The Perceived Power and Powerlessness in School Health Nurses' Mental Health Promotion Practices: A Synthesis of Qualitative Studies.

Schools are important arenas for mental health promotion initiatives. School nurses have the opportunity and ability to support and promote students' mental health, but their role and practices have been perceived as somewhat unclear. Therefore, the aim of this study was to explore school nurses' mental health promotion practices. A total of 12 scientific studies were synthesized through a meta-ethnographic approach. The overarching results of the synthesis show that school nurses' mental health promotion practices are largely about balancing and combining the students' needs with different professional perspectives, competencies, and conditions. The school nurses perceived that they had the power to influence their practices through a variety of ways, highlighting the importance of letting the students' needs guide the practices. Yet, at the same time they described feelings of powerlessness because of the different organizational structures that were hindering their mental health promotion practices.

Immunohistochemical staining seems mandatory for individualizing and shortening follow-up in unilateral primary aldosteronism.

OBJECTIVE: The clinical significance of immunohistochemistry (IHC) for unilateral primary aldosteronism (PA) has been unclear. Individualized follow-up of PA patients could be in sight. Long-term outcomes of patients, classified based on IHC, need further investigation. We aimed to assess long-term clinical outcomes for unilateral PA, classifying patients based on IHC. DESIGN: A nationwide observational study, with up to 16 years follow-up, executed in 2007-2016 at Landspitali University Hospital, tertiary referral center. Patients were diagnosed and treated in line with the current guidelines. Haematoxylin and eosin (H&E) tissue slides were stained using CYP11B1 and -B2 antibodies. All cases were re-evaluated and classified according to the HISTALDO consensus. Outcomes were assessed using the PASO criteria. PATIENTS: All unilateral PA patients diagnosed in 2007-2016 in Iceland, 26 patients aged 28-73 years, who underwent adrenalectomy, were included. MEASUREMENTS: Aldosterone, renin, and cortisol values, use and dosage of antihypertensives, potassium supplementation, blood pressure and serum potassium pre-intervention and throughout follow-up, and histopathology results post-adrenalectomy. RESULTS: Following IHC, an aldosterone-producing nodule was seen in 12 adrenals, an aldosterone-producing adenoma in 10 and multiple aldosterone-producing micronodules in four. IHC altered histopathology from previous H&E diagnosis in 23% (6/26) of the patients. In total, 81% (21/26) of the patients had partial clinical success. Eight percent (2/26) of the patients needed potassium supplementation during follow-up. In the classical group, the AVS results were more determinative with significantly higher lateralization index (median 10.1 vs. 5.3, p = .04) and more contralateral suppression (median nondominant ratio 0.4 vs. 1.0, p = .03). One out of five patients with complete clinical success at 12 months post-op had severe relapse later, the other four were normotensive without antihypertensives for up to 10 years. CONCLUSIONS: We found IHC mandatory for accurate histopathologic diagnosis of PA. Our results support the importance of contralateral suppression when interpreting AVS results. Also, the study highlights the complicated assessment of clinical outcome and importance of aldosterone and renin measurements during follow-up.

Through an Intersectional Lens: Prevalence of Violence Against Disabled Women in Iceland.

Using an intersectional lens, this study analyses data from a nationally representative sample in Iceland, examining violence among marginalized groups of different social locations. The results highlight the precarious position of disabled women and show a significant increase of risk of violence with each marginalized social location women inhabit. Results illustrate how precarity and exposure increases for multiply marginalized women, demonstrating the importance of considering the social dimensions of violence. The article argues for the importance of advancing critical dialogue and research on violence, using an intersectional frame and including factors such as disability, gender, sexual orientation, and financial strain.

Are universal measures sufficient in reducing child poverty in the Nordic countries? An analysis of policies and political commitments.

BACKGROUND: The five Nordic countries (Denmark, Finland, Iceland, Norway and Sweden) have long traditions of social welfare policies that have eradicated poverty as part of their goals. The purpose of this study was to increase our understanding of why child poverty is still significant in the Nordic countries despite existing strategies. METHODS: A qualitative analysis of Nordic government documents and reports between 2007 and 2019 was carried out to track changes in public health priorities and political measures and to determine the similarities and differences between the five countries. RESULTS: In all countries, most of the measures were universal, such as benefits during pregnancy, paid parental leave before and after the child was born, paid parental leave related to children's sickness, child allowances, day care, free health care for children and support for disabled children. National policies aimed to reduce social inequalities and child poverty exist in all five countries, but unaffordable housing, unequal disposable family income distribution and unequal income distribution at local municipality levels seem to be obstacles to reaching national policy goals. CONCLUSIONS: Despite comprehensive universal measures to eradicate child poverty, inequalities are significant and increasing in some of the Nordic countries. This might be due to a lack of proportional universalism, where universal measures are in place in all Nordic countries, but with a lack of scale and intensity proportional to the children and families at risk. The significance of eliminating social inequalities needs to be emphasised at the local level.

Are We Only Detecting the Tip of the Iceberg? A Nationwide Study on Primary Aldosteronism with up to 8-Year Follow-up.

BACKGROUND: Long-term follow-up studies on primary aldosteronism (PA) are lacking. OBJECTIVE: We aim to review results of diagnostic procedures and histopathology for patients diagnosed during 2012-2016 in Iceland, compare unilateral (UD) and bilateral disease (BD) and assess treatment response. METHODS: Thirty-two patients aged 28-88 were diagnosed and treated according to guidelines. RESULTS: The majority had BD. Everyone needed potassium supplementation at case detection. We saw a reduction in systolic blood pressure (p < .001, both groups), antihypertensive agents (p = .002 UD and p = .04 BD) and potassium supplementation (p < .001, both groups). CONCLUSION: Similar treatment response was seen in both subgroups. Ratio of hypokalemia and number of cases indicates severe PA underdiagnosis in Iceland.

Assessing and promoting responsive interaction between parents and children - A qualitative study of the experiences of child health care nurses in Sweden.

PURPOSE: One of the main tasks of a child health care nurse is to assess and promote a responsive interaction and secure connection between children and their parents for the future. This study aims to develop an understanding of Swedish child health care nurses´ experiences of assessing and promoting responsive interaction between parents and children. DESIGN AND METHOD: A qualitative interview study using an inductive approach was implemented. Eleven nurses were interviewed (range: 30-58 min) during the period March to August 2016, and the transcripts were analysed using qualitative content analysis according to Graneheim and Lundman. RESULTS: Three categories emerged: Interpreting signals in parent and child behaviour, Reinforcing the parents in their role and Feeling inadequate as professional. Interpreting signals in parent and child behaviour was described fundamental when promoting responsive interaction. Further reinforcing the parents in their role was described central. The child health care nurses also described how they often felt inadequate in promoting responsive interaction. CONCLUSIONS: Assessing and promoting responsive interaction is an important but challenging task which requires extensive knowledge and good communication skills. The child health care nurses express their insufficiency in that regard. PRACTICE IMPLICATIONS: A targeted education and sufficient time for each visit at the child health care center should be allocated to facilitate the important work on parenting and child interaction and to enhance nurses' feelings of managing their work.

Relative Wellbeing of Women Maltreated as Children.

This study explores and analyzes how adult women in Sweden exposed to childhood maltreatment describe wellbeing, by using a thematic analysis of 22 semi-structured interviews with women maltreated as children. The results show that wellbeing was described as relative to both social norms and the childhood experiences and constituted four dimensions: Material and/or economic; Social and relational;Emotional; and Physical and/or mental. This study concludes that it is important to consider the relative and multiple ways wellbeing can be experienced and understood and to problematize norms of wellbeing, acknowledging the various ways people appraise their lives.

Determinants of non-response in a longitudinal study of participants in the Women and Alcohol in Gothenburg project.

Longitudinal assessment is useful for tracking patterns of alcohol use over time. Non-response is a common feature of longitudinal design and can bias estimates of alcohol use if there exist systematic differences between respondents and non-respondents. We investigated whether alcohol use, health status, and sociodemographic characteristics were determinants of non-response in a longitudinal cohort of women in the general population. We used data from a stratified, random sample of 479 women born in 1925, 1935, 1945, 1955, 1965, and 829 women born in 1970 and 1975, who were initially selected as participants in the Women and Alcohol in Gothenburg project. Results from multivariable logistic regression revealed that problematic alcohol use, depression, poor self-rated physical health, and basic education were associated with increased odds of non-response among women born in 1925, 1935, 1945, 1955, and 1965. Among women born between 1970 and 1975, older age and being unmarried increased the odds of non-response at follow-up. Surprisingly, problematic alcohol use and poor health were not associated with non-response in these younger birth cohorts. This study finding suggests that approaches to improve future survey response rates need to consider factors of greatest relevance to birth year and age.

Experiences of family violence and parental unavailability in childhood in relation to parental socioeconomic position and psychological problems: a cohort study of young Swedish women 1990-2013.

BACKGROUND: Despite the high prevalence and severe consequences for health and wellbeing, epidemiological research of neglected emotional needs during childhood is scarce and little is known about its relation to parental socioeconomic position (SEP). This study investigates the prevalence of family violence and parental unavailability in childhood and its association with parental SEP and parental psychological problems in four strata of young Swedish women examined 1990, 1995, 2000, and 2013. METHOD: The sample comprised 976 women (mean age 22, range 20-25) living in Sweden. Secular trends for family violence, parental rejection and unavailability were analyzed using logistic regression as a function of year of examination. The associations with parental SEP and parental psychological problems were assessed using logistic regression with results in terms of odds ratios (OR) and 95% confidence intervals. RESULTS: Gendered patterns were observed in the associations between parental psychological problems and family violence and parental unavailability. Maternal psychological problems were associated with maternal rejection OR 6.8 (3.5-13.0), maternal lack of time OR 2.4 (1.2-5.0), and paternal rejection OR 1.9 (1.1-3.5). Paternal psychological problems were associated with paternal rejection OR 4.0 (2.1-7.7), paternal lack of time OR 4.9 (2.3-10.6), and experiencing family violence OR 4.9 (2.1-11.6). Low and medium parental SEP were associated with experience of family violence in childhood OR 3.1 (CI 1.1-8.5) and OR 3.4 (1.7-6.9), respectively. No changes between 1990 and 2013 were observed for the prevalence of any of the outcomes. CONCLUSIONS: A stable prevalence of family violence and parental unavailability was reported by young women examined between 1990 and 2013. Lower socioeconomic position was associated with family violence while the association with parental unavailability was non-significant. Gendered patterns were observed in the association between parental psychological problems and family violence, where paternal but not maternal psychological problems were associated with family violence. Further, maternal psychological problems were associated with paternal rejection while paternal psychological problems were not associated with maternal rejection. Gendered patterns of parental unavailability need further studies.

Poor school connectedness in adolescence and adulthood depressiveness: a longitudinal theory-driven study from the Northern Sweden Cohort.

BACKGROUND: Foundations for mental health are laid early in family and school life. Family climate embraces the emotional connections within a family, and school connectedness embraces both functional and affective dimensions of relationship with school. Based on the lack of theory-driven and longitudinal epidemiological studies addressing public mental health, the aim of this longitudinal study was to investigate the associations between adolescents' school connectedness, family climate and depressiveness in adulthood, by relying on Bronfenbrenner's ecological theory. METHODS: The data are from the Northern Swedish Cohort, and the sample consists of 481 women and 526 men born in 1965 who participated in data collection at age 16, 21, 30 and 43. The generalized linear model method with random intercepts was used to examine the associations between family climate and school connectedness and depressiveness in adulthood. RESULTS: Poor school connectedness was associated with depressiveness in adulthood [ß = 0.038 (95% CI 0.018-0.058) P ≤ 0.001], but poor family climate was not [ß = 0.014 (95% CI -0.004-0.032)]. No difference in associations was observed between those experiencing social/material adversities in adolescence. CONCLUSIONS: This study shows that poor school connectedness in adolescence can affect depressiveness in adulthood. The study confirms the complex processes that determine mental health and proposes a theoretical approach appealing to public mental health research. In addition, this study concludes that more life-course studies are needed to advance the knowledge of the mechanisms behind the associations between family climate and school connectedness and depressiveness in adulthood.

To Live, Not Only Survive-An Ongoing Endeavor: Resilience of Adult Swedish Women Abused as Children.

Background: A significant proportion of individuals exposed to maltreatment in childhood adapt positively in adulthood despite the adversities, i.e., show resilience. Little is known about resources and processes related to adulthood that promote resilience. Since women are overrepresented as victims of intrafamilial violence, understanding resilience among adult women is important. Objective: To explore experiences of resilience among adult women who perceive well-being and well-functioning although being exposed to maltreatment during childhood. Participants and Setting: This study included 22 women with experiences of childhood maltreatment, mean age of 48 years, living in Sweden. Methods: Individual interviews were conducted and analyzed according to constructivist grounded theory. Results: The process of resilience was experienced as an ongoing endeavor to live, not only survive, an internal process that interacted with external processes involving social relations and conditions. This endeavor was built on four interrelated resources: establishing and maintaining command of life; employing personal resources; surrounding oneself with valuable people; and reaching acceptance. These worked together, not in a linear or chronological order, but in up and down ways, turns and straight lines (now and then), through the process from maltreatment to well-being. Conclusion: Resilience was found to rest on intrapersonal and interpersonal resources. Individual's inherent capabilities can be, depending on life circumstances and available resources, realized in a way that promote well-being and well-functioning despite severe adversities. Therefore, public health initiatives, social services, and policies should provide conditions that help women maltreated in childhood to live fully rather than merely to survive.

Economic poverty among children and adolescents in the Nordic countries.

AIMS: This study aimed to identify applied definitions and measurements of economic poverty and to explore the proportions and characteristics of children and adolescents living in economic poverty in Denmark, Finland, Iceland, Norway and Sweden during the last decade and to compare various statistics between the Nordic countries. METHODS: Official data from central national authorities on statistics, national reports and European Union Statistics of income and living conditions data were collected and analysed during 2015-2016. RESULTS: The proportion of Nordic children living in economic poverty in 2014 ranged from 9.4% in Norway to 18.5% in Sweden. Compared with the European Union average, from 2004 to 2014 Nordic families with dependent children experienced fewer difficulties in making their money last, even though Icelandic families reported considerable difficulties. The characteristics of children living in economic poverty proved to be similar in the five countries and were related to their parents' level of education and employment, single-parent households and - in Denmark, Norway and Sweden - to immigrant background. In Finland, poverty among children was linked in particular to low income in employed households. CONCLUSIONS: This study showed that economic poverty among Nordic families with dependent children has increased during the latest decade, but it also showed that poverty rates are not necessarily connected to families' ability to make their money last. Therefore additional studies are needed to explore existing policies and political commitments in the Nordic countries to compensate families with dependent children living in poverty.

Health lifestyles of pre-school children in Nordic countries: parents' perspectives.

Summary: Holistic understanding of health is one of the key principles of health promotion indicating that the health status of individuals and populations is determined by a variety of environmental, economic, social and personal factors. Traditionally, research focus has been on school-aged children and school-based interventions and less on pre-school children and their families' engagement in promoting health in everyday life. The aim of the present study was to explore factors that parents of pre-school children in the Nordic countries experienced as influencing health lifestyles in their children's everyday lives. Semi-structured interviews were conducted with 25 parents of pre-school children in the five Nordic countries. Qualitative content analysis was used to analyse the data. The parents identified themselves as the primary shapers of their children's lifestyles and described influencing factors related to themselves as well as to their immediate surroundings and the larger society. Attaining a health lifestyle in everyday life of Nordic parents with pre-school children appeared to be all about the 'management of time when attempting to live up to expectations'. Pre-school children's lifestyles are to a great extent intertwined with their parent's lifestyles and should be approached, both in research and practice, accordingly. Parents of pre-school children in the Nordic countries appear to be living their everyday lives straining to adapt to norms prevailing in society and may need encouragement and support in managing time in order to promote health lifestyles for themselves and their children.

Relative deprivation in the Nordic countries-child mental health problems in relation to parental financial stress.

BACKGROUND: The Nordic welfare system has been acknowledged as favourable for children, successfully contributing to low child mortality and poverty rates. Nevertheless, mental health problems among children and adolescents are common and the economic situation of the family has been highlighted as an important determinant. In spite of similar social, political and cultural structures, the Nordic countries differ; Iceland was most affected by the global financial crisis in 2008. The aim of this study was to examine potential differences in parental financial stress and the associations to child mental health between the Nordic countries as well as age and gender differences. METHODS: The study sample consisted of 6330 children aged 4-16 years old included in the 2011 version of the Nordic Study of Children's Health, Wellbeing and Quality of life. The Strengths and Difficulties Questionnaire was used to measure mental health problems. RESULTS: In Iceland, 47.7% of the parents reported financial stress while ≤20% did so in the other countries except for Finland (33.5%). However, in case of parental financial stress the OR of mental health problems comparing children to parents with and without financial stress was significantly lower among the Icelandic children (OR 1.60, 95% CI 1.15-2.24) than among the others: Denmark OR 3.07 (95% CI 2.15-4.39), Finland OR 2.28 (95% CI 1.60-3.25), Norway OR 2.77 (95% CI 1.86-4.12), Sweden OR 3.31(95% CI 2.26-4.86). No significant age or gender differences in the ORs were observed. CONCLUSIONS: Besides socioeconomic situation, relative deprivation should be considered an important determinant of child mental health.

Associations between parents' subjective time pressure and mental health problems among children in the Nordic countries: a population based study.

BACKGROUND: The home, the family and the parents represent a context of everyday life that is important for child health and development, with parent-child relationships highlighted as crucial for children's mental health. Time pressure is an emerging feature of modern societies and previous studies indicates that parents with children living at home experience time pressure to a greater extent than people with no children living at home. Previous studies of children's mental health in relation to parents' time pressure are lacking. Hence, the purpose of this study was to examine the association between parents' subjective time pressure and mental health problems among children in the Nordic countries as well as potential disparities between boys and girls in different age groups. METHODS: 4592 children, aged 4-16 from Denmark, Finland, Norway and Sweden, participating in the 2011 version of the NordChild study, were included. The Strength and Difficulties Questionnaire was used to measure children's mental health and associations to parents' time pressure were assessed by multiple logistic regression analysis. RESULTS: Among children of parents experiencing time pressure, 18.6% had mental health problems compared to 10.1% among children of parents experiencing time pressure not or sometimes. The odds of mental health problems were higher among both boys (OR 1.80 95% CI 1.32-2.46) and girls (OR 1.95 95% CI 1.42-2.66) if their parents experienced time pressure when adjusted for financial stress. The highest prevalence of mental health problems in the case of parental time pressure was found among girls 13-16 years old (23.6%) and the lowest prevalence was found among boys 13-16 years old (10.7%). CONCLUSIONS: In this study an association between parents' subjective time pressure and increased mental health problems among children was found. Given that time pressure is a growing feature of modern societies, the results might contribute to an explanation as to mental health problems are common among children in the Nordic countries in spite of otherwise favourable conditions. Additional research on the linkage between parents' experienced time pressure and children's and adolescents' mental health problems is needed to confirm the novel findings of this study.

Mental health problems and social resource factors among bullied children in the Nordic countries: a population based cross-sectional study.

This study estimated internalising and externalising mental health problems among bullied-, unclear if bullied- and not bullied children aged 4-16 in the Nordic countries, and identified resource factors to bullied children's mental health. Data comes from the cross-sectional NordChild survey 2011 and the Strength and Difficulties Questionnaire, including 6,214 children in the analyses. Mental health problems were most prevalent among children parent-reported as bullied (29.2-44.3 %), followed by children with unclear status if bullied (13.0-25.6 %) and not bullied children (5.3-7.9 %). Externalising problems were more prevalent in all groups except among bullied girls aged 7-16, where internalising problems were more prevalent. Ten potential resource factors to bullied children's mental health were analyzed, finding that (1) children with at least three close friends had higher odds to be mentally healthy than children with fewer close friends and (2) bullied boys had higher odds to be mentally healthy if they regularly practiced sport.

Time pressure among parents in the Nordic countries: a population-based cross-sectional study.

AIMS: To estimate the prevalence of time pressure experienced by parents in the Nordic countries and examine potential gender disparities as well as associations to parents' family and/or living conditions. METHODS: 5949 parents of children aged 2-17 years from Denmark, Finland, Norway and Sweden, participating in the 2011 version of the NordChild study, reported their experience of time pressure when keeping up with duties of everyday life. A postal questionnaire addressed to the most active caretaker of the child, was used for data gathering and logistic regression analysis applied. RESULTS: The mother was regarded as the primary caregiver in 83.9% of the cases. Of the mothers, 14.2% reported that they experienced time pressure "most often", 54.7 % reported "sometimes" and 31.1 % reported they did "not" experience time pressure at all. Time pressure was experienced by 22.2 % of mothers in Sweden, 18.4% in Finland, 13.7% in Norway and 3.9% in Denmark, and could be associated to lack of support, high educational level, financial stress, young child age and working overtime. CONCLUSIONS: The mother is regarded as the child's primary caregiver among the vast majority of families in spite of living in societies with gender-equal family policies. The results indicate that time pressure is embedded in everyday life of mainly highly-educated mothers and those experiencing financial stress and/or lack of social support. No conclusion could be made about time pressure from the "normbreaking" fathers participating in the study, but associations were found to financial stress and lack of support.