Planting a seed - child health care nurses’ perceptions of speaking to parents about overweight and obesity : a qualitative study within the STOP project

Background Nurses in child health care (CHC) centers in Sweden play a key role in the early detection and management of childhood overweight/obesity, through meeting families early, regularly and over many years. However, research focusing on CHC nurses’ perceptions of their role in childhood overweight/obesity management is scarce. As part of the EU-funded project “Science and Technology in childhood Obesity Policy” (STOP), this study examines CHC nurses’ perceptions of speaking to parents about children’s overweight/obesity and of their role in referring children to treatment for overweight/obesity. Methods All registered CHC nurses in Stockholm County (n = 442) received an email invitation letter explaining the study. Individual face-to-face visits (n = 15) in selected centers, and phone calls (n = 24) to nurses working in these centres were also conducted. In total, 17 CHC nurses (all female, average work experience 6.7 years (SD ± 4.9 years)) from 10 municipalities (including four of the top five municipalities with the highest prevalence of overweight and obesity) in Stockholm County were interviewed. The interviews were conducted by phone, transcribed and analyzed using thematic analysis. Results Two main themes were developed through the analysis: 1) The relationship between the nurse and the parent and 2) Glitch in the system. Under the first theme, nurses reported that weight-related discussions were facilitated by building and maintaining trust with parents. However, nurses also said they were reluctant to address children’s weights if this could compromise parents’ trust. Under the second theme, nurses highlighted several organizational barriers to addressing a child’s weight with parents, including insufficient cooperation with other healthcare providers and limited time for visits. Nurses also identified lack of sufficient knowledge about what to offer the family and lack of confidence in their communication skills as additional barriers. Conclusions We found that pediatric nurses perceive relational and organizational factors as barriers to address childhood obesity with parents. To improve care, it is necessary to provide nurses with continuing education about obesity and communication skills and organizational support to improve communication within the healthcare system

Within-site adaptation: growth and mortality of Norway spruce, Scots pine and silver birch seedlings in different planting positions across a soil moisture gradient

Adapting to site conditions is a central part of forest regeneration and can be done through selec-tion of different planting positions. Requirements are tree species specific, and the use of soil moisture maps could be a way to support decision making in forest regeneration planning. At two experimental sites with varying soil moisture conditions in southern Sweden Norway spruce (Picea abies (L.) Karst.), Scots pine (Pinus sylvestris L.), and silver birch (Betula pendula Roth) seedlings were planted in four different planting positions following mounding site preparation; Depression, Hinge, Mound and Unscarified. Soil moisture estimates were obtained from a high-resolution depth-to-water raster for each planting spot. The effect of soil moisture, planting position and their interactions on mortality, height and diameter was evaluated for each tree species. In wet conditions mounds proved to be the best option to minimize seedling mortality for conifers, but with decreasing soil moisture, differences between the planting positions decreased. Birch on the other hand had the greatest survival in the hinge. The coniferous species displayed increased height and diameter when planted in mounds independent of the soil moisture conditions, whereas silver birch was less dependent on a specific planting position. Results from this study shows that a soil moisture map can explain mortality, height and diameter and thus can be a useful tool when choosing planting position in different soil moisture conditions

Successful spruce regenerations - impact of site preparation and the use of variables from digital elevation models in decision-making?

Various site preparation methods are used in Swedish forestry. However, some methods can lead to unnecessary disturbance, which could be avoided by using variables from digital elevation models in management decisions. The current study aimed to investigate how different site preparation methods, and their intensities, affect Norway spruce (Picea abies (L.) Karst.) regeneration. Additional aims were to clarify how these methods affect soil disturbance and vegetation development, along with how variables from digital elevation models could be used in silvicultural decision-making. Experimental sites were established in southern Sweden to assess five different site preparation treatments with different planting densities: (1) conventional disc trenching 2500 seedlings/ha (DT2500); (2) low intensity disc trenching 1250 seedlings/ha (LDT1250); (3) low intensity disc trenching 2500 seedlings/ha (LDT2500); (4) low-intensity patch-wise 1250 seedlings/ha (PW1250); and (5) patch-wise 2500 seedlings/ha (PW2500). Site preparation intensity had no effect on seedling growth and, survival or vegetation development; the tested treatments differed in terms of soil disturbance. Planting spot properties and weather conditions influenced the seedling performance. DTW and slope could not substantially explain either seedling growth or survival. The results indicate that the choice of site preparation method should consider flexibility when planting while adapting the level of disturbance accordingly

General anxiety, depression, and physical health in relation to symptoms of heart-focused anxiety- a cross sectional study among patients living with the risk of serious arrhythmias and sudden cardiac death

<p>Abstract</p> <p>Objective</p> <p>To investigate the role of three distinct symptoms of heart-focused anxiety (cardio-protective <it>avoidance</it>, heart-focused <it>attention</it>, and <it>fear </it>about heart sensations) in relation to general anxiety, depression and physical health in patients referred to specialized cardio-genetics outpatient clinics in Norway for genetic investigation and counseling.</p> <p>Methods</p> <p>Participants were 126 patients (mean age 45 years, 53.5% women). All patients were at higher risk than the average person for serious arrhythmias and sudden cardiac death (SCD) because of a personal or a family history of an inherited cardiac disorder (familial long QT syndrome or hypertrophic cardiomyopathy). Patients filled in, Hospital Anxiety and Depression Scale, Short-Form 36 Health Survey, and Cardiac Anxiety Questionnaire, two weeks before the scheduled counseling session.</p> <p>Results</p> <p>The patients experienced higher levels of general anxiety than expected in the general population (mean difference 1.1 (p < 0.01)). Hierarchical regression analyses showed that avoidance and fear was independently related to general anxiety, depression, and physical health beyond relevant demographic covariates (age, gender, having children) and clinical variables (clinical diagnosis, and a recent SCD in the family). In addition to heart-focused anxiety, having a clinical diagnosis was of importance for physical health, whereas a recent SCD in the family was independently related to general anxiety and depression, regardless of disease status.</p> <p>Conclusion</p> <p>Avoidance and fear may be potentially modifiable symptoms. Because these distinct symptoms may have important roles in determining general anxiety, depression and physical health in at-risk individuals of inherited cardiac disorders, the present findings may have implications for the further development of genetic counseling for this patient group.</p

Is it safe to exercise during oncological treatment? A study of adverse events during endurance and resistance training–data from the Phys-Can study

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Parents’ experiences following conversations about their young child’s weight in the primary health care setting : a study within the STOP project

Background: In primary healthcare, conversations between clinicians and parents about young children’s overweight are key to providing support and initiating weight management. However, given the sensitivity of this topic, these conversations are difficult for both clinicians and parents and are sometimes delayed or avoided. To understand the emotional impact of these conversations, this study aims to shed light on parents’ experiences following conversations with primary care nurses about their child’s overweight. Methods: Participants were recruited through a childhood obesity randomized controlled trial (RCT) conducted in Sweden. Telephone-based semi-structured interviews were conducted with 17 parents (mean age 40; the majority were women (n = 12/17), had a university degree (n = 14/17) and were born in Sweden (n = 13/16)). Their children were between 3 and 7 years old (mean age 4.8 years) with overweight (n = 7) or obesity (n = 10). The interviews were recorded, transcribed, and analyzed using thematic analysis. Results: Two main themes were developed. Theme 1, ‘Receiving the overweight/obesity diagnosis’, explores parents’ reactions to the conversation with the primary care nurse. Depending on how the nurse presented the topic, conversations either fostered an alliance between the parent and the nurse, encouraging parents to reflect and develop insights about the child’s and the family’s needs (subtheme Conversations that empower), or felt limited, uncomfortable, or belittling (subtheme Conversations that provoke resistance). Theme 2, ‘Parenting a child with a formal diagnosis of obesity’, explores challenges parents faced following the weight conversations, including managing their own feelings and concerns (subtheme Fear of transferring weight anxiety), dealing with others’ reactions (subtheme Involve family and manage surroundings) and asking for and receiving support from health care professionals (subtheme Obtain support from health care professionals). Conclusions: While conversations with primary care nurses about children’s weight were often emotional, most parents felt these conversations were ultimately helpful, as they encouraged them to enact positive lifestyle changes. Importantly, when nurses initiated conversations in a responsive, non-blaming way, inviting parents to reflect on their situation, parents felt more supported and empowered. These findings convey the importance of providing communication skills training to pediatric healthcare professionals, with particular focus on childhood overweight and obesity. Trial registration number: ClinicalTrials.gov NCT03800823; 11 Jan 2019

Health status in patients at risk of inherited arrhythmias and sudden unexpected death compared to the general population

<p>Abstract</p> <p>Background</p> <p>The possibilities in the molecular genetics of long QT syndrome (LQTS) and hypertrophic cardiomyopathy (HCM) has made family screening, with diagnostic and predictive genetic testing part of the health care offer in genetic counselling of inherited arrhythmias, potentially affecting the subjective health among these individuals. The study compared health status among patients at risk of arrhythmia because of family history or clinical diagnosis of LQTS and HCM with reference health status scores of the general population.</p> <p>Methods</p> <p>In the period 2005-2007, 127 patients (mean age 45 years, 53.5% women), with a family history of arrhythmia (n = 95) or a clinical diagnosis of LQTS (n = 12) or HCM (n = 19) referred for genetic counselling at the medical genetic departments in Norway filled in a questionnaire (Short Form Health Survey SF-36) measuring health status on eight domains. The patient SF-36 scores were compared to expected scores of the general population by t-test, and the relationship between the socio-demographic variables, clinical status, and SF-36 domains were analysed by multiple linear regression.</p> <p>Results</p> <p>The total sample reported significant lower SF-36 score as compared to the general population scores for the domain of general health (mean difference -7.3 (<0.001). When analysing the sample in subgroups according to clinical status, the general health was still significant lower for the group of family risk and in the group of HCM. In addition the physical functioning, role physical, vitality and role emotional domains were reduced for the latter group. In general, employment, higher education and being referred to genetic counselling through a family member were associated with better scores on the health status domains.</p> <p>Conclusions</p> <p>Having a genetic risk of arrhythmia affects general health significantly. In addition, patients with a clinical diagnosis of HCM demonstrate a significantly poorer health in both physical and mental domains.</p

Pandemic Pedagogy: Elements of Online Supportive Course Design

The purpose of this study was to identify which course design elements students perceive as supporting an easier transition to emergency remote teaching due to COVID-19, as well as to use those items to develop the Online Supportive Course Design (OSCD) measure. By asking students to rate their course with the easiest transition and hardest transition to emergency remote teaching, this study identified which structural elements were most important for supporting students during the transition. Using exploratory and confirmatory factor analyses, a seven-item measure was developed to operationalize OSCD, and initial validity was established by examining the relationships between OSCD, autonomy support, and teacher competence. Finally, practical implications for university faculty and areas for future research are discussed