Interventions during pregnancy and labor and obstetric outcome

Objectives: The overall objective with the present thesis was to assess pregnancy and delivery associated risk factors for adverse pregnancy outcomes. Specific aims were : 1) to analyze the association between fetal size at the time of dating ultrasound and the risk of preterm delivery, small for gestational age birth (SGA), and macrosomia and to evaluate if the timing of ultrasound, i.e. before 14 weeks of gestation or after 16 weeks, affected this association, 2) to assess the risk of emergency cesarean section among women who were induced to labor in gestational week ≥ 41 and to evaluate if parity and mode of induction affected this association, and 3) to analyze if starting time for labor induction affected the risk of night-time delivery, and evaluate to what extent the risk was influenced by Bishop score at start of induction, mode of induction, and parity. Study 1 and 2 were retrospective cohort studies based on an obstetrical database containing data on all obstetrical care at Danderyd Hospital from 1998-2004. The data was linked to the Swedish Medical Birth Registry. The analysis included 27 952 women. Of these, 5053 had gestational duration assessed through ultrasound before 14 weeks (early) and 22 889 after 16 weeks (late). Risks of preterm delivery, SGA and macrosomia were calculated. When the expected date of delivery was postponed after ultrasound dating ≥ 7 days, regardless of time of dating ultrasound, there was an increased risk of SGA. For preterm birth there was an increased risk for fetuses dated late. When the fetus was ≥ 7 days larger than expected at late ultrasound dating, compared to the expected size according to last menstrual period, there was an increased risk of macrosomia. Fetal size in early pregnancy is not only a function of gestational duration, but also of fetal growth. Accordingly, our studies suggest that surveillance of pregnancies with postponed estimated date of delivery may provide means for increased detection of fetal growth restriction. However, only a limited proportion of all infants born macrosomic can be detected at the time of dating ultrasound. Study 3 and 4 were retrospective cohort studies including 23 030 women with singleton pregnancies who were delivered in gestational week ≥ 37 at Danderyd Hospital, Stockholm, Sweden, during the period 2002 - 2006. The data was linked to the Swedish Medical Birth Registry. 881 of these pregnancies were induced to labor at ≥41 gestational weeks, and 1940 at gestational week ≥37. All of the included women with induction of labor had a Bishop score of <7. Prostaglandin E2 or transcervical catheter was used for cervical ripening. Risks of emergency cesarean section and night-time delivery were calculated. Among nulliparous women who were induced at gestational week ≥ 41 there was threefold increase in risk of emergency caesarean section and an almost twofold increase in risk among multiparous compared to women with spontaneous onset of delivery. When labor is induced the high risk for emergency cesarean must be kept in mind. For nulliparae with Bishop score of 0-3 induced by transcervical catheter there was a reduction in risk for night-time delivery when inductions started in the afternoon and evening compared to inductions started in the morning. For multiparae, however, the risk of night-time delivery was highest after induction started in the afternoon and evening, respectively independent of bishop score or method of cervical ripening. Thus, the starting time of labor induction affects the risk of giving birth at night

GWAS meta-analysis of intrahepatic cholestasis of pregnancy implicates multiple hepatic genes and regulatory elements.

Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy-specific liver disorder affecting 0.5-2% of pregnancies. The majority of cases present in the third trimester with pruritus, elevated serum bile acids and abnormal serum liver tests. ICP is associated with an increased risk of adverse outcomes, including spontaneous preterm birth and stillbirth. Whilst rare mutations affecting hepatobiliary transporters contribute to the aetiology of ICP, the role of common genetic variation in ICP has not been systematically characterised to date. Here, we perform genome-wide association studies (GWAS) and meta-analyses for ICP across three studies including 1138 cases and 153,642 controls. Eleven loci achieve genome-wide significance and have been further investigated and fine-mapped using functional genomics approaches. Our results pinpoint common sequence variation in liver-enriched genes and liver-specific cis-regulatory elements as contributing mechanisms to ICP susceptibility

GWAS meta-analysis of intrahepatic cholestasis of pregnancy implicates multiple hepatic genes and regulatory elements

Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy-specific liver disorder affecting 0.5–2% of pregnancies. The majority of cases present in the third trimester with pruritus, elevated serum bile acids and abnormal serum liver tests. ICP is associated with an increased risk of adverse outcomes, including spontaneous preterm birth and stillbirth. Whilst rare mutations affecting hepatobiliary transporters contribute to the aetiology of ICP, the role of common genetic variation in ICP has not been systematically characterised to date. Here, we perform genome-wide association studies (GWAS) and meta-analyses for ICP across three studies including 1138 cases and 153,642 controls. Eleven loci achieve genome-wide significance and have been further investigated and fine-mapped using functional genomics approaches. Our results pinpoint common sequence variation in liver-enriched genes and liver-specific cis-regulatory elements as contributing mechanisms to ICP susceptibility

'Alone in a fragile vessel, what is that, are we going out to sea?' : A qualitative study of how high school teachers work with Swedish Romanticism in the teaching of Swedish.

Syftet är att undersöka hur den svenska romantiken används och uppfattas av svensk­lärare i gymnasieskolan. Studien har genomförts genom kvalitativa intervjuer med verk­sam­ma gymnasielärare i svenska. Forskningsfrågorna är hur lärarna arbetar med och uppfattar den svenska romantiken i svenskundervisningen samt hur lärarna ser på hur epoken berörs i styrdokumenten. Undersökningen visar att arbete med den svenska romantiken främst sker med ut­gångspunkt i en kulturell bildningstradition och genom kronologiska litterära epokar­beten, där tidsbristen är en avgörande faktor för begränsningen av undervisningens volym och upplägg­ning. Det framkommer även att det finns ett värde i att knyta an till elevernas värld och skapa liv och association i undervisningen för att öka elevernas en­gagemang. Därför är val av litteratur avgörande för att skapa engagemang och väcka intresse. Undersökningen visar även att styrdokumenten är öppna för tolkning och skapar något av en paradox, då detta både anses som någonting positivt och negativ. Lärarna diskuterar också vad litterär kanon kan vara, och det faktum att det inte finns någon officiell sådan men en inofficiell eller lokal kanon som påverkar svensk­under­visningen

“The ultimate book does not exist, I’ve been searching for thirty years” : A study of how upper secondary school teachers of Swedish work with female authors writing in the period 1900−1940.

The aim of the study is to investigate how upper secondary school teachers of Swedish work with female authors writing in the period 1900–1940. The research questions concern how upper secondary school teachers work with the female authors, how their work interacts with steering documents and textbooks, whether the teachers show any similarities and differences in their work, and how female authors are treated in the textbooks and steering documents that are used. Semi-structured qualitative interviews were conducted with three upper secondary school teachers and one textbook per teacher was analysed together with the steering documents. The study reveals clear similarities and differences in the teachers’ work. The teachers work chronologically, period by period, and they deal with female authors in terms of a societal context, but they do not think that the work with women has any intrinsic value. Textbooks and steering documents have a central role to play in the teaching and are used together with other teaching material. The textbooks have an over-representation of male authors and the female authors are treated on their own, separated from the rest of the text and viewed in relation to male authors. The textbooks maintain a gender system where the man is the norm and the sexes are kept apart. The steering documents explicitly deal with female authors to a small extent and are shown to dictate of fundamental principles for what is considered valuable to consider in school work

Most were craftsmen, shopkeepers and workers and their wives : Teaching aids and gender analysis of textbooks and curricula in history 1970-2011

The study's aim is to implement a textbook analysis and examine how women are described in history textbooks for high school and in the curriculums Lgy 70, Lpf 94 and Gy 11. The study has a gender perspective and the study's purpose is to make a comparative study and compare textbooks with the current curriculum and compare the results with each other to see if there has been any change over time. The survey's material is three editions of Alla tiders historia from Gleerups förlag. The study refers to editions from 1989, 1996 and 2011. General parts from Lgy 70, Lpf 94 and Gy 11 are also central for my study. The general cur­riculum of history from 1981, the course Historia A in Lpf 94 and Historia 1b in Gy 11 are also studied. The study shows that the role of women doesn’t get much space in textbooks and when women are mentioned explicitly, it’s mainly through illustrations or through texts of statement representation. The role of women has not been treated much in governing documents but equality between men and women is something that is common. The study shows that the governing documents interact with the curricula in a relatively large range, although this varies between the different editions. The results demonstrate that there has been a change over time in administrative documents and textbooks. Content and design have changed based on the societal context in which they were designed. The study shows that men are the norm and men are mentioned more than women, both in textbooks and curriculum

Cesarean delivery and risk for postoperative adhesions and intestinal obstruction: a nested case-control study of the Swedish Medical Birth Registry

OBJECTIVE: The objective of the study was to estimate the risk for postoperative adhesions and intestinal obstruction after cesarean delivery and to estimate whether the rate remains stable over time. STUDY DESIGN: Women who had the aforementioned diagnoses in the Swedish Hospital Discharge Registry were linked to the Swedish Medical Birth Registry. Women with diagnoses increasing the risk for adhesions were excluded. More than 900,000 women were investigated. Risks were calculated and were adjusted for age, parity, body mass index, and smoking. RESULTS: Women delivered by cesarean delivery had an increased risk of adhesions: adjusted odds ratio, 2.1 (95% confidence interval, 1.8-2.4) and intestinal obstruction: adjusted odds ratio, 2.0 ( 95% confidence interval, 1.7-2.4). The number needed to harm was 360. Multiple caesarean deliveries increased the risk of adhesions. The risk did not increase over time. CONCLUSION: The absolute risk of postoperative adhesions and intestinal obstruction after cesarean section are low but should be included when counseling women requesting cesarean delivery

Lurigt med Light – Hur marknadsförs lightprodukter som ett hälsosamt alternativt utan att, i lagens mening, vara vilseledande?

Lurigt med Light – Hur marknadsförs lightprodukter som ett hälsosamt alternativt utan att, i lagens mening, vara vilseledande? Syftet med uppsatsen är att undersöka hur företag gör för att marknadsföra lightprodukter som del av en hälsosam livsstil utan att vara vilseledande. Uppsatsens teoretiska bas består av teori främst från semiotik och retorik men även om den perceptuella processen och hur reklam utformas i allmänhet. Vi inkluderade även teori om rationalitet och emotioner i reklamsammanhang. Vi tittade också närmare på den svenska lagstiftningen gällande vilseledande marknadsföring. Uppsatsens empiri består av tre fallstudier kring lightprodukter; Coca-Cola light, Carlsberg Lite samt Fun Light. Vi har analyserat två reklamfilmer samt en tryckt annons per produkt. I analysen hittade vi med hjälp av semiotik åtta övergripande teman. Dessa var: Associationer, Distraktion, Problem och Lösning, Undanhållande av sanningen, Smutskastning, Förebilder och Expertis, Försköning samt Humor. Dessa teman är olika metoder vi tror används av marknadsförare för att vilseleda sina konsumenter att tro att deras produkt är mer hälsosamma än vad de kanske egentligen är. I analysen fann vi inslag på argumentation både genom pathos samt logos. De teman vi hittade var alla metoder för att vilseleda konsumenter till att tro att en specifik lightprodukt är hälsosammare än den i själva verket kanske är. Metoderna klarade sig undan marknadsföringslagens definition av vilseledande marknadsföring då de inte explicit vilseledde konsumenterna, utan använde sig av underliggande budskap. Detta är något vi kunde utläsa genom vår semiotiska referensram. De flesta teman appellerade till konsumenternas känsla, pathos, men även rationella teman, logos, förekom i viss utsträckning. Genom att använda sig av pathos i sina reklamfilmer och annonser vädjade marknadsförarna till konsumenternas emotioner. De inslag av logos som vi hittade vädjade till konsumenternas rationella sida. Marknadsförare kan vilseleda konsumenter både genom emotioner och genom rationalitet och ändå stanna inom lagens ramar

Exploration of psychological distress experienced by survivors of adolescent cancer reporting a need for psychological support

Objective In this qualitative study, we aimed to provide an in-depth exploration of cancer-related psychological distress experienced by young survivors of cancer during adolescence reporting a need for psychological support. Methods Two individual interviews were held with ten young survivors of cancer diagnosed in adolescence. The interviews were audio-recorded and transcribed verbatim. Analysis followed the guidelines for inductive qualitative manifest content analysis. Results The survivors described distress experienced during and after the end of treatment. Five categories comprising 14 subcategories were generated. The categories included: A tough treatment, Marked and hindered, Not feeling good enough, Struggling with the fragility of life, and finally, An ongoing battle with emotions. Conclusion Young survivors of adolescent cancer reporting a need for psychological support described feeling physically, socially, and mentally marked by the cancer experience. They struggled with powerlessness, insecurity, social disconnection, loneliness, and feelings of being unimportant and a failure, and had difficulties understanding and managing their experiences. These concerns should be addressed in psychological treatments for the population irrespective of which approach or model is used to understand survivors’ difficulties. A transdiagnostic approach targeting processes that underpin different manifestations of distress may be effective

Exploration of psychological distress experienced by survivors of adolescent cancer reporting a need for psychological support

<div><p>Objective</p><p>In this qualitative study, we aimed to provide an in-depth exploration of cancer-related psychological distress experienced by young survivors of cancer during adolescence reporting a need for psychological support.</p><p>Methods</p><p>Two individual interviews were held with ten young survivors of cancer diagnosed in adolescence. The interviews were audio-recorded and transcribed verbatim. Analysis followed the guidelines for inductive qualitative manifest content analysis.</p><p>Results</p><p>The survivors described distress experienced during and after the end of treatment. Five categories comprising 14 subcategories were generated. The categories included: A tough treatment, Marked and hindered, Not feeling good enough, Struggling with the fragility of life, and finally, An ongoing battle with emotions.</p><p>Conclusion</p><p>Young survivors of adolescent cancer reporting a need for psychological support described feeling physically, socially, and mentally marked by the cancer experience. They struggled with powerlessness, insecurity, social disconnection, loneliness, and feelings of being unimportant and a failure, and had difficulties understanding and managing their experiences. These concerns should be addressed in psychological treatments for the population irrespective of which approach or model is used to understand survivors’ difficulties. A trans-diagnostic approach targeting processes that underpin different manifestations of distress may be effective.</p></div