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Abstract Background There are few support interventions for women with fear of childbirth tailored towards type of fears and parity. To inform the future development of an acceptable and relevant intervention for women with severe fear of childbirth, primary objectives were to examine: (1) pregnant women’s experiences of and preferences for support and (2) barriers and facilitators to help-seeking. Secondary objectives were to examine if there are any differences based on pregnant women’s parity. Methods Pregnant women with a severe fear of childbirth in Sweden completed an online cross-sectional survey between February and September 2022. Severe fear of childbirth was measured using the fear of childbirth scale. Quantitative data were analysed using descriptive and inferential statistics and free answers were analysed using manifest content analysis. A contiguous approach to integration was adopted with qualitative and quantitative findings reported separately. Results In total, 609 participants, 364 nulliparous and 245 parous women, had severe fear of childbirth. The main category “A twisting road to walk towards receiving support for fear of childbirth” was explored and described by the generic categories: Longing for support, Struggling to ask for support, and Facilitating aspects of seeking support. Over half (63.5%), of pregnant women without planned or ongoing treatment, wanted support for fear of childbirth. Most (60.2%) pregnant women with ongoing or completed fear of childbirth treatment regarded the treatment as less helpful or not at all helpful. If fear of childbirth treatment was not planned, 35.8% of women would have liked to have received treatment. Barriers to help seeking included stigma surrounding fear of childbirth, previous negative experiences with healthcare contacts, fear of not being believed, fear of not being listened to, and discomfort of having to face their fears. Facilitators to help seeking included receiving respectful professional support that was easily available, flexible, and close to home. Conclusions Most pregnant women with severe fear of childbirth felt unsupported during pregnancy. Findings emphasise the need to develop individual and easily accessible psychological support for women with severe fear of childbirth, delivered by trained professionals with an empathetic and respectful attitude.

The aim of this mixed-method study was to identify support needs, as well as barriers and facilitators to seeking support in a sample of Swedish fathers with a fear of childbirth (FOC). Participants completed an anonymous quantitative online survey ( N = 131), with three free-text items for those self-identifying as having an FOC ( N = 71) and five individual in-depth interviews. Data analysis included descriptive and chi-square analyses for quantitative data, and manifest content analysis for qualitative data. Those with a severe FOC were more likely to report having on-going mental health difficulties ( p = .039) and one fifth (21%) of the participants with severe FOC wanted to receive professional treatment, but only 8.1% received treatment. Most participants either preferred individual support or to receive support together with their partner. Fathers with severe FOC were more likely to report one or more barriers than those without FOC ( p = .005), where unwanted social stigma was the single largest barrier. Qualitative findings identified one main category: Expectant fathers missing and wishing for support for FOC composed four generic categories: (1) support in developing an understanding of their fear , (2) coping by being aware of feelings , (3) professional support through trust and respect , and (4) needing individualized support . To encourage healthy fathers, clinical professionals should find ways to support fathers, such as by providing them with their own perinatal appointments, asking them about their feelings, as well as screening, diagnosing, and treating fathers with severe FOC.

Abstract Background It is well known that breastfeeding plays an important role in the health of women and children. However, women are not always given optimal support and most do not reach their breastfeeding goals. About one in five, breastfeeding women report mastitis and a small proportion of these develop a breast abscess. Our aim was to describe the experiences of a group of Swedish breastfeeding women who developed a breast abscess. Methods A qualitative cross-sectional study with 18 study participants was undertaken in Sweden in 2017–2018. Potential participants were identified through electronic medical records at a university hospital and invited to participate in audio-recorded telephone interviews. Women were between 2 and 24 months postpartum at the time of the interview, on average 8 months. We conducted a thematic analysis in six steps according to Braun and Clark. Results Our analysis identified two themes: 1) Seeking care and receiving treatment was long and unpleasant, and 2) Importance of adequate professional care. Women who experienced a breast abscess were uncertain about where to ask for professional help. They often had a long wait for the right time to undergo the unpleasant and painful procedure of draining their breast abscess. The women felt it was important to receive professional care with respectful communication, continuity of care, and to receive adequate information, but they did not always receive this level of care. Conclusions Women with puerperal breast abscesses often fall between medical specialty areas. No longer under the care of obstetricians and maternity services, their problem is too complicated for general practitioners or emergency departments, but not regarded as serious by breast surgeons. Healthcare professionals urgently need adequate training in order to deal with breastfeeding problems and be able to offer women-centred care.

AbstractBackground Fear of birth is common and complex, caused by a variety of reasons. The aim was to investigate the prevalence of pre-established reasons in relation to fear, and to identify profiles of women based on their reported reasons behind fear of birth.Methods A cross-sectional Swedish study of women with self-reported fear of birth who completed an online survey. Descriptive statistics, chi-square test, crude and adjusted odds ratios with 95% confidence intervals were used in the analysis of pre-established reasons in relation to self-reported severe fear. A Kappa-means cluster analysis was performed in order to group reasons, that were further investigated in relation to women’s background variables.Results A total of 1419 women completed the survey. The strongest reason behind fear of birth was to be forced to give birth vaginally. Four clusters were identified and labeled: minor complexity (reference group), relative minor complexity, relative major complexity, and major complexity. Cesarean section preference, previous mental health problems, being younger, primiparity, and exposure to domestic violence were factors related to cluster grouping.Conclusions Women with fear of birth have various reasons and diverse complexities behind their fear. Health care providers need to investigate these reasons and support pregnant women with childbirth fear, based on their needs.

Abstract Background Caesarean section (CS) can be a life-saving operation but might also negatively affect the health of both the woman and the baby. The aim of this study was to synthesize and contrast women’s and clinicians’ attitudes toward maternal-requested CS, and their experiences of the decision-making process around CS. Methods The databases of CINAHL, MEDLINE, PsycInfo and Scopus were screened. All qualitative studies that answered the study question and that were assessed to have minor or moderate methodological limitations were included. Synthesised findings were assessed using GRADE-CERQual. Results The Qualitative Evidence Synthesis included 14 qualitative studies (published 2000–2022), involving 242 women and 141 clinicians. From the women’s perspectives, two themes arose: women regarded CS as the safest mode of birth; and women’s rights to receive support and acceptance for a CS request. From the clinicians’ perspectives, four themes emerged: clinicians were concerned about health risks associated with CS; demanding experience to consult women with a CS request; conflicting attitudes about women’s rights to choose a CS; and the importance of respectful and constructive dialogue about birthing options. Conclusion Women and clinicians often had different perceptions regarding the right of a woman to choose CS, the risks associated with CS, and the kind of support that should be part of the decision-making process. While women expected to receive acceptance for their CS request, clinicians perceived that their role was to support the woman in the decision-making process through consultation and discussion. While clinicians thought it was important to show respect for a woman’s birth preferences, they also felt the need to resist a woman’s request for CS and encourage her to give birth vaginally due to the associated increases in health risks.

Winter warming events (WWE) are abrupt and short-lasting (hours-to-days) events of extraordinarily warm weather occurring during wintertime, sometimes accompanied by rainfall (rain on snow events; ROS). Through direct heat transfer and changes in the snowpack properties, these events cause changes in the below-ground thermal regime that, in turn, controls a suite of ecosystem processes ranging from microbial activity to permafrost and vegetation dynamics. In addition, the overall impacts of WWE on ground temperatures may also depend on the timing of the events and the preceding snowpack characteristics. The frequency and intensity of these events in the Arctic, including the Swedish subarctic, has increased remarkably during the recent decades and is expected to increase even further during the 21st Century. In addition, snow depth (not necessarily snow duration) is projected to increase in many parts of the Arctic. In 2005, a manipulation experiment was set up on a lowland permafrost mire in the Swedish subarctic, to simulate projected future increases in winter precipitation. In this study, we analyse this 15-year record of ground temperature, AL thickness, and meteorological variables, to evaluate the influence of different types and timings of WWE on permafrost under different snowpack conditions. We found that all WWE types were strongly linked to permafrost warming in both the ambient and the manipulated plots during the winter months, but that significantly warmer summer ground temperatures and, consequently, thicker active layer (AL) were only linked to ROS events in manipulated plots. Additional long-term AL thickness data from nearby permafrost sites indicate an increasingly stronger influence of WWE over time since the mid-1990s, to the detriment of the influence of summer air temperatures.

Abstract Background The World Health Organization recommends exclusive breastfeeding for 6 months followed by continued breastfeeding with complementary food up to 2 years of age or beyond. Few women achieve this recommendation in Sweden, and they often stop breastfeeding earlier than they would like. Investigating women’s advice to healthcare professionals is important for the provision of optimal breastfeeding support. The aim of this study was to explore women’s advice to healthcare professionals regarding support for continuing to breastfeed for at least 6 months. Methods This investigation used an exploratory study design, and a purposive sample of women was recruited between 2015 and 2016 through social media platforms. The work is a follow-up of an earlier study exploring women’s perceptions of the factors that assisted them in breastfeeding for at least 6 months. Telephone interviews were conducted with 139 Swedish women who reported that they had breastfed for at least 6 months. Women were asked the question, “Do you have any advice that you would like to give to healthcare professionals regarding breastfeeding support?”. The data were analysed using content analysis. Results The theme, “Professionals need to offer women sensitive, individualized breastfeeding support to promote a positive breastfeeding experience”, describes the women’s advice based on five categories: 1) providing evidence-based care, 2) preparing expectant parents during pregnancy, 3) creating a respectful and mutual dialogue, 4) offering individual solutions to breastfeeding problems, and 5) offering practical support. Conclusions This study highlights the importance of professionals providing evidence-based breastfeeding support in a sensitive and individualized manner. This consideration is an important prerequisite to strengthening women’s self-confidence and assisting them in reaching their breastfeeding goals, which may enhance the positive nature of their breastfeeding experience.

Climate change strongly impacts regions in high latitudes and altitudes that store high amounts of carbon in yet frozen ground. Here the authors show that the consequence of these changes is global warming of permafrost at depths greater than 10 m in the Northern Hemisphere, in mountains, and in Antarctica.

The Northern high latitudes are warming twice as fast as the global average, and permafrost has become vulnerable to thaw. Changes to the environment during thaw leads to shifts in microbial communities and their associated functions, such as greenhouse gas emissions. Understanding the ecological processes that structure the identity and abundance (i.e., assembly) of pre- and post-thaw communities may improve predictions of the functional outcomes of permafrost thaw. We characterized microbial community assembly during permafrost thaw using in situ observations and a laboratory incubation of soils from the Storflaket Mire in Abisko, Sweden, where permafrost thaw has occurred over the past decade. In situ observations indicated that bacterial community assembly was driven by randomness (i.e., stochastic processes) immediately after thaw with drift and dispersal limitation being the dominant processes. As post-thaw succession progressed, environmentally driven (i.e., deterministic) processes became increasingly important in structuring microbial communities where homogenizing selection was the only process structuring upper active layer soils. Furthermore, laboratory-induced thaw reflected assembly dynamics immediately after thaw indicated by an increase in drift, but did not capture the long-term effects of permafrost thaw on microbial community dynamics. Our results did not reflect a link between assembly dynamics and carbon emissions, likely because respiration is the product of many processes in microbial communities. Identification of dominant microbial community assembly processes has the potential to improve our understanding of the ecological impact of permafrost thaw and the permafrost–climate feedback.

Permafrost, a key component of the arctic and global climate system, is highly sensitive to climate change. Observed and ongoing permafrost degradation influences arctic hydrology, ecology and biogeochemistry, and models predict that rapid warming is expected to significantly reduce near-surface permafrost and seasonally frozen ground during the 21st century. These changes raise concern of how permafrost thaw affects the exchange of water and energy with the atmosphere. However, associated impacts of permafrost thaw on the surface energy balance and possible feedbacks on the climate system are largely unknown. In this study, we show that in northern subarctic Sweden, permafrost thaw and related degradation of peat plateaus significantly change the surface energy balance of three peatland complexes by enhancing latent heat flux and, to less degree, also ground heat flux at the cost of sensible heat flux. This effect is valid at all radiation levels but more pronounced at higher radiation levels. The observed differences in flux partitioning mainly result from the strong coupling between soil moisture availability, vegetation composition, albedo and surface structure. Our results suggest that ongoing and predicted permafrost degradation in northern subarctic Sweden ultimately result in changes in land–atmosphere coupling due to changes in the partitioning between latent and sensible heat fluxes. This in turn has crucial implications for how predictive climate models for the Arctic are further developed.

Increased snow depth already observed, and that predicted for the future are of critical importance to many geophysical and biological processes as well as human activities. The future characteristics of sub-arctic landscapes where permafrost is particularly vulnerable will depend on complex interactions between snow cover, vegetation and permafrost. An experimental manipulation was, therefore, set up on a lowland peat plateau with permafrost, in northernmost Sweden, to simulate projected future increases in winter precipitation and to study their effects on permafrost and vegetation. After seven years of treatment, statistically significant differences between manipulated and control plots were found in mean winter ground temperatures, which were 1.5 ° C higher in manipulated plots. During the winter, a difference in minimum temperatures of up to 9 ° C higher could be found in individual manipulated plots compared with control plots. Active layer thicknesses increased at the manipulated plots by almost 20% compared with the control plots and a mean surface subsidence of 24 cm was recorded in the manipulated plots compared to 5 cm in the control plots. The graminoid Eriophorum vaginatum has expanded in the manipulated plots and the vegetation remained green longer in the season.

Background and purpose: In Norway, comprehensive molecular tumour profiling is implemented as part of the public healthcare system. A substantial number of tumours harbour potentially targetable molecular alterations. Therapy outcomes may improve if targeted treatments are matched with actionable genomic alterations. In the IMPRESS-Norway trial (NCT04817956), patients are treated with drugs outside the labelled indication based on their tumours molecular profile. Patients and methods: IMPRESS-Norway is a national, prospective, non-randomised, precision cancer medicine trial, offering treatment to patients with advanced-stage disease, progressing on standard treatment. Comprehensive next-generation sequencing, TruSight Oncology 500, is used for screening. Patients with tumours harbouring molecular alterations with matched targeted therapies available in IMPRESS-Norway, are offered treatment. Currently, 24 drugs are available in the study. Primary study endpoints are percentage of patients offered treatment in the trial, and disease control rate (DCR) defined as complete or partial response or stable disease in evaluable patients at 16 weeks (W16) of treatment. Secondary endpoint presented is DCR in all treated patients. Results: Between April 2021 and October 2023, 1,167 patients were screened, and an actionable mutation with matching drug was identified for 358 patients. By the data cut off 186 patients have initiated treatment, 170 had a minimum follow-up time of 16 weeks, and 145 also had evaluable disease. In patients with evaluable disease, the DCR was 40% (58/145). Secondary endpoint analysis of DCR in all treated patients, showed DCR of 34% (58/170). Interpretation: Precision cancer medicine demonstrates encouraging clinical effect in a subset of patients included in the IMPRESS-Norway trial.