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  • 1. Dykes, Fiona
    et al.
    Flacking, Renée
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Encouraging breastfeeding: A relational perspective2010In: Early Human Development, ISSN 0378-3782, E-ISSN 1872-6232, Vol. 86, no 11, p. 733-736Article in journal (Refereed)
    Abstract [en]

    Despite the WHO recommendations that babies should be breastfed exclusively for six months and thereafter for up to two years and beyond this pattern of feeding is far from the global norm. Although breastfeeding is triggered through biological mechanisms which have not changed with time, the perception of breastfeeding as a phenomenon is variable, as it not only reflects cultural values of motherhood but is also negotiable from the perspective of the individual. This paper argues that relationships are central to encouraging breastfeeding at an organisational, family and staff-parent level. This shifts our conceptualisations away from the primary focus of breastfeeding as nutrition which, in turn, removes the notion of breastfeeding as a productive process, prone to problems and failure.

  • 2.
    Ericson, Jenny
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Eriksson, Mats
    Hellström-Westas, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Hagberg, Lars
    Hoddinott, Pat
    Flacking, Renée
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    The effectiveness of proactive telephone support provided to breastfeeding mothers of preterm infants: study protocol for a randomized controlled trial2013In: BMC Pediatrics, ISSN 1471-2431, E-ISSN 1471-2431, Vol. 13, p. 73-Article in journal (Refereed)
    Abstract [en]

    Background: Although breast milk has numerous benefits for infants' development, with greater effects in those born preterm (at < 37 gestational weeks), mothers of preterm infants have shorter breastfeeding duration than mothers of term infants. One of the explanations proposed is the difficulties in the transition from a Neonatal Intensive Care Unit (NICU) to the home environment. A person-centred proactive telephone support intervention after discharge from NICU is expected to promote mothers' sense of trust in their own capacity and thereby facilitate breastfeeding. Methods/design: A multicentre randomized controlled trial has been designed to evaluate the effectiveness and cost-effectiveness of person-centred proactive telephone support on breastfeeding outcomes for mothers of preterm infants. Participating mothers will be randomized to either an intervention group or control group. In the intervention group person-centred proactive telephone support will be provided, in which the support team phones the mother daily for up to 14 days after hospital discharge. In the control group, mothers are offered a person-centred reactive support where mothers can phone the breastfeeding support team up to day 14 after hospital discharge. The intervention group will also be offered the same reactive telephone support as the control group. A stratified block randomization will be used; group allocation will be by high or low socioeconomic status and by NICU. Recruitment will be performed continuously until 1116 mothers (I: 558 C: 558) have been included. Primary outcome: proportion of mothers exclusively breastfeeding at eight weeks after discharge. Secondary outcomes: proportion of breastfeeding (exclusive, partial, none and method of feeding), mothers satisfaction with breastfeeding, attachment, stress and quality of life in mothers/partners at eight weeks after hospital discharge and at six months postnatal age. Data will be collected by researchers blind to group allocation for the primary outcome. A qualitative evaluation of experiences of receiving/providing the intervention will also be undertaken with mothers and staff. Discussion: This paper presents the rationale, study design and protocol for a RCT providing person-centred proactive telephone support to mothers of preterm infants. Furthermore, with a health economic evaluation, the cost-effectiveness of the intervention will be assessed. Trial registration: NCT01806480

  • 3. Ericson, Jenny
    et al.
    Flacking, Renee
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Estimated Breastfeeding to Support Breastfeeding in the Neonatal Intensive Care Unit2013In: Journal of Obstetric, Gynecologic and Neonatal Nursing, ISSN 0884-2175, E-ISSN 1552-6909, Vol. 42, no 1, p. 29-37Article in journal (Refereed)
    Abstract [en]

    Objective To evaluate the effects of estimated breastfeeding on infant outcomes in comparison to test weighing and to describe staff members experiences of estimated breastfeeding as a method for supporting the transition from tube feeding to breastfeeding. Design A mixed method evaluation. Setting Neonatal Intensive Care Unit (NICU) in Sweden. Participants The study included 365 preterm (25th36th gestational weeks) infants and 45 nurses or nurse assistants. Methods A retrospective comparative medical record study was used to assess infant outcomes during a period of test weighing (196 infants) and again after the implementation of estimated breastfeeding (169 infants). A qualitative survey was conducted to explore the staff experiences of estimated breastfeeding. Results No differences were found between groups regarding duration of tube feeding, length of hospital stay, gestational age, weight at discharge, and rate of any breastfeeding. Infants in the estimated breastfeeding group had a higher risk of not being exclusively breast milk fed than infants in the test-weighing group (OR = 2.76, CI [1.5, 5.1]). Staff perceived estimated breastfeeding as a more facilitative and less stressful method for mothers than test weighing. Some staff had difficulty following guidelines while simultaneously providing person-centered care. Conclusions Estimated breastfeeding is a nonintrusive and feasible method for assessing and supporting the transition from tube feeding to breastfeeding among preterm infants in a NICU. However, the increased risk for not being exclusively breastfed is of concern. Additional research is needed to assess whether this method is appropriate and feasible in varying contexts and cultures.

  • 4.
    Flacking, Renee
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Lehtonen, Liisa
    Thomson, Gill
    Axelin, Anna
    Ahlqvist, Sari
    Moran, Victoria Hall
    Ewald, Uwe
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Dykes, Fiona
    Closeness and separation in neonatal intensive care2012In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 101, no 10, p. 1032-1037Article, review/survey (Refereed)
    Abstract [en]

    In this paper, we highlight the need for acknowledging the importance and impact of both physical and emotional closeness between the preterm infant and parent in the neonatal intensive care unit. Physical closeness refers to being spatially close and emotional closeness to parental feelings of being emotionally connected to the infant (experiencing feelings of love, warmth and affection). Through consideration of the literature in this area, we outline some of the reasons why physical closeness and emotional closeness are crucial to the physical, emotional and social well-being of both the infant and the parent. These include positive effects on infant brain development, parent psychological well-being and on the parentinfant relationship. The influence of the neonatal unit environment and culture on physical and emotional closeness is also discussed.

    Conclusions: Culturally sensitive care practices, procedures and the physical environment need to be considered to facilitate parentinfant closeness, such as through early and prolonged skin-to-skin contact, family-centred care, increased visiting hours, family rooms and optimization of the space on the units. Further research is required to explore factors that facilitate both physical and emotional closeness to ensure that parentinfant closeness is a priority within neonatal care.

  • 5.
    Flacking, Renée
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Center for Clinical Research Dalarna. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Dykes, Fiona
    MAINN, School of Public Health and Clinical Sciences, University of Central Lancashire, Preston, UK.
    Ewald, Uwe
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    The influence of fathers' socioeconomic status and paternity leave on breastfeeding duration: a population-based cohort study2010In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 38, no 4, p. 337-343Article in journal (Refereed)
    Abstract [en]

    AIM:

    The propensity to breastfeed is a matter of public concern because of the favourable effects for infants. However, very few studies have described the influence of paternal variables upon duration of breastfeeding. The aim of this study was to describe the effects of fathers' socioeconomic status and their use of paternity leave on breastfeeding duration for infants up to 1 year of age.

    METHODS:

    A prospective population-based cohort study was undertaken. Data on breastfeeding, registered in databases in two Swedish counties for 1993-2001, were matched with data on socioeconomic status and paternity leave obtained from Statistics Sweden. Fathers of 51,671 infants were identified and included.

    RESULTS:

    Infants whose fathers had a lower level of education, were receiving unemployment benefit and/or had a lower equivalent disposable household income were significantly less likely to be breastfed at 2, 4, 6, 9, and 12 months of age. Infants whose fathers did not take paternity leave during the infant's first year were significantly less likely to be breastfed at 2 (p < 0.001), 4 (p < 0.001), and 6 months (p < 0.001).

    CONCLUSIONS:

    This paper shows that an enabling of an increased involvement from fathers during the infants' first year of life, such as by paid paternity leave, may have beneficial effects on breastfeeding up to 6 months of age. A more systematic approach to supporting fathers' involvement may be particularly valuable to those infants whose fathers have a lower socioeconomic status.

  • 6.
    Flacking, Renée
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Center for Clinical Research Dalarna. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Ewald, Uwe
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Hedberg Nyqvist, Kerstin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Starrin, Bengt
    Trustful bonds: A key to "becoming a mother" and to reciprocal breastfeeding. Stories of mothers of very preterm infants at a neonatal unit2006In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 62, no 1, p. 70-80Article in journal (Refereed)
    Abstract [en]

    A preterm birth and subsequent hospitalization of an infant at a neonatal unit (NU) implies an extraordinary life situation for mothers, in which the maternal role and breastfeeding begin and evolve in a medical and unfamiliar setting. Descriptions of how women experience “becoming a mother” and breastfeeding in such a situation are sparse and this question was addressed in the present study. In this qualitative study, inspired by the grounded theory approach, in-depth interviews were conducted with 25 mothers whose very preterm infants had been cared for in seven NUs in Sweden. Findings indicated the importance of quality in social bonds with the infant, father, staff and other mothers at the NU, for “becoming mothers” and experiencing mutually satisfying breastfeeding. Three themes comprised a structure for descriptions of experiences, social bonds and mediated emotions: (1) ‘loss’ of the infant and the emotional chaos—“putting life on hold”; (2) separation—a sign of being unimportant as a person and mother; and (3) critical aspects of becoming more than a physical mother. The qualities were described as trustful or distrustful, characterized by accompanying feelings of pride/trust or shame/distrust. Social bonds were affected not only by the interpersonal interplay but also by the public environment and care routines. In conclusion, the contextual setting and distrustful social bonds impaired the ability to “become mothers” and the sensation of reciprocity i.e. breastfeeding becoming dutiful and not mutually satisfying. As breastfeeding is an intimate interplay and a personal choice it was considered that the best breastfeeding support would seem to be provision of a favorable environment that enhances the mother's confidence in herself. The contextual setting should be modeled such as to create conditions for a trustful and reciprocal mother–infant bond.

  • 7.
    Flacking, Renée
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Center for Clinical Research Dalarna. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Ewald, Uwe
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Starrin, Bengt
    "I wanted to do a good job": Experiences of 'becoming a mother' and breastfeeding in mothers of very preterm infants after discharge from a neonatal unit2007In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 64, no 12, p. 2405-2416Article in journal (Refereed)
    Abstract [en]

    In mothers of preterm infants, the process of becoming a mother is initiated in a public and medical environment, in which the mothers become dependent on the benevolence and support of the staff. This setting and an experience of insecure social bonds impair the ability to become a mother during the infant's stay at the neonatal unit (NU), and breastfeeding may become a duty and not be mutually satisfying. Studies on how women experience becoming a mother and breastfeeding after the infant's discharge are sparse and this question is addressed in the present grounded theory study. Twenty five mothers, whose very preterm infants had received care in seven NUs in Sweden, were interviewed once, 1–12 months after discharge. We propose a model to increase understanding of the process of becoming a mother and breastfeeding, after the infant's discharge from the NU. The mother's emotional expressions in this process showed pendular swings from feeling emotionally exhausted to feeling relieved, from experiencing an insecure to a secure bond, and from regarding breastfeeding as being non-reciprocal to being reciprocal. Unresolved grief, the institutional authority at the NU and experiences of shame were three of the central barriers to a secure and reciprocal relationship. The pendular changes give us a deeper understanding of the variations in both attachment and attunement. Perhaps the negative extremes are more prominent among these mothers on account of their infant's illness and their NU experiences. If our proposed model is valid, it is vital that these findings are considered by those involved in the short- and long-term care in order to support the mothers to establish a secure bond, comprising both attachment and attunement.

  • 8.
    Flacking, Renée
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Ewald, Uwe
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Wallin, Lars
    Positive Effect of Kangaroo Mother Care on Long-Term Breastfeeding in Very Preterm Infants2011In: Journal of Obstetric, Gynecologic and Neonatal Nursing, ISSN 0884-2175, E-ISSN 1552-6909, Vol. 40, no 2, p. 190-197Article in journal (Refereed)
    Abstract [en]

    Objective

    To investigate the use of Kangaroo Mother Care (KMC) and its association with breastfeeding at 1 to 6 months of corrected age in mothers of very preterm (VPT) and preterm (PT) infants.

    Design

    Prospective longitudinal study.

    Setting

    Neonatal Intensive Care Units in four counties in Sweden.

    Participants

    The study included 103 VPT (< 32 gestational weeks) and 197 PT (32-36 gestational weeks) singleton infants and their mothers.

    Methods

    Data on KMC, measured in duration of skin-to-skin contact/day during all days admitted to a neonatal unit, were collected using self-reports from the parents. Data on breastfeeding were obtained by telephone interviews.

    Results

    VPT dyads that breastfed at 1, 2, 5, and 6 months had spent more time in KMC per day than those not breastfeeding at these times. A trend toward significance was noted at 3 and 4 months. In the PT dyads no statistically significant differences were found in the amount of KMC per day between those dyads that breastfed and those that did not.

    Conclusions

    This study shows the importance of KMC during hospital stay for breastfeeding duration in VPT dyads. Hence, KMC has empowering effects on the process of breastfeeding, especially in those dyads with the smallest and most vulnerable infants.

  • 9.
    Flacking, Renée
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Center for Clinical Research Dalarna. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Hedberg Nyqvist, Kerstin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Ewald, Uwe
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Effects of socioeconomic status on breastfeeding duration in mothers of preterm and term infants2007In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 17, no 6, p. 579-584Article in journal (Refereed)
    Abstract [en]

    Background:

    The propensity to breastfeed is not only of importance with regard to the beneficial effects on the individual, but is also of concern as an indicator of health behaviour related to social conditions. Thus, our aim was to investigate the impact of socioeconomic status (SES) on breastfeeding duration in mothers of preterm and term infants.

    Methods:

    Prospective population based cohort study. Data for infants registered in breastfeeding databases of two Swedish counties 19932001 were matched with data from two national registriesthe Medical Birth Registry and Statistics Sweden. A total of 37 343 mothers of 2093 preterm and 35 250 term infants participated.

    Results:

    All socioeconomic factors; maternal educational level, maternal unemployment benefit, social welfare and equivalent disposable income, were strongly associated with breastfeeding when examined individually in mothers of preterm and term infants. Some of the associations attenuated when investigated simultaneously. Independently of SES and confounders, mothers of preterm infants were at higher risk of weaning before the infant was 2 months (adjusted odds ratio (OR) 1.70; 95 confidence interval ((Cl) 1.46-1.99)), 4 months (OR 1.79; Cl 1.602.01), 6 months (OR 1.48; Cl 1.331.64), and 9 months old (OR 1.19; Cl 1.061.34), compared with mothers of term infants.

    Conclusions:

    In Sweden, despite its social welfare support system and a positive breastfeeding tradition, SES clearly has an impact on the breastfeeding duration. Mothers of preterm infants breastfeed for a shorter time compared with mothers of term infants, even when adjustments are made for SES and confounders.

  • 10.
    Flacking, Renée
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Center for Clinical Research Dalarna. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Nyqvist, Kerstin Hedberg
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Ewald, Uwe
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Wallin, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Long-term duration of breastfeeding in Swedish low birth weight infants2003In: Journal of Human Lactation, ISSN 0890-3344, E-ISSN 1552-5732, Vol. 19, no 2, p. 157-165Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to describe the long-term incidence of breastfeeding in a geographically defined cohort of low birth weight (LBW) (< 2500 g) Swedish infants (N = 70) at discharge from a neonatal unit and at the postnatal ages of 2, 4, 6, and 8 months. The infants' breastfeeding data were examined retrospectively and compared to annual breastfeeding data for all infants born in the same year and county (N = 2,751). Ninety-three percent of the LBW infants were fed breast milk at discharge and 36% at 6 months, compared to 97% and 75%, respectively, of the county population. Cox regression analysis showed that multiparity was a significant predictor associated with shorter breastfeeding in LBW infants (odds ratio = 2.51. 95% confidence interval, 1.35-4.69). LBW infants had a high breastfeeding incidence but a significantly shorter duration than controls. This result indicates the need for intensified support throughout the breastfeeding period.

  • 11.
    Flacking, Renée
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Thomson, G.
    Ekenberg, L.
    Loewegren, L.
    Wallin, L.
    Influence of NICU co-care facilities and skin-to-skin contact on maternal stress in mothers of preterm infants2013In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 4, no 3, p. 107-112Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate the influence of co-care facilities and amount of skin-to-skin contact during Neonatal Intensive Care Unit (NICU) stay on maternal stress in mothers of preterm infants at two months corrected age. Methods: A prospective cohort study that involved 300 mothers of pre-term infants was conducted in four NICUs (two with co-care facilities and two with non co-care) in Sweden. Data on duration of skin-to-skin contact per day for all days admitted to the NICU were collected using self-reports. Maternal stress was measured by the Swedish Parental Stress Questionnaire (SPSQ) at two months of infant's corrected age. Results: Mothers whose infants were cared for in a NICU with co-care facilities reported significantly lower levels of stress in the dimension of 'incompetence' compared to mothers whose infants had been cared for in non co-care NICUs. The amount of skin-to-skin experienced during the neonatal stay was not significantly associated with levels of maternal stress at two months corrected age. Conclusion: The finding that mothers who do not experience co-care facilities experience greater levels of stress in relation to feelings of incompetence is of concern. Improvements to NICU environments are needed to ensure that mother-infant dyads are not separated.

  • 12.
    Flacking, Renée
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Center for Clinical Research Dalarna.
    Wallin, Lars
    Ewald, Uwe
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Perinatal and socioeconomic determinants of breastfeeding duration in very preterm infants2007In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 96, no 8, p. 1126-1130Article in journal (Refereed)
    Abstract [en]

    Aim: To describe the impact of prematurity, size at birth, neonatal disorders and the families' socioeconomic status (SES) on breastfeeding duration in mothers of very preterm infants. Methods: Prospective population-based cohort study. Data on breastfeeding, registered in databases in two Swedish counties in 1993-2001, were matched with data from two national registries: the Medical Birth Registry and Statistics Sweden. Mothers of 225 very preterm singleton infants were identified and included. Results: Seventy-nine percent of the mothers breastfed at 2 months, 62% at 4 months, 45% at 6 months, 22% at 9 months and 12% at 12 months. Prematurity, size at birth and neonatal disorders did not show an effect on breastfeeding duration. Being adversely exposed to any of the SES factors (maternal education, unemployment benefit, social welfare and equivalent disposable income in the household) was significantly associated with earlier weaning up to 6 months of infants' postnatal age. Conclusions: This study shows new and noteworthy results concerning breastfeeding duration in mothers of very preterm infants, which was not influenced by degree of prematurity, size at birth or neonatal disorders but was affected by SES. This highlights the need for improved support of socioeconomically disadvantaged mothers, during and after the hospital stay.

  • 13.
    Jerdén, Lars
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Center for Clinical Research Dalarna.
    Hillervik, Charlotte
    Hansson, Ann-Christin
    Flacking, Renée
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Center for Clinical Research Dalarna.
    Weinehall, Lars
    Experiences of Swedish community health nurses working with health promotion and a patient-held health record2006In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 20, no 4, p. 448-454Article in journal (Refereed)
    Abstract [en]

    Community health nurses have a tradition of preventive care, and might therefore be a key group in the introduction of new health-promotion methods. The aim of this study was to describe Swedish community health nurses' experiences in working with health promotion and a patient-held record as an integrated tool in their health-promotion work. Interviews were performed with 12 nurses at primary healthcare centres in the county of Dalarna, Sweden. A qualitative content analysis applying aspects of the grounded theory approach was performed. Central to the analysis was the nurses' struggle for balance, in being both a doer of practical disease-oriented tasks and a health-promotion communicator. Descriptions of the nurses' struggles to balance their work were grouped into three themes: (i) working alone and as a part of a team; (ii) nurse-related and patient-related interests; and (iii) patient's responsibility and shared responsibility between patient and nurse. The findings indicated that the structural organization in the primary healthcare centres was important for the community health nurses' means to work with health promotion and the patient-held record. In addition, the community health nurses' cognitive and emotional needs also affected this balance. In conclusion, the struggle of community health nurses to find a balance between being doers and health-promotion communicators is valuable in understanding health promotion in primary health care. The study indicates that it is not enough to develop health-promotion methods acceptable to community health nurses. A comprehensive examination of working conditions and the content of daily work is needed to ensure an emphasis on health promotion, including long-term usage of patient-held records.

  • 14.
    Joffer, Junia
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna. Umea Univ, Dept Publ Hlth & Clin Med Epidemiol & Global Hlth, SE-90187 Umea, Sweden..
    Jerden, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna. Umea Univ, Dept Publ Hlth & Clin Med Epidemiol & Global Hlth, SE-90187 Umea, Sweden.; Dalarna Univ, Sch Educ Hlth & Social Studies, SE-79188 Falun, Sweden..
    Öhman, Ann
    Umea Univ, Dept Publ Hlth & Clin Med Epidemiol & Global Hlth, SE-90187 Umea, Sweden.;Umea Univ, Umea Ctr Gender Studies, SE-90187 Umea, Sweden..
    Flacking, Renee
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics. Dalarna Univ, Sch Educ Hlth & Social Studies, SE-79188 Falun, Sweden..
    Exploring self-rated health among adolescents: a think-aloud study2016In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 16, article id 156Article in journal (Refereed)
    Abstract [en]

    Background: Despite extensive use of self-rated health questions in youth studies, little is known about what such questions capture among adolescents. Hence, the aim of this study was to explore how adolescents interpret and reason when answering a question about self-rated health. Methods: A qualitative study using think-aloud interviews explored the question, "How do you feel most of the time?", using five response options ("Very good", "Rather good", "Neither good, nor bad", "Rather bad", and "Very bad"). The study involved 58 adolescents (29 boys and 29 girls) in lower secondary school (7th grade) and upper secondary school (12th grade) in Sweden. Results: Respondents' interpretations of the question about how they felt included social, mental, and physical aspects. Gender differences were found primarily in that girls emphasized stressors, while age differences were reflected mainly in the older respondents' inclusion of a wider variety of influences on their assessments. The five response options all demonstrated differences in self-rated health, and the respondents' understanding of the middle option, "Neither good, nor bad", varied widely. In the answering of potential sensitive survey questions, rationales for providing honest or biased answers were described. Conclusions: The use of a self-rated health question including the word 'feel' captured a holistic view of health among adolescents. Differences amongst response options should be acknowledged when analyzing self-rated health questions. If anonymity is not feasible when answering questions on self-rated health, a high level of privacy is recommended to increase the likelihood of reliability.

  • 15. Östlund, Åsa
    et al.
    Nordström, Maria
    Dykes, Fiona
    Flacking, Renée
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Center for Clinical Research Dalarna. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Breastfeeding in Preterm and Term Twins-Maternal Factors Associated With Early Cessation: A Population-Based Study2010In: Journal of Human Lactation, ISSN 0890-3344, E-ISSN 1552-5732, Vol. 26, no 3, p. 235-241Article in journal (Refereed)
    Abstract [en]

    To investigate the duration of breastfeeding and the impact of maternal factors for cessation of breastfeeding in twin infants, the authors undertook a population-based cohort study. Breastfeeding data obtained from Child Health Centres were matched with data on infant and maternal demographics from Swedish national registers. A total of 1.657 twins were included, of whom 695 were born preterm. Breastfeeding frequencies in preterm twins were 79% at 2 months, 58% at 4 months, 39% at 6 months, 14% at 9 months, and 6% at 12 months. In term twins, the corresponding frequencies were 84%, 63%, 45%, 18%, and 6%, respectively. In both preterm and term mothers, mothers who had a lower educational level or smoked at first antenatal care visit were subject to earlier cessation of breastfeeding by 6 months of age. In addition, in mothers of term infants, mothers who were < 23 years old or primiparous had a higher risk for cessation of breastfeeding before 6 months. Thus, mothers of twins have a good potential to breastfeed, but additional support is needed for those more susceptible to early cessation of breastfeeding.

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