'I felt a little bubbly in my tummy': eliciting pre-schoolers' accounts of their health visit using a computer-assisted interview method.

BACKGROUND: In the health care services, children's rights to participate in all matters that concern them are considered important. However, in practice this can be challenging with young children. In My Shoes (IMS) is a computer-assisted interview tool developed to help children talk about their experiences. The aim of the study was to evaluate the IMS' ability to elicit pre-schoolers' subjective experiences and accurate accounts of a routine health visit as well as the children's engagement in the interview process. METHODS: Interviews were conducted with 23 children aged 4-5 years, 2-4 weeks after their health visit. The interviews were transcribed verbatim and analysed using a method inspired by Content Analysis to evaluate IMS's ability to elicit accounts about subjective experiences. Accurate accounts were assessed by comparing the transcribed interviews with the filmed visits at the child health centre. The children's engagement was defined by the completion and length of the interviews, and the children's interaction with the software. RESULTS: All children gave accounts about their subjective experiences, such as their emotional state during the visit, available toys or rewards they received. All children related to the correct event, they all named at least one person who was present and 87% correctly named at least one examination procedure. The majority of children (91%) completed the interview, which lasted 17-39 min (M = 24), and 96% interacted with the IMS software. CONCLUSIONS: IMS was feasible to help children describe their health care experiences, in both detail and depth. The children interacted with the software and maintained their interest for an extended period of time.

Maternal and child health nurses' self-perceived confidence in dealing with child behaviour problems.

BACKGROUND: Addressing behaviour problems in children is increasingly becoming part of routine care. The question therefore arises as to which workforce members are best suited to deliver structured interventions and what skill sets they might need apart from knowledge of the specific parenting programme offered. OBJECTIVES: To assess maternal and child health (MCH) nurses' self-perceived confidence in dealing with child behaviour problems. DESIGN: Cross-sectional questionnaire study. Data collection occurred prior to cluster randomization in the Families in Mind trial. SETTING: MCH clinics in nine local government areas in greater Melbourne, in 2010. PARTICIPANTS: All MCH nurses in the nine areas were invited to participate, 153 (79%) completed the survey. MAIN OUTCOMES MEASURES: Nurses' comfort, competency, attitudes and perceived difficulties in dealing with child behaviour problems. RESULTS: The majority of nurses (63%) viewed it as their role to deal with, rather than refer, child behaviour problems and felt that the task was rewarding (86%). They believed that parenting advice should be offered universally, rather than only to families with severe problems (94%). Nurses felt rather comfortable and competent to broach and discuss child behaviour problems without need for prior parental request, but somewhat less comfortable and competent to manage child behaviour problems or to make a difference. Experienced nurses (>10 years in practice) felt more comfortable and competent. Nurses described that the major challenge in their dealing with child behaviour problems was parental denial or resistance (60%). CONCLUSIONS: MCH nurses are at the frontline of preventive medical services for families with young children where behaviour problems are a common concern. Because managing young children's behaviour problems primarily occurs through adult behaviour change, techniques addressing parent denial and non-compliance, such as motivational interviewing and empowerment should be a part of MCH nurses' skill sets.

"Nobody asked us if we needed help": Swedish parents experiences of enuresis.

OBJECTIVE: To explore the everyday dilemmas of parents living with a child with nocturnal enuresis and to describe their support needs in relation to healthcare professionals. SUBJECTS AND METHODS: The study was conducted in 2011 in Uppsala County, Sweden. Parents of 13 children with enuresis, 10 mothers and three fathers, participated in qualitative semi-structured in-depth interviews, which were analysed using systematic text condensation. RESULTS: The analysis of the material resulted in six themes: enuresis is socially stigmatising and handicapping; all practices and home remedies are tested; it creates frustration in the family; protecting the child from gossip or teasing; support from healthcare providers would have helped; it's something we just have to live with. Two patterns of coping were identified: the Unworried wet-bed-fixers and the Anxious night-launderers. CONCLUSION: Having a child with enuresis can be stressful for parents, although they tried hard not to blame their child. Because parents can feel reluctant to bring up enuresis themselves, they want child health nurses to routinely raise the issue of bedwetting at the yearly check-up. Parents' information needs included causes of and available treatment options for enuresis as well as access to aids and other support for affected families.

Anti-cytokine autoantibodies preceding onset of autoimmune polyendocrine syndrome type I features in early childhood.

PURPOSE: Almost all patients with autoimmune polyendocrine syndrome (APS)-I have high titer neutralizing autoantibodies to type I interferons (IFN), especially IFN-ω and IFN-α2, whatever their clinical features and onset-ages. About 90 % also have antibodies to interleukin (IL)-17A, IL-17F and/or IL-22; they correlate with the chronic mucocutaneous candidiasis (CMC) that affects ~90 % of patients. Our aim was to explore how early the manifestations and endocrine and cytokine autoantibodies appear in young APS-I patients. That may hold clues to very early events in the autoimmunization process in these patients. METHODS: Clinical investigations and autoantibody measurements in 13 APS-I patients sampled before age 7 years, and 3 pre-symptomatic siblings with AIRE-mutations in both alleles. RESULTS: Antibody titers were already high against IFN-α2 and IFN-ω at age 6 months in one sibling-8 months before onset of APS-I-and also against IL-22 at 7 months in another (still unaffected at age 5 years). In 12 of the 13 APS-I patients, antibody levels were high against IFN-ω and/or IL-22 when first tested, but only modestly positive against IFN-ω in one patient who had only hypo-parathyroidism. Endocrine organ-specific antibodies were present at age 6 months in one sibling, and as early as 36 and 48 months in two of the six informative subjects. CONCLUSION: This is the first study to collate the onset of clinical features, cytokine and endocrine autoantibodies in APS-I infants and siblings. The highly restricted early autoantibody responses and clinical features they show are not easily explained by mere loss of broad-specific self-tolerance inducing mechanisms, but hint at some more sharply focused early event(s) in autoimmunization.

'Children are exposed to temptation all the time'- parents' lifestyle-related discussions in focus groups.

AIM: To explore parents' perspectives on providing their preschool child with a healthy lifestyle, including obstacles and resources. METHODS: Five semi-structured focus group interviews were conducted, with 30 parents of 4-year-olds in Sweden. Interviews were transcribed verbatim and analysed using Systematic Text Condensation. RESULTS: Four themes emerged from the qualitative analysis: Lifestyle -'The way you live is parents' responsibility', Challenges to promote children's healthy lifestyle, Support from professionals, and peers might facilitate, and Request for an overall responsibility from society. Parents felt that they were role models for their child's lifestyle, a concept including many factors. Attractive and tempting sedentary activities and unhealthy foods were perceived as obstacles, and parents were frustrated by the media's contradictory lifestyle messages. Child health services were expected to more actively invite parents to discuss their child's lifestyle issues. Parents desired some collective responsibility for children's lifestyles through agencies, services and media messages that support and promote healthy choices. CONCLUSION: Parents struggled to give their children a healthy lifestyle and the 'temptations' of daily unhealthy choices causing hassles and conflicts. Parents desired professional support from preschool, Child Health Care and a collective responsibility from society with uniform guidelines. Parents groups were mentioned as peer support.

Variation of patients' views on Type 2 diabetes management over time.

AIMS: The aim of the study was to examine the relationship between participants' views about their role in diabetes treatment and their glycaemic control 3-7 years after having entered an educational intervention, and to investigate whether people's attitudes towards diabetes management change over an extended period of time. METHODS: The present study is a long-term follow-up analysis of data collected from 193 persons with Type 2 diabetes. A qualitative content analysis of three open-ended questions about participants' self-perceived role in diabetes treatment was used. The related outcome measure was haemoglobin A(1c) (HbA(1c)). RESULTS: The way people viewed their role in diabetes management affected glycaemic control. Individuals in the Disease Manager or Compliant categories had significantly lower HbA(1c) compared with those in the Disheartened category. Furthermore, in people whose attitudes towards diabetes treatment was variable, weight and age influenced why participants changed their views and thus switched categories. Paradoxically, when people changed their views, this change did not produce a change in blood glucose control, which would have been expected. CONCLUSIONS: From the health-care provider's perspective, it is important to know how the person with diabetes perceives his/her role in disease management and to determine if a change in perception would be followed by intervention to adjust glycaemic control. Consequently, individuals' perception of disease management should be incorporated in patient education programmes and routine diabetes care to enable customized care and prevent stagnation in negative roles.

Socially unbiased parenting support on the Internet: a cross-sectional study of users of a large Swedish parenting website.

BACKGROUND: The Internet is becoming increasingly recognized as a source of social support. Parents of children with cancer and autism have been shown to find social support online, and many parents of healthy infants and children seek information about parenting online. However, access and use of the Internet is greater among socio-economically advantaged groups, a phenomenon known as the 'digital divide'. Our aim was to investigate whether users of a Swedish general parenting website perceived support in the parenting role and, if so, whether this support was socially biased because of the digital divide phenomenon. METHODS: Users of the largest Swedish parenting website were asked to participate in the study. A total of 2221 users completed the anonymous survey posted on the website during a one-week period. RESULTS: Most respondents (95%) were female (mean age 30.6 years). Respondents' educational level was slightly, but not significantly, higher than that in the general population, whereas 68% had income levels at or under the national average, contradicting the intuitive hypothesis that users would be socio-economically privileged. Perceived social support, measured by the Interpersonal Support Evaluation List (ISEL) appraisal subscale, indicated high perceived support. Living without a partner and having lower levels of income and education increased perceived support. The perception that other parents' opinions are more valuable than the advice of experts was influential in the regression equation for ISEL scores, indicating that peer help is important in online social support. CONCLUSIONS: Internet use for general parenting issues in Sweden, mainly by women, does not seem to follow the digital divide phenomenon. Therefore, the internet provides an exciting opportunity for future infant and child public health work. The lack of fathers, however, was a surprising finding and introduces a gender bias into this seemingly socially unbiased medium.

Screening for cerebroprotective agents using an in vivo model of cerebral reversible depolarization in awake rats.

The need to screen cerebroprotective compounds without anesthetic interference prompted the development of a model using hypoxic rats. In this model two outcome measures were used: (1) the time to reach isoelectric electroencephalogram (iEEG), caused by nitrogen gas inhalation in the test chamber, and (2) the time for behavioral recovery measuring the latency of restoration of the head-withdrawal reflex upon vibrissae stimulation. We report here data of blood chemistry, cerebral tissue oxygen measurements, a definition of a proposed scoring system, and the pharmacological results of RGH-2202. The findings with RGH-2202 are used here to show the utility of the screening method. Events during hypoxia: Arterial and venous pO(2), pCO(2), and pH, and brain tissue pO(2)significantly declined. Significant correlations were established among the pO(2)of cerebral tissue, blood, and the test chamber. RGH-2202 significantly and dose-dependently shortened the iEEG time; the compound's Effective Dose(30)was 227.8 mg kg(-1). Events during recovery: Immediately after the iEEG, when the atmosphere in the chamber was replaced with room air, the arterial, venous and brain tissue pO(2)increased above the control level and subsequently recovered to baseline levels. Behavioral recovery occurred before blood chemistry was otherwise normalized. RGH-2202 significantly and dose-dependently shortened the recovery time; the Effective Dose(30)was 8.71 mg kg(-1). The available data define and support the physiological basis of this practicable rat-screening model.

Field test of a group education program for type 2 diabetes: measures and predictors of success on individual and group levels.

We performed field testing of a previously described group education program for type 2 diabetes. HbA(1c) levels at start, 6 and 12 months were collected and demographic factors examined to identify predictors of long-term glycemic control on individual and group levels. "Glycemic success" comprised of (1) achieving target values of HbA(1c) < or =6.5% and/or (2) decreasing HbA(1c) progressively, depending on initial values. Groups in the field test and previous pilot-study (N=105) decreased their mean HbA(1c) significantly after 6 months, implying that diabetes mass education led by pharmacists could be possible in the future. Target HbA(1c) < or =6.5% was seen in 51% at start and 63% after 12 months (P=0.023). Initial HbA(1c) and BMI were the most important success predictors; age, sex, duration, and civil status showed no effects. Overweight individuals relapsed after initially decreasing their HbA(1c), emphasizing the need for long-term support in weight management. Experienced loneliness affected outcomes, indicating interaction between diet self-care and social relations.

Contradictions in the medical encounter: female sexual dysfunction in primary care contacts.

BACKGROUND: Over the past two decades, primary care physicians have been encouraged to participate in the management of sexual disturbances. Women with type 2 diabetes, often treated by GPs, are at high risk of experiencing sexual dysfunction. OBJECTIVE: Very few qualitative studies have described the impact of sexual dysfunction on the diabetic women experiencing it. Our aim was, therefore, to explore the effects, if any, of type 2 diabetes on "womanhood and intimacy" and investigate whether women wish to receive medical attention for their sexual disturbances. METHODS: We used a purposeful sample of middle-aged and older women (44-80 years) diagnosed with type 2 diabetes (n = 33). Methods triangulation was employed: focus group interviews were combined with observer data and a structured, anonymous questionnaire. We performed content analysis, with co-researcher control for systematic bias during the coding process. RESULTS: Personal characteristics, such as age, sex, experience and attitude of the doctor, the specialty considered to be appropriate (GP versus gynaecologist) and circumstances (time and privacy) in the primary care setting appeared to significantly influence women's willingness to discuss--if at all--sexual matters with physicians. CONCLUSION: GPs should aim to create an open atmosphere to encourage discussion of female sexual dysfunction in the consultation room. However, women with sexual problems might benefit more from peer help through patient or women's organizations. The role of GPs might therefore consist of supporting these services and identifying female sexual dysfunction in type 2 diabetes, a problem that middle-aged and older women have difficulty communicating.

Cerebroprotective drugs shorten the hypoxia-induced onset of electrical silence in unanesthetized rats.

Pharmacological agents that delay the hypoxic arrest of neuronal electrical activity, as indicated by the suppression of electroencephalogram (EEG), have previously been thought to increase brain resistance to oxygen insufficiency. On the other hand, acceleration of the EEG suppression may offer some protection against severe hypoxia by reducing neuronal energy spending on electrogenesis. In unanesthetized rats we examined the effects of several antihypoxic drugs on the time of appearance of isoelectric EEG (tiEEG), caused by normobaric hypoxia. In addition, alterations in cerebral blood flow induced by hypoxia and by some drugs were monitored using polarographic techniques to determine if cerebrocirculatory changes play a significant role in the drug effects on tiEEG. We also assessed drug effects on behavioral recovery after hypoxia by measuring the latency of restoration of the head-withdrawal reflex upon vibrissae stimulation. Pentobarbital (30 and 60 mgkg(-1)i.p.), chloralhydrate (400 mgkg(-1)i.p.) flunarizine (50-100 mgkg(-1)p.o.), hydergine (3-50 mgkg(-1)p.o.), nicergoline (50 mgkg(-1)and 85 mgkg(-1)p.o.), sabeluzole (3 and 7.5 mgkg(-1)i.p.) and vincamine (80 mgkg(-1)p.o.) reduced tiEEG (mean 27.1 +/- 3.3 min prior to drugs). In contrast, idebenone (29-85 mgkg(-1)p.o.) and vinpocetine (29-85 mgkg(-1)p.o.) had no significant effects on tiEEG. The divergent effects on cerebral blood flow suggest an insignificant role for cerebrocirculatory changes in the drug-induced reduction of tiEEG during severe hypoxia. The drug effects on recovery of the head-withdrawal reflex (mean 4.2 +/- 1.3 min prior to drugs) varied from a delay (sabeluzole) to acceleration (flunarizine) with no correlation to the effects on tiEEG, suggesting that EEG criteria alone may not predict the course of functional recovery.

Study circles at the pharmacy--a new model for diabetes education in groups.

During the past years diabetes education has developed greatly. However, a survey of diabetes care in Sweden in 1995 showed that only 40% of the patients examined had acceptable HbAlc values. This underlines the need for an effective and low-cost patient education programme. In this study we tested the feasibility of a 1-year group education model for patients with type 2 diabetes at Swedish pharmacies. In the study circles, led by specially trained pharmacists, participants learned how to self-monitor glucose, to interpret the results and to act upon them. We conclude that study circles held at pharmacies are a feasible way of educating persons with type 2 diabetes. The group setting promoted learning through peer help and gave emotional support to participants. Metabolic control as measured by HbAlc improved significantly after 6 months, but reverted to baseline levels again at 12 months. The reason for this needs further investigation.

Simultaneous quantitative evaluation of visual-evoked responses and background EEG activity in rat: normative data.

An integrated quantitative electroencephalography system (Phegra) for pharmacological and toxicological research in rat is described. Peak latencies and amplitudes of visual-evoked potentials, occurrence, duration, and linear excursions of photically evoked afterdischarges, "activity," "mobility," "complexity" of Hjorth, and absolute spectral powers of delta, theta, alpha, and beta frequency bands of background activity of visual cortex and frontal-visual leads were measured in freely moving rats. Counts of small and large movements were also registered. Data of baseline measurements performed in large amount of animals are presented. None of the parameters except the occurrence of photically evoked afterdischarge and the linear excursion of its averaged waveshape changed significantly in five measurements performed within six hours following the intraperitoneal and oral administration of two commonly used drug vehicles.

Classification of drugs based on visually evoked responses in rats.

Quantified parameters of photically evoked afterdischarge and EEG background activity of visual cortex of freely moving rats were used as variables to obtain a t profile for each drug dosage. Behavioural scores were also used. The determination of the dose/time-effect profile of a compound was based on normalization of data and on calculation of the first two factor values in comparison with pooled data of representatives of neuroleptic, anxiolytic, convulsant, petit mal anticonvulsant, antidepressant and psychostimulant drug classes. The compounds were investigated in different dosages and/or routes of administration. The model and procedure are validated for antipsychotic, anxiolytic and vigilance enhancer effect, and comprise the predictability of proconvulsive and petit mal anticonvulsive effects.

Hypoxia-induced sleep disturbance in rats.

The effects of varying degrees of hypoxia on sleep-wake organization were studied in rats prepared for chronic electrophysiological recording. The influence of Piracetam (75, 50, and 500 mg/kg, i.p.) and Hydergine (0.5, 1, and 3 mg/kg, i.p.) on sleep-wake organization in 10.5% oxygen was also investigated. The sleep-wake organization of rats under the effect of 15.5% oxygen content was unchanged, compared to that of normoxic control. More extreme hypoxia (12.6 and 10.5% oxygen) produced dramatic changes in sleep organization without influencing gross behavior. Paradoxical sleep (PS) stages became less frequent and shortened and were totally absent in 10.5% oxygen. Frequent wakings caused disturbed and superficial sleep. Central biochemical mechanisms, peripheral chemoreceptor reflex pathways and, as a consequence, decrease of duration of deep sleep periods, may contribute to the development of hypoxic sleep disturbances. Piracetam alleviated and Hydergine moderately reversed the hypoxic sleep disturbance.

Effects of thyrotropin-releasing hormone and its analogue L-6-ketopiperidine-2-carbonyl-leucyl-L-prolin-amide on behaviour and electroencephalogram.

A comparative dose-response investigation of thyrotropin-releasing hormone (TRH) and L-6-ketopiperidine-2-carbonyl-leucyl-L-proline-amide (RGH-2202) was carried out on rats and cats. RGH-2202 reduced the occurrence of photically evoked after-discharge in rats more significantly than TRH. Neither of the two compounds influenced the parameters of visually evoked potentials. Both compounds desynchronized the background electrocortical activity in rats. The amplitude of the acoustic startle reflex in rats was decreased dose-dependently only by RGH-2202, and this effect was nearly 3 times more potent than that of TRH. Both compounds increased the time spent awake, the latency to light sleep and the proportion of light sleep in a dose-dependent manner. The higher doses of TRH equalled the effects of the lower doses of RGH-2202. In cats the latency increasing effect of TRH on paradoxical sleep was about 30% less than that of RGH-2202; furthermore, the relative increase in the proportion of light sleep coupled with a corresponding decrease of deep sleep and paradoxical sleep was significant only in the case of RGH-2202. In a complex conditioned reflex situation in cats, the dose-dependent motivation decreasing effect on food intake and, as a consequence, on spontaneous motor activity was more pronounced in the case of TRH. The effective doses of RGH-2202 and TRH in rats were nearly equal, while in cats RGH-2202 showed about 1/10 of the potency of TRH. This finding suggests a considerably lower species variability of the effects of RGH-2202.(ABSTRACT TRUNCATED AT 250 WORDS)