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OBJECTIVES: To investigate women's decision-making on induced abortion. MATERIALS AND METHODS: A multi-centre cross-sectional survey among 623 abortion-seeking women in Sweden (2021). The perceived difficulty to decide on abortion was measured using a 7-point Likert scale, and analysed with univariate and multivariate analysis (odds ratios [OR], 95% confidence intervals [CI]). RESULTS: About half (n = 322;52%) scored 1-4, suggesting the decision was perceived as easier compared to those (n = 292;48%) who scored 5-7. Reasons for the abortion were: poor economy (n = 166;27%), too early in the relationship (n = 154;25.1%), want to work first (n = 147;23.9%), want to study first (n = 132;21.5%), uncertain about the relationship (104;16.9%), and too young (n = 104;16.9%). Predictors for perceiving the decision as difficult: partner's hesitance (OR = 3.18, CI:1.76-5.73), being born outside the Nordic countries (OR = 2.23, CI:1.28-3.87), having discussed the decision with someone (OR = 2.42, CI:1.67-3.50), age ≥30 (OR = 2.22, CI:1.03-4.76), the Covid-19 pandemic (OR = 2.08, CI:1.20-3.59), and the desire to have children in the future (OR = 1.96, CI:1.18-3.28). After confirmed pregnancy, poor mental well-being was more common among those who scored 5-7 (n = 140;47.9%) compared to those who scored 1-4 (n = 122;37.9), p = .029. CONCLUSION: Women's decision-making on abortion is complex; in times of crises, the decision procedure may be even more difficult. This valuable knowledge could be used to improve and promote satisfactory counselling beyond medical routines.
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Introduction: During the SARS-CoV-2 vaccinations in 2021, a record number of Individual Case Safety Reports (ICSR) were submitted to the Swedish Medical Products Agency (MPA). MPA further initiated a record-linkage study [1] by which vaccination data from the National Vaccination Register (NVR) was made accessible. Objective(s): We aimed at identifying temporal variations in reporting rates of ICSRs by number of administered vaccine doses, and if found, seek plausible explanations to them. Method(s): The weekly number of ICSRs submitted to the MPA was divided by the weekly number of administered doses between December 27, 2001, and May 1st, 2022, resulting in the reporting rate per 1,000 doses and week. Result(s): A total of 102,798 submitted ICSRs and 21.9 million administered doses resulted in an overall reporting rate of 4.7 ICSRs per 1000 doses, range: 0.9/1000 (April 2022) to 21.3/1000 (March 2021). Eighty-two percent of the reports were submitted by consumers. A four-fold increase in reporting rate was observed between weeks 5 and 11, 2021. This coincided with the start of vaccination of prioritized health-care personnel and ensuing mass media activity on e.g. whole hospital wards having to close due to the personnel's flu-like symptoms (fever, headache, fatigue, chills, etc.) following vaccination. On March 16, the Public Health Agency of Sweden decided that only individuals aged 65 or older would receive the Astra Zeneca AZD1222 vaccine. This was followed by a steep seven-fold decline in reporting in three weeks. Reporting rates from both health-care professionals and consumers increased and decreased in a similar fashion. During the summer of 2021, additional peaks in reporting rates were observed. At the same time, menstruation disorders following vaccination were debated in both social and traditional media. The most recent decline in reporting rates, which has yet to turn to an increase, occurred after the Russian invasion of Ukraine in the end of February 2022. The fluctuating reporting rates observed since April 2021 and onwards were almost exclusively seen in consumer reports. Conclusion(s): Rates of submitted spontaneous reports per 1.000 vaccinations in Sweden varied markedly during the studied period, the most pronounced of which originated from changes in consumer reporting. Many peaks in reporting rates can be-at least temporally-associated to various media or world events, even if a causal relationship can't be proven.
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Aims Medical simulation is a well-recognised tool in reducing anxiety and improving clinical confidence and competence in medical students (1). During the coronavirus pandemic a large proportion of medical students studied virtually with >23.5% of students studying online for >15 hours a week (2), reducing clinical exposure. We appreciate that this may affect confidence in clinical assessment. Studies have shown repeated exposure to simulation is important in building and retaining confidence in medical students (3). We developed a robust simulation programme at a children's teaching hospital for 20 fourth year undergraduate medical students from one higher education institution, aiming to establish whether simulation could improve students' confidence in assessing an unwell child. Methods A seven week programme was developed providing students up to four simulation sessions in total. All students acted as both participants and active observers. We surveyed 20 students on their confidence in assessing a child before and after the implementation of the programme, running alongside their paediatric rotation. The students divided their roles as junior doctors, nurses, and healthcare assistants. We discussed these roles in detail so they could appreciate the interprofessional involvement in such scenarios. Each scenario involved an introduction to simulation, introduction to the equipment, a pre-brief of the scenario and proposed methods of management, a ten minute acute paediatric scenario, and a debrief as per the diamond debrief model (figure 1). Scenarios covered included bronchiolitis, sepsis, acute asthma, and anaphylaxis;providing a range of acute paediatrics. APLS guidelines, the BNFC, and local protocols were available;as well as senior support if called. All teachers were trained in simulation teaching and debriefing. We collected qualitative and quantitative feedback through anonymous surveys. Of note, for 89% of students this programme was their first experience of paediatric simulation. Given the limited exposure of the students to simulation, the first session had a dedicated 10 minute talk on the concepts of simulation including the 'suspension of disbelief '. Results Initially, students felt 'scared', 'stressed', 'anxious' and 'inexperienced' about assessing a sick child and 'intimidated', 'terrified' and 'nervous' about simulation. Following the programme (see figure 2): 65% of students felt 'somewhat confident' in examining children. 94.7% of students feel that simulating acute scenarios will benefit their practice. 90% of students felt more confident about future simulation. Students appreciated the opportunity to 'practice making decisions'. One student commented that this is 'hard to come by on wards as you're often just observing rather than assessing'. Conclusion This seven-week paediatric simulation programme improved student confidence in examining and assessing an unwell child, in addition to improving confidence for future simulation. Alanazi et al proposed five best practice measures of simulation in education: study design, debriefing, integration of interprofessional education values, outcome measures, and student satisfaction. All were practised in this programme. Through ensuring a psychologically safe workspace, with appropriate resources and trained teachers, we believe we have created a non-intimidating and encouraging simulation environment. We look to provide virtual alternatives such as online video based interactive simulation should social distancing affect simulation teaching further.
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Introduction: During the SARS-CoV-2 vaccinations in 2021, a record number of Individual Case Safety Reports (ICSR) were submitted to the Swedish Medical Products Agency (MPA). MPA further initiated a record-linkage study [1] by which vaccination data from the National Vaccination Register (NVR) was made accessible. Objective: We aimed at identifying temporal variations in reporting rates of ICSRs by number of administered vaccine doses, and if found, seek plausible explanations to them. Methods: The weekly number of ICSRs submitted to the MPA was divided by the weekly number of administered doses between December 27, 2001, and May 1st, 2022, resulting in the reporting rate per 1,000 doses and week. Results: A total of 102,798 submitted ICSRs and 21.9 million administered doses resulted in an overall reporting rate of 4.7 ICSRs per 1000 doses, range: 0.9/1000 (April 2022) to 21.3/1000 (March 2021). Eighty-two percent of the reports were submitted by consumers. A four-fold increase in reporting rate was observed between weeks 5 and 11, 2021. This coincided with the start of vaccination of prioritized health-care personnel and ensuing mass media activity on e.g. whole hospital wards having to close due to the personnel's flu-like symptoms (fever, headache, fatigue, chills, etc.) following vaccination. On March 16, the Public Health Agency of Sweden decided that only individuals aged 65 or older would receive the Astra Zeneca AZD1222 vaccine. This was followed by a steep seven-fold decline in reporting in three weeks. Reporting rates from both health-care professionals and consumers increased and decreased in a similar fashion. During the summer of 2021, additional peaks in reporting rates were observed. At the same time, menstruation disorders following vaccination were debated in both social and traditional media. The most recent decline in reporting rates, which has yet to turn to an increase, occurred after the Russian invasion of Ukraine in the end of February 2022. The fluctuating reporting rates observed since April 2021 and onwards were almost exclusively seen in consumer reports. Conclusion: Rates of submitted spontaneous reports per 1.000 vaccinations in Sweden varied markedly during the studied period, the most pronounced of which originated from changes in consumer reporting. Many peaks in reporting rates can be-at least temporally-associated to various media or world events, even if a causal relationship can't be proven.