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Vogt, T., Lindkvist, M., Ivarsson, A., Silfverdal, S.-A. & Vaezghasemi, M. (2024). Temporal trends and educational inequalities in obesity, overweight and underweight in pre-pregnant women and their male partners: a decade (2010–2019) with no progress in Sweden. European Journal of Public Health, Article ID ckae052.
Open this publication in new window or tab >>Temporal trends and educational inequalities in obesity, overweight and underweight in pre-pregnant women and their male partners: a decade (2010–2019) with no progress in Sweden
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2024 (English)In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, article id ckae052Article in journal (Refereed) Published
Abstract [en]

Background: Trends in overweight and obesity among expectant parents can provide useful information about the family environment in which children will grow up and about possible social inequalities that may be passed on to them. Therefore, we aimed to assess whether the prevalence of underweight, overweight and obesity changed over time in pre-pregnant women and their male partners in northern Sweden, and if there were any educational inequalities.

Methods: This study is based on cross-sectional data from a repeated survey of the population in Västerbotten, Sweden. The study population included 18,568 pregnant women and 18,110 male partners during the period 2010–2019. Multinomial logistic regression models were fitted separately for pregnant women and male partners to assess whether the prevalence of age-adjusted underweight, normal weight, overweight and obesity had evolved between 2010 and 2019, and whether trends differed by educational level.

Results: Among women, obesity prevalence increased from 9.4% in 2010 to 11.7% in 2019. Among men, it went from 8.9 to 12.8%. Educational inequalities were sustained across the study period. In 2019, the prevalence of obesity was 7.8 percentage points (pp) (CI = 4.4–11.3) higher among women with low compared to high education. The corresponding figure for men was 6.4 pp (CI = 3.3–9.6).

Conclusions: It is not obvious that the prevalence of obesity among parents-to-be will decrease under current dispositions. Public health policies and practice should therefore be strengthened.

Place, publisher, year, edition, pages
Oxford University Press, 2024
Keywords
obesity, pregnancy, body mass index procedure, educational status, parent, knowledge acquisitionunder, weight, overweight
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-223140 (URN)10.1093/eurpub/ckae052 (DOI)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2022-00493
Available from: 2024-04-10 Created: 2024-04-10 Last updated: 2024-04-10
Lwin, M. W., Timby, E., Ivarsson, A., Eurenius, E., Vaezghasemi, M., Silfverdal, S.-A. & Lindkvist, M. (2023). Abnormal birth weights for gestational age in relation to maternal characteristics in Sweden: a five year cross-sectional study. BMC Public Health, 23(1), Article ID 976.
Open this publication in new window or tab >>Abnormal birth weights for gestational age in relation to maternal characteristics in Sweden: a five year cross-sectional study
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2023 (English)In: BMC Public Health, E-ISSN 1471-2458, Vol. 23, no 1, article id 976Article in journal (Refereed) Published
Abstract [en]

Background: Abnormal birth weight - small for gestational age (SGA) and large for gestational age (LGA) - are important indicators for newborn health. Due to changes in lifestyle in recent decades, it is essential to keep up-to-date with the latest information on maternal factors linked to abnormal birth weight. The aim of this study is to investigate SGA and LGA in relation to maternal individual, lifestyle and socioeconomic characteristics.

Methods: This is a register-based cross-sectional study. Self-reported data from Sweden's Salut Programme maternal questionnaires (2010-2014) were linked with records in the Swedish Medical Birth Register (MBR). The analytical sample comprised 5089 singleton live births. A Swedish standard method using ultrasound-based sex-specific reference curves defines the abnormality of birth weight in MBR. Univariable and multivariable logistic regressions were used to examine crude and adjusted associations between abnormal birth weights and maternal individual, lifestyle and socioeconomic characteristics. A sensitivity analysis, using alternative definitions of SGA and LGA under the percentile method, was undertaken.

Results: In multivariable logistic regression, maternal age and parity were associated with LGA (aOR = 1.05, CI = 1.00, 1.09) and (aOR = 1.31, CI = 1.09, 1.58). Maternal overweight and obesity were strongly associated with LGA (aOR = 2.28, CI = 1.47, 3.54) and (aOR = 4.55, CI = 2.85, 7.26), respectively. As parity increased, the odds of delivering SGA babies decreased (aOR = 0.59, CI = 0.42, 0.81) and preterm deliveries were associated with SGA (aOR = 9.46, CI = 5.67, 15.79). The well-known maternal determinants of abnormal birthweight, such as unhealthy lifestyles and poor socioeconomic factors, were not statistically significant in this Swedish setting.

Conclusions: The main findings suggest that multiparity, maternal pre-pregnancy overweight and obesity are strong determinants for LGA babies. Public health interventions should address modifiable risk factors, especially maternal overweight and obesity. These findings suggest that overweight and obesity is an emerging public health threat for newborn health. This might also result in the intergenerational transfer of overweight and obesity. These are important messages for public health policy and decision making.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023
Keywords
Birth weight, Body mass index, Cross-sectional, Large for gestational age, Lifestyle, Maternal obesity, Small for gestational age
National Category
Public Health, Global Health, Social Medicine and Epidemiology Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:umu:diva-209152 (URN)10.1186/s12889-023-15829-y (DOI)000995510200006 ()37237290 (PubMedID)2-s2.0-85160376071 (Scopus ID)
Funder
Region Västerbotten
Available from: 2023-06-26 Created: 2023-06-26 Last updated: 2023-08-28Bibliographically approved
Sampaio, F., Häggström, J., Ssegonja, R., Eurenius, E., Ivarsson, A., Pulkki-Brännström, A.-M. & Feldman, I. (2023). Health and economic outcomes of a universal early intervention for parents and children from birth to age five: evaluation of the Salut Programme using a natural experiment. Cost Effectiveness and Resource Allocation, 21(1), Article ID 29.
Open this publication in new window or tab >>Health and economic outcomes of a universal early intervention for parents and children from birth to age five: evaluation of the Salut Programme using a natural experiment
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2023 (English)In: Cost Effectiveness and Resource Allocation, E-ISSN 1478-7547, Vol. 21, no 1, article id 29Article in journal (Refereed) Published
Abstract [en]

Background: The aim of this study was to investigate the health and economic outcomes of a universal early intervention for parents and children, the Salut Programme, from birth to when the child completed five years of age.

Methods: This study adopted a retrospective observational design using routinely collected linked register data with respect to both exposures and outcomes from Västerbotten county, in northern Sweden. Making use of a natural experiment, areas that received care-as-usual (non-Salut area) were compared to areas where the Programme was implemented after 2006 (Salut area) in terms of: (i) health outcomes, healthcare resource use and costs around pregnancy, delivery and birth, and (ii) healthcare resource use and related costs, as well as costs of care of sick child. We estimated total cumulative costs related to inpatient and specialised outpatient care for mothers and children, and financial benefits paid to mothers to stay home from work to care for a sick child. Two analyses were conducted: a matched difference-in difference analysis using the total sample and an analysis including a longitudinal subsample.

Results: The longitudinal analysis on mothers who gave birth in both pre- and post-measure periods showed that mothers exposed to the Programme had on average 6% (95% CI 3–9%) more full-term pregnancies and 2% (95% CI 0.03-3%) more babies with a birth weight ≥ 2500 g, compared to mothers who had care-as-usual. Savings were incurred in terms of outpatient care costs for children of mothers in the Salut area ($826). The difference-in-difference analysis using the total sample did not result in any significant differences in health outcomes or cumulative resource use over time.

Conclusions: The Salut Programme achieved health gains, as a health promotion early intervention for children and parents, in terms of more full-term pregnancies and more babies with a birth weight ≥ 2500 g, at reasonable cost, and may lead to lower usage of outpatient care. Other indicators point towards positive effects, but the small sample size may have led to underestimation of true differences.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023
Keywords
Child health, Early intervention, Health care costs, Maternal health costs, Universal prevention
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-208946 (URN)10.1186/s12962-023-00439-7 (DOI)000980523200001 ()37143113 (PubMedID)2-s2.0-85157979665 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2017-00912
Available from: 2023-06-02 Created: 2023-06-02 Last updated: 2023-06-02Bibliographically approved
Vaezghasemi, M., Vogt, T., Lindkvist, M., Pulkki-Brännström, A.-M., Richter Sundberg, L., Lundahl, L., . . . Ivarsson, A. (2023). Multifaceted determinants of social-emotional problems in preschool children in Sweden: An ecological systems theory approach. SSM - Population Health, 21, Article ID 101345.
Open this publication in new window or tab >>Multifaceted determinants of social-emotional problems in preschool children in Sweden: An ecological systems theory approach
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2023 (English)In: SSM - Population Health, ISSN 2352-8273, Vol. 21, article id 101345Article in journal (Refereed) Published
Abstract [en]

Social-emotional problems occurring early in life can place children at future risk of adverse health, social and economic outcomes. Determinants of social-emotional problems are multi-layered and originate from different contexts surrounding children, though few studies consider them simultaneously. We adopted a holistic approach by using Bronfenbrenner's process-person-context-time model as a structuring device. We aimed to assess what characteristics of families and children from pregnancy, over birth, and up to 3 years of age are associated with social-emotional problems in boys and girls. This study used regional data from the Salut Programme, a universal health promotion programme implemented in Antenatal and Child Health Care, and data from national Swedish registers. The study population included 6033 3-year-olds and their parents during the period 2010–2018. Distinct logistic regression models for boys and girls were used to assess associations between the family social context, parents' lifestyle, parent's mental health, children's birth characteristics, and indicators of proximal processes (the independent variables); and children's social-emotional problems as measured by the parent-completed Ages and Stages Questionnaire: Social-Emotional between 33 and 41 months of age (the outcome). Overall, a less favourable family social context, detrimental lifestyle of the parents during pregnancy, and parents' mental illness from pregnancy onwards were associated with higher odds of social-emotional problems in 3-year-olds. Higher screentime and infrequent shared book-reading were associated with higher odds of social-emotional problems. The multifaceted determinants of children's social-emotional problems imply that many diverse targets for intervention exist. Additionally, this study suggests that Bronfenbrenner's process-person-context-time theoretical framework could be relevant for public health research and policy.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
Social-emotional health, Mental health, Preschool children, Ecological systems theory:sweden
National Category
Public Health, Global Health, Social Medicine and Epidemiology Pediatrics
Identifiers
urn:nbn:se:umu:diva-204344 (URN)10.1016/j.ssmph.2023.101345 (DOI)2-s2.0-85147123061 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2021-00155
Available from: 2023-02-02 Created: 2023-02-02 Last updated: 2023-02-17Bibliographically approved
Vaezghasemi, M., Pulkki-Brännström, A.-M., Lindkvist, M., Silfverdal, S.-A., Lohr, W. & Ivarsson, A. (2023). Social inequalities in social-emotional problems among preschool children: a population-based study in Sweden. Global Health Action, 16(1), Article ID 2147294.
Open this publication in new window or tab >>Social inequalities in social-emotional problems among preschool children: a population-based study in Sweden
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2023 (English)In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 16, no 1, article id 2147294Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Social-emotional ability is important for overall health and wellbeing in early childhood. Recognizing preschool children in need of extra support, especially those living in unfavourable conditions, can have immediate positive effects on their health and benefit their wellbeing in the long-term.

OBJECTIVES: The aim of this study is to investigate whether there are social inequalities in preschool children's social-emotional problems, and whether inequalities differ between boys and girls.

METHOD: This study utilized repeated measures from cross-sectional population-based surveys of three-year old children (2014-2018). The final study population comprised of 9,099 children which was 61% of all the eligible children in Västerbotten County during the study period. The Ages and Stages Questionnaires: Social-Emotional (ASQ:SE) 36-month interval was used to measure children's social-emotional ability. Social inequalities were studied with respect to parents' income, education, and place of birth, for which data was obtained from Statistics Sweden. Multiple logistic and ordered regressions were used.

RESULTS: Among 3-year-olds, social-emotional problems were more common in the most vulnerable social groups, i.e. parents in the lowest income quintile (OR: 1.45, p < 0.001), parents with education not more than high school (OR: 1.51, p < 0.001), and both parents born outside Sweden (OR: 2.54, p < 0.001). Notably, there was a larger difference in social-emotional problems between the lowest and highest social categories for girls compared to boys. Higher odds of social-emotional problems were associated with boys not living with both parents and girls living in the areas of Skellefteå and Umeå, i.e. more populated geographical areas.

CONCLUSION: Already at 3-years of age social-emotional problems were more common in children with parents in the most vulnerable social groups. This does not fulfil the ambition of an equitable start in life for every child and might contribute to reproduction of social inequalities across generations.

Place, publisher, year, edition, pages
Taylor & Francis, 2023
Keywords
Ages and Stages Questionnaires: Social-Emotional (ASQ:SE), Population-based, mental health, preschool children, social inequality
National Category
Public Health, Global Health, Social Medicine and Epidemiology Pediatrics
Identifiers
urn:nbn:se:umu:diva-204345 (URN)10.1080/16549716.2022.2147294 (DOI)000923029200001 ()36722260 (PubMedID)2-s2.0-85147186828 (Scopus ID)
Funder
Public Health Agency of Sweden Region Västerbotten
Available from: 2023-02-02 Created: 2023-02-02 Last updated: 2023-09-05Bibliographically approved
Johansson, K., Norström, F., Green, P. H., Ivarsson, A., Richter Sundberg, L., Själander, A. & Myléus, A. (2022). Celiac disease and upper secondary school achievement in Sweden: A retrospective cohort study. BMC Pediatrics, 22(1), Article ID 709.
Open this publication in new window or tab >>Celiac disease and upper secondary school achievement in Sweden: A retrospective cohort study
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2022 (English)In: BMC Pediatrics, ISSN 1471-2431, E-ISSN 1471-2431, Vol. 22, no 1, article id 709Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Both undiagnosed celiac disease and some chronic childhood diseases are associated with lower academic achievement. However, there is little knowledge of achievements in those diagnosed with celiac disease. Our aim was to investigate school achievements in upper secondary school among Swedish adolescents with celiac disease.

METHODS: We performed a retrospective cohort study using register data. We analyzed choice of upper secondary school program, completion of upper secondary school including achievements of basic eligibility for college/university, and final grade in individuals with celiac disease diagnosed before 15 years of age, born 1991-97. We compared with the Swedish population of the same birth years. Analyses were adjusted for sex, year of birth, living region at 17 years of age, and parental education as well as income.

RESULTS: The cohort included 734 074 individuals, whereof 3 257 (62% females) with celiac disease. There was no significant difference in choice of upper secondary school program. No significant difference was found in completion or achieving basic eligibility for college/university in adjusted analyses. The mean final grade in the celiac disease group was 13.34 (standard deviation 4.85) compared to 12.78 (standard deviation 5.01) in the reference population (p < 0.001), out of a maximum of 20. The effect of celiac disease on final grade remained in adjusted analyses (p = 0.012).

CONCLUSIONS: We found that diagnosed celiac disease does not negatively affect school achievements in upper secondary school. This finding suggests the diagnosis, treatment and follow-up programs of celiac disease could reverse potential deleterious academic processes.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2022
Keywords
Celiac disease, Follow-up, Gluten-free diet, Grades, School performance
National Category
Public Health, Global Health, Social Medicine and Epidemiology Pediatrics
Identifiers
urn:nbn:se:umu:diva-201645 (URN)10.1186/s12887-022-03773-6 (DOI)000897782900004 ()36503420 (PubMedID)2-s2.0-85143758235 (Scopus ID)
Funder
Region VästernorrlandRegion VästerbottenSwedish Research CouncilRiksbankens Jubileumsfond
Available from: 2022-12-13 Created: 2022-12-13 Last updated: 2023-09-05Bibliographically approved
Sandström, O., Norström, F., Carlsson, A., Högberg, L., van der Pals, M., Stenhammar, L., . . . Myléus, A. (2022). Five-year follow-up of new cases after a coeliac disease mass screening. Archives of Disease in Childhood, 107(6), 596-600
Open this publication in new window or tab >>Five-year follow-up of new cases after a coeliac disease mass screening
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2022 (English)In: Archives of Disease in Childhood, ISSN 0003-9888, E-ISSN 1468-2044, Vol. 107, no 6, p. 596-600Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: We previously performed a population-based mass screening of coeliac disease in children aged 12 years in two birth cohorts resulting in 296 seropositive children, of whom 242 were diagnosed with coeliac disease after duodenal biopsies. In this follow-up study, we wanted to identify new cases in the screening population that tested negative-either converting from potential coeliac disease (seropositive but normal duodenal mucosa) or converting from seronegative at screening to diagnosed coeliac disease.

METHODS: All seropositive children were invited to a follow-up appointment 5 years after the screening with renewed serological testing and recommended endoscopic investigation if seropositive. Seronegative children in the screening study (n=12 353) were linked to the National Swedish Childhood Coeliac Disease Register to find cases diagnosed in healthcare during the same period.

RESULTS: In total, 230 (77%) came to the follow-up appointment, including 34 of 39 with potential coeliac disease. Of these, 11 (32%) had converted to coeliac disease. One new case was found in the National Swedish Childhood Coeliac Disease Register who received the diagnosis through routine screening in children with type 1 diabetes.

CONCLUSIONS: There is a high risk of conversion to coeliac disease among those with potential disease. However, a negative screening test was associated with a very low risk for a clinical diagnosis within a follow-up period of 5 years.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2022
Keywords
epidemiology, gastroenterology, paediatrics
National Category
Pediatrics Gastroenterology and Hepatology Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-190637 (URN)10.1136/archdischild-2021-322755 (DOI)000731958400001 ()34921003 (PubMedID)2-s2.0-85130767943 (Scopus ID)
Funder
EU Sixth Framework Programme for Research, FP6-2005-FOOD-4B-36383-PREVENTCDSwedish Research Council, 521-2004-7093Swedish Research Council, 521-2007-2953Swedish Research Council for Environment, Agricultural Sciences and Spatial Planning, 222-2004-1918Swedish Research Council for Environment, Agricultural Sciences and Spatial Planning, 222-2007-1394Forte, Swedish Research Council for Health, Working Life and Welfare, 2005-0802
Available from: 2021-12-20 Created: 2021-12-20 Last updated: 2022-07-12Bibliographically approved
Vaezghasemi, M., Eurenius, E., Ivarsson, A., Richter Sundberg, L., Silfverdal, S.-A. & Lindkvist, M. (2022). The Ages and Stages Questionnaire: Social-Emotional—What Is the Optimal Cut-Off for 3-Year-Olds in the Swedish Setting?. Frontiers in Pediatrics , 10, Article ID 756239.
Open this publication in new window or tab >>The Ages and Stages Questionnaire: Social-Emotional—What Is the Optimal Cut-Off for 3-Year-Olds in the Swedish Setting?
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2022 (English)In: Frontiers in Pediatrics , E-ISSN 2296-2360, Vol. 10, article id 756239Article in journal (Refereed) Published
Abstract [en]

Objective: Expressions of emotional and behavioral symptoms in preschool age can predict mental health problems in adolescence and adulthood. The Ages and Stages Questionnaires: Social-Emotional (ASQ:SE) has been successful in detecting social and emotional problems in young children in some countries but had not been tested in Sweden. The objective of this study was to determine the optimal cut-off for the ASQ:SE instrument when administered to 3-year-old children in a northern Swedish setting, using the Strengths and Difficulties Questionnaire (SDQ) as the reference.

Methods: The ASQ:SE (36-month interval, first edition) was administered at routine 3-year-olds' visits to Child Health Care centers in Region Västerbotten, Sweden. During the study period (September 2017 to March 2018) parents were invited to also fill out the SDQ (2–4 year version). In the final analyses 191 children fulfilled the criteria for inclusion in the study sample. Non-parametric Receiver Operating Characteristic analysis was performed to quantify the discriminatory accuracy of ASQ:SE based on SDQ.

Results: The Pearson correlation between ASQ:SE and SDQ indicated strong correlation between the two instruments. The Receiver Operating Characteristic curve showed good accuracy of ASQ:SE in relation to SDQ. However, our results suggest that the existing ASQ:SE cut-off score of 59 was not optimal in the Swedish context. Changing the cut-off from 59 to 50 would allow us to detect 100% (n = 14) of children with problems according to SDQ, compared to 64% (n = 9) when the cut-off was 59. However, the proportion of false positives would be higher (9% compared to 3%).

Conclusion: The main finding was that for 3-year-olds in Sweden a decreased ASQ:SE cut-off score of 50 would be optimal. This would increase the detection rate of at-risk children according to SDQ (true positive), thus prioritizing sensitivity. Our conclusion is that, although this change would result in more false positives, this would be justifiable.

Place, publisher, year, edition, pages
Frontiers Media S.A., 2022
Keywords
emotional and behavioral problems, mental health, preschool children, screening, Strengths and Difficulties Questionnaire (SDQ), Receiver Operating Characteristic (ROC) analysis
National Category
Public Health, Global Health, Social Medicine and Epidemiology Pediatrics
Research subject
Pediatrics
Identifiers
urn:nbn:se:umu:diva-192313 (URN)10.3389/fped.2022.756239 (DOI)000760724700001 ()35223687 (PubMedID)2-s2.0-85125137892 (Scopus ID)
Funder
Public Health Agency of Sweden Region Västerbotten
Available from: 2022-02-09 Created: 2022-02-09 Last updated: 2023-09-05Bibliographically approved
Takeuchi, H., Lee, S.-H. & Ivarsson, A. (2022). Towards optimising children’s capability and tackling relative child poverty in high-income countries: the cases of Japan, Sweden and the UK since 2000. Global Health Action, 15(1), Article ID 2084230.
Open this publication in new window or tab >>Towards optimising children’s capability and tackling relative child poverty in high-income countries: the cases of Japan, Sweden and the UK since 2000
2022 (English)In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 15, no 1, article id 2084230Article in journal (Refereed) Published
Abstract [en]

Background: We question why child poverty still prevails even in high-income countries, such as Japan, Sweden and the United Kingdom. We address the intersection between social relations and individual experiences that should be considered when optimising children’s capability.

Objectives: The study is therefore aimed at exploring compensatory societal actions taken to optimise children’s capability among these affluent countries. In order to do so, we operationalised children’s capability by including key societal domains along with statistical indicators and variables from relevant sources.

Methods: A secondary quantitative method was adopted by drawing upon data sources from 2000 up to almost 2020 from the Organisation for Economic Co-operation and Development, the World Bank and the United Nations Children’s Fund, with these being complemented by governmental data. Given a lack of currently available and comparable data for those three countries, four key societal domains were explored in an absolute descriptive analysis.

Results: It is obvious that child poverty prevailed over the focal 20 years in these three high-income countries. Also, the exploratory data analysis revealed a lack of sufficient supporting social services in each societal domain. This demonstrates that optimising children’s capability should not just be about subsidising economic resources, but also supporting all initiatives aimed at addressing the lack of interactions between each domain of children’s capability.

Conclusions: The study shows how essential it is to consider societal compensatory measures along with supporting the financial circumstances. We therefore argue that optimising children’s capability should not only be about subsidising economic resources, but also ensuring adequate social resources and relations.

Place, publisher, year, edition, pages
Taylor & Francis, 2022
Keywords
Children’s capability, high-income countries, relative child poverty
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-198348 (URN)10.1080/16549716.2022.2084230 (DOI)000826880300001 ()35848789 (PubMedID)2-s2.0-85134564650 (Scopus ID)
Available from: 2022-08-01 Created: 2022-08-01 Last updated: 2022-08-01Bibliographically approved
Westerlund, A., Ivarsson, A. & Richter Sundberg, L. (2021). Evidence-based practice in child and adolescent mental health services: The challenge of implementing national guidelines for treatment of depression and anxiety. Scandinavian Journal of Caring Sciences, 35(2), 476-484
Open this publication in new window or tab >>Evidence-based practice in child and adolescent mental health services: The challenge of implementing national guidelines for treatment of depression and anxiety
2021 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 35, no 2, p. 476-484Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Mental health problems are one of the most pressing public health concerns of our time. Sweden has seen a sharp increase in mental disorders among children and youth during the last decade. The evidence base for treatment of psychiatric conditions has developed strongly. Clinical practice guidelines aim to compile such evidence and support healthcare professionals in evidence-based clinical decision-making. In Sweden, the national guidelines for the treatment of depression and anxiety disorders in children and adolescents were launched in 2010. The aim of this study was two folded, (i) to explore to what extent these guidelines were known and adhered to by health professionals in Child and Adolescent Mental Health Services and (ii) to investigate factors influencing implementation of the guidelines informed by the Consolidated Framework for Implementation Research.

METHODS: A qualitative approach was used, and data were collected through interviews with 18 health professionals in Child Mental Health Services in Sweden and a combination of conventional and directed content analyses was used. The Consolidated Framework for Implementation Research guided and structured data collection and analysis.

RESULTS: The guidelines were largely unknown by health professionals in Child Mental Health Services in all the clinics investigated. Adherence to guideline recommendations was reported as very low. Barriers to implementation were found in relation to the characteristics of the intervention, outer setting, inner setting and characteristics of the individuals involved.

CONCLUSIONS: The government initiative to develop and disseminate the guidelines seems to have made very little impact on health professionals' clinical practice. The guidelines were poorly aligned with the health professionals' knowledge and beliefs about effective mental health services for children and youth with depression and anxiety disorders. Suggestions for future efforts to improve the development and implementation of guidelines in Child Mental Health Services settings are given.

Place, publisher, year, edition, pages
John Wiley & Sons, 2021
Keywords
Consolidated Framework for Implementation Research, child and adolescent psychiatry, clinical practice guidelines, implementation research
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-170095 (URN)10.1111/scs.12859 (DOI)000527545600001 ()32323362 (PubMedID)2-s2.0-85083791137 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2014‐1552
Available from: 2020-04-26 Created: 2020-04-26 Last updated: 2023-03-24Bibliographically approved
Projects
CELIAC DISEASE. HAS THE TIME COME FOR PRIMARY PREVENTION AND MASS SCREENING? Evaluation of the Swedish epidemic and post-epidemic cohorts at twelve-years-of-age. [2011-03248_VR]; Umeå University
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-8944-2558

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