Associations between pain thresholds for heat, cold and pressure, and Pain Sensitivity Questionnaire scores in healthy women and in women with persistent pelvic pain

Background The Pain Sensitivity Questionnaire (PSQ) is a self‐rating instrument developed as a time‐ and cost‐saving alternative to quantitative sensory testing (QST). The aims of the study were to assess (a) the associations between PSQ scores and QST in women with persistent pelvic pain and in pain‐free controls and (b) to what extent demographic variables and psychological distress influenced PSQ scores. Methods Fifty‐five healthy women and 37 women with persistent pelvic pain participated. All filled in the PSQ and Hospital Anxiety and Depression Scale and had QST (heat, cold and pressure pain thresholds) performed on six locations on the body. Information on age, body mass index, smoking habits and pain duration were collected. Principal component analysis and orthogonal partial least square regressions were used. Results The patients scored significantly higher on PSQ than the controls. Significant multivariate correlations between pain thresholds and PSQ scores were found only in the patient group. In the patient group, the heat and cold pain thresholds correlated more strongly with PSQ scores than the pressure pain threshold. Conclusions The PSQ score was significantly higher in pelvic pain patients, and correlations between QSTs and the PSQ were only found for patients. Significance The PSQ reflects pain sensitivity in women with PPP and can be used as a non‐invasive and painless way to assess this condition in clinical practice.Funding Agencies|Medical Research Council of Southeast Sweden; Swedish Research Council; County council of Ostergotland; Linkoping University; IMI Paincare</p

Reduced pain thresholds and signs of sensitization in women with persistent pelvic pain and suspected endometriosis

INTRODUCTION: Endometriosis is a gynecological disorder that may cause considerable pelvic pain in women of fertile age. Determining pain mechanisms is necessary in order to optimize the treatment of the disease. The objective of the study was to evaluate pain thresholds in women with persistent pelvic pain with and without confirmed endometriosis, and healthy, unaffected controls, and analyze how pain thresholds in these cohorts related to duration of pelvic pain, quality of life, and symptoms of anxiety and depression. MATERIAL AND METHODS: Pain thresholds for heat, cold and pressure were assessed with quantitative sensory testing on six locations on a reference group of 55 healthy women and on 37 women with persistent pelvic pain who had been admitted for diagnostic laparoscopy on the suspicion of endometriosis. Validated instruments were applied to assess quality of life and symptoms of anxiety and depression. Data were analyzed by means of uni- and multivariate analysis of variance and Spearman's rank-order correlation. RESULTS: The women with persistent pelvic pain had significantly lower pain thresholds compared with the reference women. In the women with pain, no differences were observed in pain thresholds between women with (n = 13) and women without (n = 24) biopsy-proven endometriosis. The duration of pelvic pain correlated significantly positively with reduced pain thresholds, ie, the longer the duration, the more sensitization. In the persistent pelvic pain group, pain thresholds for heat correlated significantly with the Short Form Health Survey 36 dimension of bodily pain, and thresholds for cold correlated with Short Form Health Survey 36 bodily pain and with symptoms of depression. CONCLUSIONS: Our results showed widespread alterations in pain thresholds in women with persistent pelvic pain that are indicative of central sensitization and a time-dependent correlation. Women with pelvic pain and suspicion of endometriosis should probably be treated more thoroughly to prevent or at least minimize the concomitant development of central sensitization.Funding agencies:  Medical Research Council of Southeast Sweden; Region Ostergotland; Linkoping University</p

Trafficking in persons for sexual purposes and international protection : A feminist analysis of the international protection for female victims of trafficking or at risk of being trafficked

Trafficking in persons for sexual purposes is a modern form of slavery which causes serious violation of fundamental human rights. Despite that, trafficking victims are often left without international protection. Furthermore, the majority of the victims of trafficking for sexual purposes are women. In this thesis the author examines the international refugee law from a feminist perspective to determine why some actions are capable of international attention and protection while others are not. The international regulation for combating trafficking, so called anti-trafficking measures, are rather comprehensive. However, these measures focus on eliminating trafficking through prevention and prosecution and do not give much, if any, protection to the victims of trafficking. Instead protection can be found in the refugee convention and the complementary protection under non-refoulement. The refugee law has been criticised for its gender bias and male norm which affect women’s possibility to be granted international protection. As a result of this, persecution or other serious harm that mostly affects women, such as trafficking for sexual purposes, are seen as gender-specific and not as a part of the core definition of a refugee. Trafficking victims from the EU who seek protection in another country in the union faces the most obstacles, since citizens from the EU are not recognised to be in need of international protection because of the presumption that countries in the EU are democratic and safe. This presumption is questionable since the majority of the trafficking victims in the Union are from a country in the EU. The feminist analysis on the refugee law aim to examine to what extent women’s need for international protection in relation to trafficking is fulfilled

Trafficking in persons for sexual purposes and international protection : A feminist analysis of the international protection for female victims of trafficking or at risk of being trafficked

Trafficking in persons for sexual purposes is a modern form of slavery which causes serious violation of fundamental human rights. Despite that, trafficking victims are often left without international protection. Furthermore, the majority of the victims of trafficking for sexual purposes are women. In this thesis the author examines the international refugee law from a feminist perspective to determine why some actions are capable of international attention and protection while others are not. The international regulation for combating trafficking, so called anti-trafficking measures, are rather comprehensive. However, these measures focus on eliminating trafficking through prevention and prosecution and do not give much, if any, protection to the victims of trafficking. Instead protection can be found in the refugee convention and the complementary protection under non-refoulement. The refugee law has been criticised for its gender bias and male norm which affect women’s possibility to be granted international protection. As a result of this, persecution or other serious harm that mostly affects women, such as trafficking for sexual purposes, are seen as gender-specific and not as a part of the core definition of a refugee. Trafficking victims from the EU who seek protection in another country in the union faces the most obstacles, since citizens from the EU are not recognised to be in need of international protection because of the presumption that countries in the EU are democratic and safe. This presumption is questionable since the majority of the trafficking victims in the Union are from a country in the EU. The feminist analysis on the refugee law aim to examine to what extent women’s need for international protection in relation to trafficking is fulfilled

Disclosing the invisible : experiences, outcomes and quality of endometriosis healthcare

Introduction: Many women with endometriosis report that their symptoms are normalized and trivialized when they seek medical care and they often experience diagnostic delays, ineffective treatments and physiological, psychological and social consequences. However, there is a knowledge gap when it comes to women’s experiences of different aspects of endometriosis healthcare, and the quality of that care. Aim: The aim of this thesis was to identify, describe and analyse the experiences, encounters and outcomes of endometriosis healthcare from different perspectives. Design and Method: This thesis is a summary of four studies with different methods and designs. Study I and II were qualitative interview studies in which nine women with a laparoscopy-verified endometriosis diagnosis (study I) and 25 healthcare professionals (HCPs) (study II) described their experiences of healthcare encounters related to endometriosis symptoms. The interviews were analysed using interpretive phenomenology (study I) and conventional content analysis (study II). Study III was a cross-sectional observational comparative study measuring pain thresholds, health-related quality of life (HRQoL) and symptoms of anxiety and depression using quantitative sensory testing (QST) and questionnaires in order to determine pain thresholds in healthy women (n=55) and women with persistent pelvic pain (PPP), with (n=14) and without (n=23) a confirmed diagnosis of endometriosis. The correlations between pain thresholds and duration of PPP, HRQoL and symptoms of anxiety and depression were also analysed. Study IV was a quantitative observational study using register data from the National Quality Register for Gynaecological Surgery. Patient-reported experience measures (PREM) and patient-reported outcome measures (PROM) after benign hysterectomy were analysed and compared in women with and without PPP and endometriosis (study IV). Results: The results of the thesis are summarized in three themes: The struggle to visualize the pain, The endometriosis diagnosis as a key to understanding and enduring persistent pelvic pain and Healthcare encounters as potentially life changing. In the first theme, women and HCPs described the healthcare encounters concerning endometriosis symptoms as troublesome (study I, II). The women struggled with disclosing, visualizing and communicating their hidden pain to the HCPs (study I), and HCPs expressed insecurity and limited knowledge when caring for these women (study II). Study III showed widespread reduced pain thresholds among women with PPP compared with healthy controls, and a significant positive correlation between duration of PPP and reduced pain thresholds . Study III also showed a reduced HRQoL and higher prevalence of anxiety and depressive symptoms among women with PPP, which were also described by the women (study I). The importance of getting a diagnosis was described in the second theme by both women and HCPs (study I, II), but women with PPP with and without endometriosis diagnosis did not differ significantly in their pain thresholds or psychosocial outcomes in study III. Likewise, women with PPP with and without endometriosis gave more equal PREM and PROM answers than women in the pain-free comparison group. Overall, women undergoing hysterectomy on benign indications were satisfied with the experience and outcomes of the surgery (study IV). As described in the last theme, healthcare encounters could be constructive or destructive. Positive experiences could make the symptoms easier to endure. The constructive encounters were often characterized by a holistic approach and a care structured in multidisciplinary teams. Conclusion and clinical implications: The results suggest that PPP should be taken seriously and treated actively in order to minimize the risk of physiological and psychological consequences, such as reduced pain thresholds, lower HRQoL and symptoms of anxiety and depression. Unrelieved PPP could also be an explanatory factor for long-term physiological consequences, such as lower PREM and PROM after hysterectomy. High-quality endometriosis healthcare should provide an interaction of physical, psychological and social factors. If women experience that HCPs acknowledge their pain and the effect of pain on HRQoL and mental health, and are offered proper pain-relieving treatment, healthcare encounters could change their lives

Supporting girls with painful menstruation - A qualitative study with school nurses in Sweden

Background: Painful menstruation is common among girls. To optimize school nurses' work more knowledgeabout their experiences of supporting these girls is needed. The aim of this study was to describe school nurses'experiences of supporting girls with menstrual pain.Methods: Interviews were conducted with 15 school nurses in Sweden and analyzed using thematic analysis.Results: Three themes emerged: Taking menstrual pain seriously, Being a disseminator of knowledge, andExternal conditions for conducting professional work as a school nurse.Conclusion: School nurses felt competent in supporting girls with menstrual pain. However, they lacked struc-tural, written guidelines and routines for how to treat, support, follow-up and refer girls with menstrual pain.Practice implications: School education about menstruation and sexual health needs to be strengthened. Cooper-ation with other healthcare facilities and networks with other school nurses should be increased. Specific guide-lines on how to support girls with menstrual pain should be implemented

Preferensaktier och obligationer som fastighetsfinansiering

The recent turbulence in the financial markets has contributed to the banks becoming more restrictive to lend to real estate financing. Deleveraging in Europe's banking sector has also contributed to banks reducing their leverage and increasing capital adequacy to meet the new requirements. Loan-to-value ratios in real estate loans have fallen while banks' interest margins have increased, which has made property investors to look for alternative sources of funding in the capital markets. The two most interesting forms of financing for real estate right now is bonds and preferred shares as they fit property companies that generate stable and predictable cash flows. A bond is an interest-bearing debenture certifying that the purchaser has lent money to the company that issued the bond. It's a very safe security since the only reason you would not be able to get your money back is if the company goes bankrupt. Preference shares structure is something between an ordinary share and a bond. The preference share generates an annual fixed predetermined dividend paid before common shareholders receive dividend which makes it much more predictable and stable relative to an ordinary share. Demand for investing in bonds and preference shares is considered good since equity investors have shown strong interest and these securities offer a good risk adjusted return The property companies that has issued both bonds and preferred shares have been selected to be further examined in this paper. The property companies currently consist of Corem Property Group, Fastighets AB Balder, Klövern AB and Sagax AB. Since 2007, all of these companies diversified their financing primarily through the issuing of preference shares and bonds, and the majority has moved towards a greater proportion of equity. It is clear that alternative sources of financing such as preferred shares and bonds will become more common in the future as it is abroad.De senaste årens oro på finansmarknaden har bidragit till att bankerna har blivit mer restriktiva till att ge krediter till fastighetsfinansiering. Skuldnedväxlingen i den europeiska banksektorn har också bidragit till att bankerna minskar sin skuldsättningsgrad och ökar kapitaltäckningen för att möta nya krav. Belåningsgraderna vid fastighetskrediter har sjunkit samtidigt som bankernas räntemarginaler har ökat vilket har fått fastighetsinvesterare att söka sig till alternativa finansieringskällor på kapitalmarknaden. De två kanske mest intressanta finansieringsformerna för fastigheter just nu är obligationer och preferensaktier då de passar fastighetsbolag bra som genererar stabila och förutsägbara kassaflöden. En obligation är ett räntebärande skuldebrev som intygar att köparen har lånat ut pengar till det företag som emitterat obligationen. Det är väldigt säkra värdepapper då den enda anledningen till att man inte skulle kunna få tillbaka sina pengar är om företaget går i konkurs. Preferensaktiers struktur befinner sig i det närmaste mellan en vanlig stamaktie och en obligation. Preferensaktien ger en fast årlig förutbestämd utdelning som betalas ut före stamaktieägarna får utdelning vilket gör att den är mer förutsägbar och stabil i förhållande till en stamaktie. Efterfrågan på att investera i obligationer och preferensaktier får anses god då investerare vid emissioner har visat ett starkt intresse och nämnda värdepapper erbjuder en bra riskjusterad avkastning De fastighetsbolag som har emitterat både obligationer och preferensaktier har valts ut att undersökas närmare i denna uppsats. Dessa fastighetsbolag består i dagsläget av Corem Property Group, Fastighets AB Balder, Klövern AB och Sagax AB. Sedan år 2007 har alla dessa bolag diversifierat sin finansiering främst genom emitterande av preferensaktier och obligationer och majoriteten har gått mot en större andel eget kapital. Det kan konstateras att alternativa finansieringskällor som preferensaktier och obligationer kommer bli vanligare i framtiden vilket det är utomlands

Associations between relationship status and mental well-being in different life phases from young to middle adulthood

The aim of this study was to assess the associations between relationship status and mental well-being in four different phases during the life course, and to identify whether relationship quality moderated these associations. We used a broader concept of relationship status (instead of marital status) and also included the positive dimension of mental health. Participants in a Finnish cohort study were followed up at ages 22 (N = 1,656), 32 (N = 1,471), 42 (N = 1,334), and 52 (N = 1,159). Measures in all study panels covered relationship status (marriage, cohabitation, dating, single and divorced/widowed), Short Beck Depression Inventory (S-BDI), self-esteem (seven items) and relationship quality (six items). Analyses were carried out using linear regression. Compared to marriage, being single or being divorced/widowed were associated with depressive symptoms at every age in men. For women, in turn, being single - but not being divorced/widowed - was associated with depressive symptoms. Among men, being single or being divorced/widowed were also associated with lower self-esteem at age 32, 42 and 52, but in women, only one association between lower self-esteem and being single was found at age 32. Of the age stages, the age 32 is highlighted in men, at which point all relationship statuses were risk factors compared to marriage. There were only few indications of the moderating role of the relationship quality. Compared to marriage, being single or being divorced/widowed were quite consistently associated with poorer mental well-being during the life course, especially among men. For dating and cohabiting the associations were more fragmented depending on age and gender; particularly among women, these relationship statuses tended not to differ from marriage in terms of mental well-being. These observations on mental well-being across five relationship statuses are important in our contemporary society, where the number of marriages is decreasing, and other forms of relationships are becoming more common.Peer reviewe

Skönlitteratur ett läromedel? : - Sju författare och en litteraturpedagog resonerar om skönlitteraturens betydelse i skolan

The essay concerns the role of fiction in school. The research questions is; what is “readable”, what does the authors think of teacher's task to develop students' literacy skills through fiction and how do the authors think of the teachers' task of using fiction in school. The questions give a basis that describes the role of fiction in school today based on the authors' perspective. We have chosen to use the open surveys as a method. In addition to the questionnaire, we have chosen to interview two authors when requested. The results show that from the authors perspective literature plays an important role in the school. The authors want the teachers to take a bigger responsibility for literature in the school in order to offer the students fiction that is interesting and readable. They also think that by using literature frequently, and by engaging the authors in lesson about fiction the students reading will improve