Dropout or Drop-In Experiences in an Internet-Delivered Intervention to Prevent Depression and Enhance Subjective Well-Being During the Perinatal Period: Qualitative Study.

Background: The perinatal period is a vulnerable time when women are at increased risk of depression. "Mamma Mia" is a universal preventive internet-delivered intervention offered to pregnant women, with the primary goals of preventing the onset or worsening of depression and enhancing subjective well-being during the perinatal period. However, treatment dropout from internet-delivered interventions is often reported. Objective: The study aim was to acquire an understanding of the different experiences among participants who dropped out of the Mamma Mia intervention during pregnancy, compared to participants who dropped out during the postpartum follow-up phase. Methods: A total of 16 women from a larger randomized controlled trial (Mamma Mia) participated in individual semistructured interviews following a strengths, weaknesses, opportunities, and threats format. Of the 16 participants included, 8 (50%) women dropped out early from the intervention during pregnancy (pregnancy group), whereas 8 (50%) women dropped out later, after giving birth (postpartum follow-up group). Data were analyzed using the framework approach. Results: The results showed that there were differences between the groups. In general, more participants in the postpartum follow-up group reported that the program was user-friendly. They became more aware of their own thoughts and feelings and perceived that the program had provided them with more new knowledge and practical information than participants in the pregnancy group. Participants in both groups suggested several opportunities for improving the program. Conclusions: There were differences between women who dropped out of the intervention during pregnancy and the postpartum follow-up phase. The reported differences between groups should be further examined.

A qualitative study of public health nurses' experiences detecting and preventing child maltreatment in primary care settings.

AIM: To explore how public health nurses in child and family health centres experience detecting and preventing child maltreatment. DESIGN: Qualitative study. METHODS: Fourteen semi-structured individual interviews with public health nurses who worked in 11 different child and family health centres were conducted. The interviews were analysed using thematic analysis. RESULTS: Three themes were identified: (i) integrating knowledge to prevent child maltreatment as part of their everyday job, (ii) striving hard to detect child maltreatment and (iii) experiencing the assignment to be complex and demanding. CONCLUSION: Despite extensive experience, knowledge and following the guidelines, public health nurses in this study had difficulties finding children exposed to child maltreatment in child and family health centres. Public health nurses called for mutual multidisciplinary cooperation with other services and organizational facilitation, such as enough time and clear guidelines to effectively address this issue. IMPLICATIONS FOR PRACTICE: This study provides knowledge about how public health nurses work with child maltreatment at the Child and Family Health Center, which can serve as valuable foundation for further research as well for collaborating services. REPORTING METHOD: EQUATOR guidelines were followed, using the COREQ checklist. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Quality of life and associated factors among Norwegian public health nurse students during the first months of the COVID-19 pandemic: A cross-sectional study.

The main objective of this study was to investigate the association between quality of life (QOL) and civil status, self-efficacy, loneliness, and physical and mental health among public health nurse (PHN) students during the COVID-19 pandemic in April 2020. PHN students were recruited from eight universities and university colleges in Norway. A range of potential predictive factors were entered into a model using a stepwise linear regression approach. In general, the PHN students reported a high level of QOL during the first month of the pandemic. The students' civil status, perceived physical health, self-efficacy and loneliness were all significantly correlated with QOL. Among these, the strongest predictive factors for QOL were found to be perceived loneliness and self-efficacy. Our results provide insight into the QOL of PHN students, which managers in the higher education sector can use to outline specific coping strategies that can help students during a pandemic.

Unpacking the Public Health Triad of Social Inequality in Health, Health Literacy, and Quality of Life-A Scoping Review of Research Characteristics.

Social inequalities in health, health literacy, and quality of life serve as distinct public health indicators, but it remains unclear how and to what extent they are applied and combined in the literature. Thus, the characteristics of the research have yet to be established, and we aim to identify and describe the characteristics of research that intersects social inequality in health, health literacy, and quality of life. We conducted a scoping review with systematic searches in ten databases. Studies applying any design in any population were eligible if social inequality in health, health literacy, and quality of life were combined. Citations were independently screened using Covidence. The search yielded 4111 citations, with 73 eligible reports. The reviewed research was mostly quantitative and aimed at patient populations in a community setting, with a scarcity of reports specifically defining and assessing social inequality in health, health literacy, and quality of life, and with only 2/73 citations providing a definition for all three. The published research combining social inequality in health, health literacy, and quality of life is heterogeneous regarding research designs, populations, contexts, and geography, where social inequality appears as a contextualizing variable.

A Path to Inclusiveness - Peer Support Groups as a Resource for Change.

Being bullied is associated with anxiety, depression symptoms, and long-term negative health outcomes. The aim of this qualitative pilotstudy was to explore bullied children's experiences of support groups and how participating in a group affected the children. The sample consisted of 24 children aged 11-13 years. Four of them were bullied, while 20 participated in support groups. Individual and focus group interviews were conducted. The main theme identified was that support groups provide an opportunity for change and can help children to be included among peers. The changes were achieved through encouragement and support from peers. The children participating in the support groups reported a feeling of being selected. The groups provided fellowship, and an opportunity for change. Both getting support from and being part of a support group contributed to inclusion, strength, and valuable experiences. The findings suggest that a systemic approach to bullying is advantageous.

Infant colic, young children's temperament and sleep in a population based longitudinal cohort study.

BACKGROUND: Colic and sleep problems are common among infants, constitute challenges and distress for parents, and are often reasons for seeking help from health professionals. The literature debates whether infant colic and sleep problems are linked together or not. Further, limited evidence exists on how colic impacts on child temperament and sleep during early childhood. Thus, the purpose of this study was to increase our knowledge of the characteristics of infants with a history of colic compared to infants without, and to study how infant colic is associated with the development of child temperament and sleep over time. METHODS: The study is based on The Norwegian Mother, Father and Child Cohort Study (MoBa), a population-based cohort study conducted by the Norwegian Institute of Public Health. This sample contains 88,186 mothers and children. Data was retrieved from questionnaires distributed to mothers at recruitment (in pregnancy) and when the child was 6 months, 18 months, 3 years, and 5 years. Data was analysed using linear mixed models and GLM models for repeated measures. RESULTS: At 6 months, infants with reported colic are described as fussier, present more sleeping problems, are breastfed less, and the families visit the child health centre more often when compared to the non-colic group. Mothers of children with reported colic perceive their children's temperament significantly more challenging from the age of 6 months to 5 years. Further, children with reported colic were more likely to sleep less than recommended (22%) and to have more frequent night awakenings (14%) than usual for their age (6 months to 5 years). CONCLUSION: Infant colic often occurs together with other signs of regulatory problems which may amplify the load on the parents. Moderate differences in temperament and sleep-problems across time, between those with colic and those without, indicate that the diagnosis of colic is moderately associated with later behavioural difficulties. However, it is demanding for the parents, and important to be aware of and act upon symptoms of colic in the child health centres to reduce the parents' load and prevent adverse long-term outcomes.

Sleep problems reduced from 6 to 24 months of age with no evidence of links between disturbed sleep and later developmental problems.

AIM: Sleep is essential for infant development. We assessed the prevalence of sleep problems in infants at 6, 12 and 24 months, investigated the relationship between infants' sleep problems and development, and determined to what extent sleep problems at 6 months were related to changes in the developmental course. METHODS: Infant sleep problems were measured by a parent-reported sleep questionnaire. The Ages and Stages Questionnaires were used to measure developmental skills in a sample of 1555 infants recruited from 9 well-baby clinics in Norway. ASQ scores were compared between infants with and without sleep problems by using two-sample t-tests. The relationship between infant sleep problems at 6 months and changes in Ages and Stages Questionnaires scores over time was investigated using linear mixed-effects models. RESULTS: The prevalence of infant sleep problems were 14.6% at 6 months, 7.4% at 12 months and 3.3% at 24 months. There was no clear evidence of differences in ASQ or ASQ:SE scores by sleep problems from 6 to 24 months, but communication and problem-solving scores for infants with sleep problems increased faster. CONCLUSION: Prevalence of sleep problems decreased with age. There was no clear evidence of early sleep disturbance and later development problems.

Factors associated with maternal overall quality of life six months postpartum: a cross sectional study from The Norwegian Mother, Father and Child Cohort Study.

BACKGROUND: Having good Quality of Life (QoL) is essential, particularly for women after childbirth. However, little is known about the factors associated with maternal QoL after giving birth. We aimed to investigate the relationship between characteristics of the mother (socio-demographic variables), selected symptoms (depression and joy/anger), health perception (perception of birth) and possible characteristics of the environment (infant temperament, colic, sleep, parental relationship), with mothers' overall quality of life when the child is 6 months of age. METHODS: This study is based on the Norwegian Mother, Father and Child Cohort Study (MoBa), conducted at the Norwegian Institute of Public Health from June 1999 to December 2008, which included a total of 86,724 children. Maternal QoL was assessed by the Satisfaction With Life Scale. Joy and anger were measured using the Differential Emotional Scale, mothers' mental health was assessed using the Edinburgh Postnatal Depression Scale and satisfaction with relationship was measured using the Relationship Satisfaction Scale. Child temperament was measured using the Infant Characteristics Questionnaire and colic, sleep duration and feelings related to childbirth were assessed by mothers' reports. The associations between life satisfaction and selected variables were analysed using stepwise multiple linear regression models, and the results are presented as effect sizes (ES). RESULTS: Maternal feelings of joy of having a baby (ES = 0.35), high relationship satisfaction (ES = 0.32), as well as having a baby with normal sleep (ES = 0.31), are factors associated with higher maternal overall QoL. Postnatal depression was negatively associated with mothers' QoL, and infant colic or child's temperament (fussiness) showed no such association with mothers' QoL. CONCLUSIONS: Health professionals and clinicians should focus on infants sleep but also on supporting joy of motherhood and strengthening relationships of the new parents when they develop health interventions or provide counselling to new mothers and their families.

Students' top 10 priorities of research uncertainties on students' sleep: a pragmatic James Lind Alliance approach.

OBJECTIVES: Inspired by the James Lind Alliance (JLA) user involvement approach, the aim of the present study was to identify the top 10 uncertainties for sleep research raised by students in higher education, and to discuss our experiences with adapting the JLA method to a student population. DESIGN: The study design is a pragmatic JLA approach, including a priority setting partnership within the field of sleep, collection of sleep-related research uncertainties as reported by students in higher education, sorting of the uncertainties and a final identification of the top 10 uncertainties through collaborative work between researchers, students, stakeholders and experts in the field. Uncertainties were collected using a one-question online survey: 'as a student, which question(s) do you consider to be important with regards to sleep?'. A variety of approaches were applied to promote the survey to the students, including social media, radio, the university website, stands in university cafeterias and a sleep stunt. NVivo V.12 was used to code and sort the questions. SETTING: A higher education institution in Norway. PARTICIPANTS: 555 students. RESULTS: The data collection provided 608 uncertainties, and the following prioritised top 10: (1) screen time, (2) stress, (3) educational achievements, (4) social relations, (5) mental health, (6) physical activity, (7) indoor environment, (8) substance abuse, (9) shift work and (10) sleep quality. Despite successful data collection, we found sleep to be a broad topic, and defining specific questions throughout the sorting and verification process proved difficult. CONCLUSIONS: We identified the prioritised top 10 research uncertainties as reported by students in higher education, ranking screen time first. However, the process was time and resource consuming. The research uncertainties addressed by the students showed great diversity, characterised by heterogeneity and a lack of specificity, making verification of the uncertainties challenging.

Association between colic and sleep problems in infancy and subsequent development, emotional and behavioral problems: a longitudinal study.

BACKGROUND: Sleep and colic problems in infancy have been linked to adverse health outcome, but there is limited knowledge of the association between sleep and colic problems in infancy and subsequent development, emotional and behavior problems in young children. The aim of the present study was to examine whether there is an associations between infants' crying and sleep problems at 6 months and behavioral and development problems at 18 months, 3 and 5 years. METHODS: This study is based on the Norwegian Mother, Father and Child Cohort Study (MoBa), conducted at the Norwegian Institute of Public Health from June 1999 to December 2008. A total of 86,724 children were included. Colic and sleep (sleep duration, nocturnal awakenings and easy to put to bed) was assessed by mother-reports. Z-scores were used to assess differences between groups of children (e.g. having colic or not, having a sleep problem or not). Emotional and behavioral problems were measured with items from the Child Behavior Checklist. Development problems were measured with items from The Ages and Stages Questionnaire. RESULTS: Infants with colic scored significantly lower on development at 5 years (B=-0.10, CI [- 0.14 to - 0.06]) and higher on internalizing problems both at 3 years (B=0.15. CI [0.11 to 0.18]) and 5 years (B=0.17. CI [0.12 to 0.21]) than the reference population. Children who awoke frequently and were more difficult to put to bed at 6 months scored significantly lower on development at 18 months and 3 and 5 years, and higher on internalizing behavior problems at 3 and 5 years (B=0.18 and B=0.16). Children with shorter sleep duration at 6 months had more internalizing behavior problems at 3 years (B=0.14. CI [0.07 to 0.21]) and 5 years (B=0.15. CI [0.05 to 0.25]) than the reference population. CONCLUSIONS: Colic and sleep problems early in life should be taken into account as risk factors for development and behavioral problems within the first 5 years of a child's life.

Evaluating a Web-Based Health-Promoting Dialogue Tool in School Health Services: Feasibility and User Experiences.

Adolescence is a sensitive period in life and a time to redefine and learn new skills. In Norway, school health services provide individual health-promoting consultations with all eighth-grade students. As an aid to support these consultations, a dialogue tool called SchoolHealth was developed using a co-creation approach. SchoolHealth consists of a web-based health information form designed to be completed by the students and generates individual feedback reports to help the school nurses to prepare for the consultation and tailor it to the individual student's need. Our aims were to evaluate the feasibility and user experiences of SchoolHealth among students and school nurses using a mixed methods approach. A total of 79 eighth-grade students (69% of those invited) and four school nurses from three schools participated. Analyses indicated that SchoolHealth was feasible, promoted reflection among students, and helped prepare students and school nurses for the consultation.

Motor skills and later communication development in early childhood: Results from a population-based study.

BACKGROUND: Motor milestones in infancy are important developmental markers, not only for later motor skills but also for more widespread social, cognitive, and communication development. The aim of the current study was to investigate the relationships between fine and gross motor development in infants at 6 and 12 months of age and communication skills at 24 months of age. METHODS: The Ages & Stages Questionnaire (ASQ-II) was used to measure gross motor, fine motor, and communication skills in a large population-based sample of 1,555 infants, recruited from well-baby clinics in five municipalities in South-Eastern Norway. Of these, 557 children had valid values of gross and fine motor scores at 6 and 12 months and for communication score at 24 months. The relationships between motor skills at 6 and 12 months and communication skills at 24 months were analysed using a linear regression analysis. RESULTS: Gross motor skills at 6 months were positively associated with communication skills at 24 months (coefficients 0.09, p = 0.036) and fine motor skills at 12 months were positively associated with communication skills at 24 months (coefficient 0.23, p < 0.001). We did not find clear evidence for a relationship between gross motor skills at 12 months and communication skills at 24 months (coefficient 0.05, p = 0.126) or between fine motor skills at 6 months and communication skills at 24 months (coefficient 0.08, p = 0.098). CONCLUSION: The present study supports previous research showing associations between early motor development and later communication development in infancy. Targeted intervention should be considered with at-risk infants.

Bullying in School: Importance of and Challenges Involved in Talking to the School Nurse.

Bullying has negative consequences for health and quality of life of students. This study is part of a pilot project, "School Health," which included a web-based questionnaire completed by students before a consultation with the school nurse. The aim of this study was to explore how students experience answering questions about bullying before an individual consultation and how they talk about bullying with the school nurse. This study had qualitative design with individual and focus group interviews and involved 38 students aged 13-14 years, both boys and girls, from three schools. Data were analyzed according to Kvale's three levels of interpretation within a phenomenological and hermeneutic perspective. The students found it difficult to report being bullied. They expressed confidence in the school nurse and liked talking with her. Some complained about the school environment and reported that having a friend was important.

Parent satisfaction before and after implementing of a developmental screening tool in nine well-baby clinics in Norway.

AIM: The aim of the study was to compare parental satisfaction items before and after the implementation of The Ages & Stages Questionnaires (ASQ) as part of the health check-up. METHODS: ASQ was implemented in regular health check-ups of infants up to two years of age in 9 Norwegian well-baby clinics. After the infant's two years' health check-ups, a questionnaire-based survey among 652 families before and 562 families after intervention was conducted. Descriptive analyses and ordinal logistic regression were used to report and compare parental satisfaction items before and after the project. RESULTS: Parents reported high satisfaction with well-baby services both before and after the implementation of ASQ, and ninety-six per cent recommended other well-baby clinics to use ASQ. Some significant differences appeared, before the implementation of ASQ, parents were more satisfied with the support they received regarding parenting and child development in general and information about the child's physical health. After ASQ was implemented, parents were significantly more satisfied with the information they received about 'the child's mental health'. CONCLUSION: Developmental screening in well-baby clinics in Norway is acceptable among parents with young children. The use of standardised instruments must not come at the expense of listening to parents' concerns.

Latent trajectory classes of postpartum depressive symptoms: A regional population-based longitudinal study.

PURPOSE: This study aimed to (a) assess trajectories of women's depressive symptoms during the first year postpartum to (b) identify potential unobserved classes of women as defined by their trajectories, (c) identify antepartum and early postpartum risk factors associated with trajectory classes, and (d) examine the association between trajectory classes and counselling during the postpartum period. METHODS: Data on depressive symptoms, using the Edinburgh Postnatal Depression Scale (EPDS), were collected from 1374 women across nine Norwegian well-baby clinics at 1.5, 4, 6, and 12 months postpartum. Well-baby clinics offer universal, free services to all families living in the municipality. Thus, there were no specific exclusion criteria for this study. All clinics had implemented the Edinburgh-method which combines screening for PPD, using the EPDS, with supportive counselling. RESULTS: Analyses showed that depressive symptoms decreased initially, followed by a flattening in symptoms at 6 months. Mixture analyses, however, identified two classes of women with distinct trajectories; (1) a low-risk (n = 1249, 91%) and (2) a high-risk group (n = 119, 9%). Complications after birth, elevated prenatal depressive symptoms, previous or current mental illness, and gestational week, predicted trajectory class membership. Women in the high-risk group were more likely to receive counselling than low-risk women. LIMITATIONS: Women had higher educational level than the general population and one of the municipalities did not have a 12-months routine consultation. CONCLUSION: Findings suggest heterogeneity among women in their depressive symptoms during the first year postpartum with a distinct set of risk factors associated with high-risk women. This has implications for the prevention and follow-up of women during pregnancy and the first year after childbirth.

A population-based study of the relationship between perinatal depressive symptoms and breastfeeding: a cross-lagged panel study.

Studies suggest that perinatal depression and breastfeeding co-vary, but determining the relationship between breastfeeding and perinatal depression has proved challenging. A bidirectional association has been suggested, implying that depression may impact on breastfeeding and that breastfeeding might influence depressive symptoms. The present study aimed to contribute to the understanding of the relationship between perinatal depression and breastfeeding in a population-based sample where we used structural equation modeling (SEM) techniques to investigate cross-lagged and autoregressive effects as well as concurrent associations. The present study was part of a large-scale Norwegian prospective study. Nurses and midwives at nine well-baby clinics recruited participants. All the well-baby clinics had implemented the Edinburgh method, which combines the use of the Edinburgh Postnatal Depression Scale (EPDS) with an immediate follow-up conversation. Completed EPDS forms were recorded, as well as the mothers' reports of breastfeeding behaviors. Depressive symptoms measured prenatally during the last trimester, at 4 and 6 months postpartum did not predict breastfeeding behavior at 4, 6, or 12 months postpartum, respectively. Furthermore, breastfeeding at 4 and 6 months postpartum did not predict depressive symptomatology at 6 or 12 months postpartum. There were no significant concurrent associations between breastfeeding and depressive symptoms at 4, 6, or 12 months postpartum. Depressive symptoms predicted subsequent depressive symptoms and breastfeeding predicted subsequent breastfeeding. There was no evidence of a relationship between depressive symptoms and breastfeeding. Potential explanations and implications are discussed.

Association between maternal postnatal depressive symptoms and infants' communication skills: A longitudinal study.

Postnatal depression (PND) is associated with adverse effects on a broad range of child outcomes, including language problems. The current study aimed to investigate if the time of exposure to maternal PND symptoms measured with the Edinburgh Postnatal Depression Scale (EPDS) at 6 weeks, 4 months and 6 months postpartum were related to the infants' communication skills measured with the Ages and Stages Questionnaires (ASQ) at 12 and 24 months. Secondly, to study to what extent the number of exposures to high level of PND symptoms (i.e., EPDS score≥10) might be associated with level of communication skills later (at 12 and 24 months), and last, to determine to what extent maternal PND symptoms at 6 weeks were related to changes in the developmental course of communication skills from 4 to 24 months. 1555 children and their mothers participate in the study. Regression analyses indicated that PND at 4 months were associated with lower levels of communicative skills at 12 (coefficient -0.37, 95% CI -0.63 to -0.12, p=0.004) and 24 months (coefficient -0.34, CI -0.56 to -0.13, p=0.002). Infants of mothers with an EPDS sum score≥10 obtained at a minimum of two time points, had significantly worse communicative skills at 12 months than infants of mothers with no indication of PND (difference -6.12, CI -11.14 to -1.09, p=0.017). No such significant relations were found at 24 months. However, linear mixed effects analysis showed that mothers' depressive symptoms at 6 weeks were not significantly related to changes in infant communication scores from age 4 to 24 months. These findings suggest that symptoms of maternal PND symptoms should be taken into account for communication development in infancy.

Analysing four Norweigian population-based samples using the six-month version of the Ages and Stages Questionnaire showed few relevant clinical differences.

AIM: We investigated whether there were clinically relevant differences in the area mean scores of the six-month Ages and Stages Questionnaire (ASQ) between four Norwegian population-based samples. METHODS: Area mean scores and standard deviations (SDs) were investigated for the five developmental areas of the ASQ: communication, gross motor, fine motor, problem solving and personal-social. Sample sizes varied from 166 to 1192 and the ASQ was completed on paper or by computer. ASQ scores in the four samples were compared using ANOVA and Tukey's procedure was used to adjust for multiple comparisons. RESULTS: The ASQ mean area scores were generally similar in the four data sets, with few clinically relevant differences, defined as a mean difference of greater than five points, which is the smallest increment in area score, or an effect size of >0.5 in absolute value. All the clinically relevant differences occurred when samples used a modified ASQ administration format. Several additional minor differences were statistically significant, which was expected due to the large samples. CONCLUSION: These results support the original Norwegian normative findings for the ASQ six-month form and the ASQ's use as a low-cost developmental screening tool in Norway, at least when the original format is administered.

Prevalence of suspected developmental delays in early infancy: results from a regional population-based longitudinal study.

BACKGROUND: Prevalence estimates on suspected developmental delays (SDD) in young infants are scarce and a necessary first step for planning an early intervention. We investigated the prevalence of SDD at 4, 6 and 12 months, in addition to associations of SDD with gender, prematurity and maternal education. METHODS: This study is based on a Norwegian longitudinal sample of 1555 infants and their parents attending well-baby clinics for regular health check-ups. Moreover, parents completed the Norwegian translation of the Ages and Stages Questionnaires (ASQ) prior to the check-up, with a corrected gestational age being used to determine the time of administration for preterm infants. Scores ≤ the established cut-offs in one or more of the five development areas: communication, gross motor, fine motor, problem solving and personal-social, which defined SDD for an infant were reported. Chi-square tests were performed for associations between the selected factors and SDD. RESULTS: According to established Norwegian cut-off points, the overall prevalence of SDD in one or more areas was 7.0 % (10.3 % US cut-off) at 4 months, 5.7 % (12.3 % US cut-off) at 6 months and 6.1 % (10.3 % US cut-off) at 12 months. The highest prevalence of SDD was in the gross motor area at all three time points. A gestational age of < 37 weeks revealed a significant association with the communication SDD at 4 months, and with the fine motor and personal social SDD at 6 months. Gender was significantly associated with the fine motor and problem solving SDD at 4 months and personal- social SDD at 6 months: as more boys than girls were delayed. No significant associations were found between maternal education and the five developmental areas of the ASQ. CONCLUSION: Our findings indicate prevalence rates of SDD between 5.7 and 7.0 % in Norwegian infants between 4 and 12 months of age based on the Norwegian ASQ cut-off points (10.3-12.3 %, US cut-off points). During the first year of life, delay is most frequent within the gross motor area. Special attention should be paid to infants born prematurely, as well as to boys. Separate norms for boys and girls should be considered for the ASQ.