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  • 1.
    Abrahamsson, Thomas R.
    et al.
    Department of Clinical and Experimental Medicine, Division of Pediatrics, Linköping University, Linköping, Sweden.
    Jakobsson, Hedvig E.
    Department of Preparedness, Swedish Institute for Communicable Disease Control, Solna, Sweden; Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden.
    Andersson, Anders F.
    Science for Life Laboratory, School of Biotechnology, KTH Royal Institute of Technology, Stockholm, Sweden .
    Björkstén, Bengt
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; .
    Engstrand, Lars
    Department of Preparedness, Swedish Institute for Communicable Disease Control, Solna, Sweden; Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden.
    Jenmalm, Maria C.
    Department of Clinical and Experimental Medicine, Division of Pediatrics, Linköping University, Linköping, Sweden; Department of Clinical and Experimental Medicine, Unit of Autoimmunity and Immune Regulation, Linköping University, Linköping, Sweden.
    Low diversity of the gut microbiota in infants with atopic eczema2012In: Journal of Allergy and Clinical Immunology, ISSN 0091-6749, E-ISSN 1097-6825, Vol. 129, no 2, p. 434-440.e2Article in journal (Refereed)
    Abstract [en]

    Background: It is debated whether a low total diversity of the gut microbiota in early childhood is more important than an altered prevalence of particular bacterial species for the increasing incidence of allergic disease. The advent of powerful, cultivation-free molecular methods makes it possible to characterize the total microbiome down to the genus level in large cohorts.

    Objective: We sought to assess microbial diversity and characterize the dominant bacteria in stool during the first year of life in relation to atopic eczema development.

    Methods: Microbial diversity and composition were analyzed with barcoded 16S rDNA 454-pyrosequencing in stool samples at 1 week, 1 month, and 12 months of age in 20 infants with IgE-associated eczema and 20 infants without any allergic manifestation until 2 years of age (ClinicalTrials.gov ID NCT01285830).

    Results: Infants with IgE-associated eczema had a lower diversity of the total microbiota at 1 month (P = .004) and a lower diversity of the bacterial phylum Bacteroidetes and the genus Bacteroides at 1 month (P = .02 and P = .01) and the phylum Proteobacteria at 12 months of age (P = .02). The microbiota was less uniform at 1 month than at 12 months of age, with a high interindividual variability. At 12 months, when the microbiota had stabilized, Proteobacteria, comprising gram-negative organisms, were more abundant in infants without allergic manifestation (Empirical Analysis of Digital Gene Expression in R [edgeR] test: P = .008, q = 0.02).

    Conclusion: Low intestinal microbial diversity during the first month of life was associated with subsequent atopic eczema.

  • 2.
    Albertsson-Wikland, Kerstin
    et al.
    Univ Gothenburg, Goteborg Pediat Growth Res Ctr, Dept Pediat, Inst Clin Sci,Sahlgrenska Acad, Gothenburg, Sweden.
    Kriström, Berit
    Umeå Univ, Dept Clin Sci, Pediat Unit, Umeå, Sweden.
    Lundberg, Elena
    Umeå Univ, Dept Clin Sci, Pediat Unit, Umeå, Sweden.
    Aronson, A. Stefan
    Halmstad Cty Hosp, Dept Pediat, Halmstad, Sweden.
    Gustafsson, Jan
    Uppsala Univ, Dept Womens & Childrens Hlth, Uppsala, Sweden.
    Hagenäs, Lars
    Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden.
    Ivarsson, Sten-A.
    Lund Univ, Dept Pediat, Malmö, Sweden.
    Jonsson, Björn
    Uppsala Univ, Dept Womens & Childrens Hlth, Uppsala, Sweden.
    Ritzen, Martin
    Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden.
    Tuvemo, Torsten
    Uppsala Univ, Dept Womens & Childrens Hlth, Uppsala, Sweden.
    Westgren, Ulf
    Lund Univ, Dept Pediat, Malmo, Sweden.
    Westphal, Otto
    Univ Gothenburg, Goteborg Pediat Growth Res Ctr, Dept Pediat, Inst Clin Sci,Sahlgrenska Acad, Gothenburg, Sweden.
    Åman, Jan
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Growth hormone dose-dependent pubertal growth: a randomized trial in short children with low growth hormone secretion2014In: Hormone Research in Paediatrics, ISSN 1663-2818, E-ISSN 1663-2826, Vol. 82, no 3, p. 158-170Article in journal (Refereed)
    Abstract [en]

    Background/Aims: Growth hormone (GH) treatment regimens do not account for the pubertal increase in endogenous GH secretion. This study assessed whether increasing the GH dose and/or frequency of administration improves pubertal height gain and adult height (AH) in children with low GH secretion during stimulation tests, i. e. idiopathic isolated GH deficiency.

    Methods: A multicenter, randomized, clinical trial (No. 88-177) followed 111 children (96 boys) at study start from onset of puberty to AH who had received GH(33) mu g/kg/day for >= 1 year. They were randomized to receive 67 mu g/kg/day (GH(67)) given as one (GH(67x1); n = 35) or two daily injections (GH(33x2); n = 36), or to remain on a single 33 mu g/kg/day dose (GH(33x1); n = 40). Growth was assessed as height SDS gain for prepubertal, pubertal and total periods, as well as AH SDS versus the population and the midparental height.

    Results: Pubertal height SDS gain was greater for patients receiving a high dose (GH(67), 0.73) than a low dose (GH(33x1), 0.41, p < 0.05). AH(SDS) was greater on GH(67) (GH(67x1), -0.84; GH(33x2), -0.83) than GH(33) (-1.25, p < 0.05), and height SDS gain was greater on GH(67) than GH(33) (2.04 and 1.56, respectively; p < 0.01). All groups reached their target height SDS.

    Conclusion: Pubertal height SDS gain and AH SDS were dose dependent, with greater growth being observed for the GH(67) than the GH(33) randomization group; however, there were no differences between the once-and twice-daily GH(67) regimens. (C) 2014 S. Karger AG, Basel.

  • 3.
    Allbrand, Marianne
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro Univ Hosp, Dept Obstet & Gynaecol, Örebro, Sweden.
    Björkqvist, Maria
    Örebro University, School of Medicine, Örebro University, Sweden. Örebro University Hospital. Dept Paediat.
    Nilsson, Kerstin
    Örebro University, School of Medicine, Örebro University, Sweden. Örebro University Hospital. Dept Obstet & Gynaecol.
    Östlund, Ingrid
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Dept Obstet & Gynaecol.
    Åman, Jan
    Örebro University Hospital. Örebro University. Dept Paediat.
    Placental gene expression of inflammatory markers and growth factors: a case control study of obese and normal weight women2015In: Journal of Perinatal Medicine, ISSN 0300-5577, E-ISSN 1619-3997, Vol. 43, no 2, p. 159-164Article in journal (Refereed)
    Abstract [en]

    Objective: To survey the placental gene expression of inflammatory markers and growth factors in non-smoking obese women with an uncomplicated pregnancy without associated morbidity and delivery at term compared with normal weight women.

    Methods: Placental tissue samples from 32 obese women (body mass index, BMI >= 35.0 kg/m(2)) were compared with samples from 94 normal weight women (BMI 18.5-25.0 kg/m(2)) matched for age (+/- 1 year), gestational age (+/- 3 days), parity and mode of delivery. Semi-quantitative reverse transcription polymerase chain reaction (RT-PCR) was used to analyse toll receptor-2 and -4, interleukin-6 and -8, tumour necrosis factor-alpha, leptin, adiponectin, insulin-like growth factor-1 and -2, hepatocyte growth factor, hepatocyte growth factor receptor and insulin receptor.

    Results: There was no significant difference in gene expression in placental tissue samples from obese and normal weight women.

    Conclusion: We found no difference in the occurrence of inflammatory marker and growth factor mRNA levels in placental tissue samples from a large group of obese women without associated morbidity and with healthy infants compared to a closely matched control group of healthy normal weight women. Compared with the previous studies, this anomalous finding may be explained by the absence of associated morbidity in the obese women in our study.

  • 4.
    Allbrand, Marianne
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Åman, Jan
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Lodefalk, Maria
    Örebro University, School of Medical Sciences.
    Adipocytokines in placenta and cord blood in relation to maternal obesity, and foetal and postnatal growth of the child2015In: Hormone Research in Paediatrics, ISSN 1663-2818, E-ISSN 1663-2826, Vol. 82, no Suppl. 1, p. 47-48Article in journal (Other academic)
    Abstract [en]

    Background: The nutritional and hormonal state in utero may be a link between maternal obesity and obesity in the offspring. The gene expression in placentae in pregnancies complicated by diabetes is reduced for leptin, but increased for ghrelin. It is not known whether these genes’ expressions in placentae are altered in maternal obesity.

    Objectives and hypotheses: To compare obese and normal-weight women and their children concerning gene expressions of leptin and ghrelin in placentae; leptin, ghrelin, adiponectin, and C-peptide levels in cord blood, birth size and postnatal growth. Changes in the expression of these adipocytokines may lead to an altered hypothalamic sensitivity to leptin and ghrelin resulting in an increased risk of obesity in the offspring.

    Method: 32 women with pre-pregnancy obesity, but otherwise healthy, were compared to 32 matched, normal-weight controls. Full-term placenta biopsies were analysed with qPCR for leptin mRNA and ghrelin mRNA. Cord blood samples were examined with ELISA for leptin, ghrelin, adiponectin, and C-peptide concentrations. Birth size and postnatal growth of the children were collected from clinical registers at the Child Health Care Units.

    Results: The leptin and ghrelin gene expressions in placentae did not differ between obese and normal-weight women. The leptin concentration in cord blood was higher in children of obese mothers (P=0.021). It correlated with birth weight Z-score (r=0.467, P<0.001) and C-peptide level in cord blood (r=0.446, P<0.001). Children of obese women were slightly heavier at birth, but postnatal growth did not differ between groups. Children with birth weight  ≤−0.67 Z-score had higher ghrelin levels in cord blood than heavier children (P=0.042). The leptin level in cord blood correlated negatively with weight gain at 6 months (r=−0.332, P=0.009). The ghrelin level in cord blood correlated with weight gain at 3 months in girls (r=0.611, P=0.001), but not in boys. The adiponectin level in cord blood correlated negatively with length gain at 3 years in the obese group (r=−0.571, P=0.033), but not in the normal-weight group.

    Conclusion: Leptin and ghrelin placental gene expressions are not altered in obese women, but foetal adipocytokine production may influence early postnatal growth, possibly by influencing hunger signalling or insulin levels

  • 5.
    Alm, Fredrik
    et al.
    Örebro University, School of Health Sciences. Department of Anaesthesia and Intensive Care, School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Jaensson, Maria
    Örebro University, School of Health Sciences.
    Lundeberg, Stefan
    Pain Treatment Service, Astrid Lindgren Children's Hospital, Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden.
    Ericsson, Elisabeth
    Örebro University, School of Health Sciences.
    Adherence to Swedish guidelines for pain treatment in relation to pediatric tonsil surgery: A survey of the multidisciplinary team2017In: International Journal of Pediatric Otorhinolaryngology, ISSN 0165-5876, E-ISSN 1872-8464, Vol. 101, p. 123-131Article in journal (Refereed)
    Abstract [en]

    Background: Pain management in children after tonsil surgery is essential, and optimal pain treatment has been discussed for many years. Data from the National Tonsil Register in Sweden (NTRS) and a national mapping system have demonstrated the need for national pain treatment guidelines for pediatric tonsil surgery. As a result, Swedish national guidelines, together with updated patient information on the website tonsilloperation.se, were developed and implemented in 2013.

    Objectives The objective of this study was to evaluate the professionals’ opinions of and adherence to pain treatment guidelines for pediatric tonsil surgery patients in a two-year follow-up.

    Method: This descriptive cross-sectional study was based on data from an inter-professional questionnaire, which was validated by an expert group using a content validity index (S-CVI 0.93). The questionnaire was sent to all Swedish ear, nose and throat (ENT) departments (n=49) that the NTRS identified as performing tonsil surgery on children younger than 18 years of age. In each clinic, we asked for responses from staff in each of the following professions: ENT physicians, anesthesia physicians, registered nurse anesthetists, and registered nurses in the ENT departments.

    Results: Respondents from 48 ENT departments participated, and 139/163 (85%) completed questionnaires were returned. The guidelines were reported as being clear, ensuring patient safety and providing optimal pharmacological treatment. Treatment was given according to the guidelines: Half of the departments gave pre- or intraoperative treatment with clonidine, betamethasone and high-dose paracetamol (acetaminophen). A multimodal pain approach (paracetamol and COX inhibitors) after hospital discharge was prescribed by all departments after tonsillectomy and, more extensively, after tonsillotomy. One-third of the departments prescribed paracetamol with a higher normal dose for the first three postoperative days. Half of the departments prescribed rescue analgesics, clonidine or opioids after tonsillectomy. None of the departments prescribed codeine or tramadol, drugs that are discouraged in the guidelines. The majority of the departments used the website tonsilloperation.se to provide information to the patients and their caregivers.

    Conclusion: The respondents' opinions of and the ENT departments adherence to the Swedish national guidelines were considered to be good. The national implementation process in Sweden has impacted the manner in which ENT departments treat pain after tonsil surgery.

  • 6.
    Amer, Ahmed
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital.
    Eliasson, Ann-Christin
    Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden.
    Peny-Dahlstrand, Marie
    Regional Rehabilitation Centre, Queen Silvia Children's Hospital, Gothenburg, Sweden; Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Hermansson, Liselotte
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Prosthetics and Orthotics.
    Validity and test-retest reliability of Children's Hand-use Experience Questionnaire in children with unilateral cerebral palsy2016In: Developmental Medicine & Child Neurology, ISSN 0012-1622, E-ISSN 1469-8749, Vol. 58, no 7, p. 743-749Article in journal (Refereed)
    Abstract [en]

    Aim: To investigate the validity of the internet-based version of the Children's Hand-use Experience Questionnaire (CHEQ) by testing the new four-category rating scale, internal structure, and test-retest reliability.

    Method: Data were collected for 242 children with unilateral cerebral palsy (CP) (137 males and 105 females; mean age 9y 10mo, SD 3y 5mo, range 6-18y). Twenty children from the study sample (mean age 11y 8mo, SD 3y 10mo) participated in a retest within 7 to 14 days. Validity was tested by Rasch analysis based on a rating scale model and test-retest reliability by Kappa analysis and intraclass correlation coefficient (ICC).

    Results: The four-category rating scale was within recommended criteria for rating scale structure. One item was removed because of misfit. CHEQ showed good scale structure according to the criteria. The effective operational range was >90% for two of the CHEQ scales. Test-retest reliability for the three CHEQ scales was: grasp efficacy, ICC=0.91; time taken, ICC=0.88; and feeling bothered, ICC=0.91.

    Interpretation: The internet-based CHEQ with a four-category rating scale is valid and reliable for use in children with unilateral CP. Further studies are needed to investigate the validity of the internet-based version of CHEQ for children with upper limb reduction deficiency or obstetric brachial plexus palsy and the validity of the recommended improvements to the current version.

  • 7.
    Anand, Kanwlajeet J. S.
    et al.
    Departments of Pediatrics, Anesthesiology, Perioperative & Pain Medicine, Stanford University School of Medicine, Stanford CA, USA.
    Eriksson, Mats
    Örebro University, School of Health Sciences.
    Boyle, Elaine M.
    Department of Health Sciences, University of Leicester, Leicester, United Kingdom .
    Avila-Alvarez, Alejandro
    Department of Neonatology, Complexo Hospitalario Universitario de A Coruña, Coruña, Spain.
    Dovland Andersen, Randi
    Department of Child & Adolescent Health Services, Telemark Hospital, Skien, Norway.
    Sarafidis, Kosmas
    1st Department of Neonatology, Hippokrateion General Hospital, Aristotle University of Thessaloniki, Thessalokiki, Greece.
    Pölkki, Tarja
    Children and Women Department, Oulu University Hospital, Oulu, Finland.
    Matos, Christina
    Maternidade Dr. Alfredo da Costa, Lisboa, Portugal.
    Lago, Paola
    Department of Woman's and Child's Health, University of Padua, Padua, Italy.
    Papadouri, Thalia
    Department of Paediatrics, Arch. Makarios III Hospital, Nicosia, Cyprus.
    Attard-Montalto, Simon
    Department of Paediatrics, Mater Dei Hospital, Msida, Malta.
    Ilmoja, Mari-Liis
    Department of Paediatrics, Tallinn Children's Hospital, Tallinn, Estonia.
    Simmons, Sinno
    Department of Pediatrics, Erasmus MC–Sophia Kinderziekenhuis, Rotterdam, The Netherlands.
    Tameliene, Rasa
    Department of Neonatology, Kaunas Perinatal Center, Lithuanian University of Health Sciences, Kaunas, Lithuania.
    van Overmeire, Bart
    Cliniques Universitaires de Bruxelles, Erasme Hospital, Bruxelles, Belgium.
    Berger, Angelika
    Department of Pediatrics and Adolescent Medicine, Medical University Vienna, Vienna, Austria.
    Dobrzanska, Anna
    Department of Neonatology, Children's Memorial Health Institute Warsaw, Warszawa, Poland.
    Schroth, Michael
    Department of Paediatrics, Cnopf'sche Kinderklinik, Nürnberg Children's Hospital, Nürenberg, Germany.
    Bergqvist, Lena
    Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Solna, Sweden.
    Courtois, Emilie
    Urgences Pédiatriques, Hôpital Armand Trousseau, INSERM U1153, Université Pierre et Marie Curie Paris VI, Paris, France.
    Rousseau, Jessica
    Urgences Pédiatriques, Hôpital Armand Trousseau, INSERM U1153, Université Pierre et Marie Curie Paris VI, Paris, France.
    Carbajal, Ricardo
    Urgences Pédiatriques, Hôpital Armand Trousseau, INSERM U1153, Université Pierre et Marie Curie Paris VI, Paris, France.
    EUROPAIN survey working group of the NeoOpioid Consortium, Group author
    Assessment of continuous pain in newborns admitted to NICUs in 18 European countries2017In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 106, no 8, p. 1248-1259Article in journal (Refereed)
    Abstract [en]

    Aim: Continuous pain occurs routinely, even after invasive procedures, or inflammation and surgery, but clinical practices associated with assessments of continuous pain remain unknown.

    Methods: A prospective cohort study in 243 Neonatal Intensive Care Units (NICUs) from 18 European countries recorded frequency of pain assessments, use of mechanical ventilation, sedation, analgesia, or neuromuscular blockade for each neonate upto 28 days after NICU admission.

    Results: Only 2113/6648 (31·8%) of neonates received assessments of continuous pain, occurring variably among tracheal ventilation (TrV, 46·0%), noninvasive ventilation (NiV, 35·0%), and no ventilation (NoV, 20·1%) groups (p<0·001). Daily assessments for continuous pain occurred in only 10·4% of all neonates (TrV: 14·0%, NiV: 10·7%, NoV: 7·6%; p<0·001). More frequent assessments of continuous pain occurred in NICUs with pain guidelines, nursing champions, and surgical admissions prompted (all p<0·01), and for newborns <32 weeks gestational age, those requiring ventilation, or opioids, sedatives-hypnotics, general anesthetics (O-SH-GA) (all p<0·001), or surgery (p=0·028). Use of O-SH-GA drugs increased the odds for pain assessment in the TrV (OR:1·60, p<0·001) and NiV groups (OR:1·40, p<0·001).

    Conclusion: Assessments of continuous pain occurred in less than one-third of NICU admissions, and daily in only 10% of neonates. NICU clinical practices should consider including routine assessments of continuous pain in newborns.

  • 8.
    Andersen, Randi Dovland
    et al.
    Telemarkshospitalet, Skien, Norway; Karolinska Institutet, Stockholm, Sweden.
    Axelin, Anna
    University of Turku, Turku, Finland.
    Kristjánsdóttir, Guðrún
    University of Iceland, Reykjavik, Iceland.
    Eriksson, Mats
    Örebro University, School of Health Sciences.
    PEARL—Pain in Early Life: A New Network for Research and Education2017In: Journal of Perinatal & Neonatal Nursing, ISSN 0893-2190, E-ISSN 1550-5073, Vol. 31, no 2, p. 91-95Article in journal (Refereed)
  • 9.
    Andersen, Randi Dovland
    et al.
    Department of Child and Adolescent Health Services, Telemark Hospital, Skien, Norway; Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Munsters, Josanne M. A.
    Department of Women’s and Children’s Health, University Children’s Hospital Uppsala, Uppsala, Sweden.
    Vederhus, Bente Johanne
    Department of Pediatrics, Haukeland University Hospital, Bergen, Norway and.
    Gradin, Maria
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Paediatrics.
    Pain assessment practices in Swedish and Norwegian neonatal care units2017In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The use of measurement scales to assess pain in neonates is considered a prerequisite for effective management of pain, but these scales are still underutilised in clinical practice.

    AIM: The aim of this study was to describe and compare pain assessment practices including the use of pain measurement scales in Norwegian and Swedish neonatal care units.

    METHODS: A unit survey investigating practices regarding pain assessment and the use of pain measurement scales was sent to all neonatal units in Sweden and Norway (n = 55). All Norwegian and 92% of Swedish units responded.

    RESULTS: A majority of the participating units (86.5%) assessed pain. Swedish units assessed and documented pain and used pain measurement scales more frequently than Norwegian units. The most frequently used scales were different versions of Astrid Lindgren's Pain Scale (ALPS) in Sweden and Echelle Douleur Inconfort Noveau-Ne (EDIN), ALPS and Premature Infant Pain Profile (PIPP) in Norway. Norwegian head nurses had more confidence in their pain assessment method and found the use of pain measurement scales more important than their Swedish colleagues.

    CONCLUSION: The persisting difference between Swedish and Norwegian units in pain assessment and the use of pain measurement scales are not easily explained. However, the reported increased availability and reported use of pain measurement scales in neonatal care units in both countries may be seen as a contribution towards better awareness and recognition of pain, better pain management and potentially less suffering for vulnerable neonates.

  • 10.
    Anderzén-Carlsson, Agneta
    et al.
    Örebro University, Department of Clinical Medicine.
    Kihlgren, Mona
    Skeppner, Gunnar
    Sörlie, Venke
    How physicians and nurses handle fear in children with cancer2007In: Journal of Pediatric Nursing: Nursing Care of Children and Families, ISSN 0882-5963, E-ISSN 1532-8449, Vol. 22, no 1, p. 71-80Article in journal (Refereed)
    Abstract [en]

    Previous research on fear in children with cancer has often focused on interventions to alleviate fear related to medical procedures and less on how to meet the challenges related to existential fear. This study aimed to describe how experienced nurses and physicians handle fear in children with cancer. Ten nurses and physicians with more than 10 years of experience in child oncology from a university hospital in Sweden were interviewed, and a qualitative content analysis was performed on the data. Nurses' and physicians' handling of fear encompasses commitment and closeness and yet also a distancing from fear and its expressions

  • 11.
    Anderzén-Carlsson, Agneta
    et al.
    Örebro University, Department of Clinical Medicine.
    Kihlgren, Mona
    Svantesson, Mia
    Örebro University, Department of Clinical Medicine.
    Sörlie, Venke
    Children's fear as experienced by the parents of children with cancer2007In: Journal of Pediatric Nursing: Nursing Care of Children and Families, ISSN 0882-5963, E-ISSN 1532-8449, Vol. 22, no 3, p. 233-244Article in journal (Refereed)
    Abstract [en]

    It is known that children with cancer experience and express fear, but little is found in the literature about how the parents experience their child's fear. This study aimed to highlight the parents' lived experience and understanding of their child's fear. Focus group interviews with 15 parents were performed. Data were analyzed through a phenomenological hermeneutic method. Fear in children with cancer is described by the parents as a multidimensional phenomenon, which is somehow difficult to identify. It appears in contrast to the absence of fear. The comprehensive understanding of the results reveals that the parents experience their children's fear as both a suffering and an ethical demand for the parents to answer.

  • 12.
    Andrade, Anenisia C.
    et al.
    Karolinska Inst, Stockholm, Sweden; Univ Hosp, Stockholm, Sweden.
    Gkourogianni, Alexandra
    Karolinska Inst, Stockholm, Sweden; Univ Hosp, Stockholm, Sweden.
    Segerlund, Emma
    Sunderby Hosp, Sunderby, Sweden.
    Werner-Sperker, Antje
    Sunderby Hosp, Sunderby, Sweden.
    Horemuzova, Eva
    Karolinska Inst, Stockholm, Sweden; Univ Hosp, Stockholm, Sweden.
    Dahlgren, Jovanna
    Univ Gothenburg, Sahlgrenska Acad, Gothenburg, Sweden.
    Nilsson, Ola
    Örebro University, School of Medical Sciences. Karolinska Inst, Stockholm, Sweden; Univ Hosp, Stockholm, Sweden.
    SHORT STATURE DUE TO TWO NOVEL HETEROZYGOUS IGF1R MUTATIONS AND RESPONSE TO GH TREATMENT2017In: Hormone Research in Paediatrics, ISSN 1663-2818, E-ISSN 1663-2826, Vol. 88, no Suppl. 1, p. 130-131, article id P1-842Article in journal (Other academic)
  • 13.
    Andrade, Anenisia C.
    et al.
    Division of Pediatric Endocrinology, Department of Women’s and Children’s Health, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
    Jee, Youn Hee
    Section of Growth and Development, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA.
    Nilsson, Ola
    Örebro University, School of Medical Sciences. Division of Pediatric Endocrinology, Department of Women’s and Children’s Health, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Örebro University Hospital, Örebro, Sweden.
    New Genetic Diagnoses of Short Stature Provide Insights into Local Regulation of Childhood Growth2017In: Hormone Research in Paediatrics, ISSN 1663-2818, E-ISSN 1663-2826, Vol. 88, no 1, p. 22-37Article, review/survey (Refereed)
    Abstract [en]

    Idiopathic short stature is a common condition with a heterogeneous etiology. Advances in genetic methods, including genome sequencing techniques and bioinformatics approaches, have emerged as important tools to identify the genetic defects in families with monogenic short stature. These findings have contributed to the understanding of growth regulation and indicate that growth plate chondrogenesis, and therefore linear growth, is governed by a large number of genes important for different signaling pathways and cellular functions, including genetic defects in hormonal regulation, paracrine signaling, cartilage matrix, and fundamental cellular processes. In addition, mutations in the same gene can cause a wide phenotypic spectrum depending on the severity and mode of inheritance of the mutation.

  • 14. Bahmanyar, Shahram
    et al.
    Montgomery, Scott M.
    Örebro University, School of Health and Medical Sciences.
    Weiss, Rüdiger J.
    Ekbom, Anders
    Maternal smoking during pregnancy, other prenatal and perinatal factors, and the risk of Legg-Calvé-Perthes disease2008In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 122, no 2, p. e459-e464Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The causes of Legg-Calvé-Perthes disease are largely unknown, but this pediatric disease seems to result from interruption of the blood supply to the proximal femur and is considered a vascular disease. Because maternal smoking during pregnancy influences fetal development and is associated with cardiovascular diseases in offspring, we hypothesized that this exposure is a risk for Legg-Calvé-Perthes disease and also investigated other markers of impaired fetal development and early-life exposures.

    MATERIALS AND METHODS: The Swedish Inpatient Register identified 852 individuals with a diagnosis of Legg-Calvé-Perthes disease from 1983 to 2005, individually matched by year of birth, age, sex, and region of residence with 4432 randomly selected control subjects. Linkage with the Swedish Medical Birth Register provided information on prenatal factors, including maternal smoking. Conditional logistic regression examined associations of maternal smoking during pregnancy and the other measures with the risk of Legg-Calvé-Perthes disease in offspring, adjusted for socioeconomic index and other potential confounding factors.

    RESULTS: Maternal smoking during pregnancy was associated with an increased Legg-Calvé-Perthes disease risk, and heavy smoking was associated with a risk increase of almost 100%. Very low birth weight and cesarean section were independently associated with approximately 240% and 36% increases in the risk of Legg-Calvé-Perthes disease, respectively.

    CONCLUSION: Maternal smoking during pregnancy and other factors indicated by impaired fetal development may be associated with an increased risk of Legg-Calvé-Perthes disease. 

  • 15.
    Baylis, Rebecca
    et al.
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Ewald, Uwe
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Gradin, Maria
    Örebro University Hospital.
    Nyqvist, Kerstin Hedberg
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Rubertsson, Christine
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Blomqvist, Ylva Thernstrom
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    First-time events between parents and preterm infants are affected by the designs and routines of neonatal intensive care units2014In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 103, no 10, p. 1045-1052Article in journal (Refereed)
    Abstract [en]

    Aim: Early parental bonding with preterm babies is particularly important, and the aim of our study was to explore when parents experienced what they regarded as important events for the first time while their infant was in the neonatal intensive care unit (NICU).

    Methods: The study was part of a longitudinal project on Kangaroo Mother Care at two Swedish university hospitals. The parents of 81 infants completed questionnaires during their infants' hospital stay.

    Results: Most parents saw and touched their infants immediately after birth, but only a few could hold them skin to skin or swaddle them. Other important events identified by parents included the first time they performed care giving activities and did so independently, interaction and closeness with the infant, signs of the infant's recovery and integration into the family. The timing of the events depended on the physical design of the NICU, whether parents' could stay with their infant round-the-clock and when they were allowed to provide care under supervision and on their own.

    Conclusion: The design and routines of the NICU dictated when parents first interacted with their infants. Clinical guidelines that facilitate early contact with preterm babies can help parents to make the transition to their parental role.

  • 16.
    Bejerot, Susanne
    et al.
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Edgar, Johan
    Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Humble, Mats B.
    Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden.
    Poor performance in physical education: a risk factor for bully victimization. A case-control study2011In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 100, no 3, p. 413-419Article in journal (Refereed)
    Abstract [en]

    Aim: Poor social skills are a risk factor for becoming bullied, which could explain why this frequently occurs to children with autism spectrum disorders (ASD) and attention-deficit hyperactivity disorder (ADHD). Poor social skills tend to coexist with clumsiness. According to a pilot study, poor performance in physical education (PE) was correlated with bully victimization.

    Methods: Sixty-nine healthy university students reported performance in PE and bully victimization in childhood. In addition, the participants responded to questionnaires for ADHD and ASDs to assess personality traits related to increased risk for bully victimization.

    Results: Below average performance in PE was a risk factor of being bullied in school with an odds ratio of 3.6 [95% confidence interval: 1.23-10.5; p = 0.017]. Strong correlations between poor performance in PE and long duration of victimization (p = 0.007) and poor performance in PE and high frequency of victimization (p = 0.008) were found. Autistic traits were related to performance below average in PE.

    Conclusion: Poor motor skills are a strong risk factor for becoming bullied. Prevention programmes that identify, protect and empower the clumsy children could be an important step to avoid bullying of the most vulnerable children.

  • 17.
    Bejerot, Susanne
    et al.
    Department of Clinical Neuroscience, Section Psychiatry St. Göran, Karolinska Institute, Stockholm, Sweden .
    Humble, Mats B.
    Department of Clinical Sciences, Lund University, Malmö, Sweden.
    Relevance of motor skill problems in victims of bullying2007In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 120, no 5, p. 1227-1228Article in journal (Refereed)
  • 18. Beraki, Åsa
    et al.
    Magnuson, Anders
    Samuelsson, Ulf
    Åman, Jan
    Särnblad, Stefan
    Örebro University, School of Medicine, Örebro University, Sweden.
    Ökad fysisk aktivitet är relaterat till lägre HbA1c -nivåer hos barn och ungdomar med typ 1-diabetes: Resultat från en studie baserad på det Svenska pediatriska kvalitets registret för barn och ungdomar med diabetes (SWEDIABKIDS)2014In: BestPractice ApS, ISSN 1902-7583, no 12Article in journal (Other academic)
  • 19.
    Beraki, Åsa
    et al.
    Linköping University, Linköping, Sweden.
    Magnusson, Anders
    Clinical Epidemiology and Biostatistic Unit, Örebro University Hospital, Örebro, Sweden.
    Särnblad, Stefan
    Örebro University, School of Medicine, Örebro University, Sweden. Örebro University Hospital. Department of Pediatrics.
    Åman, Jan
    Örebro University Hospital. Department of Pediatrics.
    Samuelsson, Ulf
    Department of Clinical and Experimental Medicine, Division of Pediatrics and Diabetes Research Centre, Linköping University, Linköping, Sweden.
    Increase in physical activity is associated with lower HbA1c levels in children and adolescents with type 1 diabetes: results from a cross-sectional study based on the Swedish pediatric diabetes quality registry (SWEDIABKIDS)2014In: Diabetes Research and Clinical Practice, ISSN 0168-8227, E-ISSN 1872-8227, Vol. 105, no 1, p. 119-125Article in journal (Refereed)
    Abstract [en]

    Aims: To evaluate the associations between physical activity (PA) and metabolic control, measured by glycated hemoglobin (HbA1c), in a large group of children and adolescents with type 1 diabetes.

    Methods: Cross-sectional analysis of data from 4655 patients, comparing HbA1c values with levels of physical activity. The data for the children and adolescents were obtained from the Swedish pediatric diabetes quality registry, SWEDIABKIDS. The patients were 7-18 years of age, had type 1 diabetes and were not in remission. Patients were grouped into five groups by frequency of PA.

    Results: Mean HbA1c level was higher in the least physically active groups (PA0: 8.8% +/- 1.5 (72 +/- 16 mmol/mol)) than in the most physically active groups (PA4: 7.7% +/- 1.0 (60 +/- 11 mmol/mol)) (p < 0.001). An inverse dose-response association was found between PA and HbA1c (beta: -0.30, 95%CI: -0.34 to -0.26, p < 0.001). This association was found in both sexes and all age groups, apart from girls aged 7-10 years. Multiple regression analysis revealed that the relationship remained significant (beta: -0.21, 95% CI: -0.25 to -0.18, p < 0.001) when adjusted for possible confounding factors.

    Conclusions: Physical activity seems to influence HbA1c levels in children and adolescents with type 1 diabetes. In clinical practice these patients should be recommended daily physical activity as a part of their treatment.

  • 20.
    Bixo Ottosson, Anna
    et al.
    Department of Internal Medicine, Västmanland County Hospital, Västerås, Sweden.
    Åkesson, Karin
    Department of Paediatrics, Ryhov County Hospital, Jönköping, Sweden; Futurum – The Academy for Health and Care, Jönköping University, Jönköping, Sweden.
    Ilvered, Rosita
    Department of Paediatrics, Ryhov County Hospital, Jönköping, Sweden.
    Forsander, Gun
    Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; The Queen Silvia Children’s Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Särnblad, Stefan
    Örebro University, School of Medical Sciences. Department of Paediatrics.
    Self-care management of type 1 diabetes has improved in Swedish schools according to children and adolescents2017In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 106, no 12, p. 1987-1993Article in journal (Refereed)
    Abstract [en]

    Aim: Age-appropriate support for diabetes self-care is essential during school time, and we investigated the perceived quality of support children and adolescents received in 2015 and 2008.

    Methods: This national study was based on questionnaires answered by children and adolescents aged 6-15 years of age with type 1 diabetes attending schools or preschools in 2008 (n = 317) and 2015 (n = 570) and separate parental questionnaires. The subjects were recruited by Swedish paediatric diabetes units, with 41/44 taking part in 2008 and 41/42 in 2015.

    Results: Fewer participants said they were treated differently in school because of their diabetes in 2015 than 2008. The opportunity to perform insulin boluses and glucose monitoring in privacy increased (80% versus 88%; p < 0.05). Most (83%) adolescents aged 13-15 years were satisfied with the support they received, but levels were lower in girls (p < 0.05). More subjects had hypoglycaemia during school hours (84% versus 70%, p < 0.001), but hypoglycaemia support did not increase and was lower for adolescents than younger children (p < 0.001).

    Conclusion: Children and adolescents received more support for type 1 diabetes in Swedish schools in 2015 than 2008, but more support is needed by girls and during hypoglycaemia.

  • 21.
    Björkman, Louise
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Pediatrics.
    Ohlin, Andreas
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Pediatrics.
    Scrubbing the hub of intravenous catheters with an alcohol wipe for 15 sec reduced neonatal sepsis2015In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 104, no 3, p. 232-236Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this study was to investigate whether scrubbing the hub of intravenous catheters with an alcohol wipe for 15 sec could reduce the incidence of neonatal sepsis in a level-three neonatal intensive care unit.

    Methods: We studied the incidence of neonatal sepsis caused by coagulase-negative staphylococci (CoNS) for 16.5 months before the initiative was launched on May 15, 2012 and then for a further 8.5 months after it was introduced. The hub routine was applied to all intravenous catheters.

    Results: During the control period before the initiative was launched, there were nine cases of CoNS sepsis compared with no cases after it was introduced, resulting in a decrease in sepsis incidence from 1.5% to 0% with a risk reduction of 1.5% (0.53-2.58%) (p = 0.06). In the preterm infant population, the incidence of sepsis decreased from 3.6% to 0% (1.1-6.0%) (p = 0.11).

    Conclusion: Scrubbing the hub of intravenous catheters with an alcohol wipe for 15 sec seemed to be an efficient way of preventing sepsis caused by CoNS in newborn infants. However, the evidence for the benefits will remain weak until a large randomised trial has been completed.

  • 22.
    Blomberg, Karin
    et al.
    Örebro University, School of Health Sciences.
    Carlsson, Agneta Anderzén
    Karlstad University, Faculty of Health, Science and Technology, Department of Health Sciences, Karlstad, Sweden.
    Hagberg, Lars
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Centre.
    Jonsson, Östen
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Paediatrics.
    Leissner, Lena
    Örebro University, Faculty of Medicine and Health, Department of Neurology, Örebro, Sweden.
    Eriksson, Mats
    Örebro University, School of Health Sciences.
    Quality of life and trust among young people with narcolepsy and their families, after the Pandemrix® vaccination: Protocol for a case-control study2017In: BMC Pediatrics, ISSN 1471-2431, E-ISSN 1471-2431, Vol. 17, no 1, article id 183Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The extensive vaccination programme against swine flu resulted in an increased incidence of narcolepsy among children and adolescents. There is a need to explore if these young persons' experiences have affected their trust in healthcare, their willingness to participate in future prevention programmes, and their contacts with the healthcare system. The overall aim is to identify factors important for the life-situation of children and adolescents with narcolepsy and their families, and factors that correlate with trust in healthcare.

    METHODS/DESIGN: Data will be collected via questionnaires from all available children with narcolepsy following the vaccination and their families, as well as a control group of children with diabetes and their families. Longitudinal descriptive interviews will also be conducted with a selection of 20-25 children and their families. Techniques from media research will be used for Internet-based data collection and analysis of information relating to narcolepsy from social media.

    DISCUSSION: This project will use the situation of young persons with narcolepsy after the swine flu vaccination as a case to build a model that can be used in situations where trust in healthcare is essential. This model will be based on findings from the included studies on how trust is influenced by support, quality of life, burden of disease, impact on family, and use of social media. The model developed in this project will be beneficial in future situations where trust in healthcare is essential, such as new pandemic outbreaks but also for "everyday" adherence to health advice.

  • 23.
    Blomqvist, Ylva Thernstrom
    et al.
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden .
    Ewald, Uwe
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden .
    Gradin, Maria
    Örebro University Hospital.
    Nyqvist, Kerstin Hedberg
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden .
    Rubertsson, Christine
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden .
    Initiation and extent of skin-to-skin care at two Swedish neonatal intensive care units2013In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 102, no 1, p. 22-28Article in journal (Refereed)
    Abstract [en]

    Aim To describe initiation and extent of parents application of skin-to-skin care (SSC) with their preterm infants at two Swedish neonatal intensive care units.

    Methods The duration of SSC was recorded in 104 infants medical charts during their hospital stay, and the parents answered a questionnaire.

    Results Both parents were involved in the practice of SSC. Three infants experienced SSC directly after birth, 34 within 1 h, 85 within 24 h and the remaining 19 at 2478 h postbirth. SSC commenced earlier (median age of 50 min) in infants whose first SSC was with their father instead of with their mother (median age of 649 min: p < 0.001). The earlier the SSC was initiated, the longer the infant was cared for skin-to-skin per day during his/her hospital stay (p < 0.001). The median daily duration of SSC was 403 min.

    Conclusion Early initiation of SSC had positive impact on the extent of parents application of SSC. Even though the infants in this study were cared for skin-to-skin to a high extent, there is a potential for extended use of SSC in this type of hospital setting for reducing separation between infants and parents.

  • 24.
    Bolhuis, Koen
    et al.
    Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, Netherlands.
    Lubke, Gitta H.
    University of Notre Dame, Notre Dame, IN, United States; Vrije Universiteit, Amsterdam, Netherlands.
    van der Ende, Jan
    Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, Netherlands.
    Bartels, Meike
    Vrije Universiteit, Amsterdam, Netherlands.
    van Beijsterveldt, Catharina E. M.
    Vrije Universiteit, Amsterdam, Netherlands.
    Lichtenstein, Paul
    Karolinska Institutet, Stockholm, Sweden.
    Larsson, Henrik
    Örebro University, School of Medical Sciences. Karolinska Institutet, Stockholm, Sweden.
    Jaddoe, Vincent W. V.
    Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, Netherlands.
    Kushner, Steven A.
    Erasmus Medical Center, Rotterdam, Netherlands.
    Verhulst, Frank C.
    Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, Netherlands.
    Boomsma, Dorret I.
    Vrije Universiteit, Amsterdam, Netherlands.
    Tiemeier, Henning
    Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, Netherlands.
    Disentangling Heterogeneity of Childhood Disruptive Behavior Problems Into Dimensions and Subgroups2017In: Journal of the American Academy of Child and Adolescent Psychiatry, ISSN 0890-8567, E-ISSN 1527-5418, Vol. 56, no 8, p. 678-686Article in journal (Refereed)
    Abstract [en]

    Objective: Irritable and oppositional behaviors are increasingly considered as distinct dimensions of oppositional defiant disorder. However, few studies have explored this multidimensionality across the broader spectrum of disruptive behavior problems (DBPs). This study examined the presence of dimensions and distinct subgroups of childhood DBPs, and the cross-sectional and longitudinal associations between these dimensions.

    Method: Using factor mixture models (FMMs), the presence of dimensions and subgroups of DBPs was assessed in the Generation R Study at ages 6 (n = 6,209) and 10 (n = 4,724) years. Replications were performed in two population-based cohorts (Netherlands Twin Registry, n = 4,402, and Swedish Twin Study of Child and Adolescent Development, n = 1,089) and a clinical sample (n = 1,933). We used cross-lagged modeling in the Generation R Study to assess cross-sectional and longitudinal associations between dimensions. DBPs were assessed using mother-reported responses to the Child Behavior Checklist.

    Results: Empirically obtained dimensions of DBPs were oppositional behavior (age 6 years), disobedient behavior, rule-breaking behavior (age 10 years), physical aggression, and irritability (both ages). FMMs suggested that one-class solutions had the best model fit for all dimensions in all three population-based cohorts. Similar results were obtained in the clinical sample. All three dimensions, including irritability, predicted subsequent physical aggression (range, 0.08-0.16).

    Conclusion: This study showed that childhood DBPs should be regarded as a multidimensional phenotype rather than comprising distinct subgroups. Incorporating multidimensionality will improve diagnostic accuracy and refine treatment. Future studies need to address the biological validity of the DBP dimensions observed in this study; herein lies an important opportunity for neuro-imaging and genetic measures.

  • 25.
    Borgestig, Maria
    et al.
    Faculty of Health Sciences, Department of Social and Welfare Studies, Linköping University, Sweden; Folke Bernadotte Regional Habilitation Centre, Department of Women's and Children's Health, Uppsala University, Sweden.
    Falkmer, Torbjörn
    School of Occupational Therapy and Social Work, Curtin Health Innovation Research Institute, Curtin University, Perth WA, Australia; School of Occupational Therapy, La Trobe University, Melbourne, VIC, Australia; Department of Medicine and Health Sciences (IMH), Faculty of Health Sciences, Linköping University and Pain and Rehabilitation Centre, Linköping, Sweden.
    Hemmingsson, Helena
    Faculty of Health Sciences, Department of Social and Welfare Studies, Linköping University, Sweden.
    Change in eye controlled performance over time with an eye tracker controlled system, used by children with severe physical disabilities2013In: Assistive Technology: From Research to Practice, IOS Press , 2013, p. 473-477Chapter in book (Refereed)
    Abstract [en]

    The aim of this study was to describe how speed and accuracy in eye controlled computer performance changed over time for children with severe physical disabilities that used eye tracker controlled system (ETCS) in daily activities as an effect of assistive technology (AT) intervention. Data was collected with diaries and with Compass software. The preliminary results from this study from the first four children indicate that two children improved significantly in eye controlled performance up to 19 months since start of ETCS usage in daily activities.

  • 26.
    Borgestig, Maria
    et al.
    Department of Social and Welfare Studies, Linköping University, Linköping, Sweden; Folke Bernadotte Regional Habilitation Centre and Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
    Sandqvist, Jan
    Department of Social and Welfare Studies, Linköping University, Linköping, Sweden.
    Parsons, Richard
    School of Occupational Therapy & Social Work, Curtin University, Perth, WA, Australia.
    Falkmer, Torbjörn
    School of Occupational Therapy & Social Work, Curtin University, Perth, Australia; School of Occupational Therapy, La Trobe University, Melbourne, Australia; Rehabilitation Medicine, Department of Medicine and Health Sciences (IMH), Faculty of Health Sciences, Linköping University & Pain and Rehabilitation Centre, UHL, County Council, Linköping, Sweden.
    Hemmingsson, Helena
    Department of Social and Welfare Studies, Linköping University, Linköping, Sweden.
    Eye gaze performance for children with severe physical impairments using gaze-based assistive technology: a longitudinal study2016In: Assistive technology, ISSN 1040-0435, E-ISSN 1949-3614, Vol. 28, no 2, p. 93-102Article in journal (Refereed)
    Abstract [en]

    Gaze-based assistive technology (gaze-based AT) has the potential to provide children affected by severe physical impairments with opportunities for communication and activities. This study aimed to examine changes in eye gaze performance over time (time on task and accuracy) in children with severe physical impairments, without speaking ability, using gaze-based AT. A longitudinal study with an AB design was conducted on ten children (aged 1–15 years) with severe physical impairments, who were beginners to gaze-based AT at baseline. Thereafter, all children used the gaze-based AT in daily activities over the course of the study. Compass computer software was used to measure time on task and accuracy with eye selection of targets on screen, and tests were performed with the children at baseline, after 5 months, 9–11 months, and after 15–20 months. Findings showed that the children improved in time on task after 5 months and became more accurate in selecting targets after 15–20 months. This study indicates that these children with severe physical impairments, who were unable to speak, could improve in eye gaze performance. However, the children needed time to practice on a long-term basis to acquire skills needed to develop fast and accurate eye gaze performance.

  • 27.
    Bornehag, Carl-Gustaf
    et al.
    Department of Health and Environmental Sciences, Karlstad University, Karlstad, Sweden; SP, Technical Research Institute of Sweden, Borås, Sweden.
    Moniruzzaman, Syed
    Department of Health and Environmental Sciences, Karlstad University, Karlstad, Sweden.
    Larsson, Malin
    Department of Health and Environmental Sciences, Karlstad University, Karlstad, Sweden.
    Lindström, Cecilia Boman
    Department of Health and Environmental Sciences, Karlstad University, Karlstad, Sweden.
    Hasselgren, Mikael
    Centre for Clinical Research, County Council of Värmland, Karlstad, Sweden.
    Bodin, Anna
    Clinical Research, County Council of Värmland, Karlstad, Sweden.
    von Kobyletzkic, Laura B.
    Clinical Research, County Council of Värmland, Karlstad, Sweden; Institute of Clinical Research, Lund University, Lund, Sweden.
    Carlstedt, Fredrik
    Clinical Research, County Council of Värmland, Karlstad, Sweden.
    Lundin, Fredrik
    Clinical Research, County Council of Värmland, Karlstad, Sweden.
    Nånberg, Eewa
    Department of Chemistry and Biomedical Sciences, Karlstad University, Karlstad, Sweden.
    Jönsson, Bo A. G.
    Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden.
    Sigsgaard, Torben
    Department of Public Health, Unit of Environmental and Occupational Medicine, University of Aarhus, Aarhus, Denmark.
    Janson, Staffan
    Department of Health and Environmental Sciences, Karlstad University, Karlstad, Sweden; Centre for Clinical Research, County Council of Värmland, Karlstad, Sweden.
    The SELMA study: a birth cohort study in Sweden following more than 2000 mother-child pairs2012In: Paediatric and Perinatal Epidemiology, ISSN 0269-5022, E-ISSN 1365-3016, Vol. 26, no 5, p. 456-467Article in journal (Refereed)
    Abstract [en]

    Background:  This paper describes the background, aim and study design for the Swedish SELMA study that aimed to investigate the importance of early life exposure during pregnancy and infancy to environmental factors with a major focus on endocrine disrupting chemicals for multiple chronic diseases/disorders in offspring.

    Methods: The cohort was established by recruiting women in the 10th week of pregnancy. Blood and urine from the pregnant women and the child and air and dust from home environment from pregnancy and infancy period have been collected. Questionnaires were used to collect information on life styles, socio-economic status, living conditions, diet and medical history.

    Results: Of the 8394 reported pregnant women, 6658 were invited to participate in the study. Among the invited women, 2582 (39%) agreed to participate. Of the 4076 (61%) non-participants, 2091 women were invited to a non-respondent questionnaire in order to examine possible selection bias. We found a self-selection bias in the established cohort when compared with the non-participant group, e.g. participating families did smoke less (14% vs. 19%), had more frequent asthma and allergy symptoms in the family (58% vs. 38%), as well as higher education among the mothers (51% vs. 36%) and more often lived in single-family houses (67% vs. 60%).

    Conclusions: These findings indicate that the participating families do not fully represent the study population and thus, the exposure in this population. However, there is no obvious reason that this selection bias will have an impact on identification of environmental risk factors.

  • 28.
    Borneskog, Catrin
    et al.
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Lampic, Claudia
    Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.
    Sydsjö, Gunilla
    Department of Clinical and experimental Medicine, Faculty of Health and Science, Linköping University.
    Bladh, Marie
    Department of Clinical and experimental Medicine, Faculty of Health and Science, Linköping University.
    Svanberg, Agneta Skoog
    Uppsala universitet, Obstetrik & gynekologi.
    How do lesbian couples compare with heterosexual IVF and spontaneously pregnant couples when it comes to parenting stress?2014In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 103, no 5, p. 537-545Article in journal (Refereed)
    Abstract [en]

    AIM: To study parenting stress in lesbian parents and to compare that stress with heterosexual parents following in vitro fertilization (IVF) or spontaneous pregnancies.

    METHODS: This survey took place during 2005 to 2008 and was part of the Swedish multi-centre study on gamete donation. It comprised 131 lesbian parents, 83 heterosexual IVF parents, who used their own gametes, and 118 spontaneous pregnancy parents. The participants responded to the questionnaire when the child was between 12 and 36-months-old and parenting stress was measured by the Swedish Parenting Stress Questionnaire (SPSQ).

    RESULTS: Lesbian parents experienced less parenting stress than heterosexual IVF parents when it came to the General Parenting Stress measure (p=0.001) and the sub areas of Incompetence (p<0.001), Social Isolation (p=0.033) and Role Restriction (p=0.004). They also experienced less parenting stress than heterosexual spontaneous pregnancy couples, according to the Social Isolation sub area (p=0.003). Birth mothers experienced higher stress than co-mothers and fathers, according to the Role Restriction measure (p=0.041).

    CONCLUSION: These are reassuring findings, considering the known challenges that lesbian families face in establishing their parental roles and, in particular, the challenges related to the lack of recognition of the co-mother. This article is protected by copyright. All rights reserved.

  • 29.
    Boyle, Eline M
    et al.
    University of Leicester, Leicester, UK .
    Courtois, Emilie
    Inserm U953, Paris, France; 22UPMC, Paris, France; Trousseau Hospital, Paris, France .
    Eriksson, Mats
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Lagercrantz, Hugo
    Karolinska University Hospital, Stockholm, Sweden .
    Carbajal, Ricardo
    Inserm U953, Paris, France; 22UPMC, Paris, France; Trousseau Hospital, Paris, France.
    Pain assessment in ventilated and non-ventilated neonates in NICUs across the UK: European Pain Audit in Neonates (Europain)2014In: Archives of Disease in Childhood: Fetal and Neonatal Edition, ISSN 1359-2998, E-ISSN 1468-2052, Vol. 99 (Suppl 1), p. A53-A53, article id PC.50Article in journal (Refereed)
    Abstract [en]

    Background: Neonates undergo many painful procedures during their neonatal intensive care stay. These may include tracheal intubation/ventilation, skin-breaking procedures, drainage/suctioning of body orifices or cavities. Inherent subjectivity and difficulties associated with neonatal pain assessment contribute to a wide variety of assessment tools and clinical practices. To date, these practices have been not studied on a large scale.

    Objective: To determine current clinical practices for neonatal pain assessment in neonatal units across the United Kingdom (UK).

    Design/Methods: As part of a European epidemiological observational study on bedside pain assessment practices data were collected for all neonates in participating NICUs until infants left the unit (discharge, death, transfer to another hospital) or for 28 days. Data collection occurred via an online database for 1 month at each NICU. All neonates up to a gestational age of 44 weeks were included.

    Results: Between February 2013 to May 2013, 66 UK NICUs collected data on 2691 neonates. Of these, 713 received tracheal ventilation and 1978 had spontaneous breathing or non-invasive ventilation. The median (IQR) gestational age of ventilated neonates [32.1 (27.9-38.6)] was less than non-ventilated neonates [37.0 (34.1-39.7), p < 0.001]. Overall, 56.9% of ventilated neonates and 32.5% of non-ventilated neonates received bedside pain assessments (p < 0.001), with use of pain assessments ranging from 0-100% between units.

    CONCLUSIONS: Over half (56.9%) of ventilated neonates and about one third (32.5%) of non-ventilated neonates had pain assessments performed in UK neonatal units. Wide variations in the methods used and rates of pain assessment exist among centres.

  • 30.
    Brander, Gustaf
    et al.
    Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Rydell, Mina
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden .
    Kuja-Halkola, Ralf
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden .
    Fernández de la Cruz, Lorena
    Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Lichtenstein, Paul
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Serlachius, Eva
    Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden .
    Rück, Christian
    Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.
    Almqvist, Catarina
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden .
    D'Onofrio, Brian M.
    Department of Psychological and Brain Sciences, Indiana University, Bloomington.
    Larsson, Henrik
    Örebro University, School of Medical Sciences. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden .
    Mataix-Cols, David
    Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.
    Association of Perinatal Risk Factors With Obsessive-Compulsive Disorder: A Population-Based Birth Cohort, Sibling Control Study2016In: JAMA psychiatry, ISSN 2168-6238, E-ISSN 2168-622X, Vol. 73, no 11, p. 1135-1144Article in journal (Refereed)
    Abstract [en]

    Importance: Perinatal complications may increase the risk of obsessive-compulsive disorder (OCD). Previous reports were based on small, retrospective, specialist clinic-based studies that were unable to rigorously control for unmeasured environmental and genetic confounding.

    Objective: To prospectively investigate a wide range of potential perinatal risk factors for OCD, controlling for unmeasured factors shared between siblings in the analyses.

    Design, Setting, and Participants: This population-based birth cohort study included all 2 421 284 children from singleton births in Sweden from January 1, 1973, to December 31, 1996, who were followed up through December 31, 2013. From the 1 403 651 families in the cohort, differentially exposed siblings from the 743 885 families with siblings were evaluated; of these, 11 592 families included clusters of full siblings that were discordant for OCD. Analysis of the data was conducted from January, 26, 2015, to September, 5, 2016.

    Exposures: Perinatal data were collected from the Swedish Medical Birth Register and included maternal smoking during pregnancy, labor presentation, obstetric delivery, gestational age (for preterm birth), birth weight, birth weight in relation to gestational age, 5-minute Apgar score, and head circumference.

    Main Outcomes and Measures: Previously validated OCD codes (International Statistical Classification of Diseases and Health Related Problems, Tenth Revision, code F42) in the Swedish National Patient Register.

    Results: Of 2 421 284 individuals included in the cohort, 17 305 persons were diagnosed with OCD. Of these, 7111 were men (41.1%). The mean (SD) age of individuals at first diagnosis of OCD was 23.4 (6.5) years. An increased risk for OCD remained after controlling for shared familial confounders and measured covariates (including sex, year of birth, maternal and paternal age at birth, and parity), for smoking 10 or more cigarettes per day during pregnancy (hazard ratio [HR], 1.27; 95% CI, 1.02-1.58), breech presentation (HR, 1.35; 95% CI, 1.06-1.71), delivery by cesarean section (HR, 1.17; 95% CI, 1.01-1.34), preterm birth (HR, 1.24; 95% CI, 1.07-1.43), birth weight 1501 to 2500 g (HR, 1.30; 95% CI, 1.05-1.62) and 2501 to 3500 g (HR, 1.08; 95% CI, 1.01-1.16), being large for gestational age (HR, 1.23; 95% CI, 1.05-1.45), and Apgar distress scores at 5 minutes (HR, 1.50; 95% CI, 1.07-2.09). Gestational age and birth weight followed inverse dose-response associations, whereby an increasingly higher risk for OCD was noted in children with a shorter gestational age and lower birth weight. We also observed a dose-response association between the number of perinatal events and increased OCD risk, with HRs ranging from 1.11 (95% CI, 1.07-1.15) for 1 event to 1.51 (95% CI, 1.18-1.94) for 5 or more events.

    Conclusions and Relevance: A range of perinatal risk factors is associated with a higher risk for OCD independent of shared familial confounders, suggesting that perinatal risk factors may be in the causal pathway to OCD.

  • 31.
    Brikell, Isabell
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Kuja-Halkola, Ralf
    Karolinska Institutet, Stockholm, Sweden.
    Larsson, Jan-Olov
    Karolinska Institutet, Stockholm, Sweden.
    Lahey, Benjamin B.
    University of Chicago, Chicago, USA .
    Kuntsi, Jonna
    King’s College London, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom.
    Lichtenstein, Paul
    Karolinska Institutet, Stockholm, Sweden.
    Rydelius, Per-Anders
    Karolinska Institutet, Stockholm, Sweden; Center for Research on Child and Adolescent Mental Health, Karlstad University, Karlstad, Sweden.
    Larsson, Henrik
    Örebro University, School of Medical Sciences. Karolinska Institutet, Stockholm, Sweden; .
    Relative Immaturity in Childhood and Attention-Deficit/Hyperactivity Disorder Symptoms From Childhood to Early Adulthood: Exploring Genetic and Environmental Overlap Across Development2016In: Journal of the American Academy of Child and Adolescent Psychiatry, ISSN 0890-8567, E-ISSN 1527-5418, Vol. 55, no 10, p. 886-895Article in journal (Refereed)
    Abstract [en]

    Objective: Attention-deficit/hyperactivity disorder (ADHD) has been linked to immaturity relative to peers in childhood, yet it is unclear how such immaturity is associated with ADHD across development. This longitudinal twin study examined the genetic and environmental contributions to the association between parents' perception of their child's immaturity relative to peers (RI) in childhood and ADHD symptoms across development.

    Method: 1,302 twin pairs from the Swedish Twin Study of Child and Adolescent Development were followed prospectively from childhood to early adulthood. Parent ratings of RI were collected at 8 to 9 years and parent and self-ratings of ADHD symptoms were collected at 8 to 9, 13 to 14, 16 to 17, and 19 to 20 years using the Child Behavior Checklist Attention Problems scale. In addition, ADHD symptoms corresponding to DSM criteria were used for sensitivity analysis. Analyses were conducted using longitudinal structural equation modeling with multiple raters.

    Results: RI-related etiologic factors, predominantly influenced by genes, explained 10-14% of the variance in ADHD symptoms from 8 to 9 up to 16 to 17 years. The influence of these RI-related factors on ADHD symptoms attenuated to 4% by 19 to 20 years of age. The remaining variance in ADHD symptoms was primarily explained by genetic factors independent of RI, which remained relatively stable across development, explaining 19% to 30% of the variance in ADHD symptoms from 13 to 14 up to 19 to 20 years.

    Conclusion: The results show that RI is significantly associated with ADHD symptoms, particularly during childhood and adolescence, and that the association is primarily explained by a shared genetic liability. Nevertheless, the magnitude of associations across development was modest, highlighting that RI is merely one aspect contributing to the complex etiology of ADHD symptoms.

  • 32.
    Butwicka, Agnieszka
    et al.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden;.
    Lichtenstein, Paul
    Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden .
    Frisén, Louise
    Child and Adolescent Psychiatry Research Center, Stockholm, Sweden; Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
    Almqvist, Catarina
    Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden; Child and Adolescent Psychiatry Research Center, Stockholm, Sweden.
    Larsson, Henrik
    Örebro University, School of Medical Sciences. Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
    Ludvigsson, Jonas F.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro, Sweden; Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom; Department of Medicine, Columbia University College of Physicians and Surgeons, New York NY, United States.
    Celiac disease is associated with childhood psychiatric disorders: A Population-Based Study2017In: Journal of Pediatrics, ISSN 0022-3476, E-ISSN 1097-6833, Vol. 184, p. 87-93.e1, article id S0022-3476(17)30153-1Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To determine the risk of future childhood psychiatric disorders in celiac disease, assess the association between previous psychiatric disorders and celiac disease in children, and investigate the risk of childhood psychiatric disorders in siblings of celiac disease probands.

    STUDY DESIGN: This was a nationwide registry-based matched cohort study in Sweden with 10 903 children (aged <18 years) with celiac disease and 12 710 of their siblings. We assessed the risk of childhood psychiatric disorders (any psychiatric disorder, psychotic disorder, mood disorder, anxiety disorder, eating disorder, psychoactive substance misuse, behavioral disorder, attention-deficit hyperactivity disorder [ADHD], autism spectrum disorder [ASD], and intellectual disability). HRs of future psychiatric disorders in children with celiac disease and their siblings was estimated by Cox regression. The association between previous diagnosis of a psychiatric disorder and current celiac disease was assessed using logistic regression.

    RESULTS: Compared with the general population, children with celiac disease had a 1.4-fold greater risk of future psychiatric disorders. Childhood celiac disease was identified as a risk factor for mood disorders, anxiety disorders, eating disorders, behavioral disorders, ADHD, ASD, and intellectual disability. In addition, a previous diagnosis of a mood, eating, or behavioral disorder was more common before the diagnosis of celiac disease. In contrast, siblings of celiac disease probands were at no increased risk of any of the investigated psychiatric disorders.

    CONCLUSIONS: Children with celiac disease are at increased risk for most psychiatric disorders, apparently owing to the biological and/or psychological effects of celiac disease.

  • 33.
    Bécares, Laia
    et al.
    University of Manchester, United Kingdom.
    Kelly, Yvonne
    University College London, United Kingdom.
    Montgomery, Scott
    Örebro University, School of Medical Sciences.
    Sacker, Amanda
    University College London, United Kingdom.
    Bi-directional relationships between body mass index and height from three to seven years of age: an analysis of children in the United Kingdom Millennium Cohort Study2016In: Longitudinal and life course studies, ISSN 1124-9064, E-ISSN 1757-9597, Vol. 7, no 1, p. 41-52Article in journal (Refereed)
    Abstract [en]

    Adiposity and height are known to correlate in childhood but it is less clear whether height and weight gain occur in synergy. We investigate the bidirectional relationships between measures of height and body mass index (BMI) - an indicator of adiposity - and their rates of change. The sample comprises singleton children in the Millennium Cohort Study (N = 11,357). Child anthropometrics measured by trained interviewers at ages three, five and seven years (2003-2009) were transformed to standardised scores based on 1990 British Growth Reference data from which piecewise linear models for height and BMI were jointly fitted. At three years of age, zHeight was positively related to subsequent zBMI velocities, whereas zBMI at three years was positively related to zHeight velocity to age five but inversely related to zHeight velocity from five to seven years of age. Age three zBMI predicted zHeight velocity from three to five years more strongly than age three zHeight predicted zBMI velocity over the same period. The rate of change in zHeight was positively correlated with subsequent zBMI velocity and vice versa. This new evidence on the bidirectional relationships between height and BMI velocities sheds light on the early childhood origins of obesity in adulthood and the need to monitor growth as well as weight gain.

  • 34.
    Campbell-Yeo, Marsha
    et al.
    Dalhousie University, Halfiax, Canada.
    Eriksson, Mats
    Örebro University, School of Health Sciences.
    Kyolole, O'Brien
    Moi University, Eldoret, Kenya.
    Redefining and implementing parent controlled analgesia through active parent engagement in neonatal pain treatment2017Conference paper (Refereed)
    Abstract [en]

    Involvement of parents in neonatal pain management is of increased interest in both research and clinical settings. From an evolutionary view, the mother is the optimal source of physical and psychological support for the infant, both as a fetus and after birth. Hospital care and medical interventions are sources of separation and stress, leading to a diminished capacity for the infant to endure painful procedures and situations. After decades of healthcare providers not recognising newborn infants’ capacity to feel pain and the associated adverse outcomes, most surgical and end-of-life pain is now prevented and treated with pharmacological methods. However, the drugs used are often not effective for the most common repeated painful procedures, and have potential short and long-term adverse effects. Recent research has thus focused on finding non-pharmacological interventions as a substitute to drugs, or to decrease the drug-doses needed for optimal analgesia. Several of these interventions involve parents, e.g. skin-to-skin care, breastfeeding, or facilitated tucking by parents.

    In this workshop we suggest redefining PCA from Patient Controlled Analgesia to Parent Controlled Analgesia that includes the parents of the newborn infant. This implies a change of role of parents, from being present or being advocates for their infant, to being responsible for their infants as pain-free. We will discuss obstacles and facilitators, in both high and low resource settings, for implementing a structured and highly recommended participation of parents in the pain management of their infant.

  • 35.
    Carbajal, Ricardo
    et al.
    Hôpital Armand Trousseau, Paris, France.
    Courtois, Emilie
    Hôpital Armand Trousseau, Paris, France.
    Eriksson, Mats
    Örebro University, School of Health Sciences.
    Boyle, Elaine
    University of Leicester, Leicester, United Kingdom.
    Avila-Alvarez, A.
    Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain.
    Dovland-Andersen, Randi
    Telemark Hospital, Skien, Norway.
    Sarafidis, K.
    Aristotle University of Thessaloniki, NICU, Thessaloniki, Greece.
    Polkki, Tarja
    University of Oulu, Oulu, Finland.
    Matos, C.
    Maternidade Dr Alfredo da Costa, Lisboa, Portugal.
    Lago, Paola
    University of Padua, Padua, Italy.
    Papadouri, T.
    Arch. Makarios Hospital, Nicosia, Cyprus.
    Attard Montalto, S.
    Mater Dei Hospital, L-Imsida, Malta.
    Ilmoja, M.
    Tallinn Children's Hospital, Tallinn, Estonia.
    Simons, Sinno
    Erasmus MC–Sophia Kinderziekenhuis, Rotterdam, Netherlands.
    Tameliene, Rasa
    Perinatal center, Lithuania.
    van Overmeire, Bart
    Erasme Hospital, Belgium.
    Berger, Angelika
    Medical University of Vienna, Austria.
    Dobrzanska, Anna
    Children's Memorial Health Institute, Poland.
    Schroth, Michael
    Cnopf'sche Kinderklinik, Germany.
    Bergqvist, Lena
    Karolinska Institute, Women's and Children's health, Sweden.
    Lagercrantz, Hugo
    Karolinska Institute, Women’s and Children’s health, Stockholm, Sweden.
    Anand, KJS
    Stanford University School of Medicine, Stanford, CA, USA.
    Pain Assessment in Ventilated and Non-Ventilated Neonates in NICUS across Europe: Results from the EUROPAIN Study2016Conference paper (Refereed)
    Abstract [en]

    Aim of Investigation: Pain from invasive or noninvasive procedures, mechanical ventilation, or painful medical and surgical conditions is commonplace in neonatal intensive care units (NICUs). While prevention and treatment of neonatal pain seem essential, an adequate analgesic approach cannot be implemented without relevant and timely pain assessments. Data on neonatal pain assessment practices are scarce, with undefined best practices or clinical benefits. We aimed to describe pain assessment practices in 243 NICUs from 18 European countries and to examine the NICU and patient characteristics influencing pain assessments at the bedside.

    Methods: Demographic data, modes of respiration, use of sedation, analgesia, or neuromuscular blockers, frequency and types of pain assessments were recorded for all newborns during the first 28 days of NICU admission. Multivariable models tested the associations between the performance of pain assessments and center and neonatal factors.

    Results: Among 6648 neonates enrolled, highest level of ventilation during the study period classified patients into tracheal ventilation (TV, n=2138 [32%]), non-invasive ventilation (NIV, n=1493 [23%]), and spontaneous ventilation groups (SV, n=3017 [45%]). Pain assessments were performed in 1250 (58%), 672 (45%), and 916 (30%) of these groups respectively (p<0.001). Using data from 78,742 patient-days, we found that 2,838 (43%) neonates received 4.3 (5.2) pain assessments per neonate and per day (median (IQR): 2.4 (1-5)), whereas 3810 (57%) neonates did not receive any pain assessments. Pain assessments occurred on every day of the NICU stay in 461/2138 (22%) TV patients, 236/1493 (16%) NIV patients, and 393/3016 (13%) SV patients (p<0.001).Many different pain assessment methods were used; the EDIN scale was used most frequently (42.3% among those who had at least one pain assessment). We analysed 33,625 patient-days in the TV group to test for associations between pain assessment and the use of opioids, sedatives-hypnotics, or general anaesthetics (O-SH-GA). The rates of pain assessments on patient-days with and without O-SH-GA use were, respectively, 57% vs. 43% while receiving mechanical ventilation, and 60% vs. 34% while not receiving mechanical ventilation (both p<0.001). Multivariable analyses showed that NICU-based guidelines, nursing leadership, and increased surgical admissions promoted the use of routine pain assessments (p<0.001). More pain assessments were performed in newborns below 32-weeks gestational age, those with decreased severity of illness, those already intubated at admission, those requiring mechanical or non-invasive ventilation, or surgery, or use of O-SH-GA.

    Conclusion: Even though pain is considered the 5th vital sign, only 43% of NICU neonates received bedside pain assessments. Clinical practice variability and low rates of pain assessments in NICUS may reflect weaknesses in the current paradigm used for neonatal pain assessments, their subjectivity, lack of inter-rater reliability, and other long-standing concerns. Results suggest that training to improve the rate of pain assessment in NICUs will enhance pain management in NICUs.

    Trial Registration: ClinicalTrials.gov #NCT01694745 

  • 36.
    Carbajal, Ricardo
    et al.
    Trousseau Hospital, Paris, France; Inserm U953, Paris, France; UPMC, Paris, France.
    Courtois, Emilie
    Trousseau Hospital, Paris, France; Inserm U953, Paris, France; UPMC, Paris, France.
    Eriksson, Mats
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Lagercrantz, Hugo
    Karolinska University Hospital, Stockholm.
    Boyle, Elaine M
    University of Leicester, Leicester, UK.
    Sedation and analgesia for neonates in NICUs across the United Kingdom: The Europain survey.2014In: Archives of Disease in Childhood: Fetal and Neonatal Edition, ISSN 1359-2998, E-ISSN 1468-2052, Vol. 99 (Suppl 1), p. A62-A62, article id PC.77Article in journal (Refereed)
    Abstract [en]

    Background: Pain and stress induced by mechanical ventilation, invasive procedures, or painful diseases supports the use of sedation/analgesia (S/A) in newborns admitted to Neonatal Units (NNUs). To date, these practices have not been studied on a large scale.

    Objective: To determine current clinical practices regarding the use of S/A drugs in NNUs across the United Kingdom (UK).

    Design/Methods: A European epidemiological observational study on clinical practices regarding bedside use of S/A collected data for all neonates in participating NNUs until the infant left the unit (discharge, death, transfer) or for up to 28 days. Data collection occurred via an online database for 1 month at each NNU. Neonates up to 44 weeks gestation were included.

    Results: From February 2013 to May 2013, 66 UK NNUs collected data on 2691 eligible neonates. Of these, 713 received tracheal ventilation and 1978 had spontaneous breathing or non-invasive ventilation. The median (IQR) gestational age of ventilated neonates [32.1 (27.9-38.6)] was lower than for non-ventilated neonates [37.0 (34.1-39.7), p < 0.001]. Overall, more ventilated neonates [83.0% (n = 592)] received S/A drugs than non-ventilated neonates [7.4% (n = 147); p < 0.001]. The table shows S/A drugs used in ventilated neonates. fetalneonatal;99/Suppl_1/A62-b/T1T1T1 Abstract PC.77 Table   Ventilated and S/A, n = 592 Non-ventilated, and S/A n = 147 Fentanyl 105 (17.7%) 4 (2;7%) Midazolam 55 (9.3%) 3 (2.0%) Paracetamol 17 (2.9%) 92 (62.6%) Morphine 592 (91.6%) 44 (29.9%) Sufentanil 2 (0.3%) 0 Neuroblocker 352 (59.4%) 0 CONCLUSIONS: Most ventilated but few non-ventilated neonates receive S/A therapy in UK NNUs. Wide variations in rates of S/A use and drugs used exist among centres.

  • 37.
    Carbajal, Ricardo
    et al.
    Hôpital Armand-Trousseau, Paris, France.
    Eriksson, Mats
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for health care sciences, Örebro University hospital, Örebro.
    Courtois, Emilie
    Hôpital Armand-Trousseau, Paris, France.
    Anand, KJS
    University of Tennessee health Science Center, Memphis, USA.
    Pratiques de sédation et d’analgésie dans les unités de réanimation néonatale européennes2015In: Archives de pédiatrie, ISSN 0929-693X, E-ISSN 1769-664X, Vol. 22, no 5, Suppl. 1, p. 95-96Article in journal (Refereed)
  • 38.
    Carbajal, Ricardo
    et al.
    Emergency Department, Hôpital Armand-Trousseau, Paris, France.
    Eriksson, Mats
    Centre for health care sciences, Örebro University Hospital, Örebro, Sweden.
    Courtois, Emilie
    Emergency Department, Hôpital Armand-Trousseau, Paris, France.
    Andersen, Randi Dovland
    Telemark Hospital, Skien, Norway.
    Avila-Alvarez,, A.
    Complexo Hospitalario Universitario de a Coruña, a Coruña, Spain.
    Boyle, Elaine
    University of Leicester, Leicester, UK.
    Lago, Paola
    University of Padova, Padova, Italy.
    Sarafidis, K.
    Aristotle University of Thessaloniki, Thessaloniki, Greece.
    Simons, Sinno
    Erasmus MC Sophia Children’s Hospital, Rotterdam, Netherlands.
    Pölkki, Tarja
    Institute of Health Sciences, University of Oulu, Oulu, Finland.
    Ilmoja, M.L.
    Tallinn Children’s Hospital, Tallinn, Estonia.
    Van Overmeire, Bart
    Erasme Hospital, Bruxelles, Belgium.
    Berger, A.
    Univ. Klinik F. Kinder and Jugendheilkunde, Vienna, Austria.
    Papadouri, T.
    Arch. Makarios Hospital, Nicosia, Cyprus.
    Schroth, M.
    Cnopf’sche Kinderklinik, Nuremberg, Germany.
    Tameliene, R.
    Perinatal Center, Kaunas, Lithuania.
    Attard Montalto, S.
    Mater Dei Hospital, Msida, Malta.
    Dobrzanska, A.
    Children’s Memorial Health Institute, Warsaw, Poland.
    Matos, C.
    Maternidade Dr Alfredo Da Costa, Lisboa, Portugal.
    E Europain Study group,
    Europain Study Group, Europain Study Group, Paris, France.
    Bergqvist, Lena
    Karolinska University Hospital, Stockholm, Sweden.
    Lagercrantz, Hugo
    Karolinska University Hospital, Stockholm, Sweden.
    Anand, K.J.S.
    Department of Pediatrics Critical Care Medecine Division, University of Tennessee Health Science Center.
    Pain Assessment In Ventilated And Non-ventilated Neonates In Nicus Across Europe: European Pain Audit In Neonates (europain Survey)2014In: Archives of Disease in Childhood, ISSN 0003-9888, E-ISSN 1468-2044, Vol. 99, p. A68-A68Article in journal (Refereed)
    Abstract [en]

    Background: Neonates undergo many painful procedures during their NICU stay. These may include tracheal intubation/ventilation, skin-breaking procedures, drainage/suctioning of body orifices or cavities. Inherent subjectivity and difficulties of neonatal pain assessment contribute to a wide variety of assessment tools and clinical practices. To date, these practices have been not studied at a large scale.

    Objective: To determine current clinical practices for neonatal pain assessment in NICUs across Europe.

    Methods: An epidemiological observational study on bedside pain assessment practices collected data for all neonates in participating NICUs until infants left the unit (discharge, death, transfer to another hospital) or for 28 days. Data collection occurred via an online database for 1 month at each NICU. All neonates up to a gestational age of 44 weeks were included.

    Results: From October 2012 to June 2013, 243 NICUs from 18 European countries collected pain assessment data in 6680 neonates. Of these, 2142 received tracheal ventilation (TV), 1496 non-invasive ventilation (NIV) and 3042 only spontaneous ventilation (SV). The median (IQR) gestational age of TV, NIV and SV neonates were 32.1 (28.1–37.4), 33.6 (31.0–36.6) and 37.9 (35.0–39.9), respectively (p < 0.001). Overall, 58.5% of TV neonates, 45.0% of NIV neonates and 30.4% of SV neonates received bedside pain assessments (p < 0.001). Fig. shows pain assessments by country.

    Conclusions: Over half (58.5%) of TV neonates and less than half (45.0%) of NIV neonates had pain assessments performed in European NICUs. Wide variations in the rates of pain assessment exist among countries and an important improvement seems necessary.

  • 39.
    Carbajal, Ricardo
    et al.
    Emergency Department, Hôpital Armand-Trousseau, Paris, France.
    Eriksson, Mats
    Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden.
    Courtois, Emilie
    Emergency Department, Hôpital Armand-Trousseau, Paris, France.
    Avila-Alvarez,, A.
    Complexo Hospitalario Universitario de a Coruña, a Coruña, Spain.
    Berger, A.
    Univ. Klinik F. Kinder and Jugendheilkunde, Vienna, Austria.
    Lago, Paola
    University of Padova, Padova, Italy.
    Van Overmeire, Bart
    Erasme Hospital, Bruxelles, Belgium.
    Papadouri, T.
    Arch. Makarios Hospital, Nicosia, Cyprus.
    Ilmoja, M.L.
    Tallinn Children’s Hospital, Tallinn, Estonia.
    Pölkki, Tarja
    Institute of Health Sciences, University of Oulu, Oulu, Finland.
    Schroth, M.
    Cnopf’sche Kinderklinik, Nuremberg, Germany.
    Sarafidis, K.
    Aristotle University of Thessaloniki, Thessaloniki, Greece.
    Tameliene, R.
    Perinatal Center, Kaunas, Lithuania.
    Attard Montalto, S.
    Mater Dei Hospital, Msida, Malta.
    Simons, Sinno
    Erasmus MC Sophia Children’s Hospital, Rotterdam, Netherlands.
    Andersen, Randi Dovland
    Telemark Hospital, Skien, Norway.
    Dobrzanska, A.
    Children’s Memorial Health Institute, Warsaw, Poland.
    Matos, C.
    Maternidade Dr Alfredo Da Costa, Lisboa, Portugal.
    Boyle, Elaine
    University of Leicester, Leicester, UK.
    E Europain Study group,
    Europain Study Group, Europain Study Group, Paris, France.
    Lagercrantz, Hugo
    Karoliniska institutet.
    Bergqvist, Lena
    Karolinska institutet.
    Anand, K.J.S.
    Department of Pediatrics Critical Care Medecine Division, University of Tennessee Health Science Center, Memphis, USA.
    Sedation And Analgesia For Neonates In Nicus Across Europe: The Europain Survey2014In: Archives of Disease in Childhood, ISSN 0003-9888, E-ISSN 1468-2044, Vol. 99, p. A64-A64Article in journal (Refereed)
    Abstract [en]

    Background: Pain and stress induced by mechanical ventilation, invasive procedures, or painful diseases supports the use of sedation/analgesia (S/A) in newborns admitted to Neonatal Intensive Care Units (NICUs). To date, these practices have not been studied at a large scale.

    Objective: To determine current clinical practices regarding the use of S/A drugs in NICUs across Europe.

    Methods: This epidemiological observational study on bedside clinical practices regarding S/A collected data for all neonates in participating NICUs until the infant left the unit (discharge, death, transfer) or for up to 28 days. Data collection occurred via an online database for 1 month at each NICU. All neonates up to 44 weeks gestation were included.

    Results: From October 2012 to June 2013, 243 NICUs from 18 European countries collected data on 6680 eligible neonates. Of these, 2142 received tracheal ventilation (TV), 1496 non-invasive ventilation (NIV) and 3042 only spontaneous ventilation (SV). The median (IQR) gestational age of TV, NIV and SV neonates were 32.1 (28.1–37.4), 33.6 (31.0–36.6) and 37.9 (35.0–39.9), respectively (p < 0.001). Overall, more TV neonates [81.5% (n = 1746)] received S/A drugs than NIV neonates [17.8% (n = 266)] and SV neonates [9.3% (n = 282)]; p < 0.001. Fig. shows the rate of S/A use by country; table shows S/A drugs used.

    Conclusions: Most ventilated but few non-ventilated neonates (NIV and SV) receive S/A therapy in European NICUs. Wide variations in S/A use, drugs used, and mode of administration (continuous, bolus, or both) exist among countries.

  • 40.
    Carbajal, Ricardo
    et al.
    Hôpital Armand Trousseau, Service des Urgences Pédiatriques, Faculté de Médecine, Paris, France; INSERM U1153, Faculté de Médecine, Paris, France; Université Pierre et Marie Curie, Faculté de Médecine, Paris, France.
    Eriksson, Mats
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Courtois, Emilie
    Hôpital Armand Trousseau, Service des Urgences Pédiatriques, Faculté de Médecine, Paris, France; INSERM U1153, Faculté de Médecine, Paris, France.
    Boyle, Elaine
    University of Leicester, Leicester, United Kingdom.
    Avila-Alvarez, Alejandro
    Complexo Hospitalario Universitario de A Coruña, Coruña, Spain.
    Dovland-Andersen, Randi
    Telemark Hospital, Skien, Norway.
    Sarafidis, Kosmas
    Aristotle University of Thessaloniki, Neonatal Intensive Care Unit, Thessaloniki, Greece.
    Pölkki, Tarja
    University of Oulu, Oulu, Finland.
    Matos, Cristina
    Maternidade Dr Alfredo da Costa, Lisbon, Portugal.
    Lago, Paola
    University of Padua, Padua, Italy.
    Papadouri, Thalia
    Archbishop Makarios Hospital, Nicosia, Cyprus.
    Attard Montalto, Simon
    Mater Dei Hospital, Msida, Malta.
    Ilmoja, Mari-Liis
    Tallinn Children's Hospital, Tallin, Estonia.
    Simons, Sinno
    Erasmus MC–Sophia Kinderziekenhuis, Rotterdam, Netherlands.
    Tameliene, Rasa
    Lithuanian University of Health Sciences, Kaunas Perinatal Center, Kaunas, Lithuania.
    van Overmeire, Bart
    Erasme Hospital, Brussels, Belgium.
    Berger, Angelika
    Medical University of Vienna, Vienna, Austria.
    Dobrzanska, Anna
    Children's Memorial Health Institute, Warsaw, Poland.
    Schroth, Michael
    Cnopf'sche Kinderklinik, Nürnberg, Germany.
    Bergqvist, Lena
    Karolinska Institute, Stockholm, Sweden.
    Lagercrantz, Hugo
    Karolinska Institute, Stockholm, Sweden.
    Anand, Kanvaljeet J. S.
    University of Tennessee, Memphis, TN, USA.
    Sedation and analgesia practices in neonatal intensive care units (EUROPAIN): results from a prospective cohort study2015In: The Lancet Respiratory Medicine, ISSN 2213-2600, E-ISSN 2213-2619, Vol. 3, no 10, p. 796-812Article in journal (Refereed)
    Abstract [en]

    Background: Neonates who are in pain or are stressed during care in the intensive care unit (ICU) are often given sedation or analgesia. We investigated the current use of sedation or analgesia in neonatal ICUs (NICUs) in European countries.                                         

    Methods: EUROPAIN (EUROpean Pain Audit In Neonates) was a prospective cohort study of the management of sedation and analgesia in patients in NICUs. All neonates admitted to NICUs during 1 month were included in this study. Data on demographics, methods of respiration, use of continuous or intermittent sedation, analgesia, or neuromuscular blockers, pain assessments, and drug withdrawal syndromes were gathered during the first 28 days of admission to NICUs. Multivariable linear regression models and propensity scores were used to assess the association between duration of tracheal ventilation (TV) and exposure to opioids, sedatives-hypnotics, or general anaesthetics in neonates (O-SH-GA). This study is registered with ClinicalTrials.gov, number NCT01694745.                                         

    Findings: From Oct 1, 2012, to June 30, 2013, 6680 neonates were enrolled in 243 NICUs in 18 European countries. Mean gestational age of these neonates was 35∙0 weeks (SD 4∙6) and birthweight was 2384 g (1007). 2142 (32%) neonates were given TV, 1496 (22%) non-invasive ventilation (NIV), and 3042 (46%) were kept on spontaneous ventilation (SV). 1746 (82%), 266 (18%), and 282 (9%) neonates in the TV, NIV, and SV groups, respectively, were given sedation or analgesia as a continuous infusion, intermittent doses, or both (p<0∙0001). In the participating NICUs, the median use of sedation or analgesia was 89∙3% (70∙0–100) for neonates in the TV group. Opioids were given to 1764 (26%) of 6680 neonates and to 1589 (74%) of 2142 neonates in the TV group. Midazolam was given to 576 (9%) of 6680 neonates and 536 (25%) neonates of 2142 neonates in the TV group. 542 (25%) neonates in the TV group were given neuromuscular blockers, which were administered as continuous infusions to 146 (7%) of these neonates. Pain assessments were recorded in 1250 (58%) of 2138, 672 (45%) of 1493, and 916 (30%) of 3017 neonates in the TV, NIV, and SV groups, respectively (p<0∙0001). In the univariate analysis, neonates given O-SH-GA in the TV group needed a longer duration of TV than did those who were not given O-SH-GA (mean 136∙2 h [SD 173∙1] vs 39∙8 h [94∙7] h; p<0∙0001). Multivariable and propensity score analyses confirmed this association (p<0∙0001).                        

    Interpretation: Wide variations in sedation and analgesia practices occur between NICUs and countries. Widespread use of O-SH-GA in intubated neonates might prolong their need for mechanical ventilation, but further research is needed to investigate the therapeutic and adverse effects of O-SH-GA in neonates, and to develop new and safe approaches for sedation and analgesia. 

  • 41.
    Carbajal, Ricardo
    et al.
    Emergency Department, Trousseau Hospital, Paris, France.
    Eriksson, Mats
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Courtois, Emilie
    Trousseau Hospital, Paris, France.
    Dovland Andersen, Randi
    Telemark Hospital, Skien, Norway.
    Avila-Alvarez, A
    Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain.
    Boyle, Elaine
    University of Leicester, Leicester, United Kingdom.
    Lago, Paola
    University of Padova, Padova, Italy.
    Sarafidis, K
    Aristotle University of Thessaloniki, Thessaloniki, Greece.
    Simons, Sinno
    Erasmus MC – Sophia Kinderziekenhuis, Rotterdam, Netherlands.
    Pölkki, Tarja
    Institute of Health Sciences University of Oulu, Oulu, Finland.
    Ilmoja, ML
    Tallinn Children's Hospital, Tallinn, Estonia.
    Van Overmeire, Bart
    Erasme Hospital, Bruxelles, Belgium.
    Berger, A
    Univ. Klinik f. Kinder und Jugendheilkunde, Vienna, Austria.
    Papadouri, T
    Arch. Makarios Hospital, Nicosia, Cyprus.
    Schroth, Michael
    Cnopf'sche Kinderklinik, Nuremberg, Germany.
    Tameliene, R
    Perinatal Center, Kaunas, Lithuania.
    Attard-Montalto, S
    Mater Dei Hospital, Msida, Malta.
    Dobrzanska, A
    Children's' Memorial Health Institute, Warsaw, Poland .
    Matos, C
    Maternidade Dr Alfredo da Costa, Lisboa, Portugal.
    Bergqvist, Lena
    Karolinska University Hospital, Stockholm, Sweden.
    Lagercrantz, Hugo
    Karolinska University Hospital, Stockholm, Sweden.
    Anand, KJS
    Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA.
    Pain Assessment in Ventilated and Non-Ventilated Neonates in NICUs across Europe: EUROpean Pain Audit in Neonates (EUROPAIN Survey)2014Conference paper (Refereed)
    Abstract [en]

    Background: Neonates undergo many painful procedures during their NICU stay. These may include tracheal intubation/ventilation, skin-breaking procedures, drainage/suctioning of body orifices or cavities. Inherent subjectivity and difficulties of neonatal pain assessment contribute to a wide variety of assessment tools and clinical practices. To date, these practices have been not studied at a large scale. OBJECTIVE: To determine current clinical practices for neonatal pain assessment in NICUs across Europe. DESIGN/METHODS: An epidemiological observational study on bedside pain assessment practices collected data for all neonates in participating NICUs until infants left the unit (discharge, death, transfer to another hospital) or for 28 days. Data collection occurred via an online database for 1 month at each NICU. All neonates up to a gestational age of 44 weeks were included. RESULTS: From October 2012 to June 2013, 243 NICUs from 18 European countries collected pain assessment data in 6680 neonates. Of these, 2142 received tracheal ventilation (ventilated) and 4538 had spontaneous breathing or non- invasive ventilation (non-ventilated). The median (IQR) gestational age of ventilated neonates [32.1 (28.1-37.4)] was less than non-ventilated neonates [36.6 (33.6-39.1), p<0.001]. Overall, 58.5% of ventilated neonates and 35.2%% of non-ventilated neonates received bedside pain assessments (p<0.001). CONCLUSIONS: Over half (58.5%) of ventilated neonates and about one third (35.2%) of non-ventilated neonates had pain assessments performed in European NICUs. Wide variations in the methods used and rates of pain assessment exist among countries 

  • 42.
    Cario, Holger
    et al.
    University Medical Center Ulm, Germany.
    McMullin, Mary Frances
    Queens university, Belfast, Northern Ireland.
    Bento, Celeste
    University Hospital Coimbra, Portugal.
    Pospisilova, Dagmar
    Palacky University, Olomouc, Czech Republic.
    Percy, Melanie J.
    Belfast City Hospital, Northern Ireland.
    Hussein, Kais
    Hannover Medical School, Germany.
    Schwarz, Jiri
    Institute of Hematology and Blood Transfusion, Prague, Czech Republic.
    Åström, Maria
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital.
    Hermouet, Sylvie
    Université de Nantes, France.
    Erythrocytosis in Children and Adolescents: Classification, Characterization, and Consensus Recommendations for the Diagnostic Approach2013In: Pediatric Blood & Cancer, ISSN 1545-5009, E-ISSN 1545-5017, Vol. 60, no 11, p. 1734-1738Article in journal (Refereed)
    Abstract [en]

    During recent years, the increasing knowledge of genetic and physiological changes in polycythemia vera (PV) and of different types of congenital erythrocytosis has led to fundamental changes in recommendations for the diagnostic approach to patients with erythrocytosis. Although widely accepted for adult patients this approach may not be appropriate with regard to children and adolescents affected by erythrocytosis. The congenital erythrocytosis working group established within the framework of the MPN&MPNr-EuroNet (COST action BM0902) addressed this question in a consensus finding process and developed a specific algorithm for the diagnosis of erythrocytosis in childhood and adolescence which is presented here. Pediatr Blood Cancer 2013;60:1734-1738. (c) 2013 Wiley Periodicals, Inc.

  • 43.
    Chen, Ruoqing
    et al.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Regodón Wallin, Amanda
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Sjölander, Arvid
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Valdimarsdóttir, Unnur
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
    Ye, Weimin
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Tiemeier, Henning
    Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Child and Adolescent Psychiatry, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
    Fall, Katja
    Örebro University, School of Medical Sciences. Department of Clinical Epidemiology and Biostatistics.
    Almqvist, Catarina
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Lung and Allergy Unit, Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden.
    Czene, Kamila
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Fang, Fang
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Childhood injury after a parental cancer diagnosis2015In: eLIFE, E-ISSN 2050-084X, Vol. 4, article id e08500Article in journal (Refereed)
    Abstract [en]

    A parental cancer diagnosis is psychologically straining for the whole family. We investigated whether a parental cancer diagnosis is associated with a higher-than-expected risk of injury among children by using a Swedish nationwide register-based cohort study. Compared to children without parental cancer, children with parental cancer had a higher rate of hospital contact for injury during the first year after parental cancer diagnosis (hazard ratio [HR]=1.27, 95% confidence interval [CI]=1.22-1.33), especially when the parent had a comorbid psychiatric disorder after cancer diagnosis (HR=1.41, 95% CI=1.08-1.85). The rate increment declined during the second and third year after parental cancer diagnosis (HR=1.10, 95% CI=1.07-1.14) and became null afterwards (HR=1.01, 95% CI=0.99-1.03). Children with parental cancer also had a higher rate of repeated injuries than the other children (HR=1.13, 95% CI= 1.12-1.15). Given the high rate of injury among children in the general population, our findings may have important public health implications.

  • 44.
    Colins, Olivier F.
    et al.
    Department of Child and Adolescent Psychiatry, Curium-Leiden University Medical Center, Leiden, The Netherlands; Center for Criminological and Psychosocial Research, Örebro University, Örebro, Sweden.
    Van Damme, Lore
    Department of Special Education, Ghent University, Ghent, Belgium.
    Fanti, Kostas A.
    Department of Psychology, University of Cyprus, Nicosia, Cyprus.
    Andershed, Henrik
    Örebro University, School of Law, Psychology and Social Work.
    The prospective usefulness of callous-unemotional traits and conduct disorder in predicting treatment engagement among detained girls2017In: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 26, no 1, p. 75-85Article in journal (Refereed)
    Abstract [en]

    Although treatment engagement (TE) is crucial for treatment success it is not well known how likely detained girls are to engage in treatment and what features may impede them from doing so. This study is the first to examine the prognostic usefulness of two features of potential interest, being callous-unemotional (CU) traits and conduct disorder (CD), in relation to TE. Detained girls and their parents (n = 75) were interviewed with the Diagnostic Interview Schedule for Children to assess CD, and completed the Antisocial Process Screening Device to assess CU traits dimensionally and categorically as in the new diagnostic and statistical manual of mental disorders, fifth edition (DSM-5) CU-based specifier. One to two months later, the girls reported how much they engaged in treatment. At the zero-order level, self-, but not parent-reported CU traits and CD were predictive of lower levels of TE. The incorporation of CU traits into a diagnosis of CD identified girls with lower levels of future TE, a finding that held across different informants. Of note, the aforementioned findings only became apparent when using a dimensional measure of CU traits, and not when using the categorical measure of CU traits currently included in DSM-5. This study showed that CU traits can help developing an understanding of what factors hinder TE among detained girls. Our findings also support recommendations to incorporate CU traits into the CD diagnosis, and suggest that dimensional approaches to do so may yield relevant information about future levels of TE.

  • 45.
    Dalal, Koustuv
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Lao, Zhinqin
    Gifford, Mervyn
    School of Life Sciences, University of Skövde, Sweden.
    Wang, Shu-Mei
    School of Public Health, Key Laboratory of Public Health Safety Ministry of Education, Fudan University, Shanghai, China .
    Knowledge and attitudes towards childhood injury prevention: a study of parents in Shanghai, China2012In: HealthMed, ISSN 1840-2291, E-ISSN 1986-8103, Vol. 6, no 11, p. 3783-3789Article in journal (Refereed)
    Abstract [en]

    Childhood injuries are a major problem worldwide. The study explored the parents' knowledge and attitudes towards childhood injury prevention in relation to theirsocioeconomic status. The study also tried to compare parents' perceptions of cause and place of child injury with actual cause and place of injury. This was a cross sectional study of 986 randomly selected parents whose children (3-6 years old) were enrolled at selected kindergartens in a 'Safe Community' in Shanghai, China. Chi-square tests and bar diagrams were used. Almost all parents (97%) thought that injury was a serious problem for their children. Around half of the parents thought that child injuries could be prevented while almost one-third (29%) of parents indicated that there were risk factors in the living environment of their children. Parental perceptions of cause of injuries and place of injuries significantly differed from that of the reality. Parents identified the most common barriers of childhood injury prevention: lack of parental attention (41.6%), environment (35.6%) and children's risky behavior (22.7%). The difference between parental opinions and reality illustrated that parents had incorrect knowledge of childhood injuries, which might lead to incorrect foci of prevention programs.

    Before tackling environmental modifications to prevent child injuries, policy makers should focus on rectifying parents' incorrect perceptions and on modifying their attitudes as key players. It is important to first raise awareness about childhood injury prevention among the parents for appropriate intervention strategies.

  • 46.
    de Beaufort, Carine E.
    et al.
    CHL, Pediat Clin, L-1210 Luxembourg, Luxembourg..
    Lange, Karin
    Hannover Med Sch, Dept Med Psychol, Hannover, Germany..
    Swift, Peter G. F.
    Childrens Hosp, Leicester Royal Infirm, Leicester, Leics, England..
    Åman, Jan
    Örebro University Hospital. Dept Pediat.
    Cameron, Fergus
    Royal Childrens Hosp, Dept Endocrinol & Diabet, Parkville, Vic 3052, Australia..
    Castano, Luis
    Univ Basque Country, Endocrinol & Diabet Res Grp, Hosp Cruces, Baracaldo, Spain..
    Dorchy, Harry
    Univ Hosp Reine Fabiola, Diabetol Clin, Brussels, Belgium..
    Fisher, Lynda K.
    Childrens Hosp Los Angeles, Dept Endocrinol & Diabet, Los Angeles, CA 90027 USA..
    Hoey, Hilary
    Univ Dublin Trinity Coll, Natl Childrens Hosp, Dublin 2, Ireland..
    Kaprio, Eero
    Peijas Hosp, Dept Paediat, Helsinki, Finland..
    Kocova, Mirjana
    Univ Pediat Clin, Dept Endocrinol & Genet, Skopje, Macedonia..
    Neu, Andreas
    Univ Tubingen, Clin Children & Adolescence, Tubingen, Germany..
    Njolstad, Pal R.
    Univ Bergen, Dept Clin Med, Bergen, Norway.;Haukeland Hosp, Dept Pediat, N-5021 Bergen, Norway..
    Phillip, Moshe
    Schneiders Med Ctr Israel, Natl Ctr Childhood Diabet, Petah Tiqwa, Israel..
    Schoenle, Eugen
    Univ Childrens Hosp, Dept Diabet & Endocrinol, Zurich, Switzerland..
    Robert, Jean J.
    Hop Necker Enfants Malad, Dept Childhood & Adolescent Diabet, Paris, France..
    Urukami, Tatsuhiko
    Nihon Univ, Sch Med, Tokyo, Japan..
    Vanelli, Maurizio
    Ctr Diabetol, Pediat Clin, Parma, Italy..
    Danne, Thomas
    Krankenhaus Bult, Hannover, Germany..
    Barrett, Tim
    Univ Birmingham, Inst Child Hlth, Birmingham B15 2TT, W Midlands, England.;Univ Birmingham, Birmingham Childrens Hosp, Birmingham, W Midlands, England..
    Chiarelli, Franco
    Osped Policlin, Pediat Clin, Chieti, Italy..
    Aanstoot, Henk J.
    Ctr Pediat & Adolescent Diabet Care & Res, Rotterdam, Netherlands..
    Mortensen, Henrik B.
    Herlev Hosp, Dept Pediat, DK-2730 Herlev, Denmark.;Univ Copenhagen, Fac Hlth Sci, Copenhagen, Denmark..
    Metabolic outcomes in young children with type 1 diabetes differ between treatment centers: the Hvidoere Study in Young Children 20092013In: Pediatric Diabetes, ISSN 1399-543X, E-ISSN 1399-5448, Vol. 14, no 6, p. 422-428Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate whether center differences in glycemic control are present in prepubertal children <11yr with type 1 diabetes mellitus. Research Design and Methods: This cross-sectional study involved 18 pediatric centers worldwide. All children, <11 y with a diabetes duration 12months were invited to participate. Case Record Forms included information on clinical characteristics, insulin regimens, diabetic ketoacidosis (DKA), severe hypoglycemia, language difficulties, and comorbidities. Hemoglobin A1c (HbA1c) was measured centrally by liquid chromatography (DCCT aligned, range: 4.4-6.3%; IFFC: 25-45mmol/mol). Results: A total of 1133 children participated (mean age: 8.0 +/- 2.1 y; females: 47.5%, mean diabetes duration: 3.8 +/- 2.1 y). HbA1c (overall mean: 8.0 +/- 1.0%; range: 7.3-8.9%) and severe hypoglycemia frequency (mean 21.7 events per 100 patient-years), but not DKA, differed significantly between centers (p<0.001 resp. p=0.179). Language difficulties showed a negative relationship with HbA1c (8.3 +/- 1.2% vs. 8.0 +/- 1.0%; p = 0.036). Frequency of blood glucose monitoring demonstrated a significant but weak association with HbA1c (r=-0.17; p<0.0001). Although significant different HbA1c levels were obtained with diverse insulin regimens (range: 7.3-8.5%; p<0.001), center differences remained after adjusting for insulin regimen (p<0.001). Differences between insulin regimens were no longer significant after adjusting for center effect (p=0.199). Conclusions: Center differences in metabolic outcomes are present in children <11yr, irrespective of diabetes duration, age, or gender. The incidence of severe hypoglycemia is lower than in adolescents despite achieving better glycemic control. Insulin regimens show a significant relationship with HbA1c but do not explain center differences. Each center's effectiveness in using specific treatment strategies remains the key factor for outcome.

  • 47.
    Dickson, Daniel J.
    et al.
    Department of Psychology, Florida Atlantic University, Fort Lauderdale, FL, United States.
    Laursen, Brett
    Department of Psychology, Florida Atlantic University, Fort Lauderdale, FL, United States.
    Stattin, Håkan
    Örebro University, School of Law, Psychology and Social Work.
    Kerr, Margaret
    Örebro University, School of Law, Psychology and Social Work.
    Parental Supervision and Alcohol Abuse Among Adolescent Girls2015In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 136, no 4, p. 617-624Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Inadequate parent supervision during the early adolescent years forecasts a host of conduct problems, including illicit alcohol consumption. Early pubertal maturation may exacerbate problems, because girls alienated from same-age peers seek the company of older, more mature youth. The current study examines overtime associations between parent autonomy granting and adolescent alcohol abuse during a developmental period when alcohol consumption becomes increasingly normative, to determine if early maturing girls are at special risk for problems arising from a lack of parent supervision.

    METHODS: At annual intervals for 4 consecutive years, a community sample of 957 Swedish girls completed surveys beginning in the first year of secondary school (approximate age: 13 years) describing rates of alcohol intoxication and perceptions of parent autonomy granting. Participants also reported age at menarche.

    RESULTS: Multiple-group parallel process growth curve models revealed that early pubertal maturation exacerbated the risk associated with premature autonomy granting: Alcohol intoxication rates increased 3 times faster for early maturing girls with the greatest autonomy than they did for early maturing girls with the least autonomy. Child-driven effects were also found such that higher initial levels of alcohol abuse predicted greater increases in autonomy granting as parent supervision over children engaged in illicit drinking waned.

    CONCLUSIONS: Early maturing girls are at elevated risk for physical and psychological adjustment difficulties. The etiology of escalating problems with alcohol can be traced, in part, to a relative absence of parent supervision during a time when peer interactions assume special significance.

  • 48.
    Dornbusch, Hans Juergen
    et al.
    Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.
    Hadjipanayis, Adamos
    Department of Paediatrics, Larnaca General Hospital, Derynia, Cyprus; Medical School, European University of Cyprus, Nicosia, Cyprus .
    Del Torso, Stefano
    Dipartimento della Sanità Pubblica, Padova, Italy.
    Mercier, Jean-Christophe
    Service de Pédiatrie-Urgences, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris & Université Paris Diderot, Paris, France .
    Wyder, Corinne
    Paediatric Primary Care Center Kurwerk, Burgdorf, Switzerland.
    Schrier, Lenneke
    Juliana Children’s Hospital, The Hague, Netherlands.
    Ross-Russell, Robert
    Department of Paediatric Respiratory Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.
    Stiris, Tom
    Department of Neonatology, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway .
    Ludvigsson, Jonas F.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Paediatrics, Örebro University Hospital, Örebro, Sweden.
    We strongly support childhood immunisation-statement from the European Academy of Paediatrics (EAP)2017In: European Journal of Pediatrics, ISSN 0340-6199, E-ISSN 1432-1076, Vol. 176, no 5, p. 679-680Article in journal (Refereed)
    Abstract [en]

    The eradication of smallpox and the elimination of several other infectious diseases from much of the world has provided convincing evidence that vaccines are among the most effective interventions for promoting health. The current scepticism about immunisation among members of the new US administration carries a risk of decreasing immunisation rates also in Europe. While only a small minority of the population are strongly anti-vaccine, their public activities have significantly influenced an uncertainty among the general population about both the safety of and the necessity for vaccination. Therefore, the EAP calls for greater publically available, scientifically supported information on vaccination, particularly targeted at health care providers, for the further development of electronically based immunisation information systems (IIS). We further call on all European countries to work together both in legislative and public health arenas in order to increase vaccination coverage among the paediatric population. In the interest of children and their parents, the EAP expresses its strong support for childhood immunisation and recommended vaccination schedules. We are prepared to work with governments and media and share the extensive evidence demonstrating the effectiveness and safety of vaccines.

  • 49.
    Du Rietz, Ebba
    et al.
    MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, London, United Kingdom.
    Kuja-Halkola, Ralf
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Brikell, Isabell
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Jangmo, Andreas
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Sariaslan, Amir
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Lichtenstein, Paul
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Kuntsi, Jonna
    MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, London, United Kingdom.
    Larsson, Henrik
    Örebro University, School of Medical Sciences. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Predictive validity of parent- and self-rated ADHD symptoms in adolescence on adverse socioeconomic and health outcomes2017In: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 26, no 7, p. 857-867Article in journal (Refereed)
    Abstract [en]

    There is scarcity of research investigating the validity of self-report of attention deficit hyperactivity disorder (ADHD) symptoms compared to other informants, such as parents. This study aimed to compare the predictive associations of ADHD symptoms rated by parents and their children across adolescence on a range of adverse socioeconomic and health outcomes in early adulthood. Parent- and self-rated ADHD symptoms were assessed in 2960 individuals in early (13-14 years) and late adolescence (16-17 years). Logistic regression analyses were used to compare the associations between parent- and self-rated ADHD symptoms at both time points and adverse life outcomes in young adulthood obtained from Swedish national registries. Both parent- and self-ratings of ADHD symptoms were associated with increased risk for adverse outcomes, although associations of parent-ratings were more often statistically significant and were generally stronger (OR = 1.12-1.49, p < 0.05) than self-ratings (OR = 1.07-1.17, p < 0.05). After controlling for the other informant, parent-ratings of ADHD symptoms in both early and late adolescence significantly predicted academic and occupational failure, criminal convictions and traffic-related injuries, while self-ratings of ADHD symptoms only in late adolescence predicted substance use disorder and academic failure. Our findings suggest that both parent- and self-ratings of ADHD symptoms in adolescence provides valuable information on risk of future adverse socioeconomic and health outcomes, however, self-ratings are not valuable once parent-ratings have been taken into account in predicting most outcomes. Thus, clinicians and researchers should prioritize parent-ratings over self-ratings.

  • 50.
    Edvinsson, Siv E.
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. University Health Care Research Center.
    Lundqvist, Lars-Olov
    Örebro University, School of Law, Psychology and Social Work. University Health Care Research Center.
    Prevalence of orofacial dysfunction in cerebral palsy and its association with gross motor function and manual ability2016In: Developmental Medicine & Child Neurology, ISSN 0012-1622, E-ISSN 1469-8749, Vol. 58, no 4, p. 385-394Article in journal (Refereed)
    Abstract [en]

    Aim: To investigate the prevalence of orofacial dysfunction (OFD) and explore factors associated with OFD in young individuals with cerebral palsy (CP).

    Method: We conducted a cross-sectional study on a population with CP in a Swedish county (132 individuals, mean age 14y 2mo [SD 4y 5mo], range 5-22y) using the Nordic Orofacial Test - Screening (NOT-S), Gross Motor Function Classification System (GMFCS), and Manual Ability Classification System (MACS). The NOT-S interview was completed by 129 individuals (76 males, 53 females) of whom 52 (30 males, 22 females) also agreed to complete the NOT-S examination.

    Results: OFD occurred in at least one NOT-S domain in about 80% of the individuals and was present in all subdiagnoses, GMFCS levels, and MACS levels. Prevalence of OFD increased with increasing levels of GMFCS and MACS from level I=55% to level V=100%. Within the 12 NOT-S domains, the prevalence of OFD varied between 19% and 69%, wherein seven of them were at least 40%: 'Drooling', 'Nose breathing', 'Chewing and swallowing', 'Face at rest', 'Oral motor function', 'Speech', and 'Facial expression' (in ascending order).

    Interpretation: OFD is common in CP. The use of OFD screening in health service planning would assist detection of areas in need of further evaluation.

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