Publications by authors named "Helena Lindgren"

107 Publications

Midwife-led continuity of care improved maternal and neonatal health outcomes in north Shoa zone, Amhara regional state, Ethiopia: A quasi-experimental study.

Women Birth 2021 Sep 3. Epub 2021 Sep 3.

Department of Women's and Children's Health, Division of Reproductive Health, Karolinska Institute, Sweden.

Background: In a low-resource setting, information on the effect of midwife-led continuity of care (MLCC) is limited. Therefore, this study aimed to determine the effect of MLCC on maternal and neonatal health outcomes in the Ethiopian context.

Method: A study with a quasi-experimental design was conducted from August 2019 to September 2020 in four primary hospitals of the north Shoa zone, Amhara regional state, Ethiopia. A total of 1178 low risk women were allocated to one of two groups; the midwife-led continuity of care (MLCC or intervention group) (received all antenatal, labour, birth, and immediate postnatal care from a single midwife or backup midwife) (n = 589) and the Shared model of care (SMC or comparison group) (received care from different staff members at different times) (n = 589). The two outcomes studied were Spontaneous vaginal birth and preterm birth. Outcome variables were compared using multivariate generalized linear models (GLMs) and reported using adjusted risk ratios (aRR) with 95% confidence intervals.

Findings: Women in MLCC were, in comparison with women in the SMC group more likely to have spontaneous vaginal birth (aRR of 1.198 (95% CI 1.101-1.303)). Neonates of women in MLCC were in comparison with those in SMC less likely to be preterm (aRR of 0.394; 95% CI (0.227-0.683)).

Conclusion: In this study, use of the MLCC model improved maternal and neonatal health outcomes. To scale up and further investigate the effect and feasibility of this model in a low resource setting could be of considerable importance in Ethiopia and other Sub-Saharan Africa countries.
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http://dx.doi.org/10.1016/j.wombi.2021.08.008DOI Listing
September 2021

Half-time evaluation of a new 4-year Ph.D. program in nursing and midwifery at the University of Gondar, Ethiopia.

Glob Health Action 2021 Jan;14(1):1905304

Women's and Children's Health, Karolinska Institutet, Sweden.

A new four-year Ph.D. programme in nursing and midwifery, the first of its kind in Ethiopia, was started in 2018/2019 at the University of Gondar when eight doctoral students in nursing and midwifery entered the program. We who have been involved see this as an appropriate time to evaluate what has been accomplished to date and to look toward future possibilities. Our aim in carrying out such an evaluation and presenting our findings is in part to determine if similar programs might be developed in other similar settings and in part to learn what modifications to the present program might be considered. The key elements of a questionnaire survey with closed and open response alternatives were based on the content, structure and learning outcomes of the home university Ph.D. programme as described in the curriculum. The questionnaire responses captured changes that would be needed to maintain a fully satisfactory programme that blends onsite instruction and online access to faculty resulting in a twenty-first century blended Ph.D. programme. Improved dialogue between the home university faculty and the external supervisors is needed. The programme can provide a career pathway that midwifery and nursing educators can follow in their own country rather than having to leave to study in another country. The findings provide insight into the feasibility of extending similar Ph.D. programmes to other parts of East Africa and with the SDG 5 in mind with an increased focus on women leadership. The justification for this initiative is to meet the need for more nursing and midwifery faculty who can provide quality midwifery and nursing education in East African countries. Retention of these professionals will help to deal with the shortage of healthcare personnel and will provide better care for the general population.
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http://dx.doi.org/10.1080/16549716.2021.1905304DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8381928PMC
January 2021

Provider-perceived benefits and constraints of complete adherence to antenatal care guideline among public health facilities, Ethiopia: A qualitative study.

PLoS One 2021 9;16(8):e0255297. Epub 2021 Aug 9.

Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.

Background: In Ethiopia, health care providers' level of adherence to the national Antenatal Care (ANC) guideline is relatively low. The reasons why they do not follow the guidelines are not well known. Therefore, this study aimed to explore the provider-perceived benefits and constraints associated with using the guideline for ANC in public health facilities in Gondar town.

Methods: A qualitative study was conducted using a semi-structured interview guide. The interview was conducted among a purposive sample of nine health care providers working in four public health facilities in Gondar town. After the interviews were transcribed and coded, a content analysis was done using Atlas ti version 7.5 software packages.

Result: Decreasing provider's workload and maximizing performance, improving safe motherhood, and improving the process of service delivery were reported as the perceived benefits of following ANC guideline. Organizational problems, care providers' existing knowledge, attitude, and skills and availability of training and mentorship were the three main identified groups of factors that hinder complete providers' adherence to ANC guideline.

Conclusion: Although providers acknowledged the benefits of following ANC guideline, the guideline is not fully implemented. Refresher training should be given at the start of the updated eight-contact ANC guideline and continuing education and supervision throughout the implementation process. Health care providers call for profound and urgent revisions of the supply chain system for supplies and equipment.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0255297PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8351951PMC
August 2021

Developing a midwifery service task list for Chinese midwives in the task-shifting context: a Delphi study.

BMJ Open 2021 07 15;11(7):e044792. Epub 2021 Jul 15.

Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, Shanghai, China

Objective: To develop and validate a midwifery-led task list in the task-shifting context.

Design: An extensive literature review followed by a two-iterative Delphi survey.

Setting: Twenty university hospitals, three non-university hospitals and four university colleges from nine provincial regions of China.

Participants: Purposive non-probability sampling of a national panel of experts in maternal healthcare, obstetrics, nursing and midwifery. Experts in the panel were asked to rate each midwifery service item regarding importance, feasibility and advancement on a 5-point scale, in order to determine those best suited for midwifery-led practice in China.

Results: Two rounds of Delphi surveys were completed before consensus was achieved, with effective response rate ranging from 96.4% (27/28) to 100% (27/27), indicating a high positive coefficient of the experts. The authority coefficient of experts was 0.882, indicating the high reliability of this study. The Kendall harmony coefficient (W) in the two rounds of consultations was 0.196 (p<0.001) and 0.324 (p<0.001), respectively. A detailed, three-level midwifery-led task list was developed, including 3 domains of midwifery practice (first-level indicators), 13 types of task (second-level indicators) and 58 midwifery service items (third-level indicators). The 3 domains of midwifery practice involved the appropriate scope of practice for Chinese midwives, including antenatal care, intrapartum care and postnatal care. The 58 service items embraced core components of caring task in the Chinese midwifery profession.

Conclusion: This study outlines the first midwifery-led task list that defines clearly the Chinese midwives' scope of practice. It will provide a foundational framework for future midwifery practice in China and abroad, and can be used to inform the design of midwifery-led task shifting interventions in various maternity settings.
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http://dx.doi.org/10.1136/bmjopen-2020-044792DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8286777PMC
July 2021

Country of birth, educational level and other predictors of seeking care due to decreased fetal movements: an observational study in Sweden using data from a cluster-randomised controlled trial.

BMJ Open 2021 06 25;11(6):e050621. Epub 2021 Jun 25.

Health Promoting Science, Sophiahemmet University, Stockholm, Sweden

Objectives: To identify predictors of seeking care for decreased fetal movements and assess whether care-seeking behaviour is influenced by Mindfetalness.

Design: Observational study with data from a cluster-randomised controlled trial.

Setting: 67 maternity clinics and 6 obstetrical clinics in Sweden.

Participants: All pregnant women with a singleton pregnancy who contacted the obstetrical clinic due to decreased fetal movements from 32 weeks' gestation of 39 865 women.

Methods: Data were collected from a cluster-randomised controlled trial where maternity clinics were randomised to Mindfetalness or routine care. Mindfetalness is a self-assessment method for women to use daily to become familiar with the unborn baby's fetal movement pattern.

Outcome Measures: Predictors for contacting healthcare due to decreased fetal movements.

Results: Overall, 5.2% (n=2059) of women contacted healthcare due to decreased fetal movements, among which 1287 women (62.5%) were registered at a maternity clinic randomised to Mindfetalness and 772 women (37.5%) were randomised to routine care. Predictors for contacting healthcare due to decreased fetal movements were age, country of birth, educational level, parity, prolonged pregnancy and previous psychiatric care (p<0.001). The main differences were seen among women born in Africa as compared with Swedish-born women (2% vs 6%, relative risk (RR) 0.34, 95% CI 0.25 to 0.44) and among women with low educational level compared with women with university-level education (2% vs 5.4%, RR 0.36, 95% CI 0.19 to 0.62). Introducing Mindfetalness in maternity care increased the number of women seeking care due to decreased fetal movements overall.

Conclusion: Women with country of birth outside Sweden and low educational level sought care for decreased fetal movements to a lesser extent compared with women born in Sweden and those with university degrees. Future research could explore whether pregnancy outcomes can be improved by motivating women in these groups to contact healthcare if they feel a decreased strength or frequency of fetal movements.

Trial Registration Number: NCT02865759.
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http://dx.doi.org/10.1136/bmjopen-2021-050621DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8237734PMC
June 2021

African midwifery students' self-assessed confidence in postnatal and newborn care: A multi-country survey.

Midwifery 2021 Oct 29;101:103051. Epub 2021 May 29.

Department of Women's and Children's Health, Uppsala University, Sweden.

Background: Majority of maternal and new-born deaths occur within 28 hours and one week after birth. These can be prevented by well-educated midwives. Confidence in postnatal and newborn care skills depend on the quality of midwifery education.

Objective: To assess confidence and its associated factors for basic postnatal and new-born care skills of final year midwifery students , from seven African countries.

Methods: A multi-country cross-sectional study where final year midwifery students answered a questionnaire consisting of basic skills of postnatal and newborn care listed by the International Confederation of Midwives. The postnatal care area had 16 and newborn care area had 19 skill statements. The 16 skills of postnatal care were grouped into three domains through principle component analysis (PCA); Basic postnatal care; postnatal complications and educating parents and documentation. The 19 skills under the newborn care area were grouped into three domains; Basic care and care for newborn complications; Support parents for newborn care; and Care for newborns of HIV positive mothers and documentation.

Results: In total 1408 midwifery students from seven Sub-Saharan countries participated in the study namely; Kenya, Malawi, Tanzania, Uganda, Zambia, Zimbabwe, and Somaliland Overall high confidence for all domains under Post Natal Care ranged from 30%-50% and for Newborn care from 39-55%. High confidence for postnatal skills was not found to be associated with any background variables (Age, sex, type and level of educational programme). High confidence for newborn care was associated with being female students, those aged 26-35 years, students from the direct entry programmes and those enrolled in diploma programmes.

Conclusions: Almost half of the study participants expressed lack of confidence for skills under postnatal and newborn care. No association was found between high confidence for domains of postnatal care and background variables. High confidence was associated with being a female, between 26-35 years of age, from direct entry or diploma programmes for newborn care area. The results of the study indicate gaps in midwifery education. Countries could use the ICM list of competencies to develop country specific standards for midwifery education. However, actual competence remains to be measured.
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http://dx.doi.org/10.1016/j.midw.2021.103051DOI Listing
October 2021

Exploring Limitations of User Interface Design to Understanding the Gap Between Technology and Seniors.

Stud Health Technol Inform 2021 May;281:931-935

Department of Community Medicine and Rehabilitation, Umeå University, Sweden.

Participating in social activities promotes healthy ageing, whereas loneliness and isolation are known to cause adverse effects on both physical and mental wellbeing. Technology that exists in society today can facilitate healthy ageing. However, a gap can be seen between seniors and technology in today's internet and communication technological device's user interfaces. Due to limited prior knowledge of interacting with touch screen devices, seniors sometimes have difficulties using them. This research aims to explore the user interfaces and their elements designed using a human-centered design methodology by involving seniors as activate participants in the design process. This work's outcome can improve current user interface design practices in touch screen devices, which might be seen as contributing step to understand the gap between seniors and technology.
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http://dx.doi.org/10.3233/SHTI210315DOI Listing
May 2021

Client Factors Affect Provider Adherence to Guidelines during First Antenatal Care in Public Health Facilities, Ethiopia: A Multi-Center Cross-Sectional Study.

Ethiop J Health Sci 2020 Nov;30(6):903-912

Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.

Background: Timely entry to an antenatal care with a healthcare provider who follows a set of national guidelines is assumed to ensure higher levels of client satisfaction. It is also expected to improve perinatal outcomes. Little is known about the level of adherence of Ethiopian providers to these guidelines. Therefore, this study aims to assess the proportion of clients who received complete (100%) provider adherence to antenatal care guidelines at the first visit and client associated factors in Gondar Town.

Methods: A cross-sectional study of 834 study participants was conducted in public health facilities of Gondar Town in Ethiopia. An 18 point checklist was used to observe provider adherence to the first antenatal care visit guidelines. Descriptive statistics and multivariable binary logistic regression model were done by using STATA 14 software.

Result: The proportion of clients who received the complete provider's adherence to the first antenatal care guideline was 32.25% (95% CI: 29.1-35.5). The mean adherence score was 16.78%. Women who had prior history of pregnancy and/or birth-related complications (AOR = 1.58; 95%CI: 1.04-2.04) and late antenatal care booking at gestational week 16 or greater (AOR = 1.45; 95%CI: 1.03-2.03) were significantly associated with clients receiving complete providers' adherence to the first antenatal guideline.

Conclusions: We found the level of adherence to national antenatal care guidelines during first visit as surprisingly low. When considering to upgrade the guidelines to the actual WHO guideline of eight visits, we recommend that refresher training be provided regularly to help staff understand the importance of following the guidelines as closely as possible. Perhaps, we need to learn more from the health care providers themselves about their reasons for not following the guidelines.
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http://dx.doi.org/10.4314/ejhs.v30i6.8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8047236PMC
November 2020

The community-based bilingual doula - A new actor filling gaps in labour care for migrant women. Findings from a qualitative study of midwives' and obstetricians' experiences.

Sex Reprod Healthc 2021 Jun 17;28:100614. Epub 2021 Mar 17.

Division of Reproductive Health, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.

Objectives: To explore midwives' and obstetricians' views about community-based bilingual doula (CBD) support during migrant women's labour and birth and their experiences of collaborating with CBDs.

Study Design: A qualitative study with semi-structured individual interviews with 7 midwives and 4 obstetricians holding clinical positions in labour care in Stockholm, Sweden, who all had experiences of working with a CBD. Data analysis followed the framework of thematic analysis.

Results: The overarching theme was A new actor filling gaps in labour care - With appropriate boundary setting, CBDs can help improve care for migrant women. One year after the introduction of CBDs, the midwives and obstetricians had mainly positive experiences of CBDs who were considered to fill important gaps in maternity care for migrant women, being with the woman and simultaneously being part of the care team and this made providing high quality care easier. The CBDs' main contribution was to help migrant women navigate the maternity care system, to bridge language and cultural divides, and guarantee continuous labour and birth support. However, midwives and obstetricians sometimes experienced CBDs interfering with their professional assessments and decisions and the role of the CBD was somewhat unclear to them.

Conclusions: Community-based bilingual doula support was viewed as improving migrant women's well-being during labour and birth and as increasing the possibilities for midwives and obstetricians to provide good and safe care, however, some ambivalence remained about the CBD's role and boundaries.
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http://dx.doi.org/10.1016/j.srhc.2021.100614DOI Listing
June 2021

Sustainable Behavior Change for Health Supported by Person-Tailored, Adaptive, Risk-Aware Digital Coaching in a Social Context: Study Protocol for the STAR-C Research Programme.

Front Public Health 2021 1;9:593453. Epub 2021 Mar 1.

Public Health Unit, Region Västerbotten, Umeå, Sweden.

The Västerbotten Intervention Programme (VIP) in the Region Västerbotten Sweden is one of the very few cardiovascular disease (CVD) prevention programmes globally that is integrated into routine primary health care. The VIP has been shown as a cost-effective intervention to significantly reduce CVD mortality. However, little is known about the effectiveness of a digital solution to tailor risk communication strategies for supporting behavioral change. STAR-C aims to develop and evaluate a technical platform for personalized digital coaching that will support behavioral change aimed at preventing CVD. STAR-C employs a mixed-methods design in seven multidisciplinary projects, which runs in two phases during 2019-2024: (i) a formative intervention design and development phase, and (ii) an intervention implementation and evaluation phase. In the 1st phase, STAR-C will model the trajectories of health behaviors and their impact on CVDs (Project 1), evaluate the role of the social environment and social networks on behavioral change (Project 2) and assess whether and how social media facilitates the spread of health information beyond targeted individuals and stimulates public engagement in health promotion (Project 3). The findings will be utilized in carrying out the iterative, user-centered design, and development of a person-tailored digital coaching platform (Project 4). In the 2nd phase, STAR-C will evaluate the implementation of the coaching programme and its effectiveness for promoting behavioral change and the spreading of health information across social networks and via social media (Project 5). The cost-effectiveness (Project 6) and ethical issues (Project 7) related to the coaching programme intervention will be evaluated. The STAR-C research programme will address the knowledge and practice research gaps in the use of information technologies in health promotion and non-communicable disease (NCD) prevention programmes in order to narrow the health inequality gaps. STAR-C has received approval from the Swedish Ethical Review Authority (Dnr. 2019-02924;2020-02985). The collaboration between Umeå University and Region Västerbotten will ensure the feasibility of STAR-C in the service delivery context. Results will be communicated with decision-makers at different levels of society, stakeholders from other regions and healthcare professional organizations, and through NGOs, local and social media platforms.
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http://dx.doi.org/10.3389/fpubh.2021.593453DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7957003PMC
May 2021

Posterior compartment symptoms in primiparous women 1 year after non-assisted vaginal deliveries: a Swedish cohort study.

Int Urogynecol J 2021 07 1;32(7):1825-1832. Epub 2021 Mar 1.

Karolinska Pelvic Floor Centre, Karolinska University Hospital Huddinge, Stockholm, Sweden.

Introduction And Hypothesis: This is a prospective cohort follow-up study based on the hypothesis that primiparous women with non-assisted vaginal deliveries and a second-degree perineal tear have more posterior compartment symptoms 1 year after delivery than those with no or first-degree tears.

Methods: A follow-up questionnaire, including validated questions on pelvic floor dysfunction, was completed 1 year postpartum by 410 healthy primiparas, delivered without instrumental assistance at two maternity wards in Stockholm between 2013 and 2015. Main outcome measures were posterior compartment symptoms in women with second-degree perineal tears compared with women with no or only minor tears.

Results: Of 410 women, 20.9% had no or only minor tears, 75.4% had a second-degree tear, and 3.7% had a more severe tear. Of women presenting with second-degree tears, 18.9% had bowel-emptying difficulties compared with 20.0% of women with minor tears. Furthermore, almost 3% of them with second-degree tears complained of faecal incontinence (FI) of formed stool, 7.2% of FI of loose stool compared with 1.2% and 3.5% respectively in women with no or only minor tears.

Conclusions: Symptomatic pelvic floor dysfunction is common among primiparous women within 1 year following uncomplicated vaginal delivery, and there are no significant differences between second-degree perineal tears and minor tears. These symptoms should be addressed in all women after delivery to improve pelvic floor dysfunction and quality of life.
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http://dx.doi.org/10.1007/s00192-021-04700-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8295137PMC
July 2021

Guanylate-Binding Proteins Are Critical for Effective Control of Strains in a Mouse Co-Culture System of Adaptive Immunity.

Front Cell Infect Microbiol 2020 10;10:594063. Epub 2020 Dec 10.

Department of Clinical Microbiology and Laboratory for Molecular Infection Medicine Sweden (MIMS), Umeå University, Umeå, Sweden.

is a Select Agent that causes the severe disease tularemia in humans and many animal species. The bacterium demonstrates rapid intracellular replication, however, macrophages can control its replication if primed and activation with IFN-γ is known to be essential, although alone not sufficient, to mediate such control. To further investigate the mechanisms that control intracellular replication, an co-culture system was utilized containing splenocytes obtained from naïve or immunized C57BL/6 mice as effectors and infected bone marrow-derived wild-type or chromosome-3-deficient guanylate-binding protein (GBP)-deficient macrophages. Cells were infected either with the live vaccine strain (LVS), the highly virulent SCHU S4 strain, or the surrogate for , . Regardless of strain, significant control of the bacterial replication was observed in co-cultures with wild-type macrophages and immune splenocytes, but not in cultures with immune splenocytes and -deficient macrophages. Supernatants demonstrated very distinct, infectious agent-dependent patterns of 23 cytokines, whereas the cytokine patterns were only marginally affected by the presence or absence of GBPs. Levels of a majority of cytokines were inversely correlated to the degree of control of the SCHU S4 and LVS infections, but this was not the case for the infection. Collectively, the co-culture assay based on immune mouse-derived splenocytes identified a dominant role of GBPs for the control of intracellular replication of various strains, regardless of their virulence, whereas the cytokine patterns markedly were dependent on the infectious agents, but less so on GBPs.
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http://dx.doi.org/10.3389/fcimb.2020.594063DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7758253PMC
June 2021

Midwives' experiences of using the Mindfetalness method when talking with pregnant women about fetal movements.

Women Birth 2021 Sep 24;34(5):e498-e504. Epub 2020 Oct 24.

Sophiahemmet University, Stockholm, Sweden; Department of Women and Children's Health, Karolinska Institutet, Stockholm, Sweden. Electronic address:

Background: Information given to pregnant women about fetal movements is important in maternity care and decreased fetal movements is associated with fetal growth restriction and stillbirth. The fetal movement pattern is different for every fetus and women perceive different types of movements. Mindfetalness is a self-assessment method for a woman to use to become familiar with her unborn baby's fetal movement pattern.

Aim: We aimed to explore midwives' perceptions about informing pregnant women about fetal movements and their experiences of working with Mindfetalness in their daily work.

Methods: A web-questionnaire was distributed to midwives who participated in a randomized controlled trial evaluating Mindfetalness, a method for the observation of fetal movements. In total, 67 maternity clinics in Stockholm, Sweden, were randomized to Mindfetalness or routine care. Of the 144 midwives working in maternity clinics randomized to Mindfetalness, 80% answered the questionnaire.

Findings: The midwives thought that the leaflet about Mindfetalness was supportive in their work when informing women about fetal movements and the majority wanted to continue to distribute the leaflet when the trial ended. The midwives also expressed that the study increased their own knowledge about fetal movements. Women embraced the information about Mindfetalness positively and appreciated the written material. The midwives thought that talking about fetal movements in maternity care is an important but challenging task.

Conclusion: Mindfetalness is a useful tool to use in maternity clinics when informing pregnant women about fetal movements. The written information was appreciated by both pregnant women and midwives.
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http://dx.doi.org/10.1016/j.wombi.2020.10.007DOI Listing
September 2021

The STAR-C Intelligent Coach: A Cross-Disciplinary Design Process of a Behavior Change Intervention in Primary Care.

Stud Health Technol Inform 2020 Sep;273:203-208

Department of Epidemiology and Global Health, Umeå University.

A broad range of aspects are needed to be taken into consideration in the design and development of personalized coaching systems based on artificial intelligence methodologies. This research presents the initial phase of joining different professional and stakeholder perspectives on behavior change technologies into a flexible design proposal for a digital coaching system. The diversity and sometimes opposed views on content, behavior, purposes and context were managed using a structured argument-based design approach, which also feed into the behavior of the personalized system. Results include a set of personalization strategies that will be further elaborated with the target user group to manage sensitive issues such as ethics, social norms, privacy, motivation, autonomy and social relatedness.
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http://dx.doi.org/10.3233/SHTI200640DOI Listing
September 2020

A decrease in cesarean sections and labor inductions among Swedish women by awareness of fetal movements with the Mindfetalness method.

BMC Pregnancy Childbirth 2020 Oct 1;20(1):577. Epub 2020 Oct 1.

Sophiahemmet University, Stockholm, Sweden.

Background: Maternal perception of decreased fetal movements is commonly used to assess fetal well-being. However, there are different opinions on whether healthcare professionals should encourage maternal observation of fetal movements, as researchers claim that raising awareness increases unnecessary interventions, without improving perinatal health. We aimed to investigate whether cesarean sections and labor induction increase by raising women's awareness of fetal movements through Mindfetalness. Further, we aimed to study perinatal health after implementing Mindfetalness in maternity care.

Methods: In a cluster randomized controlled trial, 67 maternity clinics were allocated to Mindfetalness or routine care. In the Mindfetalness group, midwives distributed a leaflet telling the women to focus on the character, strength and frequency of the fetal movements without counting each movement. The instruction was to do so for 15 min daily when the fetus was awake, from gestational week 28 until birth. In this sub-group analysis, we targeted women born in Sweden giving birth from 32 weeks' gestation. We applied the intention-to-treat principle.

Results: The Mindfetalness group included 13,029 women and the Routine-care group 13,456 women. Women randomized to Mindfetalness had less cesarean sections (18.4% vs. 20.0%, RR 0.92, CI 0.87-0.97) and labor inductions (19.2% vs. 20.3%, RR 0.95, CI 0.90-0.99) compared to the women in the Routine-care group. Less babies were born small for gestational age (8.5% vs. 9.3%, RR 0.91, CI 0.85-0.99) in the Mindfetalness group. Women in the Mindfetalness group contacted healthcare due to decreased fetal movements to a higher extent than women in the Routine care group (7.8% vs. 4.3%, RR 1.79, CI 1.62-1.97). The differences remain after adjustment for potential confounders.

Conclusions: Raising awareness about fetal movements through Mindfetalness decreased the rate of cesarean sections, labor inductions and small-for-gestational age babies.

Trial Registration: ClinicalTrials.gov ( NCT02865759 ). Registered 12 August 2016, www.clinicaltrials.gov .
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http://dx.doi.org/10.1186/s12884-020-03268-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7528254PMC
October 2020

Older adults' perceptions of contexts surrounding their social participation in a digitalized society-an exploration in rural communities in Northern Sweden.

Eur J Ageing 2020 Sep 11;17(3):281-290. Epub 2020 Feb 11.

Department of Community Medicine and Rehabilitation, Occupational Therapy, Umeå University, 901 87 Umeå, Sweden.

Social participation and digital engagement can contribute to health and well-being among older adults. Because of older adults' decline in abilities, coupled with complex technology and its perceived insufficient relevance to daily life, there is a need to create and tailor social opportunities and services that are supported by digital technologies for older adults to continue participating in society. Thus, it becomes relevant to explore older adults' perceptions about contexts surrounding their social participation in a digital society. This exploration used a qualitative research design with focus group interviews and qualitative content analysis. Eighteen older adults, aged 66-81 years, from rural communities in Northern Sweden, participated in this study. The analysis resulted in three categories: and These categories were encapsulated in the theme- The findings suggested that co-creating usable digitalized services and facilitating satisfactory use of digital technologies could support older adults' social participation through activities that they find relevant in their lives, and subsequently, might enable them to live longer at home.
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http://dx.doi.org/10.1007/s10433-020-00558-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7458988PMC
September 2020

Pregnancy outcomes among women born in Somalia and Sweden giving birth in the Stockholm area - a population-based study.

Glob Health Action 2020 12;13(1):1794107

Department of Health Promoting Science, Sophiahemmet University , Stockholm, Sweden.

Background: Studies report that women born in some African countries, after migrating to the Nordic countries, have worse pregnancy outcomes than women born in the receiving countries. With the aim of identifying unmet needs among Somali-born women, we here study this subgroup.

Objective: We compared pregnancy outcomes among women born in Somalia to women born in Sweden. Further, we investigated whether the proactive maternal observation of fetal movements has effects on birth outcomes among women born in Somalia.

Methods: In Stockholm, half of the maternity clinics were randomized to intervention, in which midwives were instructed to be proactive towards women by promoting daily self-monitoring of fetal movements. Data for 623 women born in Somalia and 26 485 born in Sweden were collected from a population-based register.

Results: An Apgar score below 7 (with stillbirth counting as 0) at 5 minutes was more frequent in babies of women born in Somalia as compared to babies of women born in Sweden (RR 2.17, 95% CI 1.25-3.77). Babies born small for gestational age were more common among women born in Somalia (RR 2.22, CI 1.88-2.61), as were babies born after 41 + 6 gestational weeks (RR 1.65, CI 1.29-2.12). Somali-born women less often contacted obstetric care for decreased fetal movements than did Swedish-born women (RR 0.19, CI 0.08-0.36). The differences between women born in Somalia and women born in Sweden were somewhat lower (not statistically significant) among women allocated to proactivity as compared to the Routine-care group.

Conclusions: A higher risk of a negative outcome for mother and baby is seen among women born in Somalia compared to women born in Sweden. We suggest it may be worthwhile to investigate whether a Somali-adapted intervention with proactivity concerning self-monitoring of fetal movements may improve pregnancy outcomes in this migrant population.
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http://dx.doi.org/10.1080/16549716.2020.1794107DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7480426PMC
December 2020

Older adults' preferences for, adherence to and experiences of two self-management falls prevention home exercise programmes: a comparison between a digital programme and a paper booklet.

BMC Geriatr 2020 06 15;20(1):209. Epub 2020 Jun 15.

Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, Umeå, Sweden.

Background: Fall prevention exercise programmes are known to be effective, but access to these programmes is not always possible. The use of eHealth solutions might be a way forward to increase access and reach a wider population. In this feasibility study the aim was to explore the choice of programme, adherence, and self-reported experiences comparing two exercise programmes - a digital programme and a paper booklet.

Methods: A participant preference trial of two self-managed fall prevention exercise interventions. Community-dwelling adults aged 70 years and older exercised independently for four months after one introduction meeting. Baseline information was collected at study start, including a short introduction of the exercise programme, a short physical assessment, and completion of questionnaires. During the four months intervention period, participants self-reported their performed exercises in an exercise diary. At a final meeting, questionnaires about their experiences, and post-assessments, were completed. For adherence analyses data from diaries were used and four subgroups for different levels of participation were compared. Exercise maintenance was followed up with a survey 12 months after study start.

Results: Sixty-seven participants, with mean age 77 ± 4 years were included, 72% were women. Forty-three percent chose the digital programme. Attrition rate was 17% in the digital programme group and 37% in the paper booklet group (p = .078). In both groups 50-59% reported exercise at least 75% of the intervention period. The only significant difference for adherence was in the subgroup that completed ≥75% of exercise duration, the digital programme users exercised more minutes per week (p = .001). Participants in both groups were content with their programme but digital programme users reported a significantly higher (p = .026) degree of being content, and feeling supported by the programme (p = .044). At 12 months follow-up 67% of participants using the digital programme continued to exercise regularly compared with 35% for the paper booklet (p = .036).

Conclusions: Exercise interventions based on either a digital programme or a paper booklet can be used as a self-managed, independent fall prevention programme. There is a similar adherence in both programmes during a 4-month intervention, but the digital programme seems to facilitate long-term maintenance in regular exercise.

Trial Registration: ClinTrial: NCT02916849.
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http://dx.doi.org/10.1186/s12877-020-01592-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7294667PMC
June 2020

Variations in use of childbirth interventions in 13 high-income countries: A multinational cross-sectional study.

PLoS Med 2020 05 22;17(5):e1003103. Epub 2020 May 22.

Department of Midwifery Science, AVAG, Amsterdam Public Health research institute, Amsterdam UMC, location VUmc, Amsterdam, the Netherlands.

Background: Variations in intervention rates, without subsequent reductions in adverse outcomes, can indicate overuse. We studied variations in and associations between commonly used childbirth interventions and adverse outcomes, adjusted for population characteristics.

Methods And Findings: In this multinational cross-sectional study, existing data on 4,729,307 singleton births at ≥37 weeks in 2013 from Finland, Sweden, Norway, Denmark, Iceland, Ireland, England, the Netherlands, Belgium, Germany (Hesse), Malta, the United States, and Chile were used to describe variations in childbirth interventions and outcomes. Numbers of births ranged from 3,987 for Iceland to 3,500,397 for the USA. Crude data were analysed in the Netherlands, or analysed data were shared with the principal investigator. Strict variable definitions were used and information on data quality was collected. Intervention rates were described for each country and stratified by parity. Uni- and multivariable analyses were performed, adjusted for population characteristics, and associations between rates of interventions, population characteristics, and outcomes were assessed using Spearman's rank correlation coefficients. Considerable intercountry variations were found for all interventions, despite adjustments for population characteristics. Adjustments for ethnicity and body mass index changed odds ratios for augmentation of labour and episiotomy. Largest variations were found for augmentation of labour, pain relief, episiotomy, instrumental birth, and cesarean section (CS). Percentages of births at ≥42 weeks varied from 0.1% to 6.7%. Rates among nulliparous versus multiparous women varied from 56% to 80% versus 51% to 82% for spontaneous onset of labour; 14% to 36% versus 8% to 28% for induction of labour; 3% to 13% versus 7% to 26% for prelabour CS; 16% to 48% versus 12% to 50% for overall CS; 22% to 71% versus 7% to 38% for augmentation of labour; 50% to 93% versus 25% to 86% for any intrapartum pain relief, 19% to 83% versus 10% to 64% for epidural anaesthesia; 6% to 68% versus 2% to 30% for episiotomy in vaginal births; 3% to 30% versus 1% to 7% for instrumental vaginal births; and 42% to 70% versus 50% to 84% for spontaneous vaginal births. Countries with higher rates of births at ≥42 weeks had higher rates of births with a spontaneous onset (rho = 0.82 for nulliparous/rho = 0.83 for multiparous women) and instrumental (rho = 0.67) and spontaneous (rho = 0.66) vaginal births among multiparous women and lower rates of induction of labour (rho = -0.71/-0.66), prelabour CS (rho = -0.61/-0.65), overall CS (rho = -0.61/-0.67), and episiotomy (multiparous: rho = -0.67). Variation in CS rates was mainly due to prelabour CS (rho = 0.96). Countries with higher rates of births with a spontaneous onset had lower rates of emergency CS (nulliparous: rho = -0.62) and higher rates of spontaneous vaginal births (multiparous: rho = 0.70). Prelabour and emergency CS were positively correlated (nulliparous: rho = 0.74). Higher rates of obstetric anal sphincter injury following vaginal birth were found in countries with higher rates of spontaneous birth (nulliparous: rho = 0.65). In countries with higher rates of epidural anaesthesia (nulliparous) and spontaneous births (multiparous), higher rates of Apgar score < 7 were found (rhos = 0.64). No statistically significant variation was found for perinatal mortality. Main limitations were varying quality of data and missing information.

Conclusions: Considerable intercountry variations were found for all interventions, even after adjusting for population characteristics, indicating overuse of interventions in some countries. Multivariable analyses are essential when comparing intercountry rates. Implementation of evidence-based guidelines is crucial in optimising intervention use and improving quality of maternity care worldwide.
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http://dx.doi.org/10.1371/journal.pmed.1003103DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7244098PMC
May 2020

Tailoring to support digital technology-mediated occupational engagement for older adults - a multiple case study.

Scand J Occup Ther 2020 Nov 12;27(8):577-590. Epub 2020 May 12.

Department of Community Medicine and Rehabilitation, Occupational Therapy, Umeå University, Umeå, Sweden.

With the evolution of contemporary occupations mediated by digital technologies (DTs), there is a need for occupational therapists to develop and structure knowledge on how to support older adults' engagement in occupations and social participation in a digitalised society. The objective of this study is to explore how tailoring to support older adults' engagement in DT-mediated occupations could be schematised. The study employed a multiple case study methodology. There were nine cases, with each case involving an older adult undergoing a collaborative process to support engagement in DT-mediated occupations. The collaborative process was initiated through questionnaires, observations, and dialogues. Meetings and tailoring strategies were documented in fieldnotes and memos on tailoring, respectively. Semi-structured interviews concluded data collection. Cross-case synthesis was used in data analysis. The result is a proposed scheme for tailoring to support older adults' engagement in digital technology-mediated occupations, wherein strategies undertaken in the collaborative processes were synthesised and described. The proposed scheme for tailoring could contribute to occupational therapists' knowledge on how to support older adults' engagement in contemporary occupations. Testing the model in various practice settings is recommended in order to enhance occupational therapy practice.
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http://dx.doi.org/10.1080/11038128.2020.1760347DOI Listing
November 2020

Vaccine-Mediated Mechanisms Controlling SCHU S4 Growth in a Rat Co-Culture System.

Pathogens 2020 Apr 30;9(5). Epub 2020 Apr 30.

Department of Clinical Microbiology and Laboratory for Molecular Infection Medicine Sweden (MIMS), Umeå University, SE-901 85 Umeå, Sweden.

causes the severe disease tularemia. In the present study, the aim was to identify correlates of protection in the rat co-culture model by investigating the immune responses using two vaccine candidates conferring distinct degrees of protection in rat and mouse models. The immune responses were characterized by use of splenocytes from naïve or Live vaccine strain- (LVS) or ∆∆-immunized Fischer 344 rats as effectors and bone marrow-derived macrophages infected with the highly virulent strain SCHU S4. A complex immune response was elicited, resulting in cytokine secretion, nitric oxide production, and efficient control of the intracellular bacterial growth. Addition of LVS-immune splenocytes elicited a significantly better control of bacterial growth than ∆∆ splenocytes. This mirrored the efficacy of the vaccine candidates in the rat model. Lower levels of IFN-γ, TNF, fractalkine, IL-2, and nitrite were present in the co-cultures with ∆∆ splenocytes than in those with splenocytes from LVS-immunized rats. Nitric oxide was found to be a correlate of protection, since the levels inversely correlated to the degree of protection and inhibition of nitric oxide production completely reversed the growth inhibition of SCHU S4. Overall, the results demonstrate that the co-culture assay with rat-derived cells is a suitable model to identify correlates of protection against highly virulent strains of .
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http://dx.doi.org/10.3390/pathogens9050338DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7280961PMC
April 2020

Care-seeking behavior and disclosure on self-reported mental health among young women in urban Shanghai, China.

Health Psychol Open 2020 Jan-Jun;7(1):2055102919897382. Epub 2020 Feb 6.

Karolinska Institutet, Sweden.

Mental health is a major public health concern in China. Help-seeking behavior typically does not involve professionals. Aim of the study was to assess Shanghai women's care-seeking behavior for common mental health disorders. Using an online survey, fielding questions regarding perinatal mental health status and help-seeking behavior. A total of 487 women participated. One fifth of participants reporting badwell-being did not seek help for mental distress. A total of 82.2 percent seek online support. A majority entrusted in family and avoided professional contact. Mother-in-laws were the least trusted source of support. Shanghai women avoid seeking professional help for mental health issues. Friends, spouses, and online resources are preferred venues.
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http://dx.doi.org/10.1177/2055102919897382DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7005976PMC
February 2020

Community-based doula support for migrant women during labour and birth: study protocol for a randomised controlled trial in Stockholm, Sweden (NCT03461640).

BMJ Open 2020 02 18;10(2):e031290. Epub 2020 Feb 18.

Women's and Children's health, Karolinska Institute, Stockholm, Sweden.

Introduction: Migrant women consistently rate their care during labour and birth more negatively than non-migrant women, due to communication difficulties, lack of familiarity with how care is provided, and discrimination and prejudicial staff attitudes. They also report being left alone, feeling fearful, unsafe and unsupported, and have poorer birth outcomes than non-migrant women. Community-based doulas (CBDs) are bilingual women from migrant communities who are trained in childbirth and labour support, and who facilitate communication between woman-partner-staff during childbirth. This study protocol describes the design, rationale and methods of a randomised controlled trial that aims to evaluate the effectiveness of CBD support for improving the intrapartum care experiences and postnatal well-being of migrant women giving birth in Sweden.

Methods And Analysis: A randomised controlled trial. From six antenatal care clinics in Stockholm, Sweden, we aim to recruit 200 pregnant Somali, Arabic, Polish, Russian and Tigrinya-speaking women who cannot communicate fluently in Swedish, are 18 years or older and with no contraindications for vaginal birth. In addition to standard labour support, women are randomised to CBD support (n=100) or no such support during labour (n=100). Trained CBDs meet with women once or twice before the birth, provide emotional, physical and communication support to women throughout labour and birth in hospital, and then meet with women once or twice after the birth. Women's ratings of the intrapartum care experiences and postnatal well-being are assessed at 6-8 weeks after the birth using selected questions from the Migrant Friendly Maternity Care Questionnaire and by the Edinburgh Postnatal Depression Scale. The intervention group will be compared with the control group using intention-to-treat analyses. ORs and 95% CIs will be estimated and adjustments made if key participant characteristics differ between trial arms.

Ethics And Dissemination: The study was approved by the Regional Ethical Review Board in Stockholm (approval number: 2018/12 - 31/2).

Trial Registration Number: NCT03461640; Pre-results.
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http://dx.doi.org/10.1136/bmjopen-2019-031290DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7045267PMC
February 2020

Differences in help-seeking behaviours and perceived helpfulness of services between abused and non-abused women: A cross-sectional survey of Australian postpartum women.

Health Soc Care Community 2020 05 12;28(3):958-968. Epub 2019 Dec 12.

Judith Lumley Centre (for mother, infant and family health research), La Trobe University, Melbourne, Vic, Australia.

New mothers may face substantial physical and mental health challenges during the postpartum period and are at a greater risk of intimate partner violence. Healthcare services provide support, however, acknowledging a problem and seeking help for it can be difficult. Research on where postpartum women seek help and how helpful they perceive it is limited. Additionally, little is known of how these help-seeking behaviours differ between abused and non-abused postpartum women. The aim of this study was to examine the help-seeking behaviour and perceived helpfulness of services in abused and non-abused postpartum women. Secondary analysis was undertaken of data collected during the MOVE (Improving Maternal and Child Health Care for Vulnerable Mothers) cluster randomised controlled trial of a nurse, intimate partner violence screening and supportive care intervention. MOVE was set in eight community-based nurse teams in Melbourne, Australia. The trial (2010-2013) included a survey of n = 2,621 postpartum Australian women who had given birth within the previous 8 months. Data were analysed using descriptive and interferential statistics. Findings indicate that abused women who had experienced partner violence sought informal family support less frequently (81.3% compared with 92.4%, p < .001) and were more frequent users of hospital emergency departments (p = .03), nurse home visiting programs (p = .02) and some breastfeeding services (p = .001), compared with non-abused women. They were also more frequent users of psychiatrists (p ≤ 0.001), early parenting centres (both day stay (p = .006) and residential (p = .008), child welfare services (p < .001), and were generally less satisfied with the help received. Postpartum women experiencing partner violence seek help from certain formal services more frequently and are less satisfied with the care received, compared with non-abused women. Access to potential protective supports from family and friends is limited. Further qualitative research is needed to gain a greater understanding of abused postpartum women's experiences and help-seeking behaviours.
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http://dx.doi.org/10.1111/hsc.12927DOI Listing
May 2020

Effect of maternal birth positions on duration of second stage of labor: systematic review and meta-analysis.

BMC Pregnancy Childbirth 2019 Dec 4;19(1):466. Epub 2019 Dec 4.

Department of Gynecology and Obstetrics, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia.

Background: It is believed that giving birth in an upright position is beneficial for both mother and the infant for several physiologic reasons. An upright positioning helps the uterus to contract more strongly and efficiently, the baby gets in a better position and thus can pass through the pelvis faster. Upright and lateral positions enables flexibility in the pelvis and facilitates the extension of the outlet. Before implementing a change in birthing positions in our clinics we need to review evidences available and context valid related to duration of second stage of labor and birthing positions. Therefore this review aimed to examine the effect of maternal flexible sacrum birth position on duration of second stage of labor.

Method: The research searched articles using bibliographical Databases: Medline/PUBMED, SCOPUS, Google scholar and Google. All study designs were considered while investigating the impact of maternal flexible sacrum birthing positioning in relation duration of second stage of labor. Studies including laboring mothers with normal labor and delivery. A total of 1985 women were included in the reviewed studies. We included both qualitative and quantitative analysis.

Results: We identified 1680 potential citations, of which 8 articles assessed the effect of maternal upright birth positioning on the reduction during the duration of second stage of labor. Two studies were excluded because of incomplete reports for meta analysis. The result suggested a reduction in duration of second stage of labor among women in a flexible sacrum birthing position, with a mean duration from 3.2-34.8. The pooled weighted mean difference with random effect model was 21.118(CI: 11.839-30.396) minutes, with the same significant heterogeneity between the studies (I = 96.8%, p < 000).

Conclusion: The second stage duration was reduced in cases of a flexible sacrum birthing position. Even though the reduction in duration varies across studies with considerable heterogeneity, laboring women should be encouraged to choose her comfortable birth position. Researchers who aim to compare different birthing positions should consider study designs which enable women to choose birthing position. PROSPERO REGISTRATION NUMBER: [CRD42019120618].
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http://dx.doi.org/10.1186/s12884-019-2620-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6894325PMC
December 2019

Value based maternal and newborn care requires alignment of adequate resources with high value activities.

BMC Pregnancy Childbirth 2019 Nov 21;19(1):428. Epub 2019 Nov 21.

Nuffield Department of Primary Care Health Sciences, Medical Science Division, Gibson Building, 1st Floor, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK.

Background: Evidence based practice has been associated with better quality of care in many situations, but it has not been able to address increasing need and demand in healthcare globally and stagnant or decreasing healthcare resources. Implementation of value-based healthcare could address many important challenges in health care systems worldwide. Scaling up exemplary high value care practices offers the potential to ensure values-driven maternal and newborn care for all women and babies.

Discussion: Increased use of healthcare interventions over the last century have been associated with reductions in maternal and newborn mortality and morbidity. However, over an optimum threshold, these are associated with increases in adverse effects and inappropriate use of scarce resources. The Quality Maternal and Newborn Care framework provides an example of what value based maternity care might look like. To deliver value based maternal and newborn care, a system-level shift is needed, 'from fragmented care focused on identification and treatment of pathology for the minority to skilled care for all'. Ideally, resources would be allocated at population and individual level to ensure care is woman-centred instead of institution/ profession centred but oftentimes, the drivers for spending resources are 'the demands and beliefs of the acute sector'. We argue that decisions to allocate resources to high value activities, such as continuity of carer, need to be made at the macro level in the knowledge that these investments will relieve pressure on acute services while also ensuring the delivery of appropriate and high value care in the long run. To ensure that high value preventive and supportive care can be delivered, it is important that separate staff and money are allocated to, for example, models of continuity of carer to prevent shortages of resources due to rising demands of the acute services. To achieve value based maternal and newborn care, mechanisms are needed to ensure adequate resource allocation to high value maternity care activities that should be separate from the resource demands of acute maternity services. Funding arrangements should support, where wanted and needed, seamless movement of women and neonates between systems of care.
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http://dx.doi.org/10.1186/s12884-019-2512-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6868860PMC
November 2019

African midwifery students' self-assessed confidence in antenatal care: a multi-country study.

Glob Health Action 2019 ;12(1):1689721

Indian Institute of Public Health, Gandhinagar, India.

: Evidence-based antenatal care is one cornerstone in Safe Motherhood and educated and confident midwives remain to be optimal caregivers in Africa. Confidence in antenatal midwifery skills is important and could differ depending on the provision of education among the training institutions across Africa.: The aim of the study was to describe and compare midwifery students' confidence in basic antenatal skills, in relation to age, sex, program type and level of program.: A survey in seven sub-Saharan African countries was conducted. Enrolled midwifery students from selected midwifery institutions in each country presented selfreported data on confidence to provide antenatal care. Data were collected using a selfadministered questionnaire. The questionnaire consisted of 22 antenatal skills based on the competency framework from the International Confederation of Midwives. The skills were grouped into three domains; Identify fetal and maternal risk factors and educate parents; Manage and document emergent complications and Physical assessment and nutrition.: In total, 1407 midwifery students from seven Sub-Saharan countries responded. Almost one third (25-32%) of the students reported high levels of confidence in all three domains. Direct entry programs were associated with higher levels of confidence in all three domains, compared to post-nursing and double degree programs. Students enrolled at education with diploma level presented with high levels of confidence in two out of three domains.: A significant proportion of student midwives rated themselves low on confidence to provide ANC. Midwifery students enrolled in direct entry programs reported higher levels of confidence in all domains. It is important that local governments develop education standards, based on recommendations from the International Confederation of midwives. Further research is needed for the evaluation of actual competence.
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http://dx.doi.org/10.1080/16549716.2019.1689721DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6882463PMC
March 2020

Perineal pain the first year after childbirth and uptake of post-partum check-up- A Swedish cohort study.

Midwifery 2019 Nov 5;78:85-90. Epub 2019 Aug 5.

Department of Women's and Children's Health, Karolinska Institutet, Tomtebodavägen 18a, 171 77 Stockholm, Sweden.

Objective: The aim of this prospective cohort study was to investigate the prevalence of perineal pain related to the perineal injury within the first year after childbirth. The study further explored the rates of postpartum check-up attendance, and whether they had undergone a vaginal examination, pelvic floor assessment and exercise advice.

Research Design: The primary outcome was women's self-perceived and selfreported occurrence of pain related to perineal injuries (within three, six and 12 months) after birth. Secondary outcomes were uptake of postpartum check-up six to 12 weeks after birth and care received at the check-up. A postal questionnaire was completed one year after birth. Descriptive data was used to present data.

Findings: A total of 461 Swedish women (77%) were included in the study. The majority of women with severe perineal injuries (75.0%), and 61.8% of those with moderate injuries II suffered from perineal pain three months postpartum, while 60% with severe injuries and 38.7 with moderate injuries II still had perineal pain six months after birth. The postpartum check-up was attended by 90.6%. However, one out of four had not been given a pelvic examination or advised about pelvic floor exercises.

Key Conclusion: Many primiparas suffer from pain related to perineal injuries during the first year after birth. One out of ten women has problems with perineal pain one year postpartum. It is essential to investigate and recognize the impact of perineal pain on women's daily life and psychological and emotional wellbeing at the postpartum checkup.
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http://dx.doi.org/10.1016/j.midw.2019.08.004DOI Listing
November 2019

Factors associated with well-controlled asthma-A cross-sectional study.

Allergy 2020 01 1;75(1):208-211. Epub 2019 Aug 1.

Department of Respiratory Medicine, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.

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http://dx.doi.org/10.1111/all.13976DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7003902PMC
January 2020

Intermittent auscultation fetal monitoring during labour: A systematic scoping review to identify methods, effects, and accuracy.

PLoS One 2019 10;14(7):e0219573. Epub 2019 Jul 10.

Faculty of Health Sciences, OsloMet-Oslo Metropolitan University, Oslo, Norway.

Background: Intermittent auscultation (IA) is the technique of listening to and counting the fetal heart rate (FHR) for short periods during active labour and continuous cardiotocography (CTC) implies FHR monitoring for longer periods. Although the evidence suggests that IA is the best way to monitor healthy women at low risk of complications, there is no scientific evidence for the ideal device, timing, frequency and duration for IA. We aimed to give an overview of the field, identify and describe methods and practices for performing IA, map the evidence and accuracy for different methods of IA, and identify research gaps.

Methods: We conducted a systematic scoping review following the Joanna Briggs methodology. Medline, EMBASE, Cinahl, Maternity & Infant Care, Cochrane Library, SveMed+, Web of Science, Scopus, Lilacs and African Journals Online were searched for publications up to January 2019. We did hand searches in relevant articles and databases. Studies from all countries, international guidelines and national guidelines from Denmark, United Kingdom, United States, New Zealand, Australia, The Netherlands, Sweden, Denmark, and Norway were included. We did quality assessment of the guidelines according to the AGREEMENT tool. We performed a meta-analysis assessing the effects of IA with a Doppler device vs. Pinard device using methods described in The Cochrane Handbook, and we performed an overall assessment of the summary of evidence using the GRADE approach.

Results: The searches generated 6408 hits of which 26 studies and 11 guidelines were included in the review. The studies described slightly different techniques for performing IA, and some did not provide detailed descriptions. Few of the studies provided details of normal and abnormal IA findings. All 11 guidelines recommended IA for low risk women, although they had slightly different recommendations on the frequency, timing, and duration for IA, and the FHR characteristics that should be observed. Four of the included studies, comprising 8436 women and their babies, were randomised controlled trials that evaluated the effect of IA with a Doppler device vs. a Pinard device. Abnormal FHRs were detected more often using the Doppler device than in those using the Pinard device (risk ratio 1.77; 95% confidence interval 1.29-2.43). There were no significant differences in any of the other maternal or neonatal outcomes. Four studies assessed the accuracy of IA findings. Normal FHR was easiest to identify correctly, whereas identifying periodic FHR patterns such as decelerations and saltatory patterns were more difficult.

Conclusion: Although IA is the recommended method, no trials have been published that evaluate protocols on how to perform it. Nor has any study assessed interrater agreements regarding interpretations of IA findings, and few have assessed to what degree clinicians can describe FHR patterns detected by IA. We found no evidence to recommend Doppler device instead of the Pinard for IA, or vice versa.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0219573PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6619817PMC
February 2020
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