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  • 1.
    Agnafors, Sara
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences.
    Comasco, Erika
    Division of Pharmacology, Department of Neuroscience, Uppsala University, Uppsala, Sweden.
    Bladh, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Dekeyser, Linda
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Oreland, Lars
    Division of Pharmacology, Department of Neuroscience, Uppsala University, Uppsala, Sweden.
    Svedin, Carl Göran
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Effect of gene, environment and maternal depressive symptoms on pre-adolescence behavior problems - a longitudinal study.2013In: Child and Adolescent Psychiatry and Mental Health, ISSN 1753-2000, E-ISSN 1753-2000, Vol. 7, no 1, 10- p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Depression is a common and disabling condition with a high relapse frequency. Maternal mental health problems and experience of traumatic life events are known to increase the risk of behavior problems in children. Recently, genetic factors, in particular gene-by-environment interaction models, have been implicated to explain depressive etiology. However, results are inconclusive.

    METHODS: Study participants were members of the SESBiC-study. A total of 889 mothers and their children were followed during the child's age of 3 months to 12 years. Information on maternal depressive symptoms was gathered postpartum and at a 12 year follow-up. Mothers reported on child behavior and traumatic life events experienced by the child at age 12. Saliva samples were obtained from children for analysis of 5-HTTLPR and BDNF Val66Met polymorphisms.

    RESULTS: Multivariate analysis showed a significant association between maternal symptoms of depression and anxiety, and internalizing problems in 12-year-old children (OR 5.72, 95% CI 3.30-9.91). Furthermore, carriers of two short alleles (s/s) of the 5-HTTLPR showed a more than 4-fold increased risk of internalizing problems at age 12 compared to l/l carriers (OR 4.73, 95% CI 2.14-10.48). No gene-by-environment interaction was found and neither depressive symptoms postpartum or traumatic experiences during childhood stayed significant in the final model.

    CONCLUSIONS: Concurrent maternal symptoms of depression and anxiety are significant risk factors for behavior problems in children, which need to be taken into account in clinical practice. Furthermore, we found a main effect of 5-HTTLPR on internalizing symptoms in 12-year-old children, a finding that needs to be confirmed in future studies.

  • 2.
    Agnafors, Sara
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Svedin, Carl Göran
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Oreland, Lars
    Department of Neuroscience, Uppsala University, Uppsala, Sweden.
    Bladh, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Comasco, Erika
    Department of Neuroscience, Uppsala University, Uppsala, Sweden.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    A biopsychosocial approach to risk and resilience on behavior in children followed from birth to age twelve2016Manuscript (preprint) (Other academic)
    Abstract [en]

    An increasing prevalence of mental health problems calls for more knowledge into factors associated with resilience in the context of child behavior. Biological factors are seldom considered in psychosocial models of resilience. The present study used multiple statistical methodologies to examine a biopsychosocial model of risk and resilience on behavior at preadolescence. Data from 889 children and their mothers were used. A cumulative adversity score was created by combining maternal symptoms of depression, psychosocial risk and children’s experiences of life events. The proposed resilience factors investigated were candidate genetic polymorphisms, child temperament and social functioning, and maternal sense of coherence. Results show that the l/l genotype of the serotonin transporter linked polymorphic region (5-HTTLPR) was associated with lower internalizing scores, especially for children exposed to low adversity. An easy temperament was associated with resilient outcomes for children exposed to high adversity. Child social functioning was found to be more of a general resource variable buffering risk in both high and low adversity groups. The results support a multiple level model of resilience indicating effects, though small, of both biological and psychosocial factors. The present findings call for both preventive actions and further studies on biopsychosocial models in resilience research.

  • 3.
    Agnafors, Sara
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Comasco, Erika
    Department of Neuroscience, Uppsala University, Uppsala, Sweden.
    Bladh, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Oreland, Lars
    Department of Neuroscience, Uppsala University, Uppsala, Sweden.
    Svedin, Carl Göran
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Early predictors of behavioural problems in pre-schoolers: a longitudinal study of constitutional and environmental main and interaction effects2016In: BMC Pediatrics, ISSN 1471-2431, E-ISSN 1471-2431, Vol. 16Article in journal (Refereed)
    Abstract [en]

    Background: The early environment is important for child development and wellbeing. Gene-by-environment studies investigating the impact of the serotonin transporter genelinked polymorphic region (5-HTTLPR) and the Brain Derived Neurotrophic Factor (BDNF) Val66Met polymorphisms by life events on mental health and behaviour problems have been inconclusive. Methodological differences regarding sample sizes, study population, definitions of adversities and measures of mental health problems obstacle their comparability. Furthermore, very few studies included children. The aim of this study was to examine the associations between a broad range of risk factors covering pregnancy and birth, genetic polymorphism, experience of multiple life events and psychosocial environment, and child behaviour at age three, using a comparably large, representative, population-based sample.

    Methods: A total of 1,106 children, and their mothers, were followed from pregnancy to age three. Information on pregnancy and birth-related factors was retrieved from the Medical Birth Register. Questionnaires on depressive symptoms, child behaviour and child experiences of life events were filled in by the mothers. Child saliva samples were used for genotyping the 5-HTTLPR and BDNF Val66Met polymorphisms. Multiple logistic regression was used to investigate the association between psychological scales and genetic polymorphisms.

    Results: Symptoms of postpartum depression increased the risk of both internalizing and externalizing problems. Experience of multiple life events was also a predictor of behavioural problems across the scales. No gene-by-environment or gene-bygene-by-environment interactions were found. Children of immigrants had an increased risk of internalizing problems and parental unemployment was significantly associated with both internalizing and externalizing type of problems.

    Conclusion: This study shows the importance of the psychosocial environment for psychosocial health in preschool children, and adds to  the literature of null-findings of gene-by-environment effects of 5-HTTLPR and BDNF in children

  • 4.
    Agnafors, Sara
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    deKeyser, Linda
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences.
    Göran Svedin, Carl
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences.
    Symptoms of Depression Postpartum and 12 years Later-Associations to Child Mental Health at 12 years of Age2013In: Maternal and Child Health Journal, ISSN 1092-7875, E-ISSN 1573-6628, Vol. 17, no 3, 405-414 p.Article in journal (Refereed)
    Abstract [en]

    Children of depressed mothers have been shown to express behaviour problems to a greater extent than children of non-depressed mothers. The purpose of this study was to examine the persistence of depressive symptoms in mothers and to evaluate the relative importance of symptoms of postpartum depression (PPD) and concurrent maternal symptoms of depression, on child behaviour at age 12. A birth cohort of 1,707 children and their mothers was followed from 3 months after birth to 12 years after birth. Self-reported symptoms of depression in mothers were assessed at baseline and 12-year follow-up where 893 mothers (52.3 %) and their children participated. The mothers reports on the behaviour of their children at age 12 were used. Multivariate analysis was used to assess factors that increased the risk of child behaviour problems. At baseline, 10.4 % scored above the cutoff for symptoms of postpartum depression. At follow up, 18.2 % scored above the cutoff for depressive symptoms. Multivariate analysis showed that ongoing maternal symptoms of depression, as distinct from PPD-symptoms, was the strongest predictor of child behaviour problems at age 12. The gender of the child and socio-demographic factors at baseline were additional factors that affected the risk of behaviour problems in the 12 year old children. Children of mothers who reported symptoms of depression, both postpartum and at follow-up, were at a greater risk of behaviour problems compared to children of women with no depressive symptoms on either occasion. Our findings indicate that recurrent and ongoing maternal depressive symptoms significantly increase the risk of child behaviour problems as reported by mothers, while symptoms of PPD do not seem to result in an increased risk of behaviour problems in 12 year olds. High maternal socio-demographic life stress at childbirth constitutes an important risk factor for later child behaviour problems.

  • 5.
    Berg, Göran
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Ernerudh, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Diagnostics, Department of Clinical Immunology and Transfusion Medicine.
    Jenmalm, Maria
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Rodriguez-Martinez, Heriberto
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Special Issue: Marcus Wallenberg International Symposium in Comparative Reproductive Immunology, "Immunology at the fetal maternal interface: Basic science and clinical applications", July 7-8th, 2011, Linkoping University, Sweden2011In: American Journal of Reproductive Immunology, ISSN 1046-7408, E-ISSN 1600-0897, Vol. 66, no Issue supplement 1, 1-1 p.Article in journal (Other academic)
  • 6.
    Bladh, Marie
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Carstensen, John
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences.
    Josefsson, Ann
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Finnström, Orvar
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Hospitalization in Adolescence and Young Adulthood Among Twins and Singletons: A Swedish Cohort Study of Subjects Born Between 1973 and 19832013In: Twin Research and Human Genetics, ISSN 1832-4274, E-ISSN 1839-2628, Vol. 16, no 3, 707-715 p.Article in journal (Refereed)
    Abstract [en]

    Children born with non-optimal birth characteristics — that is, are small for gestational age and/or preterm — have an increased risk for several long-term effects such as neurological sequelae and chronic disease. The purpose of this study was to examine whether twins exhibited a different outcome, compared with singletons, in terms of hospitalization during adolescence and early adulthood, and to what extent differences remain when considering the divergence in birth characteristics between singletons and twins. Persons born between 1973 and 1983 in Sweden and surviving until age 13 were included and followed until the end of 2006. Data on birth characteristics, parental socio-demographic factors, and hospitalizations were collected from national registers. Adjusting for parental socio-demographic factors, twins had a higher risk of being hospitalized than singletons (odds ratio, OR = 1.17, 95% confidence interval, CI = 1.10–1.25) and more often due to ‘Congenital anomalies’ (OR = 1.18, 95% CI = 1.06–1.28), ‘Infections’ (OR = 1.14; 95% CI = 1.08–1.20), ‘External causes of illness’ (OR = 1.10, 95% CI = 1.06–1.15), and ‘Diseases of the nervous system’ (OR = 1.18, 95% CI = 1.10–1.26). Stratifying for birth characteristics, this difference diminishes, and for some diagnoses non-optimal twins seem to do slightly better than non-optimal singletons. Thus, twins with non-optimal birth characteristics had a lower risk of hospitalization than non-optimal singletons on, for example, ‘Congenital anomalies’ and ‘Diseases of the nervous system’ (OR = 0.86, 95% CI = 0.77–0.96; OR = 0.88, 95% CI = 0.81–0.97, respectively) and Total (any) hospitalization (OR = 0.87, 95% CI = 0.83–0.92). Among those with optimal birth characteristics, twins had an increased hospitalization due to ‘External causes of illness’ (OR = 1.07, 95% CI = 1.02–1.13) compared with optimal singletons. Twins have higher hospitalization rates than singletons. In stratifying for birth characteristics, this difference diminishes, and for some diagnoses, non-optimal twins seem to do less poorly than non-optimal singletons.

  • 7.
    Bladh, Marie
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Josefsson, Ann
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Carstensen, John
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Finnström, Orvar
    Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping. Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Intergenerational cohort study of preterm and small-for-gestational-age birth in twins and singletons2015In: Twin Research and Human Genetics, ISSN 1832-4274, E-ISSN 1839-2628, Vol. 18, no 5, 581-590 p.Article in journal (Refereed)
    Abstract [en]

    To date several studies have investigated the intergenerational effect of preterm and small-for-gestational-age births. However, most studies excluded both twin mothers and twin offspring from the analyses. Thus, the objective of this study was to investigate the intergenerational effect of preterm birth and small for gestational age (SGA) among twins and singletons.

    A prospective population based register study of mother-first-born offspring pairs recorded in the Swedish Medical Birth Register was performed. The study included 4073 twins and 264,794 singletons born in 1973-1983 and their firstborns born in 1986-2009. Preterm birth was defined as birth <37 weeks of gestation and SGA as < 2 standard deviations of the Swedish standard. Logistic regressions were performed to estimate the intergenerational effect of each birth characteristic. Adjustments were made for maternal grandmothers and mother’s socio-demographic factors in addition to maternal birth- characteristics.

    Among mothers born as singletons, being born preterm was associated with an increased risk for delivering a preterm child (adjusted OR 1.39, 95% CI 1.29-1.50) while being born SGA increased the likelihood of a SGA child (adjusted OR 3.04, 95% CI 2.80-3.30) as well as a preterm child (adjusted OR 1.30, 95% CI 1.20-1.40). In twin mothers, the corresponding ORs tended to be lower and the only statistically significant association was between a SGA mother and a SGA child (adjusted OR 2.15, 95% CI 1.40-3.31). A statistically significant interaction between twinning and mother’s size for gestational was identified in a multivariate linear regression analysis indicating that singleton mothers born SGA were associated with a lower birth weight compared to mothers not born SGA.

    Preterm birth and SGA appear to be transferred from one generation to the next, although not always reaching statistical significance. These effects seem to be less evident in mothers born as twins compared with those born as singletons.

  • 8.
    Bladh, Marie
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Josefsson, Ann
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Carstensen, John
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Finnström, Orvar
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Reproductive pattern among twins and singletons in relation to number of siblings: a Swedish cohort study of individuals born between 1973 and 19932015Manuscript (preprint) (Other academic)
    Abstract [en]

    Background Twinning has been shown to be associated with a reduced reproductive rate compared to singletons. This can partly be explained by the birth-characteristics pertaining to twinning as many twins are born preterm, with low birth weight or small for gestational age. However, the intergenerational reproductive rate may also be due to familial factors such as number of siblings.

    Methods This is a register-based study of all men and women born in Sweden between 1973 and 1993 who were living in Sweden at 13 years of age. Data on the study objects’ own births as well as their offspring, parental socio-demographic factors were collected from Swedish population based registers. Hazard ratios for the likelihood of becoming a parent were estimated using Cox’s proportion hazard models. All models were adjusted for socio-demographic and birth characteristics.

    Results Adjusting for number of siblings, socio-demographic factors and birth characteristics, twinning was associated with a decreased likelihood of becoming a first-time parent, compared with singletons both for females (HR (95% CI)=0.90 (0.88-0.93) and males (HR (95% CI)=0.96 (0.93-0.99). Having 3 or more siblings increased the chance of becoming a first-time parent among both male twins (HR (95% CI)=1.17 (1.08-1.27)) and singletons (HR (95% CI)=1.16 (1.15-1.18)) compared to having fewer than 3 siblings. This increased likelihood of becoming a parent was also present among female twins (HR (95% CI)=1.18 (1.10-1.26)) and singletons (HR (95% CI)=1.22 (1.21-1.24)).

    Conclusions Twins have a decreased likelihood of becoming a parent compared to singletons even when adjusting for number of siblings.

  • 9.
    Bladh, Marie
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Josefsson, Ann
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Carstensen, John
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences.
    Finnström, Orvar
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Reproductive patterns among twins: a Swedish register study of men and women born 1973-19832013In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 13Article in journal (Refereed)
    Abstract [en]

    Background

    During the last decades there has been a steady increase of twin births. A combination of improved medical treatment of preterm and small-for-gestational age children has contributed to a higher number of surviving twins. Prematurity is known to affect reproduction in a negative way. Few studies have focused on the potential effect twinning may have on future reproduction. Thus, the aim of this study was to investigate the effect of being born a twin compared to being born a singleton have on future reproduction.

    Methods

    In a national population-based register study, all individuals born between 1973–1983 who were alive and living in Sweden at 13 years of age (n = 1 016 908) constituted the sample. Data on each study subject’s own birth as well as the birth of their first offspring, and parental socio-demographic factors were collected from Swedish population based registers. Hazard ratios and corresponding 95% CI was calculated using Cox proportional hazards model.

    Results

    Twins, both men and women, had a reduced likelihood of reproducing compared to singletons (women: HR = 0.89, 95% CI = 0.86-0.93; men: HR = 0.92, 95% CI = 0.87-0.97). This difference in birth rates can only partly be explained by diverging birth characteristics. Amongst men and women born very preterm, twins had an increased likelihood of reproducing compared to singletons (women: HR = 1.25, 95% CI = 1.02-1.62; men: HR = 1.34, 95% CI = 1.01-1.78).

    Conclusions

    Twins have lower reproduction rates compared to singletons, which only to a certain degree can be explained by diverging birth characteristics.

  • 10.
    Borneskog, C.
    et al.
    Uppsala University, Sweden .
    Lampic, C.
    Karolinska Institute, Sweden .
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Bladh, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynecology and Obstetrics UHL.
    Skoog Svanberg, A.
    Uppsala University, Sweden .
    How do lesbian couples compare with heterosexual in vitro fertilization and spontaneously pregnant couples when it comes to parenting stress?2014In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 103, no 5, 537-545 p.Article in journal (Refereed)
    Abstract [en]

    AimTo study parenting stress in lesbian parents and to compare that stress with heterosexual parents following in vitro fertilisation (IVF) or spontaneous pregnancies. MethodsThis survey took place during 2005-2008 and was part of the Swedish multicentre study on gamete donation. It comprised 131 lesbian parents, 83 heterosexual IVF parents, who used their own gametes, and 118 spontaneous pregnancy parents. The participants responded to the questionnaire when the child was between 12 and 36-months-old and parenting stress was measured by the Swedish Parenting Stress Questionnaire (SPSQ). ResultsLesbian parents experienced less parenting stress than heterosexual IVF parents when it came to the General Parenting Stress measure (p=0.001) and the subareas of Incompetence (pless than0.001), Social Isolation (p=0.033) and Role Restriction (p=0.004). They also experienced less parenting stress than heterosexual spontaneous pregnancy couples, according to the Social Isolation subarea (p=0.003). Birth mothers experienced higher stress than co-mothers and fathers, according to the Role Restriction measure (p=0.041). ConclusionThese are reassuring findings, considering the known challenges that lesbian families face in establishing their parental roles and, in particular, the challenges related to the lack of recognition of the co-mother.

  • 11.
    Borneskog, C
    et al.
    Uppsala University.
    Skoog Svanberg, A
    Uppsala University.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Lampic, C
    Karolinska Institute.
    Lesbian relationships - a study of relationship quality in lesbian couples treated with sperm donation in HUMAN REPRODUCTION, vol 26, issue , pp I57-I582011In: HUMAN REPRODUCTION, Oxford University Press (OUP) , 2011, Vol. 26, I57-I58 p.Conference paper (Refereed)
    Abstract [en]

    n/a

  • 12.
    Borneskog, Catrin
    et al.
    Uppsala University, Sweden.
    Lampic, Claudia
    Karolinska Institute, Sweden.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Bladh, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Skoog Svanberg, Agneta
    Uppsala University, Sweden.
    Relationship satisfaction in lesbian and heterosexual couples before and after assisted reproduction: a longitudinal follow-up study2014In: BMC Women's Health, ISSN 1472-6874, E-ISSN 1472-6874, Vol. 14, no 154Article in journal (Refereed)
    Abstract [en]

    Background: More and more lesbian couples are planning parenthood through donor insemination and IVF and the number of planned lesbian families is growing in Sweden and other western countries. Research has shown that lesbian couples report as much overall satisfaction in their relationships as do heterosexual couples. However, although parenthood is highly desired, many parents are unaware of the demands of parenthood and the strain on their relationship that the arrival of the baby might bring. The aim of this study was to compare lesbian and heterosexual couples? perceptions of relationship satisfaction at a three-year follow up after assisted reproduction. Methods: The present study is a part of the Swedish study on gamete donation, a prospective longitudinal cohort study. The present study constitutes a three-year follow up assessment of lesbian and heterosexual couples after assisted reproduction. Participants requesting assisted reproduction at all fertility clinics performing gamete donation in Sweden, were recruited consecutively during 2005? 2008. A total of 114 lesbian women (57 treated women and 57 partners) and 126 heterosexual women and men (63 women and 63 men) participated. Participants responded to the ENRICH inventory at two time points during 2005? 2011; at the commencement of treatment (time point 1) and about three years after treatment termination (time point 3). To evaluate the bivariate relationships between the groups (heterosexual and lesbian) and socio-demographic factors Pearsons Chi- square test was used. Kolmogorov-Smirnov test was used for testing of normality, Mann? Whitney U-test to examine differences in ENRICH between the groups and paired samples t-test to examine scores over time. Results: Lesbian couples reported higher relationship satisfaction than heterosexual couples, however the heterosexual couples satisfaction with relationship quality was not low. Both lesbian and heterosexual couples would be classified accordingly to ENRICH-typology as vitalized or harmonious couples. Conclusions: At a follow-up after assisted reproduction with donated sperm, lesbian couples reported stable relationships and a high satisfaction with their relationships, even when treatment was unsuccessful.

  • 13.
    Borneskog, Catrin
    et al.
    Uppsala University.
    Skoog Svanberg, Agneta
    Uppsala University.
    Lampic, Claudia
    Karolinska Institute.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Relationship quality in lesbian and heterosexual couples undergoing treatment with assisted reproduction2012In: Human Reproduction, ISSN 0268-1161, E-ISSN 1460-2350, Vol. 27, no 3, 779-786 p.Article in journal (Refereed)
    Abstract [en]

    One of the major factors impacting on a couples relationship is the desire to have children. To many couples having a child is a confirmation of their love and relationship and a means to deepen and develop their intimate relationship. At the same time parental stress can impact on relationship quality. Relationship quality in lesbian couples is, currently, sparsely studied. The aim of the present study was to compare lesbian and heterosexual couples perceptions of their relationship quality at the commencement of assisted reproduction, and to relate this to background data such as educational level, having previous children and, for lesbian couples, the use of a known versus anonymous donor. less thanbrgreater than less thanbrgreater thanThe present study is part of the prospective longitudinal oSwedish study on gamete donation, including all fertility clinics performing donation treatment in Sweden. Of a consecutive cohort of 214 lesbian couples about to receive donor insemination and 212 heterosexual couples starting regular IVF treatment, 166 lesbian couples (78 response) and 151 heterosexual couples (71 response) accepted participation in the study. At commencement of assisted reproduction participants individually completed questionnaires including the instrument oENRICH, which is a standardized measure concerning relationship quality. less thanbrgreater than less thanbrgreater thanIn general, the couples rated their relationship quality as good, the lesbian couple better than the heterosexuals. In addition, the lesbian women with previous children assessed their relationship quality lower than did the lesbian woman without previous children. For heterosexual couples previous children did not influence their relationship quality. Higher educational levels reduced the satisfaction with the sexual relationship (P 0.04) for treated lesbian women, and enhanced the rating of conflict resolution for treated lesbian women (P 0.03) and their partners (P 0.02). Heterosexual women with high levels of education expressed more satisfaction with communication in their relationship (P 0.02) than did heterosexual women with lower educational levels. less thanbrgreater than less thanbrgreater thanIn this Swedish study sample of lesbian and heterosexual couples relationships, we found that they were generally well adjusted and stable in their relationships when starting treatment with donated sperm or IVF, respectively. However, where lesbian women had children from a previous relationship, it decreased relationship quality. For the heterosexual couples previous children did not affect relationship quality.

  • 14.
    Borneskog, Catrin
    et al.
    Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi, Uppsala University, Sweden.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Lampic, C
    Karolinska Institute, Sweden.
    Bladh, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Skoog Svanberg, Agneta
    Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi, Uppsala University, Sweden.
    Symptoms of anxiety and depression in lesbian couples treated with donated sperm: a descriptive study2013In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 120, no 7, 839-846 p.Article in journal (Refereed)
    Abstract [en]

    Objective

    To investigate symptoms of anxiety and depression in lesbian couples undergoing assisted reproductive treatment (ART), and to study the relationship of demographic data, pregnancy outcome and future reproductive plans with symptoms of anxiety and depression.

    Design

    Descriptive, a part of the prospective longitudinal ‘Swedish study on gamete donation’.

    Setting

    All university clinics in Sweden performing gamete donation.

    Population

    A consecutive sample of 214 lesbian couples requesting assisted reproduction, 165 of whom participated.

    Methods

    Participants individually completed three study-specific questionnaires and the Hospital Anxiety and Depression Scale (HADS): time point 1 (T1), at commencement of ART; time point 2 (T2), approximately 2 months after treatment; and time point 3 (T3), 2–5 years after first treatment.

    Main outcome measures

    Anxiety and depression (HADS), pregnancy outcome and future reproductive plans.

    Results

    The vast majority of lesbian women undergoing assisted reproduction reported no symptoms of anxiety and depression at the three assessment points. A higher percentage of the treated women, compared with the partners, reported symptoms of anxiety at T2 (14% versus 5%, P = 0.011) and T3 (10% versus 4%, P = 0.018), as well as symptoms of depression at T2 (4% versus 0%, P = 0.03) and T3 (3% versus 0%, P = 0.035). The overall pregnancy outcome was high; almost three-quarters of lesbian couples gave birth 2–5 years after sperm donation treatments. Open-ended comments illustrated joy and satisfaction about family building.

    Conclusion

    Lesbian women in Sweden reported good psychological health before and after treatment with donated sperm.

  • 15.
    Brynhildsen, Jan
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Sydsjö, Adam
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Norinder, E.
    Ekholm, Katarina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology .
    Sydsjö, Gunilla
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Trends in body mass index during early pregnancy in Swedish women 1978-20012006In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 120, no 5, 393-399 p.Article in journal (Refereed)
    Abstract [en]

    Objective: to study the body mass index (BMI) in women seeking maternity health care during early pregnancy in Sweden, and to show trends for a period of more than 20 years. Study design: register study. Methods: data from the maternity health programme on consecutively delivered women in two Swedish hospitals were collected for the years 1978, 1986, 1992, 1997 and 2001. All women were weighed at their first midwife visit between 8 and 10 weeks of gestation and height was also measured. Results: data on 4883 women were collected. Data on weight were available for 4490 (92%) women and data on BMI were available for 4378 (90%) women. The age-adjusted average weight increased from 59.5 kg in 1978 to 68.2 kg in 2001, and the BMI increased from 21.7 in 1978 to 24.7 in 2001. In 2001, 38.6% of the women had a BMI >25 compared with 11.2 in 1978. In 2001, 11.6% of the women were obese compared with 2.2% in 1978. Conclusions: during the last two decades, an alarming increase in weight has occurred in Swedish women of childbearing age. © 2005.

  • 16.
    Brynhildsen, Jan
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Blomberg, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Claesson, Ing-Marie
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Theodorsson, Elvar
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Chemistry. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Diagnostics, Department of Clinical Chemistry.
    Nyström, Fredrik H.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Endocrinology.
    Sydsjö, Adam
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Josefsson, Ann
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Leptin and adiponectin in cord blood from children of normal weight, overweight and obese mothers2013In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 102, no 6, 620-624 p.Article in journal (Refereed)
    Abstract [en]

    Aim To study cord blood concentrations of adiponectin and leptin in children born by normal weight, overweight and obese mothers and to study these parameters in relation to a weight gain intervention programme for obese mothers. Methods Ten millilitre cord blood was collected and analysed for leptin and adiponectin concentrations in children with gestational age andgt;37weeks born by 60 normal weight, 45 overweight and 145 obese mothers. 82 obese mothers took part in a weight gain intervention programme. Results Concentrations of leptin and adiponectin were higher in cord blood from children of overweight and obese mothers compared with children of normal weight mothers (leptin: Md 13.2, 30, 3 and 90.2ng/mL respectively, pandlt;0.001; adiponectin 35.9, 205.4, 213.8ng/L pandlt;0.001). No differences were found between overweight and obese mothers. The weight gain intervention programme for obese pregnant women had significant effects on the weight gain during pregnancy but had no effects on cord blood serum concentrations of leptin and adiponectin. Conclusion Cord blood leptin and adiponectin concentrations were higher in children born by overweight or obese women compared with children of normal weight mothers. A weight gain intervention programme for obese pregnant women did not affect these results. Intrauterine exposition to high concentrations of leptin and adiponectin may play a role in weight development later in life.

  • 17.
    Cedergren, Marie
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Brynhildsen, Jan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Josefsson, Ann
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Sydsjö, Adam
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Sydsjö, Gunilla
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Hyperemesis gravidarum that requires hospitalization and the use of antiemetic drugs in relation to maternal body composition2008In: American Journal of Obstetrics and Gynecology, ISSN 0002-9378, E-ISSN 1097-6868, Vol. 198, no 4Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The purpose of this study was to assess whether maternal prepregnancy body mass index was associated with the use of antiemetic drugs in early pregnancy and/or with the occurrence of hyperemesis gravidarum. STUDY DESIGN: A retrospective, population-based, cohort study. Women who delivered singleton infants (n = 749,435) from 19952003 were evaluated concerning the use of antiemetic drugs in early pregnancy (data available from 1995). Women who delivered singleton infants (n = 942,894) from 1992-2001 were evaluated concerning hospitalization because of hyperemesis gravidarum (data available until 2001). Adjusted odds ratios were determined by Mantel- Haenszel technique and were used as estimates of relative risk (RR). RESULTS: Underweight pregnant women were more likely to use antiemetic drugs (RR, 1.19, 95% CI, 1.14-1.24) and to become hospitalized for hyperemesis gravidarum (RR, 1.43, 95% CI, 1.33-1.54) compared with ideal weight women. Obese women were less likely to use antiemetic drugs (RR, 0.93, 95% CI, 0.89-0.97) and less likely to require hospitalization because of hyperemesis (RR, 0.90, 95% CI, 0.85-0.95) compared with women with an ideal body mass index. CONCLUSION: The use of antiemetic drugs and the occurrence of hyperemesis gravidarum are related to maternal body composition.

  • 18.
    Claesson, Ing-Marie
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Josefsson, Ann
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Cedergren, Marie
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Brynhildsen, Jan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Jeppsson, Annika
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Nyström, Fredrik
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Internal Medicine. Östergötlands Läns Landsting, Centre for Medicine, Department of Endocrinology and Gastroenterology UHL.
    Sydsjö, Adam
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Consumer satisfaction with a weight-gain intervention programme for obese pregnant women.2008In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 24, no 2, 163-167 p.Article in journal (Refereed)
    Abstract [en]

    Objective: to investigate women's attitudes and satisfaction with a weight-gain intervention programme during pregnancy.

    Design: exploratory, descriptive study. Data were collected via interviews.

    Setting: University hospital.

    Participants: 56 obese pregnant women who attended antenatal care at the University Hospital of Linköping's obstetrical department and took part in an intervention programme aimed at reducing weight gain during pregnancy, between November 2003 and August 2004.

    Findings: the interviews comprised several questions concerning attitudes and opinions of the programme. Most of the women expressed positive experiences with the treatment and would attend the programme if they became pregnant again. Most of the women stated that they had changed their eating and exercise habits during pregnancy, and almost all of them had continued with these new habits. Even though the weight gain goal of a maximum 6.9 kg was reached by less than half of the participants, most of the women were satisfied with their weight gain. A total of 71.4% of the women participated in aqua aerobics classes. They stated that they were most satisfied with this form of exercise, and that it also was a good social experience.

    Key conclusions and implications for practice: a pregnant woman herself must be actively involved in setting her own goals to prevent excessive weight gain during pregnancy. Considerable effort and support must be placed on discussing strategies, pitfalls and risks. In order for the woman to maintain the change in attitude and habits, she must probably be given continuous feedback and reinforcement over the long term.

  • 19.
    Claesson, Ing-Marie
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Josefsson, Ann
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Prevalence of anxiety and depressive symptoms among obese pregnant and postpartum women: an intervention study.2010In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 10, 766- p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Although studies have shown an association between anxiety and depression and obesity, psychological health among obese women during and after pregnancy has not been carefully studied. The aim of this study was to investigate psychological well-being using symptoms of depression and/or anxiety among obese pregnant women attending a weight gain restriction program and to then compare this group with a control group receiving traditional antenatal care.

    METHODS: 151 obese pregnant women in an intervention group and 188 obese pregnant women in a control group answered the Beck Anxiety Inventory (BAI) and the Edinburgh Postnatal Depression Scale (EPDS). Group differences between the two groups were estimated by using the χ2 - test on categorical variables. The Student's t-test on continuous, normally distributed variables measuring changes in mean score on BAI and EPDS over time was used. To make a more comprehensive assessment of group differences, between as well as within the two groups, logistic regressions were performed with the BAI and EPDS as dependent variables, measured at gestational weeks 15 and 35 and 11 weeks postnatal. The grouping variable has been adjusted for socio-demographic variables and complications.

    RESULTS: The prevalence of symptoms of anxiety during pregnancy varied between 24% and 25% in the intervention group and 22% and 23% in the control group. The prevalence of symptoms of anxiety postnatally was 9% in the intervention group and 11% in the control group. Five percent of the women in the intervention group and 4% of the women in the control group showed symptoms of anxiety during the course of pregnancy and at the postpartum assessment. The prevalence of symptoms of depression during pregnancy varied between 19% and 22% in the intervention group but was constant at 18% in the control group. Postnatal prevalence was 11% in both groups. Six percent of the women in the intervention group and 4% in the control group showed symptoms of depression during the course of pregnancy and at the postpartum assessment. We found no differences between the two groups as concerns demographic characteristics, weight gain in kg, or the distribution of scores on anxiety and depressive symptoms nor did we find differences in the fluctuation of anxiety and depressive symptoms over time between the women in the intervention group and in the control group.

    CONCLUSION: Obese pregnant women attending an intervention program seem to have the same risk of experiencing anxiety and/or depressive symptoms as do obese pregnant and postnatal women in general.

  • 20.
    Claesson, Ing-Marie
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Josefsson, Ann
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Weight six years after childbirth: a follow-up of obese women in a weight-gain restriction programmme2014In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 30, no 5, 506-511 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: to compare weight development in an intervention group and a control group, six years after participation in a gestational weight-gain restriction programme.

    DESIGN: follow-up of a prospective intervention study.

    SETTINGS: antenatal care clinics.

    PARTICIPANTS: a total of 129 women (88.4%) from the original intervention group and 166 women (88.8%) from the original control group.

    MEASUREMENTS: the women answered a study specific questionnaire, covering socio-demographic data and health- and weight status.

    FINDINGS: after adjusting for socio-demographic factors, the mean weight was lower (4.1kg) among the women in the intervention group, compared to the controls (p=0.028). Furthermore, the mean weight change, e.g. the weight at the six year assessment compared with the weight at the start of the intervention at the first antenatal care visit, was greater in the intervention group than in the control group. The women in the intervention group had a larger mean weight change (-5.2kg), e.g. weighed less than the women in the control group (-1.9kg) (p=0.046). Mean weight change expressed in 5kg classes also showed a significant difference between the two groups (p=0.030).

    KEY CONCLUSIONS: the results indicate that attending a gestational weight-gain-restriction programme can have a positive effect on weight up to six years after the intervention.

    IMPLICATION FOR PRACTISE: a restrictive gestational weight gain can result in a positive weight development during the first years after childbirth. It might provide both short- and long term medical health benefits for the mother as well as the child.

  • 21.
    Claesson, Ing-Marie
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynecology and Obstetrics UHL.
    Klein, Sofia
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynecology and Obstetrics UHL.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Josefsson, Ann
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Physical activity and psychological well-being in obese pregnant and postpartum women attending a weight-gain restriction programme2014In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 30, no 1, 11-16 p.Article in journal (Refereed)
    Abstract [en]

    Objective

    the objective of the study was to compare the differences in psychological well-being and quality of life during pregnancy and post partum of obese physically active women and obese physically inactive women enroled in a weight gain restriction programme. We also wanted to explore whether physical activity influences weight change or health status during pregnancy.

    Design

    a prospective intervention study.

    Setting

    antenatal care clinic.

    Participants

    a total of 74 obese pregnant women in a physically active group and 79 obese women in a physically inactive group.

    Measurements

    the women kept diaries of their physical activity during pregnancy and answered the Beck Anxiety Inventory, the Edinburgh Postnatal Depression Scale and Medical Study Short-Form Health Survey in gestational weeks 15 and 35 and 11 weeks post partum. Physical activity was measured in metabolic equivalents.

    Findings

    the physically active women experienced fewer depressive symptoms and estimated an improved quality of life during their pregnancies as measured by physical functioning, bodily pain, social functioning, role limitations due to emotional problems and general mental health as compared with the physically inactive women. There were no differences between the groups in gestational weight gain or weight change from early pregnancy to post partum or in prevalence of complications.

    Key conclusions

    physical activity among obese pregnant women provides better psychological well-being and improved quality of life, but does not prevent weight change.

    Implications for practice

    staff at Antenatal Care Clinics that face obese pregnant women, should encourage and emphasise the benefits of being physically active throughout pregnancy.

  • 22.
    Claesson, Ing-Marie
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Brynhildsen, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Blomberg, Maria
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Jeppsson, Annika
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Sydsjö, Adam
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Josefsson, Ann
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Weight after childbirth: A 2-year follow-up of obese women in a weight-gain restriction program2011In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 90, no 1, 103-110 p.Article in journal (Other academic)
    Abstract [en]

    Objective: To investigate the effects of a weight gain restriction program on weight development or weight maintenance two years after childbirth.

    Methods: The intervention group consisted of 155 obese pregnant women who participated in a weight gain restriction program with weekly support duringpregnancy. The control group consisted of 193 obese pregnant women. Follow-up weight measurements were done at 12 and 24 months postpartum.

    Results: The mean value of weight change in the intervention group was -2.2 kg compared to + 0.4 kg in the control group from early pregnancy to the follow-up 12 months after childbirth (p = .046). A greater percentage of women in the intervention group showed a weight loss 24 months after delivery than did women in the control group at that same time (p = .034). Women in the intervention group who gained less than 7 kg during pregnancy had a significantly lower weight than the controls at the 24 months follow-up (p = .018).

    Conclusion: An intervention program with weekly motivational support visits during pregnancy and every 6 months after childbirth seems to have an impact on weight gain up to 24 months after childbirth for those women in the intervention group who succeeded in restricting their gestational weight gain to less than 7 kg.

  • 23.
    Claesson, Ing-Marie
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Sydsjö, Gunilla
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Brynhildsen, Jan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Cedergren, Marie
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Jeppsson, Annika
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Nyström, Fredrik
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Internal Medicine. Östergötlands Läns Landsting, Centre for Medicine, Department of Endocrinology and Gastroenterology UHL.
    Sydsjö, Adam
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Josefsson, Ann
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Weight gain restriction for obese pregnant women: A case-control intervention study2008In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 115, no 1, 44-50 p.Article in journal (Refereed)
    Abstract [en]

    Objective: To minimise obese women's total weight gain during pregnancy to less than 7 kg and to investigate the delivery and neonatal outcome. Design: A prospective case-control intervention study. Setting: Antenatal care clinics in the southeast region of Sweden. Population: One hundred fifty-five pregnant women in an index group and one hundred ninety-three women in a control group. Methods: An intervention programme with weekly motivational talks and aqua aerobic classes for obese pregnant women. Main outcome measures: Weight gain in kilograms, delivery and neonatal outcome. Results: The index group had a significantly lower weight gain during pregnancy compared with the control group (P < 0.001). The women in the index group weighed less at the postnatal check-up compared with the weight registered in early pregnancy (P < 0.001). The percentage of women in the index group who gained less than 7 kg was greater than that of women in the control group who gained less than 7 kg (P = 0.003). The percentage of nulliparous women in this group was greater than that in the control group (P = 0.018). In addition, the women in the index group had a significantly lower body mass index at the postnatal check-up, compared with the control group (P < 0.001). There were no differences between the index group and the control group regarding birthweight, gestational age and mode of delivery. Conclusion: The intervention programme was effective in controlling weight gain during pregnancy and did not affect delivery or neonatal outcome.

  • 24.
    Claesson, Ing-Marie
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping. Linköping University, Faculty of Medicine and Health Sciences.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Olhager, Elisabeth
    Lund University, Sweden.
    Oldin, Carin
    Regional Jonköping County, Sweden.
    Josefsson, Ann
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Effects of a Gestational Weight Gain Restriction Program for Obese Pregnant Women: Childrens Weight Development during the First Five Years of Life2016In: CHILDHOOD OBESITY, ISSN 2153-2168, Vol. 12, no 3, 162-170 p.Article in journal (Refereed)
    Abstract [en]

    Background: Maternal prepregnancy obesity (BMI 30kg/m(2)) and excessive gestational weight gain (GWG) have shown a strong positive association with a higher BMI and risk of obesity in the offspring. The aim of this study is to estimate the effect of a GWG restriction program for obese pregnant women on the childrens BMI at 5 years of age and weight-for-length/height (WL/H) development from 2 months of age until 5 years of age. Methods: This was a follow-up study of 302 children (137 children in an intervention group and 165 children in a control group) whose mothers participated in a weight gain restriction program during pregnancy. Results: BMI at five years of age did not differ between girls and boys in the intervention and control group. The degree of maternal GWG, amp;lt;7kg or 7kg, did not affect the offsprings WL/H. Compared with Swedish reference data, just over half of the children in both the intervention and control group had a BMI within the average range, whereas slightly more than one-third of the children had a higher BMI. Conclusion: Despite a comprehensive gestational intervention program for obese women containing individual weekly visits and opportunity to participate in aqua aerobic classes, there were no differences between BMI or weight development among the offspring at 5 years of age in the intervention and control group.

  • 25.
    Cocozza, Madeleine
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences.
    Gustafsson, Per
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Child Protection in a Family Service Organisation in Sweden- What is the outcome for maltreated children?2010In: Children and youth services review, ISSN 0190-7409, E-ISSN 1873-7765, Vol. 32, no 7, 922-928 p.Article in journal (Refereed)
    Abstract [en]

    This study was conducted to increase the knowledge of what characterises the child-protection process in family-service organisations. A total of 1570 (regarding 1051 children) reports made to Social Services in one municipality during 1 year were followed to a final decision. A five-year follow-up study was conducted. There were 651 (41%) of the reports that were not investigated, 84% of the reports filed were judged not to demonstrate child maltreatment. The most usual cluster consisted of children that had committed a crime/offence when they were between 13 and 18 years old (314/1051–30%). The social worker reported 38% of the reports that regarded sexual or physical abuse to the police. Comparing the filtering pattern with the results from a study conducted in England, the family-service organisation does not seem to lead to the provision of services for a greater percentage of children than does a distinctive child-protection system. In the five-year follow-up period there were 61% of the children that were or had been targeted for an intervention or an investigation. This study raises questions about child protection in Sweden and emphasises the need for the system to be studied further.

  • 26.
    Cocozza, Madeleine
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry . Linköping University, Faculty of Health Sciences.
    Gustafsson, Per
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry . Linköping University, Faculty of Health Sciences.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    Child Protection in Sweden: Are routine assesments reliable?2006In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 95, no 11, 1474-1480 p.Article in journal (Refereed)
    Abstract [en]

    Aim: To study the validity of the decision not to investigate mandatory reports of suspected child maltreatment.

    Methods: Written files of 220 reports indicating possible child maltreatment were analysed and re-evaluated. As a measure of the justification for the decisions, a 5-y follow-up study was done.

    Results: We determined that 76% of the reports still indicated child maltreatment after the initial assessment was done. In the follow-up study, 45% of the children had been investigated. The social worker used the family as the only source of information in 74% of the cases, in 6% someone outside the family was contacted, and in 11% no further information in addition to the report was collected. In 9%, data on information sources were missing.

    Conclusion: The findings are rather discouraging, as they challenge the belief that a report is a means of ensuring that maltreatment does not continue. The study shows that, depending upon the way in which the initial assessments are made, maltreated children may run a risk of not being identified, even though the maltreatment has been reported. This suggests that there may be a need for national guidelines concerning the reporting of maltreatment.

  • 27.
    Cocozza, Madeleine
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry . Linköping University, Faculty of Health Sciences.
    Gustafsson, Per
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry . Linköping University, Faculty of Health Sciences.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    The Impact of Socio-economic load in Family Service organized child protection2007Article in journal (Refereed)
  • 28.
    Cocozza, Madeleine
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry . Linköping University, Faculty of Health Sciences.
    Gustafsson, Per
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Who suspects and report child maltreatment to Social Services in Sweden?: Is there a reliable mandatory reporting process?2007In: European Journal of Social Work, ISSN 1369-1457, E-ISSN 1468-2664, Vol. 10, no 2, 209-223 p.Article in journal (Refereed)
    Abstract [en]

    This article deals with the mandatory report process in Sweden. The components that are analysed are who makes the reports, what is reported and the outcome for the reports. Data were collected in a Swedish county in the year 2000 by means of locating every report made to the Social Services during one year (1998). The net sample consisted of 1,570 reports regarding 1,051 children. A follow-up study was carried out in 2003 of all the children for whom a report in 1998 did not lead to an investigation being initiated. We found in these study indicators that the process might not be secure. The professionals reported 1% of the children in the municipality; 22% of the reports from professionals were not investigated. The five-year follow-up study shows that 53% of the children that these reports concerned had been the subject of an investigation. This could be an indicator that children continue to be maltreated after being reported since the assessments are not accurate. In this study, 67% of 'crime reports' were 'not indicating' child maltreatment. There should be a questioning of 'crime reports' automatically entering the mandated report process as, if registered nationally, this could lead to a deflation of mandatory reports. Administration needs to change introducing a national form for filing reports.

  • 29.
    Comasco, Erika
    et al.
    Uppsala University, Sweden.
    Gustafsson, Per
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Agnafors, Sara
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Aho, Nikolas
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Svedin, Carl Göran
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Psychiatric symptoms in adolescents: FKBP5 genotype-early life adversity interaction effects2015In: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 24, no 12, 1473-1483 p.Article in journal (Refereed)
    Abstract [en]

    Psychiatric disorders are multi-factorial and their symptoms overlap. Constitutional and environmental factors influence each other, and this contributes to risk and resilience in mental ill-health. We investigated functional genetic variation of stress responsiveness, assessed as FKBP5 genotype, in relation to early life adversity and mental health in two samples of adolescents. One population-based sample of 909 12-year-old adolescents was assessed using the Life Incidence of Traumatic Events scale and the Strengths and Difficulties Questionnaire. One sample of 398 17-year-old adolescents, enriched for poly-victimized individuals (USSS), was assessed using the Juvenile Victimization Questionnaire and the Trauma Symptom Checklist for Children (TSCC). The FKBP5 rs1360780 and rs3800373 polymorphisms were genotyped using a fluorescence-based competitive allele-specific PCR. Most prominently among poly-victimized older male adolescents, the least common alleles of the polymorphisms, in interaction with adverse life events, were associated with psychiatric symptoms, after controlling for ethno-socio-economic factors. The interaction effect between rs3800373 and adverse life events on the TSCC sub-scales-anxiety, depression, anger, and dissociation-and with the rs1360780 on dissociation in the USSS cohort remained significant after Bonferroni correction. This pattern of association is in line with the findings of clinical and neuroimaging studies, and implies interactive effects of FKBP5 polymorphisms and early life environment on several psychiatric symptoms. These correlates add up to provide constructs that are relevant to several psychiatric symptoms, and to identify early predictors of mental ill-health.

  • 30.
    deKeyser, Linda
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Svedin, Carl Göran
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Agnafors, Sara
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Bladh, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Multi-informant reports of mental health in Swedish-born children of immigrants and children born to non-immigrants - the SESBiC-study2014In: BMC Pediatrics, ISSN 1471-2431, E-ISSN 1471-2431, Vol. 14, 95- p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    The European literature on mental health of the children of immigrants is limited. Therefore this study aims to investigate gender-specific mental health reported by teachers, parents and the children themselves in 12-year old children of immigrants and non-immigrants and also to study the level of agreement between the different informants.

    METHODS:

    This cross-sectional study is a part of the longitudinal South East Sweden Birth Cohort-study (the SESBiC-study) on children's health. All children born in town in the south of Sweden 1995-1996 were invited to take part. The mothers of 1723 children (88%) consented. In this part 87 Swedish-born 12-year old children of immigrants and 687 12-year old children of non-immigrants were investigated regarding gender-specific differences in mental health as reported by teachers (Teacher-report form), parents (Child behavior checklist), and children (Strengths and Difficulties Questionnaire) and the agreement reached between the informants.

    RESULTS:

    Parental immigrant status was not associated with mental health in any of the groups, but living arrangements and parental educational level were mainly found to have an effect on the health status of boys (TRF-Internalizing β = .77 95% CI = .02-1.52; TRF-Externalizing.β = 2.31 95% CI = .63-3.99; TRF-Total β = 6.22 95% CI = 2.27-10.18) The agreement between different informants was generally low, except for externalizing problems among boys (Boys of immigrant parents: Parent and teacher correlation ρ = .422 and Child teacher correlation ρ = .524, p-value < .05, respectively). The correlation between teachers and parents were lower in the index group compared to the reference group. In the index group, the correlations between teacher's and children's assessments were fairly high for boys but not for girls (ρ Total = .400, ρ Internalizing = .240 and ρ Externalizing = .524, p-value < .05 for Total and Externalizing).

    CONCLUSION:

    This study confirms previous findings that the mental health of children of immigrants is similar to that of children of non-immigrants. We found that family factors have a greater impact on the reported mental health than immigrant status does. This might be of clinical importance for healthcare workers to recognize when investigating and treating children from other cultures.

  • 31.
    Dekeyser, Linda
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Svedin, Carl Göran
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences.
    Agnaförs, Sara
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Self-reported mental health in 12-year-old second-generation immigrant children in Sweden2011In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 65, no 6, 389-395 p.Article in journal (Refereed)
    Abstract [en]

     Today 29.3% of all newborns in Sweden are second-generation immigrants. Studies on mental health among these children are few, inconclusive and vary widely with regard to the informant used and the age of the immigrant. The majority of previous studies focus on study groups that cover a wide age span but since mental health varies considerably during the pre-adolescent and adolescent years, more age-specific studies are needed. Additional focus on the health and well-being of these children is necessary if a well-functioning society is to develop. Aim: To investigate whether and how second-generation immigrant children in Sweden differ from non-immigrant children in their presentation of self-reported mental health at the age of 12. Methods: Second-generation immigrant children (n = 142) from a birth cohort in southern Sweden, subjects of the SESBiC-study (the South East Sweden Birth Cohort-study) were compared with non-immigrant children (n = 1036) from the same cohort in their presentation of self-reported mental health at the age of 12 using the Strengths and Difficulties Questionnaire. Gender, family structure and parents educational level were controlled for. Results: Second-generation immigrant children did not differ from the non-immigrant children in their own presentation of mental health at the age of 12 in any of the categories of immigrant groups. Conclusion: It is a promising sign for future integration that second-generation immigrant childrens self-reported mental health at the age of 12 was quite similar to that of non-immigrant children.

  • 32.
    DeKeyser, Nicholas
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Josefsson, Ann
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Bladh, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Carstensen, John
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Finnström, Orvar
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Premature birth and low birthweight are associated with a lower rate of reproduction in adulthood: a Swedish population-based registry study2012In: Human Reproduction, ISSN 0268-1161, E-ISSN 1460-2350, Vol. 27, no 4, 1170-1178 p.Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to investigate if individuals born with sub-optimal birth characteristics have reduced probability of reproducing in adulthood. less thanbrgreater than less thanbrgreater thanUsing population-based registries, the authors included 522 216 males and 494 692 females born between 1973 and 1983 and examined their reproductive status as of 2006. Outcome measure was the hazard ratio (HR) of reproducing. Adjustments were made for socio-economic factors. less thanbrgreater than less thanbrgreater thanMales and females born very premature displayed a reduced probability of reproducing [HR 0.78, 95 confidence interval (CI): 0.700.86 for males; HR 0.81, CI: 0.750.88 for females]. Likewise for very low birthweight (HR 0.83, CI: 0.710.95 for males; HR 0.80, 95 CI: 0.720.89 for females). Individuals born large for gestational age (LGA) displayed no significant changes. Males born small for gestational age (SGA) had a 9 lower reproductive rate (CI: 0.890.94) and that reduction increased as the individuals aged. Women born SGA tended to start reproducing at an earlier age. less thanbrgreater than less thanbrgreater thanThe results suggest that being born with low birthweight, premature or SGA (for males) is associated with a reduced probability of reproducing as an adult. LGA shows no statistically significant relationship with future reproduction.

  • 33.
    DeKeyser, Nicholas
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology.
    Josefsson, Ann
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Monfils-Gustavsson, Wiktor
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Claesson, Ing-Marie
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Carlsson, Per
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Sydsjö, Adam
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Total cost comparison of standard antenatal care with a weight gain restriction programme for obese pregnant women2011In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 125, no 5, 311-317 p.Article in journal (Refereed)
    Abstract [en]

    Objective: To perform a cost comparison of a weight gain restriction programme for obese pregnant women with standard antenatal care, and to identify if there were differences in healthcare costs within the intervention group related to degree of gestational weight gain or degree of obesity at programme entry. Study design: A comparison of mean healthcare costs for participants of an intervention study at antenatal care clinics with controls in south-east Sweden. Methods: In total, 155 women in an intervention group attempted to restrict their gestational weight gain to less than7 kg. The control group comprised 193 women. Mean costs during pregnancy, delivery and the neonatal period were compared with the costs of standard care. Costs were converted from Swedish Kronor to Euros ((sic)). Results: Healthcare costs during pregnancy were lower in the intervention group. There was no significant difference in total healthcare costs (i.e. sum of costs during pregnancy, delivery and the neonatal period) between the intervention group and the control group. Within the intervention group, the subgroup that gained 4.5-9.5 kg had the lowest costs. The total cost, including intervention costs, was (sic)1283 more per woman/ infant in the intervention group compared with the control group (P = 0.025). The degree of obesity at programme entry had no bearing on the outcome. Conclusions: The weight gain restriction programme for obese pregnant women was effective in restricting gestational weight gain to less than7 kg, but had a higher total cost compared with standard antenatal care.

  • 34.
    Ekholm Selling, Katarina
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    Carstensen, John
    Linköping University, Department of Medicine and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Finnström, Orvar
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Josefsson, Ann
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Hospitalization in adolescence affects the likelihood of giving birth: a Swedish population-based register study.2009In: Acta paediatrica, ISSN 0803-5253 (print) 1651-2227 (online), Vol. 98, no 3, 561-6 p.Article in journal (Refereed)
    Abstract [en]

    Aim: To examine the effect of hospitalization during adolescence on the likelihood of giving birth.

    Methods: 142 998 women born in 1973-75 were followed with the help of the Swedish Medical Birth Register (MBR) and the Swedish Total Population Register (TPR) up until the end of 2000 with respect to their likelihood of giving birth. All analyses were adjusted for parental socio-economic characteristics and factors related to the studied women's own birth.

    Results: The likelihood of giving birth between 20 and 27 years of age was positively affected by hospitalization at least once during adolescence according to the Swedish Hospital Discharge Register (HDR); adjusted hazard ratio (HR) = 1.32, 95% confidence interval: 1.29-1.35. Women hospitalized due to genitourinary diseases, respiratory diseases, abdominal problems and abuse of alcohol and drugs were more likely to have given birth during the study period, while hospitalizations according to cerebral palsy and congenital malformations tended to decrease childbearing. Women hospitalized due to psychiatric diseases had an increase likelihood of given birth at 20-24 years but a reduced thereafter.

    Conclusion: A majority of the causes of hospitalization during adolescence increased the likelihood of giving birth between ages 20 to 27.

  • 35.
    Ekholm Selling, Katarina
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    Carstensen, John
    Linköping University, Department of Medicine and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Finnström, Orvar
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Josefsson, Ann
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Hospitalizations in adolescence and early adulthood among Swedish men and women born preterm or small for gestational age2008In: Epidemiology, ISSN 1044-3983, E-ISSN 1531-5487, Vol. 19, no 1, 63-70 p.Article in journal (Refereed)
    Abstract [en]

    Background: Preterm birth and reduced intrauterine growth appear to be related to morbidity in childhood and later adulthood. We studied whether the risk of all-cause hospitalization in adolescence and early adulthood differed between individuals who were born preterm or small for gestational age (SGA) compared with those bom at term and appropriate for gestational age.

    Methods: Using Swedish registries, we followed 304,275 men and women born in 1973-1975 for any hospitalizations occurring in 1987-1996. Preterm birth was defined as <37 weeks of gestation and SGA as babies smaller than 2 standard deviations below the mean weight for gestational length, according to Swedish standards. We created 3 mutually exclusive categories: "preterm" (<37 weeks and not SGA), "SGA" (SGA and not preterm), and "both preterm and SGA." The comparison group was all term births not SGA. Childhood socioeconomic characteristics were accounted for in the analyses.

    Results: The overall risk of hospitalization was higher for men and women bom SGA (adjusted odds ratio = 1.16; 95% confidence interval = 1.12-1.21), for those born preterm (1.06; 1.02-1.10), and for those born both preterm and SGA (1.42; 1.26-1.59). In addition to higher risks for previously reported adverse health outcomes, such as neurodevelopment sequelae and congenital anomalies, men and women born SGA or preterm were more likely to be hospitalized due to unspecified symptoms. SGA also appeared to be associated with genitourinary diseases and drug use.

    Conclusions: Men and women born SGA or preterm were at higher risk for hospitalization during adolescence and early adulthood, with men and women born SGA more at risk than those bom preterm.

  • 36.
    Ekholm Selling, Katarina
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    Carstensen, John
    Linköping University, Department of Medicine and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Finnström, Orvar
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    Intergenerational effects of preterm birth and reduced intrauterine growth: A population-based study of Swedish mother-offspring pairs2006In: British Journal of Obstetrics and Gynaecology, ISSN 0306-5456, E-ISSN 1365-215X, Vol. 113, no 4, 430-440 p.Article in journal (Refereed)
    Abstract [en]

    Objective To estimate the intergenerational effects of preterm birth and reduced intrauterine growth.

    Design Population-based cohort study.

    Settings Mother–first-born offspring pairs recorded in the Swedish Medical Birth Registry.

    Population Children born before 2001 to 38 720 women born in 1973–75.

    Methods The relationships between the mother's and the child's birth characteristics were estimated using logistic regression analysis. Adjustments were made for smoking habits, body mass index (BMI), and current and childhood socio-economic conditions. Analyses were performed on all mother–offspring pairs and on the pairs for which information on neither of the included background variables was missing (n= 24 520).

    Main outcome measures Preterm birth (<37 weeks of gestation) and small for gestational age (SGA) (<−2 SD of the Swedish standard).

    Results Mothers who themselves had been born preterm were not significantly more likely to deliver their own children preterm, compared with those who had been born at term (adjusted OR 1.24, 95% CI 0.95–1.62). Also, preterm birth in the mothers did not influence the occurrence of SGA in the children. However, the odds ratio for giving birth to SGA and preterm children, respectively, was higher among SGA mothers (OR 2.68, 95% CI 2.11–3.41 and OR 1.30, 95% CI 1.05–1.61). Mothers whose intrauterine growth was moderately reduced but who did not meet the criterion of being born SGA were also at higher risk of giving birth to both preterm and SGA children, respectively.

    Conclusions The present study showed evidence of intergenerational effects of reduced intrauterine growth even when socio-economic factors as well as BMI and smoking were adjusted for. There was, however, no consistent intergenerational effect of preterm birth.

  • 37.
    Ekholm (Selling), Katarina
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    Carstensen, John
    Linköping University, Department of Medicine and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Finnström, Orvar
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    The probability of giving birth among women who were born preterm or with impaired fetal growth: A Swedish population-based registry study2005In: American Journal of Epidemiology, ISSN 0002-9262, E-ISSN 1476-6256, Vol. 161, no 8, 725-733 p.Article in journal (Refereed)
    Abstract [en]

    The primary aim of this study was to investigate whether women born prematurely or with impaired fetal growth have a reduced probability of giving birth. Using Swedish population-based registries, the authors identified 148,281 women born in 1973–1975 for follow-up until 2001. Of these women, 4.1% were born preterm and 0.32% very preterm, 0.29% were born with a very low birth weight, and 5.4% were small for gestational age. Outcome measures were the hazard ratios for giving birth during the study period. Adjustments were made for socioeconomic factors. Very-low-birth-weight women displayed a reduced probability of giving birth (hazard ratio = 0.74, 95% confidence interval: 0.60, 0.91), most apparent among women aged 25 or more years. There were also tendencies of reduced hazard ratios of giving birth among women born preterm or very preterm in this age interval. Women born small for gestational age (below –2 standard deviations) seemed to be more likely to have given birth (hazard ratio = 1.09, 95% confidence interval: 1.04, 1.14), but when a more extreme group of small-for-gestational-age women (below –3 standard deviations) was defined, the association was less evident (hazard ratio = 1.04, 95% confidence interval: 0.94, 1.16). The results suggest that very-low-birth-weight women and, possibly, women born preterm or very preterm have a reduced probability of giving birth, while the results regarding small for gestational age are less clear.

  • 38.
    Elenis, Evangelia
    et al.
    Uppsala University, Sweden.
    Skoog Svanberg, Agneta
    Uppsala University, Sweden.
    Lampic, Claudia
    Karolinska Institute, Sweden.
    Skalkidou, Alkistis
    Uppsala University, Sweden.
    Akerud, Helena
    Uppsala University, Sweden.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Adverse obstetric outcomes in pregnancies resulting from oocyte donation: a retrospective cohort case study in Sweden2015In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 15, no 247Article in journal (Refereed)
    Abstract [en]

    Background: Oocyte donation has been associated to gestational diabetes, hypertensive disorders, placental abnormalities, preterm delivery and increased rate of caesarean delivery while simultaneously being characterized by high rates of primiparity, advanced maternal age and multiple gestation constituting the individual risk of mode of conception difficult to assess. This study aims to explore obstetrical outcomes among relatively young women with optimal health status conceiving singletons with donated versus autologous oocytes (via IVF and spontaneously). Methods: National retrospective cohort case study involving 76 women conceiving with donated oocytes, 150 nulliparous women without infertility conceiving spontaneously and 63 women conceiving after non-donor IVF. Data on obstetric outcomes were retrieved from the National Birth Medical Register and the medical records of oocyte recipients from the treating University Hospitals of Sweden. Demographic and logistic regression analysis were performed to examine the association of mode of conception and obstetric outcomes. Results: Women conceiving with donated oocytes (OD) had a higher risk of hypertensive disorders [adjusted Odds Ratio (aOR) 2.84, 95 % CI (1.04-7.81)], oligohydramnios [aOR 12.74, 95 % CI (1.24-130.49)], postpartum hemorrhage [aOR 7.11, 95 % CI (2.02-24.97)] and retained placenta [aOR 6.71, 95 % CI (1.58-28.40)] when compared to women who conceived spontaneously, after adjusting for relevant covariates. Similar trends, though not statistically significant, were noted when comparing OD pregnant women to women who had undergone non-donor IVF. Caesarean delivery [aOR 2.95, 95 % CI (1.52-5.71); aOR 5.20, 95 % CI (2.21-12.22)] and induction of labor [aOR 3.00, 95 % CI (1.39-6.44); aOR 2.80, 95 % CI (1.10-7.08)] occurred more frequently in the OD group, compared to the group conceiving spontaneously and through IVF respectively. No differences in gestational length were noted between the groups. With regard to the indication of OD treatment, higher intervention was observed in women with diminished ovarian reserve but the risk for hypertensive disorders did not differ after adjustment. Conclusion: The selection process of recipients for medically indicated oocyte donation treatment in Sweden seems to be effective in excluding women with severe comorbidities. Nevertheless, oocyte recipients-despite being relatively young and of optimal health status-need careful counseling preconceptionally and closer monitoring prenatally for the development of hypertensive disorders.

  • 39. Gaddlin, P-O
    et al.
    Finnström, Orvar
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Leijon, Ingemar
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Most very low birth weight subjects do well as adults2009In: ACTA PAEDIATRICA, ISSN 0803-5253, Vol. 98, no 9, 1513-1520 p.Article in journal (Refereed)
    Abstract [en]

    Aim: To study health, quality of life, educational level and occupation in very low birth weight (VLBW) children in early adulthood and the relationship of the findings to neonatal risk factors and later handicap. Methods: This is a prospective long-term follow-up study of a regional cohort of 20-year-old VLBW subjects (n = 77) of all surviving VLBW children (n = 86) and 69/86 term controls born in 1987-1988 in the south-east of Sweden. Postal questionnaires were used: 1. A study-specific form, 2. Medical Outcomes Study, Short Form (SF-36), 3. Sense of Coherence. Results: VLBW subjects did not differ significantly from their controls in self-perceived health, use of tobacco, education, occupation and way of living, or scoring on SF-36 and Sense of Coherence. Sixteen had cerebral palsy, attention deficit hyperactivity disorder or isolated mental retardation, and these subjects differed significantly from controls on SF-36 in physical functioning and physical health score, but not on Sense of Coherence. VLBW subjects were significantly lighter and shorter than their controls. Extremely low birth weight (ELBW), bronchopulmonary dysplasia and intraventricular haemorrhage were significantly associated with poorer scores on physical function. Conclusion: The 20-year old VLBW subjects reported perceived health and managed transition to adulthood similar to controls. Handicapped subjects had poorer self-perceived physical function. ELBW and severe neonatal complications were associated with poorer self-perceived physical health.

  • 40.
    Gunnervik, Christina
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    Josefsson, Ann
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Sydsjö, Adam
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Attitudes towards mode of birth among Swedish midwives2010In: MIDWIFERY, ISSN 0266-6138, Vol. 26, no 1, 38-44 p.Article in journal (Refereed)
    Abstract [en]

    Objective: to investigate midwives attitudes and opinions on mode of birth. Design: exploratory descriptive study. Data were collected via study-specific questionnaires during 2006. Setting: southeastern Sweden. Participants: all midwives working in two counties. Findings: regardless of age, experience and working field, the midwives considered a reasonable caesarean rate to be around 11.5 per cent. None of the participants thought that the caesarean rate was too low. Midwives younger than 50 years tended to consider the current caesarean rate to be too high (p = 0.059). Midwives working on labour wards stated that they thought the current caesarean rate was too high compared with midwives working at antenatal care clinics (ACCs)(pandlt;0.001). Midwives working at ACCs agreed with the statements one should agree to a womans right to have an elective caesarean (pandlt;0.001) and elective caesarean is the best choice for a woman with fear of birth (p = 0.046) more often than midwives working on labour wards, regardless of age or working experience. Key conclusions and implications for practice: midwives working at ACCs are more willing to accept caesarean section at the womans request and for women with fear of birth. It is of importance that ACC caregivers and professionals on labour wards increase their collaboration and have continuous discussions with one another in an attempt to reach consensus about the appropriate caesarean rates on evidence-based grounds.

  • 41.
    Gunnervik, Christina
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine.
    Sydsjö, Gunilla
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Sydsjö, Adam
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Ekholm, Katarina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology .
    Josefsson, Ann
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Attitudes towards cesarean section in a nationwide sample of obstetricians and gynecologists2008In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 87, no 4, 438-444 p.Article in journal (Refereed)
    Abstract [en]

    Objective. The Swedish cesarean section (CS) rate has increased dramatically over the last decades, but remains relatively low compared to several other countries in the Western world. The reasons for this continuous increase are multifactorial and difficult to investigate. That pregnant women are demanding CS more frequently does not appear to be the major explanatory factor for the increasing CS rate. Since Swedish CS rates are relatively low, it is important to study attitudes to CS in a nationwide population of Swedish obstetricians and gynecologists in order to determine the possible concerns of this group. Methods. In 2006, a study-specific questionnaire was created and posted to Swedish obstetricians and gynecologists. In total, 1,280 obstetricians and gynecologists received a questionnaire and replied with a response rate of 66%. Results. In general, older and longer work experience physicians had a more positive attitude towards providing CS on maternal request or elective CS for women who fear vaginal delivery. In addition, these colleagues were more positive in expressing their belief that elective CS is as safe as vaginal delivery for the mother and her child. The main difference between female and male physicians was that males were more positive toward providing CS on maternal request (p<0.001). Conclusion. We have shown that female physicians differ from their male colleagues in their attitudes toward providing CS on maternal request. Female physicians were more reluctant than males to provide CS on maternal request. © 2008 Taylor & Francis.

  • 42.
    Gäddlin, Per-Olof
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Finnström, Orvar
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    Leijon, Ingemar
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Health, quality of life, educational level, and occupation in early adulthood in very low birthweight subjects in south-east SwedenManuscript (Other academic)
    Abstract [en]

    Objectives: To study health, quality of life, educational level and occupation in very low birthweight children (VLBW; ≤1500 g) in early adulthood and relationship to neonatal risk factors and handicap.

    Design: Prospective long-term follow-up study.

    Setting: Regional cohort.

    Participants: Twenty-year-old VLBW subjects (n=77) of all surviving VLBW children (n=86) and 69/86 term controls born in 1987-1988 in the south-east of Sweden.

    Outcome Measures: Postal questionnaires: 1. A study-specific form with questions about health, tobacco and alcohol use, weight and height, education, occupation and socio-economic situation. 2. Medical Outcomes Study, Short Form (SF-36). 3. Sense of Coherence (SOC).

    Results: VLBW subjects did not differ significantly from the controls in self-perceived health, use of tobacco, education, occupation and way of living, or scoring on SF-36 and SOC. Sixteen had cerebral palsy, attention deficit hyperactivity disorder, or isolated mental retardation, and those differed significantly from controls on SF-36 in physical functioning and physical health score, but not on SOC. VLBW subjects were significantly lighter and shorter than their controls. Extremely low birthweight (ELBW), bronchopulmonary dysplasia and intraventricular haemorrhage were significantly associated with poorer scores on physical functioning and physical health score.

    Conclusions: A majority of VLBW subjects were healthy at 20 years of age and managed transition to adulthood similar to controls. A minority had handicaps that influenced their physical function. ELBW and severe neonatal complications were associated with poorer self-perceived physical health in early adulthood.

  • 43.
    Isaksson, S
    et al.
    Uppsala University.
    Skoog Svanberg, A
    Uppsala University.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Thurin-Kjellberg, A
    Sahlgrens Academy.
    Karlstrom, P-O
    Uppsala University.
    Solensten, N-G
    Umea University Hospital.
    Lampic, C
    Karolinska Institute.
    Two decades after legislation on identifiable donors in Sweden: are recipient couples ready to be open about using gamete donation?2011In: HUMAN REPRODUCTION, ISSN 0268-1161, Vol. 26, no 4, 853-860 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Two decades after the introduction of Swedish legislation that allows children born as a result of gamete donation access to identifying information about the donor, a nationwide multicentre study on the psychosocial consequences of this legislation for recipients and donors of gametes was initiated in 2005. The aim of the present study was to investigate recipient couples attitudes and behaviour regarding disclosure to offspring and others, attitudes towards genetic parenthood and perceptions of information regarding parenthood after donation. METHODS: The present study is part of the prospective longitudinal Swedish study on gamete donation, including all fertility clinics performing donation treatment in Sweden. A consecutive cohort of 152 heterosexual recipient couples of donated oocytes (72% response) and 127 heterosexual recipient couples of donated sperm (81% response) accepted participation in the study. In connection with the donation treatment, male and female participants individually completed two questionnaires with study-specific instruments concerning disclosure, genetic parenthood and informational aspects. RESULTS: About 90% of participants (in couples receiving anonymous donated gametes) supported disclosure and openness to the offspring concerning his/her genetic origin. Only 6% of all participants had not told other people about their donation treatment. Between 26 and 40% of participants wanted additional information/support about parenthood following donation treatment. CONCLUSIONS: Two decades after the Swedish legislation of identifiable gamete donors, recipient couples of anonymously donated sperm and oocytes are relatively open about their treatment and support disclosure to offspring. Recipient couples may benefit from more information and support regarding parenthood after gamete donation. Further studies are required to follow-up on the future parents actual disclosure behaviour directed to offspring.

  • 44.
    Isaksson, S
    et al.
    Uppsala University.
    Skoog Svanberg, A
    Uppsala University.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Thurin-Kjellberg, A
    Sahlgrens Academy.
    Karlström, P O
    Uppsala University.
    Solensten, N G
    Umeå University Hospital.
    Lampic, C
    Karolinska Institute.
    Editorial Material: Two Decades After Legislation on Identifiable Donors in Sweden: Are Recipient Couples Ready to be Open About Using Gamete Donation? EDITORIAL COMMENT in OBSTETRICAL and GYNECOLOGICAL SURVEY, vol 66, issue 7, pp 423-4242011In: Obstetrical and Gynecological Survey, ISSN 0029-7828, E-ISSN 1533-9866, Vol. 66, no 7, 423-424 p.Article in journal (Other academic)
    Abstract [en]

    n/a

  • 45.
    Isaksson, S.
    et al.
    Uppsala University, Sweden.
    Skoog-Svanberg, A.
    Uppsala University, Sweden.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Linell, L.
    Karolinska University Hospital, Sweden.
    Lampic, C.
    Uppsala University, Sweden; Karolinska Institute, Sweden.
    It takes two to tango: information-sharing with offspring among heterosexual parents following identity-release sperm donation2016In: Human Reproduction, ISSN 0268-1161, E-ISSN 1460-2350, Vol. 31, no 1, 125-132 p.Article in journal (Refereed)
    Abstract [en]

    How do heterosexual parents reason about and experience information-sharing with offspring following identity-release sperm donation? Sharing information about using donor-conception with offspring is a complex process at several levels, with the parents personal beliefs and the childs responses serving as driving or impeding forces for the information-sharing process. The overall view of disclosure in gamete donation has shifted from secrecy to openness, but there is still uncertainty among parents concerning how and when to tell the child about his/her genetic origin. Most research on donor-conceived families has focused on donation treatment under anonymous or known circumstances, and there is a lack of studies in settings with identity-release donations. A qualitative interview study among 30 parents following identity-release sperm donation treatment. Interviews were conducted from February 2014 to March 2015. The present study is part of the prospective longitudinal Swedish Study on Gamete Donation (SSGD), including all fertility clinics performing gamete donation in Sweden. A sample of participants in the SSGD, consisting of heterosexual parents with children aged 7-8 years following identity-release sperm donation, participated in individual semi-structured interviews. The analysis revealed one main theme: information-sharing is a process, with three subthemes; (i) the parent as process manager, (ii) the child as force or friction and (iii) being in the process. The first two subthemes were viewed as being linked together and their content served as driving or impeding forces in the information-sharing process. The fact that the study was performed within the context of the Swedish legislation on identity-release donation must be taken into consideration as regards transferability to other populations, as this may affect parents reasoning concerning their information-sharing with the child. The present findings highlight the role of the donor-conceived child in the information-sharing process and may contribute to develop counselling that increases parents confidence in handling childrens reactions to information about their genetic origin. Financial support from The Swedish Research Council, The Family Planning Fund in Uppsala and Ferring Pharmaceuticals. There are no conflicts of interest to declare. N/A.

  • 46.
    Isaksson, S
    et al.
    Uppsala University, Sweden .
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Skoog Svanberg, A
    Uppsala University, Sweden .
    Lampic, C
    Karolinska Institute, Sweden .
    Disclosure behaviour and intentions among 111 couples following treatment with oocytes or sperm from identity-release donors: follow-up at offspring age 14 years2012In: Human Reproduction, ISSN 0268-1161, E-ISSN 1460-2350, Vol. 27, no 10, 2998-3007 p.Article in journal (Refereed)
    Abstract [en]

    Do heterosexual parents of young children following oocyte donation (OD) and sperm donation (SD) tell or intend to tell their offspring about the way he/she was conceived? less thanbrgreater than less thanbrgreater thanFollowing successful treatment with oocytes or sperm from identity-release donors in Sweden, almost all heterosexual couples intend to tell their offspring about the way he/she was conceived and some start the information-sharing process very early. less thanbrgreater than less thanbrgreater thanAlthough the Swedish legislation on identity-release gamete donors has been in effect since 1985, there is a discrepancy between the behaviour of donor-insemination parents and the legal intention that offspring be informed about their genetic origin. The present study contributes data on a relatively large sample of oocyte and sperm recipient couples intended compliance with the Swedish legislation. less thanbrgreater than less thanbrgreater thanThe present study constitutes a follow-up assessment of heterosexual couples who had given birth to a child following treatment with donated oocytes. Data collection was performed during 20072011; participants individually completed a questionnaire when the child was between 1 and 4 years of age. less thanbrgreater than less thanbrgreater thanThe present study is part of the Swedish Study on Gamete Donation, a prospective longitudinal cohort study including all fertility clinics performing gamete donation in Sweden. For children conceived via OD, 107 individuals (including 52 couples and 3 individuals) agreed to participate (73 response). For children conceived via SD, the response rate was 70 (n 122 individuals, including 59 couples and 4 individuals). Mean age of participants was 34 years (SD 4.4) and they reported a high level of education. less thanbrgreater than less thanbrgreater thanThe majority of participants (78) planned to tell the child about the donation, 16 had already started the information-sharing process and 6 planned not to tell their child about the donation or were undecided. Many were unsure about a suitable time to start the disclosure process and desired more information about strategies and tools for information sharing. Agreement on disclosure to offspring within the couple was related to the quality of the partner relationship. less thanbrgreater than less thanbrgreater thanThere is a risk of selection bias, with gamete recipients preferring secrecy and non-disclosure declining study participation. The results may be regarded as partly generalizable to heterosexual couples with young children following treatment with gametes from legislatively mandated identity-release donors in an established donor programme. less thanbrgreater than less thanbrgreater thanStudy funding by Merck Serono, The Swedish Research Council and The Family Planning Fund in Uppsala. No conflicts of interest to declare.

  • 47.
    Isaksson, Stina
    et al.
    Uppsala University, Sweden.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Skoog Svanberg, Agneta
    Uppsala University, Sweden.
    Lampic, Claudia
    Karolinska Institute, Sweden.
    Preferences and needs regarding future contact with donation offspring among identity-release gamete donors: results from the Swedish Study on Gamete Donation2014In: Fertility and Sterility, ISSN 0015-0282, E-ISSN 1556-5653, Vol. 102, no 4, 1160-1166 p.Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate the attitudes and preferences regarding future contact with donation offspring among identity-release donors of oocytes or sperm. Design: Longitudinal cohort study. Setting: University-based fertility clinics in Sweden. Patient(s): A total of 210 women and men were questioned 5-8 years after their donation of oocytes or sperm. Intervention(s): Questionnaires given to donors prior to their donation and 5-8 years after donation. Main Outcome Measure(s): Donors attitudes and preferences regarding future contact with their donation offspring. Result(s): A majority of identity-release oocyte (65%) and sperm (70%) donors were positive toward being contacted by an offspring of mature age. More than half wanted to be notified by the clinic when an offspring requested information about them, but about a third were negative toward receiving this information. One in four reported a need for counseling regarding future contact with an offspring. Conclusion(s): Several years after donation, a majority of identity-release oocyte and sperm donors show positive attitudes toward future contact with their offspring. Donors appear to have different preferences for information and support regarding such contact. Fertility clinics and health-care services should provide counseling regarding contact with an offspring to the donors who express a need for this.

  • 48.
    Jarkman Björn, Gunilla
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Bodén, Christina
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Gustafsson, Per A.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Brief Family Therapy for Refugee Children2013In: The Family Journal, ISSN 1066-4807, E-ISSN 1552-3950, Vol. 21, no 3, 272-278 p.Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to compare refugee children’s psychological well-being before and after brief family therapy. Families from Bosnia-Herzegovina with one child aged 5–12 years received three family therapy sessions. Psychological assessments using the Erica play-diagnostic method and parental interviews were made before and after the intervention. The main finding was that more children built normal sandboxes (showing no pathological findings)after the intervention than before, indicating that the rather short intervention had a positive effect on the children’s psychological well-being. To conclude, it might be valuable to offer refugee families a few family therapy sessions even if the children do not have psychiatric symptoms with the aim of helping them adapt to a new system of society.

  • 49.
    Jarkman Björn, Gunilla
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Gustafsson, Per A.
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Berterö, Carina
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Family therapy sessions with regugee families: a qualitative study2013In: Conflict and Health, ISSN 1752-1505, E-ISSN 1752-1505, Vol. 7, 7Article in journal (Refereed)
    Abstract [en]

    Background

    Due to the armed conflicts in the Balkans in the 1990s many families escaped to other countries. The main goal of this study was to explore in more detail the complexity of various family members’ experiences and perceptions from their life before the war, during the war and the escape, and during their new life in Sweden. There is insufficient knowledge of refugee families’ perceptions, experiences and needs, and especially of the complexity of family perspectives and family systems. This study focused on three families from Bosnia and Herzegovina who came to Sweden and were granted permanent residence permits. The families had at least one child between 5 and 12 years old.

    Method

    Family therapy sessions were videotaped and verbatim transcriptions were made. Nine family therapy sessions were analysed using a qualitative method with directed content analysis.

    Results

    Three main categories and ten subcategories were found - 1. Everyday life at home, with two subcategories: The family, Work and School/preschool; 2. The influence of war on everyday life, with three subcategories: The war, The escape, Reflections; 3. The new life, with five subcategories: Employment, Health, Relatives and friends, Limited future, Transition to the new life.

    Conclusions

    Health care and social welfare professionals need to find out what kind of lives refugee families have lived before coming to a new country, in order to determine individual needs of support. In this study the families had lived ordinary lives in their country of origin, and after experiencing a war situation they escaped to a new country and started a new life. They had thoughts of a limited future but also hopes of getting jobs and taking care of themselves and their families. When analysing each person’s point of view one must seek an all-embracing picture of a family and its complexity to tie together the family narrative. To offer refugee families meetings with family-oriented professionals to provide the opportunity to create a family narrative is recommended for the health and social welfare sector. Using this knowledge by emphasizing the salutogenic perspectives facilitates support to refugee families and individuals. This kind of support can help refugee families to adapt to a new system of society and recapture a sense of coherence, including all three components that lead to coherence: comprehensibility, manageability and meaningfulness. More studies are needed to further investigate the thoughts, experiences and needs of various refugee families and how refugee receiving societies can give the most effective support.

  • 50.
    Jarkman-Björn, Gunilla
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Bodén, Christina
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Gustafsson, Per A
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Psychological evaluation of refugee children: contrasting results from play diagnosis and parental interviews2011In: Clinical Child Psychology and Psychiatry, ISSN 1359-1045, E-ISSN 1461-7021, Vol. 16, no 4, 517-34 p.Article in journal (Refereed)
    Abstract [en]

    Many refugee families from Bosnia and Herzegovina arrived in Sweden during the Balkan conflict in the 1990s. We studied 14 of these families to compare psychological evaluation of the children using two different methods. We first carried out a semi-structured interview of a parent or parents in each family. The symptoms of each of the children, who ranged in age from 5 to 12 years, were evaluated based on these interview results. Then a second method, the Erica play-diagnosis method, was used to study the inner thoughts and feelings of the children. Results from the Erica play-diagnosis method were compared with results from Erica play- diagnosis from a normal group. According to results from the parental interviews all but one child in this study had a low level of psychological symptoms. In contrast, results from Erica play-diagnosis of these children showed that there were higher frequencies of not-normal play in these children compared with those in the normal group, which is an indication of deficiencies in the psychological well-being of these children. The results emphasise the importance of getting diagnostic information from the child in order to understand each child's psychological condition.

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