Parents' expectations, experiences and reactions to a routine ultrasound examination during pregnancy

The overall aim of this thesis was to describe parents’ expectations, experiences and reactions to a routine ultrasound examination during the second trimester of pregnancy and to develop, test and use a questionnaire. The aim was also to conceptualize the parents’ experiences and ways of handling the situation when the diagnosis was a non-viable fetus. The data for this thesis was collected between 2001 and 2007. The work started qualitatively and inductively with interviews using the Grounded Theory method for data collection and analysis of 22 women’s and 22 men’s expectations experiences and reactions to routine ultrasound examination with normal findings. The results were used during the instrument development of the PEER-U questionnaire. The procedure included a pilot study where 126 parents answered both parts of the questionnaire. Factor analysis and statistical tests for validity and reliability were performed. The PEER-U questionnaire was then used for deductive testing of the results of the qualitative study with a one year cohort in which 2183 parents (1258 women and 925 men) answered both parts of a two-part (before and after ultrasound) questionnaire. The questionnaire included the PEER-U scale with an ultrasound specific state of mind index and the scales state and trait anxiety (STAI) and sense of coherence (SOC) as well as demographics. A follow-up Grounded Theory interview study was performed with 15 parents from the cohort who had been given a diagnosis of a non-viable fetus. The results from the qualitative parts showed that the parents expected to get a confirmation of a normal and apparently healthy child during the ultrasound. For parents with normal results, the ultrasound was experienced as very positive and they started to feel like a family. Afterwards these parents were left with a feeling of relief. Parents who received the diagnosis of a non-viable fetus experienced a collision between hopes and facts. They felt deceived by a false sense of security as the condition was unexpectedly discovered during a routine examination. These parents required clear information and focused on what would happen next. The need for a general and individual care plan was evident as was the need for a follow-up initiated by the care-givers. The development of the PEER-U questionnaire resulted in 30 items to measure parents’ expectations and 23 items to measure their experiences and reactions. Internal consistency, calculated by Cronbach’s coefficient alpha, was 0.77 for the “before ultrasound” part of the PEER-U questionnaire and 0.75 for the “after ultrasound” part. The results from the cohort study showed that both parents’ degree of worried state of mind decreased after the ultrasound but their sense of coherence remained stable. In a gender comparison the women’s state anxiety decreased significantly while the men showed no significant change. Before the examination the women showed a significantly higher degree of worried state of mind in relation to ultrasound than the men while afterwards the situation was reversed. The findings show that parents easily accept fetal diagnosis that gives them a visual evidence of the fetus. This should be remembered when new forms of fetal diagnosis are introduced in the future. Their state of mind in relation to ultrasound can be measured with the ultrasound specific state of mind index. Further research might improve the questionnaire and make it better adapted for use when the parents have experienced adverse findings during a routine ultrasound examination

Is Dark Matter made up of Massive Quark Objects?

We suggest that dark matter is made up of massive quark objects that have survived from the Big Bang, representing the ground state of ``baryonic'' matter. Hence, there was no overall phase transition of the original quark matter, but only a split-up into smaller objects. We speculate that normal hadronic matter comes about through enforced phase transitions when such objects merge or collide, which also gives rise to the cosmic gamma-ray bursts.Comment: 8 pages Latex, no figures; to be published in the Proceedings of Dark '98, Heidelberg, July 199

Midwives' attitudes to and knowledge about a newly introduced foetal screening method.

A number of screening procedures are offered by midwives during pregnancy and the number is increasing rapidly. The measurement of nuchal translucency is a fairly new ultrasound method for antenatal screening, primarily for Down syndrome. The results give a better risk calculation than maternal age alone and can mean a decrease in the number of invasive procedures needed to identify this syndrome prenatally. The aim of this study was to gain insight into the midwives' point of view concerning the introduction of the method in two different hospitals. In one hospital it had been introduced as part of a research project while in the other it had been integrated as an offer in the antenatal care programme. A questionnaire was sent to the 80 midwives working in the antenatal clinics serving these two hospitals. A total of 79% of the questionnaires were answered. The results indicate that in both districts, the similarities are greater than the differences with regard to the midwives' education, knowledge and their own opinions of their ability to inform pregnant women about the method. Although most of the respondents were positive to it, a number of midwives felt that, in general, information about foetal diagnosis was a difficult part of their work, mentioning both ethical and practical aspects. This highlights the need for continuing education, standardized policy and an ongoing ethical debate

Gamma-Ray Bursts from Primordial Quark Objects in Space

We investigate the possibility that gamma-ray bursts originate in a concentric spherical shell with a given average redshift and find that this is indeed compatible with the data from the third BATSE (3B) catalog. It is also shown that there is enough freedom in the choice of unknown burst properties to allow even for extremely large distances to the majority of bursts. Therefore, we speculate about an early, and very energetic, origin of bursts, and suggest that they come from phase transitions in massive objects of pure quark matter, left over from the Big Bang.Comment: 11 pages, Latex, 3 postscript figures, to be publ in the Proc of the Joint Meeting of the Networks 'The Fundamental Structure of Matter' and 'Tests of the Electroweak Symmetry Breaking', Ouranoupolis, Greece, May 199

Analysis of midwifery students' written reflections to evaluate progression in learning during clinical practice at birthing units.

Written daily reflections during clinical practice on birthing units have been used during several years in midwifery education at Lund University, Sweden. However, the usefulness of these reflections for evaluation of progression in learning and professional development of students has to date not been evaluated. In order to analyse written reflections, two taxonomies developed by Bloom and Pettersen have been applied to the texts. Progression in the professional development of midwifery students can be seen through levels of complexity in cognitive and psycho-motor learning areas and also in the description of learning situations. Progression can be seen from a basic description of facts in simple situations at the beginning of the students' practice to a complex description of complicated situations towards the end of the practice. Written daily reflections appear to be a suitable method to help students to reflect in a structured way, thereby helping their professional development. Reflections can help clinical supervisors to understand the needs of the individual student and to support their knowledge accruement. Daily written reflections on clinical practice can be of use in other health education programs

A qualitative study of mothers' and fathers' experiences of routine ultrasound examination in Sweden.

Objective: to conceptualise mothers’ and fathers’ thoughts and feelings before, during and after the routine ultrasound examination during the second trimester of pregnancy. Design, setting and participants: a grounded theory study. Two to four weeks after their ultrasound examination, 22 Swedish mothers and 22 fathers were interviewed in their homes. Findings: the basic social process was confirmation of a new life. The four categories, visualising—the evident option, overwhelming to see life; becoming a family and reassuring, all represent a time span in the parents’ process towards confirmation of a new life. The caregivers’ way of assisting and supporting the process by information and treatment was very important to parents. Key conclusions and implications for practice: as the ultrasound examination is perceived as a confirmation of a new life it is an extremely important milestone for both parents so the father should be encouraged to participate. It is an important and unique event for both women and men in their process towards becoming parents. This process was largely dependent on the treatment the parents had received during the examination and the information given. The findings of this study are of interest to midwives and others who perform ultrasound examinations as it explains why adequate time must be allowed for the examination and the importance of the information given before hand. When introducing new forms of fetal diagnosis in the future it should be kept in mind that this might irrevocably be accepted by parents who long for confirmation of a new life

Barnen vi blundar för - Om den rättsliga regleringen avseende barn som bevittnar våld mot närstående

Mäns våld mot kvinnor är ett omfattande samhällsproblem. En aspekt av detta problem som inte har uppmärksammats i samma utsträckning är att barn ofta bevittnar våldet, eftersom att det vanligtvis sker i hemmet. Det är svårt att fastställa hur många barn som bevittnar våld mot närstående, men studier visar att ungefär 100 000–200 000 barn i Sverige är drabbade. Denna framställning syftar till att, utifrån ett barnperspektiv, undersöka och analysera hur barn som bevittnar våld mot närstående uppmärksammas och hanteras i svensk gällande rätt. Här ingår att utreda hur barnen påverkas av sina upplevelser, vilka rättigheter barn tillskrivs samt hur synen på barn och barns rättigheter har förändrats i Sverige genom historien. En viktig del i denna framställning är även redogörelsen för kriminaliseringsprinciper, detta för att analysera vilka möjligheter och förutsättningar det finns att införa ett straffrättslig skydd för barn som bevittnar våld mot närstående. För att kunna besvara de frågeställningar uppsatsen behandlar används en rättsdogmatisk och en rättsanalytisk metod. Genom forskning på området har barnen samt hur de påverkas av att bevittna våld mot närstående synliggjorts alltmer och det har konstaterats att de utsätts för psykisk misshandel. Barnen drabbas av omfattande skador, främst psykiska, både på kort och på lång sikt, inte minst på grund av att de befinner sig i en beroendesituation där de är totalt utelämnade och skyddslösa. Det har konstaterats att barn som bevittnar våld i nära relationer kan lida samma psykiska skador som de barn som utsätts för direkt fysiskt våld. Trots detta är det inte en kriminaliserad gärning enligt dagens lagstiftning att utsätta barn för att bevittna våld mot närstående. Detta resulterar i att barnen inte är att anses som målsägande och att de därmed går miste om processuella rättigheter i den efterföljande rättsliga processen. Sedan 2006 har dock barn som bevittnat våld mot närstående brottofferstatus enligt socialtjänstlagen samt, under vissa förutsättningar, rätt till brottsskadeersättning från staten. I framställningen konstateras att låta barn bevittna våld mot närstående är, utifrån principer för kriminalisering, en gärning som både kan och bör kriminaliseras. Anledningen till att så inte är fallet tycks främst vara den allmänna synen på barn samt hur vi traditionellt begränsar vad som utgör en ”skada” i straffrättslig mening. Med beaktande av de skador barnen riskerar att lida kan det argumenteras för att barnets status som vittne framför målsägande inte är giltig på ett rationellt sätt. En kriminalisering av att utsätta barn för att bevittna våld mot närstående hade inneburit ett viktigt ställningstagande och en markering från lagstiftarens sida – att ett sådant våldshandlande inte är acceptabelt – även i förhållande till barnen. Barnen skulle troligtvis uppmärksammas i högre utsträckning, inte minst i polisanmälningar och i förundersökningar. Upprättelse och bekräftelse för barnen är andra viktiga faktorer som talar för en kriminalisering. Genom en kriminalisering skulle barnen även få möjlighet att tillskrivas de rättigheter som följer av en målsägandestatus, som exempelvis förordnandet av en särskild företrädare samt skadestånd från gärningsmannen. Vidare hade införandet av ett nytt straffbud som tar sikte på psykisk misshandel av barn inneburit en bättre överrensstämmelse med de rättigheter som barnet tillskrivs genom nationell rätt och barnkonventionen. I längden skulle en kriminalisering förhoppningsvis även kunna bidra till att förändra vuxnas syn på att låta barn bevittna våld mot närstående och därigenom ha en handlingsdirigerande verkan.One of the most relevant and major issues in todays’ society is men’s violence against women. Another issue in relation to domestic violence, which has not been addressed to the same extent, is that children often witness this violence since it usually takes place at home. It is difficult to estimate how many children witness domestic violence, but studies show that approximately 100,000 - 200,000 children in Sweden are affected. The purpose of this thesis is to, from a child’s perspective, examine and analyze how children who witness domestic violence are attended to and treated within the Swedish law. This includes examining how these children are affected by their experiences, children’s rights, and how the society’s general view on children and their rights has changed in Sweden through history. An important part of this thesis is also to present principles of criminalization and thereby analyze the possibility of introducing criminal protection for children who witness domestic violence. In order to answer the issues set out in this thesis, a legal as well as a legal analysis approach is used. According to research studies in the relevant field, more efforts have been made to investigate how children are affected by witnessing domestic violence. More recent studies have shown that such children are often subjected to psychological abuse and suffer from extensive injuries, mainly psychological, both short-term and long-term. This is mainly due to the fact that the affected children are in a state of dependence towards their parents and thus, they are completely vulnerable and defenseless. Even though research studies have shown that children who witness domestic violence are affected in the same way as children who are being exposed to physical violence, allowing children to witness domestic violence is not a criminalized act according to Swedish legislation. As a result, the affected children are not entitled to the same rights as an injured party during legal proceedings. However, according to the Swedish Social Services Act it was established in 2006 that children who witness domestic violence are victims of crime. Furthermore, under certain criteria, the affected children are entitled to financial compensation from the Swedish state. As argued in this thesis and based on general principles of criminalization, a conclusion can be made that allowing children to witness domestic violence is an act that both could and should be criminalized. The reasons behind why this act not yet being criminalized is mainly due to the society’s general view on children and how the society traditionally defines what constitutes "harm" in a criminal law perspective. Considering the grave injuries the affected children suffer from, it seems that this categorization is not valid in a reasonable way. To criminalize this act would constitute an important statement that allowing children to witness domestic violence is not acceptable at any time. Furthermore, a criminalization would most likely also lead to attention being paid to these children to a greater extent, especially as regards reports of offences and preliminary investigations. An important implication is also that the affected children would gain satisfaction and acknowledgement. Through a criminalization, the affected children would be entitled to the same rights as the injured party during the legal proceedings, such as e.g. a special representative for children and damages from the offender. An expressed criminalization of psychological child abuse would be much more in accordance with children’s rights as stated in national law and by the UN Convention on the Rights of the Child. In a long-term perspective, a criminalization could hopefully also contribute to adults changing their views on allowing children to witness domestic violence and thereby lead to a change in behavior

Policy-centric integration and dynamic composition of autonomic computing techniques

This paper presents innovative work in the development of policy-based autonomic computing. The core of the work is a powerful and flexible policy-expression language AGILE, which facilitates run-time adaptable policy configuration of autonomic systems. AGILE also serves as an integrating platform for other self-management technologies including signal processing, automated trend analysis and utility functions. Each of these technologies has specific advantages and applicability to different types of dynamic adaptation. The AGILE platform enables seamless interoperability of the different technologies to each perform various aspects of self-management within a single application. The various technologies are implemented as object components. Self-management behaviour is specified using the policy language semantics to bind the various components together as required. Since the policy semantics support run-time re-configuration, the self-management architecture is dynamically composable. Additional benefits include the standardisation of the application programmer interface, terminology and semantics, and only a single point of embedding is required

A Quark-Matter Dominated Universe

We present a new scenario for the development of the Universe after the Big Bang, built on the conjecture that a vast majority of the primordial quark matter did not undergo a phase transition to normal nuclear matter, but rather split up into massive quark objects that remained stable. Hence, such primordial quark matter would make up the so-called dark matter. We discuss, mostly in qualitative terms, the consequences for galaxy formation, the origin of normal matter, the occurrence of massive black-holes in galactic centres and the cosmic gamma-ray bursts.Comment: 32 pages Latex, 3 postscipt figure