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  • 1.
    Alehagen, Siw
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Finnström, Orvar
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Pediatrik. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Barn- och kvinnocentrum, Barn- och ungdomskliniken i Linköping.
    Hermansson, Göran
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Pediatrik. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Barn- och kvinnocentrum, Barn- och ungdomskliniken i Linköping.
    Somasunduram, Konduri
    Centre for Social Medicine, Pravara Institute of Medical Sciences-Deemed University, Loni, Maharashtra, India.
    Bangal, Vidyadhar
    Pravara Institute of Medical Sciences-Deemed University, Loni, Maharashtra, India.
    Patil, Ashok
    Pravara Institute of Medical Sciences-Deemed University, Loni, Maharashtra, India.
    Chandekar, Pratibha
    Pravara Institute of Medical Sciences-Deemed University, Loni, Maharashtra, India.
    Johansson, AnnaKarin
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Nurse-based antenatal and child health care in rural India, implementation and effects - an Indian-Swedish collaboration2012Inngår i: Rural and remote health, ISSN 1445-6354, Vol. 12, nr 3Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 2.
    Alehagen, Siw
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Hägg, Monica
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Kalén-Enterlöv, Maria
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Johansson, AnnaKarin
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Experiences of community health nurses regarding father participation in child health care2011Inngår i: Journal of Child Health Care, ISSN 1367-4935, E-ISSN 1741-2889, Vol. 15, nr 3, s. 153-162Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Traditionally child health care (CHC) has been an arena where mothers and nurses meet, but in recent years fathers are entering CHC with increasing frequency. The aim of this study was to describe nurses’ experiences of fathers’ participation in CHC. Nine Swedish nurses working in CHC were interviewed and asked to give a description of their experiences from meetings with fathers in CHC. Phenomenology according to Giorgi was used for the analysis and the essence of the findings was that father participation was seen from the perspective of mother participation and was constantly compared to mother participation in CHC. The essence is explicated in the following themes: participation through activities; equal participation although diverse; influence of structures in society; and strengthening participation. Clinical implications include the need for creating a separate identity in CHC for fathers and more communication directed at fathers.

  • 3.
    Byström, IngMarie
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Hollén, Elisabet
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Medicinsk mikrobiologi. Linköpings universitet, Hälsouniversitetet.
    Fälth-Magnusson, Karin
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Pediatrik. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Barn- och kvinnocentrum, Barn- och ungdomskliniken i Linköping.
    Johansson, AnnaKarin
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Health-Related Quality of Life in Children and Adolescents with Celiac Disease: From the Perspectives of Children and Parents2012Inngår i: Gastroenterology Research and Practice, ISSN 1687-6121, E-ISSN 1687-630X, Vol. 2012Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim. To examine how celiac children and adolescents on gluten-free diet valued their health-related quality of life, and if age and severity of the disease at onset affected the childrens self-valuation later in life. We also assessed the parents valuation of their childs quality of life. Methods. The DISABKIDS Chronic generic measure, short versions for both children and parents, was used on 160 families with celiac disease. A paediatric gastroenterologist classified manifestations of the disease at onset retrospectively. Results. Age or sex did not influence the outcome. Children diagnosed before the age of five scored higher than children diagnosed later. Children diagnosed more than eight years ago scored higher than more recently diagnosed children, and children who had the classical symptoms of the disease at onset scored higher than those who had atypical symptoms or were asymptomatic. The parents valuated their childrens quality of life as lower than the children did. Conclusion. Health-related quality of life in treated celiac children and adolescents was influenced by age at diagnosis, disease severity at onset, and years on gluten-free diet. The disagreement between child-parent valuations highlights the importance of letting the children themselves be heard about their perceived quality of life.

  • 4.
    Carlsson, Noomi
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Pediatrik. Linköpings universitet, Hälsouniversitetet.
    Alehagen, Siw
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Andersson Gäre, Boel
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Pediatrik. Linköpings universitet, Hälsouniversitetet.
    Johansson, AnnaKarin
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    "Smoking in children's environment test": a qualitative study of experiences of a new instrument applied in preventive work in child health care2011Inngår i: BMC Pediatrics, ISSN 1471-2431, E-ISSN 1471-2431, Vol. 11, nr 113Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

    Despite knowledge of the adverse health effects of passive smoking, children are still   being exposed. Children's nurses play an important role in tobacco preventive work   through dialogue with parents aimed at identifying how children can be protected from   environmental tobacco smoke (ETS) exposure. The study describes the experiences of   Child Health Care (CHC) nurses when using the validated instrument SiCET (Smoking   in Children's Environment Test) in dialogue with parents.

    Method

    In an intervention in CHC centres in south-eastern Sweden nurses were invited to use   the SiCET. Eighteen nurses participated in focus group interviews. Transcripts were   reviewed and their contents were coded into categories by three investigators using   the method described for focus groups interviews.

    Results

    The SiCET was used in dialogue with parents in tobacco preventive work and resulted   in focused discussions on smoking and support for behavioural changes among parents.   The instrument had both strengths and limitations. The nurses experienced that the   SiCET facilitated dialogue with parents and gave a comprehensive view of the child's   ETS exposure. This gave nurses the possibility of taking on a supportive role by offering   parents long-term help in protecting their child from ETS exposure and in considering   smoking cessation.

    Conclusion

    Our findings indicate that the SiCET supports nurses in their dialogue with parents   on children's ETS exposure at CHC. There is a need for more clinical use and evaluation   of the SiCET to determine its usefulness in clinical practice under varying circumstances.

  • 5.
    Carlsson, Noomi
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Pediatrik. Linköpings universitet, Hälsouniversitetet.
    Johansson, AnnaKarin
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Abrahamsson, Agneta
    Jönköping University, School of Health Sciences, Jönköping, Sweden.
    Andersson-Gäre, Boel
    Linköpings universitet, Institutionen för klinisk och experimentell medicin. Linköpings universitet, Hälsouniversitetet.
    How to minimize children’s environmental tobacco smoke exposure: An intervention study in a child health service setting2013Inngår i: BMC Pediatrics, ISSN 1471-2431, E-ISSN 1471-2431, Vol. 13, nr 76Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Despite the low prevalence of daily smokers in Sweden, children are still being exposed to environmental tobacco smoke (ETS), primarily by their smoking parents. A prospective intervention study using methods from Quality Improvement was performed in Child Health Care (CHC). The aim was to provide nurses with new methods for motivating and supporting parents in their efforts to protect children from ETS exposure. Method: Collaborative learning was used to implement and test an intervention bundle. Twenty-two CHC nurses recruited 86 families with small children which had at least one smoking parent. Using a bundle of interventions, nurses met and had dialogues with the parents over a one-year period. A detailed questionnaire on cigarette consumption and smoking policies in the home was answered by the parents at the beginning and at the end of the intervention, when children also took urine tests to determine cotinine levels. Results: Seventy-two families completed the study. Ten parents (11%) quit smoking. Thirty-two families (44%) decreased their cigarette consumption. Forty-five families (63%) were outdoor smokers at follow up. The proportion of children with urinary cotinine values of >6 ng/ml had decreased. Conclusion: The intensified tobacco prevention in CHC improved smoking parents' ability to protect their children from ETS exposure.

  • 6.
    Carlsson, Noomi
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin. Linköpings universitet, Hälsouniversitetet.
    Johansson, AnnaKarin
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Hermansson, Göran
    Östergötlands Läns Landsting, Närsjukvården i östra Östergötland, Barnhälsovårdsenheten i Östergötland. Östergötlands Läns Landsting.
    Andersson Gäre, Boel
    Akademin för hälsa och vård, Landstinget i Jönköpings län.
    En nollversion av barns tobaksexponering - för jämlik hälsa2010Konferansepaper (Fagfellevurdert)
  • 7.
    Carlsson, Noomi
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Pediatrik. Linköpings universitet, Hälsouniversitetet.
    Johansson, AnnaKarin
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Hermansson, Göran
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Pediatrik. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Barn- och kvinnocentrum, Barn- och ungdomskliniken i Linköping.
    Andersson-Gare, Boel
    Jonkoping County Council.
    Child health nurses' roles and attitudes in reducing children's tobacco smoke exposure2010Inngår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, nr 3-4, s. 507-516Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 8.
    Carlsson, Noomi
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Pediatrik. Linköpings universitet, Hälsouniversitetet.
    Johansson, AnnaKarin
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Hermansson, Göran
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Pediatrik. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Barn- och kvinnocentrum, Barn- och ungdomskliniken i Linköping.
    Andersson-Gäre, Boel
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Pediatrik. Linköpings universitet, Hälsouniversitetet.
    Parents' attitudes to smoking and passive smoking and their experience of the tobacco preventive work in child health care2011Inngår i: Journal of Child Health Care, ISSN 1367-4935, E-ISSN 1741-2889, Vol. 15, nr 4, s. 272-286Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 9.
    Jangland, Eva
    et al.
    Institutionen för kirurgiska vetenskaper, Uppsala Universitet.
    Becker, Deborah
    School of Nursing, University of Pennsylvania, USA.
    Börjeson, Sussanne
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för kirurgi, ortopedi och cancervård, Onkologiska kliniken US.
    Doherty, Caroline
    Adult Gerontology Acute Care Nurse Practitioner Program, Phildelphia, Pennsylvania, USA.
    Gimm, Oliver
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet.
    Griffith, Patricia
    School of Nursing, University of Pennsylvania, USA.
    Johansson, AnnaKarin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Juhlin, Claes
    Avdelningen för kirurgi, Uppsala Universitetssjukhus.
    Pawlow, Patricia
    School of Nursing, University of Pennsylvania, USA.
    Sicoutris, Corinna
    School of Nursing, University of Pennsylvania, USA.
    Yngman-Uhlin, Pia
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Hälsouniversitetet.
    The development of a Swedish Nurse Practitioner Program - a request from clinicians and a process supported by US experience2013Inngår i: Journal of Nursing Education and Practice, ISSN 1925-4040, E-ISSN 1925-4059, Vol. 4, nr 2, s. 38-48Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    High nursing turnover and a shortage of nurses in acute hospital settings in Sweden challenge health care systems to deliver and ensure safe care. Advanced nursing roles implemented in other countries have offered nurses new career opportunities and had positive effects on patient safety, effectiveness of care, and patient satisfaction. The advanced nursing position of Nurse Practitioner has existed for many years in the United States, while similar extended nursing roles and changes in the scope of nursing practice are being developed in many other countries. In line with this international trend, the role of Nurse Practitioner in surgical care has been proposed for Sweden, and a master’s programme for Acute Nurse Practitioners has been in development for many years. To optimize and facilitate the introduction of this new nursing role and its supporting programme, we elicited the experiences and support of the group who developed a Nurse Practitioner programme for a university in the US. This paper describes this collaboration and sharing of experiences during the process of developing a Swedish Nurse Practitioner programme. We also discuss the challenges of implement- ting any new nursing role in any national health care system. We would like to share our collaborative experiences and thoughts for the future and to open further national and international dialogue about how best to expand the scope of practice for nurses in acute hospital care, and thereby to improve patient care in Sweden and elsewhere.

  • 10.
    Johansson, Anna-Karin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Att möta och kommunicera med barn och deras föräldrar2007Inngår i: Kommunikation : samtal och bemötande i vården / [ed] Bjöörn Fossum, Studentlitteratur , 2007, 1, s. 353-372Kapittel i bok, del av antologi (Annet vitenskapelig)
    Abstract [sv]

    All vård innebär kommunikation. Men ofta upplevs samtalen med patienter och deras anhöriga som den stora utmaningen av studenter inom omvårdnad, medicin, sjukgymnastik och arbetsterapi. Även yrkesverksamma inom vården tycker ibland att dessa samtal är något av det svåraste och mest krävande med yrket.Denna andra upplaga av Kommunikation skapar förutsättningar för att underlätta och förbättra kommunikationen mellan vårdare, patienter och anhöriga. För att uppnå god kommunikation behövs kunskap från flera discipliner, varför boken också är skriven av författare från olika professioner.Boken omfattar modeller, teorier, reflektioner, övningar, fallbeskrivningar och beskrivningar av olika slags samtal i skilda vårdsituationer som täcker de flesta områden inom vården.Kommunikation är i första hand avsedd för studenter inom hälso-och sjukvårdsutbildningarna på grundläggande nivå, men fungerar också för avancerad nivå. Boken används även av kliniskt verksamma. Den hör till de mest uppskattade titlarna inom Studentlitteraturs utgivning för medicin och hälsa

  • 11.
    Johansson, Anna-Karin
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård.
    Barns exponering för tobaksrök - betydelsen av föräldrars rökning och rökbeteende2005Inngår i: Barnläkaren, ISSN 1651-0534, Vol. 5Artikkel i tidsskrift (Annet vitenskapelig)
  • 12.
    Johansson, AnnaKarin
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Betydelsen av att skydda barn mot passiv rökning.2004Inngår i: Forskning och UtvecklingArtikkel i tidsskrift (Annet (populærvitenskap, debatt, mm))
  • 13.
    Johansson, AnnaKarin
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Passiv rökning hos barn: Betydelsen av föräldrars rökning och rökbeteende2004Inngår i: Medikament, ISSN 1402-3881, Vol. 4, s. 33-37Artikkel i tidsskrift (Annet (populærvitenskap, debatt, mm))
  • 14.
    Johansson, AnnaKarin
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Passive Smoking in Children: The Importance of Parents’ Smoking and Use of Protective Measures2004Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Passive smoking has been recognised as a health hazard, and chidren are especially vulnerable. The general aim of this thesis was to describe and analyse the importance of parents’ smoking and smoking behaviour for children’s tobacco smoke exposure. The studies were conducted in the South-East part of Sweden and pre-school children and their parents constituted the study samples. Five studies are described in six papers. Smoking prevalence among parents (14%) and commonly used measures of protection were surveyed. An instrument designed to measure children’s tobacco smoke exposure in the home was developed and validated. It was used on 687 families with a smoking parent and a child 2½-3 years old, included in a prospective cohort study on environmental variables of importance for immun-mediated diseases ABIS (All Babies in South-East Sweden). Almost 60% of the parents stated that they always smoked outdoors with the door closed, 14% mixed this with smoking near the kitchen fan, 12% near an open door, 7% mixed all these behaviours and 8 % smoked indoors without precautions. The smoking behaviours were related to the children’s creatinine adjusted urine cotinine. All groups had significantly higher values than had children from non-smoking homes, controls. Outdoor smoking with the door closed seemed to be the best, though not a total, measure for tobacco smoke protection in the home.

    Most parents were aware of the importance of protecting children from tobacco smoke exposure but all were not convinced of the increased risk for disease for exposed children. The majority of parents were not satisfied with the smoking prevention in health-care and 50% did not think that their smoking was of any concern to the child health care nurse.

    Further research is warranted to describe if the difference in exposure score related to smoking behaviours is related to different prevalence of disease. Efforts are needed to convince those who still smoke indoors that tobacco smoke exposure influence children’s health and that consequent outdoor smoking with the door closed seemed to give the best protection.

    Delarbeid
    1. Indoor and outdoor smoking: Impact on children’s health
    Åpne denne publikasjonen i ny fane eller vindu >>Indoor and outdoor smoking: Impact on children’s health
    2003 (engelsk)Inngår i: European Journal of Public Health, ISSN 1101-1262, Vol. 13, nr 1, s. 61-66Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    Background: Many children are exposed to ETS (environmental tobacco smoke), which has both immediate and long-term adverse health effects. The aim was to determine the prevalence and nature of smoking among parents with infants and the association of indoor or outdoor smoking with the health of their children.

    Methods: Mail-questionnaire study, which was performed in a county in the south-east of Sweden, as a retrospective cross-sectional survey including 1990 children, 12–24 months old.

    Results: 20% of the children had at least one smoking parent; 7% had parents who smoked indoors and 13% parents who smoked only outdoors. Indoor smoking was most prevalent among single and blue-collar working parents. In the case of smoking cessation during pregnancy, smoking was usually resumed after delivery or at the end of the breast-feeding period. Coughing more than two weeks after a URI (upper respiratory infection), wheezing without a URI as well as pooled respiratory symptoms differed significantly between children of non-smokers and indoor smokers.

    Conclusion: Further research of the common belief that outdoor smoking is sufficient to protect infants from health effects due to ETS exposure is warranted.

    Emneord
    children, environmental tobacco smoke, health effects, smoking behaviour
    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-13622 (URN)10.1093/eurpub/13.1.61 (DOI)
    Tilgjengelig fra: 2004-03-12 Laget: 2004-03-12 Sist oppdatert: 2009-05-20
    2. Does having children affect adult smoking and behaviours at home?
    Åpne denne publikasjonen i ny fane eller vindu >>Does having children affect adult smoking and behaviours at home?
    2003 (engelsk)Inngår i: Tobacco Induced Diseases, ISSN 1617-9625, Vol. 1, nr 3, s. 175-183Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    Background

    Smoking prevalence and smoking behaviours have changed in society and an increased awareness of the importance of protecting children from environmental tobacco smoke (ETS) is reported. The aim of this study was to find out if smoking prevalence and smoking behaviours were influenced by parenthood, and if differences in health-related quality of life differed between smoking and non-smoking parents.

    Methods

    Questionnaires were sent to a randomly selected sample, including 1735 men and women (20–44 years old), residing in the south-east of Sweden. Participation rate was 78%. Analyses were done to show differences between groups, and variables of importance for being a smoker and an indoor smoker.

    Results

    Parenthood did not seem to be associated with lower smoking prevalence. Logistic regression models showed that smoking prevalence was significantly associated with education, gender and mental health. Smoking behaviour, as well as attitudes to passive smoking, seemed to be influenced by parenthood. Parents of dependent children (0–19 years old) smoked outdoors significantly more than adults without children (p < 0.01). Logistic regression showed that factors negatively associated with outdoor smoking included having immigrant status, and not having preschool children. Parents of preschool children found it significantly more important to keep the indoor environment smoke free than both parents with schoolchildren (p = 0.02) and adults without children (p < 0.001). Significant differences in self-perceived health-related quality of life indexes (SF-36) were seen between smokers and non-smokers.

    Conclusion

    As smoking behaviour, but not smoking prevalence, seems to be influenced by parenthood, it is important to consider the effectiveness of commonly used precautions when children's risk for ETS exposure is estimated.

    Emneord
    smoking prevalence, children, protection, parents, SF-36
    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-13623 (URN)10.1186/1617-9625-1-3-175 (DOI)
    Tilgjengelig fra: 2004-03-12 Laget: 2004-03-12 Sist oppdatert: 2009-05-20
    3. Assessment of Smoking Behaviors in the Home and Their Influence on Children's Passive Smoking: Development of a Questionnaire
    Åpne denne publikasjonen i ny fane eller vindu >>Assessment of Smoking Behaviors in the Home and Their Influence on Children's Passive Smoking: Development of a Questionnaire
    2005 (engelsk)Inngår i: Annals of Epidemiology, ISSN 1047-2797, Vol. 15, nr 6, s. 453-459Artikkel i tidsskrift (Fagfellevurdert) 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.

    Emneord
    Cotinine; ETS; Parents; Outdoor Smoking
    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-13624 (URN)10.1016/j.annepidem.2004.09.012 (DOI)
    Tilgjengelig fra: 2004-03-12 Laget: 2004-03-12 Sist oppdatert: 2009-05-20
    4. When does exposure of children to tobacco smoke become child abuse?
    Åpne denne publikasjonen i ny fane eller vindu >>When does exposure of children to tobacco smoke become child abuse?
    2003 (engelsk)Inngår i: The Lancet, ISSN 0140-6736, Vol. 361, nr 9371, s. 1828-1828Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    We report an instance of a child aged 2.5 years, who is exposed to tobacco smoke in the home. The child is a participant in a prospective cohort study (ABIS; all babies in southeast Sweden) we are undertaking, on environmental factors affecting development of immune-mediated diseases in children.1

    Exposure to environmental tobacco smoke, known to affect present and future health of children,2 is one of the environmental factors being studied. Parents are asked, in questionnaires, if and how much they smoke. A subsample of smoking parents of 2–3 year-old children has been asked about their smoking behaviour at home—ie, what precautions they use to protect their child from tobacco smoke. To validate this questionnaire, we have analysed urine cotinine concentrations (the major urinary metabolite of nicotine) in specimens provided by children of this age. We recorded that the smoking behaviour of parents at home was significantly associated with cotinine concentrations of their child. Cotinine concentrations were adjusted for creatinine.3

    The child we report here had a cotinine/creatinine ratio of 800 μg cotinine/1 g creatinine, corresponding to active smoking of 3–5 cigarettes a day.4 The parents reported a joint consumption of 41–60 cigarettes a day. They said they smoke in the kitchen and living room, whereas bedrooms were reported to be smoke-free. The parents reported smoking at the dinner table once a day and in front of the television set several times a day. They also said they smoke near the kitchen fan several times a day and near an open door at least once a week. These comments from the parents indicate that, in their opinion, their child was well protected from exposure to environmental tobacco smoke, since they did not smoke in bedrooms and the windows were almost always open.

    Though nicotine and cotinine metabolism is independent probably due to genetic differences,5 the cotinine concentration of this child is remarkably high. If active smoking in adults causes lung cancer and other serious diseases, passive smoking from the age of 2.5 years (and probably younger) must be even more deleterious. Since a child at this age cannot, by his or her own will, avoid a smoky environment, we ask ourselves when exposure to tobacco smoke should be regarded as child abuse?

    We want to stress the fact that, although most parents are aware of the importance of protecting their children from tobacco smoke, and try in different ways, children can still be massively exposed to this toxic drug. Since to just forbid smoking might be ineffective, nurses and doctors should pay attention to smoking behaviour of smoking parents they meet. Until we know more about effective measures of protection, the recommendation should be never to smoke indoors in homes with children.

    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-13625 (URN)10.1016/S0140-6736(03)13431-9 (DOI)
    Tilgjengelig fra: 2004-03-12 Laget: 2004-03-12 Sist oppdatert: 2009-08-19
    5. How should parents protect their children from environmental tobacco-smoke exposure in the home?
    Åpne denne publikasjonen i ny fane eller vindu >>How should parents protect their children from environmental tobacco-smoke exposure in the home?
    2004 (engelsk)Inngår i: Pediatrics, ISSN 1098-4275, Vol. 113, nr 4, s. 291-295Artikkel i tidsskrift (Fagfellevurdert) 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.

    Emneord
    ETS, cotinine, children, smoking behavior, measures of precaution
    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-13626 (URN)
    Tilgjengelig fra: 2004-03-12 Laget: 2004-03-12 Sist oppdatert: 2009-08-19
    6. Parents' attitudes to children's tobacco smoke exposure and how the issue is handled in health care
    Åpne denne publikasjonen i ny fane eller vindu >>Parents' attitudes to children's tobacco smoke exposure and how the issue is handled in health care
    2004 (engelsk)Inngår i: Journal of Pediatric Health Care, ISSN 0891-5245, Vol. 18, nr 5, s. 228-235Artikkel i tidsskrift (Fagfellevurdert) 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.

    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-13627 (URN)10.1016/j.pedhc.2004.03.006 (DOI)
    Tilgjengelig fra: 2004-03-12 Laget: 2004-03-12 Sist oppdatert: 2009-08-19
  • 15.
    Johansson, AnnaKarin
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Carlsson, Noomi
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Department of Public Health and Medical Care, Jönköping County Council, Sweden.
    Almfors, Helena
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Rosén, Monica
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Alehagen, Siw
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Parents' experiences of participating in an intervention on tobacco prevention in Child Health Care2014Inngår i: BMC Pediatrics, ISSN 1471-2431, E-ISSN 1471-2431, Vol. 14, nr 69Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

    Child health care is an important arena for tobacco prevention in Sweden. The aim of this study was to describe parents’ experiences from participating in a nursebased tobacco prevention intervention.     

    Methods

    Eleven parents were interviewed using semi-structured interviews. The material was analysed in a qualitative content analysis process.     

    Results

    The analysis emerged four categories; Receiving support, Respectful treatment, Influence on smoking habits and Receiving information. The parents described how the CHC nurses treated them with support and respect. They described the importance of being treated with respect for their autonomy in their decisions about smoking. They also claimed that they had received little or no information about health consequences for children exposed to environmental tobacco smoke (ETS). The findings also indicate that both the questionnaire used and the urine-cotinine test had influenced parents’ smoking.     

    Conclusion

    The clinical implication is that CHC is an important arena for preventive work aiming to minimize children’s tobacco smoke exposure. CHC nurses can play an important role in tobacco prevention but should be more explicit in their communication with parents about tobacco issues. The SiCET was referred to as an eye-opener and can be useful in the MI dialogues nurses perform in order to support parents in their efforts to protect their children from ETS.

  • 16.
    Johansson, AnnaKarin
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Pediatrik. Linköpings universitet, Hälsouniversitetet.
    Halling, Arne
    Department of Health Sciences, Kristianstad University, Kristianstad, Sweden .
    Hermansson, Göran
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Pediatrik. Linköpings universitet, Hälsouniversitetet.
    Ludvigsson, Johnny
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Pediatrik. Linköpings universitet, Hälsouniversitetet.
    Assessment of Smoking Behaviors in the Home and Their Influence on Children's Passive Smoking: Development of a Questionnaire2005Inngår i: Annals of Epidemiology, ISSN 1047-2797, Vol. 15, nr 6, s. 453-459Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 17.
    Johansson, AnnaKarin
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Halling, Arne
    Department of Health Sciences, Kristianstad University, Kristianstad, Sweden.
    The Linquest Study Group,
    Does having children affect adult smoking and behaviours at home?2003Inngår i: Tobacco Induced Diseases, ISSN 1617-9625, Vol. 1, nr 3, s. 175-183Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

    Smoking prevalence and smoking behaviours have changed in society and an increased awareness of the importance of protecting children from environmental tobacco smoke (ETS) is reported. The aim of this study was to find out if smoking prevalence and smoking behaviours were influenced by parenthood, and if differences in health-related quality of life differed between smoking and non-smoking parents.

    Methods

    Questionnaires were sent to a randomly selected sample, including 1735 men and women (20–44 years old), residing in the south-east of Sweden. Participation rate was 78%. Analyses were done to show differences between groups, and variables of importance for being a smoker and an indoor smoker.

    Results

    Parenthood did not seem to be associated with lower smoking prevalence. Logistic regression models showed that smoking prevalence was significantly associated with education, gender and mental health. Smoking behaviour, as well as attitudes to passive smoking, seemed to be influenced by parenthood. Parents of dependent children (0–19 years old) smoked outdoors significantly more than adults without children (p < 0.01). Logistic regression showed that factors negatively associated with outdoor smoking included having immigrant status, and not having preschool children. Parents of preschool children found it significantly more important to keep the indoor environment smoke free than both parents with schoolchildren (p = 0.02) and adults without children (p < 0.001). Significant differences in self-perceived health-related quality of life indexes (SF-36) were seen between smokers and non-smokers.

    Conclusion

    As smoking behaviour, but not smoking prevalence, seems to be influenced by parenthood, it is important to consider the effectiveness of commonly used precautions when children's risk for ETS exposure is estimated.

  • 18.
    Johansson, AnnaKarin
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Hermansson, Göran
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Pediatrik. Linköpings universitet, Hälsouniversitetet.
    Halling, Arne
    Department of Health sciences, Kristianstad University, Sweden .
    Indoor and outdoor smoking: Impact on children’s health2003Inngår i: European Journal of Public Health, ISSN 1101-1262, Vol. 13, nr 1, s. 61-66Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Many children are exposed to ETS (environmental tobacco smoke), which has both immediate and long-term adverse health effects. The aim was to determine the prevalence and nature of smoking among parents with infants and the association of indoor or outdoor smoking with the health of their children.

    Methods: Mail-questionnaire study, which was performed in a county in the south-east of Sweden, as a retrospective cross-sectional survey including 1990 children, 12–24 months old.

    Results: 20% of the children had at least one smoking parent; 7% had parents who smoked indoors and 13% parents who smoked only outdoors. Indoor smoking was most prevalent among single and blue-collar working parents. In the case of smoking cessation during pregnancy, smoking was usually resumed after delivery or at the end of the breast-feeding period. Coughing more than two weeks after a URI (upper respiratory infection), wheezing without a URI as well as pooled respiratory symptoms differed significantly between children of non-smokers and indoor smokers.

    Conclusion: Further research of the common belief that outdoor smoking is sufficient to protect infants from health effects due to ETS exposure is warranted.

  • 19.
    Johansson, AnnaKarin
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Hermansson, Göran
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Pediatrik. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Barn- och kvinnocentrum, Barn- och ungdomskliniken i Linköping.
    Ludvigsson, Johnny
    Östergötlands Läns Landsting, Barn- och kvinnocentrum, Barn- och ungdomskliniken i Linköping. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Pediatrik. Linköpings universitet, Hälsouniversitetet.
    How should parents protect their children from environmental tobacco-smoke exposure in the home?2004Inngår i: Pediatrics, ISSN 1098-4275, Vol. 113, nr 4, s. 291-295Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 20.
    Johansson, AnnaKarin
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Hermansson, Göran
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Pediatrik. Linköpings universitet, Hälsouniversitetet.
    Ludvigsson, Johnny
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Pediatrik. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Barn- och kvinnocentrum, Barn- och ungdomskliniken i Linköping.
    Parents' attitudes to children's tobacco smoke exposure and how the issue is handled in health care2004Inngår i: Journal of Pediatric Health Care, ISSN 0891-5245, Vol. 18, nr 5, s. 228-235Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 21.
    Johansson, AnnaKarin
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Hermansson, Göran
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Pediatrik. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Barn- och kvinnocentrum, Barn- och ungdomskliniken i Linköping.
    Ludvigsson, Johnny
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Pediatrik. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Barn- och kvinnocentrum, Barn- och ungdomskliniken i Linköping.
    Tobacco Exposure and Diabetes-Related Autoantibodies in Children Results from the ABIS Study2008Inngår i: Annals of the New York Academy of Sciences, ISSN 0077-8923, E-ISSN 1749-6632, Vol. 1150, s. 197-199Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 22.
    Johansson, AnnaKarin
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Hermansson, Göran
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Pediatrik. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Barn- och kvinnocentrum, Barn- och ungdomskliniken i Linköping.
    Ludvigsson, Johnny
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Pediatrik. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Barn- och kvinnocentrum, Barn- och ungdomskliniken i Linköping.
    When does exposure of children to tobacco smoke become child abuse?2003Inngår i: The Lancet, ISSN 0140-6736, Vol. 361, nr 9371, s. 1828-1828Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    We report an instance of a child aged 2.5 years, who is exposed to tobacco smoke in the home. The child is a participant in a prospective cohort study (ABIS; all babies in southeast Sweden) we are undertaking, on environmental factors affecting development of immune-mediated diseases in children.1

    Exposure to environmental tobacco smoke, known to affect present and future health of children,2 is one of the environmental factors being studied. Parents are asked, in questionnaires, if and how much they smoke. A subsample of smoking parents of 2–3 year-old children has been asked about their smoking behaviour at home—ie, what precautions they use to protect their child from tobacco smoke. To validate this questionnaire, we have analysed urine cotinine concentrations (the major urinary metabolite of nicotine) in specimens provided by children of this age. We recorded that the smoking behaviour of parents at home was significantly associated with cotinine concentrations of their child. Cotinine concentrations were adjusted for creatinine.3

    The child we report here had a cotinine/creatinine ratio of 800 μg cotinine/1 g creatinine, corresponding to active smoking of 3–5 cigarettes a day.4 The parents reported a joint consumption of 41–60 cigarettes a day. They said they smoke in the kitchen and living room, whereas bedrooms were reported to be smoke-free. The parents reported smoking at the dinner table once a day and in front of the television set several times a day. They also said they smoke near the kitchen fan several times a day and near an open door at least once a week. These comments from the parents indicate that, in their opinion, their child was well protected from exposure to environmental tobacco smoke, since they did not smoke in bedrooms and the windows were almost always open.

    Though nicotine and cotinine metabolism is independent probably due to genetic differences,5 the cotinine concentration of this child is remarkably high. If active smoking in adults causes lung cancer and other serious diseases, passive smoking from the age of 2.5 years (and probably younger) must be even more deleterious. Since a child at this age cannot, by his or her own will, avoid a smoky environment, we ask ourselves when exposure to tobacco smoke should be regarded as child abuse?

    We want to stress the fact that, although most parents are aware of the importance of protecting their children from tobacco smoke, and try in different ways, children can still be massively exposed to this toxic drug. Since to just forbid smoking might be ineffective, nurses and doctors should pay attention to smoking behaviour of smoking parents they meet. Until we know more about effective measures of protection, the recommendation should be never to smoke indoors in homes with children.

  • 23.
    Johansson, AnnaKarin
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Ludvigsson, Johnny
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Pediatrik. Östergötlands Läns Landsting, Barn- och kvinnocentrum, Barn- och ungdomskliniken i Linköping.
    Hermansson, Göran
    Adverse health effects related to tobacco smoke exposure in a cohort of three-year olds2008Inngår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 97, nr 3, s. 354-357Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim: To analyse the importance of mothers' smoking during pregnancy and/or environmental tobacco smoke (ETS) exposure in early childhood for children's health and well-being at the age of 3 years. Methods: Four groups from a population based cohort (n = 8850) were compared: children with nonsmoking mother during pregnancy and nonsmoking parents at the age of 3 years (n = 7091), children with only foetal exposure (n = 149), children exposed only postnatally (n = 895) and children exposed both pre- and postnatally (n = 595). Odds ratios and 95% confidence intervals were calculated. Results: Children exposed both pre- and postnatally had more wheezing (1.14, 1.07-1.21) and rhinitis (1.16, 1.06-1.26), used more cough-mixture (1.07, 1.01-1.14) and broncodilatating drugs (1.08, 1.02-1.15) and suffered more from excessive crying (1.31, 1.13-1.51) and irritability (1.27, 1.09-1.48) compared to children with nonsmoking parents. Children exposed only postnatally had more rhinitis (1.24, 1.12-1.37), used more cough-mixture (1.14, 1.05-1.29) and suffered more from poor sleep (1.26, 1.07-1.47) than children of nonsmoking parents. Children with prenatal exposure only used more broncodilatating drugs (1.45, 1.03-2.04) and suffered more from poor sleep (2.06, 1.09-3.87). Conclusion: Health differences, small but significant, indicate that prenatal and/or postnatal ETS exposure alone, or in combination, seems to interfere with child health, supporting the importance of zero tolerance. However, as most smoking parents in Sweden try to protect their children from ETS exposure, the results also might indicate that protective measures are worthwhile. © 2007 The Author(s).

  • 24.
    Johansson, Magdalena
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Nyirenda, John L Z
    Embangweni Mission Hospital, Mzimba, Malawi.
    Johansson, AnnaKarin
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Lorefält, Birgitta
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Perceptions of Malawian Nurses about Nursing Interventions for Malnourished Children and Their Parents2011Inngår i: Journal of Health, Population and Nutrition, ISSN 1606-0997, E-ISSN 2072-1315, Vol. 29, nr 6, s. 612-618Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    in developing countries, malnutrition among children is a major public-health issue. The aim of the study was to describe perceptions of Malawian nurses about nursing interventions for malnourished children and their parents. A qualitative method was used. Data were collected and analyzed according to the phenomenographic research approach. Twelve interviews were performed with 12 nurses at a rural hospital in northern Malawi, Southeast Africa. Through the analysis, two major concepts, comprising four categories of description, emerged: managing malnutrition today and promotion of a favourable nutritional status. The categories of description involved identification and treatment of malnutrition, education during treatment, education during prevention, and assurance of food security. The participating nurses perceived education to be the most important intervention, incorporated in all areas of prevention and treatment of malnutrition. Identification and treatment of malnutrition, education during treatment, education to prevent malnutrition, and assurance of food security were regarded as the most important areas of intervention.

  • 25.
    Söderhamn, Ulrika
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Christensson, Lennart
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Idvall, Ewa
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Johansson, Annakarin
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Bachrach-Lindström, Margareta
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Factors associated with nutritional risk in 75-year-old community living people2010Inngår i: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim.  To identify risk factors for being at nutritional risk, by means of a nutritional screening, in a population based sample of 75-year-old people living in three county councils in Sweden.

    Background.  Undernutrition in older people is known to contribute to poor health. The instrument ‘Nutritional Form For the Elderly’ (NUFFE) helps to identify those at nutritional risk.

    Method.  The screening instrument ‘Nutritional Form For the Elderly’, background variables and health related questions were mail distributed. A total of 1461 persons (75 years old) were included in the study. Descriptive statistical methods were used in the analyses.

    Results.  One percent of the participants had high risk, 21.3% medium and 77.7% low risk for undernutrition. Medium or high risk was predicted by: living alone, receiving help and impaired perceived health. Low Body Mass Index was associated with low risk for undernutrition.

    Conclusion.  By using a simple nutritional screening instrument, significant risk factors were highlighted.

    Relevance to practice.  This instrument can identify older people at nutritional risk and is easy to use. Older people living alone have an increased risk of undernutrition. Body Mass Index (BMI) should be used with caution as one and only indicator of nutritional risk in older people.

  • 26. Thorné, Å
    et al.
    Ljungberg, U
    Johansson, Anna-Karin
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Omvårdnad.
    Rökning och barn/ungdomar: Passiv rökning bland barn och metoden Peer Education i skolan2005Inngår i: Allergistämman,2005, 2005Konferansepaper (Annet vitenskapelig)
  • 27.
    Wennerholm, Carina
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten.
    Bromley, Catherine
    Public Health Observatory Division, NHS Health Scotland, Edinburgh, UK..
    Johansson, AnnaKarin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten.
    Nilsson, Staffan
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Primärvårdscentrum, Vårdcentralen Vikbolandet.
    Frank, John
    Scottish Collaboration of Public Health Research & Policy (SCPHRP); Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.
    Faresjö, Tomas
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Two tales of cardiovascular risks-middle-aged women living in Sweden and Scotland: a cross-sectional comparative study2017Inngår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, nr 8, artikkel-id e016527Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES: To compare cardiovascular risk factors as well as rates of cardiovascular diseases in middle-aged women from urban areas in Scotland and Sweden.

    DESIGN: Comparative cross-sectional study.

    SETTING: Data from the general population in urban areas of Scotland and the general population in two major Swedish cities in southeast Sweden, south of Stockholm.

    PARTICIPANTS: Comparable data of middle-aged women (40-65 years) from the Scottish Health Survey (n=6250) and the Swedish QWIN study (n=741) were merged together into a new dataset (n=6991 participants).

    MAIN OUTCOME MEASURE: We compared middle-aged women in urban areas in Sweden and Scotland regarding risk factors for cardiovascular disease (CVD), CVD diagnosis, anthropometrics, psychological distress and lifestyle.

    RESULTS: In almost all measurements, there were significant differences between the countries, favouring the Swedish women. Scottish women demonstrated a higher frequency of alcohol consumption, smoking, obesity, low vegetable consumption, a sedentary lifestyle and also more psychological distress. For doctor-diagnosed coronary heart disease, there were also significant differences, with a higher prevalence among the Scottish women.

    CONCLUSIONS: This is one of the first studies that clearly shows that Scottish middle-aged women are particularly affected by a worse profile of CVD risks. The profound differences in CVD risk and outcome frequency in the two populations are likely to have arisen from differences in the two groups of women's social, cultural, political and economic environments.

  • 28.
    Wennerholm, Carina
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Grip, Björn
    Linköpings universitet, Institutionen för studier av samhällsutveckling och kultur. Linköpings universitet, Filosofiska fakulteten.
    Johansson, AnnaKarin
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Nilsson, Hans
    Linköpings universitet, Institutionen för studier av samhällsutveckling och kultur, Centrum för lokalhistoria. Linköpings universitet, Filosofiska fakulteten.
    Honkasalo, Marja-Liisa
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Hälsouniversitetet.
    Faresjö, Tomas
    Linköpings universitet, Institutionen för medicin och hälsa, Allmänmedicin. Linköpings universitet, Hälsouniversitetet.
    Cardiovascular disease occurrence in two close but different social environments2011Inngår i: INTERNATIONAL JOURNAL OF HEALTH GEOGRAPHICS, ISSN 1476-072X, Vol. 10, nr 5Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Cardiovascular diseases estimate to be the leading cause of death and loss of disability-adjusted life years globally. Conventional risk factors for cardiovascular diseases only partly account for the social gradient. The purpose of this study was to compare the occurrence of the most frequent cardiovascular diseases and cardiovascular mortality in two close cities, the Twin cities. Methods: We focused on the total population in two neighbour and equally sized cities with a population of around 135 000 inhabitants each. These twin cities represent two different social environments in the same Swedish county. According to their social history they could be labelled a "blue-collar" and a "white-collar" city. Morbidity data for the two cities was derived from an administrative health care register based on medical records assigned by the physicians at both hospitals and primary care. The morbidity data presented are cumulative incidence rates and the data on mortality for ischemic heart diseases is based on official Swedish statistics. Results: The cumulative incidence of different cardiovascular diagnoses for younger and also elderly men and women revealed significantly differences for studied cardiovascular diagnoses. The occurrence rates were in all aspects highest in the population of the "blue-collar" twin city for both sexes. Conclusions: This study revealed that there are significant differences in risk for cardiovascular morbidity and mortality between the populations in the studied different social environments. These differences seem to be profound and stable over time and thereby give implication for public health policy to initiate a community intervention program in the "blue-collar" twin city.

  • 29.
    Wennerholm, Carina
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Jern, Michaela
    Linköpings universitet, Hälsouniversitetet, Hälsouniversitetets läkarutbildning.
    Johansson, AnnaKarin
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Faresjö, Tomas
    Linköpings universitet, Institutionen för medicin och hälsa, Allmänmedicin. Linköpings universitet, Hälsouniversitetet.
    How Could Cardiovascular Disease Occurrence Be so Different in Two Close Cities?2011Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    Background: The leading cause of death and loss of disability-adjusted life years globally are cardiovascular diseases. Conventional risk factors for cardiovascular diseases only partly account for the social gradient. The aim of this study was to estimate the occurrence of common cardiovascular diseases and cardiovascular mortality in defined populations in two geographical close but socially different cities, a white-collar and a blue-collar twin city - “The Twincities”.

    Methods: We focused on the total population in these two neighbouring and equally sized cities with a population of around 135 000 inhabitants respectively, representing two close but different social environments in the same Swedish county. Data about morbidity for the two cities was derived from an administrative health care register based on medical records assigned by the physicians at both hospitals and primary care and calculated as cumulative incidence rates. Mortality for ischemic heart diseases is based on official Swedish national statistics.

    Results: The cumulative incidence of cardiovascular diagnoses for younger as well as elderly men and women revealed significant differences between these two cities. The relative risks for both sexes were highest for all cardiovascular diagnosis studied and cardiovascular mortality in the population of the blue-collar twin city.

    Conclusions: There are major differences in cardiovascular morbidity and mortality between the studied twin cities representing two close but different social environments. Since these differences seem to be profound and stable over time preventive measures is warranted in the blue-collar city.

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