Papers by Anna-Lena Hellström
Scandinavian Journal of Urology and Nephrology, 2000
The aim of this study was to investigate the effects of a long series of electro-acupuncture (EAP... more The aim of this study was to investigate the effects of a long series of electro-acupuncture (EAP) sessions on bedwetting symptoms. Material and methods: Twenty-five children (age range 7-16 years) with monosymptomatic nocturnal enuresis and treated earlier without success were included in the study. The median number of wet nights per week was 4.7 before treatment. Bedwetting, voided volume, sleep and nocturia were evaluated 3 weeks, 3 months and 6 months after 20 sessions of EAP lasting 8 weeks. Results: All the children, with the exception of one, tolerated EAP treatment well. At the three follow-up sesssions it was found that the number of dry nights had increased gradually from a median of 2.3 in the pre-test to 3.0, 4.3 and 5.0 per week, respectively. Compared to pre-treatment findings there were more dry nights in 65% of the children (p < 0.001) and 5 out of 23 children were responders (> 90% reduction of the numbers of wet nights) at the 6 months' follow-up. According to the parents, the sleep arousal threshold had decreased in about 50% of the children.
Journal of Advanced Nursing, 2005
Ostomy patients' perceptions of quality of care Aim. This paper reports a study whose aim was to ... more Ostomy patients' perceptions of quality of care Aim. This paper reports a study whose aim was to assess the quality of care in ostomy patients seen from a patient perspective. Background. A stoma operation causes profound changes in a patient's life because of resulting physical damage, disfigurement, loss of bodily function, and change in personal hygiene. Such changes are a cause of major concern for patients and raise important issue for the quality of care. Methods. The study group comprised patients who had undergone a colostomy for rectal cancer or an ileostomy for ulcerative colitis, all attending a stoma outpatient clinic. Quality of care was assessed using the identity-oriented dimension of the validated questionnaire 'Quality of Care from the Patient's Perspective'. Forty-two ileostomy and 49 colostomy patients completed the questionnaire. Result. While the vast majority of patients in both groups thought that most topics in the questionnaire were important, most rated many aspects of their quality of care as unsatisfactory. One-third of the colostomy patients and one-half of the ileostomy patients were dissatisfied with the information they received about the results of medical examinations and laboratory tests, and an even higher proportion was dissatisfied with their opportunities to participate in the decision-making process or to discuss sexual matters. Stoma-related complications, which occurred in 71% of the ileostomy patients and in 43% of the colostomy patients, had no impact on these results.
Pediatric Nephrology, 2020
BackgroundAn association between bladder-bowel dysfunction (BBD) and urinary tract infection (UTI... more BackgroundAn association between bladder-bowel dysfunction (BBD) and urinary tract infection (UTI) is well-known. However, a question less explored is whether children with UTI early in life also have increased prevalence of BBD after they are toilet-trained. In this study, consecutively selected children with pyelonephritis during their first year of life were assessed for BBD at pre-school age.MethodsNinety-two children (51 boys) hospitalized due to pyelonephritis during their first year of life were assessed for BBD at median age 5.4 years. A validated BBD questionnaire, along with urine flow and residual volume measurements, was used for diagnosing BBD. During follow-up, the group was well-characterized regarding renal status, vesicoureteral reflux (VUR), and recurrent UTI.ResultsBBD was diagnosed in 35/92 (38%), of which the majority was sub-diagnosed with dysfunctional voiding (DV). There was a strong association between BBD and recurrent UTI during follow-up (p < 0.0001), ...
Psychology, 2017
The purpose was to illuminate preschool children's experiences of learning from a web-based inter... more The purpose was to illuminate preschool children's experiences of learning from a web-based intervention comprising person-centred learning support. A qualitative method was chosen based on open-ended interviews with ten children born with urogenital or bowel malformation. The data were analysed using qualitative content analysis. Two main categories and eight subcategories were identified. The findings show that the participants remembered the web preschool with pleasure and thought it had been useful. The children were able to express what they found important and in the conversations they easily associated the intervention with events in their daily life. Most of the children in this present study could manage toilet visits by themselves but worried about the standard in the school toilets. Their own integrity was important with regard to toilet matters and they wanted privacy for their visits.
Health, 2016
Background: It is known that, for reasons of hygiene and/or anxiety, some first year primary scho... more Background: It is known that, for reasons of hygiene and/or anxiety, some first year primary school children actively choose to avoid going to the toilet whilst at school, while at the same time many young children's primary care visits are due to urinary tract and bowel problems. By this age most children can recognise the bodily signals indicating the need for a toilet visit, and can independently perform the associated routines. Aim of this study was to describe the experience of healthy 5 to 6 years old when needing and using toilets whilst at preschool. Methods: A qualitative descriptive method was used. Seventeen children aged 5 to 6 years were interviewed. Results: Nearly all used the toilet when the need arose, but there were times during the day when their freedom to use the toilet was restricted. Most children experienced periods of waiting outside the toilet and a long wait could result in a decision to not use it. On those occasions when help was needed, it was usually necessary to shout once or more in order to attract the teacher's attention. Some children found the toilets clean and fresh while others found them dirty and smelly. Privacy during toilet visits was desirable among the children but queue outside the toilet was a cause of worry. Conclusion: The children were mostly able to use the toilet whilst at preschool, despite the challenges to their senses and integrity and occasionally issues with the teacher's rules. The need for privacy often had to yield to the teacher's need to control the children or even because toilet doors and/or locks were not adapted to the children's requirements.
European Journal for Person Centered Healthcare, 2013
Background: E-health solutions are increasingly being developed to meet patients’ preferences and... more Background: E-health solutions are increasingly being developed to meet patients’ preferences and promote their participation in healthcare. Few studies have explored the participatory design process from the perspective of person-centeredness, including how it becomes materialized in technology. This paper explores how applied participatory approaches and the design of 4 web-based interventions directed towards long-term illness correspond to key areas of person-centeredness. Methods: Data were collected during 2009 to 2012, from 4 Swedish research projects. The analysis followed an inductive approach involving a step-wise cross-case analysis. The purpose was to create shared knowledge and understanding of each separate case and to generate relevant categories.Results: A number of question areas describe the dialogue with the case participants. Results of the dialogue are categorized into 4 support areas: psychological/emotional, personal, information and technical. Person-centered...
J. of Health Science, 2016
It is well known that a lot of children avoid going to the toilet during school. This is mainly d... more It is well known that a lot of children avoid going to the toilet during school. This is mainly due to poor hygienic standards in the toilets but also due to fear and insecurity when visiting the toilet during recess. Studies show that children are not always allowed to go to the toilet during class and that many teachers decide when the children may satisfy their toilet needs. The purpose of this study was to describe teacher's attitudes and strategies when schoolchildren need to go to the toilet. Interviews with 17 teachers working in five Swedish compulsory schools. The teacher's attitudes were that the physiological need or children's will should determine when they could go to the toilet and that children have different toilet needs. All teachers used rules to regulate toilet visits during class. The rules were not communicated and required the interpretation of the children. The teachers demanded openness and information about the toilet needs of the children. Suspected misuse of toilet visits led the teacher to make their own assessment of the children's toilet needs, as a sanction toilet visits could be prohibited. The strategies used during class did not reflect the health-promoting attitude the teachers told about. In reality, the task of maintaining order and control was prioritised. The strategies used were not adapted to children's needs, which could have significance for maintaining toilet habits consistent with health and well-being.
Health, 2016
Introduction: Children need intensive care in the first days after open-heart surgery. In some ho... more Introduction: Children need intensive care in the first days after open-heart surgery. In some hospitals visits to Intensive Care Units (ICU), are not allowed, even by parents. Aim: The study aimed to illuminate the experiences of children and parents regarding permission or not to visit the ICU. Subjects and Methods: Twenty children aged between 8 and 15 years with planned open-heart surgery, together with their parents, were chosen consecutively to participate in the study. They were divided into two groups. Group 1, followed the routine with no visits by parents allowed to the ICU. Group 2 were allowed such visits. Data were collected through open interviews with parents and children, following an interview guide. Results "Missing" was the overall theme illustrated in the findings, with two major categories; "being seen" and "taking care" being developed. The parents trusted the expert knowledge of the medical staff but Missing was strongly expressed and influenced the feelings within the categories in Group 1. Parents felt they were not seen and the lack of information made them anxious, frightened and feel they were losing control over their parenthood. They asked to see their children only briefly to allay their fears. They knew their children's needs and thought they could help by taking care of practical issues to improve their well-being. All children in this group felt sad and abandoned. The families in Group 2 felt happy and confident despite not being allowed to stay with children all the time. The parents felt included in their care, which had a positive effect on the children.
Journal of Psychology Research, 2016
Aims and objectives: The aim of the study was to evaluate support in daily life, in terms of one-... more Aims and objectives: The aim of the study was to evaluate support in daily life, in terms of one-year outcomes of a person-centered web-based programme. Background: Children with a chronic disease are at risk of ill health. In school they are vulnerable as they differ from the other children. The united nation convention on the rights of the child awards them rights concerning the promotion of their health and wellbeing. Design: Descriptive qualitative design. Methods: The study was conducted from 2014-2015. Open questions were used in Skype conversations between children and web teachers (a mean of 12 conversations per child). Data were analyzed using qualitative content analysis Results. The web-preschool was found to support the ability to understand, reflect, discuss and find tools dealing with different situations. Sense of coherence was important. The development of verbal and communication skills was clear. The programme included images, narration and two-way Skype communication between child and web-teacher with the possibility of offering flexible support depending on needs. Conclusion: The web-based programme offered support in daily life for the participants-children aged 3-7 years with long-term illnesses.
Open Journal of Pediatrics, 2016
Background: Children with urogenital malformation or bowel disturbances are a vulnerable group an... more Background: Children with urogenital malformation or bowel disturbances are a vulnerable group and are at risk of experiencing ill health. At school they have to face and cope with situations they are unused to and often feel excluded. There is a lack of studies investigating prevention of ill health in this group of children. Objective: The aim of the study was to investigate the health/wellbeing and self-esteem, before and after a one-year intervention comprising person-centred, webbased learning support, in preschool children born with malformations in the urethra, bladder, genitals and/or bowel. Study design: Nine boys and one girl participated, aged 3-7 years (study group) with diagnoses of epispadia, bladder exstrophy, urethra valves and Hirschprung's disease. Two questionnaires were used, developed to measure index of health/wellbeing and self-esteem in younger children. In the study group, the interviews were repeated after one year. The group was compared with a control group of 20 healthy, age-matched children. Results: Before the intervention, there were no differences in wellbeing (Children condition index) between the study group and the control group. One year after the start of the web-based preschool, wellbeing in the study group had slightly improved, but not significantly compared to before the intervention. No
International Journal of Qualitative Studies on Health and Well-being, 2007
Nursing Research and Practice, 2012
For children living with long-term illness, school age is a risk period with regard to psychosoci... more For children living with long-term illness, school age is a risk period with regard to psychosocial ill health and poor compliance with treatment. There is a need for methods to promote health, well-being, and self-esteem. This study describes a new concept for supporting children, person-centred web-based learning and support, which has been tested in 12 preschool children and incorporates learning about feelings, relationships, and the right to integrity. SKYPE was used for conversations between the child and the web teacher.Methods. The programme was developed and tested in two steps. The conversations were tape-recorded and analysed using phenomenography. The questions addressed concerned the quality of the intervention process: accessibility of intervention, learning content and support, and identification of measurable items and patterns.Findings. The children found it interesting to communicate with their web teacher using SKYPE. The story about Max and Sara served as a good ...
International Journal of Pediatric Obesity, 2008
Objective. Growth surveillance of children in school health services is a routine in Sweden. We d... more Objective. Growth surveillance of children in school health services is a routine in Sweden. We describe the effect at followup of an overt identification of obesity in school children. Methods. Follow-up data were collected in two populations of tenyear-old children with obesity. Children in the study group belonged to a cohort born in 1990. Here the presence of obesity had been identified at the routine growth screening, and intervention activities against obesity had been actively offered. Controls belonged to a cohort born in 1989. Results. Of the 176 children with obesity, 91 were in the study group (41 girls) and 85 (44 girls) in the control group. No differences were found between the groups in age, gender or body mass index at baseline. At follow-up, after one to two years, children in the study group had a modest but significantly more pronounced decrease in the relative body mass index, compared with controls. The mean difference between the populations in body mass index standard deviation score (z-score) after adjustment for baseline body mass index and follow-up time was (0.14 (95% confidence interval: (0.25 to (0.02; P 00.027). Socioeconomic status, gender, follow-up time and group were independent predictors for change in body mass index z-score. Conclusions. To identify children with obesity in a routine school health survey may be a crucial initial step in the management of childhood obesity.
Open Journal of Pediatrics, 2013
Introduction: To investigate if potty training from infancy can affect bladder dysfunction in boy... more Introduction: To investigate if potty training from infancy can affect bladder dysfunction in boys with posterior urethral valves (PUV). Subjects and Methods: The voiding pattern and emptying ability were followed using the 4-hour voiding observation method in 17 Vietnamese boys with PUV aged 3 months to 4 years who had been potty-trained from infancy. This group was compared with a group of healthy Vietnamese boys. Results: In the boys with PUV, the bladder volume increased according to age, and interrupted voiding was rare. However, when comparing boys with PUV with healthy boys, a significant difference was noted with more frequent voidings and lower voided volumes in the age group 0-1 year (P < 0.001). Despite the minimum amount of residual urine, average 8 ml or less in the boys with PUV, the age groups 1-2 and 2-4 years had significantly higher residual volumes compared with those of the healthy boys (P < 0.001). Conclusion: The findings from the 4-hour voiding observation showed few signs of dysfunctional bladder in the Vietnamese boys with PUV, including residual urine, even if there were signs of dysfunction compared with the healthy Vietnamese boys. Potty training from infancy could favor early bladder rehabilitation in boys with PUV.
Scandinavian Journal of Caring Sciences, 2008
Experiences of the first year as father Background and aims: The importance of fathers' participa... more Experiences of the first year as father Background and aims: The importance of fathers' participation for development of the child and the well-being of the family is recognized from earlier research. In Sweden, legislation allows fathers to share the parental leave equally with the mother even so fathers only use a small of their paid leave. The aim of the study was to explore experiences of the first year as a father. Method: A phenomenological life world approach was used. Ethical approval was obtained. Ten men, recruited by a purposive sample, were interviewed 12-14 months after the delivery of their first child. The data collection was performed during June and August 2004 in the southwest area of Sweden. Findings: The essence of the experiences of the first year as father was to place the baby in the centre without giving up one's own person. The child provided warmth and happiness in the family and men experienced a deeper relationship to their partner. The contact between father and child was facilitated by engagement and time spent alone with the child. The major constituents identified from the findings were 'To be overwhelmed', 'To master the new situation' and 'To get a new completeness in life'. Discussion and conclusion: To master fatherhood maintenance of integrity and possibility to develop an independent relationship with the child is important. Fathers are invited to participate in postnatal childbirth education but the activities address women's needs and it is doubtful if the fathers benefit from participation. Though fathers entered the delivery room some decades ago, as a support to the woman, health personnel of today must be aware of fathers' own needs and the impact gender aspects have on their professional support.
Scandinavian Journal of Caring Sciences, 2010
Everyday experiences of life, body and well-being in children with overweight Background and aims... more Everyday experiences of life, body and well-being in children with overweight Background and aims: Childhood overweight is presented as a complex problem to solve. To elaborate efforts required in striving for normal weight in overweight children healthy signs of life from the child's point of view should be identified and promoted. The aim of the present study is to describe everyday experiences of life, body and well-being in children with overweight. Method: A qualitative descriptive design based on lifeworld perspective was used in 16 open-ended interviews with overweight children aged 10-12 years. Child overweight was defined by body mass index (kg/m 2) for each age. Drawings and body pictograms were used to supplement the interviews. Text was analysed using qualitative content analysis. Findings: The primary finding was the respondents' search for a sense of community in daily life. The respondents yearned to be part of a community but spent a lot of time alone. Parents and other family members were an important source of community but were not present enough in the respondents' daily life. The respondents had a sound body image, were concerned about their bodies and were aware of a healthy lifestyle. Nevertheless, they did not manage to implement this awareness in practice. Unhealthy sleeping, eating and exercise habits along with a sense of victimization were revealed in the interviews. Well-being meant self-esteem, trust and satisfaction and was preserved and improved through exciting relationships and activities. Feeling well was equal to feeling capable, feeling happy and feeling a sense of community. Discussion and conclusions: Findings emphasize the problem of loneliness in the children studied. Their healthy signs of life were not promoted in an acceptable way. They spent too much time alone doing sedentary activities with easy access to junk food. Findings indicate they should be provided with company at all meals and during activities on a daily basis.
Midwifery, 2011
Father for the first time-Development and validiation of a questionnaire to assess fathers´ exper... more Father for the first time-Development and validiation of a questionnaire to assess fathers´ experiences of childbirth. Manus
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Papers by Anna-Lena Hellström