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The Swedish preschool curriculum stipulates that all children independent of support needs should attend mainstream preschool groups, with equal opportunities for learning and engagement. Preschool teachers are responsible for paying attention to children in need of special support to achieve this. How support is provided for children in need of special support due to behavior difficulties in Swedish preschools varies, however. Some children, often formally identified as in need of special support, are supported by preschool staff supervised by external services. Other children receive support initiated and implemented by preschool staff, without supervision from external services. A further number of children receive no support for behavior difficulties, on top of what is provided to all children. This study investigated associations between support format (i.e. supervised support, staff-initiated support or no additional support), support content (i.e. implementation of support), behavior difficulties, socio-demographics and engagement. A mixed methods approach was used with a sample of 232 preschool children 15 to 71 months with assessed behavior difficulties. Preschool staff reported on the children's engagement, behavior difficulties, socio-demographics and support provision. Logistic regression models were used to analyze the probability of children receiving either support format. Content analysis was used to categorize the support content, reported by preschool staff through open-ended questions. Point-biserial correlations were used to test associations between support content, behavior, socio-demographics and engagement. All children receiving supervised support for behavior difficulties were formally identified by external services as in need of special support. Supervised support was also more common if children disturbed the free play in the preschool group, with the most frequent support being collaboration with external teams. Staff-initiated support was most commonly given to children with high engagement, and for children who are not early second language learners. These children were most frequently supported by staff paying attention to negative behavior. Children who were not perceived as a burden to the group were less likely to receive any form of additional support. Ways of managing the preschool group seem to guide support strategies for children with behavior difficulties, rather than child-focused strategies emphasizing engagement in everyday activities.
Under 2015 genomfördes nationella lärandeseminarier för att stärka implementeringen av den lag som ger barn rätt till information, råd och stöd när en förälder plötsligt avlider, är svårt sjuk eller skadad (HSL 2g §). Satsningen var ett förbättringsarbete som omfattade sex landsting som med hjälp av en projektledning träffades vid fyra tillfällen från januari till september. Två av träffarna skedde i Stockholm och två var digitala. Under våren 2015 knöts följeforskning till arbetet med frågeställningar om vilka resultat förbättringsarbetet gav och hur deltagarna upplevde arbetssättet. Syftet var att lyfta fram vad satsningen gav samt att lära inför framtida satsningar – är lärandeseminarier ett användbart arbetssätt för nationella implementeringssatsningar?
Rapporten visar att lärandeseminarier tycks vara en användbar form. Teamen kan redovisa att de uppnått många av de mål som de föresatte sig under projekttiden. Det handlade om kartläggning av kunskapsläge och strukturer, kompetensutveckling samt utveckling av rutiner och material. Teamen uppskattade också att få delta i ett nationellt sammanhang som gav inspiration. Samtidigt framkom det önskemål om fortsatt och ännu mer handfast stöd i fortsatt implementering i klinisk verksamhet.
Breakthrough Collaborative (BC) aims at learning through networking, mainly at micro level, and is used as a tool to improve care and welfare organizations. The aim of this study was to explore and illuminate the challenges when applying BC model at meso and macro level. In 2010, the Swedish Health and Medical Services Act stated the responsibility of healthcare professionals to consider children's needs as relatives. This study uses an interactive collaborative research model. To support healthcare organizations in the implementation of the regulation, county councils/regions in Sweden were invited to take part in a BC during 2015. Six teams from different county councils/regions participated. Team members were interviewed several times during the project time. Data were analyzed with an explorative and descriptive qualitative content analysis. The result illuminates the challenges faced when applying BC at meso and macro level. Most challenges concern preparation, support structures and system connections. There are similarities with the challenges met at micro level when BC is used at meso and macro level. But it seems even more important to consider how the team is constituted at meso and macro level to make use of the learnings and achieve long-term impact in the home organization.
The purpose of this study was to elucidate conditions at all system levels in a specific health care service to develop practices for identification of children as relatives. An interactive research approach with the intention to create mutual learning between practice and research was used. The participating health care service cared for both clinic in- and outpatients with psychiatric disorders. Health care professionals from different system levels (micro, meso, macro) participated, representing different professions. At the first project meeting, it was obvious that there was no systematic approach to identify children as relatives. At the micro level, activities such as a pilot survey and an open house activity were carried out. At the meso level, it was discussed how to better support collaboration between units. At the management (macro) level, it was decided that all units should appoint at least one child agent, with the aim to increase collaboration throughout the whole health care service. To change focus, in this case from only parents to inclusion of children, is an important challenge faced by health care services when forced to incorporate new policies and regulations. The new regulations contribute to increased complexity in already complex organizations. This study highlights that such challenges are underestimated.
Visiting the hospital is likely a frightening experience for a child, and going through a radiographic examination has been reported as both distressing and painful. More knowledge from the children's perspective is needed on this subject, however, and thus, the aim of this study was to investigate children's anxiety, pain, and distress in conjunction with an acute radiographic procedure and whether these factors can be related to the perception of care. A mixed method design was used to analyze data from 110 participants between 5 and 15 years of age, who were examined in a Swedish radiology department. The quantitative findings showed anxiety, pain, and distress to be a concern during a radiographic examination. Significant correlations were obtained between anxiety and pain as well as between anxiety and distress. In addition, also the qualitative findings showed pain and the waiting time to be concerns. Regardless of the quantitative findings, however, children of all ages were satisfied with the care performed in the periradiographic process, perceiving the examination as supportive and geared to their needs. Robust assessment of anxiety, pain, and distress is imperative when interacting with children in acute examination situations to avoid both negative short-term and long-term consequences.
This study investigated the nature of verbal interactions between child, parent and radiographer and theextent to which it varied as a function of the child's age. The participants were 20 female radiographersand 32 children (3–15 years) examined for acute injuries. The verbal interactions during theexamination were video recorded and analyzed using the Roter Interaction Analysis System (RIAS).Results indicated that 80% of the verbal interaction was accounted for by the radiographer, 17% by thechild and 3% by the parent. The distribution of utterances varied with regard to children's age.
Pregnant women are not always satisfied with the professional support they receive during their midwifery care. More knowledge is needed to understand what professional support pregnant women need for childbirth and parenting.
Childbearing and the transition to becoming a parent is a sensitive period in one's life during which one should have the opportunity to receive professional support. Professional support does not always correspond to pregnant women's needs. To understand pregnant women's needs for professional support within midwifery care, it is crucial to further illuminate women's experiences of this support.
To explore pregnant women's perceptions of professional support in midwifery care.
A qualitative study using semi-structured interviews. Fifteen women were interviewed during gestational weeks 36–38. Data was analysed using phenomenography.
The women perceived professional support in midwifery care to be reassuring and emotional, to consist of reliable information, and to be mediated with pedagogical creativity. The professional support facilitated new social contacts, partner involvement and contributed to mental preparedness. The findings of the study were presented in six categories and the category Professional support contributes to mental preparedness was influenced by the five other categories.
Pregnant women prepare for childbirth and parenting by using several different types of professional support in midwifery care: a strategy that could be described as piecing together a puzzle. When the women put the puzzle together, each type of professional support works as a valuable piece in the whole puzzle. Through this, professional support could contribute to women's mental preparedness for childbirth and parenting.
Background: Professional support does not always meet the needs of expectant fathers or co-mothers. The way in which professional support is offered during pregnancy varies internationally, depending on the country. In order to attain a greater understanding of partners' experiences of professional support, it is necessary to further illuminate their perceptions of it. The aim of this study was therefore to explore pregnant women's partners' perceptions of professional support during pregnancy.
Methods: Qualitative research design. Partners of pregnant women were interviewed during gestational week 36-38. Individual semi-structured interviews were used to explore the partners' perceptions. The data was analysed using a phenomenographic approach. The study was performed in a county in south-western Sweden; the data collection was conducted from November 2014 to February 2015. Fourteen partners (expectant fathers and co-mothers) of women who were expectant first-time mothers with singleton pregnancies, were interviewed.
Results: The findings of the study are presented through four descriptive categories: Ability to absorb adequate information; Possibility to meet and share with other expectant parents; Confirmation of the partner's importance; and Influence on the couple relationship. Using a theoretical assumption of the relationship between the categories showed that the fourth category was influenced by the other three categories.
Conclusions: The partners perceived that professional support during pregnancy could influence the couple relationship. The partners' ability to communicate and to experience togetherness with the women increased when the expectant couple received professional support together. The support created also possibilities to meet and share experiences with other expectant parents. In contrast, a lack of support was found to contribute to partners' feelings of unimportance. It was essential that the midwives included the partners by confirming that they were individuals who had different needs for various types of professional support. The partners perceived it easier to absorb information when it was adequate and given with a pedagogic that made the partners become interested and emotionally engaged.
Objectives: We evaluated the efficacy of daily relaxation training on psychosomatic symptoms during one school year among 8-year-old children. Methods: Cortisol in saliva, abdominal circumference including body mass index (BMI), heart rate, rate pressure product (RPP), and stress in children (SIC) were measured. Teachers in the intervention classes were interviewed. The intervention consisted of a daily relaxation therapy (RT). Results: The intervention group showed reduced heart rate. Individuals of the intervention group showed an improvement regarding headaches and the ability to fall asleep. The qualitative results showed that the RT had a calming effect on both the children and the teachers. Conclusions: RT among children may be of use to cope with stress as interpreted by some improved parameters in the intervention group.
AIM: This study explored weight trends among children aged 4, 7, 11, 14 and 17 years in Jönköping County Sweden, from 2004 to 2015.
METHODS: The study had a repeated cross-sectional design, and body mass index (BMI) was calculated based on height and weight measurements collected from child health and school health records. The prevalence of thinness, overweight and obesity was estimated with international cut-offs, with linear trends calculated separately for boys and girls.
RESULTS: There were 190 965 measurements of BMI and these covered 82-97% of the younger children and 55-69% of the older children during the study period. The prevalence of thinness varied between 0.2% and 2.2% across time and age groups and did not change over the study period. There was a small decrease in overweight among both girls and boys aged four years. There were increasing trends in overweight and obesity in both girls and boys aged 11 and 14 years of age and a sharp increase among 17-year-old boys, with 7.3% obese in 2014/2015 and 3.6% in 2004/2005.
CONCLUSION: The prevalence of obesity decreased from 2004 to 2015 or was stable in younger Swedish children, but increased among older children, with a large increase in adolescent boys.
The overall aim of this thesis was to explore and describe health dialogues from pupils' and nurses' perspectives as well as the verbal interaction between them, in the context of a structured health and lifestyle tool.
Seventy-four pupils and 23 school nurses participated in focus group interviews, and further 14 nurses participated in individual interviews. To explore the verbal interaction, 24 health dialogues with pupils and school nurses were recorded using a video camera. The data from the interviews were subjected to qualitative content analysis and the verbal interactions were analysed using the paediatric version of the Roter Interaction Analysis System.
Health dialogues based on the pupil's own situation were described as a process that provided them opportunities to influence their own health. Prerequisites for a pupil-centered health dialogue were that the pupils were prepared, felt respected and like active participants, and that their own experiences were in focus. How the nurses acted was crucial to the pupils' experience of and possibility to benefit from of the health dialogue based on their own needs and wishes. A health and lifestyle tool could support the dialogue by constituting a structure, open up for discussion and contribute to an understanding of the individual's situation. The tool could also facilitate the transmittal of health information on an individual as well as a group level. In terms of utterances in the dialogues, the school nurses were the ones who talked the most. The pupils most frequently gave information about their lifestyle and agreed with the nurses. The nurses asked questions and provided information about lifestyle, and checked that they had understood the pupils. Just over a third of the nurses' verbal interaction approaches were aimed to make the pupil more active and participatory in the dialogues.
In conclusion, the health dialogues were described as an opportunity to gain knowledge about and insight into health and lifestyle, but a pupil-centered dialogue was considered crucial. The challenge is to adapt the health dialogue based on each pupil's needs and wishes, and a health and lifestyle tool could contribute structure and support the dialogue.
Background: Throughout childhood, children take part in health visits according to a health-monitoring programme. The visits are aimed to promote the children's development and health and to strengthen them to take own responsibility for their health. Nurses' actions when encountering children at these visits are not explored to any great extent. Exploring nurses' actions can facilitate their reflections on their actions towards children and thereby promote children's involvement in such visits.
Aim: The aim of this study was to explore nurses' actions when encountering children at health visits.
Method: A qualitative explorative design, based on 30 video recordings of health visits in child and school health care, was used in this study. These visits were ordinary real-life health visits. The data were subjected to qualitative content analysis. The right to conduct video recordings during health visits was approved by appropriate research ethics committees.
Results: The findings show that nurses, in order to carry out the health visits, encounter children through negotiated guidance. This guidance is understood as the process through which the nurses reach agreement with the children, and is comprised of directed and pliable strategies. At one moment, the nurse can use a directed strategy to inform the child and at the next moment a pliable strategy to provide the child space within the given frame, the health-monitoring programme. By using these strategies intertwined, the nurse can provide the child space within the given frame and, at the same time, fulfil his/her responsibility to promote children's health and development.
Conclusion: The results highlight nurses' challenging and complex assignment of guiding children to promote their engagement in the health visits, thereby enabling the nurses to promote the children's health and development according to the national health-monitoring programme.
Aim: To explore how school nurses perceive their assignment when caring for children having parents with serious physical illness.
Design: An explorative inductive qualitative design.
Method: The study is based on interviews with 16 school nurses. The interviews were subjected to qualitative content analysis.
Results: The main category, "Contribute in making the school a safe place for the child", reveals how the school nurses try to contribute to making the school a safe place for a child when his/her parent has a serious physical illness. They support children through individual support, as well as at an overall level in the school health team to make the school, as an organization, a safe place. Routines and collaboration to recognize the child when his/her parent has become ill is described as crucial to accomplishing this assignment
Research has shown that a child's knowledge about what is happening to a parent when he/she has a cancer disease is crucial to the child's health and wellbeing. Therefore the purpose of this study was to explore parents' perceptions of how nurses in clinical practice care for children as relatives when one parent in the family has a cancer disease.
A qualitative explorative design with interviews was used. Altogether 28 parents (17 patients and 11 partners) were interviewed. The transcripts from the interviews were subjected to qualitative content analysis.
The parents perceive that the nurses make efforts to support the child as well as them as parents, but feel that the care needs to be more tailored to the specific child and his/her situation. The children are initially invited, generally informed and seen by the nurses, but the parents perceive that they themselves need repeated support and advice over time to uphold their parental responsibility for caring for their children during the illness trajectory.
The parents argue for the importance of receiving repeated advice and support for how to talk to their children about the disease and treatment. The parents describe how the nurses were helpful by asking after the children and explaining the value of their visiting the hospital.
The Health Curve, used by nurses in community-based health care, is an educational tool for conducting goal-directed dialogues concerning lifestyle and health. The aim of this study was to investigate how child health nurses experienced the Health Curve as a tool for conducting dialogues with parents. Fourteen nurses were interviewed. The data were analysed according to qualitative analysis. The results showed that nurses working in child health care experienced the Health Curve as a useful tool for conducting health dialogues with parents. Through their work with the Health Curve, the nurses gained a greater insight into, and understanding of, the families' health and life situation. The results indicated that working with the Health Curve could increase the opportunity for nurses to provide parents with support early in the process, helping the family to lead a healthy lifestyle.
The aim was to explore school nurses' health dialogues with pupils regarding physical activity. A descriptive explorative qualitative design based on video recordings of 15 nurses performing 24 ordinary real-life health visits with pupils aged 10,14 and 16 years was used to accomplish this. Audio files from the video recordings were transcribed verbatim and subjected to qualitative content analysis. The results showed that the school nurses created a flow and kept the conversation going to enable the progress of the health dialogue about physical activity. To gain the pupils' trust, the nurses used social talk and gave positive feedback. By assessing information about the pupils' activity the nurses created an overview and then, based on this overview, tried to create a potential for change in physical activity.
Purpose: The purpose of this study was to elucidate how nurses perceive their role in caring for children as relatives to a parent with a serious physical illness.
Method: A qualitative explorative design with focus group interviews was used. In total, 22 nurses working at one neurological, one haematological and two oncological wards were interviewed. The transcripts from the interviews were analysed in steps in accordance with inductive qualitative content analysis.
Results: This study revealed six variations in how nurses perceived their role in the encounter with child relatives, ranging from being convinced that it is not their responsibility to being aware of the children's situation and working systematically to support them.
Conclusion: Nurses should consider whether their patients have children who might be affected by their parent's illness. The nurses' self-confidence when meeting these children must be increased by education in order to strengthen their professional role. Furthermore, guidelines on how to encounter child relatives are required.
Objective: To describe general practitioners' (GPs') accounts of how to facilitate consultations with children aged 1–2 years.
Design: A qualitative study based on focus group interviews.
Setting and subjects: Five focus group interviews were conducted with a total of 25 GPs at Swedish primary health care (PHC) centres. The GPs regularly invited toddlers to consultations.
Result: The GPs' accounts of how to facilitate consultations with toddlers revealed descriptions of making efforts to instil confidence in the situation to enable the consultation. Toddlers in need of health care always visit the GP with adults such as their parents, guardians or other relatives. Therefore, the GP directs efforts towards the adults and the child more or less simultaneously, as they both need to rely on the GP. The GPs describe how they instil confidence in the adults by establishing a mutual understanding that the consultation is necessary to secure the child's health. Regarding the child, the GP instils confidence by establishing a relationship in order to approach the child and accomplish bodily examinations.
Conclusion: The result shows that GPs' encounters with children in consultations are two-sided. The GP needs to conduct bodily examinations to secure the child's health and development, but to do so he/she needs to establish purposeful relationships with the adults and the child by instilling confidence. This indicates that establishing relationships in the consultation is significant, and a way to achieve a child-centred consultation.
KEY POINTS Research regarding GPs' encounters with toddlers in consultation is limited, even though toddlers frequently visit PHC. GPs make efforts to instil confidence by establishing mutual understanding with parents and a relationship with the child. Establishing purposeful relationships with both the child and parent is significant in enabling the consultation. Establishing a relationship with the child overrides conducting the bodily examination, t opromote the child's feeling of ease and allow a child-centred consultation.
Objective:The purpose of this study was to explore and describe the content and the verbal interaction in health dialogues between pupils and school nurses.
Method: Twenty-four health dialogues were recorded using a video camera and the conversations were analysed using the paediatric version of the Roter Interaction analysis system.
Results:The results showed that the age appropriate topics suggested by national recommendations were brought up in most of the health dialogues. The nurses were the ones who talked most, in terms of utterances. The pupils most frequently gave information about their lifestyle and agreed with the nurses' statements. The nurses summarized and checked that they had understood the pupils, asked closed-ended questions about lifestyle and gave information about lifestyle. Strategies aimed to make the pupil more active and participatory in the dialogues were the most widely used verbal interaction approaches by the nurses.
Conclusion:The nurses' use of verbal interaction approaches to promote pupils' activity and participation, trying to build a partnership in the dialogue, could indicate an attempt to build patient-centred health dialogues.
Clinical implications: The nurses' great use of questions and being the ones leading the dialogues in terms of utterances point at the necessity for a nurses to have an openness to the pupils own narratives and an attentiveness to what he or she wants to talk about.
Aim: To explore school nurses' strategies for supporting adolescents with recurrent pain.
Method: Twenty-one Swedish school nurses were interviewed, and the interviews were subjected to content analysis.
Results: The findings show that the nurses are aware that recurrent pain problems are common among the adolescents. In their attempt to support these adolescents, the nurses describe how they are striving in attempts to acquire an understanding of the adolescents' situation, to understand the cause of the pain problem and to devise strategies that can be used to help the adolescents handle the situation.
The aim of this study was to describe the content of school nurses' health dialogues with pupils regarding food habits. A qualitative content analysis of 24 recorded health dialogues resulted in five categories describing the content of the dialogues, regarding food habits. Current food habits covered food, mealtimes and food related to physical activity. Social context and food habits showed that social groups in the pupils' surroundings affected their food habits. Society and food habits included external factors that affected food habits, such as school and laws. School nurses' advice and support regarding food habits described how nurses offered advice, support and information. Pupils' understanding of health in connection to food habits comprised the pupils' knowledge, participation and willingness to change. The results showed a variety of interacting factors which affected the pupils' food habits, upon which health-promotional work can be based.
Aim and objective. To describe and explore adolescents' and nurses' perceptions of using a health and lifestyle tool in healthdialogues in the School Health Service.
Background. In Sweden, dialogues concerning health and lifestyle are offered to adolescents aged 14 years with the purpose of encouraging an interest in a healthy lifestyle. A health and lifestyle tool including a health questionnaire and a health profile has recently been developed, with the aim of facilitating the communication about health and lifestyle in these dialogues.
Design.Qualitative descriptive design.
Method. Twenty-nine adolescents and 23 nurses participated in focus group interviews, which were subjected to qualitative content analysis.
Results. The health and lifestyle tool was perceived as constituting a structure for the dialogues and as a clear and applicable starting point, focusing on individual aspects. The tool contributed to an understanding of the health situation and to the transmittal of health information on an individual as well as a group level.
Conclusion.The tool was perceived as constituting a useful structure for the dialogues about health and lifestyle. When it was used the individual's health and lifestyle were concretised, which opened up for a dialogue and different aspects of health and lifestyle were detected. However, in some cases the outcome of the tool could be conceived as a stringent assessment and thereby complicate the dialogues.
Relevance to clinical practice.The use of a tool, such as the one used in this study, is one way to improve the dialogues in the School Health Service, allowing them to be more focused on the individual's needs and to detect aspects that would otherwise not be so easily detected. The implications of this study include using the findings to guide counselling sessions in the schools and other health care settings.
Nurses in the Swedish child healthcare system can make a difference by offering support to parents of children who are overweight or at risk of becoming so. Still, research concerning these nurses? clinical practice when encountering parents whose child is overweight is inadequate. The aim of this study was to describe nurses? clinical practice when encountering parents of an overweight child. Data were collected through interviews with 10 nurses, and a content analysis approach was used. The nurses? clinical practice is described in relation to Olander?s theory: Individualising actions, Creating a dialogue, Documenting, and Focusing on normality. This study adds knowledge about nurses? clinical practice in encounters with parents whose child is overweight. Also, it adds information on how an issue in a specific care situation may contribute to further understanding and use of an existing theory in caring science.
Nurses in Swedish child and school healthcare need to balance their assignment of promoting children's health and development based on the national health-monitoring programme with their responsibility to consider each child's needs. In this balancing act, they encounter children through directed and pliable strategies to fulfil their professional obligations. The aim of this study was to analyse the extent to which nurses use different strategies when encountering children during their recurrent health visits throughout childhood. A quantitative descriptive content analysis was used to code 30 video recordings displaying nurses' encounters with children (3–16 years of age). A constructed observation protocol was used to identify the codes. The results show that nurses use pliable strategies (58%) and directed strategies (42%) in encounters with children. The action they use the most within the pliable strategy is encouraging (51%), while in the directed strategy, the action they use most is instructing (56%). That they primarily use these opposing actions can be understood as trying to synthesize their twofold assignment. However, they seem to act pliably to be able to fulfil their public function as dictated by the national health-monitoring programme, rather than to meet each child's needs.
OBJECTIVE: To describe the breastfeeding experiences of mothers with preterm and low-birth-weight infants in a neonatal unit in Tanzania.
DESIGN: A qualitative research design.
SETTING: A neonatal unit at a referral hospital in rural Tanzania.
PARTICIPANTS: Convenience sample of 10 new mothers with preterm infants. Additionally, to triangulate the data, five nurses affiliated with the neonatal unit were interviewed.
METHODS: A semistructured interview guide was used for data collection. All interviews were audiotaped and transcribed verbatim. Data were analyzed with inductive qualitative content analysis.
RESULTS: One main category, The mother has to adapt to the new situation to make breastfeeding natural, and three generic categories, The challenges of breastfeeding a premature infant, Enhancing the feeding situation, and The need for support, were used to describe breastfeeding challenges. Challenges consisted of the perception that the infant was different than healthy infants and the infant's and mother's health problems and needs. To improve the feeding situation, mothers learned how to feed their infants using timing strategies. Confidence and security were achieved with support from family and friends, the other mothers, and the health care staff.
CONCLUSION: Mothers perceived breastfeeding as natural but needed support to overcome the challenges of breastfeeding preterm infants. Through support and education they were empowered, adapted to their new situations, and felt confident with breastfeeding.
The aim of this study was to explore child health care nurses' experiences of conducting health dialogues with non-native-speaking parents. In Sweden, it is not routine that all non-native-speaking parents are invited to a health dialogue. Regardless of language and cultural background, it is important that all parents have the same opportunities to participate. The data were obtained through two focus-group interviews and analysed using qualitative content analysis. The results revealed one theme Need for cultural awareness in the health dialogue and two categories: Overcoming feelings of uncertainty, with a need for more transcultural knowledge regarding what health and health promotion mean in other cultures; and Adapting the process of the health dialogue, whereby interpreters need knowledge about the intention of health dialogues and the content of the tool used in the encounter. Transcultural competence is needed in encounters with parents from other cultures.
BACKGROUND: Both high socioeconomic status (SES) and high physical activity (PA) are associated with better self-rated health (SRH) and higher quality-of-life (QoL).
AIM: To investigate whether high levels of PA may compensate for the association between low SES and subjective health outcomes in terms of poorer SRH and lower QoL.
METHOD: Data from a cross-sectional, population-based study (n = 5326) was utilized. Multiple logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (95% CI) for the associations between indicators of SES (economic situation and educational level), SRH and QoL, as well as between the combination of SES and PA in relation to SRH and QoL.
RESULT: Participants with high PA and economic problems had approximately the same OR for good SRH as those with low PA and without economic problems (OR 1.75 [95% CI 1.20-2.54] and 1.81 [1.25-2.63] respectively). Participants with high PA and low education had higher odds for good SRH (OR 3.34 [2.96-5.34] compared to those with low PA and high education (OR 1.46 [0.89-2.39]).Those with high PA and economic problems had an OR of 2.09 [1.42-3.08], for high QoL, while the corresponding OR for those with low PA and without economic problems was 4.38 [2.89-6.63].
CONCLUSION: Physically active people with low SES, had the same or even better odds to report good SRH compared to those with low PA and high SES. For QoL the result was not as consistent. The findings highlight the potential for promotion of PA to reduce SES-based inequalities in SRH.
An illness or injury sustained by a family member affects all family members. It is consequently important that a child's need to be involved in a family member's care is clearly recognized by healthcare professionals. The aim of this study was to describe healthcare professionals' approaches to children as relatives of a parent being cared for in a clinical setting. A web-based study-specific questionnaire was sent and responded to by 1052 healthcare professionals in Sweden. Data were analysed using descriptive statistics and qualitative analysis. The results show that guidelines and routines are often lacking regarding involving children in the care of a parent. Compared to other areas, psychiatric units seem to have enacted routines and guidelines to a greater extent than other units. The results indicate that structured approaches based on an awareness of the children's needs as well as a child-friendly environment are vital in family-focused care. These aspects need to be prioritized by managers in order to support children's needs and promote health and wellbeing for the whole family.
Despite a cultural change in visitation policies for children (0-17 years) in the intensive care unit (ICU) to a more open approach, children are still restricted from visiting for various reasons. To overcome these obstacles, it is vital to determine what is needed while encountering a child.
To elucidate nurses' experiences of what constitutes the encounter with children visiting a sick parent in an adult ICU.
An explorative inductive qualitative design was used, entailing focus group interviews with 23 nurses working at a general ICU. The interviews were analysed according to inductive content analysis.
The findings show components that constitute the encounter with children as relatives at the ICU, as experienced by ICU nurses: nurses need to be engaged and motivated; parents need to be motivated; the child needs individual guidance; and a structured follow-up is needed. This reflects a child-focused encounter.
Nurses need to adopt a holistic view, learn to see and care for the child individually, and be able to engage parents in supporting their children. To accomplish this the nurses need engagement and motivation, and must have knowledge about what constitutes a caring encounter, in order to achieve a caring child-focused encounter.
Chronic pain and its consequences are major global health challenges, and the prevalence is increasing worldwide among adolescents. Adolescents spend most of their waking hours in school; however, there is limited research available on how school nurses can address chronic pain among adolescents in the Swedish school context. Therefore, we designed a person-centred intervention, known as Help Overcoming Pain Early (HOPE), to enable school nurses to offer adolescents strategies to manage their stress and pain. We used the Medical Research Council (MRC) framework for developing and designing this new complex intervention. For this study, we describe two of the four phases: (a) development and (b) feasibility and piloting. The final version of the HOPE programme consists of (i) an educational package for school nurses in the areas person-centred care, stress and pain education/management and gender perspective; and (ii) an intervention package for adolescents with chronic pain. The programme consists of four sessions during which adolescents with chronic pain have person-centred dialogues with a school nurse. The HOPE programme is based on the existing evidence of managing chronic pain and on the assumption that school nurses can support adolescents with chronic pain by using person-centred care.
This study evaluated the introduction of rotavirus vaccination in Jönköping County, Sweden, starting in 2014. This project explored the parental factors that influenced the decision to vaccinate and studied the obtained vaccination coverage and its potential influence on hospital admissions due to acute gastroenteritis.
This was a descriptive, cross-sectional study based on a study-specific questionnaire (n = 356) and regional statistical data on vaccination coverage and hospital admissions in Jönköping County, Sweden.
Central aspects when deciding on vaccination were vaccine efficacy and safety, that the vaccine was offered to all children, and recommended by healthcare professionals. One in five parents expressed uncertainty about whether they had sufficient information to make a decision. However, the rotavirus vaccination coverage was elevated from 76.1% to 81.0% and the hospital admissions due to acute gastroenteritis decreased by approximately 60%.
The results highlight the necessity for Child Health Services to have solid knowledge regarding vaccinations, to understand individual parental issues and to support uncertain parents. The high vaccination coverage achieved is an indication of the trust in healthcare professionals and is considered to be a major contributing factor to the substantial reduction of hospital admissions due to acute gastroenteritis.
Background: Children and healthcare professionals should be provided with easy-to-use tools which could lead to actionable results.
Objectives: There is increasing interest in the use of patient reported outcomes to aid management of individual care; therefore, the use of health-related qualityof life (HRQOL) assessments during consultations need to be studied. The aim of this study was to explore how healthcare professionals use a HRQOL assessment tool during paediatric encounters.
Design: A descriptive, explorative design with a qualitative approach based on video recordings was chosen.
Methods: Twenty-one video recordings, from nine different healthcare professionals' consultations where an assessment tool of HRQOL were used were analysed by content analysis.
Results: The healthcare professionals were using different strategies and when they combined these strategies three approaches emerged. The instructing approach was characterized by healthcare professionals giving a summary of the results, leading to children becoming passive bystanders in the encounter. Based on an inviting approach, the children's perceptions of their situation were requested while the items were explored. This resulted in involving the children in the conversations. In the engaging approach, an open dialogue and a common interpretation were sought to guide further care which was interpreted as children becoming actively involved.
Conclusions: The child's involvement could be facilitated depending on which approach is being used. When an inviting and engaging approach is used, actions in a non-linear set of interactions is co-produced with the child.
Relevance to practice: The use of an HRQOL assessment tool change the management during consultations and could promote child involvement dependent on which approach the healthcare professionals are using.
The purpose of this study was to investigate associations between school nurses' self-assessed cultural competence in health visits with children of foreign origin and demographic variables, by using a cross-sectional design. A Web-based questionnaire assessing cultural competence and demographic variables was distributed to a nationally representative sample (n = 816) of school nurses in Sweden. Data were analyzed using regression analysis. School nurses assessed themselves as culturally aware and moderately culturally competent, but not as culturally knowledgeable, culturally skilled, or comfortable in cultural encounters. Cultural competence was related to education in cultural diversity, how often nurses encounter children of foreign origin, and nurses' country of origin. In total, these variables explained 23.6% of the variation in school nurses' cultural competence. Because school nurses regard themselves as moderately culturally competent, a foundation for promoting children's health on equal terms in school health care exists. However, education in cultural diversity combined with other additional strategies is needed to further strengthen school nurses' cultural knowledge, skills, and comfort level in encounters with children of foreign origin.
Stress has a negative impact on students' daily lives and can be associated with recurrent pain. School nurses play a key role in supporting young people with stress-related pain. The purpose of this qualitative interview study was to elucidate school nurses' experiences of encountering students with recurrent pain when practicing person-centred care. The school nurses were based at public and private schools and worked with students aged 12-19. Data were collected through interviews with 18 school nurses and analyzed with deductive content analysis. The school nurses felt that actively listening to the students' narratives about daily life with recurrent pain, and co-creation of a health plan, encouraged the students to participate as partners in their own care and strengthened their relation with the students. The application of a person-centred approach in school health care meant that traditional knowledge transfer was replaced with a dialogue that reflects both the student's and school nurse's perspective.


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Lee County has collected 63,000 cubic yards of debris in the first 10 days since post-Hurricane Irma cleanup began, officials reported today.
The county is working to create a schedule to show residents when each area of the county can expect to have its first pass-through of debris collection.
There are 2,436 miles of county roads that have storm-related horticultural debris to be removed. Lee County anticipates its first pass of horticulture debris collection from the storm will be completed within a month.
Lee County's debris-management hauler, Crowder Gulf, is picking up debris - currently in the San Carlos Park and East Lee County areas of Alva, Buckingham and Lehigh Acres.
Lee County is working to open more debris staging sites as quickly as possible. Unfortunately, many of the pre-certified sites the county had before the storm are under water or very wet due to the significant rainfall in August and September.
Crowder Gulf has 20 double-barrel debris collection trucks and 34 bucket trucks on the roads. It is anticipating 10 more double-barrel trucks by the weekend, with more on the way as the county ramps up collection efforts.
Debris from Hurricane Irma should be separated between horticultural (yard waste) and construction & demolition (C&D or structural waste). It does not have to be bundled or cut to length. Do not place piles on sidewalks - particularly in areas of school bus stops - or near mailboxes, fire hydrants or trees in case a clam bucket is used to pick up the pile.
See: www.leegov.com/solidwaste for more information and a diagram of proper set out.
You can help speed the cleanup by placing yard waste that is in compliance out for weekly collection by your regular hauler. This includes yard waste that is bagged, bundled and tied, or in containers. Each bag, bundle or container needs to weigh less than 50 pounds. Bundles need to be less than 6 feet. Palm fronds can be stacked in neat piles at the curb.
Lee County is working to pick up debris from private gated communities. A right of entry form will have to be signed by the gated community's HOA in order to collect the debris curbside. HOAs can contact Solid Waste at 239-533-8970. Communities should not consolidate the debris in common areas, as this may make it ineligible for collection.
Source: Lee County

subset: commoncrawl


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Welcome to our new hotel in Torslanda, Gothenburg
In Amhult centrum, Torslanda, Gothenburg we have a new hotel with apartments for self dependant living. The hotel is placed centrally with 2 min walk to the bus station "Amhults Resecentrum". Staying with us is simple and free, you check in quickly as we have no reception, park your car and walk up to your apartment using your code given in time before come here. Free wifi awaits you in the area and on your room.
We have 28 modern and comfortable apartments, all fully furnitured and with a kitchen including all kitchen utilities. The apartments have either one or two rooms, TV and access to washing machine and tumbler. Extra beds can be ordered and parking for one car is included in the designated area. Our hotel is perfect if you need "a home in between homes" or ir you need a hotel for a longer period than a few days that feels more like home.
In the same building you also find a gym, a supermarket, a restaurant and market hall for fish, gourmet sausages and other foods. the gym is organized by Friskis & Svettis, Willy's is the owner of the supermarket and market hall and the restaurant is BBQ Galore. Not far from the area you find other restaurants, including Amhults Krog.
We have a room suitable for your preferences;
1 suite ca 66 m².
1 grand studios plus ca 50 m2.
8 grand studios ca 40 m².
15 studios ca 29 m².
3 ministudios ca 20 m² med artificiellt skylight.
If you wish to stay for a shorter period than a month, please book your room via Expedia, Hotels, or Booking. If you wish to stay with us monthly, please make your booking request here.


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This class is not like the typical, regular, Zumba dance. STRONG is a non-dance based class from the fitness brand. STRONG revolves around high-intensity training but still focuses on moving to the beat. STRONG takes signature exercise moves and applies it to music. Get ready to sweat while having some fun.
Tuesday, February 19, 2019 at 6:15pm to 7:15pm
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Press Releases
Travellers' net profit reaches P1.8B in 9-mos 2018
Pasay City, November 12, 2018 –Travellers International Hotel Group, Inc. (TIHGI), owner and operator of Resorts World Manila (RWM), reported unaudited consolidated financial results with gross revenues reaching P17.0 billion and net profit amounted to P1.8 billion.
For the first nine months of 2018, gross gaming revenues rose by 7.5% year-on-year to P13.8 billion while non-gaming revenues from rose by 11.3% to P3.2 billion.
On a quarter-on-quarter basis, gross gaming revenues saw a 4.9% increase to P4.7 billion versus P4.5 billion in the second quarter driven by growth in both the non-VIP and VIP segments. Non-gaming revenues generated P1.2 billion in the third quarter, increasing by 10.7% versus the second quarter. Property visitation averaged 27,500 per day in the third quarter and average occupancy rate for the three hotels – Marriott Hotel Manila, Maxims Hotel, and Holiday Inn Express Manila Newport City – was 79%.
"The latest addition to the hotel portfolio of Resorts World Manila is the Hilton Manila Hotel, which opened its doors to the public last October 25," says Kingson Sian, President and CEO of RWM. "The hotel offers 357 rooms, three restaurants, two bars, several meeting spaces, and a 545-square meter ballroom that can accommodate up to 600 people for a cocktail set-up.
"We will continue to invest in the property to be able to provide thrilling and unique experiences for our customers," continued Sian. "We are in full swing working to complete our Phase 3 development called the Grand Wing,"
The Grand Wing will have three international luxury hotels – Hilton Manila, Sheraton Manila Hotel, and Hotel Okura Manila – adding approximately 940 rooms. It will include new gaming, entertainment, and retail spaces, as well as six basement parking decks.
Current Reports
Contact Us
TRAVELLERS INTERNATIONAL HOTEL GROUP, INC.Office: +632 7908-8000
Fax: +632 7908-8107
FOR INVESTOR RELATIONS AND COMPLIANCEBernard Than
Chief Financial Officer, Investor Relations Officer, Corporate Information Officer, & Compliance Officer
Email: email@example.com


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BOSTON � The Celtics could very well face the Magic in the opening round of the playoffs and right now that looks like a very welcome draw.
BOSTON - The Celtics could very well face the Magic in the
opening round of the playoffs and right now that looks like a very
welcome draw.
Magic coach Stan Van Gundy says that he does not expect all-star
center Dwight Howard to play again in the regular season and isn't
counting on him for a first-round playoff series, either.
"Right now our approach is this is our team. Now and in the
playoffs," Van Gundy said.
The one Magic player who needs to pick up the slack in Howard's
absence is, ironically, ex-Celtic Glen Davis. Baby came into
Wednesday's game averaging 8.9 points and 5.4 rebounds in his first
season with the Magic after leaving Boston as a free agent. He says
dealing with Howard's injury and season-long distraction of whether
he'd be traded or not "has been tough," but says his team will be
ready come playoff time.
Davis, who scorched the Celts early with 12 first quarter
points, says he's not surprised that the Celtics continued to
prosper without him. He said he "used to look up to Brandon Bass
growing up," back in Louisiana, and that Bass' medium-range jumper
has really helped the Celts. He also was happy to see Avery Bradley
enjoy a breakout second half of the season.
"He came in a young player and we always saw the upside in him,"
he said. "His energy and the way he approached the game were key.
He's going to be a big, big, big help to them."
As for the playoffs, Davis would not be surprised to see his old
team in the mix once again.
"I know this team. I know the coach, I know the spirit of this
team, and you never count these guys out. I knew for a fact they'd
turn it up and make some things happen this year," he said. "I
think they're really dangerous. Just their mental mindset and the
way they play the game. They're a playoff team, especially when
they're healthy."
Rondo, Allen, Pietrus forced out
The Celtics sat Rajon Rondo (back), Ray Allen (ankle) and
Mickael Pietrus (knee), and coach Doc Rivers said if it were a
playoff game, none of the three could have played.
Rondo has played heavy minutes for the last several weeks and
clearly needed a rest at some point, but Rivers said he's developed
back spasms that could also keep him out of Friday's game at
Pietrus didn't play for about three weeks with a concussion but
returned and saw heavy minutes in the next four games. He did not
play Tuesday at the Knicks, however, after some swelling in his
The most important injury clearly belongs to Allen. The veteran
shooter missed his sixth straight game with a balky ankle that
apparently was not responding to heavy treatment.
'62 championship marked
The Celtics honored the 50th anniversary of their 1962
championship team at halftime. That group, led by Bill Russell, Bob
Cousy and Tommy Heinsohn, won a fourth straight title but needed
seven games in The Finals to defeat the Los Angeles Lakers.
In Game Seven, the Celtics dodged a major bullet when Laker
Frank Selvy missed an open 12-footer from the baseline that would
have won the series. Instead, the game went into overtime, during
which the Celtics won the game and the series, 110-107. Russell
enjoyed one of the greatest playoff efforts ever in Game Seven with
30 points and 40 rebounds.
Red Auerbach, of course, was Boston's coach that season. The
Celtics now honor the legend with the Red Auerbach Award, which is
given to the Celtics player or coach who exemplifies the spirit of
what it means to be a Celtic through performance on the court and
off. This year's winner is Kevin Garnett, who took a bow before
Wednesday's game. Garnett also won the award in 2008.
Orton's time
The young big man the Magic will need help from in the playoffs
is second-year man Daniel Orton. He's played only bit minutes most
of this season and ironically would've been a junior at Kentucky if
he chose to remain in school. Kentucky set a record with five
players being drafted from the same school in the first round of
the 2010 draft. The five were John Wall (first), DeMarcus Cousins
(fifth), Patrick Patterson (14th), Eric Bledsoe (18th) and Orton


text:
Leupold VX-R Patrol 1.25-4x20 Riflescope (FireDot Special Purpose Reticle)
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In Understanding camera shutters and the shutter angle, we learnt there are two fundamental types of shutters relevant to the video industry:
- Electronic Shutters
- Rotating Discs
Rotating Discs are less common, and will probably be phased out completely, simply because their advantages can be incorporated into electronic shutters.
Global Shutter
Today, there are two fundamental types of electronic shutters:
- Global Shutter
- Rolling Shutter
Traditional film cameras have rotating discs, and each frame is exposed whole. Such a frame is called a progressive frame.
A global shutter captures a frame whole, exactly like a good film movie camera rotating disc shutter does. All the pixels are read at the same point of time, so we have a whole frame.
The ideal global shutter doesn't exist, just as the ideal rotary disc shutter never existed. However, electronic global shutters have the potential for the greatest accuracy and uniformity across the frame.
For this reason, many people categorically proclaim every camera must have a global shutter. That's baloney. It's like saying all cameras should be black in color.
Rolling Shutter
A rolling shutter is an electronic system that scans lines (rows) of pixels, similar to how NTSC/PAL television scanning occurs.
Look at the above image. Imagine each orange box is a pixel, and our image is made of only three pixels. As our hero climbs the stairs, the pixels are read one at a time, thereby causing a lag in the final frame.
Don't let the simplicity of my example fool you. Rolling shutters are more complicated than this, and can be so designed to approximate global shutters.
The Rolling Shutter system follows television scanning systems in essence, and is quite useful if your camera is shooting interlaced broadcast television.
On the other hand, most people today prefer capturing in progressive frames, to emulate the film look, whether they know what that is or not. Therefore, it has become a general demand that electronic rolling shutters be confined to history. Here are some weird artifacts that might be caused by the rolling shutter:
- Jello Effect
- Skew
- Smear
- Exposure changes
Which is better: Rolling Shutter or Global Shutter?
Usually CMOS sensors use rolling shutter systems while CCDs use global shutters. However, this is not universally true. There are CMOS sensors with global shutters and CCD sensors with rolling shutters.
Furthermore, there are different types of rolling shutters, and just because some technologies produce undesirable results doesn't mean the system or methodology is bad.
E.g., a lot of people think the rolling shutter is bad. Most of this is due to misinformation from idiots who don't understand the science and technology behind it. In fact, there are many situations where a rolling shutter will give a more filmic look than a global shutter!
Stay away from anyone who proclaims a technology is good or bad by itself. The simplest thing to do is forget about technology, and test for yourself. This is why I've included the video in this article. A painter won't start creating a masterpiece with an untested brush recommended by an expert, so why would a filmmaker do the same?
After all, modern cameras are a lot more complicated. Soon we will reach a point where the technology is so beyond us (like computers, airplanes, medicine, etc.) that we will be forced to test. Get used to it.


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If you're not watching Dracula, the mini-series by the creators of Downton Abbey, showing Friday nights on NBC ... you are not alone. I'm watching it, but that's just because I have EXCEPTIONALLY GOOD TASTE. I also have a sixth sense for sussing out any television program wherein Jonathan Rhys Meyers gets very, very naked (hellllooooo, The Tudors).
In an extender trailer for tonight's episode of Dracula, we not only get to witness Jonathan Rhys Meyers in his Victorian-era underwear (helllloooo, tattoos), but the stakes (pun not intended but infinitely delightful) are raised when Drac tries to cure his inability to walk in the sun or face dire consequences. I mean, as dire as anything could be for an immortal blood sucker. I can't even handle it, you guys.
More from The Stir: Jonathan Rhys Meyers Isn't the Only Thing 'Dracula' Has Going for It
In this adaptation of the Bram Stoker classic, Dracula is actually one of the good guys (be still my beating heart). He was awoken by the infamous Van Helsing and enlisted to help him do battle against their shared enemy, the Order of the Dragon (pause here to push up my glasses). In a take worthy of Dickens, this Gothic horror story now centers around the quiet dismantling of the corporate machine that powers the order, comprised of wealthy, powerful, and totally homophobic dudes.
Drac's managed to infiltrate their midst, pretending to be Southern (JRM's accent has grown on me). But they are suspicious now and are holding a meeting in the noonday sun. If he doesn't show up, that will completely out him as a vampire! So he and Van Helsing are trying to cure his pesky sun problem. If dude can walk around all Twilight style, do you even know what that means? He basically will become a superhero. Though I wonder, could his sun-walking antics and the cure that comes with him be a mistake? What if he becomes mortal again in the process? I HAVE SO MANY QUESTIONS.
Do you think Dracula being able to walk in the sun helps or hurts the series?
Image via NBC


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I love beer, I love wine too, but I'm in love with beer, there is a difference.
The thing is this, the craft of making beer has ascended to high art. That means high pleasure, believe me it's true. Beer is not your daddy's Bud anymore. Then there are places like the Beer Authority that take the enjoyment of beer to a wonderful new level.
For months I've been waiting anxiously for the opening of this exciting new place that promised 80 taps and another 100 beers in bottles. I was sceptical at first fearing that this might be another shallow corporate restaurant with all the icing but no cake. Not so with Beer Authority, this is the real thing, or at least the 21st Century version of real thing.
The music is just right and there is a very friendly vibe, you are with beer drinkers after all. Were a very gregarious bunch who love to mix and mingle.
I sat down at the bar and was presented with a well organized menu of the 90 ales and lagers on tap. Everything from sour ales like Liefmans Cuvee Brut to deep brews like Two Brothers Red Eye Coffee Porter.
My bartender, Juli I think is her name, knew her beer menu well and made some fine recomendations Smuttynose Finestkind IPA which is balanced and flavorfull revealing surprises of subtle flavor, Stone Sublimely Self Righteous Ale, a truley remarkable ale that rates a straight up 100 on RateBeer.Com and a solid 94 on Beer Advocate. Then a truly unique O'Hara's Irish Stout. Someone is doing a great job of selecting Beer Authroities menu.
Speaking of menus the food looks really good too. Very interesting menu. I enjoyed this juicy Lamb Burger with Sweet Potato Fries.
My first visit exceed every expectation and plan to be back next week with my beer loving brother in-law. He is in love with beer too.
Read what the NY Times had to say.
613 8th Avenue (corner of 40th street across from Port Authority) New York, NY 10018.
Tel: 212 510 8415
Open everyday from 8am to 4am