What is good parental education?

The aim of the study was to highlight the experiences and expectations of Swedish parents with respect to general parental education within child healthcare. Interviews were carried out with 25 parents who had attended education sessions. With a few exceptions the fathers did not take part, and those mothers who did comprised a relatively highly educated group; their views therefore predominate in this study. Socially vulnerable parents such as the unemployed and immigrants took part more sporadically in the meetings, which is why less material is available from these groups. The arrangement and analysis of the material was done using qualitative content analysis. We identified two main categories of importance: 'parental education content' and 'parental education structure'. The parents were on the whole satisfied with the content with respect to the child's physical and psychosocial development. On the other hand, first-time parents expressed a degree of uncertainty with respect to the new parent roles and parent relation and they thought that the education should place more emphasis on the interplay between the parents and between child and parents. The degree of confidence in the nurse as group leader was mainly high. The parents thought that the groups functioned well socially and were satisfied with the organization of the meetings. They did, however, demand clearer structure and framework with respect to the content. Since the aim of legally established parental education is to improve the conditions of childhood growth and to provide support to parents, it must be considered especially important to provide resources so that the socially vulnerable groups in the community may also be reached

Hip and fragility fracture prediction by 4-item clinical risk score and mobile heel BMD: a women cohort study

<p>Abstract</p> <p>Background</p> <p>One in four Swedish women suffers a hip fracture yielding high morbidity and mortality. We wanted to revalidate a 4-item clinical risk score and evaluate a portable heel bone mineral density (BMD) technique regarding hip and fragility fracture risk among elderly women.</p> <p>Methods</p> <p>In a population-based prospective cohort study we used clinical risk factors from a baseline questionnaire and heel BMD to predict a two-year hip and fragility fracture outcome for women, in a fracture preventive program. Calcaneal heel BMD was measured by portable dual X-ray laser absorptiometry (DXL) and compared to hip BMD, measured with stationary dual X-ray absorptiometry (DXA) technique.</p> <p>Results</p> <p>Seven women suffered hip fracture and 14 women fragility fracture/s (at hip, radius, humerus and pelvis) among 285 women; 60% having heel BMD ≤ -2.5 SD. The 4-item FRAMO (Fracture and Mortality) Index combined the clinical risk factors age ≥80 years, weight <60 kg, prior fragility fracture, and impaired rise-up ability. Women having 2-4 risk factors showed odds ratio (OR) for hip fracture of 5.9 and fragility fracture of 4.4. High risk group hip fracture risk was 2.8% annually compared to 0.5% for the low risk majority (69%). Heel BMD showed hip fracture OR of 3.1 and fragility fracture OR of 2.6 per SD decrease. For 30 DXA assessed participants mean hip BMD at -2.5 SD level corresponded to a lower BMD at the heel. Five of seven hip fractures occurred within a small risk group of 32 women, identified by high FRAMO Index + prior fragility fracture + heel T-score ≤-3.5 SD.</p> <p>Conclusions</p> <p>In a follow-up study we identified high risk groups for hip and fragility fracture with our plain 4-item risk model. Increased fracture risk was also related to decreasing heel BMD in calcaneal bone, measured with a mobile DXL technique. A combination of high FRAMO Index, prior fragility fracture, and very low BMD restricted the high risk group to 11%, among whom most hip fractures occurred (71%). These practical screening methods could eventually reduce hip fracture incidence by concentrating preventive resources to high fracture risk women.</p

β-cell function and metabolic control in latent autoimmune diabetes in adults with early insulin versus conventional treatment: a 3-year follow-up

Objectives: The optimal treatment of latent autoimmune diabetes in adults (LADA) is not established. We explored whether early insulin treatment, which has shown beneficial effects in rodents and in human pilot studies, would result in better preservation of beta-cell function or metabolic control, compared with conventional treatment. Subjects and methods: Glucagon-stimulated C-peptide and HbAlc were evaluated at baseline and after 12, 24 and 36 months in 37 patients recently diagnosed with diabetes, aged >= 30 years, non-insulin-requiring and GADAb and/or ICA positive. Twenty patients received early insulin and 17 received conventional treatment (diet +/- oral hypoglycaemic agents (OHA), metformin, some and/or sulfonylurea) and insulin when necessary. Results: Level of metabolic control, HbAlc, was preserved in the early insulin treated, while it significantly deteriorated in the conventionally treated. There was no significant difference between the groups in C-peptide after 12, 24 or 36 months, or in the decline of C-peptide. Only baseline C-peptide predicted a C-peptide of >= 0.5 nmol/l at 36 months. Gender, body mass index, antibody titres or HbAlc did not influence the levels of C-peptide or HbAlc at baseline or end-of-study, or the decline in C-peptide. Among the diet +/- OHA-treated, 5/17 (30%) developed insulin dependency during the follow-up. No major hypoglycaemic events occurred. Conclusions: Early insulin treatment in LADA leads to better preservation of metabolic control and was safe. Superior preservation of C-peptide could not be significantly demonstrated. Only baseline level of C-peptide significantly influenced C-peptide level after 3 years. Further studies exploring the best treatment in LADA are warranted. European Journal of Endocrinology 164 239-24

Levels of C-peptide, body mass index and age, and their usefulness in classification of diabetes in relation to autoimmunity, in adults with newly diagnosed diabetes in Kronoberg, Sweden

Objective: C-peptide is a main outcome measure in treatment trials of diabetes. C-peptide also has a role in the classification of diabetes, which is often difficult in adults and this is also increasingly recognised in adolescents and elders. Aim: We aimed to describe the levels of C-peptide in relation to age and body mass index (BMI) in a large population-based cohort of adults with newly diagnosed diabetes and compare the capabilities of C-peptide, age and BMI to discriminate between autoimmune and non-autoimmune diabetes. Subjects and methods: Blood samples from 1180 patients were analysed regarding islet cell antibody, glutamic acid decarboxylase antibody and fasting C-peptide (FCP). Receiver operating characteristics (ROC) curves were analysed to check the ability of age, BMI and C-peptide to discriminate between autoantibody-positive (Ab(+)) and -negative (Ab(-)) diabetes. Results: Mean FCP was 0.73 +/- 0.5 (range 0.13-1.80) nmol/l in the Ab(+) and 1.42 +/- 0.9 (range 0.13-8.30) nmol/l in the Ab(-). FCP was 0.02 nmol/l higher per year increase in age at diagnosis of diabetes. Mean BMI was 26.0 +/- 4.8 (range 18.0-39.0) kg/m(2) in the Ab(+) and 28.9 +/- 5.3 (range 15.5-62.6) kg/m(2) in the Ab(-). FCP increased with age also within each BMI group. The highest area under the curve (AUC) in the ROC analysis was found for C-peptide, followed by age and BMI (0.78, 0.68 and 0.66 respectively). Conclusions: At diagnosis of diabetes, C-peptide was superior to age and BMI in discriminating between autoimmune and non-autoimmune diabetes. C-peptide increased significantly with BMI and age, latter also within each BMI group. Most of the adults had normal or high levels of C-peptide at presentation of diabetes among the autoimmune patients

Identification of a Sex Pheromone Produced by Sternal Glands in Females of the Caddisfly Molanna angustata Curtis

In the caddisfly Molanna angustata, females produce a sex pheromone in glands with openings on the fifth sternite. Gas chromatographic analyses of pheromone gland extracts with electroantennographic detection revealed four major compounds that stimulated male antennae. These compounds were identified by means of gas chromatography–mass spectrometry and enantioselective gas chromatography as heptan-2-one, (S)-heptan-2-ol, nonan-2-one, and (S)-nonan-2-ol in the approximate ratio of 1:1:4:10, respectively. Field tests showed that the mixture of the two alcohols was attractive to males whereas addition of the corresponding ketones reduced trap catches. The sex pheromone of M. angustata, a species in the family Molannidae within the suborder Integripalpia, is similar to the pheromones or pheromone-like compounds previously reported from six other trichopteran families, including members of the basal suborder Annulipalpia. This suggests that minimal evolutionary change of the pheromone chemistry has taken place within the leptoceroid branch of integripalpian Trichoptera compared to the ancestral character state

“Frontbyråkrater” och uppgiftsberoendehandlingsutrymme : En fallstudie av kommunala inspektörer

“Frontbyråkrater” (eng. Street-level bureaucrats), som arbetar i slutet av den offentliga policykedjan, har en viktig roll för hur offentlig policy implementeras. Teorin om frontbyråkrater sägeratt tjänstemän som arbetar i slutet av policykedjan måste tas i beaktande för att fullt ut förståimplementeringen av offentlig policy. Anledningen är att, säger teorin, dessa tjänstemänutformar policy mer än politikerna på grund av det handlingsutrymme och den handlingsfrihet dehar. Med utgångspunkt i teorin om frontbyråkrater och uppfattningen att "handlingsutrymme"ska ses som uppgiftsberoende vill den här studien undersöka vilka faktorer som påverkarhandlingsutrymmet. En fallstudie med flera analysenheter genomfördes för att besvarauppsatsens frågeställningar. Det empiriska materialet består av semistrukturerade intervjuer med8 kommunala inspektörer och en granskning av det legala ramverk som styr deras arbete. Utifrånteorin härleds tre faktorer och ett tentativt analytiskt ramverk konstrueras för analys. Resultatetvisar att det legala ramverket och kontrollmekanismer påverkar arbetsuppgiftens komplexitetvilken i sin tur påverkar det faktiska handlingsutrymmet hos frontbyråkraten. Resultatet stöderuppfattningen att handlingsutrymme ska ses utifrån den uppgift som är för handen varför vidareforskning behöver använda tillvägagångssätt som karakteriseras av en hög grad avkontextualisering. Resultatet visar också, vilket stöds av tidigare forskning, att politiskabeslutsfattare kan stödja implementeringen av policy genom tydligare vägledningar och direktiv

Ett kvartssekel med föräldragrupper i barnhälsovården - var står vi idag?

En trygg föräldrarelation, präglad av värme och rimliga gränser, är en viktig förutsättning för barns hälsa och välfärd och för att de senare i livet ska kunna samspela förtroendefullt med omgivningen. Inom hälso- och sjukvården finns idag en omfattande verksamhet, exempelvis öppna föräldragrupper, vars syfte är att ge stöd i föräldraskapet. En aktuell rapport från Folkhälsoinstitutet visar att en stor del av denna verksamhet fortfarande saknar vetenskaplig evidens, men också att tillgången på evidens ökat dramatiskt under de senaste 10–15 åren. Här redovisas resultaten från tre lokala studier av föräldragrupper inom barnhälsovården, vilka exemplifierar resultaten i Folkhälsoinstitutets rapport