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Carlsson Lalloo E, Temple F, Berg M, Berg U, Désiré AM, Mulunda A, Bogren M. Testing the feasibility of a translated and culturally adapted person-centred training programme in maternal and newborn healthcare in Democratic Republic of Congo: A process evaluation. Sex Reprod Healthc 2024; 40:100979. [PMID: 38754346 DOI: 10.1016/j.srhc.2024.100979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 04/08/2024] [Accepted: 04/29/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVE Ensuring quality of maternal and newborn healthcare is challenging in the Democratic Republic of Congo (DRC) as the maternal and newborn mortality and morbidity rate is high. Essential for quality care is a person-centred approach. One model of person-centred care (PCC) has been developed at Gothenburg University. To support its implementation a training programme, "Mutual Meetings", has been developed. This study aims to test the feasibility of a translated and culturally adapted version of this PCC training programme for healthcare providers in the maternal and newborn healthcare context of DRC. METHODS The PCC programme was translated into French and tested in a workshop with 31 maternal and newborn healthcare providers in eastern DRC. The feasibility of the programme was evaluated through focus group interviews and individual interviews. The interview transcripts were analysed deductively using key components in a process evaluation framework including fidelity, dose, reach, adaptation, acceptability, and application. RESULTS The French PCC programme exceeded the participants' expectations and was found being applicable in both teaching and clinical setting with some suggested contextual modifications. Its pedagogic structure including a participatory reflective approach, was perceived innovative and inspirational, mediated a sense of comfort, and enabled the participants to use a person-centred approach towards each other. CONCLUSION The results show that the French on-site version of the PCC training programme was valid in terms of feasibility and how it was received by the participants. The study demonstrates the importance of contextual adaptation of complex interventions in new settings.
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Affiliation(s)
- Ewa Carlsson Lalloo
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Allégatan 1, 501 90 Borås, Sweden; Centre for Person-centred Care (GPCC) University of Gothenburg, Arvid Wallgrens backe, House 1, 413 46 Gothenburg, Sweden.
| | - Frida Temple
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Arvid Wallgrens backe, House 1, 413 46 Gothenburg, Sweden
| | - Marie Berg
- Centre for Person-centred Care (GPCC) University of Gothenburg, Arvid Wallgrens backe, House 1, 413 46 Gothenburg, Sweden; Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Arvid Wallgrens backe, House 1, 413 46 Gothenburg, Sweden; Faculty of Medicine and Community Health, Evangelical University in Africa, Bukavu, The Democratic Republic of Congo
| | - Urban Berg
- Faculty of Medicine and Community Health, Evangelical University in Africa, Bukavu, The Democratic Republic of Congo; Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Medicinaregatan 3, 41390 Gothenburg, Sweden
| | - Alumeti Munyali Désiré
- Faculty of Medicine and Community Health, Evangelical University in Africa, Bukavu, The Democratic Republic of Congo
| | - Aline Mulunda
- United Nations Population Fund, Kinshasa, The Democratic Republic of Congo
| | - Malin Bogren
- Centre for Person-centred Care (GPCC) University of Gothenburg, Arvid Wallgrens backe, House 1, 413 46 Gothenburg, Sweden; Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Arvid Wallgrens backe, House 1, 413 46 Gothenburg, Sweden
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Berg M, Berg U, Mapatano E, Mukwege D. Caesarean section rate reduced by a redesigned birthing room. Results of a quality improvement intervention at a hospital in Democratic Republic of Congo. Sex Reprod Healthc 2024; 39:100925. [PMID: 38056384 DOI: 10.1016/j.srhc.2023.100925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/08/2023] [Accepted: 11/20/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVE To evaluate the influence of a new birthing room at a tertiary hospital in eastern Democratic Republic of Congo (DRC), on the caesarean section (CS) rate in women classified as Robson group 1, i.e., nulliparous women at term with spontaneous onset of labour of one foetus in cephalic presentation. METHOD As part of quality improvement interventions, a new birthing room designed to promote person-centredness was constructed at the labour ward at Panzi General Referral Hospital in DRC. In a quasi-experimental study on women classified as Robson 1, a comparison was performed between the group being cared for in the new birthing room and the group being cared for in the general birthing room. The main outcome measure was CS rate. RESULTS In the new person-centred birthing room, the CS rate was 17.1 % versus 28.4 % in women cared for in the general birthing room (p-value 0.001). There was also a higher presence of accompanying persons (p-value < 0.0001) and less use of synthetic oxytocin for the augmentation of labour (p-value 0.024). No difference in fear and childbirth experience was identified between women in the two rooms. CONCLUSION The results demonstrate that it is possible, in a low-income country as the Democratic Republic of Congo, to reduce the CS rate in women classified as Robson 1 by adapting the birthing environment to be more person-centred, without compromising other obstetric and neonatal outcomes.
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Affiliation(s)
- M Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Arvid Wallgrens backe 1, 413 46 Gothenburg, Sweden; Faculty of Medicine and Community Health, Evangelical University in Africa, Bukavu, Democratic Republic of Congo; Panzi General Referral Hospital, Bukavu, Democratic Republic of Congo.
| | - U Berg
- Faculty of Medicine and Community Health, Evangelical University in Africa, Bukavu, Democratic Republic of Congo; Panzi General Referral Hospital, Bukavu, Democratic Republic of Congo; Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - E Mapatano
- Faculty of Medicine and Community Health, Evangelical University in Africa, Bukavu, Democratic Republic of Congo; Panzi General Referral Hospital, Bukavu, Democratic Republic of Congo
| | - D Mukwege
- Faculty of Medicine and Community Health, Evangelical University in Africa, Bukavu, Democratic Republic of Congo; Panzi General Referral Hospital, Bukavu, Democratic Republic of Congo
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Goldkuhl L, Tistad M, Gyllensten H, Berg M. Implementing a new birthing room design: a qualitative study with a care provider perspective. BMC Health Serv Res 2023; 23:1122. [PMID: 37858103 PMCID: PMC10585888 DOI: 10.1186/s12913-023-10051-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 09/22/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Research shows that interventions to protect the sensitive physiological process of birth by improving the birthing room design may positively affect perinatal outcomes. It is, however, crucial to understand the mechanisms and contextual elements that influence the outcomes of such complex interventions. Hence, we aimed to explore care providers' experiences of the implementation of a new hospital birthing room designed to be more supportive of women's birth physiology. METHODS This qualitative study reports on the implementation of the new birthing room, which was evaluated in the Room4Birth randomised controlled trial in Sweden. Individual interviews were undertaken with care providers, including assistant nurses, midwives, obstetricians, and managers (n = 21). A content analysis of interview data was conducted and mapped into the three domains of the Normalisation Process Theory coding manual: implementation context, mechanism, and outcome. RESULTS The implementation of the new room challenged the prevailing biomedical paradigm within the labour ward context and raised the care providers' awareness about the complex interplay between birth physiology and the environment. This awareness had the potential to encourage care providers to be more emotionally present, rather than to focus on monitoring practices. The new room also evoked a sense of insecurity due to its unfamiliar design, which acted as a barrier to integrating the room as a well-functioning part of everyday care practice. CONCLUSION Our findings highlight the disparity that existed between what care providers considered valuable for women during childbirth and their own requirements from the built environment based on their professional responsibilities. This identified disparity emphasises the importance of hospital birthing rooms (i) supporting women's emotions and birth physiology and (ii) being standardised to meet care providers' requirements for a functional work environment. TRIAL REGISTRATION ClinicalTrials.gov: NCT03948815, 14/05/2019.
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Affiliation(s)
- Lisa Goldkuhl
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Gothenburg, Region Västra Götaland, Sweden.
| | - Malin Tistad
- School of Health and Welfare, Dalarna University, Falun, Sweden
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Huddinge, Sweden
| | - Hanna Gyllensten
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska Academy, University of Gothenburg Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska Academy, University of Gothenburg Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
- Faculty of Medicine and Community Health, Evangelical University in Africa, Bukavu, Democratic Republic of Congo
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Goldkuhl L, Gyllensten H, Begley C, Wijk H, Nilsson C, Lindahl G, Ringqvist AK, Uvnäs-Moberg K, Berg M. Corrigendum to "Room4Birth - The effect of giving birth in a hospital birthing room designed with person-centred considerations: A Swedish randomised controlled trial" [Sex. Reprod. Healthc. 32 (2022) 100731]. Sex Reprod Healthc 2023; 37:100883. [PMID: 37399758 DOI: 10.1016/j.srhc.2023.100883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Affiliation(s)
- Lisa Goldkuhl
- Institute of Health and Care Sciences, Sahlgrenska Academy, Arvid Wallgrens backe, Box 457, 405 30, University of Gothenburg, Gothenburg, Sweden; Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Diagnosvagen 11, 41685 Gothenburg, Region Västra Götaland, Sweden.
| | - Hanna Gyllensten
- Institute of Health and Care Sciences, Sahlgrenska Academy, Arvid Wallgrens backe, Box 457, 405 30, University of Gothenburg, Gothenburg, Sweden; University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Cecily Begley
- School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, College Green, Dublin 2, Ireland
| | - Helle Wijk
- Institute of Health and Care Sciences, Sahlgrenska Academy, Arvid Wallgrens backe, Box 457, 405 30, University of Gothenburg, Gothenburg, Sweden; Department of Quality Assurance and Patient Safety, Sahlgrenska University Hospital, Blå stråket 5, 413 45, Region Västra Götaland, Gothenburg, Sweden; Centre for Healthcare Architecture (CVA), Chalmers University of Technology, Chalmersplatsen 4, 412 96 Gothenburg, Sweden; Department of Architecture and Civil Engineering, Building Design, Chalmers University of Technology, Chalmersplatsen 4, 412 96 Gothenburg, Sweden
| | - Christina Nilsson
- Munkebäck Antenatal Clinic, Munkebäckstorg 6, 416 73 Gothenburg, Region Västra Götaland, Sweden
| | - Göran Lindahl
- Centre for Healthcare Architecture (CVA), Chalmers University of Technology, Chalmersplatsen 4, 412 96 Gothenburg, Sweden; Department of Architecture and Civil Engineering, Building Design, Chalmers University of Technology, Chalmersplatsen 4, 412 96 Gothenburg, Sweden
| | - Anna-Karin Ringqvist
- Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Diagnosvagen 11, 41685 Gothenburg, Region Västra Götaland, Sweden
| | - Kerstin Uvnäs-Moberg
- University of Agriculture (SLU), Almas Allé 8, 750 07, Uppsala University, Sweden
| | - Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, Arvid Wallgrens backe, Box 457, 405 30, University of Gothenburg, Gothenburg, Sweden; Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Diagnosvagen 11, 41685 Gothenburg, Region Västra Götaland, Sweden; Faculty of Medicine and Community Health, Evangelical University of Africa, Bukavu, DR Congo
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Berg M, Lalloo EC, Ngongo FK, Bogren M. Contextual factors influencing implementation of a university-based midwifery education programme in Central Africa: A qualitative study. Nurse Educ Pract 2023; 71:103720. [PMID: 37451168 DOI: 10.1016/j.nepr.2023.103720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/19/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023]
Abstract
AIM To investigate contextual factors and their influence on implementing a 90-credit midwifery education programme for nurses at a university in the eastern DRC. BACKGROUND To improve maternal and neonatal health, there is a government policy in the Democratic Republic of Congo (DRC) to educate midwives at a higher education level according to international norms. This study investigates contextual factors and their influence on the implementation of a midwifery education programme which is based on national curriculum and has a profile of person-centred care, simulation-based learning pedagogy and information and communication technology. METHOD A qualitative study was conducted with data collected through semi-structured interviews with 22 participants who were directly or indirectly involved in establishing the midwifery education programme. Transcribed interviews were analysed using content analysis. RESULTS The factors influencing the implementation of the new midwifery education programme comprise facilitating and hindering factors. Facilitating factors were: (i) awareness that midwives educated at a higher education level can deliver higher-quality health care, (ii) women are motivated to seek care from well-educated midwives, (iii) the planned programme is attractive and (iv) the university has a stable academic administration and established collaborations. Hindering factors were: (i) Students' lack of prerequisites for study; (ii) objections to educating midwives at a higher education level; (iii) inadequate teaching resources; and (iv) inadequate working conditions for midwives. CONCLUSION The facilitating factors strengthen the belief that it is possible to implement this midwifery education programme, while the hindering factors need to be addressed to run the programme successfully. The findings can guide higher education institutions starting similar midwifery education programmes in the DRC and elsewhere, although it is crucial to conduct a context study in those specific contexts.
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Affiliation(s)
- Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Arvid Wallgrens backe 1, 413 46 Gothenburg, Sweden; Faculty of Medicine and Community Health, Evangelical University in Africa, Bukavu, Democratic Republic of Congo; Centre for Person-centred Care (GPCC) University of Gothenburg, Arvid Wallgrens backe, Hus 1, 413 46 Gothenburg, Sweden
| | - Ewa Carlsson Lalloo
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Arvid Wallgrens backe 1, 413 46 Gothenburg, Sweden; Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden; Centre for Person-centred Care (GPCC) University of Gothenburg, Arvid Wallgrens backe, Hus 1, 413 46 Gothenburg, Sweden
| | - Fatuma Kilongo Ngongo
- Faculty of Theology, Evangelical University in Africa, Bukavu, Democratic Republic of Congo
| | - Malin Bogren
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Arvid Wallgrens backe 1, 413 46 Gothenburg, Sweden; Centre for Person-centred Care (GPCC) University of Gothenburg, Arvid Wallgrens backe, Hus 1, 413 46 Gothenburg, Sweden.
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Nilvér H, Berg M. The Birth Companions' Experience of the Birthing Room and How It Influences the Supportive Role: A Qualitative Study. HERD 2023; 16:156-167. [PMID: 37113053 PMCID: PMC10328140 DOI: 10.1177/19375867231163336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
AIM To explore birth companions' experience of the birthing room and how it influences their role supporting the woman during labor and birth. BACKGROUND Although support from a birth companion positively affects the outcome of labor and birth, limited research explores how the birthing room influences the companion. This study identifies elements of the birthing room essential for the birth companion to offer optimal support to the woman during labor and birth. METHODS Fifteen birth companions were individually interviewed 2 weeks to 6 months after birth using a semi-structured interview guide. Transcribed interviews were analyzed based on reflexive thematic analysis. RESULTS The findings are captured by one overall theme: creating a supportive birth space in an unfamiliar environment. This creation process is further described by three subthemes: not being in the way, finding one's role, and being close to the birthing woman. CONCLUSIONS The findings illustrate how the birthing room was an unfamiliar environment for the birth companions, but one that they needed in order to give the required support. With slight changes in physical design, the birthing room can become calmer and more private and better help the birth companion fulfill the supportive role.
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Affiliation(s)
- Helena Nilvér
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
- Faculty of Medicine and Community Health, Evangelical University in Africa, Bukavu, Democratic Republic of Congo
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Goldkuhl L, Gyllensten H, Begley C, Nilsson C, Wijk H, Lindahl G, Uvnäs-Moberg K, Berg M. Impact of Birthing Room Design on Maternal Childbirth Experience: Results From the Room4Birth Randomized Trial. HERD 2023; 16:200-218. [PMID: 36239523 PMCID: PMC9755691 DOI: 10.1177/19375867221124232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To study the effect of the birthing room design on nulliparous women's childbirth experience up to 1 year after birth. BACKGROUND Although it is known that the birth environment can support or hinder birth processes, the impact of the birthing room design on maternal childbirth experience over time is insufficiently studied. METHODS The Room4Birth randomized controlled trial was conducted at a labor ward in Sweden. Nulliparous women in active stage of spontaneous labor were randomized (n = 406) to either a regular birthing room (n = 202) or a new birthing room designed with more person-centered considerations (n = 204). Childbirth experiences were measured 2 hr, 3 months, and 12 months after birth by using a Visual Analogue Scale of Overall Childbirth Experience (VAS-OCE), the Fear of Birth Scale (FOBS), and the Childbirth Experience Questionnaire (CEQ2). RESULTS Women randomized to the new room had a more positive childbirth experience reported on the VAS-OCE 3 months (p = .002) and 12 months (p = .021) after birth compared to women randomized to a regular room. Women in the new room also scored higher in the total CEQ2 score (p = .039) and within the CEQ2 subdomain own capacity after 3 months (p = .028). The remaining CEQ2 domains and the FOBS scores did not differ between the groups. CONCLUSIONS These findings show that a birthing room offering more possibilities to change features and functions in the room according to personal needs and requirements, positively affects the childbirth experience of nulliparous women 3 and 12 months after they have given birth.
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Affiliation(s)
- Lisa Goldkuhl
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden,Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Gothenburg, Sweden,Lisa Goldkuhl, MSc, RN, RM, Arvid Wallgrens backe, Box 457, 405 30 Gothenburg, Sweden.
| | - Hanna Gyllensten
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden,University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Cecily Begley
- School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, Ireland
| | - Christina Nilsson
- Munkebäck Antenatal Clinic, Region Västra Götaland, Gothenburg, Sweden
| | - Helle Wijk
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden,Department of Quality Assurance and Patient Safety, Sahlgrenska University Hospital, Gothenburg, Sweden,Centre for Healthcare Architecture, CVA, Chalmers University of Technology, Gothenburg, Sweden,Department of Architecture and Civil Engineering, Building Design, Chalmers University of Technology, Gothenburg, Sweden
| | - Göran Lindahl
- Centre for Healthcare Architecture, CVA, Chalmers University of Technology, Gothenburg, Sweden,Department of Architecture and Civil Engineering, Building Design, Chalmers University of Technology, Gothenburg, Sweden
| | | | - Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden,Faculty of Medicine and Community Health, Evangelical University in Africa, Bukavu, D. R. Congo
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Lindgren H, Bogren M, Osika Friberg I, Berg M, Hök G, Erlandsson K. The midwife's role in achieving the Sustainable Development Goals: protect and invest together - the Swedish example. Glob Health Action 2022; 15:2051222. [PMID: 35522127 PMCID: PMC9090391 DOI: 10.1080/16549716.2022.2051222] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
'The midwife's role in achieving the Sustainable Development Goals: Protect and Invest Together' is a report providing the reader the opportunity for understanding and appreciating the history of midwifery in Sweden and the interlinked nature of the United Nation's SDGs supporting health and wellbeing of women and children. To realise the opportunity to have a country with well-educated midwives of high academic standard, and, at the same time, promoting gender equality and equity we need to protect and invest together in midwives. This paper provides the foundation for a revitalised discussion on midwives' role for women and child health in the 21st century. The full Swedish Midwifery report was published in October 2021.
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Affiliation(s)
- Helena Lindgren
- Department of Women’s and Children’s Health, Karolinska Institutet, Solna, Sweden,CONTACT Helena Lindgren Department of Women’s and Children’s Health, Karolinska Institutet, Solna, Sweden
| | - Malin Bogren
- Institute for Health and Care Science, Sahlgrenska Academy, Gothenburg, Sweden
| | - Ingrid Osika Friberg
- Department of Women’s and Children’s Health, Karolinska Institutet, Solna, Sweden,Swedish Agency for Gender Equality, Gothenburg, Sweden
| | - Marie Berg
- Institute for Health and Care Science, Sahlgrenska Academy, Gothenburg, Sweden
| | - Gabriella Hök
- Swedish Institute for Global Health Transformation, Stockholm, Sweden
| | - Kerstin Erlandsson
- Department of Women’s and Children’s Health, Karolinska Institutet, Solna, Sweden,Department of Health, Care and Wellbeing, Dalarna University, Falun, Sweden
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Berg M, Mwambali SN, Bogren M. Implementation of a three-pillar training intervention to improve maternal and neonatal healthcare in the Democratic Republic Of Congo: a process evaluation study in an urban health zone. Glob Health Action 2022; 15:2019391. [PMID: 35007185 PMCID: PMC8751495 DOI: 10.1080/16549716.2021.2019391] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Numerous quality-improvement projects including healthcare professional training are conducted globally every year, but there is a gap between the knowledge obtained in the training and its implementation in practice and policy. A quality-improvement programme was conducted in eastern Democratic Republic of Congo (DRC) to reduce maternal and neonatal mortality and morbidity. Objective This study explores the implementation process, mechanisms of impact, and outcomes of a training intervention addressing labour and birth management and involving healthcare providers in an urban health zone in eastern part of DRC. Methods In 2019, master trainers were educated and in turn trained facilitators from seven participating healthcare facilities, which received the necessary equipment. Data comprised statistics on maternal and neonatal birth outcomes for the years before and after the training intervention, and focus group discussions (n = 18); and interviews (n = 2) with healthcare professionals, at the end of (n = 52) and after the training intervention (n = 59), respectively. The analysis was guided by a process evaluation framework, using descriptive statistics and content analysis. Results The three-pillar training intervention using a low-dose, high-frequency approach was successfully implemented in terms of fidelity, dose, adaptation, and reach. Several improved care routines were established, including improved planning, teamwork, and self-reflection skills, as well as improved awareness of the influence of the care environment, of having a respectful encounter, and of allowing a companion to be present with the birthing woman. The proportions of emergency caesareans decreased and of vaginal births increased without an increase in maternal and neonatal complications. Conclusion The findings of this study are encouraging and provide learnings for other healthcare facilities in DRC as well as other low-income countries. When designing similar training interventions, it is crucial to consider contextual factors such as incentives and to measure more salutogenic outcomes.
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Affiliation(s)
- Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Faculty of Medicine and Community Health, Evangelical University of Africa, Bukavu, Democratic Republic of Congo
| | - Sylvie Nabintu Mwambali
- Department of Obstetrics and Gynecology, Faculty of Medicine and Community Health, Evangelical University of Africa, Bukavu, Democratic Republic of Congo
| | - Malin Bogren
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Goldkuhl L, Gyllensten H, Begley C, Wijk H, Nilsson C, Lindahl G, Ringqvist AK, Uvnäs-Moberg K, Berg M. Room4Birth - The effect of giving birth in a hospital birthing room designed with person-centred considerations: A Swedish randomised controlled trial. Sex Reprod Healthc 2022; 32:100731. [PMID: 35500476 DOI: 10.1016/j.srhc.2022.100731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 04/18/2022] [Accepted: 04/20/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate if a birthing room designed with person-centred considerations improves labour and birth outcomes for nulliparous women when compared to regular birthing rooms. METHODS A randomised controlled trial was conducted at a Swedish labour ward between January 2019 and October 2020. Nulliparous women in spontaneous labour were randomised either to a birthing room designed with person-centred considerations (New room) or a Regular room. The primary outcome was a composite of four variables: vaginal non-instrumental birth; no oxytocin augmentation; postpartum blood loss < 1000 ml; and a positive childbirth experience. To detect a difference of 8% between the groups, 1274 study participants were needed, but the trial was terminated early due to consequences of the Covid-19 pandemic. RESULTS A total of 406 women were randomised; 204 to the New room and 202 to the Regular room. There was no significant difference in the primary outcome between the groups (42.2% versus 35.1%; odds ratio: 1.35, 95% Confidence Interval 0.90-2.01; p = 0.18). Participants in the New room used epidural analgesia to a lower extent (54.4% versus 65.3%, relative risk: 0.83, 95% Confidence Interval 0.71-0.98; p = 0.03) and reported to a higher degree that the room contributed to a sense of safety, control, and integrity (p=<0.001). CONCLUSIONS The hypothesis that the New room would improve the primary outcome could not be verified. Considering the early discontinuation of the study, results should be interpreted with caution. Nevertheless, analyses of our secondary outcomes emphasise the experiential value of the built birth environment in improving care for labouring women.
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Affiliation(s)
- Lisa Goldkuhl
- Institute of Health and Care Sciences, Sahlgrenska Academy, Arvid Wallgrens backe, Box 457, 405 30, University of Gothenburg, Gothenburg, Sweden; Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Diagnosvagen 11, 41685 Gothenburg, Region Västra Götaland, Sweden.
| | - Hanna Gyllensten
- Institute of Health and Care Sciences, Sahlgrenska Academy, Arvid Wallgrens backe, Box 457, 405 30, University of Gothenburg, Gothenburg, Sweden; University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Cecily Begley
- School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, College Green, Dublin 2, Ireland
| | - Helle Wijk
- Institute of Health and Care Sciences, Sahlgrenska Academy, Arvid Wallgrens backe, Box 457, 405 30, University of Gothenburg, Gothenburg, Sweden; Department of Quality Assurance and Patient Safety, Sahlgrenska University Hospital, Blå stråket 5, 413 45, Region Västra Götaland, Gothenburg, Sweden; Centre for Healthcare Architecture (CVA), Chalmers University of Technology, Chalmersplatsen 4, 412 96 Gothenburg, Sweden; Department of Architecture and Civil Engineering, Building Design, Chalmers University of Technology, Chalmersplatsen 4, 412 96 Gothenburg, Sweden
| | - Christina Nilsson
- Munkebäck Antenatal Clinic, Munkebäckstorg 6, 416 73 Gothenburg, Region Västra Götaland, Sweden
| | - Göran Lindahl
- Centre for Healthcare Architecture (CVA), Chalmers University of Technology, Chalmersplatsen 4, 412 96 Gothenburg, Sweden; Department of Architecture and Civil Engineering, Building Design, Chalmers University of Technology, Chalmersplatsen 4, 412 96 Gothenburg, Sweden
| | - Anna-Karin Ringqvist
- Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Diagnosvagen 11, 41685 Gothenburg, Region Västra Götaland, Sweden
| | - Kerstin Uvnäs-Moberg
- University of Agriculture (SLU), Almas Allé 8, 750 07, Uppsala University, Sweden
| | - Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, Arvid Wallgrens backe, Box 457, 405 30, University of Gothenburg, Gothenburg, Sweden; Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Diagnosvagen 11, 41685 Gothenburg, Region Västra Götaland, Sweden; Faculty of Medicine and Community Health, Evangelical University of Africa, Bukavu, Democratic Republic of the Congo, The
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11
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Carlsson-Lalloo E, Berg M, Rusner M, Svedhem V, Mellgren Å. Sexual satisfaction and its associations with patient-reported outcomes in a cohort of women living with human immunodeficiency virus in Sweden. Int J STD AIDS 2022; 33:751-760. [PMID: 35622448 DOI: 10.1177/09564624221100056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Sexual satisfaction is an important dimension of health-related quality of life that needs to be addressed. Various factors may influence sexual satisfaction in women living with HIV (WLHIV); however, research in this area is limited. The aim of this study was to investigate patients' self-reported sexual satisfaction and its associations with patient-reported outcomes in WLHIV in Sweden. Methods: Data was retrieved from the InfCareHIV registry for the years 2011-2016. The registry includes a self-reported validated 9-item health questionnaire to assess patient-reported outcomes, side effects and adherence. In total, 1292 WLHIV aged ≥18 years were included, corresponding to 42.8% of the female Swedish InfCareHIV cohort 2011-2016. A total of 2444 questionnaires were included in the study. The patient-reported outcomes used were satisfaction with physical health and psychological health, sexual satisfaction, and experiencing side effects from HIV-medication. Associations were tested in univariable and multivariable models. Results: The study shows that there was a significant association between sexual satisfaction and satisfaction with psychological health (p ≤ 0.0001). There was a lower probability of reporting sexual satisfaction in women who were of an older age when they received an HIV-diagnosis (p = 0.033), who had lived for more years with HIV (p = 0.0004), or who had experienced side effects (p = 0.028). Conclusions: This national register-based study identified that sexual satisfaction in WLHIV is associated with psychological health and with having experienced side-effects. Patient-reported outcomes can provide valuable information so that the care of WLHIV covers all aspects of health and supports sexual satisfaction, which is an important part of quality of life.
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Affiliation(s)
- Ewa Carlsson-Lalloo
- Institute of Health and Care Sciences, 70712Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Faculty of Caring Science, Work Life and Social Welfare, 101066University of Borås, Borås, Sweden
| | - Marie Berg
- Institute of Health and Care Sciences, 70712Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Faculty of Medicine and Community Health, 485354Evangelical University of Africa, Bukavu, Democratic Republic of Congo
| | - Marie Rusner
- Institute of Health and Care Sciences, 70712Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Research, Education and Innovation, 531534Södra Älvsborg Hospital, Borås, Sweden
| | - Veronica Svedhem
- Department of Infectious Diseases, 59562Karolinska University Hospital, Stockholm, Sweden.,Unit of Infectious Diseases, Department of Medicine, 27106Karolinska Institute, Huddinge, Stockholm, Sweden
| | - Åsa Mellgren
- Department of Infectious Diseases, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, 3570University of Gothenburg, Gothenburg, Sweden
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12
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Thomsen M, Alsner J, Berg M, Jensen I, Josipovic M, Lorenzen E, Yates E, Nielsen H, Jakobsen E, Stenbygaard L, Pedersen A, Nielsen M, Jensen M, Overgaard J, Offersen B. OC-0930 Breast induration versus irradiated breast volume in the randomized phase III DBCG PBI trial. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02710-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Skarsø E, Hindhede Refsgaard L, Ravkilde T, Dahl Nissen H, Berg M, Boye K, Kamby C, Jakobsen K, Olesen M, Vrou Offersen B, Korreman S. OC-0780 Parametrization of artery delineation and nationwide implementation in the DBCG RT Nation cohort. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02686-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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14
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Refsgaard L, Skarsø E, Ravkilde T, Nissen H, Berg M, Olsen M, Jakobsen K, Boye K, Kamby C, Lind Laursen K, Jensen I, Bekke S, Matthiessen L, Laugaard Lorenzen E, Thorsen L, Offersen B, Korreman S. OC-0941 Impact of guidelines on nationwide breast cancer treatment planning practices (DBCG RT Nation study). Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02721-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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15
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Thing R, Nilsson R, Andersson S, Berg M, Lund M. PO-1477 Evaluation of two generic algorithms for CBCT based dose calculation. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03441-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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16
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Eleftheriadou D, Berg M, Phillips JB, Shipley RJ. A combined experimental and computational framework to evaluate the behavior of therapeutic cells for peripheral nerve regeneration. Biotechnol Bioeng 2022; 119:1980-1996. [PMID: 35445744 PMCID: PMC9323509 DOI: 10.1002/bit.28105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 03/22/2022] [Accepted: 04/08/2022] [Indexed: 11/08/2022]
Abstract
Recent studies have explored the potential of tissue‐mimetic scaffolds in encouraging nerve regeneration. One of the major determinants of the regenerative success of cellular nerve repair constructs (NRCs) is the local microenvironment, particularly native low oxygen conditions which can affect implanted cell survival and functional performance. In vivo, cells reside in a range of environmental conditions due to the spatial gradients of nutrient concentrations that are established. Here we evaluate in vitro the differences in cellular behavior that such conditions induce, including key biological features such as oxygen metabolism, glucose consumption, cell death, and vascular endothelial growth factor secretion. Experimental measurements are used to devise and parameterize a mathematical model that describes the behavior of the cells. The proposed model effectively describes the interactions between cells and their microenvironment and could in the future be extended, allowing researchers to compare the behavior of different therapeutic cells. Such a combinatorial approach could be used to accelerate the clinical translation of NRCs by identifying which critical design features should be optimized when fabricating engineered nerve repair conduits.
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Affiliation(s)
- D Eleftheriadou
- Centre for Nerve Engineering, University College London, London, WC1E 6B.,Department of Pharmacology, UCL School of Pharmacy, University College London, London, WC1N 1AX.,Department of Mechanical Engineering, University College London, London, WC1E 7JE
| | - M Berg
- Centre for Nerve Engineering, University College London, London, WC1E 6B.,Department of Mechanical Engineering, University College London, London, WC1E 7JE
| | - J B Phillips
- Centre for Nerve Engineering, University College London, London, WC1E 6B.,Department of Pharmacology, UCL School of Pharmacy, University College London, London, WC1N 1AX
| | - R J Shipley
- Centre for Nerve Engineering, University College London, London, WC1E 6B.,Department of Mechanical Engineering, University College London, London, WC1E 7JE
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17
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Lundgren I, Dencker A, Berg M, Nilsson C, Bergqvist L, Ólafsdóttir ÓÁ. Implementation of a midwifery model of woman-centered care in practice: Impact on oxytocin use and childbirth experiences. Eur J Midwifery 2022; 6:16. [PMID: 35434536 PMCID: PMC8972199 DOI: 10.18332/ejm/146084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 10/21/2021] [Accepted: 01/24/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Ingela Lundgren
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anna Dencker
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | | | - Ólöf-Ásta Ólafsdóttir
- Department of Midwifery, Faculty of Nursing, University of Iceland, Reykjavík, Iceland
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18
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Abstract
Aim: To explore women’s experiences of physical features in a birthing room
designed to be adaptable to personal wishes and needs during labor and
birth. Background: Childbirth is a central life event influenced by numerous factors, including
the healthcare environment; however, there is insufficient knowledge on how
the physical design affects women during birth. Methods: This study was part of a randomized controlled trial in the Room4Birth
research project, including women randomized to receive care in a new
birthing room designed with physical features changeable according to
personal wishes. Data consisted of responses to two questions analyzed with
descriptive statistics (n = 202) and semi-structured
interviews analyzed for content (n = 19). Results: A total of 93.6% (n = 189) assessed the physical features in
the birthing room as meaningful to a very high or high extent. The overall
impression of the room was positive and exceeded women’s expectations. They
felt welcomed and strengthened by the room, which shifted the focus to a
more positive emotional state. The room differed from traditional hospital
birthing rooms, contained familiar features that maintained integrity, and
had space for companions. The variety of physical features was appreciated.
Of nine listed physical features, the bathtub was ranked most important,
followed by the projection of nature scenery, and dimmable lighting, but the
room as a whole appeared most important. Conclusions: When planning and designing hospital-based birthing rooms, it is crucial to
offer possibilities to adapt the room and physical features according to
personal wishes.
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Affiliation(s)
- Lisa Björnson Skogström
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Centre for Healthcare Architecture (CVA), Chalmers University of Technology, Gothenburg, Sweden
| | - Emma Vithal
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Helle Wijk
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.,Centre for Healthcare Architecture (CVA), Chalmers University of Technology, Gothenburg, Sweden.,Division of Building Design, Department of Architecture and Civil Engineering, Chalmers University of Technology, Gothenburg, Sweden.,Department of Quality Assurance and Patient Safety, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Göran Lindahl
- Centre for Healthcare Architecture (CVA), Chalmers University of Technology, Gothenburg, Sweden.,Division of Building Design, Department of Architecture and Civil Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden
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19
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Haby K, Gyllensten H, Hanas R, Berg M, Premberg Å. A Lifestyle Intervention During Pregnancy and Its Effects on Child Weight 2.5 Years Later. Matern Child Health J 2022; 26:1881-1890. [PMID: 35253077 PMCID: PMC9374787 DOI: 10.1007/s10995-022-03395-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2022] [Indexed: 11/27/2022]
Abstract
Aim The aim of this study was to evaluate if overweight and obesity in the offspring is reduced by a low-intensity antenatal primary care intervention with focus on diet and physical activity for pregnant women with obesity, comparing children to mothers receiving the intervention with children to mothers who did not. Methods This study is a follow-up of children 2.5 years of age after their mothers’ participation in a non-randomised controlled intervention intending to limit gestational weight gain. All study participants received standard antenatal care. The intervention group received lifestyle support via motivational talks with midwife and support from dietician. Data on child weight were collected by medical records, letter and phone. Results There was no significant difference between the groups 2.5 years after intervention (International Obesity Task Force ISO-BMI 25 (child BMI corresponding to adult BMI of 25): 20% vs. 21%; ISO-BMI 30: 4.6% vs. 1.3%). The mother’s BMI at the beginning of pregnancy significantly influenced child BMI at 2.5 years (r = 0.13, p = 0.014, r2 = 0.017). For each unit of increase in maternal BMI at enrollment, the probability of child ISO-BMI ≥ 25 increased by 7.5% (p = 0.021) and of ≥ 30, by 12.9% (p = 0.017). Conclusion The frequency of overweight and obesity of the children at 2.5 years of age was significantly correlated to the mother’s BMI, but not correlated to the mothers’ participation in the antenatal lifestyle intervention. Thus, it seems important to address obesity and lifestyle issues before and between pregnancies. Trial registration The study has been registered at ClinicalTrials.gov, Identifier: NCT03147079. Supplementary Information The online version contains supplementary material available at 10.1007/s10995-022-03395-5.
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Affiliation(s)
- Karin Haby
- Antenatal Health Care, Primary Health Care, Research and Development Unit, Regionhälsan, Gothenburg, Sweden.
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Primary Health Care and Research and Development Unit, Regionhälsan, Gothenburg, Region Västra Götaland, Sweden.
| | - Hanna Gyllensten
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ragnar Hanas
- Department of Paediatrics, NU Hospital Group, Uddevalla, Sweden
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Åsa Premberg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Primary Health Care and Research and Development Unit, Regionhälsan, Gothenburg, Region Västra Götaland, Sweden
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20
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Kaplan G, Berg M, Friedrich C, Schimanski CC, Heyne von Haußen R, Bergmann F. Erratum: Endosonographisch gesteuerte Feinnadelbiopsie vs. Feinnadelaspiration von Pankreaskarzinomen. Z Gastroenterol 2022. [DOI: 10.1055/a-0658-7795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- G Kaplan
- Klinikum Darmstadt GmbH, Medizinische Klinik II, Darmstadt, Deutschland
| | - M Berg
- Klinikum Darmstadt GmbH, Medizinische Klinik II, Darmstadt, Deutschland
| | - C Friedrich
- Klinikum Darmstadt GmbH, Medizinische Klinik II, Darmstadt, Deutschland
| | - CC Schimanski
- Klinikum Darmstadt GmbH, Medizinische Klinik II, Darmstadt, Deutschland
| | - R Heyne von Haußen
- Klinikum Darmstadt GmbH, MVZ Pathologie des Klinikum Darmstadt GmbH, Darmstadt, Deutschland
| | - F Bergmann
- Klinikum Darmstadt GmbH, MVZ Pathologie des Klinikum Darmstadt GmbH, Darmstadt, Deutschland
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21
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Brandão PE, Berg M, Silva SOS, Taniwaki SA. Emergence of Avian coronavirus Escape Mutants Under Suboptimal Antibody Titers. J Mol Evol 2022; 90:176-181. [PMID: 35195749 PMCID: PMC8865171 DOI: 10.1007/s00239-022-10050-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 02/16/2022] [Indexed: 11/16/2022]
Abstract
To perform a quasispecies assessment of the effect of vaccine combinations and antibody titers on the emergence of Avian coronavirus (AvCoV) escape mutants, 5-week-old males from a commercial chicken breeder lineage were vaccinated intramuscularly with one dose of a monovalent (genotype GI-1) or a bivalent (genotypes GI-1 and GI-11 (n = 40 birds/group) AvCoV vaccine. Seven birds were kept as controls. Six weeks later, pools of sera of each group were prepared and incubated at virus neutralization doses of 10 and 10–1 with the Beaudette strain (GI-1) of AvCoV in VERO cells. Rescued viruses were then submitted to genome-wide deep sequencing for subconsensus variant detection. After treatment with serum from birds vaccinated with the bivalent vaccine at a titer of 10–1, an F307I variant was detected in the spike glycoprotein that mapped to an important neutralizing region, which indicated an escape mutant derived from natural selection. Further variants were detected in nonstructural proteins and non-coding regions that are not targets of neutralizing antibodies and might be indicators of genetic drift. These results indicate that the evolution of AvCoV escape mutants after vaccination depends on the type of vaccine strain and the antibody titer and must be assessed based on quasispecies rather than consensus dominant sequences only because quasispecies may be otherwise undetected.
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Affiliation(s)
- P E Brandão
- Department of Preventive Veterinary Medicine and Animal Health, School of Veterinary Medicine, University of São Paulo, São Paulo, Brazil. .,Departamento de Medicina Veterinária Preventiva e Saúde Animal, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, Av Prof. Dr. Orlando M Paiva 87, São Paulo, SP, 05508-270, Brazil.
| | - M Berg
- Department of Biomedical Sciences and Veterinary Public Health, Section of Virology, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - S O S Silva
- Department of Preventive Veterinary Medicine and Animal Health, School of Veterinary Medicine, University of São Paulo, São Paulo, Brazil
| | - S A Taniwaki
- Department of Preventive Veterinary Medicine and Animal Health, School of Veterinary Medicine, University of São Paulo, São Paulo, Brazil
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22
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Bogren M, Mwambali SN, Berg M. Contextual factors influencing a training intervention aimed at improved maternal and newborn healthcare in a health zone of the Democratic Republic of Congo. PLoS One 2021; 16:e0260153. [PMID: 34843565 PMCID: PMC8629278 DOI: 10.1371/journal.pone.0260153] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 11/03/2021] [Indexed: 11/18/2022] Open
Abstract
Background Maternal and neonatal mortality and morbidity in the Democratic Republic of Congo (DRC) are among the highest worldwide. As part of a quality improvement programme in a health zone in the DRC aimed at contributing to reduced maternal and neonatal mortality and morbidity, a three-pillar training intervention around childbirth was developed and implemented in collaboration between Swedish and Congolese researchers and healthcare professionals. The aim of this study is to explore contextual factors influencing this intervention. Methods A qualitative research design was used, with data collected through focus group discussions (n = 7) with healthcare professionals involved in the intervention before and at the end (n = 9). Transcribed discussions were inductively analysed using content analysis. Results Three generic categories describe the contextual factors influencing the intervention: i) Incentives motivated participants’ efforts to begin a training programme; ii) Involving the local health authorities was important; and (iii) Having physical space, electricity, and equipment in place was crucial. Conclusions This study and similar ones highlight that incentives of various types are crucial contextual factors that influence training interventions, and have to be considered already in the planning of such interventions. One such factor is expectations of monetary incentives. To meet this in a small research project like ours would require a reduction of the scale and thus limit the implementation of new evidence-based knowledge into practice aimed at reducing maternal mortality and morbidity.
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Affiliation(s)
- Malin Bogren
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- * E-mail:
| | - Sylvie Nabintu Mwambali
- Faculty of Medicine and Community Health, Department of Obstetrics and Gynecology, Evangelical University of Africa, Bukavu, Democratic Republic of Congo
| | - Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Faculty of Medicine and Community Health, Department of Obstetrics and Gynecology, Evangelical University of Africa, Bukavu, Democratic Republic of Congo
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23
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Gyllensten H, Haby K, Berg M, Premberg Å. Cost effectiveness of a controlled lifestyle intervention for pregnant women with obesity. BMC Pregnancy Childbirth 2021; 21:639. [PMID: 34548038 PMCID: PMC8456662 DOI: 10.1186/s12884-021-04098-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 08/29/2021] [Indexed: 11/30/2022] Open
Abstract
Background The Mighty Mums antenatal lifestyle intervention is a person-centered behavioral intervention focusing on nutrition and physical activity for pregnant women with obesity (body mass index [BMI] ≥30). The aim of this study was to evaluate the costs and clinical outcomes of adding the Mighty Mums intervention to standard antenatal care. Methods Participants in the intervention group (n = 434) received motivational talks with their midwife and a selection of physical and/or nutritional activities in addition to antenatal care. Control participants (n = 867) from adjacent geographic areas received standard antenatal care. Costs for staff, unit costs for specific activities, and registered costs for specialized antenatal care were analyzed for associations with gestational weight gain and self-reported health. Results are reported for the intention-to-treat (ITT) population and a per protocol (PP) population identified by participation in the intervention. Analyses included bootstrapped linear regressions adjusted for background characteristics that differed significantly between groups. Results The average costs were SEK 9727 higher (95% confidence interval [CI]: 6677 to 12,777) among participants in the intervention group than in the control ITT population and SEK 8655 (95% CI 4586 to 12,724) higher than in the PP population. The cost increase per 1 kg reduction in gestational weight gain was SEK 12,369 in the ITT population and SEK 7209 for the PP population. Conclusion Participation in the Mighty Mums intervention was associated with higher costs, but also reduced gestational weight gain. The cost per kilogram reduction in gestational weight gain was low, particularly in the PP population. A future decision to implement this behavioral intervention in standard care should take into account society’s willingness to pay per unit reduction in gestational weight gain. Trial registration The study is registered at ClinicalTrials.gov, Identifier: NCT03147079. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04098-5.
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Affiliation(s)
- Hanna Gyllensten
- Institute of Health and Care Sciences, University of Gothenburg, Box 457, SE-405 30, Göteborg, Sweden. .,Centre for Person-Centred Care - GPCC, University of Gothenburg, Gothenburg, Sweden. .,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Karin Haby
- Institute of Health and Care Sciences, University of Gothenburg, Box 457, SE-405 30, Göteborg, Sweden.,Region Västra Götaland, Research and Development Primary Health Care, Gothenburg, Sweden
| | - Marie Berg
- Institute of Health and Care Sciences, University of Gothenburg, Box 457, SE-405 30, Göteborg, Sweden.,Centre for Person-Centred Care - GPCC, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Sahlgrenska University Hospital, Department of Obstetrics, Gothenburg, Sweden
| | - Åsa Premberg
- Institute of Health and Care Sciences, University of Gothenburg, Box 457, SE-405 30, Göteborg, Sweden.,Region Västra Götaland, Research and Development Primary Health Care, Gothenburg, Sweden
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24
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Goldkuhl L, Dellenborg L, Berg M, Wijk H, Nilsson C. The influence and meaning of the birth environment for nulliparous women at a hospital-based labour ward in Sweden: An ethnographic study. Women Birth 2021; 35:e337-e347. [PMID: 34321183 DOI: 10.1016/j.wombi.2021.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 06/18/2021] [Accepted: 07/20/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Labour and birth are sensitive physiological processes substantially influenced by environmental and psychosocial factors. AIM To explore the influence and meaning of the birth environment for nulliparous women giving birth in either one of two differently designed birthing rooms at a hospital-based labour ward. METHODS Five months of ethnographic fieldwork was conducted at a labour ward in Sweden, consisting of participant observations of 16 nulliparous women giving birth in either a 'Regular' birthing room (n = 8) or a specially designed, 'New room' (n = 8). Data included field notes, informal interviews, reflective notes, and individual interviews with eight women after birth. The data was analysed through an ethnographic iterative hermeneutic analysis process. FINDINGS The analysis identified the birth environment as consisting of the physical space, the human interaction within it, and the institutional context. The analytic concept; Birth Manual was conceived as an instrument for managing labour in accordance with institutional authority. Significant to the interpretation of the influence and meaning of the birth environment were two abstract rooms: an Institutional room, where birth was approached as a critical event, designating birthing women as passive; and a Personal room, where birth was approached as a physiological event in which women's agency was facilitated. CONCLUSION Institutional authority permeated the atmosphere within the birth environment, irrespective of the design of the room. A power imbalance between institutional demands and birthing women's needs was identified, emphasising the vital role the birth philosophy plays in creating safe birth environments that increase women's sense of agency.
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Affiliation(s)
- Lisa Goldkuhl
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Lisen Dellenborg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Gothenburg, Region Västra Götaland, Sweden
| | - Helle Wijk
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Quality Assurance and Patient Safety, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; Department of Architecture and Civil Engineering, Building Design, Chalmers University of Technology, Gothenburg, Sweden
| | - Christina Nilsson
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
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Andrén A, Begley C, Dahlberg H, Berg M. The birthing room and its influence on the promotion of a normal physiological childbirth - a qualitative interview study with midwives in Sweden. Int J Qual Stud Health Well-being 2021; 16:1939937. [PMID: 34148522 PMCID: PMC8216256 DOI: 10.1080/17482631.2021.1939937] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
The birthing room is a major workplace for midwives but how it influences them in practice is not enough investigated. Purpose: This study aimed to explore midwives´ experiences of how the birthing room affects them in their work to promote a normal physiological birth. Methods: A phenomenological reflective lifeworld research approach was used and included individual interviews with 15 midwives working at four different hospitals in western Sweden, and of which two also assisted at homebirths. The analysis focused on the meanings of the study phenomenon. Results: A birthing room can by its design either support a normal physiological birth or support a risk approach to childbirth. Four opposing constituents complete the essential meaning of the birthing rooms, and to which the midwives need to relate in their roles as guardians for normal birth: i) a private or a public room; ii) a home-like or hospital-like room; iii) a room promoting activity or passivity; iv) a room promoting the midwife´s presence or absence. Conclusions: The birthing room mirrors a pathogenic-oriented care approach. A presupposition for the work to keep the birth bubble intact is to protect the mother from disturbing elements both inside and outside the room.
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Affiliation(s)
- Anna Andrén
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Obstetrics, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Cecily Begley
- School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, Dublin 2, Ireland
| | - Helena Dahlberg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Obstetrics, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
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Carlsson-Lalloo E, Mellgren Å, Berg M, Rusner M. Supportive conditions for sexual and perinatal wellbeing in women living with HIV in Sweden: A phenomenological study. Sex Reprod Healthc 2021; 29:100640. [PMID: 34087654 DOI: 10.1016/j.srhc.2021.100640] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 03/26/2021] [Accepted: 05/15/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Women living with HIV have specific needs regarding sexuality, pregnancy, and childbirth. However, there is lack of knowledge about how these needs can be met. The aim of this study was to identify supportive conditions for sexual and perinatal wellbeing in women living with HIV in Sweden. METHODS A phenomenological reflective lifeworld research approach was used. Transcribed interviews with 18 women living with HIV in Sweden were analyzed focusing on the meanings of the study phenomenon. RESULTS When living with HIV, "feeling safe with oneself and in relationships with others" is essential for sexual and perinatal wellbeing. This is constituted by having good overall health, being in a caring context, having access to high quality information about HIV, and being ensured the same rights as other women. CONCLUSIONS The study shows that women living with HIV have specific needs for the support of their sexual and perinatal wellbeing. This knowledge can be used by all those engaged in HIV care and HIV prevention in order to improve and implement supportive conditions for women living with HIV. It is important that all those involved in the care of women living with HIV constantly update their knowledge about HIV and women's experiences of living with HIV in order to provide safe arenas and caring contexts that support the wellbeing of these women.
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Affiliation(s)
- Ewa Carlsson-Lalloo
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30 Gothenburg, Sweden; Regional Cancer Center West, Region Västra Götaland, Medicinaregatan 18 G, 413 45 Gothenburg, Sweden.
| | - Åsa Mellgren
- Department of Infectious Diseases, Sahlgrenska University Hospital, Region Västra Götaland, Journalvägen 10, 416 50 Gothenburg, Sweden
| | - Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30 Gothenburg, Sweden; Department of Obstetrics, Sahlgrenska University Hospital, Region Västra Götaland, Diagnosvägen 15, 416 50 Gothenburg, Sweden; Department of Gynaecology and Obstetrics, Faculty of Medicine and Community Health, Evangelical University of Africa, Bukavu, The Democratic Republic of the Congo
| | - Marie Rusner
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30 Gothenburg, Sweden; Department of Research, Education and Innovation, Södra Älvsborg Hospital, Region Västra Götaland, Brämhultsvägen 53, 501 82 Borås, Sweden
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Thomsen MS, Berg M, Zimmermann S, Lutz CM, Makocki S, Jensen I, Hjelstuen MHB, Pensold S, Hasler MP, Jensen MB, Offersen BV. Dose constraints for whole breast radiation therapy based on the quality assessment of treatment plans in the randomised Danish breast cancer group (DBCG) HYPO trial. Clin Transl Radiat Oncol 2021; 28:118-123. [PMID: 33937532 PMCID: PMC8079332 DOI: 10.1016/j.ctro.2021.03.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/27/2021] [Accepted: 03/28/2021] [Indexed: 12/25/2022] Open
Abstract
Purpose Quality assessment of the treatment plans in the Danish Breast Cancer Group (DBCG) HYPO trial was carried out based on prospectively reported dosimetric parameters and evidence-based dose constraints for whole breast radiation therapy were derived. Materials and methods From 2009 to 2014, 1882 patients (pts) were randomised between 50 Gy/25fractions (fr) versus 40 Gy/15fr. Doses to CTVp_breast (V95%, V107%-V110%, Dmax, and in addition for 40 Gy plans V105%-V107%), ipsilateral lung (V20Gy/V17Gy), heart (V20Gy/V17Gy, V40Gy/V35Gy), and left anterior descending coronary artery (LADCA) (Dmax) and use of respiratory gated technique were prospectively reported to the DBCG database. After end of accrual, these dosimetric parameters from all plans in the trial were compared to the pre-specified treatment constraints. Results In total, 1854 pts from eight radiation therapy (RT) centres in three countries were treated. No statistically significant differences were found between the results for 40 Gy and 50 Gy plans, except for CTVp_breast hot-spot volume (V107%-V110%). Of the 40 Gy pts, 90% with CTVp_breast > 600 mL and 95% with CTVp_breast ≤ 600 mL had a CTVp_breast hot-spot volume (V105%-V107%) <2%. In 95% of the 50 Gy plans, the CTVp_breast absolute hot-spot volume (V107%-V110%) was <0.5 mL and 1.7 mL for CTVp_breast ≤ 600 mL and > 600 mL, respectively. Compliance was >99% for both heart and lung constraints. Largest deviation from protocol constraints was found for the volume of CTVp_breast covered with 95% of the prescription dose or more (V95%). The CTV dose coverage (V95%) was >94.3% in 95% of the right-sided pts, whereas the figures for 95% of the left-sided pts treated with and without respiratory gating were 93.2% and 88.8%, respectively. Conclusion A high degree of compliance with protocol dose constraints was found for treatment plans in the DBCG HYPO trial. New constraints for dose to organs at risk and high-dose volumes in the breast are suggested for breast-only RT planning.
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Affiliation(s)
- M S Thomsen
- Department of Medical Physics, Aarhus University Hospital, Aarhus, Denmark
| | - M Berg
- Department of Medical Physics, Lillebaelt Hospital, Vejle, Denmark
| | - S Zimmermann
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - C M Lutz
- Department of Medical Physics, Aarhus University Hospital, Aarhus, Denmark
| | - S Makocki
- Dept of Radiation Oncology and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - I Jensen
- Department of Medical Physics, Aalborg University Hospital, Aalborg, Denmark
| | - M H B Hjelstuen
- Department of Radiotherapy, Stavanger University Hospital, Stavanger, Norway
| | - S Pensold
- Praxis for Radiotherapy, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany
| | - M P Hasler
- Department of Oncology, Sørlandet Hospital, Kristiansand, Norway
| | - M-B Jensen
- Danish Breast Cancer Cooperative Group, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - B V Offersen
- Department of Experimental Clinical Oncology and Department of Oncology, Aarhus University Hospital, Denmark
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Carlsson-Lalloo E, Rusner M, Berg M, Svedhem V, Mellgren Å. People living with HIV in Sweden report high levels of sexual satisfaction in a registry-based cohort study. AIDS Care 2021; 34:559-567. [PMID: 33793361 DOI: 10.1080/09540121.2021.1909698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Sexual satisfaction can be challenging for people living with HIV (PLWH). To investigate self-reported sexual satisfaction in PLWH and its association with HIV-related biomarkers, a retrospective observational cohort study with data on sociodemographic characteristics and changes in PLWH's assessment of their sexual satisfaction over time were retrieved from the Swedish National Quality Assurance Registry (InfCareHIV) where patient-related outcomes are reported annually. PLWH who had assessed self-reported sexual satisfaction 2011-2016 were included. Sexual satisfaction was dichotomized into sexual "satisfaction and dissatisfaction" and associations were analysed. In total, 3798 patients (66% men) answered 8202 questionnaires. Overall, 67% reported sexual satisfaction, with women more satisfied than men (72% vs 64%, p < 0.0001). Sexual satisfaction did not differ between patients on antiretroviral treatment (ART) >6 months whether the viral load was suppressed or not. Overall, the probability of reporting sexual satisfaction increased by 4% annually (p < 0.001). This increase may be explained by evolving knowledge about the minimal risks of sexual HIV transmission when on ART together with Sweden's concomitant revision of legal restrictions. The use of patient-related outcomes in clinical practice is an important tool for facilitating conversations about sexuality in order to promote the health and well-being of PLWH.
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Affiliation(s)
- Ewa Carlsson-Lalloo
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Regional Cancer Center West, Gothenburg, Sweden
| | - Marie Rusner
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Research, Södra Älvsborg Hospital, Borås, Sweden
| | - Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Obstetrics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Veronica Svedhem
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine, Unit of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden
| | - Åsa Mellgren
- Department of Infectious Diseases, Sahlgrenska University Hospital, Gothenburg, Sweden
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Mukamurigo J, Berg M, Nyirazinyoye L, Bogren M, Dencker A. Women's childbirth experience emphasizing own capacity and safety: A cross-sectional Rwandan study. Women Birth 2021; 34:e146-e152. [PMID: 32192910 DOI: 10.1016/j.wombi.2020.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 02/29/2020] [Accepted: 03/01/2020] [Indexed: 01/01/2023]
Abstract
PROBLEM AND AIM Women's childbirth experience is central when assessing intrapartum care quality. This study accordingly measures women's childbirth experience in Rwandan health facilities, focusing on own capacity and perceived safety. METHODS A cross-sectional health facility-based study was conducted December 2014 to January 2015 in Kigali City and the Northern Province. Childbirth experience was assessed before discharge using an overall assessment and two subscales, Own capacity and Perceived safety, of the Childbirth Experience Questionnaire, with high scores reflecting a good experience. The questionnaire was translated from English into Kinyarwanda. Reliability was tested using Cronbach's alpha; and mean scores between groups were compared using Mann-Whitney U test. FINDINGS All invited women (n = 817) agreed to participate after informed consent. Mean age was 27.8 years and 63.6% were multiparous. A majority of women (82.3%) reported an overall positive childbirth experience (≥8 out of 10). Cronbach's alpha indicated good reliability for Own capacity (0.78) and Perceived safety (0.76). In both subscales multiparous women had higher mean scores than primiparous, married women scored higher than unmarried, older women (>35) scored higher than younger (<35), and women with higher level of education scored higher than those with lower level. Women with HIV scored lower on perceived safety. CONCLUSION A majority of the women reported a positive overall childbirth experience. Own capacity and perceived safety are important dimensions of childbirth experience and should be addressed in building high-quality intrapartum care. Further research is needed and should include exploration of specific groups.
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Affiliation(s)
- Judith Mukamurigo
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; School of Public Health, College of Medicine and Health and Care Sciences, Department of Epidemiology and Biostatistics, University of Rwanda, Rwanda.
| | - Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Obstetric Unit, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Laetitia Nyirazinyoye
- School of Public Health, College of Medicine and Health and Care Sciences, Department of Epidemiology and Biostatistics, University of Rwanda, Rwanda
| | - Malin Bogren
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna Dencker
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Bogren M, Ndela B, Toko C, Berg M. Midwifery education, regulation and association in the Democratic Republic of Congo (DRC) - current state and challenges. Glob Health Action 2021; 13:1717409. [PMID: 31983317 PMCID: PMC7034491 DOI: 10.1080/16549716.2020.1717409] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: In the Democratic Republic of Congo (DRC), maternal and neonatal health outcomes are poor and delivering healthcare services of sufficient quality is a challenge as there are only 0.6 midwives, physicians, or nurses for every 1,000 inhabitants. Objective: To explore the current state of the midwifery profession in the DRC and to suggest suitable strategies for increasing the quality and quantity of a highly competent midwifery health workforce in the DRC. Methods: Data were collected at a workshop with 17 key persons using three questionnaires developed by the International Confederation of Midwives, and three focus group discussions. The analysis was focusing on quantitative and qualitative content. Results: In DRC the midwife profession is not legislated. A midwifery association is well established, but due to a lack of resources does not function optimally. Two midwifery education programmes exist: a three-year direct-entry programme resulting in a diploma in midwifery, and a 12-month postgraduate programme for nurses resulting in a certificate in midwifery. Neither of the programmes leads to a bachelor’s or master’s degree. At the institutions offering the midwifery programmes (n = 16), the educators’ academic qualifications are lower than required and there is a lack of teaching and training equipment for meeting the education needs. Conclusions: The Sustainable Development Goal on health, and specifically the health of mother and newborn, will be difficult to meet in the DRC. We therefore suggest that (i) the midwifery education programmes be improved to meet international standards; (ii) these programmes be designed in a way that allows for an academic degree at either the bachelor’s or master’s level; (iii) the competence level of the midwifery educators be increased; and, most crucially, (iv) a regulatory structure be formed that legislates and regulates the midwifery profession and its autonomous practice.
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Affiliation(s)
- Malin Bogren
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Britou Ndela
- SANRU Asbl, Ville de Kinshasa, Democratic Republic of Congo
| | - Carla Toko
- SANRU Asbl, Ville de Kinshasa, Democratic Republic of Congo
| | - Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Selin L, Berg M, Wennerholm UB, Dencker A. Dosage of oxytocin for augmentation of labor and women's childbirth experiences: A randomized controlled trial. Acta Obstet Gynecol Scand 2021; 100:971-978. [PMID: 33176392 PMCID: PMC8248083 DOI: 10.1111/aogs.14042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/31/2020] [Accepted: 11/03/2020] [Indexed: 11/27/2022]
Abstract
Introduction The aim of this study was to compare childbirth experiences and experience of labor pain in primiparous women who had received high‐ vs low‐dose oxytocin for augmentation of delayed labor. Material and methods A multicenter, parallel, double‐blind randomized controlled trial took place in six Swedish labor wards. Inclusion criteria were healthy primiparous women at term with uncomplicated singleton pregnancies, cephalic fetal presentation, spontaneous onset of labor, confirmed delayed labor progress and ruptured membranes. The randomized controlled trial compared high‐ vs low‐dose oxytocin used for augmentation of a delayed labor progress. The Childbirth Experience Questionnaire version 2 (CEQ2) was sent to the women 1 month after birth. The CEQ2 consists of 22 items in four domains: Own capacity, Perceived safety, Professional support and Participation. In addition, labor pain was reported with a visual analog scale (VAS) 2 hours postpartum and 1 month after birth. The main outcome was the childbirth experience measured with the four domains of the CEQ2. The clinical trial number is NCT01587625. Results The CEQ2 was sent to 1203 women, and a total of 1008 women (83.8%) answered the questionnaire. The four domains of childbirth experience were scored similarly in the high‐ and low‐dose oxytocin groups of women: Own capacity (P = .36), Perceived safety (P = .44), Professional support (P = .84), Participation (P = .49). VAS scores of labor pain were reported as similar in both oxytocin dosage groups. Labor pain was scored higher 1 month after birth compared with 2 hours postpartum. There was an association between childbirth experiences and mode of birth in both the high‐ and low‐dose oxytocin groups. Conclusions Different dosage of oxytocin for augmentation of delayed labor did not affect women’s childbirth experiences assessed through CEQ2 1 month after birth, or pain assessment 2 hours or 1 month after birth.
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Affiliation(s)
- Lotta Selin
- Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Region Vastra Gotaland , NU-Hospital Group, Trollhättan, Sweden
| | - Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Region Vastra Gotaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ulla-Britt Wennerholm
- Department of Obstetrics and Gynecology, Region Vastra Gotaland, Sahlgrenska University Hospital, Gothenburg, Sweden.,Center of Perinatal Medicine and Health, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden
| | - Anna Dencker
- Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg, Sweden.,Center for Person-centered Care, Sahlgrenska Academy, Gothenburg, Sweden
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Assi M, Koshy K, El Atrouni W, Burke K, Berg M, Opardija A, Temesgen Z. Investigational immunomodulatory therapies for COVID-19. DRUG FUTURE 2021. [DOI: 10.1358/dof.2021.46.9.3317238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Baumgartner R, Berg M, Matic L, Polyzos KP, Forteza MJ, Hjorth SA, Schwartz TW, Paulsson-Berne G, Hansson GK, Hedin U, Ketelhuth DFJ. Evidence that a deviation in the kynurenine pathway aggravates atherosclerotic disease in humans. J Intern Med 2021; 289:53-68. [PMID: 32794238 DOI: 10.1111/joim.13142] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 05/24/2020] [Accepted: 06/04/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The metabolism of tryptophan (Trp) along the kynurenine pathway has been shown to carry strong immunoregulatory properties. Several experimental studies indicate that this pathway is a major regulator of vascular inflammation and influences atherogenesis. Knowledge of the role of this pathway in human atherosclerosis remains incomplete. OBJECTIVES In this study, we performed a multiplatform analysis of tissue samples, in vitro and in vivo functional assays to elucidate the potential role of the kynurenine pathway in human atherosclerosis. METHODS AND RESULTS Comparison of transcriptomic data from carotid plaques and control arteries revealed an upregulation of enzymes within the quinolinic branch of the kynurenine pathway in the disease state, whilst the branch leading to the formation of kynurenic acid (KynA) was downregulated. Further analyses indicated that local inflammatory responses are closely tied to the deviation of the kynurenine pathway in the vascular wall. Analysis of cerebrovascular symptomatic and asymptomatic carotid stenosis data showed that the downregulation of KynA branch enzymes and reduced KynA production were associated with an increased probability of patients to undergo surgery due to an unstable disease. In vitro, we showed that KynA-mediated signalling through aryl hydrocarbon receptor (AhR) is a major regulator of human macrophage activation. Using a mouse model of peritoneal inflammation, we showed that KynA inhibits leukocyte recruitment. CONCLUSIONS We have found that a deviation in the kynurenine pathway is associated with an increased probability of developing symptomatic unstable atherosclerotic disease. Our study suggests that KynA-mediated signalling through AhR is an important mechanism involved in the regulation of vascular inflammation.
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Affiliation(s)
- R Baumgartner
- From the, Cardiovascular Medicine Unit, Center for Molecular Medicine, Department of Medicine, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - M Berg
- From the, Cardiovascular Medicine Unit, Center for Molecular Medicine, Department of Medicine, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - L Matic
- Department of Molecular Medicine and Surgery, Center for Molecular Medicine, Karolinska Institute, Stockholm, Sweden.,Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - K P Polyzos
- From the, Cardiovascular Medicine Unit, Center for Molecular Medicine, Department of Medicine, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - M J Forteza
- From the, Cardiovascular Medicine Unit, Center for Molecular Medicine, Department of Medicine, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - S A Hjorth
- Section for Metabolic Receptology, Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark.,Laboratory for Molecular Pharmacology, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - T W Schwartz
- Section for Metabolic Receptology, Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark.,Laboratory for Molecular Pharmacology, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - G Paulsson-Berne
- From the, Cardiovascular Medicine Unit, Center for Molecular Medicine, Department of Medicine, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - G K Hansson
- From the, Cardiovascular Medicine Unit, Center for Molecular Medicine, Department of Medicine, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - U Hedin
- Department of Molecular Medicine and Surgery, Center for Molecular Medicine, Karolinska Institute, Stockholm, Sweden.,Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - D F J Ketelhuth
- From the, Cardiovascular Medicine Unit, Center for Molecular Medicine, Department of Medicine, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.,Department of Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
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Nissen H, McIlroy S, Havelund B, Krog C, Pløen J, Berg M. PO-1774: First clinical experiences with MR-only treatment planning and delivery for pelvic cancers. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01792-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Thorsen L, Overgaard J, Holm-Hansen S, Berg M, Jensen I, Kamby C, Nielsen M, Overgaard M, Offersen B. OC-0326: DBCG-IMN: Long-term survival gain with internal mammary node irradiation to breast cancer patients. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00350-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Berg M, Coy R, Phillips J, Shipley R. Modelling regenerative angiogenesis in peripheral nerve injuries. Comput Methods Biomech Biomed Engin 2020. [DOI: 10.1080/10255842.2020.1811503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- M. Berg
- Department of Mechanical engineering, University College London, London, UK
- Center for Nerve Engineering, University College London, London, UK
| | - R. Coy
- Department of Mechanical engineering, University College London, London, UK
- Center for Nerve Engineering, University College London, London, UK
| | - J. Phillips
- Center for Nerve Engineering, University College London, London, UK
- School of Pharmacy, University College London, London, UK
| | - R. Shipley
- Department of Mechanical engineering, University College London, London, UK
- Center for Nerve Engineering, University College London, London, UK
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Bogren M, Denovan A, Kent F, Berg M, Linden K. Impact of the Helping Mothers Survive Bleeding After Birth learning programme on care provider skills and maternal health outcomes in low-income countries - An integrative review. Women Birth 2020; 34:425-434. [PMID: 33041235 DOI: 10.1016/j.wombi.2020.09.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/07/2020] [Accepted: 09/08/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND To improve maternal health outcomes, highly competent healthcare providers are needed. One strategy used to improve performance among healthcare providers is simulation-based learning. An integrative review was designed with the aim of synthesising available research on Helping Mothers Survive (HMS), a learning programme used in low-income countries, and its impact on care provider skills and maternal health outcomes. METHOD A systematic search was conducted in June 2020 in CINAHL, PubMed, Scopus, and Web of Science. All stages of inclusion, quality assessment, and data extraction were done independently by four reviewers. A narrative synthesis was used for the outcomes of care provider skills and knowledge, as well as maternal health outcomes. FINDINGS The search identified 50 articles, 22 of which were excluded due to being duplicates, 16 based on their title and abstract, and two based on their full text. Eleven papers were included in the synthesis: eight quantitative, two qualitative, and one mixed-method study, originating from India, Malawi, Tanzania, Uganda, and Zanzibar. The Helping Mothers Survive-Bleeding After Birth (HMS-BAB) learning programme was found to have a positive impact on care providers' competencies and maternal health outcomes, with a reduced number of postpartum haemorrhages and a reduction in maternal mortality. CONCLUSION The HMS-BAB learning programme has the potential to increase competence among care providers and improve maternal health outcomes in low-income settings. A successful use of the programme to maintain improved care routines for mothers requires multi-professional teams, facility readiness, a low-dose high-frequency approach, a local coordinator, and accountability and ownership.
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Affiliation(s)
- Malin Bogren
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Arvid Wallgrens Backe 1, 413 46 Gothenburg, Sweden.
| | - Anna Denovan
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Arvid Wallgrens Backe 1, 413 46 Gothenburg, Sweden
| | - Felicity Kent
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Arvid Wallgrens Backe 1, 413 46 Gothenburg, Sweden
| | - Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Arvid Wallgrens Backe 1, 413 46 Gothenburg, Sweden
| | - Karolina Linden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Arvid Wallgrens Backe 1, 413 46 Gothenburg, Sweden
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Abstract
Being pregnant, giving birth, and becoming a mother the first months after birth, is for women with type 1 diabetes mellitus (T1DM) a period of difficult challenges. In order to identify their need of support from healthcare, the aim of this study was to describe healthcare during pregnancy, labour, birth, and up to 12 weeks after birth as experienced by Swedish women with T1DM. We used a phenomenological reflective lifeworld research approach, and made 1-2 individual interviews with ten women in late pregnancy and/or 2-3 months after. Transcribed interviews were analysed through focusing on the meanings of the study phenomenon. The results revealed how the diabetes disease, as well as the risks and responsibility that comes with it, become more visible during the period in question, due to a constant monitoring, performed by the woman herself as well as by the healthcare professionals. The essential meaning of the phenomenon is a need to share the burden of risks and responsibilities with healthcare professionals. The complex situation that these women are in, both as experts on their illness and care and in need of care, requires a care that make women feel capable and responsible, but at the same time offers support and relieve them of their responsibility when needed.
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Affiliation(s)
- Helena Dahlberg
- Institute of Health and Care Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Gothenburg Centre for Person-centred Care, University of Gothenburg, Gothenburg, Sweden
| | - Marie Berg
- Institute of Health and Care Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Gothenburg Centre for Person-centred Care, University of Gothenburg, Gothenburg, Sweden.,Department of Obstetrics, Sahlgrenska University Hospital, Gothenburg, Sweden
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Bogren M, Grahn M, Kaboru BB, Berg M. Midwives' challenges and factors that motivate them to remain in their workplace in the Democratic Republic of Congo-an interview study. Hum Resour Health 2020; 18:65. [PMID: 32943067 PMCID: PMC7499901 DOI: 10.1186/s12960-020-00510-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/07/2020] [Indexed: 05/17/2023]
Abstract
BACKGROUND The Democratic Republic of Congo (DRC) has high maternal mortality and a low number of midwives, which undermines the achievement of goal 3 of the Sustainable Development Goals (SDGs) for 2030, specifically the health of the mother and newborn. Scaling up the midwifery workforce in relation to number, quality of healthcare, and retention in service is therefore critical. The aim of this study was to investigate midwives' challenges and factors that motivate them to remain in their workplace in the DRC. METHODS Data were collected in two out of 26 provinces in the DRC through ten focus group discussions with a total of 63 midwives working at ten different healthcare facilities. Transcribed discussions were inductively analysed using content analysis. RESULTS The midwives' challenges and the factors motivating them to remain in their workplace in the DRC are summarised in one main category-Loving one's work makes it worthwhile to remain in one's workplace, despite a difficult work environment and low professional status-consisting of three generic categories: Midwifery is not just a profession; it's a calling is described in the subcategories Saving lives through midwifery skills, Building relationships with the women and the community, and Professional pride; Unsupportive organisational system is expressed in the subcategories Insufficient work-related security and No equitable remuneration system, within Hierarchical management structures; and Inadequate pre-conditions in the work environment includes the subcategories Lack of resources and equipment and Insufficient competence for difficult working conditions. CONCLUSION Midwives in the DRC are driven by a strong professional conscience to provide the best possible care for women during childbirth, despite a difficult work environment and low professional status. To attract and retain midwives and ensure that they are working to their full scope of practice, we suggest coordinated actions at the regional and national levels in the DRC and in other low-income countries with similar challenges, including (i) conducting midwifery education programmes following international standards, (ii) prioritising and enforcing policies to include adequate remuneration for midwives, (iii) involving midwives' associations in policy and planning about the midwifery workforce, and (iv) ensuring that midwives' working environments are safe and well equipped.
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Affiliation(s)
- Malin Bogren
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Arvid Wallgrens backe 1, 413 46, Gothenburg, Sweden.
| | - Malin Grahn
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Arvid Wallgrens backe 1, 413 46, Gothenburg, Sweden
- Department of Obstetrics, Sahlgrenska University Hospital, Region Västra Götaland, Diagnosvägen 15, 416 50, Gothenburg, Sweden
| | - Berthollet Bwira Kaboru
- Swedish Embassy in Kinshasa, Democratic Republic of Congo, 93 Avenue Roi Baudouin, Kinshasa-Gombe, Democratic Republic of Congo
| | - Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Arvid Wallgrens backe 1, 413 46, Gothenburg, Sweden
- Department of Obstetrics, Sahlgrenska University Hospital, Region Västra Götaland, Diagnosvägen 15, 416 50, Gothenburg, Sweden
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Glodowska M, Stopelli E, Schneider M, Lightfoot A, Rathi B, Straub D, Patzner M, Duyen VT, Berg M, Kleindienst S, Kappler A. Correction to Role of in Situ Natural Organic Matter in Mobilizing As during Microbial Reduction of Fe III-Mineral-Bearing Aquifer Sediments from Hanoi (Vietnam). Environ Sci Technol 2020; 54:10380. [PMID: 32806919 DOI: 10.1021/acs.est.0c04088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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Eri TS, Berg M, Dahl B, Gottfreðsdóttir H, Sommerseth E, Prinds C. Models for midwifery care: A mapping review. Eur J Midwifery 2020; 4:30. [PMID: 33537631 PMCID: PMC7839165 DOI: 10.18332/ejm/124110] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/04/2020] [Accepted: 06/16/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION According to WHO, midwives are found competent to provide evidencebased and normalcy-facilitating maternity care. Models for midwifery care exist, but seem to be lacking explicit epistemological status, mainly focusing on the practical and organizational level of care delivery. To make the values and attitudes of care visible, it is important to implement care models with explicit epistemological status. The aim of this paper is to identify and gain an overview of publications of theoretical models for midwifery care. METHODS A mapping review was conducted with systematic searches in nine databases for studies describing a theoretical model or theory for midwifery care that either did or was intended to impact clinical practice. Eligibility criteria were refined during the selection process. RESULTS Six models from six papers originating from different parts of the world were included in the study. The included models were developed using different methodologies and had different philosophical underpinnings and complexity gradients. Some characteristics were common, the most distinctive being the emphasis of the midwife-woman relationship, secondly the focus on woman-centeredness, and thirdly the salutogenic focus in care. CONCLUSIONS Overall, scarcity exists regarding theoretical models for midwifery care with explicit epistemological status. Further research is needed in order to develop generic theoretical models with an epistemological status to serve as a knowledge base for midwifery healthcare.
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Affiliation(s)
- Tine S. Eri
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Marie Berg
- Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
- The Obstretic Unit, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Bente Dahl
- Centre for Women’s, Family and Child Health, Faculty of Health and Social Sciences, University of South-Eastern Norway, Kongsberg, Norway
| | - Helga Gottfreðsdóttir
- Department of Midwifery, Faculty of Nursing, University of Iceland, Reykjavík, Iceland
- Women´s Clinic, Landspitali University Hospital, Reykjavík, Iceland
| | - Eva Sommerseth
- Centre for Women’s, Family and Child Health, Faculty of Health and Social Sciences, University of South-Eastern Norway, Kongsberg, Norway
| | - Christina Prinds
- Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark
- Department of Research, University College South Denmark, Haderslev, Denmark
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Bogren M, Kaboru BB, Berg M. Barriers to delivering quality midwifery education programmes in the Democratic Republic of Congo - An interview study with educators and clinical preceptors. Women Birth 2020; 34:e67-e75. [PMID: 32620381 DOI: 10.1016/j.wombi.2020.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/11/2020] [Accepted: 06/11/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND In the Democratic Republic of Congo, the education of midwives at a higher education level has recently been introduced as a strategy to improve maternal and neonatal health. However, little is known about the preconditions for such an education. AIM To explore the barriers to delivering high-quality midwifery education programmes in the DRC and reflect on potential areas for improvement. METHOD Data was collected through 14 focus group discussions with 85 midwifery educators and clinical preceptors, at four higher education institutions delivering midwifery education programmes. Transcribed discussions were inductively analysed using content analysis. FINDINGS Overall, the teaching environment was insufficient. Most midwifery educators and clinical preceptors had deficient competencies, and there was a shortage of didactic resources and equipment as well as poor communication routines between the education institutions and clinical education sites. The barriers varied between locations; for instance, the institution in the country's capital was overall well equipped. CONCLUSION The identified barriers constitute major risks undermining the quality of future midwives in the DRC. Reforming the education of midwives, together with general higher education reform, will be critical for achieving the Sustainable Development Goal on health in the country. We therefore suggest that (i) midwifery educators have at least one academic level above the programme in which they teach, (ii) continuing education be available for midwifery educators and clinical preceptors, (iii) education institutes and clinical sites are fit for purpose, and (vi) routines for clear communication links between education and clinical sites be used.
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Affiliation(s)
- Malin Bogren
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Arvid Wallgrens backe 1, 413 46 Gothenburg, Sweden.
| | - Berthollet Bwira Kaboru
- The Swedish Embassy in Kinshasa, Democratic Republic of Congo, 93 Avenue Roi Baudouin, Kinshasa-Gombe, Democratic Republic of Congo
| | - Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Arvid Wallgrens backe 1, 413 46 Gothenburg, Sweden
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Glodowska M, Stopelli E, Schneider M, Lightfoot A, Rathi B, Straub D, Patzner M, Duyen VT, Berg M, Kleindienst S, Kappler A. Role of in Situ Natural Organic Matter in Mobilizing As during Microbial Reduction of Fe III-Mineral-Bearing Aquifer Sediments from Hanoi (Vietnam). Environ Sci Technol 2020; 54:4149-4159. [PMID: 32157881 DOI: 10.1021/acs.est.9b07183] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Natural organic matter (NOM) can contribute to arsenic (As) mobilization as an electron donor for microbially-mediated reductive dissolution of As-bearing Fe(III) (oxyhydr)oxides. However, to investigate this process, instead of using NOM, most laboratory studies used simple fatty acids or sugars, often at relatively high concentrations. To investigate the role of relevant C sources, we therefore extracted in situ NOM from the upper aquitard (clayey silt) and lower sandy aquifer sediments in Van Phuc (Hanoi area, Vietnam), characterized its composition, and used 100-day microcosm experiments to determine the effect of in situ OM on Fe(III) mineral reduction, As mobilization, and microbial community composition. We found that OM extracted from the clayey silt (OMC) aquitard resembles young, not fully degraded plant-related material, while OM from the sandy sediments (OMS) is more bioavailable and related to microbial biomass. Although all microcosms were amended with the same amount of C (12 mg C/L), the extent of Fe(III) reduction after 100 days was the highest with acetate/lactate (43 ± 3.5% of total Fe present in the sediments) followed by OMS (28 ± 0.3%) and OMC (19 ± 0.8%). Initial Fe(III) reduction rates were also higher with acetate/lactate (0.53 mg Fe(II) in 6 days) than with OMS and OMC (0.18 and 0.08 mg Fe(II) in 6 days, respectively). Although initially more dissolved As was detected in the acetate/lactate setups, after 100 days, higher concentrations of As (8.3 ± 0.3 and 8.8 ± 0.8 μg As/L) were reached in OMC and OMS, respectively, compared to acetate/lactate-amended setups (6.3 ± 0.7 μg As/L). 16S rRNA amplicon sequence analyses revealed that acetate/lactate mainly enriched Geobacter, while in situ OM supported growth and activity of a more diverse microbial community. Our results suggest that although the in situ NOM is less efficient in stimulating microbial Fe(III) reduction than highly bioavailable acetate/lactate, it ultimately has the potential to mobilize the same amount or even more As.
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Affiliation(s)
- M Glodowska
- Geomicrobiology, Center for Applied Geosciences, University of Tübingen, Tübingen 72074, Germany
- Microbial Ecology, Center for Applied Geosciences, University of Tübingen, Tübingen 72074, Germany
| | - E Stopelli
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, Dübendorf CH-8600, Switzerland
| | - M Schneider
- Institute of Applied Geosciences, Karlsruhe Institute of Technology (KIT), Karlsruhe 76131, Germany
| | - A Lightfoot
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, Dübendorf CH-8600, Switzerland
| | - B Rathi
- Hydrogeology, Center for Applied Geosciences, University of Tübingen, Tübingen 72074, Germany
| | - D Straub
- Microbial Ecology, Center for Applied Geosciences, University of Tübingen, Tübingen 72074, Germany
- Quantitative Biology Center (QBiC), University of Tübingen, Tübingen 72074, Germany
| | - M Patzner
- Geomicrobiology, Center for Applied Geosciences, University of Tübingen, Tübingen 72074, Germany
| | - V T Duyen
- Vietnam National University, Hanoi - Key Laboratory of Analytical Technology for Environmental Quality and Food Safety Control (KLATEFOS), Hanoi 10000, Vietnam
| | - M Berg
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, Dübendorf CH-8600, Switzerland
| | - S Kleindienst
- Microbial Ecology, Center for Applied Geosciences, University of Tübingen, Tübingen 72074, Germany
| | - A Kappler
- Geomicrobiology, Center for Applied Geosciences, University of Tübingen, Tübingen 72074, Germany
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Dencker A, Bergqvist L, Berg M, Greenbrook JTV, Nilsson C, Lundgren I. Measuring women's experiences of decision-making and aspects of midwifery support: a confirmatory factor analysis of the revised Childbirth Experience Questionnaire. BMC Pregnancy Childbirth 2020; 20:199. [PMID: 32252679 PMCID: PMC7137445 DOI: 10.1186/s12884-020-02869-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 03/09/2020] [Indexed: 12/20/2022] Open
Abstract
Background Women’s experiences of labour and birth can have both short- and long-term effects on their physical and psychological health. The original Swedish version of the Childbirth Experience Questionnaire (CEQ) has shown to have good psychometric quality and ability to differentiate between groups known to differ in childbirth experience. Two subscales were revised in order to include new items with more relevant content about decision-making and aspects of midwifery support. The aim of the study was to develop new items in two subscales and to test construct validity and reliability of the revised version of CEQ, called CEQ2. Method A total of 11 new items (Professional Support and Participation) and 14 original items from the first CEQ (Own capacity and Perceived safety), were answered by 682 women with spontaneous onset of labour. Confirmatory factor analysis was used to analyse model fit. Results The hypothesised four-factor model showed good fit (CMIN = 2.79; RMR = 0.33; GFI = 0.94; CFI = 0.94; TLI = 0.93; RMSEA = 0.054 and PCLOSE = 0.12) Cronbach’s alpha was good for all subscales (0.82, 0.83, 0.76 and 0.73) and for the total scale (0.91). Conclusions CEQ2, like the first CEQ, yields four important aspects of experience during labour and birth showing good psychometric performance, including decision-making and aspects of midwifery support, in both primiparous and multiparous women.
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Affiliation(s)
- Anna Dencker
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, SE-405 30, Gothenburg, Sweden.
| | - Liselotte Bergqvist
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, SE-405 30, Gothenburg, Sweden.,Department of Obstetrics, Sahlgrenska University hospital, Gothenburg, Sweden
| | - Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, SE-405 30, Gothenburg, Sweden.,Department of Obstetrics, Sahlgrenska University hospital, Gothenburg, Sweden
| | - Josephine T V Greenbrook
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, SE-405 30, Gothenburg, Sweden.,Mason Institute of Medicine, Life Science and the Law, University of Edinburgh, Edinburgh, UK
| | - Christina Nilsson
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Ingela Lundgren
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, SE-405 30, Gothenburg, Sweden.,Department of Obstetrics, Sahlgrenska University hospital, Gothenburg, Sweden
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Abstract
Aim: To summarize, categorize, and describe published research on how birthing room design influences maternal and neonate physical and emotional outcomes. Background: The physical healthcare environment has significant effects on health and well-being. Research indicates that birthing environments can impact women during labor and birth. However, summaries of the effects of different environments around birth are scarce. Methods: We conducted a systematic review, searching 10 databases in 2016 and 2017 for published research from their inception dates, on how birthing room design influences maternal and neonate physical and emotional outcomes, using a protocol agreed a priori. The quality of selected studies was assessed, and data were extracted independently by pairs of authors and described in a narrative analysis. Results: In total, 3,373 records were identified and screened by title and abstract; 2,063 were excluded and the full text of 278 assessed for analysis. Another 241 were excluded, leaving 15 articles presenting qualitative and quantitative data from six different countries on four continents. The results of the analysis reveal four prominent physical themes in birthing rooms that positively influence on maternal and neonate physical and emotional outcomes: (1) means of distraction, comfort, and relaxation; (2) raising the birthing room temperature; (3) features of familiarity; and (4) diminishing a technocratic environment. Conclusions: The evidence on how birthing environments affect outcomes of labor and birth is incomplete. There is a crucial need for more research in this field.
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Affiliation(s)
- Christina Nilsson
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Sweden
| | - Helle Wijk
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.,Quality Assurance and Patient Safety Unit, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Architecture, Chalmers University of Technology, Gothenburg, Sweden
| | - Lina Höglund
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.,Obstetric Unit, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Helen Sjöblom
- Biomedical Library, University of Gothenburg, Sweden
| | - Eva Hessman
- Biomedical Library, University of Gothenburg, Sweden
| | - Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.,Obstetric Unit, Sahlgrenska University Hospital, Gothenburg, Sweden
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Berg M, Goldkuhl L, Nilsson C, Wijk H, Gyllensten H, Lindahl G, Uvnäs Moberg K, Begley C. Room4Birth - the effect of an adaptable birthing room on labour and birth outcomes for nulliparous women at term with spontaneous labour start: study protocol for a randomised controlled superiority trial in Sweden. Trials 2019; 20:629. [PMID: 31744523 PMCID: PMC6862754 DOI: 10.1186/s13063-019-3765-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 09/28/2019] [Indexed: 12/24/2022] Open
Abstract
Background An important prerequisite for optimal healthcare is a secure, safe and comfortable environment. There is little research on how the physical design of birthing rooms affects labour, birth, childbirth experiences and birthing costs. This protocol outlines the design of a randomised controlled superiority trial (RCT) measuring and comparing effects and experiences of two types of birthing rooms, conducted in one labour ward in Sweden. Methods/design Following ethics approval, a study design was developed and tested for feasibility in a pilot study, which led to some important improvements for conducting the study. The main RCT started January 2019 and includes nulliparous women presenting to the labour ward in active, spontaneous labour and who understand either Swedish, Arabic, Somali or English. Those who consent are randomised on a 1:1 ratio to receive care either in a regular room (control group) or in a newly built birthing room designed with a person-centred approach and physical aspects (such as light, silencer, media installation offering programmed nature scenes with sound, bathtub, birth support tools) that are changeable according to a woman’s wishes (intervention group). The primary efficacy endpoint is a composite score of four outcomes: no use of oxytocin for augmentation of labour; spontaneous vaginal births (i.e. no vaginal instrumental birth or caesarean section); normal postpartum blood loss (i.e. bleeding < 1000 ml); and a positive overall childbirth experience (7–10 on a scale of 1–10). To detect a difference in the composite score of 8% between the groups we need 1274 study participants (power of 80% with significance level 0.05). Secondary outcomes include: the four variables in the primary outcome; other physical outcomes of labour and birth; women’s self-reported experiences (the birthing room, childbirth, fear of childbirth, health-related quality of life); and measurement of costs in relation to the hospital stay for mother and neonate. Additionally, an ethnographic study with participant observations will be conducted in both types of birthing rooms. Discussion The findings aim to guide the design of birthing rooms that contribute to optimal quality of hospital-based maternity care. Trial registration ClinicalTrials.gov NCT03948815. Registered 13 May 2019—retrospectively registered.
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Affiliation(s)
- Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University, Box 457, SE-405 30, Gothenburg, Sweden. .,Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, SE-416 50, Gothenburg, Sweden.
| | - Lisa Goldkuhl
- Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University, Box 457, SE-405 30, Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, SE-416 50, Gothenburg, Sweden
| | - Christina Nilsson
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90, Borås, Sweden
| | - Helle Wijk
- Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University, Box 457, SE-405 30, Gothenburg, Sweden.,Quality and Patient Safety Unit, Sahlgrenska University Hospital of Gothenburg, SE-413 45, Gothenburg, Sweden.,Centre for Healthcare Architecture , CVA, Chalmers University of Technology, SE-412 96, Gothenburg, Sweden
| | - Hanna Gyllensten
- Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University, Box 457, SE-405 30, Gothenburg, Sweden.,Centre for Person-Centred Care (GPCC), University of Gothenburg, Box 457, SE-405 30, Gothenburg, Sweden
| | - Göran Lindahl
- Centre for Healthcare Architecture , CVA, Chalmers University of Technology, SE-412 96, Gothenburg, Sweden.,Building Design, Architecture and Civil Engineering, Chalmers University of Technology, SE 412 96, Gothenburg, Sweden
| | | | - Cecily Begley
- School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, 24 D'Olier St, Dublin 2, Ireland
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Patriksson K, Wigert H, Berg M, Nilsson S. Health care professional's communication through an interpreter where language barriers exist in neonatal care: a national study. BMC Health Serv Res 2019; 19:586. [PMID: 31426785 PMCID: PMC6701045 DOI: 10.1186/s12913-019-4428-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 08/13/2019] [Indexed: 11/14/2022] Open
Abstract
Background A number of parents in neonatal care are foreign-born and do not speak the local language, which makes communication between healthcare professionals and parents more difficult. Interpreters can be used when language barriers exist - parent interactions, medical communication and communication about the care of the child. The aim in this study was to examine healthcare professionals’ use of interpreters and awareness of local guidelines for interpreted communication in neonatal care. Method A survey was distributed to all 2109 employees at all 38 neonatal units in Sweden, thus to all physicians, registered nurses and nurse assistants in active service. Data were analysed with descriptive statistics and dichotomized so the professionals were compared in groups of two using the Mantel-Haenszel Chi Square test and Fisher’s Non Parametric Permutation test. Results The survey was answered by 41% (n = 858) representing all neonatal units. The study showed a difference between the professional groups in awareness of guidelines, availability of interpreters, and individual resources to communicate through an interpreter. Nurse assistants significantly lesser than registered nurses (p < .0001) were aware of guidelines concerning the use of interpreters. In emergency communications nurse assistants used authorized interpreters to a significantly lesser extent than physicians (p < .0001) and registered nurses (p < .0001). Physicians used authorized interpreters to a significantly higher extent than registered nurses (p 0.006) and non-authorized interpreters to a significantly lesser extent than registered nurses (p 0.013). In planned communications, nurse assistants used authorized interpreters to a significantly lesser extent than physicians (p < .0001) and registered nurses (p < .0001). Nurse assistants rated their ability to communicate with parents through an interpreter to a significantly lesser extent than physicians (p 0.0058) and registered nurses (p 0.0026). No other significant differences were found. Conclusion The results of the study show insufficient awareness of guidelines in all neonatal units in Sweden. Clinical implications might be to provide healthcare professionals with guidelines and training clinical skills in using interpreters and increasing the availability of interpreters by having interpreters employed by the hospital. Electronic supplementary material The online version of this article (10.1186/s12913-019-4428-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Katarina Patriksson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Arvid Wallgrens Backe, Box 457, S-405 30, Gothenburg, Sweden. .,Division of Paediatrics, NÄL Hospital, S-461 85, Trollhättan, Sweden. .,Norra Älvsborgs Länssjukhus, Lärketorpsvägen, S-46185, Trollhättan, Sweden.
| | - Helena Wigert
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Arvid Wallgrens Backe, Box 457, S-405 30, Gothenburg, Sweden.,Division of Neonatology, Sahlgrenska University Hospital, S-416 85, Gothenburg, Sweden
| | - Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Arvid Wallgrens Backe, Box 457, S-405 30, Gothenburg, Sweden
| | - Stefan Nilsson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Arvid Wallgrens Backe, Box 457, S-405 30, Gothenburg, Sweden
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Uvnäs-Moberg K, Ekström-Bergström A, Berg M, Buckley S, Pajalic Z, Hadjigeorgiou E, Kotłowska A, Lengler L, Kielbratowska B, Leon-Larios F, Magistretti CM, Downe S, Lindström B, Dencker A. Maternal plasma levels of oxytocin during physiological childbirth - a systematic review with implications for uterine contractions and central actions of oxytocin. BMC Pregnancy Childbirth 2019; 19:285. [PMID: 31399062 PMCID: PMC6688382 DOI: 10.1186/s12884-019-2365-9] [Citation(s) in RCA: 119] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 06/17/2019] [Indexed: 01/17/2023] Open
Abstract
Background Oxytocin is a key hormone in childbirth, and synthetic oxytocin is widely administered to induce or speed labour. Due to lack of synthetized knowledge, we conducted a systematic review of maternal plasma levels of oxytocin during physiological childbirth, and in response to infusions of synthetic oxytocin, if reported in the included studies. Methods An a priori protocol was designed and a systematic search was conducted in PubMed, CINAHL, and PsycINFO in October 2015. Search hits were screened on title and abstract after duplicates were removed (n = 4039), 69 articles were examined in full-text and 20 papers met inclusion criteria. As the articles differed in design and methodology used for analysis of oxytocin levels, a narrative synthesis was created and the material was categorised according to effects. Results Basal levels of oxytocin increased 3–4-fold during pregnancy. Pulses of oxytocin occurred with increasing frequency, duration, and amplitude, from late pregnancy through labour, reaching a maximum of 3 pulses/10 min towards the end of labour. There was a maximal 3- to 4-fold rise in oxytocin at birth. Oxytocin pulses also occurred in the third stage of labour associated with placental expulsion. Oxytocin peaks during labour did not correlate in time with individual uterine contractions, suggesting additional mechanisms in the control of contractions. Oxytocin levels were also raised in the cerebrospinal fluid during labour, indicating that oxytocin is released into the brain, as well as into the circulation. Oxytocin released into the brain induces beneficial adaptive effects during birth and postpartum. Oxytocin levels following infusion of synthetic oxytocin up to 10 mU/min were similar to oxytocin levels in physiological labour. Oxytocin levels doubled in response to doubling of the rate of infusion of synthetic oxytocin. Conclusions Plasma oxytocin levels increase gradually during pregnancy, and during the first and second stages of labour, with increasing size and frequency of pulses of oxytocin. A large pulse of oxytocin occurs with birth. Oxytocin in the circulation stimulates uterine contractions and oxytocin released within the brain influences maternal physiology and behaviour during birth. Oxytocin given as an infusion does not cross into the mother’s brain because of the blood brain barrier and does not influence brain function in the same way as oxytocin during normal labour does. Electronic supplementary material The online version of this article (10.1186/s12884-019-2365-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Anette Ekström-Bergström
- School of Health and Education, University of Skövde, Skövde, Sweden. .,Department of Health Sciences, University West, Trollhättan, Sweden.
| | - Marie Berg
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care, University of Gothenburg, Gothenburg, Sweden
| | - Sarah Buckley
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Zada Pajalic
- Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Eleni Hadjigeorgiou
- Faculty of Health Sciences, Cyprus, University of Technology, Limassol, Cyprus
| | - Alicja Kotłowska
- Faculty of Health Sciences with Subfaculty of Nursing and Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Luise Lengler
- Midwifery Research and Education Unit, Hannover Medical School, Hannover, Germany
| | | | - Fatima Leon-Larios
- Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain
| | - Claudia Meier Magistretti
- Department of Social Work Center for Health Promotion and Social Participation, Lucerne University of Applied Sciences and Arts, Luzern, Switzerland
| | - Soo Downe
- Research in Childbirth and Health (ReaCH) group, University of Central Lancashire, Preston, UK
| | - Bengt Lindström
- Norwegian University of Science and Technology, Trondheim, Norway
| | - Anna Dencker
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care, University of Gothenburg, Gothenburg, Sweden
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