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  • 151.
    Kjölhede, Preben
    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.
    Borendal Wodlin, Ninnie
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Nilsson, Lena
    Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Fredrikson, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine. Linköping University, Faculty of Health Sciences.
    Wijma, Klaas
    Linköping University, Department of Clinical and Experimental Medicine, Gender and medicine. Linköping University, Faculty of Health Sciences.
    Impact of stress coping capacity on recovery from abdominal hysterectomy in a fast-track programme: a prospective longitudinal study2012In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 119, no 8, p. 998-1007Article in journal (Refereed)
    Abstract [en]

    Objective To evaluate the effect of stress coping capacity in combination with mode of anaesthesia on postoperative recovery in fast-track abdominal hysterectomy. Design Prospective longitudinal study. Setting Five hospitals in the south-east of Sweden. Population A cohort of 162 women undergoing fast-track abdominal hysterectomy for benign conditions. Methods Self-administered questionnaires, the Stress Coping Inventory (SCI) and the Swedish Postoperative Symptom Questionnaire (SPSQ), and clinical information were collected prospectively. Stress coping capacity was categorised as high or low according to the summed score of the SCI. Comparisons of effect variables were adjusted using a propensity score-matching model. Main outcome measures Associations between stress coping capacity and hospital stay, sick leave, use of analgesic and self-reported postoperative symptoms. Results Women with high stress coping capacity had a significantly shorter sick leave, experienced postoperative symptoms significantly less often, and with lower intensity, than women with low stress coping capacity. With the exception of symptom intensity, these findings were related to having had the operation under spinal anaesthesia as opposed to general anaesthesia. Hospital stay, use of analgesics and abdominal pain were not related to stress coping capacity. Conclusions In patients for whom spinal anaesthesia was applied, high stress coping seems to be a quality that helps patients manage the burden of surgery. It is desirable for the individual, as well as for the healthcare system, to enhance recovery by using intervention programmes designed to improve or manage stress coping, particularly for individuals with low stress coping capacity. This recommendation merits further investigation.

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  • 152.
    Kjölhede, Preben
    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.
    Halili, Shefqet
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Lofgren, Mats
    Umea University Hospital.
    Vaginal cleansing and postoperative infectious morbidity in vaginal hysterectomy. A register study from the Swedish National Register for Gynecological Surgery2011In: ACTA OBSTETRICIA ET GYNECOLOGICA SCANDINAVICA, ISSN 0001-6349, Vol. 90, no 1, p. 63-71Article in journal (Refereed)
    Abstract [en]

    Objective. To evaluate whether preoperative vaginal preparation routines influence postoperative infectious morbidity in vaginal hysterectomy and to analyze risk factors for postoperative infectious morbidity. Design. Retrospective, longitudinal cohort study. Setting. Forty -three hospitals in Sweden, participating in the Swedish National Register for Gynecological Surgery. Population. All 6,496 women who were enrolled in the Register and underwent vaginal or laparoscopically assisted vaginal hysterectomy between 1 January 2000 and 1 February 2008. Methods. Register data were collected prospectively using doctors forms and patient questionnaires. Information about vaginal preparation routines in the clinics were achieved retrospectively by an e-mail survey. Multiple logistic regression analyses models were used to determine associations and risk factors. Main outcome measures. Infectious morbidity within 6-8 weeks postoperatively. Results. No significant differences were seen in postoperative infectious morbidity in long term between vaginal preparation using saline or chlorhexidine solution or no cleansing. At discharge from hospital, those who had had vaginal cleansing using saline solution had a significantly higher risk of postoperative infections. Risk factors for infectious morbidity were young age, obesity, peroperative injury of the urinary bladder, operative time and duration of hospital stay. Protective were prophylactic antibiotics and concomitant prolapse surgery. Conclusions. Saline solution should not be used for vaginal cleansing due to a higher risk of infectious morbidity in the immediate postoperative period. Infectious morbidity may be reduced further by employing preventive measures such as meticulous surgical technique, preoperative weight reduction in obese women and minimizing time in hospital.

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  • 153.
    Kjölhede, Preben
    et al.
    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. Linköping University, Faculty of Health Sciences.
    Halili, Shefqet
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    Löfgren, Mats
    Umea University Hospital.
    The influence of preoperative vaginal cleansing on postoperative infectious morbidity in abdominal total hysterectomy for benign indications2009In: ACTA OBSTETRICIA ET GYNECOLOGICA SCANDINAVICA, ISSN 0001-6349, Vol. 88, no 4, p. 408-416Article in journal (Refereed)
    Abstract [en]

    Objective. To evaluate whether vaginal cleansing reduces the risk of postoperative infection after abdominal total hysterectomy on benign indications and to analyze risk factors. Design. Retrospective cohort study. Setting. All clinics including patients in the Swedish National Register for Gynecological Surgery. Population. All 7,193 women who underwent abdominal total hysterectomy for benign indications from 2000 to 2007. Methods. Information on clinic routines for preoperative vaginal cleansing was obtained retrospectively in a postal survey. Associations between routines for vaginal cleansing and structured data from the Register were analyzed by means of multivariate logistic regression models. The main effect variable was postoperative infections defined as infections treated with antibiotics within six to eight weeks postoperatively, reported by the patient or the physician. Main outcome measures. Prevalence and risk factors for postoperative infections. Results. Prevalence of postoperative infections was 14.4%. The prevalence did not differ between those having had vaginal cleansing using chlorhexidine and those without vaginal cleansing, whereas using saline solution was encumbered with a significantly increased risk. Risk factors for postoperative infections were age 60, obesity, smoking, weight of the uterus, duration of hospital stay, blood transfusion, and peroperative injury of the urinary bladder or ureter. Conclusion. Vaginal cleansing using chlorhexidine solution did not reduce the risk of postoperative infections, whereas vaginal cleansing using saline solution seemed to increase the risk. Some risk factors for postoperative infectious morbidity seem to be preventable.

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  • 154.
    Kjölhede, Preben
    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.
    Halili, Shefqet
    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.
    Löfgren, Mats
    Department of Clinical Science, Obstetrics and Gynecology, Umeå University Hospital, Umeå, Sweden.
    The Influence of Preoperative Vaginal Cleansing on Postoperative Infectious Morbidity in Abdominal Total Hysterectomy for Benign Indications: A Study From the Swedish National Register for Gynecological Surgery2009In: Obstetrical and Gynecological Survey, ISSN 0029-7828, E-ISSN 1533-9866, Vol. 64, no 7, p. 453-455Article in journal (Other academic)
    Abstract [en]

    n/a

  • 155.
    Kjölhede, Preben
    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.
    Langström, Petra
    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.
    Nilsson, Pernilla
    Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Borendal Wodlin, Ninnie
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Nilsson, Lena
    Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Quality of sleep the night after surgery, does it matter? A prospective cohort study of women undergoing fast track abdominal hysterectomy in ACTA OBSTETRICIA ET GYNECOLOGICA SCANDINAVICA, vol 91, issue SI, pp 18-182012In: ACTA OBSTETRICIA ET GYNECOLOGICA SCANDINAVICA, Informa Healthcare / Wiley-Blackwell , 2012, Vol. 91, no SI, p. 18-18Conference paper (Refereed)
    Abstract [en]

    n/a

  • 156.
    Kjölhede, Preben
    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.
    Langström, Petra
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Nilsson, Pernilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Borendal Wodlin, Ninnie
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Nilsson, Lena
    Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    The Impact of Quality of Sleep on Recovery from Fast-Track Abdominal Hysterectomy2012In: Journal of Clinical Sleep Medicine (JCSM), ISSN 1550-9389, E-ISSN 1550-9397, Vol. 8, no 4, p. 395-402Article in journal (Refereed)
    Abstract [en]

    Study Objectives: To examine the impact of mode of anesthesia on perceived quality of sleep and to analyze the perceived quality of sleep in affecting recovery from surgery. less thanbrgreater than less thanbrgreater thanMethods: A randomized, controlled, open multicenter trial was conducted in 5 hospitals in Southeast Sweden. One-hundred eighty women scheduled for fast-track abdominal hysterectomy for benign conditions were randomized to spinal anesthesia or general anesthesia; 162 women completed the trial; 82 allocated to spinal anesthesia and 80 to general anesthesia. Symptoms and perceived quality of sleep after surgery were registered daily in the Swedish Postoperative Symptoms Questionnaire. less thanbrgreater than less thanbrgreater thanResults: Women in the general anesthesia group experienced bad quality of sleep the night after surgery significantly more often than the women who had spinal anesthesia (odds ratio [OR] 2.45; p = 0.03). This was almost exclusively attributed to a significantly higher consumption of opioids postoperatively in the general anesthesia group. Risk factors for bad quality of sleep during the first night postoperatively were: opioids (OR 1.07; p = 0.03); rescue antiemetics (OR 2.45; p = 0.05); relative weight gain (OR 1.47; p = 0.04); summary score of postoperative symptoms (OR 1.13; p = 0.02); and stress coping capacity (OR 0.98; p = 0.01). A longer hospital stay was strongly associated with a poorer quality of sleep the first night postoperatively (p = 0.002). less thanbrgreater than less thanbrgreater thanConclusions: The quality of sleep the first night after abdominal hysterectomy is an important factor for recovery. In fast-track abdominal hysterectomy, it seems important to use anesthesia and multimodal analgesia reducing the need for opioids postoperatively and to use strategies that diminish other factors that may interfere negatively with sleep. Efforts to enhance quality of sleep postoperatively by means of preventive measures and treatment of sleep disturbances should be included in fast-track programs.

  • 157.
    Kjölhede, Preben
    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.
    Wahlström, Johan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Wingren, Gun
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine .
    Pelvic floor dysfunction after Burch colposuspension - A comprehensive study. Part II2005In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 84, no 9, p. 902-908Article in journal (Refereed)
    Abstract [en]

    Objective. To evaluate the prevalence of pelvic floor dysfunction (PFD) concerning bowel function at long-term follow-up after Burch colposuspension (Bc) in relation to the bowel function in an age-matched sample of women in the general population. Methods and material. This is a follow-up study of a cohort of 190 patients who underwent Bc in 1980-1988 and 305 age-matched control women without urinary anti-incontinence surgery, randomly selected from the general population. The participants answered a postal questionnaire with detailed questions about the pelvic floor function in 1998. Univariate and multivariate analyses were performed. Results. The patients showed considerable signs of bowel dysfunction compared with the general population in the following aspects: they used the fingers to help emptying the bowel [odds ratio (OR) 3.25 (1.35-7.86)], had feeling of incomplete emptying of the bowel [OR 2.29 (1.11-4.73)], felt no warning before passing a motion [OR 3.04 (1.20-7.71)], had gas incontinence [OR 1.98 (1.17-3.37), had loose stool incontinence [OR 3.67 (1.43-9.42)], used protection against fecal leakage during daytime [OR 3.22 (1.30-7.95)], and experienced that the bowel function affected the general well-being adversely [OR 2.15 (1.30-3.56)]. Conclusion. The patients who have undergone colposuspension for stress urinary incontinence have more symptoms of PFD concerning the bowel function than women without urinary anti-incontinence surgery in the general population. This affects the general well-being. A comprehensive concept of multidisciplinary assessment and treatment of PFD should be encouraged. © Acta Obstet Gynecol Scand 2005.

  • 158.
    Lampic, C
    et al.
    Karolinska Institute.
    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.
    Attitudes towards disclosure and future contact with offspring among 226 identity-release oocyte and sperm donors in Sweden in HUMAN REPRODUCTION, vol 26, issue , pp I260-I2602011In: HUMAN REPRODUCTION, Oxford University Press (OUP) , 2011, Vol. 26, p. I260-I260Conference paper (Refereed)
    Abstract [en]

    n/a

  • 159.
    Lampic, Claudia
    et al.
    Uppsala University.
    Skoog Svanberg, Agneta
    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.
    Attitudes towards gamete donation among IVF doctors in the Nordic countries-are they in line with national legislation?2009In: JOURNAL OF ASSISTED REPRODUCTION AND GENETICS, ISSN 1058-0468, Vol. 26, no 5, p. 231-238Article in journal (Refereed)
    Abstract [en]

    To compare attitudes towards gamete donation between IVF doctors in the Nordic countries, and to determine whether attitudes are in correspondence with national legislation. A study-specific questionnaire was used to study attitudes of 108 IVF doctors (92% response). Participants constituted 78% of all IVF doctors in Sweden, Denmark and Norway and 15% of IVF doctors in Finland. Despite similar legislation regarding offspring right to learn his/her donors identity, IVF doctors from Norway reported significantly more negative attitudes towards disclosure than did Swedish physicians. A majority from all countries demonstrated positive attitudes towards embryo donation and allowing sperm donation for lesbian couples. Physicians reported strong support for anonymous donation but less support for known donation. There are discrepancies between IVF doctors attitudes towards gamete donation and national legislation in four Nordic countries. Negative attitudes towards disclosure to offspring may counteract legislative intentions.

  • 160.
    Larsson, Per-Göran
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Gender and medicine .
    Carlsson, Bodil
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Clinical Microbiology . Linköping University, Department of Clinical and Experimental Medicine, Clinical Microbiology .
    Fåhraeus, Lars
    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.
    Jakobsson, Tell
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology .
    Forsum, Urban
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Clinical Microbiology . Linköping University, Department of Clinical and Experimental Medicine, Clinical Microbiology .
    Diagnosis of bacterial vaginosis: need for validation of microscopic image area used for scoring bacterial morphotypes2004In: Sexually Transmitted Infections, ISSN 1368-4973, E-ISSN 1472-3263, Vol. 80, no 1, p. 63-67Article in journal (Refereed)
    Abstract [en]

    Background: The diagnosis of bacterial vaginosis (BV) is often made according to Nugent's classification, a scoring system based on bacterial counting of Gram stained slides of vaginal secretion. However as the image area of the microscope field will influence the number of morphotypes seen there is a need to standardise the area. Methods: A graph intended for recalculation of number of bacterial morphotypes seen by the observer using 1000 x magnification from various microscope set-ups was constructed and applied to data sets typical for scoring BV. The graph was used in recalculation of Nugent scores, which were also compared with the Ison/Hay scores to evaluate the consequences for the diagnosis of BV. Results: The observed image area differed by 300% among the investigated microscope set-ups. In two different data sets, one treatment study and one screening study, a considerable change in the number of women classified as intermediate was seen when the graph was used to standardise the image area. The recalculated numbers were also compared to the Ison/Hay classification. Weighted kappa indexes between the different methods were 0.84, 0.88, and 0.90, indicating that the methods are comparable. Conclusion: Because of the considerable differences among image areas covered by different microscope set-ups used in Nugent and Ison/Hay scoring, there is a need to standardise the area in order to reach comparable scores reflecting the diagnosis of BV in different laboratories. The differences in the intermediate group will have a considerable effect on the results from both treatment and prevalence studies, even though the kappa indexes indicate very good agreement between the methods used.

  • 161.
    Larsson, Per-Göran
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Gender and medicine .
    Platz-Christensen, JJ
    Cent Hosp Skovde, Dept Obstet & Gynaecol, S-54185 Skovde, Sweden Sahlgrenska Univ Hosp, Dept Obstet & Gynaecol, Gothenburg, Sweden Cent Hosp Boras, Dept Obstet & Gynaecol, Boras, Sweden Linkoping Univ Hosp, Dept Obstet & Gynaecol, Linkoping, Sweden Cent Hosp Jonkoping, Dept Obstet & Gynaecol, Jonkoping, Sweden Univ Lund Hosp, Dept Obstet & Gynaecol, Lund, Sweden Haukeland Hosp, Dept Obstet & Gynaecol, N-5021 Bergen, Norway Ulleval Hosp, Dept Obstet & Gynaecol, Oslo, Norway Aker Hosp, Dept Obstet & Gynaecol, Oslo, Norway.
    Dalaker, K
    Cent Hosp Skovde, Dept Obstet & Gynaecol, S-54185 Skovde, Sweden Sahlgrenska Univ Hosp, Dept Obstet & Gynaecol, Gothenburg, Sweden Cent Hosp Boras, Dept Obstet & Gynaecol, Boras, Sweden Linkoping Univ Hosp, Dept Obstet & Gynaecol, Linkoping, Sweden Cent Hosp Jonkoping, Dept Obstet & Gynaecol, Jonkoping, Sweden Univ Lund Hosp, Dept Obstet & Gynaecol, Lund, Sweden Haukeland Hosp, Dept Obstet & Gynaecol, N-5021 Bergen, Norway Ulleval Hosp, Dept Obstet & Gynaecol, Oslo, Norway Aker Hosp, Dept Obstet & Gynaecol, Oslo, Norway.
    Eriksson, K
    Fåhraeus, Lars
    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.
    Irminger, K
    Cent Hosp Skovde, Dept Obstet & Gynaecol, S-54185 Skovde, Sweden Sahlgrenska Univ Hosp, Dept Obstet & Gynaecol, Gothenburg, Sweden Cent Hosp Boras, Dept Obstet & Gynaecol, Boras, Sweden Linkoping Univ Hosp, Dept Obstet & Gynaecol, Linkoping, Sweden Cent Hosp Jonkoping, Dept Obstet & Gynaecol, Jonkoping, Sweden Univ Lund Hosp, Dept Obstet & Gynaecol, Lund, Sweden Haukeland Hosp, Dept Obstet & Gynaecol, N-5021 Bergen, Norway Ulleval Hosp, Dept Obstet & Gynaecol, Oslo, Norway Aker Hosp, Dept Obstet & Gynaecol, Oslo, Norway.
    Jerve, F
    Cent Hosp Skovde, Dept Obstet & Gynaecol, S-54185 Skovde, Sweden Sahlgrenska Univ Hosp, Dept Obstet & Gynaecol, Gothenburg, Sweden Cent Hosp Boras, Dept Obstet & Gynaecol, Boras, Sweden Linkoping Univ Hosp, Dept Obstet & Gynaecol, Linkoping, Sweden Cent Hosp Jonkoping, Dept Obstet & Gynaecol, Jonkoping, Sweden Univ Lund Hosp, Dept Obstet & Gynaecol, Lund, Sweden Haukeland Hosp, Dept Obstet & Gynaecol, N-5021 Bergen, Norway Ulleval Hosp, Dept Obstet & Gynaecol, Oslo, Norway Aker Hosp, Dept Obstet & Gynaecol, Oslo, Norway.
    Stray-Pedersen, B
    Cent Hosp Skovde, Dept Obstet & Gynaecol, S-54185 Skovde, Sweden Sahlgrenska Univ Hosp, Dept Obstet & Gynaecol, Gothenburg, Sweden Cent Hosp Boras, Dept Obstet & Gynaecol, Boras, Sweden Linkoping Univ Hosp, Dept Obstet & Gynaecol, Linkoping, Sweden Cent Hosp Jonkoping, Dept Obstet & Gynaecol, Jonkoping, Sweden Univ Lund Hosp, Dept Obstet & Gynaecol, Lund, Sweden Haukeland Hosp, Dept Obstet & Gynaecol, N-5021 Bergen, Norway Ulleval Hosp, Dept Obstet & Gynaecol, Oslo, Norway Aker Hosp, Dept Obstet & Gynaecol, Oslo, Norway.
    Wolner-Hanssen, P
    Cent Hosp Skovde, Dept Obstet & Gynaecol, S-54185 Skovde, Sweden Sahlgrenska Univ Hosp, Dept Obstet & Gynaecol, Gothenburg, Sweden Cent Hosp Boras, Dept Obstet & Gynaecol, Boras, Sweden Linkoping Univ Hosp, Dept Obstet & Gynaecol, Linkoping, Sweden Cent Hosp Jonkoping, Dept Obstet & Gynaecol, Jonkoping, Sweden Univ Lund Hosp, Dept Obstet & Gynaecol, Lund, Sweden Haukeland Hosp, Dept Obstet & Gynaecol, N-5021 Bergen, Norway Ulleval Hosp, Dept Obstet & Gynaecol, Oslo, Norway Aker Hosp, Dept Obstet & Gynaecol, Oslo, Norway.
    Treatment with 2% clindamycin vaginal cream prior to first trimester surgical abortion to reduce signs of postoperative infection: A prospective, double-blinded, placebo-controlled, multicenter study2000In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 79, no 5, p. 390-396Article in journal (Refereed)
    Abstract [en]

    Background. Bacterial vaginosis (BV) and intermediate flora is known risk-factor for post-operative infection after surgical termination of pregnancy. Vaginal application of 2% clindamycin cream is an efficacious treatment for BV, but it is not known whether preoperative administration of clindamycin cream might reduce the signs of post-abortion infection after surgical termination of pregnancy. Aim. To evaluate whether preoperative treatment with clindamycin cream might reduce the signs of post-abortion infection after legal abortion. Design. Prospective, double-blinded, placebo-controlled, multicenter study. Material and methods. Consecutive women attending for surgical termination prior to 11 + 4 gestational weeks were approached. We randomized participants to preoperative vaginal treatment with 2% clindamycin cream or placebo cream in a double-blinded fashion. At all visits vaginal smears were air dried on microscopy slides to be stored. The rate of postoperative pelvic infection according to our definition was the main outcome variable, the cure rates of BV and of intermediate flora were secondary outcome variables. Results. Of 1655 enrolled women, 1102 were evaluable for analyses. Fifty-eight women developed signs of post-abortion infection. Preoperative treatment with clindamycin cream significantly (RR: 4.2, 95% C.I. 1.2-15.9) reduced the risk of post-abortion infection among women with abnormal vaginal Bora (BV and intermediate flora). Treatment with clindamycin cream in women with normal lactobacilli flora did not demonstrate any difference compared to the non-treatment group. Conclusion. Preoperative treatment for at least three days with clindamycin cream significantly reduced the risk for developing signs of post-abortion infection only among women with preoperative abnormal vaginal flora (BV and intermediate flora).

  • 162.
    Lidström Gustafsson, Charlotte
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Immunology and Transfusion Medicine.
    Matthiesen, Leif
    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.
    Berg, Göran
    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.
    Sharma, Surendra
    Department of Pediatrics & Department of Pathology, Brown University and Women and Infants' Hospital of Rhode Island, Providence, RI, USA.
    Ernerudh, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Immunology and Transfusion Medicine.
    Ekerfelt, Christina
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Cytokine secretion patterns of NK cells and macrophages in early human pregnancy decidua and blood: Implications for suppressor macrophages in decidua2003In: American Journal of reproductive immunology, ISSN 8755-8920, Vol. 50, no 6, p. 444-452Article in journal (Refereed)
    Abstract [en]

    Problem: Local immune modulation has been shown to be of considerable importance for the maintenance of successful pregnancy. We have previously reported the secretion of interferon-γ (IFN-γ), interleukin-4 (IL-4) and IL-10 in human decidua from early normal pregnancy. The aim of this study was to investigate the cellular source of cytokine secretion in the decidua, and compare this to secretion patterns in peripheral blood.

    Method of study: Decidual tissue and peripheral blood was collected from 20 women undergoing surgical abortion during first trimester pregnancy. Monocytes/macrophages and NK cells were enriched by immunomagnetic cell separation and cytokine secretion was detected by enzyme-linked immunosorbent spot-forming cell assay.

    Results: Decidual and peripheral monocytes/macrophages and NK cells spontaneously secrete IFN-γ, IL-4 and IL-10. The number of IL-10 secreting cells was significantly higher in decidual macrophages compared with decidual non-monocytic cells as well as compared with blood monocytes/macrophages. These differences were not seen for IFN-γ or IL-4.

    Conclusions: Our results indicate that decidual macrophages subserve important suppressive functions in the pregnant uterus.

  • 163. Order onlineBuy this publication >>
    Lilliecreutz, Caroline
    Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology.
    Blood-and Injection Phobia in Pregnancy: Epidemiological, Biological and Treatment aspects2010Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Introduction: Blood- and injection phobia is an anxiety disorder with a prevalence of approximately 3-5% in the general population. The etiology is often a combination of genetic factors and a conditioning experience. The symptoms of blood- and injection phobia are dizziness, confusion, nausea, epigastria discomfort, anxiety and sometimes panic attacks when receiving injections, seeing blood or having a blood sample taken. Unique for this specific phobia is the high probability of fainting when the phobic situation is encountered if there is no possibility to escape or to avoid the stimuli.

    During pregnancy and labor, women with blood- and injection phobia are exposed to most of their fears and they therefore find themselves in anxiety-ridden situations. Stress and anxiety during pregnancy is known to be risk factors for adverse obstetric and neonatal outcomes. Studies have shown an altered hypothalamic-adrenal-pituitary axis in women with stress or/and anxiety during pregnancy and increased cortisol concentrations can imply negative consequences for the unborn child. Cognitive behavioral therapy (CBT) is known to be effective in treating specific phobias such as blood- and injection phobia.

    Aim: The prevalence, obstetric and neonatal consequences, impact on the hypothalamic adrenal-pituitary axis and treatment aspects of blood- and injection phobia in a pregnant population have not been investigated before. The aims of this thesis were to study each of these phenomena.

    Material and methods: During 2005 a total of 1606 pregnant women were approached at their first visit in an antenatal care clinic in the southeast region in Sweden. They were asked to complete the “Injection Phobia Scale-Anxiety” questionnaire. All women who scored ≥ 20 on the “Injection Phobia Scale-Anxiety” questionnaire (N=347), were interviewed and either diagnosed for blood- and injection phobia or dismissed. In total, 110 women were diagnosed as having blood- and injection phobia. Among the women who scored <20 on the “Injection Phobia Scale-Anxiety” questionnaire, 220 women were randomly stratified for age and parity as a control group. The women in the study population answered questionnaires in gestational week 25, 36 and postpartum concerning symptoms of blood- and injection phobia, depression and anxiety. Samples of cortisol in the saliva were collected in the morning and evening in gestational week 25 and 36 in both groups of pregnant women. The medical records from the antenatal care visits, the delivery and postpartum check-up was used to collect data of importance. A treatment study was conducted using a two session cognitive behavioral therapy in a group of pregnant woman with blood- and injection phobia.

    Results: The prevalence of blood- and injection phobia is 7 % in a pregnant population. Pregnant women with blood- and injection phobia stated more often a fear of childbirth (p<0.001) and were more frequently delivered by elective cesarean section (p=0.032). The incidence of having a baby diagnosed with a complication (p=0.001) was also higher among these women. The women with blood- and injection phobia had increased cortisol concentrations in the saliva compared to the healthy controls (p=0.014). A two-session CBT in group for pregnant women with blood- and injection phobia reduced phobic (p<0.001) anxiety (p<0.001) and depressive (p<0.001) symptoms during pregnancy.

    Conclusions: Blood- and injection phobia during pregnancy is rather common. Pregnant women with blood- and injection phobia are more likely to be delivered by elective cesarean section and having a baby born with a complication compared to women not suffering from this specific phobia. Untreated blood- and injection phobia during pregnancy increases salivary cortisol concentrations indicating an altered hypothalamic-adrenal-pituitary axis during these weeks of pregnancy. To enhance psychological well being in pregnant women with blood- and injection phobia a two-session program providing CBT for groups of pregnant women is valuable and produces stable results for at least 3 months after delivery.

    List of papers
    1. Prevalence of blood and injection phobia among pregnant women
    Open this publication in new window or tab >>Prevalence of blood and injection phobia among pregnant women
    2008 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 87, no 12, p. 1276-1279Article in journal (Refereed) Published
    Abstract [en]

    Objective: The aim of the study was to investigate the prevalence of blood and injection phobia in an unselected pregnant population, in order to estimate the need for curative intervention programmes.

    Design: A cross-sectional study. Setting. Antenatal care clinics in the southeast region of Sweden.

    Sample: In total, 1,606 consecutively registered pregnant women attending their first visit with a midwife.

    Methods: The women were asked to complete the Injection Phobia-Anxiety scale, measuring phobic symptoms. Women who scored 20 on the questionnaire were telephone-interviewed and then diagnosed or dismissed according to the DSM-IV criteria for blood and injection phobia. Main outcome measures. Prevalence of blood and injection phobia according to the DSM-IV.

    Results: Of 1,529 women who chose to participate (92.5%), 110 women or 7.2% fulfilled the DSM-IV criteria for blood and injection phobia. The mean age of the women was 29.1 years.

    Conclusions: Blood and injection phobia is hitherto unreported in the literature, but seems to be relatively common and needs to be recognized during pregnancy as it causes a great deal of discomfort and fear among pregnant women. The Injection Phobia-Anxiety scale is suitable as a screening tool in an antenatal care clinic setting.

    Keywords
    Blood-injection, phobia, pregnancy, prevalence
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-16232 (URN)10.1080/00016340802468324 (DOI)
    Available from: 2009-01-12 Created: 2009-01-09 Last updated: 2019-06-28
    2. An open trial with cognitive behavioral therapy for blood- and injection phobia in pregnant women-a group intervention program
    Open this publication in new window or tab >>An open trial with cognitive behavioral therapy for blood- and injection phobia in pregnant women-a group intervention program
    2010 (English)In: ARCHIVES OF WOMENS MENTAL HEALTH, ISSN 1434-1816, Vol. 13, no 3, p. 259-265Article in journal (Refereed) Published
    Abstract [en]

    Around 7% of pregnant women suffer from blood- and injection phobia. The aim was to investigate if cognitive behavior group therapy (CBT) is effective in treating pregnant womens blood- and injection phobia. Thirty pregnant women with blood- and injection phobia according to DSM-IV took part in an open treatment intervention. A two-session cognitive behavior group therapy was conducted. As controls, 46 pregnant women with untreated blood- and injection phobia and 70 healthy pregnant women were used. Repeated measures ANOVA were performed. The scores for the CBT treatment group on the "Injection Phobia Scale-Anxiety" were reduced both after each treatment session and postpartum (p andlt; 0.001). Anxiety and depressive symptoms were also reduced (p andlt; 0.001). Cognitive-behavior group therapy for pregnant women with blood- and injection phobia is effective and stable up to at least 3 months postpartum. It seems also to reduce anxiety and depressive symptoms during pregnancy.

    Place, publisher, year, edition, pages
    Springer Science Business Media, 2010
    Keywords
    Anxiety, Blood- and injection phobia, Cognitive behavior group therapy, Depression, Pregnancy
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-56809 (URN)10.1007/s00737-009-0126-x (DOI)000277935600010 ()
    Note
    The original publication is available at www.springerlink.com: Caroline Lilliecreutz, Ann Josefsson and Gunilla Sydsjö, An open trial with cognitive behavioral therapy for blood- and injection phobia in pregnant women-a group intervention program, 2010, ARCHIVES OF WOMENS MENTAL HEALTH, (13), 3, 259-265. http://dx.doi.org/10.1007/s00737-009-0126-x Copyright: Springer Science Business Media http://www.springerlink.com/ Available from: 2010-06-04 Created: 2010-06-04 Last updated: 2019-06-28
    3. Obstetric and perinatal outcomes among women with blood- and injection phobia during pregnancy
    Open this publication in new window or tab >>Obstetric and perinatal outcomes among women with blood- and injection phobia during pregnancy
    2011 (English)In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 129, no 1-3, p. 289-295Article in journal (Refereed) Published
    Abstract [en]

    Backgroun: Little is known about how anxiety disorders affect pregnancy outcomes. Therefore we investigated the impact of one anxiety disorder, blood- and injection phobia, on obstetric and neonatal outcomes.

    Method: From a population-based prospectively collected cohort we compared an index group of 110 women with blood- and injection phobia with a control group of 220 women. Standardized medical records were used to collect data. Obstetric and neonatal outcomes e.g. elective cesarean, prematurity, and small for gestational age were used as the main outcome measures.

    Result: Women with blood- and injection phobia stated more often a fear of childbirth (p < 0.001) and were more frequently delivered by elective cesarean section (p = 0.032). The incidence of premature delivery (p = 0.028), neonatal morbidity (p = 0.001) and the risk of having a baby born small for gestational age (p = 0.009) was higher among women with blood- and injection phobia.

    Limitation: The medical records, from which all information is drawn, despite standardization, sometimes may lack some information. However, this dilemma exists in both groups.

    Conclusions: Women with an anxiety disorder such as blood- and injection phobia are at increased risk for adverse obstetric outcomes, premature delivery and for having a baby born with higher neonatal morbidity. It therefore seems important to identify and treat women with anxiety disorders without delay early during pregnancy in an effort to minimize risks of complications for the woman herself and the child.

    Place, publisher, year, edition, pages
    Elsevier, 2011
    Keywords
    Anxiety, blood-and injection phobia, premature, small for gestational age, cesarean
    National Category
    Obstetrics, Gynecology and Reproductive Medicine
    Identifiers
    urn:nbn:se:liu:diva-59743 (URN)10.1016/j.jad.2010.08.013 (DOI)000288293400038 ()20825998 (PubMedID)
    Note
    Original Publication: Caroline Lilliecreutz, Gunilla Sydsjö and Ann Josefsson, Obstetric and perinatal outcomes among women with blood- and injection phobia during pregnancy, 2011, Journal of Affective Disorders, (129), 1-3, 289-295. http://dx.doi.org/10.1016/j.jad.2010.08.013 Copyright: Elsevier Science B.V., Amsterdam. http://www.elsevier.com/ Available from: 2010-09-24 Created: 2010-09-24 Last updated: 2019-06-28Bibliographically approved
    4. Salivary cortisol in pregnant women suffering from blood-and injection phobia
    Open this publication in new window or tab >>Salivary cortisol in pregnant women suffering from blood-and injection phobia
    2011 (English)In: Archives of Women's Mental Health, ISSN 1434-1816, E-ISSN 1435-1102, Vol. 14, no 5, p. 405-411Article in journal (Refereed) Published
    Abstract [en]

    Purpose: Stress and/or anxiety during pregnancy affect maternal and fetal wellbeing and can cause premature delivery and postnatal pathology in the child. Women suffering from phobias related to blood and injections are prone to high levels of stress including anxiety and sometimes panic attacks during pregnancy. Cortisol is amongst the mediators through which the neurohormonal expressions of maternal psychological factors may be transduced to the fetus. The aim was to investigate if pregnant women suffering from blood- and injection phobia have raised cortisol levels or are characterized by unusual diurnal salivary cortisol profiles compared to healthy controls.

    Methods: The sample consisted of 110 pregnant women with blood- and injection phobia and 110 pregnant healthy controls. Both groups provided morning and evening saliva samples in week 25 and 36 for the assay of cortisol. In gestational week 25 when blood was drawn for the mandatory blood testing extra blood was taken to analyze corticotrophin releasing  factor (CRF), adrenocorticotropic hormone (ACTH) and cortisol in serum.

    Results: The expected diurnal decline in salivary cortisol was observed as well as increased cortisol levels during pregnancy. Pregnant women suffering from blood- and injection phobia had higher output of cortisol compared to women without the phobia (F=6.25 df=1 p=0.014) but no marked difference in the diurnal cortisol rhythm was found between the groups.

    Conclusion: Our findings indicate that untreated blood- and injection phobia during pregnancy increases cortisol concentrations. Blood- and injection phobia is treatable and cognitive behavioral therapy can be used.

    Place, publisher, year, edition, pages
    Springer Berlin/Heidelberg, 2011
    Keywords
    Cortisol, anxiety, stress, pregnancy, blood- and injection phobia
    National Category
    Obstetrics, Gynecology and Reproductive Medicine
    Identifiers
    urn:nbn:se:liu:diva-59744 (URN)10.1007/s00737-011-0234-2 (DOI)000297847800005 ()
    Available from: 2010-09-24 Created: 2010-09-24 Last updated: 2019-06-28
    Download full text (pdf)
    Blood-and Injection Phobia in Pregnancy : Epidemiological, Biological and Treatment aspects
    Download (pdf)
    Cover
  • 164.
    Lilliecreutz, Caroline
    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.
    Prevalence of blood and injection phobia among pregnant women2008In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 87, no 12, p. 1276-1279Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of the study was to investigate the prevalence of blood and injection phobia in an unselected pregnant population, in order to estimate the need for curative intervention programmes.

    Design: A cross-sectional study. Setting. Antenatal care clinics in the southeast region of Sweden.

    Sample: In total, 1,606 consecutively registered pregnant women attending their first visit with a midwife.

    Methods: The women were asked to complete the Injection Phobia-Anxiety scale, measuring phobic symptoms. Women who scored 20 on the questionnaire were telephone-interviewed and then diagnosed or dismissed according to the DSM-IV criteria for blood and injection phobia. Main outcome measures. Prevalence of blood and injection phobia according to the DSM-IV.

    Results: Of 1,529 women who chose to participate (92.5%), 110 women or 7.2% fulfilled the DSM-IV criteria for blood and injection phobia. The mean age of the women was 29.1 years.

    Conclusions: Blood and injection phobia is hitherto unreported in the literature, but seems to be relatively common and needs to be recognized during pregnancy as it causes a great deal of discomfort and fear among pregnant women. The Injection Phobia-Anxiety scale is suitable as a screening tool in an antenatal care clinic setting.

  • 165.
    Lilliecreutz, Caroline
    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.
    An open trial with cognitive behavioral therapy for blood- and injection phobia in pregnant women-a group intervention program2010In: ARCHIVES OF WOMENS MENTAL HEALTH, ISSN 1434-1816, Vol. 13, no 3, p. 259-265Article in journal (Refereed)
    Abstract [en]

    Around 7% of pregnant women suffer from blood- and injection phobia. The aim was to investigate if cognitive behavior group therapy (CBT) is effective in treating pregnant womens blood- and injection phobia. Thirty pregnant women with blood- and injection phobia according to DSM-IV took part in an open treatment intervention. A two-session cognitive behavior group therapy was conducted. As controls, 46 pregnant women with untreated blood- and injection phobia and 70 healthy pregnant women were used. Repeated measures ANOVA were performed. The scores for the CBT treatment group on the "Injection Phobia Scale-Anxiety" were reduced both after each treatment session and postpartum (p andlt; 0.001). Anxiety and depressive symptoms were also reduced (p andlt; 0.001). Cognitive-behavior group therapy for pregnant women with blood- and injection phobia is effective and stable up to at least 3 months postpartum. It seems also to reduce anxiety and depressive symptoms during pregnancy.

    Download full text (pdf)
    FULLTEXT01
  • 166.
    Lilliecreutz, Caroline
    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.
    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.
    Obstetric and perinatal outcomes among women with blood- and injection phobia during pregnancy2011In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 129, no 1-3, p. 289-295Article in journal (Refereed)
    Abstract [en]

    Backgroun: Little is known about how anxiety disorders affect pregnancy outcomes. Therefore we investigated the impact of one anxiety disorder, blood- and injection phobia, on obstetric and neonatal outcomes.

    Method: From a population-based prospectively collected cohort we compared an index group of 110 women with blood- and injection phobia with a control group of 220 women. Standardized medical records were used to collect data. Obstetric and neonatal outcomes e.g. elective cesarean, prematurity, and small for gestational age were used as the main outcome measures.

    Result: Women with blood- and injection phobia stated more often a fear of childbirth (p < 0.001) and were more frequently delivered by elective cesarean section (p = 0.032). The incidence of premature delivery (p = 0.028), neonatal morbidity (p = 0.001) and the risk of having a baby born small for gestational age (p = 0.009) was higher among women with blood- and injection phobia.

    Limitation: The medical records, from which all information is drawn, despite standardization, sometimes may lack some information. However, this dilemma exists in both groups.

    Conclusions: Women with an anxiety disorder such as blood- and injection phobia are at increased risk for adverse obstetric outcomes, premature delivery and for having a baby born with higher neonatal morbidity. It therefore seems important to identify and treat women with anxiety disorders without delay early during pregnancy in an effort to minimize risks of complications for the woman herself and the child.

    Download full text (pdf)
    fulltext
  • 167.
    Lilliecreutz, Caroline
    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.
    Theodorsson, Elvar
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Chemistry. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Chemistry.
    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.
    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.
    Salivary cortisol in pregnant women suffering from blood-and injection phobia2011In: Archives of Women's Mental Health, ISSN 1434-1816, E-ISSN 1435-1102, Vol. 14, no 5, p. 405-411Article in journal (Refereed)
    Abstract [en]

    Purpose: Stress and/or anxiety during pregnancy affect maternal and fetal wellbeing and can cause premature delivery and postnatal pathology in the child. Women suffering from phobias related to blood and injections are prone to high levels of stress including anxiety and sometimes panic attacks during pregnancy. Cortisol is amongst the mediators through which the neurohormonal expressions of maternal psychological factors may be transduced to the fetus. The aim was to investigate if pregnant women suffering from blood- and injection phobia have raised cortisol levels or are characterized by unusual diurnal salivary cortisol profiles compared to healthy controls.

    Methods: The sample consisted of 110 pregnant women with blood- and injection phobia and 110 pregnant healthy controls. Both groups provided morning and evening saliva samples in week 25 and 36 for the assay of cortisol. In gestational week 25 when blood was drawn for the mandatory blood testing extra blood was taken to analyze corticotrophin releasing  factor (CRF), adrenocorticotropic hormone (ACTH) and cortisol in serum.

    Results: The expected diurnal decline in salivary cortisol was observed as well as increased cortisol levels during pregnancy. Pregnant women suffering from blood- and injection phobia had higher output of cortisol compared to women without the phobia (F=6.25 df=1 p=0.014) but no marked difference in the diurnal cortisol rhythm was found between the groups.

    Conclusion: Our findings indicate that untreated blood- and injection phobia during pregnancy increases cortisol concentrations. Blood- and injection phobia is treatable and cognitive behavioral therapy can be used.

    Download full text (pdf)
    fulltext
  • 168.
    Lindberg, Malou
    et al.
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Foldemo, Anniqa
    Linköping University, Department of Medical and Health Sciences, Nursing Science. 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.
    Wiréhn, Ann-Britt
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Differences in prescription rates and odds ratios of antidepressant drugs in relation to individual hormonal contraceptives: A nationwide population-based study with age-specific analyses2012In: European journal of contraception & reproductive health care, ISSN 1362-5187, E-ISSN 1473-0782, Vol. 17, no 2, p. 106-118Article in journal (Refereed)
    Abstract [en]

    Objectives To examine, among young women, the association of individual hormonal contraceptives, within two broad groupings, with antidepressant therapy. less thanbrgreater than less thanbrgreater thanMethods In a nationwide register-based study, we examined the prescription rates of antidepressant drugs in relation to individual combined hormonal and progestin-only contraceptives among Swedish women aged 16-31 years (N = 917,993). Drug data were obtained from the Swedish Prescribed Drug Register for the period 1 July 2005-30 June 2008. Data on the total population of women aged 16-31 in 2008 were obtained from the Total Population Register of Statistics Sweden. The proportion of women using both hormonal contraception and antidepressants, and odds ratios (ORs) for antidepressant use for hormonal contraceptive users versus non-users, were calculated, the latter by logistic regression, for each formulation. less thanbrgreater than less thanbrgreater thanResults The highest antidepressant OR in all age groups, particularly in the 16-19 years age group, related to medroxyprogesterone-only, followed by etonogestrel-only, levonorgestrel-only and ethinylestradiol/norelgestromin formulations. Oral contraceptives containing ethinylestradiol combined with lynestrenol or drospirenone had considerably higher ORs than other pills. ORs significantly lower than 1 were observed when ethinylestradiol was combined with norethisterone, levonorgestrel or desogestrel. less thanbrgreater than less thanbrgreater thanConclusion The association between use of hormonal contraceptives and antidepressant drugs varies considerably within both the combined hormonal contraceptive and the progestin-only groups.

  • 169.
    Lindberg, Malou
    et al.
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Foldemo, Anniqa
    Linköping University, Department of Medical and Health Sciences, Nursing Science. 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.
    Wiréhn, Ann-Britt
    Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Differences in prescription rates of antidepressant drugs in relation to individual hormonal contraceptives: a nationwide population-based study2012Conference paper (Other academic)
  • 170.
    Lindh-Astrand, Lotta
    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.
    Nedstrand, Elizabeth
    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.
    Effects of applied relaxation on vasomotor symptoms in postmenopausal women: a randomized controlled trial2013In: Menopause: The Journal of the North American Menopause, ISSN 1072-3714, E-ISSN 1530-0374, Vol. 20, no 4, p. 401-408Article in journal (Refereed)
    Abstract [en]

    Objective: This work aimed to study the efficacy of group therapy with applied relaxation on vasomotor symptoms and health-related quality of life in postmenopausal women. less thanbrgreater than less thanbrgreater thanMethods: In this open, randomized controlled trial, 60 healthy postmenopausal women with at least seven moderate to severe hot flashes per 24 hours were randomized to either group therapy with applied relaxation (n = 33) or untreated control group (n = 27) for 12 weeks. A follow-up visit was scheduled 3 months after the end of therapy or participation in the control group. Salivary cortisol was measured three times during a 6-month period. Hot flashes were recorded in self-registered diaries, and health-related quality of life was assessed with the Womens Health Questionnaire. less thanbrgreater than less thanbrgreater thanResults: The number of hot flashes decreased by 5.0 per 24 hours in the applied relaxation group compared with 1.9 in the control group on the 12th week (P andlt; 0.001) and still remained at the same level at the 3-month follow-up (P andlt; 0.001). Health-related quality of life for vasomotor symptoms, sleep, and memory improved significantly on the 12th week measurement in the applied relaxation group compared with the control group. Salivary cortisol concentration was lowered markedly in the applied relaxation group on a single measurement but was otherwise mainly stable in both groups. less thanbrgreater than less thanbrgreater thanConclusions: Applied relaxation can be used to treat vasomotor symptoms in healthy postmenopausal women.

  • 171. Order onlineBuy this publication >>
    Lindh-Åstrand, Lotta
    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.
    Women's knowledge, attitudes, and management of the menopausal transition2009Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Introduction: Hormone therapy (HT) has been considered as a safe treatment for menopausal symptoms. Use of HT increased dramatically in the 1980s and 1990s. Results from large randomized clinical trials (RCT) could, around the turn of the century, however not find evidence for long-term benefits with HT. These results attracted great attention from media and the scientific community leading to changed treatment guidelines and decreased use of HT.

    Aim: The overall aim of this thesis was to explore Swedish women’s conceptions, knowledge, management, and attitudes regarding the menopausal transition and HT.

    Material and methods: To explore and describe women’s conceptions of the menopausal transition women seeking medical advice due to climacteric symptoms were interviewed (n=20) and their statements were analyzed with a qualitative method (paper I). In 1999 (n=1760) and 2003 (n=1733) attitudes to (paper II) and knowledge of (paper III) the menopausal transition and HT among 53- and 54 year old women were investigated with a cross-sectional design using postal questionnaires. We also analyzed if attitudes differed before and after new scientific findings were published on risks and benefits of HT and if knowledge differed between educational levels. Since many women try to abandon use of HT a RCT was performed to study the effect of two different methods to discontinue HT, on recurrence of hot flushes, resumption of HT and on health related quality of life (HRQoL). Women (n=87) with vasomotor symptoms before initiating HT participated.

    Results: We found that the majority of the middle aged women in our study viewed the menopausal transition as a natural process the nature of which is affected by both hormonal changes and by ageing. Each woman seems to experience a set of psychological and physical symptoms that are in some sense unique to her experience. Women’s answers to the questions about HT demonstrate that attitudes towards HT held by women going through menopause have changed rather dramatically between 1999 and 2003. These changes probably reflect the influence on the women of media reports based on research that identified risks associated with HT that had not been identified before 1998.

    Women’s knowledge of the effects of HT seems to be unsatisfactory from a clinical perspective. No differences in hot flush frequency and resumption of HT were found between the women randomized to two different modes of discontinuation of HT. Almost 50 % of the women restarted HT within one year after discontinuation. Deteriorated wellbeing and severity of hot flushes were important predicting factors for resumption of HT.

    Conclusion: It is important to be aware of the individual woman’s conceptions and attitudes about and knowledge of the menopausal transition and HT to be able to individualize the counselling situation. Women who initiate HT due to hot flushes may experience recurrence of vasomotor symptoms and deteriorated HRQoL after discontinuation. A great proportion of them may resume HT. At present knowledge of possible advantages for the taper-down method when discontinuing HT is still lacking.

    List of papers
    1. Women’s conception of the menopausal transition – a qualitative study
    Open this publication in new window or tab >>Women’s conception of the menopausal transition – a qualitative study
    2007 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 16, no 3, p. 509-517Article in journal (Refereed) Published
    Abstract [en]

    Aim: To explore, with a qualitative approach, whether the conception of menopause varies between women seeking medical advice due to climacteric symptoms and, if so, to describe these different conceptions.

    Background: For many women, the menopausal transition is a troublesome period of life, often associated with decreased well-being and a number of symptoms. Besides the hormonal changes, many other factors such as psychological, sociological and lifestyle factors affect how women perceive their menopause.

    Method: Semi-structured interviews were held with 20 women after their first-time visits at outpatient clinics of gynaecology for discussion of climacteric symptoms. The interviews were audio-taped, transcribed and analysed using a phenomenographic approach.

    Results: A wide variation of conceptions was revealed. Two main categories were identified including different physical changes with varying symptoms and both positive and negative psychological changes. The menopausal transition was also described as a natural process and as a developmental phase of life.

    Conclusion and relevance to clinical practice: Women’s conceptions of the menopausal transition were individual and contained both physical and psychological symptoms but also expressed a more holistic view of the menopausal transition. The transition was described as a natural process affected by endocrine and life-style factors as well as by the psychosocial situation and by aging per se. It is important that health care providers are aware of women’s conceptions about the menopausal transition to be able to communicate optimally, support and empower middle-aged women in different health care situations and thereby optimise the result of care.

    Place, publisher, year, edition, pages
    Institutionen för klinisk och experimentell medicin, 2007
    Keywords
    Phenomenography, conceptions, menopausal transition, qualitative study, nurses, nursing.
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-11699 (URN)10.1111/j.1365-2702.2005.01547.x (DOI)
    Note
    The definitive version is available at www.blackwell-synergy.com: Lotta Lindh-Åstrand, Mikael Hoffmann, Mats Hammar and Karin I Kjellgren, Women’s conception of the menopausal transition – a qualitative study, 2007, Journal of Clinical Nursing, (16), 3, 509-517. http://dx.doi.org/10.1111/j.1365-2702.2005.01547.x. Copyright: Blackwell Publishing www.blackwell-synergy.comAvailable from: 2008-04-29 Created: 2008-04-29 Last updated: 2017-12-13Bibliographically approved
    2. Attitudes towards the menopause and hormone therapy over the turn of the century
    Open this publication in new window or tab >>Attitudes towards the menopause and hormone therapy over the turn of the century
    Show others...
    2007 (English)In: Maturitas, ISSN 0378-5122, E-ISSN 1873-4111, Vol. 56, no 1, p. 12-20Article in journal (Refereed) Published
    Abstract [en]

    Objective: To assess attitudes and beliefs about the menopausal transition in a population of peri- and postmenopausal women, and if these attitudes differed before and after publication of studies on risks and benefits with hormone therapy (HT).

    Material and methods: In 1999 and 2003 all women aged 53 and 54 years in the community of Linköping, Sweden, were sent a questionnaire about use of HT, menopausal status and attitudes regarding menopause and HT.

    Results: Most women regarded menopause as a natural process characterized by both hormonal deficiency and aging and these views did not differ between 1999 and 2003. A majority of women thought that significant climacteric symptoms were a good reason to use HT, but not that women without symptoms should use HT. The fraction of women who supported HT use was, however, significantly lower in 2003 than in 1999. Most women agreed that menopause leads to increased freedom and that it is a relief not to have to think about contraception and pregnancies.

    Conclusions: Most Swedish women had a mainly biological view on menopause but nevertheless they thought that only women with climacteric symptoms should use HT. Women’s attitudes towards HT have changed after recent reports on risks from long-term use of HT whereas the attitudes towards the menopausal transition were stable. Other factors than attitudes towards menopause affect women’s actual use of HT. Probably women’s and health care provider’s apprehension of the risk-benefit balance of HT use is one such factor.

    Place, publisher, year, edition, pages
    Institutionen för klinisk och experimentell medicin, 2007
    Keywords
    Menopause transition, climacteric, attitudes to menopause, attitudes to hormone therapy, population-based questionnaire
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-11697 (URN)10.1016/j.maturitas.2006.05.002 (DOI)
    Note
    Original publication: Lotta Lindh-Åstrand, Jan Brynhildsen, Mikael Hoffmann, Susanne Liffner and Mats Hammar, Attitudes towards the menopause and hormone therapy over the turn of the century, 2007, Maturitas, (56), 1, 12-20. http://dx.doi.org/10.1016/j.maturitas.2006.05.002. Copyright: Elsevier B.V., http://www.elsevier.com/Available from: 2008-04-29 Created: 2008-04-29 Last updated: 2017-12-13Bibliographically approved
    3. Knowledge of reproductive physiology and hormone therapy in 53- to 54-year-old Swedish women: a population-based study.
    Open this publication in new window or tab >>Knowledge of reproductive physiology and hormone therapy in 53- to 54-year-old Swedish women: a population-based study.
    Show others...
    2007 (English)In: Menopause: The Journal of the North American Menopause, ISSN 1072-3714, E-ISSN 1530-0374, Vol. 14, no 6, p. 1039-1046Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVE: To investigate knowledge of hormone therapy (HT), reproductive physiology, and menopause in a population of 53- to 54-year-old women. Further aims were to determine whether the knowledge differed between users and nonusers of HT and between groups with different levels of education.

    DESIGN: In 2003, all 53- and 54-year-old women (N = 1,733) in Linköping, Sweden, were sent a questionnaire containing questions about reproductive physiology related to menopause and HT. Answers from 73% of the women were analyzed.

    RESULTS: Swedish women had limited knowledge of HT, reproductive physiology, and menopause irrespective of HT use or educational level. Most of the women knew that hot flashes are common around menopause and decreasing estrogen production causes the menopause. They knew little about the effects of progestagens and the effects of HT on fertility. Women with low educational level were more likely to answer the questions by stating that they were unsure than did women with high educational level. Ever-users of HT knew more than never-users about risks and benefits of HT in relation to breast cancer and osteoporosis, and ever-users thought that the risks of thrombosis and myocardial infarction were lower than did never-users.

    CONCLUSIONS: Women need improved knowledge of the risks and benefits of HT as well as education about the reproductive system around menopause. This would probably better support and empower women to manage an important period of their lives.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-20096 (URN)10.1097/gme.0b013e31803816ca (DOI)17519805 (PubMedID)
    Note
    This is a non-final version of an article published in final form in: Lotta Lindh-Åstrand, Jan Brynhildsen, Mikael Hoffmann, Karin I Kjellgren and Mats Hammar, Knowledge of reproductive physiology and hormone therapy in 53- to 54-year-old Swedish women: a population-based study., 2007, Menopause, (14), 6, 1039-1046. http://dx.doi.org/10.1097/gme.0b013e31803816ca Copyright: Raven Press, Ltd. Available from: 2009-08-28 Created: 2009-08-28 Last updated: 2017-12-13Bibliographically approved
    4. A randomized controlled study of taper-down or abrupt discontinuation of hormone therapy in women treated for vasomotor symptoms.
    Open this publication in new window or tab >>A randomized controlled study of taper-down or abrupt discontinuation of hormone therapy in women treated for vasomotor symptoms.
    Show others...
    2010 (English)In: Menopause (New York, N.Y.), ISSN 1530-0374, Vol. 17, no 1, p. 72-79Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVE:: The aim of this study was to investigate whether tapering down of combined estrogen plus progestogen therapy (EPT) reduced the recurrence of hot flashes and resumption of therapy compared with abrupt discontinuation. A secondary aim was to evaluate whether health-related quality of life (HRQoL) was affected after discontinuation of EPT and to investigate the possible factors predicting resumption of EPT.

    METHODS:: Eighty-one postmenopausal women undergoing EPT because of hot flashes were randomized to tapering down or abrupt discontinuation of EPT. Vasomotor symptoms were recorded in self-registered diaries, and resumption of hormone therapy (HT) was asked for at every follow-up. The Psychological General Well-being Index was used to assess HRQoL.

    RESULTS:: Neither the number nor the severity of hot flashes or HRQoL or frequency of resumption of HT differed between the two modes of discontinuation of EPT during up to 12 months of follow-up. About every other woman had resumed HT within 1 year. Women who resumed HT after 4 or 12 months reported more deteriorated HRQoL and more severe hot flashes after discontinuation of therapy than did women who did not resume HT.

    CONCLUSIONS:: Women who initiate EPT because of hot flashes may experience recurrence of vasomotor symptoms and impaired HRQoL after discontinuation of EPT regardless of the discontinuation method used, abrupt or taper down. Because, in addition to severity of flashes, decreased well-being was the main predictor of the risk to resume HT, it seems important to also discuss quality of life in parallel with efforts to discontinue HT.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-20552 (URN)10.1097/gme.0b013e3181b397c7 (DOI)19675505 (PubMedID)
    Note
    This is a non-final version of an article published in final form in: Lotta Lindh-Åstrand, Marie Bixo, Angelica Hirschberg, Inger Sundström-Poromaa and Mats Hammar, A randomized controlled study of taper-down or abrupt discontinuation of hormone therapy in women treated for vasomotor symptoms., 2009, Menopause (New York, N.Y.). http://dx.doi.org/10.1097/gme.0b013e3181b397c7 Copyright: Raven Press, Ltd. Available from: 2009-09-11 Created: 2009-09-11 Last updated: 2011-01-19Bibliographically approved
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    Women’s knowledge, attitudes, and management of the menopausal transition
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  • 172.
    Lindh-Åstrand, Lotta
    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.
    Bixo, Marie
    Umeå University.
    Hirschberg, Angelica
    Karolinska Institutet.
    Sundström-Poromaa, Inger
    Uppsala University.
    Hammar, Mats
    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.
    A randomized controlled study of taper-down or abrupt discontinuation of hormone therapy in women treated for vasomotor symptoms.2010In: Menopause (New York, N.Y.), ISSN 1530-0374, Vol. 17, no 1, p. 72-79Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:: The aim of this study was to investigate whether tapering down of combined estrogen plus progestogen therapy (EPT) reduced the recurrence of hot flashes and resumption of therapy compared with abrupt discontinuation. A secondary aim was to evaluate whether health-related quality of life (HRQoL) was affected after discontinuation of EPT and to investigate the possible factors predicting resumption of EPT.

    METHODS:: Eighty-one postmenopausal women undergoing EPT because of hot flashes were randomized to tapering down or abrupt discontinuation of EPT. Vasomotor symptoms were recorded in self-registered diaries, and resumption of hormone therapy (HT) was asked for at every follow-up. The Psychological General Well-being Index was used to assess HRQoL.

    RESULTS:: Neither the number nor the severity of hot flashes or HRQoL or frequency of resumption of HT differed between the two modes of discontinuation of EPT during up to 12 months of follow-up. About every other woman had resumed HT within 1 year. Women who resumed HT after 4 or 12 months reported more deteriorated HRQoL and more severe hot flashes after discontinuation of therapy than did women who did not resume HT.

    CONCLUSIONS:: Women who initiate EPT because of hot flashes may experience recurrence of vasomotor symptoms and impaired HRQoL after discontinuation of EPT regardless of the discontinuation method used, abrupt or taper down. Because, in addition to severity of flashes, decreased well-being was the main predictor of the risk to resume HT, it seems important to also discuss quality of life in parallel with efforts to discontinue HT.

    Download full text (pdf)
    FULLTEXT01
  • 173.
    Lindh-Åstrand, Lotta
    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.
    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.
    Hoffman, Mikael
    Linköping University, Department of Medicine and Health Sciences, Clinical Pharmacology . Linköping University, Faculty of Health Sciences.
    Hammar, Mats
    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.
    Vasomotor symptoms usually reappear after cessation of postmenopausal hormone therapy: a Swedish population-based study.2009In: Menopause (New York, N.Y.), ISSN 1530-0374Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:: The purpose of this study was to investigate the extent of reappearance of vasomotor symptoms after cessation of postmenopausal hormone therapy (HT) in women who started HT because of hot flashes. METHODS:: A cross-sectional postal survey was conducted. A validated questionnaire was sent to all women 53 to 54 years old living in Linköping, Sweden (n = 1,733), including questions about menopause, HT, and vasomotor symptoms. Pearson's chi test and logistic regression were used for statistical analyses. RESULTS:: Response rate after one reminder was 77.3%. After omitting incomplete answers, 72.9% remained for analysis. In all women, 319 (25.3%) were current users of HT, 242 (19.2%) were previous users, and 702 (55.6%) were never-users. Of the 242 previous users, 165 (69%) women stated that they had vasomotor symptoms before starting HT. Vasomotor symptoms recurred after cessation of HT in 143 (87%) of these 165 women. We found no significant difference in symptom recurrence in comparisons of the three groups based on usage of HT for 0 to 1, 2 to 4, or 5 years or more. CONCLUSIONS:: Most women who had vasomotor symptoms when they initiated HT reported recurrence of symptoms after cessation of HT (87%), although the flashes were usually reported to be less frequent and bothersome than they were before HT. Effective and safe treatment approaches for women with recurrence of vasomotor symptoms are needed.

    Download full text (pdf)
    FULLTEXT01
  • 174.
    Lindh-Åstrand, Lotta
    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.
    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.
    Hoffmann, Mikael
    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.
    Kjellgren, Karin I
    Sahlgrenska Academy.
    Hammar, Mats
    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.
    Knowledge of reproductive physiology and hormone therapy in 53- to 54-year-old Swedish women: a population-based study.2007In: Menopause: The Journal of the North American Menopause, ISSN 1072-3714, E-ISSN 1530-0374, Vol. 14, no 6, p. 1039-1046Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate knowledge of hormone therapy (HT), reproductive physiology, and menopause in a population of 53- to 54-year-old women. Further aims were to determine whether the knowledge differed between users and nonusers of HT and between groups with different levels of education.

    DESIGN: In 2003, all 53- and 54-year-old women (N = 1,733) in Linköping, Sweden, were sent a questionnaire containing questions about reproductive physiology related to menopause and HT. Answers from 73% of the women were analyzed.

    RESULTS: Swedish women had limited knowledge of HT, reproductive physiology, and menopause irrespective of HT use or educational level. Most of the women knew that hot flashes are common around menopause and decreasing estrogen production causes the menopause. They knew little about the effects of progestagens and the effects of HT on fertility. Women with low educational level were more likely to answer the questions by stating that they were unsure than did women with high educational level. Ever-users of HT knew more than never-users about risks and benefits of HT in relation to breast cancer and osteoporosis, and ever-users thought that the risks of thrombosis and myocardial infarction were lower than did never-users.

    CONCLUSIONS: Women need improved knowledge of the risks and benefits of HT as well as education about the reproductive system around menopause. This would probably better support and empower women to manage an important period of their lives.

    Download full text (pdf)
    FULLTEXT01
  • 175.
    Lindh-Åstrand, Lotta
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. 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.
    Hoffmann, Mikael
    Linköping University, Department of Medicine and Health Sciences, Clinical Pharmacology . Linköping University, Faculty of Health Sciences.
    Liffner, Susanne
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Hammar, Mats
    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 the menopause and hormone therapy over the turn of the century2007In: Maturitas, ISSN 0378-5122, E-ISSN 1873-4111, Vol. 56, no 1, p. 12-20Article in journal (Refereed)
    Abstract [en]

    Objective: To assess attitudes and beliefs about the menopausal transition in a population of peri- and postmenopausal women, and if these attitudes differed before and after publication of studies on risks and benefits with hormone therapy (HT).

    Material and methods: In 1999 and 2003 all women aged 53 and 54 years in the community of Linköping, Sweden, were sent a questionnaire about use of HT, menopausal status and attitudes regarding menopause and HT.

    Results: Most women regarded menopause as a natural process characterized by both hormonal deficiency and aging and these views did not differ between 1999 and 2003. A majority of women thought that significant climacteric symptoms were a good reason to use HT, but not that women without symptoms should use HT. The fraction of women who supported HT use was, however, significantly lower in 2003 than in 1999. Most women agreed that menopause leads to increased freedom and that it is a relief not to have to think about contraception and pregnancies.

    Conclusions: Most Swedish women had a mainly biological view on menopause but nevertheless they thought that only women with climacteric symptoms should use HT. Women’s attitudes towards HT have changed after recent reports on risks from long-term use of HT whereas the attitudes towards the menopausal transition were stable. Other factors than attitudes towards menopause affect women’s actual use of HT. Probably women’s and health care provider’s apprehension of the risk-benefit balance of HT use is one such factor.

    Download full text (pdf)
    FULLTEXT01
  • 176.
    Lindh-Åstrand, Lotta
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Hoffmann, Mikael
    Linköping University, Department of Medicine and Health Sciences, Clinical Pharmacology . Linköping University, Faculty of Health Sciences.
    Hammar, Mats
    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.
    Kjellgren, Karin I.
    Faculty of Health and Caring Sciences, Institute of Nursing, The Sahlgrenska Academy, Göteborg, Sweden.
    Women’s conception of the menopausal transition – a qualitative study2007In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 16, no 3, p. 509-517Article in journal (Refereed)
    Abstract [en]

    Aim: To explore, with a qualitative approach, whether the conception of menopause varies between women seeking medical advice due to climacteric symptoms and, if so, to describe these different conceptions.

    Background: For many women, the menopausal transition is a troublesome period of life, often associated with decreased well-being and a number of symptoms. Besides the hormonal changes, many other factors such as psychological, sociological and lifestyle factors affect how women perceive their menopause.

    Method: Semi-structured interviews were held with 20 women after their first-time visits at outpatient clinics of gynaecology for discussion of climacteric symptoms. The interviews were audio-taped, transcribed and analysed using a phenomenographic approach.

    Results: A wide variation of conceptions was revealed. Two main categories were identified including different physical changes with varying symptoms and both positive and negative psychological changes. The menopausal transition was also described as a natural process and as a developmental phase of life.

    Conclusion and relevance to clinical practice: Women’s conceptions of the menopausal transition were individual and contained both physical and psychological symptoms but also expressed a more holistic view of the menopausal transition. The transition was described as a natural process affected by endocrine and life-style factors as well as by the psychosocial situation and by aging per se. It is important that health care providers are aware of women’s conceptions about the menopausal transition to be able to communicate optimally, support and empower middle-aged women in different health care situations and thereby optimise the result of care.

    Download full text (pdf)
    FULLTEXT01
  • 177.
    Lundberg, Kristina
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Chemistry. Linköping University, Faculty of Health Sciences.
    Hilke, Susanne
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Chemistry. Linköping University, Faculty of Health Sciences.
    Nordin, Conny
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Chemistry. Linköping University, Faculty of Health Sciences.
    Theodorsson, Elvar
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Chemistry. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Chemistry.
    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.
    Cholecystokinin in plasma and cerebrospinal fluid-A study in healthy young women2010In: PEPTIDES, ISSN 0196-9781, Vol. 31, no 8, p. 1625-1628Article in journal (Refereed)
    Abstract [en]

    Cholecystokinin (CCK) is widely distributed in the brain and is known to affect behavioral and physiological functions including anxiety and pain. The expression of CCK has been shown to be regulated by estrogen and to vary during the estrous cycle in rat brain. In the present study CCK was determined in plasma from 25 healthy women (age 25.0 +/- 3.5) during the menstrual cycle, in the late luteal phase and in the follicular phase. In the follicular phase, a lumbar puncture was performed at the same time that a plasma sample was taken in 15 subjects. The participants had fasted and were nicotine-free for at least 8 h preceding the sampling. We compared CCK-like immunoreactivity (CCK-LI) in plasma from 25 subjects in the late luteal phase (LLP) and the follicular phase (FP) and found that there was no difference during the menstrual cycle (n-25, R-2 =89.60%, p = n.s.). In the follicular phase no significant difference was found between CCK-LI in plasma and in cerebrospinal fluid (CSF) collected at the same time (n =15, R-2 = 55.32%, p = n.s.).

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    FULLTEXT01
  • 178.
    Matthiesen, Leif
    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.
    Letter: Reply to Do dose-related mechanisms exist for the angiogenic behaviours of heparin derivatives?, Yavuc C, Karahan O.2012In: American Journal of Reproductive Immunology and Microbiology, ISSN 8755-8920, Vol. 68, no 3, p. 187-188Article in journal (Other academic)
    Abstract [en]

    n/a

  • 179.
    Mernelius, Sara
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Medical Microbiology. Linköping University, Faculty of Health Sciences. Ryhov County Hospital, Sweden .
    Lofgren, Sture
    Ryhov County Hospital, Sweden .
    Lindgren, Per-Eric
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences.
    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.
    Olhager, Elisabeth
    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.
    Gunnervik, Christina
    Varnamo Hospital, Sweden .
    Lenrick, Raymond
    Ryhov County Hospital, Sweden .
    Tiefenthal Thrane, Malena
    Hoglands Hospital Eksjo, Sweden .
    Isaksson, Barbro
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Microbiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Diagnostics, Department of Clinical Microbiology.
    Matussek, Andreas
    Ryhov County Hospital, Sweden .
    The effect of improved compliance with hygiene guidelines on transmission of Staphylococcus aureus to newborn infants: The Swedish Hygiene Intervention and Transmission of S aureus study2013In: American Journal of Infection Control, ISSN 0196-6553, E-ISSN 1527-3296, Vol. 41, no 7, p. 585-590Article in journal (Refereed)
    Abstract [en]

    Background: Newborn infants are often colonized with Staphylococcus aureus originating from health care workers (HCWs). We therefore use colonization with S aureus of newborn infants to determine the effect of an improved compliance with hygiene guidelines on bacterial transmission. Methods: Compliance with hygiene guidelines was monitored prior to (baseline) and after (follow-up) a multimodal hygiene intervention in 4 departments of obstetrics and gynecology. spa typing was used to elucidate transmission routes of S aureus collected from newborn infants, mothers, fathers, staff members, and environment. Results: The compliance with hygiene guidelines increased significantly from baseline to follow-up. The transmission of S aureus from HCWs to infants was however not affected. Fathers had the highest colonization rates. Persistent carriage was indicated in 18% of the HCWs. The most commonly isolated spa type was t084, which was not detected in a previous study from the same geographic area. Conclusion: It is possible to substantially improve the compliance with hygiene guidelines, by using multimodal hygiene intervention. The improved compliance did not decrease the transmission of S aureus from sources outside the own family to newborn infants. Furthermore, we show the establishment of a new spa type (t084), which now is very common in our region. Copyright (C) 2013 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  • 180.
    Mjösberg, Jenny
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology. Linköping University, Faculty of Health Sciences.
    Berg, Göran
    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.
    Jenmalm, Maria C.
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    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.
    FOXP3+ regulatory T cells, T helper 1, T helper 2 and T helper 17 cells in human early pregnancy decidua2010In: Biology of Reproduction, ISSN 0006-3363, E-ISSN 1529-7268, Vol. 82, no 4, p. 698-705Article in journal (Refereed)
    Abstract [en]

    In pregnancy, the decidua is infiltrated by leukocytes promoting fetal development without causing immunological rejection. Murine regulatory T (Treg) cells are known to be important immune regulators at this site. The aim of the study was to characterize the phenotype and origin of Treg cells and determine the quantitative relationship between Treg, T-helper type 1 (TH1), TH2, and TH17 cells in first-trimester human decidua. Blood and decidual CD4+ T cells from 18 healthy first-trimester pregnant women were analyzed for expression of Treg-cell markers (CD25, FOXP3, CD127, CTLA4, and human leukocyte antigen-DR [HLA-DR]), chemokine receptors (CCR4, CCR6, and CXCR3), and the proliferation antigen MKI67 by six-color flow cytometry. Treg cells were significantly enriched in decidua and displayed a more homogenous suppressive phenotype with more frequent expression of FOXP3, HLA-DR, and CTLA4 than in blood. More decidual Treg cells expressed MKI67, possibly explaining their enrichment at the fetal-maternal interface. Using chemokine receptor expression profiles of CCR4, CCR6, and CXCR3 as markers for TH1, TH2, and TH17 cells, we showed that TH17 cells were nearly absent in decidua, whereas TH2-cell frequencies were similar in blood and decidua. CCR6+ TH1 cells, reported to secrete high levels of interferon gamma (IFNG), were fewer, whereas the moderately IFNG-secreting CCR6 TH1 cells were more frequent in decidua compared with blood. Our results point toward local expansion of Treg cells and low occurrence of TH17 cells. Furthermore, local, moderate TH1 activity seems to be a part of normal early pregnancy, consistent with a mild inflammatory environment controlled by Treg cells.

  • 181.
    Mjösberg, Jenny
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology . Linköping University, Faculty of Health Sciences.
    Boij, Roland
    Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Immunology and Transfusion Medicine.
    Matthiesen, Leif
    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.
    Jenmalm, Maria C.
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Ernerudh, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Immunology and Transfusion Medicine.
    Berg, Göran
    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.
    Circulating CD4dimCD25highFOXP3+ regulatory T cells in severe early-onset preeclampsiaManuscript (preprint) (Other academic)
    Abstract [en]

    Preeclampsia is an inflammatory condition suggested to involve regulatory CD4+CD25high T helper cell (Treg) disturbances. However, the importance of Tregs in early-onset preeclampsia, associated with increased disease severity and possibly representing a more distinct placental disease, remains unclear. We recently showed that by defining Tregs as CD4dimCD25high cells, the risk of including activated non-Tregs, being more prominent in the circulation during pregnancy, is avoided. The aim of this study was to determine, using updated Treg markers and flow cytometric gating strategies, the frequency and phenotype of circulating Tregs from women with severe early-onset preeclampsia (n=10) as compared with healthy pregnant (n=20) and nonpregnant (n=20) women. The frequency of CD4dimCD25high cells and the expression of FOXP3 was similar in healthy and preeclamptic pregnancy. However, the occurrence of CTLA-4+ and HLA-DR+ cells in the Treg population from preeclamptic women tended to be higher than in healthy pregnant women, indicating alterations in Treg functionality in preeclampsia. Further, the Treg population from healthy pregnant, but not preeclamptic, women tended to be enriched for CCR4+ and CD45R0+ cells as compared with nonpregnant women. In conclusion, although the findings do not support a role for diminished circulating Treg frequency in severe early-onset preeclampsia, the study suggests functional alterations related to Treg suppression, activation and migration mechanisms in this subgroup of preeclamptic women.

  • 182.
    Mjösberg, Jenny
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Jenmalm, Maria
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Berg, Göran
    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.
    Ernerudh, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Immunology and Transfusion Medicine.
    Enrichment of Foxp3(+) T-regs and reduction of T(H)17 cells in human early pregnancy decidua indicate immunosuppressive T cell dominance2009In: in JOURNAL OF REPRODUCTIVE IMMUNOLOGY vol 81, issue 2, 2009, Vol. 81, no 2, p. 147-147Conference paper (Refereed)
    Abstract [en]

    n/a

  • 183.
    Mjösberg, Jenny
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Svensson, J
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology . Linköping University, Faculty of Health Sciences.
    Johansson, E
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology . Linköping University, Faculty of Health Sciences.
    Hellstrom, L
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology . Linköping University, Faculty of Health Sciences.
    Casas, Rosaura
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Jenmalm, Maria
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Boij, R
    Ryhov Hospital.
    Matthiesen, L
    Helsingborg Hospital.
    Jönsson, Jan-Ingvar
    Linköping University, Department of Clinical and Experimental Medicine, Experimental Hematology . Linköping University, Faculty of Health Sciences.
    Berg, Göran
    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.
    Ernerudh, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Immunology and Transfusion Medicine.
    Systemic reduction of functionally suppressive CD4dimCD25highFoxp3+ T-regs in human second trimester pregnancy is induced by progesterone and 17 beta-estradiol2009In: Journal of Reproductive Immunology(ISSN 0165-0378), vol 81, issue 2, 2009, Vol. 81, no 2, p. 160-161Conference paper (Refereed)
    Abstract [en]

    CD4+CD25high regulatory T cells (Tregs) are implicated in maintenance of murine pregnancy. However, reports regarding circulating Treg frequencies in human pregnancy are inconsistent and the functionality and phenotype of these cells in pregnancy have not been clarified. The aim was to determine the frequency, phenotype and function of circulating Tregs in second trimester human pregnancy and the influence of progesterone and 17β-estradiol on Treg phenotype and frequency. Based on expression of Foxp3, CD127 and HLA-DR, as determined by multi-color flow cytometry, we defined a proper CD4dimCD25high Treg population and showed, in contrast to most previous reports, that this population was reduced in second trimester pregnancy. Unexpectedly, Foxp3 expression was decreased in the Treg, as well as in the CD4+ population. These changes could be replicated in an in vitro system resembling the pregnancy hormonal milieu, where 17β-estradiol, and in particular progesterone, induced, in line with the pregnancy situation, a reduction of CD4dimCD25highFoxp3+ cells in PBMC from non-pregnant women. By co-culturing FACS-sorted Tregs and autologous CD4+CD25- responder cells, we showed that Tregs from pregnant women still displayed the same suppressive capacity as non-pregnant women in terms of suppressing IL-2, TNF-α and IFN-γ secretion from responder cells while efficiently producing IL-4 and IL-10. Our findings support the view of hormones, particularly progesterone, as critical regulators of Tregs in pregnancy. Further, we suggest that in the light of the results of this study, early data on circulating Treg frequencies in pregnancy need re-evaluation.

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  • 184.
    Mjösberg, Jenny
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology. Linköping University, Faculty of Health Sciences.
    Svensson, Judit
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology. Linköping University, Faculty of Health Sciences.
    Johansson, Emma
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology. Linköping University, Faculty of Health Sciences.
    Hellström, Lotta
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology. Linköping University, Department of Clinical and Experimental Medicine, Geriatric. Linköping University, Faculty of Health Sciences.
    Casas, Rosaura
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Jenmalm, Maria
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Boij, Roland
    Ryhov Hospital, Jönköping, Sweden.
    Matthiesen, Leif
    Helsingborg Hospital, Helsingborg, Sweden.
    Jönsson, Jan-Ingvar
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Berg, Göran
    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.
    Ernerudh, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Immunology and Transfusion Medicine.
    Systemic reduction of functionally suppressive CD4dimCD25highFoxp3+ Tregs in human second trimester pregnancy is induced by progesterone and 17θ-estradiol2009In: Journal of Immunology, ISSN 0022-1767, E-ISSN 1550-6606, Vol. 183, no 1, p. 759-769Article in journal (Refereed)
    Abstract [en]

    CD4+CD25high regulatory T cells (Tregs) are implicated in the maintenance of murine pregnancy. However, reports regarding circulating Treg frequencies in human pregnancy are inconsistent, and the functionality and phenotype of these cells in pregnancy have not been clarified. The aim of this study was to determine the frequency, phenotype, and function of circulating Tregs in the second trimester of human pregnancy and the influence of progesterone and 17β-estradiol on Treg phenotype and frequency. Based on expressions of Foxp3, CD127, and HLA-DR as determined by multicolor flow cytometry, we defined a proper CD4dimCD25high Treg population and showed, in contrast to most previous reports, that this population was reduced in second trimester of pregnancy. Unexpectedly, Foxp3 expression was decreased in the Treg, as well as in the CD4+ population. These changes could be replicated in an in vitro system resembling the pregnancy hormonal milieu, where 17β-estradiol, and in particular progesterone, induced, in line with the pregnancy situation, a reduction of CD4dimCD25highFoxp3+ cells in PBMC from nonpregnant women. By coculturing FACS-sorted Tregs and autologous CD4+CD25 responder cells, we showed that Tregs from pregnant women still displayed the same suppressive capacity as nonpregnant women in terms of suppressing IL-2, TNF-, and IFN- secretion from responder cells while efficiently producing IL-4 and IL-10. Our findings support the view of hormones, particularly progesterone, as critical regulators of Tregs in pregnancy. Furthermore, we suggest that in the light of the results of this study, early data on circulating Treg frequencies in pregnancy need reevaluation.

    The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked advertisement in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.

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  • 185.
    Monfils Gustafsson, Wiktor
    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.
    Ekholm, Katarina
    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.
    Preterm birth or foetal growth impairment and psychiatric hospitalization in adolescence and early adulthood in a Swedish population-based birth cohort2009In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 119, no 1, p. 54-61Article in journal (Refereed)
    Abstract [en]

    Objective: Preterm birth and restricted foetal growth are related to symptoms of psychiatric disorder. Our aim was therefore to investigate possible relations between being born preterm and/or small for gestational age (SGA) and later psychiatric hospitalization.

    Method: A population-based registry study of psychiatric hospitalization of in total 155 994 boys and 148 281 girls born in Sweden in 1973-1975.

    Results: The risk of hospitalization for all mental disorders was increased for preterm SGA boys (OR 2.19, 95% CI 1.49-3.21); at-term SGA boys (OR 1.55, 95% CI 1.34-1.79); at-term SGA girls (OR 1.31, 95% CI 1.15-1.50). At-term SGA boys and girls suffered increased risk of anxiety and adjustment disorders (OR 1.70, 95% CI 1.18-2.45 and OR 1.49, 95% CI 1.14-1.94). Preterm SGA boys were at risk of personality disorders (OR 3.30, 95% CI 1.16-9.41) and psychotic disorders (OR 4.36, 95% CI 1.85-10.30).

    Conclusion: The results show a relationship between being born SGA and later psychiatric hospitalization, where preterm birth and male gender seem to increase the risk.

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  • 186.
    Murphy, Shaun P
    et al.
    Brown University.
    Hanna, Nazeeh N
    Brown University.
    Fast, Loren D
    Brown University.
    Shaw, Sunil K
    Brown University.
    Berg, Göran
    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.
    Padbury, James F
    Brown University.
    Romero, Roberto
    NICHD, Detroit.
    Sharma, Surendra
    Brown University.
    Evidence for participation of uterine natural killer cells in the mechanisms responsible for spontaneous preterm labor and delivery2009In: AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, ISSN 0002-9378, Vol. 200, no 3, p. 308.e1-308.e9Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The purpose of this study was to determine in a mouse model whether uterine natural killer (uNK) cell cytotoxic activation induces infection/inflammation-associated preterm labor and delivery.

    STUDY DESIGN: Wild type or interleukin (IL)-10(-/-) mice were injected intraperitoneally with lipopolysaccharide on gestational day 14. Mice were either killed for collection of uteroplacental tissue, spleen, and serum or allowed to deliver. Uteroplacental tissue was used for histology and characterization of uNK cells.

    RESULTS: Low-dose lipopolysaccharide treatment triggered preterm labor and delivery in IL-10(-/-), but not wild type mice, in a manner independent of progesterone levels. Preterm labor and delivery in IL-10(-/-) mice was associated with an increased number and placental infiltration of cytotoxic uNK cells and placental cell death. Depletion of NK cells or tumor necrosis factor (TNF)-alpha neutralization in these mice restored term delivery. Furthermore, TNF-alpha neutralization prevented uNK cell infiltration and placental cell apoptosis.

    CONCLUSION: The uNK cell-TNF-alpha-IL-10 axis plays an important role in the genesis of infection/inflammation-induced pretermlabor/delivery.

  • 187.
    Nedstrand, Elisabeth
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    Wijma, Klaas
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    Wyon, Yvonne
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    Hammar, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    Vasomotor symptoms decrease in women with breast cancer randomized to treatment with applied relaxation or electro-acupuncture: a preliminary study2005In: Climacteric, ISSN 1369-7137, E-ISSN 1473-0804, Vol. 8, no 3, p. 243-250Article in journal (Refereed)
    Abstract [en]

    Objective: To evaluate the effect of applied  relaxation and electro-acupuncture on vasomotor symptoms in women treated for breast cancer.

    Methods: Thirty-eight postmenopausal women with  breast cancer and vasomotor symptoms were randomized to treatment with electro-acupuncture (n = 19) or applied relaxation (n = 19) during 12 weeks. The number of hot flushes was registered daily in a logbook before and during treatment and after 3 and 6 months of follow-up.

    Results: Thirty-one women completed 12 weeks of treatment and 6  months of follow-up. After 12 weeks of applied relaxation, the number of flushes/24 h had decreased from 9.2 (95% confidence interval (CI) 6.6-11.9) at baseline to 4.5 (95% CI 3.2-5.8) and to 3.9 (95% CI 1.8-6.0) at 6 months follow-up (n = 14). The flushes/24 h were reduced from 8.4 (95% CI 6.6-10.2) to 4.1 (95% CI 3.0-5.2) after 12 weeks of treatment with electro-acupuncture and to 3.5 (95% CI 1.7-5.3) after 6 months follow-up (n = 17). In both groups, the mean Kupperman Index score was significantly reduced after treatment and remained unchanged 6 months after end of treatment.

    Conclusion: We suggest that applied relaxation and  electro-acupuncture should be further evaluated as possible treatments for vasomotor symptoms in postmenopausal women with breast cancer.

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  • 188.
    Nedstrand, Elisabeth
    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.
    Wyon, Yvonne
    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.
    Hammar, Mats
    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.
    Wijma, Klaas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Gender and medicine .
    Psychological well-being improves in women with breast cancer after treatment with applied relaxation or electro-acupuncture for vasomotor symptom2006In: Journal of Psychosomatic Obstetrics and Gynaecology, ISSN 0167-482X, E-ISSN 1743-8942, Vol. 27, no 4, p. 193-199Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to evaluate the effect of applied relaxation and electro-acupuncture (EA) on psychological well-being in breast cancer-treated women with vasomotor symptoms. Thirty-eight breast cancer-treated postmenopausal women with vasomotor symptoms were included in the study. They were randomized to either treatment with electro-acupuncture (EA) (N = 19, three of them with tamoxifen) or applied relaxation (AR) (n = 19, five of them with tamoxifen) over a 12-week study period with six months follow-up. Vasomotor symptoms were registered daily. A visual analog scale was used to assess climacteric symptom, estimation of general well-being was made using the Symptom Checklist, and mood using the Mood Scale. These were applied during treatment and at follow-up. In total 31 women completed 12 weeks of treatment and six months of follow-up. Hot flushes were reduced by more than 50%. Climacteric symptoms significantly decreased during treatment and remained so six months after treatment in both groups. Psychological well-being significantly improved during therapy and at follow-up visits in both groups. Mood improved significantly in the electro-acupuncture treated group. In conclusion psychological well-being improved in women with breast cancer randomized to treatment with either AR or EA for vasomotor symptoms and we therefore suggest that further studies should be performed in order to evaluate and develop these alternative therapies. © 2006 Informa UK Ltd.

  • 189.
    Nilsen, Per
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Holmqvist, Marika
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Bendtsen, Preben
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Department of Medical Specialist.
    Hultgren, Eva
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    Cedergren, 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.
    Is Questionnaire-Based Alcohol Counseling More Effective for Pregnant Women Than Standard Maternity Care?2010In: JOURNAL OF WOMENS HEALTH, ISSN 1540-9996, Vol. 19, no 1, p. 161-167Article in journal (Refereed)
    Abstract [en]

    Objective: To compare current standard maternity care in Sweden concerning provision of alcohol advice with a more comprehensive questionnaire-based counseling model. Methods: The study population included pregnant women in Linkoping who were registered at a maternity care center during a 2-year period and whose pregnancies resulted in liveborn infants without birth defects, representing 93% of all pregnant women. Anonymous questionnaires were mailed to the women. The first cohort (registered April 2005 1, to March 31, 2006) received standard care according to a procedure that is common practice in Sweden. The second cohort (April 1, 2006 to March 31, 2007) received alcohol advice based on a comprehensive counseling model, incorporating the use of the three-item Alcohol Use Disorders Identification Test (AUDIT-C) questionnaire and tailored counseling based on the AUDIT-C score. Results: The response rate was 61% in the first cohort (standard care) and 70% in the second cohort (questionnaire-based counseling). The cohorts were similar in sociodemographic variables and prepregnancy drinking characteristics. The proportion of women who continued drinking alcohol during the pregnancy was 6.0% in cohort 1 and 5.8% in cohort 2. Women in cohort 2 were more favorable to the advice and, to a larger extent, perceived the main message to be abstinence from drinking during pregnancy. Conclusions: The questionnaire-based counseling model was more favorably perceived than the standard care model, but the new model was not more effective in terms of its impact on the proportion of women who abstained from drinking during pregnancy.

  • 190.
    Nilsen, Per
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science.
    Holmqvist, Marika
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science.
    Hultgren, Eva
    Department of Clinical and Experimental Medicine Linlöping University.
    Bendtsen, Preben
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine.
    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.
    Alcohol use before and during pregnancy and factors influencing change among Swedish women2008In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 87, no 7, p. 768-774Article in journal (Refereed)
    Abstract [en]

    Objective. To investigate alcohol intake during pregnancy among women, to assess health cares providers' advice to the women and the relative importance of different factors on changes in the women's drinking. Design. Questionnaire study. Setting. Linkoping, Sweden. Population. A total number of 1,533 women registered at a maternity health care center in Linkoping during a one-year period, from 1 April 2005 to 31 March 2006. Methods. Mailed anonymous questionnaire with a response rate of 61%. Main outcome measures. Drinking behavior and information sources. Results. During pregnancy, 94% (n=869) of the responding women abstained from alcohol, including 13% (n=117) who were already abstainers. Six percent (n=55) continued drinking during the pregnancy. Those who continued drinking during pregnancy were older, had more often given birth and drank more frequently before pregnancy than the women who abstained. Half of the respondents (n=428) believed that decreases in alcohol intake during pregnancy reported in previous studies could be due to inaccurate self-reporting. The main message from maternity health care providers was perceived to be complete abstinence from alcohol during pregnancy (85%, n=777), although 8% (n=76) claimed that they had not received any advice regarding this. Media attention concerning risks associated with drinking during pregnancy was seen as slightly more important to achieve reduced alcohol intake during pregnancy than advice from maternity health care providers. Conclusions. A majority of women in this study reported abstaining from alcohol during pregnancy. © 2008 Informa UK Ltd. (Informa Healthcare, Taylor & Francis AS).

  • 191.
    Nilsen, Per
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics.
    Skagerström, Janna
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Rahmqvist, Mikael
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Hultgren, Eva
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    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.
    Alcohol prevention in Swedish antenatal care: effectiveness and perceptions of the Risk Drinking project counseling model2012In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 91, no 6, p. 736-743Article in journal (Refereed)
    Abstract [en]

    Objective. To compare an earlier Swedish antenatal care counseling routine concerning alcohol consumption with an expanded model in terms of effectiveness in achieving abstinence in pregnancy. A further objective was to assess the womens perceptions of the alcohol counseling. Design. Cohort study. Setting. Antenatal care center in a provincial Swedish university town. Population. Women who received alcohol counseling; 1533 in cohort 1 (routine counseling) and 1476 in cohort 2 (expanded model). Approximately 93% of all pregnant women in Linkoping are registered at this center. Methods. Data were collected by means of an anonymous questionnaire. Thirteen questions in the questionnaire were analysed for this study. Main outcome measures. Replies from three questions concerning pre-pregnancy drinking and three questions on drinking during pregnancy. Results. The response rate was 60% for cohort 1 and 64% for cohort 2. Perceptions of the advice from the antenatal care center were generally favorable. Similar proportions of women, approximately 6%, in both cohorts drank at least once during the pregnancy (after pregnancy recognition). There were four predictors for drinking during pregnancy: older age; having previously given birth to a child; frequency of pre-pregnancy drinking; and perceiving the message from antenatal care as small amounts of alcohol during pregnancy dont matter.Conclusions. An expanded counseling model implemented in Swedish antenatal care did not reduce the proportion of women who continued drinking during pregnancy in comparison with a previous counseling model, although the advice provided in the new model was perceived more favorably.

  • 192.
    Nilsson, Lena
    et al.
    Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Borendal Wodlin, Ninnie
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Kjölhede, Preben
    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.
    Risk factors for postoperative complications after fast-track abdominal hysterectomy2012In: Australian and New Zealand journal of obstetrics and gynaecology, ISSN 0004-8666, E-ISSN 1479-828X, Vol. 52, no 2, p. 113-120Article in journal (Refereed)
    Abstract [en]

    Background: Fast-track regimen has been shown to reduce postoperative complications in gastrointestinal surgery. less thanbrgreater than less thanbrgreater thanAims: We investigated the incidence and type of postoperative complications and associated risk factors after benign abdominal hysterectomy undertaken in a fast-track program. less thanbrgreater than less thanbrgreater thanMethods: A prospective longitudinal cohort study. In five Swedish hospitals, a cohort of 162 women, ASA 1-2, undergoing abdominal hysterectomy in a fast-track program was prospectively studied. Surgery was performed under spinal or general anaesthesia. The fast-track concept was standardised with discharge criteria and a restricted intravenous fluid regimen. Complications were systematically registered during the five-week follow-up period. Risk factors for complications were analysed using multiple logistic regression models. less thanbrgreater than less thanbrgreater thanResults: Forty-one (25.3%) developed postoperative complications, mainly infection and wound healing complications. The majority of the complications developed after discharge and were treated in the outpatient clinics. Four women (2.5%) were readmitted to hospital. Substantial risk factors for postoperative complications were obesity (OR 8.83), prior laparotomy (OR 2.92) and relative increase in body weight on the first postoperative day (OR 1.52). less thanbrgreater than less thanbrgreater thanConclusions: Minor infection and wound healing complications seem to be common in healthy women undergoing abdominal hysterectomy in a fast-track program. Obesity is an important risk factor also in fast-track abdominal hysterectomy. A modest increase in postoperative relative weight gain during the first postoperative day seemed to increase the risk of postoperative complications. This factor merits further study. Randomised studies are necessary to determine the impact of fast-track program and perioperative fluid regimens on postoperative complications.

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  • 193.
    Nilsson, Ulrika K.
    et al.
    Linköping University, Department of Medicine and Health Sciences, Pharmacology . Linköping University, Faculty of Health Sciences.
    Grenegård, Magnus
    Linköping University, Department of Medicine and Health Sciences, Pharmacology . Linköping University, Faculty of Health Sciences.
    Berg, Göran
    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.
    Svensson, Samuel P.S.
    Linköping University, Department of Medicine and Health Sciences, Pharmacology . Linköping University, Faculty of Health Sciences.
    Different proliferative responses of Gi/o-protein-coupled receptors in human myometrial smooth muscle cells: a possible role of calcium1998In: Journal of Molecular Neuroscience, ISSN 0895-8696, Vol. 11, no 1, p. 11-21Article in journal (Refereed)
    Abstract [en]

    The majority of studies investigating the proliferative effect of Gi/o-protein-coupled receptor agonists are performed in recombinant receptor systems or cell lines. In these systems the relative stoichiometry of receptors compared to other cell components might be changed, which may lead to anomalies in cellular responses in contrast to natural occurring systems. In the present study, we have used primary cultures of smooth muscle cells (SMCs) isolated from human myometrium to characterize the proliferative effects of agonists binding to two different G protein-coupled receptors. Treatment of quiescent SMCs with lysophosphatidic acid (LPA) and noradrenaline resulted in significant increases in [3H]thymidine incorporation. However, LPA was almost four times more effective than noradrenaline in this respect. The proliferative effects of the agonists could be completely blocked by pertussis toxin, indicating that the response are mediated through Gi/o-proteins. The selective α2-adrenergic receptor (α2-AR) antagonist yohimbine dose-dependently reduced the effect of noradrenaline suggesting that the proliferative response was mediated through α2-ARs. The proliferative effects induced by LPA and noradrenaline was markedly reduced in SMCs treated with the tyrosine kinase inhibitor genistein and the cAMP elevating compound forskolin. However, LPA but not noradrenaline induced rapid rises in the cytosolic free Ca2+ concentration [Ca2+]i. The ability to increase Ca2+ might be one explanation why LPA produce a more pronounced proliferative response than noradrenaline in primary cultures of human myometrial SMCs.

  • 194.
    Pelling, Staffan
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Kalén, Anders
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Hammar, Mats
    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.
    Wahlström, Ola
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Preparation for becoming members of health care teams: findings from a 5-year evaluation of a student interprofessional training ward2011In: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567, Vol. 25, no 5, p. 328-332Article in journal (Refereed)
    Abstract [en]

    Setting. An orthopaedic interprofessional training ward manned by students at a University Hospital. less thanbrgreater than less thanbrgreater thanObjective. To assess to what extent students from different undergraduate programmes evaluated the effects of a 2-week rotation at the ward on their professional roles and the value of teamwork within health care. less thanbrgreater than less thanbrgreater thanMethod. A questionnaire was filled in by 841 students by the end of a 2-week rotation at the ward over 5 years. Questions concerned students estimate of how the rotation had strengthened their insight into their own future professional role, into other students professional roles and into the value of teamwork within health care. Differences between the different student categories and possible associations between the different estimates were statistically analysed. less thanbrgreater than less thanbrgreater thanResults. Students from all programmes reported that the rotation at the student ward had dramatically strengthened their insight about their own future professional role as well as the roles of the other professions and the value of teamwork within health care. less thanbrgreater than less thanbrgreater thanConclusion. Health care is a complicated system based on cooperation and professionalism. We suggest that interprofessional training of students from all professions within health care should be a part of their education as a worthwhile preparation for their future professional work and to ensure high-quality health care.

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  • 195.
    Persson, M
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Ekerfelt, Christina
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology. Linköping University, Faculty of Health Sciences.
    Jablonowska, Barbara
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Jonsson, Yvonne
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology. Linköping University, Faculty of Health Sciences.
    Ernerudh, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre 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.
    Berg, Göran
    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.
    Cytokine networks for implantation and early pregnancy: immunologic status in patients undergoing in vitro fertilization in JOURNAL OF REPRODUCTIVE IMMUNOLOGY, vol 90, issue 2, pp 166-1662011In: JOURNAL OF REPRODUCTIVE IMMUNOLOGY, Elsevier , 2011, Vol. 90, no 2, p. 166-166Conference paper (Refereed)
    Abstract [en]

    n/a

  • 196.
    Persson, Marie
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology. Linköping University, Faculty of Health Sciences.
    Ekerfelt, Christina
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology. Linköping University, Faculty of Health Sciences.
    Ernerudh, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology. Linköping University, Faculty of Health Sciences.
    Matthiesen, Leif
    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. Linköping University, Faculty of Health Sciences.
    Jenmalm, Maria
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Jonsson, Yvonne
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology. Linköping University, Faculty of Health Sciences.
    Sandberg, Martina
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Berg, Göran
    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. Linköping University, Faculty of Health Sciences.
    Increased circulating paternal antigen-specific IFN-γ- and IL-4-secreting cells during pregnancy in allergic and non-allergic women2008In: Journal of Reproductive Immunology, ISSN 0165-0378, E-ISSN 1872-7603, Vol. 79, no 1, p. 70-78Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Allergic women have been reported to give birth to more children than non-allergic women, speculatively explained by the former's predisposition for Th2 polarization, possibly favoring pregnancy.

    AIM: The aim of this study was to test the hypothesis that allergy is associated with more Th2-deviated responses to paternal antigens throughout pregnancy.

    METHODS: Blood samples were collected on six occasions during pregnancy and two occasions postpartum (pp). Of the 86 women initially included, 54 women had a normal pregnancy and completed the sampling procedures. Eleven women fulfilled the strict criteria for allergy (allergic symptoms and circulating IgE antibodies to inhalant allergens) and 23 were strictly non-allergic (non-sensitized without symptoms). The numbers of blood mononuclear cells secreting IFN-gamma and IL-4, spontaneously and in response to paternal alloantigens, were compared between the groups.

    RESULTS: The numbers of spontaneously as well as paternal antigen-induced IFN-gamma- and IL-4-secreting cells were similar in allergic and non-allergic pregnant women on all occasions. A similar increase in the numbers of both IFN-gamma- and IL-4-secreting cells were found in allergic and non-allergic women during pregnancy, both regarding spontaneous and paternal antigen-induced secretion.

    CONCLUSIONS: This study does not support the hypothesis of a more pronounced Th2-deviation to paternal antigens in allergic pregnant women compared with non-allergic pregnant women, as measured by number of cytokine-secreting cells. The observed increase of both IFN-gamma- and IL-4-secreting cells during normal pregnancy may be interpreted as a Th2-situation, since the effects of IL-4 predominate over the effects of IFN-gamma.

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  • 197.
    Persson, Marie
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology. Linköping University, Faculty of Health Sciences.
    Ekerfelt, Christina
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology. Linköping University, Faculty of Health Sciences.
    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.
    Matthiesen, Leif
    Department of Obstetrics and Gynecology, Helsingborg Hospital, Helsingborg, Sweden.
    Sandberg, Martina
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Jonsson, Yvonne
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology. Linköping University, Faculty of Health Sciences.
    Berg, Göran
    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.
    Jenmalm, Maria C.
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Reduced IFN-γ and IL-10 responses to paternal antigens during and after pregnancy in allergic women2012In: Journal of Reproductive Immunology, ISSN 0165-0378, E-ISSN 1872-7603, Vol. 95, no 1-2, p. 50-58Article in journal (Refereed)
    Abstract [en]

    Normal pregnancy and allergy are both characterized by a T helper (Th) 2 deviation. In the current study, we hypothesized that paternal antigen-induced cytokine responses during pregnancy would be deviated toward Th2 and an anti-inflammatory profile, and that the Th2 deviation would be more pronounced in allergic pregnant women. Blood samples were collected longitudinally on three occasions during pregnancy and two occasions post partum (pp). Of the 86 women initially included, 54 women had a normal pregnancy and completed the sampling procedures. Twelve women fulfilled the criteria for allergy (allergic symptoms and circulating immunoglobulin [Ig] E antibodies to inhalant allergens) and 20 were non-allergic (nonsensitized without symptoms). The levels of Th1- and Th2-associated cytokines and chemokines, the Th17 cytokine IL-17 and the anti-inflammatory cytokine IL-10 of the groups were compared. Paternal antigen-induced IL-4 and IL-10 responses increased between the first and the third trimester. Allergy was associated with decreased paternal antigen-induced IFN-γ and CXCL10 secretion in the nonpregnant state (one year pp) and also decreased IFN-γ/IL-4 and IFN-γ/IL-13 ratios during pregnancy. We also observed a decreased paternal antigen-induced IL-10 response in allergic compared with non-allergic women during pregnancy, along with a decreased IL-10/IL-13 ratio. In conclusion, our findings support the hypothesis of lower Th1 responses toward paternal antigens in allergic than in non-allergic women, but also indicate that allergy is associated with a lower capacity to induce anti-inflammatory IL-10 responses after paternal antigen stimulation during pregnancy.

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  • 198.
    Persson, Marie
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Ekerfelt, Christina
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology. Linköping University, Faculty of Health Sciences.
    Jablonowska, Barbara
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Jonsson, Yvonne
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology. Linköping University, Faculty of Health Sciences.
    Berg, Göran
    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.
    Ernerudh, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Diagnostics, Department of Clinical Immunology and Transfusion Medicine.
    Jenmalm, Maria C.
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Leukocyte populations in patients undergoing in vitro fertilization: responses to hormone treatment and relation to outcome2012Manuscript (preprint) (Other academic)
    Abstract [en]

    We aimed to prospectively investigate circulating leukocyte populations in infertile women undergoing IVF treatment and to determine whether any differences in cell proportions were associated with the IVF outcome. We also assessed the effect of IVF-based ovarian stimulation on the leukocyte populations. Twenty-five women were included and IVF treatment was successful in six and unsuccessful in 19 women. Blood samples were collected before IVF treatment, at the time of embryo transfer and four weeks after embryo transfer. The numbers and proportions of lymphocytes, T cells, NK cells, monocytes and granulocytes were analysed by flow cytometry, as well as the following lymphocyte subpopulations: CD3+HLA-DR+, CD4+CD45RA+, CD4+CD45R0+, CD8+CD45RA+, CD8+CD45R0+, CD4+CD25+, CD4dimCD25bright regulatory T cells, CD3-CD56bright and CD3-CD56dim NK cells. The proportions and numbers of leukocytes during IVF treatment were not related to the IVF outcome, although pregnant women (four weeks after ET) had a lower proportion of lymphocytes than the non-pregnant women. The absolute counts of lymphocytes, T cells, granulocytes and monocytes, as well as the proportions of granulocytes and T cells, increased at the time of ET, coinciding with high FSH and hCG levels. In conclusion, the proportions and numbers of leukocyte populations were not associated with the IVF outcome, although a larger study should be conducted to confirm this conclusion. Changes in both proportions and numbers of several leukocyte populations were observed during the course of IVF treatment, suggesting a stimulatory effect of the hormonal influence.

  • 199.
    Persson, Marie
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology. Linköping University, Faculty of Health Sciences.
    Ekerfelt, Christina
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology. Linköping University, Faculty of Health Sciences.
    Jablonowska, Barbara
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Jonsson, Yvonne
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology. Linköping University, Faculty of Health Sciences.
    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 C.
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology. Linköping University, Faculty of Health Sciences.
    Berg, Göran
    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.
    Immunological status in patients undergoing in vitro fertilisation: responses to hormone treatment and relationship to outcome2012In: Journal of Reproductive Immunology, ISSN 0165-0378, E-ISSN 1872-7603, Vol. 96, no 1-2, p. 58-67Article in journal (Refereed)
    Abstract [en]

    We aimed to prospectively investigate the paternal antigen-induced cytokine secretion by peripheral blood mononuclear cells (PBMCs) in response to hormone treatment in women undergoing in vitro fertilisation (IVF) and to examine the predictive value of the cytokine secretion profile in the outcome of IVF treatment, in a pilot study. Twenty-five women were included and IVF treatment was successful for six and unsuccessful for 19 women. Blood samples were collected before IVF treatment, on four occasions during IVF and four weeks after embryo transfer. The numbers of Th1-, Th2- and Th17-associated cytokine-secreting cells and cytokine levels in cell supernatants were analysed by enzyme-linked immunospot-forming (ELISpot), enzyme-linked immune-sorbent (ELISA) or Luminex assay. None of the cytokines (IFN-γ, IL-4, IL-5, IL-10, IL-12, IL-13, IL-17, TNF and GM-CSF) had any predictive value regarding IVF outcome. The majority of the cytokines reached their peak levels at ovum pick-up, suggesting an enhancing influence of the hormonal stimulation. Pregnancy was associated with a high number of IL-4-, IL-5- and IL-13-secreting cells four weeks after ET. In conclusion, the results do not support our hypothesis of a more pronounced peripheral Th1 and Th17 deviation towards paternal antigens in infertile women with an unsuccessful IVF outcome, although this is based on a small number of observations. A larger study is required to confirm this conclusion. Higher numbers of Th2-associated cytokine-secreting cells in pregnant women four weeks after ET do corroborate the hypothesis of a Th2 deviation during pregnancy.

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  • 200.
    Persson, P.
    et al.
    University of Uppsala Hospital.
    Brynhildsen, Jan
    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.
    Kjölhede, Preben
    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.
    Short-Term Recovery After Subtotal and Total Abdominal Hysterectomy-A Randomized Clinical Trial2010In: Obstetrical and Gynecological Survey, ISSN 0029-7828, E-ISSN 1533-9866, Vol. 65, no 6, p. 370-371Article in journal (Other academic)
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