Högskolan i Skövde

Bakgrund: Under ungdomsåren förändras ungdomar fysiskt, emotionellt och kognitivt. De går in i en ny fas i livet och utvecklas från att vara barn till att bli vuxna. Under ungdomsåren etablerara och experimenterar ungdomar med vanor, attityder, tro samt livsstil. Vid ogynnsamma förhållanden kan olika riskbeteende öka. Bland ungdopmar idag ses en ökning av sexuellexponering på sociala medier. Etfersom internet idag är mer lättillgängligt än tidigare kan det medföra att ungdomar i högre utsträckning exponerar sig sexuellt, vilket kan leda till sexuella övergrepp och missbruk.

Syfte: Är att beskriva vad ungdomar kommunicerar om i bloggar, angående sex och relationer.

Metod: En kvalitativ innehållsanalys enligt Graneheim och Lundman användes där fem ungdomsbloggar i åldrarna 17-25 år användes och analyserades

Resultat: Utifrån de analyserade ungdomsbloggarna framkom det två huvudkategorier; Samhällets trender påverkar ungdomars sexuella hälsa och Tillit har betydelse för relationen. Under kategorierna bildades sex underkategorier. I resultatet framkom det att ungdomar kommunicerar i stor utsträckning om sex och relationer på sociala forum. De ansåg att det idag är mer accepterat med olika sexuella läggningar och familjekonstellationer samt diskuterades dagens könsideal. Det uttrycktes en negativ syn på hormonella preventivmedel. Bloggarna uttryckte att det var viktigt med bekräftelse i en relation.

Konklusion: Ungdomar kommunicerar brett om sex och relationer på nätet, där de har en possitiv inställning till alternativa familjekontellationer. Synen på preventivmedel var negativ bland annat på grund av dess biverkningar och de förespråkade istället hormonfria alternativ. Relationer kan påverkas av olika förändringar i livet och att vara offentlig på internet kan upplevas som ansträngande för relationen.

Bakgrund: Att genomgå förlossning och bli förälder för första gången är en av de största händelserna i livet och förlossningsupplevelsen påverkas av flera faktorer. Mer kunskap behövs om sambandet mellan föräldrars förlossningsupplevelser, uppfattat socialt stöd samt deras känsla av sammanhang ett år efter förlossning. Syfte: Syftet med studien är att utforska samband mellan förstföderskors samt partners förlossningsupplevelser ett år efter förlossning och deras uppfattning om socialt stöd samt deras känsla av sammanhang. Metod: Kvantitativ longitudinell kohortstudie med 380 förstföderskor och 266 partners. Datainsamlingen genomfördes med upprepade enkätutskick mellan en vecka och ett år efter förlossning. Dataanalys genomfördes genom deskriptiv samt analyserande statistik med logistisk binär- och multipel regressionsanalys. Resultat: Den multipla regressionsanalysen påvisade att mer positiv förlossningsupplevelse ett år efter förlossning visade samband med: högre skattad betydelse av positiv förlossningsupplevelse, uppfattad normal förlossning, känsla av trygghet och kontroll under förlossning, vid olika mättillfällen i studien. Utöver ovan beskriva samband i den multipla regressionsanalysen visade det sig i den binära regressionsanalysen att uppfattat socialt stöd spelar en betydande roll för förstföderskors förlossningsupplevelse. Studien visar även att en högre skattad känsla av sammanhang hos förstföderskor samt partners står i samband med en mer positiv förlossningsupplevelse ett år efter förlossning. Konklusion: Betydelsen av en positiv förlossning, uppfattad normal förlossning samt känsla av trygghet och kontroll under förlossning påvisar samband med en mer positiv förlossningsupplevelse ett år efter förlossning.

Emotional events are often better preserved in memory than events without an emotional component. Emotional stimuli benefit from capturing and holding the attention of a perceiver to a higher degree than more emotion-neutral stimuli. Arousal associated with experiencing emotionally valenced stimuli or situations affects every major stage in creating, maintaining and retrieving lasting memories. Presented in this thesis were models delineating the behavioral and neurological mechanisms that might explain arousal-induced effects on subsequent memory outcome. Based on a study of relevant literature, findings were presented in this thesis that highlight amygdala activation as crucial for the enhancement of memory generally associated with emotional arousal. The amygdala modulates processing in other areas of the brain involved in memory. Heightened levels of norepinephrine, stemming from sympathetic nervous system activation, underlies observable arousal-induced memory effects and seem to be a crucial component in enabling glucocorticoid augmentation of memory. Arousal seems to further amplify the biased competition between stimuli that favors the neural representation of motivationally relevant stimuli and stimuli of a sensory salient nature. The aim of this thesis was to outline the impact of emotional arousal on different stages of memory processing, including processes for memory formation, strengthening of memory traces, and eventual subsequent retrieval. 

ProblemPregnant women are not always satisfied with the professional support they receive during their midwifery care. More knowledge is needed to understand what professional support pregnant women need for childbirth and parenting.

BackgroundChildbearing and the transition to becoming a parent is a sensitive period in one's life during which one should have the opportunity to receive professional support. Professional support does not always correspond to pregnant women's needs. To understand pregnant women's needs for professional support within midwifery care, it is crucial to further illuminate women's experiences of this support.

AimTo explore pregnant women's perceptions of professional support in midwifery care.

MethodsA qualitative study using semi-structured interviews. Fifteen women were interviewed during gestational weeks 36–38. Data was analysed using phenomenography.

FindingsThe women perceived professional support in midwifery care to be reassuring and emotional, to consist of reliable information, and to be mediated with pedagogical creativity. The professional support facilitated new social contacts, partner involvement and contributed to mental preparedness. The findings of the study were presented in six categories and the category Professional support contributes to mental preparedness was influenced by the five other categories.

ConclusionPregnant women prepare for childbirth and parenting by using several different types of professional support in midwifery care: a strategy that could be described as piecing together a puzzle. When the women put the puzzle together, each type of professional support works as a valuable piece in the whole puzzle. Through this, professional support could contribute to women's mental preparedness for childbirth and parenting.

Objective: The aim of this study was to explore expecting parents’ perceptions of the Childbirth Journey as an intervention that includes medical information for parental support, constructed as a serious game.

Methods: In this qualitative study, semi-structured interviews were held with expecting parents in Sweden who were able to talk about specific parts of the Childbirth Journey they appreciated or found difficult to understand. A phenomenographic methodology was employed for data analysis.

Results: Participants perceived the Childbirth Journey to be easily accessible and customized with reliable information. The design and features of the intervention were perceived by the expecting parents to enhance the intervention’s usability, appeal, and trustworthiness. When parental couples used the Childbirth Journey together, it gave them an opportunity to discuss and better understand each other’s situation. The participants proposed several changes to the existing version of the game, mostly related to extending practical information and illustrated scenarios but also to the further development of the game’s design and animations. The participants found the Knowledge portal to be the most appealing part of the Childbirth Journey.

Conclusions: The Childbirth Journey intervention was concluded to be a valuable digital complement to in-person profes- sional support, especially given the current COVID-19 pandemic restrictions in place in Sweden, which do not allow antenatal visits by partners. However, in its current form, the Childbirth Journey has some deficiencies and would therefore benefit from further development and exploration.

Bakgrund: Att bli förälder är en omvälvande händelse och en transition som innebär en livsförändring. Föräldrar får vanligtvis stöd från barnmorskan och andra personer runt om. Digitala kanaler används av föräldrar under graviditet och efter barnafödseln, då den erbjuder informativt stöd. Forskning visar att trots tillgängligt informativt stöd i digital form, finns det behov av innovation- och vidareutveckling av digitalt föräldrastöd. Syfte: Att beskriva svensk- och icke svensktalande föräldrars uppfattningar om framtida digitalt föräldrastöd i relation till graviditet och barnets första 18 levnadsmånader. Metod: En fenomenografisk intervjustudie med induktiv ansats där totalt 15 semistrukturerade intervjuer genomfördes. Resultat: Resultatet av analysprocessen mynnade ut i följande fyra beskrivningskategorier: reella och virtuella kontakter i framtida digitalt föräldrastöd, individanpassat digitalt föräldrastöd, professionell kunskap i relation till framtida digitalt föräldrastöd samt tillgänglighet i framtida digitalt föräldrastöd. Dessa beskrivningskategorier består av elva olika uppfattningar som visar hur föräldrar, svensk- och icke svensktalande, uppfattade det framtida digitalt föräldrastödet. Konklusion: Digitalt föräldrastöd är i behov av innovation- och vidareutveckling av varierande tjänster och funktioner. Framtida föräldrastöd bör utformas utifrån föräldrars behov för att de ska kunna uppleva ökad trygghet och tillfredsställelse inför och under föräldraskapet.

Bakgrund: Förlossningen kan upplevas som en positiv livshändelse och har betydelse för framtida hälsa, välbefinnande och relation till partner. Förlossningsupplevelsen påverkas av de blivande föräldrarnas förberedelser inför förlossningen och föräldraskapet. Parrelationen är central under förlossningen där stöd från partnern är viktigt. I nuläget finns dock begränsad forskning kring hur förlossningsupplevelsen påverkas av kvinnors och partners kvalitet i parrelation samt deras tankar och känslor inför förlossningen och föräldraskapet i ett longitudinellt perspektiv, varför det finns behov av att studera detta.

Syfte: Syftet med studien är att undersöka faktorer relaterade till förstföderskor och partners förlossningsupplevelse sex månader efter förlossning.

Metod: Studien är en kvantitativ longitudinell kohortstudie. Datainsamlingen genomfördes via webbaserade enkäter vid tre tillfällen under graviditet och de första sex månaderna efter förlossning. Enkäterna innehöll frågor kring studiedeltagarnas bakgrund, förlossningsupplevelse (QPP), kvalitet i parrelation (QDR36) och känslor inför förlossning och föräldraskap. Analys av data har skett i SPSS där deskriptiv statistik och multipel logistisk regressionsanalys har genomförts.

Resultat: Följande faktorer hade ett samband med en mer positivt skattad förlossningsupplevelse sex månader efter förlossning; Upplevelse av normal förlossning (QPP 5), förstföderska (p=0.001), partner (p=0.003); Upplevelse av kontroll vid förlossning (QPP9), förstföderska (p=0.024); Högre uppfattad kvalitet i parrelation (QDR36-index), partner (p=<0.001).

Konklusion: Förlossningsupplevelsen påverkas av upplevelsen av förlossningen som normal, upplevelsen av kontroll under förlossningen samt högre uppfattad kvalitet i parrelation.

Background:

Several models suggest how the qualities of a product or service influence user satisfaction. Models, such as the Customer Satisfaction Index (CSI), Technology Acceptance Model (TAM), and Delone and McLean Information Systems Success (D&M IS), demonstrate those relations and have been used in the context of health information systems.

Objective:

We want to investigate which qualities foster greater satisfaction among patient and professional users. In addition, we are interested in knowing to what extent improvement in those qualities can explain user satisfaction and if this makes user satisfaction a proxy indicator of those qualities.

Methods:

The Unified eValuation using ONtology (UVON) method was utilised to construct an ontology of the required qualities for seven e-health applications being developed in the FI-STAR project, a European Union (EU) project in e-health. The e-health applications were deployed across seven EU countries. The ontology included and unified the required qualities of those systems together with the aspects suggested by the Model for ASsessment of Telemedicine applications (MAST) evaluation framework. Two similar questionnaires, for 87 patient users and 31 health professional users, were elicited from the ontology. In the questionnaires, user was asked if the system has improved the specified qualities and if the user was satisfied with the system. The results were analysed using Kendall correlation coefficients matrices, incorporating the quality and satisfaction aspects. For the next step, two Partial Least Squares Structural Equation Modelling (PLS-SEM) path models were developed using the quality and satisfaction measure variables and the latent construct variables that were suggested by the UVON method.

Results:

Most of the quality aspects grouped by the UVON method are highly correlated. Strong correlations in each group suggest that the grouped qualities can be measures which reflect a latent quality construct. The PLS-SEM path analysis for the patients reveals that the effectiveness, safety, and efficiency of treatment provided by the system are the most influential qualities in achieving and predicting user satisfaction. For the professional users, effectiveness and affordability are the most influential. The parameters of the PLS-SEM that are calculated allow for the measurement of a user satisfaction index similar to CSI for similar health information systems.

Conclusions:

For both patients and professionals, the effectiveness of systems highly contributes to their satisfaction. Patients care about improvements in safety and efficiency, while professionals care about improvements in the affordability of treatments with health information systems. User satisfaction is reflected more in the users' evaluation of system output and fulfilment of expectations, but slightly less in how far the system is from ideal. Investigating satisfaction scores can be a simple, fast way to infer if the system has improved the abovementioned qualities in treatment and care.

Background: Becoming parents for the first time is challenging. Mothers need both social and professional support to handle these challenges. Professionals’ attitudes affect quality of care and support. So to improve professional support, an intervention consisting of a process-oriented training was performed. Due to the positive results of the intervention there is a need to illuminate the methodological approach further. The overall aim was therefore to describe a methodological approach to improve and evaluate health care professionals’ attitudes toward breastfeeding and parental support in order to improve quality of care in childbearing.

Methods: This study was a longitudinal randomized control intervention study, in which groups of mothers received care in childbearing from midwives and child health nurses. These health professionals had gone through a process-oriented training, or not. In order to improve attitudes of health professionals the training was based on evidence, practical skills and reflective processes (both private and professional experiences) in relation to breastfeeding and parental support. Included in the longitudinal study were health professionals from five intervention municipalities n = 36 and health professionals from five control municipalities n = 45. All mothers who fulfilled the inclusion criteria were consecutively identified from the hospital register and asked to participate in the study. Mothers who accepted to participate were included in the interventions group (n = 206) or control groups (n = 162, n = 172 respectively) based on which municipality they belonged to.

Results: The results of the process-oriented training improved the professionals’ attitudes toward breastfeeding and parental support. These improved attitudes in health professionals increased intervention-group mother’s satisfaction with professional and social support. Intervention-group mother’s relation to and feelings for their baby as well as breastfeeding was also improved.

Conclusion: These results stress the importance of professionals’ attitude in quality of care during childbearing, as well as pointing to the possibility to improve professionals’ attitudes with a process-oriented training.

Trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR), trial registration:ACTRN12611000354987.

Bakgrund: Tidigare forskning visar att ungdomar är missnöjda med sex och samlevnadsundervisningen som bedrivs i skolan och uppger att de troligtvis skulle agerat annorlunda kring sexuella handlingar om de fått tillräcklig och relevant undervisning i tidig ålder. Syfte: Att undersöka lärares upplevelser av att undervisa i sex och samlevnad för högstadieelever. Metod: En kvalitativ innehållsanalys med induktiv ansats användes för att besvara syftet. I studien intervjuades sex högstadielärare från fyra olika grundskolor i Sydvästra Sverige. Resultat: I resultatet uttrycker lärarna att sex och samlevnadsundervisningen är ett viktigt och roligt ämne att undervisa i. De anser det angeläget att inkludera eleverna i undervisningen för att fånga deras upplevda behov. Lärarna upplever att undervisningen leder till ett mer respektfullt bemötande mellan eleverna. Det är en utmaning för lärarna att anpassa undervisningen för att tillgodose elevernas behov. En önskan från lärare är ett bättre och utökat samarbete med ungdomsmottagningarna. Konklusion: För att integrera ungdomar med samhället och främja en positiv sexuell hälsa är det av betydande roll att ungdomen får en individanpassad och grundläggande sex och samlevnadsundervisning de är i behov av.

Bakgrund Tidigare forskning visar att behovet av stöd under graviditet, förlossning och första tiden som förälder är stort. I dagens digitaliserade samhälle kan digitala medier vara en plattform för att erhålla stöd. Digitala medier är ett lättillgänglighet verktyg som ger möjlighet att självständigt söka kunskap. Föräldrar kan dock ha svårt att förhålla sig till den informationen som finns att tillgå. Syfte Att beskriva föräldrars upplevelser av att använda digitala medier i relation till graviditet, förlossning och barnets första 18 levnadsmånader. Metod Kvalitativ innehållsanalys med induktiv ansats användes. 15 semistrukturerade intervjuer genomfördes. Resultat Deltagarna använde digitala kanaler för att söka information i relation till graviditet, förlossning och föräldraskap. Analysen resulterade i ett tema: Digitala medier är ett stöd som även kan skapa oro. Centralt fynd var att det professionella stödet ansågs som mest värdefullt. Konklusion Digitala medier upplevdes som ett stöd när information och sociala kontakter upplevdes som tillfredsställande. Om information eller sociala kontakter inte var tillfredsställande kunde digitala medier skapa oro.

Background: Parenting is life-changing, a stable and secure social network, and a well-functioning relationship contributes to a positive perceived parenting. It’s essential to be able to adapt parenting support and to discover parents with increased need for support early, in which home-visits can be an important part. This study describes parents' experiences of a care intervention that involves professional support in form of extended home-visits during pregnancy and the child's first fifteen months of life. Aim: To describe parents' experiences of receiving support through extended home-visits during pregnancy and the child's first fifteen months of life. Method: Qualitative study with inductive approach. Twelve semi-structured interviews were conducted. Phenomenographic method was used for data analysis. Results: Parents' experiences of receiving support through extended home-visits resulted in three categories: The place and form of the meeting are important for parents' sense of coherence; Home-visits promote parents' sense of security and strengthen the parental role; Home-visits promote parental involvement, integration and relationships. Parents described that everything fell into place and became more real when they received support at home. Conclusion: Home-visits and support in the home environment increased parents' sense of coherence, participation, sense of security and strengthened their role as parents.

Patients feeling offended by reading records online is a concern among healthcare professionals, however previously published work has focused on adult patients. Here, a survey was used to explore and compare experiences of offense among adolescents (15-19 years old) and young adults (20-24 years old). Findings indicated that while the ratio of those offended did not differ between adolescents and young adults, reasons for feeling offended did.

The purpose of this study was to explore how older people experience and perceive decisions to seek hospital care while receiving home health care. Twenty-two Swedish older persons were interviewed about their experiences of decision to seek hospital while receiving home health care. The interviews were analyzed using qualitative content analysis. The findings consist of one interpretative theme describing an overall confidence in hospital staff to deliver both medical and psychosocial health care, In Hospital We Trust, with three underlying categories: Superior Health Care, People's Worries, and Biomedical Needs. Findings indicate a need for establishing confidence and ensuring sufficient qualifications, both medical and psychological, in home health care staff to meet the needs of older people. Understanding older peoples' arguments for seeking hospital care may have implications for how home care staff address individuals' perceived needs. Fulfillment of perceived health needs may reduce avoidable hospitalizations and consequently improve quality of life.

Background: When designing, implementing, and evaluating a work site health promotion program, it is necessary to ensure that the program is evidence based. The present article aims to present in-depth information on the design of a longitudinal randomized controlled complementary intervention pilot study that follows the Consort recommendations to evaluate possible effects of a health promotive intervention in healthy workers.

Methods: Employees from four different workplaces were randomly assigned to one of the following groups: i) Massage and mental training (sitting in the armchair and receiving mechanical massage while listening to mental training programs, n=19), ii) Massage (sitting in the armchair and receiving mechanical massage only, n=19), iii) Mental training (sitting in the armchair and listening to mental training programs only, n=19), iv) Pause (sitting in the armchair but not receiving mechanical massage or listening to mental training programs, n=19), v) Control (not sitting in the armchair at all, n=17). The study lasted for eight weeks. Immediately before the randomization, after four weeks and after eight weeks the participants responded to statements from the Swedish Scale of Personality and had their heart rate, blood pressure and fingertip temperature measured.

Results: Receiving mechanical massage and listening to mental training programs, either separately or in combination, during working hours had some positive effects on the employees’ own evaluation of their health, as well as their heart rate, blood pressure and fingertip temperature. However, the intervention need to be evaluated further.

Conclusion: The approach described makes it possible to design, implement and evaluate a work site health promotion program, also on pilot-study level and these results should be seen as a first step towards larger randomized studies. This types of studies need to focus on healthy participants and special care should be taken to guarantee adequately powered study groups and their homogeneity.

Resilience is a dynamic process that reflect individual ability to successfully recover and positively adapt to severe circumstances. In this essay, attachment, social support, self- regulation and affective processing, taken from the "shortlist of resilience" provided by Masten, are further analyzed and connected to findings within neuroscience. The result suggest that brain areas originated from the prefrontal cortex, such as orbitofrontal and dorsolateral cortex, are two major neural correlates to attachment and stress- and self- regulation. The amygdala is also an area of interest, because of its’ connection to emotions and affective memories. Research on affective style suggest that the functions associated with the prefrontal cortex are dampening the effect of the amygdala, which later supports resilience and recovery. The area of resilience is suffering from a lacking general definition, measurement and operationalization, which is argued to be the major challenge of this research area. Prominent researchers prospect that resilience research will continue to flourish within the area of neuroscience, and that further discoveries will be made concerning how this cognitive ability is related to structural and functional differences in the brain.

Kännedom om Omega-3 började med att man upptäckte att omega-3 har en effekt på kardiovaskulära sjukdomar, sedan dess har man börjat utforska allt fler områden där omega-3 har visat sig ha en positiv effekt. Syftet med den här uppsatsen är att undersöka huruvida Omega-3 har en effekt på demens och den vanligaste demenssjukdomen Alzheimer. Demens orsakas bland annat av en omfattande celldöd i hjärnan och uttrycker sig genom att minnet och kognitionen blir gradvis försämrat eftersom det episodiska minnet är försämrat hos dementa. Alzheimer i sin tur har visat sig ha låga nivåer av DHA i hippocampus. Studier har visat att ett intag av fisk och Omega-3 kan förebygga en uppkomst av demens och Alzheimer och förbättra den kognitiva försämringen som sker vid demenssjukdom. Slutresultaten är motsägelsefulla. De flesta studier visar att Omega-3 påverkar och förbättrar kognitionen hos Demens och Alzheimer patienter och kan verka förebyggande och även som behandling. Emellertid finns det de studier som visar på att Omega-3 inte har visat någon signifikant effekt, eller enbart har en förebyggande effekt och endast ifall demenssjukdomen inte är starkt genetiskt betingad.

An increasing number of older persons have complex health care needs. This, along with the organizational principle of remaining at home, emphasizes the need to develop collaborations among organizations caring for older persons. A health care model developed in Sweden, the Mobile Integrated Care Model aims to promote work in teams across organizations. The aim of the study was to describe nurses’ experiences in working and providing health care in the Mobile Integrated Care Model in the home with home health care physicians. Semi-structured interviews were conducted with 18 nurses and analyzed through qualitative content analysis. The method was compliant with the COREQ checklist. A mutually trusting collaboration with physicians, which formed person-centered care, created work satisfaction for the nurses. Working within the Mobile Integrated Care Model was negatively impacted by being employed by different organizations, lack of time to provide health care, and physicians’ person-centered work abilities.

Background: An increasing older population, along with the organizational principle of remaining at home, has moved health care from institutions into the older person’s home, where several health care providers facilitate care. The Mobile Integrated Care Model strives to provide cost-efficient, coherent, person-centered health care in the home. In the integrated care team, where the home health care physician is the medical authority, several health care professions work across organizational borders. Therefore, the aim of this study was to describe Home Health Care Physicians perceptions of working and providing health care in the Mobile Integrated Care Model, as well as perceptions of participating in and forming health care.

Methods: A phenomenographic qualitative study design, with semi-structured interviews using an interview guide.

Results: Working within Mobile Integrated Care Model was a different way of working as a physician. The physicians’ role was to support the patient by making safe medical decisions. Physicians described themselves as a piece in the team puzzle, where the professional knowledge of others was crucial to give quality health care. Being in the patients’ homes was expressed as adding a unique dimension in the provision of health care, and the physicians learned more about the patients by meeting them in their homes than at an institution. This aided the physicians in respecting patient autonomy in medical decision making, even though the physicians sometimes disregarded patient autonomy in favor of their own medical experience. There was a divided view on next of kin participation among the home health care physicians, ranging from always including to total absence of involving next of kin in decision making.

Conclusions: The home health care physicians described the Mobile Integrated Care Model as the best way to work, but there was still a need for additional resources and structure when working in different organizations. The need for full-time employment, additional time or hours, more equipment, access to each other’s medical records, and additional collaboration with other health care providers were expressed, which could contribute to increased work satisfaction and facilitate further development of person-centered care in the Mobile Integrated Care Model. 

Background: Research shows that first-time fathers want to take part in preparation for birth and parenthood but they describe being excluded by health professionals. Aim: The aim of this study was to illustrate first-time fathers’ experiences of support from midwives in maternity clinics as a step in the validation of “The Father Perceived-Professional-Support” (The FaPPS) scale. Methods: A qualitative content analysis with an inductive and deductive approach was used; seven first-time fathers were strategically selected and interviewed. In the inductive part the following open question was asked: “How did you perceive the support from the antenatal midwife/midwives?” In the deductive part, the fathers were asked to respond to the FaPPS scale, in order to receive their thoughts and understanding of the scale, inspired by the “Think-aloud” method. Findings. The inductive results showed two main categories: Experience of not knowing what support they needed and Experience of being excluded. The fathers found support from other fathers in parental education classes, but they lack time to discuss. Overall it seems as if the fathers answered both from their own perspective and from the mothers’ perspective. This was not evident in the deductive results. The FaPPs scale should therefore include professionals’ ability to strengthen social support from other first-time fathers and professionals’ ability to offer support to the mother. Conclusion and Clinical Implications. The fathers experienced exclusion both by themselves and also by midwives. Midwives should offer both parents the opportunity to pose questions. It is important for expectant fathers that time for discussion is planned in parental education classes. The FaPPS scale is useful but needs further development. Parts of our result are in line with earlier research, for decades; therefore it is necessary to focus more on support for fathers.

Bakgrund: I alla tider har kvinnor stöttat andra kvinnor under förlossningen och den födande kvinnan ses som huvudperson. Omfattande forskning finns på kvinnors behov av professionellt stöd under förlossningen. Nyligen har även pappors upplevelse och behov uppmärksammats. Pappans förlossningsupplevelse är av betydelse för pappans och barnets interaktion, i transitionen till faderskapet och för hans egna välbefinnande. Inom området behövs mer kunskap om pappors behov av professionellt stöd vid födseln av sitt första barn. Denna kunskap behövs för att pappor ska uppleva ett professionellt stöd.

Syfte: Att beskriva det professionella stödets betydelse för pappors upplevelse av sitt första barns födelse.

Metod: Sex informanter har blivit intervjuade över telefon. En kvalitativ innehållsanalys har använts för att besvara studiens syfte.

Resultat: Information, kommunikation, delaktighet och tillgänglig förlossningspersonal är betydande för pappors upplevelse av det professionella stödet. Pappor avläser barnmorskans kroppsspråk och känner tillit till förlossningspersonalen som utstrålar kompetens och säkerhet. Pappor anser att deras huvudsakliga uppgift är att vara ett stöd till den födande kvinnan och ett professionellt stöd möjliggör för detta.

Konklusion: Professionellt stöd till pappan är betydelsefullt för att han ska uppleva förlossningen som hanterbar.

Worldwide, drowning is the third leading cause of death among children. In Asia it is the first leading cause of death and a major public health threat. The objective of this paper was to develop a drowning prevention program including swimming training, CPR and lifesaving methods for children and to evaluate it. This intervention was provided and evaluated in Thailand where drowning is the first leading cause of death among children. The study used observations, quantitative and qualitative methods. In total 20 children in the age of seven to ten, from Nan Province in northern Thailand were participating.The result of this intervention is that the children are highly capable to learn swimming, CPR and lifesaving activities within 10 days. Out of 20 participants all have successfully completed the swimming, CPR and lifesaving programs.The conclusion of this intervention study can be sum up by both the interventions result, the questionnaires and the independent evaluators is that swimming program as this one is highly needed for saving lives. Support from the local as well as the central authority is also needed. Therefore such swimming program shows the importance of swimming knowledge and water security to prevent drowning in near future.

Att vänta barn och att bli mamma är en transition som leder kvinnan från en känd till en okänd tillvaro och både socialt och professionellt stöd kan underlätta vid denna omvälvande händelse. För att bättre kunna erbjuda kvinnorna ett gott stöd behövs mer kunskap om kvinnornas tankar inför deras första barns födelse, då detta område är relativt outforskat. Syfte: Att belysa gravida kvinnors tankar inför sitt första barns födelse. Metod: Kvalitativ innehållsanalys med induktiv ansats.Kvalitativa frågeformulär besvarades av 18 informanter. Resultat: Det framkommer fyra huvudkategorier; tankar om den egna förmågan och upplevelsen, tankar om förlossningsmiljön, tankar kring partnern och tankar om det ofödda barnet.Temat som genomsyrar resultatet är att gravida kvinnors tankar kring sitt första barns födelse pendlar mellan tillit och tvivel.Konklusion: Kvinnorna har tilltro till den egna förmågan men samtidigt en oro inför det okända.Tankar inför förlossningen kan påverka upplevelsen, därför är det viktigt att barnmorskan hjälper kvinnan att hantera sina tankar så att hon får realistiska förväntningar. Kvinnorna har ambivalenta tankar om det stöd hon kommer att erbjudas. Professionellt och socialt stöd är viktigt för att uppnå en positiv förlossningsupplevelse och därför bör kontinuerligt stöd erbjudas till alla födande kvinnor.

Introduction A positive childbirth experience promotes women’s health, both during and beyond the perinatal period. Understanding what constitutes a positive childbirth experience is thus critical to providing high-quality maternity care. Currently, there is no clear, inclusive, woman-centered definition of a positive childbirth experience to guide practice, education, and research.

Aim To formulate an inclusive woman-centered definition of a positive childbirth experience.

Methods A six-step process was undertaken: (a) Key concepts associated with a positive childbirth were derived from a rapid literature review; (b) The key concepts were used by interdisciplinary experts in the author group to create a draft definition; (c) The draft definition was presented to clinicians and researchers during a European research meeting on perinatal mental health; (d) The authors integrated the expert feedback to refine the working definition; (e) A revised definition was shared with women from consumer groups in six countries to confirm its face validity; and (f) A final definition was formulated based on the women’s feedback (n = 42).

Results The following definition was formulated: “A positive childbirth experience refers to a woman’s experience of interactions and events directly related to childbirth that made her feel supported, in control, safe, and respected; a positive childbirth can make women feel joy, confident, and/or accomplished and may have short and/or long-term positive impacts on a woman’s psychosocial well-being.”

Conclusions This inclusive, woman-centered definition highlights the importance of provider interactions for facilitating a positive childbirth experience. Feeling supported and having a sense of control, safety, and respect are central tenets. This definition could help to identify and validate positive childbirth experience(s), and to inform practice, education, research, advocacy, and policy-making.

BACKGROUND:

Working people's reduced ability to recover has been proposed as a key factor behind the increase in stress-related health problems. One not yet evidence-based preventive method designed to help employees keep healthy and be less stressed is an armchair with built-in mechanical massage and mental training programmes, This study aimed to evaluate possible effects on employees' experience of levels of "Anxiety", "Stress Susceptibility", "Detachment" and "Social Desirability" when using mechanical massage and mental training programmes, both separately and in combination, during working hours.

METHODS:

Employees from four different workplaces were randomly assigned to one of the following groups: i) Massage and mental training (sitting in the armchair and receiving mechanical massage while listening to the mental training programmes, n=19), ii) Massage (sitting in the armchair and receiving mechanical massage only, n=19), iii) Mental training (sitting in the armchair and listening to the mental training programmes only, n=19), iv) Pause (sitting in the armchair but not receiving mechanical massage or listening to the mental training programmes, n=19), v) Control (not sitting in the armchair at all, n=17). In order to discover how the employees felt about their own health they were asked to respond to statements from the "Swedish Scale of Personality" (SSP), immediately before the randomisation, after four weeks and after eight weeks (end-of-study).

RESULTS:

There were no significant differences between the five study groups for any of the traits studied ("Somatic Trait Anxiety", "Psychic Trait Anxiety", "Stress Susceptibility", "Detachment" and "Social Desirability") at any of the occasions. However, the massage group showed a significant decrease in the subscale "Somatic Trait Anxiety" (p=0.032), during the entire study period. Significant decreases in the same subscale were also observed in the pause group between start and week eight (p=0.040) as well as between week four and week eight (p=0.049) and also in the control group between the second and third data collection (p=0.014). The massage and mental training group showed a significant decrease in "Stress Susceptibility" between week four and week eight (p=0.022). The pause group showed a significant increase in the subscale "Detachment" (p=0.044).

CONCLUSIONS:

There were no significant differences between the five study groups for any of the traits studied. However, when looking at each individual group separately, positive effects in their levels of "Anxiety", "Stress Susceptibility" and "Detachment" could be seen. Although the results from this pilot study indicate some positive effects, mechanical chair massage and mental training programmes used in order to increase employee's ability to recover, needs to be evaluated further as tools to increase the employees ability to recover.

OBJECTIVE:

The aim of this paper was to discuss differences between having a child perspective and taking the child's perspective based on the problem being investigated.

METHODS:

Conceptual paper based on narrative review.

RESULTS:

The child's perspective in research concerning children that need additional support are important. The difference between having a child perspective and taking the child's perspective in conjunction with the need to know children's opinions has been discussed in the literature. From an ideological perspective the difference between the two perspectives seems self-evident, but the perspectives might be better seen as different ends on a continuum solely from an adult's view of children to solely the perspective of children themselves. Depending on the research question, the design of the study may benefit from taking either perspective. In this article, we discuss the difference between the perspectives based on the problem being investigated, children's capacity to express opinions, environmental adaptations and the degree of interpretation needed to understand children's opinions.

CONCLUSION:

The examples provided indicate that children's opinions can be regarded in most research, although to different degrees.

Background:Continued refinement of resources for patient information, education and support is needed. Considering the rapid development of new communication practices, the perspectives of young people themselves warrant more attention using a wide research focus. The purpose of this study was to understand information-seeking behaviours, Internet use and social networking online in adolescents with type 1 diabetes (T1DM). This applied to their everyday life, including the context of diabetes and their experiences and need of contact with T1DM peers.Methodology/Principal Findings:Twenty-four adolescents aged 10-17 years with T1DM were recruited from a county hospital in the south-east of Sweden. Qualitative data were obtained using eight focus groups, wherein each participant engaged in a 60-90 minute video/audio-recorded session. The focus group data were transcribed and analysed using qualitative content analysis. Some demographic and medical information was also collected. The three main categories that were identified; Aspects of Security, Updating, and Plainness and their sub-categories gave significant information about how to enhance information retrieval and peer contacts related to T1DM. Regarding the persons' information-seeking behaviour, Internet use, and use of social media some differences could be identified depending on gender and age.Conclusions/Significance:Sensitivity and adaptation to users' needs and expectations seem crucial in the development of future online resources for adolescents with T1DM. To start with, this could mean applying a wider range of already existing information and communication technologies. Health practitioners need to focus on the areas of security of information and communication, frequency of updating, and simplicity of design-less is more. © 2013 Nordfeldt et al.

Bakgrund: Barnmorskor på ungdomsmottagningar spelar en viktig roll i att informera och utbilda ungdomar om pubertetsutveckling och sexualitet. Under puberteten sker fysiska förändringar med unga tjejers kroppar. I underlivet sker tillväxt och en ökad sekretion vilket ger upphov till flytningar.  Trots att detta är en normal process är det något som unga tjejer har frågor om då de söker sig till ungdomsmottagningar.

Syfte: Syftet med denna studie var att undersöka barnmorskors erfarenheter av hur unga tjejer på ungdomsmottagningen informeras om normala flytningar.

Metod: Kvalitativ innehållsanalys användes som metod. Semistrukturerade intervjuer genomfördes och totalt inkluderades sju barnmorskor verksamma inom ungdomsmottagning.

Resultat: Resultatet presenteras genom två kategorier; Information om vad som är normala flytningar och hur kroppen fungerar samt Information för ungdomar i olika åldrar vid utåtriktat arbete. Underliggande dessa fanns tre underkategorier; Normala flytningars förändringar genom menstruationscykeln, Stärkande gynekologisk undersökning och egenundersökning samt Konkret information genom visuella hjälpmedel.

Konklusion: Genom att ge hälsofrämjande information kan barnmorskor ge unga tjejer en tydlig bild över vad som är normalt och även ge en uppfattning om vad som avviker från det normala. Ökad kunskap och förståelse bör kunna ge unga tjejer en starkare självkänsla.

Hearing loss is a growing public health concern associated with decreased health-related quality of life (HRQoL) and a negative impact on work life. Knowledge about the long-term benefits for patients receiving cochlear implants may provide knowledge imperative for policymakers to promote better HRQoL and working life outcomes for individuals with hearing loss. The purpose of this study was to explore how HRQoL, hearing disabilities, and work satisfaction outcomes changed in working-aged adults with severe to profound hearing loss from pre- to post-receiving a cochlear implant (CI) between the baseline, year one, and year two. This longitudinal study used Cochlear’s Implant Recipient Observational Study (IROS) registry data to assess HRQoL, hearing disabilities, and work satisfaction in 18–65-year-old CI recipients. Data were collected pre- and post-implantation at baseline, year one, and year two follow-up. One hundred and twenty-seven CI recipients participated in the study. Significant improvements were observed for HRQoL outcomes for hearing, speech, emotion, and health utility post-implant. Overall hearing disability decreased post-CI, and work satisfaction improved. With the increasing prevalence of hearing disabilities, this is pertinent knowledge that supports the use of CIs for hearing rehabilitation which may promote better HRQoL and work satisfaction. 

Bakgrund: Artros är den vanligaste reumatiska ledsjukdomen i Sverige. Totalt har mellan 7-800 000 personer i Sverige artros. Artros innebär en obalans mellan nedbrytning och uppbyggnad av ledbrosket som leder till bristande funktion, stelhet och smärta i leden. Med motion så kan man både förebygga sjukdomen och minska symptomen. Studier har visat att motion ger lika bra smärtlindring som smärtstillande, vid lätt till måttlig artros. Att träna upp sin känsla av sammanhang och copingfärdigheter kan vara ett sätt att öka sin känsla av egen förmåga och på så sätt lära sig hantera smärta och sjukdom. Syfte: Att undersöka hur styrketräning påverkar personer med artros vad det gäller smärta och rörlighet. Metod: En litteraturstudie där tio vetenskapliga artiklar inkluderades och granskades, för att sedan jämföras och sammanställas i ett resultat. Resultat: Styrketräning ger stora fördelar för personer med artros. Vilken sorts träning det handlar om verkar inte spela någon större roll. Huvudsaken är att man stärker upp musklerna för att avlasta leden, vilket leder till minskad smärta och större rörlighet. Slutsats: Styrketräning påverkar personer med artros på ett positivt sätt både vad det gäller styrka och rörlighet. I studierna som granskades visades en signifikant skillnad i grupper där styrketräning användes som behandling.

The aim was to explore how male and female older twins experience their lifelong relationship with one another. Method: Qualitative data consisting of 32 life stories of Swedish older (70+) identical and fraternal twins were analyzed with narrative analysis. Results: Both male and female older twins experienced their twin relationships as the emotionally closest as related to other sibling relationships. Female twins stressed open and frequent communication as an important aspect contributing to closeness in the twin relationship, whereas the male twins related closeness to doing activities together. Dependency was stressed as emotionally draining in the female twin relationships, meaning that both of the twin sisters had not separated emotionally from one another. In contrast, the male older twins talked about competition as an aspect that was emotionally draining. Males and females define emotional closeness differently. The relationship patterns for both female/male older twins remained stable over the life course.

Twins do not exist apart from a family and, for a more comprehensive understanding, twinship needs to be seen in its family context. The objective of this study was to explore twinship from the perspectives of adult twins, their non-twin siblings and parents. Methods: Qualitative methodology based on semi-structured interviews of middle-aged twins, their non-twin siblings and parents within their families. The data were analyzed using qualitative content analysis. Findings: Twinship was described by the twins as an emotionally close relationship with the co-twin but also feeling unnoticed as individuals when treated as a ‘unit’ by family members. Likewise, the older non-twin siblings could feel unnoticed, due to the parental attention given to the twins and, to compensate, take on a ‘caregiving role’ for the twins. Depending on the parents’ insights on twinship, they could facilitate or limit the development of the sibling relationships within the family.

The aim of this study was to explore the experiences of twinship as described by older twins and their siblings. Method: Qualitative data based on interviews with 14 Swedish older (70+) identical and fraternal twins and with 15 siblings to twins, which were analyzed with qualitative content analysis. Results indicate that the siblings particularly in larger families substituted as parents in the raising of the twins, whereas in smaller families the role of the siblings were more unclear. In addition to bonding to one another, both twins also found comfort in having a supportive relationship of their own with yet one other sibling in the family and influential in the developing of the individual identity of the twins. For the siblings of the twins, engaging in the raising of the twins, was a way to prevent the feeling of being unnoticed. 

The aim was to explore and describe how older twins reared apart and reared together experience the twin relationship over a life course. Method: The life stories of 30 Swedish older (70+) identical and fraternal twins were analyzed with qualitative content analysis. Results: The relationship patterns among twins reared apart were related to the time of separation, family upbringing, time together after re-union and over the life course. Twins who spent their first years in the biological family and thereafter separated could continue their relationship over the life course, showing the same kind of relationship patterns as twins reared together. Twins who were separated during their first year after birth and reunited several years later showed a more complex relationship pattern, where some lacked an emotionally close relationship and others gradually developed such a relationship over the years. This finding challenges popular views on twins reared apart being emotionally close.

Background: Alexithymia is an important transdiagnostic risk factor for emotion-based psychopathologies. However, it remains unclear whether alexithymia questionnaires actually measure alexithymia, or whether they measure emotional distress. Our aim here was to address this discriminant validity concern via exploratory factor analysis (EFA) of the 20-item Toronto Alexithymia Scale (TAS-20) and the Perth Alexithymia Questionnaire (PAQ). Method: United States general community adults (N = 508) completed the TAS-20, PAQ, and the Depression Anxiety Stress Scales-21 (DASS-21). EFA was used to examine the latent dimensions underlying these measures' scores. Results: Our EFA extracted two higher-order factors, an “alexithymia” factor and a “general distress” factor (i.e., depression, anxiety, stress). All PAQ scores loaded cleanly on the alexithymia factor, with no cross-loadings on the distress factor. However, for the TAS-20, Difficulty Identifying Feelings (DIF) facet scores cross-loaded highly on the distress factor. Limitations: Our sample consisted of general community adults; future work in clinical settings will be useful. Conclusions: Our data indicate that the PAQ has good discriminant validity. However, the TAS-20 appears to have significant discriminant validity problems, in that much of the variance in its DIF facet reflects people's current levels of distress, rather than alexithymia. The TAS-20, which has traditionally been the most widely used alexithymia questionnaire, may therefore not be the optimal alexithymia tool. Our findings add to the body of evidence supporting the validity and utility of the PAQ and suggest that, moving forward, it is a superior option to the TAS-20 for alexithymia assessments.

Bakgrund: Forskning visar att den sexuella hälsan hos kvinnor minskar under barnafödandet och kvinnans relation till partnern förändras. Kvinnan har behov av närhet och intimitet men mindre fokus på sexuell aktivitet. Kvinnor upplever att barnmorskor saknar tid och intresse att fokusera på deras sexuella hälsa vid besöken på kvinnohälsovården. Barnmorskor upplever att de har en kunskapsbrist och känner osäkerhet kring hur frågorna ska ställas i mötet med kvinnorna.

Syfte: Att beskriva barnmorskors erfarenheter av att stödja kvinnors sexuella hälsa under barnafödande.

Metod: Kvalitativ innehållsanalys användes för att analysera intervjuer med åtta barnmorskor från kvinnohälsovården.

Resultat: Fyra kategorier framkom: Anpassa samtalet till situationen, Stödja den fysiska processen, Stärka parets relation och Hinder som försvårar. Barnmorskors erfarenhet är att deras professionella kunskap bidrar till öppna samtal och att de stödjer genom att informera om de psykiska och fysiska förändringar som sker hos kvinnan och genom att stärka parets relation. Hinder för stödjande kan vara tidsbrist, kunskapsbrist, kvinnans fokusering på förlossningen eller att kvinnor förväntas ta egenansvar att inhämta information.

Konklusion: För att förbättra stödet av kvinnors sexuella hälsa behövs mer utbildning till barnmorskor och eventuellt omorganisering av besöken för att kunna fånga upp kvinnan en längre tid efter barnafödandet.

BackgroundHealthcare professionals’ attitudes to and knowledge of oral health are fundamental to providing good oral health care to older adults. One instrument that assesses healthcare professionals’ attitudes to and knowledge of oral health in a Swedish context is the “Attitudes to and Knowledge of Oral health” (AKO) questionnaire. Two of the three item-groups of the AKO have previously been validated in a Swedish context. However, it is crucial that all three item-groups are validated, and beneficial to design a shorter, easy-to-use questionnaire for healthcare professionals while maintaining adequate integrity of its reliability and validity. Therefore, the present study aims to develop a short-form version of AKO and to secure its psychometric properties.

MethodsPsychometric evaluation with Classical Test Theory and Item Response Theory to validate and shorten AKO with 611 healthcare professionals from a population of 1159 working in a municipality in an urban area in western Sweden.

ResultsOf the original 16 items in the AKO, 13 were shown to warrant retention in the abbreviated/shortened form. These showed acceptable validity and reliability for assessing healthcare professionals’ attitudes to and knowledge of oral health.

ConclusionThis validated short-form version of AKO shows acceptable validity and reliability after being reduced to 13 items, structured in a 3-part scale. The items are consistent with the total scale, indicating that the internal consistency is acceptable. Future studies should be performed to evaluate AKO in other groups of healthcare professionals, across cultures, languages, and so on, to investigate its use and strengthen its validity and reliability.

The somatosensory system concerns the sense of touch. It is sectioned into various kinds of touch, such as the proprioceptive sense, providing information of sense of self and position of limbs, and the cutaneous sense, informing of the modalities of touching or being touched. The cutaneous sense is further divided into discriminative touch and affective touch. Discriminative touch is an exteroceptive sense of touch that responds to stimuli of pressure and vibration, and affective touch is an interoceptive sense of touch that corresponds to e.g. pleasant and painful stimuli, communicating information to the brain through A-delta and C-fibers. Recent studies investigates affective touch to have emotional affect on the subjective experience of touch, affecting subjective wellbeing. The aim of this thesis is to examine the sense of touch and its relevant neural correlates, focusing on affective touch and its role in subjective wellbeing and social relations. A presentation of physiological and neural aspects of touch will be held as well as a description of subjective wellbeing. The conclusion for this thesis is that affective touch appears to activate brain areas of orbitofrontal cortex, frontal polar cortice, prefrontal cortex and insula cortex, which are brain areas processing subjective wellbeing, e.g. evaluating positive and negative effect and processing emotional information and behavior. Examining correlations between affective touch and positive affect, negative affect, oxytocin release, social relations and affiliative behavior shows influence from affective touch on subjective wellbeing. A discussion of the current findings is provided, including directions for future research.

Aim: The aim of this study was to describe and compare the experiences of nursing staff caring for ethnic elderly persons suffering from dementia in an ethnic care setting and a Swedish-speaking care setting. 

Background: The numbers of ethnic elderly persons who speaks only their native language and are suffering from dementia are growing. As the dementia progresses into its ́ advanced stage the person suffering from dementia first loses the second language and later the native language and needs to be admitted to institutional care. In some municipalities in Sweden ethnic elders suffering from dementia receives care in an ethnic care setting where the persons` native language is spoken, but most ethnic elders suffering from dementia receives care in Swedish-speaking institutions. In terms of communication this may be a challenge for the nursing staff. 

Methods: The study has a qualitative approach with 27 semi-structured interviews. Data consist of 12 interviews with Finnish-speaking nursing staff working in a Finnish-speaking group home for persons suffering from dementia in Sweden and of 15 interviews with nursing staff working in Swedish-speaking group homes caring for non-Swedish older persons with dementia. The material is analysed with qualitative analysis. 

Findings: The experiences of the nursing staff showed that caring for the patients in a Finnish-speaking environment meant that they could communicate with the patients in their native language, which in turn stimulated the cognitive, physiological and social abilities of the person with dementia. Besides the language, the Finnish-speaking nursing staff also included cultural aspects such as Finnish music, food and media into the daily life in the care. The nursing staff in the Swedish-speaking group homes, perceived that all patients received equal basic care, but as they did not speak the patients` language communication was limited The language barrier resulted in behavioural disturbances at times in the non-Swedish patients with dementia. 

Implications: The two types of care settings were compared and besides a mutual language, the bilingual staff in the Finnish-speaking group home were able to include more of the cultural aspects which all together contributed to a sense of homeness for the Finnish elders with dementia. The care in the Swedish-speaking group homes was considered good and equal, but was also experienced as limited and frustrating by the Swedish-speaking nursing staff. Other strategies to communicate with the patients had were used and which will be further discussed.

Self-determination theory (SDT), a motivation theory, consists of motivation types: intrinsic motivation, extrinsic motivation, and amotivation, where the social environment is important. SDT’s motivation orientations are about individual differences in people’s tendencies to orient towards environments. The five factor model (FFM), a personality theory, consists of five factors and can be grouped into two metatraits; plasticity: extraversion and openness; and stability: agreeableness, conscientiousness, and neuroticism. Studies show that SDT’s motivation orientations and the factors of FFM significantly covary. Intrinsic motivation and trait plasticity have similar features; the desire for exploration, engagement, well-being, and dopamine as neural correlate. The thesis reviews the role of dopamine as the neural correlate of intrinsic motivation and trait plasticity – a relation between motivation and personality. Dopamine and trait plasticity function to attain rewards of uncertainty and explore, but uncertainty is threatening. Salience coding neurons, value coding neurons and a combination of both are related, respectively, to rewards of information, specific rewards and the value of any uncertainty. Intrinsic motivation is related to the value coding neurons, flow via D2 receptors, the salience network, and the seeking system. Conclusions: there are many appealing similarities and rational that relate constructs/mechanisms – motivation is related to personality; can there even be a common construct? However; results based on proposed theories, neuroscientific quality issues, early inconsistent findings of intrinsic motivation mechanisms, and trait stability are speculated to, also, be needed to model intrinsic motivation. Unifying cross-disciplinary work and proposed theories of neural correlates are encouraged.

INTRODUCTION: Among the world's regions, the WHO European Region has the lowest rates of exclusive breastfeeding at age 6 months with around 25%. Low rates and early cessation of breastfeeding have important adverse health consequences for women, infants and young children. Protecting, promoting and supporting breastfeeding are a public health priority.

OBJECTIVES: National breastfeeding data and monitoring systems among selected European countries and the WHO European Region are compared. Mechanisms for the support, protection and promotion of breastfeeding are reviewed and successes and challenges in implementation of national programs are presented.

METHODS: National representatives of national breastfeeding committees and initiatives in eleven European countries, including Belgium, Croatia, Denmark, Germany, Ireland, Italy, The Netherlands, Norway, Spain, Sweden and Switzerland, participated in a standardized survey. Results are evaluated and compared in a narrative review.

RESULTS: Variation exists in Europe on breastfeeding rates, methodology for data collection and mechanisms for support, protection and promotion of breastfeeding. Directly after birth, between 56 and 98 % of infants in all countries were reported to receive any human milk, and at 6 months 38-71% and 13-39 % of infants to be breastfed or exclusively breastfed, respectively. National plans addressing breastfeeding promotion, protection and support exist in 6 of the 11 countries.

CONCLUSIONS: National governments should commit to evidence-based breastfeeding monitoring and promotion activities, including financial and political support, to improve breastfeeding rates in the Europe. Renewed efforts for collaboration between countries in Europe, including a sustainable platform for information exchange, are needed.

Background: Pregnancy can be physically and emotionally stressful for the parents, which means they need adequate professional support. Easy-to-use, validated scales are important in order to develop professional support in Antenatal care as well as in research.

The aim: Our aim was to illuminate pregnant women’s experience of professional support at the Antenatal care, in relation to the Mother-Perceived-Professionals-Support (MoPPS) scale.

Method: A qualitative study design using the method “Think aloud” with both inductive and deductive approaches, was used. Five first-time mothers were interviewed with open questions followed by questions related to the MoPPS scale items. Data was analyzed using inductive and deductive qualitative content analyses.

Results: The inductive analysis resulted in one theme: “Professional support from midwives made women created a feeling of security and unique or rejected and lonely during pregnancy” and three categories: “Continuity and competence”, “Perceiving trust or not” and “Parental groups or individual visits”. The deductive analysis described the mothers’ understanding of each item. However, coherence between the inductive and deductive analyses varied and the MoPPS-scale needs development.

Conclusion: The result shows that women's experience of professional support affects their sense of feeling safe or lonely during pregnancy. Important for midwives were to meet the women’s unique individual needs. The MoPPS scale was considered to be relevant and easy to understand, but it needs development to include questions about continuity, parental groups and the perception of midwives’ competence, which all were important for the women during their pregnancies.

Clinical implications: To offer adequate professional support for women during pregnancy, midwives need to meet the women’s unique individual needs with both medical and supportive knowledge.