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  • 1.
    Aili, Katarina
    et al.
    Halmstad University, School of Health and Welfare.
    Nygren, Jens M.
    Halmstad University, School of Health and Welfare.
    Arvidsson, Susann
    Halmstad University, School of Health and Welfare.
    Olsson, Maria
    Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Jarfelt, Marianne
    Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Health Outcomes in Adult Survivors of Childhood All and Their Siblings – A National Long Term Follow Up2022In: Pediatric Blood & Cancer, ISSN 1545-5009, E-ISSN 1545-5017, Vol. 69, no S5, p. S173-S173, article id e29952Article in journal (Refereed)
  • 2.
    Almqvist-Tangen, Gerd
    et al.
    Child Health Care Team, County Council Halland, Sweden & Department of Paediatrics, University of Gothenburg, Gothenburg, Sweden.
    Bergman, Stefan
    Research and Development Centre, Spenshult Hospital, Oskarström, Sweden.
    Dahlgren, Jovanna
    Department of Paediatrics, University of Gothenburg, Gothenburg, Sweden.
    Roswall, Josefine
    Department of Paediatrics, County Hospital, Halmstad, Sweden & Department of Paediatrics, University of Gothenburg, Gothenburg, Sweden.
    Alm, Bernt
    Child Health Care Team, County Council Halland, Sweden & Department of Paediatrics, University of Gothenburg, Gothenburg, Sweden.
    Factors associated with discontinuation of breastfeeding before 1 month of age2012In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 101, no 1, p. 55-60Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Breastfeeding is associated with many benefits for both mother and child. Initiation rates are high in Sweden. Recently a slight decline is seen.

    AIM: The aim of this study was to assess factors associated with discontinuation of breastfeeding during the first 4 weeks.

    METHOD: A population-based longitudinal birth cohort study recruiting from 2007 to 2008 in south-western Sweden. At the first visit to the child health centre, parents were asked to complete a questionnaire. Also, the infants' height, weight, head and waist circumference were collected. Response rate was 69.2%.

    RESULTS: Twenty-seven per cent of mothers had breastfeeding problems. In a multivariate analysis, there was a negative correlation between breastfeeding and use of pacifier (OR 3.72; CI 2.09-6.63), maternal smoking (OR 2.09; CI 1.08-4.05) and breastfeeding problems (OR 2.54; CI 1.73-3.71). Breastfeeding problems were correlated with poor sucking technique (OR 2.96; CI 2.14-4.07), support from maternity ward (OR 2.56; CI 2.05-3.19) and perceived poor weight gain (OR 1.37; CI 1.00-1.86).

    CONCLUSION: Many mothers reported breastfeeding problems that are associated with an early cessation. This is preventable with support, but the timing is crucial. To promote breastfeeding, the support from the child health centres must be tailored with the maternal perspective in mind.

    © 2011 Foundation Acta Pædiatrica

  • 3.
    Backman, Ellen
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Region Halland, Halmstad, Sverige.
    Ordinary mealtimes under extraordinary circumstances: Routines and rituals of nutrition, feeding and eating in children with a gastrostomy and their families2021Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The aim of this thesis is to explore routines and rituals related to feeding, eating, and mealtimes in families that have a child with a gastrostomy tube (G-tube), from the perspectives of healthcare professionals, the children, and their parents. The thesis is based on four empirical studies. Study I is a longitudinal, quantitative study with the aim to describe children with developmental or acquired disorders receiving a G-tube, and to compare characteristics, contacts with healthcare professionals, and longitudinal eating outcomes. Findings from Study I demonstrated that children with developmental disorders needed G-tube feeding for longer than children with acquired disorders. Children with developmental disorders were also younger at G-tube placement, and had more multidisciplinary healthcare. These findings led to the subsequent studies focused specifically on children with developmental disorders. 

    Study II applies mixed methods and explores everyday life, health care, and intervention goals during the first year following G-tube placement through the documentation in medical records. In Studies III and IV, the experiences of family mealtimes for children with a G-tube and their parents are collected through individual interviews that are analysed qualitatively. Triangulation of methods, participants, researchers, and data across the four studies is applied to search for confirmation between findings, as well as to identify areas of discrepancy. Ecocultural theory, the WHO framework ICF, and the concept of participation form the conceptual framework of the thesis. Taken together, findings from the studies describe how the main experiences of feeding, eating, and mealtime relate to specific impairments of the child, the collective value attached to family mealtimes, and the parental responsibility to harmonise competing interests and conflicts among family members and/or healthcare professionals. 

    This thesis extends previous research by focusing on the ecocultural context of the child in combination with a dimensional understanding of health. The findings shed light on measures taken by the families themselves to adjust to and handle their daily lives, as well as spell out areas where more support is needed. Furthermore, this thesis suggests that an expanded focus on children’s participation in everyday mealtimes, and in the healthcare follow-up of G-tube feeding, is important in enhancing intervention outcomes.

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  • 4.
    Backman, Ellen
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Region Halland, Kungsbacka, Sweden.
    Granlund, Mats
    Jönköping University, Jönköping, Sweden.
    Karlsson, Ann-Kristin
    Region Halland, Kungsbacka, Sweden.
    Parental Perspectives on Family Mealtimes Related to Gastrostomy Tube Feeding in Children2021In: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, Vol. 31, no 9, p. 1596-1608Article in journal (Refereed)
    Abstract [en]

    Built on the important functions daily routines serve families and child health, this study aimed to explore parents’ descriptions of mealtimes and food-related challenges when living with a child using a gastrostomy feeding tube. The study was informed by ecocultural theory and based on in-depth interviews combined with stimulated recall. The interviews of 10 parents were inductively analyzed by means of qualitative content analysis. Four main categories comprised the parents’ descriptions: “One situation, different functions,” “On the child’s terms,” “Doing something to me,” and “An unpredictable pattern,” with one overarching theme. The analyses showed that the parents strived to establish mealtimes in line with their cultural context, although they struggled to reach a point of satisfaction. The study highlights the importance of health care professionals to address the medical aspects of caring for a child with a G-tube, but also the potential psychological and social consequences for ordinary family life. © The Author(s) 2021.

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  • 5.
    Backman, Ellen
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Region Halland, Halmstad, Sweden.
    Karlsson, Ann-Kristin
    Department of Research and Development, Region Halland, Halmstad, Sweden.
    Sjögreen, Lotta
    Mun-H-Center Orofacial Resource Center for Rare diseases, Gothenburg, Sweden.
    The use of gastrostomy in Swedish children – indications, and trends between 2005 and 20152017Conference paper (Refereed)
    Abstract [en]

    Children with complex medical needs requiring nutritional support are growing in number. This presentation will add new knowledge regarding gastrostomy in children by reporting primary diagnosis, and indications for the use of gastrostomy. Furthermore, the presentation will discuss and analyse data evolution trends from 2005 to 2015 in Sweden.

    Methods: The first part of the study used national statistics to provide a broad picture of gastrostomy use in Swedish children. The second part applied a retrospective observational study design, reviewing medical charts in order to obtain an in-depth picture of the children in need for gastrostomy, and its use in a five-year perspective.

    Results: The number of gastrostomy cases recorded in the national database was 3 946, 53% male, and 47% female. The distribution of age groups was: 0-4 years: 61% , 5-9 years: 17%, 10-14 years: 12%, and 15-19: years 10%.  When observing trends on a national level, the number of children receiving gastrostomy increased in average by 13% per year. Changes in the separate age groups were analysed. An increase was noted for children aged 0-4 years and for children aged 5-9 years. In the age groups 10-14 years and 15-19 years, there was no progressive increase. The results from the national statistics database will be discussed in relation to the medical chart-analyses of 75 children receiving gastrostomy in one Swedish administrative region between 2005 and 2015. 

    Conclusions: As in many parts of Europe, the number of children in need for gastrostomy is also growing in Sweden, with the youngest children seeming to be the group increasing most.

    Clinical implications: Nutritional support in Sweden is publicly financed, therefore these findings may be useful when planning both monetary and human resources in meeting the future challenges of paediatric health care.

  • 6.
    Bramsved, Rebecka
    et al.
    The Queen Silvia Children’s Hospital, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.
    Regber, Susann
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Novak, Daniel
    The Queen Silvia Children’s Hospital, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.
    Mehlig, Kirsten
    Institute of Medicine, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.
    Lissner, Lauren
    Institute of Medicine, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.
    Mårild, Staffan
    The Queen Silvia Children’s Hospital, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.
    Parental education and family income affect birthweight, early longitudinal growth and body mass index development differently2018In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 107, no 11, p. 1946-1952Article in journal (Refereed)
    Abstract [en]

    AIM: This study investigated the effects of two parental socio-economic characteristics, education and income, on growth and risk of obesity in children from birth to 8 years of age.

    METHODS: Longitudinal growth data and national register-based information on socio-economic characteristics were available for 3,030 Swedish children. The development of body mass index (BMI) and height was compared in groups dichotomised by parental education and income.

    RESULTS: Low parental education was associated with a higher BMI from 4 years of age, independent of income, immigrant background, maternal BMI and smoking during pregnancy. Low family income was associated with a lower birthweight, but did not independently predict BMI development. At 8 years of age, children from less educated families had a three times higher risk of obesity, independent of parental income. Children whose parents had fewer years of education but high income had significantly higher height than all other children.

    CONCLUSION: Parental education protected against childhood obesity, even after adjusting for income and other important parental characteristics. Income-related differences in height, despite similar BMIs, raise questions about body composition and metabolic risk profiles. The dominant role of education underscores the value of health literacy initiatives for the parents of young children. ©2018 Foundation Acta Pædiatrica.

  • 7.
    Brantmark, Anna
    et al.
    Halmstad University, School of Social and Health Sciences (HOS).
    Karlsson, Rebecca
    Halmstad University, School of Social and Health Sciences (HOS).
    Föräldrars påverkan i utvecklingen av övervikt och fetma hos barn2011Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Overweight and obesity in children are serious conditions, with many negative consequences to the health of individuals and the health care system as a whole. The prevalence is particularly great in certain groups of people and the frequency of these conditions is increasing at an alarming rate. Parents, as the primary caregivers, play a vital role in determining whether or not their children lead a healthy lifestyle. The aim of this literature review was to establish the influence that parents have on the development of overweight and obesity in their children. 19 articles were systematically reviewed and the results showed three main areas of influence; socio-economic factors, factors within the family and the role of the parent. In each of these areas, risk factors of developing overweight and obesity in children were identified. In general, parents lack information about these conditions and are in need of support from nurses and other health care professionals, who in turn carry the responsibility to support the parents, promote good health and prevent disease.

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  • 8.
    Bäckhed, Fredrik
    et al.
    The Wallenberg Laboratory, Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden & Novo Nordisk Foundation Center for Basic Metabolic Research, Section for Metabolic Receptology and Enteroendocrinology, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
    Roswall, Josefine
    Department of Pediatrics, Hallands Hospital Halmstad, Halmstad, Sweden & Göteborg Paediatric Growth Research Center, Department of Paediatrics, the University of Gothenburg, Queen Silvia Children’s Hospital, Gothenburg, Sweden.
    Peng, Yangqing
    BGI-Shenzhen, Shenzhen, China.
    Feng, Qiang
    BGI-Shenzhen, Shenzhen, China &Department of Biology, University of Copenhagen, Copenhagen, Denmark.
    Jia, Huijue
    BGI-Shenzhen, Shenzhen, China.
    Kovatcheva-Datchary, Petia
    The Wallenberg Laboratory, Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden.
    Li, Yin
    BGI-Shenzhen, Shenzhen, China.
    Xia, Yan
    BGI-Shenzhen, Shenzhen, China.
    Xie, Hailiang
    BGI-Shenzhen, Shenzhen, China.
    Zhong, Huanzi
    BGI-Shenzhen, Shenzhen, China.
    Khan, Muhammad Tanweer
    The Wallenberg Laboratory, Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden.
    Zhang, Jianfeng
    BGI-Shenzhen, Shenzhen, China.
    Li, Junhua
    BGI-Shenzhen, Shenzhen, China.
    Xiao, Liang
    BGI-Shenzhen, Shenzhen, China.
    Al-Aama, Jumana
    BGI-Shenzhen, Shenzhen, China & Princess Al Jawhara Albrahim Center of Excellence in the Research of Hereditary Disorders, King Abdulaziz University, Saudi Arabia.
    Zhang, Dongya
    BGI-Shenzhen, Shenzhen, China.
    Lee, Ying Shiuan
    The Wallenberg Laboratory, Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden.
    Kotowska, Dorota
    Department of Biology, University of Copenhagen, Copenhagen, Denmark.
    Colding, Camilla
    Department of Biology, University of Copenhagen, Copenhagen, Denmark.
    Tremaroli, Valentina
    The Wallenberg Laboratory, Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden.
    Yin, Ye
    BGI-Shenzhen, Shenzhen, China.
    Bergman, Stefan
    Göteborg Paediatric Growth Research Center, Department of Paediatrics, the University of Gothenburg, Queen Silvia Children’s Hospital, Gothenburg & Research and Development Center Spenshult, Oskarström, Sweden.
    Xu, Xun
    BGI-Shenzhen, Shenzhen, China.
    Madsen, Lise
    Department of Biology, University of Copenhagen, Copenhagen, Denmark & National Institute of Nutrition and Seafood Research, Bergen, Norway.
    Kristiansen, Karsten
    BGI-Shenzhen, Shenzhen, China & Department of Biology, University of Copenhagen, Copenhagen, Denmark.
    Dahlgren, Jovanna
    Göteborg Paediatric Growth Research Center, Department of Paediatrics, the University of Gothenburg, Queen Silvia Children’s Hospital, Gothenburg & .
    Wang, Jun
    BGI-Shenzhen, Shenzhen, China, Department of Biology, University of Copenhagen, Copenhagen, Denmark, Princess Al Jawhara Albrahim Center of Excellence in the Research of Hereditary Disorders, King Abdulaziz University, Saudi Arabia, Macau University of Science and Technology, Avenida Wai long, Taipa, China & Department of Medicine and State Key Laboratory of Pharmaceutical Biotechnology, University of Hong Kong, Hong Kong.
    Dynamics and Stabilization of the Human Gut Microbiome during the First Year of Life2015In: Cell Host and Microbe, ISSN 1931-3128, E-ISSN 1934-6069, Vol. 17, no 5, p. 690-703Article in journal (Refereed)
    Abstract [en]

    The gut microbiota is central to human health, but its establishment in early life has not been quantitatively and functionally examined. Applying metagenomic analysis on fecal samples from a large cohort of Swedish infants and their mothers, we characterized the gut microbiome during the first year of life and assessed the impact of mode of delivery and feeding on its establishment. In contrast to vaginally delivered infants, the gut microbiota of infants delivered by C-section showed significantly less resemblance to their mothers. Nutrition had a major impact on early microbiota composition and function, with cessation of breast-feeding, rather than introduction of solid food, being required for maturation into an adult-like microbiota. Microbiota composition and ecological network had distinctive features at each sampled stage, in accordance with functional maturation of the microbiome. Our findings establish a framework for understanding the interplay between the gut microbiome and the human body in early life. © 2015 Elsevier Inc.

  • 9.
    Börnhorst, Claudia
    et al.
    Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany.
    Siani, Alfonso
    Unit of Epidemiology and Population Genetics, Institute of Food Sciences, National Research Council, Avellino, Italy.
    Russo, Paola
    Unit of Epidemiology and Population Genetics, Institute of Food Sciences, National Research Council, Avellino, Italy.
    Kourides, Yannis
    Research and Education Institute of Child Health, Strovolos, Cyprus.
    Sion, Isabelle
    Department of Public Health, Ghent University, Ghent, Belgium.
    Molnár, Denés
    Department of Pediatrics, University of Pécs, Pécs, Hungary.
    Moreno, Luis A.
    Rodríguez, Gerardo
    GENUD (Growth, Exercise, Nutrition and Development) Research Group, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain.
    Ben-Shlomo, Yoav
    School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom.
    Howe, Laura
    School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom, MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, United Kingdom.
    Lissner, Lauren
    Section for Epidemiology and Social Medicine, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Mehlig, Kirsten
    Section for Epidemiology and Social Medicine, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Regber, Susann
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Bammann, Karin
    Institute for Public Health and Nursing Research (IPP), Faculty for Human and Health Sciences, University Bremen, Bremen, Germany.
    Foraita, Ronja
    Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany.
    Ahrens, Wolfgang
    Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany, Faculty of Mathematics and Computer Science, University of Bremen, Bremen, Germany.
    Tilling, Kate
    School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom.
    Early Life Factors and Inter-Country Heterogeneity in BMI Growth Trajectories of European Children: The IDEFICS Study2016In: PLOS ONE, E-ISSN 1932-6203, Vol. 11, no 2, article id e0149268Article in journal (Refereed)
    Abstract [en]

    Background

    Starting from birth, this explorative study aimed to investigate between-country differences in body mass index (BMI) trajectories and whether early life factors explain these differences.

    Methods

    The sample included 7,644 children from seven European countries (Belgium, Cyprus, Germany, Hungary, Italy, Spain, Sweden) participating in the multi-centre IDEFICS study. Information on early life factors and in total 53,409 repeated measurements of height and weight from 0 to <12 years of age were collected during the baseline (2007/2008) and follow-up examination (2009/2010) supplemented by records of routine child health visits. Country-specific BMI growth curves were estimated using fractional polynomial mixed effects models. Several covariates focussing on early life factors were added to the models to investigate their role in the between-countries differences.

    Results

    Large between-country differences were observed with Italian children showing significantly higher mean BMI values at all ages ≥ 3 years compared to the other countries. For instance, at age 11 years mean BMI values in Italian boys and girls were 22.3 [21.9;22.8; 99% confidence interval] and 22.0 [21.5;22.4], respectively, compared to a range of 18.4 [18.1;18.8] to 20.3 [19.8;20.7] in boys and 18.2 [17.8;18.6] to 20.3 [19.8;20.7] in girls in the other countries. After adjustment for early life factors, differences between country-specific BMI curves became smaller. Maternal BMI was the factor being most strongly associated with BMI growth (p<0.01 in all countries) with associations increasing during childhood. Gestational weight gain (GWG) was weakly associated with BMI at birth in all countries. In some countries, positive associations between BMI growth and children not being breastfed, mothers’ smoking during pregnancy and low educational level of parents were found.

    Conclusion

    Early life factors seem to explain only some of the inter-country variation in growth. Maternal BMI showed the strongest association with children’s BMI growth.

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  • 10.
    Börnhorst, Claudia
    et al.
    a Biometry and Data Management, Leibniz Institute for Epidemiology and Prevention Research, BIPS, Bremen, Germany.
    Siani, Alfonso
    Institute of Food Sciences, National Research Council, Avellino, Italy.
    Tornaritis, M.
    c Research and Education Institute of Child Health, Research and Education Institute of Child Health, Strovolos, Cyprus.
    Molnár, D.
    Department of Pediatrics, University of Pécs, Pécs, Hungary.
    Lissner, Lauren
    Section for Epidemiology and Social Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Regber, Susann
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Potential selection effects when estimating associations between the infancy peak or adiposity rebound and later body mass index in children2018In: Revue d'épidémiologie et de santé publique, ISSN 0398-7620, E-ISSN 1773-0627, Vol. 66, no Suppl. 5, p. S422-S423Article in journal (Refereed)
    Abstract [en]

    Aim: Lots of research has been conducted to identify early life factors or growth characteristics in infancy and childhood related to an unfavorable weight development. For instance, a late age at infancy peak (IP), an early age at adiposity rebound (AR) as well as body mass index (BMI) at IP and AR were shown to be positively associated with later adiposity status. The present study aims to investigate the usefulness of the IP and AR in comparison to other measures of BMI growth as indicators of later weight status. For the first time, the selection effect possibly occurring when excluding children with non-identifiable IP or AR will be explored.

    Methods: Identification and Prevention of Dietary- and Lifestyle-Induced Health Effects in Children and Infants (IDEFICS)/I. Family is an ongoing cohort study conducted in eight European countries with 16,229 children participating in the baseline survey in 2006/2007 [1]. In a subset of 4744 children with at least four repeated measurements of height and weight in the age interval from 0 to 8 years (37,998 measurements in total; survey data supplemented with records of routine child visits), fractional polynomial mixed-effects models were used to derive individual BMI trajectories. Based on these trajectories, age and BMI at IP and AR, BMI values and growth velocities at selected ages as well as the area under the BMI curve were estimated. The BMI growth measures were standardized and related to later BMI z-scores (mean age at outcome assessment: 9.2 years).

    Results: Age and BMI at IP and AR were not identifiable in 5.4% and 7.8% of the children, respectively. These groups of children showed a significantly higher BMI growth during infancy and childhood. In the remaining sample, BMI at IP correlated almost perfectly (r ≥ 0.99) with BMI at ages 0.5, 1 and 1.5 years, whereas BMI at AR correlated perfectly with BMI at ages 4–6 years (r ≥ 0.98). In the total study group, BMI values in infancy and childhood were positively associated with later BMI z-scores where associations increased with age. Associations between BMI velocities and later BMI z-scores were largest at ages 5 and 6 years. Results markedly differed for children with non-identifiable IP and AR, demonstrating a selection effect.

    Conclusions: IP and AR may not be estimable in children with higher-than-average BMI growth. Excluding these children from analyses may result in a selection bias that distorts effect estimates. BMI values at ages 1 and 5 years might be more appropriate to use as predictors for later weight status instead.

    © 2018 Published by Elsevier Masson SAS

  • 11.
    Gilljam, Britt-Mari
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Region Halland, Halmstad Hospital, Halmstad, Sweden .
    Nygren, Jens M.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Svedberg, Petra
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Arvidsson, Susann
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Impact of an Electronic Health Service on Child Participation in Pediatric Oncology Care: Quasiexperimental Study2020In: Journal of Medical Internet Research, E-ISSN 1438-8871, Vol. 22, no 7, article id e17673Article in journal (Refereed)
    Abstract [en]

    Background: There is a shortage of electronic Health (eHealth) services for children 6-12 years old, which promotes their participation in healthcare. Children with long-term diseases want to be more involved in their healthcare, and have the right to receive information, to be listened to, to express their opinions and to participate in decision-making in healthcare.

    Objective: The aim of this study was to investigate children’s participation during appointments with pediatricians at pediatric oncology clinics, with or without the use of the eHealth service Sisom.

    Method: A quasi-experimental design with mixed methods was used. Twenty-seven appointments with pediatricians for 14 children aged 6-12 years (mean 8.3) with a cancer diagnosis were filmed and analyzed. The intervention group consisted of children who used an eHealth service prior their appointments with pediatricians at a pediatric oncology clinic and the control group consisted of children during their appointments with pediatricians at four other pediatric oncology clinics. The data from the observations from the films were analyzed with quantitative and qualitative analysis. The quantitative analysis included manual calculations of how many times the pediatricians spoke directly to the children, of the proportion of the appointment time that the children were talking and their levels of participation. The qualitative analysis included directed content analysis included observations of the video films to assess the children´s levels of participation manifested themselves.

    Results:  A greater proportion of what the pediatrician said in the intervention group was addressed to the child than occurred in the control group, but the proportion of the appointment time the children talked was almost the same for both the intervention and the control groups. The levels of participation corresponded to the first three levels of Shier´s participation model: Children were listened to, Children were supported to express their views and Children´s views were taken into account. The results showed an increased level of the children´s participation in the intervention group. Several codes were found about information, which did not fit into any of the existing categories, and a new category was thus formed: Children received information. Situations were also identified where children were actively excluded from participation; these were presented as negative codes.

    Conclusions: This study shows that the eHealth service Sisom can increase children´s participation during appointments with healthcare professionals. Future research should focus on evaluating outcomes on individual and organizational levels and in different healthcare contexts. © The authors. All rights reserved

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  • 12.
    Helgadottir, Birgitta Holm
    et al.
    Halmstad University, School of Health and Welfare.
    Schöbel, Malin
    Halmstad University, School of Health and Welfare.
    Kompetensutveckling genom tvärprofessionell simuleringsövning: En intervjustudie om barnsjuksköterskors erfarenhet2022Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: The workload at a pediatric emergency department can change within a few minutes. The pediatric nurse must be able to identify lite-threatening conditions in the meeting with the acutely ill child in order to be able to take action quickly. Successful care of a child outcome requires a systematic and competent teamwork based on interprofessional simulation-based training. The aim of this study was to investigate pediatric nurses´ experiences of competence development through interprofessional simulation-based training in pediatric emergency care. Method: An interview study was conducted based on a qualitative content analysis. The data collection was based on semi structured interviews with eight pediatric nurses at five pediatric clinics in southern Sweden. A qualitative content analysis was used in the analysis process. Results: The result is divided into four categories based on the analysis: The importance of continuous simulation-based training, Improved team collaboration, Clearer role distribution and more efficient communication in the team. Interprofessional simulation-based training results in increased patient-safe care. And an overall theme: Increased patient safety and improved collaboration through recurring simulation-based training. Conclusion: Increased patient safety and improved collaboration are achieved through annual interprofessional simulation-based training.

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  • 13.
    Jendle, Johan
    et al.
    Örebro University, Örebro, Sweden.
    Agvall, Björn
    Region Halland, Halmstad, Sweden.
    Galozy, Alexander
    Halmstad University, School of Information Technology.
    Adolfsson, Peter
    Örebro University, Örebro, Sweden; The Hospital Of Halland, Kungsbacka, Sweden.
    Patterns and Predictors Associated With Long-Term Glycemic Control in Pediatric and Young Adult Patients with Type 1 Diabetes2022In: Journal of Diabetes Science and Technology, E-ISSN 1932-2968, Vol. 17, no 5, p. 1243-1251Article in journal (Refereed)
    Abstract [en]

    Background: The development of diabetes technology is rapid and requires education and resources to be successfully implemented in diabetes care management.

    Method: In an observational study, we evaluated the use of advanced diabetes technology, resource utilization, and glycemic control. The study population was 725 individuals with type 1 diabetes (T1D) living in Region Halland, Sweden. The study cohort was followed for 7 years between 2013 and 2019.

    Results: Children aged 0 to 17 years were associated with significantly better glucose control than young adults aged 18 to 25 years. The mean HbA1c in children and young adults was 53 mmol/mol (7.0%) compared to 61 mmol/mol (7.7%) (P <.0001), respectively. Comorbidities such as attention deficit hyperactivity disorder (ADHD), autism, and coelic disease were associated with higher HbA1c. All groups, regardless of age and comorbidity, showed a positive effect on glucose control after visiting a dietitian or psychologist. Differences were found between the age groups in terms of more use of advanced diabetes technology and more frequent visits to a physician in children compared to young adults.

    Conclusions: More frequent visits to physicians, and a visit to dietitians, and psychologists were associated with improved glucose control in individuals with T1D 0 to 25 years. Increased resources, including access to more advanced technologies, may be required in young adults with T1D. © 2022 Diabetes Technology Society.

  • 14.
    Larsson, Ingrid
    et al.
    Halmstad University, School of Health and Welfare.
    Aili, Katarina
    Halmstad University, School of Health and Welfare.
    Lönn, Maria
    Halmstad University, School of Health and Welfare. Psychiatry Halland, Halmstad, Sweden.
    Svedberg, Petra
    Halmstad University, School of Health and Welfare.
    Nygren, Jens M.
    Halmstad University, School of Health and Welfare.
    Ivarsson, Andreas
    Halmstad University, School of Health and Welfare.
    Johansson, Pia
    Halmstad University, School of Health and Welfare.
    Sleep interventions for children with attention deficit hyperactivity disorder (ADHD): A systematic literature review2023In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 102, p. 64-75Article, review/survey (Refereed)
    Abstract [en]

    Objective/background: Healthy sleep is particularly important for children with attention deficit hyperactivity disorder (ADHD), as sleep disturbances might aggravate disease symptoms. This review aims to synthesize and report evidence on the effectiveness of sleep interventions in increasing sleep, quality of life (QoL), and ADHD symptoms among children with ADHD. Patients/methods: The systematic literature review follows the Cochrane Collaboration methodology recommendations for literature reviews. Four databases were used based on the population, intervention, control and outcome (PICO) framework. Controlled trials with minimum 20 children in each group, aged 6–18, and published from 2005 and onwards were included. Results from the studies were reported in forest plots and three of the seven review outcomes were synthesized in meta-analyses. Results: The search identified 7710 records; of which 4808 abstracts were screened. After fulltext-screening of 99 papers, eight papers from five studies were included. The studies included behavioral sleep interventions and pharmacological interventions using melatonin and eszopiclone. For six of the seven outcomes, the effect sizes were small to moderate and the certainty of the evidence was low. For one outcome, sleep disturbances, the effect size was a moderate −0.49 standardized mean differences (95% confidence interval −0.65;-0.33), with a moderate certainty of evidence for the behavioral interventions for children aged 5–13 years with ADHD. Conclusions: This review identified few and heterogeneous studies. A moderate certainty of evidence for a moderate effect size was only obtained for sleep disturbances from the behavioral interventions. A low certainty of the evidence for a moderate effect size was found for the total sleep time from the pharmacological intervention using melatonin and one behavioral intervention, which indicates that these sleep interventions impact sleep quantity and quality among children with ADHD. © 2022 The Authors

  • 15.
    Lilleberg, Nanna
    et al.
    Halmstad University, School of Health and Welfare.
    Brevigh, Ida
    Halmstad University, School of Health and Welfare.
    Haahr, Viktoria
    Halmstad University, School of Health and Welfare.
    Diabetes mellitus typ 2: Det dagliga stödet till barn och ungdomar: En litteraturöversikt2019Independent thesis Advanced level (degree of Master (One Year)), 40 credits / 60 HE creditsStudent thesis
    Abstract [en]

    Background: In 2018, 7630 children and adolescents with diabetes mellitus were diagnosed in Sweden. Type 2 diabetes mellitus was previously a rare diagnosis in children and adolescents but has increased in line with overweight, obesity and physical inactivity.  The Convention on the Rights of the Child gives children and adolescents the right to be supported by the family and the health and medical services to manage the disease in the best way. Purpose: Was to illustrate how children and adolescents with type 2 diabetes mellitus can be supported in their disease. Method: Conducted with systematic search, review and analysis of qualitative and quantitative articles. The searches were performed in five databases. The literature review consisted of nine scientific articles. Results: Children and adolescents with type 2 diabetes mellitus were in great need of a supporting network. Encouraging support was a cornerstone of self-management of the disease. Emotional and practical support from the family and friends was of great importance for the individual's diabetesmanagement. Even the pediatric nurse had an important role in supporting the child or adolescent by informing, teaching and creating a good relationship around the individual. Conclusion: When children and adolescents with type 2 diabetes mellitus received support from the environment, diabetes management was facilitated

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  • 16.
    Lindholm, Annelie
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Spenshult Research and Development Center, Halmstad, Sweden.
    Overweight and Obesity in Preschool Children: Early Risk Factors and Early Identification2019Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    BACKGROUND: Overweight and obesity in children has reached epidemic proportions in recent decades, and even the youngest age groups are affected. Excess weight during childhood often follows the child into adulthood and is associated with diseases such as cardiovascular diseases and type 2 diabetes mellitus. In addition, excess weight often leads to health problems already during childhood. Childhood obesity is therefore one of the greatest public health challenges of the 21st century.

    AIM: The overall aim was to study growth patterns and early risk factors for overweight, obesity and an elevated waist-to-height ratio (WHtR) in preschool children. The specific aims were to: examine early body mass index (BMI) and WHtR growth patterns and their ability to predict overweight or obesity in children at 5 years of age (Paper I); examine if BMI and WHtR growth patterns from an early age could identify children with an elevated WHtR at 5 years of age by using standard deviation score(s) (SDS) in children classified according to WHtRSDS at 5 years of age. Another aim was to study the association between BMISDS and WHtRSDS at 5 years of age (Paper II); examine nutrition- and feeding practice-related risk factors for rapid weight gain during the first 0–6 months and the following 6–12 months (Paper III); examine the association between potential early risk factors and an elevated WHtR, defined as WHtRSDS ≥ 1 at 5 years of age, and examine whether similar associations also were found for overweight or obesity at the same age (Paper IV).

    METHODS: This project was part of the population-based birth cohort study the Halland Health and Growth Study, including 2,666 children born in the county of Halland in the southwestern part of Sweden between October 2007 and December 2008. Weight, height and waist circumference were measured at nine time points starting at birth. At every measurement point the parents filled in questionnaires regarding their child’s nutrition, health and lifestyle and also background information about the family.

    RESULTS: We found that children with overweight or obesity at 5 years of age could be identified already from an early age by significantly higher mean BMISDS and WHtRSDS than corresponding values in children with normal weight or underweight. BMI was sufficient for predicting overweight or obesity at 5 years of age and WHtR did not add any further information in this prediction.

    Children with a WHtRSDS ≥ 1 at 5 years of age could be identified already from an early age by significantly higher mean BMISDS and WHtRSDS than corresponding values in children with a WHtRSDS < 1. When comparing WHtRSDS and BMISDS at 5 years of age, 55% of the children with an elevated WHtRSDS had normal BMISDS.

    Rapid weight gain was more common during the first 6 months of the first year than during the next 6 months. Bottle-feeding and nighttime meals containing formula milk were associated with rapid weight gain between 0 and 6 months. Breastfeeding was negatively associated with rapid weight gain during the same period.

    Rapid weight gain during 0–6 months and also maternal pre-pregnancy BMI and paternal BMI were associated with a WHtRSDS ≥ 1 at 5 years of age. Rapid weight gain during both 0–6 and 6–12 months and also maternal pre-pregnancy BMI, were associated with overweight or obesity at 5 years of age.

    CONCLUSION: This thesis showed that BMI was sufficient for predicting overweight or obesity at 5 years of age, and WHtR did not add any further information to this prediction. For identification of children with an elevated WHtR, BMI classification missed every second child, indicating that WHtR adds value in children who may need further investigation regarding cardiometabolic risk factors. Risk factors operating before pregnancy and early in life increase the risk of early rapid weight gain, an elevated WHtR and overweight or obesity at 5 years of age and bottle feeding, nighttime meals, early rapid weight gain as well as parental overweight are potential modifiable risk factors in this development.

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  • 17.
    Lindholm, Annelie
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Research and Development Center Spenshult, Halmstad, Sweden.
    Bergman, Stefan
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Research and Development Center Spenshult, Halmstad, Sweden & Department of Public Health and Community Medicine, The Primary Health Care Unit at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Alm, Bernt
    Department of Pediatrics, The Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Almquist-Tangen, Gerd
    Department of Pediatrics, The Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden & Child Health Care Unit, Region Halland, Kungsbacka, Sweden.
    Dahlgren, Jovanna
    Department of Pediatrics, The Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Roswall, Josefine
    Department of Pediatrics, The Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden & Department of Pediatrics, County Hospital, Halmstad, Sweden.
    Infant body mass index growth patterns predicted overweight at five years, waist-to-height ratio did not add to this predictivity2019In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 108, no 5, p. 945-953Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of the present study was to examine body mass index (BMI) and waist‐to‐height ratio (WHtR) growth patterns from birth until five years regarding their ability to predict overweight or obesity in children at five years of age.

    Methods: Population‐based longitudinal birth cohort study of 1540 children from the south‐west region of Sweden, recruited at the first visit to the child health care centres in 2007–2008. The children were followed for five years and classified into two weight groups according to the 2012 International Obesity Task Force criteria. BMI and WHtR standard deviation scores (SDS) were analysed with Student's t‐tests and multiple logistic regression models. ©2018 Foundation Acta Pædiatrica. Published by John Wiley & Sons Ltd

    Results: BMI‐SDS and WHtR‐SDS growth patterns were from an early age different in children with overweight or obesity, compared to in children with normal weight or underweight. Overweight or obesity was significantly predicted by BMI‐SDS at 0–1 month (p < 0.001), ΔBMI‐SDS between 0–1 and 12 months (p < 0.001) and between 18 and 48 months (p < 0.001), but not by WHtR‐SDS, except for a negative association between 18 and 48 months in the boys (p = 0.040).

    Conclusion: Overweight or obesity at five years could be predicted by early BMI‐SDS growth patterns, and WHtR‐SDS did not add to the predictivity with regard to BMI‐SDS. ©2018 Foundation Acta Pædiatrica. Published by John Wiley & Sons Ltd

  • 18.
    Lindholm, Annelie
    et al.
    Halmstad University, School of Health and Welfare.
    Lissner, Lauren
    University of Gothenburg, Gothenburg, Sweden.
    Hunsberger, Monica
    University of Gothenburg, Gothenburg, Sweden.
    Early childhood feeding with Swedish Milk Cereal Drink, does it promote (un)healthy growth?2023In: Abstract book for the ISBNPA 2023 Annual Meeting, International Society of Behavioral Nutrition and Physical Activity , 2023, p. 622-622Conference paper (Refereed)
    Abstract [en]

    Purpose: Early rapid weight gain (RWG) is associated with overweight and abdominal adiposity in children, and these factors are in turn related to adverse health consequences later in life. Early nutrition has been identified as an important risk factor. In Sweden, milk cereal drink (MCD) is recommended to be introduced at 6 months and continued during introduction of complementary foods, often longer. The aim of this study was to investigate if MCD consumption was associated with RWG in infancy and elevated waist-to-height ratio (WHtR) later in childhood.

    Methods: This study is based on longitudinal data in the Swedish cohort of the IDEFICS study between birth and 15 years. Early growth data from archival health records and information from parents regarding MCD consumption, maternal BMI and family income was available for 1391 children. After excluding 58 children born prematurely, n=1333. RWG was defined as a change > 0.67 in weight standard deviation scores between 6–12 months. Follow-up data regarding waist circumference and height were available in around half of the children who were re-examined at ages 7–15 years. Logistic and linear regressions were used to study associations between MCD and early RWG and subsequent predictive value of RWG on WHtR later in childhood.

    Results/findings: MCD was consumed by 61% of the children and 59% of them consumed it for more than three months. RWG, which was observed in 17% of the children between 6–12 months was associated with MCD consumption ever/never (OR: 1.52 95% CI: 1.19–2.07 p: <0.01), when corrected for maternal BMI, birth weight, sex and household income. When investigating WHtR in the 626 children at follow-up, RWG between 6–12 months was associated with WHtR (3.98, 1.15–13.83 and p<0.05) when corrected for birth weight, sex, maternal BMI, age at follow-up, parental education and breastfeeding. In the full model considering the total observation time the MCD effect was not independent of RWG.

    Conclusions: Our results indicate that early RWG is associated with higher WHtR later in childhood. Our results also raise the possibility that MCD consumption may be involved in later development of centralized adiposity.

  • 19.
    Lindholm, Annelie
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Roswall, Josefine
    Department of Pediatrics, The Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Alm, Bernt
    Department of Pediatrics, The Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Almquist-Tangen, Gerd
    Department of Pediatrics, The Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS).
    Dahlgren, Jovanna
    Department of Pediatrics, The Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Staland Nyman, Carin
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Bergman, Stefan
    Department of Public Health and Community Medicine, The Primary Health Care Unit at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Body mass index classification misses to identify children with an elevated waist-to-height ratio at 5 years of age2019In: Pediatric Research, ISSN 0031-3998, E-ISSN 1530-0447, Vol. 85, no 1, p. 30-32Article in journal (Refereed)
    Abstract [en]

    Background:  Abdominal adiposity is an important risk factor in the metabolic syndrome. Since BMI does not reveal fat distribution, waist-to-height ratio (WHtR) has been suggested as a better measure of abdominal adiposity in children, but only a few studies cover the preschool population. The aim of the present study was to examine BMI and WHtR growth patterns and their association regarding their ability to identify children with an elevated WHtR at 5 years of age.

    Methods: A population-based longitudinal birth cohort study of 1540 children, followed from 0 to 5 years with nine measurement points. The children were classified as having WHtR standard deviation scores (WHtRSDS) <1 or ≥1 at 5 years. Student’s t-tests and Chi-squared tests were used in the analyses.

    Results: Association between BMISDS and WHtRSDS at 5 years showed that 55% of children with WHtRSDS ≥1 at 5 years had normal BMISDS (p < 0.001). Children with WHtRSDS ≥1 at 5 years had from an early age significantly higher mean BMISDS and WHtRSDS than children with values <1.

    Conclusions: BMI classification misses every second child with WHtRSDS ≥1 at 5 years, suggesting that WHtR adds value in identifying children with abdominal adiposity who may need further investigation regarding cardiometabolic risk factors.

    © 2018, International Pediatric Research Foundation, Inc.

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  • 20.
    Lindholm, Annelie
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Research and Development Centre Spenshult, Halmstad, Sweden.
    Roswall, Josefine
    The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden & Halland Hospital, Halmstad, Sweden.
    Almqvist-Tangen, Gerd
    The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden & Child Health Care Unit, Region Halland, Sweden.
    Alm, Bernt
    The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden & Child Health Care Unit, Region Halland, Sweden.
    Dahlgren, Jovanna
    The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Bergman, Stefan
    Research and Development Centre Spenshult, Halmstad, Sweden & The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Changes in Waist-to-Height Ratio during Preschool Years Differ between Children being Obese or Overweight at Five Years of Age Compared with not Overweight Children2016In: Hormone Research in Paediatrics, ISSN 1663-2818, E-ISSN 1663-2826, Vol. 86, no Suppl. 1, p. 308-308, article id P1-P465Article in journal (Other academic)
  • 21.
    Linge, Lotta
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Joyful and serious intentions in the work of hospital clowns: A meta-analysis based on a 7-year research project conducted in three parts2013In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 8, no 1, article id 18907Article in journal (Refereed)
    Abstract [en]

    The present meta-analysis focuses on a 7-year research project entitled "Hospital clowns-in encounters with ailing children" and funded by the Swedish Childhood Cancer Foundation. The aim of the meta-analysis, which is based on the project's three studies, was to attempt to achieve a deeper psychological and more nuanced understanding of the unique encounters taking place between the hospital clowns and ailing children in the study. The methodological procedures were qualitative and included 51 interviews with four informant groups: the clowns, staff, children, and their parents. The meta-analysis revealed the unique aspects of hospital clowns' work with respect to: a) a quality of care that transcends boundaries, that is, a magical safe area where demands and adjustment were temporarily set aside and where the lighter side of life took precedence; b) a non-demanding quality of care, where joy could be experienced without requiring something in return, where the child's terms mattered and where the child perspective was clearly in focus; and c) a defusing quality of care, which is expressed as a positive counterweight that was otherwise lacking in medical care, where the hospital clowns used different solutions that bypassed regular hospital routines by temporarily distracting and making things easier for the children, parents, and staff in various care situations. Finally, the aim of the theoretical framework, in its synthesizing form, was to promote further psychological understanding of the area of humor that exists between fantasy and reality-an intermediate or transitional area that the hospital clowns created together with the children. In this transitional area, the hospital clowns' unique contribution can be interpreted, in psychological terms, as being available as a vicarious therapeutic clown figure in a magical world that parallels reality.

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  • 22.
    Lönn, Maria
    Halmstad University, School of Health and Welfare.
    Weighted blankets as a sleep intervention for children with ADHD2024Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    BAKGRUND: Healthy sleep practices for children should be promoted as an essential part of a healthy lifestyle, with important implications for the entire family. Unhealthy sleep patterns and sleep-related problems disrupt everyday life and functioning. Sleep problems are common among children, especially those with attention deficit hyperactivity disorder (ADHD). Weighted blankets are one type of non-pharmacological intervention that has been used in health-care settings, such as occupational therapy practice. However, evidence is scarce and knowledge is lacking concerning the effects of weighted blankets on sleep and their potential benefits. Given the challenges children with ADHD face in sleep problems and emotional and behavioural regulation, weighted blankets could be a particular relevant intervention. The SLEEP project was thus designed to increase current evidence and knowledge about the use of weighted blankets as a sleep intervention for children with ADHD. 

    AIM: The overall aim of this thesis was to investigate the impact of weighted blankets on the sleep health of children with ADHD and sleep problems.

    METHODS: A crossover randomised controlled trial (Study I) was conducted that included 94 children with ADHD, 6-14 years old. Children were randomly assigned to four weeks of a weighted blanket or four weeks of a lighter control blanket, followed by the other intervention. Data was collected with actigraphy (primary outcome), child- and parent-questionnaires and a daily sleep diary. The efficacy of weighted blankets was analysed with a paired t-test. An experimental longitudinal study (Study II) was carried out that involved the same 94 children, who were followed for 16 weeks. Weighted blanket-adherent vs non-adherent children were compared based on sample characteristics and changed sleep outcomes. The data collected at baseline, at 4 weeks, 8 weeks and at 16-week follow-up were analysed with mixed effect models. Weighted blanket-adherent children were further examined longitudinally (Study III) and compared from baseline to the 16-week follow-up. Parents’ ratings of children’s sleep problems were analysed using paired t-test and McNemar’s test. Furthermore, a qualitative study (Study IV) was performed in which a purposive sample of 26 children participated in individual interviews. A qualitative content analysis was performed to analyse the data.

    RESULTS: In Study I, weighted blankets were found to be more efficacious than the lighter control blankets, according to objectively measured sleep (increased total sleep time, increased sleep efficiency and decreased wake after sleep onset). Older children, 11-14 years old, and children with an inattentive ADHD subtype slept longer and more effectively with the weighted blanket. In Study II, weighted blanket-adherent children showed improvement, with fewer sleep problems, compared to non-adherent children. Weighted blanket-adherent children also showed a stable total sleep time compared to non-adherent children, who displayed a decrease in their total sleep time during the 16-week sleep intervention. This association was shown for the older children aged 11-14, but not for the younger children aged 6-10. Furthermore, in Study III, the parents of the Weighted blanket-adherent children reported fewer episodes of night wakings, sleep onset delay, sleep duration difficulties and daytime sleepiness. Bedtime resistance and daytime sleepiness were considered the most problematic domains at baseline, and these also showed the greatest change, according to parents’ experiences of children’s problematic sleep. In Study IV, children described that using WBs requires a commitment, improves emotional regulation, changes sleeping patterns and promotes everyday participation.

    CONCLUSION: The overall results of this thesis indicate that children with ADHD and sleep problems benefit from using weighted blankets. Weighted blankets could thus be an efficient sleep intervention and an important complement to standard treatment for children with ADHD and sleep problems. More research is needed to establish the effectiveness of weighted blankets in different subgroups and settings. 

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  • 23.
    Mårild, Staffan
    et al.
    Department of Pediatrics, Institute of Clinical Sciences, The Queen Silvia Children’s Hospital, The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
    Regber, Susann
    Nordic School of Public Health, Göteborg, Sweden.
    Novak, M.
    Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Eiben, G.
    Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Bammann, K.
    BIPS-Institute, Bremen, Germany.
    De Henauw, S.
    Ghent University, Ghent, Belgium.
    Fernández-Alvira, J.M.
    University of Zaragoza, Zaragoza, Spain.
    Gwozdz, W.
    Copenhagen Business School, Frederiksberg, Denmark.
    Kourides, Y.
    Research & Education Institute of Child Health, Strovolos, Cyprus.
    Moreno, L.
    University of Zaragoza, Zaragoza, Spain.
    Molnár, D.
    University of Pécs, Pécs, Hungary.
    Reisch, L.
    Copenhagen Business School, Frederiksberg, Denmark.
    Russo, P.
    CNR, Avellino, Italy.
    Veidebaum, T.
    National Institute for Health Development, Tallinn, Estonia.
    Borup, I.
    Nordic School of Public Health, Gothenburg, Sweden.
    Pigeot, I.
    BIPS-Institute, Bremen, Germany.
    Parental perceptions of and concerns about child´s body weight in eight European countries - the IDEFICS study2014In: Obesity Reviews, ISSN 1467-7881, E-ISSN 1467-789X, Vol. 15, no S2, p. 105-105Article in journal (Refereed)
    Abstract [en]

    Background: Few studies have studied parental perceptions in different settings of their children's weight in relation to objective measurements.

    Aim: To evaluate parental perceptions of their child's weight category in relation to anthropometric measurements.

    Key Methods: This was cross-sectional study of 16 220 children, 2–9 year of age, from eight European countries. Parents completed a questionnaire on their perception of the children's weight and concern for future weight deviations. Objective children's weight categories from the International Obesity Task Force were used.

    Results: Parental weight perception corresponded overall to children's mean body mass index (BMI) z-scores, but there were exceptions, e.g. 63% of parents to children with overweight marked ‘proper weight’. One-third of the total indicated concern for future underweight, most often in parents of children in the overweight category. The strongest predictor for accurate parental weight perception for children with overweight and obesity was BMI z-score (odds ratio [OR] 7.2, 95% confidence interval [CI] 6.1–8.7). Compared to Southern Europe, ORs for accurate parental weight perception were 4.4 (95% CI 3.3–6.0) in Northern Europe and 3.4 (95% CI 2.7–4.2) in Central Europe.

    Conclusion: Parents of children categorized as being overweight or obese systematically underestimated weight category. Parents differed regionally in accurate perception of weight.

  • 24.
    Parmvi, Jannie
    et al.
    Halmstad University, School of Social and Health Sciences (HOS).
    Ottosson, Carola
    Halmstad University, School of Social and Health Sciences (HOS).
    ”Skada inte vår framtid”: Kännetecken för sjuksköterskan att uppmärksamma vid misstanke om fysisk barnmisshandel2010Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    The disclosure of physical child abuse is a complex task for the medical care. A great number of cases are never revealed. There is a trend of an increased reporting frequency of child abuse, since the general attitude in the society has changed. Physical child abuse is defined as: An adult physically harming a child with or without an object. The purpose of this literature study was to summarize what nurses on the field should look for to discover physical child abuse. This paper was formed as a result of a literature study which included 13 articles and 1 thesis. The literature study resulted in identification of a large number of relevant warning signals of child abuse, for example somatic injuries and parental behaviour in social groups. To simplify the nurses' work of separating cases of child abuse from cases of normal accidents during play, existing experience within this area must be disseminated by education. Also, further research within this area is required to improve the nursing profession and help a larger fraction of exposed children.

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  • 25.
    Regber, Susann
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Jormfeldt, Henrika
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Foster homes for neglected children with severe obesity— Debated but rarely studied2019In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 108, no 11, p. 1955-1964Article in journal (Refereed)
    Abstract [en]

    Aim: To explore current research and theoretical articles on foster home placement of children with severe obesity.

    Methods: An integrative literature review. Literature searches in six electronic databases included theoretical, quantitative and qualitative articles and case reports published in English (2008‐2018) on the topic of severe childhood obesity and foster home placement.

    Results: Seventeen selected papers included six theoretical articles, nine quantitative studies, one qualitative study and one case report. Eight of the nine quantitative studies did not specify the grading of obesity in children in foster care. The case report and the qualitative study showed distinct and sustainable body mass index (BMI) reductions after a child had been placed in foster care. Five theoretical articles justified foster care placement when chronic parental neglect led to severe obesity in the child, while one article emphasised the opposite.

    Conclusion: Parental and societal neglect of children with severe obesity placed in a foster home is rarely studied or the exclusive aim of research. The views of the chil‐dren themselves are lacking in research articles, as well as the child’s right to health obligations concerning children with severe obesity. © 2019 Foundation Acta Pædiatrica. Published by John Wiley & Sons Ltd.

  • 26.
    Samuelsson, Carolina
    et al.
    Halmstad University, School of Health and Welfare.
    Törnqvist, Amanda
    Halmstad University, School of Health and Welfare.
    Föräldrars hopp i upplevelsen av att ha ett barn med diagnosen cancer2015Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Each year about 300 children gets sick in some sort of cancer in Sweden. That a child becomes ill in cancer do not only affects the sick child even the parents. Cancer diagnosis creates a crisis to the whole family. In connection with this crisis situation arising also the concept of hope. Parents hope in the experience of having a child with cancer. To enable parents to be able to have a chance to cope with the challenging situation it is important to illuminate the factors that can affect the parents hope in a positive or in a negatively way. What can the medical personnel do to eliminate the factors that are a threat to the hope and how hope can be maintained. Which corresponds to the literature study’s purpose. Five categories have been identified to reflect the result to describe the factors that promotes and threats the hope; Knowledge gives hope, Social support gives hope, family-centered care gives hope, Threats to the hope and Belief in the future gives hope. If the parents are well-informed, receive social support from family, friends and other parents in a similar situation and have belief in the future makes the parents to have good opportunities to maintain hope. However, there are factors that can threaten the feelings and experiences of hope.

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  • 27.
    Svedberg, Petra
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health and Nursing.
    Arvidsson, Susann
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health and Nursing.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health and Nursing.
    Carlsson, Ing-Marie
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Nygren, Jens M.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health and Nursing.
    Barriers and Enablers Affecting Successful Implementation of the Electronic Health Service Sisom: Multicenter Study of Child Participation in Pediatric Care2019In: Journal of Medical Internet Research, E-ISSN 1438-8871, Vol. 21, no 11, p. 1-15, article id 14271Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Children's participation in health care is one of the most important components in the management of their disease. Electronic health (eHealth) services that are adapted to the needs of children have the potential for restructuring how children and professionals work together. Therefore, a digital interactive assessment and communication tool, Sisom, was developed to give children aged between 6 and 12 years a voice in their own health care. However, the implementation of eHealth services such as Sisom in daily practice in pediatric health care is rarely investigated. OBJECTIVE: The aim of this study was to explore the process of implementing Sisom for children in pediatric care in Sweden. More specifically, the study aimed to (1) evaluate whether the implementation strategy was conducted as planned, (2) understand the barriers and facilitators of the implementation strategy in pediatric care settings, (3) gain insight into how professionals work with the specific intervention, and (4) gain insight into the usefulness and effects of the intervention from the professionals' perspectives. METHODS: A process evaluation design was used to study the implementation of Sisom at 4 pediatric care centers in Sweden. An extensive amount of qualitative and quantitative data was collected before, during, and after the intervention through self-report checklists, memos, and interviews with professionals. In total, 46 children, aged between 6 and 13 years, participated. The children used Sisom on two occasions during 6 months. When they used Sisom, a printed report formed the basis for a forthcoming dialogue between professionals, children, and their parents. RESULTS: To our knowledge, this is the first implementation study of an eHealth communication tool aimed at strengthening children's participation in pediatric health care. Key factors for successful implementation were alignment of the solution with the values and goals of the organization, health care professionals' beliefs in the usefulness and usability of the solution, and health care professionals' willingness to change their professional roles guided by the solution. CONCLUSIONS: The results from the study show that it is possible to restructure health care delivery toward a child-centered approach, if there is a willingness and preparedness in the organization to implement an eHealth solution with the aim of restructuring the way of working with children's participation. ©Petra Svedberg, Susann Arvidsson, Ingrid Larsson, Ing-Marie Carlsson, Jens M Nygren.

  • 28.
    Sällfors, Christina
    et al.
    The Nordic School of Public Health, Göteborg University, Sweden.
    Hallberg, Lillemor R.-M.
    The Nordic School of Public Health, Göteborg University, Göteborg, Sweden.
    Fasth, Anders L.
    Department of Paediatrics, Göteborg University, Göteborg, Sweden.
    Well-being in children with juvenile chronic arthritis2004In: Clinical and Experimental Rheumatology, ISSN 0392-856X, E-ISSN 1593-098X, Vol. 22, no 1, p. 125-130Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The aim of this study was to describe a model for predicting well-being in children with juvenile chronic arthritis (JCA). METHODS: 125 children (43 boys) (median age 14.1 yrs; range 10.3-17.8) rated disability and discomfort (Childhood Health Assessment Questionnaire). Pain control, pain reduction and fatigue were evaluated (visual analogue scales). In addition, variation of pain intensity was rated by a pain intensity scale. Analysis by the stepwise regression technique was used to explain the variability in well-being. Eight independent variables were included as possible predictors in the model (p < 0.1). RESULTS: The analyses indicated that well-being in children with JCA is related to three clusters of variables; pain "as it normally is", number of pain-free days and attending physical education classes. The analysis explained a substantial portion of the total variance in the children's well-being (55.1%). CONCLUSION: Pain is a robust predictor of well-being in children with JCA. This supports the concept of the benefits of reducing chronic joint pain as a major goal in caring of these children.

  • 29.
    Önnerfält, Jenny
    et al.
    Department of Paediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden & Vårdalinstitutet, Swedish Institute for Health Sciences, Lund University, Lund, Sweden & Department of Paediatrics, Lund University, Lund, Sweden & Skåne University Hospital, Lund, Sweden.
    Erlandsson, Lena-Karin
    Vårdalinstitutet, Swedish Institute for Health Sciences, Lund University, Lund, Sweden & Department of Health Sciences, Faculty of medicine, Lund University, Lund, Sweden.
    Orban, Kristina
    Vårdalinstitutet, Swedish Institute for Health Sciences, Lund University, Lund, Sweden & Department of Health Sciences, Faculty of medicine, Lund University, Lund, Sweden.
    Broberg Olsson, Malin
    Vårdalinstitutet, Swedish Institute for Health Sciences, Lund University, Lund, Sweden & Department of Psychology, University of Gothenburg, Gothenburg, Sweden.
    Thorngren-Jerneck, Kristina
    Department of Paediatrics, Clinical Sciences, Lund University, Lund, Sweden & Vårdalinstitutet, Swedish Institute for Health Sciences, Lund University, Lund, Sweden & Skåne University Hospital, Lund, Sweden.
    A family-based intervention targeting parents of preschool children with overweight and obesity: Conceptual framework and study design of LOOPS- Lund Overweight and Obesity Preschool Study2012In: BMC Public Health, E-ISSN 1471-2458, Vol. 12, no 1, article id 879Article in journal (Refereed)
    Abstract [en]

    Background: As the rate of overweight among children is rising there is a need for evidence-based research that will clarify what the best interventional strategies to normalize weight development are. The overall aim of the Lund Overweight and Obesity Preschool Study (LOOPS) is to evaluate if a family-based intervention, targeting parents of preschool children with overweight and obesity, has a long-term positive effect on weight development of the children. The hypothesis is that preschool children with overweight and obesity, whose parents participate in a one-year intervention, both at completion of the one-year intervention and at long term follow up (2-, 3- and 5-years) will have reduced their BMI-for-age z-score.

    Methods/Design: The study is a randomized controlled trial, including overweight (n=160) and obese (n=80) children 4-6-years-old. The intervention is targeting the parents, who get general information about nutrition and exercise recommendations through a website and are invited to participate in a group intervention with the purpose of supporting them to accomplish preferred lifestyle changes, both in the short and long term. To evaluate the effect of various supports, the parents are randomized to different interventions with the main focus of: 1) supporting the parents in limit setting by emphasizing the importance of positive interactions between parents and children and 2) influencing the patterns of daily activities to induce alterations of everyday life that will lead to healthier lifestyle. The primary outcome variable, child BMI-for-age z-score will be measured at referral, inclusion, after 6 months, at the end of intervention and at 2-, 3- and 5-years post intervention. Secondary outcome variables, measured at inclusion and at the end of intervention, are child activity pattern, eating habits and biochemical markers as well as parent BMI, exercise habits, perception of health, experience of parenthood and level of parental stress.

    Discussion: The LOOPS project will provide valuable information on how to build effective interventions to influence an unhealthy weight development to prevent the negative long-term effects of childhood obesity.

    Trial registration: ClinicalTrials.gov NCT00916318

    © 2012 Önnerfält et al.; licensee BioMed Central Ltd.

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