On a national level, several factors are responsible for Sweden's leading position in achieving the excellent health of children because Sweden has experienced a long history of peace and success in establishing a parliamentary democracy throughout the 20th century. Among the different sectors of society, Sweden has been able to focus on prevention and health promotion. The Swedish health care system is publicly financed based on local taxation. Pediatricians working in secondary and tertiary care are employed by the public sector, whereas family physicians are employed by both the private and public sectors. The pediatric departments at county and university levels provide a high quality of inpatient care for neonates and children. The county hospital pediatric departments typically include one neonatal ward and one ward for older children. Subspecialization exists even at the county level, and there is close cooperation between the county level and subspecialist units at the university level. Within the primary care sector, most children receive care from family physicians. The majority of family physicians have completed 3 months of pediatrics in their basic training program. In the more densely populated areas there are also pediatric ambulatory care centers working mostly with referrals from the family physicians. Preventive care is carried out at midwife-led maternity health centers, nurse-led Child Health Centers, and nurse-led school health care settings and reach almost everyone (99%). All health care for children and adolescents is free of charge up to 18 years of age.
We present a historical and analytical overview of the Russian child health care system describing strengths and challenges of the system. Main indicators of social environment and children's health, general demographics, and socioeconomic factors of Russia are described. The Russian health care system has preserved positive elements of the former Soviet model of pediatric care. However, beginning in 1991, it has been altered greatly in its funding and management. The child health care system is composed of a special network of outpatient and inpatient facilities. The key element of pediatric community care is the pediatric polyclinic, staffed by district pediatricians and nurses. Undergraduate pediatric training is separate from adult medical training. From day one onward, future pediatricians are trained at separate pediatric faculties of universities. Thus, they qualify as general pediatricians after only 2 years of postgraduate training. It should be emphasized that the gap between the health status of children in developed countries and the Russian Federation is largely due to the influence of socioeconomic determinants, such as traffic accidents, poverty, pollution, and hazardous life styles, including binge drinking. Further improvements of children's health require protective measures by the state to address the underlying socioeconomic determinants.
Due to the current world situation, Sweden has one of the highest asylum applications within the European Union. Immigrant mothers, specifically those who have immigrated during the last ten years and do not speak the language of the new country, are found to be at particular risk of being effected by postpartum depression.
In this study, we elucidate Swedish Child Health Services nurses' experiences of identifying signs of postpartum depression in non-Swedish-speaking immigrant mothers.
Latent content analysis was used when analysing data material from 13 research interviews.
Being able to interpret a non-Swedish-speaking immigrant mother's mood required establishing and constant deepening of a transcultural caring relationship, the use of cultural knowledge to perceive signs of postpartum depression from observations and interactions and to rely on intuition.
There are both challenges and key factors for success in interpreting the mood of non-Swedish-speaking immigrant mothers.
This study provides information to healthcare professionals about challenges with adapting the screening with the Edinburgh Postnatal Depression Scale to immigrant mothers not speaking the language of residence. Tacit knowledge and cultural competence among healthcare personnel are invaluable assets when interpreting mental health in this vulnerable group of mothers.
Sweden has a reputation for gender equality, and its child health services seek to support both parents. However, this meta-ethnographic analysis of 62 studies from 2000 to 2015 covering prenatal clinics, labour and birth wards, postnatal wards and child health centres found programmes had not been designed around paternal needs. Therefore, despite the policy change nearly 50 years ago to include both parents, fathers were still not fully accepted and supported.
To provide fathers in Sweden with greater support throughout the child health field, organisational changes should be considered, as this could provide further beneficial outcomes for children, families and society.
Health counseling is an essential part of health promotion and there is a need for new, family-oriented health counseling methods. The objective of this study was to describe the differences in physical activity conversations from the perspective of family-oriented care between child health visits using the Weighty Matter Toolkit and those using normal protocol. In total, 35 health visits were analyzed. The results indicate that the Weighty Matter Toolkit offers the child, and other family members, a better opportunity to participate to conversations, and the focus of the conversation is more diverse and based on the family's perception regarding physical activity compared to the normal protocol. Thus, the Weighty Matter Toolkit is a promising method for family-oriented health counseling.
In light of the growing emphasis on individualization in healthcare, it is vital to take the diversity of inhabitants and users into consideration. Thus, identifying shared perceptions among group members may be important in improving healthcare that is relevant to the particular group, but also perceptions of the staff with whom interactions take place. This study investigates how motherhood is perceived among three groups: Somali-born mothers; Swedish-born mothers; and nurses at Swedish child health centers. Inequities in terms of access and satisfaction have previously been identified at the health centers.
Participants in all three groups were asked to finalize two statements about motherhood; one statement about perfect motherhood, another about everyday motherhood. The responses were analyzed using qualitative coding and categorization to identify differences and similarities among the three groups.
The responses to both statements by the three groups included divergences as well as convergences. Overall, biological aspects of motherhood were absent, and respondents focused almost exclusively on social matters. Working life was embedded in motherhood, but only for the Somali-born mothers. The three groups put emphasis on different aspects of motherhood: Somali-born mothers on the community; the Swedish-born mothers on the child; and the nurses on the mother herself. The nurses - and to some extent the Swedish-born mothers - expected the mother to ask for help with the children when needed. However, the Somali-born mothers responded that the mother should be independent, not asking for such help. Nurses, more than both groups of mothers, largely described everyday motherhood in positively charged words or phrases.
The findings of this paper suggest that convergences and divergences in perceptions of motherhood among three groups may be important in equitable access and utilization of healthcare. Individualized healthcare requires nuance and should avoid normative or stereotypical encounters by recognizing social context and needs that are relevant to specific groups of the population.
To investigate current nutrition counselling practices, knowledge of nutrition and the need for nutrition education by nurses in mother and child health clinics.
Nutrition counselling of young families offers a tangible means to implement preventive measures for lifestyle-related chronic diseases. Nurses in health clinics are at prime position to execute this preventive work, which demands knowledge of current nutrition research as well as skill in counselling. Knowledge is limited regarding the current nutrition counselling practices of nurses and their needs in improving counselling.
Descriptive questionnaire survey.
A questionnaire was formulated and sent to nurses in mother and child health clinics (n=650) nationwide via e-mail links using a computerised program. Non-respondents were re-contacted twice, the final response rate being 50% (n=327).
Nurses considered nutrition counselling an important but challenging task in the clinics. In addition to promotion of health, they had counselled clients in the management of various disorders ranging from constipation to coeliac disease. Variability was noted in the extent to which nurses had adopted nutrition guidelines. As means to improve counselling, better collaboration with both families and healthcare professionals and an increase in resources, including time available for counselling, up-to-date educational material and clinical guidelines, as well as increased education in nutrition were suggested.
The results demonstrated a need and a readiness amongst nurses to develop nutrition counselling in health clinics. Given the health benefits presumably deriving from nutrition counselling, investments in operational counselling, comprising advancement of both knowledge and skills in the health clinics, are clearly warranted. RELEVANCE TO CLINICAL PRACTICES: The findings provide important insights into the current clinical practice in health clinics and can be exploited in designing nutrition counselling and in-service training.