Women's experiences of dealing with fertility and side effects in contraceptive decision making: a qualitative study based on women's blog posts.

BACKGROUND: Worldwide, there is limited knowledge regarding women's views of future fertility in relation to contraceptive use. Few studies include material where women share their experiences at peer-written public domain websites, in spite of a larger portion of women discontinuing use of contraceptives. The objective of this study was to explore women's experiences of contraceptive methods based on data gathered from individual blog posts. METHODS: Explorative qualitative study including 123 individual blog posts as the data source analysed with inductive thematic analysis. RESULTS: Two themes were identified. Theme 1, 'Seeking control over reproduction and optimise fertility' including the sub-themes; Having the possibility to decide if, and when, to become pregnant, The value of effective contraceptive methods and the impact of women's sexuality, A wish to understand the body's normal fertility function and Limited knowledge-sharing information about the menstrual cycle during counselling and Theme 2, 'Making the complex decision on their own' including the sub- themes; Limited or subpar guidance in counselling and need for information from social media, Relational and environmental factors influencing contraceptive decision making and Considering beneficial effects and fears of adverse health effects when using hormonal contraceptive methods. CONCLUSIONS: During counselling, women desired an extended dialogue regarding effectiveness, health effects of different methods and an increased understanding of their menstrual cycle. Insufficient understanding of contraceptive methods can lead to use of methods not providing the expected level of protection. Hormonal contraceptives, especially Long-acting reversible contraception (LARC) were believed to inhibit fertility long after ending treatment.

Patients' Expectations Before Initiation of Intrathecal Baclofen Treatment: A Longitudinal Study with 1-Year Follow-Up.

OBJECTIVE: To investigate patients' expectations, met/unmet expectations and satisfaction with intrathecal baclofen treatment in relation to effect on spasticity, pain intensity, sleep quality, occupational performance, well-being and self-efficacy. DESIGN: A prospective longitudinal study with follow-up at 1 year. PATIENTS: Consecutive patients, age ≥ 18 years with a disabling spasticity of cerebral or spinal origin selected for intrathecal baclofen treatment at 2 university hospitals in Sweden were included. From August 2016 to June 2019, 35 patients began intrathecal baclofen treatment; 29 patients were included and completed the study. METHODS: Baseline and 1-year follow-up included assessment of spasticity by physiotherapists, a semi-structured interview regarding occupational performance using the Canadian Occupational Performance Measure and a questionnaire. RESULTS: Overall satisfaction with treatment and satisfaction with occupational performance were reported as moderate. Important variables that explained satisfaction with occupational performance were improvements in performance, expectations and performance before treatment. Patients had higher expectations compared with the 1-year outcomes regarding occupational performance, spasticity, pain intensity and sleep quality, although improvements were reported. CONCLUSION: A thorough discussion of goal setting with intrathecal baclofen treatment before implantation is necessary to give patients individual and realistic expectations.

Incidence of self-reported pelvic pain and risk factors for pain 1 year after benign hysterectomy: A register study from the Swedish National Quality Registry for Gynecological Surgery.

INTRODUCTION: The primary aim of this study was to determine the incidence of patient-reported pain 1 year after hysterectomy for benign gynecological conditions in relation to occurrence of preoperative pain. The secondary aim was to analyze clinical risk factors for pain 1 year after the hysterectomy in women with and without preoperatively reported pelvic/lower abdominal pain. MATERIAL AND METHODS: This was a historical cohort study using data from the Swedish National Quality Registry for Gynecological Surgery on 16 694 benign hysterectomies. Data were analyzed using multivariable logistic regression models. RESULTS: One year after surgery, 22.4% of women with preoperative pain reported pelvic pain and 7.8% reported de novo pelvic pain. For those with preoperative pain younger age (adjusted odds ratio [aOR] 1.75, 95% confidence interval [CI] 1.38-2.23 and aOR 1.21, 95% CI 1.10-1.34 for women aged <35 and 35-44 years, respectively), not being gainfully employed (aOR 1.43, 95% CI 1.26-1.63), pelvic pain as the main symptom leading to hysterectomy (aOR 1.51, 95% CI 1.19-1.90), endometriosis (aOR 1.18, 95% CI 1.06-1.31), and laparoscopic hysterectomy (aOR 1.30, 95% CI 1.07-1.58), were clinically relevant independent risk factors for pelvic/lower abdominal pain 1 year after surgery, as were postoperative complications within 8 weeks after discharge. Meanwhile, clinically relevant independent risk factors for reporting de novo pain 1 year after surgery were younger age (aOR 2.05, 95% CI 1.08-3.86 and aOR 1.29, 95% CI 1.04-1.60 for women aged <35 and 35-44 years, respectively), and postoperative complications within 8 weeks after discharge. CONCLUSIONS: The incidence of pelvic pain and de novo pain 1 year after hysterectomy was relatively high. Women with and without reported preoperative pelvic/lower abdominal pain represented clinically different populations. The risk factors for pelvic pain seemed to differ in these two populations. The differences in risk factors could be taken into consideration in the preoperative counseling and in the decision-making concerning method of hysterectomy, provided that large well-designed studies confirm these risk factors.

Translation, cross-cultural adaptation, and validation of the Swedish version of the female genital self-image scale.

OBJECTIVE: The objective of the study was to translate and culturally adapt the Female Genital Self-Image Scale (FGSIS-7) into a valid and reliable Swedish version, and to test the instrument. METHODS: The instrument was translated into Swedish in a three-stage process of translation, back-translation and synthesis. The face validity of the pre-final translation was tested in a cognitive debriefing with a test group of eight women, while construct validity was tested in a group of six subject matter experts. Internal consistency, data completeness, score distributions, and floor and ceiling effects were measured using an online survey with a cross-sectional design. RESULTS: The Swedish version of the instrument (SWE-FGSIS-7) was perceived as a comprehensible, understandable and user-friendly instrument by the test group and the experts. The online survey included 147 responders with 100 % data completeness and no floor or ceiling effects. The internal consistency was good (Cronbach's Alpha coefficient 0.82). The total mean score was 22.44 (SD = 3.98). CONCLUSION: SWE-FGSIS-7 is a user-friendly, understandable, valid and reliable instrument for estimating genital self-image, which can be used to initiate a dialogue that may contribute to increased knowledge about women's own bodies and strengthen their reproductive and sexual health.

Self-experienced sexual and reproductive health in young women with Attention Deficit Hyperactivity Disorder a qualitative interview study.

BACKGROUND: Sexual risk behaviors and struggles in romantic relationships result in higher risk of unplanned pregnancy, sexually transmitted diseases, sexual victimization and lower satisfaction in relationships for young women with Attention Deficit Hyperactivity Disorder (ADHD). There is a need to better understand sexual behaviors and the consequences of relational difficulties to help health professionals promote sexual and reproductive health. To deepen knowledge in this area, this study aimed to identify and describe self-experienced sexual and reproductive health in young women with ADHD. METHODS: A qualitative design was used. Data was collected with individual and focus group interviews with 15 young women, aged 15-29, with an ADHD diagnosis, and analyzed with thematic analysis. RESULTS: Data analysis identified the themes Acceptance of being different and Feeling sexually secure. The women reveal feelings of being different from others without ADHD as they break norms of sexual behavior, struggle with romantic relationships, and have difficulties concentrating during sex. There is a need to be understood and accepted, to not feel judged, and to manage romantic relationships. Self-knowledge helps them to recognize needs for support and to develop strategies that can improve sexual satisfaction. Feeling sexually secure illustrates the women's need to feel comfortable with their own sexuality and in control in the sexual situation. Low self-esteem and a negative self-image, described as a consequence of living with ADHD, can compromise communication in sexual situations and increase fear of being rejected. Further, misjudging sexual partners and situations can contribute to sexual victimization. CONCLUSIONS: This study provides knowledge of how ADHD affects emotions and sexual behaviors in young women. The results highlight the need for understanding and acceptance by peers and partners. It accentuates the value of involving the partner in counselling and the importance of self-knowledge. Feeling insecure in sexual relationships further implies the importance of early diagnosis to prevent secondary outcomes of ADHD, and the need for sexual victimization screening in professional settings.

Identifying sexual risk-taking and ill health in the meeting with young people-experiences of using an assessment tool.

BACKGROUND: Identifying young people exposed to sexual risk-taking or violence is fundamental, when seeking to strengthen their health. However, young people seldom share sexual health concerns or experiences of violence with healthcare professionals (HCPs). Studies evaluating how use of a risk assessment tool influences the dialogue about sexual health and violence are sparse. AIMS: The aim of this study was to explore HCPs' experiences of using the SEXual health Identification Tool (SEXIT) in encounters with young people at Swedish youth clinics. METHOD: Three focus group interviews were conducted with 21 HCPs from nine youth clinics, where SEXIT had been introduced. Data were analysed using thematic content analysis. RESULTS: Three themes were identified. The theme, Facilitates dialogue about sexuality and vulnerability, describes how the questionnaire pertaining to SEXIT helped to normalise and help both HCPs and young people to take part in the dialogue about sensitive issues. Need for a trustful encounter presents HCPs' ethical concerns regarding how the questionnaire affects the integrity of young people and trust-making. Sensitive topics entail challenges describes HCPs' challenges when dealing with sensitive issues. Additionally, it describes needs for knowledge and collaboration when targeting vulnerable young people. CONCLUSIONS: The HCPs stated that using SEXIT developed their ability to address sensitive issues and helped both them and young people to take part in the dialogue about sexuality and exposure to violence. SEXIT involves experiences of ethical concerns regarding integrity and trust-making. It also entails challenges in having dialogues about sensitive issues, how to deal with risk assessment outcomes and in improvements regarding inter-professional collaborations.

Supporting women's reproductive capabilities in the context of childbirth: Empirical validation of a midwifery theory synthesis.

OBJECTIVE: To conduct an empirical validation of the theoretical model of midwifery care suggested by Peters et al. (2020). DESIGN: A qualitative deductive methodology was used to validate the theoretical model of aims and objectives of midwifery care. The existing model was validated for midwifery care before, during and after childbirth by interviewing women who had reported high satisfaction with childbirth and low fear of childbirth postpartum. SETTING: Data were collected via interviews with women who had given birth from January to March 2018 at a middle-sized hospital in south-east Sweden. PARTICIPANTS: Swedish-speaking women aged ≥ 18 years, were invited by midwives to participate at a postpartum maternal healthcare ward, and they received oral and written information. They filled in a demographic questionnaire, a grading of their birth experience on a 0-10 numeric rating scale (NRS) and the Wijma Delivery Experience Questionnaire Version B (W-DEQ B). We used ≥7 as the cut-off for high satisfaction with childbirth (NRS), and a sum score ≤60 for low fear of childbirth (W-DEQ B). Of 172 women, 28 were eligible, of whom 20 were interviewed 8-13 months postpartum. The interviews were analysed using qualitative content analysis with a directed approach. FINDINGS: All of the model's levels and their aspects were found in the interviews. All women had experienced a trusting relationship, including individual and woman-centred care, communication, choice and continuity, prompt attention and an empathic attitude. A majority described midwifery in terms of promoting security, and almost all had experienced aspects of personal control. The objective of midwifery care, described as the facilitation of women's reproductive capabilities, was described as being met by half of the women. The importance of pep talks and coaching was emphasized, and partner support could be added to the model. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Our findings indicate that the theoretical model proposed by Peters et al. (2020) is mainly applicable to midwifery care of women reporting high satisfaction with their birth experience and low postpartum fear of childbirth. Our findings suggest that this model may serve as a clarification of the unique objective of midwifery care, and could be used by midwives in daily clinical work and in midwifery education programs.

Violence and sexual risk taking reported by young people at Swedish youth clinics.

BACKGROUND: Early identification of sexual risk taking and exposure to violence is fundamental when seeking to strengthen young people's health. The purpose of this study was to study factors associated with sexual risk taking and ill health, as well as to study gender differences, and the associations amongst exposure to multiple forms of violence, sexual risk taking and ill health. METHODS: This was a cross-sectional study based on data from 3,205 young people answering a questionnaire belonging to the Sexual health Identification Tool (SEXIT 2.0), during consultations at 12 youth clinics in Sweden. The analyses are based on descriptive statistics and nominal multiple regression analysis. RESULTS: Male, transgender and non-binary youths reported significantly more events of sexual risk taking and ill health compared to women. Those who reported sexual initiation before the age of 15 (OR 2.87, CI 1.81-4.56), three or more sexual partners in the past 12 months (OR 2.68, CI 1.70-4.22) and to have ever experienced an unintended pregnancy (OR 2.29, CI 1.32-3.97) were more than twice as likely to report exposure to physical, emotional and sexual violence. Transgender, non-binary youths and women were more exposed to multiple violence (OR 3.68, 13.50) compared to men. CONCLUSIONS: Transgender and non-binary youths are exposed to significantly more violence compared to women and men. Experiences of sexual risk taking and ill health demonstrated strong associations with exposure to multiple violence.

Desejando parir naturalmente: perspectiva de mulheres sobre o parto domiciliar planejado com uma enfermeira obstétrica / Wanting to give birth naturally: women's perspective on planned homebirth with a nurse midwife / Deseando parir naturalmente: perspectiva de mujeres sobre el parto domiciliario planificado con una enfermera obstétrica

Objetivo: descrever a escolha do parto domiciliar planejado acompanhado por enfermeira obstétrica em um centro urbano de grande porte, na perspectiva de mulheres brasileiras. Métodos: estudo qualitativo guiado pela Grounded Theory. Foram entrevistadas dez mulheres com idade entre 20 e 41 anos que tiveram parto domiciliar planejado acompanhadas por enfermeiras obstétricas. As participantes foram recrutadas por meio de rede social, acessando um grupo de mulheres que escreveram sobre seu parto domiciliar. Resultados: Emergiram duas categorias: Não vendo possibilidade de parir naturalmente no ambiente hospitalar e Pensando na segurança do parto domiciliar planejado. O hospital representou vários aspectos desfavoráveis como intervenções desnecessárias e solidão. As mulheres consideravam o lar um lugar seguro para parir, conectado aos cuidados de enfermeiras obstétricas. Conclusão: há mulheres que não desejam parir no hospital, preferindo parir em casa e do ponto de vista dos direitos humanos e dos cuidados desmedicalizados, as enfermeiras obstétricas devem apoiar as mulheres nessa sua decisão.

Objective: to describe the choice of planned homebirth attended by a nurse midwife in a large urban centre, from the perspective of Brazilian women. Methods: in this Grounded Theory study, ten women aged 20 to 41 years, who had a planned homebirth accompanied by a nurse midwife, were interviewed. Participants were recruited through a social network by accessing a group of women who wrote about their homebirth. Results: two categories emerged: seeing no possibility of giving birth naturally in the hospital environment; and thinking about the safety of a planned homebirth. Hospital represented several unfavourable aspects, such as unnecessary interventions and loneliness. Women thought of home as a safe place to give birth, connected with nurse midwife care. Conclusion: there are women who do not wish to give birth in hospital, but prefer to give birth at home and, from the point of view of human rights and de-medicalized care, nurse midwives should support women in their decision.

Objetivo: describir la elección del parto domiciliario planificado con enfermera obstétrica en un gran centro urbano, desde la perspectiva de mujeres brasileñas. Métodos: estudio cualitativo guiado por la Grounded Theory. Se entrevistó a diez mujeres entre 20 y 41 años que tuvieron parto domiciliario planificado, siendo acompañadas de enfermeras obstétricas. Las participantes fueron reclutadas a través de red social, accediendo a un grupo de mujeres que escribieron sobre su parto en domicilio. Resultados: surgieron dos categorías: las que no veían posibilidad de dar a luz naturalmente en el hospital y las que pensaron en la seguridad del parto domiciliario planificado. El hospital representó varios aspectos desfavorables como intervenciones innecesarias y soledad. Las mujeres consideraban que el hogar era un ambiente seguro para dar a luz, vinculado al cuidado de enfermeras obstétricas. Conclusión: hay mujeres que no desean dar a luz en el hospital, prefieren hacerlo en casa y, desde el punto de vista de los derechos humanos y de los cuidados sin la intervención de un médico, las enfermeras obstétricas deben apoyarlas en esa decisión.

Fathers' experiences of feeding their extremely preterm infants in family-centred neonatal intensive care: a qualitative study.

BACKGROUND: Extremely preterm infants need advanced intensive care for survival and are usually not discharged before they reach the time of expected birth. In a family-centred neonatal intensive care unit both parents are involved at all levels of care including the feeding process. However, studies focusing on fathers in this situation are scarce. The purpose of this study was to explore the experiences of feeding extremely preterm infants in a neonatal intensive care unit from fathers' perspectives. METHODS: The study adopts a qualitative inductive method, reported according to the COREQ checklist. Seven fathers of extremely preterm infants (gestational age 24-27 weeks) in neonatal intensive care in Sweden were interviewed by telephone after discharge in 2013-2014. The interviews were analysed using a qualitative content analysis and confirmed by triangulation in 2021. RESULTS: Six sub-categories and two generic categories formed the main category: "a team striving towards the same goal". The fathers were equally involved and engaged members of the feeding team all hours of the day. The fathers shared responsibility and practical duties with the mothers, and they provided as much support to the mothers as they could. However, the fathers found it difficult to support and encourage the mothers to breastfeed and express breastmilk when the breastmilk production was low. The fathers experienced a loss when breastfeeding was not successful. CONCLUSIONS: The findings indicate that fathers want to be involved with infant care, including night-time feeds, and long and demanding feeding processes. Fathers and staff need to collaborate to provide the best support to mothers during the feeding process. This study may inspire hospital staff to acknowledge and support fathers to become more involved in the oral feeding process when an infant is born extremely preterm.

Dosing Patterns In Treatment of Disabling Spasticity With Intrathecal Baclofen.

PURPOSE: The aim of this study was to describe and analyze dosing patterns for patients with ITB treatment over time and to identify possible subgroups demonstrating diversity in patterns. DESIGN: A retrospective design. METHODS: For 81 patients from six different hospitals, baclofen doses from the first 2 years of treatment were identified using medical records. Line graphs of each patient's doses were analyzed and grouped based on similarities in dosing pattern. FINDINGS: The analyses of the dosing patterns resulted in four different subgroups classified as stable, slow increase, rapid increase, and fluctuating. CONCLUSION: The results highlight the clinical challenge of predicting dose development over time. CLINICAL RELEVANCE TO REHABILITATION NURSING: This study provides rehabilitation healthcare professionals with a better understanding of intrathecal baclofen dose development. Illustrations of the four subgroups can be used as an educational tool for patients, family, and caregivers.

Supporting Premature Infants' Oral Feeding in the NICU-A Qualitative Study of Nurses' Perspectives.

One major task in the neonatal intensive care unit (NICU) involves ensuring adequate nutrition and supporting the provision of human milk. The aim of this study was to explore nurses' experiences of the oral feeding process in the NICU when the infant is born extremely or very preterm. We used a qualitative inductive approach. Nine nurses from three family-centered NICUs were interviewed face-to-face. The interviews were transcribed verbatim and analyzed using content analysis. Five sub-categories and two generic categories formed the main category: 'A complex and long-lasting collaboration.' The nurses wished to contribute to the parents' understanding of the feeding process and their own role as parents in this process. The nurses' intention was to guide and support parents to be autonomous in this process. They saw the family as a team in which the preterm infant was the leader whose needs and development directed the feeding and the parents' actions in this process. Written and verbal communication, seeing all family members as important members of a team and early identification of the most vulnerable families to direct the emotional and practical feeding support accordingly can strengthen the feeding process in the NICU.

The relationship between fear of childbirth and sense of coherence in women expecting their first child.

OBJECTIVE: The aim was to investigate fear of childbirth (FOC) and sense of coherence (SOC), and their components in women expecting their first child. METHODS: A cross-sectional study where 414 women answered the Wijma Delivery Expectancy Questionnaire Version A and the Sense of Coherence Scale. Statistical analyses were performed. RESULTS: The main results show that women with severe FOC reported lower SOC, and all three components of SOC were lower in women with severe FOC. Comprehensibility turned out to have a significant correlation with FOC. Psychological problems before pregnancy were more common in women with severe FOC and low SOC. CONCLUSIONS: Women with severe FOC reported lower SOC and lower levels of each of the following components: comprehensibility, manageability and meaningfulness.

Examining the pace of change in contraceptive practices in abortion services - a follow-up case study of a quality improvement collaborative.

BACKGROUND: Among all women who experienced an abortion in Sweden 2017, 45% had previously underwent at least one abortion. This phenomenon of increasing rates of repeat abortions stimulated efforts to improve contraceptive services through a Quality Improvement Collaborative (QIC) with user involvement. The participating teams had difficulty in coordinating access post-abortion to the most effective contraception, Long-acting reversible contraception (LARC), during the eight-month QIC. This prompted questions about the pace of change in contraceptive services post-abortion. The aim of the study is to evaluate the evolution and impact of QIC changes regarding patient outcomes, system performance and professional development over 12 months after a QIC designed to enhance contraceptive services in the context of abortion. METHODS: This follow-up case study involves three multi-professional teams from abortion services at three hospitals in Sweden, which participated in a QIC during 2017. We integrated qualitative data on the evolution of changes and quantitative data regarding the monthly proportion of women initiating LARC, analysed in statistical control charts from before the QIC up until 12 months after its conclusion. RESULTS: Teams A and B increased the average proportion of women who initiated LARC within 30 days post abortion in the 12 months after the QIC; Team A 16-25%; Team B 20-34%. Team C achieved more than 50% in individual months but not consistently in the Post-QIC period. Elusive during the QIC, they now could offer timely appointments for women to initiate LARC more frequently. Team members reported continued focus on how to create trustful relationships when counseling women. They described improved teamwork, leadership support and impact on organizing appointments for initiating LARC following the QIC. CONCLUSIONS: QIC teams further improved women's timely access to LARC post abortion through continued changes in services 12 months after the QIC, demonstrating that the 8-month QIC was too short for all changes to materialize. Teams simultaneously improved women's reproductive health, health services, and professional development.

Should the PBL tutor be present? A cross-sectional study of group effectiveness in synchronous and asynchronous settings.

BACKGROUND: The tutorial group and its dynamics are a cornerstone of problem-based learning (PBL). The tutor's support varies according to the setting, and it is pertinent to explore group effectiveness in relation to different settings, for example online or campus-based. The PBL groups' effectiveness can partly be assessed in terms of cognitive and motivational aspects, using a self-report tool to measure PBL group effectiveness, the Tutorial Group Effectiveness Instrument (TGEI). This study's aim was to explore tutor participation in variations of online and campus-based tutorial groups in relation to group effectiveness. A secondary aim was to validate a tool for assessing tutorial group effectiveness in a Swedish context. METHODS: A cross-sectional study was conducted with advanced-level nursing students studying to become specialised nurses or midwives at a Swedish university. The TGEI was used to measure motivational and cognitive aspects in addition to overall group effectiveness. The instrument's items were translated into Swedish and refined with an expert group and students. The responses were calculated descriptively and compared between groups using the Mann-Whitney U and Kruskal-Wallis tests. A psychometric evaluation was performed using the Mokken scale analysis. The subscale scores were compared between three different tutor settings: the tutor present face-to-face in the room, the tutor present online and the consultant tutor not present in the room and giving support asynchronously. RESULTS: All the invited students (n = 221) participated in the study. There were no differences in motivational or cognitive aspects between students with or without prior PBL experience, nor between men and women. Higher scores were identified on cognitive aspects (22.6, 24.6 and 21.3; p < 0.001), motivational aspects (26.3, 27 and 24.5; p = 002) and group effectiveness (4.1, 4.3, 3.8, p = 0.02) for the two synchronously tutored groups compared to the asynchronously tutored group. The TGEI subscales showed adequate homogeneity. CONCLUSIONS: The tutor's presence is productive for PBL group effectiveness. However, the tutor need not be in the actual room but can provide support in online settings as long as the tutoring is synchronous.

You can't flight, you need to fight-A qualitative study of mothers' experiences of feeding extremely preterm infants.

AIM: To describe mother's experiences of feeding their extremely preterm infant. BACKGROUND: When an infant is born extremely preterm, there is a long rocky road for the mother if she wants to breastfeed. Some manage to reach their goals, others do not. Studies of feeding extremely preterm infants in the neonatal intensive care unit (NICU) are scarce. DESIGN: A qualitative method with an inductive approach. METHODS: Nine mothers giving birth to extremely preterm infants were interviewed by telephone after discharge from the NICU. The interviews were transcribed verbatim and analysed with qualitative content analysis. The COREQ checklist was followed. RESULTS: The overall theme was "you can't flight, you need to fight." The theme reflects the mothers' will to do the best for their infants even if the struggle with milk expression and breastfeeding practice evoked feelings of helplessness, exposure, worry and disappointment. The categories forming the theme were as follows: The wish to provide own breastmilk; For the infant's best; Loss of control; and Help to reach the goals. CONCLUSION: The mothers had a strong will to provide breastmilk to their infants but requested more support in order to be successful. RELEVANCE TO CLINICAL PRACTICE: There is a need for evidence-based support programmes for mothers of extremely preterm infants to encourage them to persevere with milk expression and breastfeeding over time.

Collaboratively seeking to improve contraceptive counselling at the time of an abortion: a case study of quality improvement efforts in Sweden.

BACKGROUND: Many women find it difficult to choose and initiate a contraceptive method at the time of an abortion. There is a gap between regular clinical practice and existing evidence on motivational and person-centred counselling, as well as on use of long-acting reversible contraception (LARC). This study aims to describe and evaluate a Quality Improvement Collaborative (QIC) designed to enhance contraceptive services, with regard to changes in healthcare professionals' (HCPs') counselling in clinical practice, and in women's subsequent choice of, and access to, contraception. METHODS: Three multiprofessional teams working in abortion services from three hospitals in Sweden, and two women contributing with user experience, participated in a QIC during the period March-November 2017. Using a case study design, we collected and analysed both quantitative and qualitative data. RESULTS: Teams agreed on QIC goals, including that ≥50% of women would start LARC within 30 days post-abortion, and tested multiple evidence-based changes, aided by the two women's feedback. During the QIC, participating HCPs reported that they gained new knowledge and developed skills in contraceptive counselling at the time of an abortion. The teams welcomed the development of a performance feedback system regarding women's post-abortion contraception. While the majority of women counselled during the QIC chose LARC, only 20%-40% received it within 30 days post-abortion. CONCLUSION: The QIC, incorporating user feedback, helped HCPs to develop capability in providing contraceptive services at the time of an abortion. Timely access to LARC remains a challenge in the present setting.

Experiences from intrathecal baclofen treatment based on medical records and patient- and proxy-reported outcome: a multicentre study.

PURPOSE: To investigate patient satisfaction with intrathecal baclofen treatment, complications from the treatment, and the impact of general expectations on treatment outcome in relation to satisfaction. METHODS: A multicentre study with cross-sectional design. Data were collected through questionnaires and patient records. Patients were recruited from six outpatient intrathecal baclofen clinics in Sweden. Eighty-three patients who had been treated with intrathecal baclofen for 1-4 years were included. For patients unable to communicate, data were collected through a proxy. The Patient Global Impression of Change was used to measure patients' general satisfaction with change from intrathecal baclofen treatment. The Life Orientation Test - revised, was used to measure general expectations/optimism. RESULTS: General satisfaction with intrathecal baclofen treatment was high; 51/77 patients reported "much improved" or "very much improved." There was no relationship between the two main outcomes (general satisfaction and general expectations/optimism) (rs = 0.12, p = 0.382). The two groups; those who could and those who could not communicate, did differ regarding personal characteristics and should be evaluated as such. CONCLUSIONS: Most patients/proxies reported a high level of satisfaction with intrathecal baclofen treatment. The reported satisfaction with intrathecal baclofen treatment was not dependent on general expectations. Implications for Rehabilitation Patients with intrathecal baclofen treatment report low levels of health and quality of life at the same time as they are highly satisfied with their treatment. Intrathecal baclofen should be equally offered to both optimistic and less optimistic patients. Patients who are able to/not able to communicate, differs in characteristics and should be informed and followed up in different ways in daily clinical practice.

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.

Women's experiences of contraceptive counselling in the context of an abortion - An interview study.

OBJECTIVE: To identify and understand women's lived experiences of contraceptive counselling given at the same time as abortion counselling. METHODS: We interviewed 13 women aged 20-39 who had experienced an abortion and the related counselling. The women were recruited from five hospitals in Sweden. Interviews were analysed using an interpretative phenomenological approach. RESULTS: We identified two themes: need for respectful counselling and needs for guidance and access to contraceptives. The essence "Being in a state of limbo and feeling sceptical" was coalesced from the themes. The women described a state of limbo, as being caught in an unwanted and emotionally charged situation. They reported that respectful counselling and meeting a skilled health professional helped to dispel their scepticism and influenced their plans for contraceptive use post abortion. Furthermore, women who wanted an intrauterine device described difficulties in access post abortion. CONCLUSION: The women seem to have a limited receptivity to contraceptive counselling when they have an unwanted pregnancy and are sceptical about contraceptives. Women, who experience respect in the counselling, report being helped in contraceptive decision-making. To receive respectful counselling and to have good access to intrauterine devices emerged as central needs among women at the time of an abortion.