentages of positive samples were recorded in September and October. IgG and IgM titers declined with age and these differences were highly significant for IgG titers, with decreasing average titers for each 20-year interval. Discussion Collectively, the data demonstrate the marked annual and seasonal variations in tularemia sampling occurring in Sweden. Also, the proportion of positive samples increased during months and years with peak number of samples. Another notable finding was that average antibody titers decreased with increased age.
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Affiliation(s)
- Helena Lindgren
- Department of Clinical Microbiology, Umeå University, Umeå, Sweden
| | - Xijia Liu
- Umeå School of Business, Economics and Statistics, Umeå University, Umeå, Sweden
| | - Anders Sjöstedt
- Department of Clinical Microbiology, Umeå University, Umeå, Sweden
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Ternström E, Akselsson A, Small R, Andersson J, Lindgren H. Obstetric outcomes and uptake of care among 149 non-Swedish speaking migrant women attending a birth preparation visit during pregnancy - An observational study from Sweden. J Migr Health 2024; 9:100226. [PMID: 38596616 PMCID: PMC11002845 DOI: 10.1016/j.jmh.2024.100226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 08/31/2023] [Accepted: 03/26/2024] [Indexed: 04/11/2024] Open
Abstract
Introduction In Sweden almost one third of the population is born in another country and a large number of the women who do not speak Swedish are of reproductive age. Women migrating from low-income countries have higher risks for poor obstetric outcomes than receiving country-born citizens. INFOR (a Swedish word for "before" or "ahead of") is an intervention offering language-assisted, individual birth preparation for non-Swedish speaking pregnant women unfamiliar with the maternity care system. The aim of this study was to describe the uptake of care and obstetric outcomes among non-Swedish speaking migrant women attending INFOR. Methods A descriptive study of the obstetric outcomes and uptake of care was conducted of the 149 non-Swedish speaking pregnant women who participated in INFOR between 2016 and 2020. The data were accessed retrospectively from the medical record system Obstetrix and the population-based Swedish Pregnancy Registry and analysed descriptively. Results Women participating in INFOR originated from 44 countries and spoke 35 different languages. During late pregnancy, 20 percent of the women sought care for decreased fetal movements and 80 percent of the women attended the postpartum visit. While the majority of the participants were offered professional language support during pregnancy, almost none had a professional interpreter present during labour and birth. After birth, 80 percent of the primiparous women were asked to rate their birth experience, but only half of the multiparous women were asked. Further, only half of the primiparous women attending the postpartum visit were asked about their self-rated health. Conclusion INFOR may increase uptake of some important aspects of care during pregnancy, birth and postpartum among migrants of diverse backgrounds. The findings raise concerns however about communication support for migrant women, especially during labour and birth. The offer of professional interpreting as part of standard maternity care for women who need it is essential and must be improved in order to provide equitable care for all.
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Affiliation(s)
- Elin Ternström
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Anna Akselsson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
| | - Rhonda Small
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Judith Lumley Centre, La Trobe University, Melbourne, Australia
| | | | - Helena Lindgren
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
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Blomgren J, Wells MB, Erlandsson K, Amongin D, Kabiri L, Lindgren H. Putting co-creation into practice: lessons learned from developing a midwife-led quality improvement intervention. Glob Health Action 2023; 16:2275866. [PMID: 37930253 PMCID: PMC10629418 DOI: 10.1080/16549716.2023.2275866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/23/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND Integrating evidence-based midwifery practices improves healthcare quality for women and newborns, but an evidence-to-practice gap exists. Co-created quality improvement initiatives led by midwives could bridge this gap, prevent resource waste and ensure intervention relevance. However, how to co-create a midwife-led quality improvement intervention has not been scientifically explored. OBJECTIVE The objective of this study is to describe the co-creation process and explore the needs and determinants of a midwife-led quality improvement targeting evidence-based midwifery practices. METHODS A qualitative deductive approach using the Consolidated Framework for Advancing Implementation Science was employed. An analysis matrix based on the framework was developed, and the data were coded according to categories. Data were gathered from interviews, focus group discussions, observations and workshops. New mothers and birth companions (n = 19) were included through convenience sampling. Midwives (n = 26), professional association representatives, educators, policymakers, managers, and doctors (n = 7) were purposely sampled. RESULTS The co-creation process of the midwife-led Quality Improvement intervention took place in four stages. Firstly, core elements of the intervention were established, featuring a group of midwife champions leading a quality improvement initiative using a train-the-trainers approach. Secondly, the intervention needs, context and determinants were explored, which showed knowledge and skills gaps, a lack of shared goals among staff, and limited resources. However, there was clear relevance, compatibility, and mission alignment for a midwife-led quality improvement at all levels. Thirdly, during co-creation workshops with new mothers and companions, the consensus was to prioritise improved intrapartum support, while workshops with midwives identified enhancing the use of birth positions and perineal protection as key focus areas for the forthcoming Quality Improvement intervention. Lastly, the findings guided intervention strategies, including peer-assisted learning, using existing structures, developing educational material, and building stakeholder relationships. CONCLUSIONS This study provides a practical example of a co-creation process for a midwife-led quality improvement intervention, which can be relevant in different maternity care settings.
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Affiliation(s)
- Johanna Blomgren
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Michael B. Wells
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Kerstin Erlandsson
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
- Institution of Health and Welfare, Dalarna University, Falun, Sweden
| | - Dinah Amongin
- Department of Health Policy Planning and Management, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Lydia Kabiri
- Department of Nursing and Midwifery, School of Health Sciences, College of Health Sciences Makerere University, Kampala, Uganda
| | - Helena Lindgren
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
- Department of Health Promotion, Sophiahemmet University, Stockholm, Sweden
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Asaye MM, Gelaye KA, Matebe YH, Lindgren H, Erlandsson K. Experience and perceptions of healthcare providers on clinical management and care of near-miss infants: a qualitative content analysis. BMC Health Serv Res 2023; 23:1403. [PMID: 38093259 PMCID: PMC10720054 DOI: 10.1186/s12913-023-10097-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 09/30/2023] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION Neonatal Near Miss (NNM) refers to neonates with severe complications who almost died but survived immediately after birth. In Ethiopia, the prevalence of NNM has been assessed using a validated Neonatal Near-Miss Assessment Scale. However, understanding the experiences and perceptions of healthcare providers in the clinical management and care of NNM infants remains unexplored. The aim was to investigate the determinants contributing to the survival of neonatal near-miss babies and to identify any barriers encountered, as reported by the experiences of healthcare providers in public hospitals of Amhara Regional State, northwest Ethiopia. METHODS Semi structured interviews were used to collect data from 25 midwives, nurses, and pediatricians with at least six months of prior experience in one of the labor wards or neonatal intensive care units at one of the four public health hospitals in the Amhara Regional state of northwest Ethiopia included in a large intervention study assessing a NNM scale. Purposeful sampling was used, selecting participants based on their experiences related to the aim of this study. The participants had a varying level of education and years of experience to care for NNM infants. The average age of the healthcare providers was 31 years, with 7 years of work experience. The transcripts of the interviews with the healthcare providers were analyzed using qualitative content analysis. RESULTS The experience and perceptions of healthcare providers was described in the main category "A sense of hopelessness when caring for the baby" capturing a broader emotional and professional aspect, while the subcategories "Unclear responsibilities discharging one's mission", "Provision of kangaroo mother care" and "Quick action required at birth" are more specific and practical. Healthcare providers perceived a sense of hopelessness when caring for the NNM infant, particularly providing Kangaroo Mother Care (KMC) and quick actions when required at birth to save the life of the infant. CONCLUSION Unclear responsibilities and a sense of hopelessness could have acted as barriers, hindering the ability of healthcare providers to fulfill their mission of taking swift actions and providing KMC to NNM infants, thus impacting their ability to save the lives of these infants. Healthcare providers' and parents' attitudes must be changed towards hope rather than hopelessness when caring for NNM infants.
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Affiliation(s)
- Mengstu Melkamu Asaye
- Department of Women and Family Health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Kassahun Alemu Gelaye
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yohannes Hailu Matebe
- Department of Pediatrics and Child Health, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Helena Lindgren
- Department of Women's and Children's Health, Karolinska Institutet, Solna, Sweden
- Sofiahemmet University, Stockholm, Sweden
| | - Kerstin Erlandsson
- Department of Women's and Children's Health, Solna, Sweden.
- School of Health and Welfare, Karolinska Institute, Dalarna University, Falun, Sweden.
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Guerrero E, Tewari M, Kalmi P, Lindgren H. Forming We-intentions under breakdown situations in human-robot interactions. Comput Methods Programs Biomed 2023; 242:107817. [PMID: 37813056 DOI: 10.1016/j.cmpb.2023.107817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 05/05/2023] [Accepted: 09/14/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND AND OBJECTIVE When agents (e.g. a person and a social robot) perform a joint activity to achieve a joint goal, they require sharing a relevant group intention, which has been defined as a We-intention. In forming We-intentions, breakdown situations due to conflicts between internal and "external" intentions are unavoidable, particularly in healthcare scenarios. To study such We-intention formation and "reparation" of conflicts, this paper has a two-fold objective: introduce a general computational mechanism allowing We-intention formation and reparation in interactions between a social robot and a person; and exemplify how the formal framework can be applied to facilitate interaction between a person and a social robot for healthcare scenarios. METHOD The formal computational framework for managing We-intentions was defined in terms of Answer set programming and a Belief-Desire-Intention control loop. We exemplify the formal framework based on earlier theory-based user studies consisting of human-robot dialogue scenarios conducted in a Wizard of Oz setup, video-recorded and evaluated with 20 participants. Data was collected through semi-structured interviews, which were analyzed qualitatively using thematic analysis. N=20 participants (women n=12, men=8, age range 23-72) were part of the study. Two age groups were established for the analysis: younger participants (ages 23-40) and older participants (ages 41-72). RESULTS We proved four theoretical propositions, which are well-desired characteristics of any rational social robot. In our study, most participants suggested that people were the cause of breakdown situations. Over half of the young participants perceived the social robot's avoidant behavior in the scenarios. CONCLUSIONS This work covered in depth the challenge of aligning the intentions of two agents (for example, in a person-robot interaction) when they try to achieve a joint goal. Our framework provides a novel formalization of the We-intentions theory from social science. The framework is supported by formal properties proving that our computational mechanism generates consistent potential plans. At the same time, the agent can handle incomplete and inconsistent intentions shared by another agent (for example, a person). Finally, our qualitative results suggested that this approach could provide an acceptable level of action/intention agreement generation and reparation from a person-centric perspective.
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Affiliation(s)
- Esteban Guerrero
- University of Vaasa, Finland; School of Technology and Innovations, Information Systems Science, Finland.
| | - Maitreyee Tewari
- Umeå University, Sweden; Department of Computing Science, Sweden.
| | - Panu Kalmi
- University of Vaasa, Finland; School of Accounting and Finance, Economics, Finland.
| | - Helena Lindgren
- Umeå University, Sweden; Department of Computing Science, Sweden.
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Ternström E, Small R, Lindgren H. Migrant women's experiences of an individual language-assisted information and support visit to the labor ward before giving birth - A qualitative study from Sweden. Sex Reprod Healthc 2023; 38:100915. [PMID: 37717410 DOI: 10.1016/j.srhc.2023.100915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 08/10/2023] [Accepted: 09/06/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Migrant women are less likely to receive an individualized maternal care where they feel safe, informed and supported but few measures have been undertaken to meet their needs. In Södertälje municipality in Sweden, community-based antenatal care midwives identify migrant women and offer them and their partners language-assisted information and support through an individual two-hour-visit to the labor ward. The aim of the present study was to explore migrant women's experiences of antenatal care including receiving language-assisted information and support during pregnancy through a two-hour INFOR-visit to the labor ward. METHODS Semi-structured interviews were conducted with 10 non-Swedish speaking migrant women, using an interpreter. Interview analysis was conducted using reflexive thematic analysis. RESULTS The individualized support, including thorough information given with language support available, sufficient time for questions and discussion, and a caring approach - did appear to inform and reassure the women. Overall, they felt that they were seen and treated as individuals during both pregnancy and birth and that their specific needs were listened to and met by the health care providers. Having professional interpreters was seen as essential for receiving the right information, something achieved at the individual visit. CONCLUSIONS The findings from this study provide evidence that a two-hour-visit to the labor ward during pregnancy has potential to empower migrant women during pregnancy and birth and to improve their experiences of maternity care. The two-hour-visit is a relatively simple intervention with the potential of not only improving migrant women's experiences of pregnancy and birth, but also their medical outcomes.
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Affiliation(s)
- Elin Ternström
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Rhonda Small
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Helena Lindgren
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Sophiahemmet University, Stockholm, Sweden.
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Andrén A, Akselsson A, Rådestad I, Ali SB, Lindgren H, Osman HM, Erlandsson K. Miscommunication influences how women act when fetal movements decrease an interview study with Swedish Somali migrant women. Midwifery 2023; 126:103796. [PMID: 37672854 DOI: 10.1016/j.midw.2023.103796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVE To explore how Swedish Somali migrant women perceive fetal movements, process information about fetal movements, and take actions if decreased fetal activity occurs. DESIGN A qualitative study based on individual semi-structured interviews. The interviews were analysed using content analysis. SETTING The study was conducted in Sweden. PARTICIPANTS Swedish Somali migrant women (n=15) pregnant in their third trimester or recently given birth. FINDINGS The analysis led to the main category: tailored information about fetal movements enhances the possibility to seek care if the movements decrease. The results are described in the generic categories: explanatory models determine action; and understand and interpret information. KEY CONCLUSIONS Miscommunication on fetal movements can be a hurdle for Swedish Somali migrant women that may have impact on stillbirth prevention and the quality of care. Improved communication and information tailored to individual needs is essential to achieve equality for women and their newborns. IMPLICATIONS FOR PRACTICE The midwife can be used as a hub for reassuring that adequate information about fetal movements reaches each individual woman in antenatal care. Individualised information on fetal movements based on the women's own understanding is suggested to increase the possibility that the pregnant woman will seek care if the movements decrease. Somali women's verbal communication can be used to spread accurate information in the Somali community on the importance of seeking care if fetal movements decrease.
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Affiliation(s)
| | | | | | - Salma Burhan Ali
- Region Uppsala, Enköping Hospital, Department of Gynecology, Sweden
| | - Helena Lindgren
- Sophiahemmet University, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Sweden
| | - Hodan Mohamoud Osman
- College of Health Science and Medicine, Faculty of Nursing and Midwifery, Hargeisa University, Somaliland
| | - Kerstin Erlandsson
- Department of Women's and Children's Health, Karolinska Institutet, Sweden; School of Health and Welfare, Dalarna University, Sweden
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Lindgren H, Eneslätt K, Golovliov I, Gelhaus C, Sjöstedt A. Analyses of human immune responses to Francisella tularensis identify correlates of protection. Front Immunol 2023; 14:1238391. [PMID: 37781364 PMCID: PMC10540638 DOI: 10.3389/fimmu.2023.1238391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 08/24/2023] [Indexed: 10/03/2023] Open
Abstract
Francisella tularensis is the etiological agent of the potentially severe infection tularemia. An existing F: tularensis vaccine, the live vaccine strain (LVS), has been used to protect at-risk personnel, but it is not licensed in any country and it has limited efficacy. Therefore, there is a need of a new, efficacious vaccine. The aim of the study was to perform a detailed analysis of the characteristics of the human immune response to F. tularensis, since this will generate crucial knowledge required to develop new vaccine candidates. Nine individuals were administered the LVS vaccine and peripheral blood mononuclear cells (PBMC) were collected before and at four time points up to one year after vaccination. The properties of the PBMC were characterized by flow cytometry analysis of surface markers and intracellular cytokine staining. In addition, the cytokine content of supernatants from F. tularensis-infected PBMC cultures was determined and the protective properties of the supernatants investigated by adding them to cultures with infected monocyte-derived macrophages (MDM). Unlike before vaccination, PBMC collected at all four time points after vaccination demonstrated F. tularensis-specific cell proliferation, cytokine secretion and cytokine-expressing memory cells. A majority of 17 cytokines were secreted at higher levels by PBMC collected at all time points after vaccination than before vaccination. A discriminative analysis based on IFN-γ and IL-13 secretion correctly classified samples obtained before and after vaccination. Increased expression of IFN-γ, IL-2, and MIP-1β were observed at all time points after vaccination vs. before vaccination and the most significant changes occurred among the CD4 transient memory, CD8 effector memory, and CD8 transient memory T-cell populations. Growth restriction of the highly virulent F. tularensis strain SCHU S4 in MDM was conferred by supernatants and protection correlated to levels of IFN-γ, IL-2, TNF, and IL-17. The findings demonstrate that F. tularensis vaccination induces long-term T-cell reactivity, including TEM and TTM cell populations. Individual cytokine levels correlated with the degree of protection conferred by the supernatants. Identification of such memory T cells and effector mechanisms provide an improved understanding of the protective mechanisms against F. tularensis. mechanisms against F. tularensis.
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Affiliation(s)
- Helena Lindgren
- Department of Clinical Microbiology, Umeå University, Umeå, Sweden
| | - Kjell Eneslätt
- Department of Clinical Microbiology, Umeå University, Umeå, Sweden
| | - Igor Golovliov
- Department of Clinical Microbiology, Umeå University, Umeå, Sweden
| | | | - Anders Sjöstedt
- Department of Clinical Microbiology, Umeå University, Umeå, Sweden
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Kiragu JM, Osika Friberg I, Erlandsson K, Wells MB, Wagoro MCA, Blomgren J, Lindgren H. Costs and intermediate outcomes for the implementation of evidence-based practices of midwifery under a MIDWIZE framework in an urban health facility in Nairobi, Kenya. Sex Reprod Healthc 2023; 37:100893. [PMID: 37586305 DOI: 10.1016/j.srhc.2023.100893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 07/05/2023] [Accepted: 07/20/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Three evidence-based midwife-led care practices: dynamic birth positions (DBP), immediate skin-to-skin contact (SSC) with zero separation between mother and newborn, and delayed cord clamping (DCC), were implemented in four sub-Saharan African countries after an internet-based capacity building program for midwifery leadership in quality improvement (QI). Knowledge on costs of this QI initiative can inform resource mobilization for scale up and sustainability. METHODS We estimated the costs and intermediate outcomes from the implementation of the three evidence-based practices under the midwife-led care (MIDWIZE) framework in a single facility in Kenya through a pre- and post-test implementation design. Daily observations for the level of practice on DBP, SSC and DCC was done at baseline for 1 week and continued during the 11 weeks of the training intervention. Three cost scenarios from the health facility perspective included: scenario 1; staff participation time costs ($515 USD), scenario 2; staff participation time costs plus hired trainer time costs, training material and logistical costs ($1318 USD) and scenario 3; staff participation time costs plus total program costs for the head trainer as the QI leader from the capacity building midwifery program ($8548 USD). RESULTS At baseline, the level of DBP and SSC practices per the guidelines was at 0 % while that of DCC was at 80 %. After 11 weeks, we observed an adoption of DBP practice of 36 % (N = 111 births), SSC practice of 79 % (N = 241 births), and no change in DCC practice. Major cost driver(s) were midwives' participation time costs (56 %) for scenario 1 (collaborative), trainers' material and logistic costs (55 %) in scenario 2(collaborative) and capacity building program costs for the trainer (QI lead) (94 %) in scenario 3 (programmatic). Costs per intermediate outcome were $2.3 USD per birth and $0.5 USD per birth adopting DBP and SSC respectively in Scenario 1; $6.0 USD per birth adopting DBP and $1.4 USD per birth adopting SSC in Scenario 2; $38.5 USD per birth adopting DBP and $8.8 USD per birth adopting SSC in scenario 3. The average hourly wage of the facility midwife was $4.7 USD. CONCLUSION Improving adoption of DBP and SSC practices can be done at reasonable facility costs under a collaborative MIDWIZE QI approach. In a programmatic approach, higher facility costs would be needed. This can inform resource mobilization for future QI in similar resource-constrained settings.
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Affiliation(s)
- John Macharia Kiragu
- Department of Public and Global Health, University of Nairobi, Kenya; Department of Nursing Sciences, University of Nairobi, Kenya.
| | | | - Kerstin Erlandsson
- Women's and Children's Health, Karolinska Institutet, Solna, Sweden; Institution for Health and Welfare, Dalarna University, Falun, Sweden.
| | - M B Wells
- Women's and Children's Health, Karolinska Institutet, Solna, Sweden.
| | | | - Johanna Blomgren
- Women's and Children's Health, Karolinska Institutet, Solna, Sweden.
| | - Helena Lindgren
- Women's and Children's Health, Karolinska Institutet, Solna, Sweden; Sophiahemmet University, Sweden.
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Blomgren J, Gabrielsson S, Erlandsson K, Wagoro MCA, Namutebi M, Chimala E, Lindgren H. Maternal health leaders' perceptions of barriers to midwife-led care in Ethiopia, Kenya, Malawi, Somalia, and Uganda. Midwifery 2023; 124:103734. [PMID: 37269678 DOI: 10.1016/j.midw.2023.103734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 04/05/2023] [Accepted: 05/19/2023] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To identify and examine barriers to midwife-led care in Eastern Africa and how these barriers can be reduced DESIGN: A qualitative inductive study with online focus group discussions and semi-structured interviews using content analysis SETTING: The study examines midwife-led care in Ethiopia, Malawi, Kenya, Somalia, and Uganda -five African countries with an unmet need for midwives and a need to improve maternal and neonatal health outcomes. PARTICIPANTS Twenty-five participants with a health care profession background and current position as a maternal and child health leader from one of the five study countries. FINDINGS The findings demonstrate barriers to midwife-led care connected to organisational structures, traditional hierarchies, gender disparities, and inadequate leadership. Societal and gendered norms, organisational traditions, and differences in power and authority between professions are some factors explaining why the barriers persist. A focus on intra- and multisectoral collaborations, the inclusion of midwife leaders, and providing midwives with role models to leverage their empowerment are examples of how to reduce the barriers. KEY CONCLUSIONS This study provides new knowledge on midwife-led care from the perspectives of health leaders in five African countries. Transforming outdated structures to ensure midwives are empowered to deliver midwife-led care at all healthcare system levels is crucial to moving forward. IMPLICATIONS FOR PRACTISE This knowledge is important as enhancing the midwife-led care provision is associated with substantially improved maternal and neonatal health outcomes, higher satisfaction of care, and enhanced utilisation of health system resources. Nevertheless, the model of care is not adequately integrated into the five countries' health systems. Future studies are warranted to further explore how reducing barriers to midwife-led care can be adapted at a broader level.
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Affiliation(s)
- Johanna Blomgren
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
| | | | - Kerstin Erlandsson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Institution of Health and Welfare, Dalarna University, Falun, Sweden
| | | | - Mariam Namutebi
- Department of Nursing, Makerere University College of Health Sciences, Kampala, Uganda
| | - Eveles Chimala
- School of Maternal, Neonatal and Reproductive Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Helena Lindgren
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Sophiahemmet University, Stockholm, Sweden
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Liu X, Tabibzada N, Lindgren H, Sjöstedt A. Utility of Borrelia-specific IgM and IgG antibody titer determinations during a 12-year period - results from a clinical laboratory in Northern Sweden. Front Cell Infect Microbiol 2023; 13:1192038. [PMID: 37465761 PMCID: PMC10350645 DOI: 10.3389/fcimb.2023.1192038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/16/2023] [Indexed: 07/20/2023] Open
Abstract
Interpretation of serological findings in suspected Lyme borreliosis (LB) is challenging and IgM reactivities may have low predictive value. Therefore, if used indiscriminately, there is a risk for incorrect diagnosis of LB. To evaluate the usefulness of IgM titer determination, we performed a study of the prevalence of Borrelia-specific antibodies in serological samples from patients with suspected LB analyzed during the period 2010 - 2021 at the University Hospital of Umeå in Sweden. In total, 19,335 samples had been analyzed for the presence of IgG and IgM antibodies. Overall, there were higher percentages of IgM positive or borderline titers, 1,847 (9.6%) and 905 (4.7%), respectively, than IgG positive or borderline titers, 959 (5.0%) and 406 (2.1%), respectively. Peak number of samples were recorded 2012 - 2013, exceeding 1,800, whereas there were around 1,200 during 2020 - 2021. The peak number of positive IgG and/or positive IgM samples were observed during the period 2015 - 2017 with close to, or above 400, and concomitantly, the proportion of IgG positive samples increased markedly. For IgG positive samples, the increase followed a positive linear time trend (P< 0.001). Peak monthly numbers were observed during August, September, and October. This seasonal increase was significant for the IgG positive group (P< 0.05), but not for the IgM positive/IgG negative group. Repeated samples were obtained from 3,188 individuals and of the initial samples 2,817 were (88%) IgG negative and 2,315 (72%) were IgM negative and of these, 130 (4%) showed IgG seroconversion and 300 (9%) IgM seroconversion. Collectively, the data demonstrate that IgG and/or IgM positive samples represented a minority of all samples, even when repeated sampling had occurred, and IgM positive samples were much more common than IgG positive samples. Thus, the accuracy of the clinical suspicion was low and this will lead to a low predictive value of the analysis, in particular of IgM. These findings question the use of IgM titer determination as a routine analysis.
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Affiliation(s)
- Xijia Liu
- Umeå School of Business, Economics and Statistics, Statistics, Västerbotten, Sweden
| | | | - Helena Lindgren
- Department of Clinical Microbiology, Umeå University, Umeå, Sweden
| | - Anders Sjöstedt
- Department of Clinical Microbiology, Umeå University, Umeå, Sweden
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Ferede AJ, Wettergren L, Erlandsson K, Gezie LD, Lindgren H, Geda B. Patients' perceptions of caring behaviors at referral hospitals in Ethiopia: A cross-sectional survey. Int J Nurs Sci 2023; 10:391-397. [PMID: 37545766 PMCID: PMC10401340 DOI: 10.1016/j.ijnss.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 08/08/2023] Open
Abstract
Objective The purpose of this study was to determine patients' perceptions of nurse caring behaviors and to identify factors associated with these perceptions. Methods A cross-sectional study was conducted at three referral hospitals in Ethiopia. A consecutive sample of male and female patients (n = 652, response rate 98.8%) was interviewed using the Amharic version of the Caring Behaviors Inventory-16 (CBI-16, including four subscales: Assurance, Knowledge and skill, Respectful, and Connectedness) and the Patient Satisfaction Instrument (PSI). Socio-demographic and clinical factors associated with perceptions of caring behaviors were identified using multiple linear regression analysis. Results Patients' perceptions of nurse caring behaviors were high (total Mean = 4.86, SD = 0.72). Behaviors related to the Assurance subscale were rated the highest. The multiple linear regression analysis result showed several socio-demographic and clinical factors statistically significantly associated with patients' perceptions of caring behaviors (total mean scores). Patients who were 40-49 years (B = -0.19, P = 0.012) and single (B = -0.13, P = 0.03) scored lower on total CBI-16 scores. Whereas, patients who had a higher educational level (B = 0.35, P = 0.001), cared for at surgery units (B = 0.11, P = 0.027), and reported having spent more time with a nurse in the past 8-h shift (B = 0.16, P < 0.001) were more likely to have higher perceptions of the care they received. The CBI-16 was positively correlated with satisfaction with received care, as measured with the Patient Satisfaction Instrument (r = 0.62, P < 0.001). Conclusion Hospitalized patients in Ethiopia have overall high perceptions of nurse caring behaviors, especially with regard to physical-based caring, while their expectations of emotional-focused care are lower. We identified patients who were in need of care, patients aged 40-49 years and single. The time spent with nurses plays a pivotal role in patients' perceptions of nurse caring behaviors.
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Affiliation(s)
- Abebaw Jember Ferede
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Postal address: 196, Gondar, Ethiopia
| | - Lena Wettergren
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Kerstin Erlandsson
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- School of Education, Health and Welfare, Dalarna University, Falun, Sweden
| | - Lemma Derseh Gezie
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Helena Lindgren
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Biftu Geda
- Department of Nursing, College of Health Science, Shashamene Campus, Madda Walabu University, Shashamene, Ethiopia
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Gebrie MH, Asfaw HM, Bilchut WH, Lindgren H, Wettergren L. Patients' experience of undergoing maintenance hemodialysis. An interview study from Ethiopia. PLoS One 2023; 18:e0284422. [PMID: 37252918 DOI: 10.1371/journal.pone.0284422] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/30/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND People with kidney failure require renal replacement therapy in the form of dialysis or a kidney transplant for survival. Many facets of their life, both within and outside the dialysis unit, are impacted by the management of this disease. It is important to comprehend the experiences of people undergoing hemodialysis in order to improve the care provided to them. Therefore, this study aimed to explore the experiences of patients undergoing maintenance hemodialysis in Ethiopia. METHODS A qualitative descriptive study was conducted at two healthcare facilities in Ethiopia. Individual interviews with 15 participants (men and women aged 19-63), undergoing hemodialysis in Ethiopia, were analyzed using reflexive thematic analysis. RESULTS The analysis resulted in five themes: Feeling grateful, Facing a restricted life, a Supportive environment, Dreaming of a transplant, and Leading a hassled life. The subthemes include Trust in treatment, Faith in God, Challenging fluid and dietary restrictions, Being too fatigued to socialize, Being stigmatized, Family and social support, Supportive healthcare, Lacking a donor and sponsor, COVID-19 as a barrier, Financial constraints, Inaccessibility to care and transport and Access line implantation. Despite being dependent on a machine and having to deal with food and fluid restrictions as well as financial challenges, participants were hopeful and dreamed of a transplant. CONCLUSION From the study's participants, it was discovered that the experiences of people with kidney failure undergoing hemodialysis were generally, considerably negative narratives. Based on the results we recommend development of multidisciplinary teams to better meet patients' physical, emotional, and social needs while undergoing hemodialysis. Such a team should also involve the patient's family members when caring for patients on hemodialysis.
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Affiliation(s)
- Mignote Hailu Gebrie
- School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Hussen Mekonnen Asfaw
- Department of Nursing, School of Nursing & Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Workagegnehu Hailu Bilchut
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Helena Lindgren
- Division of Reproductive Health, Department of Women's and Children's Health, Karolinska Institutet, Solna, Sweden
- Sophiahemmet University, Stockholm, Sweden
| | - Lena Wettergren
- Division of Reproductive Health, Department of Women's and Children's Health, Karolinska Institutet, Solna, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Blusi M, Lindgren H, Nilsson I. Factors to Consider when Introducing Digital Social Activities to Older Persons with Home Care. Stud Health Technol Inform 2023; 302:453-457. [PMID: 37203715 DOI: 10.3233/shti230171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Social isolation and loneliness have become everyday concerns for populations all over the world as these factors are affecting both physical and mental health in a negative way. Feelings of isolation and loneliness are increasingly acknowledged as a health risk among older persons. ICTs have been recognized as effective tools to combat social isolation among older people. The aim of this study was to explore factors of significance when introducing a tablet-based system providing digital social activities for older persons with home care. Participants were 17 persons, age 70 and older, who lived alone and had assistance from home care. This exploratory study used cross-sectional qualitative data analyzed through thematic analysis. Three themes were generated: 1) lacking vocabulary related to the context, 2) intuitive user interface may replace extensive instructions and 3) unwillingness to commit to a pre-defined measure of performance.
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Affiliation(s)
| | | | - Ingeborg Nilsson
- Department of Community Medicine and Rehabilitation, Umeå University, Sweden
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Gebrie MH, Asfaw HM, Bilchut WH, Lindgren H, Wettergren L. Health-related quality of life among patients with end-stage renal disease undergoing hemodialysis in Ethiopia: a cross-sectional survey. Health Qual Life Outcomes 2023; 21:36. [PMID: 37069562 PMCID: PMC10111728 DOI: 10.1186/s12955-023-02117-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 04/11/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND Measurement of health-related quality of life (HRQOL) enables identification of treatment-related side effects of a disease. Such aspects may negatively impact on patients' lives and should be taken into consideration in medical decision-making. In sub-Saharan Africa, research from the perspective of patients with chronic kidney disease is scarce, and it is almost non-existent in patients undergoing hemodialysis. We aimed to determine HRQOL among end-stage renal disease patients undergoing maintenance hemodialysis in Ethiopia and to identify factors associated with HRQOL. METHODS A multi-center cross-sectional study was conducted in Addis Ababa, Ethiopia directed to all patients receiving hemodialysis due to kidney failure at 11 randomly-selected government and private hospitals/dialysis centers in the capital of Ethiopia. Data were collected by trained nurses using the KDQOL-36 instrument with five subscales measuring generic and disease-specific HRQOL. Study-specific items were used to collect socio-demographic and clinical data. Factors associated with HRQOL were examined using multivariable linear regression models. RESULTS Four hundred eighty-one patients completed the survey through face-to-face interviews (response rate 96%; mean age 45.34 ± 14.67). The mean scores of the subscales ranged from 25.6 to 66.68 (range 0-100), with higher scores reflecting better health. Factors associated with low HRQOL included older age, female sex, no formal education, poor medication adherence, > 2 hemodialysis sessions/week, lower body mass index (< 18.5), longer duration of hemodialysis treatment (≥ 12 months), and poor social support. CONCLUSION Patients with kidney failure undergoing hemodialysis in Addis Ababa, Ethiopia, had low HRQOL across all subscales compared to previous studies. Therefore, the implementation of guidelines is crucial to improve patients' adherence to their prescribed medications. Furthermore, establishing patient support groups and encouraging patients to use the available support resources from family members, neighbors, and friends have the potential to improve patients' HRQOL.
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Affiliation(s)
- Mignote Hailu Gebrie
- College of Medicine and Health Sciences, School of Nursing, University of Gondar, Gondar, Ethiopia.
| | - Hussen Mekonnen Asfaw
- College of Health Sciences, School of Nursing & Midwifery, Department of Nursing, Addis Ababa University, Addis Ababa, Ethiopia
| | - Workagegnehu Hailu Bilchut
- College of Medicine and Health Sciences, School of Medicine, Department of Internal Medicine, University of Gondar, Gondar, Ethiopia
| | - Helena Lindgren
- Department of Women's and Children's Health, Division of Reproductive Health, Karolinska Institutet, Solna, Sweden
- Sophiahemmet University, Stockholm, Sweden
| | - Lena Wettergren
- Department of Women's and Children's Health, Division of Reproductive Health, Karolinska Institutet, Solna, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Solna, Sweden
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Dragoni M, Bailoni T, Donadello I, Martin JC, Lindgren H. Integrating Functional Status Information into Knowledge Graphs to Support Self-Health Management. Data Intelligence 2023. [DOI: 10.1162/dint_a_00203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
Abstract
Functional Status Information (FSI) describes physical and mental wellness at the whole-person level. It includes information on activity performance, social role participation, and environmental and personal factors that affect the well-being and quality of life. Collecting and analyzing this information is critical to address the needs for caring for an aging global population, and to provide effective care for individuals with chronic conditions, multi-morbidity, and disability. Personal knowledge graphs (PKGs) represent a suitable way for meaning in a complete and structured way all information related to people's FSI and reasoning over them to build tailored coaching solutions supporting them in daily life for conducting a healthy living. In this paper, we present the development process related to the creation of a PKG by starting from the HeLiS ontology in order to enable the design of an AI-enabled system with the aim of increasing, within people, the self-awareness of their own functional status. In particular, we focus on the three modules extending the HeLiS ontology aiming to represent (i) enablers and (ii) barriers playing potential roles in improving (or deteriorating) own functional status and (iii) arguments driving the FSI collection process. Finally, we show how these modules have been instantiated into real-world scenarios.
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Mekonnen HS, Lindgren H, Geda B, Azale T, Erlandsson K. Being an Elderly Person Living in Metropolitan Cities of Northwestern Ethiopia: A Descriptive Phenomenological Study. Clin Interv Aging 2023; 18:205-218. [PMID: 36814539 PMCID: PMC9939788 DOI: 10.2147/cia.s389305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 02/10/2023] [Indexed: 02/17/2023] Open
Abstract
Background As people grow old, they pass through various life courses. Thus, it is important to realize aging in the context of each of these stages, as aging is not only physiological and psychological processes. To understand the lifeworld experiences of the phenomenon "being an elderly person" from the individual perspective was important, in this study, within day-to-day life in Metropolitan cities of northwestern Ethiopia. Objective The aim of this study was to describe the lifeworld of elderly persons living in Bahir Dar and Gondar Cities, Northwest Ethiopia. Methods A community based qualitative study conducted from October 29, 2021 to November 6, 2021. A purposive sampling technique and in-depth interviews were used for sampling and data collection, respectively. To explore the life experience /life-world/ of the elderly, a descriptive phenomenological study was conducted among 15 elderly persons. The audio records were transcribed and the field notes incorporated. Transcribed texts were translated into the English language, and a descriptive phenomenological analysis was done. Results In this study, the essence of the phenomenon, being an elderly person, means, in an ebb and flow motion, balancing a life change characterized by changing perspective, ambiguity to body functions, and preparing for being released. The elderly experienced physical, mental, and psychosocial changes. They had encountered positive and negative situations throughout their life span. They also expressed that their time was over and wished to prepare for God's Kingdom. Conclusion The use of phenomenology for this research provided an opportunity for a deeper understanding of the experiences of elderly persons. With knowledge from this study, nurses and other health professionals can understand and support the elderly from an individual point of view.
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Affiliation(s)
- Habtamu Sewunet Mekonnen
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia,Correspondence: Habtamu Sewunet Mekonnen, Email
| | - Helena Lindgren
- Department of Women’s and Children’s Health, Karolinska Institutet, Solna, Sweden
| | - Biftu Geda
- Department of Nursing, College of Health Science, Madda Walabu University, Shashemene Campus, Shashemene, Ethiopia
| | - Telake Azale
- Department of Health Education and Behavioral Sciences, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kerstin Erlandsson
- Department of Women’s and Children’s Health, Karolinska Institutet, Solna, Sweden and School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
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Lindgren H, Eklund J, Eneslätt K, Sjöstedt A. Kinetics of the serological response up to one year after tularemia. Front Cell Infect Microbiol 2023; 12:1072703. [PMID: 36683705 PMCID: PMC9853284 DOI: 10.3389/fcimb.2022.1072703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 12/07/2022] [Indexed: 01/08/2023] Open
Abstract
Serological analysis is the predominant method used to diagnose tularemia, a zoonotic disease caused by the highly virulent bacterium F. tularensis. We determined F. tularensis-specific IgM and IgG antibody titers by an LPS-based ELISA assay on five occasions one to twelve months after onset of ulceroglandular tularemia in 19 individuals. Peak IgM antibody titers were observed at the one-month time point and peak IgG antibody titers at the two-month time point. Both IgG and IgM antibody levels declined linearly thereafter with rather similar kinetics. Compared to the average one-month antibody titers, average IgG titers were not significantly lower before the 12-month time point and IgM titers before the 4-month time point. All, but one average titer, were significantly increased compared to the cut-off of the assay. Average IgG and IgM titers were significantly lower for the group = 69 years old compared to the group < 69 years. Collectively, the data demonstrate a persistence of F. tularensis-specific IgM and IgG antibody titers for at least 12 months after ulceroglandular tularemia. Thus, low, but significantly elevated F. tularensis-specific antibody titers are of limited diagnostic value since they are not indicative of ongoing tularemia.
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Affiliation(s)
- Helena Lindgren
- Department of Clinical Microbiology, Umeå University, Umeå, Sweden
| | - Johan Eklund
- Ljusdal-Ramsjö Primary Care Centre, Ljusdal, Sweden
| | - Kjell Eneslätt
- Department of Clinical Microbiology, Umeå University, Umeå, Sweden
| | - Anders Sjöstedt
- Department of Clinical Microbiology, Umeå University, Umeå, Sweden,*Correspondence: Anders Sjöstedt,
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Kilic K, Weck S, Kampik T, Lindgren H. Argument-based human-AI collaboration for supporting behavior change to improve health. Front Artif Intell 2023; 6:1069455. [PMID: 36872933 PMCID: PMC9979214 DOI: 10.3389/frai.2023.1069455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 01/20/2023] [Indexed: 02/18/2023] Open
Abstract
This article presents an empirical requirement elicitation study for an argumentation-based digital companion for supporting behavior change, whose ultimate goal is the promotion and facilitation of healthy behavior. The study was conducted with non-expert users as well as with health experts and was in part supported by the development of prototypes. It focuses on human-centric aspects, in particular user motivations, as well as on expectations and perceptions regarding the role and interaction behavior of a digital companion. Based on the results of the study, a framework for person tailoring the agent's roles and behaviors, and argumentation schemes are proposed. The results indicate that the extent to which a digital companion argumentatively challenges or supports a user's attitudes and chosen behavior and how assertive and provocative the companion is may have a substantial and individualized effect on user acceptance, as well as on the effects of interacting with the digital companion. More broadly, the results shed some initial light on the perception of users and domain experts of "soft," meta-level aspects of argumentative dialogue, indicating potential for future research.
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Affiliation(s)
- Kaan Kilic
- Department of Computing Science, Umeå University, Umeå, Sweden
| | - Saskia Weck
- Department of Computing Science, Umeå University, Umeå, Sweden
| | | | - Helena Lindgren
- Department of Computing Science, Umeå University, Umeå, Sweden
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Asaye MM, Gelaye KA, Matebe YH, Lindgren H, Erlandsson K. Effect of fetal malposition, primiparous, and premature rupture of membrane on Neonatal Near miss mediated by grade three meconium-stained amniotic fluids and duration of the active first stage of labor: Mediation analysis. PLoS One 2023; 18:e0285280. [PMID: 37146028 PMCID: PMC10162561 DOI: 10.1371/journal.pone.0285280] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 04/18/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND In many low-income countries, including Ethiopia, neonatal mortality remains a major concern. For every newborn that dies, many more neonates survived (near-miss neonates) the first 28 days after birth from life-threatening conditions. The generation of evidence on neonatal near-miss determinants could be a critical step in reducing neonatal mortality rates. However, studies causal pathway determinants are limited in Ethiopia. This study aimed to investigate the Neonatal Near-miss determinants in public health hospitals in Amhara Regional State, northwest Ethiopia. METHOD A cross-sectional study was conducted on 1277 mother-newborn pairs at six hospitals between July 2021 and January 2022. A validated interviewer-administered questionnaire and a review of medical records were used to collect data. Data were entered into Epi-Info version 7.1.2 and exported to STATA version 16 in California, America for analysis. The paths from exposure variables to Neonatal Near-Miss via mediators were examined using multiple logistic regression analysis. The adjusted odds ratio (AOR) and ß-coefficients were calculated and reported with a 95% confidence interval and a p-value of 0.05. RESULTS The proportion of neonatal near-misses was 28.6% (365/1277) (95% CI: 26-31%). Women who could not read and write (AOR = 1.67,95%CI:1.14-2.47), being primiparous (AOR = 2.48,95% CI:1.63-3.79), pregnancy-induced hypertension (AOR = 2.10,95% CI:1.49-2.95),being referred from other health facilities (AOR = 2.28,95% CI:1.88-3.29), premature rupture of membrane (AOR = 1.47,95% CI:1.09-1.98), and fetal malposition (AOR = 1.89,95% CI:1.14-3.16) were associated with Neonatal Near-miss. Grade III meconium stained amniotic fluid partially mediated the relationship between primiparous (ß = 0.517), fetal malposition (ß = 0.526), pregnant women referred from other health facilities (ß = 0.948) and Neonatal Near-Miss at P-value < 0.01. Duration of the active first stage of labour partially mediated the relationship between primiparous (ß = -0.345), fetal malposition (ß = -0.656), premature rupture of membranes (ß = -0.550) and Neonatal Near-Miss at P- value <0.01.It had also a significant indirect effect (ß = 0.581, P<0.001) on NNM with variables (primiparous, fetal malposition, and premature rupture of membranes). CONCLUSIONS The relationship between fetal malposition, primiparous, referred from other health facilities, premature rupture of membrane, and Neonatal Near miss were partially mediated by grade III meconium stained amniotic fluid and duration of the active first stage of labour. Early diagnosis of these potential danger signs and appropriate intervention could be of supreme importance in reducing NNM.
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Affiliation(s)
- Mengstu Melkamu Asaye
- Department of Women and Family Health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kassahun Alemu Gelaye
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yohannes Hailu Matebe
- Department of Pediatrics and Child Health, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Helena Lindgren
- Department of Women's and Children's Health, Karolinska Institute, Solna, Sweden
| | - Kerstin Erlandsson
- Department of Women's and Children's Health, Karolinska Institute, Solna, Sweden
- Institution for Health and Welfare, Dalarna University, Solna, Sweden
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Melkamu Asaye M, Gelaye KA, Matebe YH, Lindgren H, Erlandsson K. Valid and reliable neonatal near-miss assessment scale in Ethiopia: a psychometric validation. Glob Health Action 2022; 15:2029334. [PMID: 35107412 PMCID: PMC8812796 DOI: 10.1080/16549716.2022.2029334] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background The concept of a neonatal near miss is used to explain neonates who nearly died but survived a life-threatening complication in the first 28 days of life. We have left many ill surviving (near-miss) neonates, due to a lack of valid and reliable assessment scale, particularly in Ethiopia. Aim We aim to psychometrically validate the neonatal near-miss assessment scale (NNMAS) for Ethiopia. Methods A total of 465 live birth neonates were included with the assumption of a participant-to-item ratio of 15:1. A new contextually validated NNMAS was used to collect data. The Kaiseri––Mayer––Olkin (KMO) measure of sampling adequacy with a cutoff value of ≥0.50 for each item was applied. For reliability and validity of NNMAS, exploratory factor analysis using principal component analysis with oblique varimax rotation was used. Internal consistency and reliability were assessed using Cronbach’s alpha. Convergent and discriminant validity was assessed using composite reliability (CR) and average variance extracted (AVE). Results The Kaiser––Mayer––Olkin (KMO = 0.74) measure of sampling adequacy and Bartlett’s Sphericity test for the appropriateness of the identity matrix (χ2 = 2903.9, df = 276, and P = 0.000) were suitable for exploratory factor analysis (EFA). The correlation matrix determinant of the study was 0.002. The principal component analysis (PCA) identified six factors and together explained 54.3% of the variation in the Neonatal Near miss. The Cronbach-alpha coefficient was 0.80 for the entire scale. The composite reliability values of the factors ranged from 0.87 to 0.95. The AVEs, CR, and factor loadings were above 0.5 for all factors indicating that convergent validity was met. The square roots of the AVEs were greater than factor correlation values. It was revealed that discriminated validity was also met. Conclusion The neonatal near-miss assessment scale was found to be valid and reliable in the present context. The scale can be used to identify near-miss neonates in Ethiopia.
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Affiliation(s)
- Mengstu Melkamu Asaye
- Department of Women and Family Health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kassahun Alemu Gelaye
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yohannes Hailu Matebe
- Department of Pediatrics and Child Health, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Helena Lindgren
- Department of Women's and Children's Health, Karolinska Institute, Solna, Sweden
| | - Kerstin Erlandsson
- Department of Women's and Children's Health, Karolinska Institute, Solna, Sweden.,Institution for Health and Welfare, Dalarna University, Falun, Sweden
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23
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Lindgren H, Bogren M, Osika Friberg I, Berg M, Hök G, Erlandsson K. The midwife's role in achieving the Sustainable Development Goals: protect and invest together - the Swedish example. Glob Health Action 2022; 15:2051222. [PMID: 35522127 PMCID: PMC9090391 DOI: 10.1080/16549716.2022.2051222] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
'The midwife's role in achieving the Sustainable Development Goals: Protect and Invest Together' is a report providing the reader the opportunity for understanding and appreciating the history of midwifery in Sweden and the interlinked nature of the United Nation's SDGs supporting health and wellbeing of women and children. To realise the opportunity to have a country with well-educated midwives of high academic standard, and, at the same time, promoting gender equality and equity we need to protect and invest together in midwives. This paper provides the foundation for a revitalised discussion on midwives' role for women and child health in the 21st century. The full Swedish Midwifery report was published in October 2021.
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Affiliation(s)
- Helena Lindgren
- Department of Women’s and Children’s Health, Karolinska Institutet, Solna, Sweden,CONTACT Helena Lindgren Department of Women’s and Children’s Health, Karolinska Institutet, Solna, Sweden
| | - Malin Bogren
- Institute for Health and Care Science, Sahlgrenska Academy, Gothenburg, Sweden
| | - Ingrid Osika Friberg
- Department of Women’s and Children’s Health, Karolinska Institutet, Solna, Sweden,Swedish Agency for Gender Equality, Gothenburg, Sweden
| | - Marie Berg
- Institute for Health and Care Science, Sahlgrenska Academy, Gothenburg, Sweden
| | - Gabriella Hök
- Swedish Institute for Global Health Transformation, Stockholm, Sweden
| | - Kerstin Erlandsson
- Department of Women’s and Children’s Health, Karolinska Institutet, Solna, Sweden,Department of Health, Care and Wellbeing, Dalarna University, Falun, Sweden
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24
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Janols R, Sandlund M, Lindgren H, Pettersson B. Older adults as designers of behavior change strategies to increase physical activity-Report of a participatory design process. Front Public Health 2022; 10:988470. [PMID: 36620266 PMCID: PMC9811391 DOI: 10.3389/fpubh.2022.988470] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Abstract
Background Despite the significant value of physical activity for the health of older adults, this population often fails to achieve recommended activity levels. Digital interventions show promise in providing support for self-managed physical activity. However, more information is needed about older adults' preferences for digital support to change physical activity behaviors as well as the process of designing them. The aim of this paper was to describe the participatory design process in which older adults were involved in the co-creation of digitally supported behavioral change strategies to support self-managed physical activity, and how the results were integrated in a prototype. Methods The participatory design process involved with nine older adults and two researchers. The participants were divided in two groups, and each group participated in three workshops and completed home tasks in between workshops. Following an iterative design process influenced by theories of behavior change, the workshops and home tasks were continuously analyzed, and the content and process were developed between groups and the next set of workshops. Prototypes of a mobile health (mHealth) solution for fall preventive exercise for older adults were developed in which the conceptualized strategies were integrated. To support coherence in reporting and evaluation, the developed techniques were mapped to the Behavior Change Technique Taxonomy v1 and the basic human psychosocial needs according to the Self-determination Theory. Results The results highlight different preferences of older adults for feedback on physical activity performance, as well as the importance of transparency regarding the identification of the sender of feedback. Preferences for content and wording of feedback varied greatly. Subsequently, the design process resulted in a virtual health coach with three different motivational profiles and tools for goal setting and self-monitoring. These behavior change strategies were integrated in the exercise application Safe Step v1. The conformity of the design concepts with the needs of Self-determination Theory and Behavior Change Technique Taxonomy v1 are presented. Conclusion The participatory design process exemplifies how older adults successfully contributed to the design of theory-based digital behavior change support, from idea to finished solution. Tailoring feedback with a transparent sender is important to support and not undermine motivation.
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Affiliation(s)
- Rebecka Janols
- Department of Community Medicine and Rehabilitation, Occupational Therapy, Umeå University, Umeå, Sweden,Department of Computing Science, Umeå University, Umeå, Sweden
| | - Marlene Sandlund
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Helena Lindgren
- Department of Computing Science, Umeå University, Umeå, Sweden
| | - Beatrice Pettersson
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden,*Correspondence: Beatrice Pettersson ✉
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25
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Tewari M, Lindgren H. Expecting, understanding, relating, and interacting-older, middle-aged and younger adults' perspectives on breakdown situations in human-robot dialogues. Front Robot AI 2022; 9:956709. [PMID: 36388253 PMCID: PMC9650620 DOI: 10.3389/frobt.2022.956709] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/22/2022] [Indexed: 10/11/2023] Open
Abstract
Purpose: The purpose of this study is to explore how older, middle aged and younger adults perceive breakdown situations caused by lack of or inconsistent knowledge, sudden focus shifts, and conflicting intentions in dialogues between a human and a socially intelligent robot in a home environment, and how they perceive strategies to manage breakdown situations. Methods: Scenarios embedding dialogues on health-related topics were constructed based on activity-theoretical and argumentation frameworks. Different reasons for breakdown situations and strategies to handle these were embedded. The scenarios were recorded in a Wizard-of-Oz setup, with a human actor and a Nao robot. Twenty participants between 23 and 72 years of age viewed the recordings and participated in semi-structured interviews conducted remotely. Data were analyzed qualitatively using thematic analysis. Results: Four themes relating to breakdown situations emerged: expecting, understanding, relating, and interacting. The themes span complex human activity at different complementary levels and provide further developed understanding of breakdown situations in human-robot interaction (HRI). Older and middle-aged adults emphasized emphatic behavior and adherence to social norms, while younger adults focused on functional aspects such as gaze, response time, and length of utterances. A hierarchical taxonomy of aspects relating to breakdown situations was formed, and design implications are provided, guiding future research. Conclusion: We conclude that a socially intelligent robot agent needs strategies to 1) construct and manage its understanding related to emotions of the human, social norms, knowledge, and motive on a higher level of meaningful human activity, 2) act accordingly, for instance, adhering to transparent social roles, and 3) resolve conflicting motives, and identify reasons to prevent and manage breakdown situations at different levels of collaborative activity. Furthermore, the novel methodology to frame the dynamics of human-robot dialogues in complex activities using Activity Theory and argumentation theory was instrumental in this work and will guide the future work on tailoring the robot's behavior.
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26
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Kabwama SN, Wanyenze RK, Kiwanuka SN, Namale A, Ndejjo R, Monje F, Wang W, Lazenby S, Kizito S, Troeger C, Liu A, Lindgren H, Razaz N, Ssenkusu J, Sambisa W, Bartlein R, Alfvén T. Interventions for Maintenance of Essential Health Service Delivery during the COVID-19 Response in Uganda, between March 2020 and April 2021. Int J Environ Res Public Health 2022; 19:ijerph191912522. [PMID: 36231823 PMCID: PMC9566395 DOI: 10.3390/ijerph191912522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/19/2022] [Accepted: 09/27/2022] [Indexed: 06/03/2023]
Abstract
INTRODUCTION The COVID-19 pandemic overwhelmed health systems globally and affected the delivery of health services. We conducted a study in Uganda to describe the interventions adopted to maintain the delivery of other health services. METHODS We reviewed documents and interviewed 21 key informants. Thematic analysis was conducted to identify themes using the World Health Organization health system building blocks as a guiding framework. RESULTS Governance strategies included the establishment of coordination committees and the development and dissemination of guidelines. Infrastructure and commodity strategies included the review of drug supply plans and allowing emergency orders. Workforce strategies included the provision of infection prevention and control equipment, recruitment and provision of incentives. Service delivery modifications included the designation of facilities for COVID-19 management, patient self-management, dispensing drugs for longer periods and the leveraging community patient networks to distribute medicines. However, multi-month drug dispensing led to drug stock-outs while community drug distribution was associated with stigma. CONCLUSIONS Health service maintenance during emergencies requires coordination to harness existing health system investments. The essential services continuity committee coordinated efforts to maintain services and should remain a critical element of emergency response. Self-management and leveraging patient networks should address stigma to support service continuity in similar settings and strengthen service delivery beyond the pandemic.
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Affiliation(s)
- Steven Ndugwa Kabwama
- Department of Community Health and Behavioral Sciences, School of Public Health, Makerere University, Kampala P.O. Box 7062, Uganda
- Department of Global Public Health, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Rhoda K. Wanyenze
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University, Kampala P.O. Box 7072, Uganda
| | - Suzanne N. Kiwanuka
- Department of Health Policy Planning and Management, School of Public Health, Makerere University, Kampala P.O. Box 7072, Uganda
| | - Alice Namale
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University, Kampala P.O. Box 7072, Uganda
| | - Rawlance Ndejjo
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University, Kampala P.O. Box 7072, Uganda
| | - Fred Monje
- School of Public Health, Makerere University, Kampala P.O. Box 7072, Uganda
| | | | | | - Susan Kizito
- School of Public Health, Makerere University, Kampala P.O. Box 7072, Uganda
| | | | - Anne Liu
- Gates Ventures, Kirkland, WA 98033, USA
| | - Helena Lindgren
- Department of Women’s and Children’s Health, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Neda Razaz
- Department of Medicine, Karolinska Institutet, 17177 Stockholm, Sweden
| | - John Ssenkusu
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala P.O. Box 7072, Uganda
| | | | | | - Tobias Alfvén
- Department of Global Public Health, Karolinska Institutet, 17177 Stockholm, Sweden
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27
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Lindgren H, Erlandsson K. The MIDWIZE conceptual framework: a midwife-led care model that fits the Swedish health care system might after contextualization, fit others. BMC Res Notes 2022; 15:306. [PMID: 36138471 PMCID: PMC9503192 DOI: 10.1186/s13104-022-06198-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 09/07/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Familiarity with the unique tradition and experience of Swedish midwives during the more than 300 years in which midwife-led care has contributed to one of the lowest maternal and neonatal mortality and morbidity ratio in the world might encourage professionals in other countries to follow the Swedish example. The framework described below, reflecting the midwife's role in the Swedish health care system, might, after implementation, strengthen maternal and neonatal outcomes if contextualized to other settings. RESULTS Using a four-step procedure we identified our topic, made a literature review, identified the key components and their internal relationship, and finally developed the MIDWIZE conceptual framework. In this framework, the midwives in collaboration with obstetricians, provide evidence-based care with continuous quality improvements during the whole reproductive life cycle. Teamwork including specialists for referral and a responsive, relational, trust-based practice is the foundation for provision of midwife-led care for healthy women with a normal pregnancy. The well-educated midwife, of high academic standard, promoting gender equality and equity is the hub in the team and the primary care provider.
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Affiliation(s)
- Helena Lindgren
- Department of Women's and Children's Health, Karolinska Institutet, Solna, Sweden.
| | - Kerstin Erlandsson
- Department of Women's and Children's Health, Karolinska Institutet, Solna, Sweden.,Department of Health, Care and Wellbeing, Dalarna University, Falun, Sweden
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Salih MH, Mekonnen H, Derseh L, Lindgren H, Erlandsson K. Anticipated stigma and associated factors among chronic illness patients in Amhara Region Referral Hospitals, Ethiopia: A multicenter cross-sectional study. PLoS One 2022; 17:e0273734. [PMID: 36107943 PMCID: PMC9477324 DOI: 10.1371/journal.pone.0273734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 08/14/2022] [Indexed: 11/18/2022] Open
Abstract
Background Anticipated stigma related to chronic illness patients undermines diagnosis, treatment, and successful health outcomes. The study aimed to assess the magnitude and factors associated with anticipated stigma among patients with chronic illness attending follow-up clinics in Amhara Region Referral Hospitals, Ethiopia. Methods A cross-sectional institution-based study was conducted in Amhara Region Referral Hospitals from 01 March to 15 April 2021. A simple random sampling technique was used to select the three Referral Hospitals in the region and study subjects. Data were collected using a pre-tested interview-based questionnaire. Data were entered and cleaned with Epi-Info version 6 and exported for analysis STATA version 14. Multiple linear regression was used to show the association between anticipated stigma and potential factors. Associations were measured using ß coefficients and were considered statistically significant if the p-value > 0.05. Results A total of 779 patients were included for analysis with a response rate of 97%. Their mean (Standard deviation) of anticipated stigma was estimated at 1.86 and 0.5, respectively. After running an assumption test for multiple linear regression; educational status, cigarette smoking, psychological distress, medication adherence, alcohol consumption, and social part of the quality of life were statically significantly associated with anticipated stigma. Conclusion and recommendation The result showed a high level of anticipated stigma reported among the participants. Emphasizing improving their social part of the quality of life, avoiding risky behaviors like alcohol consumption and cigarette smoking, access to health education for chronically ill patients, integrating mental health in all types of chronic disease, and developing strategies and protocols which will help to improve patient medication adherence to their prescribed medication will be crucial. This can provide a foundation for government andnon-governmental organizations, and researchers implementing evidence-based interventions and strategies on chronic care to address factors related to anticipated stigma.
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Affiliation(s)
- Mohammed Hassen Salih
- University of Gondar, College of Medicine and Health Sciences, School of Nursing, Gondar, Ethiopia
- * E-mail:
| | - Hussen Mekonnen
- Addis Ababa University, School of Nursing and Midwifery, College of Nursing and Midwifery, Addis Ababa, Ethiopia
| | - Lema Derseh
- University of Gondar, College of Medicine and Health Sciences, Institute of Public Health, Gondar, Ethiopia
| | - Helena Lindgren
- Department of Women’s and Children’s Health, Karolinska Institute, Solna, Sweden
| | - Kerstin Erlandsson
- Department of Women and Children’s Health, Karolinska Institute, Karolinska Institutet, Solna and School of Health and Welfare, Dalarna University, Falun, Sweden
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Mekonnen HS, Lindgren H, Geda B, Azale T, Erlandsson K. Satisfaction with life and associated factors among elderly people living in two cities in northwest Ethiopia: a community-based cross-sectional study. BMJ Open 2022; 12:e061931. [PMID: 36581991 PMCID: PMC9438199 DOI: 10.1136/bmjopen-2022-061931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE This study aimed to determine the level of life satisfaction and identify associated factors among elderly people living in two cities in northwest Ethiopia. DESIGN Community-based cross-sectional study. SETTING Two cities in northwest Ethiopia (Gondar and Bahir Dar). PARTICIPANTS 816 elderly people age 60 years and above living in Gondar and Bahir Dar, northwest Ethiopia. Systematic random sampling was used to select study participants. MAIN OUTCOME MEASURE Level of life satisfaction. Considering the mean and SD, three levels of satisfaction appeared to suffice as the basis for analysis and discussion: 23.5-34.4 dissatisfied, 34.5-56.5 averagely satisfied and 56.6-67.5 satisfied. Multivariable ordinal regression analysis was done to control the confounders. Since the outcome variable has an ordinal category, ordinal regression analysis is appropriate. A p≤0.05 and AOR (adjusted OR) with a 95% CI were considered to determine the statistically significant variables and strength of the association. RESULTS The mean age of the respondents was 68.2 years with an SD±7.2. The level of life satisfaction was: dissatisfied 17.2%, moderately satisfied 63.8% and well satisfied 19.0%. Overall, 45.8% (95% CI 42.2% to 49.2%) of the participants had a score equal to or above the mean. Regarding associated factors; retired current occupation (AOR=2.23, 95% CI 1.09 to 4.55), good self-rated health status (AOR=2.54, 95% CI 1.29 to 4.99), having no chronic disease (AOR=1.48, 95% CI 1.03 to 2.11), somewhat-good (AOR=2.15, 95% CI 1.12 to 4.13) and good (AOR=4.51, 95% CI 2.40 to 8.45) self-perception on ageing life, moderate functional impairment on daily living activities (AOR=5.43, 95% CI 1.81 to 16.24), high sense of coherence (AOR=3.80, 95% CI 2.04 to 7.08), house rent as a source of finance (AOR=2.60, 95% CI 1.49 to 4.52) and high perceived social support (AOR=2.13, 95% CI 1.44 to 3.16) had statistically significant association with the life satisfaction. CONCLUSION The life satisfaction level in our study group was lower than in some more highly developed countries. To improve the level of life satisfaction in Ethiopia, a holistic programme of nursing care for elderly people, particularly as concerns about their health and psychosocial conditions is crucial in both community and clinical settings.
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Affiliation(s)
- Habtamu Sewunet Mekonnen
- School of Nursing, Department of Medical Nursing, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Helena Lindgren
- Department of Women's and Children's Health, Karolinska Institutet, Solna, Sweden
| | - Biftu Geda
- College of Health Science, Department of Nursing, Madda Walabu University, Shashamene Campus, Robe, Ethiopia
| | - Telake Azale
- Institute of Public Health, Department of Health Education and Behavioral Sciences, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Kerstin Erlandsson
- Department of Women's and Children's Health, Karolinska Institutet, Solna, Sweden
- Dalarna University School of Education Health and Social Studies, Falun, Sweden
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30
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Badi MB, Abebe SM, Weldetsadic MA, Christensson K, Lindgren H. Effect of Flexible Sacrum Position on Maternal and Neonatal Outcomes in Public Health Facilities, Amhara Regional State, Ethiopia: A Quasi-Experimental Study. Int J Environ Res Public Health 2022; 19:9637. [PMID: 35955012 PMCID: PMC9368710 DOI: 10.3390/ijerph19159637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/29/2022] [Accepted: 07/29/2022] [Indexed: 06/15/2023]
Abstract
Restricting women giving birth in health care facilities from choosing the most comfortable position during labor and birth is a global problem. This study was aimed to examine the effect of flexible sacrum birth positions on maternal and neonatal outcomes in public health facilities in Ethiopia's Amhara Region. A non-equivalent control group post-test-only design was employed at public health facilities from August to November 2019. A total of 1048 participants were enrolled and assigned to intervention or control groups based on their choice of birth position. Participants who preferred the flexible sacrum birth position received the intervention, while participants who preferred the supine birth position were placed in the control group. Data were collected using observational follow-up from admission to immediate postpartum period. Log binomial logistic regression considering as treated analysis was used. Of the total participants, 970 women gave birth vaginally, of whom 378 were from the intervention group, and 592 were from the control group. The intervention decreased the chance of perineal tear and poor Apgar score by 43 and 39%, respectively. The flexible sacrum position reduced the duration of the second stage of labor by a mean difference of 26 min. Maternal and newborn outcomes were better in the flexible sacrum position.
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Affiliation(s)
- Marta Berta Badi
- Department of Women’s and Family Health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar 6200, Ethiopia
| | - Solomon Mekonnen Abebe
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar 6200, Ethiopia
| | - Mulat Adefris Weldetsadic
- Department of Gynecology and Obstetrics, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar 6200, Ethiopia
| | - Kyllike Christensson
- Department of Women’s and Children’s Health, Karolinska Institute, 17164 Stockholm, Sweden
| | - Helena Lindgren
- Department of Women’s and Children’s Health, Karolinska Institute, 17164 Stockholm, Sweden
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31
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Gebrie MH, Asfaw HM, Bilchut WH, Lindgren H, Wettergren L. Psychometric properties of the kidney disease quality of life-36 (KDQOL-36) in Ethiopian patients undergoing hemodialysis. Health Qual Life Outcomes 2022; 20:24. [PMID: 35144625 PMCID: PMC8832803 DOI: 10.1186/s12955-022-01932-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/26/2022] [Indexed: 11/21/2022] Open
Abstract
Background Health-related quality of life (HRQOL) has a direct association with increased morbidity and mortality among end stage renal disease patients. Valid and reliable instruments to measure the HRQOL of patients with end stage renal disease are therefore required. This study aimed to translate, culturally adapt and evaluate the psychometric properties of the Amharic version of the Kidney Disease Quality of Life-36 (KDQOL-36) instrument in Ethiopian patients with end stage renal disease undergoing hemodialysis. Methods The KDQOL-36 instrument was developed for individuals with kidney disease who are being treated with dialysis and includes both generic and disease-specific components. The KDQOL-36 was translated to Amharic language and distributed to a cross-sectional sample of 292 hemodialysis patients. The psychometric evaluation included construct validity through corrected item-total correlation, confirmatory factor analysis and known group analysis. Convergent validity was evaluated by correlations between each of the three kidney disease targeted scales (symptoms/problems list, burden of kidney disease and effects of kidney diseases) and the European Quality of Life 5D-5L and Visual Analog Scales. Regarding reliability, internal consistency and test–retest reliability were assessed. Results Two hundred ninety-two patients with a mean age of 48 (SD ± 14.7) completed the questionnaire. Corrected item- total correlation scores were > 0.4 for all items. Confirmatory factor analysis revealed a two χ2 /df was 4.4, Root Mean Square Error of Approximation (RMSEA) = 0.108 (90% CI 0.064–0.095), Comparative Fit Index (CFI) = 0.922, Tucker Lewis Index (TLI) = 0.948 and Standardized Root mean-squared residual (SRMR) = 0.058) and three χ2 /df = 3.1, RMSEA = 0.085 (90% CI 0.064–0.095), CFI = 0.854, TLI = 0.838 and SRMR = 0.067) factor models for the generic and disease specific components respectively. The mean scores of the three kidney disease targeted domains were correlated to the EQ-5D-5L & VAS with correlation coefficients of large magnitude (0.55–0.81). The reliability of the instrument was satisfactory (Cronbach’s alpha = 0.81–0.91) and Intra-class correlation (ICC) = 0.90–0.96). Conclusion The Amharic version of the KDQOL-36 is a reliable and valid instrument recommended for assessment of HRQOL of Ethiopian patients on hemodialysis. Supplementary Information The online version contains supplementary material available at 10.1186/s12955-022-01932-y.
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Affiliation(s)
- Mignote Hailu Gebrie
- College of Medicine and Health Sciences, School of Nursing, University of Gondar, Gondar, Ethiopia.
| | - Hussen Mekonnen Asfaw
- College of Health Sciences, School of Nursing & Midwifery, Department of Nursing, Addis Ababa University, Addis Ababa, Ethiopia
| | - Workagegnehu Hailu Bilchut
- College of Medicine and Health Sciences, School of Medicine, Department of Internal Medicine, University of Gondar, Gondar, Ethiopia
| | - Helena Lindgren
- Department of Women's and Children's Health, Division of Reproductive Health, Karolinska Institutet, Solna, Sweden
| | - Lena Wettergren
- Department of Women's and Children's Health, Division of Reproductive Health, Karolinska Institutet, Solna, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Salih MH, Wettergren L, Lindgren H, Erlandsson K, Mekonen H, Derseh L. Translation and psychometric evaluation of chronic illness anticipated stigma scale (CIASS) among patients in Ethiopia. PLoS One 2022; 17:e0262744. [PMID: 35061829 PMCID: PMC8782391 DOI: 10.1371/journal.pone.0262744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 01/04/2022] [Indexed: 12/03/2022] Open
Abstract
Background Stigma is common among patients with chronic illnesses. It affects the delivery of healthcare for not addressing the psychological components and may interfere with the patient’s attendance to necessary health care services. Therefore, a valid and reliable instrument to measure anticipated stigma related to chronic illness is vital to inform possible interventions. This study aimed to translate the Chronic Illness Anticipated Stigma Scale (CIASS) into the Amharic language and evaluate its psychometric properties in Ethiopia. Methods The CIASS was translated into Amharic language using standard procedures. The Amharic version was completed by 173 patients (response rate 96%) with chronic illness from three referral hospitals in the Amhara region. Internal consistency was examined through Cronbach’s alpha. Construct validity was evaluated by confirmatory factor analysis and convergent validity by using a Pearson correlation of P-value less than or equal to 0.05. Results The internal consistency was estimated at Cronbach alpha of 0.92. By using a structural equation model, and modification indices a model fitness testing was run and shows a root mean squared error of approximation 0.049 (90% CI, 0.012–0.075). The structural validity results in 78.8% of confirmatory factor analysis showed from the extraction of the three-dimension (components). Validity tests for convergent by using Pearson correlation positively correlated with common mental distress and negatively correlated with quality of life–BREF, and the construct validity shows a good valid tool to CIASS. Conclusion The Amharic language version of the chronic illness anticipated stigma scale shows a satisfactory level of reliability and validity on different psychometric measures of assessment. The tool may be useful for future researchers and patients with chronic illness in the Amharic-speaking population. Moreover, it will be used to see the psychological burden related to chronic illness and for comparison among international population groups.
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Affiliation(s)
- Mohammed Hassen Salih
- School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- * E-mail:
| | - Lena Wettergren
- Department of Public Health and Caring Sciences, Uppsala University and Department of Women’s and Children’s Health, Karolinska Institute, Solna, Sweden
| | - Helena Lindgren
- Department of Women’s and Children’s Health, Karolinska Institute, Solna, Sweden
| | - Kerstin Erlandsson
- School of Education, Health and Social Studies, Dalarna University and Department of Women’s and Children’s Health, Division of Reproductive Health, Karolinska Institute, Solna, Sweden
| | - Hussen Mekonen
- School of Nursing and Midwifery, College of Nursing and Midwifery, Addis Ababa University, Addis Ababa, Ethiopia
| | - Lemma Derseh
- College of Medicine and Health Sciences, Institute of Public Health, University of Gondar, Gondar, Ethiopia
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Mohammadi N, Lindgren H, Yamamoto M, Martin A, Henry T, Sjöstedt A. Macrophages Demonstrate Guanylate-Binding Protein-Dependent and Bacterial Strain-Dependent Responses to Francisella tularensis. Front Cell Infect Microbiol 2022; 11:784101. [PMID: 35004352 PMCID: PMC8738097 DOI: 10.3389/fcimb.2021.784101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 12/09/2021] [Indexed: 11/13/2022] Open
Abstract
Francisella tularensis is a facultative intracellular bacterium and the etiological agent of tularemia, a zoonotic disease. Infection of monocytic cells by F. tularensis can be controlled after activation with IFN-γ; however, the molecular mechanisms whereby the control is executed are incompletely understood. Recently, a key role has been attributed to the Guanylate-binding proteins (GBPs), interferon-inducible proteins involved in the cell-specific immunity against various intracellular pathogens. Here, we assessed the responses of bone marrow-derived murine macrophages (BMDM) and GBP-deficient BMDM to F. tularensis strains of variable virulence; the highly virulent SCHU S4 strain, the human live vaccine strain (LVS), or the widely used surrogate for F. tularensis, the low virulent F. novicida. Each of the strains multiplied rapidly in BMDM, but after addition of IFN-γ, significant GBP-dependent control of infection was observed for the LVS and F. novicida strains, whereas there was no control of the SCHU S4 infection. However, no differences in GBP transcription or translation were observed in the infected cell cultures. During co-infection with F. novicida and SCHU S4, significant control of both strains was observed. Patterns of 18 cytokines were very distinct between infected cell cultures and high levels were observed for almost all cytokines in F. novicida-infected cultures and very low levels in SCHU S4-infected cultures, whereas levels in co-infected cultures for a majority of cytokines showed intermediate levels, or levels similar to those of F. novicida-infected cultures. We conclude that the control of BMDM infection with F. tularensis LVS or F. novicida is GBP-dependent, whereas SCHU S4 was only controlled during co-infection. Since expression of GBP was similar regardless of infecting agent, the findings imply that SCHU S4 has an inherent ability to evade the GBP-dependent anti-bacterial mechanisms.
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Affiliation(s)
- Nasibeh Mohammadi
- Department of Clinical Microbiology and Laboratory for Molecular Infection Medicine Sweden (MIMS), Umeå University, Umeå, Sweden
| | - Helena Lindgren
- Department of Clinical Microbiology and Laboratory for Molecular Infection Medicine Sweden (MIMS), Umeå University, Umeå, Sweden
| | - Masahiro Yamamoto
- Department of Immunoparasitology, Research Institute for Microbial Diseases, Osaka, Japan
| | - Amandine Martin
- Inserm, U1111, Centre International de Recherche en Infectiologie, Lyon, France
| | - Thomas Henry
- Inserm, U1111, Centre International de Recherche en Infectiologie, Lyon, France
| | - Anders Sjöstedt
- Department of Clinical Microbiology and Laboratory for Molecular Infection Medicine Sweden (MIMS), Umeå University, Umeå, Sweden
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Hailemeskel S, Alemu K, Christensson K, Tesfahun E, Lindgren H. Midwife-led continuity of care increases women’s satisfaction with antenatal, intrapartum, and postpartum care: North Shoa, Amhara regional state, Ethiopia: A quasi-experimental study. Women Birth 2022; 35:553-562. [DOI: 10.1016/j.wombi.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 01/12/2022] [Accepted: 01/12/2022] [Indexed: 10/19/2022]
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Seyoum T, Alemayehu M, Christensson K, Lindgren H. Effect of complete adherence to antenatal care guideline during first visit on maternal and neonatal complications during the intrapartum and postpartum periods: a prospective cohort study in Northwest Ethiopia. BMJ Open 2021; 11:e049271. [PMID: 34903535 PMCID: PMC8671911 DOI: 10.1136/bmjopen-2021-049271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To examine the relationship between complete of providers' adherence to antenatal care (ANC) guideline during first visit and maternal and neonatal complications during intrapartum and postpartum periods. DESIGN Prospective cohort study. SETTING Gondar town public health facilities in Northwest, Ethiopia. PARTICIPANTS A total of 832 pregnant women with gestational age <28 weeks who came for first ANC visit were enrolled and followed up to the first 6 hours of the postpartum periods. EXPOSURE Providers' adherence to ANC guideline during first visit was the exposure variable. An 18-point checklist was used to record the level of providers' adherence. Clients who received care from providers who adhered completely to the guideline constituted the 'exposed group', and those who did not receive such care constituted the 'unexposed group'. MAIN OUTCOMES Maternal and neonatal complications occurred during the intrapartum and postpartum periods. DATA ANALYSIS Negative binomial regression model was used to analyse the data. The adjusted incidence risk ratio (AIRR) with 95% CI was reported in the final model. RESULTS A total of 782 pregnant women were followed up and included in the final analysis (254 in the exposed group and 528 non-exposed). Complete adherence to the guidelines during first visit reduced the risk of neonatal complications (AIRR 0.56; 95% CI 0.39 to 0.79). However, complete adherence to the guidelines was not found to have a statistically significant effect on maternal complications (AIRR 0.84; 95% CI 0.67 to 1.05) during the intrapartum and the postpartum periods. CONCLUSIONS The group that received care from providers who completely adhered to the ANC guidelines during the first antenatal visit showed significantly improved neonatal outcomes. However, it did not show a significant improvement in maternal outcomes. Hence, focusing on safe motherhood programmes like training that gears provider's conformity to ANC guideline is quite crucial to improve neonatal outcomes.
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Affiliation(s)
- Tewodros Seyoum
- School of Midwifery, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Mekuriaw Alemayehu
- Department of Environmental Health, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Kyllike Christensson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Helena Lindgren
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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Mekonnen HS, Lindgren H, Geda B, Azale T, Erlandsson K. Translation, Cultural Adaptation, and Psychometric Properties of the Life Satisfaction Index for the Third Age-Short Form (LSITA-SF12) for Use among Ethiopian Elders. Nurs Rep 2021; 11:981-996. [PMID: 34968283 PMCID: PMC8715472 DOI: 10.3390/nursrep11040089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/22/2021] [Accepted: 12/02/2021] [Indexed: 01/07/2023] Open
Abstract
(1) Background: Self-reported measures play a crucial role in research, clinical practice, and health assessment. Instruments used to assess life satisfaction need validation to ensure that they measure what they are intended to detect true variations over time. An adapted instrument measuring life satisfaction for use among Ethiopian elders was lacking; therefore, this study aimed to culturally adapt and evaluate the psychometric properties of the Life Satisfaction Index for the Third Age—Short Form (LSITA-SF12) in Ethiopia. (2) Methods: Elderly people (n = 130) in Metropolitan cities of northwestern Ethiopia answered the LSITA-SF12 in the Amharic language. Selected reliability and validity tests were examined. (3) Result: The scale had an acceptable limit of content validity index, internal consistency, test-retest, inter-rater reliabilities, and concurrent and discriminant validities. (4) Conclusion: The Amharic language version of LSITA-SF12 appeared to be valid and reliable measures and can be recommended for use in research and clinical purposes among Amharic-speaking Ethiopian elders.
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Affiliation(s)
- Habtamu Sewunet Mekonnen
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar 196, Ethiopia
- Correspondence:
| | - Helena Lindgren
- Department of Women’s and Children’s Health, Karolinska Institutet, 171 77 Solna, Sweden; (H.L.); (K.E.)
| | - Biftu Geda
- Department of Nursing, College of Health Science, Shashamene Campus, Madda Walabu University, Robe 247, Ethiopia;
| | - Telake Azale
- Department of Health Education and Behavioral Sciences, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar 196, Ethiopia;
| | - Kerstin Erlandsson
- Department of Women’s and Children’s Health, Karolinska Institutet, 171 77 Solna, Sweden; (H.L.); (K.E.)
- School of Education, Health and Social Studies, Dalarna University, 791 31 Falun, Sweden
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Djerf H, Svensson M, Nordanstig J, Gottsäter A, Falkenberg M, Lindgren H. Cost Effectiveness of Primary Stenting in the Superficial Femoral Artery for Intermittent Claudication: Two Year Results of a Randomised Multicentre Trial. J Vasc Surg 2021. [DOI: 10.1016/j.jvs.2021.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lindgren H, Weck S. Conceptual Model for Behaviour Change Progress - Instrument in Design Processes for Behaviour Change Systems. Stud Health Technol Inform 2021; 285:277-280. [PMID: 34734886 DOI: 10.3233/shti210614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of the work presented in this article was to develop a conceptual model for behavior change progress, which could be used for automated assessment of reasons for progress or non-progress. The model was developed based on theories for behavior change, and evaluated by domain experts. The information models of two prototype systems of a digital coach under development for preventing cardio-vascular diseases and stress respectively, were evaluated by comparing the content of the prototypes with concepts in the model. The conceptual model was found useful as instrument to evaluate to what extent the prototypes are based in theories for behavior change, whether some vital information is missing, and to identify mechanisms for short and long time goal setting. Moreover, the connection between the ontology underpinning the prototypes and the conceptual model could be defined. Future work includes the integration of the conceptual model to function as a meta-ontology, which could be used for capturing causal relationships between information collected by the applications at baseline and at runtime.
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Affiliation(s)
- Helena Lindgren
- Department of Computing Science, Umeå University, Umeå, Sweden
| | - Saskia Weck
- Department of Computing Science, Umeå University, Umeå, Sweden
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Hailemeskel S, Alemu K, Christensson K, Tesfahun E, Lindgren H. Health care providers' perceptions and experiences related to Midwife-led continuity of care-A qualitative study. PLoS One 2021; 16:e0258248. [PMID: 34648571 PMCID: PMC8516211 DOI: 10.1371/journal.pone.0258248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 09/22/2021] [Indexed: 11/18/2022] Open
Abstract
Background Though Midwife-led care remains a key to improving the health status of pregnant mothers, in Ethiopia, maternity care has traditionally been based on a model in which responsibility for care is shared by hospital-based midwives, nurses, general practitioners, and obstetricians. This type of care has been seen as representing a fragmented approach. Objective The aim of this study was to explore health care providers’ perceptions and experiences related to Midwife-led continuity of care at primary hospitals in the north Shoa zone Ethiopia Methods A qualitative approach was selected as the methodology for this study. Data were collected from 25 midwives and 8 integrated emergency surgical officers (IESO) and medical doctors working in maternal health care units in four primary hospitals in the north Shoa zone, Amhara Regional State. Four focus group discussions and eight individual interviews were conducted. The facilitator utilized a set of open-ended questions for the focus group discussion. Semi-structured interview questions were used for the interviews and thematic data analysis was done. Finding The main theme extracted was “Midwives welcome consideration of a Midwife-led model that would provide greater continuity of care, but they expressed concerns about organisation and workload”. The midwives said that they would welcome working with the midwife-led care model, as they believed using it could lead to improving the quality of maternal health care, provide greater continuity, and improve coverage, birth outcomes, and maternal satisfaction. The midwives could become more autonomous and be able to take more responsibility for maternity care. The group of 25 midwives and the group of 8 IESO and medical doctors perceived that working procedures and changes in the organization of care in the health facility would have to be studied carefully before any changes can be considered. Conclusion In this study, we found that replacing the existing system of maternal care with a Midwife-led model would require careful analysis of how this model of care might be implemented in Ethiopia. Further investigation will be of great importance in providing insights that will help in developing a final model.
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Affiliation(s)
- Solomon Hailemeskel
- School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Department of Midwifery, College of Health Science, Debre Berhan University, Debre Berhan, Ethiopia
- * E-mail:
| | - Kassahun Alemu
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kyllike Christensson
- Division of Reproductive Health, Department of Women’s and Children’s Health, Karolinska Institute, Solna, Sweden
| | - Esubalew Tesfahun
- Department of Public Health, College of Health Science, Debre Berhan University, Debre Berhan, Ethiopia
| | - Helena Lindgren
- Division of Reproductive Health, Department of Women’s and Children’s Health, Karolinska Institute, Solna, Sweden
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Lindgren H, Rådestad I, Pettersson K, Skokic V, Akselsson A. Epidural use among women with spontaneous onset of labour - an observational study using data from a cluster-randomised controlled trial. Midwifery 2021; 103:103156. [PMID: 34634721 DOI: 10.1016/j.midw.2021.103156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 08/11/2021] [Accepted: 09/27/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To investigate whether the proportion of pregnant women who use epidural analgesia during birth differed between women registered at a maternity clinic randomised to Mindfetalness or to routine care. DESIGN An observational study including women born in Sweden with singleton pregnancies, with spontaneous onset of labour from 32 weeks' gestation. Data used from a cluster-randomised controlled trial applying the intention-to-treat principle in 67 maternity clinics where women were randomised to Mindfetalness or to routine care. ClinicalTrials.gov (NCT02865759). INTERVENTIONS Midwives were instructed to distribute a leaflet about Mindfetalness to pregnant women at 25 weeks' gestation. Mindfetalness is a self-assessment method for the woman to use to become familiar with the unborn baby's fetal movement pattern. When practising the method in third trimester, the women are instructed to daily lie down on their side, when the baby is awake, and focus on the movements' intensity, character and frequency (but not to count each movement). FINDINGS Of the 18 501 women with spontaneous onset of labour, 47 percent used epidural during birth. Epidural was used to a lower extent among women registered at a maternity clinic randomised to Mindfetalness than women in the routine-care group (46.2% versus 47.8%, RR 0.97, CI 0.94-1.00, p= 0.04). Epidural was more common among primiparous women, women younger than 35 years, those with educational levels below university, with BMI ≥25 and with a history of receiving psychiatric care or psychological treatment for mental illness. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Pregnant women who were informed about a self-assessment method, with the aim of becoming familiar with the unborn baby's fetal movement pattern, used epidural to a lower extent than women who were not informed about the method. Future studies are needed to investigate and understand the association between Mindfetalness and the reduced usage of epidural during birth.
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Affiliation(s)
- Helena Lindgren
- Department of Women and Children's Health, Karolinska Institutet, Stockholm, Sweden.
| | | | - Karin Pettersson
- Department of Clinical Science, Intervention and Technology, Stockholm, Sweden.
| | - Viktor Skokic
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Anna Akselsson
- Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden.
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Seyoum T, Alemayehu M, Christensson K, Lindgren H. Client Factors Affect Provider Adherence to Guidelines during First Antenatal Care in Public Health Facilities, Ethiopia: A Multi-Center Cross-Sectional Study. Ethiop J Health Sci 2021; 30:903-912. [PMID: 33883835 PMCID: PMC8047236 DOI: 10.4314/ejhs.v30i6.8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Timely entry to an antenatal care with a healthcare provider who follows a set of national guidelines is assumed to ensure higher levels of client satisfaction. It is also expected to improve perinatal outcomes. Little is known about the level of adherence of Ethiopian providers to these guidelines. Therefore, this study aims to assess the proportion of clients who received complete (100%) provider adherence to antenatal care guidelines at the first visit and client associated factors in Gondar Town. Methods A cross-sectional study of 834 study participants was conducted in public health facilities of Gondar Town in Ethiopia. An 18 point checklist was used to observe provider adherence to the first antenatal care visit guidelines. Descriptive statistics and multivariable binary logistic regression model were done by using STATA 14 software. Result The proportion of clients who received the complete provider's adherence to the first antenatal care guideline was 32.25% (95% CI: 29.1–35.5). The mean adherence score was 16.78%. Women who had prior history of pregnancy and/or birth-related complications (AOR = 1.58; 95%CI: 1.04–2.04) and late antenatal care booking at gestational week 16 or greater (AOR = 1.45; 95%CI: 1.03–2.03) were significantly associated with clients receiving complete providers' adherence to the first antenatal guideline. Conclusions We found the level of adherence to national antenatal care guidelines during first visit as surprisingly low. When considering to upgrade the guidelines to the actual WHO guideline of eight visits, we recommend that refresher training be provided regularly to help staff understand the importance of following the guidelines as closely as possible. Perhaps, we need to learn more from the health care providers themselves about their reasons for not following the guidelines.
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Affiliation(s)
- Tewodros Seyoum
- School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mekuriaw Alemayehu
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Kyllike Christensson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Helena Lindgren
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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Erlandsson K, Lindgren H, Wettergren L, Mekuriaw A, Berta M, Melkamu M, Seyoum T, Hailemeskel S, Jember A, Hassen M, Gebrie M, Geda B, Gelaye K, Mekonnen SH, Mekonnen Abebe S, Christensson K. Half-time evaluation of a new 4-year Ph.D. program in nursing and midwifery at the University of Gondar, Ethiopia. Glob Health Action 2021; 14:1905304. [PMID: 34402771 PMCID: PMC8381928 DOI: 10.1080/16549716.2021.1905304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A new four-year Ph.D. programme in nursing and midwifery, the first of its kind in Ethiopia, was started in 2018/2019 at the University of Gondar when eight doctoral students in nursing and midwifery entered the program. We who have been involved see this as an appropriate time to evaluate what has been accomplished to date and to look toward future possibilities. Our aim in carrying out such an evaluation and presenting our findings is in part to determine if similar programs might be developed in other similar settings and in part to learn what modifications to the present program might be considered. The key elements of a questionnaire survey with closed and open response alternatives were based on the content, structure and learning outcomes of the home university Ph.D. programme as described in the curriculum. The questionnaire responses captured changes that would be needed to maintain a fully satisfactory programme that blends onsite instruction and online access to faculty resulting in a twenty-first century blended Ph.D. programme. Improved dialogue between the home university faculty and the external supervisors is needed. The programme can provide a career pathway that midwifery and nursing educators can follow in their own country rather than having to leave to study in another country. The findings provide insight into the feasibility of extending similar Ph.D. programmes to other parts of East Africa and with the SDG 5 in mind with an increased focus on women leadership. The justification for this initiative is to meet the need for more nursing and midwifery faculty who can provide quality midwifery and nursing education in East African countries. Retention of these professionals will help to deal with the shortage of healthcare personnel and will provide better care for the general population.
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Affiliation(s)
| | - Helena Lindgren
- Women's and Children's Health, Karolinska Institutet, Sweden
| | - Lena Wettergren
- Women's and Children's Health, Karolinska Institutet, Sweden
| | - Alemayehu Mekuriaw
- Institute of Public Health, College of Medicine and Health Science, University of Gondar, Ethiopia
| | - Marta Berta
- School of Midwifery, College of Medicine and Health Science, University of Gondar, Ethiopia
| | - Mengstu Melkamu
- School of Midwifery, College of Medicine and Health Science, University of Gondar, Ethiopia
| | - Tewodros Seyoum
- School of Midwifery, College of Medicine and Health Science, University of Gondar, Ethiopia
| | - Solomon Hailemeskel
- School of Midwifery, College of Medicine and Health Science, University of Gondar, Ethiopia
| | - Abebaw Jember
- School of Nursing, College of Medicine and Health Science, University of Gondar, Ethiopia
| | - Mohammed Hassen
- School of Nursing, College of Medicine and Health Science, University of Gondar, Ethiopia
| | - Mignote Gebrie
- School of Nursing, College of Medicine and Health Science, University of Gondar, Ethiopia
| | - Biftu Geda
- Department of Nursing, College of Health and Medical Science, Meda Welabu University, Ethiopia
| | - Kassahun Gelaye
- Institute of Public Health, College of Medicine and Health Science, University of Gondar, Ethiopia
| | | | - Salomon Mekonnen Abebe
- Health Sciences, Addis Ababa University by College of Health Science, Addis Ababa University, Ethiopia
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Seyoum T, Alemayehu M, Christensson K, Lindgren H. Provider-perceived benefits and constraints of complete adherence to antenatal care guideline among public health facilities, Ethiopia: A qualitative study. PLoS One 2021; 16:e0255297. [PMID: 34370765 PMCID: PMC8351951 DOI: 10.1371/journal.pone.0255297] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 07/13/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND In Ethiopia, health care providers' level of adherence to the national Antenatal Care (ANC) guideline is relatively low. The reasons why they do not follow the guidelines are not well known. Therefore, this study aimed to explore the provider-perceived benefits and constraints associated with using the guideline for ANC in public health facilities in Gondar town. METHODS A qualitative study was conducted using a semi-structured interview guide. The interview was conducted among a purposive sample of nine health care providers working in four public health facilities in Gondar town. After the interviews were transcribed and coded, a content analysis was done using Atlas ti version 7.5 software packages. RESULT Decreasing provider's workload and maximizing performance, improving safe motherhood, and improving the process of service delivery were reported as the perceived benefits of following ANC guideline. Organizational problems, care providers' existing knowledge, attitude, and skills and availability of training and mentorship were the three main identified groups of factors that hinder complete providers' adherence to ANC guideline. CONCLUSION Although providers acknowledged the benefits of following ANC guideline, the guideline is not fully implemented. Refresher training should be given at the start of the updated eight-contact ANC guideline and continuing education and supervision throughout the implementation process. Health care providers call for profound and urgent revisions of the supply chain system for supplies and equipment.
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Affiliation(s)
- Tewodros Seyoum
- School of Midwifery, College of Medicine Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mekuriaw Alemayehu
- Department of Environmental Health, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Kyllike Christensson
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Helena Lindgren
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
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Gu C, Lindgren H, Wang X, Zhang Z, Liang S, Ding Y, Qian X. Developing a midwifery service task list for Chinese midwives in the task-shifting context: a Delphi study. BMJ Open 2021; 11:e044792. [PMID: 34266838 PMCID: PMC8286777 DOI: 10.1136/bmjopen-2020-044792] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 06/16/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To develop and validate a midwifery-led task list in the task-shifting context. DESIGN An extensive literature review followed by a two-iterative Delphi survey. SETTING Twenty university hospitals, three non-university hospitals and four university colleges from nine provincial regions of China. PARTICIPANTS Purposive non-probability sampling of a national panel of experts in maternal healthcare, obstetrics, nursing and midwifery. Experts in the panel were asked to rate each midwifery service item regarding importance, feasibility and advancement on a 5-point scale, in order to determine those best suited for midwifery-led practice in China. RESULTS Two rounds of Delphi surveys were completed before consensus was achieved, with effective response rate ranging from 96.4% (27/28) to 100% (27/27), indicating a high positive coefficient of the experts. The authority coefficient of experts was 0.882, indicating the high reliability of this study. The Kendall harmony coefficient (W) in the two rounds of consultations was 0.196 (p<0.001) and 0.324 (p<0.001), respectively. A detailed, three-level midwifery-led task list was developed, including 3 domains of midwifery practice (first-level indicators), 13 types of task (second-level indicators) and 58 midwifery service items (third-level indicators). The 3 domains of midwifery practice involved the appropriate scope of practice for Chinese midwives, including antenatal care, intrapartum care and postnatal care. The 58 service items embraced core components of caring task in the Chinese midwifery profession. CONCLUSION This study outlines the first midwifery-led task list that defines clearly the Chinese midwives' scope of practice. It will provide a foundational framework for future midwifery practice in China and abroad, and can be used to inform the design of midwifery-led task shifting interventions in various maternity settings.
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Affiliation(s)
- Chunyi Gu
- Department of Nursing, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, Shanghai, China
- Global Health Institute, Fudan University, Shanghai, China
| | - Helena Lindgren
- Department of Women's and Children's Health, Reproductive Health, Karolinska Institute, Stockholm, Sweden
| | - Xiaojiao Wang
- Department of Nursing, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Zheng Zhang
- Department of Obstetrics, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Shuang Liang
- Department of Nursing, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Yan Ding
- Department of Nursing, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Xu Qian
- Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, Shanghai, China
- Global Health Institute, Fudan University, Shanghai, China
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Radestad I, Pettersson K, Lindgren H, Skokic V, Akselsson A. Country of birth, educational level and other predictors of seeking care due to decreased fetal movements: an observational study in Sweden using data from a cluster-randomised controlled trial. BMJ Open 2021; 11:e050621. [PMID: 34172554 PMCID: PMC8237734 DOI: 10.1136/bmjopen-2021-050621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To identify predictors of seeking care for decreased fetal movements and assess whether care-seeking behaviour is influenced by Mindfetalness. DESIGN Observational study with data from a cluster-randomised controlled trial. SETTING 67 maternity clinics and 6 obstetrical clinics in Sweden. PARTICIPANTS All pregnant women with a singleton pregnancy who contacted the obstetrical clinic due to decreased fetal movements from 32 weeks' gestation of 39 865 women. METHODS Data were collected from a cluster-randomised controlled trial where maternity clinics were randomised to Mindfetalness or routine care. Mindfetalness is a self-assessment method for women to use daily to become familiar with the unborn baby's fetal movement pattern. OUTCOME MEASURES Predictors for contacting healthcare due to decreased fetal movements. RESULTS Overall, 5.2% (n=2059) of women contacted healthcare due to decreased fetal movements, among which 1287 women (62.5%) were registered at a maternity clinic randomised to Mindfetalness and 772 women (37.5%) were randomised to routine care. Predictors for contacting healthcare due to decreased fetal movements were age, country of birth, educational level, parity, prolonged pregnancy and previous psychiatric care (p<0.001). The main differences were seen among women born in Africa as compared with Swedish-born women (2% vs 6%, relative risk (RR) 0.34, 95% CI 0.25 to 0.44) and among women with low educational level compared with women with university-level education (2% vs 5.4%, RR 0.36, 95% CI 0.19 to 0.62). Introducing Mindfetalness in maternity care increased the number of women seeking care due to decreased fetal movements overall. CONCLUSION Women with country of birth outside Sweden and low educational level sought care for decreased fetal movements to a lesser extent compared with women born in Sweden and those with university degrees. Future research could explore whether pregnancy outcomes can be improved by motivating women in these groups to contact healthcare if they feel a decreased strength or frequency of fetal movements. TRIAL REGISTRATION NUMBER NCT02865759.
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Affiliation(s)
- Ingela Radestad
- Reproductive Health, Sophiahemmet University, Stockholm, Sweden
| | - Karin Pettersson
- Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - Helena Lindgren
- Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Viktor Skokic
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
| | - Anna Akselsson
- Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
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Sharma B, Christensson K, Bäck L, Karlström A, Lindgren H, Mudokwenyu-Rawdon C, Maimbolwa MC, Laisser RM, Omoni G, Chimwaza A, Mwebaza E, Kiruja J, Hildingsson I. African midwifery students' self-assessed confidence in postnatal and newborn care: A multi-country survey. Midwifery 2021; 101:103051. [PMID: 34153740 DOI: 10.1016/j.midw.2021.103051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 04/08/2021] [Accepted: 05/20/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Majority of maternal and new-born deaths occur within 28 hours and one week after birth. These can be prevented by well-educated midwives. Confidence in postnatal and newborn care skills depend on the quality of midwifery education. OBJECTIVE To assess confidence and its associated factors for basic postnatal and new-born care skills of final year midwifery students , from seven African countries. METHODS A multi-country cross-sectional study where final year midwifery students answered a questionnaire consisting of basic skills of postnatal and newborn care listed by the International Confederation of Midwives. The postnatal care area had 16 and newborn care area had 19 skill statements. The 16 skills of postnatal care were grouped into three domains through principle component analysis (PCA); Basic postnatal care; postnatal complications and educating parents and documentation. The 19 skills under the newborn care area were grouped into three domains; Basic care and care for newborn complications; Support parents for newborn care; and Care for newborns of HIV positive mothers and documentation. RESULTS In total 1408 midwifery students from seven Sub-Saharan countries participated in the study namely; Kenya, Malawi, Tanzania, Uganda, Zambia, Zimbabwe, and Somaliland Overall high confidence for all domains under Post Natal Care ranged from 30%-50% and for Newborn care from 39-55%. High confidence for postnatal skills was not found to be associated with any background variables (Age, sex, type and level of educational programme). High confidence for newborn care was associated with being female students, those aged 26-35 years, students from the direct entry programmes and those enrolled in diploma programmes. CONCLUSIONS Almost half of the study participants expressed lack of confidence for skills under postnatal and newborn care. No association was found between high confidence for domains of postnatal care and background variables. High confidence was associated with being a female, between 26-35 years of age, from direct entry or diploma programmes for newborn care area. The results of the study indicate gaps in midwifery education. Countries could use the ICM list of competencies to develop country specific standards for midwifery education. However, actual competence remains to be measured.
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Affiliation(s)
- Bharati Sharma
- Indian Institute of Public Health Gandhinagar, India; Department of Women's and Children's health, Karolinska Institutet, Stockholm, Sweden.
| | - Kyllike Christensson
- Department of Women's and Children's health, Karolinska Institutet, Stockholm, Sweden
| | - Lena Bäck
- Department of Nursing, Mid Sweden University, Sundsvall, Sweden
| | | | - Helena Lindgren
- Department of Women's and Children's health, Karolinska Institutet, Stockholm, Sweden
| | | | | | | | - Grace Omoni
- School of Nursing Science, University of Nairobi, Kenya
| | | | - Enid Mwebaza
- Jhpiego Johns Hopkins University, Kampala, Uganda
| | - Jonah Kiruja
- Hargeisa University, Somaliland, Africa; Dalarna University, Falun, Sweden
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Jingar M, Lindgren H, Blusi M. Exploring Limitations of User Interface Design to Understanding the Gap Between Technology and Seniors. Stud Health Technol Inform 2021; 281:931-935. [PMID: 34042810 DOI: 10.3233/shti210315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Participating in social activities promotes healthy ageing, whereas loneliness and isolation are known to cause adverse effects on both physical and mental wellbeing. Technology that exists in society today can facilitate healthy ageing. However, a gap can be seen between seniors and technology in today's internet and communication technological device's user interfaces. Due to limited prior knowledge of interacting with touch screen devices, seniors sometimes have difficulties using them. This research aims to explore the user interfaces and their elements designed using a human-centered design methodology by involving seniors as activate participants in the design process. This work's outcome can improve current user interface design practices in touch screen devices, which might be seen as contributing step to understand the gap between seniors and technology.
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Affiliation(s)
- Monika Jingar
- Department of Computing Science, Umeå University, Sweden
| | | | - Madeleine Blusi
- Department of Community Medicine and Rehabilitation, Umeå University, Sweden
- Department of Nursing, Umeå University, Sweden
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Schytt E, Wahlberg A, Small R, Eltayb A, Lindgren H. The community-based bilingual doula - A new actor filling gaps in labour care for migrant women. Findings from a qualitative study of midwives' and obstetricians' experiences. Sex Reprod Healthc 2021; 28:100614. [PMID: 33813256 DOI: 10.1016/j.srhc.2021.100614] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 02/26/2021] [Accepted: 03/08/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To explore midwives' and obstetricians' views about community-based bilingual doula (CBD) support during migrant women's labour and birth and their experiences of collaborating with CBDs. STUDY DESIGN A qualitative study with semi-structured individual interviews with 7 midwives and 4 obstetricians holding clinical positions in labour care in Stockholm, Sweden, who all had experiences of working with a CBD. Data analysis followed the framework of thematic analysis. RESULTS The overarching theme was A new actor filling gaps in labour care - With appropriate boundary setting, CBDs can help improve care for migrant women. One year after the introduction of CBDs, the midwives and obstetricians had mainly positive experiences of CBDs who were considered to fill important gaps in maternity care for migrant women, being with the woman and simultaneously being part of the care team and this made providing high quality care easier. The CBDs' main contribution was to help migrant women navigate the maternity care system, to bridge language and cultural divides, and guarantee continuous labour and birth support. However, midwives and obstetricians sometimes experienced CBDs interfering with their professional assessments and decisions and the role of the CBD was somewhat unclear to them. CONCLUSIONS Community-based bilingual doula support was viewed as improving migrant women's well-being during labour and birth and as increasing the possibilities for midwives and obstetricians to provide good and safe care, however, some ambivalence remained about the CBD's role and boundaries.
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Affiliation(s)
- Erica Schytt
- Division of Reproductive Health, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Centre for Clinical Research Dalarna - Uppsala University, Falun, Sweden; Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway.
| | - Anna Wahlberg
- Division of Reproductive Health, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Rhonda Small
- Division of Reproductive Health, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Judith Lumley Centre, La Trobe University, Melbourne Victoria, Australia
| | - Amani Eltayb
- Division of Reproductive Health, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Helena Lindgren
- Division of Reproductive Health, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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Akselsson A, Lindgren H, Georgsson S, Pettersson K, Skokic V, Rådestad I. Pregnancy outcomes among women born in Somalia and Sweden giving birth in the Stockholm area - a population-based study. Glob Health Action 2021; 13:1794107. [PMID: 32744184 PMCID: PMC7480426 DOI: 10.1080/16549716.2020.1794107] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Studies report that women born in some African countries, after migrating to the Nordic countries, have worse pregnancy outcomes than women born in the receiving countries. With the aim of identifying unmet needs among Somali-born women, we here study this subgroup. Objective We compared pregnancy outcomes among women born in Somalia to women born in Sweden. Further, we investigated whether the proactive maternal observation of fetal movements has effects on birth outcomes among women born in Somalia. Methods In Stockholm, half of the maternity clinics were randomized to intervention, in which midwives were instructed to be proactive towards women by promoting daily self-monitoring of fetal movements. Data for 623 women born in Somalia and 26 485 born in Sweden were collected from a population-based register. Results An Apgar score below 7 (with stillbirth counting as 0) at 5 minutes was more frequent in babies of women born in Somalia as compared to babies of women born in Sweden (RR 2.17, 95% CI 1.25–3.77). Babies born small for gestational age were more common among women born in Somalia (RR 2.22, CI 1.88–2.61), as were babies born after 41 + 6 gestational weeks (RR 1.65, CI 1.29–2.12). Somali-born women less often contacted obstetric care for decreased fetal movements than did Swedish-born women (RR 0.19, CI 0.08–0.36). The differences between women born in Somalia and women born in Sweden were somewhat lower (not statistically significant) among women allocated to proactivity as compared to the Routine-care group. Conclusions A higher risk of a negative outcome for mother and baby is seen among women born in Somalia compared to women born in Sweden. We suggest it may be worthwhile to investigate whether a Somali-adapted intervention with proactivity concerning self-monitoring of fetal movements may improve pregnancy outcomes in this migrant population.
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Affiliation(s)
- Anna Akselsson
- Department of Health Promoting Science, Sophiahemmet University , Stockholm, Sweden
| | - Helena Lindgren
- Department of Women and Children's Health, Karolinska Institutet , Stockholm, Sweden
| | - Susanne Georgsson
- The Swedish Red Cross University College , Stockholm, Sweden.,Department of Clinical Science, Intervention and Technology, Karolinska Institutet , Stockholm, Sweden
| | - Karin Pettersson
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet , Stockholm, Sweden
| | - Viktor Skokic
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg , Gothenburg, Sweden
| | - Ingela Rådestad
- Department of Health Promoting Science, Sophiahemmet University , Stockholm, Sweden
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Rotstein E, Åhlund S, Lindgren H, Lindén Hirschberg A, Rådestad I, Tegerstedt G. Posterior compartment symptoms in primiparous women 1 year after non-assisted vaginal deliveries: a Swedish cohort study. Int Urogynecol J 2021; 32:1825-1832. [PMID: 33646348 PMCID: PMC8295137 DOI: 10.1007/s00192-021-04700-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/10/2021] [Indexed: 11/26/2022]
Abstract
Introduction and hypothesis This is a prospective cohort follow-up study based on the hypothesis that primiparous women with non-assisted vaginal deliveries and a second-degree perineal tear have more posterior compartment symptoms 1 year after delivery than those with no or first-degree tears. Methods A follow-up questionnaire, including validated questions on pelvic floor dysfunction, was completed 1 year postpartum by 410 healthy primiparas, delivered without instrumental assistance at two maternity wards in Stockholm between 2013 and 2015. Main outcome measures were posterior compartment symptoms in women with second-degree perineal tears compared with women with no or only minor tears. Results Of 410 women, 20.9% had no or only minor tears, 75.4% had a second-degree tear, and 3.7% had a more severe tear. Of women presenting with second-degree tears, 18.9% had bowel-emptying difficulties compared with 20.0% of women with minor tears. Furthermore, almost 3% of them with second-degree tears complained of faecal incontinence (FI) of formed stool, 7.2% of FI of loose stool compared with 1.2% and 3.5% respectively in women with no or only minor tears. Conclusions Symptomatic pelvic floor dysfunction is common among primiparous women within 1 year following uncomplicated vaginal delivery, and there are no significant differences between second-degree perineal tears and minor tears. These symptoms should be addressed in all women after delivery to improve pelvic floor dysfunction and quality of life.
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Affiliation(s)
- Emilia Rotstein
- Karolinska Pelvic Floor Centre, Karolinska University Hospital Huddinge, Stockholm, Sweden.
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, 171 77, Solna, Sweden.
| | - Susanne Åhlund
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Helena Lindgren
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Angelica Lindén Hirschberg
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Department of Gynaecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | | | - Gunilla Tegerstedt
- Karolinska Pelvic Floor Centre, Karolinska University Hospital Huddinge, Stockholm, Sweden
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, 171 77, Solna, Sweden
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