Slå ring om de minste : En kvalitativ studie om tverrfaglig samarbeid rundt sped- og småbarn i alvorlig risiko

Bakgrunn Tverrfaglig samarbeid har siden slutten av 1960-tallet utviklet seg til å bli en viktig del av det sosialfaglige arbeidet i Norge. Begrepet tidlig innsats har også utviklet seg til å få en sentral rolle i arbeidet med risikoutsatte barn og familier. Dette prosjektet tar utgangspunkt i teorier om tverrfaglig samarbeid og organisasjonsteori. Samtidig brukes teorier om sped- og småbarns utvikling og kunnskap om risiko- og beskyttelsesfaktorer for å si noe om behovet for tverrfaglighet og tidlig innsats. Problemstilling Problemstillingen for dette prosjektet er: Hvilke opplevelser har yrkesutøvere med tverrfaglig samarbeid rundt sped- og småbarn i alvorlig risiko? Metode Dette prosjektet er en kvalitativ studie som baserer seg på semi-strukturerte intervjuer med åtte informanter fra ulike kommuner på Østlandet. Informantene er yrkesutøvere som jobber i barnehage, barnevern, helsestasjon og på barneavdeling ved sykehus. Analysen av datamaterialet er gjort ved å anvende kvalitativ innholdsanalyse som analysemetode. Resultater Gjennom analysen av datamaterialet har jeg identifisert tre kategorier som beskriver resultatene fra intervjuene. Å sikre et helhetsbilde (1) handler om hvordan yrkesutøverne bruker deres ulike kompetanse til å skape et helhetsbilde av barnets og familiens situasjon. Informantene opplever også kompetanseheving på flere områder som viktig for å få til gode tverrfaglige samarbeid. Informantene beskriver også hvordan de opplever taushetspliktens rolle i det tverrfaglige samarbeidet, og da særlig hvordan den påvirker muligheten til å skape et helhetsbilde. Formelle og uformelle kontaktpunkt (2) handler om hvordan yrkesutøverne opplever kontakten med de andre tjenestene. Funnene viser at det er lav terskel for å ta kontakt og det er en utbredt «ingen spørsmål er for små»-holdning blant yrkesutøvere i disse tjenestene. Å sikre fremdrift i samarbeidet (3) handler først og fremst om kontinuitet. Det kan se ut som at informantene opplever kontinuitet og fremdrift som særlig viktig i samarbeid som omhandler sped- og småbarn. Funnene i undersøkelsen viser at felles målsetting i samarbeidsgruppen og rolle- og ansvarsavklaring har betydning for samarbeidsprosessen. Leders holdning til tverrfaglig samarbeid trekkes frem som en viktig faktor når det kommer til å skape positive holdninger blant ansatte. Konklusjon Funnene i denne studien viser at yrkesutøverne i stor grad opplever det tverrfaglige samarbeidet rundt risikoutsatte sped- og småbarn som godt. Det er likevel områder ved det tverrfaglige samarbeide hvor det er stort forbedringspotensial. Organiseringen av det tverrfaglige samarbeidet er varier fra kommune til kommune, men informantene opplever likevel de samme utfordringene. Informantene etterspør mer felles faglig opplegg med de andre tjenestene, de ønsker flere tjenester inn i de tverrfaglige samarbeidsgruppene og de etterspør mer kompetanse om sped- og småbarn. Samtidig som de jobber for å skape et helhetsbilde av barnets og familiens behov, er det også behov får et helhetsbilde på tverrfaglig samarbeid som et system. Mellomrommet mellom tjenestene bør fylles med, som nevnt ovenfor, mer kompetanse, felles fagdager og en helhetlig tverrfaglig ledelse

Factorii de risc pentru paralizia cerebrală în Republica Moldova

University of Oslo, Norvegia, Registrul Paraliziei Cerebrale Norvegia (NCPR), Oslo, Norvegia, Catedra de management și psihologie, USMF „Nicolae Testemiţanu”, Congresul consacrat aniversării a 75-a de la fondarea Universității de Stat de Medicină și Farmacie „Nicolae Testemițanu” din Republica Moldova, Ziua internațională a științei pentru pace și dezvoltareBackground. Cerebral palsy (CP) is a severe neurological condition that occurs in early childhood, causing both mild and severe disability later in life. In-depth study on the potential risk factors can lead to prevention of cases and reduced prevalence of severe forms. Objective of the study. To identify potential risk factors and co-variates among children diagnosed with CP in Moldova in comparison to other developing countries and to industrial developed countries. Material and Methods. Crosssectional, case-control study was performed, with two groups: children with CP (351) and children without CP (417), born in 2009-2010. Complete information was retrieved from the medical records. Descriptive statistics and multivariate logistic regression were applied. Results. Significant risk factors for CP included mother educational level (OR 3.889, 95% CI 2.8-5.25), p=.000), alcohol consumption (OR 1.903, 95% CI 1.23-2.85, p=.000), preeclampsia (OR 2.26, 95% CI 1.5-5.4, p=.000), hyperbilirubinemia (OR 6.3, 95% CI 4.1-9.6, p=.000), breech delivery (OR 3.5, 95% CI 2-6.01, p=.000), assisted vaginal delivery (OR 47, 95% CI 11-194, p=.000), premature rupture of membranes (OR 1.903, 95% CI 1.23-2.85, p=.000). Conclusion. Major risk factors for CP in Moldova differ from those described in developed countries. A national Register for CP in Moldova could be an opportunity to follow up these findings. Introducere. Paralizia cerebrală (PC) – afecțiune neurologică severă care apare în frageda copilărie, provocând dizabilitate de la ușoară la severă pe tot parcursul vieții. Studiul aprofundat asupra potențialilor factori de risc poate duce la prevenirea cazurilor și la prevalența redusă a formelor severe. Scopul lucrării. Identificarea factorilor potențiali de risc și covariantelor în rândul copiilor diagnosticați cu PC în Moldova în comparație cu alte țări în curs de dezvoltare și cu țări industrial dezvoltate. Material și Metode. S-a efectuat un studiu caz-control, transversal, cu două grupuri: copii cu PC (351) și copii fără PC (417), născuți în 2009-2010. Informațiile complete au fost preluate din fișele medicale. Au fost aplicate statistica descriptivă și regresia logistică multivariată. Rezultate. Factorii de risc semnificativi pentru PC au inclus: nivelul de studii al mamei (OR 3.889, IC 95% 2.8-5.25), p = .000), consumul de alcool (OR 1.903, IC 95% 1.23-2.85, p = .000), preeclampsia (OR 2.26 , 95% CI 1.5-5.4, p = .000), hiperbilirubinemia (OR 6.3, IC 95% 4.1-9.6, p = .000), prezentația podalică (OR 3.5, CI 95% 2-6.01, p = .000), nașterea vaginală asistată (OR 47, CI 95% 11-194, p = .000), ruperea prematură a pungii amniotice (OR 1.903, IC 95% 1.23-2.85, p = .000). Concluzii. Factorii de risc majori pentru PC în Moldova diferă de cei descriși în țările dezvoltate. Un registru național pentru PC în Moldova ar putea fi o oportunitate de a urmări aceste constatări

Risk factors for cerebral palsy in Republic of Moldova

State University of Medicine and Pharmacy "Nicolae Testemiteanu" Chișinău, Republic of Moldova, Norvegian Cerebral Palsy Register, University of Oslo, Congresul consacrat aniversării a 75-a de la fondarea Universității de Stat de Medicină și Farmacie „Nicolae Testemițanu” din Republica Moldova, Ziua internațională a științei pentru pace și dezvoltareIntroduction: Cerebral palsy (CP) is a severe neurological condition that occurs in early childhood, causing both mild and severe disability later in life. Indepth study on the potential risk factors can lead to prevention of cases and reduced prevalence of severe forms. Purpose: To identify potential risk factors and covariates among children diagnosed with CP in Moldova in comparison to other developing countries and to industrial developed countries. Material and methods: Cross-sectional, case-control study was performed, with two groups: children with CP (351) and children without CP (417), born in 2009- 2010. Complete information was retrieved from the medical records. Descriptive statistics and multivariate logistic regression were applied. Results: Significant risk factors for CP included mother educational level (OR 3.889, 95% CI 2.8-5.25), p=.000), alcohol consumption (OR 1.903, 95% CI 1.23- 2.85, p=.000), preeclampsia (OR 2.26, 95% CI 1.5-5.4, p=.000), hyperbilirubinemia (OR 6.3, 95% CI 4.1-9.6, p=.000), breech delivery (OR 3.5, 95% CI 2-6.01, p=.000), assisted vaginal delivery (OR 47, 95% CI 11- 194, p=.000), premature rupture of membrains (OR 1.903, 95%CI 1.23-2.85, p=.000). Conclusions: Major risk factors for CP in Moldova differ from those described in developed countries. A national Register for CP in Moldova could be an opportunity to follow up these findings

Anthropometrics of neonates born to mothers with PCOS with metformin or placebo exposure in utero

Introduction: Fetal growth may be affected by both maternal polycystic ovary syndrome (PCOS) and metformin therapy. Here, we explore the effect of intrauterine metformin exposure on birth anthropometrics of infants born to women with PCOS. We also investigated whether the effect of metformin on birth anthropometrics is modified by maternal pre-pregnancy body mass index, PCOS hyperandrogenic phenotype, serum androgen levels, preconception use of metformin and offspring sex. Additionally, we assessed newborn anthropometrics in relation to a national reference population. Material and methods: Individual data from three randomized controlled triasl were pooled. The randomized controlled trials investigated the effects of metformin in pregnant women with PCOS. In all, 397 and 403 were randomized to the metformin and placebo groups, respectively. A Scandinavian growth reference was used to calculate sex and gestational age adjusted z-scores. Linear regression models were used to estimate the effect of metformin on offspring z-scores of head circumference, birth length, birthweight, placental weight, body mass index, ponderal index and birthweight:placental weight ratio. S-testosterone, s-androstenedione, and s-sex-hormone binding globulin from four timepoints in pregnancy were analyzed. Results: Compared with the PCOS-placebo group, newborns in the PCOS-metformin group had larger head circumference (head circumference z-score: mean difference = 0.25, 95% CI = 0.11– 0.40). This effect of metformin on head circumference z-score was particularly observed among offspring of overweight/obese mothers and mothers with hyperandrogenic PCOS-phenotype. We observed no difference in other anthropometric measures between the metformin and placebo groups or any clear interaction between maternal androgen levels and metformin. Newborns in the PCOS-placebo group were shorter than in the reference population (birth length z-score: mean = −0.04, 95% CI = –0.05 to −0.03), but head circumference and birthweight were similar. Conclusions: Larger head circumference was observed at birth in metformin-exposed offspring of mothers with PCOS. PCOS-offspring were also shorter, with a similar birthweight to the reference population, indirectly indicating higher weight-to-height ratio at birth.publishedVersio

Treatment of spasticity in children and adolescents with cerebral palsy in Northern Europe : a CP-North registry study

BackgroundSpasticity is present in more than 80% of the population with cerebral palsy (CP). The aim of this study was to describe and compare the use of three spasticity reducing methods; Botulinum toxin-A therapy (BTX-A), Selective dorsal rhizotomy (SDR) and Intrathecal baclofen therapy (ITB) among children and adolescents with CP in six northern European countries.MethodsThis registry-based study included population-based data in children and adolescents with CP born 2002 to 2017 and recorded in the follow-up programs for CP in Sweden, Norway, Denmark, Iceland and Scotland, and a defined cohort in Finland.ResultsA total of 8,817 individuals were included. The proportion of individuals treated with SDR and ITB was significantly different between the countries. SDR treatment ranged from 0% ( Finland and Iceland) to 3.4% (Scotland) and ITB treatment from 2.2% (Sweden) to 3.7% (Denmark and Scotland). BTX-A treatment in the lower extremities reported 2017-2018 ranged from 8.6% in Denmark to 20% in Norway (pPeer reviewe

CP-North: Living life in the Nordic countries? A retrospective register research protocol on individuals with cerebral palsy and their parents living in Sweden, Norway, Denmark, Finland and Iceland

Export Date: 25 February 2020Peer reviewe

Birth weight, cardiometabolic risk factors and effect modification of physical activity in children and adolescents : pooled data from 12 international studies

Objectives: Low and high birth weight is associated with higher levels of cardiometabolic risk factors and adiposity in children and adolescents, and increases the risk of cardiovascular diseases, obesity, and early mortality later in life. Moderate-to-vigorous physical activity (MVPA) is associated with lower cardiometabolic risk factors and may mitigate the detrimental consequences of high or low birth weight. Thus, we examined whether MVPA modified the associations between birth weight and cardiometabolic risk factors in children and adolescents. Methods: We used pooled individual data from 12 cohort- or cross-sectional studies including 9,100 children and adolescents. Birth weight was measured at birth or maternally reported retrospectively. Device-measured physical activity (PA) and cardiometabolic risk factors were measured in childhood or adolescence. We tested for associations between birth weight, MVPA, and cardiometabolic risk factors using multilevel linear regression, including study as a random factor. We tested for interaction between birth weight and MVPA by introducing the interaction term in the models (birth weight x MVPA). Results: Most of the associations between birth weight (kg) and cardiometabolic risk factors were not modified by MVPA (min/day), except between birth weight and waist circumference (cm) in children (p = 0.005) and HDL-cholesterol (mmol/l) in adolescents (p = 0.040). Sensitivity analyses suggested that some of the associations were modified by VPA, i.e., the associations between birth weight and diastolic blood pressure (mmHg) in children (p = 0.009) and LDL- cholesterol (mmol/l) (p = 0.009) and triglycerides (mmol/l) in adolescents (p = 0.028). Conclusion: MVPA appears not to consistently modify the associations between low birth weight and cardiometabolic risk. In contrast, MVPA may mitigate the association between higher birth weight and higher waist circumference in children. MVPA is consistently associated with a lower cardiometabolic risk across the birth weight spectrum. Optimal prenatal growth and subsequent PA are both important in relation to cardiometabolic health in children and adolescents.publishedVersio

Association between gestational levels of toxic metals and essential elements and cerebral palsy in children

IntroductionCerebral palsy (CP) is the most common motor disability in childhood, but its causes are only partly known. Early-life exposure to toxic metals and inadequate or excess amounts of essential elements can adversely affect brain and nervous system development. However, little is still known about these as perinatal risk factors for CP. This study aims to investigate the associations between second trimester maternal blood levels of toxic metals, essential elements, and mixtures thereof, with CP diagnoses in children.MethodsIn a large, population-based prospective birth cohort (The Norwegian Mother, Father, and Child Cohort Study), children with CP diagnoses were identified through The Norwegian Patient Registry and Cerebral Palsy Registry of Norway. One hundred forty-four children with CP and 1,082 controls were included. The relationship between maternal blood concentrations of five toxic metals and six essential elements and CP diagnoses were investigated using mixture approaches: elastic net with stability selection to identify important metals/elements in the mixture in relation to CP; then logistic regressions of the selected metals/elements to estimate odds ratio (OR) of CP and two-way interactions among metals/elements and with child sex and maternal education. Finally, the joint effects of the mixtures on CP diagnoses were estimated using quantile-based g-computation analyses.ResultsThe essential elements manganese and copper, as well as the toxic metal Hg, were the most important in relation to CP. Elevated maternal levels of copper (OR = 1.40) and manganese (OR = 1.20) were associated with increased risk of CP, while Hg levels were, counterintuitively, inversely related to CP. Metal/element interactions that were associated with CP were observed, and that sex and maternal education influenced the relationships between metals/elements and CP. In the joint mixture approach no significant association between the mixture of metals/elements and CP (OR = 1.00, 95% CI = [0.67, 1.50]) was identified.ConclusionUsing mixture approaches, elevated levels of copper and manganese measured in maternal blood during the second trimester could be related to increased risk of CP in children. The inverse associations between maternal Hg and CP could reflect Hg as a marker of maternal fish intake and thus nutrients beneficial for foetal brain development