Implementing a Hospital Call Center Service for Mental Health in Uganda: User-Centered Design Approach.

BACKGROUND: Mental health conditions are a significant public health problem globally, responsible for >8 million deaths per year. In addition, they lead to lost productivity, exacerbate physical illness, and are associated with stigma and human rights violations. Uganda, like many low- and middle-income countries, faces a massive treatment gap for mental health conditions, and numerous sociocultural challenges exacerbate the burden of mental health conditions. OBJECTIVE: This study aims to describe the development and formative evaluation of a digital health intervention for improving access to mental health care in Uganda. METHODS: This qualitative study used user-centered design and design science research principles. Stakeholders, including patients, caregivers, mental health care providers, and implementation experts (N=65), participated in focus group discussions in which we explored participants' experience of mental illness and mental health care, experience with digital interventions, and opinions about a proposed digital mental health service. Data were analyzed using the Consolidated Framework for Implementation Research to derive requirements for the digital solution, which was iteratively cocreated with users and piloted. RESULTS: Several challenges were identified, including a severe shortage of mental health facilities, unmet mental health information needs, heavy burden of caregiving, financial challenges, stigma, and negative beliefs related to mental health. Participants' enthusiasm about digital solutions as a feasible, acceptable, and convenient method for accessing mental health services was also revealed, along with recommendations to make the service user-friendly, affordable, and available 24×7 and to ensure anonymity. A hospital call center service was developed to provide mental health information and advice in 2 languages through interactive voice response and live calls with health care professionals and peer support workers (recovering patients). In the 4 months after launch, 456 calls, from 236 unique numbers, were made to the system, of which 99 (21.7%) calls went to voicemails (out-of-office hours). Of the remaining 357 calls, 80 (22.4%) calls stopped at the interactive voice response, 231 (64.7%) calls were answered by call agents, and 22 (6.2%) calls were not answered. User feedback was positive, with callers appreciating the inclusion of peer support workers who share their recovery journeys. However, some participant recommendations (eg, adding video call options) or individualized needs (eg, prescriptions) could not be accommodated due to resource limitations or technical feasibility. CONCLUSIONS: This study demonstrates a systematic and theory-driven approach to developing contextually appropriate digital solutions for improving mental health care in Uganda and similar contexts. The positive reception of the implemented service underscores its potential impact. Future research should address the identified limitations and evaluate clinical outcomes of long-term adoption.

Study protocol for a feasibility study of an online educational programme for people working and living with persistent low back pain.

BACKGROUND: Low back pain (LBP) is the main cause of activity limitation and work absence across the world, leading to a high social and economic burden for individuals, families, the labour market and society. The overall aim of this multicentre study is to test the usability, acceptability and feasibility of an evidence-based, digital education programme for people living and working with persistent LBP who are in sedentary or physically demanding jobs and need advice on ergonomics, self-management of pain and healthy behavioural strategies. METHODS: This is the protocol of a multinational, multicentre, prospective uncontrolled feasibility study targeting people with persistent LBP in Lithuania, Northern Ireland, Italy, Sweden and Portugal. Eligible participants will be offered the opportunity to use the MyRelief educational platform as part of their care and will undergo evaluations at baseline (enrollment) and 1-month follow-up. Feasibility will be assessed using measures of recruitment and retention, intervention engagement, outcome measure completion rates and within-group effect sizes in response to the digital education programme. DISCUSSION: This study will identify the challenges and implications of delivering a digital training programme in advance of potentially delivering the programme via an online educational platform available on mobile devices. The findings will inform the design of a future randomised controlled trial if it proves feasible. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04673773 . Registered 17 December 2020.

Perceptions of everyday life during lenient COVID-19 restrictions in Sweden- an interview study.

BACKGROUND: Both COVID-19 and its associated societal restrictions have affected individuals' health and everyday life. In Sweden, more lenient public health restrictions were implemented, with individuals asked to act responsibly in terms of reducing spread of disease. The majority of studies reporting on experiences of Covid-19 restrictions have been in the context of more substantial mandatory rules aimed at reducing social contact, therefore it is important to describe how more lenient restrictions have impacted individuals' well-being. This study aims to describe perceptions of everyday life during the first wave of the COVID-19 pandemic, perceived by individuals with no underlying medical condition, and living with more lenient public health restrictions in Sweden. METHOD: The participants were recruited from individuals who originally had participated in an online survey about life satisfaction, health, and physical activity. Fifteen individuals (median age 49, range 26-76 years, seven women) in various social situations, such as living alone/cohabiting, having children at home, geographical area and size of city were interviewed. Qualitative content analysis was applied to the data. RESULTS: An overall theme "Both hindrances and opportunities in important life domains were experienced within the same person during lenient Covid-19 restrictions" was derived and covered three categories: "New possibilities of flexibility in work and better health", "Life went on as usual with minor adjustments" and "Everyday life changed and became more difficult" together with eight subcategories. For most participants, both facilitating and hindering important domains in life were described. Unexpected findings were positive experiences regarding working from home, physical activities, leisure time activities and the balance between work and leisure time. In areas where only minor adjustments were made, life was perceived as going on as before. On the other hand, restrictions increased worries and were perceived to have negative effects on social participation. CONCLUSION: The impact of the pandemic and lenient restrictions in Sweden on the participants´ everyday life was multifaceted. Both hindrances and opportunities in important life domains were experienced within the same person. An increased flexibility in work- and leisure activities were perceived having positive effects for health and wellbeing and led to a better balance in life.

COVID-19: From health crises to food security anxiety and policy implications.

Like the rest of the world, African countries are reeling from the health, economic and social effects of COVID-19. The continent's governments have responded by imposing rigorous lockdowns to limit the spread of the virus. The various lockdown measures are undermining food security, because stay at home orders have among others, threatened food production for a continent that relies heavily on agriculture as the bedrock of the economy. This article draws on quantitative data collected by the GeoPoll, and, from these data, assesses the effect of concern about the local spread and economic impact of COVID-19 on food worries. Qualitative data comprising 12 countries south of the Sahara reveal that lockdowns have created anxiety over food security as a health, economic and human rights/well-being issue. By applying a probit model, we find that concern about the local spread of COVID-19 and economic impact of the virus increases the probability of food worries. Governments have responded with various efforts to support the neediest. By evaluating the various policies rolled out we advocate for a feminist economics approach that necessitates greater use of data analytics to predict the likely impacts of intended regulatory relief responses during the recovery process and post-COVID-19.

Self-Perceived Changes in Physical Activity and the Relation to Life Satisfaction and Rated Physical Capacity in Swedish Adults during the COVID-19 Pandemic-A Cross Sectional Study.

COVID-19 restrictions may prevent people from reaching recommended levels of physical activity (PA). This study examines self-perceived changes in the extent and intensity of PA during the COVID-19 pandemic, and the relation between perceived changes in PA and general life satisfaction and perceived physical capacity. A total of 1318 participants (mean age 47.8 SD12.6; 82.1% women) were recruited through social media in Sweden during autumn 2020. The survey included questions regarding perceived changes in PA compared to the previous year, the "Rating of Perceived Capacity" scale and "Life Satisfaction Questionnaire-11". A change in PA was reported by 65% of participants. More participants reported an increase (36%) than a decrease (29%), however a decrease in PA was significantly more often considered to be due to the pandemic. The highest odds of decreased PA was found in the oldest age group (70+ years) (OR 2.8; 95% CI 1.4-5.7). Those who reported decreased levels of PA reported lower life satisfaction and aerobic capacity than the other groups (p > 0.001). Decreased physical activity was reported by many, but an equal share reported increased activity during the pandemic. The highest odds for decreased activity was found in the oldest group-the group that has been subjected to the strictest recommended COVID-19 restrictions in Sweden.

Kinesiophobia and its relation to pain characteristics and cognitive affective variables in older adults with chronic pain.

BACKGROUND: The contribution of kinesiophobia (fear of movement) to the pain experience among older adults has been poorly evaluated. The aim of this study was to study prevalence at baseline, development over a 12-month period and cognitive-affective variables of kinesiophobia in a population-based sample of older adults with chronic pain. METHODS: The study included 433 older adults (+65 years) with chronic pain (mean age 74.8 years) randomly selected using a Swedish register of inhabitants. Kinesiophobia was measured at baseline and 12-month follow-up with the 11-item version of the Tampa Scale of Kinesiophobia (TSK-11). Associations of demographic-, cognitive affective - and pain-related variables to kinesiophobia were analysed with linear regression analyses. RESULTS: The mean level of kinesiophobia was low. Worsening and recovering from kinesiophobia occurred over time, but the mean level of kinesiophobia remained unchanged (p = 0.972). High levels of kinesiophobia (TSK ≥35) were found among frailer and older adults predominately living in care homes, but not dependent on sex. Poor self-perceived health (OR = 8.84) and high pain intensity (OR = 1.22) were significantly associated with kinesiophobia. CONCLUSION: Results indicate that potential interventions regarding kinesiophobia among older adults should aim to decrease pain intensity and strengthen health beliefs.

Impact of pain characteristics and fear-avoidance beliefs on physical activity levels among older adults with chronic pain: a population-based, longitudinal study.

BACKGROUND: To explore the level of physical activity in a population based sample of older adults; to analyze the influence of pain characteristics and fear-avoidance beliefs as predictors of physical activity among older adults reporting chronic pain. METHODS: Demographics, pain characteristics (duration, intensity), physical activity, kinesiophobia (excessive fear of movement/(re) injury), self-efficacy and self-rated health were measured with questionnaires at baseline and 12-months later. Logistic regression analyses were done to identify associations at baseline and predictors of physical activity 12-months later during follow-up. RESULTS: Of the 1141 older adults (mean age 74.4 range 65-103 years, 53.5% women) included in the study, 31.1% of those with chronic pain were sufficiently active (scoring ≥ 4 on Grimby's physical activity scale) compared to 56.9% of those without chronic pain. Lower age (OR = 0.93, 95% CI = 0.88-0.99), low kinesiophobia OR = 0.95, 95% CI = 0.91-0.99), and higher activity level at baseline (OR = 10.0, 95% CI = 4.98-20.67) significantly predicted higher levels of physical activity in individuals with chronic pain. CONCLUSION: The level of physical activity was significantly lower among those with chronic pain and was significantly associated with kinesiophobia. Our findings suggest that fear- avoidance believes plays a more important role in predicting future physical activity levels than pain characteristics. Thus our findings are important to consider when aiming to increase physical activity in older adults that have chronic pain.

The ¹³C bicarbonate method: an inverse end product method for measuring CO2 production and energy expenditure.

We reconsider the principle of the (13)C bicarbonate (NaH(13)CO3) method ((13)C-BM) for the determination of the CO2 production to obtain an estimate of energy expenditure (EE). Its mathematical concept based on a three-compartmental model is related to the [(15)N]glycine end product method. The CO2 production calculated by the (13)C-BM, RaCO2((13)C) is compared to the result from the indirect calorimetry, RCO2(IC). In an interspecies comparison (dog, goat, horse, cattle, children, adult human; body mass ranging from 15 to 350 kg, resting and fasting conditions) we found an excellent correlation between the results of (13)C-BM and IC with RCO2(IC) = 0.703 × RaCO2((13)C), (R(2) = 0.99). The slope of this correlation corresponds to the fractional (13)C recovery (RF((13)C)) of (13)C in breath CO2 after administration of NaH(13)CO3. Significant increase in RF((13)C) was found in physically active dogs (0.95 ± 0.14; n = 5) vs. resting dogs (0.71 ± 0.10, n = 17; p = .015). The (13)C recovery in young bulls was greater in blood CO2 (0.81 ± 0.05) vs. breath CO2 (0.73 ± 0.05, n = 12, p < .001) and in ponies with oral (0.76 ± 0.03, n = 8) vs. intravenous administration of NaH(13)CO3 (0.69 ± 0.07; n = 8; p = .026). We suggest considering the (13)C-BM as a 'stand-alone' method to provide information on the total CO2 production as an index of EE.

The oral [(13)C]bicarbonate technique for measurement of short-term energy expenditure of sled dogs and their physiological response to diets with different fat:carbohydrate ratios.

The oral [(13)C]bicarbonate technique (o(13)CBT) was assessed for the determination of short-term energy expenditure (EE) under field conditions. A total of eight Alaskan huskies were fed two experimental diets in a cross-over experiment including two periods of 3 weeks. Effects of diets on EE, apparent total tract digestibility (ATTD) and on plasma hormones, blood lactate and glucose were furthermore investigated. The percentages of metabolisable energy derived from protein (P), fat (F) and carbohydrates (C) were 26:58:16 in the PFC diet and 24:75:1 in the PF diet. Measurements of EE were performed in the post-absorptive state during rest. Blood samples were collected during rest and exercise and ATTD was determined after days with rest and with exercise. EE was higher (P < 0·01) in period 2 than in period 1 (68 v. 48 kJ/kg body weight(0·75) per h). The ATTD of organic matter, crude protein and crude fat was higher (P < 0·01) in the PF diet compared with the PFC diet, and lower (P < 0·01) for total carbohydrates. Exercise did not affect ATTD. Higher (P < 0·01) insulin-like growth factor 1 and leptin concentrations were measured when fed the PF diet compared with the PFC diet. Concentrations of insulin decreased (P < 0·01), whereas cortisol and ghrelin increased (P < 0·05), after exercise. There was no effect of diet on blood lactate and glucose, but higher (P < 0·001) lactate concentrations were measured in period 1 than in period 2. The results suggest that the o(13)CBT can be used in the field to estimate short-term EE in dogs during resting conditions. Higher ATTD and energy density of the PF diet may be beneficial when energy requirements are high.

Evaluation of the oral (13)C-bicarbonate technique for measurements of energy expenditure in dogs before and after body weight reduction.

BACKGROUND: Overweight and obesity are the most common nutritional disorders in dogs and may lead to various secondary diseases and decreased lifespan. In obesity research, measurement of energy expenditure (EE) and determination of the energy requirements are essential. The objective with this study was to validate and evaluate the suitability of the oral (13)C-bicarbonate technique (o(13)CBT) for measuring EE in dog obesity studies. A further objective was to investigate the impact of body weight (BW) reduction and changes in body composition on the EE when measured under conditions corresponding to the basal metabolic rate (BMR). RESULTS: The EE in five privately owned, overweight dogs was measured simultaneously with the o(13)CBT and indirect calorimetry (IC) for comparison of the results. Two measurements per dog were performed under the same standardised conditions (i.e. fasted and resting state) at the start, and after completing a 12-week BW reduction program. Additionally, measurements of body composition by Dual-energy X-ray absorptiometry (DEXA) were conducted at the beginning and at the end of the BW reduction program. There were no differences in EE results obtained by the o(13)CBT and IC. Overweight and the BW reduction did not affect the estimates for the respiratory quotient (RQ) or the recovery factor for the (13)C-tracer (RF), both needed when using the o(13)CBT. The dogs lost 16% (SD ± 2.0) of their initial BW in reduced fat mass (P < 0.001), whereas fat free mass (FFM) remained unchanged. There was no effect of the BW reduction on the determined EE expressed in kJ/kg BW/d, or in kJ/kg BW(0.75)/d. However, EE was lower (P < 0.001) after the BW reduction program when expressed in relation to FFM (kJ/kg FFM/d). CONCLUSIONS: Results from the present study show that the o(13)CBT can be a used in obesity research to determine EE in fasted dogs and under resting conditions. Furthermore, the results suggest that the BMR does not change with reduced BW in overweight dogs as long as the FFM remains unchanged. This indicates that the BMR to maintain one gram of fat is equal to maintaining one gram of FFM in overweight dogs.

The oral (13)C-bicarbonate technique for estimation of energy expenditure in dogs: validation against indirect calorimetry.

To get more knowledge about the energy requirements of dogs and to formulate appropriate feeding guidelines, it is essential to determine their energy expenditure (EE) in a reliable and feasible way. In this study, the non-invasive oral stable isotope (13)C-bicarbonate technique (o(13)CBT) was validated against indirect calorimetry (IC) for the determination of CO2-production and EE in dogs. Eleven privately owned dogs were simultaneously measured with IC and the o(13)CBT after being fasted overnight. All dogs were measured twice on two separate days. For calculation, measurements were divided into two groups depending on dogs' behaviour during the measurement. Dogs of Group 1 (n = 17) were resting calmly in the chamber and dogs of Group 2 (n = 5) were more active. Mean heart rate was significantly higher in Group 2 (102 beats per minute [bpm]) than in Group 1 (77 bpm) (p < 0.001). Within groups, the CO2-production and EE [kJ d(-1) kg BW(-0.75)] estimated by the o(13)CBT or IC did not differ significantly (Group 1: [Formula: see text] = 368; EEIC = 363; Group 2: [Formula: see text] = 701; EEIC = 718). However, the estimated (13)C recovery factor (RF) for the estimation of CO2-production was significantly different between Groups 1 and 2 (0.72 and 0.94, respectively, p < 0.001). The respiratory quotient (RQ), which is needed for the estimation of EE, did not differ between groups. This study shows that the non-invasive o(13)CBT can be used for accurate estimation of the CO2-production rate and EE in resting dogs. A value of 0.77 can be applied as an estimate of the RQ in fasted dogs and 0.72 as an appropriate estimate for RF when dogs are resting calmly during the measurements.

Psychometric properties of the Tampa Scale of Kinesiophobia (TSK-11) among older people with chronic pain.

OBJECTIVES: The study aimed to test the construct validity, factor structure and reliability of the 11-item version of the Tampa Scale for Kinesiophobia (TSK-11, Swedish version) among older people (65+) with chronic pain. DESIGN: Methodological study. SUBJECTS: 433 participants with chronic pain (mean age 74.8, 65-98 years) completed postal questionnaires. 264 of the participants completed a test-retest assessment. METHODS: Construct validity was evaluated through corrected item-total correlations. Convergent validity was analyzed by correlations with activity/activities of daily living (ADL) dependence, pain intensity and physical activity (all of which are constructs related to kinesiophobia according to fear-avoidance theories). Factor structure was tested through confirmatory factor analysis. Reliability was assessed with Cronbach's α and test-retest reliability, analyzed by intra-class correlation coefficient (ICC) and weighted κ coefficient analysis. RESULTS: Evidence of convergent validity was shown by significant positive correlations with activity/ADL dependence (r = 0.20) and pain intensity (r = 0.31), and a significant negative correlation with physical activity (r = -0.38). Confirmatory factor analysis showed that both one- and two factor-solutions were possible. Cronbach's α coefficients ranged between 0.74 and 0.87. Test-retest analysis showed strong agreement regarding ICC (r = 0.75, 95% confidence interval 0.64-0.82). The weighted κ coefficients for the individual items showed fair to moderate reliability. CONCLUSION: The Swedish version of TSK-11 had acceptable construct validity, factor structure, and reliability and, hence, can be considered suitable for older people with chronic pain.

Smoking and chronic pain among people aged 65 years and older.

OBJECTIVE: To study the relationship between smoking and chronic pain among people aged 65+ years. DESIGN: A cross-sectional study. SAMPLE: The study was carried out in 2011 and included a randomly selected (N = 2000, response rate 57%) sample of people aged 65 years and older, living in Sweden. MEASUREMENT: A postal questionnaire with questions about demographic data, living conditions, tobacco use (both smoking and moist snuff), subjective health, and chronic pain (eg, intensity, duration, location). Chronic pain was defined as a pain lasting for 3 months or longer. RESULTS: In the total sample (n = 1141, aged 65 to 103 years), 53.6% were women, 38.5% reported chronic pain, and 9% were smokers. Among the smokers were 47.6% reporting chronic pain. When comparing smokers and nonsmokers, there was a significant difference only in pain intensity but not in prevalence. However, when the sample was divided by gender, significant differences were found in both prevalence and intensity among women, but only in intensity among men. No association was found between moist snuff and pain. CONCLUSIONS: There was an association between smoking and chronic pain among older people, especially regarding pain intensity. This indicates that interventions to help people cease smoking may be one way (among other methods) to ease pain intensity among older people.

Student learning about biomolecular self-assembly using two different external representations.

Self-assembly is the fundamental but counterintuitive principle that explains how ordered biomolecular complexes form spontaneously in the cell. This study investigated the impact of using two external representations of virus self-assembly, an interactive tangible three-dimensional model and a static two-dimensional image, on student learning about the process of self-assembly in a group exercise. A conceptual analysis of self-assembly into a set of facets was performed to support study design and analysis. Written responses were collected in a pretest/posttest experimental design with 32 Swedish university students. A quantitative analysis of close-ended items indicated that the students improved their scores between pretest and posttest, with no significant difference between the conditions (tangible model/image). A qualitative analysis of an open-ended item indicated students were unfamiliar with self-assembly prior to the study. Students in the tangible model condition used the facets of self-assembly in their open-ended posttest responses more frequently than students in the image condition. In particular, it appears that the dynamic properties of the tangible model may support student understanding of self-assembly in terms of the random and reversible nature of molecular interactions. A tentative difference was observed in response complexity, with more multifaceted responses in the tangible model condition.

Metabolic and growth response of mink (Neovison vison) kits until 10 weeks of age when exposed to different dietary protein provision.

Growth performance and metabolism were investigated in mink kits (n = 210) exposed to the same dietary treatment as their dams (n = 30), i.e. high (HP; 61% of metabolisable energy, ME), medium (MP; 48% of ME) or low (LP; 30% of ME) protein supply, from birth until 10 weeks of age. The kits were weighed weekly, and were measured by means of balance experiment and indirect calorimetry, in weeks eight and nine post-partum (p.p.). At weaning (seven weeks p.p.) and 10 weeks p.p. one kit per litter was killed and blood, liver and kidneys were collected. Plasma amino acid profiles, and hepatic abundance of mRNA for phosphoenolpyruvate carboxykinase (PEPCK), fructose 1,6-biphosphatase, pyruvate kinase and glucose-6-phosphatase (G-6-Pase) by q-PCR, were determined. There were no differences in live weights among kits the first four weeks of life when kits solely consumed milk, but male LP kits were the heaviest. After transition to solid feed MP kits weighed most at nine weeks of age (p < 0.05). At eight weeks of age, the kits fed the LP diet retained less (p < 0.05) N than HP and MP kits. Heat production did not differ among kits, although protein oxidation was higher (p < 0.001) in HP kits than in LP kits. Kits fed the LP diet had lower (p < 0.05) plasma concentrations of lysine, methionine and leucine than MP kits. Dietary treatment was not reflected in the relative abundance of any of the studied mRNAs, but kits had significantly lower abundance of all studied mRNA than their dams, ranging from 83% less PEPCK abundance to 40% less for G-6-Pase. The kidney mass was smallest (p < 0.01) in kits fed the LP diet, and liver masses were largest (p < 0.001) in HP kits. The results indicate that the LP diet did not meet the protein requirements for mink kits in the transition period from milk to solid feed. The capacity to regulate the rate of gluconeogenesis was even more limited in young mink kits than in adult dams. However, young mink kits can regulate protein oxidation in response to dietary protein supply, probably by adapting the size of the liver and kidneys to the level of protein supply.

Evaluation of the oral ¹³C-bicarbonate tracer technique for the estimation of CO2 production and energy expenditure in dogs during rest and physical activity.

For feeding of working dogs during their daily life, illness, routine jobs or sporting activities, an accurate determination of their nutritional requirements is essential to ensure their optimal health and performance. To predict the appropriate guidelines about how to feed dogs, it appears essential to determine the energy expenditure (EE) in a reliable and feasible way. In the present experiment, the non-invasive oral ¹³C-bicarbonate tracer technique (o¹³CT), i.e. collection of breath samples after oral administration of NaH¹³CO3, was used for the estimation of CO2 production and EE in dogs. Measurements were conducted during two days of rest, and during three days with 3 h of exercise per day. Average EE was 483 and 876 kJ kg⁻°·75 d⁻¹ during rest and exercise, respectively. The o¹³CT seems appropriate to use as a minimal restrictive and non-invasive method to obtain reliable estimates of EE in dogs at different activity levels under near natural conditions.

Obstetricians' attitudes and opinions on sickness absence and benefits during pregnancy.

BACKGROUND: In Sweden, sick leave is taken more frequently by pregnant women than by nonpregnant women. This led us to ask if the taking of sick leave during pregnancy could possibly be explained by attitudes to sickness absence held among obstetricians working in antenatal care. METHODS: All obstetricians (n = 45) engaged in public antenatal care and at work in May 2001 in seven hospitals in South Eastern Sweden were asked to anonymously respond to questions/statements concerning their work; 87% participated. The results were presented as percent (the median value) on a visual analog scale. RESULTS: In 60% of all contacts with pregnant women issues such as working conditions, sickness absence or benefit programs were discussed besides the actual pregnancy. In 46% the obstetricians stated that they could not exactly pinpoint a correct medical diagnosis motivating a sickness certificate asked for by the pregnant woman. As the majority of the obstetricians (74%) often did not like to conform to the pregnant women's wishes, unpleasant situations were not uncommon (56%). A conflict was experienced in the dual role that the obstetrician had as the patient's confidant on the one hand and as a representative or gatekeeper for the social security system on the other. Male and female obstetricians did not differ in their opinions on their handling of pregnant women with regard to taking sick leave but for one issue, back pain. CONCLUSIONS: The high degree of work dealing with sickness absence and social benefits at the Antenatal Care Centers seems to have a negative effect on the obstetrician's evaluation of their work environment. The obstetricians' opinion is that pregnant women are sick-listed too frequently, but obstetricians comply as a rule to the women's wishes in order to avoid conflict.

Health, sociodemographic data, and pregnancy outcome in women with antepartum depressive symptoms.

OBJECTIVE: To study whether women with antepartum depression have an increased risk for adverse perinatal outcome. METHODS: From a sample of 1,489 women, an index group (n = 259) of all women with depressive symptoms on the Edinburgh Postnatal Depression Scale in gestational week 35-36 was selected. Two hundred fifty-nine women with no depressive symptoms on the Edinburgh Postnatal Depression Scale antepartum or postpartum were randomly chosen as the reference group. Medical, gynecologic, and obstetric history, socioeconomic status, pregnancy, and perinatal data were collected from standardized medical records for all women. RESULTS: Women with antepartum depressive symptoms were more often multiparas with a history of earlier obstetric complications. Complications during the present pregnancy were more frequent in the antepartum-depressed group of women. There were no differences concerning outcome of delivery, puerperium, and neonatal health between the index and reference groups. Forty-six percent of the women with antepartum depressive symptoms had depressive symptoms at 6-8 weeks or 6 months postpartum or both. CONCLUSION: Women depressed during pregnancy constitute a group without an increased risk for adverse obstetric or neonatal outcome but with a high risk for postpartum depressive symptoms.