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Hermansson, Göran
Publications (10 of 13) Show all publications
Bergfors, E., Hermansson, G., Nyström Kronander, U., Falk, L., Valter, L. & Trollfors, B. (2014). How common are long-lasting, intensely itching vaccination granulomas and contact allergy to aluminium induced by currently used pediatric vaccines? A prospective cohort study. European Journal of Pediatrics, 173(10), 1297-1307
Open this publication in new window or tab >>How common are long-lasting, intensely itching vaccination granulomas and contact allergy to aluminium induced by currently used pediatric vaccines? A prospective cohort study
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2014 (English)In: European Journal of Pediatrics, ISSN 0340-6199, E-ISSN 1432-1076, Vol. 173, no 10, p. 1297-1307Article in journal (Refereed) Published
Abstract [en]

The frequency of long-lasting, intensely itching subcutaneous nodules at the injection site for aluminium (Al)-adsorbed vaccines (vaccination granulomas) was investigated in a prospective cohort study comprising 4,758 children who received either a diphtheria-tetanus-pertussis-polio-Haemophilus influenzae type b vaccine (Infanrix®, Pentavac®) alone or concomitant with a pneumococcal conjugate (Prevenar). Both vaccines were adsorbed to an Al adjuvant. Altogether 38 children (0.83 %) with itching granulomas were identified, epicutaneously tested for Al sensitisation and followed yearly. Contact allergy to Al was verified in 85 %. The median duration of symptoms was 22 months in those hitherto recovered. The frequency of granulomas induced by Infanrix® was >0.66 % and by Prevenar >0.35 %. The risk for granulomas increased from 0.63 to 1.18 % when a second Al-adsorbed vaccine was added to the schedule. Conclusion: Long-lasting itching vaccination granulomas are poorly understood but more frequent than previously known after infant vaccination with commonly used diphtheria-tetanus-pertussis-polio-Haemophilus influenzae type b and pneumococcal conjugate vaccines. The risk increases with the number of vaccines given. Most children with itching granulomas become contact allergic to aluminium. Itching vaccination granulomas are benign but may be troublesome and should be recognised early in primary health care to avoid unnecessary investigations, anxiety and mistrust.

Place, publisher, year, edition, pages
Springer Berlin/Heidelberg, 2014
Keywords
Itching nodule, Granuloma, Contact allergy, Aluminium, Adsorbed vaccines, Child health care
National Category
Pediatrics
Identifiers
urn:nbn:se:liu:diva-107372 (URN)10.1007/s00431-014-2318-2 (DOI)000342227700004 ()24752308 (PubMedID)
Available from: 2014-06-11 Created: 2014-06-11 Last updated: 2017-12-05
Alehagen, S., Finnström, O., Hermansson, G., Somasunduram, K., Bangal, V., Patil, A., . . . Johansson, A. (2012). Nurse-based antenatal and child health care in rural India, implementation and effects - an Indian-Swedish collaboration. Rural and remote health, 12(3)
Open this publication in new window or tab >>Nurse-based antenatal and child health care in rural India, implementation and effects - an Indian-Swedish collaboration
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2012 (English)In: Rural and remote health, ISSN 1445-6354, Vol. 12, no 3Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION:

Improving maternal and child health care are two of the Millennium Development Goals of the World Health Organization. India is one of the countries worldwide most burdened by maternal and child deaths. The aim of the study was to describe how families participate in nurse-based antenatal and child health care, and the effect of this in relation to referrals to specialist care, institutional deliveries and mortality.

METHODS:

The intervention took place in a remote rural area in India and was influenced by Swedish nurse-based health care. A baseline survey was performed before the intervention commenced. The intervention included education program for staff members with a model called Training of Trainers and the establishment of clinics as both primary health centers and mobile clinics. Health records and manuals, and informational and educational materials were produced and the clinics were equipped with easily handled instruments. The study period was between 2006 and 2009. Data were collected from antenatal care and child healthcare records. The Chi-square test was used to analyze mortality differences between years. A focus group discussion and a content analysis were performed.

RESULTS:

Families' participation increased which led to more check-ups of pregnant women and small children. Antenatal visits before 16 weeks among pregnant women increased from 32 to 62% during the period. Women having at least three check-ups during pregnancy increased from 30 to 60%. Maternal mortality decreased from 478 to 121 per 100 000 live births. The total numbers of children examined in the project increased from approximately 6000 to 18 500 children. Infant mortality decreased from 80 to 43 per 1000 live births. Women and children referred to specialist care increased considerably and institutional deliveries increased from 47 to 74%.

CONCLUSION:

These results suggest that it is possible in a rural and remote area to influence peoples' awareness of the value of preventive health care. The results also indicate that this might decrease maternal and child mortality. The education led to a more patient-friendly encounter between health professionals and patients.

Keywords
India, infant mortality, institutional deliveries, maternal mortality, MDG 4 and 5, prevention, training of trainers.
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-84262 (URN)000318412500028 ()22998337 (PubMedID)
Note

Article No. 2140

Funding Agencies|Pravara Medical Trust, India||Swedish International Development Cooperation Agency, Sweden||Linkoping University||County Council in Ostergotland, Sweden||

Available from: 2012-10-03 Created: 2012-10-03 Last updated: 2017-12-07Bibliographically approved
Carlsson, N., Johansson, A., Hermansson, G. & Andersson-Gäre, B. (2011). Parents' attitudes to smoking and passive smoking and their experience of the tobacco preventive work in child health care. Journal of Child Health Care, 15(4), 272-286
Open this publication in new window or tab >>Parents' attitudes to smoking and passive smoking and their experience of the tobacco preventive work in child health care
2011 (English)In: Journal of Child Health Care, ISSN 1367-4935, E-ISSN 1741-2889, Vol. 15, no 4, p. 272-286Article in journal (Refereed) Published
Abstract [en]

The purpose of this study was to describe parents' attitudes to smoking and their experience of the tobacco preventive work in antenatal care and in Child Health Care (CHC) in Sweden. A population based survey in which 62 percent of 3000 randomly selected parents with 1- and 3-year-old children answered a questionnaire. Fifty-six percent stated that smoking was registered in the health record of the child yet no further discussion regarding passive smoking took place. The parents' educational level and smoking status was related to the attitudes and experiences of the tobacco preventive work. The results indicated that the dialogue with parents regarding children and environmental tobacco smoke (ETS) exposure has to be redesigned and intensified in order to meet the needs of parents with different backgrounds.

Place, publisher, year, edition, pages
Sage Publications, 2011
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-73547 (URN)10.1177/1367493510382243 (DOI)000299562500004 ()
Available from: 2012-01-09 Created: 2012-01-09 Last updated: 2017-12-08
Carlsson, N., Johansson, A., Hermansson, G. & Andersson-Gare, B. (2010). Child health nurses' roles and attitudes in reducing children's tobacco smoke exposure. Journal of Clinical Nursing, 19(3-4), 507-516
Open this publication in new window or tab >>Child health nurses' roles and attitudes in reducing children's tobacco smoke exposure
2010 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, no 3-4, p. 507-516Article in journal (Refereed) Published
Abstract [en]

Aim. To investigate and analyse the attitudes to tobacco prevention among child healthcare nurses, to study how tobacco preventive work is carried out at child healthcare centres today. To evaluate how the tobacco preventive work had changed in child health care since the Swedish National Board of Health and Welfares national evaluation in 1997. Background. Exposure to environmental tobacco smoke has adverse health effects. Interventions aiming at minimising environmental tobacco smoke have been developed and implemented at child healthcare centres in Sweden but the long-term effects of the interventions have not been studied. Design. Survey. Methods. In 2004, a postal questionnaire was sent to all nurses (n = 196) working at 92 child healthcare centres in two counties in south-eastern Sweden. The questionnaire was based on questions used by the National Board of Health and Welfare in their national evaluation in 1997 and individual semi-structured interviews performed for this study. Results. Almost all the nurses considered it very important to ask parents about their smoking habits (median 9.5, range 5.1-10.0). Collaboration with antenatal care had decreased since 1997. Nearly all the nurses mentioned difficulties in reaching fathers (70%), groups such as immigrant families (87%) and socially vulnerable families (94%) with the tobacco preventive programme. No nurses reported having special strategies to reach these groups. Conclusions. Improvement of methods for tobacco prevention at child healthcare centres is called for, especially for vulnerable groups in society. However, the positive attitude among nurses found in this study forms a promising basis for successful interventions. Relevance to clinical practice. This study shows that launching national programmes for tobacco prevention is not sufficient to achieve sustainable work. Nurses working in child healthcare centres have an overall positive attitude to tobacco prevention but need continuous education and training in communication skills especially to reach social vulnerable groups. Regular feedback from systematic follow-ups might increase motivation for this work.

Keywords
child health services, nurses, passive smoking, prevention
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-53685 (URN)10.1111/j.1365-2702.2009.02847.x (DOI)
Available from: 2010-02-01 Created: 2010-02-01 Last updated: 2017-12-12Bibliographically approved
Johansson, A., Hermansson, G. & Ludvigsson, J. (2008). Tobacco Exposure and Diabetes-Related Autoantibodies in Children Results from the ABIS Study. Annals of the New York Academy of Sciences, 1150, 197-199
Open this publication in new window or tab >>Tobacco Exposure and Diabetes-Related Autoantibodies in Children Results from the ABIS Study
2008 (English)In: Annals of the New York Academy of Sciences, ISSN 0077-8923, E-ISSN 1749-6632, Vol. 1150, p. 197-199Article in journal (Refereed) Published
Abstract [en]

Passive smoking has decreased in recent years ("increased hygiene"). Less environmental tobacco smoke (ETS) gives increased hygiene that, if the hygiene hypothesis is true, in turn might give more autoimmune diseases. The presence of auto antibodies is considered to be an early indicator of type 1 diabetes (T1D). Because tobacco exposure may influence the immune system, we analyzed the relation between passive smoking and development of autoantibodies. A subsample (n = 8794) of the children in the ABIS study was used for this analysis. The parents answered questionnaires on smoking from pregnancy and onwards, and blood samples from the children aged 2.5-3 years were analyzed for GADA and IA-2A. Results showed that there was no significant difference in the prevalence of GADA or IA-2A (> 95 percentile) between tobacco-exposed and nonexposed children. It was concluded that passive smoking does not seem to influence development of diabetes-related autoantibodies early in life.

Keywords
autoantibodies, diabetes, children, tobacco exposure, hygiene
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-16621 (URN)10.1196/annals.1447.023 (DOI)
Note
Volume 1150 Issue: Immunology of Diabetes V From Bench to Bedside.Available from: 2009-02-07 Created: 2009-02-06 Last updated: 2017-12-14
Timpka, T., Angbratt, M., Hermansson, G., Bolme, P., Häger, A. & Valter, L. (2007). A high-precision protocol for identification of preschool children at risk for persisting obesity. PLoS ONE, 2(6)
Open this publication in new window or tab >>A high-precision protocol for identification of preschool children at risk for persisting obesity
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2007 (English)In: PLoS ONE, ISSN 1932-6203, Vol. 2, no 6Article in journal (Refereed) Published
Abstract [en]

Background: Recent studies suggest that adolescent adiposity is established already in preadolescence. Earlier studies have confirmed a strong tracking of obesity from adolescence to adulthood. Our aim was to examine the diagnostic accuracy of a population-derived protocol for identification of preschool children at risk for obesity in preadolescence. Methodology/Principal Findings: We analysed data obtained for child health surveillance up to age 5 from 5778 children born in a swedish county in 1991. The basic data set included age, sex, and weight and height measurements from the regular checkups between ages 1.5 and 5. Data not routinely collected in the child health centre setting were disregarded. The children were at age 10 randomly assigned to protocol derivation and validation cohorts and assessed for obesity according to IOTF criteria. The accuracy of predicting obesity in the validation cohort was measured using decision precision, specificity, and sensitivity. The decision protocol selected 1.4% of preschool children as being at obesity risk. The precision of the protocol at age 10 was 82% for girls and 80% for boys, and the specificity was 100% for both boys and girls, The sensitivity was higher for girls (41 %) than for boys (21%). The relative risk for obesity at age 10 estimated by the odds ratio for individuals selected by the protocol compared to non-selected peers was 212.6 (95% confidence interval 56.6 to 798.4) for girls and 120.3 (95% Cl 24.5 to 589.91for boys. Conclusion/Significance: A simple and inexpensive decision protocol based on BMI values proved to have high precision and specificity for identification of preschool children at risk for obesity persisting into adolescence, while the sersitivity was low especially for boys. Implementation and further evaluations of the protocol in chlid health centre settings are warranted. © 2007 Timpka et al.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-40928 (URN)10.1371/journal.pone.0000535 (DOI)54657 (Local ID)54657 (Archive number)54657 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2014-01-16Bibliographically approved
Johansson, A., Halling, A., Hermansson, G. & Ludvigsson, J. (2005). Assessment of Smoking Behaviors in the Home and Their Influence on Children's Passive Smoking: Development of a Questionnaire. Annals of Epidemiology, 15(6), 453-459
Open this publication in new window or tab >>Assessment of Smoking Behaviors in the Home and Their Influence on Children's Passive Smoking: Development of a Questionnaire
2005 (English)In: Annals of Epidemiology, ISSN 1047-2797, Vol. 15, no 6, p. 453-459Article in journal (Refereed) Published
Abstract [en]

Purpose

To construct and validate a questionnaire aiming to measure children's exposure to environmental tobacco smoke (ETS) in the home.

Methods

The development of the instrument included epidemiological studies, qualitative interviews, pilot studies, and validation with biomarkers and is described in seven consecutive steps. Parents of preschool children, from different population-based samples in south-east Sweden, have participated in the studies.

Results

Content and face validity was tested by an expert panel and core elements for the purpose of the instrument identified. Reliability was shown with test-retest of the first version. The validation with biomarkers indicated that the sensitivity of the instrument was high enough to discriminate between children's ETS exposure levels. Cotinine/creatinine levels were related to parents' described smoking behaviors. Differences were shown between children from non-smoking homes, and all groups with smoking parents, independent of their smoking behavior (p < 0.01), as well as between parents smoking strictly outdoors and parents reporting indoor smoking (p < 0.001).

Conclusion

The results indicate that the presented instrument can be used to discriminate between different levels of ETS exposure and when children's level of tobacco smoke exposure is to be assessed.

Keywords
Cotinine; ETS; Parents; Outdoor Smoking
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13624 (URN)10.1016/j.annepidem.2004.09.012 (DOI)
Available from: 2004-03-12 Created: 2004-03-12 Last updated: 2009-05-20
Dannetun, E., Tegnell, A., Hermansson, G. & Giesecke, J. (2005). Parents' reported reasons for avoiding MMR vaccination: A telephone survey. Scandinavian Journal of Primary Health Care, 23(3), 149-153
Open this publication in new window or tab >>Parents' reported reasons for avoiding MMR vaccination: A telephone survey
2005 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 23, no 3, p. 149-153Article in journal (Refereed) Published
Abstract [en]

Objective. During the second half of the 1990s and the first years of the 2000s a declining coverage for MMR vaccination in two-year-olds was observed in Sweden. The aim was to assess reasons for postponement or non-vaccination. Design. A telephone survey using a structured questionnaire on parents' attitudes regarding their choice to postpone or abstain from vaccinating their child. Setting. The County of Östergötland in Sweden. Subjects. A total of 203 parents of children who had no registered date for MMR vaccination at a Child Health Centre. Main outcome measures. Parental reasons for non-vaccination. Results. In all, 26 of the 203 children had received MMR vaccination but this had not been registered. Of those not vaccinated, 40% of the parents had decided to abstain and 60% to postpone vaccination. Fear of side effects was the most common reason for non-vaccination in both groups. The main source of information was the media followed by the Child Health Centre. Parents with a single child more often postponed vaccination and those who abstained were more likely to have had a discussion with a doctor or nurse about MMR vaccine. Conclusion. Postponers and abstainers may have different reasons for their decision. The role of well-trained healthcare staff in giving advice and an opportunity to discuss MMR vaccination with concerned parents is very important. © 2005 Taylor & Francis.

Keywords
Attitudes, MMR, Parents, Vaccination
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-50432 (URN)10.1080/02813430510031306 (DOI)
Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2017-12-12
Johansson, A., Hermansson, G. & Ludvigsson, J. (2004). How should parents protect their children from environmental tobacco-smoke exposure in the home?. Pediatrics, 113(4), 291-295
Open this publication in new window or tab >>How should parents protect their children from environmental tobacco-smoke exposure in the home?
2004 (English)In: Pediatrics, ISSN 1098-4275, Vol. 113, no 4, p. 291-295Article in journal (Refereed) Published
Abstract [en]

Background. Children’s exposure to tobacco smoke is known to have adverse health effects, and most parents try to protect their children.

Objective. To examine the effectiveness of parents’ precautions for limiting their children’s tobacco-smoke exposure and to identify variables associated to parents’ smoking behavior.

Design and participants. Children, 2.5 to 3 years old, participating in All Babies in Southeast Sweden, a prospective study on environmental factors affecting development of immune-mediated diseases. Smoking parents of 366 children answered a questionnaire on their smoking behavior. Cotinine analyses were made on urine specimen from these children and 433 age-matched controls from nonsmoking homes.

Results. Smoking behavior had a significant impact on cotinine levels. Exclusively outdoor smoking with the door closed gave lower urine cotinine levels of children than when mixing smoking near the kitchen fan and near an open door or indoors but higher levels than controls.

Variables of importance for smoking behavior were not living in a nuclear family (odds ratio: 2.1; 95% confidence interval: 1.1–4.1) and high cigarette consumption (odds ratio: 1.6; 95% confidence interval: 1.2-2.1).

An exposure score with controls as the reference group (1.0) gave an exposure score for outdoor smoking with the door closed of 2.0, for standing near an open door + outdoors of 2.4, for standing near the kitchen fan + outdoors of 3.2, for mixing near an open door, kitchen fan, and outdoors of 10.3, and for indoor smoking of 15.2.

Conclusion. Smoking outdoors with the door closed was not a total but the most effective way to protect children from environmental tobacco-smoke exposure. Other modes of action had a minor effect.

Keywords
ETS, cotinine, children, smoking behavior, measures of precaution
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13626 (URN)
Available from: 2004-03-12 Created: 2004-03-12 Last updated: 2009-08-19
Johansson, A., Hermansson, G. & Ludvigsson, J. (2004). Parents' attitudes to children's tobacco smoke exposure and how the issue is handled in health care. Journal of Pediatric Health Care, 18(5), 228-235
Open this publication in new window or tab >>Parents' attitudes to children's tobacco smoke exposure and how the issue is handled in health care
2004 (English)In: Journal of Pediatric Health Care, ISSN 0891-5245, Vol. 18, no 5, p. 228-235Article in journal (Refereed) Published
Abstract [en]

Introduction

The objective of the study was to understand the opinions and attitudes among parents of preschool children towards children's passive smoking, to show how attitudes influenced smoking and smoking behavior, and how the parents had experienced the handling of the tobacco issue in antenatal and child health care.

Method

A subsample of smoking and nonsmoking parents (n = 300) with 4- to 6-year-old children participating in All Babies in Southeast Sweden (ABIS), a prospective study on environmental factors affecting development of immune-mediated diseases, answered a questionnaire on their opinions and attitudes to children's passive smoking.

Results

Indoor smokers were more positive regarding smoking, less aware of the adverse health effects from passive smoking, and more negative regarding the handling of tobacco prevention in health care than both outdoor smokers and nonsmokers. Indoor smokers' idea of how children should be protected from tobacco smoke exposure was significantly different from the idea of nonsmokers and outdoor smokers.

Discussion

Results indicate that further intense efforts are needed to convince the remaining indoor smokers about the adverse health effects related to tobacco smoke exposure. Pediatric nurses meet these parents in their daily work and should be aware of the need to focus this group and their use of protective measures.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13627 (URN)10.1016/j.pedhc.2004.03.006 (DOI)
Available from: 2004-03-12 Created: 2004-03-12 Last updated: 2009-08-19
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