Vibeke Koushede

The effect of antenatal education in small classes on obstetric and psycho-social outcomes: a systematic review

BackgroundThe aims of antenatal education are broad and encompass outcomes related to pregnancy, birth, and parenthood. Both form and content of antenatal education have changed over time without evidence of effects on relevant outcomes. The effect of antenatal education in groups, with participation of a small number of participants, may differ from the effect of other forms of antenatal education due to, for example, group dynamic. The objective of this systematic review is to assess the effects of antenatal education in small groups on obstetric as well as psycho-social outcomes.MethodsBibliographic databases (Medline, EMBASE, CENTRAL, CINAHL, Web of Science, and PsycINFO) were searched. We included randomized and quasi-randomized trials irrespective of language, publication year, publication type, and publication status. Only trials carried out in the Western world were considered in this review. Studies were assessed for bias using the Cochrane risk of bias tool. Results are presented as structured summaries of the included trials and as forest plots.ResultsWe identified 5,708 records. Of these, 17 studies met inclusion criteria. Studies varied greatly in content of the experimental and control condition. All outcomes were only reported in a single or a few trials, leading to limited or uncertain confidence in effect estimates. Given the heterogeneity in interventions and outcomes and also the high risk of bias of studies, we are unable to draw definitive conclusions as to the impact of small group antenatal education on obstetric and psycho-social outcomes.ConclusionsInsufficient evidence exists as to whether antenatal education in small classes is effective in regard to obstetric and psycho-social outcomes. We recommend updating this review following the emergence of well-conducted randomized controlled trials with a low risk of bias.Systematic review registrationPROSPERO CRD42013004319

Promotion of Social and Emotional Competence: Experiences from a Mental Health Intervention Applying a Whole School Approach.

Purpose – Within the framework of Health Promoting Schools Up is an intervention using a whole school approach aimed at promoting mental health by strengthening social and emotional competence among schoolchildren. Social and emotional competence is an integral part of many school-based mental health interventions but only a minority of interventions measure changes in competences. The purpose of this paper is to present the intervention Up and document changes in social and emotional competence among schoolchildren before and after the intervention. Design/methodology/approach –Up consists of four components: education and activities for schoolchildren; development of staff skills; involvement of parents; and initiatives in everyday life at school. Up was implemented in two Danish schools in 2010-2011. Social and emotional competence was measured among 11-15-year old schoolchildren before (response rate 96.2 per cent, n=589) and after (response rate 83.9 per cent, n=532) the intervention. Findings – Chan...

From rhetoric to action: Adapting the Act-Belong-Commit Mental Health Promotion Programme to a Danish context

In response to recent calls for implementing mental health promotion (MHP) in Denmark, the Danish National Institute of Public Health undertook a perusal of existing MHP frameworks. While a small number of such frameworks exist, the Act-Belong-Commit campaign that originated in Western Australia, was the only comprehensive, population-wide program identified that had a strong evidence base, demonstrated success in implementation and universal principles of well-being. Following a successful funding application to the Ministry of Health, the National Institute for Public Health, is leading a partnership to implement the Act-Belong-Commit campaign in Denmark in 2015–2017. This article describes the Act-Belong-Commit campaign and its implementation in Australia and how the National Institute of Public Health plans to introduce the campaign into Denmark. It is hoped that our planning for Denmark will be helpful to other countries planning to adopt the Act-Belong-Commit campaign.

The effect of antenatal education in small classes on obstetric and psycho-social outcomes: a systematic review and meta-analysis protocol

BackgroundThe aims of antenatal education contain both outcomes related to pregnancy, birth and parenthood. Both content and methods of antenatal education have changed over time without evidence of effects on relevant outcomes. The effect of antenatal education in groups, with participation of a small number of participants, may differ from the effect of other forms of antenatal education. The latest Cochrane review, assessed as up-to-date in 2007, concluded that the effect of antenatal education for childbirth or parenthood or both remains largely unknown. This systematic review and meta-analysis aims to assess the effects of antenatal education in small groups on obstetric as well as psycho-social outcomes.Methods/designEligible studies include individually randomized as well as cluster-randomized trials irrespective of language, publication year, publication type, and publication status. Only interventions carried out in the Western world will be considered in this review. We will search the databases Medline, EMBASE, CENTRAL, CINAHL, Web of Science, and PsycINFO using relevant search terms. Two independent review authors will extract data and assess risk of bias. Results will be presented as structured summaries of the included trials. A meta-analysis will be conducted. We will assess heterogeneity by using both the Chi-squared test and the I-squared statistic, and conduct subgroup analysis separately for various intervention types.DiscussionIn healthcare systems with limited resources evidence of the effectiveness of services provided is important for decision making, and there is a need for policy makers to implement changes in healthcare systems based on scientific evidence. The effectiveness of antenatal education in small classes is still questioned. Therefore an up-to-date systematic review is needed.This systematic review protocol was registered within the International Prospective Register of Systematic Reviews (PROSPERO) as number CRD42013004319.

Socioeconomic differences in emotional symptoms among adolescents in the Nordic countries: Recommendations on how to present inequality

Aims: This comparative study examines absolute and relative socioeconomic differences in emotional symptoms among adolescents using standardised data from five Nordic countries and gives recommendations on how to present socioeconomic inequality. Methods: The Health Behaviour in School-aged Children (HBSC) international cross-sectional study from 2005/2006 provided data on 29,642 11–15-year-old adolescents from nationally random samples in Denmark, Finland, Iceland, Norway and Sweden. The outcome was daily emotional symptoms. Family Affluence Scale (FAS) was used as indicator of socioeconomic position. We applied four summary measures of inequality: Prevalence Difference, Odds Ratio, Slope Index of Inequality and Relative Index of Inequality, and presented the socioeconomic inequality by a graphical illustration of the prevalence of emotional symptoms, the size of the FAS groups and the summary indices of inequality in each country. Results: The prevalence of emotional symptoms ranged from 8.1% in Denmark to 13.2% in Iceland. There were large country variations in the size of the low FAS-group ranging from 2% in Iceland to 12% in Finland. The largest absolute and relative socioeconomic inequalities were found in Iceland and the smallest in Finland for girls and in Denmark for boys. Conclusions: Emotional symptoms were more common among Nordic adolescents from low affluence families. This association appeared in the study of both absolute and relative inequality. A comprehensive presentation of socioeconomic inequality should include the prevalence of the health outcome, the size of the socioeconomic groups, and the regression line representing the summary indices of inequality.

Group-based antenatal birth and parent preparation for improving birth outcomes and parenting resources: Study protocol for a randomised trial

OBJECTIVES To examine the efficacy and cost-effectiveness of group based antenatal education for improving childbirth and parenting resources compared to auditorium based education. METHODS PARTICIPANTS 2350 Danish pregnant women and their partners ≥18 years old, recruited before 20+0 gestational weeks. Population-based individually randomised superiority trial with two parallel arms: Four sessions of birth and parent preparation in small groups (experimental group); two lectures in an auditorium (control group). Data is collected by (1) questionnaires at baseline (≈18 weeks of gestation), 37 weeks of gestation, 9 weeks-, 6 months-, and 1 year post-partum, (2) the hospital obstetric database, (3) national registers. PRIMARY OUTCOME use of epidural analgesia. SECONDARY OUTCOMES stress, parenting alliance; explorative outcomes: depressive symptoms, use of health care services, self-efficacy, well-being, family break-ups. Analyses will be intention-to-treat as well as per protocol. Process evaluation will be conducted using questionnaires and qualitative interviews. The incremental societal cost of the intervention will be computed and compared to the measured outcomes in a cost-effectiveness analysis. CONCLUSION To the best of our knowledge this is the largest well-designed randomised trial of its kind to date. The trial will bring much-needed evidence for decision makers of the content and form of antenatal education.

Emotional symptoms among adolescents: epidemiological analysis of individual-, classroom- and school-level factors

BACKGROUND Large proportions of schoolchildren suffer from emotional symptoms and there are large variations across schools. It is unknown to what degree this variation is due to composition of schoolchildren in each school or to contextual factors. Objectives are to identify factors at individual, classroom and school levels associated with emotional symptoms. METHOD Data stem from the Danish contribution to the international Health Behaviour in School-aged Children study 2010 including 4922 schoolchildren aged 11-15-years from a random sample of schools and including data from school leaders. Emotional symptoms are defined as daily presence of at least one of four symptoms: feeling low, irritable or bad tempered, nervous and having difficulties falling asleep. Multilevel multivariable logistic regression analyses are applied to identify and quantify factors at individual, classroom and school level. RESULTS Schoolchildren from low (odds ratio (OR) 1.70, 95% CI: 1.33-2.17) and medium (OR 1.50, 95% CI: 1.22-1.85) occupational social class (OSC), girls (OR 1.32, 95% CI: 1.13-1.56) and schoolchildren exposed to bullying (OR 3.82, 95% CI: 2.71-5.40), had increased odds for emotional symptoms. A negative classroom climate was associated with emotional symptoms (OR 1.29, 95% CI: 0.99-1.69) and so was being part of classrooms with a high prevalence of bullying (OR 1.28, 95% CI: 1.0-1.60). CONCLUSION Female sex, low OSC, single parent family, exposure to bullying and a high prevalence of bullying within a class are all associated with emotional symptoms. Most variation across schools is explained by individual-level factors but psychosocial aspects of the classroom environment also play a role.

Loneliness, immigration background and self-identified ethnicity: a nationally representative study of adolescents in Denmark

ABSTRACT Migration is an increasing worldwide phenomenon that creates multicultural societies with a growing number of adolescents who have experienced a process of migration or who have an ethnic background other than that of the majority. Migration may lead to loss of social relations and create challenges related to acculturation in the new country. These experiences may induce feelings of loneliness. Research on ethnic and migrant disparities in loneliness among adolescents is limited and inconsistent. The purpose of this study was to examine how adolescents’ immigration background and self-identified ethnicity are associated, independently and combined, with loneliness. We used data from the Danish 2010 Health Behaviour in School-aged Children survey which included a representative sample of 3083 13- and 15-year-olds. The results suggest that immigrants but not descendants of immigrants have an increased risk of loneliness compared to adolescents with a Danish origin. The results also suggest that adolescents’ self-identified ethnicity plays an essential role but differently for immigrants and descendants: identifying with the Danish majority was protective against loneliness among immigrants, whereas identifying with an ethnic minority group was protective against loneliness among descendants.

The protective properties of Act-Belong-Commit indicators against incident depression, anxiety, and cognitive impairment among older Irish adults: Findings from a prospective community-based study

ABSTRACT The Act‐Belong‐Commit campaign is the worlds first comprehensive, population‐wide, community‐based program designed to promote mental health. The campaign targets individuals to engage in mentally healthy activities, while at the same time, encouraging community organizations that offer such activities, to increase participation in their activities. Using nationally‐representative data from Ireland, the aim of this study was to prospectively assess the association between indicators of the Act‐Belong‐Commit behavioral domains and incident depression, anxiety, and cognitive impairment. Data from two consecutive waves of the Irish Longitudinal Study on Ageing (TILDA) were analyzed. The analytical sample consisted of 6098 adults aged ≥ 50 years. Validated scales for depression, anxiety, and cognitive impairment were used. The number of social/recreational activities engaged in was used as an indicator of Act, social network integration as an indicator of Belong, and frequency of participation in these social/recreational activities as an indicator of Commit. Multivariable logistic regression analyses were conducted to assess associations between baseline indicators of Act‐Belong‐Commit and incident depression, anxiety, and cognitive impairment at two‐year follow‐up. The adjusted model showed that each increase in the number of social/recreational activities (Act) inversely predicted the onset of depression, anxiety, and cognitive impairment. The same was the case for social network integration (Belong); that is, being well integrated into social networks was a significant protective factor against all mental health outcomes. Finally, frequency of participation in social/recreational activities (Commit) significantly and inversely predicted the onset of depression and anxiety, while the protective effect against cognitive impairment was only marginally significant. Act‐Belong‐Commit indicators are shown to be protective against mental disorders and cognitive impairment among older Irish adults. This provides further evidence for the campaigns potential efficacy and has potentially wide‐ranging implications for preventing the deterioration of mental health and cognitive decline in the aging community. HighlightsThe predictive validity of Act‐belong‐Commit indicators was assessed.Outcomes were incident depression, anxiety and cognitive impairment at 2‐year follow‐up.A large nationally‐representative sample of older Irish adults was used.More activities and better social network integration protected against all outcomesThe Act‐Belong‐Commit campaign holds potential for promoting public mental health.

Antenatal education in small classes may increase childbirth self-efficacy: Results from a Danish randomised trial

Antenatal education in small classes may increase childbirth self-efficacy. In this randomised trial we assessed the effect of a structured antenatal programme versus auditorium-based lectures on childbirth self-efficacy measured by three single items. We found that women in the intervention group reported statistically significant higher levels of confidence in their ability to cope at home during labour compared to the control group. Likewise, the intervention had a positive effect on the womens confidence in own ability to handle the birth process.