"All Children in Focus": Effects of a Universal Parenting Program at a 6-Month Follow-Up in a Randomized Controlled Trial in Sweden.

Parenting programs have been shown to empower parents and prevent mental health problems in children. However, few programs are designed to promote wellbeing, which led to the development of the Swedish-promotive universal program, "All Children in Focus" (ACF). This study aimed to understand the effects of parents' participation in the ACF program on parents' emotion regulation and parenting practices over a 6-month follow-up and if intervention-produced changes predict child wellbeing (CW). Parental self-efficacy (PSE) was also included to assess the relation with parental outcomes and CW. This is an evaluation of a multicenter randomized waitlisted control trial conducted in Stockholm County, Sweden, with parents of children aged 3 to 12 years (n = 621) in 2012. Parents were randomized 1:1 to enter the program or to a waitlist. Questionnaires were completed by parents at baseline, post-intervention, and 6 months post-baseline. We used generalized mixed modeling to test effects on parental outcomes over time and regression analyses to study the predictive role of parental outcomes on CW. From baseline to the post- and to the 6-month follow-ups, parents in the intervention group reported greater levels of emotion regulation skills, cognitive reappraisal, and positive parenting than did parents in the control group. A decrease in negative and harsh parenting was evident in both groups, although it was greater in the intervention group. An increase in PSE was associated with high negative parenting at baseline in the intervention group. Child gender moderated positive parenting, suggesting that parents of girls in the intervention group had more favorable development of positive strategies. The findings indicate that a change in PSE predicts a change in CW at 6 months. The ACF program can be used to strengthen and develop parenting. This study advances our knowledge about the potential advantages of using a health-promoting approach to strengthen the wellbeing of families in the general population. Clinical trial registration: ISRCTN70202532 Current Controlled Trials.

Study protocol for a non-randomized controlled trial of the effects of internet-based parent training as a booster to the preschool edition of PATHS®: Universal edition of the Parent Web.

Well implemented, universal parental support is often effective in families with younger children, but research on their effects on families with adolescent children is scarce. In this study, a trial of the universal parent training intervention "Parent Web" in early adolescence is added to the social emotional learning intervention Promoting Alternative Thinking Strategies (PATHS®), completed in early childhood. The Parent Web is a universal online parenting intervention based on social learning theory. The intervention aims to promote positive parenting and family interaction through five weekly modules completed over 6-8 weeks. The main hypothesis is that participants in the intervention group will exhibit significant pre- to post- intervention-related benefits relative participants in the comparison group. The aims of this study are: 1) provide Parent Web as a booster aimed at improving parenting support and practices at the transition into adolescence to a cohort of parents whose children have previously participated in preschool PATHS, and 2) examine the effects of the universal edition of Parent Web. The study has a quasi-experimental design with pre- and post-testing. The incremental effects of this internet-delivered parent training intervention are tested in parents of early adolescents (11-13 years) who participated in PATHS when 4-5 years old compared to a matched sample of adolescents with no prior experience of PATHS. The primary outcomes are parent reported child behavior and family relationships. Secondary outcomes include self-reported parent health and stress. The proposed study is one of the few trials to test the effects of universal parental support in families of early adolescents and will therefore contribute to the understanding of how mental health in children and young people can be promoted across developmental periods through a continuum of universal measures. Trial registration: Clinical trials.gov (NCT05172297), prospectively registered on December 29, 2021.

Little All Children in Focus (Little ACF), evaluation of a parental support program for parents of children aged 1-2 years: study protocol for a randomized controlled trial.

BACKGROUND: Child health and development can be promoted by strengthening and supporting parents. Research on parental support programs based on positive psychology and a health-promoting approach aimed at all parents, and in particular parents of infants is limited. All Children in Focus (ACF) is a parental support program that has been evaluated in a randomized trial in parents of children 3-12 years. The ACF is based on health promotion aiming to increase parents' confidence and child's well-being. In the current study, we will study the effects of a revised version of the ACF called Little ACF adapted to parents with children aged 1-2 years. METHODS: The study includes a randomized controlled trial (RCT) taking place at several Child Health Centers (CHCs) in Sweden. The RCT will evaluate the efficacy of Little ACF (intervention) in comparison with four digital lectures about child development and parenting (active control). Parents are recruited at the 10-, 12-, or 18-month visits to CHC by CHC-nurses. Data to assess changes in parental competencies and child socio-emotional development are collected through online questionnaires completed by parents at five time points: baseline, post-intervention, after 6 and 12 months, and when the child is 3 years old. DISCUSSION: The paper describes a study protocol of a randomized controlled trial evaluating the effects of a parental support program during infancy. Several issues related to the methodology and implementation are discussed. TRIAL REGISTRATION: ClinicalTrials.gov NCT05445141. Registered on 6 July 2022.

A randomized, controlled trial of a Nordic, protein-reduced complementary diet in infants: effects on body composition, growth, biomarkers, and dietary intake at 12 and 18 months.

BACKGROUND: High intake of protein and low intake of plant-based foods during complementary feeding can contribute to negative long-term health effects. OBJECTIVES: To investigate the effects of a protein-reduced, Nordic complementary diet on body composition, growth, biomarkers, and dietary intake, compared with current Swedish dietary recommendations for infants at 12 and 18 mo. METHODS: Healthy, term infants (n = 250) were randomly allocated to either a Nordic group (NG) or a conventional group (CG). From 4 to 6 mo, NG participants received repeated exposures of Nordic taste portions. From 6 to 18 mo, NG was supplied with Nordic homemade baby food recipes, protein-reduced baby food products, and parental support. CG followed the current Swedish dietary recommendations. Measurements of body composition, anthropometry, biomarkers, and dietary intake were collected from baseline and at 12 and 18 mo. RESULTS: Of the 250 infants, 82% (n = 206) completed the study. There were no group differences in body composition or growth. In NG, protein intake, blood urea nitrogen and plasma IGF-1 were lower compared to CG at 12 and 18 mo. Infants in NG consumed 42% to 45% more fruits and vegetables compared to CG at 12 and 18 mo, which was reflected in a higher plasma folate at 12 and 18 mo. There were no between-group differences in EI or iron status. CONCLUSIONS: Introduction of a predominantly plant-based, protein-reduced diet as part of complementary feeding is feasible and can increase fruit and vegetable intake. This trial was registered at clinicaltrials.gov as NCT02634749.

Changes in Comprehensive Health Literacy Among First-Time Parents Attending Extended Home Visiting in Swedish Multicultural Settings: A Case-Comparison Study.

INTRODUCTION: This study aimed to gain knowledge about the impact of an extended postnatal home visiting program on parents' comprehensive health literacy (CHL) in multicultural, socioeconomically disadvantaged Swedish settings. METHOD: This quasi-experimental study adopted a case-control sampling method recruiting first-time parents through two Child Health Care Centers in Stockholm. Participants were interviewed twice through structured questionnaires when their child was aged between less than two months (n = 193) and 15-18 months (n = 151) from October 2017 to August 2020. Analyses used linear regression models and nonparametric tests. RESULTS: A subgroup of parents that needed language interpreters demonstrated statistically significantly improved CHL from premeasures to postmeasures within the intervention group that received an extended home visiting intervention (F = 11.429; p <.001), and when compared with a corresponding subgroup that received merely the ordinary Swedish Child Health Care Centers program (F = 5.025; p = .027). DISCUSSION: Postnatal home visiting interventions may reduce inequity in CHL for parents living in multicultural, socioeconomically disadvantaged settings.

Psychometric qualities of the HLS-EU-Q16 instrument for parental health literacy in Swedish multicultural settings.

BACKGROUND: Health literacy (HL) is important for individuals in terms of knowledge and competence to make decisions about healthcare, health promotion and disease prevention. Migrants generally demonstrate lower HL levels compared to the majority populations. HL interventions among migrants are rarely studied. Thus, there is a need to find useful HL measurements for multicultural settings. The importance of understanding parents' HL is related to their key role in providing and promoting the health of their children. This study aimed to add knowledge about the psychometric properties of the HLS-EU-Q16 instrument (Swedish version) among parents in Swedish multicultural settings. METHODS: A cross sectional design was used. Totally 193 first-time parents (N = 193) were recruited through two child healthcare centres in Stockholm. Parents were interviewed when their infants were < 2 months old using structured questionnaires including HLS-EU-Q16. For psychometric evaluation of HLS-EU-Q16 instrument, exploratory factor analyses (EFA) were used to test internal consistency (N = 164). HL levels in sub-groups were explored with Kruskal-Wallis/Chi2 tests. Participants' comments on HLS-EU-Q16 questionnaire were viewed to explore how the questions were perceived by the target population. RESULTS: One factor solution of EFA explained 37.3% of the total variance in HLS-EU-Q16. Statistically significant differences in HL levels were found in relation to migration including language difficulties and level of education of the study population and access to support in line with previous research. Challenges related to understanding HLS-EU-Q16 questionnaire were found among participants with migrant background. CONCLUSIONS: The Swedish version of HLS-EU-Q16 could be used together with other instruments for measuring overall HL in multicultural settings. HLS-EU-Q16 appears to discriminate between different levels of HL in relation to migrant background and shorter education and limited access to support. However, other measures of HL which should be adapted to use in multicultural settings, need to be explored in further studies of parental HL and its relationship to child health in multicultural settings. TRIAL REGISTRATION: The study was retrospectively registered (18 February 2020) in the ISRCTN registry ( ISRCTN10336603 ).

Exploring associations between subjective well-being and personality over a time span of 15-18 months: a cohort study of adolescents in Sweden.

INTRODUCTION: Subjective well-being (SWB) is a contributing factor for building resilience and a resource for positive outcomes, e.g. study achievement and work performance. Earlier studies have examined associations between and prospective effects of personality traits on SWB, but few addressed the role that SWB plays in formation of personality over time. The purpose of our study was to examine associations and prospective effects of SWB on personality traits and vice versa in a cohort sample of secondary school students in Sweden who completed self-reported measures of SWB and personality traits at baseline (N = 446, 76% females) and at 15-18 month follow-up (N = 283, 71% females). METHODS: SWB was defined and measured by the WHO-5 Well-being Index and the Satisfaction with Life Scale. The Big Five Inventory was used to measure personality traits. Autoregressive models were used to analyse associations and potential prospective effects of SWB on personality traits and vice versa. RESULTS: Low levels of neuroticism and high levels of extraversion, conscientiousness and agreeableness were associated with high levels of SWB at baseline and follow-up. The association between SWB and neuroticism was notably strong. We found high statistically significant rank order stability across the two time points for all measures of personality traits with stability effects, derived from the autoregressive models, ranging from .199 for extraversion to .440 for neuroticism. Stability for SWB was statistically significant across the two time points and ranged from .182 for well-being to .353 for life satisfaction. SWB had a prospective effect on agreeableness only. None of the personality traits had any significant prospective effects on SWB. CONCLUSIONS: The present findings indicate that although correlated, bidirectional prospective effects between personality traits and SWB could not be confirmed. Neuroticism displayed the strongest negative association with adolescents' SWB. Schools are an appropriate setting to improve well-being, and allocating resources that reduce neuroticism is crucial, including structural interventions, policies for healthy school settings and teaching emotional regulation techniques.

Acceptance of a Nordic, Protein-Reduced Diet for Young Children during Complementary Feeding-A Randomized Controlled Trial.

Early life is critical for developing healthy eating patterns. This study aimed to investigate the effects of a Nordic, protein-reduced complementary diet (ND) compared to a diet following the current Swedish dietary guidelines on eating patterns and food acceptance. At 4-6 months (mo) of age infants were randomized to a Nordic group (NG, n = 41) or a Conventional group (CG, n = 40), and followed until 18 mo of age. Daily intake of fruits and vegetables (mean ± sd) at 12 mo was significantly higher in the NG compared to the CG: 341 ± 108 g/day vs. 220 ± 76 g/day (p < 0.001), respectively. From 12 to 18 mo, fruit and vegetable intake decreased, but the NG still consumed 32% more compared to the CG: 254 ± 99 g/day vs. 193 ± 67 g/day (p = 0.004). To assess food acceptance, both groups were tested with home exposure meals at 12 and 18 mo. No group differences in acceptance were found. We find that a ND with parental education initiates healthy eating patterns during infancy, but that the exposure meal used in the present study was insufficient to detect major differences in food acceptance. This is most likely explained by the preparation of the meal. Nordic produce offers high environmental sustainability and favorable taste composition to establish healthy food preferences during this sensitive period of early life.

Narrative review of interventions suitable for well-baby clinics to promote infant attachment security and parents' sensitivity.

AIM: The aim of this narrative review was to evaluate the evidence for interventions for children's secure attachment relationships and parents' caregiving sensitivity that could potentially be implemented in the context of a well-baby clinic. METHODS: Literature search on programmes for parental caregiving sensitivity and secure attachment for infants aged 0-24 months. Randomised controlled trials (RCTs) published 1995-2018 with interventions starting from one week postpartum, and with a maximum of 12 sessions (plus potential booster session) were included. RESULTS: We identified 25 studies, of which 22 studied effects of home-based programmes using video feedback techniques. Positive effects of these interventions in families at risk were found on parental caregiving sensitivity and to a lesser extent also on children's secure or disorganised attachment. The effects of two of these programmes were supported by several RCTs. Three intervention studies based on group and individual psychotherapy showed no significant positive effects. Most of the interventions targeted mothers only. CONCLUSION: The review found some evidence for positive effects of selective interventions with video feedback techniques for children's secure attachment and strong evidence for positive effects on parental caregiving sensitivity. Important knowledge gaps were identified for universal interventions and interventions for fathers and parents with a non-Western background.

Healthcare utilisation and measles, mumps and rubella vaccination rates among children with an extended postnatal home visiting programme in a disadvantaged area in Stockholm, Sweden-A 3-year follow-up.

AIM: To follow up healthcare utilisation and measles, mumps and rubella (MMR) vaccination rates among children 0-36 months, receiving an extended postnatal home visiting programme in a disadvantaged area with poorer child health, and in control groups, in Stockholm, Sweden. METHODS: We analysed electronic child health records regarding outpatient visits, inpatient episodes and MMR vaccination for children 0-36 months receiving the home visiting programme (Intervention Group) and in control groups (Control Group and Rinkeby Comparison Group). RESULTS: Children in the Intervention Group had significantly higher MMR vaccination rate than children in the Rinkeby Comparison Group. Healthcare utilisation was similar in the Intervention Group and the control groups. In stratified analyses by number of home visits received, children receiving the recommended six home visits had significantly fewer inpatient episodes and somewhat fewer emergency visits than those receiving fewer home visits. CONCLUSION: The extended home visiting programme had a positive impact on the MMR vaccination rate. Children receiving the recommended six home visits had lower use of inpatient care. In addition to being positively perceived by parents in an area with greater healthcare needs, the programme may have a positive impact on their children's healthcare utilisation.

Protein-Reduced Complementary Foods Based on Nordic Ingredients Combined with Systematic Introduction of Taste Portions Increase Intake of Fruits and Vegetables in 9 Month Old Infants: A Randomised Controlled Trial.

Abstract: Fruits and vegetables are healthy foods but under-consumed among infants and children. Approaches to increase their intake are urgently needed. This study investigated the effects of a systematic introduction of taste portions and a novel protein-reduced complementary diet based on Nordic foods on fruit and vegetable intake, growth and iron status to 9 months of age. Healthy, term infants (n = 250) were recruited and randomly allocated to either a Nordic diet group (NG) or a conventional diet group (CG). Infants were solely breast- or formula-fed at study start. From 4 to 6 months of age, the NG followed a systematic taste portions schedule consisting of home-made purées of Nordic produce for 24 days. Subsequently, the NG was supplied with baby food products and recipes of homemade baby foods based on Nordic ingredients but with reduced protein content compared to the CG. The CG was advised to follow current Swedish recommendations on complementary foods. A total of 232 participants (93%) completed the study. The NG had significantly higher intake of fruits and vegetables than the CG at 9 months of age; 225 ± 109 g/day vs. 156 ± 77 g/day (p < 0.001), respectively. Energy intake was similar, but protein intake was significantly lower in the NG (-26%, p < 0.001) compared to the CG. This lower protein intake was compensated for by higher intake of carbohydrate from fruits and vegetables. No significant group differences in growth or iron status were observed. The intervention resulted in significantly higher consumption of fruits and vegetables in infants introduced to complementary foods based on Nordic ingredients.

Study protocol: optimized complementary feeding study (OTIS): a randomized controlled trial of the impact of a protein-reduced complementary diet based on Nordic foods.

BACKGROUND: What we eat as infants and children carries long-term consequences. Apart from breastfeeding, the composition of the complementary diet, i.e. the foods given to the infant during the transition from breast milk/infant formula to regular family foods affects the child's future health. A high intake of protein, a low intake of fruits, vegetables and fish and an unfavorable distribution between polyunsaturated and saturated fats are considered to be associate with health risks, e.g. obesity, type 2 diabetes and dyslipidemia later in life. METHODS: In a randomized, controlled study from 6 to 18 months of age we will compare the currently recommended, Swedish complementary diet to one based on Nordic foods, i.e. an increased intake of fruits, berries, vegetables, tubers, whole-grain and game, and a lower intake of sweets, dairy, meat and poultry, with lower protein content (30% decrease), a higher intake of vegetable fats and fish and a systematic introduction of fruits and greens. The main outcomes are body composition (fat and fat-free mass measured with deuterium), metabolic and inflammatory biomarkers (associated with the amount of body fat) in blood and urine, gut microbiota (thought to be the link between early diet, metabolism and diseases such as obesity and insulin resistance) and blood pressure. We will also measure the participants' energy and nutrient intake, eating behavior and temperament through validated questionnaires, acceptance of new and unfamiliar foods through video-taped test meals and assessment of cognitive development, which we believe can be influenced through an increased intake of fish and milk fats, notably milk fat globule membranes (MFGM). DISCUSSION: If the results are what we expect, i.e. improved body composition and a less obesogenic, diabetogenic and inflammatory metabolism and gut microbiota composition, a more sustainable nutrient intake for future health and an increased acceptance of healthy foods, they will have a profound impact on the dietary recommendations to infants in Sweden and elsewhere, their eating habits later in life and subsequently their long-term health. TRIAL REGISTRATION: NCT02634749 . Registration date 18 December 2015.

Strengthening resilience through an extended postnatal home visiting program in a multicultural suburb in Sweden: fathers striving for stability.

BACKGROUND: To improve prerequisites for better health development among children growing up in multicultural suburbs in Stockholm County, where poorer health is displayed in several aspects including child health, early support was initiated for first-time parents in one of the suburbs. An extended postnatal home visiting program during the child's first 15 months was offered to families with first-time mothers during 2013-2014 and consisted of six home visits by a child health care nurse and a parental advisor from social services. Almost all invited families (94%) participated in the program and the program evaluation. Fathers' participation in two or more home visits within the program was 53%. The aim of this study was to explore the experiences of fathers participating in the program, with respect to their role as a first-time parent from a resilience perspective. METHODS: In-depth interviews were conducted with nine fathers. Constructivist grounded theory (GT) was applied in the analysis. RESULTS: The fathers' experiences formed the core category of the study, 'striving for stability in living conditions', as well as three categories: 'everyday life conditions', 'adjustment to fatherhood in Sweden' and 'channels of support'. The fathers perceived that the home visiting program strengthened their parental confidence and increased their knowledge of societal services and local resources for their family. CONCLUSIONS: In terms of resilience, the extended postnatal home visiting program benefitted the interviewed migrant fathers on an individual level by meeting part of their need for support regarding knowledge and parental confidence; on a structural level the program helped fathers gain information about available societal services and resources in their local area. TRIAL REGISTRATION: The study was retrospectively registered (11 August 2016) in the ISRCTN registry (ISRCTN11832097 DOI: https://doi.org/10.1186/ISRCTN11832097 ).

What Predicts Stable Mental Health in the 18⁻29 Age Group Compared to Older Age Groups? Results from the Stockholm Public Health Cohort 2002⁻2014.

Mental health has decreased in young people since the 1990s, and mental health promotion is an urgent matter. A first step is to identify which social determinants could be of importance for intervention. We used the Stockholm Public Health Cohort, a longitudinal population-based health survey, completed by 31,000 inhabitants in the Stockholm County. We focused on the 18⁻29 age group, n = 3373 (60% females, 40% males) and aimed at assessing which social determinants predict stable mental health, measured as scoring <3 points on the General Health Questionnaire 12 at all time points: 2002, 2007, 2010, and 2014. Forty-six percent of males and 36% of females reported stable mental health. Among the 17 predictors on sociodemographics, socioeconomics, social capital, health behavior, and victimization, six predicted stable mental health in the following order: occupation and especially employment, emotional support, male gender, being born in Sweden, absence of financial strain, and consumption of fruit and berries. In the 30⁻84 age group, 66% males and 55% females reported stable mental health. Nine determinants in the following rank predicted stable mental health: absence of financial strain, occupation and especially being self-employed, emotional support, male gender, physical activity, instrumental support, interpersonal trust, community trust, and absence of hazardous alcohol consumption. Interaction analysis showed significant difference between the younger and older group regarding physical activity and absence of financial strain with importance being higher for the older group. Our findings indicate that the determinants of health differ across the life-course with fewer predictors related to social capital and health behavior in the younger group compared to the older. We conclude that health-promoting interventions should be lifespan-sensitive.

Screening fathers for postpartum depression can be cost-effective: An example from Sweden.

BACKGROUND: Postpartum depression negatively affects the whole family and its prevalence in Sweden ranges between 6-10% for fathers and 13-16% for mothers. However, only mothers in Sweden are currently routinely screened. AIM: The aim of this study was to determine if a postpartum depression screening for fathers in Stockholm County could be cost-effective. METHODS: National Swedish databases were used to find registry data and a literature review was undertaken to identify the model data inputs associated with postpartum depression in Sweden. The generated evidence was used to build a Markov model in TreeAge. One-way and probabilistic sensitivity analyses were performed to account for parameter uncertainties. Alternative scenario analyses were further undertaken to test the assumptions in the base case analysis. RESULTS: A postpartum screening for depression in fathers is cost-effective in base case and alternative scenarios. The results indicate that the screening program is associated with lower costs and higher health effects. The results were sensitive to variables of quality adjusted life years for the depressed fathers, probabilities of remission in treatment and no treatment groups and start age and productivity losses. The probabilistic sensitivity analysis resulted in a 70% probability of the postnatal depression screening intervention being cost-effective. LIMITATIONS: The current study only uses secondary data; therefore future research should assess the cost-effectiveness of screening fathers for depression. CONCLUSION: The postpartum screening intervention for fathers could be cost-effective compared to no screening. Future research should replicate the potential cost-effectiveness for screening fathers for postpartum depression.

Effects of mental health interventions for students in higher education are sustainable over time: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Symptoms of depression, anxiety, and distress are more common in undergraduates compared to age-matched peers. Mental ill health among students is associated with impaired academic achievement, worse occupational preparedness, and lower future occupational performance. Research on mental health promoting and mental ill health preventing interventions has shown promising short-term effects, though the sustainability of intervention benefits deserve closer attention. We aimed to identify, appraise and summarize existing data from randomized control trials (RCTs) reporting on whether the effects of mental health promoting and mental ill health preventing interventions were sustained at least three months post-intervention, and to analyze how the effects vary for different outcomes in relation to follow-up length. Further, we aimed to assess whether the effect sustainability varied by intervention type, study-level determinants and of participant characteristics. MATERIAL AND METHODS: A systematic search in MEDLINE, PsycInfo, ERIC, and Scopus was performed for RCTs published in 1995-2015 reporting an assessment of mental ill health and positive mental health outcomes for, at least, three months of post-intervention follow-up. Random-effect modeling was utilized for quantitative synthesis of the existing evidence with standardized mean difference (Hedges' g) used to estimate an aggregated effect size. Sustainability of the effects of interventions was analyzed separately for 3-6 months, 7-12 months, and 13-18 months of post-intervention follow-up. RESULTS: About 26 studies were eligible after reviewing 6,571 citations. The pooled effects were mainly small, but significant for several categories of outcomes. Thus, for the combined mental ill health outcomes, symptom-reduction sustained up to 7-12 months post-intervention (standardized mean difference (Hedges' g) effect size (ES) = -0.28 (95% CI [-0.49, -0.08])). Further, sustainability of symptom-reductions were evident for depression with intervention effect lasting up to 13-18 months (ES = -0.30 (95% CI [-0.51, -0.08])), for anxiety up to 7-12 months (ES = -0.27 (95% CI [-0.54, -0.01])), and for stress up to 3-6 months (ES = -0.30 (95% CI [-0.58, -0.03])). The effects of interventions to enhance positive mental health were sustained up to 3-6 months for the combined positive mental health outcomes (ES = 0.32 (95% CI [0.05, 0.59])). For enhanced active coping, sustainability up to 3-6 months was observed with a medium and significant effect (ES = 0.75 (95% CI [0.19, 1.30])). DISCUSSION: The evidence suggests long-term effect sustainability for mental ill health preventive interventions, especially for interventions to reduce the symptoms of depression and symptoms of anxiety. Interventions to promote positive mental health offer promising, but shorter-lasting effects. Future research should focus on mental health organizational interventions to examine their potential for students in tertiary education.

Paternal Perinatal Depression Assessed by the Edinburgh Postnatal Depression Scale and the Gotland Male Depression Scale: Prevalence and Possible Risk Factors.

Several studies have used the Edinburgh Postnatal Depression Scale (EPDS), developed to screen new mothers, also for new fathers. This study aimed to further contribute to this knowledge by comparing assessment of possible depression in fathers and associated demographic factors by the EPDS and the Gotland Male Depression Scale (GMDS), developed for "male" depression screening. The study compared EPDS score ≥10 and ≥12, corresponding to minor and major depression, respectively, in relation to GMDS score ≥13. At 3-6 months after child birth, a questionnaire was sent to 8,011 fathers of whom 3,656 (46%) responded. The detection of possibly depressed fathers by EPDS was 8.1% at score ≥12, comparable to the 8.6% detected by the GMDS. At score ≥10, the proportion detected by EPDS increased to 13.3%. Associations with possible risk factors were analyzed for fathers detected by one or both scales. A low income was associated with depression in all groups. Fathers detected by EPDS alone were at higher risk if they had three or more children, or lower education. Fathers detected by EPDS alone at score ≥10, or by both scales at EPDS score ≥12, more often were born in a foreign country. Seemingly, the EPDS and the GMDS are associated with different demographic risk factors. The EPDS score appears critical since 5% of possibly depressed fathers are excluded at EPDS cutoff 12. These results suggest that neither scale alone is sufficient for depression screening in new fathers, and that the decision of EPDS cutoff is crucial.

Men's Perceptions of Women's Participation in Development Initiatives in Rural Bangladesh.

Without taking masculine issues into account, women's participation in development initiatives does not always guarantee their empowerment, health, and welfare in a male-dominated society. This study aimed to explore men's perceptions of women's participation in development (WPD) in rural Bangladesh. In adopting a qualitative approach, the study examined 48 purposively selected married and unmarried men aged 20-76 years in three northwest villages. Data collection was accomplished through four focus group discussions (FGDs) with 43 men clustered into four groups and through individual interviews with five other men. A qualitative content analysis of the data revealed an overall theme of "feeling challenged by fears and hopes," indicating variations in men's views on women's participation in development initiatives as represented by three main categories: (a) fearing the loss of male authority, (b) recognizing women's roles in enhancing family welfare, and (c) valuing women's independence. In the context of dominant patriarchal traditions in Bangladesh, these findings provide new insight into dynamics and variations of men's views, suggesting a need to better engage men during different stages of women-focused development initiatives.

Practising proportionate universalism - a study protocol of an extended postnatal home visiting programme in a disadvantaged area in Stockholm, Sweden.

BACKGROUND: In spite of a well-developed welfare system in Sweden, there are important health divides between residential areas in Stockholm county, with shorter life expectancy in disadvantaged areas. These socioeconomic and health divides also affect children. Extra efforts and organized collaboration by different authorities are required to meet the greater needs of children growing up in these areas. METHODS/DESIGN: This article reports on the programme logic and evaluation design of an extended postnatal home visiting programme in collaboration between child health services and social services in the Rinkeby area, Stockholm, Sweden, where a large proportion are recent immigrants and more than 50% are at-risk of poverty. The intervention consists of five extra home visits when the child is aged between 2-15 months, jointly by a child health nurse and a social service parental advisor, offered to all parents of first-born children attending Rinkeby child health centre. Parents of first-born children attending child health centres in neighboring areas serve as controls. The evaluation will use a mixed methods approach, including participant observation, in-depth interviews, interviews using structured questionnaires, review and analysis of child health records and records of health care utilization. DISCUSSION: The intervention has so far been very positively received by the parents (95% participation rate), who seem to perceive that they actually benefit from participating, and also from staff in child health services and social services who find this approach to be in line with their professional intentions. The staff members interviewed also appreciate the inter-professional collaboration. The intervention has sparked activities also in other sectors (the local library, the open child day care centre) of the local area. The timing of the intervention, at the start of the child's life, may be well suited to support parents in reorienting themselves and finding a positive parenting role, to the benefit of the development of the child. The intervention may be seen as a concrete example of "proportionate universalism", as a strategy to reduce inequalities in health - applying a universal intervention with increased intensity in groups that have a greater need for it. TRIAL REGISTRATION: The study was retrospectively registered (11 August 2016) in the ISRCTN registry ( ISRCTN11832097 DOI: 10.1186/ISRCTN11832097 ).

Changing caring behaviours in rehabilitation after a hip fracture - A tool for empowerment?

Different rehabilitation programs after surgery have been presented to improve the outcome for patients with a hip fracture. Empowerment has been suggested as useful, but requires a change in the caring behaviours of health professionals. The aim with this study was to evaluate if training and supervision of the nursing staff could alter caring behaviours. A case-control study of nursing staff treating hip fracture patients was performed at a hospital with two sites. Training and supervision was given to the nursing staff at the intervention site. The intervention focused on creating positive care interaction by using eight guidelines. The evaluation was performed with recordings of a constructed caring situation before training, and observations of care situations at the ward before and after intervention. The results showed no differences at baseline between the two sites in the caring behaviours. After intervention, significant effects of caring behaviours were seen in seven out of eight guidelines, the effect sizes ranged from medium to large. The findings indicate that the nursing staff can change caring behaviours and facilitate the empowerment of patients with a hip fracture.