Are there differences in birth weight between neighbourhoods in a Nordic welfare state?

<p>Abstract</p> <p>Background</p> <p>The objective of this cohort study was to examine the effect on birth weight of living in a disadvantaged neighbourhood in a Nordic welfare state. Birth weight is a health indicator known to be sensitive to political and welfare state conditions. No former studies on urban neighbourhood differences regarding mean birth weight have been carried out in a Nordic country.</p> <p>Methods</p> <p>A register based on individual data on children's birth weight and maternal risk factors was used. A neighbourhood characteristic, i.e. an aggregated measure on income was also included. Connections between individual- and neighbourhood-level determinants and the outcome were analysed using multi-level regression technique. The study covered six hundred and ninety-six neighbourhoods in the three major cities of Sweden, Stockholm, Göteborg and Malmö, during 1992–2001. The majority of neighbourhoods had a population of 4 000–10 000 inhabitants. An average of 500 births per neighbourhood were analysed in this study.</p> <p>Results</p> <p>Differences in mean birth weight in Swedish urban neighbourhoods were minor. However, gestational length, parity and maternal smoking acted as modifiers of the neighbourhood effects. Most of the observed variation in mean birth weight was explained by individual risk factors.</p> <p>Conclusion</p> <p>Welfare institutions and benefits in Sweden might buffer against negative infant outcomes due to adverse structural organisation of urban neighbourhoods.</p

Obesity prevalence in a cohort of women in early pregnancy from a neighbourhood perspective

<p>Abstract</p> <p>Background</p> <p>The evidence of an association between neighbourhood deprivation and overweight is established for different populations. However no previous studies on neighbourhood variations in obesity in pregnant women were found. In this study we aimed to determine whether obesity during early pregnancy varied by neighbourhood economic status.</p> <p>Methods</p> <p>A register based study on 94,323 primiparous pregnant women in 586 Swedish neighbourhoods during the years 19922001. Multilevel technique was used to regress obesity prevalence on socioeconomic individual-level variables and the neighbourhood economic status. Five hundred and eighty-six neighbourhoods in the three major cities of Sweden, Stockholm, Göteborg and Malmö, during 19922001, were included. The majority of neighbourhoods had a population of 4 00010 000 inhabitants.</p> <p>Results</p> <p>Seven per cent of the variation in obesity prevalence was at the neighbourhood level and the odds of being obese were almost doubled in poor areas.</p> <p>Conclusion</p> <p>Our findings supports a community approach in the prevention of obesity in general and thus also in pregnant women.</p

Studies in safety promotion for preschool children

The multifactorial aetiology in childhood injuries indicates a need for a systemic approach in the development of safety promotion strategies. In the present thesis, the feasibility of a systemic approach for the development of safety promotion strategies directed at pre-school children was investigated. In a theoretical paper (I) a system model was outlined and in five empirical papers (II-IV), parts of the model were studied. The framework of Haddon and system models developed within occupational- accident research constituted the point of departure for the elaboration of a system model in paper I. The system model was applied to three common injury situations among pre-school children. A literature review was undertaken in order to describe the importance of potentially modifiable risk factors. Empirical studies where child-, family- and, physical environment risk factors had been quantified by means of relative risks and aetiological fractions were used for the analyses. The model illustrated the multifactorial aetiology in childhood injuries and consequently, a strategy including both active and passive prevention was supported. Safety education is an integral part of most child injury prevention programmes. In the design of safety education, knowledge about the determinants of parental behaviour and their modifiability is crucial. In paper II predictors of parental risk perception was investigated. From this study it was concluded that safety education might increase risk perception in mothers by means of emphasising the involvement of the child in the cause of events leading to an injury. In paper III, risk perception and other potentially modifiable determinants of parental safety behaviour were investigated. Perceived social norms were found to be the most powerful determinants of parental behaviour, and this study indicated that safety promotion programmes should not only use safety education to alter the behaviour of the individual mother, but also aim at changing social norms in society and, thus, take into consideration the societal context in which families live. In the prevention of injuries, injury surveillance is used to feed back information on injuries to receivers at different levels in society. If receivers of injury data shall respond to the feedback by taking preventive measures, the presentation of data must be elaborated in an interpretable way. In paper IV, data from ten local registration systems were compiled and the injury incidence was found to be higher in day-care centres than in the home environment. These data are relevant to incorporate in a feedback system to prevent injuries in day-care centres. In paper V, it was shown that fracture rates in four European regions varied considerably. Fractures constitute a substantial part of all severe injuries in children and can thus serve as an indicator of severe injuries. Furthermore fracture registers have a high validity and are easily accessible, as most persons who have sustained a fracture seek medical care at a hospital. From these papers it was concluded that, as a part of a safety promotion strategy, injury surveillance should be easily accessible, easily interpreted by receivers of information and also maintain a high quality. In paper VI, factors that influence the safety in day-care settings were studied. It was shown that further training of personnel in child safety was a decisive factor in the set-up of the environment from a safety point of view. To offer personnel such further education is a typical decision taken by politicians or civil servants at the municipal level. Thereby, they also constitute receivers of information regarding injury risks in day-care centres. In conclusion, the empirical studies included in this thesis illuminated chains of events that are potentially efficient targets for the promotion of childhood safety and systems thinking illuminated crucial steps in the further development of safety promotion strategies for pre-school children

Growing up in rural community - children's experiences of social capital from perspectives of wellbeing

Introduction: People are influenced by the neighborhood in which they live. The neighborhood may be particularly important for children’s wellbeing because of the constraints it imposes on their patterns of daily activities. Furthermore, the neighborhood is a central context for social development, being a place where children form networks and learn social skills and values. The aim of this study was to describe how social capital in the neighborhood is perceived by children living in rural areas, and to reveal what this adds to their sense of wellbeing. Methods: The study had a descriptive research design with a qualitative approach. Seven single-sex focus group interviews were conducted with children the in 6th grade (aged 11–12 years). Data were analyzed using deductive content analysis. Results: The children perceived a lack of social capital due to environmental and social constraints in their everyday lives. However, their wellbeing was enhanced by strong cohesion in the neighborhood. In addition, settings such as the school, the natural environment, and sporting associations were highly valued and emerged as crucial factors for enhancing the children’s wellbeing. The spatial isolation that characterizes rural areas created a special context of social network structures, cohesion and trust, but was also a breeding ground for exclusion and social control. The stories revealed paradoxical feelings of living in a good and safe area that simultaneously felt isolated and restricted. Conclusions: From a rural perspective, this study reveals the complexity of the children’s perceptions of their social environment, and the ways in which these perceptions have both positive and negative effects on wellbeing. The results highlight how important it is for health professionals in rural areas to consider the complex influence of bonding social capital on children’s wellbeing, and to be aware that it can promote exclusion as well as cohesion

Swedish Parent’s Experiences of Joint Physical Custody

Abstract: Aim: This study’s aim was to learn more about parent experiences, when living in joint physical custody with their children. Methods: The study design was descriptive, using a qualitative approach. Interviews were conducted with 28 parents who lived in joint physical custody with their children. Content was analysed using inductive content analysis. Results: Participants with joint custody reported many positive experiences, and a similar process of adapting to the new living- arrangement. Results indicate that shortly after the separation parents were mainly occupied with emotional reactions to the new family situation. After two to three years, or in some cases longer, things seemed to settle down and the participants became more accustomed to the arrangements. Conclusion: This qualitative study provides insights into parents’ experiences of living in joint physical custody with their children. Many positive experiences and a similar process of adapting to the new arrangement were revealed. In the initial period, the parents seemed mainly to have been occupied with emotional reactions to the new family situation

'Girls need to strengthen each other as a group' : experiences from a gender-sensitive stress management intervention by youth-friendly Swedish health services: a qualitative study

Mental health problems among young people, and girls and young women in particular, are a well-known health problem. Such gendered mental health patterns are also seen in conjunction with stress-related problems, such as anxiety and depression and psychosomatic complaints. Thus, intervention models tailored to the health care situation experienced by young women within a gendered and sociocultural context are needed. This qualitative study aims to illuminate young women's experiences of participating in a body-based, gender-sensitive stress management group intervention by youth-friendly health services in northern Sweden. A physiotherapeutic body-based, health-promoting, gender-sensitive stress management intervention was created by youth-friendly Swedish health services. The stress management courses (n = 7) consisted of eight sessions, each lasting about two hours, and were led by the physiotherapist at the youth centre. The content in the intervention had a gender-sensitive approach, combining reflective discussions; short general lectures on, for example, stress and pressures related to body ideals; and physiotherapeutic methods, including body awareness and relaxation. Follow-up interviews were carried out with 32 young women (17--25 years of age) after they had completed the intervention. The data were analysed with qualitative content analysis. The overall results of our interview analysis suggest that the stress management course we evaluated facilitated 'a space for gendered and embodied empowerment in a hectic life', implying that it both contributed to a sense of individual growth and allowed participants to unburden themselves of stress problems within a trustful and supportive context. Participants' narrated experiences of 'finding a social oasis to challenge gendered expectations', 'being bodily empowered', and 'altering gendered positions and stance to life' point to empowering processes of change that allowed them to cope with distress, despite sometimes continuously stressful life situations. This intervention also decreased stress-related symptoms such as anxiousness, restlessness, muscle tension, aches and pains, fatigue, and impaired sleep. The participants' experiences of the intervention as a safe and exploratory space for gendered collective understanding and embodied empowerment further indicates the need to develop gender-sensitive interventions to reduce individualisation of health problems and instead encourage spaces for collective support, action, and change.Stress and Health in Youth (Umeå SHY