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  • 51.
    Jarkman-Björn, Gunilla
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Barn- och ungdomspsykiatriska kliniken.
    Bodén, Christina
    Linköpings universitet, Institutionen för klinisk och experimentell medicin. Linköpings universitet, Hälsouniversitetet.
    Sydsjö, Gunilla
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Obstetrik och gynekologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Gustafsson, Per A
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Barn- och ungdomspsykiatriska kliniken.
    Psychological evaluation of refugee children: contrasting results from play diagnosis and parental interviews2011Inngår i: Clinical Child Psychology and Psychiatry, ISSN 1359-1045, E-ISSN 1461-7021, Vol. 16, nr 4, s. 517-34Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Many refugee families from Bosnia and Herzegovina arrived in Sweden during the Balkan conflict in the 1990s. We studied 14 of these families to compare psychological evaluation of the children using two different methods. We first carried out a semi-structured interview of a parent or parents in each family. The symptoms of each of the children, who ranged in age from 5 to 12 years, were evaluated based on these interview results. Then a second method, the Erica play-diagnosis method, was used to study the inner thoughts and feelings of the children. Results from the Erica play-diagnosis method were compared with results from Erica play- diagnosis from a normal group. According to results from the parental interviews all but one child in this study had a low level of psychological symptoms. In contrast, results from Erica play-diagnosis of these children showed that there were higher frequencies of not-normal play in these children compared with those in the normal group, which is an indication of deficiencies in the psychological well-being of these children. The results emphasise the importance of getting diagnostic information from the child in order to understand each child's psychological condition.

  • 52.
    Jonsson, Linda
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin. Linköpings universitet, Hälsouniversitetet.
    Svedin, Carl Göran
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri. Linköpings universitet, Hälsouniversitetet.
    ”Online är jag någon annan…….” Unga kvinnor med erfarenhet av att sälja sexuella tjänster online: Delrapport 8 ur Prostitution i Sverige – Kartläggning och utvärdering av prostitutionsgruppernas insatser samt erfarenheter och attityder i befolkningen2012Rapport (Annet vitenskapelig)
    Abstract [sv]

    Syftet med studien var att undersöka unga mellan 15-25 år, som innan 18 års ålder sålt sexuella tjänster online. Mer specifika frågeställningar var Internet och mobiltelefonins betydelse för säljandet samt kontaktvägarna mellan säljare och köpare. Dessutom skulle även de ungas livssituation och deras berättelser om tänkbara anledningar till att de börjande sälja sexuella tjänster som unga undersökas.

    Metod. Studien bestod av intervjuer med elva unga mellan 15-25 år med erfarenhet av att sälja sexuella tjänster online innan 18 års ålder. Av 44 kontakter ledde 11 till intervju. Endast kvinnor intervjuades då det var svårt att komma i kontakt med män som ville bli intervjuade. Intervjun utgick från en semistrukturerad intervjuguide. Under intervjun ombads informanten att beskriva sig själv samt olika tillfällen då hon fått ersättning för sexuella tjänster. Intervjuerna transkriberades och analyserades. Materialet bearbetades och tematiserades utifrån studiens frågeställningar.

    Resultat. För alla informanter var både mobiltelefonen och Internet vardagliga inslag i livet och hade för alla också haft betydelse för säljandet av sex. Alla hade kommit i kontakt med sina köpare via Internet men flera hade även erfarenhet av att sälja sexuella tjänster via Internet eller mobiltelefonen, så som t.ex. försäljning av bilder och filmer. De unga hade haft olika grad av egen aktivitet för att komma i kontakt med sina köpare, från att ha blivit kontaktade i sexuellt syfte utan föraning till att de själva annonserat om försäljningen av sexuella tjänster. Olika kontaktsätt beskrevs som t.ex. kontakt via ungdomssajter eller sexsajter eller slutligen genom att informanten själv lagt ut en annons på en sexsäljarsajt. De sistnämnda var det minst vanligt förekommande. Ersättningsformen handlade framförallt om pengar. Det framkom också i intervjuerna att ersättningen betydelse inte alltid var så stor, till och med att den istället kunde orsaka bekymmer, som t.ex. att de var tvungna att göra sig av med den innan de kom hem till sina föräldrar. De unga hade erfarenheter av att säja olika typer av sexuella tjänster. Ett ofta förekommande tema i intervjuerna var bild- och filmmaterial och en oro kring t.ex. om materialet spridits. Dels hade de unga själva producerat avklädda bilder/filmer som de lagt ut och sålt. Dels hade flera erfarenheter av att bli filmade med eller utan konsensus under tillfällen då de sålde sexuella tjänster i verkliga livet. I intervjuerna framkom att anledningarna till att de sålde sexuella tjänster var för att bli sedda/få bekräftelse. Samtliga beskrev också ett stort förakt gentemot sig själva och flera beskrev försäljningen av sex som ett sätt att hantera ångest eller som ett självskadebeteende. Ett annat gemensamt tema var erfarenheten av att ha varit utsatt för sexuella övergrepp eller andra svåra händelser i livet. Informanterna beskrev sig själva som tysta och personer som under uppväxten inte gjort så mycket väsen av sig. De hade hållit sig undan vuxna och jämnåriga på olika sätt. Omgivningen hade ofta känt till att de inte mådde bra, men visste inte riktigt på vilket sätt. Denna bild av unga människor med erfarenheter av sexuella övergrepp, psykisk ohälsa, dålig självkänsla och sämre omsorg stämmer väl överens med tidigare beskrivningar av unga människor med erfarenheter av att sälja sex (Abelsson & Hulusjö, 2008; Svedin & Priebe, 2009). Alla informanter i studien hade varit aktuella inom socialtjänst och/eller barnpsykiatri men hade sällan berättat att de sålde sexuella tjänster. Alla kunde beskriva möten med socialtjänst, rättsväsende eller psykiatri där de känt sig överkörda, missuppfattade och att de inte getts möjlighet att berätta att de sålt sexuella tjänster.

    Rekommendationer. Med utgångspunkt från resultaten i studien är rekommendationerna följande:

    • De unga i denna studie är en liten, selekterad grupp, och behöver inte vara representativ för alla unga som säljer sexuella tjänster. Vi efterlyser därför studier som använder mixed methods (kombination av kvantitativ och kvalitativ metod) och med ansträngningar att också nå unga män och HBT personer. Särskilt efterlyses studier om hur de unga upplevt det stöd och den hjälp de fått av personer i deras omgivning samt yrkesverksamma.
    • För att förhindra att unga hamnar i att sälja sex krävs att unga i risk uppmärksammas. Utifrån studiens resultat bör det exempelvis vara en varningssignal t.ex. när en ung person ändrar beteendemönster eller sociala mönster genom att t.ex. dra sig undan vuxna och jämnåriga. Kunskapsspridning och utbildning av personal behövs inom vård och skola.
    • För de unga som har erfarenhet av att sälja sexuella tjänster och mår dåligt av detta är det elementärt att det finns möjlighet till ett väl kunskapsunderbyggt stöd- och behandlingsarbete inom socialtjänst och psykiatri. Detta inte minst då de unga i denna studie beskrivit en påtaglig psykisk ohälsa och obearbetade traumatiska händelser. Det kan dessutom finnas behov av skydd mot uttryckta hot, samt skydd där den unge är ett hot mot sig självt, som t.ex. vid självskadande beteenden som destruktiv sex kan utgöra. Detta gäller även för dem över 18 år. Kunskapsspridning och utbildning behövs inom socialtjänst, allmänpsykiatri och barnpsykiatri.
    • Internet och mobiltelefoni är vardagliga inslag för de flesta svenska unga. För att kunna möta dem på deras arena bör förebyggande åtgärden utformas via Internet och mobiltelefon. Åtgärderna ska syfta till att nå unga i risk för att börja sälja sexuella tjänster samt de som redan har dessa erfarenheter.  
  • 53.
    Kastbom, Åsa
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri. Linköpings universitet, Hälsouniversitetet.
    Parents' reports on 7-12-years old childrens sexual behavior2011Inngår i: Journal of Sexual Medicine, ISSN 1743-6095, E-ISSN 1743-6109, Vol. 8, nr Suppl. 3, s. 270-270Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    Aim: To understand if a sexual behaviour in a child is a sign of sexual abuse or neglect we need to investigate sexual behaviours among chil-dren. In the present study we investigated Swedish children age 7–12 to determine what constitutes usual and unusual sexual behaviours.

    Methods: Parents of 418 children answered questionnaires about their child’s behaviour, both general and sexual, and about their own attitudes.

    Results: We found that most sexual behaviours we asked about are common, and are in part related to or vary with age and gender. A small number of sexual behaviours were found to be very unusual in this normative group of children.

    Conclusion: Behaviours usually referred to as sexualized and problematic and perhaps a sign of sexual abuse or neglect were very rare in this normative sample of children 7–12 years of age.

  • 54.
    Kjellgren, Cecilia
    et al.
    Barn- och ungdomspsykiatr, Lunds universitet.
    Abelsson, Jonna
    ungdomsmottagningen, Haninge.
    Svedin, Carl Göran
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri. Linköpings universitet, Hälsouniversitetet.
    Intervjuer med personer som tidigare fått samtalsbehandling vid FAST: Delrapport 7 ur Prostitution i Sverige – Kartläggning och utvärdering av prostitutionsgruppernas insatser samt erfarenheter och attityder i befolkningen2012Rapport (Annet vitenskapelig)
    Abstract [sv]

    Syftet med undersökningen var att intervjua personer som avslutat sin behandlingskontakt vid en av de tre prostitutionsenheterna i Stockholm, Göteborg och Malmö riktat till Säljare av Sexuella Tjänster (FAST). Detta som en kvalitativ komplettering till behandlingsstudien (delrapport 5) för att få en vidgad och fördjupad förståelse för hur de intervjuade upplevt och värderat den behandling de fått vid FAST-enheterna.

    Metod. Undersökningen genomfördes under 2010-2011 genom att behandlare vid enheterna kontaktade personer som avslutat sin behandlingskontakt och tillfrågades om deltagande i studien. Trettio-sju personer tillfrågades, fyra personer avböjde deltagande. Av de 33 personer som samtyckte till att delta hade 30 personer varit klienter vid FAST (Försäljare Av Sexuella Tjänster) och tre personer vid KAST (Köpare Av Sexuella Tjänster). De respondenter som varit klienter vid FAST vars intervjuer spelats in inkluderades i den kvantitativa och kvalitativa resultatredovisningen. Den slutliga undersökningsgruppen bestod av 17 kvinnor och en man som haft kontakt med FAST.

    Resultat. De 18 personerna som medverkade i undersökningen var mellan 25 och 58 år, i genomsnitt 40,0 år gamla (sd=9,9). En tredjedel hade en relation med partner och majoriteten hade barn. Majoriteten arbetade eller studerade vid intervjutillfället. Samtliga intervjupersoner hade tidigare sålt sex och hälften hade sålt sex mer än tio år. Det var vanligast att intervjupersonerna fått information om FAST-verksamheten genom missbruksbehandling eller genom andra professionella kontakter.

    Intervjupersonerna hade avslutat sin behandlingskontakt i genomsnitt drygt tre år innan intervjutillfället. Majoriteten (72 %) hade gått i 100 samtal eller mer på enheten. Respondenter som följts upp efter i genomsnitt ett år i behandling (delrapport 5) var yngre (m=29,9 år) vid uppföljningen, hade mer sällan (en fjärdedel) en relation med partner, hade lika ofta barn och majoriteten arbetade eller studerade vid uppföljningen. En tredjedel av respondenterna i uppföljningsstudien hade sålt sex tio år eller mer.

    De som medverkade i studien hade bättre självkänsla m=21,6 (sd=6,0) än respondenterna i uppföljningsstudien m=16,8 (sd=7,5) och symptombelastning vad gäller psykisk ohälsa var jämförbar med respondenter uppföljda efter i genomsnitt ett år i behandling (delrapport 5).

    Intervjuerna transkriberades och analyserades med hjälp av latent innehållsanalys. Två teman identifierades, att tala om prostitutionen och det andra samt livet efter behandling.

    Under temat Att tala om prostitutionen och det andra berörs behovet av att förändra och bearbeta sina upplevelser från prostitution men också från självdestruktivitet och traumatiska barndomsupplevelser. Betydelsen av rätt typ av hjälp kan vara avgörande för att man överlever i en utsatt situation. Betydelsen av den specialiserade enheten, en bärande relation till en specialiserad behandlare och identifikation med andra med samma problematik som också har kontakt med enheterna. Samhällets engagemang i verksamheterna får betydelse för att synliggöra och bekräfta. Behandlingsmodellerna kan se olika ut men viktiga områden för behandlingssamtalen har varit prostitution, identitet, självbild och relationer.

    Under temat Livet efter behandling identifieras förändring som ett område som rör att se på sig själva annorlunda, bygga upp sin självkänsla, att sträva efter att må bättre och vara på väg mot ett annat liv. Intervjuerna speglar hur intervjupersonerna ser tillbaka på prostitutionen med andra ögon, identifierar flera funktioner som prostitutionen haft men uttrycker också känslor av ambivalens. Prostitutionen är kopplad till självförakt och förakt, traumatiska erfarenheter och svårigheter med närhet och relationer. Sexualiteten har påverkats av prostitutionen och kan ha lett till olika konsekvenser. I intervjuerna beskrivs avstängd sexualitet men också att få tillgång till ny sexualitet som bygger på kärlek och respekt.

    Intervjupersonerna gav avslutningsvis råd till andra i liknande situation att se sitt värde, att prata om situationen och att våga ta emot hjälp. Personer formulerade också råd till beslutsfattare som att våga se att prostitutionen finns, att inte tro att man frivilligt valt livet som prostituerad och att den med prostitutionserfarenhet har samma människovärde som andra.

    Konklusion. Personer som sålt sexuella tjänster, gått i behandling vid enheterna och som blickar tillbaka på sin behandling ger sitt personliga retrospektiva perspektiv. Denna kvalitativa studie kan ge olika dimensioner av intervjupersoners upplevelse av att komma till behandling, att tala om prostitution och annan utsatthet i behandlingen och de långsiktiga effekterna av att ha gått i behandling. Intervjupersonernas uppfattningar om vad som behöver göras för att förstärka arbetet fungerar också som en form av brukarinflytande. Resultatet av studien kan generera nya hypoteser och även tjäna som illustration och levandegöra andra delrapporter.

    Rekommendationer. Med utgångspunkt i resultaten från denna kvalitativa studie vill vi lyfta följande frågor av betydelse för det framtida arbetet med säljare av sexuella tjänster.

    • Intervjupersonerna understryker behovet av specialiserade enheter för att få hjälp att tala om erfarenheter av att ha sålt sex. Negativa erfarenheter av att tala om prostitution hos andra vårdgivare illustreras i materialet.
    • Intervjupersoner beskriver svårigheten att få tillgång till den specialiserade enheten om man bor i annan kommun. Det understryker behovet av att skapa större tillgänglighet till specialiserade enheter även utanför storstadsregionerna.
    • Kombination inom enheterna av utåtriktat arbete och behandlingskontakter har möjliggjort att personer under en längre tid motiverats och byggt upp förtroende för verksamheten för att senare påbörja en behandlingskontakt. Det arbetssättet bör fortsatt stödjas.
    • I materialet framkommer att det för många intervjupersoner tagit lång tid att etablera förtroende för behandlaren innan behandlingsarbetet har kunnat påbörjas. För många av intervjupersonerna har det krävts långa behandlingskontakter för att uppnå förändring och få möjlighet att bearbeta tidigare trauman på ett framgångsrikt sätt. Behovet för vissa klienter av långa behandlingskontakter bör beaktas inom verksamheterna.
    • I materialet framkommer behov av gruppbehandling för personer som sålt sex och behandlingshem för missbruk, med särskild fokus på prostitutionsproblematiken. Intervjupersoner talar om det positiva av att i grupp dela erfarenheter och att ta hjälp av andra i förändringsprocessen. Att undersöka behovet av att utveckla fler behandlingsalternativ bör vara ett nationellt ansvar.
    • I materialet framkommer att personer i nätverket, myndighetspersoner eller personer inom AA/NA varit viktigt stöd i samband med att man påbörjat sin behandling. Det framkommer också att kunskap och medvetenhet om prostitution bland professionella hos olika vårdgivare/myndigheter saknas och bör utvecklas.
    • En framtida nationell samordnande enhet bör ges ansvaret för ovanstående utvecklingsarbete.
  • 55.
    Kjellgren, Cecilia
    et al.
    Barn- och ungdomspsykiatr, Lunds universitet.
    Priebe, Gisela
    Barn- och ungdomspsykiatri, Lunds universitet.
    Svedin, Carl Göran
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri. Linköpings universitet, Hälsouniversitetet.
    Utvärdering av samtalsbehandling med försäljare av sexuella tjänster (FAST): Delrapport 5 ur Prostitution i Sverige – Kartläggning och utvärdering av prostitutionsgruppernas insatser samt erfarenheter och attityder i befolkningen2012Rapport (Annet vitenskapelig)
    Abstract [sv]

    Syftet med undersökningen var att utvärdera effekterna av det behandlingsarbete i form av samtalsterapi som bedrivs vid de tre prostitutionsenheterna i Stockholm, Göteborg och Malmö riktat till Säljare Av Sexuella Tjänster (FAST).

    Metod. Undersökningen genomfördes 2009-2011 genom att nya klienter vid de tre FAST-enheterna inbjöds att medverka i studien. Av 47 personer som var aktuella för samtalskontakt under perioden tillfrågades 36 personer med erfarenheter av prostitution av behandlare om deltagande och 34 accepterade medverkan. Respondenterna intervjuades och besvarade självsvarsformulär (rörande psykisk hälsa, självkänsla, alkohol- och drogmissbruk, traumatiska upplevelser i barndomen) i början av samtalsbehandlingen (baslinjeintervjun) och vid behandlingens slut eller efter ett års behandling (m=12,2 månad).

    Resultat. Respondenterna (31 kvinnor och 3 män) var i genomsnitt 29,1 år (sd=7,5) vid baslinjeintervjun och samtliga hade sålt sex. Majoriteten hade fått information om verksamheten genom andra myndigheter eller internet. Majoriteten uppgav att de sökt kontakt med enheten för att bearbeta negativa erfarenheter från prostitutionen. Majoriteten (65 %) hade inte vid baslinjeintervjun någon relation med partner, men majoriteten hade någon gång tidigare haft ett längre förhållande. Majoriteten (88 %) hade upplevt våld i en partnerrelation. Mindre än hälften (41 %) av intervjupersonerna hade barn. Barnet/barnen var oftast boende hos respondenten. Hälften arbetade eller studerade vid baslinjeintervjun. Respondenterna var vid första prostitutionstillfället i genomsnitt 21,3 år (sd=7,2) och en tredjedel var yngre än 18 år. Personerna hade i genomsnitt sålt sex i närmare sju år och majoriteten (73 %) varje vecka när prostitutionen varit som intensivast. Intervjupersonerna hade oftast fått kontakt med sexköparen via internet eller på gatan. Personerna hade oftast börjat sälja sex för att finansiera ett missbruk.

    Hälften av intervjupersonerna rapporterade vid baslinjeundersökningen riskbruk eller missbruk av alkohol och majoriteten drogmissbruk. Majoriteten rapporterade låg självkänsla och i genomsnitt 12 potentiellt traumatiska upplevelser under uppväxten. Intervjupersonerna självrapporterade hög psykisk ohälsa, en ohälsa som dessutom var sämre än i flera tidigare svenska kliniska studier.

    Vid uppföljningen medverkade 26 av 34 respondenter (24 kvinnor och två män). Bortfallsgruppen skilde sig signifikant från den uppföljda gruppen vad gäller drogmissbruk, med signifikant högre drogvändning i bortfallsgruppen än hos de uppföljda.

    Majoriteten hade vid uppföljningen avslutat sin behandlingskontakt med enheten. Respondenterna hade i genomsnitt gått i 29 samtal på enheten. Fler levde ensamma, utan partner, vid uppföljningsintervjun. Majoriteten av intervjupersoner uppgav att de fått hjälp i samtalen att avsluta destruktiva relationer och förbättra relationer till det övriga nätverket. Intervjupersonerna skattade att de var signifikant mer nöjda med sina nära relationer vid uppföljningen. Fler arbetade eller studerade vid uppföljningen och majoriteten uppgav att samtalen på enheten påverkat detta område. Respondenterna var signifikant mer nöjda vad gäller området sysselsättning vid uppföljningsintervjun.

    Sammanlagt 17 (68 %) av de deltagande hade antingen slutat sälja sex inför starten av behandlingen eller under densamma. Tre personer (12 %) hade ett år innan behandlingsstart slutat sälja sex. Majoriteten (80 %) sålde inte sex vid uppföljningen. De som fortsatte sälja sex gjorde det mer sällan. Mer än 90 procent hade i behandlingen talat om erfarenheter av att sälja sex och upplevt att samtalen varit till stöd för att hålla fast vid sitt beslut i att sluta sälja sex. Majoriteten ansåg att de fått bättre självkänsla och förbättrad livskvalitet.

    De som vid uppföljningen uppgav att de fortsatt sälja sex var signifikant äldre än övriga respondenter och hade sålt sex signifikant längre. De flesta intervjupersoner som tillhörde denna grupp uttryckte att de vid uppföljningen sålde sex mer sällan och uttryckte en önskan om vidare förändring. Hur lång tid man befunnit sig i prostitution kan ha betydelse för hur tidskrävande en sådan förändring är.

    Vid jämförelse mellan resultaten på de upprepade självsvarsformulären från baslinje och uppföljning identifierades en rad förändringar. En icke-signifikant minskning av antalet personer med alkoholmissbruk och tungt drogberoende vid uppföljningen. Respondenterna rapporterade signifikant bättre självkänsla vid uppföljningen. Signifikanta skillnader vad gäller psykisk hälsa rapporterades på samtliga delskalor och totalskala.

    Förändringar vad gäller respondenternas livssituation och hälsa kan iakttas med viss variation på alla enheter. Behandling vid de tre enheterna skilde sig åt vad gäller teoretiska utgångspunkter. Ingen av enheterna följde en strikt behandlingsmodell. Det går inte utifrån den begränsade undersökningsgruppen att dra slutsatser om en enhet bedriver en mer framgångsrik behandling än en annan. Det som är gemensamt för enheterna är att man tydligt riktar sig till målgruppen personer som sålt sex och att man erbjuder hjälp som inkluderar konsekvenser av prostitution. Respondenterna var lika nöjda med den behandling och det bemötande de fått från de tre enheterna.

    Konklusion. Då behandlingsstudier på området i stort sett saknas, nationellt och internationellt, kan föreliggande studie ses som ett av de första försöken att med en s.k. före- och eftermätning utvärdera behandling riktad till säljare av sexuella tjänster. Resultaten är lovande men man måste dock vara försiktig med tolkningen av dessa då undersökningsgruppen är liten och studien inte en randomiserad kontrollerad studie som anses vara mest optimalt för behandlingsstudier. Man kan dock i detta avseende tala om en evidensbaserad praktik (EBP) som bygger på för närvarande bästa tillgängliga kunskap dvs. bästa vetenskapliga kunskapen om insatsers effekter, brukarens erfarenheter och förväntningar, den lokala situationen och omständigheter samt de professionellas expertis.

    Metodvalet påverkades av klientgruppens sårbarhet och att de praktiska förutsättningarna inte förelegat för en randomiserad studie där någon sådan för det första inte var tillgänglig och för det andra ansågs en design med ett lottningsförfarande medföra en risk för att svårmotiverade klienter skulle kunna avskräckas från att delta om man riskerade att bli lottad till annan behandling än den specialiserade.

    Rekommendationer. Med utgångspunkt i resultaten från denna delstudie vill vi lyfta följande frågor av betydelse för det framtida arbetet med att förebygga och reducera säljande av sexuella tjänster.

    • Det finns behov av ett förstärkt arbete regionalt och nationellt riktat till personer som har sålt sex. De tre enheterna är nationella kunskapsbärare utan ett formellt nationellt uppdrag. För den fortsatta kunskapsutvecklingen och metodutvecklingen inom området krävs strukturell förändring.
    • Det finns inte någon intern eller gemensam utbildning av terapeuter som ska arbeta med kvinnor och män som säljer sex vilket innebär både en sårbarhet vid personalförändringar och kompetenstapp. Detta är något som behöver utvecklas.
    • De behandlingsmodeller som enheterna arbetar efter behöver utvecklas och tydliggöras för att det ska vara möjligt att både replikera och göra meningsfulla jämförande studier.
    • För att ytterligare undersöka styrkan i det arbete som utförs bör man i det framtida utvecklingsarbetet på området verka för att tillförsäkra förutsättningar för en randomiserad design. Ett annat sätt vore att samla behandlingsdata under en längre tid för att kunna göra en studie med matchade klienter vid de olika enheterna antingen genom ett renodlat forskningsprojekt eller genom utvecklingen av ett kvalitetsregister.
    • Effekter av andra insatser utöver samtalsbehandling som ges vid enheterna som psykosocialt stöd och medicinsk behandling behöver också undersökas. De som erhåller alternativa interventioner kan i framtida forskning utgöra kontrollgrupp till de som erhåller mer strukturerad samtalsbehandling.
    • Det pionjärarbete som bedrivs vid enheterna behöver förstärkas och utvecklas. Verksamheterna har byggts upp och drivs av ett antal eldsjälar. Ett fåtal professionella arbetar inom detta specialiserade område vilket också innebär en stor sårbarhet vad gäller kunskapsbärande och metodik i arbetet. De tre kommunala enheterna står för den nationella kunskapen men har inte ett nationellt ansvar för området. Det saknas ett sådant uppdrag.
    • De tre enheterna vänder sig till personer i storstadsregionerna som sålt sex. Personer bosatta i andra kommuner i landet har inte tillgång till ett specialiserat samhälleligt stöd när man har erfarenheter av prostitution. I studien framgår det samstämmigt att respondenter upplevt betydande svårigheter att prata om prostitution inom icke-specialiserade verksamheter.  Det finns exempel i studien på personer från andra kommuner som fått möjlighet att gå i behandling på någon av enheterna men inte utan att själv argumentera och kämpa för det, en process som ställer stora krav på individen. En översyn av hur man ska lösa behovet av specialiserad hjälp utanför storstadsregionerna bör göras. En förstärkning av de tre kommunala enheterna (med nationell finansiering) skulle kunna möjliggöra mottagande av remitterade klienter i större skala.
    • En framtida nationell samordnande enhet bör ges ansvaret för ovanstående utvecklingsarbete.
  • 56.
    Kjellgren, Cecilia
    et al.
    Lund University.
    Priebe, Gisela
    Lund University.
    Svedin, Carl Göran
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri. Linköpings universitet, Hälsouniversitetet.
    Langstrom, Niklas
    Karolinska Institute.
    Sexually Coercive Behavior in Male Youth: Population Survey of General and Specific Risk Factors2010Inngår i: ARCHIVES OF SEXUAL BEHAVIOR, ISSN 0004-0002, Vol. 39, nr 5, s. 1161-1169Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Little is known about risk/protective factors for sexually coercive behavior in general population youth. We used a Swedish school-based population survey of sexual attitudes and experiences (response rate 77%) and investigated literature-based variables across sexually coercive (SEX), non-sexual conduct problem (CP), and normal control (NC) participants to identify general and specific risk/protective factors for sexual coercion. Among 1,933 male youth, 101 (5.2%) reported sexual coercion (ever talked or forced somebody into genital, oral, or anal sex) (SEX), 132 (6.8%) were classified as CP, and the remaining 1,700 (87.9%) as NC. Of 29 tested variables, 25 were more common in both SEX and CP compared to NC youth, including minority ethnicity, separated parents, vocational study program, risk-taking, aggressiveness, depressive symptoms, substance abuse, sexual victimization, extensive sexual experiences, and sexual preoccupation. When compared to CP youth only, SEX youth more often followed academic study programs, used less drugs and were less risk-taking. Further, SEX more frequently than CP youth reported gender stereotypic and pro-rape attitudes, sexual preoccupation, prostitution, and friends using violent porn. Finally, in a multivariate logistic regression, academic study program, pro-rape attitudes, sexual preoccupation, and less risk-taking independently remained more strongly associated with SEX compared to CP offending. In conclusion, several sociodemographic, family, and individual risk/protective factors were common to non-sexual and sexually coercive antisocial behavior in late adolescence. However, pro-rape cognitions, and sexual preoccupation, were sexuality-related, specific risk factors. The findings could inform preventive efforts and the assessment and treatment of sexually coercive male youth.

  • 57.
    Kjellgren, Cecilia
    et al.
    Lund University.
    Priebe, Gisela
    Lund University.
    Svedin, Carl Göran
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri. Linköpings universitet, Hälsouniversitetet.
    Mossige, Svein
    NOVA Norwegian Social Research.
    Langström, Niklas
    Karolinska Institutet.
    Female Youth Who Sexually Coerce: Prevalence, Risk, and Protective Factors in Two National High School Surveys2011Inngår i: Journal of Sexual Medicine, ISSN 1743-6095, E-ISSN 1743-6109, Vol. 8, nr 12, s. 3354-3362Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction. Sexual coercion is recognized as a serious societal problem. Correlates and risk factors of sexually abusive behavior in females are not well known. Aim. Etiological theory and empirical study of female perpetrators of sexual coercion are usually based on small or highly selected samples. Specifically, population-based data are needed to elucidate risk/protective factors. Main Outcome Measures. Main outcome measures include a self-report questionnaire containing 65 items tapping socio-demographic and health conditions, social relations, sexual victimization, conduct problems and a set of normative and deviant sexual cognitions, attitudes, and behaviors. Methods. We used a 2003-2004 survey of sexual attitudes and experiences among high school students in Norway and Sweden to identify risk factors and correlates to sexually coercive behavior (response rate 80%); 4,363 females participated (Mean = 18.1 years). Results. Thirty-seven women (0.8%) reported sexual coercion (ever talked someone into, used pressure, or forced somebody to have sex). Sexually coercive compared with non-coercive women were similar on socio-demographic variables, but reported less parental care and more parental overprotection, aggression, depressive symptoms, and substance misuse. Also, sexually coercive females reported more sexual lust, sex partners, penetrative sexual victimization, rape myths, use of violent porn, and friends more likely to use porn. When using the Swedish subsample to differentiate risk factors specific for sexual coercion from those for antisocial behavior in general, we found less cannabis use, but more sexual preoccupation, pro-rape attitudes, and friends using violent porn in sexually coercive compared with non-sex conduct problem females. Conclusions. Sexually coercive behavior in high school women was associated with general risk/needs factors for antisocial behavior, but also with specific sexuality-related risk factors. This differential effect has previously been overlooked, agrees with similar findings in men, and should have substantial etiological importance. Kjellgren C, Priebe G, Svedin CG, Mossige S, and Langstrom N. Female youth who sexually coerce: Prevalence, risk, and protective factors in two national high school surveys.

  • 58.
    Kjellgren, Cecilia
    et al.
    Barn- och ungdomspsykiatr, Lunds universitet.
    Svedin, Carl Göran
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri. Linköpings universitet, Hälsouniversitetet.
    Utvärdering av samtalsbehandling med köpare av sexuella tjänster (KAST): Delrapport 6 ur Prostitution i Sverige – Kartläggning och utvärdering av prostitutionsgruppernas insatser samt erfarenheter och attityder i befolkningen2012Rapport (Annet vitenskapelig)
    Abstract [sv]

    Syftet med undersökningen var att utvärdera effekterna av det behandlingsarbete i form av samtalsterapi som bedrivs vid de tre prostitutionsenheterna i Stockholm, Göteborg och Malmö riktat till Köpare Av Sexuella Tjänster (KAST).

    Metod. Undersökningen genomfördes 2009-2011 genom att nya klienter vid de tre KAST-enheterna inbjöds att medverka i studien. Av 72 personer som var aktuella för samtalskontakt under perioden tillfrågades 51 av behandlare om deltagande och 29 accepterade medverkan. Respondenterna intervjuades och besvarade självsvarsformulär (rörande psykisk hälsa, självkänsla, alkohol- och drogmissbruk, traumatiska upplevelser i barndomen, stereotypa attityder till sexuellt våld och sexuellt missbruk) i början av samtalsbehandlingen (baslinjeintervjun) och vid behandlingens slut eller efter ett års behandling (m=10,1 månad).

    Resultat. Respondenterna (28 män och en kvinna) var i genomsnitt 40,1 år (sd=11,3) vid baslinjeintervjun. Majoriteten hade tagit ett eget initiativ till samtalskontakten medan en tredjedel tog kontakt efter rekommendation av annan vårdgivare eller myndighet. Majoriteten hade vid baslinjeintervjun en partner och drygt hälften hade barn. Samtliga arbetade eller studerade.

    Respondenterna uppgav olika former av sexuellt missbruk som sexköp, porrsurfande, sexchat, sexmissbruk i relationer eller besök på sexklubbar. Hälften beskrev mer än en form av sexuellt missbruk. Totalt hade femton personer (52 %) köpt sex i samband med att behandlingskontakten inleddes eller tidigare. Respondenterna motiverade behandlingskontakten med ett behov att få hjälp med att förändra sin situation, ta kontroll över sexmissbruket och för att rädda sin relation till partner/barn. Majoriteten rapporterade inget alkohol- eller drogmissbruk, men hade sämre självkänsla och fler potentiellt traumatiska erfarenheter under uppväxten än män som köpt sex eller aldrig köpt sex i en epidemiologisk studie (delrapport 1). Respondenterna rapporterade psykisk ohälsa på fyra delskalor i nivå med klinisk grupp. Alla utom en av respondenterna rapporterade ett sexuellt missbruk men å andra sidan mindre stereotypa attityder om sexuellt våld än universitetsstudenter. De som någon gång köpt sex rapporterade signifikant högre nivå på sexuellt missbruk vid baslinjemätning än de som hade annan form av sexuellt missbruk, en skillnad som inte kvarstod vid uppföljningen.

    Vid uppföljningen medverkade 28 respondenter i genomsnitt 10,1 månader efter baslinjeintervjun. Respondenterna hade gått i 25,6 samtal (sd=13,6), en tredjedel hade avslutat sin behandlingskontakt vid uppföljningsintervjun medan de övriga gick i fortsatta behandlingssamtal. Respondenterna uppgav att samtalen på enheten lett till signifikanta förbättringar vad gäller relationer till familj och partner. Majoriteten uppgav att det sexuella missbruket reducerats (blivit mindre frekvent eller förändrats i typ av handlingar) och en tredjedel att det helt upphört. Respondenterna rapporterade en mindre minskning av alkoholbruk men framför allt en signifikant förbättrad självkänsla och förbättrad psykisk hälsa. Respondenterna var mycket nöjda med bemötande, upplevde behandlarna i hög grad som lyhörda och hade stort förtroende för behandlarna. Resultaten talar för att klienterna vid KAST mottagningarna i Sverige dragit nytta av behandlingen på flera sätt men framförallt genom ett minskat sexmissbruk och en förbättrad psykisk hälsa.

    Förändringar vad gäller respondenters livssituation, psykiska hälsa och sexuella missbruk kan iakttas med viss variation på alla enheter. Behandling vid de tre enheterna skilde sig åt vad gäller teoretiska utgångspunkter. Ingen av enheterna följer heller en strikt behandlingsmodell.Det går inte utifrån den begränsade undersökningsgruppen att dra slutsatser att en enhet har en mer framgångsrik modell än en annan. Det som är gemensamt för enheterna är att man på olika sätt kommunicerar att man arbetar med problemområdet och detta har påverkat respondenter att ta kontakt med verksamheterna och påbörja en samtalskontakt. Respondenterna som deltog i studien är välmotiverade klienter som oftast sökt hjälp på eget initiativ. Den drivkraften har betydelse för en framgångsrik förändring. Om man behöver hjälp från professionella är det å andra sidan begränsat med mottagningar som är specialiserade på problematiken.

    En pilotundersökning genomfördes för att undersöka effekter av anhörigkurs vid en av enheterna. Sex kvinnor, alla med en sexmissbrukande partner, deltog i undersökningen. Fem av kvinnorna hade barn. Intervjupersonerna rapporterade att de upplevde att partnerns sexmissbruk påverkat dem negativt med känslor av att vara utnyttjad och försämrad självkänsla. Intervjupersonerna beskrev också hur barnen drabbats av pappans sexmissbruk. Vid uppföljning rapporterade intervjupersonerna att de genom kursen fått kunskap om sexmissbruk, fått hjälp till ett förändrat förhållningssätt och fått förbättrad psykisk hälsa. Intervjupersonerna uppgav också att kursen bidragit till förbättringar i relationen till partnern.

    Konklusion. Då behandlingsstudier på området i stort sett saknas, nationellt och internationellt så kan man se föreliggande studie som ett av de första försöken att utvärdera behandling riktade till sexköpare/sexmissbrukare. Hur ska man då värdera resultaten? Studien bygger inte på en randomiserad kontrollerad design och kan således inte räknas i familjen evidensbaserade psykoterapimetoder. Man kan dock i detta avseende tala om en evidensbaserad praktik (EBP) som bygger på för närvarande bästa tillgängliga kunskap dvs. bästa vetenskapliga kunskapen om insatsers effekter, brukarens erfarenheter och förväntningar, den lokala situationen och omständigheter samt de professionellas expertis.

    Rekommendationer. Med utgångspunkt i resultaten från denna delstudie vill vi lyfta följande frågor av betydelse för det framtida arbetet med att förebygga och förhindra sexköp.

    • Det finns behov av ett förstärkt arbete riktat till personer som har köpt sex eller är i risk att köpa sex. Den klientgruppen som söker hjälp vid KAST-enheterna har ett beteende som väl motsvarar diagnosen hypersexuell störning, där kanske hälften inte har köpt sex men kan vara i risk att eskalera sitt sexuella missbruk. Det bör därför vara av samhällsintresse att stödja personer med ett destruktivt sexuellt beteende även när det inte förekommit köp av sexuella tjänster.
    • Då studier på området i stort sett saknas så rekommenderas en mer långsiktig forskning om effekterna av behandling för personer med sexmissbruk/hypersexuell störning, med möjligheter till randomisering mellan olika terapimodeller för att ytterligare kvalitetssäkra behandlingen.
    • Verksamheterna har huvudsakligen storstäderna som upptagningsområde. Personer som är bosatta utanför storstadsregionerna har inte tillgång till samma samhälleliga stöd. Det är angeläget att undersöka förutsättningar för att etablera mottagningar på andra håll i Sverige (en jämlik tillgång till vård) alternativt en utökning av enheternas upptagningsområden.
    • Enheterna arbetar redan med rådgivning via telefon och internet. En utveckling av en sådan nationell verksamhet skulle ge tillgång till stöd och rådgivning för personer med sexmissbruk i hela landet.
    • Den som är partner eller familjemedlem till en sexmissbrukare blir på olika sätt drabbad av partnerns sexmissbruk. Erfarenheterna från verksamheten i Malmö och pilotstudien med anhöriga i grupp behöver tas tillvara och utvecklas som komplement till de specialiserade behandlingsresurser som riktas till den primära målgruppen (sexköpare/sexmissbrukare). I detta avseende behöver även barnens situation beaktas.
  • 59.
    Kjellgren, Cecilia
    et al.
    Linné Universitetet.
    Svedin, Carl Göran
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri. Linköpings universitet, Hälsouniversitetet.
    Nilsson, Doris
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Barn- och ungdomspsykiatriska kliniken.
    Child Physical Abuse—Experiences of Combined Treatment for Children and their Parents: A Pilot Study2013Inngår i: Child Care in Practice, ISSN 1357-5279, E-ISSN 1476-489X, Vol. 19, nr 3, s. 275-290Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    This paper reports on the results of treatment for families where child physical abuse has occurred. The Combined Parent–Child Cognitive–Behavioral Therapy for Families at Risk for Child Physical Abuse (CPC-CBT) model includes parent and child interventions. Four teams (within child protection and child and adolescent psychiatry services, based in Sweden) were trained to run the treatment. CPC-CBT is a 16-session programme where children and parents receive treatment in parallel groups and joint family sessions. A pilot study, with pre and post measures for both children and parents, was carried out to evaluate the treatment effects (18 families, 26 adults and 25 children). Significantly decreased symptoms of depression among parents, less use of violent parenting strategies and less inconsistent parenting were reported after treatment. Children initially reported high levels of traumatic experiences and symptoms of post-traumatic stress disorder. After treatment, trauma symptoms and depression among children were significantly reduced. Children also reported that parents used significantly less violence and increased positive parenting strategies after completion of the treatment. The implications of the findings are discussed.

  • 60.
    Kvist, Therese
    et al.
    Karolinska Institutet, Huddinge, Sweden.
    Annerbäck, Eva-Maria
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri. Linköpings universitet, Hälsouniversitetet. Uppsala University, Sweden.
    Sahlqvist, Lotta
    Uppsala University, Sweden.
    Flodmark, Olof
    Karolinska University Hospital, Stockholm, Sweden.
    Dahllöf, Göran
    Karolinska Institutet, Huddinge, Sweden.
    Association between adolescents' self-perceived oral health and self-reported experiences of abuse2013Inngår i: European Journal of Oral Sciences, ISSN 0909-8836, E-ISSN 1600-0722, Vol. 121, nr 6, s. 594-599Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This study investigated the association between self-perceived oral health and self-reported exposure to different types of child abuse. It was hypothesized that self-perceived oral health is compromised in exposed adolescents. All Grade-9 compulsory school and second-year high-school pupils in Södermanland County, Sweden (n = 7,262) were invited to take part in a population-based survey; 5,940 adolescents responded. Survey items on health and social wellbeing included self-perceived oral health and exposure to abuse. The results showed that poor self-perceived oral health was associated with self-reported experience of physical abuse, intimate partner violence, forced sex, and bullying (adjusted OR = 2.3–14.7). The likelihood of reporting poor oral health increased from an adjusted OR of 2.1 for a single incident of abuse to an adjusted OR of 23.3 for multiple abuses. In conclusion, poor self-perceived oral health and previous exposure to child physical abuse, intimate partner violence, bullying, and forced sex is associated. It is important that dental professionals recognize adolescents with poor subjective oral health and take into consideration child abuse as a possible cause in order to prevent these adolescents from further victimization. These results further strengthen that dental professionals are an important resource in child protection.

  • 61.
    Lindell, Charlotta
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri. Linköpings universitet, Hälsouniversitetet.
    Svedin, Carl Göran
    Linköpings universitet, Institutionen för klinisk och experimentell medicin. Linköpings universitet, Hälsouniversitetet.
    A descriptive study of mental health services provided for physically abused children in Sweden: A four-year follow-up of child and adolescent psychiatric chartsManuskript (preprint) (Annet vitenskapelig)
    Abstract [en]

    Since there has been a considerable increase in the number of police reports on physical child abuse in Sweden since the mid 1980s, there should be an increased number of children in need of trauma-focused mental health treatment. During 1986-1996 there were 126 children reported as being physically abused by a parent or equivalent and reported to the police in a police district in Sweden. Fifty-seven of these children (45%) had been the objects of interventions from Child and Adolescent Psychiatric Services. The aim of this study was to investigate the extent and content of this. Questions addressed were: What interventions were provided prior to, at the acute situation, and during the 4 years after the physical abuse incident? This group of children was referred to (CAPS) for different reasons, but few for physical abuse. Only 35 out of 122 referrals were made under the label of child physical abuse. Overall, interventions were almost exclusively directed toward the parents. Six out of 126 physically abused children received individual therapy. Abuse was not mentioned in the charts for 23 of the children, even though 8 of them had been referred due to  abuse. The results of this study indicate that physically abused children often have been in contact with mental health services prior to the abuse for different reasons. Individual interventions for physically abused children were rare due to for instance CAPS workloads, poor motivation among parents and children, and maybe due to professionals’ lack of knowledge regarding effective treatment.

  • 62.
    Lindell, Charlotta
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri. Linköpings universitet, Hälsouniversitetet.
    Svedin, Carl Göran
    Linköpings universitet, Institutionen för klinisk och experimentell medicin. Linköpings universitet, Hälsouniversitetet.
    A four-year follow-up study of help provided by the Social services for physically abused childrenManuskript (preprint) (Annet vitenskapelig)
    Abstract [en]

    Even though the number of child physical abuse cases reported to the police has been increasing, little research has been performed to investigate whether interventions directed towards physically abused children are working or not. This paper examines contacts that physically abused children have with the social services 4 years after the physical abuse incidents were reported to the police. This is done in an effort to investigate the characteristics of child and parent that determine whether or not abused children are still receiving help from the social services 4 years after the abuse incidents. All physically abused children whose perpetrators had been reported to a Swedish police district between 1986-1996, were followed through the files (n = 113) of the social services. Four years later 69 children were still receiving interventions from the department. Intervention by the social services prior to a reported abuse incident increased the odds 18.7 times that a child would still receive interventions 4 years after the incident, and the presence of a mentally ill mother increased the odds 11.8 times.

  • 63.
    Lindell, Charlotta
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri.
    Svedin, Carl Göran
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri.
    Social services provided for physically abused children: A four-year follow-up study in Sweden2006Inngår i: Child and Adolescent Social Work Journal, ISSN 0738-0151, E-ISSN 1573-2797, Vol. 23, nr 5-6, s. 597-616Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This paper examines contacts that Swedish physically abused children have with the Department of Social Services (DSS) 4 years after a physical abuse incident has been reported to the police. The children's files have been investigated in an effort to evaluate which child and parent characteristics led DSS to make interventions for the 69 children still in need of assistance, 4 years after the original abuse incident. Intervention by the DSS prior to the reported abuse incident increased the odds 18 times that a child would still receive interventions 4 years after the incident, and the presence of a mentally ill mother increased the odds 11 times. © Springer Science+Business Media, LLC 2006.

  • 64.
    Lindell, Charlotta
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri.
    Svedin, C.G.
    Department of Child and Adolescent Psychiatry, Lund University, Lund, Sweden.
    Mental health services provided for physically abused children in Sweden. A 4-year follow-up of child and adolescent psychiatric charts2005Inngår i: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 59, nr 3, s. 179-185Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    As there has been a considerable increase regarding the number of police reports on physical child abuse in Sweden since the mid-1980s, there should be an increased number of children in need of trauma-focused mental health treatment. During 1986-1996, there were 126 children reported as being physically abused by a parent or equivalent and reported to the police in a police district in Sweden. Fifty-seven of these children (45%) had been the objects of interventions from Child and Adolescent Psychiatric Services (CAPS). The aim of this study was to investigate the extent and content of this. Questions addressed were: when did the children receive interventions, were these trauma-focused and could this be reflected in their charts? This group of children was referred to CAPS for different reasons and 35/122 referrals were made under the label of child physical abuse. Overall, interventions were mainly directed toward the parents. Six of 126 physically abused children received individual therapy. Abuse was not mentioned in the charts for 23 of the children, even though eight of them had been referred due to abuse. The results of this study indicate that physically abused children have often been in contact with mental health services prior to the abuse for different reasons, initially due to individual problems and later on regarding family conflict. Individual interventions for physically abused children were rare due to for instance CAPS workloads, poor motivation among parents and children, and maybe due to professionals' lack of knowledge regarding effective treatment. The introduction of a routine checklist is recommended early on to find indications of abuse, as is the need of exploring methods working with physically abused children in Sweden. © 2005 Taylor & Francis.

  • 65.
    Lodén Gustafsson, Kerstin
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri. Linköpings universitet, Hälsouniversitetet.
    Ornstein, Kerstin
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri. Linköpings universitet, Hälsouniversitetet.
    ”Att inte dra alla över en kam”: Erfarenheter av att vara förälder med autismspektrumstörning. Erfarenheter och önskemål om stöd2013Independent thesis Advanced level (degree of Master (One Year)), 10 poäng / 15 hpOppgave
    Abstract [sv]

    Syftet med denna studie är att utifrån ett föräldraperspektiv undersöka behov av och önskemål om stödsom föräldrar med diagnos inom autismspektrum beskriver i sin föräldraroll. Ett annat syfte är att bidra med ökad kunskaptill en diskussion kring utformandet av stödinsatser för dessa familjer. Studien är kvalitativ med intervjuer som gjorts ihalvstrukturerad form. Åtta föräldrar har intervjuats. Föräldrarna beskriver att deras svårigheter gör det svårt för dem isamspelet med barn och partner. De försöker själva och tillsammans med partnern finna lösningar i samspelet. Till hjälp attfinna lösningar har varit insikt om de egna svårigheterna, stöd riktat till AST-problematiken och att få hjälp i parrelationen.Avlastning framför allt genom utökad tid i förskola beskrivs som väsentlig. Önskemål framförs om att stödet ges med enhelhetssyn på familjen, att stödet anpassas och möjlighet att få samtala med föräldrar med liknande problematik. Studienvisar att föräldrarna efterfrågar stöd i sitt föräldraskap och att ytterligare studier behövs för att kunna möta dessa föräldrarsoch deras barns och partners behov.

  • 66.
    Lundqvist, Gunilla
    et al.
    Faculty of Health and Society , Malmö University , Malmö, Sweden.
    Hansson, Kjell
    School of Social Work , Lund University , Lund, Sweden.
    Svedin, Carl Göran
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri. Linköpings universitet, Hälsouniversitetet.
    Group Therapy for Women Sexually Abused asChildren: Social Interaction, Adjustment, andRelationships Before and After Group Therapy2009Inngår i: Psychoanalytic Social Work, ISSN 1522-8878, E-ISSN 1522-9033, Vol. 16, nr 2, s. 158-175Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Forty-five female outpatients sexually abused in childhood were offered a two-year-long trauma-focused group therapy. Questionnaires were given before and after treatment concerning social interaction (ISSI), social adjustment (SAS-SR), perceived family climate (Family Climate Test, Questions of Family Members). Both the level of social interaction and social adjustment were significantly improved after treatment. There were no significant changes in family climate except for the expressed emotion subscale perceived criticism in relation to the partner that showed a reduction. We conclude that trauma-focused group therapy seems to be useful in improving the relationships and social life of women who were sexually abused as children.

  • 67.
    Mejstad, Lena
    et al.
    Lund University.
    Heiling, Kerstin
    Lund University.
    Svedin, Carl Göran
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri. Linköpings universitet, Hälsouniversitetet.
    MENTAL HEALTH AND SELF-IMAGE AMONG DEAF AND HARD OF HEARING CHILDREN2008Inngår i: AMERICAN ANNALS OF THE DEAF, ISSN 0002-726X, Vol. 153, nr 5, s. 504-515Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    MENTAL HEALTH and self-image among deaf and hard of hearing children (ages 11-18 years) in southern Sweden was investigated. The children (N = 111) attended special schools for the deaf (n = 28), special schools for the hard of hearing (n = 23), and regular schools where hard of hearing children were mainstreamed (n = 60). The Strengths and Difficulties Questionnaire (Goodman, 1997) was used to screen mental health and the "I Think I Am" questionnaire Ouvinen-Birgerstam (1982, 1984) to measure self-esteem. The study shows that hard of hearing children seem to do as well, as a group, as other children in Swedish society Mean SDQ and ITIA scores indicated that the mainstreamed students and the students in special schools for the hard of hearing had higher levels of rated mental health and self-image than the students in schools for the deaf.

  • 68.
    Mörelius, Evalotte
    et al.
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Barn- och kvinnocentrum, Barn- och ungdomskliniken i Linköping.
    Gustafsson, Per A.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri. Linköpings universitet, Hälsouniversitetet. Region Östergötland, Närsjukvården i centrala Östergötland, Barn- och ungdomspsykiatriska kliniken.
    Ekberg, Kerstin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet.
    Nelson, Nina
    Östergötlands Läns Landsting, Barn- och kvinnocentrum, Barn- och ungdomskliniken i Norrköping. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet.
    Neonatal Intensive Care and Child Psychiatry Inpatient Care: Do Different Working Conditions Influence Stress Levels?2013Inngår i: Nursing Research and Practice, ISSN 2090-1429, E-ISSN 2090-1437, Vol. 2013Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction. Nurses often experience work-related stress. High stress can negatively affect job satisfaction and lead to emotional exhaustion with risk of burnout.

    Aim. To analyse possible differences in biological stress markers, psychosocial working conditions,health, and well-being between nurses working in two different departments.

    Methods. Stress was evaluated in nurses working in a neonatal intensive care unit (NICU) (𝑛 = 33) and nursesworking in a child and adolescent psychiatry inpatient ward (CAP) (𝑛 = 14) using salivary cortisol and HbA1c. Salivary cortisol was measured three times a day on two consecutive days during two one-week periods, seven weeks apart (= 12 samples/person). Psychosocial working conditions, health, and well-being were measured once.

    Results. NICU nurses had better social support and more self-determination. CAP nurses had a lower salivary cortisol quotient,poorer general health, and higher client-related burnout scores.

    Conclusion.When comparing these nurses with existing normdata for Sweden, as a group their scores reflect less work-related stress than Swedes overall. However, the comparison between NICU and CAP nurses indicates a less healthy work situation for CAP nurses.

    Relevance to Clinical Practice. Healthcare managers need to acknowledge the less healthy work situation CAP nurses experience in order to provide optimal support and promote good health.

  • 69.
    Mörelius, Evalotte
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Pediatrik. Linköpings universitet, Hälsouniversitetet.
    Nelson, Nina
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Pediatrik. Linköpings universitet, Hälsouniversitetet.
    Gustafsson, Per A
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri. Linköpings universitet, Hälsouniversitetet.
    Salivary cortisol response in mother-infant dyads at psychosocial high-risk2006Inngår i: Child Care Health and Development, ISSN 0305-1862, E-ISSN 1365-2214, Vol. 33, nr 2, s. 128-136Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives The aim of the present study was to investigate the adrenocortical response to diaper change in mother–infant dyads with psychosocial risk factors.

    Material and methods Twenty-two mother–infant pairs with well-defined psychosocial problems were included. The mother–infant pairs were treated for 6 weeks in a daycare programme to improve attachment. Salivary cortisol was measured before and after a diaper change during the first and last weeks of enrolment in the programme. Mothers' sensitivity towards their infants' signals was measured using a scale from 1 (highly insensitive) to 9 (highly sensitive) according to Ainsworth.

    Results Median salivary cortisol increased in 15 out of 22 infants after the first diaper change. The increase was most pronounced in the group of infants below 3 months of age (n = 15) where median salivary cortisol increased 170% after the first diaper change (P < 0.05) and decreased 19% after the last diaper change (not significant). Out of these 15 infants, 11 showed an increase in salivary cortisol in response to the first diaper change while four out of 15 did so in response to the last diaper change (P < 0.05). The salivary cortisol response did not change over time in infants aged 3 months or above. A mother's sensitivity to her child increased significantly (P < 0.001) from the first to the last week. In mothers, median salivary cortisol decreased 38% after the first diaper change (P < 0.05) and 57% after the last diaper change (P = 0.001).

    Discussion A diaper change is normally not perceived as stressful. The stress response caused by a diaper change may illustrate an insufficiency in the mother–infant relationship before treatment. Professional support improved the mothers' sensitivity and stabilized the stress response to diaper change in the youngest infants.

  • 70.
    Nilsson, Doris
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Barn- och ungdomspsykiatriska kliniken.
    Trauma, Posttraumatic Stress and Dissociation Among Swedish Adolescents: Evaluation of Questionnaires2007Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    The main aim of this thesis has been to investigate trauma and dissociation among Swedish adolescents and to evaluate the psychometric properties such as reliability and various kinds of validity of three screening instruments for assessment of dissociation and other symptoms of post traumatic stress. The three instruments in question have been Dis-Q-Sweden, A-DES and TSCC, the symptoms measured by these instruments are neither easy to capture nor easy for the adolescent to talk about. Therefore these self report scales are essential. A second aim has been to compare the results with results from other countries and to develop preliminary Swedish norms for the clinician to use. Age and gender differences have been looked upon as well as assessed symptoms connected to known experienced trauma/sexual and/or physical abuse and self-reported trauma in normal and clinical populations.

    The populations, in this thesis have been children and adolescents age 10 -19 years old from the general population; the clinical groups have had the same age range. All children and adolescents in the clinical groups have been sexually and/or physically abused. Participants have answered the questionnaires Dis-Q-Sweden, A-DES and/or TSCC and their answers have been statistically analysed.

    All three instruments have been shown to have good reliability, such as internal consistency and test-retest. Validity has been established through factor analyses, concurrent, and criterion related validity. Clinical groups with known experienced trauma/sexual abuse and/or physical abuse gave significantly higher scores on all the instruments compared to normative groups. Also self-reported trauma in a normative group gave significantly higher scores even if the significances are not as high as between the normative and clinical groups. Girls scored significantly higher than boys in both the clinical and normative groups. Girls in the age range 14-15 years old gave the significantly highest scores on both Dis-Q-Sweden and ADES. Swedish adolescents gave lower mean scores on all three instruments than have been reported from other studies in other countries. The scores from the clinical groups gave about the same mean as have been reported elsewhere.

    The conclusion from this thesis is that all the three questionnaires Dis-Q-Sweden, A-DES and TSCC have shown satisfactory psychometrics properties and can very well be used by Swedish clinicians in Child and Adolescents Psychiatry.

    Delarbeid
    1. Traumatic experiences and dissociative symptoms among Swedish adolescents: A pilot study using Dis-Q-Sweden
    Åpne denne publikasjonen i ny fane eller vindu >>Traumatic experiences and dissociative symptoms among Swedish adolescents: A pilot study using Dis-Q-Sweden
    2004 (engelsk)Inngår i: Nordic Journal of Psychiatry, ISSN 0803-9488, Vol. 58, nr 5, s. 349-355Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    The aim of this study was to explore the occurrence of dissociative symptoms in relation to reported traumatic experiences among adolescents. A normative sample of 216 adolescents and a clinical sample of 30 cases with a history of traumatization were given the Swedish translation of Dissociation Questionnaire, DIS-Q. The results showed that 8.8% of the adolescents reported scores above the cut-off score of 2.5 on the Dis-Q-Sweden, with a female-male ratio of 2.6:1. In the normative sample, 53 (24.5%) of the adolescents reported one or more trauma experiences. The adolescents who self-reported trauma experiences in the normative sample scored higher on the total Dis-Q-Sweden scores and on three of the four subscales compared to the adolescents with no such experiences. The clinical group exhibited significantly higher Dis-Q-Sweden scores than the normative sample on every scale, with 60% above the cut-off score. The study confirms the results from earlier studies that adolescents with a history of trauma exhibit more dissociative symptoms in this study according to Dis-Q-Sweden. The impact of trauma qualities and background factors on the development of dissociative symptoms need to be studied further.

    Emneord
    Adolescents, DIS-Q, Dissociation, Measurement, Trauma
    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-14266 (URN)10.1080/08039480410005891 (DOI)
    Tilgjengelig fra: 2007-01-31 Laget: 2007-01-31 Sist oppdatert: 2013-09-16
    2. Evaluation of the Swedish version of Dissociation Questionnaire (DIS-Q), Dis-Q-Sweden, Among Adolescents
    Åpne denne publikasjonen i ny fane eller vindu >>Evaluation of the Swedish version of Dissociation Questionnaire (DIS-Q), Dis-Q-Sweden, Among Adolescents
    2006 (engelsk)Inngår i: Journal of Trauma & Dissociation, ISSN 1529-9732, Vol. 7, nr 3, s. 65-89Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    The aim of this study was to investigate the psychometric properties of the Swedish version of the Dissociation Questionnaire in a normative adolescent population and also to investigate dissociative symptoms associated with trauma including sexual and physical abuse. A normative sample of 449 adolescents between the ages of 12 and 19 and a clinical group of 74 adolescents with known experiences of trauma, sexual and/or physical abuse was given Dis-Q-Sweden. A mixed group of 22 abused and non-abused adolescents who answered Dis-Q-Sweden was also interviewed by using the Structural Clinical Interview for DSM-IV Dissociative Disorders (SCID-D). A test-retest procedure was conducted with 90 subjects from the normative group. The results showed good reliability concerning both internal consistency and test-retest stability. Validity was tested in several ways (criterion, predictive, construct and concurrent) and found to be satisfactory. Significant differences for the total sum scores of Dis-Q-Sweden were found between the normative group and the clinical group with known sexual abuse (p < 0.001). The prevalence of dissociative symptoms (cut-off score > 2.5) was 2.3% in the normative group and 50% in the clinical group. Dis-Q-Sweden has proven to be a screening instrument with good psychometric properties and has proven to be able to capture dissociative symptoms in adolescents with self-reported trauma and known trauma (sexual abuse).

    Emneord
    Dis-Q-Sweden; method; dissociation; adolescents; trauma
    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-14267 (URN)10.1300/J229v07n03_05 (DOI)
    Tilgjengelig fra: 2007-01-31 Laget: 2007-01-31
    3. Dissociation among Swedish Adolescents and the connection to trauma: An Evaluation of the Swedish version of Adolescent Dissociative Experience Scale
    Åpne denne publikasjonen i ny fane eller vindu >>Dissociation among Swedish Adolescents and the connection to trauma: An Evaluation of the Swedish version of Adolescent Dissociative Experience Scale
    2006 (engelsk)Inngår i: Journal of Nervous and Mental Disease, ISSN 0022-3018, Vol. 194, nr 9, s. 684-689Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    The purpose of this study was to investigate the psychometric properties of the Swedish version of Adolescent Dissociative Experience Scale (A-DES), dissociative symptoms among Swedish adolescents, and dissociative symptoms connected to trauma and sexual and physical abuse. A normative group of 400 adolescents aged 12 to 19 years and a clinical group of 20 adolescents with known experienced trauma were given A-DES. A test-retest procedure was conducted with 90 subjects from the normative group. The results showed good reliability, internal consistency and test-retest. Factor analysis in the normative sample (N = 400) resulted in a one factor solution. Correlation between A-DES and other measures of dissociation was high (r = .86). Significant differences for the total sum of A-DES were found in the normative group between adolescents with and without self-reported trauma and between the normative group and the clinical group with known experienced trauma. The Swedish version of A-DES was shown to be a screening instrument with satisfactory psychometric qualities and the capability of capturing dissociative symptoms in adolescents with self-reported trauma as well as clinical cases with identified trauma.

    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-14268 (URN)10.1097/01.nmd.0000235774.08690.dc (DOI)
    Tilgjengelig fra: 2007-01-31 Laget: 2007-01-31
    4. The psychometric properties of the Trauma Symptom Checklist For Children (TSCC) in a sample of Swedish children
    Åpne denne publikasjonen i ny fane eller vindu >>The psychometric properties of the Trauma Symptom Checklist For Children (TSCC) in a sample of Swedish children
    2008 (engelsk)Inngår i: International Journal of Child Abuse & Neglect, ISSN 0145-2134, E-ISSN 1873-7757, Vol. 32, nr 6, s. 627-636Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    Objective: To evaluate the psychometric properties of the Swedish version of the Trauma Symptom Checklist for Children (TSCC) and to study traumatic symptoms in a normative group of Swedish children and adolescents. Method: A normative group of 728 children and adolescents age 10-17 and a clinical group of 91 children and adolescents known to have experienced sexual abuse participated in the study. A test-retest procedure was conducted with 79 participants from the normative group. Results: Good reliability such as internal consistency (Cronbach's alpha) for the total scale .94 (ranging in the clinical scales .78-.83) and test-retest for the total scale r = .81 (ranging in the clinical scales .67-.81) were found. The confirmatory 6-factor analysis explained 50.7% of the variance. Other validity measures such as concurrent validity and criterion related validity were also shown to be satisfactory. The normative sample of Swedish children and adolescents showed lower means on the subscales than has been reported in previous studies from a number of other countries. Conclusion: The Swedish version of TSCC has been shown to be a screening instrument with satisfactory psychometric qualities that is capable to identify trauma symptoms among children and adolescents who have themselves self-reported experiencing trauma or for whom clinicians have identified traumatic experiences. © 2008 Elsevier Ltd. All rights reserved.

    Emneord
    TSCC, method, children, adolescents, trauma, sexual abuse
    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-42956 (URN)10.1016/j.chiabu.2007.09.009 (DOI)70185 (Lokal ID)70185 (Arkivnummer)70185 (OAI)
    Tilgjengelig fra: 2009-10-10 Laget: 2009-10-10 Sist oppdatert: 2019-01-17
  • 71.
    Nilsson, Doris
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri. Linköpings universitet, Hälsouniversitetet.
    Svedin, Carl Göran
    Department of Child and Adolescent Psychiatry, Lund University, Lund, Sweden.
    Dissociation among Swedish Adolescents and the connection to trauma: An Evaluation of the Swedish version of Adolescent Dissociative Experience Scale2006Inngår i: Journal of Nervous and Mental Disease, ISSN 0022-3018, Vol. 194, nr 9, s. 684-689Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The purpose of this study was to investigate the psychometric properties of the Swedish version of Adolescent Dissociative Experience Scale (A-DES), dissociative symptoms among Swedish adolescents, and dissociative symptoms connected to trauma and sexual and physical abuse. A normative group of 400 adolescents aged 12 to 19 years and a clinical group of 20 adolescents with known experienced trauma were given A-DES. A test-retest procedure was conducted with 90 subjects from the normative group. The results showed good reliability, internal consistency and test-retest. Factor analysis in the normative sample (N = 400) resulted in a one factor solution. Correlation between A-DES and other measures of dissociation was high (r = .86). Significant differences for the total sum of A-DES were found in the normative group between adolescents with and without self-reported trauma and between the normative group and the clinical group with known experienced trauma. The Swedish version of A-DES was shown to be a screening instrument with satisfactory psychometric qualities and the capability of capturing dissociative symptoms in adolescents with self-reported trauma as well as clinical cases with identified trauma.

  • 72.
    Nilsson, Doris
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Barn- och ungdomspsykiatriska kliniken.
    Gustafsson, Per E
    Lund University.
    Goran Svedin, Carl
    Lund University.
    Self-reported potentially traumatic life events and symptoms of post-traumatic stress and dissociation2010Inngår i: NORDIC JOURNAL OF PSYCHIATRY, ISSN 0803-9488, Vol. 64, nr 1, s. 19-26Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To investigate single potentially traumatic events and cumulative effects of these events based on the reported symptoms of post-traumatic stress and dissociation. An additional goal was to evaluate the psychometric properties of Life Incidence of Traumatic Events-Student scale (LITE-S). Methods: 400 adolescents from the normative population answered the questionnaire Life Incidence of Traumatic Experiences (LITE-S) together with Trauma Symptom Checklist for Children (TSCC), Dissociation-Questionnaire-Sweden (Dis-Q-Sweden) and Adolescent-Dissociative Experience Scale (A-DES). The single self-reported traumas, and the cumulative self-reported traumas and their effects on post-traumatic stress disorder and dissociative symptoms scales were examined. The psychometric properties of LITE-S were first investigated through calculating, test-retest reliability by Pearson correlation for the total scale and by Cohens kappa item per item. Results: Self-reported symptoms were related to both the cumulative traumas and exposure to some single traumas, such as seeing somebody get hurt, having parents destroy things or hurting each other, being whipped or hit, or even being made to carry out some kind of sexual act. Interpersonal events were consistently more strongly related to symptoms across the TSCC clinical scales. Finally, test-retest reliability as found to be for the total scale r = 0.76 and kappa item per item ranging between k = 0.33 and 0.86. Conclusion: The cumulative effects of potentially traumatic events on adolescents are significant, and interpersonal traumas results in more self-reported symptoms of post-traumatic stress and dissociation than non-interpersonal. LITE has satisfactory psychometric properties concerning reliability. Clinical implications: The results underline the importance in clinical practice of taking into consideration how many potentially traumatic events an adolescent has experienced before, seeking help on specific occasion. This knowledge can help the clinician to understand better the breadth of feelings their client is experiencing and thus can help the clinician better to be able to suggest appropriate treatment.

  • 73.
    Nilsson, Doris
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Barn- och ungdomspsykiatriska kliniken.
    Gustafsson, Per. E
    Hälsa och familje medicin Umeå.
    Larsson, Jessica
    Östergötlands Läns Landsting, Närsjukvården i östra Östergötland, Barn- och ungdomshabiliteringen.
    Svedin, Carl Göran
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri. Linköpings universitet, Hälsouniversitetet.
    Evaluation of the Linköping Youth Life experience Scale2010Inngår i: Journal of Nervous and Mental Disease, ISSN 0022-3018, E-ISSN 1539-736X, Vol. 198, nr 10, s. 768-774Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The objective of this study was to investigate the psychometric properties of a newly developed instrument for potentially traumatic life events, the Linköping Youth Life Experience Scale (LYLES), and determine the benefits of including adverse childhood circumstances (ACCs) as factors in the evaluation. In addition, we wanted to investigate the difference between interpersonal and noninterpersonal traumatic events, the impact of ACCs, and the cumulative effects of these events on self-reported symptoms of dissociation, depression, and anxiety. Adolescents from the normative population (n = 188) answered the questionnaire LYLES and also the Dissociation-Questionnaire-Sweden and Hospital Anxiety and Depression Scale. The results showed that LYLES was stable, with test-retest r = 0.79 and kappa item per item ranging between k = 0.44 and 1.0. ACCs contributed independently to the explanation of symptoms explaining them better than potentially traumatic events alone, particularly for boys where the impact of ACCs exceeded the impact of events. The conclusions are that LYLES displayed satisfactory psychometric properties and that ACCs seem to be a valuable addition to an instrument to evaluate potentially traumatic events.

  • 74.
    Nilsson, Doris
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Barn- och ungdomspsykiatriska kliniken.
    Gustafsson, Per E
    Umeå University, Sweden .
    Svedin, Carl Göran
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri. Linköpings universitet, Hälsouniversitetet.
    Lifetime Polytraumatization in Adolescence and Being a Victim of Bullying2012Inngår i: Journal of Nervous and Mental Disease, ISSN 0022-3018, E-ISSN 1539-736X, Vol. 200, nr 11, s. 954-961Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The purposes of this study were to examine the mental health consequences of having been a victim of bullying and to investigate whether the impact of bullying was dependent on the co-occurrence of other potentially traumatic events, noninterpersonal traumas, interpersonal traumas, as well as adverse childhood circumstances. less thanbrgreater than less thanbrgreater thanA community sample of participants (n = 462; 216 males and 246 females) aged 15 to 20 years completed the self-administered Linkopings Youth Life Experience Scale about lifetime exposure to a range of traumatic and other adverse events and circumstances and the Trauma Symptom Checklist for Children (TSCC). The results showed that those who reported being a victim of bullying reported significantly higher scores on all TSCC clinical scales as well as significantly more other traumatic and adverse family exposures. Multiple linear regression analyses indicated that the impact of bullying on mental health was explained, to a considerable degree, by the accumulation of other adverse and traumatic exposures, particularly in the females.

  • 75.
    Nilsson, Doris
    et al.
    Linköpings universitet, Institutionen för beteendevetenskap och lärande. Linköpings universitet, Filosofiska fakulteten. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Barn- och ungdomspsykiatriska kliniken.
    Gustafsson, Per, E
    Umeå University.
    Svedin, Carl Göran
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri. Linköpings universitet, Hälsouniversitetet.
    Polytraumatization and Trauma Symptoms in Adolescent Boys and Girls: Interpersonal and Noninterpersonal Events and Moderating Effects of Adverse Family Circumstances2012Inngår i: Journal of Interpersonal Violence, ISSN 0886-2605, E-ISSN 1552-6518, Vol. 27, nr 13, s. 2645-2664Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The objective of this study was to investigate the cumulative effect of interpersonal and noninterpersonal traumatic life events (IPEs and nIPEs, respectively) on the mental health of adolescents and to determine if the adverse impacts of trauma were moderated by adverse family circumstances (AFC). Adolescents (mean age 16.7 years) from the normative population (n = 462) completed the questionnaire, the Linköping Youth Life Experience Scale (LYLES), together with Trauma Symptom Checklist for Children (TSCC). The lifetime accumulation of interpersonal, noninterpersonal, and AFC was independently related to trauma-related symptoms in both boys and girls. The number of AFCs moderated the mental health impact of both IPEs and nIPEs in boys but not in girls. Cumulative exposure to both interpersonal and noninterpersonal traumatic events is important for the mental health of adolescents, and, at least for boys, family circumstances seem to be relevant for the impact of trauma. Our results suggest that broader approaches to the study, prevention, and treatment of trauma, including consideration of cumulative exposure, different types of trauma, and additional social risk factors, could be fruitful.

  • 76.
    Nilsson, Doris
    et al.
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Barn- och ungdomspsykiatriska kliniken.
    Gustafsson, Per E.
    Department of Public Health and Clinical Medicine, Family Medicine, Umeå University.
    Svedin, Carl Göran
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri. Linköpings universitet, Hälsouniversitetet.
    The psychometric properties of the Trauma Symptom Checklist for Young Children in a sample of Swedish children2012Inngår i: European Journal of Psychotraumatology, ISSN 2000-8066, E-ISSN 2000-8066, Vol. 3, artikkel-id 18505Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To evaluate the psychometric properties of the Swedish version of Trauma Symptom Checklist for Young Children (TSCYC).

    Method: The study was composed of a total of 629 children - 296 girls and 333 boys - aged 311, from a nonclinical population who were rated by their caretakers (26 of whom performed a re-test after 2 weeks) in addition to 59 children from a clinical population with known experience of sexual and/or physical abuse. The caretakers from the normal population completed the TSCYC and Lifetime Incidence of Traumatic Events Scale-parent scale (LITE-P) and the clinical-sample caretakers completed TSCYC. The psychometric properties of the TSCYC were examined, including reliability and validity.

    Results: The reliability (Cronbach’s alpha) of the TSCYC, total scale, was α=0.93 (normative group) and α=0.96 (clinical group). For the clinical scales, this ranged between α=0.550.88 and 0.770.93, respectively. Test-retest for the total scale was r0.77. Regarding criterion-related validity, the clinical groups scored significantly higher than the normative group, and within the normative group significant relationships were found between exposure to traumatic events and TSCYC scores. Confirmatory factor analysis testing of the construction of the TSCYC indicated significant loadings on the original scales.

    Conclusion: The Swedish version of TSCYC appears to be a screening instrument with satisfactory psychometric qualities for identifying symptoms after trauma in young children. The instrument can also be recommended to clinicians for screening purposes in a European context.

  • 77.
    Nilsson, Doris
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri. Linköpings universitet, Hälsouniversitetet.
    Svedin, Carl Göran
    Department of Child and Adolescent Psychiatry, Lund University, Lund, Sweden.
    Evaluation of the Swedish version of Dissociation Questionnaire (DIS-Q), Dis-Q-Sweden, Among Adolescents2006Inngår i: Journal of Trauma & Dissociation, ISSN 1529-9732, Vol. 7, nr 3, s. 65-89Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aim of this study was to investigate the psychometric properties of the Swedish version of the Dissociation Questionnaire in a normative adolescent population and also to investigate dissociative symptoms associated with trauma including sexual and physical abuse. A normative sample of 449 adolescents between the ages of 12 and 19 and a clinical group of 74 adolescents with known experiences of trauma, sexual and/or physical abuse was given Dis-Q-Sweden. A mixed group of 22 abused and non-abused adolescents who answered Dis-Q-Sweden was also interviewed by using the Structural Clinical Interview for DSM-IV Dissociative Disorders (SCID-D). A test-retest procedure was conducted with 90 subjects from the normative group. The results showed good reliability concerning both internal consistency and test-retest stability. Validity was tested in several ways (criterion, predictive, construct and concurrent) and found to be satisfactory. Significant differences for the total sum scores of Dis-Q-Sweden were found between the normative group and the clinical group with known sexual abuse (p < 0.001). The prevalence of dissociative symptoms (cut-off score > 2.5) was 2.3% in the normative group and 50% in the clinical group. Dis-Q-Sweden has proven to be a screening instrument with good psychometric properties and has proven to be able to capture dissociative symptoms in adolescents with self-reported trauma and known trauma (sexual abuse).

  • 78.
    Nilsson, Doris
    et al.
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Avdelningen för klinisk och socialpsykologi (CS). Linköpings universitet, Filosofiska fakulteten. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Barn- och ungdomspsykiatriska kliniken.
    Svedin, Carl Göran
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri. Linköpings universitet, Hälsouniversitetet.
    Trauma Symptom Checklist for Children: Manualsupplement2010Annet (Annet vitenskapelig)
  • 79.
    Nilsson, Doris
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Barn- och ungdomspsykiatriska kliniken.
    Wadsby, Marie
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri. Linköpings universitet, Hälsouniversitetet.
    Symboldrama, a Psychotherapeutic Method for Adolescents with Dissociative and PTSD Symptoms: A Pilot Study2010Inngår i: Journal of Trauma & Dissociation, ISSN 1529-9732, E-ISSN 1529-9740, Vol. 11, nr 3, s. 308-321Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    A total of 15 clinically referred adolescents who had been sexually or physically abused participated in this pilot study of the use of symboldrama psychotherapy. Symboldrama is a psychotherapeutic method that uses imagery as the major psychotherapeutic tool. All adolescents reported to be suffering from a high level of dissociative symptoms and other symptoms such as anxiety, depression, posttraumatic stress, and anger after their traumas. The objective of the study was to test the hypothesis that symboldrama psychotherapy in addition to psycho-education of the non-offending parent would significantly reduce the reported symptoms. Before treatment, the participants answered three questionnaires: (a) the Life Incidence of Traumatic Events Scale, (b) the Trauma Symptom Checklist for Children, and (c) the Dissociation Questionnaire-Swedish version. After treatment, the participants once again filled out the Trauma Symptom Checklist for Children and the Dissociation Questionnaire-Swedish version. The scores from before and after treatment were compared, and the results showed that the symptoms had been statistically significantly reduced.

  • 80.
    Nilsson, Doris
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Barn- och ungdomspsykiatriska kliniken.
    Wadsby, Marie
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri.
    Svedin, Carl Göran
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri.
    The psychometric properties of the Trauma Symptom Checklist For Children (TSCC) in a sample of Swedish children2008Inngår i: International Journal of Child Abuse & Neglect, ISSN 0145-2134, E-ISSN 1873-7757, Vol. 32, nr 6, s. 627-636Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To evaluate the psychometric properties of the Swedish version of the Trauma Symptom Checklist for Children (TSCC) and to study traumatic symptoms in a normative group of Swedish children and adolescents. Method: A normative group of 728 children and adolescents age 10-17 and a clinical group of 91 children and adolescents known to have experienced sexual abuse participated in the study. A test-retest procedure was conducted with 79 participants from the normative group. Results: Good reliability such as internal consistency (Cronbach's alpha) for the total scale .94 (ranging in the clinical scales .78-.83) and test-retest for the total scale r = .81 (ranging in the clinical scales .67-.81) were found. The confirmatory 6-factor analysis explained 50.7% of the variance. Other validity measures such as concurrent validity and criterion related validity were also shown to be satisfactory. The normative sample of Swedish children and adolescents showed lower means on the subscales than has been reported in previous studies from a number of other countries. Conclusion: The Swedish version of TSCC has been shown to be a screening instrument with satisfactory psychometric qualities that is capable to identify trauma symptoms among children and adolescents who have themselves self-reported experiencing trauma or for whom clinicians have identified traumatic experiences. © 2008 Elsevier Ltd. All rights reserved.

  • 81.
    Nordfeldt, Sam
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Barn- och ungdomspsykiatriska kliniken.
    On Severe Hypoglycaemia in Children and Adolescents with Type 1 Diabetes2000Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Background: For people with type 1 diabetes, there is no alternative to treatment with insulin. The major side effect of insulin is severe hypoglycaemia (SH), when the patient needs help or even becomes unconscious.

    Material: We have studied a geographic population of yearly 130-140 unselected type 1 diabetes patients aged 1-18 years during 1992-1999. They were intensively treated with 87-96% on 4-7 daily insulin doses, combined with active self-control, psychosocial support and problem-based education from onset. Average HbA1c was 6.5 with Mono-S standard (1.15% beow DCCT level).

    Methods: We evaluated use of a prospective patient questionnaire for continuous long-term registration of treatment and outcome data and analysed HbA1c, SH and other variables. Over years, 95-100% response rate was achieved. We used also temporary questionnaries.

    Results: We found SH with unconsciousness reported from on average 11% of patients yearly, SH without unconsciousness but needing assistance from on average 36% yearly and weak associations to HbA1c, such as reletive risk of SH 1.24 for yearly mean HbA1c <7.0% compared to ≥7.0% There was a seasonal variation in HbA1c (p=0.023) and incidence of SH. The strongest predictor for SH was SH during the previous year (r=9.38, p<0.0001).

    The impact from SH showed great variation, and 20-30% of events led to practical disturbancies for parents and/or other people. Hospital visits took place only at 5% and hospitalisations at 3% of events. Social activities for patients were cancelled after 10% of events. Increased worry for patients was reported after 8% of events, bad sleep after 7%. We estimated the average socio-economic cost for SH at EURO 239 per event of SH with unconsciousness, and EURO 63 per event of SH without unconsciousness but needing assistance.

    Mass-distributed self-study material (brochures and videos) aimed at the prevention of SH without compromising metabolic control reached high dissemination and was widely appreciated by patients. The material copy cost was only EURO 7 per patient. It also seems to have contributed to a decrease in SH with unconsciousness from yearly 13% of patients before to 9% after intervention (3-years average), but controlled studies are needed.

    Conclusions: We conclude that SH remains a very serious problem of multifactorial aethiology. It causes considerable discomfort and costs. Systematic patient education mgiht reduce the incidence. Interventions using mass-distribution of high quality self-study material such as videos and brochures seem to have a potential to be cost-effective. There is a great patient/consumer interest in high quality- and advanced information/education materials.

    Delarbeid
    1. Increasing response rate in data registration and follow-up of type 1 diabetes children and adolescents: A prospective population study 1992–97
    Åpne denne publikasjonen i ny fane eller vindu >>Increasing response rate in data registration and follow-up of type 1 diabetes children and adolescents: A prospective population study 1992–97
    1999 (engelsk)Inngår i: Practical Diabetes International, ISSN 1357-8170, Vol. 16, nr 4, s. 101-106Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    Aims: This study considers how a local diabetes team can develop a system for patient data registration and follow-up to enhance quality control and health economic analysis, and how a high response rate for patient data can be achieved.

    Patients and methods: A geographic population of yearly 120-130 intensively treated type 1 diabetes children. <19 years of age was studied. A prospective patient questionnaire monitored: blood glucose and urine testing, insulin doses, acute complications, medications for hypertension and epilepsy, tobacco and snuff use, and any open questions and needs of the patient. This was completed before every visit to the out-patient department and used as a database for consultation. Data were thereafter registered in regular computer software, and analysed on a yearly basis.

    Results: Response rate increased with time to near 100%. There was a time gain for diabetes nurse and physician. Many patients found the questionnaire good for overviewing treatment and easy to complete, whereas some found it was irksome and boring. The total cost of the method was <160 SEK/patient year.

    Conclusions: A very high patient data response rate can be achieved over years by a patientsupportive questionnaire integrated in the treatment program. Treatment and outcome analysis can then be performed locally at low costs. The combination of a patient questionnaire with regular hard- and software is easy to create, manage and develop. Benefits for diabetes team and patients exceed the total cost.

    Emneord
    adolescent, child, data registration, information system, evaluation, questionnaire, health economy, quality of life, diabetes mellitus
    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-13554 (URN)10.1002/pdi.1960160406 (DOI)
    Tilgjengelig fra: 2000-11-29 Laget: 2000-11-29 Sist oppdatert: 2009-08-20
    2. Severe hypoglycemia in children with IDDM: A prospective population study, 1992-1994
    Åpne denne publikasjonen i ny fane eller vindu >>Severe hypoglycemia in children with IDDM: A prospective population study, 1992-1994
    1997 (engelsk)Inngår i: Diabetes Care, ISSN 0149-5992, Vol. 20, nr 4, s. 497-503Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    OBJECTIVE: Is an increased incidence of severe hypoglycemia an unavoidable effect of improved metabolic control? And, if so, to what extent? RESEARCH DESIGN AND METHODS: In 1992-1994, severe hypoglycemia was prospectively registered in our intensively treated IDDM population, 146 children 1-18 years of age with > 90% of the patients on > or = 4 insulin injections per day. The two categories, "severe hypoglycemia with unconsciousness" (U hypoglycemia) and "severe hypoglycemia without unconsciousness but needing the assistance of another person" (NU hypoglycemia), were analyzed in relation to yearly mean HbAlc levels, insulin doses and proportion of short-acting insulin, age at onset, duration of diabetes, age, sex, and weight-to-height ratio. RESULTS: Yearly mean HbAlc levels improved from 8.1 +/- 1.6% in 1992 to 6.9 +/- 1.3% in 1994. The yearly incidence of U hypoglycemia was 0.15-0.19 events per patient-year, seen in 10-16% of patients, showing no significant increase from 1992-1994. For NU hypoglycemia, slightly increasing figures from 1.01 to 1.26 events per patient-year, seen in 27-38% of patients yearly, were reported. There was no significant correlation between severe (U or NU) hypoglycemia and HbAlc, but still an association was seen in certain calculations. In multiple regression analysis, U hypoglycemia was not related to any factor, but the square root of the rate of NU hypoglycemia was related to lower HbAlc levels (P = 0.0003), higher insulin doses (IU.kg-1.24 h-1) (P = 0.0024), and a lower proportion of short-acting insulin out of the total daily insulin dose (P = 0.031). CONCLUSIONS: Multiple-dose insulin therapy with rather low yearly mean HbAlc values causes a slight increase of NU hypoglycemia but no increase of U hypoglycemia in our population of children with IDDM. Near physiological HbAlc levels may be achieved without any pronounced risk of increasing the incidence of severe hypoglycemia when multiple-injection insulin therapy is combined with adequate self-control based on psychosocial support and active education.

    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-13555 (URN)
    Tilgjengelig fra: 2000-11-29 Laget: 2000-11-29 Sist oppdatert: 2009-08-20
    3. Adverse events in intensively treated children and adolescents with type 1 diabetes
    Åpne denne publikasjonen i ny fane eller vindu >>Adverse events in intensively treated children and adolescents with type 1 diabetes
    1999 (engelsk)Inngår i: Acta Paediatrica, ISSN 0001-656X, Vol. 88, nr 11, s. 1184-1193Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    The main objective of this study was to examine the relation between adverse events and degree of metabolic control and multiple-dose treatment. A total of 139 children, aged between 1 and 18 y, prospectively registered severe hypoglycaemia with or without unconsciousness, as well as hospitalized ketoacidosis, during 1994-95. Treatment from onset was multiple-dose insulin (> 95% > or = 4 doses) combined with intense training and psychosocial support. Median HbA1c was 6.9% (ref. 3.6-5.4%). The incidence of severe hypoglycaemia with unconsciousness was 0.17 events per patient-year, having decreased from the 1970s to the 1990s, parallel to a change from 1-2 to > or = 4 doses per day. There was no correlation or association to the year mean HbA1c for severe hypoglycaemia. Severe hypoglycaemic episodes in 1995 correlated to severe hypoglycaemic episodes in 1994 (r=0.38; p<0.0001). Severe hypoglycaemia with unconsciousness increased during the spring season, and according to case records the assumed causes were mainly mistakes with insulin, food and exercise. Ketoacidosis was rare: 0.015 episodes per patient-year. We conclude that multiple-dose insulin therapy from the very onset of diabetes, combined with adequate self-control, active problem-based training and psycho-social support, may limit severe hypoglycaemia and ketoacidosis. Strategies aimed at minimizing severe hypoglycaemia without compromising metabolic control need to be evaluated.

    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-13556 (URN)
    Tilgjengelig fra: 2000-11-29 Laget: 2000-11-29 Sist oppdatert: 2009-08-20
    4. Seasonal variation of HbA1c in intensive treatment of children with type 1 diabetes
    Åpne denne publikasjonen i ny fane eller vindu >>Seasonal variation of HbA1c in intensive treatment of children with type 1 diabetes
    2000 (engelsk)Inngår i: Journal of pediatric endocrinology and metabolism, ISSN 0334-018X, Vol. 13, nr 5, s. 529-535Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    OBJECTIVE: The aim of this study was to measure whether there is a seasonal variation in glycosylated haemoglobin concentrations and insulin dose used in the intensive treatment of children with type 1 diabetes, and whether such variation is related to severe hypoglycaemia.

    PATIENTS: A geographic population of 114 intensively treated type 1 diabetic patients < 19 years of age, mean 12.7 (SD 4.3) years, with diabetes onset before 1995, were studied in a cohort 1995-96.

    METHODS: HbA1c, insulin doses and severe hypoglycaemia were registered at regular visits scheduled quarterly, but not standardised in time. Seasonal mean values were calculated for HbA1c and insulin dose.

    RESULTS: Lower HbA1c was seen in spring and summer, and higher in autumn and winter (p=0.023). Patients reporting severe hypoglycaemia had a seasonal variation in HbA1c (p=0.019) and a tendency to seasonal variation in insulin dose, while patients not reporting severe hypoglycaemia did not vary in HbA1c or insulin dose.

    CONCLUSIONS: Self-control and adjustment of insulin doses to seasonal change need to be improved also in intensively treated children, with regard to the risk for worsened metabolic control after the summer and increased severe hypoglycaemia in spring and early summer. The findings have important implications for design of short-term studies of metabolic control.

    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-13557 (URN)
    Tilgjengelig fra: 2000-11-29 Laget: 2000-11-29 Sist oppdatert: 2009-08-20
    5. Short-term effects of severe hypoglycaemia in children and adolescents with type 1 diabetes. A cost-of-illness study
    Åpne denne publikasjonen i ny fane eller vindu >>Short-term effects of severe hypoglycaemia in children and adolescents with type 1 diabetes. A cost-of-illness study
    2001 (engelsk)Inngår i: Acta Paediatrica, ISSN 0001-656X, Vol. 90, nr 2, s. 137-142Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    The aim of this study was to describe costs and other short-term effects of severe hypoglycaemia in children and adolescents with type 1 diabetes. The study comprised a geographic population of 129 patients <19 y of age with families prospectively registering detailed data after self-reported severe hypoglycaemia. In the period Jan.-Dec. 1998, 16 events were reported with unconsciousness and 95 events without unconsciousness but needing the assistance of another person. Of all events, 20-30% had effects requiring the assistance of people other than parents, school absence, parents' absence from work, extra transport and/or telephone calls. Patient (family) activities were cancelled after 10% (5%) of events. Increased worry for parents was reported after 8% and poor sleep after 7% of events. Hospital visits took place at 5% and hospitalizations at 3% of all events. Patients with severe hypoglycaemia indicated lower global quality of life (p=0.0114). The average socio-economic burden for events of severe hypoglycaemia was estimated at EURO 17,400 yearly per 100 type 1 diabetes patients. Average cost was estimated at EURO 239 per event of severe hypoglycaemia with unconsciousness or EURO 478 yearly per patient with unconsciousness, and EURO 63 per event of severe hypoglycaemia without unconsciousness but needing assistance from another person or EURO 307 yearly per patient in this category. These are conservative estimates and do not include unpaid time and other intangibles, possible road traffic accidents, disabling or premature deaths. Conclusions: The results suggest the potential for socio-economic savings and increased quality of life for patients and families from severe hypoglycaemia prevention programs.

    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-13558 (URN)10.1080/080352501300049244 (DOI)
    Tilgjengelig fra: 2000-11-29 Laget: 2000-11-29 Sist oppdatert: 2009-08-20
    6. Self-study material to prevent severe hypoglycaemia in children and adolescents with type 1 diabetes: A prospective intervention study
    Åpne denne publikasjonen i ny fane eller vindu >>Self-study material to prevent severe hypoglycaemia in children and adolescents with type 1 diabetes: A prospective intervention study
    2002 (engelsk)Inngår i: Practical Diabetes International, ISSN 1357-8170, Vol. 19, nr 5, s. 131-136Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    The aim of this study was to evaluate use of self-study material in diabetes education aimed at prevention of severe hypoglycaemia. Targeted self-study brochures (and video programs) regarding diabetes self-care and prevention of severe hypoglycaemia were mailed to all patients in early 1997 (and in 1999): a geographic population of 122-139 intensively treated type 1 diabetes patients yearly, aged 1-18 years (mean 12.2, SD 4.3), between 1994 and 1999. Yearly mean HbA1c (1.15% below DCCT level) ranged from 4.1 to 11.6% (mean 6.6, SD 1.1), age at onset 0.5-17.4 years (mean 7.6, SD 4.0) and duration 0.1-16.6 years (mean 4.6, SD 3.7). Main outcomes were patient attitudes to the interventions, perceived benefit, level of use, severe hypoglycaemia, and HbA1c.

    Eighty-six percent of responders stated that the video was valuable. Perceived benefit was higher for the hypoglycaemia prevention video than for the brochure (p = 0.016). Those with severe hypoglycaemia the preceding year indicated greater benefit from the hypoglycaemia prevention brochure than others (p = 0.039). Average yearly incidence of severe hypoglycaemia with unconsciousness decreased from 13% in 1994-1996 to 9% (ns) in 1997-1999. The per patient cost of the material was <Euro 10.

    Conclusion. Self-study material can reach high dissemination at a low cost. It also seems to have contributed to a decrease in severe hypoglycaemia, but controlled studies are needed. There is a great need for good quality patient/consumer information materials dealing with aspects of general management and risk prevention in diabetes treatment.

    Emneord
    children and adolescents, education, pedagogical device, prevention, severe hypoglycaemia, type 1 diabetes
    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-13559 (URN)10.1002/pdi.363 (DOI)
    Tilgjengelig fra: 2000-11-29 Laget: 2000-11-29 Sist oppdatert: 2009-08-20
  • 82.
    Nordfeldt, Sam
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Medicinsk teknologiutvärdering. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Pediatrik. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Barn- och ungdomspsykiatriska kliniken.
    Berterö, Carina
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Young Patients' Views on the Open Web 2.0 Childhood Diabetes Patient Portal: A Qualitative Study2012Inngår i: Future Internet, ISSN 1999-5903, E-ISSN 1999-5903, Vol. 4, nr 2, s. 514-527Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Little is known about the views of young patients themselves on interactive Web portal services provided by pediatric practitioners. We aimed to explore their perceptions of a real-world diabetes portal that offers facts and contact with peers and practitioners; e.g., discussion forums, blog tools, self-care and treatment information, research updates and news from local practitioners. Twelve young patients (ages 12–21, median 15 years), one boyfriend, 7 mothers and one father each wrote an essay on their experience from use of the portal. Their essays underwent qualitative content analysis. A major theme was “Helping and facilitating daily life with diabetes”, the portal was perceived as a place where contents are interesting, inspiring and may trigger users’ curiosity. There were three subthemes; “Ease of use in my everyday life,” which includes the perception that the portal was perceived as smooth and easy to enter and navigate whenever needed; that information was easy to understand for different groups of users. “Support via an exchange of experience,” includes the ability to contact peers being regarded advantageous. Some said that just reading others’ experiences can be helpful in terms of persevering; children could find peers in the same age group. “Evidence based information,” includes the perception of the portal being a useful and trustworthy source of facts on e.g., physical activity, blood glucose, medical devices, emotional wellbeing, food and nutrition, and other aspects that impact living with diabetes. Young users expressed positive perceptions towards the interactive web portal. Such services seem to have great potential for supporting young patients and significant others - intergrading for confidence.

  • 83.
    Nordfeldt, Sam
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Barn- och ungdomspsykiatriska kliniken. Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Hanberger, Lena
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Pediatrik. Linköpings universitet, Hälsouniversitetet.
    Berterö, Carina
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Patient and parent views on a Web 2.0 diabetes portal - the management tool, the generator and the gatekeeper: Qualitative study2010Inngår i: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 12, nr 2, s. 1-12Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: The Internet has undergone rapid development, with significant impact on social life and on modes of communication. Modern management of type 1 diabetes requires that patients have access to continuous support and learning opportunities. Although Web 2.0 resources can provide this support, few pediatric clinics offer it as part of routine diabetes care.Objective: We aimed to explore patients’ and parents’ attitudes toward a local Web 2.0 portal tailored to young patients with type 1 diabetes and their parents, with social networking tools such as message boards and blogs, locally produced self-care and treatment information, and interactive pedagogic devices. Opportunities and obstacles to the implementation of Web 2.0 applications in clinical practice were sought.Methods: Participants were 16 mothers, 3 fathers, and 5 young patients (ages 11-18 years; median 14 years) who each wrote an essay on their experience using the portal, irrespective of frequency and/or their success in using it. Two main guiding questions were asked. A qualitative content analysis was conducted of the essays as a whole.Results: Three main categories of portal users’ attitudes were found; we named them “the management tool,” “the generator,” and “the gatekeeper.” One category was related to the management tool functionality of the portal, and a wide range of concrete examples was found regarding useful facts and updates. Being enabled to search when necessary and find reliable information provided by local clinicians was regarded as a great advantage, facilitating a feeling of security and being in control. Finding answers to difficult-to-ask questions, questions portal users did not know they had before, and questions focusing on sensitive areas such as anxiety and fear, was also an important feature. A second category was related to the generator function in that visiting the portal could generate more information than expected, which could lead to increased use. Active message boards and chat rooms were found to have great value for enhancing mediation of third party peer-to-peer information. A certain level of active users from peer families and visible signs of their activity were considered necessary to attract returning users. A third category was related to the gatekeeper function of the password requirement, which created various access problems. This and other unsuccessful experiences caused users to drop the portal. A largely open portal was suggested to enhance use by those associated with the child with diabetes, such as school personnel, relatives, friends and others, and also by young users somewhat unwilling to self-identify with the disease.Conclusions: Web 2.0 services have great potential for supporting parents and patients with type 1 diabetes by enhancing their information retrieval and disease management. Well-developed services, such as this one, may generate continued use and should, therefore, be carefully maintained and updated by health care professionals who are alert and active on the site with new information and updates. Login procedures should be simple and minimized as much as possible. The education of clinical practitioners regarding the use of Web 2.0 resources needs more attention.

  • 84.
    Nordfeldt, Sam
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Barn- och ungdomspsykiatriska kliniken.
    Jonsson, Dick
    Linköpings universitet, Institutionen för medicin och hälsa, Medicinsk teknologiutvärdering. Linköpings universitet, Hälsouniversitetet.
    Short-term effects of severe hypoglycaemia in children and adolescents with type 1 diabetes. A cost-of-illness study2001Inngår i: Acta Paediatrica, ISSN 0001-656X, Vol. 90, nr 2, s. 137-142Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aim of this study was to describe costs and other short-term effects of severe hypoglycaemia in children and adolescents with type 1 diabetes. The study comprised a geographic population of 129 patients <19 y of age with families prospectively registering detailed data after self-reported severe hypoglycaemia. In the period Jan.-Dec. 1998, 16 events were reported with unconsciousness and 95 events without unconsciousness but needing the assistance of another person. Of all events, 20-30% had effects requiring the assistance of people other than parents, school absence, parents' absence from work, extra transport and/or telephone calls. Patient (family) activities were cancelled after 10% (5%) of events. Increased worry for parents was reported after 8% and poor sleep after 7% of events. Hospital visits took place at 5% and hospitalizations at 3% of all events. Patients with severe hypoglycaemia indicated lower global quality of life (p=0.0114). The average socio-economic burden for events of severe hypoglycaemia was estimated at EURO 17,400 yearly per 100 type 1 diabetes patients. Average cost was estimated at EURO 239 per event of severe hypoglycaemia with unconsciousness or EURO 478 yearly per patient with unconsciousness, and EURO 63 per event of severe hypoglycaemia without unconsciousness but needing assistance from another person or EURO 307 yearly per patient in this category. These are conservative estimates and do not include unpaid time and other intangibles, possible road traffic accidents, disabling or premature deaths. Conclusions: The results suggest the potential for socio-economic savings and increased quality of life for patients and families from severe hypoglycaemia prevention programs.

  • 85.
    Nordfeldt, Sam
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Barn- och ungdomspsykiatriska kliniken.
    Jonsson, Dick
    Linköpings universitet, Institutionen för medicin och hälsa, Medicinsk teknologiutvärdering. 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.
    Increasing response rate in data registration and follow-up of type 1 diabetes children and adolescents: A prospective population study 1992–971999Inngår i: Practical Diabetes International, ISSN 1357-8170, Vol. 16, nr 4, s. 101-106Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aims: This study considers how a local diabetes team can develop a system for patient data registration and follow-up to enhance quality control and health economic analysis, and how a high response rate for patient data can be achieved.

    Patients and methods: A geographic population of yearly 120-130 intensively treated type 1 diabetes children. <19 years of age was studied. A prospective patient questionnaire monitored: blood glucose and urine testing, insulin doses, acute complications, medications for hypertension and epilepsy, tobacco and snuff use, and any open questions and needs of the patient. This was completed before every visit to the out-patient department and used as a database for consultation. Data were thereafter registered in regular computer software, and analysed on a yearly basis.

    Results: Response rate increased with time to near 100%. There was a time gain for diabetes nurse and physician. Many patients found the questionnaire good for overviewing treatment and easy to complete, whereas some found it was irksome and boring. The total cost of the method was <160 SEK/patient year.

    Conclusions: A very high patient data response rate can be achieved over years by a patientsupportive questionnaire integrated in the treatment program. Treatment and outcome analysis can then be performed locally at low costs. The combination of a patient questionnaire with regular hard- and software is easy to create, manage and develop. Benefits for diabetes team and patients exceed the total cost.

  • 86.
    Nordfeldt, Sam
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Barn- och ungdomspsykiatriska kliniken.
    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.
    Adverse events in intensively treated children and adolescents with type 1 diabetes1999Inngår i: Acta Paediatrica, ISSN 0001-656X, Vol. 88, nr 11, s. 1184-1193Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The main objective of this study was to examine the relation between adverse events and degree of metabolic control and multiple-dose treatment. A total of 139 children, aged between 1 and 18 y, prospectively registered severe hypoglycaemia with or without unconsciousness, as well as hospitalized ketoacidosis, during 1994-95. Treatment from onset was multiple-dose insulin (> 95% > or = 4 doses) combined with intense training and psychosocial support. Median HbA1c was 6.9% (ref. 3.6-5.4%). The incidence of severe hypoglycaemia with unconsciousness was 0.17 events per patient-year, having decreased from the 1970s to the 1990s, parallel to a change from 1-2 to > or = 4 doses per day. There was no correlation or association to the year mean HbA1c for severe hypoglycaemia. Severe hypoglycaemic episodes in 1995 correlated to severe hypoglycaemic episodes in 1994 (r=0.38; p<0.0001). Severe hypoglycaemia with unconsciousness increased during the spring season, and according to case records the assumed causes were mainly mistakes with insulin, food and exercise. Ketoacidosis was rare: 0.015 episodes per patient-year. We conclude that multiple-dose insulin therapy from the very onset of diabetes, combined with adequate self-control, active problem-based training and psycho-social support, may limit severe hypoglycaemia and ketoacidosis. Strategies aimed at minimizing severe hypoglycaemia without compromising metabolic control need to be evaluated.

  • 87.
    Nordfeldt, Sam
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Barn- och ungdomspsykiatriska kliniken.
    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.
    Seasonal variation of HbA1c in intensive treatment of children with type 1 diabetes2000Inngår i: Journal of pediatric endocrinology and metabolism, ISSN 0334-018X, Vol. 13, nr 5, s. 529-535Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: The aim of this study was to measure whether there is a seasonal variation in glycosylated haemoglobin concentrations and insulin dose used in the intensive treatment of children with type 1 diabetes, and whether such variation is related to severe hypoglycaemia.

    PATIENTS: A geographic population of 114 intensively treated type 1 diabetic patients < 19 years of age, mean 12.7 (SD 4.3) years, with diabetes onset before 1995, were studied in a cohort 1995-96.

    METHODS: HbA1c, insulin doses and severe hypoglycaemia were registered at regular visits scheduled quarterly, but not standardised in time. Seasonal mean values were calculated for HbA1c and insulin dose.

    RESULTS: Lower HbA1c was seen in spring and summer, and higher in autumn and winter (p=0.023). Patients reporting severe hypoglycaemia had a seasonal variation in HbA1c (p=0.019) and a tendency to seasonal variation in insulin dose, while patients not reporting severe hypoglycaemia did not vary in HbA1c or insulin dose.

    CONCLUSIONS: Self-control and adjustment of insulin doses to seasonal change need to be improved also in intensively treated children, with regard to the risk for worsened metabolic control after the summer and increased severe hypoglycaemia in spring and early summer. The findings have important implications for design of short-term studies of metabolic control.

  • 88.
    Nordfeldt, Sam
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Barn- och ungdomspsykiatriska kliniken.
    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.
    Self-study material to prevent severe hypoglycaemia in children and adolescents with type 1 diabetes: A prospective intervention study2002Inngår i: Practical Diabetes International, ISSN 1357-8170, Vol. 19, nr 5, s. 131-136Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aim of this study was to evaluate use of self-study material in diabetes education aimed at prevention of severe hypoglycaemia. Targeted self-study brochures (and video programs) regarding diabetes self-care and prevention of severe hypoglycaemia were mailed to all patients in early 1997 (and in 1999): a geographic population of 122-139 intensively treated type 1 diabetes patients yearly, aged 1-18 years (mean 12.2, SD 4.3), between 1994 and 1999. Yearly mean HbA1c (1.15% below DCCT level) ranged from 4.1 to 11.6% (mean 6.6, SD 1.1), age at onset 0.5-17.4 years (mean 7.6, SD 4.0) and duration 0.1-16.6 years (mean 4.6, SD 3.7). Main outcomes were patient attitudes to the interventions, perceived benefit, level of use, severe hypoglycaemia, and HbA1c.

    Eighty-six percent of responders stated that the video was valuable. Perceived benefit was higher for the hypoglycaemia prevention video than for the brochure (p = 0.016). Those with severe hypoglycaemia the preceding year indicated greater benefit from the hypoglycaemia prevention brochure than others (p = 0.039). Average yearly incidence of severe hypoglycaemia with unconsciousness decreased from 13% in 1994-1996 to 9% (ns) in 1997-1999. The per patient cost of the material was <Euro 10.

    Conclusion. Self-study material can reach high dissemination at a low cost. It also seems to have contributed to a decrease in severe hypoglycaemia, but controlled studies are needed. There is a great need for good quality patient/consumer information materials dealing with aspects of general management and risk prevention in diabetes treatment.

  • 89.
    Nordfeldt, Sam
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Barn- och ungdomspsykiatriska kliniken.
    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.
    Severe hypoglycemia in children with IDDM: A prospective population study, 1992-19941997Inngår i: Diabetes Care, ISSN 0149-5992, Vol. 20, nr 4, s. 497-503Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: Is an increased incidence of severe hypoglycemia an unavoidable effect of improved metabolic control? And, if so, to what extent? RESEARCH DESIGN AND METHODS: In 1992-1994, severe hypoglycemia was prospectively registered in our intensively treated IDDM population, 146 children 1-18 years of age with > 90% of the patients on > or = 4 insulin injections per day. The two categories, "severe hypoglycemia with unconsciousness" (U hypoglycemia) and "severe hypoglycemia without unconsciousness but needing the assistance of another person" (NU hypoglycemia), were analyzed in relation to yearly mean HbAlc levels, insulin doses and proportion of short-acting insulin, age at onset, duration of diabetes, age, sex, and weight-to-height ratio. RESULTS: Yearly mean HbAlc levels improved from 8.1 +/- 1.6% in 1992 to 6.9 +/- 1.3% in 1994. The yearly incidence of U hypoglycemia was 0.15-0.19 events per patient-year, seen in 10-16% of patients, showing no significant increase from 1992-1994. For NU hypoglycemia, slightly increasing figures from 1.01 to 1.26 events per patient-year, seen in 27-38% of patients yearly, were reported. There was no significant correlation between severe (U or NU) hypoglycemia and HbAlc, but still an association was seen in certain calculations. In multiple regression analysis, U hypoglycemia was not related to any factor, but the square root of the rate of NU hypoglycemia was related to lower HbAlc levels (P = 0.0003), higher insulin doses (IU.kg-1.24 h-1) (P = 0.0024), and a lower proportion of short-acting insulin out of the total daily insulin dose (P = 0.031). CONCLUSIONS: Multiple-dose insulin therapy with rather low yearly mean HbAlc values causes a slight increase of NU hypoglycemia but no increase of U hypoglycemia in our population of children with IDDM. Near physiological HbAlc levels may be achieved without any pronounced risk of increasing the incidence of severe hypoglycemia when multiple-injection insulin therapy is combined with adequate self-control based on psychosocial support and active education.

  • 90.
    Nordfeldt, Sam
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Barn- och ungdomspsykiatriska kliniken.
    Ängarne-Lindberg, Teresia
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri. Linköpings universitet, Hälsouniversitetet.
    Berterö, Carina
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    To use or not to use - practitioners' perceptions of an open web portal for young patients with diabetes.2012Inngår i: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 14, nr 6, s. 51-61Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Health care professionals' attitudes can be a significant factor in their acceptance and efficient use of information technology, so they need to have more knowledge about this resource to enhance their participation.

    OBJECTIVE: We explored practitioners' perceptions of using an open-access interactive Web portal tailored to young diabetes type 1 patients and their guardians or significant others. The portal offered discussion forums, blog tools, self-care and treatment information, research updates, and news from local practitioners.

    METHODS: Eighteen professionals who were on pediatric diabetes care teams each wrote an essay on their experience using the portal. For their essays, they were asked to describe two situations, focusing on positive and negative user experiences. The essays were analyzed using qualitative content analysis.

    RESULTS: Based on our analysis of the respondents essays, we identified three categories that describe perceptions of the Web portal. The first category - to use or not to use - included the different perspectives of the practioners; those who questioned the benefits of using the Web portal or showed some resistance to using it. The frequency of use among the practitioners varied greatly. Some practitioners never used it, while others used it on a daily basis and regularly promoted it to their patients. Some respondents in this category reflected on the benefits of contributing actively to online dialogues. In the second category - information center for everyone - practitioners embraced the site as a resource for scientifically sound information and advice. As part of their practice, and as a complement to traditional care, practitioners in this category described sending information through the portal to patients and their significant others. Practitioners felt safe recommending the site because they knew that the information provided was generated by other practitioners. They also assumed that their patients benefited from actively using the Web portal at home: peers brought the site to life by exchanging experiences through the discussion forums. In the third category - developing our practice - practitioners reflected upon the types of information that should be given to patients and how to give it (ie, during in-person appointments or through the Web portal). They perceived meeting with various professionals at other hospitals to update information on the portal and develop content policies as constructive teamwork. Practitioners expressed interest in reading patients' dialogues online to learn more about their views. They also thought about how they could use the portal to adapt more to patients' needs (eg, creating functions so patients could chat with the diabetes nurses and doctors).

    CONCLUSIONS: Practitioners expressed positive perceptions toward a tailored open Web portal. They suggested that future benefits could be derived from systems that integrate factual information and online dialogues between practitioners and patients (ie, exchanging information for everyone's benefit).

  • 91.
    Nordfeldt, Sam
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Barn- och ungdomspsykiatriska kliniken.
    Ängarne-Lindberg, Teresia
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri. Linköpings universitet, Hälsouniversitetet.
    Nordwall, Maria
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Pediatrik. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Barn- och kvinnocentrum, Barn- och ungdomskliniken i Norrköping.
    Ekberg, Joakim
    Folkhälsovetenskap, Högskolan i Skövde, Sweden.
    Berterö, Carina
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Hälsouniversitetet.
    As facts and chats go online, what is important for adolsescents with type 1 diabetes?2013Inngår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, nr 6, s. e67659-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

    Continued refinement of resources for patient information, education and support is needed. Considering the rapid development of new communication practices, the perspectives of young people themselves warrant more attention using a wide research focus. The purpose of this study was to understand information-seeking behaviours, Internet use and social networking online in adolescents with type 1 diabetes (T1DM). This applied to their everyday life, including the context of diabetes and their experiences and need of contact with T1DM peers.

    Methodology/Principal Findings

    Twenty-four adolescents aged 10–17 years with T1DM were recruited from a county hospital in the south-east of Sweden. Qualitative data were obtained using eight focus groups, wherein each participant engaged in a 60–90 minute video/audio-recorded session. The focus group data were transcribed and analysed using qualitative content analysis. Some demographic and medical information was also collected. The three main categories that were identified; Aspects of Security, Updating, and Plainness and their sub-categories gave significant information about how to enhance information retrieval and peer contacts related to T1DM. Regarding the persons' information-seeking behaviour, Internet use, and use of social media some differences could be identified depending on gender and age.

    Conclusions/Significance

    Sensitivity and adaptation to users' needs and expectations seem crucial in the development of future online resources for adolescents with T1DM. To start with, this could mean applying a wider range of already existing information and communication technologies. Health practitioners need to focus on the areas of security of information and communication, frequency of updating, and simplicity of design-less is more.

  • 92.
    Nordfeldt, Sam
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Medicinsk teknologiutvärdering. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Barn- och ungdomspsykiatriska kliniken.
    Ängarne-Lindberg, Teresia
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri. Linköpings universitet, Hälsouniversitetet.
    Nordwall, Maria
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Pediatrik. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Barn- och kvinnocentrum, Barn- och ungdomskliniken i Norrköping.
    Krevers, Barbro
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet.
    Parents of Adolescents with Type 1 Diabetes: Their Views on Information and Communication Needs and Internet Use. A Qualitative Study2013Inngår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, nr 4Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

    Little is known about parents’ views on the use of online resources for information, education and support regarding childhood type 1 diabetes (T1DM). Considering the rapidly evolving new communication practices, parents’ perspectives need to be explored. The main purpose of this paper was to explore parents’ perceptions of their information-seeking, Internet use, and social networking online. This applied to their everyday life, including the contexts of T1DM and contact with peers. A second aim was to identify implications for future development of Internet use in this respect.

    Methodology/Principal Findings

    Twenty-seven parents of 24 young persons aged 10–17 with T1DM participated in eight focus group interviews during their regular visits to a county hospital. Focus group discussions were video/audio-taped, transcribed and analysed using inductive qualitative content analysis. Self-reported demographic and medical information was also collected. A main theme was Finding things out, including two sub-themes, Trust and Suitability. The latter were key factors affecting parents’ perceptions of online resources. Parents’ choice of information source was related to the situation, previous experiences and knowledge about sources and, most importantly, the level of trust in the source. A constantly present background theme was Life situation, including two sub-themes, Roles and functions and Emotions and needs. Parents’ information-seeking regarding T1DM varied greatly, and was closely associated with their life situation, the adolescents development phases and the disease trajectory.

    Conclusions/Significance

    Health practitioners and system developers need to focus on creating trust and suitability for users’ needs. They should understand the children’s diverse needs, which depend on their life situation, on the children’s development, and on the disease trajectory. To enhance trust in online health information and support services, the participation of local practitioners is crucial.

  • 93.
    Nordqvist, Cecilia
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Socialmedicin och folkhälsovetenskap. Linköpings universitet, Hälsouniversitetet.
    Hanberger, Lena
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Pediatrik. Linköpings universitet, Hälsouniversitetet.
    Timpka, Toomas
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Nordfeldt, Sam
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Barn- och ungdomspsykiatriska kliniken. Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi.
    Health professionals' attitudes towards using a Web 2.0 portal for child and adolescent diabetes care: qualitative study.2009Inngår i: Journal of medical Internet research, ISSN 1438-8871, Vol. 11, nr 2, s. e12-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: The Internet, created and maintained in part by third-party apomediation, has become a dynamic resource for living with a chronic disease. Modern management of type 1 diabetes requires continuous support and problem-based learning, but few pediatric clinics offer Web 2.0 resources to patients as part of routine diabetes care. OBJECTIVES: To explore pediatric practitioners' attitudes towards the introduction of a local Web portal for providing young type 1 diabetes patients with interactive pedagogic devices, social networking tools, and locally produced self-care and treatment information. Opportunities and barriers related to the introduction of such systems into clinical practice were sought. METHODS: Twenty clinicians (seven doctors, nine nurses, two dieticians, and two social welfare officers) from two pediatric diabetes teams participated in the user-centered design of a local Web 2.0 portal. After completion of the design, individual semi-structured interviews were performed and data were analyzed using phenomenological methods. RESULTS: The practitioners reported a range of positive attitudes towards the introduction of a local Web 2.0 portal to their clinical practice. Most interviewees were satisfied with how the portal turned out, and a sense of community emerged during the design process and development of the portal's contents. A complementary role was suggested for the portal within the context of health practice culture, where patients and their parents would be able to learn about the disease before, between, and after scheduled contacts with their health care team. Although some professionals expected that email communication with patients and online patient information would save time during routine care, others emphasized the importance of also maintaining face-to-face communication. Online peer-to-peer communication was regarded as a valuable function; however, most clinicians did not expect that the portal would be used extensively for social networking amongst their patients. There were no major differences in attitudes between different professions or clinics, but some differences appeared in relation to work tasks. CONCLUSIONS: Experienced clinical practitioners working in diabetes teams exhibited positive attitudes towards a Web 2.0 portal tailored for young patients with type 1 diabetes and their parents. The portal included provision of third-party information, as well as practical and social means of support. The practitioners' early and active participation provides a possible explanation for these positive attitudes. The findings encourage close collaboration with all user groups when implementing Web 2.0 systems for the care of young patients with chronic diseases, particularly type 1 diabetes. The study also highlights the need for efforts to educate clinical practitioners in the use of Web publishing, social networking, and other Web 2.0 resources. Investigations of attitudes towards implementing similar systems in the care of adults with chronic diseases are warranted.

  • 94.
    Priebe, G.
    et al.
    Lund University.
    Svedin , Carl Göran
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri. Linköpings universitet, Hälsouniversitetet.
    Prevalence, characteristics, and associations of sexual abuse with sociodemographics and consensual sex in a population-based sample of Swedish adolescents2009Inngår i: Journal of Child Sexual Abuse, ISSN 1053-8712, Vol. 18, nr 1, s. 19-39Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The purpose of this study was to investigate lifetime prevalence and characteristics of self-reported child sexual abuse and associations between child sexual abuse, gender, sociodemographic data, and consensual sexual experiences. A questionnaire was completed by 4,339 Swedish high school seniors. Three categories of child sexual abuse were studied: noncontact, contact without penetration, and penetrating child sexual abuse. Penetrating child sexual abuse was correlated with the most severe abuse characteristics. Students reporting child sexual abuse, especially penetrating child sexual abuse, were more likely to not be living with both parents, to have parents with lower socioeconomic status, and to have their first consensual intercourse at a young age. The study showed that distinct categories of child sexual abuse must be employed since each category shows a specific pattern concerning abuse characteristics, sociodemographics, and consensual sex.

  • 95.
    Priebe, Gisela
    et al.
    Lund University.
    Hansson, Kjell
    Lund University.
    Göran Svedin, Carl
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri. Linköpings universitet, Hälsouniversitetet.
    Sexual abuse and associations with psychosocial aspects of health. A population-based study with Swedish adolescents2010Inngår i: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 64, nr 1, s. 40-48Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Few population-based Nordic studies with adolescents investigate the associations between sexual abuse (SA) and psychosocial health. Aim: Associations between adolescents self-reported experiences of SA different severity and aspects of psychosocial health such as emotional and behavioral problems, sense of coherence and self-esteem were investigated. Methods: A school-based study with 1107 Swedish high school seniors was conducted. The students completed the Strengths and Difficulties Questionnaire (SDQ), the Sense of Coherence Scale (SOC), I think I am and a self-report survey that included questions about SA, socio-demographic variables and family variables. Results: SA was related to more emotional and behavioral problems, weaker SOC and lower self- esteem when compared with non-abuse. There was also a dose-response effect insofar as more severe abuse was related to poorer psychosocial health. When adjusted for socio-demographic and family-related variables, the associations between penetrating SA and most of the health variables weakened or disappeared. SOC was associated with penetrating SA even after adjustment. Conclusions: This population-based study suggests that SA should not be regarded as an isolated factor in relation to psychosocial health as the associations at a group level may be smaller than expected. Among a number of covariates, family variables such as parental bonding showed to be especially important. Sense of Coherence may be of special interest in further research and clinical treatment.

  • 96.
    Priebe, Gisela
    et al.
    Lund University.
    Svedin, Carl Göran
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri.
    Child sexual abuse is largely hidden from the adult society An epidemiological study of adolescents disclosures2008Inngår i: Child Abuse and Neglect, ISSN 0145-2134 , Vol. 32, nr 12, s. 1095-1108Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives: The aim of this study was to investigate disclosure rates and disclosure patterns and to examine predictors of non-disclosure in a sample of male and female adolescents with self-reported experiences of sexual abuse.

    Method: A sample of 4,339 high school seniors (2,324 girls, 2,015 boys) was examined with a questionnaire concerning sexual experiences in this study with a focus on disclosure of sexual abuse (non-contact, contact or penetrating abuse, and including peer abuse).

    Results: Of the sample, 1,505 girls (65%) and 457 boys (23%) reported experience of sexual abuse. The disclosure rate was 81% (girls) and 69% (boys). Girls and boys disclosed most often to a friend of their own age. Few had disclosed to professionals. Even fewer said that the incident had been reported to the authorities. Logistic regression showed that it was less likely for girls to disclose if they had experienced contact sexual abuse with or without penetration, abuse by a family member, only a single abuse occasion or if they had perceived their parents as non-caring. Boys were less likely to disclose if they studied a vocational program, lived with both parents or had perceived their parents as either caring and overprotective or non-caring and not overprotective.

    Conclusions: Disclosing sexual abuse is a complex process. Much is hidden from the adult society, especially from professionals and the legal system. Since peers are the most common receivers of abuse information, programs for supporting peers ought to be developed. Differences in disclosure patterns for girls and boys indicate that a gender perspective is helpful when developing guidelines for professionals.

    Practice implications: Professionals, especially in the school system, need to be more aware of the finding that few sexually abused children seek help from professionals or other adults and that support offers should be directly addressed not only to the vulnerable young persons themselves but also to peers who wish to help a friend.

  • 97.
    Priebe, Gisela
    et al.
    Lund University, Sweden .
    Svedin, Carl Göran
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri. Linköpings universitet, Hälsouniversitetet.
    Online or off-line victimisation and psychological well-being: a comparison of sexual-minority and heterosexual youth2012Inngår i: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 21, nr 10, s. 569-582Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The purpose of this study was to compare sexual-minority and heterosexual youths exposure to sexual abuse off-line, problematic sexual meetings off-line with person/s met online and online harassment with regard to prevalence, psychological well-being and support seeking. A nationally representative sample of 3,432 Swedish high school seniors completed an anonymous school-based survey about sexuality, health, sexual abuse and online-related sexual victimisation or harassment. Sexual-minority adolescents reported a greater rate of sexual abuse, problematic sexual meetings off-line with person/s met online and online harassment, compared to heterosexual youth. When compared to non-victimised heterosexual adolescents, victimised heterosexual adolescents and non-victimised and victimised sexual-minority adolescents reported more psychiatric symptoms, lower self-esteem and a weaker sense of coherence. Same-sex sexual orientation was related to more psychiatric symptoms, lower self-esteem and a weaker sense of coherence even when controlled for victimisation and gender. Compared to victimised heterosexual adolescents, victimised sexual-minority adolescents were more likely to seek support because of sexual abuse (females) or Internet-related problems (males and females). Results for sexual-minority youth were basically the same whether sexual orientation was assessed as sexual identity or as sexual or emotional attraction. Health care providers are challenged to not only provide the same care to sexual-minority youth who seek counselling or psychiatric treatment for mental health problems or problems related to victimisation that all adolescents should receive but also to find ways to address topics like prevention of sexual abuse and risk-taking behaviour online or off-line.

  • 98.
    Priebe, Gisela
    et al.
    Institutionen för kliniska vetenskaper, Barn- och ungdomspsykiatri, Lunds universitet.
    Svedin, Carl Göran
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri. Linköpings universitet, Hälsouniversitetet.
    Sälja och köpa sex i Sverige 2011. Förekomst, hälsa och attityder: Delrapport 1 ur Prostitution i Sverige – Kartläggning och utvärdering av prostitutionsgruppernas insatser samt erfarenheter och attityder i befolkningen2012Rapport (Annet vitenskapelig)
    Abstract [sv]

    Syftet med undersökningen är att belysa i vilken omfattning köp och försäljning av sexuella tjänster förekommer i befolkningen år 2011, om det har skett förändringar över tid och hur dessa erfarenheter är relaterade till sexualitet i övrigt, hälsa och sociodemografiska variabler. Vidare undersöks befolkningens attityder till prostitution och åsikter om sexköpslagen. Dessutom undersöks om personer som har köpt eller sålt sexuella tjänster upplever att de har påverkats av sexköpslagen och vad som i förekommande fall har bidragit till att sluta köpa eller sälja sex.

    Metod. Undersökningen genomfördes under tiden maj till juni 2011 som webbenkät i ett stratifierat urval bland medlemmar i en webbpanel. Sammanlagd deltog 5071 personer i åldern 18 till 65 år. Svarsfrekvensen var 50,7 procent. Den ligger i linje med tidigare befolkningsstudier i ämnet (Kuosmanen, 2008; Lewin, 1998). Att relativt många som ingick i urvalet valde att inte delta, ökar resultatens osäkerhet i studierna.

    Resultat. En majoritet av deltagarna instämde i påståendet att försäljning av sex uppstår ur sociala och ekonomiska problem, medan färre instämde i att försäljning av sex borde ses som ett vanligt arbete. Män intog mer positiva attityder till prostitution än kvinnor. En stor del av deltagarna (49,8 % av männen och 80,1 % av kvinnorna) ville behålla sexköpslagen, men få trodde att antalet sexsäljare eller sexköpare hade minskat till följd av lagen. Drygt hälften av deltagarna (37 % av männen och 65 % av kvinnorna) menade att försäljning av sex borde förbjudas i lag.

    Bland deltagarna i undersökningen uppgav 5,0 procent att de någon gång i sitt liv har betalat för att sexuellt vara tillsammans med någon (10,2 % bland männen och 0,1 % bland kvinnorna). Det motsvarar en andel av mellan 260 000 och 330 000 personer i befolkningen. Vidare uppgav 0,7 procent att de någon gång i sitt liv hade tagit emot ersättning som betalning för att vara sexuellt tillsammans med någon (0,8 % bland männen och 0,6 % bland kvinnorna), motsvarande mellan 30 000 och 53 000 personer i befolkningen. En majoritet bland dem som köpt sex har gjort det mellan en och tre gånger och drygt en tiondel har köpt sex fler än tio gånger. Knappt hälften av dem som sålt sex hade gjort det mellan en och tre gånger, en tredjedel hade gjort det mellan fyra och tio gånger och drygt 20 procent hade sålt sex fler än tio gånger.

    Samtidigt som Internet och mobiltelefoni utgör viktiga kontaktarenor i samband med sexköp har olika uteställen fortfarande stor betydelse. Åttio procent av dem som köpt sex, ungefär lika många som i tidigare undersökningar, uppgav att senaste sexköpet hade skett utomlands. En tredjedel av de senaste sexköpen hade skett i samband med arbets- eller tjänsteresor antingen i Sverige eller utomlands. Användning av kondom vid senaste sexköpstillfället rapporterades av 78 procent av dem som köpt sex, men endast av 43 procent av dem som sålt sex. Få män som köpt sex uppgav att de senast hade köpt sex av en man. Samtidigt uppgav fler män än kvinnor att de hade sålt sex och av dessa hade cirka hälften senast sålt sex till en man. Få bland dem som köpt sex och ingen av dem som sålt sex uppgav att sexköpslagen hade påverkat deras beteende. De som hade slutat köpa eller sälja sex uppgav att de inte hade haft något problem med att sluta och endast enstaka personer nämnde att de hade fått informellt eller formellt stöd.

    Vid tidpunkten för undersökningen skilde sig män som köpt sex inte från män som inte köpt sex när det gäller de flesta sociodemografiska faktorerna, men också psykiska symptom och självkänsla. Samtidigt rapporterade män som köpt sex en förhöjd alkohol- eller drogkonsumtion, fler traumatiska händelser under uppväxten och förekomst av våld i pågående eller tidigare parrelationer. De levde ofta ett aktivt sexuellt liv med många samlagspartners, ett aktivt användande av Internet i kärleks- och sexuella syften, men även en förhöjd förekomst av ett tvångsmässigt sexuellt beteende.

    Det framkom också relativt få skillnader mellan män och kvinnor som någon gång i sitt liv sålt sex och de som aldrig sålt sex när det gäller sociodemografiska faktorer, psykiska symptom och självkänsla vid tidpunkten för undersökningen. Män och kvinnor som sålt sex uppgav oftare att de använde droger vid tidpunkten för undersökningen; kvinnor som sålt sex rapporterade också en högre generell alkoholkonsumtion. Kvinnor som sålt sex uppgav fler psykiska symptom och oftare våld i en parrelation än kvinnor som inte sålt sex. Män, dock inte kvinnor, som sålt sex uppgav oftare att de hade utsatts för sexuella handlingar mot sin vilja under uppväxten. Män och i något mindre utsträckning kvinnor som sålt sex hade ofta en aktiv sexuell livsstil med många samlagspartners, men även en förhöjd förekomst av ett tvångsmässigt sexuellt beteende.

    Sammanfattning och rekommendationer. Personer som köper eller säljer sexuella tjänster utgör mycket heterogena grupper. Befolkningsstudien visar att många som köpt eller sålt sex har gjort det ett fåtal gånger och att de som vill sluta med det i regel gör det utan att behöva särskilda insatser. De personer som har kontakt med prostitutionsenheterna har ofta ett tydligare hjälpbehov och framför allt de som har sålt sex har ofta en stor belastning i form av missbruk och psykosociala problem.

    Det är angeläget att insatser för prevention och minskning av prostitution svarar mot att situationen för dem som köper eller säljer sex är mångfacetterad. Även enstaka sexköp innebär ett brott mot lagen och talar för att det finns ett behov av prevention samtidigt som personer med tyngre belastning där köp eller försäljning är en del av en mer omfattande problematik är i behov av individinriktade insatser.

    Med utgångspunkt i resultaten från befolkningsstudien och mot bakgrund av övriga delar av utvärderingen vill vi lyfta fram ett antal punkter av betydelse för det framtida arbetet för att minska prostitutionen. Några av dessa punkter bekräftar de prioriteringar som redan görs medan andra kan behöva uppmärksammas mer än vad som är fallet nu.

    • Många som någon gång i sitt liv köpt eller sålt sex har gjort det enstaka gånger. De slutar utan att behöva något stöd och lever sedan ett vanligt liv. De insatser som kan bli aktuella för denna grupp kan handla om fortsatt och förstärkt information och attitydpåverkan via t.ex. frivilligorganisationer, media och Internet.
    • En stor del av sexköpen sker utomlands eller i samband med arbets- eller tjänsteresor. Vi rekommenderar också en fortsatt uppföljning och utveckling av arbetet med etiska riktlinjer och uppförandekoder inom statsförvaltningen samt en initiering och uppföljning av liknande insatser inom det privata näringslivet inte minst bland olika aktörer inom resebranschen.

    En samordnad satsning för prevention och minskning av prostitution som omfattar ett brett spektrum av insatser i samarbete mellan olika aktörer genomförs och utvärderas i ett av storstadsområdena som exempel på detta kan vara

    • En förstärkning av prostitutionsenheternas arbete med anhöriga till personer som köper sex eller har ett problematiskt sexuellt beteende.
    • En förstärkning av prostitutionsenheternas uppsökande verksamhet i samarbete med hotell- och restaurangbranschen.
    • En förstärkning av prostitutionsenheternas skadereducerande åtgärder i form av kondomutdelning.
    • Utbildning av familjehem och institutioner som tar emot unga i risk att sälja sex.

    Det finns ett samband mellan köp och i viss mån försäljning av sex och ett mycket aktivt sexliv som kan inkludera ett tvångsmässigt sexuellt beteende.

    • Ökade insatser för personer som söker stöd för problematiskt sexuellt beteende kan bidra till att minska prostitutionen även om köp eller försäljning inte står i direkt fokus för insatsen. Detta arbete bedrivs redan idag på prostitutionsenheterna, men behöver även förstärkas i andra sammanhang som till exempel sex- och samlevnadsrådgivning.

    Vi menar att en samtidig och framförallt samordnad satsning kan ge bättre resultat än ett flertal parallella insatser. Resultat från denna befolkningsstudie kan användas som basuppgifter vid uppföljningen av den samordnade satsningen. Vi vill också understryka betydelsen av ett uthålligt och långsiktigt arbete med dessa frågor.

  • 99.
    Proczkowska Björklund, Marie
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri. Linköpings universitet, Hälsouniversitetet.
    Gimbler Berglund, Ingalill
    School of Health Sciences, Jönköping.
    Ericsson, Elisabeth
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Öron- näsa- och halskliniken US.
    Reliability and validity of the Swedish version of the modified Yale Preoperative Anxiety Scale2012Inngår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 56, nr 4, s. 491-497Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: The modified Yale Preoperative Anxiety Scale (m-YPAS) is an observational behavioral checklist that has been widely used as an indicator of pre-operative anxiety in children. The present study describes the translation process of m-YPAS into Swedish and the testing of its reliability and validity when used with Swedish children. less thanbrgreater than less thanbrgreater thanMethods: The questionnaire was translated using standard forward-back-forward translation technique. The validation process was divided into two phases: a pilot study with 61 children as a first version and a test of a final version with 102 children. less thanbrgreater than less thanbrgreater thanResults: The reliability tested with Cronbachs alpha was acceptable to good. Interrater reliability analyzed with weighted kappa was acceptable to good with Students Registered Nurse Anesthetists and Certified Registered Nurse Anesthetist (CRNA) as evaluators (phase 1) and good to excellent with CRNAs very experienced in child anesthesia (phase 2). Both concurrent and constructed validity could be demonstrated. less thanbrgreater than less thanbrgreater thanConclusion: This validation study of the Swedish version of the m- YPAS shows good consistency, interrater validity, and construct validity when used by experienced assessors.

  • 100.
    Proczkowska-Björklund, Marei
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri.
    The Process of Anaesthetic induction with Children2009Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Anaesthetic induction is one of the most stressful experiences a child can have during hospitalization. High anxiety is seen in 50–60% of the children and is associated with less compliance/cooperation during anaesthetic induction. It can also lead to behaviour problems after surgery.

    Important factors that are associated with high anxiety are younger age, withdrawn shy temperament, previous negative experience in the hospital and certain kinds of adult behaviour. This thesis has been done to further illuminate the anaesthetic process and gain more knowledge about child behaviour, parent and staff communication, nurse anaesthetist decision-making communication and the reactions of children after anaesthesia and surgery.

    Materials/Methods: One-hundred and two children between the ages of 3–6 that were scheduled for ENT surgery were video filmed. Screening instruments about child behaviour, fears and parental anxiety were used before the anaesthetic procedure. All children were video filmed during the process until they were at asleep. Parents were interviewed during the operation. Forty-nine children came 14 days after the surgery for a play session that also was video filmed. The video films were then analysed to identify critical situations and behaviours. Parents and nurse communication were categorized. Decision-making communications from the nurse anaethetist were also identified and categorized.

    Results: Four critical situations or reactions were identified, premedication, degree of sedation, compliance during needle insertion or mask on child´s face and the child’s reactions when going to sleep. Each of the situations influenced the next following situation, predicting a higher risk for developing a vicious circle. The first (taking the premedication) was predicted by earlier traumatic hospital experience, if the child placed him/herself nearby or in parent’s lap, hesitant eye contact and highly active parents. The most common type of decision-making category was information, followed by negotiation. Unwillingness to take premedication was associated with more negotiation and less information. A child who takes premedication unwillingly had more often avoidant reactions toward anaesthetic equipment and anaesthetic play after surgery. An anaesthetic induction process is complex and transactional. Previous experience will together with the process of anaesthesia create a new learning history.

    Delarbeid
    1. Child related background factors affecting compliance with induction of anaesthesia.
    Åpne denne publikasjonen i ny fane eller vindu >>Child related background factors affecting compliance with induction of anaesthesia.
    2004 (engelsk)Inngår i: Pediatric Anaesthesia, ISSN 1155-5645, E-ISSN 1460-9592, Vol. 14, nr 3, s. 225-234Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    BACKGROUND: Factors such as age, sex, behaviour problems, fears, earlier traumatic hospital events and reactions to vaccination were assessed together with behaviour observed before premedication in order to evaluate their importance in predicting response to the anaesthetic process. The anaesthetic process was divided into four endpoints; compliance when given premedication, sedation, compliance during needle insertion or when an anaesthetic mask was put in place and behaviour when put to sleep.

    METHODS: A total of 102 children who were undergoing day-stay surgery and overnight stay surgery were video-filmed during premedication and anaesthetic induction. Before premedication the children and parents answered questionnaires about behaviour [Preschool Behaviour Check List (PBCL)] and fears [Fears Survey Schedule for Children-Revised (FSSC-R)]. The films were analysed to assess behaviour before and after premedication and during induction of anaesthesia. A semistructured interview was conducted with the parents during the time the children were asleep. '

    RESULTS: There was a significantly higher odds ratio for noncompliant behaviour during premedication if the child placed itself in the parent's lap or near the parent or had previously experienced traumatic hospital events. The odds ratio for not being sedated by premedication was higher if compliance was low when premedication was given or the child had experienced a traumatic hospital event in the past. A high odds ratio for noncompliant behaviour during venous access or placement of an anaesthetic mask was seen if the child was not sedated or the child had had a negative reaction when vaccinated. The odds ratio for falling asleep in an anxious or upset state was higher if the child had shown noncompliant behaviour during premedication, had not been sedated or had shown noncompliant behaviour during venous access or facemask placement.

    CONCLUSIONS: The overall most important factor that predicts noncompliant behaviour and a distressed state in the child during the anaesthetic process was the experience of earlier traumatic hospital events including negative reaction to vaccination. All elements of the process are important in determining what will happen and all steps will influence how the child reacts when put to sleep.

    sted, utgiver, år, opplag, sider
    Wily InterScience, 2004
    Emneord
    Children, background factors, compliance, anaesthesia induction
    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-17359 (URN)10.1046/j.1460-9592.2003.01185.x (DOI)14996261 (PubMedID)
    Tilgjengelig fra: 2009-03-20 Laget: 2009-03-20 Sist oppdatert: 2017-12-13bibliografisk kontrollert
    2. Communication and child behaviour associated with unwillingness to take premedication.
    Åpne denne publikasjonen i ny fane eller vindu >>Communication and child behaviour associated with unwillingness to take premedication.
    2008 (engelsk)Inngår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 97, nr 9, s. 1238-1242Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    Aim: To see how dominance in adult communication and child behaviour during premedication affects the child's unwillingness to take premedication.

    Method: Ninety-five children scheduled for ENT surgery were video-filmed during premedication. All communication was translated verbatim and the communication was grouped according to; if the parent or nurse directed their communication towards the child or not, or; if they talked about nonprocedural matters or procedural matters.

    Results: Unwillingness to take premedication was associated with more parent communication and less anaesthetic nurse communication compared to willingness to take premedication. There was a heighten risk that the child took their premedication unwillingly if their parent talked more directly to the child (OR = 4.9, p < or = 0.01), the child gave hesitant eye contact with the anaesthetic nurse (OR = 4.5, p < or = 0.05), the child had experienced an earlier traumatic medical procedure (OR = 4.1. p < or = 0.001) or if the child placed her/himself nearby their parent (OR = 4.0, p < or = 0.001).

    Conclusion: Together with behaviour that could be signs of shyness and earlier medical traumatic experience, parents that are actively communicating with their child before premedication may heighten the risk that the child will take the premedication unwillingly.

    sted, utgiver, år, opplag, sider
    WileyScience, 2008
    Emneord
    Behaviour, Child, Compliance, Communication, Premedication
    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-17362 (URN)10.1111/j.1651-2227.2008.00896.x (DOI)18540904 (PubMedID)
    Tilgjengelig fra: 2009-03-20 Laget: 2009-03-20 Sist oppdatert: 2017-12-13bibliografisk kontrollert
    3. Decision making about pre-medication to children.
    Åpne denne publikasjonen i ny fane eller vindu >>Decision making about pre-medication to children.
    2008 (engelsk)Inngår i: Child Care Health and Development, ISSN 0305-1862, E-ISSN 1365-2214, Vol. 34, nr 6, s. 713-720Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    Background: Inviting the child to participate in medical decisions regarding common medical procedures might influence the child's behaviour during the procedures. We wanted to study nurse decision-making communication regarding pre-medication before ear, nose and throat (ENT) surgery.

    Method: In total, 102 children (3-6 years) signed for ENT surgery were video-filmed during the pre-medication process. The nurse decision-making communication was identified, transcribed and grouped in six main categories dependent on the level of participation (self-determination, compromise, negotiation, questioning, information, lack of communication). Associations between child factors (age, gender, verbal communication and non-verbal communication) and different nurse decision-making communication were studied. Associations between the decision-making communication and verbal hesitation and/or the child's compliance in taking pre-medication were also studied.

    Results: Totally, information was the most frequently used category of decision making communication followed by negotiation and questioning. To the children showing signs of shyness, the nurse used more negotiation, questions and self-determination communication and less information. The nurse used more compromise, negotiation and gave less information to children with less compliance. No specific type of nurse decision-making communication was associated with verbal hesitation. The most important predictors for verbal hesitation were none or hesitant eye contact with nurse (OR = 4.5) and placement nearby or in parent's lap (OR = 4.7). Predictors for less compliance in taking pre-medication were verbal hesitation from the child (OR = 22.7) and children who did not give any verbal answer to nurse initial questions (OR = 5.5).

    Conclusion: Decision-making communication could not predict the child's compliance during pre-medication. Although negotiation, questioning and self-determination communication were associated with more unwillingness to take pre-medication. More knowledge is needed about communication to children in medical settings and how it influences the child's behaviours.

    sted, utgiver, år, opplag, sider
    WileyInterScience, 2008
    Emneord
    Anaesthesia premedication, children, compliance, decision-making communication
    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-17363 (URN)10.1111/j.1365-2214.2008.00853.x (DOI)18959568 (PubMedID)
    Tilgjengelig fra: 2009-03-20 Laget: 2009-03-20 Sist oppdatert: 2017-12-13bibliografisk kontrollert
    4. Children's play after anaesthesia and surgery: background factors and associations to behaviour during anaesthetic induction
    Åpne denne publikasjonen i ny fane eller vindu >>Children's play after anaesthesia and surgery: background factors and associations to behaviour during anaesthetic induction
    2010 (engelsk)Inngår i: Journal of Child Health Care, ISSN 1367-4935, E-ISSN 1741-2889, Vol. 14, nr 2, s. 170-178Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    Children can experience anaesthetic induction as fearful and frightening and this can lead to postoperative behaviour changes and symptoms of high anxiety. A fearful experience can also lead to avoidant reactions due to raised negative emotions in situations similar to that, which evoked the fear. To analyse children’s reactions after anaesthesia to anaesthetic play equipment, 49 children (three—six years old) were video-filmed during play with anaesthetic equipment 14 days after anaesthesia and surgery. The risk that the child avoided playing with anaesthetic equipment was increased if the child took the premedication unwillingly and if the child was younger. The risk for not telling about the experience was increased if the child took the premedication unwillingly and if the child showed signs of shyness. The risk for telling mostly unspecific memories increased if the child was younger and if the child showed signs of shyness. Avoidant reactions could bee seen in 50 percent of the children. It is important to be aware of the characteristics of a vulnerable child (age, shyness) and to meet the child without raising negative emotions in any part of the anaesthetic process, in order to avoid negative reactions in future encounters.

    sted, utgiver, år, opplag, sider
    Sage Publications, 2010
    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-17364 (URN)10.1177/1367493509359225 (DOI)000281503600005 ()20212059 (PubMedID)
    Merknad

    At the time of presentation of the thesis was the article in the status "submitted"

    Tilgjengelig fra: 2009-03-20 Laget: 2009-03-20 Sist oppdatert: 2017-12-13bibliografisk kontrollert
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