Sexual violence and pregnancy-related physical symptoms

Background Few studies have investigated the impact of sexual violence on health during pregnancy. We examined the association between sexual violence and the reporting of physical symptoms during pregnancy. Methods A population-based national cohort study conducted by The Norwegian Mother and Child Cohort study (MoBa) collected data from pregnant women through postal questionnaires at 17 and 32 weeks gestation. Three levels of sexual violence were measured: 1) mild (pressured into sexual relations), 2) moderate (forced with violence into sexual relation) and 3) severe (rape). Differences between women reporting and not reporting sexual violence were assessed using Pearson’s X2 test and multiple logistic regression analyses. Results Of 78 660 women, 12.0% (9 444) reported mild, 2.8% (2 219) moderate and 3.6% (2 805) severe sexual violence. Sexual violence was significantly associated with increased reporting of pregnancy-related physical symptoms, both measured in number of symptoms and duration/degree of suffering. Compared to women not reporting sexual violence, the probability of suffering from ≥8 pregnancy-related symptoms estimated by Adjusted Odds Ratio (AOR) was 1.49 (1.41–1.58) for mild sexual violence, 1.66(1.50–1.84) for moderate and 1.78 (1.62–1.95) for severe. Severe sexual violence both previously and recently had the strongest association with suffering from ≥8 pregnancy-related symptoms, AOR 6.70 (2.34–19.14). Conclusion A history of sexual violence is associated with increased reporting of pregnancy-related physical symptoms. Clinicians should consider the possible role of a history of sexual violence when treating women who suffer extensively from pregnancy-related symptoms

Sexual violence and mode of delivery: a population-based cohort study

Objective This study aimed to explore the association between sexual violence and mode of delivery. Design National cohort study. Setting Women presenting for routine ultrasound examinations were recruited to the Norwegian Mother and Child Cohort Study between 1999 and 2008. Population A total of 74 059 pregnant women. Methods Sexual violence was self-reported during pregnancy using postal questionnaires. Mode of delivery, other maternal birth outcomes and covariates were retrieved from the Medical Birth Registry of Norway. Risk estimations were performed using multivariable logistic regression analysis. Main outcome measures Mode of delivery and selected maternal birth outcomes. Results Of 74 059 women, 18.4% reported a history of sexual violence. A total of 10% had an operative vaginal birth, 4.9% had elective caesarean section and 8.6% had an emergency caesarean section. Severe sexual violence (rape) was associated with elective caesarean section, adjusted odds ratio (AOR) 1.56 (95% CI 1.18–2.05) for nulliparous women and 1.37 (1.06–1.76) for multiparous women. Those exposed to moderate sexual violence had a higher risk of emergency caesarean section, AOR 1.31 (1.07–1.60) and 1.41 (1.08–1.84) for nulliparous and multiparous women, respectively. No association was found between sexual violence and operative vaginal birth, except for a lower risk among multiparous women reporting mild sexual violence, AOR 0.73 (0.60–0.89). Analysis of other maternal outcomes showed a reduced risk of episiotomy for women reporting rape and a higher frequency of induced labour. Conclusions Women with a history of rape had higher odds of elective caesarean section and induction and significantly fewer episiotomies

Sexual violence and neonatal outcomes: a Norwegian population-based cohort study

Objective The objective of this study was to explore the association between sexual violence and neonatal outcomes. Design National cohort study. Setting Women were recruited to the Norwegian Mother and Child Cohort Study (MoBa) while attending routine ultrasound examinations from 1999 to 2008. Population A total of 76 870 pregnant women. Methods Sexual violence and maternal characteristics were self-reported in postal questionnaires during pregnancy. Neonatal outcomes were retrieved from the Medical Birth Registry of Norway (MBRN). Risk estimations were performed with linear and logistic regression analysis. Outcome measures: gestational age at birth, birth weight, preterm birth (PTB), low birth weight (LBW) and small for gestational age (SGA). Results Of 76 870 women, 18.4% reported a history of sexual violence. A total of 4.7% delivered prematurely, 2.7% had children with a birth weight <2500 g and 8.1% children were small for their gestational age. Women reporting moderate or severe sexual violence (rape) had a significantly reduced gestational length (2 days) when the birth was provider-initiated in an analysis adjusted for age, parity, education, smoking, body mass index and mental distress. Those exposed to severe sexual violence had a significantly reduced gestational length of 0.51 days with a spontaneous start of birth. Crude estimates showed that severe sexual violence was associated with PTB, LBW and SGA. When controlling for the aforementioned sociodemographic and behavioural factors, the association was no longer significant. Conclusions Sexual violence was not associated with adverse neonatal outcomes. Moderate and severe violence had a small but significant effect on gestational age; however, the clinical influence of this finding is most likely limited. Women exposed to sexual violence in this study reported more of the sociodemographic and behavioural factors associated with PTB, LBW and SGA compared with non-abused women

Hvilken påvirkning og betydning har rådmannen? En studie av rådmannsfunksjonens påvirkning i organisasjonsfeltet

Dette er en kvalitativ studie som har fokus på rådmannen sin betydning i egen organisasjon. Vi har benyttet oss av den kvalitative metoden, shadowing. Hensikten med studiet er å gjøre et dypdykk i rådmannen sin hverdag, hva påvirker rådmannen og hvordan påvirker han i sin kontekst. Vi tar utgangspunkt i kommuner som er organisert med to-nivå modellen, de er omtrent like i størrelse og de befinner seg på Østlandet. Studiet baserer sin datainnsamling på observasjon eller «shadowing» som Czarniawska (Czarniawska 2014) bruker, i tillegg vektlegges samtaleintervjuer med rådmenn. Vi har fulgt fire rådmenn en dag i deres organisasjon. Våre funn i denne oppgaven kan sees i sammenheng med tradisjonell ny-institusjonell teori, med organisasjonsendringer og isomorfi, men det som synes å være avgjørende er hvordan aktøren i samspill med agency har påvirket utfallet av de ulike prosessene i praksisteorien. Vi benytter oss av praksisteori som poengterer at man ikke skal unnlate aktørperspektivet i hvordan organisasjoner er dynamiske i sin utvikling. Ved hjelp av isomorfi blir organisasjonene mer homogene, men ved hjelp av aktørperspektivet så skapes det heterogene organisasjoner. Det er markante ulikheter hvordan kommunene organiserer seg og hvordan de endrer seg, selv om de tilsynelatende er svært like. Våre funn bekrefter dette, og vi understøtter dermed deler av kritikken av det ny-institusjonelle perspektivet på dette området.This is a qualitative study with focus on the significance of the chief municipal executive officer (CMEO) in own organization. We have used the qualitative method termed ‘shadowing’. The objective of this research is to, in depth, consider a typical workday of the CMEO; what influences the CMEO and what impact does the CMEO have in his context? Our research is based on municipals that are organised after the two-level model, are approximately same in size and are located in the Eastern region of Norway. Data collection is founded in observation or ‘shadowing’, used by Czarniawska (Czarniawska 2014), and emphasizes interviews with CMEOs. We have shadowed four CMEOs for one day in their organization, respectively. Our results can be understood in terms of traditional new-institutional theory, with changes inside the organization and isomorphism. However, how the actor in accordance with the agency has influenced the outcome of the different processes within the practice theory seem to be the decisive factor. We have used practice theory, which states that the actor-perspective should not be overlooked when it comes to how the development of organizations is dynamic. Isomorphism constructs a homogenous organization, whereas actor-perspectives create heterogeneous organizations. Even though they are seemingly analogous, there are distinct disparities between the way in which the municipals are organized and how they change. Our results confirm this thesis, and therefore support some of the criticisms concerning new-institutional perspective within this field

Factors associated with the level of physical activity in a multi‑ethnic pregnant population – a cross‑sectional study at the time of diagnosis with gestational diabetes

Background: Regular physical activity during pregnancy can prevent several adverse health outcomes during this period of a woman’s life. Previous studies have shown that many women do not meet national recommendations for physical activity. This study aims to examine factors associated with sufficient leisure-time physical activity (LTPA) in a multicultural sample of pregnant women recently diagnosed with gestational diabetes mellitus (GDM). Methods: We performed a cross-sectional study among 238 pregnant women. The women were recruited at diabetes outpatient clinics in the Oslo region of Norway from October 2015 to April 2017. The participants reported their activity levels using the Pregnancy Physical Activity Questionnaire (PPAQ). Pearson’s chi-square tests were used to assess differences in socio-demographic, health and pregnancy-related characteristics in relation to sufficient and insufficient LTPA, and logistic regression modelling was employed to predict the likelihood of insufficient LTPA. Results: Less than half of the women in the sample (44.5%) had sufficient LTPA according to the minimum of ≥600 Met minutes per week. The majority of women were motivated to be physically active during pregnancy (84.9%). A low joint family income and being over 38 years of age increased the odds of not having sufficient LTPA. Women with sufficient LTPA had significantly higher scores of perceived health (p = 0.007). Conclusions: The study indicates that pregnant women need to be better informed about the positive effects of physical activity on individually perceived health. To address the low levels of LTPA among pregnant women, communication strategies must be tailored towards women with low socio-economic backgrounds.publishedVersio

Studies of association of AGPAT6 variants with type 2 diabetes and related metabolic phenotypes in 12,068 Danes

BACKGROUND: Type 2 diabetes, obesity and insulin resistance are characterized by hypertriglyceridemia and ectopic accumulation of lipids in liver and skeletal muscle. AGPAT6 encodes a novel glycerol-3 phosphate acyltransferase, GPAT4, which catalyzes the first step in the de novo triglyceride synthesis. AGPAT6-deficient mice show lower weight and resistance to diet- and genetically induced obesity. Here, we examined whether common or low-frequency variants in AGPAT6 associate with type 2 diabetes or related metabolic traits in a Danish population. METHODS: Eleven variants selected by a candidate gene approach capturing the common and low-frequency variation of AGPAT6 were genotyped in 12,068 Danes from four study populations of middle-aged individuals. The case–control study involved 4,638 type 2 diabetic and 5,934 glucose-tolerant individuals, while studies of quantitative metabolic traits were performed in 5,645 non-diabetic participants of the Inter99 Study. RESULTS: None of the eleven AGPAT6 variants were robustly associated with type 2 diabetes in the Danish case–control study. Moreover, none of the AGPAT6 variants showed association with measures of obesity (waist circumference and BMI), serum lipid concentrations, fasting or 2-h post-glucose load levels of plasma glucose and serum insulin, or estimated indices of insulin secretion or insulin sensitivity. CONCLUSIONS: Common and low-frequency variants in AGPAT6 do not significantly associate with type 2 diabetes susceptibility, or influence related phenotypic traits such as obesity, dyslipidemia or indices of insulin sensitivity or insulin secretion in the population studied

Sexual violence, pregnancy and childbirth. Studies investigating the association of experienced sexual violence and outcomes in pregnancy and childbirth

Background: Sexual violence against women is a recognised public health problem, and it is a phenomenon that persists in all countries regardless of value system and culture. There is growing evidence that women who have experienced sexual violence are at greater risk for negative health outcomes, even several years after the abuse. Pregnancy does not protect women from violence. For some women, pregnancy may be the first time that they are aware of previous exposure to violence, or trauma that they have experienced may resurface. Objectives: The first aim of our study was to explore whether a history of sexual violence was associated with pregnancy-related physical symptoms. Second, we investigated the relationship between lifetime sexual violence and antenatal hospitalisations. Third, we assessed the association between sexual violence and mode of delivery, and finally, we examined the relationship between a history of sexual violence and neonatal outcomes. Subjects and methods: In this thesis, we used data from the Norwegian Mother and Child Cohort study (MoBa) linked to data from the Norwegian Medical Birth Registry. Studies I and II had a cross-sectional design and included 78 660 pregnant women. Studies III and IV were cohort studies that included 74 058 and 76 870 pregnant women, respectively. The participating women were recruited during their routine ultrasound examination, and they completed extensive questionnaires at 17 and 30 weeks gestation. History of sexual violence was reported at three levels of severity: 1) pressured into sexual acts (mild), 2) forced with violence (moderate), and 3) raped (severe). The comparison group was women not reporting sexual violence. Results: In our studies, 12.0% of the women reported mild sexual violence, 2.8% reported moderate sexual violence and 3.6% reported severe sexual violence (rape). Compared with women who did not report a history of sexual violence, women who reported a history of sexual violence suffered from more pregnancy-related physical symptoms and were more often hospitalised during pregnancy. Severe sexual violence was associated with a higher risk of elective caesarean section (CS), and moderate sexual violence was associated with an increased risk of emergency CS. There was no significant association between sexual violence and neonatal outcomes

Continuity of care: what does it mean to women during pregnancy, birth, and the postnatalperiod? : An evaluation of a project from Oslo, Norway

Bakgrunn: Bakgrunn for studien er Barsel hjemme, et prosjekt som har sett på en helhetlig modell for svangerskap, fødsel og barselomsorg. Det har vært et samarbeid mellom Ullevål universitetssykehus og Bydelene Sagene/St.Hanshugen. Kvinnene som har deltatt har gått til jordmødre fra prosjektet som er/har vært ansatt på sykehuset i svangerskapet, født på Ullevål og reist tidlig hjem i barsel med besøk fra samme gruppe jordmødre. Hensikt: Evaluere Barsel hjemme ved å se på pasienterfaringer med prosjektet og undersøke kvinnenes opplevelse og ønsker når det gjelder kontinuitet og helhet i svangerskap, fødsel og barselomsorg. Metode: En triangulering av metoder er brukt: Dette inkluderer en pasienterfaringsundersøkelse, en anonym spørreundersøkelse som er sammenliknet med en liknende undersøkelse fra en barselavdeling, og fokusgruppediskusjon med kvinner fra prosjektet som er analysert med inneholdsanalyse. Funn: Kvinnene som har deltatt i Barsel hjemme er svært fornøyd med prosjektet, gjennomgående mer fornøyd enn kvinner som har hatt vanlig barselopphold ved sykehuset. De hadde deltatt igjen om det hadde vært mulig. De er ikke opptatt av kontinuitet i den forstand at samme person trenger å følge de i hele forløpet. Her spiller forventninger en viktig rolle. Personalets evne til å skape en god relasjon, en følelse av trygghet og se individuelle behov er mer viktig. De ønsker mer kontinuitet i informasjonen de får under svangerskap, fødsel og barseltid. Konklusjoner: Barsel hjemme er et prosjekt som kvinnene anbefaler, og som de skulle ønske fortsatte. Når det gjelder kontinuitet og helhet er dette avhengig av forventinger. Det at personalet kan skape personlige relasjoner og møte kvinnene på deres individuelle behov er det viktigste.Background: This study is based on a project known as “Barsel hjemme” (“postnatal careat home”), whose main goal has been to develop a model for prenatal, birth, and postnatalcare, focusing particularly on continuity. Participants had prenatal check-ups with projectmidwives, delivered their babies at Ullevål University Hospital, and were discharged fromthe hospital early in the postnatal period. Project midwives visited all participants at home. Aim: This study aimed to evaluate Barsel hjemme by examining patient satisfaction andassessing their experiences and desires through the prism of continuity. Methods: A triangulation of methods was used. This included a patient satisfaction survey;an anonymous survey that was then compared with a similar survey from a standardpostnatal department; and content analysis of focus group discussions. Findings: Women who participated in Barsel hjemme were very satisfied, generally moresatisfied than women from a standard postnatal department. They would participate again ifpossible. They did not define continuity of care as being cared for by the same person.Expectations played an important role in how they experienced the project. Midwives’ability to create a personal connection and treat participants as individuals were paramount.Participants wanted greater continuity in the information given during pregnancy, birth, andthe postnatal period. Conclusions: Women recommend the Barsel hjemme project and want it to continue.Continuity of care hinges on individual expectations. Personal relationships and recognitionof individuality are of primary importance.ISBN 978-91-85721-94-8</p