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Sökning: WFRF:(Flacking Renée) > Doktorsavhandling

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1.
  • Ericson, Jenny, 1976- (författare)
  • Breastfeeding in mothers of preterm infants : Prevalence and effects of support
  • 2018
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • The overall aim of this thesis was to describe the prevalence of breastfeeding in preterm infants and to evaluate the effectiveness and mother’s experiences of proactive person-centred telephone support after discharge. Furthermore, to describe the duration of breastfeeding and risks of ceasing breastfeeding up to 12 months. The first study, a register study with data from the Swedish Neonatal Quality register (SNQ), included breastfeeding data at discharge from 29 445 preterm infants born from 2004-2013. The results demonstrated that the prevalence of exclusive breastfeeding among preterm infants in Sweden decreased during the study period, especially among extremely preterm infants (<28 weeks). We also performed a multicentre randomised controlled trial (RCT) of 493 breastfeeding mothers of preterm infants discharged from six neonatal units in Sweden. The intervention consisted of a proactive breastfeeding telephone support system in which a breastfeeding support team called the mothers once everyday up to 14 days after discharge. The control group received reactive support; the mothers were invited to call the breastfeeding support team if they wanted to talk or ask any questions (i.e., usual care).The RCT demonstrated that the intervention did not affect exclusive breastfeeding at eight weeks after discharge (primary outcome) or up to 12 months. The proactive support did not affect maternal breastfeeding satisfaction, attachment, quality of life or method of feeding (secondary outcomes). However, parental stress was significantly reduced in mothers in the intervention group. Mothers in the intervention group were significantly more satisfied and involved in the support and felt empowered compared with mothers in the control group, who experienced reactive support as dual. Further findings showed that a lower maternal educational level, partial breastfeeding at discharge and longer stay in the neonatal unit increased the risk of ceasing breastfeeding during the first 12 months of postnatal age. In conclusion, the trend for exclusive breastfeeding at discharge in preterm infants is declining, which necessitates concern. The evaluated intervention of telephone support did not affect breastfeeding, in the short-or long-term. However, maternal stress was reduced and mothers were significantly more satisfied with the proactive support and felt empowered by the support.
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2.
  • Flacking, Renée, 1964- (författare)
  • Breastfeeding and Becoming a Mother : Influences and Experiences of Mothers of Preterm Infants
  • 2007
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • The overall aim of this thesis was to expand the knowledge and understanding of the processes of breastfeeding and becoming a mother in mothers of preterm infants. For this purpose, in-depth interviews were conducted with 25 mothers, whose very preterm infants had received care in seven neonatal units (NU) in Sweden, 1-12 months after discharge (I-II). In addition, prospective population-based register studies were performed of infants born 1993-2001; among 35 250 term and 2093 preterm infants (III), and a subpopulation of 225 very preterm infants (IV). Data were obtained from the Child Health Service registry of breastfeeding in Uppsala and Örebro, the Medical Birth Registry, and Statistics Sweden. The experiences of mother-infant separation, institutional authority, emotional exhaustion and disregard of breastfeeding as a relational interplay, comprised major hindrances to mothers’ experiences of breastfeeding as reciprocal and of a secure mother-infant relation, during and after the discharge from an NU (I-II). All studied socioeconomic factors, i.e. lower educational level, receiving unemployment benefit or social welfare or having a low equivalent disposable income, were individually adversely associated with breastfeeding up to six months of infants’ postnatal age, but were not found more decisive for weaning in mothers of preterm infants compared to those of term infants (III). Preterm infants were breastfed for a shorter time than term infants (III), but a long breastfeeding duration was evident. In addition, gestational age and neonatal disorders were not associated with breastfeeding duration in very preterm infants (IV).In conclusion, this thesis shows that improvements in the NU environment and the caring paradigm are called for. Furthermore, as socioeconomic status clearly has an impact on breastfeeding duration, increased equity in health care in accordance with the individuals’ needs must be sought, where resources are allocated to ensure fulfilment of needs in more vulnerable mothers and infants.
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3.
  • Joffer, Junia, 1984- (författare)
  • Health for future : self-rated health and social status among adolescents
  • 2020
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • The overall aim of this thesis was to explore self-rated health, subjective social status and smoking in adolescents.This thesis consists of a qualitative and a quantitative study. The qualitative study was an interview study that included 58 participants in the 7th and 12th grades. The cognitive interviewing technique ‘think-aloud’ was employed to explore how adolescents interpret and reason when answering a question about self-rated health (‘A person may feel good sometimes and bad sometimes. How do you feel most of the time?’). Additionally, factors contributing to subjective social status in school and the different strategies adolescents used for positioning were explored. Qualitative content analysis and thematic network analyzes were used to analyze the data. The quantitative study was a cohort study involving 1046 adolescents who answered questionnaires about their health in the 7th, 8th, 9th and 12th grades. Data were used to investigate predicting factors in the 7th grade for smoking in the 12th grade, as well as to examine associations between subjective social status in school, socioeconomic status and self-rated health in boys and girls in the 12th grade. Data were analyzed using chi-square tests, binary logistic regression and ordinal logistic regression analyses.The results from the interviews showed that participants interpreted the self-rated health question in holistic terms including social, mental and physical aspects. Results from the quantitative study showed that boys rated their health higher than girls at all ages. In a multivariable analysis lower selfesteem, a less negative attitude towards smoking and ever using snus in the 7th grade were significant predictors of smoking in the 12th grade. In addition, girls had an increased risk of becoming smokers. Cross-sectional analyses in the 12th grade revealed that adolescents’ self-rated health was positively associated with subjective social status in school, mood in the family and self-esteem in both girls and boys. Boys rated their subjective social status higher than girls. When exploring subjective social status in school further through interviews, status hierarchies in school were confirmed by the participants, which were strongly influenced by norms linked to gender, age, ethnicity and parental economy, but also expectations about how to look, act and interact.In conclusion, this thesis demonstrates that the self-rated health question ‘How do you feel most of the time?’ is useful for capturing a multidimensional view of health. Early efforts to strengthen adolescents’ self-esteem, promote anti-smoking attitudes and avoid an early initiation of snus seem to be important components of smoking prevention in adolescence. The positive association between self-rated health and subjective social status in school indicates that the subjective social status question is a useful healthrelated measure of social position in adolescents. Because social desirability in the school hierarchy was defined by norms that left little room for diversity, the possible negative impact of status hierarchies on adolescents’ health should to be considered. Overall, gender differences in health and social status emphasize the need for a gender-sensitive understanding of factors that impact adolescents’ lives
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4.
  • Randell, Eva, 1960- (författare)
  • Adolescent boys’ health : managing emotions, masculinities and subjective social status
  • 2016
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • The health of adolescent boys is complex and surprisingly little is known about how adolescent boys perceive, conceptualise and experience their health. Thus, the overall aim of this thesis was to explore adolescent boys’ perceptions and experiences of health, emotions, masculinity and subjective social status (SSS).This thesis consists of a qualitative, a quantitative and a mixed methods study. The qualitative study aimed to explore how adolescent boys understand the concept of health and what they find important for its achievement. Furthermore, the adolescent boys’ views of masculinity, emotion management and their potential effects on wellbeing were explored. For this purpose, individual interviews were conducted with 33 adolescent boys aged 16-17 years. The quantitative study aimed to investigate the associations between pride, shame and health in adolescence. Data were collected through a cross-sectional postal survey with 705 adolescents. The purpose of the mixed methods study was to investigate associations between SSS in school, socioeconomic status (SES) and self-rated health (SRH), and to explore the concept of SSS in school. Cross-sectional data were combined with interview data in which the meaning of SSS was further explored. Individual interviews with 35 adolescents aged 17-18 years were conducted.In the qualitative study, data were analysed using Grounded Theory. In the quantitative study, statistical analyses (e.g., chi-square test and uni- and multivariable logistic regression analyses) were performed. In the mixed method study, a combination of statistical analyses and thematic network analysis was applied.The results showed that there was a complexity in how the adolescent boys viewed, experienced, dealt with and valued health. On a conceptual level, they perceived health as holistic but when dealing with difficult emotions, they were prone to separate the body from the mind. Thus, the adolescent boys experienced a difference between health as a concept and health as an experience (paper I). Concerning emotional orientation in masculinity, two main categories of masculine conceptions were identified: a gender-normative masculinity and a non-gender-normative masculinity (paper II). Gender-normative masculinity comprised two seemingly opposite emotional masculinity orientations, one towards toughness and the other towards sensitivity, both of which were highly influenced by contextual and situational group norms and demands, despite that their expressions are in contrast to each other. Non-gender-normative masculinity included an orientation towards sincerity, emphasising the personal values of the boys. Emotions were expressed more independently of peer group norms. The findings suggest that different masculinities and the expression of emotions are intricately intertwined and that managing emotions is vital for wellbeing. The present findings also showed that both shame and pride were significantly associated with SRH, and furthermore, that there seems to be a protective effect of experiencing pride for health (paper III). The results also demonstrated that SSS is strongly related to SRH, and high SRH is related to high SSS, and further that the positioning was done in a gendered space (paper IV).Results from all studies suggest that the emotional and relational aspects, as well as perceived SSS, were strongly related to SRH. Positive emotions, trustful relationships and having a sense of belonging were important factors for health and pride was an important emotion protecting health. Physical health, on the other hand, had a more subordinated value, but the body was experienced as an important tool to achieve health. Even though health was mainly perceived in a holistic manner by the boys, there were boys who were prone to dichotomise the health experience into a mind-body dualism when having to deal with difficult emotions.In conclusion, this thesis demonstrates that young, masculine health is largely experienced through emotions and relationships between individuals and their contexts affected by gendered practices. Health is to feel and function well in mind and body and to have trusting relationships. The results support theories on health as a social construction of interconnected processes. Having confidence in self-esteem, access to trustful relationships and the courage to resist traditional masculine norms while still reinforcing and maintaining social status are all conducive to good health. Researchers as well as professionals need to consider the complexity of adolescent boys’ health in which norms, values, relationships and gender form its social determinants. Those working with young boys should encourage them to integrate physical, social and emotional aspects of health into an interconnected and holistic experience.
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5.
  • Sahlén Helmer, Charlotte, 1971- (författare)
  • Interaction between preterm infants and their parents : Studies of early interventions in neonatal care
  • 2024
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Background  Preterm birth negatively affects infant well-being and development. A well-functioning parent-infant interaction can mitigate the risk of preterm birth on infant development. However, parent-infant interaction is often disrupted after preterm birth because of organizational factors in care, infants’ immature interaction cues, and maternal health problems. Different interventions supporting parental-infant interaction exist, but only a few target support for interaction between preterm infants born at gestational week 30-36 and their parents. Thus, an early, feasible and effective intervention that supports the preterm infant and the parents in the neonatal intensive care unit was needed. Aim  The overall aim of the thesis was two-fold; first to evaluate the early intervention skin-to-skin contact on mother-infant interaction; and second, to develop a new intervention, the Early Collaborative Intervention (EACI), to explore how mothers’ experience the new intervention, and to study its effects on mother-infant interaction.  Methods  Study I was a randomized controlled trial with two groups. Families were randomly assigned to either continuous or intermittent skin-to-skin con-tact directly after birth. Mother-infant interaction was video recorded when the infant was four months corrected age during a Still face procedure. The interaction was later scored using two different instruments, the Ains-worth’s Maternal Sensitivity Scales and the Maternal Sensitivity and Responsivity Scale. Furthermore, the dose-response relationship between time in skin-to-skin contact and interaction quality was calculated.   Study II had a descriptive design where the rationale, development, frame-work, and practical provision of the EACI program was described.   Study III had a qualitative design. Mothers were interviewed about their experiences of the EACI. Data were analyzed with reflexive thematic analysis.   Study IV was a randomized controlled trial with two groups. Families were randomly assigned to either the EACI or standard care. The intervention started within three days after birth. Mother-infant interaction was video recorded when the infant was one month corrected age during a bathing session. The interaction was later scored using two different instruments, the Ainsworth’s Maternal Sensitivity Scales, and the Emotional Availability system. Intention to treat and per protocol analysis were calculated as three sessions were considered the minimum required to detect a difference.    Results  Study I showed no significant differences in maternal interaction behavior between the groups randomized to continuous skin-to-skin contact or intermittent skin-to-skin contact. Dose-response calculations between time in skin-to-skin-contact and interaction quality showed no correlations. In Study II, the theoretical framework of the EACI was based on the attachment theory, the assessment of infant behavior described by Brazelton, and psychoeducational theory. The rationale was to provide tailored early support that improved parent-infant interaction and thereby optimized infant well-being and development. The intervention was developed by a core group in the neonatal intensive care unit at Crown Princess Victoria Children’s Hospital. It was a three-session intervention, provided during an ordinary care procedure with instant provider feedback and hands on guidance during active parental involvement. Two sessions were provided at the hospital, and one after discharge in the home of the family. In Study III two main themes were constructed, “mothers feelings evoked from the Early Collaborative Intervention” and “based on the preterm baby’s behavior”. The mothers experienced the intervention as helpful for their interaction with the infant and for them to see their infant as an individual. The per protocol analysis in Study IV showed that the intervention group had significantly higher mean scores in the Availability, Acceptance and Non-hostility subscales, indicating a more well-functioning interaction.   Conclusion  Continuous SSC was not superior to intermittent SSC for improving maternal interactive behavior. In contrast, the Early Collaborative Intervention, improved maternal interactive behavior if all three sessions of the intervention were provided. This was also confirmed in the interviews, in which the mothers described the intervention as helpful for their interactive behavior with their preterm infants. 
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