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  • 1. Arouca, Aline B
    et al.
    Meirhaeghe, Aline
    Dallongeville, Jean
    Moreno, Luis A
    Lourenço, Gustavo Jacob
    Marcos, Ascensión
    Huybrechts, Inge
    Manios, Yannis
    Lambrinou, Christina-Paulina
    Gottrand, Frederic
    Kafatos, Anthony
    Kersting, Mathilde
    Sjöström, Michael
    Widhalm, Kurt
    Ferrari, Marika
    Molnár, Denes
    González-Gross, Marcela
    Forsner, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    De Henauw, Stefaan
    Michels, Nathalie
    Interplay between the Mediterranean diet and C-reactive protein genetic polymorphisms towards inflammation in adolescents2020Ingår i: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 39, nr 6, s. 1919-1926Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: From a nutrigenetics perspective, we aim to investigate the moderating role of the Mediterranean diet and each of its subgroups in the association between C-reactive protein (CRP) gene polymorphisms and CRP blood concentration in adolescents.

    METHODS: In 562 adolescents (13-17 y) of the European HELENA study, data was available on circulating CRP levels as inflammatory biomarker, three CRP gene SNPs (rs3093068, rs1204, rs1130864), food intake determined by a self-administered computerized 24 h-dietary recall for 2 days, and body composition. A 9-point Mediterranean diet score and each food subgroup were tested as moderator via SNP*diet interaction. Analyzes were adjusted for age, sex, puberty, adiposity and socioeconomic status.

    RESULTS: The minor allele frequencies of rs3093068 and rs1130864 SNPs (GG and TT, respectively) were associated with higher CRP concentrations, while rs1205 (CT/TT) was associated with lower CRP concentrations. There were significant interactions between rs3093068 and Mediterranean diet (B = -0.1139, p = 0.011), or the fish food subgroup (B = -0.0090, p = 0.022), so that those with the highest genetic CRP risk underwent the highest CRP attenuation by a healthier diet. Although the effect of diet and SNP was substantial, the explained variance by interaction was only 1%.

    CONCLUSION: Greater adherence to the Mediterranean diet and particularly its fish component was associated with a lower CRP blood concentrations especially in those at highest genetic risk due to the rs3093068 SNP.

  • 2. Arouca, Aline B.
    et al.
    Santaliestra-Pasías, Alba M.
    Moreno, Luis A.
    Marcos, Ascensión
    Widhalm, Kurt
    Molnár, Dénes
    Manios, Yannis
    Gottrand, Frederic
    Kafatos, Anthony
    Kersting, Mathilde
    Sjöström, Michael
    Sáinz, Ángel Gutiérrez
    Ferrari, Marika
    Huybrechts, Inge
    González-Gross, Marcela
    Forsner, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
    De Henauw, Stefaan
    Michels, Nathalie
    Diet as a moderator in the association of sedentary behaviors with inflammatory biomarkers among adolescents in the HELENA study2019Ingår i: European Journal of Nutrition, ISSN 1436-6207, E-ISSN 1436-6215, Vol. 58, nr 5, s. 2051-2065Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: To assess if a healthy diet might attenuate the positive sedentary-inflammation relation, whereas an unhealthy diet may increase the effect of sedentary behaviors on inflammatory biomarkers.

    METHODS: In 618 adolescents (13-17 years) of the European HELENA study, data were available on body composition, a set of inflammation markers, and food intake assessed by a self-administered computerized 24 h dietary recall for 2 days. A 9-point Mediterranean diet score and an antioxidant-rich diet z-score were used as dietary indices and tested as moderators. A set of low-grade inflammatory characteristics was used as outcome: several cytokines in an inflammatory ratio (IL-6, IL-10, TNF-α, TGFβ-1), C-reactive protein, three cell-adhesion molecules (sVCAM-1, sICAM-1, sE-selectin), three cardiovascular risk markers (GGT, ALT, homocysteine) and three immune cell types (white blood cells, lymphocytes, CD3). Sedentary behaviors were self-reported and analyzed as total screen time. Multiple linear regression analyses tested moderation by diet in the sedentary behaviors-inflammation association adjusted for age, sex, country, adiposity (sum of six skinfolds), parental education, and socio-economic status.

    RESULTS: Both diet scores, Mediterranean and antioxidant-rich diet, were significant protective moderators in the effect of sedentary behaviors on alanine-transaminase enzyme (P = 0.014; P = 0.027), and on the pro/anti-inflammatory cytokine ratio (P = 0.001; P = 0.004), but not on other inflammatory parameters.

    CONCLUSION: A higher adherence to the Mediterranean diet or an antioxidant-rich diet may attenuate the onset of oxidative stress signs associated by sedentary behaviors, whereas a poor diet seems to increase inflammation.

  • 3. Bentham, James
    et al.
    Di Cesare, Mariachiara
    Stevens, Gretchen A.
    Zhou, Bin
    Bixby, Honor
    Cowan, Melanie
    Fortunato, Lea
    Bennett, James E.
    Danaei, Goodarz
    Hajifathalian, Kaveh
    Lu, Yuan
    Riley, Leanne M.
    Laxmaiah, Avula
    Kontis, Vasilis
    Paciorek, Christopher J.
    Riboli, Elio
    Ezzati, Majid
    Abdeen, Ziad A.
    Hamid, Zargar Abdul
    Abu-Rmeileh, Niveen M.
    Acosta-Cazares, Benjamin
    Adams, Robert
    Aekplakorn, Wichai
    Aguilar-Salinas, Carlos A.
    Agyemang, Charles
    Ahmadvand, Alireza
    Ahrens, Wolfgang
    Al-Hazzaa, Hazzaa M.
    Al-Othman, Amani Rashed
    Al Raddadi, Rajaa
    Ali, Mohamed M.
    Alkerwi, Ala'a
    Alvarez-Pedrerol, Mar
    Aly, Eman
    Amouyel, Philippe
    Amuzu, Antoinette
    Andersen, Lars Bo
    Anderssen, Sigmund A.
    Anjana, Ranjit Mohan
    Aounallah-Skhiri, Hajer
    Ariansen, Inger
    Aris, Tahir
    Arlappa, Nimmathota
    Arveiler, Dominique
    Assah, Felix K.
    Avdicova, Maria
    Azizi, Fereidoun
    Babu, Bontha V.
    Bahijri, Suhad
    Balakrishna, Nagalla
    Bandosz, Piotr
    Banegas, Jose R.
    Barbagallo, Carlo M.
    Barcelo, Alberto
    Barkat, Amina
    Barros, Mauro V.
    Bata, Iqbal
    Batieha, Anwar M.
    Batista, Rosangela L.
    Baur, Louise A.
    Beaglehole, Robert
    Ben Romdhane, Habiba
    Benet, Mikhail
    Bernabe-Ortiz, Antonio
    Bernotine, Gailute
    Bettiol, Heloisa
    Bhagyalaxmi, Aroor
    Bharadwaj, Sumit
    Bhargava, Santosh K.
    Bhatti, Zaid
    Bhutta, Zulfiqar A.
    Bi, Hongsheng
    Bi, Yufang
    Bjerregaard, Peter
    Bjertness, Espen
    Bjertness, Marius B.
    Bjorkelund, Cecilia
    Blokstra, Anneke
    Bo, Simona
    Bobak, Martin
    Boddy, Lynne M.
    Boehm, Bernhard O.
    Boeing, Heiner
    Boissonnet, Carlos P.
    Bongard, Vanina
    Bovet, Pascal
    Braeckman, Lutgart
    Bragt, Marjolijn C. E.
    Brajkovich, Imperia
    Branca, Francesco
    Breckenkamp, Juergen
    Brenner, Hermann
    Brewster, Lizzy M.
    Brian, Garry R.
    Bruno, Graziella
    Bueno-de-Mesquita, H. B(as)
    Bugge, Anna
    Burns, Con
    Cabrera de Leon, Antonio
    Cacciottolo, Joseph
    Cama, Tilema
    Cameron, Christine
    Camolas, Jose
    Can, Gunay
    Candido, Ana Paula C.
    Capuano, Vincenzo
    Cardoso, Viviane C.
    Carlsson, Axel C.
    Carvalho, Maria J.
    Casanueva, Felipe F.
    Casas, Juan-Pablo
    Caserta, Carmelo A.
    Chamukuttan, Snehalatha
    Chan, Angelique W.
    Chan, Queenie
    Chaturvedi, Himanshu K.
    Chaturvedi, Nishi
    Chen, Chien-Jen
    Chen, Fangfang
    Chen, Huashuai
    Chen, Shuohua
    Chen, Zhengming
    Cheng, Ching-Yu
    Chetrit, Angela
    Chiolero, Arnaud
    Chiou, Shu-Ti
    Chirita-Emandi, Adela
    Cho, Belong
    Cho, Yumi
    Christensen, Kaare
    Chudek, Jerzy
    Cifkova, Renata
    Claessens, Frank
    Clays, Els
    Concin, Hans
    Cooper, Cyrus
    Cooper, Rachel
    Coppinger, Tara C.
    Costanzo, Simona
    Cottel, Dominique
    Cowell, Chris
    Craig, Cora L.
    Crujeiras, Ana B.
    D'Arrigo, Graziella
    d'Orsi, Eleonora
    Dallongeville, Jean
    Damasceno, Albertino
    Damsgaard, Camilla T.
    Dankner, Rachel
    Dauchet, Luc
    De Backer, Guy
    De Bacque, Dirk
    de Gaetano, Giovanni
    De Hanauw, Stefaan
    De Smedt, Delphine
    Deepa, Mohan
    Deev, Alexander D.
    Dehghan, Abbas
    Delisle, Helene
    Delpeuch, Francis
    Deschamps, Valerie
    Dhana, Klodian
    Di Castelnuovo, Augusto F.
    Dias-da-Costa, Juvenal Soares
    Diaz, Alejandro
    Djalalinia, Shirin
    Do, Ha T. P.
    Dobson, Annette J.
    Donfrancesco, Chiara
    Donoso, Silvana P.
    Doering, Angela
    Doua, Kouamelan
    Drygas, Wojciech
    Dzerve, Vilnis
    Egbagbe, Eruke E.
    Eggertsen, Robert
    Ekelund, Ulf
    El Ati, Jalila
    Elliott, Paul
    Engle-Stone, Reina
    Erasmus, Rajiv T.
    Erem, Cihangir
    Eriksen, Loise
    Escobedo-de la Pena, Jorge
    Evans, Alun
    Faeh, David
    Fall, Caroline H.
    Farzadfar, Farshad
    Felix-Redondo, Francisco J.
    Ferguson, Trevor S.
    Fernandez-Berges, Daniel
    Ferrante, Daniel
    Ferrari, Marika
    Ferreccio, Catterina
    Ferrieres, Jean
    Finn, Joseph D.
    Fischer, Krista
    Monterubio Flores, Eric
    Foeger, Bernhard
    Foo, Leng Huat
    Forslund, Ann-Sofie
    Forsner, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Högskolan Dalarna.
    Fortmann, Stephen P.
    Francis, Heba M.
    Francis, Damian K.
    do Carmo Franco, Maria
    Franco, Oscar H.
    Frontera, Guillermo
    Fuchs, Flavio D.
    Fuchs, Sandra C.
    Fujita, Yuki
    Furusawa, Takuro
    Gaciong, Zbigniew
    Gafencu, Mihai
    Gareta, Dickman
    Garnett, Sarah P.
    Gaspoz, Jean-Michel
    Gasull, Magda
    Gates, Louise
    Geleijnse, Johanna M.
    Ghasemian, Anoosheh
    Giampaoli, Simona
    Gianfagna, Francesco
    Giovannelli, Jonathan
    Giwercman, Aleksander
    Goldsmith, Rebecca A.
    Goncalves, Helen
    Gonzalez Gross, Marcela
    Gonzalez Rivas, Juan P.
    Bonet Gorbea, Mariano
    Gottrand, Frederic
    Graff-Iversen, Sidsel
    Grafnetter, Dusan
    Grajda, Aneta
    Grammatikopoulou, Maria G.
    Gregor, Ronald D.
    Grodzicki, Tomasz
    Grontved, Anders
    Gruden, Grabriella
    Grujic, Vera
    Gu, Dongfeng
    Gualdi-Russo, Emanuela
    Guan, Ong Peng
    Gudnason, Vilmundur
    Guerrero, Ramiro
    Guessous, Idris
    Guimaraes, Andre L.
    Gulliford, Martin C.
    Gunnlaugsdottir, Johanna
    Gunter, Marc
    Guo, Xiuhua
    Guo, Yin
    Gupta, Prakash C.
    Gureje, Oye
    Gurzkowska, Beata
    Gutierrez, Laura
    Gutzwiller, Felix
    Halkjaer, Jytte
    Hambleton, Ian R.
    Hardy, Rebecca
    Kumar, Rachakulla Hari
    Hata, Jun
    Hayes, Alison J.
    He, Jiang
    Hendriks, Marleen Ekisabeth
    Hernandez Cadena, Leticia
    Herrala, Sauli
    Heshmat, Ramin
    Hihtaniemi, Ilpo Tapani
    Ho, Sai Yin
    Ho, Suzanne C.
    Hobbs, Michael
    Hofman, Albert
    Hormiga, Claudi M.
    Horta, Bernardo L.
    Houti, Leila
    Howitt, Christina
    Htay, Thein Thein
    Htet, Aung Soe
    Htike, Maung Maung Than
    Hu, Yonghua
    Husseini, Abdullatif
    Huu, Chinh Nguyen
    Huybrechts, Inge
    Hwalla, Nahla
    Iacoviello, Licia
    Iannone, Anna G.
    Ibrahim, Mohsen M.
    Ikeda, Nayu
    Ikram, M. Arfan
    Irazola, Vilma E.
    Islam, Muhammad
    Ivkovic, Vanja
    Iwasaki, Masanori
    Jackson, Rod T.
    Jacobs, Jeremy M.
    Jafar, Tazeen
    Jamil, Kazi M.
    Jamrozik, Konrad
    Janszky, Imre
    Jasienska, Grazyna
    Jelakovic, Bojan
    Jiang, Chao Qiang
    Joffres, Michel
    Johansson, Mattias
    Jonas, Jost B.
    Jorgensen, Torben
    Joshi, Pradeep
    Juolevi, Anne
    Jurak, Gregor
    Juresa, Vesno
    Kaaks, Rudolf
    Kafatos, Anthony
    Kalter-Leibovici, Ofra
    Kapantais, Efthymios
    Kasaeian, Amir
    Katz, Joanne
    Kaur, Prabhdeep
    Kavousi, Maryam
    Keil, Ulrich
    Boker, Lital Keinan
    Keinanen-Kiukaanniemi, Sirkka
    Kelishadi, Roya
    Kemper, Han C. G.
    Kengne, Andre P.
    Kersting, Mathilde
    Key, Timothy
    Khader, Yousef Saleh
    Khalili, Davood
    Khang, Young-Ho
    Khaw, Kay-Tee H.
    Khouw, Ilse M. S. L.
    Kiechl, Stefan
    Killewo, Japhet
    Kim, Jeongseon
    Klimont, Jeannette
    Klumbiene, Jurate
    Koirala, Bhawesh
    Kolle, Elin
    Kolsteren, Patrick
    Korrovits, Paul
    Koskinen, Seppo
    Kouda, Katsuyasu
    Koziel, Slawomir
    Kratzer, Wolfgang
    Krokstad, Steinar
    Kromhout, Daan
    Kruger, Herculina S.
    Kubinova, Ruzena
    Kujala, Urho M.
    Kula, Krzysztof
    Kulaga, Zbigniew
    Kumar, R. Krishna
    Kurjata, Pawel
    Kusuma, Yadlapalli S.
    Kuulasmaa, Kari
    Kyobutungi, Catherine
    Laamiri, Fatima Zahra
    Laatikainen, Tiina
    Lachat, Carl
    Laid, Youcef
    Lam, Tai Hing
    Landrove, Orlando
    Lanska, Vera
    Lappas, Georg
    Larijani, Bagher
    Laugsand, Lars E.
    Bao, Khanh Le Nguyen
    Le, Tuyen D
    Leclercq, Catherine
    Lee, Jeannette
    Lee, Jeonghee
    Lehtimaki, Terho
    Lekhraj, Rampal
    Leon-Munoz, Luz M.
    Li, Yanping
    Lilly, Christa L.
    Lim, Wei-Yen
    Fernanda Lima-Costa, M.
    Lin, Hsien-Ho
    Lin, Xu
    Linneberg, Allan
    Lissner, Lauren
    Litwin, Mieczyslaw
    Liu, Jing
    Lorbeer, Roberto
    Lotufo, Paulo A.
    Eugenio Lozano, Jose
    Luksiene, Dalia
    Lundqvist, Annamari
    Lunet, Nuno
    Ma, Guansheng
    Ma, Jun
    Machado-Coelho, George L. L.
    Machi, Suka
    Maggi, Stefania
    Magliano, Dianna J.
    Maire, Bernard
    Makdisse, Marcia
    Malekzadeh, Reza
    Malhotra, Rahul
    Rao, Kodavanti Mallikharjuna
    Malyutina, Sofia
    Manios, Yannis
    Mann, Jim I.
    Manzato, Enzo
    Margozzini, Paula
    Markey, Oonagh
    Marques-Vidal, Pedro
    Marrugat, Jaume
    Martin-Prevel, Yves
    Martorell, Reynaldo
    Masoodi, Shariq R.
    Mathiesen, Ellisiv B.
    Matsha, Tandi E.
    Mazur, Artur
    Mbanya, Jean Claude N.
    McFarlane, Shelly R.
    McGarvey, Stephen T.
    McKee, Martin
    McLachlan, Stela
    McLean, Rachael M.
    McNulty, Breige A.
    Yusof, Safiah Md
    Mediene-Benchekor, Sounnia
    Meirhaeghe, Aline
    Meisinger, Christa
    Menezes, Ana Maria B.
    Mensink, Gert B. M.
    Meshram, Indrapal I.
    Metspalu, Andres
    Mi, Jie
    Michaelsen, Kim F.
    Mikkel, Kairit
    Miller, Jody C.
    Francisco Miquel, Juan
    Jaime Miranda, J.
    Misigoj-Durakovic, Marjeta
    Mohamed, Mostafa K.
    Mohammad, Kazem
    Mohammadifard, Noushin
    Mohan, Viswanathan
    Yusoff, Muhammad Fadhli Mohd
    Molbo, Drude
    Moller, Niels C.
    Molnar, Denes
    Mondo, Charles K.
    Monterrubio, Eric A.
    Monyeki, Kotsedi Daniel K.
    Moreira, Leila B.
    Morejon, Alain
    Moreno, Luis A.
    Morgan, Karen
    Mortensen, Erik Lykke
    Moschonis, George
    Mossakowska, Malgorzata
    Mostafa, Aya
    Mota, Jorge
    Motlagh, Mohammad Esmaeel
    Motta, Jorge
    Mu, Thet Thet
    Muiesan, Maria Lorenza
    Mueller-Nurasyid, Martina
    Murphy, Neil
    Mursu, Jaakko
    Murtagh, Elaine M.
    Musa, Kamarul Imran
    Musil, Vera
    Nagel, Gabriele
    Nakamura, Harunobu
    Namesna, Jana
    Nang, Ei Ei K.
    Nangia, Vinay B.
    Nankap, Martin
    Narake, Sameer
    Maria Navarrete-Munoz, Eva
    Neal, William A.
    Nenko, Ilona
    Neovius, Martin
    Nervi, Flavio
    Neuhauser, Hannelore K.
    Nguyen, Nguyen D.
    Nguyen, Quang Ngoc
    Nieto-Martinez, Ramfis E.
    Ning, Guang
    Ninomiya, Toshiharu
    Nishtar, Sania
    Noale, Marianna
    Norat, Teresa
    Noto, Davide
    Al Nsour, Mohannad
    O'Reilly, Dermot
    Oh, Kyungwon
    Olayan, Iman H.
    Anselmo Olinto, Maria Teresa
    Oltarzewski, Maciej
    Omar, Mohd A.
    Onat, Altan
    Ordunez, Pedro
    Ortiz, Ana P.
    Osler, Merete
    Osmond, Clive
    Ostojic, Sergej M.
    Otero, Johanna A.
    Overvad, Kim
    Owusu-Dabo, Ellis
    Paccaud, Fred Michel
    Padez, Cristina
    Pahomova, Elena
    Pajak, Andrzej
    Palli, Domenico
    Palloni, Alberto
    Palmieri, Luigi
    Panda-Jonas, Songhomitra
    Panza, Francesco
    Parnell, Winsome R.
    Parsaeian, Mahboubeh
    Pecin, Ivan
    Pednekar, Mangesh S.
    Peeters, Petra H.
    Peixoto, Sergio Viana
    Peltonen, Markku
    Pereira, Alexandre C.
    Perez, Cynthia M.
    Peters, Annette
    Petkeviciene, Janina
    Peykari, Niloofar
    Pham, Son Thai
    Pigeot, Iris
    Pikhart, Hynek
    Pilav, Aida
    Pilotto, Lorenza
    Pistelli, Francesco
    Pitakaka, Freda
    Piwonska, Aleksandra
    Plans-Rubio, Pedro
    Poh, Bee Koon
    Porta, Miquel
    Portegies, Marileen L. P.
    Poulimeneas, Dimitrios
    Pradeepa, Rajendra
    Prashant, Mathur
    Price, Jacqueline F.
    Puiu, Maria
    Punab, Margus
    Qasrawi, Radwan F.
    Qorbani, Mostafa
    Bao, Tran Quoc
    Radic, Ivana
    Radisauskas, Ricardas
    Rahman, Mahmudur
    Raitakari, Olli
    Raj, Manu
    Rao, Sudha Ramachandra
    Ramachandran, Ambady
    Ramke, Jacqueline
    Ramos, Rafel
    Rampal, Sanjay
    Rasmussen, Finn
    Redon, Josep
    Reganit, Paul Ferdinand M.
    Ribeiro, Robespierre
    Rigo, Fernando
    de Wit, Tobias F. Rinke
    Ritti-Dias, Raphael M.
    Rivera, Juan A.
    Robinson, Sian M.
    Robitaille, Cynthia
    Rodri-guez-Artalejo, Fernando
    del Cristo Rodriguez-Perez, Maria
    Rodriguez-Villamizar, Laura A.
    Rojas-Martinez, Rosalba
    Rojroongwasinkul, Nipa
    Romaguera, Dora
    Ronkainen, Kimmo
    Rosengren, Annika
    Rouse, Ian
    Rubinstein, Adolfo
    Ruhli, Frank J.
    Rui, Ornelas
    Sandra Ruiz-Betancourt, Blanca
    Horimoto, Andrea R. V. Russo
    Rutkowski, Marcin
    Sabanayagam, Charumathi
    Sachdev, Harshpal S.
    Saidi, Olfa
    Salanave, Benoit
    Salazar Martinez, Eduardo
    Salomaa, Veikko
    Salonen, Jukka T.
    Salvetti, Massimo
    Sanchez-Abanto, Jose
    Sandjaja,
    Sans, Susana
    Santos, Diana A.
    Santos, Osvaldo
    dos Santos, Renata Nunes
    Santos, Rute
    Saramies, Jouko L.
    Sardinha, Luis B.
    Sarrafzadegan, Nizal
    Saum, Kai-Uwe
    Savva, Savvas C.
    Scazufca, Marcia
    Rosario, Angelika Schaffrath
    Schargrodsky, Herman
    Schienkiewitz, Anja
    Schmidt, Ida Maria
    Schneider, Ione J.
    Schultsz, Constance
    Schutte, Aletta E.
    Sein, Aye Aye
    Sen, Abhijit
    Senbanjo, Idowu O.
    Sepanlou, Sadaf G.
    Shalnova, Svetlana A.
    Sharma, Sanjib K.
    Shaw, Jonathan E.
    Shibuya, Kenji
    Shin, Dong Wook
    Shin, Youchan
    Shiri, Rahman
    Siantar, Rosalynn
    Sibai, Abla M.
    Silva, Antonio M.
    Santos Silva, Diego Augusto
    Simon, Mary
    Simons, Judith
    Simons, Leon A.
    Sjostrom, Michael
    Slowikowska-Hilczer, Jolanta
    Slusarczyk, Przemyslaw
    Smeeth, Liam
    Smith, Margaret C.
    Snijder, Marieke B.
    So, Hung-Kwan
    Sobngwi, Eugene
    Söderberg, Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Soekatri, Moesijanti Y. E.
    Solfrizzi, Vincenzo
    Sonestedt, Emily
    Song, Yi
    Sorensen, Thorkild I. A.
    Soric, Maroje
    Jerome, Charles Sossa
    Soumare, Aicha
    Staessen, Jan A.
    Starc, Gregor
    Stathopoulou, Maria G.
    Staub, Kaspar
    Stavreski, Bill
    Steene-Johannessen, Jostein
    Stehle, Peter
    Stein, Aryeh D.
    Stergiou, George S.
    Stessman, Jochanan
    Stieber, Jutta
    Stoeckl, Doris
    Stocks, Tanja
    Stokwiszewski, Jakub
    Stratton, Gareth
    Stronks, Karien
    Strufaldi, Maria Wany
    Sun, Chien-An
    Sundstroem, Johan
    Sung, Yn-Tz
    Sunyer, Jordi
    Suriyawongpaisal, Paibul
    Swinburn, Boyd A.
    Sy, Rody G.
    Szponar, Lucjan
    Tai, E. Shyong
    Tammesoo, Mari-Liis
    Tamosiunas, Abdonas
    Tang, Line
    Tang, Xun
    Tanser, Frank
    Tao, Yong
    Tarawneh, Mohammed Rasoul
    Tarp, Jakob
    Tarqui-Mamani, Carolina B.
    Taylor, Anne
    Tchibindat, Felicite
    Theobald, Holger
    Thijs, Lutgarde
    Thuesen, Betina H.
    Tjonneland, Anne
    Tolonen, Hanna K.
    Tolstrup, Janne S.
    Topbas, Murat
    Topor-Madry, Roman
    Torrent, Maties
    Toselli, Stefania
    Traissac, Pierre
    Trichopoulou, Antonia
    Trichopoulos, Dimitrios
    Trinh, Oanh T. H.
    Trivedi, Atul
    Tshepo, Lechaba
    Tulloch-Reid, Marshall K.
    Tuomainen, Tomi-Pekka
    Tuomilehto, Jaakko
    Turley, Maria L.
    Tynelius, Per
    Tzotzas, Themistoklis
    Tzourio, Christophe
    Ueda, Peter
    Ukoli, Flora A. M.
    Ulmer, Hanno
    Unal, Belgin
    Uusitalo, Hannu M. T.
    Valdivia, Gonzalo
    Vale, Susana
    Valvi, Damaskini
    van der Schouw, Yvonne T.
    Van Herck, Koen
    Minh, Hoang Van
    van Rossem, Lenie
    van Valkengoed, Irene G. M.
    Vanderschueren, Dirk
    Vanuzzo, Diego
    Vatten, Lars
    Vega, Tomas
    Velasquez-Melendez, Gustavo
    Veronesi, Giovanni
    Verschuren, W. M. Monique
    Verstraeten, Roosmarijn
    Victora, Cesar G.
    Viegi, Giovanni
    Viet, Lucie
    Viikari-Juntura, Eira
    Vineis, Paolo
    Vioque, Jesus
    Virtanen, Jyrki K.
    Visvikis-Siest, Sophie
    Viswanathan, Bharathi
    Vollenweider, Peter
    Voutilainen, Sari
    Vrdoljak, Ana
    Vrijheid, Martine
    Wade, Alisha N.
    Wagner, Aline
    Walton, Janette
    Mohamud, Wan Nazaimoon Wan
    Wang, Ming-Dong
    Wang, Qian
    Wang, Ya Xing
    Wannamethee, S. Goya
    Wareham, Nicholas
    Weerasekera, Deepa
    Whincup, Peter H.
    Widhalm, Kurt
    Widyahening, Indah S.
    Wiecek, Andrzej
    Wijga, Alet H.
    Wilks, Rainford J.
    Willeit, Johann
    Wilsgaard, Tom
    Wojtyniak, Bogdan
    Wong, Jyh Eiin
    Wong, Tien Yin
    Woo, Jean
    Woodward, Mark
    Wu, Frederick C.
    Wu, Jianfeng
    Wu, Shou Ling
    Xu, Haiquan
    Xu, Liang
    Yamborisut, Uruwan
    Yan, Weili
    Yang, Xiaoguang
    Yardim, Nazan
    Ye, Xingwang
    Yiallouros, Panayiotis K.
    Yoshihara, Akihiro
    You, Qi Sheng
    Younger-Coleman, Novie O.
    Yusoff, Ahmad F.
    Zainuddin, Ahmad A.
    Zambon, Sabina
    Zdrojewski, Tomasz
    Zeng, Yi
    Zhao, Dong
    Zhao, Wenhua
    Zheng, Yingfeng
    Zhou, Maigeng
    Zhu, Dan
    Zimmermann, Esther
    Cisneros, Julio Zuniga
    A century of trends in adult human height2016Ingår i: eLIFE, E-ISSN 2050-084X, Vol. 5, artikel-id e13410Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Being taller is associated with enhanced longevity, and higher education and earnings. We reanalysed 1472 population-based studies, with measurement of height on more than 18.6 million participants to estimate mean height for people born between 1896 and 1996 in 200 countries. The largest gain in adult height over the past century has occurred in South Korean women and Iranian men, who became 20.2 cm (95% credible interval 17.522.7) and 16.5 cm (13.319.7) taller, respectively. In contrast, there was little change in adult height in some sub-Saharan African countries and in South Asia over the century of analysis. The tallest people over these 100 years are men born in the Netherlands in the last quarter of 20th century, whose average heights surpassed 182.5 cm, and the shortest were women born in Guatemala in 1896 (140.3 cm; 135.8144.8). The height differential between the tallest and shortest populations was 19-20 cm a century ago, and has remained the same for women and increased for men a century later despite substantial changes in the ranking of countries.

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  • 4.
    Blixt, Cornelia
    et al.
    Crown Princess Victoria Children's Hospital, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
    Johansson, Elin
    Crown Princess Victoria Children's Hospital, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
    Forsner, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Department of Biosciences and Nutrition, Karolinska Institutet, Sweden.
    Angelhoff, Charlotte
    Crown Princess Victoria Children's Hospital, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Allergy Center in Linköping, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
    Compassion fatigue and compassion satisfaction in pediatric and neonatal care nurses during the COVID-19 pandemic in Sweden2023Ingår i: Journal of Pediatric Nursing: Nursing Care of Children and Families, ISSN 0882-5963, E-ISSN 1532-8449, Vol. 73, s. e646-e651Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: Quality of care and the mental and physical health of nurses are interlinked. The COVID-19 pandemic has imposed an extremely high burden on health care. This study aimed to: 1) describe professional quality of life of registered nurses (RN) working in the pediatric and neonatal care units during the COVID-19 pandemic in Sweden, 2) compare professional quality of life between RNs with and without a Master's degree in specialist nursing pediatric care (MSc), and 3) compare differences in professional quality of life associated with the nursing experience (years).

    Design and methods: This study adopted a cross-sectional survey design. The PROQoL®-5-questionnaire was administered as a web survey to 160 RNs at four pediatric wards and two neonatal units of two hospitals in Sweden.

    Results: Seventy-one RNs responded to the survey. Overall, they reported a sufficient professional quality of life. RNs with an MSc suffered significantly lower secondary traumatic stress levels. Experienced RNs reported significantly higher compassion satisfaction and lower occupational burnout.

    Conclusion: Higher education and longer experience are beneficial for nurses' professional quality of life when working in pediatric care units.

    Practical implications: Results from this study highlights the importance of offering RN education in pediatric care at master level and supporting novice nurses, to prevent negative professional well-being outcomes in pediatric care, because the health of nurses is of utterly importance when crisis such as a pandemic hits the world. The findings also suggest that the conditions for professional quality of life could improve through activities such as self-care, time for reflection, better working hours, competence-adjusted salary, and educational opportunities.

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  • 5. Bray, Lucy
    et al.
    Blake, Lucy
    Protheroe, Jo
    Nafria, Begonya
    Garcia de Avila, Marla Andreia
    Ångström-Brännström, Charlotte
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Forsner, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Campbell, Steve
    Ford, Karen
    Rullander, Anna-Clara
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Robichaud, Fanny
    Jenholt Nolbris, Margaretha
    Saron, Holly
    Kirton, Jennifer A.
    Carter, Bernie
    Children’s pictures of COVID-19 and measures to mitigate its spread: an international qualitative study2021Ingår i: Health Education Journal, ISSN 0017-8969, E-ISSN 1748-8176, Vol. 80, nr 7, s. 811-832Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: To gain insight into children's health-related knowledge and understanding of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2) and COVID-19, and measures adopted to mitigate transmission.

    Design: A child-centred qualitative creative element embedded in an online mixed-methods survey of children aged 7–12 years. 

    Setting: Children participated in the study in six countries – the UK, Australia, Sweden, Brazil, Spain and Canada.

    Method: A qualitative creative component, embedded in an online survey, prompted children to draw and label a picture. Children were recruited via their parents using the researchers' professional social media accounts, through known contacts, media and websites from health organisations within each country. Analysis of the form and content of the children's pictures took place.

    Results: A total of 128 children (mean age 9.2 years) submitted either a hand-drawn (n = 111) or digitally created (n = 17) picture. Four main themes were identified which related to children's health-related knowledge of (1) COVID-19 and how it is transmitted; (2) measures and actions to mitigate transmission; (3) places of safety during the pandemic; and (4) children’s role in mitigating COVID-19 transmission.

    Conclusion: Children's pictures indicated a good understanding of the virus, how it spreads and how to mitigate transmission. Children depicted their actions during the pandemic as protecting themselves, their families and wider society.

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  • 6. Bray, Lucy
    et al.
    Carter, Bernie
    Blake, Lucy
    Saron, Holly
    Kirton, Jennifer A.
    Robichaud, Fanny
    Avila, Marla
    Ford, Karen
    Nafria, Begonya
    Forsner, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Nilsson, Stefan
    Chelkowski, Andrea
    Middleton, Andrea
    Rullander, Anna-Clara
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Mattsson, Janet
    Protheroe, Joanne
    "People play it down and tell me it can't kill people, but I know people are dying each day". Children's health literacy relating to a global pandemic (COVID-19); an international cross sectional study.2021Ingår i: PLOS ONE, E-ISSN 1932-6203, Vol. 16, nr 2, artikel-id e0246405Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of this study was to examine aspects of children's health literacy; the information sources they were accessing, their information preferences, their perceived understanding of and their reported information needs in relation to COVID-19. An online survey for children aged 7-12 years of age and parent/caregivers from the UK, Sweden, Brazil, Spain, Canada and Australia was conducted between 6th of April and the 1st of June 2020. The surveys included demographic questions and both closed and open questions focussing on access to and understanding of COVID-19 information. Descriptive statistics and qualitative content analysis procedures were conducted. The findings show that parents are the main source of information for children during the pandemic in most countries (89%, n = 347), except in Sweden where school was the main source of information. However, in many cases parents chose to shield, filter or adapt their child's access to information about COVID-19, especially in relation to the death rates within each country. Despite this, children in this study reported knowing that COVID-19 was deadly and spreads quickly. This paper argues for a community rather than individual approach to addressing children's health literacy needs during a pandemic.

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  • 7.
    Bray, Lucy
    et al.
    Edge Hill University, Ormskirk, United Kingdom.
    Carter, Bernie
    Edge Hill University, Ormskirk, United Kingdom.
    Kiernan, Joann
    Edge Hill University and Alder Hey Children’s Hospital, Liverpool, United Kingdom.
    Horowicz, Ed
    University of Liverpool, Liverpool, United Kingdom.
    Dixon, Katie
    Expert by Experience, Liverpool, United Kingdom.
    Ridley, James
    Edge Hill University and National Restraint Reduction Network, Ormskirk, United Kingdom.
    Robinson, Carol
    University of Strathclyde, Glasglow, United Kingdom.
    Simmons, Anna
    Alder Hey Children’s Hospital, Liverpool, United Kingdom.
    Craske, Jennie
    Alder Hey Children’s Hospital, Liverpool, United Kingdom.
    Sinha, Stephanie
    Alder Hey Children’s Hospital, Liverpool, United Kingdom.
    Morton, Liza
    University of Glasgow, Glasgow, United Kingdom.
    Nafria, Begonya
    Sant Joan de Déu Children’s Hospital, Barcelona, Spain.
    Forsner, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Rullander, Anna-Clara
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Nilsson, Stefan
    University of Gothenburg, Gothenburg, Sweden.
    Darcy, Laura
    University of Borås, Borås, Sweden.
    Karlsson, Katarina
    University of Borås, Borås, Sweden.
    Hubbuck, Cath
    Great Ormond Street Hospital, London, United Kingdom.
    Brenner, Maria
    Trinity College, Dublin, Ireland.
    Spencer-Little, Sian
    Great Ormond Street Hospital, London, United Kingdom.
    Evans, Kath
    Barts Health NHS Trust, London, United Kingdom.
    Rowland, Andrew
    The University of Salford, Salford, United Kingdom.
    Hilliard, Carol
    Children’s Health Ireland (CHI) at Crumlin, Dublin, Ireland.
    Preston, Jennifer
    University of Liverpool, Liverpool, United Kingdom.
    Leroy, Piet L.
    Maastricht University Medical Centre / Maastricht University, Maastricht, Netherlands.
    Roland, Damian
    University Hospitals of Leicester NHS Trust and Leicester University, Leicester, United Kingdom.
    Booth, Lisa
    University of Cumbria, Cumbria, United Kingdom.
    Davies, Jean
    Bangor University, Bangor, United Kingdom.
    Saron, Holly
    Edge Hill University, Ormskirk, United Kingdom.
    Mansson, Marie Edwinson
    Paediatric RN, HSC, Lund University, Lund, Sweden.
    Cox, Ann
    Midlands Partnership NHS Foundation Trust & Keele University, Keele, United Kingdom.
    Ford, Karen
    University of Tasmania and the Royal Hobart Hospital, Tasmani, Australia.
    Campbell, Steven
    University of Tasmania, TAS, Australia.
    Blamires, Julie
    Auckland University of Technology, Auckland, New Zealand.
    Dickinson, Annette
    Auckland University of Technology, Auckland, New Zealand.
    Neufeld, Michael
    Auckland University of Technology, Auckland, New Zealand.
    Peck, Blake
    Federation University, VIC, Australia.
    de Avila, Marla
    São Paulo State University, São Paulo, Brazil.
    Feeg, Veronica
    Molloy College in Rockville Centre, New York City, United States.
    Mediani, Henny Suzana
    Universitas Padjadjaran, Bandung Ciry, Indonesia.
    Atout, Maha
    Philadelphia University, Amman, Jordan.
    Majamanda, Maureen D.
    University of Malawi, Kamuzu College of Nursing, Malawi, South Africa.
    North, Natasha
    The Harry Crossley Children’s Nursing Development Unit, University of Cape Town, Cape Town, South Africa.
    Chambers, Christine
    Dalhousie University, Halifax, Canada.
    Robichaud, Fanny
    Ulluriaq, Ungava Tulattavik Health Center and UQAM UQO, QC, Canada.
    Developing rights-based standards for children having tests, treatments, examinations and interventions: using a collaborative, multi-phased, multi-method and multi-stakeholder approach to build consensus2023Ingår i: European Journal of Pediatrics, ISSN 0340-6199, E-ISSN 1432-1076, Vol. 182, nr 10, s. 4707-4721Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Children continue to experience harm when undergoing clinical procedures despite increased evidence of the need to improve the provision of child-centred care. The international ISupport collaboration aimed to develop standards to outline and explain good procedural practice and the rights of children within the context of a clinical procedure. The rights-based standards for children undergoing tests, treatments, investigations, examinations and interventions were developed using an iterative, multi-phased, multi-method and multi-stakeholder consensus building approach. This consensus approach used a range of online and face to face methods across three phases to ensure ongoing engagement with multiple stakeholders. The views and perspectives of 203 children and young people, 78 parents and 418 multi-disciplinary professionals gathered over a two year period (2020–2022) informed the development of international rights-based standards for the care of children having tests, treatments, examinations and interventions. The standards are the first to reach international multi-stakeholder consensus on definitions of supportive and restraining holds.

    Conclusion: This is the first study of its kind which outlines international rights-based procedural care standards from multi-stakeholder perspectives. The standards offer health professionals and educators clear evidence-based tools to support discussions and practice changes to challenge prevailing assumptions about holding or restraining children and instead encourage a focus on the interests and rights of the child.

    What is Known:

    • Children continue to experience short and long-term harm when undergoing clinical procedures despite increased evidence of the need to improve the provision of child-centred care.
    • Professionals report uncertainty and tensions in applying evidence-based practice to children’s procedural care.

    What is New:

    • This is the first study of its kind which has developed international rights-based procedural care standards from multi-stakeholder perspectives.
    • The standards are the first to reach international multi-stakeholder consensus on definitions of supportive and restraining holds.
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  • 8.
    Edwinson Månsson, Marie
    et al.
    Department of Health Care Sciences, Medical Faculty, Lund University, Lund, Sweden.
    Forsner, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Hedén, Lena
    Department of Health Sciences, Faculty of Caring Science, Work Life, and Social Welfare, University of Borås, Borås, Sweden.
    Children Need to Know: A Follow-Up Study Two Decades Later on Informing and Preparing Children for Clinical Examinations and Procedures2023Ingår i: Pediatric Nursing, ISSN 0097-9805, Vol. 49, nr 1, s. 32-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: To describe the current practice of how children and their parents are informed and prepared for medical procedures at Swedish pediatric units, and to follow up on practices reported previously in 17 units.

    Design and Methods: A cross-sectional survey using a semi-structured questionnaire was performed in 2000, defined as Trial 1 (T1), with 58 responses, and repeated from 2017 to 2018, defined as Trial 2 (T2), with 26 responses. Potential differences between T1 and T2 were calculated with Pearson's Chi-square, and open-ended question responses were subjected to content analysis.

    Results:  In T1, 95% of respondents reported regular preparation services and 65% reported this in T2; most practices were equal between T1 and T2. However, prior to admission, conversations with nurses (p < 0.05) and video shows on the Internet or web-based programs (p < 0.001) were more frequently reported in T2 than in T1. Additionally, written information about psychological needs at discharge (p < 0.001) and communication with nurses and physicians increased in the present study (p < 0.01). Checking the child's level of understanding was reported less in T2 (p < 0.01). Open-ended responses gave the impression that the units had ambition to inform and prepare children properly but were hindered because of time constraints, a strained staff situation, and lack of routines.

    Conclusions: In Swedish Pediatric Care, preparation services are emphasized; however, increased outpatient care and decreased hospital stays challenged the practice of preparation and information. The child's perspective of preparation and information needs further illumination. 

  • 9. Esteban-Cornejo, Irene
    et al.
    Henriksson, Pontus
    Cadenas-Sanchez, Cristina
    Vanhelst, Jérémy
    Forsner, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Högskolan Dalarna.
    Gottrand, Frederic
    Kersting, Mathilde
    Moreno, Luis A
    Ruiz, Jonatan R
    Widhalm, Kurt
    Ortega, Francisco B
    Early life programming of attention capacity in adolescents: The HELENA study2018Ingår i: Maternal and Child Nutrition, ISSN 1740-8695, E-ISSN 1740-8709, Vol. 14, nr 1, artikel-id e12451Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The study aims to examine the individual and combined association of early life factors (birth weight, birth length, and any and exclusive breastfeeding) with attention capacity in adolescents. The study included 421 European adolescents (243 girls), aged 12.5-17.5 years, who participated in the Healthy Lifestyle in Europe by Nutrition in Adolescence Study. Body weight and length at birth of adolescents were collected from parental records. The duration of any and exclusive breastfeeding were self-reported. The d2 Test of Attention was administered to assess attention capacity. The main results showed that birth weight, birth length, breastfeeding, and exclusive breastfeeding were related to attention capacity in boys (β ranging from 0.144 to 0.196; all p < .05) after adjustment for age, centre, gestational age, maternal education, family affluence scale, and body mass index. Among boys, differences in attention capacity were found according to tertiles of birth weight and birth length (p < .05), as well as borderline significant differences across groups of any and exclusive breastfeeding (p = 0.055 and p = 0.108, respectively) after adjusting for potential confounders. In addition, boys with 3 early life risk factors (low birth weight, low birth length, and <3 months of breastfeeding) had significantly lower scores in attention capacity compared with boys with 0 risk factors (percentile score - 15.88; p = 0.009). In conclusion, early life factors, both separately and combined, may influence attention capacity in male European adolescents. Importantly, the combination of the 3 early life risk factors, low birth weight, low birth length, and <3 months of breastfeeding, even in normal ranges, may provide the highest reduction in attention capacity.

  • 10.
    Forsner, Maria
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Cyrén, Monika
    Gävle Sjukhus, Gävle, Sweden.
    Gerdin, Anna
    Gävle Sjukhus, Gävle, Sweden.
    Rullander, Anna-Clara
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    It hurts to get forced: Children's narratives about restraint during medical procedures2023Ingår i: Paediatric and Neonatal Pain, ISSN 2637-3807, Vol. 5, nr 4, s. 110-118Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    According to the UN Convention on the Rights of the Child (UNCRC), children have the right to be involved in decisions about medical procedures affecting them. However, research has shown that healthcare professionals sometimes find this difficult to achieve and those procedures then are performed against the will of the child. The aim was to illuminate restraint from the perspective of children’s and young people’s experiences of feeling forced during medical procedures. Following the phenomenological hermeneutic method, a secondary qualitative analysis of narrative data from four datasets collected between 2001 and 2020 was performed. Twelve children and young people aged 6-19 years (three male, nine female) from central and northern Sweden narrated their experiences of restraint related to medical procedures in nine narrative interviews and three short written narratives. The analysis revealed that it hurts to get forced, this being illustrated in six themes: bodily misery, emotional rebellion, feeling disregarded, physically limited, desiring escape, and leaving deep traces. From the perspective of children and young people, restraint was interpreted with inspiration from the philosopher Michel Foucault, as being overpowered - not voluntary submission but offering resistance - and according to the theory of caring and uncaring, a relationship in which the healthcare professional is perceived as indifferent to the patient as a person. In conclusion restraint hurts and means powerlessness to the child, leaving deep traces that remain for a long time. The findings call the healthcare profession to take action to support children’s self-determination, participation, and integrity in healthcare. How children experience restraint in healthcare merits further investigation from the children’s own perspective.

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  • 11.
    Forsner, Maria
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Edwinson Månsson, Marie
    Rullander, Anna-Clara
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Norrlands universitetssjukhus.
    Omvårdnad vid procedurer2023Ingår i: Pediatrisk omvårdnad / [ed] Inger Kristensson Hallström; Mariette Derwig, Stockholm: Liber, 2023, 3, s. 129-147Kapitel i bok, del av antologi (Refereegranskat)
  • 12.
    Forsner, Maria
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden.
    Elvhage, G.
    Ewalds-Kvist, B. M.
    Lützen, K.
    Moral Challenges When Suspecting Abuse and Neglect in School Children: A Mixed Method Study2021Ingår i: Child and Adolescent Social Work Journal, ISSN 0738-0151, E-ISSN 1573-2797, Vol. 38, nr 6, s. 599-610Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The World Health Organization (WHO), concludes that child maltreatment is a global concern calling for a multi sectoral interdisciplinary approach. School professionals, such as social workers, teachers, and health care professionals are in positions to discover and report maltreatment enabling social workers to intervene. However, a variety of reports reveal an evident gap between incidences and frequency of number of cases reported. A review of relevant research indicates that the problem of "not reporting" suggests that moral conflicts are activated in the process of decision-making. The aim was to gain a deeper understanding of school professionals' experiences of reporting suspected neglect and abuse to the Social Welfare Board. In a mixed method approach 32 school professionals, such as teachers, social workers, nurses and psychologists participated in interviews and responded to questionnaires. Findings from the qualitative content analysis were compared to the quantitative analysis in a meta-analysis. Moral conflicts occur when faced with making decisions about how to best deal with a child's situation. Thoughts about the child's best interest and relationship with his/her parents as well as the informants ' own safety, were central. The comparative meta- analysis of both data sets revealed these conflicts commence with a moral sensitivity of possible negative consequences for the child. Moral sensitivity can be viewed as a "good" personal attribute, it paradoxically might lead to moral stress despite an open ethical climate. Based on the results of this study, further research on the interpersonal aspects of dealing with moral conflicts involved in reporting suspected child abuse is indicated.

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  • 13.
    Forsner, Maria
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Högskolan Dalarna.
    Jansson, Lilian
    Kriström, Berit
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Söderberg, Anna
    Being afraid of medical care: a narrative mediated through the symbolic play of one 2 year-old boyManuskript (preprint) (Övrigt vetenskapligt)
  • 14.
    Forsner, Maria
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Högskolan Dalarna.
    Jansson, Lilian
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Soerlie, Venke
    Being ill as narrated by children aged 11-18 years.2005Ingår i: Journal of Child Health Care, ISSN 1367-4935, E-ISSN 1741-2889, Vol. 9, nr 4, s. 314-323Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Being ill from a child's perspective has not been often investigated. The aim of this study was to illuminate the experience of being ill between the ages of 11-18 years. Four girls and one boy who were suffering short-term illness were interviewed and the data obtained subjected to qualitative content analysis. Illness disrupted their daily lives and made things unrecognizable. Being ill at the age of 11-18 seemed to imply being lost, hurt and in need of comfort from themselves and others. These narrations may indicate to health care professionals how they can improve their practice. This study suggests what is appreciated by children of this age when ill, namely being spoken to and informed about the illness and treatment. The children valued peace and quiet and wanted to listen to and adjust to their bodies.

  • 15.
    Forsner, Maria
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Högskolan Dalarna.
    Jansson, Lilian
    Söderberg, Anna
    Afraid of medical care: school-aged children's narratives about medical fear2009Ingår i: Journal of Pediatric Nursing: Nursing Care of Children and Families, ISSN 0882-5963, E-ISSN 1532-8449, Vol. 24, nr 6, s. 519-528Artikel i tidskrift (Refereegranskat)
  • 16.
    Forsner, Maria
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Högskolan Dalarna.
    Jansson, Lilian
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Söderberg, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Afraid of medical care school-aged children's narratives about medical fear.2009Ingår i: Journal of Pediatric Nursing: Nursing Care of Children and Families, ISSN 0882-5963, E-ISSN 1532-8449, Vol. 24, nr 6, s. 519-528Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Fear can be problematic for children who come into contact with medical care. This study aimed to illuminate the meaning of being afraid when in contact with medical care, as narrated by children 7-11 years old. Nine children participated in the study, which applied a phenomenological hermeneutic analysis methodology. The children experienced medical care as "being threatened by a monster," but the possibility of breaking this spell of fear was also mediated. The findings indicate the important role of being emotionally hurt in a child's fear to create, together with the child, an alternate narrative of overcoming this fear.

  • 17.
    Forsner, Maria
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Högskolan Dalarna.
    Jansson, Lilian
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Sørlie, Venke
    The experience of being ill as narrated by hospitalized children aged 7-10 years with short-term illness.2005Ingår i: Journal of Child Health Care, ISSN 1367-4935, E-ISSN 1741-2889, Vol. 9, nr 2, s. 153-165Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Children's illness has been investigated through the eyes of parents and nurses but the child's own perspective has been largely ignored. The aim of this study is to illuminate the 7-10-year-olds' experiences of being ill. Three girls and four boys were interviewed and narrated their experience about short-term illness. The data obtained was subjected to a thematic qualitative content analysis. The analysis suggests that the children combined reality and imagination and contrasts seemed to coexist such as being scared/confident, sad/cosy and hurt/having fun. They felt caught and tried to escape. The experience of illness as narrated by children can lead to a richer understanding and influence the way we care for paediatric patients.

  • 18.
    Forsner, Maria
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden.
    Mörelius, Evalotte
    Hanberger, Lena
    Questionnaires to Measure Process and Structure of Quality Indicators for Pediatric Nursing2021Ingår i: Pediatric quality & safety, ISSN 2472-0054, Vol. 6, nr 1, artikel-id e381Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: The quality of nursing care has a significant impact on the outcomes of care. The specific needs of children requiring hospital care make it essential to monitor and compare data not only on the medically oriented outcome measure but also on nursing care, structure, and process, requiring perspectives from registered nurses (RNs) and nurse managers (NMs). Thus, this project aimed to evaluate the structure and process of nursing quality indicators in pediatric hospital care with questionnaires distributed to RN and NM.

    Methods: We developed separate questionnaires for NMs and RNs to assess the process and structure of the quality indicators of breastfeeding, management of pain, venous access, medication management, and provision of a child-oriented environment. Nine NMs and 113 RNs from 9 pediatric wards answered the questionnaires.

    Result: Local guidelines were available for 3 out of the 5 quality indicators: pain management, venous access, and medication management. RNs reported varying levels of adherence to pain management (62%), and venous access management (72%). Satisfaction with the conditions for safe medication management was 90%. Approximately, two-thirds (67%) of RN reported sufficient knowledge regarding the impact of the child-oriented environment and less than half (44%) regarding how to support breastfeeding.

    Conclusion: Structure and process is a prerequisite for quality of care outcomes. This study discloses areas for quality improvement and offers instruments to compare structure and process in pediatric nursing care to discuss with consumers, managers, staff, and other stakeholders.

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  • 19.
    Forsner, Maria
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Högskolan Dalarna.
    Nilsson, S
    Finnström, B
    Mörelius, E
    Expectation prior to human papilloma virus vaccination: 11 to 12-Year-old girls' written narratives2016Ingår i: Journal of Child Health Care, ISSN 1367-4935, E-ISSN 1741-2889, Vol. 20, nr 3, s. 365-373Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Expectations prior to needle-related procedures can influence individuals' decision making and compliance with immunization programmes. To protect from human papilloma virus (HPV) and cervical cancer, the immunization needs to be given before sexual debut raising interest for this study's aim to investigate how 11 to 12-year-old girls narrate about their expectations prior to HPV vaccination. A total of 27 girls aged 11 to 12 years participated in this qualitative narrative study by writing short narratives describing their expectations. The requirement for inclusion was to have accepted HPV vaccination. Data were subjected to qualitative content analysis. Findings showed the following expectations: going to hurt, going to be scared and going to turn out fine. The expectations were based on the girls' previous experiences, knowledge and self-image. The latent content revealed that the girls tried to transform uneasiness to confidence. The conclusion drawn from this study is that most girls of this age seem confident about their ability to cope with possible unpleasantness related to vaccinations. However, nurses need to find strategies to help those children who feel uneasy about needle-related procedures.

  • 20.
    Forsner, Maria
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Högskolan Dalarna.
    Norström, Fredrik
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Nordyke, Katrina
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Lindh, Viveca
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Relaxation and guided imagery used with 12-year-olds during venipuncture in a school-based screening study2014Ingår i: Journal of Child Health Care, ISSN 1367-4935, E-ISSN 1741-2889, Vol. 18, nr 3, s. 241-252Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Needle-related procedures are reported to be problematic for children. In a school-based celiac disease screening, 12-year-olds' experiences with relaxation and guided imagery (R-GI) during venipuncture were investigated. One group tried nurse-led R-GI (n = 60) and another group received standard care (SC; n = 49). A mixed method design was applied using short written narratives, facial affective scale (FAS), and visual analog scale (VAS) for pain intensity. Qualitative content analysis highlighted that diversity and contradictions when facing blood tests. FAS scores were significantly lower in the SC group before (p = 0.01), during (p = 0.01), and after (p = 0.01) venipuncture. VAS scores did not differ between the groups. The blood test was mostly experienced as unproblematic, and GI during venipuncture did not decrease pain or affect. However, the fact that a number of children scored high FAS indicates a need for effective methods to help children cope with needle-related school-based procedures.

  • 21. Furingsten, Lovisa
    et al.
    Sjögren, Reet
    Forsner, Maria
    Dalarna University, Sweden.
    Ethical challenges when caring for dying children.2015Ingår i: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 22, nr 2, s. 176-87Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Caring for dying children presents special challenges, according to the children themselves, their relatives and healthcare professionals.

    OBJECTIVE: The aim of this study was to describe caring as represented in healthcare workers' experiences of caring for dying children.

    METHOD: A phenomenological approach was chosen, in-depth interviews were carried out and data were analysed in four steps focusing on (a) open reading, (b) meaning units, (c) constituents and (d) essence.

    ETHICAL CONSIDERATIONS: Four nurses in a general acute paediatric care setting in Sweden participated after providing written informed consent. Voluntary participation and confidentiality were ensured, and the study was ethically approved.

    FINDINGS: The essence of caring for dying children was likened to a musically attuned composition, comprising five constituents: presence, self-knowledge, injustice in dying, own suffering and in need of others. Presence was found to be a prerequisite for caring when a child is dying. Self-knowledge and support from others can be of help when struggling with emotional pain and injustice.

    DISCUSSION: Caring for dying children has been found to be a delicate task for healthcare workers all over the world, and the ethical dimension is emphasized in international research. In this study, emotional pain and suffering accompanied caring, but an atmosphere in which it is possible to give and get support from colleagues and to have time to grieve and time to focus on the patient's needs may ease the burden, as can having time to process thoughts about life and death, and a possibility to grow in self-knowledge.

    CONCLUSION: Caring in ethically demanding situations may be facilitated through presence, atmosphere, self-knowledge and time. The challenge does not demand highly technological solutions; these assets are readily available, no matter where on earth. However, there is a need to further investigate these prerequisites for caring, particularly when a child is dying.

  • 22.
    Giménez-Legarre, Natalia
    et al.
    GENUD (Growth, Exercise, Nutrition and Development) Research Group, Facultad de Ciencias de la Salud, Universidad de Zaragoza, Zaragoza, Spain; Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain; Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain.
    Santaliestra-Pasías, Alba M.
    GENUD (Growth, Exercise, Nutrition and Development) Research Group, Facultad de Ciencias de la Salud, Universidad de Zaragoza, Zaragoza, Spain; Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain; Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain; Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud, Carlos III, Madrid, Spain.
    De Henauw, Stefaan
    Department of Public Health, Ghent University, Ghent, Belgium.
    Forsner, Maria
    Unit for Preventive Nutrition, Department of Biosciences and Nutrition at NOVUM, Karolinska Institutet, Huddinge, Sweden.
    González-Gross, Marcela
    Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud, Carlos III, Madrid, Spain; ImFine Research Group, Department of Health and Human Performance, Universidad Politécnica de Madrid, Madrid, Spain; Department of Nutrition and Food Sciences-Nutritional Physiology, University of Bonn, Bonn, Germany.
    Jurado-Fasoli, Lucas
    Department of Medical Physiology. School of Medicine, University of Granada, Granada, Spain; PROmoting FITness and Health through Physical Activity Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain.
    Kafatos, Anthony
    University of Crete, School of Medicine, Heraklion, Greece.
    Karaglani, Eva
    Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece.
    Lambrinou, Christina-Paulina
    Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece.
    Molnár, Dénes
    Department of Pediatrics, Medical School, University of Pécs, Pécs, Hungary.
    Sjöström, Michael
    Unit for Preventive Nutrition, Department of Biosciences and Nutrition at NOVUM, Karolinska Institutet, Huddinge, Sweden.
    Widhalm, Kurt
    Division Gastroenterology and Hepatology, Dept. Med II, MedUniv Vienna, Vienna, Austria; Department of Pediatrics, Private Medical University, Salzburg, Austria.
    Moreno, Luis A.
    GENUD (Growth, Exercise, Nutrition and Development) Research Group, Facultad de Ciencias de la Salud, Universidad de Zaragoza, Zaragoza, Spain; Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain; Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain; Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud, Carlos III, Madrid, Spain.
    Breakfast consumption and its relationship with diet quality and adherence to Mediterranean diet in European adolescents: the HELENA study2022Ingår i: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 76, nr 12, s. 1690-1696Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: The aim of the current study is to analyze the associations between breakfast consumption and adherence to diet quality index (DQI) and Mediterranean Diet Score (MDS) in European adolescents.

    Methods: A multinational cross-sectional study was carried out in 1804 adolescents aged 12.5–17.5 years. The Food Choices and Preferences questionnaire was used to ascertain breakfast consumption (consumers, occasional consumers and skippers), and two non-consecutive 24 h dietary recalls were used to estimate the total daily intake and to calculate the subsequent DQI and MDS. Mixed linear regression models were used to examine the relationship between breakfast consumption and DQI-A and MDS. Age, maternal education, BMI, country and total energy intake were included as covariates.

    Results: In both sexes, significant differences were observed among the breakfast consumption categories. In both boys and girls, breakfast consumers had significantly higher DQI indices than those adolescents who skipped breakfast regularly (p < 0.001). Regarding total MDS, in both boys and girls, breakfast consumers had a higher total MDS than breakfast skippers (p < 0.001), however, no associations were shown between occasional breakfast consumers and DQI indices and MDS.

    Conclusion: Breakfast consumption has been linked with better dietary quality scores compared with those children who usually skip breakfast. Promotion of regular breakfast consumption in adolescents could be an effective strategy to improve the overall diet quality.

  • 23.
    Göthesson, Johanna
    et al.
    Department of Clinical Science and Education, Sachs' Children and Youths Hospital, Södersjukhuset, Stockholm, Sweden.
    Håkansson, Linnéa
    Department of Women's & Children's Health, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.
    Olinder, Anna Lindholm
    Department of Clinical Science and Education, Sachs' Children and Youths Hospital, Karolinska Institutet, Stockholm, Sweden.
    Hanberger, Lena
    Division of Nursing, Department of Health, Medicine and Care Sciences, Linköping University, Linköping, Sweden.
    Mörelius, Evalotte
    Department of Nursing and Midwifery, Edith Cowan University and Perth Children's Hospital, Western, Perth, Australia.
    Nilsson, Stefan
    Department of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Forsner, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Department of Biosciences and Nutrition, Karolinska Instituten, Stockholm, Sweden.
    Children's and adolescent's narratives about pain and negative experiences in diabetes treatment2023Ingår i: Journal for Specialists in Pediatric Nursing, ISSN 1539-0136, Vol. 28, nr 1, artikel-id e12396Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Pain and fear associated with needle procedures have been found to be more common among children and adolescents treated for type 1 diabetes (T1D) than among others in their age group. Furthermore, high glycated haemoglobin (HbA1c) values are associated with needle-related fear.

    Aim: To describe negative experiences of needle procedures in childhood diabetes treatment from children's and adolescents' own perspectives. Methods: Short written narratives (n = 83) and drawings (n = 2) from children and adolescents treated for T1D, aged 7–18 years, were subjected to inductive qualitative content analysis.

    Results: Negative experiences with needle procedures had many facets, such as pain and fear, changing over time and affecting everyday life. All kinds of needle procedures caused difficulties, but venipunctures were described as the worst.

    Conclusion: All needle procedures involved in diabetes treatment are potentially experienced as creating pain and fear, but the negative experiences are multifaceted and vary between individuals. These experiences create suffering for children and adolescents, and influence their daily lives. Besides finding techniques to decrease the number of needle procedures in the treatment, research should focus on implementing methods to decrease pain, fear, and other negative experiences as well as to promote self-coping. This is urgent, since needle-related fear has an impact on glycaemic control and therefore increases the risk of long-term complications. Clinical Implications: When caring for children and adolescents with diabetes, their previous experiences with needle procedures need to be considered.

  • 24.
    Hanberger, Lena
    et al.
    Department of Health, Medicine and Care Sciences, Division of Nursing, Linköping University, Linköping, Sweden.
    Tallqvist, Emma
    Hemmesta Primary Child Health Care, Stockholm, Region Stockholm, Sweden.
    Richert, Amanda
    Crown Princess Victoria Children's Hospital, Linköping University Hospital, Linköping, Sweden.
    Olinder, Anna Lindholm
    Sachs’ Children and Youth Hospital, Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Södersjukhuset, Sweden.
    Forsner, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Karolinska Institutet, Department of Biosciences and Nutrition, Stockholm, Sweden.
    Mörelius, Evalotte
    School of Nursing and Midwifery, Edith Cowan University and Perth Children's Hospital, Australia.
    Nilsson, Stefan
    Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Needle-Related Pain, Affective Reactions, Fear, and Emotional Coping in Children and Adolescents With Type 1 Diabetes: A Cross-Sectional Study2021Ingår i: Pain Management Nursing, ISSN 1524-9042, E-ISSN 1532-8635, Vol. 22, nr 4, s. 516-521Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The self-care of type 1 diabetes (T1D) includes undergoing procedures with needles several times daily, which may cause pain and fear.

    Aims: The aim was to identify the degree of perceived pain, affective reactions, fear, and emotional coping among children and adolescents with T1D.

    Design: A cross-sectional survey was performed.

    Methods: Children and adolescents 7-18 years of age (n = 197) and their parents (n = 123) completed the Coloured Analogue Scale (CAS), the Facial Affective Scale (FAS), the Diabetes Fear of Injection Questionnaire (D-FISQ), and the Faces Emotional Coping Scale (FECS) in relation to needle procedures.

    Results: The higher the values of the CAS, FAS and D-FISQ scores, the lower values for coping were reported by children and adolescents regarding treatment with insulin pen or pump, blood glucose test, and venipuncture (p < .001). Patients reported strong negative affect regarding insulin injections (35%) and blood glucose tests (32%), as well as negative affect (48%, 69%) and substantial pain (27%, 50%) for inserting a pump needle and venipuncture, respectively. Parents reported significantly higher values than children on all scales and procedures except D-FISQ (blood glucose tests) and FECS (venipuncture).

    Conclusions: Children and adolescents who perceive greater pain during needle-related procedures have poorer coping ability. Pediatric diabetes teams need to identify those in need of extra support to develop pain coping strategies.

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  • 25. ISupport Team,
    Forsner, Maria (Medarbetare/bidragsgivare)
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Getting it right first time and every time; re-thinking children's rights when they have a clinical procedure2021Ingår i: Journal of Pediatric Nursing: Nursing Care of Children and Families, ISSN 0882-5963, E-ISSN 1532-8449, Vol. 61, s. A10-A12Artikel i tidskrift (Refereegranskat)
  • 26. Iurilli, Maria LC
    et al.
    Forsner, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Nordendahl, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Söderberg, Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Filippi, Sarah
    Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight2021Ingår i: eLIFE, E-ISSN 2050-084X, Vol. 10, artikel-id e60060Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions.

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  • 27.
    Jenholt Nolbris, M.
    et al.
    Institute of Health and Care Sciences, University of Gothenburg, Sweden; The Queen Silivia Children’s Hospital Sahlgrenska University Hospital, Sweden.
    Ragnarsson, Susanne
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Sweden.
    Brorsson, A.-L.
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Sweden.
    Garcia de Avila, M.
    Department of Nursing, Botucatu Medical School - UNESP, Brazil.
    Forsner, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Department of Biosciences and Nutrition, Karolinska Institutet, Sweden.
    Kull, I.
    Department of Clinical Science and Education, Karolinska Institutet, Sweden; Sachs’ Children and Youth’s Hospital, Södersjukhuset, Sweden.
    Olinder, A.L.
    Department of Clinical Science and Education, Karolinska Institutet, Sweden; Sachs’ Children and Youth’s Hospital, Södersjukhuset, Sweden.
    Mattson, J.
    Department of Health Science, The Swedish Red Cross University College, Sweden; Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Sweden.
    Nilsson, S.
    Institute of Health and Care Sciences, University of Gothenburg, Sweden; Centre for Person-Centred Care, University of Gothenburg, Sweden.
    Rullander, Anna-Clara
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Rydström, L.-L.
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Sweden.
    Olaya-Contreras, P.
    Institute of Health and Care Sciences, University of Gothenburg, Sweden; Centre for Person-Centred Care, University of Gothenburg, Sweden.
    Berghammer, M.
    The Queen Silivia Children’s Hospital Sahlgrenska University Hospital, Sweden; Department of Health Sciences, University West, Sweden.
    Young children’s voices in an unlocked Sweden during the COVID-19 pandemic2022Ingår i: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 50, nr 6, s. 693-702Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aims: During the COVID-19 pandemic, Sweden was one of the few countries that rejected lockdowns in favour of recommendations for restrictions, including careful hand hygiene and social distancing. Preschools and primary schools remained open. Several studies have shown negative impacts of the pandemic on children, particularly high levels of anxiety. The study aim was to explore how Swedish school-aged children aged 6–14 years, experienced the COVID-19 pandemic and their perceived anxiety.

    Methods: In total, 774 children aged 6–14 years and their guardians answered an online questionnaire containing 24 questions, along with two instruments measuring anxiety: the Children’s Anxiety Questionnaire and the Numerical Rating Scale. A convergent parallel mixed-methods design was used for analysing the quantitative and qualitative data. Each data source was first analysed separately, followed by a merged interpretative analysis.

    Results: The results showed generally low levels of anxiety, with no significant sex differences. Children who refrained from normal social activities or group activities (n=377) had significantly higher levels of anxiety. Most of the children were able to appreciate the bright side of life, despite the social distancing and refraining from activities, which prevented them from meeting and hugging their loved ones.

    Conclusions: These Swedish children generally experienced low levels of anxiety, except those who refrained from social activities. Life was nonetheless mostly experienced as normal, largely because schools remained open. Keeping life as normal as possible could be one important factor in preventing higher anxiety and depression levels in children during a pandemic.

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  • 28. Mattsson, Janet
    et al.
    Forsner, Maria
    Högskolan Dalarna.
    Castrén, Maaret
    Arman, Maria
    Caring for children in pediatric intensive care units: an observation study focusing on nurses' concerns2013Ingår i: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 20, nr 5, s. 528-538Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Children in the pediatric intensive care unit are indisputably in a vulnerable position, dependent on nurses to acknowledge their needs. It is assumed that children should be approached from a holistic perspective in the caring situation to meet their caring needs. The aim of the study was to unfold the meaning of nursing care through nurses' concerns when caring for children in the pediatric intensive care unit. To investigate the qualitative aspects of practice embedded in the caring situation, the interpretive phenomenological approach was adopted for the study. The findings revealed three patterns: medically oriented nursing--here, the nurses attend to just the medical needs, and nursing care is at its minimum, leaving the children's needs unmet; parent-oriented nursing care--here, the nursing care emphasizes the parents' needs in the situation, and the children are viewed as a part of the parent and not as an individual child with specific caring needs; and smooth operating nursing care orientation--here, the nursing care is focused on the child as a whole human being, adding value to the nursing care. The conclusion drawn suggests that nursing care does not always respond to the needs of the child, jeopardizing the well-being of the child and leaving them at risk for experiencing pain and suffering. The concerns present in nursing care has been shown to be the divider of the meaning of nursing care and need to become elucidated in order to improve the cultural influence of what can be seen as good nursing care within the pediatric intensive care unit.

  • 29. Mattsson, Janet Yvonne
    et al.
    Arman, Maria
    Castren, Maaret
    Forsner, Maria
    Academy Health and Society, Sweden.
    Meaning of caring in pediatric intensive care unit from the perspective of parents: a qualitative study.2014Ingår i: Journal of Child Health Care, ISSN 1367-4935, E-ISSN 1741-2889, Vol. 18, nr 4, s. 336-345Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    When children are critically ill, parents still strive to be present and participate in the care of their child. Pediatric intensive care differs from other realms of pediatric care as the nature of care is technically advanced and rather obstructing than encouraging parental involvement or closeness, either physically or emotionally, with the critically ill child. The aim of this study was to elucidate the meaning of caring in the pediatric intensive care unit from the perspective of parents. The design of this study followed Benner's interpretive phenomenological method. Eleven parents of seven children participated in observations and interviews. The following aspects of caring were illustrated in the themes arising from the findings: being a bridge to the child on the edge, building a sheltered atmosphere, meeting the child's needs, and adapting the environment for family life. The overall impression is that the phenomenon of caring is experienced exclusively when it is directed toward the exposed child. The conclusion drawn is that caring is present when providing expert physical care combined with fulfilling emotional needs and supporting continuing daily parental care for the child in an inviting environment.

  • 30. Mattsson, Janet Yvonne
    et al.
    Forsner, Maria
    Högskolan Dalarna.
    Arman, Maria
    Uncovering pain in critically ill non-verbal children: nurses' clinical experiences in the paediatric intensive care unit2011Ingår i: Journal of Child Health Care, ISSN 1367-4935, E-ISSN 1741-2889, Vol. 15, nr 3, s. 187-198Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Critically ill paediatric patients are frequently exposed to pain that is required to be assessed and treated effectively. The most reliable resource for assessing pain is the child itself, but children in the paediatric intensive care unit (PICU) are commonly unable to communicate their needs, requiring professional caregivers to uncover and interpret pain. However, nurses and paediatricians do not have sufficient knowledge of how critical illness affects childrens' signs of pain. The aim of this study was to illuminate clinical experiences of pain in the PICU; describing nurses' perceptions of expressions of pain in non-verbal, critically ill 2-6 year old children. The participants were 17 experienced PICU nurses. Data were analysed according to the phenomenographic method and three qualitatively different main categories, gained from clinical experience, emerged: changes in the measurable parameters; perceived muscular tension; and, altered behaviour. Furthermore, contrasting the categories revealed two diverse perspectives to focus pain: measure-oriented and patient-oriented. Subtle expressions of pain were recognised when focus was patient-oriented. These findings support the necessity of actively looking for pain deriving from various perspectives and considering diverse caring needs when doing so. Acknowledging pain makes pain visible.

  • 31. Michels, Nathalie
    et al.
    Vynckier, Lisa
    Moreno, Luis A
    Beghin, Laurent
    de la O, Alex
    Forsner, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Högskolan Dalarna.
    Gonzalez-Gross, Marcela
    Huybrechts, Inge
    Iguacel, Isabel
    Kafatos, Antonio
    Kersting, Mathilde
    Leclercq, Catherine
    Manios, Yannis
    Marcos, Ascension
    Molnar, Denes
    Sjöström, Michael
    Widhalm, Kurt
    De Henauw, Stefaan
    Mediation of psychosocial determinants in the relation between socio-economic status and adolescents' diet quality.2018Ingår i: European Journal of Nutrition, ISSN 1436-6207, E-ISSN 1436-6215, Vol. 57, nr 3, s. 951-963Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: To examine the underlying reasons for the positive relation between socio-economic status (SES) and the diet quality of adolescents.

    METHODS: In 2081 adolescents (12.5-17.5 years) of the European HELENA study, a continuous variable on diet quality via 2-day 24-h recalls was available. SES was reflected by parental education, parental occupation and family affluence. Mediation by several psychosocial determinants was tested: self-efficacy, availability at school and home, social support, barriers, benefits, awareness and some self-reported influencers (parents, school, taste, health, friends, food readily available, easy preparation, hunger, price and habits). Multiple mediation analyses were adjusted for age, sex and country.

    RESULTS: The availability of soft drinks and fruit at home, social support, parental influence, barriers, price influence, taste influence, health influence and food being readily available were significant mediators. The multiple mediation indirect effect accounted for 23-64% of the total effect. Both occupation and education and both maternal and paternal factors could be explained by the mediation. The unavailability of soft drinks was the strongest mediator (17-44% of the total effect).

    CONCLUSION: Up to 64% of the positive relation between SES and the diet quality in adolescence could be explained by several healthy eating determinants. Focusing on these factors in low-SES populations can minimize social inequalities in diet and health by improving the diet of these specific adolescents.

  • 32.
    Mishra, Anu
    et al.
    Imperial College London, London, UK.
    Zhou, Bin
    Imperial College London, London, UK.
    Rodriguez-Martinez, Andrea
    Imperial College London, London, UK.
    Bixby, Honor
    McGill University, Montreal, Québec, Canada.
    Diminishing benefits of urban living for children and adolescents' growth and development2023Ingår i: Nature, ISSN 0028-0836, E-ISSN 1476-4687, Vol. 615, s. 874-883Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Optimal growth and development in childhood and adolescence is crucial for lifelong health and well-being1-6. Here we used data from 2,325 population-based studies, with measurements of height and weight from 71 million participants, to report the height and body-mass index (BMI) of children and adolescents aged 5-19 years on the basis of rural and urban place of residence in 200 countries and territories from 1990 to 2020. In 1990, children and adolescents residing in cities were taller than their rural counterparts in all but a few high-income countries. By 2020, the urban height advantage became smaller in most countries, and in many high-income western countries it reversed into a small urban-based disadvantage. The exception was for boys in most countries in sub-Saharan Africa and in some countries in Oceania, south Asia and the region of central Asia, Middle East and north Africa. In these countries, successive cohorts of boys from rural places either did not gain height or possibly became shorter, and hence fell further behind their urban peers. The difference between the age-standardized mean BMI of children in urban and rural areas was <1.1 kg m-2 in the vast majority of countries. Within this small range, BMI increased slightly more in cities than in rural areas, except in south Asia, sub-Saharan Africa and some countries in central and eastern Europe. Our results show that in much of the world, the growth and developmental advantages of living in cities have diminished in the twenty-first century, whereas in much of sub-Saharan Africa they have amplified.

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  • 33. Moradell, Ana
    et al.
    Santaliestra-Pasías, Alba M.
    Aparicio-Ugarriza, Raquel
    Huybrechts, Inge
    Bertalanné Szommer, Aliz
    Forsner, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. School of Education, Health and Social Sciences, Dalarna University, Falun, Sweden.
    González-Gross, Marcela
    Kafatos, Anthony
    Androutsos, Odysseas
    Michels, Nathalie
    Sjöström, Michael
    Vanhelst, Jeremy
    Widhalm, Kurt
    Gutierrez, Angel
    Moreno, Luis A.
    Are physical activity and sedentary screen time levels associated with food consumption in european adolescents? the HELENA study2023Ingår i: Journal of the American Nutrition Association, ISSN 2769-707X, Vol. 42, nr 1, s. 55-66Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    One of the current main public health problems is the prevalence of obesity in children. Unhealthy lifestyle behaviors such as poor dietary habits, high sedentary screen time (SST), and low levels of physical activity (PA) have a strong tendency to track from childhood into adulthood. The aim of this manuscript is to assess the association between meeting or not meeting the PA and SST recommendations and the consumption of different food groups.

    Data were obtained from a sample of European adolescents from the multicenter cross-sectional HELENA study. In all, 1448 adolescents from 8 cities were included. PA was objectively measured by accelerometry and dietary intake by 24-hour dietary records. Adolescents were grouped according to PA and SST recommendations.

    In both sexes, intake of savory snacks was higher in those groups who did not meet any of the recommendations (p < 0.05). For males, those who met both recommendations were more likely to drink/eat milk, yogurt, and water (p < 0.05). Those not meeting recommendations were more likely to drink sugar-sweetened beverages (p < 0.05). For females, those not meeting recommendations were less likely to eat fruits and vegetables and more likely to have a higher intake of fats and oils (p < 0.05).

    Those adolescents meeting PA and SST recommendations had a higher intake of healthy foods, like fruit and vegetables and dairy products. However, the negative relationship unhealthier food and SST is stronger in males independently of PA. More studies assessing the combined effect of both PA and SST regarding dietary habits in children and adolescents are needed.

  • 34. NCD Risk Factor Collaboration (NCD-RisC),
    Zhou, Bin (Medarbetare/bidragsgivare)
    NCD Risk Factor Collaboration (NCD-RisC) pooled analysis and writing.
    Sophiea, Marisa K. (Medarbetare/bidragsgivare)
    NCD Risk Factor Collaboration (NCD-RisC) pooled analysis and writing.
    Forsner, Maria (Medarbetare/bidragsgivare)
    NCD Risk Factor Collaboration (NCD-RisC) country and regional data.
    Zuziak, monika (Medarbetare/bidragsgivare)
    NCD Risk Factor Collaboration (NCD-RisC) country and regional data.
    Ezzati, Majid (Medarbetare/bidragsgivare)
    NCD Risk Factor Collaboration (NCD-RisC) pooled analysis and writing.
    Lundqvist, Robert (Medarbetare/bidragsgivare)
    NCD Risk Factor Collaboration (NCD-RisC) pooled analysis and writing.
    Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants2020Ingår i: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 396, nr 10261, s. 1511-1524Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents.

    METHODS: For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5-19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence.

    FINDINGS: We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9-10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes-gaining too little height, too much weight for their height compared with children in other countries, or both-occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls.

    INTERPRETATION: The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks.

    FUNDING: Wellcome Trust, AstraZeneca Young Health Programme, EU.

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  • 35. NCD Risk Factor Collaboration (NCD-RisC),
    Forsner, Maria (Medarbetare/bidragsgivare)
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Söderberg, Stefan (Medarbetare/bidragsgivare)
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Lundqvist, Robert (Medarbetare/bidragsgivare)
    Norrbotten County Council, Luleå, Sweden.
    Rising rural body-mass index is the main driver of the global obesity epidemic in adults2019Ingår i: Nature, ISSN 0028-0836, E-ISSN 1476-4687, Vol. 569, nr 7755, s. 260-264Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities1,2. This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity3,4,5,6. Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017—and more than 80% in some low- and middle-income regions—was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing—and in some countries reversal—of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.

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  • 36. NCD Risk Factor Collaboration (NCD-RisC),
    Forsner, Maria (Medarbetare/bidragsgivare)
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Ezzati, Majid
    Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults2017Ingår i: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 390, nr 10113, s. 2627-2642Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Underweight, overweight, and obesity in childhood and adolescence are associated with adverse health consequences throughout the life-course. Our aim was to estimate worldwide trends in mean body-mass index (BMI) and a comprehensive set of BMI categories that cover underweight to obesity in children and adolescents, and to compare trends with those of adults.

    METHODS: We pooled 2416 population-based studies with measurements of height and weight on 128·9 million participants aged 5 years and older, including 31·5 million aged 5-19 years. We used a Bayesian hierarchical model to estimate trends from 1975 to 2016 in 200 countries for mean BMI and for prevalence of BMI in the following categories for children and adolescents aged 5-19 years: more than 2 SD below the median of the WHO growth reference for children and adolescents (referred to as moderate and severe underweight hereafter), 2 SD to more than 1 SD below the median (mild underweight), 1 SD below the median to 1 SD above the median (healthy weight), more than 1 SD to 2 SD above the median (overweight but not obese), and more than 2 SD above the median (obesity).

    FINDINGS: Regional change in age-standardised mean BMI in girls from 1975 to 2016 ranged from virtually no change (-0·01 kg/m2 per decade; 95% credible interval -0·42 to 0·39, posterior probability [PP] of the observed decrease being a true decrease=0·5098) in eastern Europe to an increase of 1·00 kg/m2 per decade (0·69-1·35, PP>0·9999) in central Latin America and an increase of 0·95 kg/m2 per decade (0·64-1·25, PP>0·9999) in Polynesia and Micronesia. The range for boys was from a non-significant increase of 0·09 kg/m2 per decade (-0·33 to 0·49, PP=0·6926) in eastern Europe to an increase of 0·77 kg/m2 per decade (0·50-1·06, PP>0·9999) in Polynesia and Micronesia. Trends in mean BMI have recently flattened in northwestern Europe and the high-income English-speaking and Asia-Pacific regions for both sexes, southwestern Europe for boys, and central and Andean Latin America for girls. By contrast, the rise in BMI has accelerated in east and south Asia for both sexes, and southeast Asia for boys. Global age-standardised prevalence of obesity increased from 0·7% (0·4-1·2) in 1975 to 5·6% (4·8-6·5) in 2016 in girls, and from 0·9% (0·5-1·3) in 1975 to 7·8% (6·7-9·1) in 2016 in boys; the prevalence of moderate and severe underweight decreased from 9·2% (6·0-12·9) in 1975 to 8·4% (6·8-10·1) in 2016 in girls and from 14·8% (10·4-19·5) in 1975 to 12·4% (10·3-14·5) in 2016 in boys. Prevalence of moderate and severe underweight was highest in India, at 22·7% (16·7-29·6) among girls and 30·7% (23·5-38·0) among boys. Prevalence of obesity was more than 30% in girls in Nauru, the Cook Islands, and Palau; and boys in the Cook Islands, Nauru, Palau, Niue, and American Samoa in 2016. Prevalence of obesity was about 20% or more in several countries in Polynesia and Micronesia, the Middle East and north Africa, the Caribbean, and the USA. In 2016, 75 (44-117) million girls and 117 (70-178) million boys worldwide were moderately or severely underweight. In the same year, 50 (24-89) million girls and 74 (39-125) million boys worldwide were obese.

    INTERPRETATION: The rising trends in children's and adolescents' BMI have plateaued in many high-income countries, albeit at high levels, but have accelerated in parts of Asia, with trends no longer correlated with those of adults.

    FUNDING: Wellcome Trust, AstraZeneca Young Health Programme.

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  • 37. NCD Risk Factor Collaboration (NCD-RisC),
    Nordendahl, Maria (Medarbetare/bidragsgivare)
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Söderberg, Stefan (Medarbetare/bidragsgivare)
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants.2021Ingår i: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 398, nr 10304, s. 957-980Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories.

    METHODS: We used data from 1990 to 2019 on people aged 30-79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age.

    FINDINGS: The number of people aged 30-79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306-359) million women and 317 (292-344) million men in 1990 to 626 (584-668) million women and 652 (604-698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55-62) of women and 49% (46-52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43-51) of women and 38% (35-41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20-27) for women and 18% (16-21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran.

    INTERPRETATION: Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings.

    FUNDING: WHO.

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  • 38. NCD Risk Factor Collaboration (NCD-RisC),
    et al.
    Forsner, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Söderberg, Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Global variation in diabetes diagnosis and prevalence based on fasting glucose and hemoglobin A1c2023Ingår i: Nature Medicine, ISSN 1078-8956, E-ISSN 1546-170X, Vol. 29, s. 2885-2901Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) are both used to diagnose diabetes, but these measurements can identify different people as having diabetes. We used data from 117 population-based studies and quantified, in different world regions, the prevalence of diagnosed diabetes, and whether those who were previously undiagnosed and detected as having diabetes in survey screening, had elevated FPG, HbA1c or both. We developed prediction equations for estimating the probability that a person without previously diagnosed diabetes, and at a specific level of FPG, had elevated HbA1c, and vice versa. The age-standardized proportion of diabetes that was previously undiagnosed and detected in survey screening ranged from 30% in the high-income western region to 66% in south Asia. Among those with screen-detected diabetes with either test, the age-standardized proportion who had elevated levels of both FPG and HbA1c was 29–39% across regions; the remainder had discordant elevation of FPG or HbA1c. In most low- and middle-income regions, isolated elevated HbA1c was more common than isolated elevated FPG. In these regions, the use of FPG alone may delay diabetes diagnosis and underestimate diabetes prevalence. Our prediction equations help allocate finite resources for measuring HbA1c to reduce the global shortfall in diabetes diagnosis and surveillance.

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  • 39. Nilsson, S.
    et al.
    Mattson, J.
    Berghammer, M.
    Brorsson, A-L.
    Forsner, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Karolinska Institutet, Department of Biosciences and Nutrition, Stockholm, Sweden.
    Jenholt Nolbris, M.
    Kull, I.
    Lindholm Olinder, A.
    Ragnarsson, Susanne
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Rullander, Anna-Clara
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Rydström, L-L.
    Andréia Garcia de Avila, M.
    Olaya-Contreras, P.
    To be or not to be vaccinated against COVID-19 - the adolescents' perspective: a mixed-methods study in Sweden2021Ingår i: Vaccine: X, E-ISSN 2590-1362, Vol. 9, artikel-id 100117Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Vaccination of the population seems to be an important strategy in halting the COVID-19 pandemic in both local and global society. The aim of this study was to explore Swedish adolescents' willingness to be vaccinated against COVID-19 and its association with sociodemographic and other possible factors. A survey was distributed in Sweden between 7 July and 8 November 2020. The main qualitative question concerned adolescents' thoughts on vaccination against COVID-19 and evaluated whether the adolescents would like to be vaccinated when a COVID-19 vaccine is made available. In total, 702 adolescents aged between 15-19 responded to the questionnaire. A convergent parallel mixed-methods design was used. The results showed that nearly one in three adolescents had not decided if they wanted to get a COVID-19 vaccine, i.e. 30.5%: n=214. Of the participants 54.3% (n=381) were willing to be vaccinated. Girls had higher levels of anxiety about the vaccine compared to boys. In addition, high levels of anxiety impacted on the participants' willingness to be vaccinated. One reason for being undecided about the vaccine was that participants felt they did not know enough about it. Practising social distancing increased willingness to be vaccinated, as reflected in the qualitative results which showed participants wanted to be vaccinated to protect others. The results impart important knowledge to healthcare professionals and contribute to their communication with adolescents about vaccine hesitancy.

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  • 40. Nilsson, Stefan
    et al.
    Finnström, Berit
    Mörelius, Evalotte
    Forsner, Maria
    Högskolan Dalarna.
    The facial affective scale as a predictor for pain unpleasantness when children undergo immunizations2014Ingår i: Nursing Research and Practice, ISSN 2090-1429, E-ISSN 2090-1437, Vol. 2014, artikel-id 628198Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Needle fear is a common problem in children undergoing immunization. To ensure that the individual child's needs are met during a painful procedure it would be beneficial to be able to predict whether there is a need for extra support. The self-reporting instrument facial affective scale (FAS) could have potential for this purpose. The aim of this study was to evaluate whether the FAS can predict pain unpleasantness in girls undergoing immunization. Girls, aged 11-12 years, reported their expected pain unpleasantness on the FAS at least two weeks before and then experienced pain unpleasantness immediately before each vaccination. The experienced pain unpleasantness during the vaccination was also reported immediately after each immunization. The level of anxiety was similarly assessed during each vaccination and supplemented with stress measures in relation to the procedure in order to assess and evaluate concurrent validity. The results show that the FAS is valid to predict pain unpleasantness in 11-12-year-old girls who undergo immunizations and that it has the potential to be a feasible instrument to identify children who are in need of extra support to cope with immunization. In conclusion, the FAS measurement can facilitate caring interventions.

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  • 41. Nilsson, Stefan
    et al.
    Forsner, Maria
    School of Education, Health and Social Studies, Nursing and Health Care, Dalarna University, Falun, Swede.
    Finnström, Berit
    Mörelius, Evalotte
    Relaxation and guided imagery do not reduce stress, pain and unpleasantness for 11- to 12-year-old girls during vaccinations.2015Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 104, nr 7, s. 724-729Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: Relaxation and guided imagery is a distraction technique known to reduce discomfort during paediatric medical procedures. We examined whether its use decreased the stress experienced by 11- to 12-year-old girls receiving the human papilloma virus vaccination, as well as the intensity and unpleasantness of any pain.

    METHODS: A randomised crossover trial was conducted with 37 girls. During the first vaccination, each girl was randomised to receive either relaxation and guided imagery or standard care. They then received the other form of care during the second vaccination. Salivary cortisol was measured before each vaccination, and 30 minutes after it was administered. The girls reported pain intensity and pain unpleasantness before and directly after each vaccination and stress after each vaccination.

    RESULTS: On a group level, relaxation and guided imagery did not decrease cortisol levels, self-reported stress, pain intensity and pain unpleasantness. Salivary cortisol levels decreased significantly in both groups during the second vaccination.

    CONCLUSION: Relaxation and guided imagery did not prove beneficial during the vaccination of 11- to 12-year-old girls and is not recommended as a regular nursing intervention. However, further research is needed into effective techniques to help children who experience pain unpleasantness in connection with needle procedures.

  • 42. Nilsson, Stefan
    et al.
    Hanberger, Lena
    Olinder, Anna Lindholm
    Forsner, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Högskolan Dalarna.
    The Faces Emotional Coping Scale as a self-reporting instrument for coping with needle-related procedures: An initial validation study with children treated for type 1 diabetes2017Ingår i: Journal of Child Health Care, ISSN 1367-4935, E-ISSN 1741-2889, Vol. 21, nr 4, s. 392-403Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of this study was to determine the concurrent and content validity, sensitivity and inter-rater reliability of the Faces Emotional Coping Scale (FECS) to evaluate the children's anticipation of the level of emotional coping in conjunction with a venepuncture. A total of 153 children with type 1 diabetes and 86 of their parents participated in the study. The age of the children, 76 of whom were boys, ranged from 7 to 18 years. The child and his or her parent reported the child's coping ability, and the child reported the pain intensity and unpleasantness of a venepuncture. The child also wrote a short narrative about his or her experience of the needle procedure. The FECS correlated negatively with the Coloured Analogue Scale and the Facial Affective Scale and positively with the FECS by proxy. The narratives of 90 children correlated negatively with the FECS. Younger children reported significantly lower scores than older children did regarding their ability to cope with a venepuncture. The children's scores on the FECS showed good agreement with the parents' scores. In this study, the FECS was deemed valid for measuring children's ability to cope with their emotions when undergoing needle-related procedures like venepuncture.

  • 43. Rydström, Lise-Lott
    et al.
    Ångström-Brännström, Charlotte
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Department of Women’s and Children’s Health, Uppsala University, Sweden.
    Blake, Lucy
    Brayl, Lucy
    Carter, Bernie
    Forsner, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Department of Biosciences and Nutrition, Karolinska Institutet, Sweden.
    Matsson, Janet
    Nilsson, Stefan
    Jenholt Nolbris, Margaretha
    Kirton, Jennifer
    Kull, Inger
    Protheroe, Joanne
    Rullander, Anna-Clara
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Saron, Holly
    Lindholm Olinder, Anna
    How children in Sweden accessed and perceived information during the first phase of the Covid-19 pandemic2022Ingår i: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 50, s. 144-151Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: To describe how children in Sweden accessed and perceived information about SARS-CoV2 and Covid-19 during the first phase of the outbreak.

    METHODS: This study is a substudy of an international cross-sectional online mixed methods survey examining elements of children's health literacy in relation to Covid-19. The survey included multiple-choice questions, open-ended questions and drawings and collected information from 50 Swedish children (7-12 years). Data were analysed concurrently on a descriptive level using statistics and content analysis. Quantitative and qualitative data, including the drawings, were considered equally important and resulted in six categories, illuminating how children accessed and perceived information about the pandemic.

    RESULTS: The survey showed that children accessed information mainly from school but also from TV. They preferred information from reliable sources. Children reported the information they accessed as easy to understand and it prompted them to ask new questions. They reported they knew a lot about the pandemic, for example, the potential danger to themselves and others and how to act to protect themselves and others. They perceived the pandemic as an intrusion on their lives.

    CONCLUSIONS: This study indicates that Swedish children between 7 and 12 years old were well informed about SARS-CoV2 and Covid-19 during the first phase of the pandemic. School was shown to be an important source of information. The children could explain how to act to protect themselves and others from becoming infected by the virus.

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  • 44. Santaliestra-Pasías, Alba M.
    et al.
    Felez, Alicia Pérez
    Huybrechts, Inge
    Censi, Laura
    González-Gross, Marcela
    Forsner, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. School of Education, Health and Social Sciences, Dalarna University, Falun, Sweden.
    Sjöström, Michael
    Lambrinou, Christina P.
    Amaro, Francisco
    Kersting, Mathilde
    Molnar, Denes
    Kafatos, Anthony
    De Henauw, Stefaan
    Beghin, Laurent
    Dellallongeville, Jean
    Widhalm, Kurt
    Gilbert, Chantal
    Marcos, Ascensión
    Fisberg, Mauro
    Goulet, Olivier
    Moreno, Luis A.
    Social environment and food and beverage intake in European adolescents: the Helena study2022Ingår i: Journal of the American Nutrition Association, ISSN 2769-707X, Vol. 41, nr 5, s. 468-480Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The family environment influences food consumption and behaviours, which impact adolescent's eating habits, diet and health. Young individuals who frequently eat family meals are less likely to develop risk- and behaviour-related outcomes as obesity.

    AIM: To assess the relationship between the family meal environment and food and macronutrient consumption in European adolescents.

    METHODS: 1,703 adolescents aged 12.5-17.5 years (46.5% male) from the European HELENA cross-sectional study were selected. Sociodemographic variables and dietary intake using two non-consecutive self-reported 24-hour dietary recalls were collected from all the included participants. The relationship between family meals' environment and food and macronutrient consumption was analized using analysis of covariance.

    RESULTS: Adolescents who used to take their main meals with their family were associated with high consumption of healthy foods and beverages (i.e. vegetables, fruit, milk, water) and low consumption of energy dense food and beverages as chocolate, savoury snacks, sugar or juices compared with those who used to eat alone, with friends or other people (p < 0.05).

    CONCLUSION: The company/people with whom adolescents consume their meal have an important influence on the adolescent's consumption of different types of food (especially at lunch). Family's environment during meals has been associated with a high consumption of healthy foods.

  • 45. Sjöberg, Veronica
    et al.
    Forsner, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Shifting roles: physiotherapists’ perception of person-centered care during a pre-implementation phase in the acute hospital setting - A phenomenographic study2022Ingår i: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 38, nr 7, s. 879-889Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Person-centered care (PCC) is an acknowledged health care practice involving increased patient influence regarding decisions and deliberation. Research indicates that physiotherapists (PTs) embrace patient participation, but that PCC is difficult to grasp and fully implement.

    Objective: To contribute to knowledge about how PCC influences physiotherapy by eliciting PTs’ experiences from the acute care setting, this study aims to describe and illuminate variations in perceptions of PCC during a pre-implementation phase, among PTs in acute hospital care.

    Methods: Phenomenological approach: individual interviews with PTs in acute care (n = 7) combined with focus group interviews (n = 3).

    Findings: The analysis yielded two main categories: 1) Physiotherapists perceived a transformed patient role involved in the transition from patient to person; and 2) Physiotherapists perceived a challenged professional role when departing from the expert role, and entailed restrictions to prescribing the best treatment and, instead, meant aiming for a collaborative and equal relationship with the patient.

    Conclusion: Although the interviewed PTs embraced PCC in principle, PCC does seem to challenge the professional roles of patient and PT. The findings indicate that theories of power relations need to be considered, and further reflection may facilitate implementation. More research is needed to deepen the knowledge of how PTs perceive PCC during all implementation phases.

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  • 46. Souza Santos, Thanise Sabrina
    et al.
    Julián, Cristina
    Vincenzi, Silvana Ligia
    de Andrade, Dalton Francisco
    Slater, Betzabeth
    Altenburg de Assis, Maria Alice
    Kafatos, Anthony
    de Henauw, Stefaan
    Gottrand, Fréderic
    Androutsos, Odysseas
    Kersting, Mathilde
    Sjöström, Michael
    Forsner, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Department of Bioscience and Nutrition, Karolinska Institute, Solna, Sweden.
    Moreno, Luis A.
    A new measure of health motivation influencing food choices and its association with food intakes and nutritional biomarkers in European adolescents2021Ingår i: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 24, nr 4, s. 685-695Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To develop a scale to assess health motivation influencing food choices and to explore its performance in the associations with food intakes and nutritional biomarkers.

    Design: Psychometric study using cross-sectional self-report questionnaires and nutritional biomarkers.

    Setting: Multi-centre investigation conducted in ten European cities.

    Participants: 2954 adolescents who were included in the HELENA study and completed the Food Choices and Preferences (FCP) questionnaire.

    Results: Nineteen out of 124 items of the FCP questionnaire were in the same dimension. Sixteen presented adequate parameters for the Scale of evaluatiOn of Food choIcEs (SOFIE). The scores were positively associated with the intakes of cereals, dairy products, meats and eggs, and fish, as well as with blood concentrations of vitamin C, β-carotene, n-3 fatty acids, cobalamin, holo-transcobalamin and folate; scores were negatively associated with the intake of alcohol.

    Conclusions: SOFIE can improve the assessment of motivation influencing food choices based on items with the best performance and is proposed as a new measure to health-related studies.

  • 47. Taddei, Christina
    et al.
    Zhou, Bin
    Bixby, Honor
    Gregg, Edward W.
    Ezzati, Majid
    Carrillo-Larco, Rodrigo M.
    Forsner, Maria (Medarbetare/bidragsgivare)
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Söderberg, Stefan (Medarbetare/bidragsgivare)
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Repositioning of the global epicentre of non-optimal cholesterol2020Ingår i: Nature, ISSN 0028-0836, E-ISSN 1476-4687, Vol. 582, nr 7810, s. 73-77Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    High blood cholesterol is typically considered a feature of wealthy western countries1,2. However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world3 and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health4,5. However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol-which is a marker of cardiovascular risk-changed from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95% credible interval 3.7 million-4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world.

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  • 48. Taddei, Cristina
    et al.
    Jackson, Rod
    Zhou, Bin
    Bixby, Honor
    Danaei, Goodarz
    Di Cesare, Mariachiara
    Kuulasmaa, Kari
    Hajifathalian, Kaveh
    Bentham, James
    Bennett, James E.
    Aekplakorn, Wichai
    Cifkova, Renata
    Dallongeville, Jean
    De Bacquer, Dirk
    Giampaoli, Simona
    Gudnason, Vilmundur
    Khang, Young-Ho
    Laatikainen, Tiina
    Mann, Jim I.
    Marques-Vidal, Pedro
    Mensah, George A.
    Müller-Nurasyid, Martina
    Ninomiya, Toshiharu
    Petkeviciene, Janina
    Rodríguez-Artalejo, Fernando
    Servais, Jennifer
    Söderberg, Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Stavreski, Bill
    Wilsgaard, Tom
    Zdrojewski, Tomasz
    Zhao, Dong
    Stevens, Gretchen A.
    Savin, Stefan
    Cowan, Melanie J.
    Riley, Leanne M.
    Ezzati, Majid
    Forsner, Maria (Medarbetare/bidragsgivare)
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Lundqvist, Robert (Medarbetare/bidragsgivare)
    Norrbotten County Council, Sweden.
    National trends in total cholesterol obscure heterogeneous changes in HDL and non-HDL cholesterol and total-to-HDL cholesterol ratio: a pooled analysis of 458 population-based studies in Asian and Western countries2020Ingår i: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 49, nr 1, s. 173-192Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Although high-density lipoprotein (HDL) and non-HDL cholesterol have opposite associations with coronary heart disease, multi-country reports of lipid trends only use total cholesterol (TC). Our aim was to compare trends in total, HDL and non-HDL cholesterol and the total-to-HDL cholesterol ratio in Asian and Western countries.

    Methods: We pooled 458 population-based studies with 82.1 million participants in 23 Asian and Western countries. We estimated changes in mean total, HDL and non-HDL cholesterol and mean total-to-HDL cholesterol ratio by country, sex and age group.

    Results: Since ∼1980, mean TC increased in Asian countries. In Japan and South Korea, the TC rise was due to rising HDL cholesterol, which increased by up to 0.17 mmol/L per decade in Japanese women; in China, it was due to rising non-HDL cholesterol. TC declined in Western countries, except in Polish men. The decline was largest in Finland and Norway, at ∼0.4 mmol/L per decade. The decline in TC in most Western countries was the net effect of an increase in HDL cholesterol and a decline in non-HDL cholesterol, with the HDL cholesterol increase largest in New Zealand and Switzerland. Mean total-to-HDL cholesterol ratio declined in Japan, South Korea and most Western countries, by as much as ∼0.7 per decade in Swiss men (equivalent to ∼26% decline in coronary heart disease risk per decade). The ratio increased in China.

    Conclusions: HDL cholesterol has risen and the total-to-HDL cholesterol ratio has declined in many Western countries, Japan and South Korea, with only a weak correlation with changes in TC or non-HDL cholesterol.

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  • 49. Wisnuwardani, Ratih W.
    et al.
    De Henauw, Stefaan
    Forsner, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. School of Education, Health and Social Sciences, Dalarna University, Falun, Sweden.
    Gottrand, Frédéric
    Huybrechts, Inge
    Kafatos, Antonios G.
    Kersting, Mathilde
    Knaze, Viktoria
    Manios, Yannis
    Nova, Esther
    Molnár, Dénes
    Rothwell, Joseph A.
    Scalbert, Augustin
    Sette, Stefania
    Widhalm, Kurt
    Moreno, Luis A.
    Michels, Nathalie
    Adolescents' dietary polyphenol intake in relation to serum total antioxidant capacity: the HELENA study.2022Ingår i: International Journal of Food Sciences and Nutrition, ISSN 0963-7486, E-ISSN 1465-3478, Vol. 73, nr 1, s. 71-81Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    We evaluated the association between intake of total polyphenols, polyphenol classes and the 10 most consumed individual polyphenols with serum total antioxidant capacity (TAC) in 749 European adolescents (53% girls; 15% overweight; 12.5-17.5 years-old) from the cross-sectional HELENA study of 2006-2007. Dietary polyphenol intake was calculated from two non-consecutive 24-h recalls matched with the Phenol-Explorer database. Multilevel linear models examined the associations between dietary polyphenols and TAC. Polyphenol intake was rather low (median = 321mg/day; p25 = 158; p75 = 536) and TAC was comparable to other literature findings (median = 1.57 mmol/L; p25 = 1.45; p75 = 1.74). Total polyphenol intake, polyphenol classes and the top 10 compounds were not associated with TAC in a linear, quadratic or cubic way in partially or fully confounder-adjusted models. A direct anti-oxidative effect of dietary polyphenol intake was not observed in European adolescents. Polyphenol biomarkers and additional antioxidant measures are needed in future prospective studies to confirm these results.

  • 50. Wisnuwardani, Ratih Wirapuspita
    et al.
    De Henauw, Stefaan
    Androutsos, Odysseas
    Forsner, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. School of Education, Health and Social Sciences, Dalarna University, Falun, Sweden.
    Gottrand, Frédéric
    Huybrechts, Inge
    Knaze, Viktoria
    Kersting, Mathilde
    Le Donne, Cinzia
    Marcos, Ascensión
    Molnár, Dénes
    Rothwell, Joseph A.
    Scalbert, Augustin
    Sjöström, Michael
    Widhalm, Kurt
    Moreno, Luis A.
    Michels, Nathalie
    Estimated dietary intake of polyphenols in European adolescents: the HELENA study2019Ingår i: European Journal of Nutrition, ISSN 1436-6207, E-ISSN 1436-6215, Vol. 58, nr 6, s. 2345-2363Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: Knowledge about polyphenols intakes and their determinants among adolescents might be helpful for planning targeted prevention strategies at an early age.

    METHODS: In the European multicenter cross-sectional HELENA study of 2006-2007, 2428 subjects (47% boys) had data on dietary intake of polyphenols from 2 non-consecutive 24 h recalls via linking with the Phenol-Explorer database. Differences by sex, age, country, BMI, maternal education, paternal education, family affluence, smoking status, alcohol use, and physical activity were explored by linear regression.

    RESULTS: Median, lower and upper quartiles of polyphenol intakes were 326, 167 and 564 mg/day, respectively. Polyphenol intake was significantly higher in the oldest (16-17.49 years), girls, non-Mediterranean countries, lowest BMI, highest paternal education, and alcohol consumers. Main food contributors were fruit (23%, mainly apple and pear, i.e., 16.3%); chocolate products (19.2%); and fruit and vegetable juices (15.6%). Main polyphenol classes were flavonoids (75-76% of total) and phenolic acids (17-19% of total). The three most consumed polyphenols were proanthocyanidin polymers (> 10 mers), hesperidin, and proanthocyanidin 4-6 oligomers.

    CONCLUSION: The current study provided for the first time numbers on the total polyphenol intake and their main food sources in a heterogeneous group of European adolescents. Major differences with adult populations are the lower polyphenol consumption and the major food sources, such as chocolate and biscuits. The discussed determinants and polyphenol types already point to some important population groups that need to be targeted in future public health initiatives.

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