Introduktion: Sundhed og sygdom i relation til børn og unge

I dette nummer af Tidsskrift for Forskning i Sygdom og Samfund sæ er vi fokus på børn; fra de for tidligt fødte til den unge som er på vej ind i et gryende vok- senliv. Hvordan børns sygdom påvirker hverdagsliv, mening, identitet, relationer og forældreskab, samt hvilken betydning det får i velfærdsstaten synes at hænge sammen med en stadig mere udbredt fortælling om barndom og ungdom som sårbare livsstadier, der afspejles i et velfærdsstatsligt fokus på det  ́gode ́ børneliv. Vi undersøger i de e særnummer børns sundhed, sygdom og erfaringer - altså hvordan børns sygdom og sundhed de neres, optræder, forstås og håndteres af børnene selv og i samspil med forældre og omsorgspersoner, af sundhedsvæsenet og af det omkringliggende samfund. Vi har også fokus på børn som slægtninge – eller deres transformation til pårørende – og undersøger, hvad det betyder for børn at leve med en syg forælder. De sociale og institutionelle praksisser, der om- giver børns sundhed og sygdom, og de værdier og normer, der er på spil angående børns sygdom og sundhed, står centralt i de e særnummer

Vi har efterhånden fundet vores egne ben som forældre: Forældreskab og sundhedspleje i spændingsfeltet mellem velfærdsstat og privatsfære

Der er særligt gennem de sidste 50 år sket en intensivering af et børnecentreret forældreskab, som i stigende omfang er orienteret mod børns sundhed og udvikling, hvor brug af ekspertråd er centralt. Præmature børn befinder sig i en forhøjet risiko for komplikationer relateret til sundhed, trivsel og udvikling, og de er ved fødslen oftest med forældrene indlagt gennem en periode på en hospitalsafdeling med specialiseret biomedicinsk ekspertise. Sundhedspleje er en universel velfærdsydelse som næsten alle forældre i Danmark tager imod, hvor Sundhedsstyrelsens medicinsk videnskabeligt informerede anbefalinger angående børns sundhed og udvikling formidles som samtidig støtte og kontrol. Støtten består i at vejlede og informere forældre, og kontrol udøves som en skærpet pligt til underretning ved forhold som sundhedsplejersken finder bekymrende. Brug af sundhedspleje indgår således som ekspertinstans i forældres liv med deres børn. Dette studie tager afsæt i et etnografisk feltarbejde i og omkring danske familier med præmature børn. Det følger familierne i barnets første år, og for enkelte hovedinformanter op til to et halvt år, og det ser på, hvordan forældreskab forhandles i forældres møde med velfærdsstat eksemplificeret gennem sundhedspleje og sundhedspleje-ekspertviden. Vi diskuterer i artiklen, hvordan sundhedsplejensråd tilpasses, omsættes eller forkastes af præmaturforældre, og hvilken indflydelse dette har på konstitueringen af forældreskab. Vi argumenterer for, at mange danske forældre til præmature børn benytter ´hverdags-modstand´ (Scott 1989) som en strategi og en reaktion på ekspertråd med tilpasninger. Dette bliver en måde at agere i det felt, der konstituerer børns liv i den danske velfærdsstat

Medically induced labor:Epidural analgesia and women’s perceptions of pain in early labor

Introduction Approximately 25% of all deliveries in Denmark are medically induced, typically characterized by more intense uterine contractions. The aim of this paper is to investigate the differences in the administration of epidural analgesia and pain experience between spontaneous and medically induced labor in nulliparous and multiparous women. Methods This is a prospective case-controlled study of 100 participating women in labor. The primary outcome was the timing of administration of epidural analgesia, by delivery progression and frequency. Pain scores were indicated by the McGill Pain Questionnaire and the duration of pain was also notified. Results In nulliparous and multiparous women, medically induced labor was associated with earlier administration of epidural analgesia in relation to the onset of labor pain, compared to women with a spontaneous onset of labor (10.4 vs 26.10 hours, p=0.0). There was a trend, however not statistical, in the use of epidural analgesia in relation to delivery progression, assessed as dilation of the cervix (3 cm vs 4.5 cm, p=0.07) and towards higher frequency for medically induced labor (51.5% vs 32.8%, p=0.07). In nulliparous women, a reduced period of labor pain was shown in medically induced deliveries compared to spontaneous deliveries (9.30 vs 19.00 hours, p=0.03). However, no significant differences in experienced pain were shown (Score: 28.70 vs 29.60, p=0.194). Conclusions Epidural analgesia was administered earlier, and duration of experienced pain was shorter in medically induced labor, in comparison to spontaneous deliveries. However, the experienced pain was not different, possibly explained by a more intense labor process

Pharmacokinetics of prednisolone in children: an open-label, randomised, two-treatment cross-over trial investigating the bioequivalence of different prednisolone formulations in children with airway disease

Introduction: One in three Danish children under 3 years of age experience asthma-like symptoms, and one-third will later be diagnosed with asthma. Oral prednisolone is used in various formulations to treat acute asthma. However, the potential differences in bioequivalence between these formulations have never been examined in children despite interchangeable use in clinical practice. Methods and analysis: An open-label, randomised, two-treatment cross-over trial investigating the bioequivalence of different prednisolone formulations in children with airway disease. The included patients (6 months-11 years of age) are admitted to the Department of Paediatric and Adolescent Medicine Nordsjællands University Hospital, Hillerød, with asthma or asthma-like symptoms. The primary objective is to assess the bioequivalence between different prednisolone formulations herein area under the concentration time curve, Cmax and Tmax using saliva samples. The secondary objectives are to evaluate tolerability (five-point face scale), adverse events and severity of the disease. If the patient has an intravenous access for other purposes, the saliva samples will be validated with plasma samples. A total of 66 evaluable patients are needed according to European Medicines Agency Guideline on bioequivalence. Ethics and dissemination: Traditional pharmacokinetic trials are burdensome due to the extent of blood samples necessary to capture the time-dependant drug profile. Saliva sampling is far more acceptable for paediatric patients. In addition, this trial adheres to standard dosing strategies. No additional venepunctures are performed, and no additional prednisolone doses are administered. Guidelines for paediatric bioequivalence trials are warranted

Parents' friends and families in neonatal intensive care units: A cross-national qualitative study on staff perceptions and experiences

Aims and objectivesThis study aimed to explore staff attitudes and experiences of parents' friends and families' social presence and involvement in neonatal intensive care units (NICUs).BackgroundIn NICUs, parents need emotional and practical support during infant hospitalisation. Friends and families of parents may constitute the most significant providers in this support, but few studies are available on when and how these ‘important others’ can be present and involved.DesignThis qualitative descriptive study was based in the philosophical tenets of naturalistic inquiry.MethodsSeven focus groups were conducted where 67 staff from Denmark, Finland, Iceland and Sweden participated. Data were analysed using thematic analysis. The study was reported following the COREQ guidelines and checklist.ResultsThe overarching theme showed that ‘important others’ were an unaddressed group of potential supporters in the periphery. The five identified themes described how staff recognised ‘important others’ as the parents' territory, but that ‘important others'’ presence and involvement needed to be negotiated with staff. Although the staff regarded ‘important others’ as necessary for parents' emotional, practical and social support, they felt less obligated to support them as part of their work remit. The staff also felt that inclusion of ‘important others’ was an essential step forward in achieving family centred care.ConclusionsThe findings indicate that ‘important others'’ involvement was primarily guided by proactive parents and unit care culture rather than by staff's formal written guidelines or guidance. Single-family rooms seemed to enhance the presence and involvement of ‘important others’.Relevance to clinical practiceThere is a need for more staff resources to enable and support the participation of ‘important others’. Parents need to be included during the development of policies to provide their experiences. Finally, more research is needed on what parents wish from their ‘important others’</p