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Tandberg, B. S., Frøslie, K. F., Markestad, T., Flacking, R., Grundt, H. & Moen, A. (2019). Single-family room design in the neonatal intensive care unit did not improve growth. Acta Paediatrica
Open this publication in new window or tab >>Single-family room design in the neonatal intensive care unit did not improve growth
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2019 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227Article in journal (Refereed) Epub ahead of print
Abstract [en]

AIM: The aim was to compare growth in very premature infants cared for in a single-family room and an open-bay unit. We recorded duration of parental presence and skin-to-skin contact as proxies for parental involvement in care of their infants.

METHODS: We consecutively included infants with gestational ages 28+0 through 32+0 weeks at two hospitals in Norway, one single-family room unit (n=35) and one open-bay unit (n=42). Weight, length, and head circumference were followed from birth to four months after term date. Both units adhered to the same nutritional protocol and methods of recording events.

RESULTS: The single-family room mothers spent a mean (standard deviation) of 111 (38) hours and the open bay mothers 33 (13) hours with their infants during the first week and 21 (5) versus 7 (3) hours per day later. The respective duration of skin-to-skin care was 21 (10) versus 12 (8) hours during the first week and 4.2 (2) versus 3.0 (2) hours per day later. The differences were similar, but less pronounced for the fathers. The growth trajectories did not differ between the groups.

CONCLUSION: Single-family room care was associated with more parental involvement, but not with better growth. This article is protected by copyright. All rights reserved.

Keywords
Family-centred care, Growth, Single-family room, Skin-to-skin contact, Very premature infant
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-29461 (URN)10.1111/apa.14746 (DOI)30729563 (PubMedID)
Available from: 2019-02-11 Created: 2019-02-11 Last updated: 2019-02-11Bibliographically approved
Ericson, J., Eriksson, M., Hoddinott, P., Hellström-Westas, L. & Flacking, R. (2018). Breastfeeding and risk for ceasing in mothers of preterm infants - long-term follow-up. Maternal and Child Nutrition, 14(4), Article ID e12618.
Open this publication in new window or tab >>Breastfeeding and risk for ceasing in mothers of preterm infants - long-term follow-up
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2018 (English)In: Maternal and Child Nutrition, ISSN 1740-8695, E-ISSN 1740-8709, Vol. 14, no 4, article id e12618Article in journal (Refereed) Published
Abstract [en]

Breastfeeding is challenging for mothers of preterm infants. The aim of this paper is to describe risk factors for ceasing breastfeeding and methods of feeding until 12 months postnatal age in mothers who breastfed their preterm infants at discharge from neonatal intensive care units (NICUs). The data come from a randomised controlled trial, which evaluated the effectiveness on exclusive breastfeeding at 8 weeks of proactive telephone support compared with reactive support offered to mothers of preterm infants following discharge from NICU. Six NICUs across Sweden randomised a total of 493 mothers. We used regression and survival analyses to assess the risk factors for ceasing breastfeeding and the long-term outcomes of the intervention. The results showed that 305 (64%) of the infants were breastfed at 6 months and 49 (21%) at 12 months. Partial breastfeeding at discharge, low maternal educational level, and longer length of stay in the NICU increased the risk for ceasing breastfeeding during the first 12 months. Furthermore, the Kaplan-Meier analysis showed that the proportion of mothers who ceased breastfeeding did not differ between the intervention (n = 231) and controls (n = 262) during the first 12 months (log-rank test p = .68). No difference was found between groups on method of feeding. More than 85% of the infants were fed directly at the breast. These findings provide important insights for health professionals who are supporting mothers of preterm infants to breastfeed long term.

Registered in www.clinicaltrials.gov (NCT01806480).

Keywords
RCT, bottle, breast milk, feeding, mother, neonatal
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-27651 (URN)10.1111/mcn.12618 (DOI)000448900800013 ()29733102 (PubMedID)2-s2.0-85046532136 (Scopus ID)
Note

Open Access APC beslut 11/2018

Available from: 2018-05-09 Created: 2018-05-09 Last updated: 2018-11-15Bibliographically approved
Maastrup, R., Haiek, L. N., Lubbe, W., Meerkin, D. Y., Wolff, L., Hatasaki, K., . . . O'Donoghue, D. (2018). Compliance with the Baby-friendly Hospital Initiative for Neonatal Wards (Neo-BFHI): A cross-sectional study in 36 countries. Maternal and Child Nutrition, Article ID e12690.
Open this publication in new window or tab >>Compliance with the Baby-friendly Hospital Initiative for Neonatal Wards (Neo-BFHI): A cross-sectional study in 36 countries
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2018 (English)In: Maternal and Child Nutrition, ISSN 1740-8695, E-ISSN 1740-8709, article id e12690Article in journal (Refereed) Epub ahead of print
Abstract [en]

In 2012, the Baby-friendly Hospital Initiative for Neonatal Wards (Neo-BFHI) began providing recommendations to improve breastfeeding support for preterm and ill infants. This cross-sectional survey aimed to measure compliance on a global level with the Neo-BFHI's expanded Ten steps to Successful Breastfeeding and three Guiding Principles in neonatal wards. In 2017 the Neo-BFHI Self-Assessment questionnaire was used in 15 languages to collect data from neonatal wards of all levels of care. Answers were summarized into compliance scores ranging from 0 to 100 at the ward, country and international levels. A total of 917 neonatal wards from 36 low, middle and high-income countries from all continents participated. The median international overall score was 77, and median country overall scores ranged from 52 to 91. Guiding Principle 1 (respect for mothers), Step 5 (breastfeeding initiation and support), and Step 6 (human milk use) had the highest scores, 100, 88, and 88, respectively. Steps 3 (antenatal information) and 7 (rooming-in) had the lowest scores, 63 and 67, respectively. High-income countries had significantly higher scores for Guiding principle 2 (family-centered care), Step 4 (skin-to-skin contact) and Step 5. Neonatal wards in hospitals ever-designated Baby-friendly had significantly higher scores than those never designated. Sixty percent of managers stated they would like to obtain Neo-BFHI designation. Currently, Neo-BFHI recommendations are partly implemented in many countries. The high number of participating wards indicates international readiness to expand Baby-friendly standards to neonatal settings. Hospitals and governments should increase their efforts to better support breastfeeding in neonatal wards.

Keywords
Baby-friendly Hospital Initiative, breastfeeding, compliance, lactation, monitoring, neonatal, preterm
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-28487 (URN)10.1111/mcn.12690 (DOI)30198645 (PubMedID)
Available from: 2018-09-17 Created: 2018-09-17 Last updated: 2018-09-17Bibliographically approved
Tandberg, B. S., Frøslie, K. F., Flacking, R., Grundt, H., Lehtonen, L. & Moen, A. (2018). Parent-infant closeness, parents' participation, and nursing support in single-family room and open bay NICUs. Journal of Perinatal & Neonatal Nursing, 32(4), E22-E32
Open this publication in new window or tab >>Parent-infant closeness, parents' participation, and nursing support in single-family room and open bay NICUs
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2018 (English)In: Journal of Perinatal & Neonatal Nursing, ISSN 0893-2190, E-ISSN 1550-5073, Vol. 32, no 4, p. E22-E32Article in journal (Refereed) Published
Abstract [en]

This was a prospective survey study, comparing parent-infant closeness, parents' perceptions of nursing support, and participation in medical rounds in single-family room (SFR) and an open bay (OB) neonatal intensive care units. Nurses' assessments of provided support were also measured. In total, 115 parents of 64 preterm infants less than 35 weeks' gestational age and 129 nurses participated. Parents recorded the presence and skin-to-skin care. Parents were sent 9 text message questions in random order. Nurses answered corresponding Internet-based questions. SFR mothers were more present, 20 hours daily (median) versus 7 hours (P < .001), initiated skin-to-skin contact (SSC) at 4 versus 12 hours (P = .03), and preformed SSC 180 min/24 h versus 120 min/24 h for mothers in the OB unit (P = .02). SFR fathers were also more present, 8 versus 4 hours (P < .001), initiated SSC at 3 versus 40 hours (P = .004), and performed SSC 67 min/24 h versus 31 min/24 h (P = .05). SFR parents rated participation in medical rounds and emotional support higher than OB parents. Parental trust was rated higher by nurses in the OB unit (P = .02). SFR facilitated parent-infant closeness, parents' participation in medical rounds, and increased support from nurses.

National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-28848 (URN)10.1097/JPN.0000000000000359 (DOI)000450894700003 ()30358674 (PubMedID)2-s2.0-85055610909 (Scopus ID)
Available from: 2018-10-29 Created: 2018-10-29 Last updated: 2019-02-19Bibliographically approved
Randell, E., Joffer, J., Flacking, R., Starrin, B. & Jerdén, L. (2018). Pride, shame and health among adolescents – a cross-sectional survey. International Journal of Adolescent Medicine and Health, 30(6), Article ID 20160107.
Open this publication in new window or tab >>Pride, shame and health among adolescents – a cross-sectional survey
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2018 (English)In: International Journal of Adolescent Medicine and Health, ISSN 0334-0139, E-ISSN 2191-0278, Vol. 30, no 6, article id 20160107Article in journal (Refereed) Published
Abstract [en]

Background

Pride and shame are important emotions known to influence identity development and psychological well-being in adolescence. Research evidence indicates that self-rated health (SRH) is a strong predictor of future health. This cross-sectional study, conducted during 2008–2009, aimed to investigate the associations between pride, shame and SRH among adolescent boys and girls.

Methods

The study sample comprised 705 adolescents in Sweden aged 17–18 years (318 boys and 387 girls) who completed a questionnaire that included items on SRH, shame and pride (participation rate 67%). Logistic regression analyses (univariable and multivariable) were used to investigate the associations between pride and shame as separate and combined constructs on SRH, adjusting for potential confounders (country of birth, parental educational level, school experience, having enough friends, mood in family and being active in associations).

Results

Pride and shame separately were significantly associated with SRH in both genders. Logistic regression analysis of the pride-shame model showed that the odds of having lower SRH were highest in boys and girls with lower pride-higher shame. In a multivariable logistic regression analysis of the pride-shame model the odds of having lower SRH remained significant in boys and girls with lower pride-higher shame [boys: odds ratio (OR) 3.51, confidence interval (CI) 1.40–8.81; girls: OR 2.70, CI 1.22–5.96] and in girls with lower pride-lower shame (OR 2.16, CI 1.02–4.56).

Conclusion

The emotions of shame and pride are associated with SRH in adolescence. Experiencing pride seems to serve as a protective mechanism in SRH in adolescents exposed to shame. We believe that this knowledge should be useful in adolescent health promotion.

Keywords
adolescent, health status, pride, priding, self-rated health, shame, shaming, Sweden
National Category
Health Sciences
Research subject
Health and Welfare, Hälsa ur ett ungdomsperspektiv
Identifiers
urn:nbn:se:du-25270 (URN)10.1515/ijamh-2016-0107 (DOI)2-s2.0-85059687925 (Scopus ID)
Available from: 2017-06-21 Created: 2017-06-21 Last updated: 2019-01-21Bibliographically approved
Ericson, J., Eriksson, M., Hellström-Westas, L., Hoddinott, P. & Flacking, R. (2018). Proactive telephone support provided to breastfeeding mothers of preterm infants after discharge: a randomised controlled trial. Acta Paediatrica, 107(5), 791-798
Open this publication in new window or tab >>Proactive telephone support provided to breastfeeding mothers of preterm infants after discharge: a randomised controlled trial
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2018 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 107, no 5, p. 791-798Article in journal (Refereed) Published
Abstract [en]

AIM: The aim was to evaluate the effectiveness of proactive telephone support provided to breastfeeding mothers of preterm infants after discharge from neonatal intensive care units (NICU).

METHODS: Between March 2013 and December 2015, a randomised controlled trial was conducted at six NICUs across Sweden. At each NICU, a breastfeeding support team recruited, randomised and delivered the support to participating mothers. The intervention group received a daily proactive telephone call up to 14 days after discharge from the support team. The control group could initiate telephone contact themselves. Primary outcome was exclusive breastfeeding eight weeks after discharge. Secondary outcomes were maternal satisfaction with breastfeeding, attachment, quality of life and parental stress.

RESULTS: In total, 493 mothers were randomised, 231 to intervention group and 262 to control group. There were no differences between the groups for exclusive breastfeeding, odds ratio 0.96, 95% CI 0.66-1.38, nor for maternal satisfaction with breastfeeding, attachment or quality of life. The intervention group reported significantly less parental stress than the controls, t=2.44, 95% CI 0.03-0.23, effect size d=0.26.

CONCLUSION: In this trial, proactive telephone support was not associated with increased exclusive breastfeeding prevalence eight weeks following discharge. However, intervention group mothers showed significantly lower parental stress. This article is protected by copyright. All rights reserved.

Keywords
Breast milk, discharge, neonatal, person-centred, preterm births
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-27209 (URN)10.1111/apa.14257 (DOI)000430115100012 ()29405368 (PubMedID)2-s2.0-85045438738 (Scopus ID)
Note

Open Access APC beslut 3/2018

Available from: 2018-02-14 Created: 2018-02-14 Last updated: 2018-12-13Bibliographically approved
Flacking, R. (2018). The neonatal environment and the long-term impact of neonatal care.
Open this publication in new window or tab >>The neonatal environment and the long-term impact of neonatal care
2018 (English)Other (Other (popular science, discussion, etc.))
National Category
Nursing
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-29012 (URN)
Available from: 2018-12-05 Created: 2018-12-05 Last updated: 2018-12-05Bibliographically approved
Osman, F., Flacking, R., Schön, U.-K. & Klingberg-Allvin, M. (2017). A support program for Somali-born parents on children's behavioral problems. Pediatrics, 139(3)
Open this publication in new window or tab >>A support program for Somali-born parents on children's behavioral problems
2017 (English)In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 139, no 3Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: The objectives of this study were to evaluate a culturally tailored parenting support program (Ladnaan) for Somali-born parents and to determine its effectiveness on children’s emotional and behavioral problems.

METHODS: This randomized controlled trial included 120 Somali-born parents with children aged 11 to 16 years. The parents reported self-perceived stress in relation to parenting practices. The intervention consisted of culturally tailored societal information combined with the parenting program Connect. Parents received 12 weeks of intervention, 1 to 2 hours each week, in groups of 12 to 17 parents. Nine group leaders with a Somali background who received a standardized training program delivered the intervention. The primary outcome was a decrease in emotional and behavioral problems based on a Child Behavior Checklist. Parents were randomly allocated either to an intervention group or a wait-list control group. Covariance analyses were conducted according to intention-to-treat principles.

RESULTS: The results showed significant improvement in the children in the intervention group for behavioral problems after a 2-month follow-up. The largest effect sizes according to Cohen’s d were in aggressive behavior (95% confidence interval [CI], 1.06 to 3.07), social problems (95% CI, 0.64 to 1.70), and externalizing problems (95% CI, 0.96 to 3.53).

CONCLUSIONS: The large effect sizes in this study show that this 12-week culturally tailored parenting support program was associated with short-term improvements in children’s behavior. The study adds to the field of parenting interventions by demonstrating how to culturally tailor, engage, and retain parenting programs for immigrant parents.

National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-23732 (URN)10.1542/peds.2016-2764 (DOI)28235795 (PubMedID)
Available from: 2016-12-26 Created: 2016-12-26 Last updated: 2017-12-19Bibliographically approved
Osman, F., Salari, R., Klingberg-Allvin, M., Schön, U.-K. & Flacking, R. (2017). Effects of a culturally tailored parenting support programme in Somali-born parents' mental health and sense of competence in parenting: a randomised controlled trial. BMJ Open, 7(12), Article ID e017600.
Open this publication in new window or tab >>Effects of a culturally tailored parenting support programme in Somali-born parents' mental health and sense of competence in parenting: a randomised controlled trial
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2017 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, no 12, article id e017600Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To evaluate the effectiveness of a culturally tailored parenting support programme on Somali-born parents' mental health and sense of competence in parenting.

DESIGN: Randomised controlled trial.

SETTING: A city in the middle of Sweden.

PARTICIPANTS: Somali-born parents (n=120) with children aged 11-16 years and self-perceived stress in their parenting were randomised to an intervention group (n=60) or a waiting-list control group (n=60).

INTERVENTION: Parents in the intervention group received culturally tailored societal information combined with the Connect parenting programme during 12 weeks for 1-2 hours per week. The intervention consisted of a standardised training programme delivered by nine group leaders of Somali background.

OUTCOME: The General Health Questionnaire 12 was used to measure parents' mental health and the Parenting Sense of Competence scale to measure parent satisfaction and efficacy in the parent role. Analysis was conducted using intention-to-treat principles.

RESULTS: The results indicated that parents in the intervention group showed significant improvement in mental health compared with the parents in the control group at a 2-month follow-up: B=3.62, 95% CI 2.01 to 5.18, p<0.001. Further, significant improvement was found for efficacy (B=-6.72, 95% CI -8.15 to -5.28, p<0.001) and satisfaction (B=-4.48, 95% CI -6.27 to -2.69, p<0.001) for parents in the intervention group. Parents' satisfaction mediated the intervention effect on parental mental health (β=-0.88, 95% CI -1.84 to -0.16, p=0.047).

CONCLUSION: The culturally tailored parenting support programme led to improved mental health of Somali-born parents and their sense of competence in parenting 2 months after the intervention. The study underlines the importance of acknowledging immigrant parents' need for societal information in parent support programmes and the importance of delivering these programmes in a culturally sensitive manner.

CLINICAL TRIAL REGISTRATION: NCT02114593.

Keywords
child protection, community child health, mental health, public health
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-26770 (URN)10.1136/bmjopen-2017-017600 (DOI)000423826700065 ()29222136 (PubMedID)
Note

Open Access APC beslut 26/2017

Available from: 2017-12-13 Created: 2017-12-13 Last updated: 2018-02-22Bibliographically approved
Ericson, J., Flacking, R. & Udo, C. (2017). Mothers' experiences of a telephone-based breastfeeding support intervention after discharge from neonatal intensive care units - a mixed-method study. International Breastfeeding Journal, 12(1), Article ID 50.
Open this publication in new window or tab >>Mothers' experiences of a telephone-based breastfeeding support intervention after discharge from neonatal intensive care units - a mixed-method study
2017 (English)In: International Breastfeeding Journal, ISSN 1746-4358, E-ISSN 1746-4358, Vol. 12, no 1, article id 50Article in journal (Refereed) Published
Abstract [en]

Background: After discharge from a neonatal intensive care unit (NICU), many mothers of preterm infants (gestational age<37 weeks) experience a lack of support for breastfeeding. An intervention study was designed to evaluate the effects of proactive (a daily telephone call initiated by a member of a breastfeeding support team) and/or reactive (mothers could call the breastfeeding support team) telephone based breastfeeding support for mothers after discharge from the NICU. The mothers in the intervention group had access to both proactive and reactive support; the mothers in the control group only had access to reactive support. The aim of this study was to explore the mothers' experiences of the proactive and reactive telephone support.

Methods: This study was a qualitatively driven, mixed-method evaluation using three data sources: questionnaires with qualitative open-ended questions, visual analogue scales and telephone interviews. In total, 365 mothers contributed data for this study. The qualitative data were analysed with an inductive thematic network analysis, while the quantitative data were analysed with Student's t-test and the chi-square test.

Results: Proactive support contributed to greater satisfaction and involvement in breastfeeding support. The mothers who received proactive support reported that they felt strengthened, supported and secure, as a result of the continuous care provided by staff who were knowledgeable and experienced (i.e., in breastfeeding and preterm infants), which resulted in the global theme 'Empowered by proactive support'. The mothers who received reactive support experienced contradictory feelings; some felt secure because they had the opportunity to call for support, whereas others found it difficult to decide when and if they should use the service, which resulted in the global theme; 'Duality of reactive support'.

Conclusion: There were positive aspects of both proactive (i.e., greater satisfaction and feelings of empowerment) and reactive support (i.e., the opportunity to call for support); however, the provision of reactive support alone may be inadequate for those with the greatest need for support as they are the least likely to access it.

Keywords
Breastfeeding, Mixed method, Neonatal, Preterm infant, Support, Telephone, Thematic network analysis
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-26808 (URN)10.1186/s13006-017-0142-9 (DOI)29270208 (PubMedID)
Available from: 2017-12-15 Created: 2017-12-15 Last updated: 2018-12-13Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-4013-1553

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