Yhteisön merkitys motivaatioon online- treenivalmennuksessa

Yhteisöjen merkitys hyvinvoinnin ja urheilun parissa on korostunut. Kuluttajat hakevat tietoa, inspiraatiota ja motivaatiota muiden kuluttajien kautta. Vuorovaikutustilanteissa muodostuvat sosiaaliset tunteet ja kokemukset ovatkin merkittävässä roolissa yhteisöllisessä kuluttamisessa. Hyvinvoinnin ja liikunnan korostumisen myötä niihin liittyvät palvelut ovat olleet kasvussa viimeisten vuosien aikana. Kuluttajien lisääntynyt kiinnostus hyvinvointia kohtaan sekä teknologinen kehitys ovat luoneet kuluttajille uusia mahdollisuuksia vuorovaikutukselle, kuten esimerkiksi sen, että kommunikaatio on siirtynyt fyysisen läsnäolon sijaan enemmän verkkoon. Erilaisilla vuorovaikutustilanteilla on myös merkitystä kuluttajan henkilökohtaiseen motivaatioon. Tässä tutkimuksessa haluttiin selvittää, miten yhteisöllisyys nousee esille kuluttajien motivaatiota tarkastellessa. Tarkoituksena oli saada selville, minkälaisia yhteisöille ominaisia jaettuja käytäntöjä pystytään tunnistamaan, ja minkälaiset motivaatiotekijät nousevat esille näiden käytäntöjen sisällä. Tässä kohtaa tarkastelu rajattiin online-treeniyhteisöihin. Tutkimuksen teoreettinen viitekehys rakennettiin yhteisöjä, yhteisöllistä kuluttamista sekä motivaatiota käsittelevien tutkimusten ja kirjallisuuden pohjalta. Tutkimus toteutettiin kvalitatiivisena tutkimuksena, jonka aineisto kerättiin teemahaastatteluiden avulla. Tutkimuksessa esitettyjen jaettujen käytäntöjen pohjalta voitiin tunnistaa lukuisia erilaisia kuluttajia motivoivia tekijöitä. Haastattelutulosten perusteella voidaan sanoa, että kuluttajat motivoituivat enemmän sisäisistä kuin ulkoisista tekijöistä. Tutkimuksessa havaittiin, että yhteisöllä on merkitystä kuluttajan motivaatioon online-treeniyhteisöissä. Eniten motivoiviksi tekijöiksi tunnistettiin vertailu muihin kuluttajiin, aiheesta keskustelu sekä kannustaminen. Motivaatiota tukevien ja vahvistavien tekijöiden lisäksi tunnistettiin myös tekijöitä, jotka heikentävät kuluttajan motivaatiota. Jotta yhteisön merkitystä motivaation kannalta saadaan vahvistettua, tulee yhteisöissä keskittyä mahdollisimman luotettavan ja avoimen ilmapiirin muodostamiseen

Intrapartum azithromycin to prevent maternal and neonatal sepsis and deaths : A systematic review with meta-analysis

Objectives: A systematic review with met-analysis was performed to summarise the evidence on the effect of intrapartum azithromycin on maternal and neonatal infections and deaths. Search strategy: PubMed, Scopus and Web of Science databases were searched in March 2023. Selection criteria: Randomised controlled trials comparing intrapartum single-dose of azithromycin with placebo. Data collection and analysis: Maternal infections, maternal mortality, neonatal sepsis, neonatal mortality. We used the random-effects Mantel–Haenszel method to calculate risk ratios (RR) with 95% confidence intervals (95% CI). We assessed risk of bias of the included studies and estimated the evidence certainty using the GRADE approach. Main results: After screening 410 abstracts, five studies with 44 190 women and 44 565 neonates were included. The risk of bias was low in four and had some concerns in one of the studies. The risk of endometritis was 1.5% in the azithromycin group and 2.3% in the placebo group (RR 0.64, 95% CI 0.55–0.75), and the evidence certainty was high. The respective risk for chorioamnionitis was 0.05% and 0.1% (RR 0.50, 95% CI 0.22–1.18; evidence certainty moderate). The wound infection rate was lower in the azithromycin group (1.6%) than in the placebo group (2.5%), RR 0.52 (95% CI 0.30–0.89; moderate certainty evidence). The maternal sepsis rate was 1.1% in the azithromycin group and 1.7% in the placebo group (RR 0.66, 95% CI 0.56–0.77; evidence certainty high). Mortality rates did not show evidence of a difference (0.09% versus 0.08%; RR 1.26, 95% CI 0.65–2.42; moderate certainty evidence). The neonatal mortality rate was 0.7% in the azithromycin group and 0.8% in the placebo group (RR 0.94, 95% CI 0.76–1.16; moderate certainty evidence). The neonatal sepsis rate was 7.6% in the azithromycin group and 7.4% in the placebo group (RR 1.02, 95% CI 0.96–1.09; moderate certainty evidence). Conclusions: Intrapartum administration of azithromycin to the mother reduces maternal postpartum infections, including sepsis. Impact on maternal mortality remains undecided. Azithromycin does not reduce neonatal sepsis or mortality rates.Peer reviewe

Use of labor analgesia in trials of labor after previous cesarean section : A nationwide register-based analysis in Finland

Objectives: The literature concerning the overall use of labor analgesia among women with trials of labor after cesarean section (TOLAC) is lacking. The primary aim of this study is to report the rate of different labor analgesia methods among women with TOLAC. The secondary aim was to compare the use of labor analgesia between women with the first TOLAC and control group consisting of nulliparous women. Study design. Data from the National Medical Birth Register was used to evaluate the usage of labor analgesia in TOLACs. The use of labor analgesia in the first TOLAC is compared to the pregnancies of nulliparous women. The analgesia methods were stratified into neuraxial analgesia, pudendal, paracervical, nitrous oxide, other medical, other non-medical, and no analgesia. These are analyzed as categorized dichotomy (yes or no) variables. Results: A total of 38 596 TOLACs as second pregnancy of the mother was found during our study period. The control group consisted of a total of 327 464 pregnancies of nulliparous women. Epidural analgesia (61.6% vs 67.1%), nitrous oxide (56.1% vs 62.0%), and non-medical analgesia (30.1% vs 35.0%) were less consumed among women with TOLAC. The rate of spinal analgesia was higher among women with TOLAC (10.1% vs 7.6%) when compared to the control group. However, when only vaginal deliveries were included, the rate of labor analgesia increased especially in the TOLAC group. Conclusions: The main finding of this study is that women with TOLAC had a generally lower rate of labor analgesia. However, the rate of spinal analgesia was higher among women with TOLAC when compared to the control group, however. The results of this study inform midwives, obstetricians, and anesthesiologists on current practices and how to improve the analgetic treatment in TOLAC.publishedVersionPeer reviewe

Fear of childbirth and use of labor analgesia : A nationwide register-based analysis in Finland

Objective: To calculate the rates of labor analgesia among women with fear of childbirth (FOC) in multiparous and nulliparous women, because FOC might be associated with higher rates of labor analgesia. Methods: In this retrospective register-based cohort study, data from the National Medical Birth Register was used to evaluate the usage of labor analgesia in pregnancies with FOC, when compared with those without. The analgesia methods were stratified into neuraxial analgesia, pudendal, paracervical, nitrous oxide, other medical, other non-medical, and no analgesia. Results: A total of 19 285 pregnancies with diagnosed maternal FOC were found during our study period. The control group consisted of 757 997 pregnancies without diagnosed maternal FOC. Nulliparous women with diagnosed FOC had a higher rate of epidural analgesia (70.2% vs 67.1%), spinal analgesia (12.3% vs 7.6%), and pudendal block (17.6% vs 9.6%). Multiparous women with FOC had a notably higher rate for epidural analgesia (47.0% vs 29.0%). Conclusion: The main finding in this study was that women with diagnosed FOC had a higher rate of labor analgesia. The results of this study can be used by midwives, obstetricians, and anesthesiologists to provide optimal pain relief for mothers with FOC.publishedVersionPeer reviewe

Severe birth injuries in neonates and associated risk factors for injury in mothers with different types of diabetes in Finland

Objective To examine severe birth-related injuries in neonates among mothers with different types of diabetes. Methods Retrospective cohort study based on Finnish Medical Birth Register data from 2004 to 2017. The study included singleton neonates born vaginally with cephalic presentation (n = 623 649) after 35(+0) weeks of gestation. The primary outcome variable was severe birth injury. Incidences, crude and adjusted odds ratios, and probabilities in regression analysis were calculated for different types of diabetes. Results There were 1952/623 649 (0.3%) severe birth injuries of which brachial plexus injury occurred most frequently. The injury incidence was highest in neonates of women with type 1 or type 2 diabetes, 42/1659 (2.5%) and 10/548 (1.8%), respectively. For gestational diabetes, the injury incidence was comparable to non-diabetic women: 422/77 810 (0.5%) and 1478/543 632 (0.3%), respectively. Shoulder dystocia, high birthweight, and vacuum-assisted delivery were associated with the highest probability for injury. Birthweight and obesity had a stronger impact on injury risk in women with pregestational diabetes compared to other pregnancies. Conclusion Neonates of women with pregestational diabetes have a higher risk for severe birth injury than other neonates. The injury risk in neonates delivered by women with gestational diabetes or non-diabetic women is generally low.Peer reviewe

Incidence of vaginal birth–related rupture of the pubic symphysis : A nationwide register study in Finland from 1998 to 2018

Background and purpose: To assess the incidence of vaginal birth -related rupture of the pubic symphysis in Finland from 1998 to 2018. Methods: A retrospective cohort study using nationwide data from the Finnish Care Register for Health Care and the Finnish Medical Birth Register. As participants we included all ≥ 22-week pregnancies of women aged between 15 and 49 years from January 1, 1998 to December 31, 2017. Pubic symphysis rupture was classified based on the ICD-10 code S33.4 and operations were gathered with pelvis-specific operation codes of the Nordic NOMESCO-classification. Incidence per 100 000 deliveries with 95% confidence intervals (CI) was calculated for symphysis rupture and surgery using Poisson’s exact test. Results: For a total 1 175 326 deliveries, a total of 9 pubic symphysis ruptures occurred during the intrapartum and puerperal periods. All ruptures occurred after vaginal delivery. Of these, 4 ruptures were treated operatively. The incidence of rupture for vaginal delivery was 0.9 per 100 000 deliveries (CI 0.1 to 1.0). No perinatal mortality was observed. Conclusions: Birth -related ruptures of the pubic symphysis are rate events and are mostly associated with vaginal delivery with most ruptures being treated conservatively.publishedVersionNon peer reviewe

Previous induced abortion or miscarriage is associated with increased odds for gestational diabetes : a nationwide register-based cohort study in Finland

Aims: The aim of this study was to investigate the association between previous induced abortion or miscarriage and the development of gestational diabetes mellitus (GDM) using high-quality register data. Methods: In this retrospective nationwide register-based cohort study, data from the national medical birth register (MBR) were used to evaluate the association between a history of miscarriage or induced abortion and GDM. We included all first pregnancies ending in delivery in which the oral glucose tolerance test was performed between 2004 and 2018. A logistic regression model was used to assess the development of GDM in the first pregnancy ending in delivery. Adjusted odds ratios (aOR) with 95% confidence intervals (Cis) were compared between groups. Results: In total, 15,873 nulliparous women with a history of induced abortions, 22,337 with a history of miscarriages and 3594 with a history of both were found. The reference group consisted of 138,869 women without a history of induced abortions or miscarriages. Women with a history of induced abortions (24.7%, aOR 1.15 [CI 1.11–1.20]), a history of miscarriages (24.8%, aOR 1.14 [CI 1.10–1.18]) and a history of both (27.7% aOR 1.18 [CI 1.09–1.28]) had higher odds for the development of GDM when compared to the reference group (20.8%). The odds for GDM increased along with the increasing number of previous induced abortions and miscarriages. Conclusion: Women with a history of induced abortions or miscarriages had higher odds for GDM in their first pregnancy leading to birth. Knowledge of this association will be helpful in the prevention and screening of GDM.publishedVersionPeer reviewe

Trends in the epidemiology of fear of childbirth and association with intended mode of delivery : A nationwide register-based cohort study in Finland

Introduction: Fear of childbirth (FOC) is a common obstetrical challenge that affects the health of women. The epidemiology of FOC has not been studied in Finland for the last decade. The aim of this study was to analyze the epidemiology and risk factors for FOC and to evaluate the association between FOC and the rate of elective cesarean section (CS) as an intended mode of delivery. Material and methods: Data from the National Medical Birth Register were used to evaluate the epidemiology of FOC and to determine the main risk factors for FOC in Finland between 2004 and 2018. Nulliparous and multiparous women were analyzed separately. Logistic regression model was used to determine the main risk factors for FOC. Multivariable logistic regression model was used to assess the intended mode of delivery in those pregnancies with diagnosed maternal FOC. Adjusted odds ratios (aOR) with 95% confidence intervals (CIs) were calculated. Results: A total of 1 million pregnancies were included. The annual rate of pregnancies with maternal FOC increased from 1.5% (CI: 1.4–1.6) in 2004 to 9.1% (CI: 8.7–9.3) in 2018 for all women. For nulliparous women, the rate increased from 1.1% (CI: 1.0–1.3) in 2004 to 7.1% (CI: 6.7–7.5) in 2018, and from 1.8% (CI: 1.7–2.0) in 2004 to 10.3% (10.0–10.7) in 2018 for multiparous women. The strongest risk factors for maternal FOC were higher maternal age and gestational diabetes. For multiparous women, the strongest risk factors were gestational diabetes and previous CS. The total odds for elective CS were notably higher among women with FOC (aOR 8.63, CI: 8.39–8.88). Conclusions: The incidence of maternal FOC rose six-fold during our study period. However, the numbers of elective CS among women with this diagnosis, which had earlier risen in parallel, leveled off in 2014.publishedVersionPeer reviewe

Fear of Childbirth After Major Orthopedic Traumas : A Nationwide Multi-Register Analysis

Background: The aim of this study was to evaluate the association between previous major traumas and the prevalence of fear of childbirth (FOC) and the subsequent effects of FOC on the intended mode of delivery. Methods: In this nationwide retrospective register-based cohort study, data from the Care Register for Health Care were linked with the National Medical Birth Register (MBR) to evaluate the prevalence of FOC after major traumas. A total of 18,573 pregnancies met the inclusion criteria. A multivariable logistic regression model was used to assess the effects of FOC on the intended mode of delivery. Women with major traumas before pregnancy were compared to individuals with wrist fractures. Adjusted odds ratios (aORs) with 95% CIs between the groups were compared. Results: Of those pregnancies that occurred after major traumas, 785 (6.2%) women were diagnosed with FOC after traumatic brain injury (TBI), 111 (6.1%) women after spine fracture, 38 (5.0%) women after pelvic fracture, 22 (3.2%) women after hip or thigh fracture, and 399 (5.2%) women in the control group. Among those women diagnosed with FOC, the adjusted odds for elective CB as an intended mode of delivery were highest among women with previous spine fractures (aOR 2.28, CI 1.45–3.60) when compared to the control group. Conclusions: We found no evidence of differences in maternal FOC in patients with preceding major traumas when compared to the control group. Therefore, it seems highly likely that the major trauma itself is the explanatory factor for the increased rate of elective CB.Peer reviewe

Previous traumatic brain injury is associated with an increased odds for gestational diabetes : a nationwide register-based cohort study in finland

Aims: Despite recent findings that traumatic brain injury (TBI) is a possible risk factor for type 2 diabetes (DM2) and that a strong association exists between gestational diabetes (GDM) and the risk for the development of DM2, no previous studies have investigated the effects of TBI on the risk for the development of GDM. Therefore, this study aims to determine the possible association between a previous traumatic brain injury and later gestational diabetes. Methods: In this retrospective register-based cohort study, data from the National Medical Birth Register were combined with data from the Care Register for Health Care. Women who had sustained a TBI before pregnancy were included in the patient group. Women who had sustained previous fractures of the upper extremity, pelvis, or lower extremity were included in the control group. A logistic regression model was used to assess the risk for the development of GDM during pregnancy. Adjusted odds ratios (aOR) with 95% confidence intervals between the groups were compared. The model was adjusted by prepregnancy body mass index (BMI) and maternal age during pregnancy, the use of in vitro fertilization (IVF), maternal smoking status, and multiple pregnancies. The risk for the development of GDM during different periods following the injury (0–3 years, 3–6 years, 6–9 years, and 9+ years) was calculated. Results: In total, a 75 g 2-h oral glucose tolerance test (OGTT) was performed on 6802 pregnancies of women who had sustained a TBI and on 11 717 pregnancies of women who sustained fractures of the upper extremity, pelvis, or lower extremity. Of these, 1889 (27.8%) pregnancies were diagnosed with GDM in the patient group and 3117 (26.6%) in the control group. The total odds for GDM were higher after TBI compared to the other traumas (aOR 1.14, CI 1.06–1.22). The odds were highest at 9 + years after the injury (aOR 1.22, CI 1.07–1.39). Conclusion: The total odds for the development of GDM after TBI were higher when compared to the control group. Based on our findings, more research on this topic is warranted. Moreover, a history of TBI should be considered a possible risk factor for the development of GDM.Peer reviewe