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Wulff, Marianne
Publications (10 of 32) Show all publications
Lindström, M., Wulff, M., Dahlgren, L. & Lalos, A. (2011). Experiences of working with induced abortion: focus group discussions with gynaecologists and midwives/nurses. Scandinavian Journal of Caring Sciences, 25(3), 542-548
Open this publication in new window or tab >>Experiences of working with induced abortion: focus group discussions with gynaecologists and midwives/nurses
2011 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 25, no 3, p. 542-548Article in journal (Refereed) Published
Abstract [en]

Background:  While there exists an extensive amount of research regarding the medical aspects of abortion, there is a great lack of studies investigating staff's views and experiences of working in abortion services.

Aims:  To elucidate gynaecologists' and midwives'/nurses' experiences, perceptions and interactions working in abortion services, their experiences of medical abortions and abortions performed at the woman's home. An additional aim was to illustrate gynaecologists', midwives' and nurses' visions of their future professional roles within the abortion services.

Method:  Three focus group discussions within each profession were carried out in 1-hour sessions with a total of 25 gynaecologists and 15 midwives/nurses from three different hospitals.

Results:  The content analysis reflected that gynaecologists and midwives/nurses had no doubts about participating in abortions despite the fact that they had experienced complex and difficult situations, such as repeat and late-term abortions. They experienced their work as paradoxical and frustrating but also as challenging and rewarding. However, they were rarely offered ongoing guidance and continuously professional development education. For gynaecologists, as well as midwives/nurses, their experiences and perceptions were strongly linked to the concurrent development of abortion methods. The interaction between the professions was found to be based on great trust in each other's skills.

Conclusions:  In order to promote women's health, gynaecologists' and midwives'/nurses' need for a forum for reflection and ongoing guidance should be acted on. With a higher number of abortions done medically and a higher proportion of home abortions, midwives/nurses will get increased, responsibilities in the abortion services in the future.

Place, publisher, year, edition, pages
Wiley, 2011
Keywords
abortion care, ethical considerations, experience, gynaecologist, focus group discussion, home abortion, interaction, midwife, nurse
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Medicine
Identifiers
urn:nbn:se:umu:diva-42138 (URN)10.1111/j.1471-6712.2010.00862.x (DOI)21251034 (PubMedID)
Available from: 2011-04-06 Created: 2011-04-06 Last updated: 2018-06-08Bibliographically approved
Goicolea, I., Wulff, M., San Sebastian, M. & Öhman, A. (2010). Adolescent pregnancies and girls' sexual and reproductive rights in the Amazon Basin of Ecuador: an analysis of providers' and policy makers' discourses. BMC International Health and Human Rights, 10(12)
Open this publication in new window or tab >>Adolescent pregnancies and girls' sexual and reproductive rights in the Amazon Basin of Ecuador: an analysis of providers' and policy makers' discourses
2010 (English)In: BMC International Health and Human Rights, ISSN 1472-698X, E-ISSN 1472-698X, Vol. 10, no 12Article in journal (Refereed) Published
Abstract [en]

Background: Adolescent pregnancies are a common phenomenon that can have both positive and negative consequences. The rights framework allows us to explore adolescent pregnancies not just as isolated events, but in relation to girls' sexual and reproductive freedom and their entitlement to a system of health protection that includes both health services and the so called social determinants of health. The aim of this study was to explore policy makers' and service providers' discourses concerning adolescent pregnancies, and discuss the consequences that those discourses have for the exercise of girls' sexual and reproductive rights' in the province of Orellana, located in the amazon basin of Ecuador.

Methods: We held six focus-group discussions and eleven in-depth interviews with 41 Orellana's service providers and policy makers. Interviews were transcribed and analyzed using discourse analysis, specifically looking for interpretative repertoires.

Results: Four interpretative repertoires emerged from the interviews. The first repertoire identified was "sex is not for fun" and reflected a moralistic construction of girls' sexual and reproductive health that emphasized abstinence, and sent contradictory messages regarding contraceptive use. The second repertoire -"gendered sexuality and parenthood"-constructed women as sexually uninterested and responsible mothers, while men were constructed as sexually driven and unreliable. The third repertoire was "professionalizing adolescent pregnancies" and lead to patronizing attitudes towards adolescents and disregard of the importance of non-medical expertise. The final repertoire -"idealization of traditional family"-constructed family as the proper space for the raising of adolescents while at the same time acknowledging that sexual abuse and violence within families was common.

Conclusions: Providers' and policy makers' repertoires determined the areas that the array of sexual and reproductive health services should include, leaving out the ones more prone to cause conflict and opposition, such as gender equality, abortion provision and welfare services for pregnant adolescents. Moralistic attitudes and sexism were present - even if divergences were also found-, limiting services' capability to promote girls' sexual and reproductive health and rights.

Place, publisher, year, edition, pages
London: BioMed Central, 2010
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:umu:diva-26785 (URN)10.1186/1472-698X-10-12 (DOI)000289980800001 ()
Available from: 2009-10-27 Created: 2009-10-27 Last updated: 2018-06-08Bibliographically approved
Goicolea, I., Wulff, M. & Öhman, A. (2010). Gender structures constraining girls’ agency: exploring pregnancy and motherhood among adolescent gilrs in Ecuador’s Amazon Basin. Sexuality, Health and Society, 5, 50-73
Open this publication in new window or tab >>Gender structures constraining girls’ agency: exploring pregnancy and motherhood among adolescent gilrs in Ecuador’s Amazon Basin
2010 (English)In: Sexuality, Health and Society, ISSN 1984-6487, Vol. 5, p. 50-73Article in journal (Refereed) Published
Identifiers
urn:nbn:se:umu:diva-43315 (URN)
Available from: 2011-04-27 Created: 2011-04-27 Last updated: 2018-06-08Bibliographically approved
Kero, A., Lalos, A. & Wulff, M. (2010). Home abortion - experiences of male involvement. European journal of contraception & reproductive health care, 15(4), 264-270
Open this publication in new window or tab >>Home abortion - experiences of male involvement
2010 (English)In: European journal of contraception & reproductive health care, ISSN 1362-5187, E-ISSN 1473-0782, Vol. 15, no 4, p. 264-270Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To gain knowledge about the male partner's experience of being present during an induced home abortion. METHODS: Twenty-three couples, whose male partner had been present when the woman aborted at home, were interviewed one to two weeks post-abortion. RESULTS: Each of the men supported his partner in her decision to have a home abortion, as this gave him the possibility of being near and of caring for her needs on the expulsion day. All the men were present and all their partners confirmed that they had been supportive. Half the men had been anxious prior to the expulsion, but most considered that their experiences during the expulsion had been 'easier than expected' and their dominant feeling was one of relief. CONCLUSIONS: Abortion is an important life event. When taking place at home, it increases the possibility for the couple to share the experience. Sharing an abortion may have a positive impact on those men who lack a sense of responsibility regarding reproductive issues, such as contraceptive use. This could facilitate society's efforts to involve men as a target group in this field. Designing an abortion policy that caters for the needs of both partners is a challenge.

Place, publisher, year, edition, pages
London: Informa Plc, 2010
Keywords
Medical abortion, Home abortion, Men, Male partner, Couple, Male experiences, Male involvement
Identifiers
urn:nbn:se:umu:diva-36775 (URN)10.3109/13625187.2010.485257 (DOI)000280900400006 ()20809674 (PubMedID)
Available from: 2010-10-11 Created: 2010-10-11 Last updated: 2018-06-08Bibliographically approved
Toniolo, P., Grankvist, K., Wulff, M., Chen, T., Johansson, R., Schock, H., . . . Lukanova, A. (2010). Human chorionic gonadotropin in pregnancy and maternal risk of breast cancer. Cancer Research, 70(17), 6779-6786
Open this publication in new window or tab >>Human chorionic gonadotropin in pregnancy and maternal risk of breast cancer
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2010 (English)In: Cancer Research, ISSN 0008-5472, E-ISSN 1538-7445, Vol. 70, no 17, p. 6779-6786Article in journal (Refereed) Published
Abstract [en]

Full-term pregnancies are associated with long-term reductions in maternal risk of breast cancer, but the biological determinants of the protection are unknown. Experimental observations suggest that human chorionic gonadotropin (hCG), a major hormone of pregnancy, could play a role in this association. A case-control study (242 cases and 450 controls) nested within the Northern Sweden Maternity Cohort included women who had donated a blood sample during the first trimester of a first full-term pregnancy. Total hCG was determined on Immulite 2000 analyzer. Odds ratios (OR) and 95% confidence intervals (CI) were estimated through conditional logistic regression. Maternal breast cancer risk decreased with increasing hCG (upper tertile OR, 0.67; CI, 0.46-0.99), especially for pregnancies before age 25 (upper tertile OR, 0.41; CI, 0.21-0.80). The association diverged according to age at diagnosis: risk was reduced after age 40 (upper tertile OR, 0.60; CI, 0.39-0.91) and seemed to increase before age 40 (upper tertile OR, 1.78; CI, 0.72-4.38). Risk was reduced among those diagnosed 10 years or longer after blood draw (upper tertile OR, 0.60; CI, 0.40-0.90), but not so among those diagnosed within 10 years (upper tertile OR, 4.33; CI, 0.86-21.7). These observations suggest that the association between pregnancy hCG and subsequent maternal risk of breast cancer is modified by age at diagnosis. Although the hormone seems to be a determinant of the reduced risk around or after age 50, it might not confer protection against, or it could even increase the risk of, cancers diagnosed in the years immediately following pregnancy.

Keywords
epidemiology; metaanalysis; prevention; birth; women
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:umu:diva-36119 (URN)10.1158/0008-5472.CAN-09-4622 (DOI)000281914600011 ()20713523 (PubMedID)
Available from: 2010-09-17 Created: 2010-09-17 Last updated: 2018-06-08Bibliographically approved
Chen, T., Lukanova, A., Grankvist, K., Zeleniuch-Jacquotte, A., Wulff, M., Johansson, R., . . . Lundin, E. (2010). IGF-I during primiparous pregnancy and maternal risk of breast cancer. Breast Cancer Research and Treatment, 121(1), 169-175
Open this publication in new window or tab >>IGF-I during primiparous pregnancy and maternal risk of breast cancer
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2010 (English)In: Breast Cancer Research and Treatment, ISSN 0167-6806, E-ISSN 1573-7217, Vol. 121, no 1, p. 169-175Article in journal (Refereed) Published
Abstract [en]

Previously, we reported that insulin-like growth factor (IGF)-I during early pregnancy is positively associated with maternal risk of breast cancer. To further explore this association, we designed a new study limited to women who donated a blood sample during their first pregnancy ending with childbirth. A case-control study was nested within the Northern Sweden Maternity Cohort in which repository since 1975, serum specimens remaining after early pregnancy screening for infectious diseases had been preserved. Study subjects were selected among women who donated a blood sample during the full-term pregnancy that led to the birth of their first child. Two hundred and forty-four women with invasive breast cancer were eligible. Two controls, matching the index case for age and date at blood donation were selected (n = 453). IGF-I was measured in serum samples on an Immulite 2000 analyzer. Conditional logistic regression was used to estimate odds ratios and 95% confidence intervals. A significant positive association of breast cancer with IGF-I was observed, with OR of 1.73 (95% CI: 1.14-2.63) for the top tertile, P < 0.009. Subgroup analyses did not indicate statistical heterogeneity of the association by ages at sampling and diagnosis or by lag time to cancer diagnosis, although somewhat stronger associations with risk were observed in women < or = age 25 at index pregnancy and for cases diagnosed within 15 years of blood donation. The results of the study add further evidence for an adverse effect of elevated IGF-I concentrations during early reproductive life on risk of breast cancer.

Keywords
insulin-like growth factor (IGF)-I, breast cancer, pregnancy, nested case-control study
Identifiers
urn:nbn:se:umu:diva-34568 (URN)10.1007/s10549-009-0519-6 (DOI)000276758200017 ()19728079 (PubMedID)
Available from: 2010-06-08 Created: 2010-06-08 Last updated: 2018-06-08Bibliographically approved
Chen, T., Lundin, E., Grankvist, K., Zeleniuch-Jacquotte, A., Wulff, M., Afanasyeva, Y., . . . Lukanova, A. (2010). Maternal hormones during early pregnancy: a cross-sectional study. Cancer Causes and Control, 21(5), 719-727
Open this publication in new window or tab >>Maternal hormones during early pregnancy: a cross-sectional study
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2010 (English)In: Cancer Causes and Control, ISSN 0957-5243, E-ISSN 1573-7225, Vol. 21, no 5, p. 719-727Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Little is known about correlates of first-trimester pregnancy hormones as in most studies maternal hormones have been measured later in gestation. We examined the associations of maternal characteristics and child sex with first-trimester maternal concentrations of four hormones implicated in breast cancer: human chorionic gonadotropin (hCG), alpha-fetoprotein (AFP), insulin-like growth factor (IGF)-I, and IGF-II. METHODS: About 338 serum samples donated to the Northern Sweden Maternity Cohort (NSMC), 1975-2001, during the first trimester of uncomplicated pregnancies, were analyzed for the hormones of interest as a part of a case-control study. The associations of maternal characteristics and child sex with hormone concentrations were investigated by correlation, general linear regression, and multivariate regression models. RESULTS: In the first trimester, greater maternal age was inversely correlated with IGF-I and IGF-II. In comparison with women carrying their first child, already parous women had higher IGF-I but lower hCG. Greater maternal weight and smoking were inversely correlated with hCG. No differences in hormone levels by child sex were observed. CONCLUSIONS: Our analyses indicated that potentially modifiable maternal characteristics (maternal weight and smoking) influence first-trimester pregnancy maternal hormone concentrations.

Keywords
Pregnancy, Cross-sectional study, Human chorionic gonadotropin (hCG), α-Fetoprotein (AFP), Insulin-like growth factor (IGF)-I, IGF-II
Identifiers
urn:nbn:se:umu:diva-34561 (URN)10.1007/s10552-009-9500-2 (DOI)000276768500008 ()20084544 (PubMedID)
Available from: 2010-06-08 Created: 2010-06-08 Last updated: 2018-06-08Bibliographically approved
Kero, A., Lalos, A. & Wulff, M. (2010). Why shouldn't one report on women's positive feelings with regard to abortion? [Letter to the editor]. European journal of contraception & reproductive health care, 15(2), 150-151
Open this publication in new window or tab >>Why shouldn't one report on women's positive feelings with regard to abortion?
2010 (English)In: European journal of contraception & reproductive health care, ISSN 1362-5187, E-ISSN 1473-0782, Vol. 15, no 2, p. 150-151Article in journal, Letter (Other academic) Published
Place, publisher, year, edition, pages
Informa Healthcare, 2010
National Category
Obstetrics, Gynecology and Reproductive Medicine Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-42140 (URN)10.3109/13625181003706604 (DOI)000275584800009 ()20230341 (PubMedID)
Available from: 2011-04-06 Created: 2011-04-06 Last updated: 2018-06-08Bibliographically approved
Lundin, E., Dossus, L., Clendenen, T., Krogh, V., Grankvist, K., Wulff, M., . . . Lukanova, A. (2009). C-reactive protein and ovarian cancer: a prospective study nested in three cohorts (Sweden, USA, Italy).. Cancer Causes and Control, 20(7), 1151-1159
Open this publication in new window or tab >>C-reactive protein and ovarian cancer: a prospective study nested in three cohorts (Sweden, USA, Italy).
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2009 (English)In: Cancer Causes and Control, ISSN 0957-5243, E-ISSN 1573-7225, Vol. 20, no 7, p. 1151-1159Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Inflammatory processes may influence the risk of epithelial ovarian cancer, but available epidemiological evidence is limited and indirect. Circulating C-reactive protein (CRP), a sensitive marker of inflammation, may serve as a direct biological marker of an underlying association. METHODS: The association between ovarian cancer risk and pre-diagnostic circulating CRP was tested in a case-control study nested within three prospective cohorts from Sweden, USA, and Italy. The study included 237 cases and 427 individually matched controls. CRP was measured in stored blood samples by high-sensitivity immunoturbidimetric assay. Odds ratios (OR) and 95% confidence intervals (CI) were calculated by conditional logistic regression. RESULTS: Overall, CRP was not related to risk of ovarian cancer. However, a marked increase in risk was observed for CRP concentrations >10 mg/l: OR (95% CI) 4.4 (1.8-10.9), which remained significant after limiting analyses to cases diagnosed more than two or five years after blood donation (OR 3.0 (1.2-8.0) and 3.6 (1.0-13.2), respectively). Risk of mucinous tumors increased with high CRP, but the number of cases in this analysis was small. CONCLUSION: Study results offer additional support to the concept that chronic inflammation plays a role in epithelial ovarian cancer.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-23468 (URN)10.1007/s10552-009-9330-2 (DOI)19301134 (PubMedID)
Available from: 2009-06-18 Created: 2009-06-18 Last updated: 2018-08-31Bibliographically approved
Kero, A., Lalos, A. & Wulff, M. (2009). Home abortion implies radical changes for women. The European journal of contraception and reproductive health care, 14(5), 324-333
Open this publication in new window or tab >>Home abortion implies radical changes for women
2009 (English)In: The European journal of contraception and reproductive health care, ISSN 1362-5187, Vol. 14, no 5, p. 324-333Article in journal (Refereed) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-27619 (URN)10.3109/13625180903128609 (DOI)
Available from: 2009-11-12 Created: 2009-11-12 Last updated: 2018-06-08Bibliographically approved
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