Smoking during pregnancy was up to 70% more common in the most deprived municipalities - a multilevel analysis of all singleton births during 2005-2010 in Finland.

OBJECTIVE: We investigated whether there was an association between maternal smoking habits during pregnancy and municipality level deprivation defined based on education, income and unemployment after adjustment for individual level covariates, including socioeconomic status (SES), in Finland, a Nordic welfare state. METHODS: Data were gathered from the Medical Birth Register and comprised all singleton births (n=337,876) during 2005-2010. To account for any correlation of women clustered within a municipality, we fitted generalized estimating equation (GEE) models. RESULTS: In total, 15.3% of the women with singleton pregnancies smoked during pregnancy. After adjustment for individual level confounders, smoking during pregnancy was 5.4-fold higher among women with the lowest as compared with highest individual SES. Controlling for individual SES, age and year of birth, women living in municipalities defined as intermediately and highly deprived based on education were 53.7% (adjusted odds ratio [aOR] 1.537, 95% confidence interval [CI] 1.493-1.583) and 71.5% (aOR 1.715, 95% CI 1.647-1.785), respectively, more likely to smoke during pregnancy than women in the least deprived municipalities. CONCLUSIONS: Individual SES is the strongest correlate of smoking during pregnancy but conditional on individual variables; lower municipality aggregate education is associated with up to 70% higher smoking prevalence.

Associations between family characteristics and public health nurses' concerns at children's health examinations.

RATIONALE: The family and the way it functions have a key role for the health and well-being of children and adolescents. Approximately 10-30% of children grow up in families where their health and well-being may be endangered or weakened. There is very little research data on public health nurses' concerns in connection with children's health examinations related to family characteristics. AIM: The aim of this study was to investigate the associations of children's gender, age, family structure, mother's employment status and parents' perception on the sufficiency of income with public health nurses' concerns on physical and psychosocial health at children's health examinations. METHODS: In 2007-2009, information about children's health and well-being and their background factors was collected from the health examinations of altogether 6506 children in Finland using a cross-sectional design. Associations between family characteristics and nurses concern related to physical and psychosocial health and development of children were assessed using logistic regression analysis. RESULTS: Physical health and psychosocial issues of school-age children raised most concern in public health nurses. Especially, public health nurses felt concern for the psychosocial development of boys both under and of school age. Family structure and the family's financial situation were associated with public health nurses' concern for children's physical health, psychosocial development and the presence of at least one concern. CONCLUSION: The fact that public health nurses found cause for concern during health examinations was associated with the child's gender, development stage and family characteristic. The research findings may be utilised in planning and targeting health counselling and services in child and school health care. Understanding the role of family characteristics in health and well-being challenges in children is useful in promoting multidisciplinary work in health care.

A new participative, family-oriented health counseling approach for children and their families: a comparative qualitative analysis.

Health counseling is an essential part of health promotion and there is a need for new, family-oriented health counseling methods. The objective of this study was to describe the differences in physical activity conversations from the perspective of family-oriented care between child health visits using the Weighty Matter Toolkit and those using normal protocol. In total, 35 health visits were analyzed. The results indicate that the Weighty Matter Toolkit offers the child, and other family members, a better opportunity to participate to conversations, and the focus of the conversation is more diverse and based on the family's perception regarding physical activity compared to the normal protocol. Thus, the Weighty Matter Toolkit is a promising method for family-oriented health counseling.

Meta-synthesis and evidence-based health care--a method for systematic review.

BACKGROUND: Even the systematic reviews of qualitative studies are discussed health literature, the significance of their results is not fully recognised in evidence-based practice. AIM: The aim of this article is to describe the systematic reviews of qualitative studies, metasynthesis and its process and consider the meaning of meta-synthesis in evidence-based practice. CONCLUSIONS: Meta-synthesis is a method for synthesising knowledge, for example, relating to service users' healthcare-related experiences and the factors that facilitate their involvement in their own care and commitment to a healthy lifestyle. This type of knowledge is needed in evidence-based practice. Meta-synthesis is a concept that includes several methodologies in synthesising qualitative research findings. This article focuses on meta-synthesis with meta-aggregation as a method for combining data from original studies. Following the principles of scientific rigour, systematic reviews synthesise the best available and critically appraised knowledge. The article describes the process and the role of systematic review of qualitative studies and discusses its significance for evidence-based practice when making clinical and administrative decisions, as well as more widely in social and political decision-making.

Systematic review--a method for nursing research.

This article by Arja Holopainen, Tuovi Hakulinen-Viitanen and Kerttu Tossavainen explains the five stages of the systematic review process and describes how this method was applied to an analysis of studies dealing with nurse 'teacherhood'. The authors argue that systematic review is an excellent method for summarising research knowledge and for highlighting evidence significant for nursing, nursing education and nursing research.

Nurse teacherhood: systematic descriptive review and content analysis.

BACKGROUND: The concept of 'nurse teacherhood' is multidimensional. In this article, 'nurse teacherhood' includes nurse teachers' tasks and different multidimensional roles as well as their personal experiences of being a nurse teacher. OBJECTIVES: The article examines the topics of nursing research concerning nurse teacherhood, the changes in these topics and the results reported from January 1990 to April 2004. DESIGN AND METHOD: The material was obtained by conducting a systematic review, and it included nursing research papers and Finnish academic dissertations (N=207). The material was analysed by using content analysis. RESULTS: The topics of the studies were divided into three thematic categories: the expansion of nurse teacherhood, the skills of nurse teacherhood and their development, nurse teacherhood and membership in working community. The number of studies on the first two themes had increased (1990-1994:43; 1995-1999:57; 2000-4/2004:65), while those on the third theme had decreased (1990-1994:18; 1995-1999:19; 2000-4/2004:5). CONCLUSIONS: Nurse teacherhood has been studied actively during the past 15 years and approached from several perspectives. Most of the topics of the studies discussed the expansion of nurse teacherhood. The focus of the studies in different years varied depending on the kind of challenges posed to nurse teachers' work in each period of time.

Family characteristics and health behaviour as antecedents of school nurses' concerns about adolescents' health and development: a path model approach.

BACKGROUND: Family socio-economic factors and parents' health behaviours have been shown to have an impact on the health and well-being of children and adolescents. Family characteristics have also been associated with school nurses' concerns, which arose during health examinations, about children's and adolescents' physical health and psychosocial development. Parental smoking has also been associated with smoking in adolescents. OBJECTIVES: The aim of this study was to determine to what extent school nurses' concerns about adolescents' physical health and psychosocial development related to family characteristics are mediated through parents' and adolescents' own health behaviours (smoking). DESIGN: A path model approach using cross-sectional data was used. SETTINGS: In 2008-2009, information about health and well-being of adolescents was gathered at health examinations of the Children's Health Monitoring Study. PARTICIPANTS: Altogether 1006 eighth and ninth grade pupils in Finland participated in the study. METHODS: The associations between family characteristics, smoking among parents and adolescents and school nurses' concerns about adolescents' physical health and psychosocial development were examined using a structural equation model. RESULTS: Paternal education had a direct, and, through fathers' and boys' smoking, an indirect association with school nurses' concerns about the physical health of boys. Paternal labour market status and family income were only indirectly associated with concerns about the physical health of boys by having an effect on boys' smoking through paternal smoking, and a further indirect effect on concerns about boys' health. In girls, only having a single mother was strongly associated with school nurses' concerns about psychosocial development through maternal and adolescent girl smoking. CONCLUSIONS: Socio-economic family characteristics and parental smoking influence adolescent smoking and are associated with school nurses' concerns about adolescents' physical health and psychosocial development. The findings underline the importance of comprehensively taking into account adolescents' and parents' health behaviours and the family situation in health-care contacts when providing health counselling.

Smoking cessation in the first trimester reduces most obstetric risks, but not the risks of major congenital anomalies and admission to neonatal care: a population-based cohort study of 1,164,953 singleton pregnancies in Finland.

BACKGROUND: In industrialised countries, approximately 5-20% of women smoke during pregnancy. We aim to study the association between smoking during pregnancy and adverse perinatal outcomes. METHODS: A retrospective population-based cohort study using data on all singleton births between 1991 and 2010 (n=1,164,953) derived from the Finnish Medical Birth Register. RESULTS: Of all the mothers included, 82.3% were non-smokers, 2.6% quit smoking during the first trimester of pregnancy, 12.5% smoked throughout pregnancy and 2.7% had no information on smoking. Continuing smoking after the first trimester of the pregnancy was associated with an increased prevalence of admission to a neonatal intensive care unit, stillbirth, preterm birth (<37 gestational weeks), low birth weight (LBW, <2500 g), small for gestational age (SGA, < -2 SDs) and major congenital anomaly compared with non-smokers. Smoking cessation reduced the risk of prematurity, stillbirth, LBW and SGA close to or at similar levels as those of non-smokers. Tobacco exposure in early pregnancy resulted in a 19% increased prevalence of admission to neonatal intensive care unit and a 22% increased prevalence of major congenital anomaly compared with non-smokers. CONCLUSIONS: Smoking cessation appeared to reduce pregnancy risks close to those of non-smoking peers. Exposure to early pregnancy smoking was, however, associated with an increased admission to neonatal intensive care and an increased prevalence of major congenital anomalies.