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  • 101.
    Risberg, Gunilla
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Johansson, Eva
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Gender perspective in medicine: a vital part of medical scientific rationality. A useful model for comprehending structures and hierarchies within medical science.2006In: BMC Medicine, ISSN 1741-7015, E-ISSN 1741-7015, no 4, p. 20-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: During the past few decades, research has reported gender bias in various areas of clinical and academic medicine. To prevent such bias, a gender perspective in medicine has been requested, but difficulties and resistance have been reported from implementation attempts. Our study aimed at analysing this resistance in relation to what is considered good medical research.

    METHOD: We used a theoretical model, based on scientific competition, to understand the structures of scientific medicine and how they might influence the resistance to a gender perspective in medicine. The model was originally introduced to discuss how pluralism improves rationality in the social sciences.

    RESULTS: The model provided a way to conceptualise different fields of research in medicine: basic research, applied research, medical philosophy, and 'empowering' research. It clarified how various research approaches within medicine relate to each other, and how they differ and compete. It also indicated why there might be conflicts between them: basic and applied research performed within the biomedical framework have higher status than gender research and other research approaches that are performed within divergent research paradigms.

    CONCLUSION: This hierarchy within medical research contributes to the resistance to a gender perspective, causing gender bias and making medical scientific rationality suboptimal. We recommend that the theoretical model can be applied in a wider medical context when different and hierarchically arranged research traditions are in conflict. In this way, the model might contribute to shape a medical community where scientific pluralism is acknowledged to enlarge, not to disturb, the scientific rationality of medicine.

  • 102.
    Risberg, Gunilla
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Johansson, Eva E
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Gender awareness among physicians - the effect of speciality and gender: A study of teachers at a Swedish medical school2003In: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 3, no 8Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: An important goal for medical education today is professional development including gender equality and awareness of gender issues. Are medical teachers prepared for this task? We investigated gender awareness among physician teachers, expressed as their attitudes towards the role of gender in professional relationships, and how it varied with physician gender and specialty. We discuss how this might be related to the gender climate and sex segregation in different specialties. METHOD: Questionnaires were sent to all 468 specialists in the clinical departments and in family medicine, who were engaged in educating medical students at a Swedish university. They were asked to rate, on visual analogue scales, the importance of physician and patient gender in consultation, of preceptor and student gender in clinical tutoring and of physician gender in other professional encounters. Differences between family physicians, surgical, and non-surgical hospital doctors, and between women and men were estimated by chi-2 tests and multivariate logistic regression analyses. RESULTS: The response rate was 65 %. There were differences between specialty groups in all investigated areas mainly due to disparities among men. The odds for a male family physician to assess gender important were three times higher, and for a male non-surgical doctor two times higher when compared to a male surgical doctor. Female teachers assessed gender important to a higher degree than men. Among women there were no significant differences between specialty groups. CONCLUSIONS: There was an interaction between physician teachers' gender and specialty as to whether they identified gender as important in professional relationships. Male physicians, especially from the surgical group, assessed gender important to a significantly lower degree than female physicians. Physicians' degree of gender awareness may, as one of many factors, affect working climate and the distribution of women and men in different specialties. Therefore, to improve working climate and reduce segregation we suggest efforts to increase gender awareness among physicians, for example educational programs where continuous reflections about gender attitudes are encouraged.

  • 103.
    Risberg, Gunilla
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Johansson, Eva E
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    A theoretical model for analysing gender bias in medicine2009In: International Journal for Equity in Health, ISSN 1475-9276, E-ISSN 1475-9276, Vol. 8, p. 28-Article in journal (Refereed)
    Abstract [en]

    During the last decades research has reported unmotivated differences in the treatment of women and men in various areas of clinical and academic medicine. There is an ongoing discussion on how to avoid such gender bias. We developed a three-step-theoretical model to understand how gender bias in medicine can occur and be understood. In this paper we present the model and discuss its usefulness in the efforts to avoid gender bias. In the model gender bias is analysed in relation to assumptions concerning difference/sameness and equity/inequity between women and men. Our model illustrates that gender bias in medicine can arise from assuming sameness and/or equity between women and men when there are genuine differences to consider in biology and disease, as well as in life conditions and experiences. However, gender bias can also arise from assuming differences when there are none, when and if dichotomous stereotypes about women and men are understood as valid. This conceptual thinking can be useful for discussing and avoiding gender bias in clinical work, medical education, career opportunities and documents such as research programs and health care policies. Too meet the various forms of gender bias, different facts and measures are needed. Knowledge about biological differences between women and men will not reduce bias caused by gendered stereotypes or by unawareness of health problems and discrimination associated with gender inequity. Such bias reflects unawareness of gendered attitudes and will not change by facts only. We suggest consciousness-rising activities and continuous reflections on gender attitudes among students, teachers, researchers and decision-makers.

  • 104.
    Risberg, Gunilla
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Johansson, Eva E.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    "Important...but of low status": male education leaders´ views on gender in medicine2011In: Medical Education, ISSN 0308-0110, E-ISSN 1365-2923, Vol. 45, no 6, p. 613-624Article in journal (Refereed)
    Abstract [en]

    Objectives The implementation of and communication about matters associated with gender in medical education have been predominantly perceived as women's issues. This study aimed to explore attitudes towards and experiences of gender-related issues among key male members of faculties of medicine.

    Methods We conducted semi-structured interviews with 20 male education leaders from the six medical schools in Sweden. The interviews were analysed qualitatively using a modified grounded theory approach.

    Results The core category -'important... but of low status'- reflects ambivalent attitudes towards gender-related issues in medicine among male education leaders. All informants were able to articulate why gender matters. As doctors, they saw gender as a determinant of health and, as bystanders, they had witnessed inequalities and the wasting of women's competence. However, they had doubts about gender-related issues and found them to be overemphasised. Gender education was seen as a threat to medical school curricula as a consequence of the time and space it requires. Gender-related issues were considered to be unscientifically presented, to mostly concern women's issues and to tend to involve 'male bashing' (i.e. gender issues were often labelled as ideological and political). Interviewees asked for facts and knowledge, but questioned specific lessons and gender theory. Experiences of structural constraints, such as prejudice, hierarchies and homosociality, were presented, making gender education difficult and downgrading it.

    Conclusions The results indicate that male faculty leaders embrace the importance of gender-related issues, but do not necessarily recognise or defend their impact on an area of significant knowledge and competence in medicine. To change this and to engage more men in gender education, faculty measures are needed to counteract prejudice and to upgrade the time allocation, merits and status of gender implementation work. Based on our findings, we present and discuss possible ways to interest more men and to improve gender education in medicine.

  • 105.
    Risberg, Gunilla
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Johansson, Eva
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine. Centre for Gender Excellence, research programme Challenging Gender, Umeå University, Umeå, SE-90187, Sweden.
    Westman, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine. Centre for Gender Excellence, research programme Challenging Gender, Umeå University, Umeå, SE-90187, Sweden.
    Attitudes toward and experiences of gender issues among physician teachers: a survey study conducted at a university teaching hospital in Sweden2008In: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 8, article id 10Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Gender issues are important to address during medical education, however research about the implementation of gender in medical curricula reports that there are obstacles. The aim of this study was to explore physician teachers' attitudes to gender issues.

    METHODS: As part of a questionnaire, physician teachers at Umeå University in Sweden were given open-ended questions about explanations for and asked to write examples why they found gender important or not. The 1 469 comments from the 243 respondents (78 women, 165 men) were analyzed by way of content analysis. The proportion of comments made by men and women in each category was compared.

    RESULTS: We found three themes in our analysis: Understandings of gender, problems connected with gender and approaches to gender. Gender was associated with differences between women and men regarding behaviour and disease, as well as with inequality of life conditions. Problems connected with gender included: delicate situations involving investigations of intimate body parts or sexual attraction, different expectations on male and female physicians and students, and difficulty fully understanding the experience of people of the opposite sex. The three approaches to gender that appeared in the comments were: 1) avoidance, implying that the importance of gender in professional relationships was recognized but minimized by comparing gender with aspects, such as personality and neutrality; 2) simplification, implying that gender related problems were easy to address, or already solved; and 3) awareness, implying that the respondent was interested in gender issues or had some insights in research about gender. Only a few individuals described gender as an area of competence and knowledge. There were comments from men and women in all categories, but there were differences in the relative weight for some categories. For example, recognizing gender inequities was more pronounced in the comments from women and avoidance more common in comments from men.

    CONCLUSION: The surveyed physician teachers gave many examples of gender-related problems in medical work and education, but comments describing gender as an area of competence and knowledge were few. Approaches to gender characterized by avoidance and simplification suggest that faculty development programs on gender need to address and reflect on attitudes as well as knowledge.

  • 106.
    Risberg, Gunilla
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Johansson, Eva
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Westman, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Gender in medicine - an issue for women only? A survey of physician teachers' gender attitudes.2003In: International Journal for Equity in Health, ISSN 1475-9276, E-ISSN 1475-9276, Vol. 2, no 1, p. 10-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: During the last decades research has disclosed gender differences and gender bias in different fields of academic and clinical medicine. Consequently, a gender perspective has been asked for in medical curricula and medical education. However, in reports about implementation attempts, difficulties and reluctance have been described. Since teachers are key persons when introducing new issues we surveyed physician teachers' attitudes towards the importance of gender in professional relations. We also analyzed if gender of the physician is related to these attitudes. METHOD: Questionnaires were sent to all 468 senior physicians (29 % women), at the clinical departments and in family medicine, engaged in educating medical students at a Swedish university. They were asked to rate, on five visual analogue scales, the importance of physician and patient gender in consultation, of physician and student gender in clinical tutoring, and of physician gender in other professional encounters. Differences between women and men were estimated by chi-2 tests and multivariate logistic regression analyses. RESULTS: The response rate was 65 %. The physicians rated gender more important in consultation than in clinical tutoring. There were significant differences between women and men in all investigated areas also when adjusting for speciality, age, academic degree and years in the profession. A higher proportion of women than men assessed gender as important in professional relationships. Those who assessed very low were all men while both men and women were represented among those with high ratings. CONCLUSIONS: To implement a gender perspective in medical education it is necessary that both male and female teachers participate and embrace gender aspects as important. To facilitate implementation and to convince those who are indifferent, this study indicates that special efforts are needed to motivate men. We suggest that men with an interest in gender issues should be involved in this work. Further research is needed to find out how such male-oriented endeavours should be outlined.

  • 107. Salander, Per
    et al.
    Bergenheim, A T
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    Henriksson, Roger
    Pathways from symptoms to medical care: a descriptive study of symptom development and obstacles to early diagnosis in brain tumour patients.1999In: Fam Pract, ISSN 0263-2136, Vol. 16, no 2, p. 143-8Article in journal (Refereed)
  • 108.
    Salander, Pär
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Gender differences in patient´s written narratives when being diagnosed with cancer2005In: Psycho-Oncology, ISSN 1057-9249, E-ISSN 1099-1611, Vol. 14, no 8, p. 685-695Article in journal (Refereed)
    Abstract [en]

    The medical field has shown a growing interest in gender and gender differences. In psychosocial oncology, for example, some studies suggest that men and women cope differently with cancer; e.g. women express their emotions more readily than men do, and men rely more on their healthy spouse.

    Using a qualitative perspective, this study examines 83 narratives written by male and female cancer patients who were asked to write down how they experienced receiving their cancer diagnosis. The narratives were analyzed both as to structure and content.

    The women wrote longer, more personally, and more emotionally than the men, and to a greater extent they included family members and other relatives in their stories. When the men mentioned relatives, they mainly referred to their spouse. Men and women commented differently as to their experiences of ‘reception’; i.e. how their psychological needs were addressed and ‘connection’; i.e. whether they felt in sufficient contact with medical staff. Although the women described good reception, they complained a lot about bad connection. Among the men, it was just as common to report about positive as negative experiences in both categories.

    There are reasons to be cautious when evaluating these findings. The found differences may be due to different ways of reacting to similar situations or different willingness and ways of commenting on similar situations, but also to different reception and connection for men and women. Further research should focus on the basic question: Are men and women without medical reasons being treated differently during their oncological treatment?

  • 109.
    Salander, Pär
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Why "spirituality" instead of "the humanistic side of medicine"?2014In: Academic Medicine, ISSN 1040-2446, E-ISSN 1938-808X, Vol. 89, no 11, p. 1430-1430Article in journal (Other academic)
  • 110.
    Salander, Pär
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Why 'spirituality' instead of 'the humanistic side of medicine'?2014In: Academic Medicine, ISSN 1040-2446, E-ISSN 1938-808X, Vol. 89, no 11, p. 1430-Article in journal (Refereed)
    Abstract [en]

    To the Editor: In a recent commentary, Puchalski et al1 describe the developing field of "spirituality” and its expansion into health professions education. However, we question whether this promotion really reflects an improvement.

    1 Puchalski CM, Blatt B, Kogan M, Butler A. Spirituality and health: The development of a field. Acad Med. 2014;89:10–16.

  • 111.
    Salander, Pär
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Why 'spirituality' instead of 'the humanistic side of medicine'?2014In: Academic Medicine, ISSN 1040-2446, E-ISSN 1938-808X, Vol. 89, no 11, p. 1430-Article in journal (Refereed)
  • 112.
    Salander, Pär
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work. Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Lilliehorn, Sara
    Umeå University, Faculty of Social Sciences, Department of Social Work. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Kero, Anneli
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    The impact of breast cancer on living an everyday life 4.5-5 years post-diagnosis: a qualitative prospective study of 39 women2011In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 50, no 3, p. 399-407Article in journal (Refereed)
    Abstract [en]

    Background. The survival of women with breast cancer has improved. There are many studies available describing different aspects of how the illness and its treatment affect the women. Usually these studies are cross-sectional and focus on assessments of a sample of women at a single point in time during post-treatment. These studies are important but of limited value if we are interested in understanding more about breast cancer in a life context. The present study is a contribution.

    Methods. A consecutive sample of 39 women was followed up by means of repeated thematic interviews about how they lived their lives, from the end of radiation therapy to a point four years later, i.e. 4.5–5 years post diagnosis.

    Results. Four different groups of women emerged. Largely, the first group evaluated the cancer initiated transformation of their lives in a positive way. The breast cancer helped them depart from a career treadmill or to positive interpersonal experiences. In the second group the cancer and its treatment seemed to pass without marked traces. The cancer made a difference for the third group, but both in positive and negative ways. A different life perspective or improved relationships were weighted against troublesome side effects from treatment. Finally, in the fourth group a bodily decline due to side effects and other health problems was predominant and this obstructed their chances of living a good life.

    Discussion. The narratives showed that being diseased by breast cancer has different impacts depending on how the woman lives her life – it is very much a matter of transition in a life context. The results are furthermore discussed in relation to adaptation and coping theory.

  • 113.
    Sperens, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Georgiev, Dejan
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. Department of Neurology, University Medical Centre Ljubljana, Slovenia; Faculty of Computer Sciences and Informatics, University of Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Slovenia.
    Eriksson Domellöf, Magdalena
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Forsgren, Lars
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Hariz, Gun-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Activities of daily living in men and women with Parkinson’s disease: eight-year prospective longitudinal studyManuscript (preprint) (Other academic)
  • 114.
    Sperens, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Hariz, Gun-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy. Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Are Patients Ready for "EARLYSTIM"?: Attitudes towards Deep Brain Stimulation among Female and Male Patients with Moderately Advanced Parkinson's Disease2017In: Parkinson's Disease, ISSN 2090-8083, E-ISSN 2042-0080, article id 1939831Article in journal (Refereed)
    Abstract [en]

    Objective: To explore, in female and male patients with medically treated, moderately advanced Parkinson's disease (PD), their knowledge and reasoning about Deep Brain Stimulation (DBS).

    Methods: 23 patients with PD (10 women), aged 46- 70, were interviewed at a mean of 8 years after diagnosis, with open-ended questions concerning their reflections and considerations about DBS. The interviews were transcribed verbatim and analysed according to the difference and similarity technique in Grounded Theory.

    Results: From the patients' narratives, the core category "Processing DBS: balancing symptoms, fears and hopes" was established. The patients were knowledgeable about DBS and expressed cautious and well considered attitudes towards its outcome but did not consider themselves ill enough to undergo DBS. They were aware of its potential side-effects. They considered DBS as the last option when oral medication is no longer sufficient. There was no difference between men and women in their reasoning and attitudes towards DBS.

    Conclusion: This study suggests that knowledge about the pros and cons of DBS exists among PD patients and that they have a cautious attitude towards DBS. Our patients did not seem to endorse an earlier implementation of DBS, and they considered that it should be the last resort when really needed.

  • 115.
    Sperens, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Hariz, Gun-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy. Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Challenges and strategies among women and men with Parkinson's disease: striving toward joie de vivre in daily life2018In: British Journal of Occupational Therapy, ISSN 0308-0226, E-ISSN 1477-6006, Vol. 81, no 12, p. 700-708Article in journal (Refereed)
    Abstract [en]

    Introduction: To offer people with Parkinson's disease optimal occupational therapy, it is important to have a detailed understanding of how they manage everyday life. The aims of this study were to explore how people with Parkinson's disease manage the effect of the disease on everyday life and to investigate gender similarities and differences concerning this issue.

    Method: We interviewed 24 people with Parkinson's disease (14 men), at a mean of 8 years after diagnosis. The interviews were analysed according to Grounded Theory.

    Findings: 'Striving to maintain a good everyday life' was established as a core category. To overcome obstacles caused by the disease, the interviewees struggled with perpetual adaptation to the medication regime and ongoing changes in their abilities. To achieve best possible everyday life, it was essential to keep their own spirit up; for example, by prioritising valued occupations. Women and men contributed to all categories and used the same strategies.

    Conclusion: Men and women with Parkinson's disease used the same strategies to manage daily life challenges. Our findings support the relevance of disease-specific occupational therapy interventions focusing on the individual fit between person, environment and occupation, and highlight the need for joyful occupations to attain a satisfactory daily life.

  • 116. Tishelman, Carol
    et al.
    Lövgren, Malin
    Broberger, Eva
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Sprangers, Mirjam A.G.
    Are the most distressing concerns of patients with inoperable lung cancer adequatley assessed? A mixed-methods analysis2010In: Journal of Clinical Oncology, ISSN 0732-183X, E-ISSN 1527-7755, Vol. 28, no 11, p. 1942-1949Article in journal (Refereed)
    Abstract [en]

    Purpose Standardized questionnaires for patient-reported outcomes are generally composed of specified predetermined items, although other areas may also cause patients distress. We therefore studied reports of what was most distressing for 343 patients with inoperable lung cancer (LC) at six time points during the first year postdiagnosis and how these concerns were assessed by three quality-of-life and symptom questionnaires.

    Patients and Methods Qualitative analysis of patients' responses to the question “What do you find most distressing at present?” generated 20 categories, with 17 under the dimensions of “bodily distress,” “life situation with LC,” and “iatrogenic distress.” Descriptive and inferential statistical analyses were conducted.

    Results The majority of statements reported as most distressing related to somatic and psychosocial problems, with 26% of patients reporting an overarching form of distress instead of specific problems at some time point. Twenty-seven percent reported some facet of their contact with the health care system as causing them most distress. While 55% to 59% of concerns reported as most distressing were clearly assessed by the European Organisation for Research and Treatment for Cancer Quality of Life Questionnaire Core-30 and Lung Cancer Module instruments, the Memorial Symptom Assessment Scale, and the modified Distress Screening Tool, iatrogenic distress is not specifically targeted by any of the three instruments examined.

    Conclusion Using this approach, several distressing issues were found to be commonly reported by this patient group but were not assessed by standardized questionnaires. This highlights the need to carefully consider choice of instrument in relation to study objectives and characteristics of the sample investigated and to consider complementary means of assessment in clinical practice.

  • 117.
    Umefjord, Göran
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Malker, Hans
    Mid-Sweden Research and Development Centre, County Council of Va¨ sternorrland, Sundsvall, Sweden.
    Petersson, Göran
    Health Institute, Department of Health and Behavioural Science, University of Kalmar, Sweden.
    The use of an internet-based ask the doctor service involving family physicians: evaluation by a web survey2006In: Family Practice, ISSN 0263-2136, E-ISSN 1460-2229, Vol. 23, no 2, p. 159-166Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Internet consultation without a previous relationship between the doctor and the enquirer seems to be increasing in popularity. However, little is known about the advantages, disadvantages or other differences compared with regular health care when using this kind of service. OBJECTIVE: To investigate how an Internet-based Ask the Doctor service out with any pre-existing doctor-patient relationship was used and evaluated by the enquirers. METHODS: We recruited to a web-based survey users of the non-commercial Swedish Internet-based Ask the Doctor service run by family physicians. The survey was conducted between November 2001 and January 2002. Questions included both multiple choice and free text formats, and the results were analysed quantitatively and qualitatively. RESULTS: The survey was completed by 1223 participants. It was mainly women who submitted questions to the service (29% men, 71% women) and also who participated in the survey (26% men, 74% women). Most participants (77%) wrote their question at home, and 80% asked on their own behalf. Almost half of the enquiries (45%) concerned a medical matter that had not been evaluated by a medical professional before. After reading the answer, 43% of the participants indicated that they would not pursue their question further having received sufficient information in the answer provided. The service was appreciated for its convenience and flexibility, but also for reasons to do with the mode of communication such as the ability to reflect on the written answer without having to hurry and to read it more than once. CONCLUSION: In the present study, we found that an Internet-based Ask the Doctor service run by family physicians on the whole was evaluated positively by the participants both in terms of the answers and the service. Internet-based consultation may act as a complement to regular health care. In future studies, the cost-effectiveness, patient security, responsibilities of the Internet doctor and the role of Ask the Doctor services compared with regular health care should be evaluated.

  • 118.
    Umefjord, Göran
    et al.
    Nyland Health Center, Biskopsgatan 1, SE-870 52 Nyland, Sweden.
    Petersson, Göran
    Department of Otorhinolaryngology, Lund University, Sweden.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Reasons for consulting a doctor on the Internet: Web survey of users of an Ask the Doctor service2003In: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 5, no 4, p. e26-Article in journal (Other academic)
    Abstract [en]

    BACKGROUND: In 1998 the Swedish noncommercial public health service Infomedica opened an Ask the Doctor service on its Internet portal. At no charge, anyone with Internet access can use this service to ask questions about personal health-related and disease-related matters. OBJECTIVE: To study why individuals choose to consult previously-unknown doctors on the Internet. METHODS: Between November 1, 2001, and January 31, 2002 a Web survey of the 3622 Ask the Doctor service users, 1036 men (29%) and 2586 (71%) women, was conducted. We excluded 186 queries from users. The results are based on quantitative and qualitative analysis of the answers to the question "Why did you choose to ask a question at Infomedica's 'Ask the Doctor' service?" RESULTS: 1223 surveys were completed (response rate 36 %). Of the participants in the survey 322 (26%) were male and 901 (74%) female. As major reasons for choosing to consult previously-unknown doctors on the Internet participants indicated: convenience (52%), anonymity (36%), "doctors too busy" (21%), difficult to find time to visit a doctor (16%), difficulty to get an appointment (13%), feeling uncomfortable when seeing a doctor (9%), and not being able to afford a doctors' visit (3%). Further motives elicited through a qualitative analysis of free-text answers were: seeking a second opinion, discontent with previous doctors and a wish for a primary evaluation of a medical problem, asking embarrassing or sensitive questions, seeking information on behalf of relatives, preferring written communication, and (from responses by expatriates, travelers, and others) living far away from regular health care. CONCLUSIONS: We found that that an Internet based Ask the Doctor service is primarily consulted because it is convenient, but it may also be of value for individuals with needs that regular health care services have not been able to meet.

  • 119. van Tongeren-Alers, M
    et al.
    van Esch, M
    Verdonk, P
    Johansson, Eva E
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Lagro-Janssen, A
    Gender-related considerations about work-life balance and speciality preferences among new Dutch and Swedish studentsIn: Teaching and learning in medicine, ISSN 1040-1334, E-ISSN 1532-8015Article in journal (Refereed)
  • 120. van Tongeren-Alers, Margret
    et al.
    van Esch, Maartje
    Verdonk, Petra
    Johansson, Eva
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Lagro-Janssen, Toine
    Are New Medical Students' Specialty Preferences Gendered?: Related Motivational Factors at a Dutch Medical School2011In: Teaching and learning in medicine, ISSN 1040-1334, E-ISSN 1532-8015, Vol. 23, no 3, p. 263-268Article in journal (Refereed)
    Abstract [en]

    Background: Female students currently outnumber male students in most medical schools. Some medical specialties are highly gender segregated. Therefore, it is interesting to know whether medical students have early specialization preferences based on their gender. Consequently, we like to know importance stipulated to motivational factors. Aim: Our study investigates new medical students' early specialization preferences and motivational factors. Methods: New students at a Dutch medical school (n = 657) filled in a questionnaire about specialty preferences (response rate = 94%; 69.5% female, 30.5% male). The students chose out of internal medicine, psychiatry, neurology, pediatrics, surgery, gynecology and family medicine, " other"or "I don't know." Finally, they valued ten motivational factors. Results: Forty percent of the medical students reported no specialty preference yet. Taken together, female medical students preferred pediatrics and wished to combine work and care, whereas male students opted for surgery and valued career opportunities. Conclusions: Gender-driven professional preferences in new medical students should be noticed in order to use competencies. Changes in specialty preferences and motivational factors in pre- and post graduates should further assess the role of medical education.

  • 121.
    van Tongeren-Alers, Margret
    et al.
    Radboud University Medical Center, Department of Primary and Community Care, Nijmegen, the Netherlands.
    Verdonk, Petra
    VU Medical Centre, Department of Medical Humanities, EMGO INstitute for Health and Care Research, School of Medical Sciences, Amsterdam, the Netherlands.
    Bor, Hans
    Radboud University Medical Center, Department of Primary and Community Care, Nijmegen, the Netherlands.
    Johansson, Eva E
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Lagro-Janssen, Antoine
    Radboud University Medical Center, Department of Primary and Community Care, Gender and Women's Health Unit,Nijmegen, the Netherlands.
    How gender or culture affects first year Dutch and Swedish students' preferences for specialties and work-life issues2014In: International Journal of Medical Education, ISSN 2042-6372, E-ISSN 2042-6372, Vol. 4, p. 214-220Article in journal (Refereed)
    Abstract [en]

    Objectives: We determine how gender or culture influence new medical students' specialty preferences and work-life issues and explore the relation between work-life issues and each specialty preference.

    Methods: In a cross-sectional study, we surveyed first year Dutch and Swedish medical students (N=1173, cohorts from 2006-2009) on their preferences for specialties, full-time or part-time work, and agreement to eleven work-life issues. We tested differences by gender or culture using chi square and logistic regression.

    Results: Over 93% of all students responded (N=1095). Almost no male first year student preferred gynecology as a specialty. Dutch male students were more often interested in surgery, Dutch female students in paediatrics. In the Netherlands, male students in particular preferred full-time work. In Sweden gender did not influence working hour preferences. Women in both countries expected equality in career-opportunities and care-tasks more than men, and agreed more often that their career would influence their family life. Women with a preference for surgery most often emphasized equality in career opportunities and care tasks. In most preferred specialties female gender related to a lower degree to full-time work. A gender gap in preferred working hours was larger for Dutch students preferring surgery or paediatrics than for Swedish students. For most of the specialty preferences studied, Swedish students anticipated childcare by day cares and Dutch students' informal day care.

    Conclusions: Early in training, medical students have gendered specialty preferences and work-life preferences which relate to each other. Gender differences are signifi-cantly more pronounced in the Netherlands than in Sweden.

  • 122.
    Waller, Göran
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Forssén, Annika
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    GPs asking patients to self-rate their health: a qualitative study2015In: British Journal of General Practice, ISSN 0960-1643, E-ISSN 1478-5242, Vol. 65, no 638, p. e624-e629Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In epidemiological research, self-rated health is an independent predictor of mortality, cardiovascular diseases, and other critical outcomes. It is recommended for clinical use, but research is lacking.

    AIM: To investigate what happens in consultations when the question 'How would you assess your general health compared with others your own age?' is posed.

    DESIGN AND SETTING: Authentic consultations with GPs at health centres in Sweden.

    METHOD: Thirty-three planned visits concerning diabetes, pain, or undiagnosed symptoms were voice-recorded. Dialogue regarding self-rated health was transcribed verbatim and analysed using a systematic text condensation method. Speaking time of patients and doctors was measured and the doctors' assessment of the value of the question was documented in a short questionnaire.

    RESULTS: Two overarching themes are used to describe patients' responses to the question. First, there was an immediate reaction, often expressing strong emotions, setting the tone of the dialogue and influencing the continued conversation. This was followed by reflection regarding their functional ability, management of illnesses and risks, and/or situation in life. The GPs maintained an attitude of active listening. They sometimes reported a slight increase in consultation time or feeling disturbed by the question, but mostly judged it as valuable, shedding additional light on the patients' situation and making it easier to discuss difficulties and resources. The patients' speaking time increased noticeably during this part of the consultation.

    CONCLUSION: Asking patients to comparatively self-rate their health is an effective tool in general practice.

  • 123.
    Waller, Göran
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Forssén, Annika
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    What does age-comparative self-rated health measure?: A cross-sectional study from the Northern Sweden MONICA Project2016In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 44, no 3, p. 233-239Article, review/survey (Refereed)
    Abstract [en]

    Aims: Self-rated health comprehensively accounts for many health domains. Using self-ratings and a knowledge of associations with health domains might help personnel in the health care sector to understand reports of ill health. The aim of this paper was to investigate associations between age-comparative self-rated health and disease, risk factors, emotions and psychosocial factors in a general population. Methods: We based our study on population-based cross-sectional surveys performed in 1999, 2004 and 2009 in northern Sweden. Participants were 25-74 years of age and 5314 of the 7500 people invited completed the survey. Comparative self-rated health was measured on a three-grade ordinal scale by the question How would you assess your general health condition compared to persons of your own age?' with the alternatives better', worse' or similar'. The independent variables were sex, age, blood pressure, cholesterol, body mass index, self-reported myocardial infarction, stroke, diabetes, physical activity, smoking, risk of unemployment, satisfaction with economic situation, anxiety and depressive emotions, education and Karasek scale of working conditions. Odds ratios using ordinal regression were calculated. Results: Age, sex, stroke, myocardial infarction, diabetes, body mass index, physical activity, economic satisfaction, anxiety and depressive emotions were associated with comparative self-rated health. The risk of unemployment, a tense work situation and educational level were also associated with comparative self-rated health, although they were considerably weaker when adjusted for the the other variables. Anxiety, depressive emotions, low economic satisfaction and a tense work situation were common in the population. Conclusions:Emotions and economic satisfaction were associated with comparative self-rated health as well as some medical variables. Utilization of the knowledge of these associations in health care should be further investigated.

  • 124.
    Waller, Göran
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Thalén, P
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Forssén, Annika
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Do not dismiss comparative self-rated health2011Conference paper (Other academic)
  • 125.
    Waller, Göran
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Thalén, Peder
    Department for Cultural Studies, Religious Studies and Educational Sciences, University of Gävle, Gävle, Sweden.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Forssén, Annika
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    A cross-sectional and semantic investigation of self-rated health in the northern Sweden MONICA-study2012In: BMC Medical Research Methodology, ISSN 1471-2288, E-ISSN 1471-2288, Vol. 12, article id 154Article in journal (Refereed)
    Abstract [en]

    Background: Self-Rated Health (SRH) correlates with risk of illness and death. But how are different questions of SRH to be interpreted? Does it matter whether one asks: “How would you assess your general state of health?”(General SRH) or “How would you assess your general state of health compared to persons of your own age?”(Comparative SRH)? Does the context in a questionnaire affect the answers? The aim of this paper is to examine the meaning of two questions on self-rated health, the statistical distribution of the answers, and whether the context of the question in a questionnaire affects the answers.

    Methods: Statistical and semantic methodologies were used to analyse the answers of two different SRH questions in a cross-sectional survey, the MONICA-project of northern Sweden.

    Results: The answers from 3504 persons were analysed. The statistical distributions of answers differed. The most common answer to the General SRH was “good”, while the most common answer to the Comparative SRH was “similar”. The semantic analysis showed that what is assessed in SRH is not health in a medical and lexical sense but fields of association connected to health, for example health behaviour, functional ability, youth, looks, way of life. The meaning and function of the two questions differ – mainly due to the comparing reference in Comparative SRH. The context in the questionnaire may have affected the statistics.

    Conclusions: Health is primarily assessed in terms of its sense-relations (associations) and Comparative SRH and General SRH contain different information on SRH. Comparative SRH is semantically more distinct. The context of the questions in a questionnaire may affect the way self-rated health questions are answered. Comparative SRH should not be eliminated from use in questionnaires. Its usefulness in clinical encounters should be investigated.

  • 126.
    Wennberg, Anna Lena
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Umeå University, Faculty of Medicine, Department of Nursing.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Midwives' strategies in challenging dietary and weight counselling situations2014In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 5, no 3, p. 107-112Article in journal (Refereed)
    Abstract [en]

    Objective: By enhancing maternal nutritional status, midwives can help women lower the risks of pregnancy complications and adverse birth outcomes as well as improve maternal health during pregnancy and in the long run. Dietary counselling is, on the other hand, not reported to be effective. Poor communication and conflicting messages are identified as possible barriers to adherence with recommendations. Midwives' experiences of providing dietary advice and counselling during pregnancy are sparsely reported. The aim of this study was therefore to explore midwives' strategies when faced with challenging dietary counselling situations. Methods: Seventeen midwives from different parts of Sweden and working within antenatal health care were interviewed by telephone. The interviews were analysed using qualitative content analysis. Results: Challenges were commonly experienced when counselling women who were overweight, obese, had eating disorders or were from different cultures. The midwives talked in terms of "the problematic women" when addressing counselling problems. Strategies used in challenging counselling situations were Getting acquainted; Trying to support and motivate; Pressure to choose "correttly"; Controlling and mastering; and Resigning responsibility. Conclusions: The results indicate that Swedish midwives' counselling strategies are quite ambiguous and need to be questioned and that counselling of vulnerable groups of women should be highlighted. We could identify a need for education of practicing midwives to develop person-centred counselling skills.

  • 127.
    Wennberg, Anna Lena
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Isaksson, Ulf
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sandström, Herbert
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Lundqvist, Anette
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Hörnell, Anette
    Umeå University, Faculty of Social Sciences, Department of Food and Nutrition.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Swedish women's food habits during pregnancy up to six months post-partum: a longitudinal studyIn: Perspectives on sexual and reproductive health, ISSN 1538-6341, E-ISSN 1931-2393Article in journal (Other academic)
  • 128.
    Wennberg, Anna Lena
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lundqvist, Anette
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Högberg, Ulf
    Uppsala Univ, Dept Womens & Childrens Hlth Obstet & Gynecol, SE-75105 Uppsala, Sweden.
    Sandström, Herbert
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Women's experiences of dietary advice and dietary changesduring pregnancy2013In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 29, no 9, p. 1027-1034Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: to describe women's experiences of dietary information and the change of dietary habits during pregnancy. DESIGN: a qualitative design was used. In 2007 we conducted six focus group interviews using open-ended questions. SETTINGS: five rural and city antenatal clinics in northern Sweden were included PARTICIPANTS: twenty-three women in mid-pregnancy participated in groups of three to seven FINDINGS: three domains were found 'Dietary information gain', 'Reactions to dietary information' and 'Dietary management'. The women had to discover dietary information by themselves, and only when health problems or symptoms occurred did they receive guidance from the midwife. Their reactions to the dietary information were 'being confused', 'feeling fear and guilt' and 'being monitored', summed up in 'being uncertain'. The diet was managed by 'checking food content', 'following bodily signals', 'using common sense', and 'making exceptions', summed up as 'being responsible but with a pinch of salt'. KEY CONCLUSIONS: the women expressed problems with dietary changes, but they could mostly manage them on their own. The pregnant women experienced that the midwives gave dietary information and advice first when problems arise. When struggling with diet, the women experienced confusion, and they had to seek information by themselves. IMPLICATIONS FOR PRACTICE: sources of information about diet during pregnancy were experienced as inconsistent and contradictory. Midwives are important in motivation for healthy lifestyle during pregnancy and with sufficient dietary knowledge and counselling skills they can help pregnant women effect dietary changes by providing guidance and support in early pregnancy.

  • 129.
    Wennberg, Anna-Lena
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Univ Umea Hosp, Dept Publ Hlth & Clin Med, Family Med, SE-90185 Umea, Sweden.
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hamberg, Katarina
    Univ Umea Hosp, Dept Publ Hlth & Clin Med, Family Med, SE-90185 Umea, Sweden.
    A questioned authority meets well-informed pregnant women: a qualitative study examining how midwives perceive their role in dietary counselling2015In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 15, no 1, article id 88Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: During pregnancy and afterward, a healthy diet is beneficial for the expecting mother and her foetus. Midwives in antenatal care have an ideal position for promoting healthy diets. Dietary counselling is however complex and recommendations can be controversial. While pregnant women struggle with dietary recommendations, midwives struggle with a lack of authority. The aim of the study was therefore to describe how midwives perceive their role and their significance in dietary counselling of pregnant women.

    METHODS: An interview study was conducted that involved twenty-one (21) experienced midwives, who worked in the Swedish prenatal health care. A qualitative content analysis was conducted.

    RESULTS: Pregnant women were perceived to be well informed, but they needed guidance to interpret information on the Internet. They were described as rigorous and eager information seekers who needed guidance to interpret information as they were worried and emotional. The midwives saw themselves as a questioned authority who lacked support. This meant being informative and directive though not always updated or listened to. Their impact was uncertain and they could also lack sufficient competence to counsel in delicate issues.

    CONCLUSION: The midwives' directive role may obstruct the women's needs to manage the dietary recommendations and risk evaluation in a women-centred dialogue. Midwives need to acknowledge pregnant women as both well informed and skilled if they are going to develop woman-centred antenatal care. Ongoing training and self-reflection will be needed to make this change.

  • 130.
    Wennberg, Anna-Lena
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Social Sciences, Department of Food and Nutrition. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Isaksson, Ulf
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sandström, Herbert
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Lundqvist, Anette
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Hörnell, Agneta
    Umeå University, Faculty of Social Sciences, Department of Food and Nutrition.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Swedish women’s food habits during pregnancy up to six months post-partum:: A longitudinal study2016In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 8, p. 31-36Article in journal (Refereed)
    Abstract [en]

    Objectives: Diet influences the health of the foetus and the woman during pregnancy and later in life. Itis therefore important to investigate pregnant women’s food habits. The aim of this study was to describewomen’s food habits during pregnancy and up to six months post-partum.Study design: A Food Frequency Questionnaire (VIP-FFQ) was distributed to 163 pregnant women on fiveoccasions during and after pregnancy. Data were analysed using Friedman’s ANOVA and a Bonferronipost-hoc test.Main outcome measures: Food habits in relation to the National Food Agency’s (NFA) food index.Results: The pregnant women’s diets were inadequate according to the NFA food index. A tendency towardsan even poorer diet after delivery was identified, something which was related to an increased intakeof discretionary food, e.g. sweets, cakes, cookies, crisps, ice cream, and decreased intake of fruit and vegetable.The alcohol consumption was low throughout.Conclusions: The food habits during pregnancy were inadequate compared to recommendations and thesehabits became unhealthier after delivery. These suggest that dietary counselling needs to be more effectiveand continued into the lactating period. An increased focus should be given to healthy eating fromthe life course perspective, not just focus on effects on the foetus and pregnancy outcomes.

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