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BackgroundAddressing behaviour problems in children is increasingly becoming part of routine care. The question therefore arises as to which workforce members are best suited to deliver structured interventions and what skill sets they might need apart from knowledge of the specific parenting programme offered. ObjectivesTo assess maternal and child health (MCH) nurses' self-perceived confidence in dealing with child behaviour problems. DesignCross-sectional questionnaire study. Data collection occurred prior to cluster randomization in the Families in Mind trial. SettingMCH clinics in nine local government areas in greater Melbourne, in 2010. ParticipantsAll MCH nurses in the nine areas were invited to participate, 153 (79%) completed the survey. Main outcomes measuresNurses' comfort, competency, attitudes and perceived difficulties in dealing with child behaviour problems. ResultsThe majority of nurses (63%) viewed it as their role to deal with, rather than refer, child behaviour problems and felt that the task was rewarding (86%). They believed that parenting advice should be offered universally, rather than only to families with severe problems (94%). Nurses felt rather comfortable and competent to broach and discuss child behaviour problems without need for prior parental request, but somewhat less comfortable and competent to manage child behaviour problems or to make a difference. Experienced nurses (>10 years in practice) felt more comfortable and competent. Nurses described that the major challenge in their dealing with child behaviour problems was parental denial or resistance (60%). ConclusionsMCH nurses are at the frontline of preventive medical services for families with young children where behaviour problems are a common concern. Because managing young children's behaviour problems primarily occurs through adult behaviour change, techniques addressing parent denial and non-compliance, such as motivational interviewing and empowerment should be a pa

Objective To investigate the prevalence of soft markers identified at second trimester ultrasound in a low-risk population and the association of these markers with trisomies and invasive testing. Design Prospective observational study. Setting Swedish University Hospital. Population All women with fetuses examined by ultrasound at 15+0–22+0 weeks gestation between July 2008 and March 2011. Methods Cases with soft markers were compared with non-cases with regard to trisomies and invasive testing. Main outcome measures Prevalence of soft markers, likelihood ratio for trisomies and risk ratio for invasive tests after detection of soft markers. Results Second trimester ultrasound was performed on 10 710 fetuses. Markers were detected in 5.9% of fetuses. 5.1% were isolated, 0.7% were multiple and 0.1% were combined with an anomaly. Presence of markers showed a positive likelihood ratio for Down syndrome, but the association (likelihood ratio = 7.1) was only statistically significant for the combined category of any marker (isolated, multiple or combined with anomaly). The risk ratio for invasive testing after the second trimester ultrasound was 24.0 in pregnancies with isolated soft markers compared with those without markers. Conclusion In a low-risk population, soft markers were found in 5.9% of fetuses at second trimester ultrasound. The likelihood ratio for Down syndrome was significant only for any marker (isolated, multiple or combined with anomaly). The presence of soft markers increased the incidence of invasive procedures substantially. Soft markers should be noted when information on second trimester ultrasound is formulated, and all units performing fetal ultrasound examinations should have established routines concerning information management when soft markers are identified.

OBJECTIVE: To explore the everyday dilemmas of parents living with a child with nocturnal enuresis and to describe their support needs in relation to healthcare professionals. SUBJECTS AND METHODS: The study was conducted in 2011 in Uppsala County, Sweden. Parents of 13 children with enuresis, 10 mothers and three fathers, participated in qualitative semi-structured in-depth interviews, which were analysed using systematic text condensation. RESULTS: The analysis of the material resulted in six themes: enuresis is socially stigmatising and handicapping; all practices and home remedies are tested; it creates frustration in the family; protecting the child from gossip or teasing; support from healthcare providers would have helped; it's something we just have to live with. Two patterns of coping were identified: the Unworried wet-bed-fixers and the Anxious night-launderers. CONCLUSION: Having a child with enuresis can be stressful for parents, although they tried hard not to blame their child. Because parents can feel reluctant to bring up enuresis themselves, they want child health nurses to routinely raise the issue of bedwetting at the yearly check-up. Parents' information needs included causes of and available treatment options for enuresis as well as access to aids and other support for affected families.

Aim To explore Swedish child health nurses' views on their role of involving fathers at the Child Health Centres (CHCs). Methods Interviews with 17 experienced Swedish Child Health nurses nurses were recorded, transcribed and analysed using systematic text condensation. Following the first analysis, the transtheoretical model of behavioural change was used to interpret the results. Results Four themes emerged during the analysis: (1) the nurses' own agenda; (2) nurses' opinion about the father's role; (3) nurses' gatekeeping; and (4) wanting more father involvement. Most nurses were in the precontemplation stage according to the transtheoretical model when they expressed their roles as nurses (Theme 1), how they perceived the father's role within the family (Theme 2) and how they actively encouraged mothers, but not fathers, to visit the CHCs (Theme 3/Mothers are our priority). Nurses in the contemplation stage started to consider involving fathers in the CHCs (Theme 3/The gate is closed...). Still others were in the preparation (Theme 4/Fathers are worthy of change) and action stages (Theme 4/Active in involving fathers), respectively. Conclusion Child Health nurses place more emphasis on engaging mothers than fathers in the services. To increase father involvement, nurses need support to become aware, initiate and maintain action.

BACKGROUND: There is large body of knowledge to support the importance of early interventions to improve child health and development. Nonetheless, it is important to identify cost-effective blends of preventive interventions with adequate coverage and feasible delivery modes. The aim of the Children and Parents in Focus trial is to compare two levels of parenting programme intensity and rate of exposure, with a control condition to address impact and cost-effectiveness of a universally offered evidence-based parenting programme in the Swedish context. METHODS/DESIGN: The trial has a cluster randomised controlled design comprising three arms: Universal arm (with access to participation in Triple P - Positive Parenting Program, level 2); Universal Plus arm (with access to participation in Triple P - Positive Parenting Program, level 2 as well as level 3, and level 4 group); and Services as Usual arm. The sampling frame is Uppsala municipality in Sweden. Child health centres consecutively recruit parents of children aged 3 to 5 years before their yearly check-ups (during the years 2013--2017). Outcomes will be measured annually. The primary outcome will be children's behavioural and emotional problems as rated by three informants: fathers, mothers and preschool teachers. The other outcomes will be parents' behaviour and parents' general health. Health economic evaluations will analyse cost-effectiveness of the interventions versus care as usual by comparing the costs and consequences in terms of impact on children's mental health, parent's mental health and health-related quality of life. DISCUSSION: This study addresses the need for comprehensive evaluation of the long-term effects, costs and benefits of early parenting interventions embedded within existing systems. In addition, the study will generate population-based data on the mental health and well-being of preschool aged children in Sweden.Trial registration: ISRCTN: ISRCTN16513449.

Trots att utvecklingen mot en socialt ansvarstagande skola har pågått under lång tid, så är föräldrastödsprogram som levereras i förskolans regi någonting nytt i Sverige. Närheten till både barn och föräldrar har visat sig vara en utmärkt utgångspunkt för den här typen av verksamhet. Föräldrarna litar på pedagogernas kompetens och känner en trygghet i att de känner deras barn väl. Men det medför också utökade arbetsuppgifter och fördjupade ansvarsområden för pedagogerna, då föräldrastöd går utanför den traditionella verksamheten. Det medför i sin tur att pedagogerna i viss mån får en ny roll i sitt arbete med barnen, och även gentemot föräldrarna. Forskning på området är ytterst sparsam, både i Sverige och internationellt. Anledningen till det är att föräldrastöd på förskola är ovanligt, med hittills endast ett genomfört projekt i Sverige.

Aim: To explore parents' perspectives on providing their preschool child with a healthy lifestyle, including obstacles and resources. Methods: Five semi-structured focus group interviews were conducted, with 30 parents of 4-year-olds in Sweden. Interviews were transcribed verbatim and analysed using Systematic Text Condensation. Results: Four themes emerged from the qualitative analysis: Lifestyle -'The way you live is parents' responsibility', Challenges to promote children's healthy lifestyle, Support from professionals, and peers might facilitate, and Request for an overall responsibility from society. Parents felt that they were role models for their child's lifestyle, a concept including many factors. Attractive and tempting sedentary activities and unhealthy foods were perceived as obstacles, and parents were frustrated by the media's contradictory lifestyle messages. Child health services were expected to more actively invite parents to discuss their child's lifestyle issues. Parents desired some collective responsibility for children's lifestyles through agencies, services and media messages that support and promote healthy choices. Conclusion: Parents struggled to give their children a healthy lifestyle and the 'temptations' of daily unhealthy choices causing hassles and conflicts. Parents desired professional support from preschool, Child Health Care and a collective responsibility from society with uniform guidelines. Parents groups were mentioned as peer support.

By reviewing the literature, we looked at how parental leave policies in Sweden have influenced two well-defined areas of early father involvement: participating in parental leave and at visits/activities at the Child Health Centers. Sweden has one of the most comprehensive and egalitarian parental leave policies in the world, permitting parents to take 480 days off of work, receive 80% of their pay for the first 15 months, and divide their leave however they see fit, barring that both parents receive 2 months of parental leave that is exclusive to them. Additionally, fathers are permitted to take the first ten working days off to be at home with his family. Most parents, especially mothers, use parental leave throughout their infant's first year. During the parents' time off from work, nearly all Swedish parents (95-99%) utilize the Child Health Centers between 11 and 13 times during the infant's first year of life. The Child Health Centers help to monitor a child's growth and development, provide parenting support, immunizations, health education, health screenings, and provide referral sources if the child has any special needs. However, fathers only use 22% of all parental leave days. Studies have pointed out that fathers may not use parental leave because of corporate, maternal, and financial attitudes. Despite the Child Health Centers' policy of including both parents, fathers do not utilize the Child Health Centers to the same extent as mothers. Research has shown that fathers may not use Child Health Centers as they are mainly only open during normal working hours, they are dominated by females (staff and mothers), and many conversations during the child's first year are directed towards mothers. Barriers for why father involvement is lower than mothers are discussed.

This article describes an evaluation of co-producing parenting support services in a rural municipalityin Sweden. The evaluation looked at the implementation process of a series of positive activities for children and their parents, data from the participating parents and the economy of the project. Methods included interviews, questionnaires, observations and a review of protocols, e-mails, and web pages. Both qualitative and quantitative analytical methods were used. We identified two essential components for successful co-production: 1) The balance between the two actors (public and voluntarysector) in terms of interests, commitment and experienced positive impacts and 2) That both actors remain within their core competencies. Parents were satisfied with the number and quality of the activities and reported improvement in their relationship with their child. Costs for the six sessions provided during the project were 1897 SEK/participant for the orienteering club and 2635 SEK/participant for the riding club.

Objective: To investigate women's expectations of routine ultrasound and experiences when soft markers were discovered: what the disclosure meant, how it affected them, how they experienced the information given and why they did or did not choose amniocentesis. Design: Semi-structured, in-depth interviews were conducted with 11 women 25-30 weeks into the pregnancy, 7-13 weeks after the discovery of a soft marker. Findings: Women lacked knowledge about the potential of the scan and detection of soft markers created strong emotional reactions that women thought could have been alleviated by prior information about potential findings. Information in connection with the scan was perceived as insufficient. Decision about amniocentesis was affected by attitudes to disability, anxiety about fetal loss due to the procedure, need for certainty by a diagnostic test, and partner's opinion. Conclusions: Women were shocked by the unexpected and sometimes unwanted information on elevated risk for a chromosomal aberration for which they lacked any preparation. Because this event often has long-lasting effects on the pregnancy, models of information that are efficient in promoting informed decisions are imperative. Practice implications: Both women and their partners need relevant information before and in connection with ultrasound scan to be able to make informed choices.

Aim: To investigate how grandparents influence their young grandchildren's eating behaviors in Chinese three-generation families. Methods: This qualitative study used semi-structured in-depth interviews with 12 parents (3 male and 9 female) and 11 grandparents (4 male and 7 female) in Beijing, China. Results: Three domains emerged in this study: (1) grandparents were the primary caretakers of children in the three-generation families. They played an important role in planning and cooking family meals; (2) grandparents' attitudes influenced young children's nutrition and eating habits. They held the belief that children being heavy at a young age would assure that they had a good nutrition status and would become tall in the future. They showed a tendency towards urging the children to eat more meals and larger portions at served meals; (3) grandparents used food as an educational and emotional tool. They shaped the behavior of their grandchildren and expressed love and caring through food. Conclusions: Grandparents were dominant in shaping children's eating behavior in some three-generation families in Chinese urban areas. Nutrition education involving grandparents is a potential framework for developing a healthy dietary behavior in young children.

Aims The aim of the study was to examine the relationship between participants' views about their role in diabetes treatment and their glycaemic control 3–7 years after having entered an educational intervention, and to investigate whether people's attitudes towards diabetes management change over an extended period of time. Methods The present study is a long-term follow-up analysis of data collected from 193 persons with Type 2 diabetes. A qualitative content analysis of three open-ended questions about participants' self-perceived role in diabetes treatment was used. The related outcome measure was haemoglobin A1c (HbA1c). Results The way people viewed their role in diabetes management affected glycaemic control. Individuals in the Disease Manager or Compliant categories had significantly lower HbA1c compared with those in the Disheartened category. Furthermore, in people whose attitudes towards diabetes treatment was variable, weight and age influenced why participants changed their views and thus switched categories. Paradoxically, when people changed their views, this change did not produce a change in blood glucose control, which would have been expected. Conclusions From the health-care provider's perspective, it is important to know how the person with diabetes perceives his/her role in disease management and to determine if a change in perception would be followed by intervention to adjust glycaemic control. Consequently, individuals' perception of disease management should be incorporated in patient education programmes and routine diabetes care to enable customized care and prevent stagnation in negative roles.

Objective The aim of the present study was to examine parents' reported and desired frequencies (practices vs. attitudes) of their 6-year-old children's meals, nutritional intake and lifestyle components, as well as possible obstacles and desired support with respect to higher or lower educational backgrounds. Design Cross-sectional questionnaire study. Setting Five elementary schools in Uppsala, Sweden. Subjects Parents of 176 6-year-old pupils attending the first grade. The total response rate was 89.7%. Results Parents with a college degree reported that their 6-year-olds had a higher frequency of milk, fruit and vegetable intake, more physical activity and fewer hours watching television compared with parents with a secondary school degree. Congruent to these differences in reported practices, more parents with a college degree desired a higher frequency of milk, fruit and vegetable intake, more physical exercise and less television viewing for their children. Regarding parents' desired meal frequencies during the week, no differences between the groups with higher and lower levels of education were found. Despite similar attitudes, however, parents with a college degree reported that their children ate mostly all meals significantly more often during the week. Both parent groups stated lack of time as the most common obstacle in providing their children with desired lifestyle practices, although parents with a secondary school education added lack of money as a contributing factor. Conclusions As attitudes are not always reflected in reported practices, it seems a fruitful approach to assess both, as well as obstacles perceived by parents, before planning interventions to enhance healthy lifestyle habits in children.