Background: Women with type 1 diabetes (T1DM) face many challenges during their pregnancy, birth ... more Background: Women with type 1 diabetes (T1DM) face many challenges during their pregnancy, birth and in the postnatal period, including breastfeeding initiation and continuation while maintaining stable glycaemic control. In both Sweden and Australia the rates of breastfeeding initiation are high. However, overall there is limited information about the breastfeeding practices of women with T1DM and the factors affecting them. Similarities in demographics, birth rates and health systems create bases for discussion. Aim: The aim of this paper is to discuss psychosocial factors, policies and practices that impact on the breastfeeding practices of women with T1DM. Findings: Swedish research indicates that the overall breastfeeding rate in women with T1DM remains significantly lower than in women without diabetes in the first 2 and 6 months after childbirth with no differences in exclusive breastfeeding. Breastfeeding initiation and continuation among women with T1DM in Sweden has been shown to be influenced by health services delivery, supportive breastfeeding polices and socioeconomic factors, particular perceived support from social networks and health professionals. Conclusion: There is limited research on the impact of attitudes towards breastfeeding, emotional and social well-being and diabetes-related stress on the decision of women with T1DM to initiate and continue to breastfeed for at least 6 months. A more comprehensive understanding of the breastfeeding practices and psychosocial factors operating during the first 6 months after birth for women with T1DM will be instrumental in the future design of interventions promoting initiation and continuation of breastfeeding in Sweden, Australia and elsewhere.
Background: As a matter of routine, midwives in Sweden have spoken with women about their experie... more Background: As a matter of routine, midwives in Sweden have spoken with women about their experiences of labour in a so-called 'postpartum consultation'. However, the possibility of offering women this kind of consultation today is reduced due to shortage of both time and resources. The aim of this study was to explore the occurrence, women's requirements of, and experiences of a postpartum consultation, and to identify expectations from women who wanted but did not have a consultation with the midwife assisting during labour. Methods: All Swedish speaking women who gave birth to a live born child at a University Hospital in western Sweden were consecutively included for a phone interview over a three-week period. An additional phone interview was conducted with the women who did not have a postpartum consultation, but who wanted to talk with the midwife assisting during labour. Data from the interviews were analysed using qualitative content analysis. Results: Of the 150 interviewed women, 56% (n = 84) had a postpartum consultation of which 61.9% (n = 52) had this with the midwife assisting during labour. Twenty of the 28 women who did not have a consultation with anyone still desired to talk with the midwife assisting during labour. Of these, 19 were interviewed. The content the women wanted to talk about was summarized in four categories: to understand the course of events during labour; to put into words, feelings about undignified management; to describe own behaviour and feelings, and to describe own fear. Conclusion: The survey shows that the frequency of postpartum consultation is decreasing, that the majority of women who give birth today still require it, but only about half of them receive it. It is crucial to develop a plan for these consultations that meets both the women's needs and the organization within current maternity care.
School children often base their toilet habits on behavioural and social reasons. Bladder emptyin... more School children often base their toilet habits on behavioural and social reasons. Bladder emptying problems, urinary tract infections and constipation are common health problems which are also associated with irregular toilet habits. School rules for going to the toilet have been shown to create difficulties for school children with bladder dysfunction. Aim of this study was to describe children's experiences of school rules for going to the toilet and their significance for the children. Individual open-ended questions with 19 schoolchildren aged 9-16 in elementary schools. To manage the children's toilet needs, teachers used rules designed for maintaining order in the classroom. The children saw their toilets needs as a private matter and experienced it complicated to go to the toilet during recess as time was short and the risk for violation of their integrity was at its highest. The most frustrating when to comply with rules during lessons was to be forced to, in front of all their classmates, make public the need to go to the toilet: i.e the most private was exposed to the disclosure. The rules for going to the toilet came from the teachers' need for maintaining order in the classroom and were not adapted to the children's physical and developmental needs. To violate the integrity of children can affect their willingness to go to the school toilet which in turn affects their wellbeing during school time.
When a newborn baby needs care in a neonatal intensive care unit (NICU), the parents are welcome ... more When a newborn baby needs care in a neonatal intensive care unit (NICU), the parents are welcome to stay with their child whenever they wish. The aim of the present study was to investigate the time per day parents are present together with their child at the NICU and to identify factors that facilitated and obstructed their presence. In a descriptive study 67 parents of 42 children from two NICUs registered all time they spent at the NICU and then took part in a structured interview. Parental presence at NICUs varied depending on types of accommodation offered. Those who stayed in parent rooms at the units showed a significantly higher presence with their children than parents who stayed at family hotel, at home or on a maternity ward. Factors that motivated parental presence were primarily the willingness to take parental responsibility, the child's condition requiring it, and the want to have control. Good treatment by the staff, a family-friendly environment and high quality care were main facilitating factors for parents to be present at the NICU. Obstructing factors were primarily ill health by parents, a non-family-friendly environment, care of the home and of children at home. The result shows that there is a need to develop a family-friendly environment that provides optimal conditions for parents to be with their child in a NICU and to consider the parent's own reason for being or not being present.
Childhood overweight is presented as a complex problem to solve. To elaborate efforts required in... more Childhood overweight is presented as a complex problem to solve. To elaborate efforts required in striving for normal weight in overweight children healthy signs of life from the child's point of view should be identified and promoted. The aim of the present study is to describe everyday experiences of life, body and well-being in children with overweight. A qualitative descriptive design based on lifeworld perspective was used in 16 open-ended interviews with overweight children aged 10-12 years. Child overweight was defined by body mass index (kg/m(2)) for each age. Drawings and body pictograms were used to supplement the interviews. Text was analysed using qualitative content analysis. The primary finding was the respondents' search for a sense of community in daily life. The respondents yearned to be part of a community but spent a lot of time alone. Parents and other family members were an important source of community but were not present enough in the respondents' daily life. The respondents had a sound body image, were concerned about their bodies and were aware of a healthy lifestyle. Nevertheless, they did not manage to implement this awareness in practice. Unhealthy sleeping, eating and exercise habits along with a sense of victimization were revealed in the interviews. Well-being meant self-esteem, trust and satisfaction and was preserved and improved through exciting relationships and activities. Feeling well was equal to feeling capable, feeling happy and feeling a sense of community. Findings emphasize the problem of loneliness in the children studied. Their healthy signs of life were not promoted in an acceptable way. They spent too much time alone doing sedentary activities with easy access to junk food. Findings indicate they should be provided with company at all meals and during activities on a daily basis.
ObjectiveAfter clinical urotherapeutic guidance, schoolchildren suffering from functional bladder... more ObjectiveAfter clinical urotherapeutic guidance, schoolchildren suffering from functional bladder disturbances are expected to manage treatment at school. To comply with treatment instructions the children have to visit the toilet at least every 3h, find the sitting position facilitating relaxation of the pelvic floor, and then empty the bladder as completely as possible. They often blame failing to comply on their
Women at obstetric high risk more often experience negative feelings related to childbirth than w... more Women at obstetric high risk more often experience negative feelings related to childbirth than women with normal outcomes. For these high-risk women, an individual birth plan does not appear to improve the overall experience of childbirth; rather, it seems to intensify the negative feelings in several aspects. The increased vulnerability in women at high risk warrants special attention to the possibility that types of care routinely offered to all women may negatively influence the experiences of high-risk women.
Objectives: to identify primary and secondary outcome measures in randomised trials, and systemat... more Objectives: to identify primary and secondary outcome measures in randomised trials, and systematic reviews of randomised trials, measuring effectiveness of oxytocin for treatment of delay in the first and second stages of labour, and to identify any positive health-focussed outcomes used. Design: eight relevant citation databases were searched up to January 2013 for all randomised trials, and systematic reviews of randomised trials, measuring effectiveness of oxytocin for treatment of delay in labour. Trials of active management of labour or partogram action lines were excluded. 1918 citations were identified. Two reviewers reviewed all citations and extracted data. Twenty-six individual trials and five systematic reviews were included. Primary and secondary outcome measures were documented and analysed using frequency distributions. Findings: most frequent primary outcomes were caesarean section (n ¼15, 46%), length of labour (n ¼14, 42%), measurements of uterine activity (n ¼13, 39%) and mode of vaginal birth (n ¼9, 27%). Maternal satisfaction was identified a priori by one review and included as a secondary outcome by three papers. No further positive health-focussed outcomes were identified.
Several biomarkers including B-type natriuretic peptide (BNP) have been suggested to improve pred... more Several biomarkers including B-type natriuretic peptide (BNP) have been suggested to improve prediction of coronary events and all-cause mortality. Moreover, coronary artery calcium (CAC) as marker of subclinical atherosclerosis is a strong predictor for cardiovascular mortality and morbidity. We aimed to evaluate the predictive ability of BNP and CAC for all-cause mortality and coronary events above traditional cardiovascular risk factors (TRF) in the general population. We followed 3782 participants of the population-based Heinz Nixdorf Recall cohort study without coronary artery disease at baseline for 7.3 ± 1.3 years. Associations of BNP and CAC with incident coronary events and all-cause mortality were assessed using Cox regression, Harrell's c, and time-dependent integrated discrimination improvement (IDI(t), increase in explained variance). Subjects with high BNP levels had increased frequency of coronary events and death (coronary events/mortality: 14.1/28.2% for BNP ≥100 pg/ml vs. 2.7/5.5% for BNP < 100 pg/ml, respectively). Subjects with a BNP ≥100 pg/ml had increased incidence of hard endpoints sustaining adjustment for CAC and TRF (for coronary events: hazard ratio (HR) (95% confidence interval (CI)) 3.41(1.78-6.53); for all-cause mortality: HR 3.35(2.15-5.23)). Adding BNP to TRF and CAC increased measures of predictive ability: coronary events (Harrell's c, for coronary events, 0.775-0.784, p = 0.09; for all-cause mortality 0.733-0.740, p = 0.04; and IDI(t) (95% CI), for coronary events: 2.79% (0.33-5.65%) and for all-cause mortality 1.78% (0.73-3.10%). Elevated levels of BNP are associated with excess incident coronary events and all-cause mortality rates, with BNP and CAC significantly and complementary improving prediction of risk in the general population above TRF.
Background: Person-centred care, asserting that individuals are partners in their care, has been ... more Background: Person-centred care, asserting that individuals are partners in their care, has been associated with care satisfaction but the value of using it to support women with obesity during pregnancy is unknown. Excessive gestational weight gain is associated with increased risks for both mother and baby and weight gain therefore is an important intervention target. The aims of this review was to 1) explore to what extent and in what manner interventions assessing weight in pregnant women with obesity use person-centred care and 2) assess if interventions including aspects of person-centred care are more effective at limiting weight gain than interventions not employing person-centred care.
Background: Women with type 1 diabetes (T1DM) face many challenges during their pregnancy, birth ... more Background: Women with type 1 diabetes (T1DM) face many challenges during their pregnancy, birth and in the postnatal period, including breastfeeding initiation and continuation while maintaining stable glycaemic control. In both Sweden and Australia the rates of breastfeeding initiation are high. However, overall there is limited information about the breastfeeding practices of women with T1DM and the factors affecting them. Similarities in demographics, birth rates and health systems create bases for discussion. Aim: The aim of this paper is to discuss psychosocial factors, policies and practices that impact on the breastfeeding practices of women with T1DM. Findings: Swedish research indicates that the overall breastfeeding rate in women with T1DM remains significantly lower than in women without diabetes in the first 2 and 6 months after childbirth with no differences in exclusive breastfeeding. Breastfeeding initiation and continuation among women with T1DM in Sweden has been shown to be influenced by health services delivery, supportive breastfeeding polices and socio-economic factors, particular perceived support from social networks and health professionals. Conclusion: There is limited research on the impact of attitudes towards breastfeeding, emotional and social well-being and diabetes-related stress on the decision of women with T1DM to initiate and continue to breastfeed for at least 6 months. A more comprehensive understanding of the breastfeeding practices and psychosocial factors operating during the first 6 months after birth for women with T1DM will be instrumental in the future design of interventions promoting initiation and continuation of breastfeeding in Sweden, Australia and elsewhere.
International Journal of Qualitative Studies on Health and Well-being, 2008
Developing the best care for clients and patients is a paramount aim of all health care practices... more Developing the best care for clients and patients is a paramount aim of all health care practices, which therefore, should be based on best evidence. This is also crucial for care during the childbearing period here defined as pregnancy, childbirth, and infancy. However, due to dominance of the evidence-based medicine (EBM) model, health care practice has encountered problems especially regarding its relationship to qualitative research. In this article, we analyze and discuss how research based on a lifeworld perspective fits with evidence-based care (EBC), and how a circular model instead of a hierarchy is suitable when attributing value to knowledge for EBC. The article focuses on the history of EBM and EBC, the power of the evidence concept, and EBC from a narrow to a broad view. Further qualitative research and its use for developing EBC is discussed and examples are presented from the authors' own lifeworld research in the Nordic childbearing context. Finally, an alternative circular model of knowledge for EBC is presented. In order to develop evidence-based care, there is need for multiple types of scientific knowledge with equal strength of evidence, integrated with clinical experience, setting, circumstances and health care resources, and incorporating the experiences and clinical state of the childbearing woman and her family.
Background: For women and their partners, the first meeting with professional staff on the labour... more Background: For women and their partners, the first meeting with professional staff on the labour ward is important. This initial encounter is a short but sensitive meeting. It may be particularly crucial for first time parents, most of whom have no prior experience of the birth environment. The objective of this study was to explore the meaning of first time mothers' and their partners' first encounter with midwives and other maternity care staff when they arrive on a hospital labour ward. Method: A hermeneutic, reflective lifeworld research approach was chosen to identify patterns of meanings, comprehension and explanations. Participants from Western Sweden were interviewed in the postnatal period; 37 individually, and 28 in focus groups. Results: Four themes were identified: 'timing it right ', 'waiting to be informed', 'being in an inferior position', and 'facing reality with a mosaic of emotions'. The final interpretation of the phenomenon is captured as 'waiting for permission to enter the labour ward world'. Conclusion: The findings demonstrate the parents' efforts trying to determine the appropriateness of arrival to the labour ward. An asymmetric power relationship was expressed in the obedient acceptance of the waiting for attention in an unfamiliar situation. These findings suggest that the labour ward entry process is not parent centred. As entry to the labour ward sets the tone for the rest of the birth, this period in the labour process needs more attention in future research and practice from the maternity care professionals perspective.
Scandinavian Journal of Occupational Therapy, 2003
The Pediatric Evaluation of Disability Inventory (PEDI) is an instrument for evaluating functiona... more The Pediatric Evaluation of Disability Inventory (PEDI) is an instrument for evaluating functional performance in disabled children aged 6 months to 7.5 years. PEDI measures both performance and caregiver assistance in three domains: self-care, mobility and social function. The purpose of this study was to investigate the applicability of the American normative reference values of PEDI, to describe ability among Norwegian children. This was investigated in a sample of 52 non-disabled Norwegian children in the age range 1.0-5.9 years. The Norwegian sample scored significantly lower than the American reference values for Functional Skills; self-care (mean 39; p <0.001), Care-giver Assistance; self-care (mean 43; p <0.001), and Functional Skills; mobility (mean 43, p <0.001). For caregiver assistance, mobility, and for functional skills and caregiver assistance, social function, there was good agreement between observations in the Norwegian sample and PEDI reference values. The result calls for a larger study, from which Norwegian reference values for PEDI can be derived.
Background: Women with type 1 diabetes (T1DM) face many challenges during their pregnancy, birth ... more Background: Women with type 1 diabetes (T1DM) face many challenges during their pregnancy, birth and in the postnatal period, including breastfeeding initiation and continuation while maintaining stable glycaemic control. In both Sweden and Australia the rates of breastfeeding initiation are high. However, overall there is limited information about the breastfeeding practices of women with T1DM and the factors affecting them. Similarities in demographics, birth rates and health systems create bases for discussion. Aim: The aim of this paper is to discuss psychosocial factors, policies and practices that impact on the breastfeeding practices of women with T1DM. Findings: Swedish research indicates that the overall breastfeeding rate in women with T1DM remains significantly lower than in women without diabetes in the first 2 and 6 months after childbirth with no differences in exclusive breastfeeding. Breastfeeding initiation and continuation among women with T1DM in Sweden has been shown to be influenced by health services delivery, supportive breastfeeding polices and socioeconomic factors, particular perceived support from social networks and health professionals. Conclusion: There is limited research on the impact of attitudes towards breastfeeding, emotional and social well-being and diabetes-related stress on the decision of women with T1DM to initiate and continue to breastfeed for at least 6 months. A more comprehensive understanding of the breastfeeding practices and psychosocial factors operating during the first 6 months after birth for women with T1DM will be instrumental in the future design of interventions promoting initiation and continuation of breastfeeding in Sweden, Australia and elsewhere.
Background: As a matter of routine, midwives in Sweden have spoken with women about their experie... more Background: As a matter of routine, midwives in Sweden have spoken with women about their experiences of labour in a so-called 'postpartum consultation'. However, the possibility of offering women this kind of consultation today is reduced due to shortage of both time and resources. The aim of this study was to explore the occurrence, women's requirements of, and experiences of a postpartum consultation, and to identify expectations from women who wanted but did not have a consultation with the midwife assisting during labour. Methods: All Swedish speaking women who gave birth to a live born child at a University Hospital in western Sweden were consecutively included for a phone interview over a three-week period. An additional phone interview was conducted with the women who did not have a postpartum consultation, but who wanted to talk with the midwife assisting during labour. Data from the interviews were analysed using qualitative content analysis. Results: Of the 150 interviewed women, 56% (n = 84) had a postpartum consultation of which 61.9% (n = 52) had this with the midwife assisting during labour. Twenty of the 28 women who did not have a consultation with anyone still desired to talk with the midwife assisting during labour. Of these, 19 were interviewed. The content the women wanted to talk about was summarized in four categories: to understand the course of events during labour; to put into words, feelings about undignified management; to describe own behaviour and feelings, and to describe own fear. Conclusion: The survey shows that the frequency of postpartum consultation is decreasing, that the majority of women who give birth today still require it, but only about half of them receive it. It is crucial to develop a plan for these consultations that meets both the women's needs and the organization within current maternity care.
School children often base their toilet habits on behavioural and social reasons. Bladder emptyin... more School children often base their toilet habits on behavioural and social reasons. Bladder emptying problems, urinary tract infections and constipation are common health problems which are also associated with irregular toilet habits. School rules for going to the toilet have been shown to create difficulties for school children with bladder dysfunction. Aim of this study was to describe children's experiences of school rules for going to the toilet and their significance for the children. Individual open-ended questions with 19 schoolchildren aged 9-16 in elementary schools. To manage the children's toilet needs, teachers used rules designed for maintaining order in the classroom. The children saw their toilets needs as a private matter and experienced it complicated to go to the toilet during recess as time was short and the risk for violation of their integrity was at its highest. The most frustrating when to comply with rules during lessons was to be forced to, in front of all their classmates, make public the need to go to the toilet: i.e the most private was exposed to the disclosure. The rules for going to the toilet came from the teachers' need for maintaining order in the classroom and were not adapted to the children's physical and developmental needs. To violate the integrity of children can affect their willingness to go to the school toilet which in turn affects their wellbeing during school time.
When a newborn baby needs care in a neonatal intensive care unit (NICU), the parents are welcome ... more When a newborn baby needs care in a neonatal intensive care unit (NICU), the parents are welcome to stay with their child whenever they wish. The aim of the present study was to investigate the time per day parents are present together with their child at the NICU and to identify factors that facilitated and obstructed their presence. In a descriptive study 67 parents of 42 children from two NICUs registered all time they spent at the NICU and then took part in a structured interview. Parental presence at NICUs varied depending on types of accommodation offered. Those who stayed in parent rooms at the units showed a significantly higher presence with their children than parents who stayed at family hotel, at home or on a maternity ward. Factors that motivated parental presence were primarily the willingness to take parental responsibility, the child's condition requiring it, and the want to have control. Good treatment by the staff, a family-friendly environment and high quality care were main facilitating factors for parents to be present at the NICU. Obstructing factors were primarily ill health by parents, a non-family-friendly environment, care of the home and of children at home. The result shows that there is a need to develop a family-friendly environment that provides optimal conditions for parents to be with their child in a NICU and to consider the parent's own reason for being or not being present.
Childhood overweight is presented as a complex problem to solve. To elaborate efforts required in... more Childhood overweight is presented as a complex problem to solve. To elaborate efforts required in striving for normal weight in overweight children healthy signs of life from the child's point of view should be identified and promoted. The aim of the present study is to describe everyday experiences of life, body and well-being in children with overweight. A qualitative descriptive design based on lifeworld perspective was used in 16 open-ended interviews with overweight children aged 10-12 years. Child overweight was defined by body mass index (kg/m(2)) for each age. Drawings and body pictograms were used to supplement the interviews. Text was analysed using qualitative content analysis. The primary finding was the respondents' search for a sense of community in daily life. The respondents yearned to be part of a community but spent a lot of time alone. Parents and other family members were an important source of community but were not present enough in the respondents' daily life. The respondents had a sound body image, were concerned about their bodies and were aware of a healthy lifestyle. Nevertheless, they did not manage to implement this awareness in practice. Unhealthy sleeping, eating and exercise habits along with a sense of victimization were revealed in the interviews. Well-being meant self-esteem, trust and satisfaction and was preserved and improved through exciting relationships and activities. Feeling well was equal to feeling capable, feeling happy and feeling a sense of community. Findings emphasize the problem of loneliness in the children studied. Their healthy signs of life were not promoted in an acceptable way. They spent too much time alone doing sedentary activities with easy access to junk food. Findings indicate they should be provided with company at all meals and during activities on a daily basis.
ObjectiveAfter clinical urotherapeutic guidance, schoolchildren suffering from functional bladder... more ObjectiveAfter clinical urotherapeutic guidance, schoolchildren suffering from functional bladder disturbances are expected to manage treatment at school. To comply with treatment instructions the children have to visit the toilet at least every 3h, find the sitting position facilitating relaxation of the pelvic floor, and then empty the bladder as completely as possible. They often blame failing to comply on their
Women at obstetric high risk more often experience negative feelings related to childbirth than w... more Women at obstetric high risk more often experience negative feelings related to childbirth than women with normal outcomes. For these high-risk women, an individual birth plan does not appear to improve the overall experience of childbirth; rather, it seems to intensify the negative feelings in several aspects. The increased vulnerability in women at high risk warrants special attention to the possibility that types of care routinely offered to all women may negatively influence the experiences of high-risk women.
Objectives: to identify primary and secondary outcome measures in randomised trials, and systemat... more Objectives: to identify primary and secondary outcome measures in randomised trials, and systematic reviews of randomised trials, measuring effectiveness of oxytocin for treatment of delay in the first and second stages of labour, and to identify any positive health-focussed outcomes used. Design: eight relevant citation databases were searched up to January 2013 for all randomised trials, and systematic reviews of randomised trials, measuring effectiveness of oxytocin for treatment of delay in labour. Trials of active management of labour or partogram action lines were excluded. 1918 citations were identified. Two reviewers reviewed all citations and extracted data. Twenty-six individual trials and five systematic reviews were included. Primary and secondary outcome measures were documented and analysed using frequency distributions. Findings: most frequent primary outcomes were caesarean section (n ¼15, 46%), length of labour (n ¼14, 42%), measurements of uterine activity (n ¼13, 39%) and mode of vaginal birth (n ¼9, 27%). Maternal satisfaction was identified a priori by one review and included as a secondary outcome by three papers. No further positive health-focussed outcomes were identified.
Several biomarkers including B-type natriuretic peptide (BNP) have been suggested to improve pred... more Several biomarkers including B-type natriuretic peptide (BNP) have been suggested to improve prediction of coronary events and all-cause mortality. Moreover, coronary artery calcium (CAC) as marker of subclinical atherosclerosis is a strong predictor for cardiovascular mortality and morbidity. We aimed to evaluate the predictive ability of BNP and CAC for all-cause mortality and coronary events above traditional cardiovascular risk factors (TRF) in the general population. We followed 3782 participants of the population-based Heinz Nixdorf Recall cohort study without coronary artery disease at baseline for 7.3 ± 1.3 years. Associations of BNP and CAC with incident coronary events and all-cause mortality were assessed using Cox regression, Harrell's c, and time-dependent integrated discrimination improvement (IDI(t), increase in explained variance). Subjects with high BNP levels had increased frequency of coronary events and death (coronary events/mortality: 14.1/28.2% for BNP ≥100 pg/ml vs. 2.7/5.5% for BNP < 100 pg/ml, respectively). Subjects with a BNP ≥100 pg/ml had increased incidence of hard endpoints sustaining adjustment for CAC and TRF (for coronary events: hazard ratio (HR) (95% confidence interval (CI)) 3.41(1.78-6.53); for all-cause mortality: HR 3.35(2.15-5.23)). Adding BNP to TRF and CAC increased measures of predictive ability: coronary events (Harrell's c, for coronary events, 0.775-0.784, p = 0.09; for all-cause mortality 0.733-0.740, p = 0.04; and IDI(t) (95% CI), for coronary events: 2.79% (0.33-5.65%) and for all-cause mortality 1.78% (0.73-3.10%). Elevated levels of BNP are associated with excess incident coronary events and all-cause mortality rates, with BNP and CAC significantly and complementary improving prediction of risk in the general population above TRF.
Background: Person-centred care, asserting that individuals are partners in their care, has been ... more Background: Person-centred care, asserting that individuals are partners in their care, has been associated with care satisfaction but the value of using it to support women with obesity during pregnancy is unknown. Excessive gestational weight gain is associated with increased risks for both mother and baby and weight gain therefore is an important intervention target. The aims of this review was to 1) explore to what extent and in what manner interventions assessing weight in pregnant women with obesity use person-centred care and 2) assess if interventions including aspects of person-centred care are more effective at limiting weight gain than interventions not employing person-centred care.
Background: Women with type 1 diabetes (T1DM) face many challenges during their pregnancy, birth ... more Background: Women with type 1 diabetes (T1DM) face many challenges during their pregnancy, birth and in the postnatal period, including breastfeeding initiation and continuation while maintaining stable glycaemic control. In both Sweden and Australia the rates of breastfeeding initiation are high. However, overall there is limited information about the breastfeeding practices of women with T1DM and the factors affecting them. Similarities in demographics, birth rates and health systems create bases for discussion. Aim: The aim of this paper is to discuss psychosocial factors, policies and practices that impact on the breastfeeding practices of women with T1DM. Findings: Swedish research indicates that the overall breastfeeding rate in women with T1DM remains significantly lower than in women without diabetes in the first 2 and 6 months after childbirth with no differences in exclusive breastfeeding. Breastfeeding initiation and continuation among women with T1DM in Sweden has been shown to be influenced by health services delivery, supportive breastfeeding polices and socio-economic factors, particular perceived support from social networks and health professionals. Conclusion: There is limited research on the impact of attitudes towards breastfeeding, emotional and social well-being and diabetes-related stress on the decision of women with T1DM to initiate and continue to breastfeed for at least 6 months. A more comprehensive understanding of the breastfeeding practices and psychosocial factors operating during the first 6 months after birth for women with T1DM will be instrumental in the future design of interventions promoting initiation and continuation of breastfeeding in Sweden, Australia and elsewhere.
International Journal of Qualitative Studies on Health and Well-being, 2008
Developing the best care for clients and patients is a paramount aim of all health care practices... more Developing the best care for clients and patients is a paramount aim of all health care practices, which therefore, should be based on best evidence. This is also crucial for care during the childbearing period here defined as pregnancy, childbirth, and infancy. However, due to dominance of the evidence-based medicine (EBM) model, health care practice has encountered problems especially regarding its relationship to qualitative research. In this article, we analyze and discuss how research based on a lifeworld perspective fits with evidence-based care (EBC), and how a circular model instead of a hierarchy is suitable when attributing value to knowledge for EBC. The article focuses on the history of EBM and EBC, the power of the evidence concept, and EBC from a narrow to a broad view. Further qualitative research and its use for developing EBC is discussed and examples are presented from the authors' own lifeworld research in the Nordic childbearing context. Finally, an alternative circular model of knowledge for EBC is presented. In order to develop evidence-based care, there is need for multiple types of scientific knowledge with equal strength of evidence, integrated with clinical experience, setting, circumstances and health care resources, and incorporating the experiences and clinical state of the childbearing woman and her family.
Background: For women and their partners, the first meeting with professional staff on the labour... more Background: For women and their partners, the first meeting with professional staff on the labour ward is important. This initial encounter is a short but sensitive meeting. It may be particularly crucial for first time parents, most of whom have no prior experience of the birth environment. The objective of this study was to explore the meaning of first time mothers' and their partners' first encounter with midwives and other maternity care staff when they arrive on a hospital labour ward. Method: A hermeneutic, reflective lifeworld research approach was chosen to identify patterns of meanings, comprehension and explanations. Participants from Western Sweden were interviewed in the postnatal period; 37 individually, and 28 in focus groups. Results: Four themes were identified: 'timing it right ', 'waiting to be informed', 'being in an inferior position', and 'facing reality with a mosaic of emotions'. The final interpretation of the phenomenon is captured as 'waiting for permission to enter the labour ward world'. Conclusion: The findings demonstrate the parents' efforts trying to determine the appropriateness of arrival to the labour ward. An asymmetric power relationship was expressed in the obedient acceptance of the waiting for attention in an unfamiliar situation. These findings suggest that the labour ward entry process is not parent centred. As entry to the labour ward sets the tone for the rest of the birth, this period in the labour process needs more attention in future research and practice from the maternity care professionals perspective.
Scandinavian Journal of Occupational Therapy, 2003
The Pediatric Evaluation of Disability Inventory (PEDI) is an instrument for evaluating functiona... more The Pediatric Evaluation of Disability Inventory (PEDI) is an instrument for evaluating functional performance in disabled children aged 6 months to 7.5 years. PEDI measures both performance and caregiver assistance in three domains: self-care, mobility and social function. The purpose of this study was to investigate the applicability of the American normative reference values of PEDI, to describe ability among Norwegian children. This was investigated in a sample of 52 non-disabled Norwegian children in the age range 1.0-5.9 years. The Norwegian sample scored significantly lower than the American reference values for Functional Skills; self-care (mean 39; p <0.001), Care-giver Assistance; self-care (mean 43; p <0.001), and Functional Skills; mobility (mean 43, p <0.001). For caregiver assistance, mobility, and for functional skills and caregiver assistance, social function, there was good agreement between observations in the Norwegian sample and PEDI reference values. The result calls for a larger study, from which Norwegian reference values for PEDI can be derived.
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Papers by Marie Berg
factors affecting them. Similarities in demographics, birth rates and health systems create bases for discussion.
Aim: The aim of this paper is to discuss psychosocial factors, policies and practices that impact on the breastfeeding practices of women with T1DM.
Findings: Swedish research indicates that the overall breastfeeding rate in women with T1DM remains significantly lower than in women without diabetes in the first 2 and 6 months after childbirth with no differences in exclusive breastfeeding. Breastfeeding initiation and continuation among women with T1DM in Sweden has been shown to be influenced by health services delivery, supportive breastfeeding polices and socio-economic factors, particular perceived support from social networks and health professionals.
Conclusion: There is limited research on the impact of attitudes towards breastfeeding, emotional and social well-being and diabetes-related stress on the decision of women with T1DM to initiate and continue to breastfeed for at least 6 months. A more comprehensive understanding of the breastfeeding
practices and psychosocial factors operating during the first 6 months after birth for women with T1DM will be instrumental in the future design of interventions promoting initiation and continuation of breastfeeding in Sweden, Australia and elsewhere.
factors affecting them. Similarities in demographics, birth rates and health systems create bases for discussion.
Aim: The aim of this paper is to discuss psychosocial factors, policies and practices that impact on the breastfeeding practices of women with T1DM.
Findings: Swedish research indicates that the overall breastfeeding rate in women with T1DM remains significantly lower than in women without diabetes in the first 2 and 6 months after childbirth with no differences in exclusive breastfeeding. Breastfeeding initiation and continuation among women with T1DM in Sweden has been shown to be influenced by health services delivery, supportive breastfeeding polices and socio-economic factors, particular perceived support from social networks and health professionals.
Conclusion: There is limited research on the impact of attitudes towards breastfeeding, emotional and social well-being and diabetes-related stress on the decision of women with T1DM to initiate and continue to breastfeed for at least 6 months. A more comprehensive understanding of the breastfeeding
practices and psychosocial factors operating during the first 6 months after birth for women with T1DM will be instrumental in the future design of interventions promoting initiation and continuation of breastfeeding in Sweden, Australia and elsewhere.