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  • 1.
    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.

  • 2.
    Austeng, Dordi
    et al.
    Dept Ophthalmol, Uppsala Univ, Uppsala, Sweden.
    Blennow, Mats
    Dept Pediat, Karolinska Univ Hosp Huddinge, Stockholm, Sweden .
    Ewald, Uwe
    Dept Pediat, Uppsala Univ, Uppsala, Sweden.
    Fellman, Vineta
    Dept Pediat, Lund Univ, Lund, Sweden.
    Fritz, Thomas
    Dept Obstet & Gynecol, Sahlgrens Univ Hosp, Gothenburg, Sweden.
    Hellstrom-Westas, Lena
    Dept Pediat, Uppsala Univ, Uppsala, Sweden .
    Hellstrom, Ann
    Dept Ophthalmol, Inst Neurosci & Physiol, Sahlgrenska Acad, Univ Gothenburg, Gothenburg, Sweden.
    Holmgren, Per Åke
    Dept Clin Sci Obstet & Gynecol, Umeå Univ Hosp, Umeå, Sweden.
    Holmstrom, Gerd
    Dept Ophthalmol, Uppsala Univ, Uppsala, Sweden.
    Jakobsson, Peter
    Dept, Ophthalmol, Linkoping Univ, Linkoping, Sweden.
    Jeppsson, Annika
    Dept Obstet & Gynecol, Linköping Univ, Linköping, Sweden.
    Johansson, Kent
    Dept Ophthalmol, Umeå Univ, Umeå, Sweden.
    Kallén, Karin
    Ctr Reprod Epidemiol, Lund Univ, Lund, Sweden.
    Lagercrantz, Hugo
    Dept Pediat, Karolinska Inst, Astrid Lindgren Childrens Hosp, Stockholm, Sweden.
    Laurini, Ricardo
    Dept Pathol, Bodø Cent Hosp, Bodø, Norway.
    Lindberg, Eva
    Department of Pediatrics, Örebro University, Örebro, Sweden.
    Lundqvist, Anita
    Dept Hlth Sci, Lund Univ, Lund, Sweden.
    Marsal, Karel
    Dept Obstet & Gynecol, Lund Univ, Lund, Sweden.
    Nilstun, Tore
    Dept Med Eth, Lund Univ, Lund, Sweden.
    Norden-Lindeberg, Solveig
    Dept Obstet & Gynecol, Uppsala Univ, Uppsala, Sweden.
    Norman, Mikael
    Dept Clin Sci Intervent & Technol, Karolinska Inst, Stockholm, Sweden; Dept Pediat, Karolinska Univ Hosp, Stockholm, Sweden.
    Olhager, Elisabeth
    Dept Pediat, Linköping Univ, Linköpinging, Sweden; Dept Obstet & Gynecol, Univ Örebro, Örebro, Sweden .
    Östlund, Ingrid
    Örebro University, School of Health and Medical Sciences.
    Serenius, Fredrik
    Dept Pediat, Umeå Univ Hosp, Umeå, Sweden.
    Simic, Marija
    Dept Obstet & Gynecol, Karolinska Univ Hosp Solna, Stockholm, Sweden.
    Sjors, Gunnar
    Dept Pediat, Uppsala Univ, Uppsala, Sweden.
    Stigson, Lennart
    Dept Pediat, Sahlgrens Univ Hosp, Gothenburg, Sweden.
    Stjernqvist, Karin
    Dept Psychol, Lund Univ, Lund, Sweden.
    Stromberg, Bo
    Dept Pediat, Uppsala Univ, Uppsala, Sweden.
    Tornqvist, Kristina
    Dept Ophthalmol, Lund Univ, Lund, Sweden.
    Wennergren, Margareta
    Dept Obstet & Gynecol, Sahlgrens Univ Hosp, Gothenburg, Sweden.
    Wallin, Agneta
    St Erik Eye Hosp, Karolinska Univ, Stockholm, Sweden.
    Westgren, Magnus
    Dept Obstet & Gynecol, Karolinska Univ Hosp Huddinge, Stockholm, Sweden.
    Incidence of and risk factors for neonatal morbidity after active perinatal care: extremely preterm infants study in Sweden (EXPRESS)2010In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 99, no 7, p. 978-992Article in journal (Refereed)
    Abstract [en]

    Aims: The aim of this study was to determine the incidence of neonatal morbidity in extremely preterm infants and to identify associated risk factors. Methods: Population based study of infants born before 27 gestational weeks and admitted for neonatal intensive care in Sweden during 2004-2007. Results: Of 638 admitted infants, 141 died. Among these, life support was withdrawn in 55 infants because of anticipation of poor long-term outcome. Of 497 surviving infants, 10% developed severe intraventricular haemorrhage (IVH), 5.7% cystic periventricular leucomalacia (cPVL), 41% septicaemia and 5.8% necrotizing enterocolitis (NEC); 61% had patent ductus arteriosus (PDA) and 34% developed retinopathy of prematurity (ROP) stage >= 3. Eighty-five per cent needed mechanical ventilation and 25% developed severe bronchopulmonary dysplasia (BPD). Forty-seven per cent survived to one year of age without any severe IVH, cPVL, severe ROP, severe BPD or NEC. Tocolysis increased and prolonged mechanical ventilation decreased the chances of survival without these morbidities. Maternal smoking and higher gestational duration were associated with lower risk of severe ROP, whereas PDA and poor growth increased this risk. Conclusion: Half of the infants surviving extremely preterm birth suffered from severe neonatal morbidities. Studies on how to reduce these morbidities and on the long-term health of survivors are warranted.

  • 3.
    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.

  • 4.
    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.

  • 5. Bergqvist, L.
    et al.
    Eriksson, Mats
    Örebro University, School of Health and Medical Sciences.
    Kronsberg, S.S.
    Schollin, Jens
    Örebro University, School of Health and Medical Sciences.
    Barton, B.
    Anand, K.J.S.
    Seeing through the blind!: ability of hospital staff to differentiate morphine from placebo, in neonates at a placebo controlled trial2007In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 96, no 7, p. 1004-1007Article in journal (Refereed)
    Abstract [en]

    AIM: To investigate whether professional training and/or clinical experience affect the ability of caregiver to assess clinical signs of pre-emptive morphine analgesia. METHODS: In the Neurological Outcomes & Pre-emptive Analgesia In Neonates trial preterm infants undergoing mechanical ventilation were randomized to receive continuous infusion, either of morphine or placebo blinded. Staff from centres in Sweden (Stockholm and Orebro) completed an assessment form. RESULTS: A total of 360 assessment forms were collected from 52 neonates. In 59% of the cases, caregivers correctly identified patients group. Comparable proportion of answers were correct between physicians, nurses and assistant nurses (63, 60 and 54%, respectively, p = 0.60). Staff with Neonatal intensive care unit experience <1 year identified 63%, as compared to 65% for working 1-5 year, and 55% that has been working >5 years (p = 0.28). Staff's ability to correctly identify group assignment was reduced by amount of additional morphine (p < 0.01) and severity of illness (p = 0.01). CONCLUSIONS: Clinical medical staffs, including neonatologists, have great difficulties in assessing the presence and severity of pain. Further studies should focus on the methods for assessment of prolonged pain in preterm neonates, define the effects of adequate analgesia, and investigate the clinical factors that may alter neonatal responses to acute and prolonged pain.

  • 6.
    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, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    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.

  • 7.
    Björkman, Louise
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Ohlin, Andreas
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    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.

  • 8.
    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.

  • 9.
    Bohman, Benjamin
    et al.
    Dept Public Health Science, Karolinska Institute, Stockholm, Sweden.
    Eriksson, Mats
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Center of Health Care Science, Örebro University Hospital, Örebro, Sweden.
    Lind, Maria
    Örebro University, School of Law, Psychology and Social Work. Child Health Service, Örebro City Council, Örebro, Sweden.
    Ghaderi, Ata
    Dept Public Health Science, Karolinska Institute, Stockholm, Sweden; Dept Psychology, Uppsala University, Uppsala, Sweden .
    Forsberg, Lars
    Dept Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
    Rasmussen, Finn
    Dept Public Health Science, Karolinska Institute, Stockholm, Sweden.
    Infrequent attention to dietary and physical activity behaviours in conversations in Swedish child health services2013In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 102, no 5, p. 520-524Article in journal (Refereed)
    Abstract [en]

    Aim: To investigate conversations between nurses and parents in Swedish child health services and to assess to what extent attention is directed towards dietary and physical activity behaviours in children.

    Methods: Twenty-three nurses audio-recorded one session each. Recordings were assessed and topics were classified according to predetermined categories.

    Results: The three most frequent topics of conversation concerned physical examinations of the child (30% of session time), talking to the child to establish or maintain contact and interest (15%), and development of language skills (12%). Dietary habits came on fourth place (10%), and physical activity ranked 14 (4%).

    Conclusion: Attention to dietary and physical activity behaviours in children is infrequent in Swedish child health services. Concern is raised about the efficacy of prevention efforts against childhood obesity.

  • 10.
    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, Linköping, Sweden.
    Bladh, Marie
    Department of Clinical and experimental Medicine, Faculty of Health and Science, Linköping University, Linköping, Sweden.
    Svanberg, Agneta Skoog
    Obstetrik & gynekologi, Uppsala universitet, Uppsala, Sweden.
    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.

  • 11.
    Ehlersson, Gustaf
    et al.
    School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Department of Laboratory Medicine, Clinical Microbiology, Örebro University Hospital, Örebro, Sweden.
    Hellmark, Bengt
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Laboratory Medicine, Clinical Microbiology, Örebro University Hospital, Örebro, Sweden.
    Svartström, Olov
    Department of Clinical Microbiology, Linköping University Hospital, Linköping, Sweden.
    Stenmark, Bianca
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Laboratory Medicine, Clinical Microbiology, Örebro University Hospital, Örebro, Sweden.
    Söderquist, Bo
    Örebro University, School of Medical Sciences. Department of Laboratory Medicine, Clinical Microbiology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Phenotypic characterisation of coagulase-negative staphylococci isolated from blood cultures in newborn infants, with a special focus on Staphylococcus capitis2017In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 106, no 10, p. 1576-1582Article in journal (Refereed)
    Abstract [en]

    AIM: This Swedish study determined which species of coagulase-negative staphylococci (CoNS) were found in neonatal blood cultures and whether they included Staphylococcus capitis clones with decreased susceptibility to vancomycin.

    METHODS: CoNS isolates (n = 332) from neonatal blood cultures collected at Örebro University Hospital during 1987-2014 were identified to species level with matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry (MALDI-TOF MS). The antibiotic susceptibility pattern of S. capitis isolates was determined by the disc diffusion test and Etest, and the presence of heterogeneous glycopeptide-intermediate S. capitis (hGISC) was evaluated.

    RESULTS: Staphylococcus epidermidis (67.4%), Staphylococcus haemolyticus (10.5%) and S. capitis (9.6%) were the most common CoNS species. Of the S. capitis isolates, 75% were methicillin-resistant and 44% were multidrug-resistant. No isolate showed decreased susceptibility to vancomycin, but at least 59% displayed the hGISC phenotype. Staphylococcus capitis isolates related to the strain CR01 displaying pulsotype NRCS-A were found.

    CONCLUSION: Staphylococcus epidermidis, S. haemolyticus and S. capitis were the predominant species detected in neonatal blood cultures by MALDI-TOF MS. The number of episodes caused by S. capitis increased during the study period, but no isolates with decreased susceptibility to vancomycin were identified. However, S. capitis isolates related to the strain CR01 displaying pulsotype NRCS-A were found.

  • 12.
    Elinder, Göran
    et al.
    Department of Pediatrics, Karolinska Institutet, Stockholm, Sweden.
    Eriksson, Anders
    Department of Community Medicine and Rehabilitation, Forensic Medicine, Umeå University, Umeå, Sweden; The National Board of Forensic Medicine, Linköping, Sweden.
    Hallberg, Boubou
    Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics and Neonatology, Karolinska University Hospital, Stockholm, Sweden.
    Lynøe, Niels
    Medical Ethics, Karolinska Institutet, Stockholm, Sweden.
    Sundgren, Pia Maly
    Diagnostic Radiology, Lund University, Lund, Sweden; Department of Neuroradiology, Skåne University Hospital, Lund, Sweden.
    Rosén, Måns
    Health Technology Assessment, Karolinska Institutet, Stockholm, Sweden.
    Engström, Ingemar
    Örebro University, School of Medical Sciences. Child and Adolecent Psychiatry, University Health Care Research Center.
    Erlandsson, Björn-Erik
    Medical Technology, Royal Institute of Technology, Stockholm, Sweden.
    Traumatic shaking: The role of the triad in medical investigations of suspected traumatic shaking2018In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 107, no S472, p. 3-23Article, review/survey (Refereed)
    Abstract [en]

    The Swedish Agency for Health Technology Assessment and Assesment of Social Services (SBU) is an independent national authority, tasked by the government with assessing methods used in health, medical and dental services and social service interventions from a broad perspective, covering medical, economic, ethical and social aspects. The language in SBU's reports are adjusted to a wide audience. SBU's Board of Directors has approved the conclusions in this report. The systematic review showed the following graded results:

    • There is limited scientific evidence that the triad (Three components of a whole. The triad associated with SBS usually comprises subdural haematoma, retinal haemorrhages and encephalopathy.) and therefore, its components can be associated with traumatic shaking (low-quality evidence).
    • There is insufficient scientific evidence on which to assess the diagnostic accuracy of the triad in identifying traumatic shaking (very low-quality evidence).

    Limited scientific evidence (low-quality evidence) represents a combined assessment of studies of high or moderate quality which disclose factors that markedly weaken the evidence. It is important to note that limited scientific evidence for the reliability of a method or an effect does not imply complete lack of scientific support. Insufficient scientific evidence (very low-quality evidence) represents either a lack of studies or situations when available studies are of low quality or show contradictory results. Evaluation of the evidence was not based on formal grading of the evidence according to GRADE but on an evaluation of the total scientific basis.

  • 13.
    Engström, Ingemar
    Örebro University, School of Health and Medical Sciences.
    Ethical reflections on organ donation from children2011In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 100, no 9, p. 1172-1174Article in journal (Refereed)
  • 14.
    Ericson, Jenny
    et al.
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Centre for Clinical Research Dalarna, Uppsala University, Falun, Sweden; Department of Paediatrics, Falu Hospital, Falun, Sweden.
    Eriksson, Mats
    Örebro University, School of Health Sciences.
    Hellström-Westas, Lena
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Hoddinott, Pat
    Nursing, Midwifery and Allied Health Professionals Research Unit, University of Stirling, Stirling, UK.
    Flacking, Renée
    School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
    Proactive telephone support provided to breastfeeding mothers of preterm infants after discharge: a randomised controlled trial2018In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 107, no 5, p. 791-798Article in journal (Refereed)
    Abstract [en]

    AIM: The aim was to evaluate the effectiveness of proactive telephone support provided to breastfeeding mothers of preterm infants after discharge from neonatal intensive care units (NICU).

    METHODS: Between March 2013 and December 2015, a randomised controlled trial was conducted at six NICUs across Sweden. At each NICU, a breastfeeding support team recruited, randomised and delivered the support to participating mothers. The intervention group received a daily proactive telephone call up to 14 days after discharge from the support team. The control group could initiate telephone contact themselves. Primary outcome was exclusive breastfeeding eight weeks after discharge. Secondary outcomes were maternal satisfaction with breastfeeding, attachment, quality of life and parental stress.

    RESULTS: In total, 493 mothers were randomised, 231 to intervention group and 262 to control group. There were no differences between the groups for exclusive breastfeeding, odds ratio 0.96, 95% CI 0.66-1.38, nor for maternal satisfaction with breastfeeding, attachment or quality of life. The intervention group reported significantly less parental stress than the controls, t=2.44, 95% CI 0.03-0.23, effect size d=0.26.

    CONCLUSION: In this trial, proactive telephone support was not associated with increased exclusive breastfeeding prevalence eight weeks following discharge. However, intervention group mothers showed significantly lower parental stress.

  • 15.
    Eriksson, Britt
    et al.
    Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Löf, Marie
    Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Eriksson, Olle
    Department of Computer and Information Science, Linköping University, Linköping, Sweden.
    Hannestad, Ulf
    Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Forsum, Elisabet
    Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Fat-free mass hydration in newborns: assessment and implications for body composition studies2011In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 100, no 5, p. 680-686Article in journal (Refereed)
    Abstract [en]

    Equipment (Pea Pod) for assessing infant body density accurately and conveniently has recently become available. This density can be converted to body composition using the “Fomon” or the “Butte” model. These models differ regarding the water content in fat-free mass (hydration factor, HF). We assessed HF and its biological variability in newborns and compared results calculated using the two models at one and 12 weeks. Body volume and body weight were measured in 12 infants less than 10 days old using Pea Pod. Their total body water was assessed using isotope dilution. Their HF was found to be 80.9% with low biological variability (0.81% of average HF). Further, Pea Pod was used to assess body density of 108 infants at one and 12 weeks of age. Values for body fat (%) calculated using the “Butte” model were significantly lower than when using the “Fomon” model at one week (p<0.05) and 12 weeks (p<0.01). The difference between the two models was particularly large at one week, probably due to their different HF-values. Our HF-value is in agreement with that in the “Fomon” model and our results support the conclusion that this model is preferable when calculating body composition in infants.

  • 16.
    Eriksson, Britt
    et al.
    Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Löf, Marie
    Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Forsum, Elisabet
    Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Body composition in full-term healthy infants measured with air displacement plethysmography at 1 and 12 weeks of age2010In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 99, no 4, p. 563-568Article in journal (Refereed)
    Abstract [en]

    Aim: To use Pea Pod, a device based on air displacement plethysmography, to study body composition of healthy, full-term infants born to well-nourished women with a western life-style. Methods: Body composition was assessed in 53 girls and 55 boys at 1 week (before 10 days of age) and at 12 weeks (between 77 and 91 days of age). Results: At 1 week girls contained 13.4 +/- 3.7% body fat and boys 12.5 +/- 4.0%. At 12 weeks, these figures were 26.3 +/- 4.2% (girls) and 26.4 +/- 5.1% (boys). Body fat (%) did not differ significantly between the genders. Body fat (%) at the two measurements was not correlated. At 1 week, the weight (r = 0.20, p = 0.044) and BMI (r = 0.26, p = 0.007) of the infants, but not their body fat (g, %) or fat free mass (g), correlated with BMI before pregnancy in their mothers. Conclusions: Pea Pod has potential for use in studies investigating the effect of external (i.e. nutritional status) and internal (i.e. age, gender, gestational age at birth) factors on infant body composition. This may be of value when studying relationships between the nutritional situation during early life and adult health.

  • 17.
    Eriksson, Mats
    et al.
    Örebro University, School of Health and Medical Sciences.
    Gradin, Maria
    Örebro University, School of Health and Medical Sciences.
    Pain management in Swedish neonatal units: a national survey2008In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 97, no 7, p. 870-874Article in journal (Refereed)
    Abstract [en]

    AIM: The aim of this study was to investigate the degree to which Swedish neonatal units have adopted the national guidelines for prevention and treatment of pain in newborn infants. METHOD: A survey was sent to all units in Sweden that provide neonatal care. For a list of potentially painful procedures, compiled from the national neonatal pain guidelines, the units were asked if they would use pharmacological and/or behavioural interventions, and in each case to specify the treatment. RESULTS: The response rate was 80.4%. Eighty-eight percent of the units had written guidelines for pain management, and 59% of these had been updated within the last 2 years. For almost every presented case, all units reported that they used either pharmacological or behavioural treatment or both. The survey showed a wide variation in morphine and paracetamol dosing and the absence of a paracetamol loading dose in a fourth of the units. CONCLUSIONS: This study suggests that a majority of Swedish neonatal units have adopted pain management guidelines in concordance with the Swedish national guidelines, and kept them up-to-date. For most painful situations a variety of behavioural and pharmacological interventions are used, often in combination.

  • 18.
    Eriksson, Mats
    et al.
    Örebro University, School of Health and Medical Sciences.
    Storm, Hanne
    Fremming, Asbjörn
    Schollin, Jens
    Örebro University, School of Health and Medical Sciences.
    Skin conductance compared to a combined behavioural and physiologicalpain measure in newborn infants2008In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 97, no 1, p. 27-30Article in journal (Refereed)
    Abstract [en]

    AIM: To assess the ability of galvanic skin response (GSR) to differentiate between tactile and painful stimulation in newborn infants, and to compare this with the ability of the premature infant pain profile (PIPP). METHODS: Thirty-two healthy full-term infants undergoing routine blood sampling were recruited. In a randomized order they were subjected to tactile and painful stimulation. The three GSR variables conductance baseline level, number of waves per second and mean amplitude of the waves were recorded together with the behavioural and physiological variables of PIPP. RESULTS: The GSR variables number of waves and amplitude of the waves increased more during painful stimulation than during tactile stimulation, as did also the PIPP score. Receiver operating characteristic curves analysis revealed no significant differences between the studied methods. CONCLUSION: GSR can differentiate painful from tactile stimulation, but more research is needed to achieve a clinically useful application.

  • 19.
    Fadl, Shalan
    et al.
    Department of Paediatrics, Örebro University Hospital, Örebro, Sweden.
    Wåhlander, Håkan
    The Queen Silvia Children`s Hospital, Institution of Clinical Sciences, Sahlgrenska University Hospital, Gothenburg University, Gothenburg, Sweden.
    Fall, Katja
    Örebro University, School of Medical Sciences.
    Cao, Yang
    Örebro University, School of Medical Sciences. Örebro University Hospital. Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Sunnegårdh, Jan
    The Queen Silvia Children`s Hospital, Institution of Clinical Sciences, Sahlgrenska University Hospital, Gothenburg University, Gothenburg, Sweden.
    The highest mortality rates in childhood dilated cardiomyopathy occur during the first year after diagnosis2018In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 107, no 4, p. 672-677Article in journal (Refereed)
    Abstract [en]

    AIM: The aim of the study was to assess the incidence, mortality and morbidity of dilated cardiomyopathy (DCM) and non-compaction of the left ventricle (LVNC) in Swedish children.

    METHODS: We reviewed hospital records of all children with dilated cardiomyopathy (DCM) or left ventricular non-compaction cardiomyopathy (LVNC) up to the age of 18 in the healthcare region of western Sweden from 1991 to 2015.

    RESULTS: In total, 69 cases (61% males) were identified. The combined incidence of DCM and LVNC was 0.77 (95% CI 0.59-0.96) per 100,000 person years. Children were divided into six groups and their outcomes were analysed depending on their aetiology. Idiopathic DCM was reported in 43% and familial dilated and left ventricular non-compaction aetiology was present in 32%. DCM due to various diseases occurred in 8%. DCM associated with neuromuscular diseases was present in 16%. The overall risk of death or receiving transplants in children with idiopathic and familial DCM was 30% over the study period and 21% died in the first year after diagnosis.

    CONCLUSION: The combined incidence of DCM and LVNC was similar to previous reports. Most children with idiopathic DCM presented during infancy and mortality was highest during the first year after diagnosis.

  • 20.
    Gradin, Maria
    et al.
    Örebro University Hospital, Örebro, Sweden.
    Eriksson, Mats
    Örebro University Hospital, Örebro, Sweden.
    Neonatal pain assessment in Sweden: a fifteen-year follow up2011In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 100, no 2, p. 204-208Article in journal (Refereed)
    Abstract [en]

    Background: It has been proposed that a systematic pain assessment increases the awareness of the need to treat and prevent pain, and most international and national neonatal pain guidelines state that pain assessment should be performed in a systematic way. National surveys show a wide variation in compliance to these guidelines.

    Methods: A survey to all Swedish neonatal units was performed in 1993, 1998, 2003 and 2008, concerning the use of, and need for, pain assessment tools.

    Results: The number of units that tried to assess pain increased from 64% in 1993 to 83% in 2008. Forty-four per cent of these used a structured method in 2003, compared to three per cent in 1998. The most common pain indicator was facial actions.

    Conclusion: The proportion of neonatal units that reported the use of a structured pain assessment tool has increased significantly from 1993 to 2008. There is a need for better evidence for the relation between the implementation of pain guidelines and the actual performance of pain assessment.

  • 21.
    Grjibovski, Andrej M
    et al.
    Unit for Preventive Nutrition, Department of Biosciences at Novum, Karolinska Institutet, Huddinge, Sweden; Institute of Hygiene and Medical Ecology, Northern State Medical University, Arkhangelsk, Russian Federation .
    Yngve, Agneta
    Unit for Preventive Nutrition, Department of Biosciences at Novum, Karolinska Institutet, Huddinge, Sweden .
    Bygren, Lars Olov
    Unit for Preventive Nutrition, Department of Biosciences at Novum, Karolinska Institutet, Huddinge, Sweden; Department of Community Medicine and Rehabilitation, Social Medicine, Umeå University, Umeå, Sweden .
    Sjöström, Michael
    Unit for Preventive Nutrition, Department of Biosciences at Novum, Karolinska Institutet, Huddinge, Sweden .
    Socio-demographic determinants of initiation and duration of breastfeeding in northwest Russia2005In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 94, no 5, p. 588-594Article in journal (Refereed)
    Abstract [en]

    AIM: This study examines socio-demographic determinants of initiation and duration of breastfeeding in a community-based cohort in northwest Russia.

    METHODS: All infants born to women who were registered at the antenatal clinics in Severodvinsk in 1999 comprised the cohort (n=1399) and were followed up at 1 y. Data on maternal and infant characteristics as well as the duration of breastfeeding were obtained from medical records. Proportional hazard analysis was applied to quantify the effect of the selected factors on the risk of breastfeeding discontinuation adjusted for potential confounders.

    RESULTS: Only 1.3% of infants were never breastfed. Breastfeeding rates were 75.0% and 47.2% at 3 and 6 mo, respectively. Maternal age and early initiation of prenatal care were positively associated with breastfeeding initiation rates. Increased risks of breastfeeding discontinuation were found in teenage mothers (OR=1.45, 95% CI: 1.06-1.99), in mothers with basic education (OR=1.68, 95% CI: 1.06-2.66) and in unmarried mothers (OR=1.19, 95% CI: 1.03-1.38). Women with no previous deliveries were more likely to breastfeed longer (OR=0.74, 95% CI: 0.62-0.90).

    CONCLUSIONS: Compared with previous studies in Russia, almost universal initiation and considerably higher rates of breastfeeding at specific time points were found. Social variations in initiation and duration of breastfeeding should raise concern of inequalities in breastfeeding practices in transitional Russia.

  • 22.
    Hagelin, Elisabeth
    et al.
    Department of Women's and Children's Health, Unit of Paediatrics, Uppsala University Children's Hospital, Uppsala, Sweden.
    Jackson, Karin
    Örebro University, Department of Nursing and Caring Sciences.
    Wikblad, Karin
    Falun College of Health and Caring Sciences, Falun, Sweden.
    Utilization of Child Health Services during the first 18 months of life: aspects of health surveillance in Swedish preschool children based on information in health records1998In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 87, no 9, p. 996-1002Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to evaluate some aspects of care given within the preventive Child Health Services (CHS) during the first 18 months of Life. A national random sample performed on child health records of 172 Swedish preschool children horn between 1982 and 1987 was analysed regarding services recorded as having been provided and used within and beyond the national programme of health surveillance. Most families had mode visits within the core programme of health surveillance to an optimal or at least sufficient extent. First-time parents visited the CHS more frequently than did more experienced parents. Procedures within the programme, such as growth monitoring, hip examination and immunizations, were documented to have been optimally performed on a majority of the children. Conversely, screening for hearing impairment and assessment of developmental milestones were performed less frequently, as were health information and postnatal parental education. To improve the quality of care, national recommendations ought to be more specific regarding both the performance and the documentation of the service.

  • 23. Hansson, M. G.
    et al.
    Kihlbom, Ulrik
    Örebro University, School of Humanities, Education and Social Sciences.
    Tuvemo, T.
    Rodriguez, A.
    Concern for privacy in relation to age during physical examination of children: an exploratory study2009In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 98, no 8, p. 1349-1354Article in journal (Refereed)
    Abstract [en]

    Objectives: To explore whether physicians behave differently regarding ethics and respect for privacy depending on children's age. We explored whether physician behaviours contributed to child uneasiness.

    Study design: Observational study of 21 children (0-12 years; 18 boys; mean age 3.2) undergoing evaluation for inguinal hernia. Specific physician-initiated verbal and nonverbal behaviours were coded from digital video discs of the consultations.

    Results: Physician intrusiveness (i.e. approaching the child suddenly or in an uninvited way) during the physical examination was related to concurrent child uneasiness (r = 0.42, p < 0.06) and lasted through the postexamination phase of the consultation (r = 0.52, p < 0.01). Child mood during the examination strongly predicted postexamination mood (r = 0.69, p < 0.0001). Neither the total number of physician-initiated positive behaviours or privacy-related behaviours was associated with child age. Negative physician behaviours were strongly related to negative mood in the child (r = 0.72, p < 0.0001) at the close of the consultation.

    Conclusion: Although physicians were more likely to provide information to older than younger children, their behaviours regarding privacy did not differ by child age. We found that intrusiveness was rather common and related to child uneasiness that has implications for the ethical practice and a child's willingness to be examined.

  • 24.
    Hasselgren, Mikael
    et al.
    Department of Public Health and Caring Sciences, Section of Family Medicine and Clinical Epidemiology, Uppsala University, Uppsala, Sweden; Primary Care Research Unit, Vårdcentralen Kronoparken, Karlstad, Sweden.
    Gustafsson, D
    Department of Paediatrics, Örebro University Hospital, Örebro, Sweden.
    Ställberg, B
    Department of Public Health and Caring Sciences, Section of Family Medicine and Clinical Epidemiology, Uppsala University, Uppsala, Sweden.
    Lisspers, K
    Department of Public Health and Caring Sciences, Section of Family Medicine and Clinical Epidemiology, Uppsala University, Uppsala, Sweden.
    Johansson, G
    Department of Public Health and Caring Sciences, Section of Family Medicine and Clinical Epidemiology, Uppsala University, Uppsala, Sweden.
    Management, asthma control and quality of life in Swedish adolescents with asthma2005In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 94, no 6, p. 682-688Article in journal (Refereed)
    Abstract [en]

    AIM: In Sweden, paediatricians or general practitioners treat most adolescents with asthma. This study compares management, treatment goals and quality of life for adolescents aged 15-18 y in paediatric or primary care.

    MATERIAL AND METHODS: A random sample of patients answered a disease-specific and a quality-of-life (MiniAQLQ) questionnaire.

    RESULTS: The 146 adolescents in paediatric care had more years with asthma, better continuity of annual surveillance, higher use of inhaled steroids and a stated better knowledge of their asthma than the 174 patients in primary care. No difference could be detected in asthma control or quality of life. Of all 320 adolescents, approximately 20% had woken at night due to asthma symptoms during the last week. About 15% had made unscheduled, urgent care visits and a third had used short-acting beta-agonist relievers more than twice a week. Quality-of-life scores were high and similar in both settings.

    CONCLUSIONS: Swedish adolescents with asthma are managed and treated somewhat differently in paediatric and primary care but with equal and, for the most part, satisfying results. The difference between the two settings probably reflects both differences in severity of asthma and different treatment traditions. For all adolescents, better fulfilment of goals regarding symptoms and exacerbations would be desirable, whereas a good quality of life including normal physical activity seems to have been achieved.

  • 25.
    Hermansson, Liselotte
    et al.
    Örebro University Hospital, Örebro, Sweden; Karolinska Institute, Stockholm, Sweden.
    Eliasson, A. C.
    Karolinska Institute, Stockholm, Sweden.
    Engström, Ingemar
    Örebro University, Department of Clinical Medicine.
    Psychosocial adjustment in Swedish children with upper-limb reduction deficiency and a myoelectric prosthetic hand2005In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 94, no 4, p. 479-88Article in journal (Refereed)
    Abstract [en]

    AIM: To study psychosocial adjustment and mental health in children with upper-limb reduction deficiency and a myoelectric prosthetic hand.

    METHODS: Sixty-two parents of children aged 8 to 18 y old answered a questionnaire concerning competence and behaviour/emotional problems in their children. Of the 62 children, 37 adolescents aged 11 to 18 y old answered questionnaires concerning competence, problems and mood state. The results were compared with Swedish normative data. The children were divided into five groups based on degree of myoelectric prosthetic use.

    RESULTS: Children with upper-limb reduction deficiency and a myoelectric prosthetic hand showed social competence and behaviour/emotional problems similar to Swedish standardized norms. However, withdrawn behaviour was significantly higher in all children, social competence was significantly lower in girls, and social activities were significantly lower in older children with upper-limb reduction deficiency. There was a significant difference between prosthetic use groups. Non-users had significantly more delinquent behaviour problems than full-time users. There was an interaction between gender and prosthetic use in their affect on competence and behaviour/emotional problems, yielding two contrasting patterns.

    CONCLUSION: Children with upper-limb reduction deficiency and a myoelectric prosthetic hand are as well adjusted psychosocially as their able-bodied peers. There are indications, however, of social stigmata related to the deficiency, which have to be considered differently in boys and girls.

  • 26. Huus, Karina
    et al.
    Brekke, Hilde K.
    Ludvigsson, Jonas F.
    Örebro University, School of Health and Medical Sciences.
    Ludvigsson, Johnny
    Relationship of food frequencies as reported by parents to overweight and obesity at 5 years2009In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 98, no 1, p. 139-143Article in journal (Refereed)
    Abstract [en]

    AIM: To investigate if food frequencies are related to overweight/obesity in 5-year-old children.

    METHODS: During 1997-1999, 21 700 infants were invited to participate in ABIS (All Babies in Southeast Sweden), a prospective, cohort study. Participants were followed from birth (n = 16 058) to 5 years (n = 7356). Food frequencies reported by parents at 2.5 and 5 years were studied in the relation to overweight/obesity at 5 years using multiple logistic regressions. A p-value < 0.01 was considered statistically significant.

    RESULTS: At 2.5 years frequencies of intake of cheese were positively associated with overweight/obesity at 5 years while porridge, fried potatoes/french fries and cream/crème fraiche showed a negative association. When adjusting for known risk factors, porridge and fried potatoes/french fries remained negatively associated with overweight/obesity. At 5 years, chocolate and lemonade were positively associated with overweight/obesity whereas cream/crème fraiche, pastries and candy were negatively associated. Candy remained negatively associated to overweight/obesity after adjustment for potential confounders.

    CONCLUSION: Food frequencies do not offer any simple explanation for overweight/obesity. Porridge at 2.5 years may protect against overweight/obesity at 5 years, while lemonade may contribute to overweight. Our finding that fried potatoes/french fries may protect against overweight/obesity is unexpected and must be interpreted with caution. These findings should be confirmed by prospective studies using objective recordings.

  • 27. Huus, Karina
    et al.
    Ludvigsson, Jonas F.
    Örebro University, School of Health and Medical Sciences.
    Enskär, Karin
    Ludvigsson, Johnny
    Risk factors in childhood obesity: findings from the All Babies In Southeast Sweden (ABIS) cohort2007In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 96, no 9, p. 1321-1325Article in journal (Refereed)
    Abstract [en]

    Aim: Our objective was to investigate whether overweight at a very young age predicts overweight at 5 years and to identify risk factors for overweight/obesity at 5 years, thereby making it easier for Child Health Services to focus their prevention strategies on risk groups.

    Methods: We analysed data from the ABIS study (All Babies In Southeast Sweden), a prospective cohort study. Parents answered questionnaires between childbirth (n = 16,058) and 5 years (n = 7356).

    Results: High body mass index (BMI; >95th percentile) at 1 year (adjusted odds ratio [AOR]= 6.57; 95% CI = 4.63–9.33; p < 0.001) and age-adjusted BMI > 25 at 2.5 years (AOR = 14.24; 95% CI = 10.52–19.29; p < 0.001) were associated with increased risk of obesity (age-adjusted BMI > 30) at 5 years. Heredity for type 2 diabetes (p = 0.022), high parental BMI and the child's own BMI at birth and at 1 year predicted higher BMI of the child at 5 years (p < 0.001). High parental education was inversely associated with child overweight (p = 0.054 respective p < 0.005).

    Conclusion: Obesity at age 1 and at 2.5 years predicts obesity at 5 years. Obese parents, especially in families with heredity for type 2 diabetes and low education, should be targeted in early obesity prevention strategies by the Child Health Service.

  • 28.
    Ivarsson, Mikael
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Schollin, Jens
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Björkqvist, Maria
    Örebro University Hospital.
    Staphylococcus epidermidis and Staphylococcus aureus trigger different interleukin-8 and intercellular adhesion molecule-1 in lung cells: implications for inflammatory complications following neonatal sepsis2013In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 102, no 10, p. 1010-1016Article in journal (Refereed)
    Abstract [en]

    Aim: Staphylococci are a major contribution for neonatal sepsis, which is the main risk factor for bronchopulmonary dysplasia. This study investigated the expression of pro-inflammatory mediators in endothelial and respiratory cells from newborns exposed to staphylococci.

    Methods: Human vascular endothelial cells and small airway epithelial cells were incubated with neonatal blood isolates of Staphylococcus epidermidis (n = 14) and Staphylococcus aureus (n = 14). The extracellular release of IL-8, IL-10, sICAM-1, ICAM-1 mRNA and the expression of membrane bound ICAM-1 were assessed by ELISA, RT-PCR and immunofluorescence microscopy.

    Results: Staphylococcus epidermidis induced higher levels of IL-8 (mean 38.5 ng/mL) and ICAM-1 mRNA (mean ratio 1.037) in the small airway epithelial cells than S. aureus (IL-8 mean 22.2 ng/mL, p < 0.01 and ICAM-1 mRNA mean ratio 0.715, p < 0.01). In the endothelial cells, ICAM-1 remained more integrated in the cell membranes after exposure to S. epidermidis compared with S. aureus, which induced disintegration and release of soluble ICAM-1 into the supernatants.

    Conclusion: Staphylococcus epidermidis induced a higher chemoattractive response than S. aureus. A persistent transmigration of granulocytes into the lung tissue in neonatal S. epidermidis sepsis might contribute to the development of bronchopulmonary dysplasia.

  • 29.
    Jackson, Karin
    et al.
    Örebro University, Department of Nursing and Caring Sciences.
    Schollin, Jens
    Department of Paediatrics, Örebro Medical Centre Hospital, Örebro, Sweden.
    Bodin, Lennart
    Örebro University, Department of Nursing and Caring Sciences. Department of Statistics, Örebro University and Örebro Medical Centre Hospital, Örebro, Sweden,.
    Ternestedt, Britt-Marie
    Örebro University, Department of Nursing and Caring Sciences.
    Utilization of healthcare by very-low-birthweight infants during their first year of life2001In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 90, no 2, p. 213-217Article in journal (Refereed)
    Abstract [en]

    New knowledge in perinatal medicine has resulted in increased survival of very-low-birthweight (VLBW) infants. After leaving hospital, the child is seen at regular medical check-ups, but there is often a persistent worry about the child which affects the family as a whole. This can lead to an increased utilization of healthcare. Our objective was therefore to describe the utilization of healthcare by VLBW infants during their first year of life and its relation to high-risk diagnoses in the neonatal period. The study group comprised 36 infants born at gestational ages of < or = 31 wk and with a birthweight of < or = 1500 g, and was compared with a control group of 36 full-term infants. Utilization of healthcare by the VLBW infants was higher than that by the control group in paediatric and ophthalmic outpatient clinics. The total number of contacts with healthcare was on average 38.7 versus 17.4. High-risk diagnoses in the neonatal period did not correlate with utilization of care, except for visits to the paediatric outpatient clinic, especially planned visits. Further studies focusing on how to support these families after leaving hospital are therefore needed.

  • 30.
    Jackson, Karin
    et al.
    Örebro University, School of Health and Medical Sciences.
    Ternestedt, Britt-Marie
    Örebro University, School of Health and Medical Sciences. Department of Health Care Sciences, Ersta Sköndal University College, Stockholm, Sweden.
    Magnuson, Anders
    Clinical Research Centre, Örebro University Hospital, Örebro, Sweden.
    Schollin, Jens
    Department of Paediatrics, Örebro University Hospital, Örebro, Sweden.
    Parental stress and toddler behaviour at age 18 months after pre-term birth2007In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 96, no 2, p. 227-232Article in journal (Refereed)
    Abstract [en]

    AIM: To describe the parent's judgement of their own stress and the child's behaviour at 18 months after pre-term birth and if there are any correlations between these assessments, the morbidity in the neonatal period, the gestational age at birth and the occurrence of twin/triplet births. METHOD: Twenty-one mothers and 19 fathers of pre-term infants answered two questionnaires, The Swedish Parenthood Stress Questionnaire (SPSQ) and The Toddler Behaviour Questionnaire (TBQ). RESULTS: Mothers scored somewhat higher than fathers concerning parental stress. Parents with twins/triplets and of children born in gestational week 25-30 felt more stress, though the differences were not statistically significant. High-risk diagnoses did not correlate to any of the dimensions. The parents judged the behaviour of the children similar except that parents of children born in gestational week 25-30 scored significantly higher for intensity/activity (p = 0.002). The correlation between parental stress and judgement of their children's behaviour did not show any significant association except for the dimension regularity in TBQ (p = 0.016). CONCLUSIONS: The mothers' and fathers' assessments of their own stress and of the children's behaviour were similar. Parents of very pre-term children felt more stress and judged the children somewhat delayed in their social behaviours, probably due to their low gestational age.

  • 31.
    Jackson, Karin
    et al.
    Örebro University, Department of Nursing and Caring Sciences.
    Ternestedt, Britt-Marie
    Örebro University, Department of Nursing and Caring Sciences. Department of Health Care Sciences, Ersta Sköndal University College, Stockholm, Sweden.
    Magnuson, Anders
    Clinical Research Centre, Örebro University Hospital, Örebro, Sweden.
    Schollin, Jens
    Department of Paediatrics, Örebro University Hospital, Örebro, Sweden.
    Quality of care of the preterm infant: the parent and nurse perspective2006In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 95, no 1, p. 29-37Article in journal (Refereed)
    Abstract [en]

    AIM: To study the subjective opinions about what is important in care at neonatal units and child health centres (CHCs) for premature newborns, and to compare these opinions with the care actually given. SUBJECTS: 21 mothers, 20 fathers and 15 nurses at the neonatal unit, and 21 mothers, 14 fathers and 18 nurses at CHCs.

    METHODS: A questionnaire on quality of Care from the Patient's Perspective was used. It contained three dimensions: identity-oriented approach, medical-technical competence and socio-cultural atmosphere. Each dimension was evaluated in terms of subjective importance and perceived reality of given care.

    RESULTS: In general, subjective importance was rated higher than perceived reality both for neonatal care and care at CHCs for the dimensions identity-oriented approach and medical-technical competence. However, higher ratings were given to neonatal care compared to CHCs for medical-technical competence. High-risk diagnoses and very low gestational age in the newborn did not affect the answers. Mothers rated medical-technical competence higher than nurses for neonatal care. Mothers and nurses rated identity-oriented approach higher than fathers for CHCs.

    CONCLUSION: Although both neonatal care and care at CHCs were highly rated, improvements can be made to fulfil the expectations of parents and nurses. Neonatal units seem to be more efficient in taking care of the special needs of these newborns compared to CHCs. The need for an optimal identity-oriented approach, medical-technical competence and socio-cultural atmosphere could strengthen the possibilities of parents to be confident in their parental role.

  • 32.
    Jönson Ring, Ingrid
    et al.
    Department of Orthodontics, Public Dental Service, Uppsala, Sweden; Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
    Nevéus, Tryggve
    Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
    Markström, Agneta
    Department of Medical Sciences, Lung, Allergy, and Sleep Research, Uppsala University, Uppsala, Sweden.
    Arnrup, Kristina
    Örebro University, School of Health Sciences. Örebro University Hospital. Dental Research Department, Public Dental Service, Region Örebro County, Örebro, Sweden.
    Bazargani, Farhan
    Department of Orthodontics, Postgraduate Dental Education Centre, Public Dental Service, Region Örebro County, Örebro, Sweden.
    Nocturnal enuresis impaired children's quality of life and friendships2017In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 106, no 5, p. 806-811Article in journal (Refereed)
    Abstract [en]

    Aim: There have not been any continence-specific measurement tools in Swedish that have allowed clinicians to investigate the quality of life (QoL) in children with bladder dysfunction. This study evaluated the QoL in Swedish children with nocturnal enuresis and tested the reliability of a Swedish translation of the Paediatric Incontinence Questionnaire (PinQ).

    Methods: This prospective study comprised 46 children aged 6-18 years with nocturnal enuresis, who completed the PinQ after it was translated into Swedish. It was completed twice by 33 patients and these responses were included in the test re-test evaluation.

    Results: The self-reported mean sum score for the whole group was 26.3 ± 13.37 (range 5-58) and the most affected domains were social relations with peers and self-esteem. The highest individual scores were four, three or two for 71.7%, 17.4%, and 10.9% of the study population, respectively. Cronbach's alpha was 0.87 for the whole questionnaire, indicating good internal consistency. The test re-test stability was excellent, with an intra-class correlation coefficient of 0.76.

    Conclusion: Children with nocturnal enuresis had impaired self-esteem and their impaired QoL affected their relationships with friends. The Swedish version of the PinQ proved to be a reliable tool that will be used in further studies.

  • 33. Lennell, Anne
    et al.
    Kühlmann-Berenzon, Sharon
    Geli, Patricia
    Hedin, Katarina
    Petersson, Christer
    Cars, Otto
    Mannerquist, Kerstin
    Burman, Lars G.
    Fredlund, Hans
    Örebro University, School of Health and Medical Sciences.
    Alcohol-based hand-disinfection reduced children's absence from Swedish day care centers2008In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 97, no 12, p. 1672-1680Article in journal (Refereed)
    Abstract [en]

    Aim: To determine if the use of alcohol-based hand-disinfection as a complement to regular hand washing at daycare centers (DCCs) can reduce the childhood rate of absenteeism. Methods: Children aged 0–6 years attending DCC were studied in a cluster randomized controlled trial during 30 weeks. Thirty matched pairs of DCCs were included in the study, where one of the DCCs was randomized to intervention and the other to control within each pair. The intervention consisted in children and staff using alcohol-based oily disinfectant gel containing 70% ethanol after regular hand washing. The main outcome was the rate of episodes of absence from DCC due to infection. A regression model was fitted at the individual level and controlling several possible confounders for illness. Absences were reported by the parents. Results: Differences in missing absence reports between the two groups led to only evaluating those 29 DCCs (1431 children) that were able to provide complete reports. In the multivariate regression, the intervention significantly reduced the rate of absenteeism of a child by 12% compared to a child in a control DCC (IRR 95% CI: 0.799–0.965).

  • 34. Liljedahl, Magnus
    et al.
    Martin, Helena
    Magnuson, Anders
    Montgomery, Scott M.
    Örebro University, School of Health and Medical Sciences.
    Schollin, Jens
    Endothelial function in children with a history of premature prolonged rupture of membranes and bronchopulmonary dysplasia: a pilot study2008In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 97, no 7, p. 909-914Article in journal (Refereed)
    Abstract [en]

    

    Aim: To investigate vascular function in children with a neonatal history of generalised inflammation indicated by premature prolonged rupture of membranes (PPROM) and bronchopulmonary dysplasia (BPD).

    Methods: Children born at ≤ 30 weeks 1994–2000 were investigated at a present age of 6–12 years. Twenty-eight children participated and were divided into two groups with regard to BPD/no BPD (n = 15/13) and PPROM/no PPROM (n = 10/18). Vascular endothelial function was assessed by acetylcholine (ACh)-induced skin vasodilatation.

    Results: Maximum ACh-induced skin perfusion was statistically significantly lower in the PPROM group compared with the non-PPROM group (p = 0.045) after adjustment for confounders. We found no association between BPD and maximum ACh-induced skin perfusion (p = 0.404), after adjustment for confounders.

    Conclusion: A neonatal history of prolonged premature rupture of membranes was associated with later impairment of vascular endothelial function in childhood. This association was not observed with BPD. Some forms of perinatal inflammation may be associated with later cardiovascular function.

  • 35.
    Lillvist, Anne
    et al.
    Örebro University, School of Law, Psychology and Social Work. Sch Sustainable Dev Soc & Technol, Malardalen Univ, Västerås, Sweden; Res Program CHILD, Jönköping Univ, Jönköping, Sweden.
    Granlund, Mats
    Jönköping Univ, Jönköping, Sweden.
    Preschool children in need of special support: prevalence of traditional disability categories and functional difficulties2010In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 99, no 1, p. 131-134Article in journal (Refereed)
    Abstract [en]

    Aim: To investigate the prevalence of children who are in need of special support in the total population of children attending preschools (CA 1-6) in two Swedish counties, and the functional problems exhibited by the children in relation to demographical and environmental factors in the preschool context. Method: Survey distributed to (N = 1138) preschools in two Swedish counties. Results: The majority of children perceived by preschool teachers and in need of special support were undiagnosed children with functional difficulties related to speech, language and interaction with peers. Conclusion: Undiagnosed and diagnosed children share the same type of difficulties. Thus, in estimating the prevalence of children in need of special support in a preschool context, traditional disability categories capture only a small proportion of the children experiencing difficulties. Therefore, a functional approach in studies of children in need of special support is recommended.

  • 36.
    Lindström, Caisa
    et al.
    Örebro University, School of Health and Medical Sciences. Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Åman, Jan
    Örebro University, School of Health and Medical Sciences. Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Lindahl Norberg, Annika
    Karolinska Institute, Stockholm, Sweden.
    Increased prevalence of burnout symptoms in parents of chronically ill children2010In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 99, no 3, p. 427-432Article in journal (Refereed)
    Abstract [en]

    Aim: To examine the prevalence of burnout symptoms in the context of parenting a chronically ill child. Methods: A total of 252 parents of children with Type 1 Diabetes Mellitus and 38 parents of children with Inflammatory Bowel Diseases participated in a population-based study. A control group consisted of 124 randomly selected parents of healthy children. We used self-report questionnaires to assess symptoms of burnout. Results: The main finding was that significantly more parents of children with chronic diseases (36%) scored for clinical burnout, compared with parents of healthy children (20%). Burnout symptoms were most prominent among mothers of children with diabetes, although fathers of children with diabetes and mothers and fathers of children with inflammatory bowel diseases also reported higher levels of various burnout symptoms. Conclusion: Burnout may be a useful model for understanding long-term parental responses and should be acknowledged among the different types of psychological consequences of the multi-faceted experience of parenting a child with chronic illness. Gender seems to influence the risk of burnout symptoms. Continued research about other background factors, and how the parents' situation changes over time are warranted. In the clinic, we need to draw attention to the group of parents who may suffer from burnout.

  • 37.
    Lindström, Caisa
    et al.
    Örebro University, School of Health and Medical Sciences.
    Åman, Jan
    Örebro University, School of Health and Medical Sciences.
    Lindahl Norberg, Annika
    Parental burnout in relation to sociodemographic, psychosocial and personality factors as well as disease duration and glycaemic control in children with Type 1 diabetes mellitus2011In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 100, no 7, p. 1011-1017Article in journal (Refereed)
    Abstract [en]

    Aim: To examine associations between burnout and sociodemographic, psychosocial, personality and medical factors in parents of children with Type 1 Diabetes Mellitus (T1DM). Methods: A total of 252 parents of children with T1DM participated in a population-based study. We used self-report questionnaires to assess symptoms of burnout and background factors. Results: Psychosocial background factors were significantly associated with burnout in parents, whereas there were no associations between sociodemographic or medical factors and burnout. For both genders, parental burnout was associated with low social support, lack of leisure time, financial concerns and a perception that the child's disease affects everyday life. Low self-esteem and high need for control were risk factors for maternal burnout. Conclusion: In the screening of risk factors for long-term stress in parents of children with T1DM, we should recognize parents' attitudes as well as situational psychosocial issues. In clinics, we need to pay attention to the day-to-day life circumstances in the support of these parents. Certain factors were associated with the risk for burnout only for mothers, which warrant further investigation of gender aspects. Continued research about the causal relationship between the parental responsibility, psychosocial factors and burnout is warranted.

  • 38.
    Ludvigsson, Jonas F.
    Örebro University, Department of Clinical Medicine.
    Epidemiological study of constipation and other gastrointestinal symptoms in 8000 children2006In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 95, no 5, p. 573-580Article in journal (Refereed)
    Abstract [en]

    AIM: Adult studies indicate that gastrointestinal symptoms vary with sex and socioeconomic status. We examined socioeconomic factors, infant sex, smoking and gastrointestinal symptoms, especially constipation, in 2.5 year-old children. METHODS: This study was part of a prospective cohort study of children born 01.10.97-01.10.99 (the ABIS study; All Babies in Southeast Sweden). Socioeconomic factors, infant sex, smoking were analyzed vs. constipation, diarrhoea, anorexia, abdominal pain, meteorism and vomiting using logistic regression. All data were obtained through questionnaires distributed at infant birth, at 1 and 2.5 years of age. RESULTS: Out of 8341 children, 539 (6.5%) suffered from constipation. In a backward stepwise regression analysis (AOR; and 95% CI AOR = are given within brackets), constipation correlated with low maternal education (1.60; 1.08-2.35), female sex (1.52; 1.23-1.85), living in a large community with >3000 inhabitants (1.35; 1.09-1.64) and having no older siblings (1.28; 1.04-1.59). Smoking during pregnancy was linked to diarrhoea (multivariate analysis: 1.76; 1.02-3.02), anorexia (univariate analysis: 1.43; 1.09-1.87) and meteorism (univariate analysis: 1.58; 1.11-2.27). Adjusting for confounders, paracetamol use was linked to a five-fold increased risk of anorexia (5.12; 1.26-20.70). CONCLUSIONS: This study indicates that socioeconomic status, infant sex and parental smoking, are associated with gastrointestinal symptoms in children.

  • 39.
    Ludvigsson, Jonas F.
    Örebro University Hospital. Örebro University, School of Medical Sciences. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro, Sweden; Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK; Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York NY, USA.
    Extensive shaken baby syndrome review provides a clear signal that more research is needed2017In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 106, no 7, p. 1028-1030Article in journal (Refereed)
  • 40.
    Ludvigsson, Jonas F.
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro University, Örebro, Sweden; Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK; Department of Medicine, Columbia University College of Physicians and Surgeons, New York NY, USA.
    Hadjipanayis, Adamos
    Department of Pediatrics, Larnaca General Hospital, Larnaca, Cyprus; Medical School, European University of Cyprus, Nicosia, Cyprus.
    del Torso, Stefano
    Dipartimento della sanità pubblica, ULSS 6 EUGANEA, Padua, Italy.
    Mercier, Jean-Christophe
    Service de Pédiatrie-Urgences, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris and Université Paris Diderot, Paris, France.
    Valiulis, Arunas
    Clinic of Children’s Diseases and Public Health Institute, Vilnius University, Vilnius, Lithuania.
    Stiris, Tom
    Department of Neonatology, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway.
    Appropriate use of antibiotics is vital for public health2017In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 106, no 5, p. 691-691Article in journal (Refereed)
  • 41.
    Ludvigsson, Jonas F.
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro, Sweden; Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, City Hospital, Nottingham, UK; Department of Medicine, Celiac Disease Center, Columbia University College of Physicians and Surgeons, New York NY, USA.
    Lebwohl, Benjamin
    Department of Medicine, Celiac Disease Center, Columbia University College of Physicians and Surgeons, New York NY, USA.
    Screening for coeliac disease in type 1 diabetes2017In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 106, no 4, p. 530-531Article in journal (Refereed)
  • 42.
    Neveus, Tryggve
    et al.
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Leissner, Lena
    University Hospital Örebro, Örebro, Sweden.
    Rudblad, Stig
    Örebro University Hospital.
    Bazargani, Farhan
    Örebro University Hospital. Department of Orthodontics, Postgraduate Dental Education Center, Örebro, Sweden.
    Orthodontic widening of the palate may provide a cure for selected children with therapy-resistant enuresis2014In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 103, no 11, p. 1187-1191Article in journal (Refereed)
    Abstract [en]

    Aim: According to a number of small case series, orthodontic treatment may have anti-enuretic effects. Thus, we evaluated whether widening of the palate can alleviate enuresis and whether prognostic information can be gained from examining children's nocturnal respiration and nasal airway dimensions.

    Methods: Children with therapy-resistant enuresis underwent polysomnography, focusing on nocturnal respiration, and had their nasal airways examined. Rapid maxillary expansion was performed, widening the maxilla by approximately 0.5cm. The dental appliance was removed after 6months. Enuresis frequency was evaluated four times: at baseline, with the orthodontic apparatus in situ, after completed maxillary expansion and 1year post-treatment.

    Results: Of the 34 children recruited, one dropped out due to oral discomfort. The numbers of wet nights per week on the four assessment occasions were 5.481.48, 5.12 +/- 1.73, 3.09 +/- 2.49 and 2.63 +/- 2.81; p<0.001. The proportions of responders, intermediate responders and non-responders during treatment were 21.2%, 27.3% and 51.5%, respectively. Responders were found to have a lower enuresis frequency at baseline (p=0.001) and to have larger nasal airway dimensions (p=0.01).

    Conclusion: Orthodontic widening of the palate may be curative in a subgroup of children with therapy-resistant enuresis.

  • 43.
    Neveus, Tryggve
    et al.
    Dept Womens & Childrens Hlth, Uppsala Univ, Uppsala, Sweden.
    Leissner, Lena
    Dept Neurol, Univ Hosp Örebro, Örebro, Sweden.
    Rudblad, Stig
    Örebro University Hospital. Dept Otorhinolaryngol, Örebro University Hospital, Örebro, Sweden.
    Bazargani, Farhan
    Örebro University Hospital. Dept Orthodont, Postgrad Dent Educ Ctr, Örebro, Sweden..
    Respiration during sleep in children with therapy-resistant enuresis2014In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 103, no 3, p. 300-304Article in journal (Refereed)
    Abstract [en]

    AimAlthough there is a known association between enuresis and snoring or sleep apnoeas, respiration during sleep has not been thoroughly studied in enuretic children. This study was performed with the aim of filling this gap in our knowledge. MethodsThirty-four children with therapy-resistant enuresis, but no history of heavy snoring or sleep apnoeas, underwent sleep registrations, including standard electroencephalography (EEG) and electrooculography (EOG) as well as registration of oxygen saturation, respiratory effort and nasal air flow. To assess nasal airway patency, rhinomanometry and acoustic rhinometry were performed before and after nasal decongestion. ResultsThe children were found to have a higher than expected apnoea hypopnoea index (AHI), due to a high frequency of hypopnoeas. They were also noted to have a tendency for respiratory arousals. Standard polysomnographic variables were normal. ConclusionWe provide baseline data of nocturnal respiration in enuretic children. The children were found to have subclinical signs of disordered respiration. This may be one of the explanations for their high arousal thresholds.

  • 44.
    Nilsen, Bente B.
    et al.
    Örebro University, School of Hospitality, Culinary Arts & Meal Science. Department of Nursing and Health Promotion, Oslo and Akershus University College of Applied Science, Oslo, Norway.
    Yngve, Agneta
    Örebro University, School of Hospitality, Culinary Arts & Meal Science. Sophiahemmet University, Stockholm, Sweden.
    Sjöberg, Agneta
    Department of Food and Nutrition, and Sport Science, University of Gothenburg, Gothenburg, Sweden.
    Moraeus, Lotta
    Department of Food and Nutrition, and Sport Science, University of Gothenburg, Gothenburg, Sweden.
    Lissner, Lauren
    Department of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden.
    Werner, Bo
    Örebro University, School of Medical Sciences. School of Hospitality, Culinary Arts and Meal Science, Örebro University, Örebro, Sweden.
    Using different growth references to measure thinness and overweight among Swedish primary school children showed considerable variations2016In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 105, no 10, p. 1158-1165Article in journal (Refereed)
    Abstract [en]

    Aim: The study compared how four different growth references determined the prevalence of thinness and overweight, based on height and weight measurements from a nationally representative sample of Swedish children from seven to nine years of age.

    Methods: The height and weight measurements of 4,518 Swedish schoolchildren aged seven to nine years were carried out in 2008 using a standardised protocol. The prevalence of different degrees of thinness and overweight were calculated using international growth references from the World Health Organization, the International Obesity Task Force and two Swedish growth references from Werner and Karlberg.

    Results: Depending on which growth reference we used, the prevalence of different degrees of thinness varied from 7.5%-16.9% for the boys and 6.9%-13.7% for the girls, while for the prevalence of overweight, including obesity and severe obesity, varied from 16.5%-25.7% for the boys and 18.2-25.2% for the girls. There were also significant gender differences depending on the growth reference we used.

    Conclusion: Using four different growth references, two international and two Swedish, produced wide variations in the prevalence of thinness and overweight, together with significant gender differences. In the absence of a global definition, we need both national and international growth references.

  • 45.
    Nilsen, Bente B.
    et al.
    Örebro University, School of Hospitality, Culinary Arts & Meal Science. Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway.
    Yngve, Agneta
    Department of food, nutrition and dietetics, Uppsala University, Uppsala, Sweden.
    Werner, Bo
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Do substantial BMI reduction episodes among Swedish schoolchildren have any impact on their final height?2018In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 107, no 7, p. 1223-1229Article in journal (Refereed)
    Abstract [en]

    AIM: This study investigated whether substantial body mass index (BMI) reductions in Swedish schoolchildren aged 7-19 years, caused by disease, healthy or unhealthy behaviour, had any impact on their final height.

    METHODS: We used height and weight data on 6,572 subjects from two nationally representative longitudinal samples of Swedish children born in 1973 and 1981. These provided information on their final height and any BMI reduction episodes.

    RESULTS: Of the 6,572 subjects (50.9% boys), among individuals with information on final height, 1,118 had a BMI reduction of 5% and less than 10%, and 346 had at least one substantial BMI reduction of 10% of more. On a group level, there was no statistically significant difference in the final height of individuals with BMI reductions of 10% or more and those without. The findings were independent of age and the subject's BMI at the start of the reduction episode. However, there were a number of cases where a substantial BMI reduction probably had an impact on the subject's final height.

    CONCLUSION: Our study found no evidence that a substantial BMI reduction had any impact on final height on a group level, but further analyses of specific case studies are necessary to determine whether substantial BMI reduction might have an impact on final height.

  • 46.
    Ohlin, Andreas
    Örebro University, School of Health and Medical Sciences.
    What is neonatal sepsis?2010In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 100, no 1, p. 7-8Article in journal (Refereed)
  • 47.
    Ohlin, Andreas
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Björkman, Louise
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of PediatricsDepartment of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Serenius, Fredrik
    Department of Women's and Children's Health, Section for Pediatrics, Uppsala University, Uppsala, Sweden; Department of Pediatrics, Institute of Clinical Sciences, Umeå University, Umeå, Sweden.
    Schollin, Jens
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of PediatricsDepartment of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Källén, Karin
    Department of Obstetrics and Gynecology, Clinical Sciences, Centre of Reproduction Epidemiology, University of Lund, Lund, Sweden.
    Sepsis as a risk factor for neonatal morbidity in extremely preterm infants2015In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 104, no 11, p. 1070-1076Article in journal (Refereed)
    Abstract [en]

    Aim: This study evaluated sepsis as a risk factor for neonatal morbidities and investigated the association between specific pathogens and neonatal morbidities.

    Methods: This was a nationwide Swedish prospective cohort study, consisting of the 497 extremely premature children, who were born before 27weeks of gestation between 2004 and 2007 and survived their first year of life. Neonatal sepsis was evaluated as a risk factor for neonatal morbidity using multiple logistic linear regression analyses.

    Results: We found that 326 (66%) of the infants had at least one sepsis episode and coagulase-negative staphylococci was the most common pathogen. Definite sepsis, with an odds ratio (OR) of 1.6, was associated with severe bronchopulmonary dysplasia, but not clinical sepsis (OR 1.1). Definite sepsis was also associated with a prolonged hospital stay (OR 1.6). Sepsis was not significantly associated with a higher risk of retinopathy of prematurity or intraventricular haemorrhage.

    Conclusion: Extremely preterm infants face a great risk of acquiring neonatal sepsis, with coagulase-negative staphylococci being the most common pathogen in this population. Definite sepsis seemed to be a risk factor for severe bronchopulmonary dysplasia and prolonged hospital stay, but the associations were weaker than in previous studies.

  • 48.
    Ohlin, Andreas
    et al.
    Örebro University, School of Health and Medical Sciences. Department of Paediatrics, Örebro University Hospital, Örebro, Sweden.
    Björkqvist, Maria
    Örebro University, School of Health and Medical Sciences. Department of Paediatrics, Örebro University Hospital, Örebro, Sweden.
    Montgomery, Scott M.
    Örebro University, School of Health and Medical Sciences.
    Schollin, Jens
    Örebro University, School of Health and Medical Sciences. Department of Paediatrics, Örebro University Hospital, Örebro, Sweden;.
    Clinical signs and CRP values associated with blood culture results in neonates evaluated for suspected sepsis2010In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 99, no 11, p. 1635-1640Article in journal (Refereed)
    Abstract [en]

    Aim: To identify which clinical signs at presentation are most predictive of sepsis subsequently confirmed by blood culture and to investigate whether the predictive power of the clinical signs varies by gestational age.

    Methods: Among 401 newborn infants <28 days of age with suspected sepsis, nine signs of sepsis and C-reactive protein (CRP) values were prospectively recorded. Logistic regression assessed the association of these signs and laboratory values with a subsequently confirmed diagnosis of sepsis by positive blood culture. The analysis was stratified by gestational age with mutual simultaneous adjustment for the signs and sex.

    Results: Five of the nine clinical signs (feeding intolerance, distended abdomen, blood pressure, bradycardia and apnoea), along with CRP were statistically significantly associated with a positive blood culture. After simultaneous adjustment for all of the signs, apnoea, hypotension and CRP were independently predictive of positive blood culture. When the material was stratified by gestational age, differences in the association with positive blood culture were found for bradycardia, tachypnea and irritability/seizures.

    Conclusion: In this selected population of infants with suspected sepsis, apnoea and hypotension are independently predictive of a confirmed diagnosis, while bradycardia is more predictive among preterm infants and tachypnea among term infants.

  • 49. Ohlin, Andreas
    et al.
    Bäckman, Anders
    Björkqvist, Maria
    Mölling, Paula
    Jurstrand, Margaretha
    Schollin, Jens
    Örebro University, School of Health and Medical Sciences.
    Real-time PCR of the 16S-rRNA gene in the diagnosis of neonatal bacteraemia2008In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 97, no 10, p. 1376-1380Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To evaluate a real-time PCR assay for the diagnosis of neonatal bacteraemia. PATIENTS AND METHODS: Two hundred ninety-five plasma samples from 288 newborns with suspected neonatal sepsis were collected prospectively for the purpose of polymerase chain reaction (PCR)-based bacterial detection. A real-time PCR targeting the bacterial gene for 16S-rRNA gene combined with four specific probes designed to detect Gram-negative bacteria, Staphylococcus aureus and coagulase-negative staphylococci (CoNS) was developed. All samples positive in the universal PCR were further sequenced for bacterial identification. RESULTS: When applied to a material from 50 patients with positive blood culture and 245 patients with negative blood culture, the universal PCR showed a sensitivity of 42% (28-57), a specificity of 95% (92-97), a positive predictive value of 64% (45-80), and a negative predictive value of 89% (84-92) (95% confidence intervals in brackets). CONCLUSION: A new real-time PCR technique was for the first time applied to a well-defined prospectively and consecutively enrolled material of newborns with suspected sepsis, combining the benefits of real-time PCR with specific probes and sequencing. The method managed to detect bacteraemia with high specificity even though the sensitivity was low. Factors causing the low sensitivity are identified and further strategies to develop the method are described.

  • 50.
    Olang, Beheshteh
    et al.
    Unit for Public Health Nutrition, Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden; Akershus University College, Lillestrøm, Norway; Kermanshah University of Medical Sciences, Kermanshah, Iran.
    Naghavi, Mohsen
    Global Health Department Institute for Health Metrics and Evaluation, University of Washington, Seattle WA, United States.
    Bastani, Delaram
    Unit for Public Health Nutrition, Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden;.
    Strandvik, Birgitta
    Unit for Public Health Nutrition, Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden;.
    Yngve, Agneta
    Dept Biosci & Nutr, Karolinska Institute, Stockholm, Sweden; Akershus University College, Lillestrøm, Norway.
    Optimal vitamin A and suboptimal vitamin D status are common in Iranian infants2011In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 100, no 3, p. 439-444Article in journal (Refereed)
    Abstract [en]

    Aim: Investigation of serum concentrations of vitamins A and D in Iranian infants. Methods: A descriptive cross-sectional study, investigating 7112 infants (1523 months of age) from all regions of Iran, who attended health care centres from May 25 to June 2, 2001. Unequal clusters with unequal household sizes were sampled. Vitamin A and D levels were analysed with high-performance liquid chromatography. Results: The mean (SD) concentration of vitamin A was 2.09 (0.83) mu mol/L. At a national level, 0.7% of the infants had a level indicating deficiency, and 0.5% of the infants had insufficient concentrations of vitamin A, defined as serum concentrations < 0.35 and < 0.7 mu mol/L retinol, respectively. A total of 88% of infants had optimal concentrations (> 1.4 mu mol /L). The mean (SD) concentration of vitamin D was 61.3 (31.4) nmol/L. Deficiency was found in 2.8% of infants (< 25 nmol/L), and insufficiency in 32.9% (< 50 nmol/L). Suboptimal and optimal concentrations were found in 44% and 20%, representing 50-75 and > 75 nmol/L, respectively. Girls had lower vitamin D concentrations than boys (p = 0.006). Conclusion: As in developed countries, vitamin A deficiency was rare in Iranian infants. Vitamin D deficiency was also rare, but 33% of infants had insufficient levels; this was more common in girls than boys.

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