Recent-onset atrial fibrillation: a study exploring the elements of Virchow's triad after cardioversion.

PURPOSE: Atrial fibrillation (AF) imposes an inherent risk for stroke and silent cerebral emboli, partly related to left atrial (LA) remodeling and activation of inflammatory and coagulation systems. The aim was to explore the effects of cardioversion (CV) and short-lasting AF on left atrial hemodynamics, inflammatory, coagulative and cardiac biomarkers, and the association between LA functional recovery and the presence of a prior history of AF. METHODS: Patients referred for CV within 48 h after AF onset were prospectively included. Echocardiography and blood sampling were performed immediately prior, 1-3 h after, and at 7-10 days after CV. The presence of chronic white matter hyperintensities (WMH) on magnetic resonance imaging was related to biomarker levels. RESULTS: Forty-three patients (84% males), aged 55±9.6 years, with median CHA2DS2-VASc score 1 (IQR 0-1) were included. The LA emptying fraction (LAEF), LA peak longitudinal strain during reservoir, conduit, and contractile phases improved significantly after CV. Only LAEF normalized within 10 days. Interleukin-6, high-sensitivity cardiac-troponin-T (hs-cTNT), N-terminal-pro-brain-natriuretic peptide, prothrombin-fragment 1+2 (PTf1+2), and fibrinogen decreased significantly after CV. There was a trend towards higher C-reactive protein, hs-cTNT, and PTf1+2 levels in patients with WMH (n=21) compared to those without (n=22). At 7-10 days, the LAEF was significantly lower in patients with a prior history of AF versus those without. CONCLUSION: Although LA stunning resolved within 10 days, LAEF remained significantly lower in patients with a prior history of AF versus those without. Inflammatory and coagulative biomarkers were higher before CV, but subsided after 7-10 days, which altogether might suggest an enhanced thrombogenicity, even in these low-risk patients.

Should the PBL tutor be present? A cross-sectional study of group effectiveness in synchronous and asynchronous settings.

BACKGROUND: The tutorial group and its dynamics are a cornerstone of problem-based learning (PBL). The tutor's support varies according to the setting, and it is pertinent to explore group effectiveness in relation to different settings, for example online or campus-based. The PBL groups' effectiveness can partly be assessed in terms of cognitive and motivational aspects, using a self-report tool to measure PBL group effectiveness, the Tutorial Group Effectiveness Instrument (TGEI). This study's aim was to explore tutor participation in variations of online and campus-based tutorial groups in relation to group effectiveness. A secondary aim was to validate a tool for assessing tutorial group effectiveness in a Swedish context. METHODS: A cross-sectional study was conducted with advanced-level nursing students studying to become specialised nurses or midwives at a Swedish university. The TGEI was used to measure motivational and cognitive aspects in addition to overall group effectiveness. The instrument's items were translated into Swedish and refined with an expert group and students. The responses were calculated descriptively and compared between groups using the Mann-Whitney U and Kruskal-Wallis tests. A psychometric evaluation was performed using the Mokken scale analysis. The subscale scores were compared between three different tutor settings: the tutor present face-to-face in the room, the tutor present online and the consultant tutor not present in the room and giving support asynchronously. RESULTS: All the invited students (n = 221) participated in the study. There were no differences in motivational or cognitive aspects between students with or without prior PBL experience, nor between men and women. Higher scores were identified on cognitive aspects (22.6, 24.6 and 21.3; p < 0.001), motivational aspects (26.3, 27 and 24.5; p = 002) and group effectiveness (4.1, 4.3, 3.8, p = 0.02) for the two synchronously tutored groups compared to the asynchronously tutored group. The TGEI subscales showed adequate homogeneity. CONCLUSIONS: The tutor's presence is productive for PBL group effectiveness. However, the tutor need not be in the actual room but can provide support in online settings as long as the tutoring is synchronous.

Serial Magnetic Resonance Imaging after Electrical Cardioversion of Recent Onset Atrial Fibrillation in Anticoagulant-Naïve Patients - A Prospective Study Exploring Clinically Silent Cerebral Lesions.

BACKGROUND: Patients with atrial fibrillation (AF) have a high incidence of cognitive impairment, which may be related to clinically silent microembolism causing cerebral infarctions. OBJECTIVE: To explore the occurrence and timing of silent brain lesions following electrical cardioversion (CV) of recent onset AF in anticoagulant-naïve patients and to study related effects on cognitive function and biomarkers of cerebral damage, S100b. METHODS: Patients with AF duration > 48 hours were prospectively included. Brain magnetic resonance imaging (MRI) and S100b, were obtained prior, after and 7-10 days following CV. Trail making tests (TMT-A and TMT-B) and their difference, ΔΤΜΤ, were assessed prior to CV, 7-10 days and 30 days after CV. RESULTS: Forty-three patients (84% males) with median CHA2DS2-VASc score 1 (interquartile range 0-1) were included. Sequential MRI, including diffusion weighted scans, showed no new brain lesions after CV. Chronic white matter hyperintensities were present at baseline in 21/43 (49%) patients. The S100b (µg/l) levels increased significantly from baseline, (mean ±SD) 0.0472±0.0182 to 0.0551±0.0185 after CV, p=0.001 and then decreased 7-10 days after CV to 0.0450±0.0186, p <.;0.001. Consecutive TMT scores improved successively after CV, being statistically and clinically significant for TMT-B (p<0.01) and ΔΤΜΤ (p=0.005) between 7-10 days and 30 days after CV (Reliable Change Index >1.96). CONCLUSIONS: New brain lesions could not be detected on MRI after CV, but the high incidence of white matter hyperintensities and the transient increase in S100b may indicate transient or minor brain damage undetectable by MRI thus heightening the need to reevaluate thromboembolic risk prior to CV even in low risk patients.

Mass balance study of brominated flame retardants in female captive peregrine falcons.

Little is known about brominated flame retardant (BFR) dynamics in birds, especially large molecules such as decabromodiphenyl ether (BDE-209). In particular, bioaccumulation from food and transfer dynamics to eggs are poorly understood. Therefore, an input-output mass balance study of tri-decaBDEs, DBDPE and HBCDD was performed in three female peregrine falcons from a captive breeding program by analyzing their naturally contaminated food (quail, chicken (cockerels)), plasma, feces and eggs. Predominant BFRs in cockerels and quail were BDE-209 and DBDPE, as well as HBCDD in quail. The predominant BFRs found in falcon plasma were BDE-209, -153 and -183, in eggs, HBCDD, BDE-209 and -153 and in feces, BDE-209. Mean absorption efficiencies (AE) for the tetra-octabrominated BDEs ranged from 84-100% and 70% for HBCDD. The AEs for BDE-206, -207, -208 and -209 varied due to the large variability seen for feces fluxes. All egg/plasma ratios for BDEs were similar and greater than one (range 1.1-2.7), including for BDE-209, indicating efficient transfer from females to the eggs. Excretion via egg-laying was approximately 6.0-29% of the initial, pre-breeding body burden of individual penta-decaBDE congeners, (15-45% for BDE-206). HBCDD was not detected in plasma but was found in eggs, also indicating efficient transfer and excretion via eggs. Input fluxes from food exceeded the output fluxes (feces, eggs) indicating considerable metabolism for tetra-octaBDEs, possibly also for the nona-decaBDEs and HBCDD. Bioaccumulation factors calculated from lipid weight concentrations in plasma and food (BAFp) were highest for BDE-208 (31), -153 (23), -209 (19) and -207 (16) and from eggs and food (BAFe), were highest for HBCDD (140), BDE-153 (41), -208 (42), BDE-207 (24) and BDE-209 (21). BAFe and BAFp values were below 10 for BDE-47, -99 and -100. For one falcon, egg results were available from three different years and estimated half-lives were 65 d (BDE-99), 624 d (BDE-153), 31 d (BDE-154), 349 d (BDE-183), 77 d (BDE-196) and 89 d (BDE-197).

Two tales of cardiovascular risks-middle-aged women living in Sweden and Scotland: a cross-sectional comparative study.

OBJECTIVES: To compare cardiovascular risk factors as well as rates of cardiovascular diseases in middle-aged women from urban areas in Scotland and Sweden. DESIGN: Comparative cross-sectional study. SETTING: Data from the general population in urban areas of Scotland and the general population in two major Swedish cities in southeast Sweden, south of Stockholm. PARTICIPANTS: Comparable data of middle-aged women (40-65 years) from the Scottish Health Survey (n=6250) and the Swedish QWIN study (n=741) were merged together into a new dataset (n=6991 participants). MAIN OUTCOME MEASURE: We compared middle-aged women in urban areas in Sweden and Scotland regarding risk factors for cardiovascular disease (CVD), CVD diagnosis, anthropometrics, psychological distress and lifestyle. RESULTS: In almost all measurements, there were significant differences between the countries, favouring the Swedish women. Scottish women demonstrated a higher frequency of alcohol consumption, smoking, obesity, low vegetable consumption, a sedentary lifestyle and also more psychological distress. For doctor-diagnosed coronary heart disease, there were also significant differences, with a higher prevalence among the Scottish women. CONCLUSIONS: This is one of the first studies that clearly shows that Scottish middle-aged women are particularly affected by a worse profile of CVD risks. The profound differences in CVD risk and outcome frequency in the two populations are likely to have arisen from differences in the two groups of women's social, cultural, political and economic environments.

Is one month treatment with dabigatran before cardioversion of atrial fibrillation sufficient to prevent thromboembolism?

AIMS: The use of direct oral anticoagulants (DOACs) in patients undergoing elective direct current (DC) cardioversion of non-acute atrial fibrillation (AF) can potentially shorten the time from initiation of anticoagulation treatment to cardioversion, compared with warfarin. The safety of this strategy needs to be investigated. Data from subgroup analysis from clinical trials with DOAC do not clarify whether 4-week treatment with DOAC is sufficient to prevent thromboembolism (TE) after cardioversion. The aim of this retrospective study was to assess the incidence of TE in anticoagulant naive patients converted after one month's pre-treatment with dabigatran. METHODS AND RESULTS: We scrutinized the medical records of 631 patients where dabigatran had been used prior to elective DC cardioversion. Transoesophageal echocardiography was rarely performed. Thromboembolism within 30 days of cardioversion was the primary endpoint. A total of 570 patients were naive to OAC when dabigatran was initiated. The mean age in this group was 64.2 ± 11 years and 31.7% were women. The mean CHA2DS2-VASc score was 2.0 ± 1.5. The dose of dabigatran was 150 mg b.i.d. in 94% of the patients. The median time from initiation of dabigatran to cardioversion was 32.0 ± 15 days. In 91% cardioversion resulted in sinus rhythm. During the 30-day follow-up, three TE occurred for an incidence of 0.53% (0.18-1.54). CONCLUSION: In this retrospective study from clinical material, we found a low incidence of TE when dabigatran was used as TE prophylaxis in association with elective cardioversion. These results indicate that dabigatran is a safe alternative strategy to warfarin during cardioversion in patients with AF.

Parents' experiences of participating in an intervention on tobacco prevention in Child Health Care.

BACKGROUND: Child health care is an important arena for tobacco prevention in Sweden. The aim of this study was to describe parents' experiences from participating in a nursebased tobacco prevention intervention. METHODS: Eleven parents were interviewed using semi-structured interviews. The material was analysed in a qualitative content analysis process. RESULTS: The analysis emerged four categories; Receiving support, Respectful treatment, Influence on smoking habits and Receiving information. The parents described how the CHC nurses treated them with support and respect. They described the importance of being treated with respect for their autonomy in their decisions about smoking. They also claimed that they had received little or no information about health consequences for children exposed to environmental tobacco smoke (ETS). The findings also indicate that both the questionnaire used and the urine-cotinine test had influenced parents' smoking. CONCLUSION: The clinical implication is that CHC is an important arena for preventive work aiming to minimize children's tobacco smoke exposure. CHC nurses can play an important role in tobacco prevention but should be more explicit in their communication with parents about tobacco issues. The SiCET was referred to as an eye-opener and can be useful in the MI dialogues nurses perform in order to support parents in their efforts to protect their children from ETS.

How to minimize children's environmental tobacco smoke exposure: an intervention in a clinical setting in high risk areas.

BACKGROUND: Despite the low prevalence of daily smokers in Sweden, children are still being exposed to environmental tobacco smoke (ETS), primarily by their smoking parents. A prospective intervention study using methods from Quality Improvement was performed in Child Health Care (CHC). The aim was to provide nurses with new methods for motivating and supporting parents in their efforts to protect children from ETS exposure. METHOD: Collaborative learning was used to implement and test an intervention bundle. Twenty-two CHC nurses recruited 86 families with small children which had at least one smoking parent. Using a bundle of interventions, nurses met and had dialogues with the parents over a one-year period. A detailed questionnaire on cigarette consumption and smoking policies in the home was answered by the parents at the beginning and at the end of the intervention, when children also took urine tests to determine cotinine levels. RESULTS: Seventy-two families completed the study. Ten parents (11%) quit smoking. Thirty-two families (44%) decreased their cigarette consumption. Forty-five families (63%) were outdoor smokers at follow up. The proportion of children with urinary cotinine values of >6 ng/ml had decreased. CONCLUSION: The intensified tobacco prevention in CHC improved smoking parents' ability to protect their children from ETS exposure.

Nurse-based antenatal and child health care in rural India, implementation and effects - an Indian-Swedish collaboration.

INTRODUCTION: Improving maternal and child health care are two of the Millennium Development Goals of the World Health Organization. India is one of the countries worldwide most burdened by maternal and child deaths. The aim of the study was to describe how families participate in nurse-based antenatal and child health care, and the effect of this in relation to referrals to specialist care, institutional deliveries and mortality. METHODS: The intervention took place in a remote rural area in India and was influenced by Swedish nurse-based health care. A baseline survey was performed before the intervention commenced. The intervention included education program for staff members with a model called Training of Trainers and the establishment of clinics as both primary health centers and mobile clinics. Health records and manuals, and informational and educational materials were produced and the clinics were equipped with easily handled instruments. The study period was between 2006 and 2009. Data were collected from antenatal care and child healthcare records. The Chi-square test was used to analyze mortality differences between years. A focus group discussion and a content analysis were performed. RESULTS: Families' participation increased which led to more check-ups of pregnant women and small children. Antenatal visits before 16 weeks among pregnant women increased from 32 to 62% during the period. Women having at least three check-ups during pregnancy increased from 30 to 60%. Maternal mortality decreased from 478 to 121 per 100 000 live births. The total numbers of children examined in the project increased from approximately 6000 to 18 500 children. Infant mortality decreased from 80 to 43 per 1000 live births. Women and children referred to specialist care increased considerably and institutional deliveries increased from 47 to 74%. CONCLUSION: These results suggest that it is possible in a rural and remote area to influence peoples' awareness of the value of preventive health care. The results also indicate that this might decrease maternal and child mortality. The education led to a more patient-friendly encounter between health professionals and patients.

Health-related quality of life in children and adolescents with celiac disease: from the perspectives of children and parents.

Aim. To examine how celiac children and adolescents on gluten-free diet valued their health-related quality of life, and if age and severity of the disease at onset affected the children's self-valuation later in life. We also assessed the parents' valuation of their child's quality of life. Methods. The DISABKIDS Chronic generic measure, short versions for both children and parents, was used on 160 families with celiac disease. A paediatric gastroenterologist classified manifestations of the disease at onset retrospectively. Results. Age or sex did not influence the outcome. Children diagnosed before the age of five scored higher than children diagnosed later. Children diagnosed more than eight years ago scored higher than more recently diagnosed children, and children who had the classical symptoms of the disease at onset scored higher than those who had atypical symptoms or were asymptomatic. The parents valuated their children's quality of life as lower than the children did. Conclusion. Health-related quality of life in treated celiac children and adolescents was influenced by age at diagnosis, disease severity at onset, and years on gluten-free diet. The disagreement between child-parent valuations highlights the importance of letting the children themselves be heard about their perceived quality of life.

Factors associated with nutritional risk in 75-year-old community living people.

AIM: To identify risk factors for being at nutritional risk, by means of a nutritional screening, in a population based sample of 75-year-old people living in three county councils in Sweden. BACKGROUND: Undernutrition in older people is known to contribute to poor health. The instrument 'Nutritional Form For the Elderly' (NUFFE) helps to identify those at nutritional risk. METHOD: The screening instrument 'Nutritional Form For the Elderly', background variables and health related questions were mail distributed. A total of 1461 persons (75 years old) were included in the study. Descriptive statistical methods were used in the analyses. RESULTS: One percent of the participants had high risk, 21.3% medium and 77.7% low risk for undernutrition. Medium or high risk was predicted by: living alone, receiving help and impaired perceived health. Low Body Mass Index was associated with low risk for undernutrition. CONCLUSION: By using a simple nutritional screening instrument, significant risk factors were highlighted. Relevance to practice. This instrument can identify older people at nutritional risk and is easy to use. Older people living alone have an increased risk of undernutrition. Body Mass Index (BMI) should be used with caution as one and only indicator of nutritional risk in older people.

"Smoking in Children's Environment Test": a qualitative study of experiences of a new instrument applied in preventive work in child health care.

BACKGROUND: Despite knowledge of the adverse health effects of passive smoking, children are still being exposed. Children's nurses play an important role in tobacco preventive work through dialogue with parents aimed at identifying how children can be protected from environmental tobacco smoke (ETS) exposure. The study describes the experiences of Child Health Care (CHC) nurses when using the validated instrument SiCET (Smoking in Children's Environment Test) in dialogue with parents. METHOD: In an intervention in CHC centres in south-eastern Sweden nurses were invited to use the SiCET. Eighteen nurses participated in focus group interviews. Transcripts were reviewed and their contents were coded into categories by three investigators using the method described for focus groups interviews. RESULTS: The SiCET was used in dialogue with parents in tobacco preventive work and resulted in focused discussions on smoking and support for behavioural changes among parents. The instrument had both strengths and limitations. The nurses experienced that the SiCET facilitated dialogue with parents and gave a comprehensive view of the child's ETS exposure. This gave nurses the possibility of taking on a supportive role by offering parents long-term help in protecting their child from ETS exposure and in considering smoking cessation. CONCLUSION: Our findings indicate that the SiCET supports nurses in their dialogue with parents on children's ETS exposure at CHC. There is a need for more clinical use and evaluation of the SiCET to determine its usefulness in clinical practice under varying circumstances.

Experiences of community health nurses regarding father participation in child health care.

Traditionally child health care (CHC) has been an arena where mothers and nurses meet, but in recent years fathers are entering CHC with increasing frequency. The aim of this study was to describe nurses' experiences of fathers' participation in CHC. Nine Swedish nurses working in CHC were interviewed and asked to give a description of their experiences from meetings with fathers in CHC. Phenomenology according to Giorgi was used for the analysis and the essence of the findings was that father participation was seen from the perspective of mother participation and was constantly compared to mother participation in CHC. The essence is explicated in the following themes: participation through activities; equal participation although diverse; influence of structures in society; and strengthening participation. Clinical implications include the need for creating a separate identity in CHC for fathers and more communication directed at fathers.

Temporal trends of polybrominated diphenyl ethers and hexabromocyclododecane in Swedish Peregrine Falcon (Falco peregrinus peregrinus) eggs.

A temporal trend study of brominated flame retardants in eggs from peregrine falcon (Falco peregrinus peregrinus), a terrestrial bird of prey, is presented. Eggs collected between 1974 and 2007 were analyzed for the major constituents of the Penta-, Octa- and Decabromodiphenyl ether technical products (BDE-47, -99, -100, -153, -183 and -209), and hexabromocyclododecane (HBCD). Concentrations of BDE-99, -100, -153, -183, -209 and HBCD increased from 1974 to 2000. After the early 2000s, BDE-99, -100, -153 and -183 concentrations decreased, whereas BDE-209 and HBCD concentrations continued to increase. No temporal trend was detected for BDE-47. Rates of increase also differed, with BDE-99 and -100 increasing 3-fold between the 1980s and mid-1990s, and BDE-153 and -183 increasing approximately 10-fold during the same period. The average yearly increase was 15% and 11% for BDE-209 and HBCD, respectively, based on log-linear regression trends. There is a change in BDE congener patterns over time, with a shift from the predominance of BDE-99 and -47 until the late 1980s, to BDE-153 becoming the predominant congener later on. BFR temporal trends in Swedish peregrine falcon eggs reflect European BFR usage patterns.

Cardiovascular disease occurrence in two close but different social environments.

BACKGROUND: Cardiovascular diseases estimate to be the leading cause of death and loss of disability-adjusted life years globally. Conventional risk factors for cardiovascular diseases only partly account for the social gradient. The purpose of this study was to compare the occurrence of the most frequent cardiovascular diseases and cardiovascular mortality in two close cities, the Twin cities. METHODS: We focused on the total population in two neighbour and equally sized cities with a population of around 135 000 inhabitants each. These twin cities represent two different social environments in the same Swedish county. According to their social history they could be labelled a "blue-collar" and a "white-collar" city. Morbidity data for the two cities was derived from an administrative health care register based on medical records assigned by the physicians at both hospitals and primary care. The morbidity data presented are cumulative incidence rates and the data on mortality for ischemic heart diseases is based on official Swedish statistics. RESULTS: The cumulative incidence of different cardiovascular diagnoses for younger and also elderly men and women revealed significantly differences for studied cardiovascular diagnoses. The occurrence rates were in all aspects highest in the population of the "blue-collar" twin city for both sexes. CONCLUSIONS: This study revealed that there are significant differences in risk for cardiovascular morbidity and mortality between the populations in the studied different social environments. These differences seem to be profound and stable over time and thereby give implication for public health policy to initiate a community intervention program in the "blue-collar" twin city.

Perceptions of Malawian nurses about nursing interventions for malnourished children and their parents.

In developing countries, malnutrition among children is a major public-health issue. The aim of the study was to describe perceptions of Malawian nurses about nursing interventions for malnourished children and their parents. A qualitative method was used. Data were collected and analyzed according to the phenomenographic research approach. Twelve interviews were performed with 12 nurses at a rural hospital in northern Malawi, Southeast Africa. Through the analysis, two major concepts, comprising four categories of description, emerged: managing malnutrition today and promotion of a favourable nutritional status. The categories of description involved identification and treatment of malnutrition, education during treatment, education during prevention, and assurance of food security. The participating nurses perceived education to be the most important intervention, incorporated in all areas of prevention and treatment of malnutrition. Identification and treatment of malnutrition, education during treatment, education to prevent malnutrition, and assurance of food security were regarded as the most important areas of intervention.

Parents' attitudes to smoking and passive smoking and their experience of the tobacco preventive work in child health care.

The purpose of this study was to describe parents' attitudes to smoking and their experience of the tobacco preventive work in antenatal care and in Child Health Care (CHC) in Sweden. A population based survey in which 62 percent of 3000 randomly selected parents with 1- and 3-year-old children answered a questionnaire. Fifty-six percent stated that smoking was registered in the health record of the child yet no further discussion regarding passive smoking took place. The parents' educational level and smoking status was related to the attitudes and experiences of the tobacco preventive work. The results indicated that the dialogue with parents regarding children and environmental tobacco smoke (ETS) exposure has to be redesigned and intensified in order to meet the needs of parents with different backgrounds.

Temporal trends of perfluorinated surfactants in Swedish peregrine falcon eggs (Falco peregrinus), 1974-2007.

Perfluorinated alkyl substances (PFAS) are today known to be globally distributed environmental contaminants. In the present study, concentrations of PFAS were analyzed in Swedish peregrine falcon eggs (Falco peregrinus), collected between 1974 and 2007. Analytes included in the study were perfluorinated carboxylates (PFCAs; carbon chain lengths C6-C15), perfluorinated sulfonates (PFSAs; C4, C6, C8, and C10), and perfluorooctane sulfonamide (PFOSA). The predominant PFAS was perfluorooctane sulfonate, PFOS (83 ng/g wet weight (w wt) mean concentration in samples from 2006), followed by perfluorotridecanoate, PFTriA (7.2 ng/g w wt) and perfluoroundecanoate, PFUnA (4.2 ng/g w wt). PFCA concentrations increased exponentially over the studied time. In contrast, concentrations of PFOS and perfluorohexane sulfonate (PFHxS) increased initially but leveled off after the mid 1980s. This is different from previously observed temporal trends in marine organisms. The present study is the first to establish temporal trends for PFAS in terrestrial biota. The results indicate potential differences between marine and terrestrial biota regarding sources of PFAS exposure and response to emission changes. The toxicological implications of PFAS exposure for the falcons are not known, but according to recent findings impaired hatching success and sublethal toxicological effects from PFOS exposure in the Swedish peregrine falcon cannot be ruled out.

Child health nurses' roles and attitudes in reducing children's tobacco smoke exposure.

AIM: To investigate and analyse the attitudes to tobacco prevention among child healthcare nurses, to study how tobacco preventive work is carried out at child healthcare centres today. To evaluate how the tobacco preventive work had changed in child health care since the Swedish National Board of Health and Welfare's national evaluation in 1997. BACKGROUND: Exposure to environmental tobacco smoke has adverse health effects. Interventions aiming at minimising environmental tobacco smoke have been developed and implemented at child healthcare centres in Sweden but the long-term effects of the interventions have not been studied. DESIGN: Survey. METHODS: In 2004, a postal questionnaire was sent to all nurses (n = 196) working at 92 child healthcare centres in two counties in south-eastern Sweden. The questionnaire was based on questions used by the National Board of Health and Welfare in their national evaluation in 1997 and individual semi-structured interviews performed for this study. RESULTS: Almost all the nurses considered it very important to ask parents about their smoking habits (median 9.5, range 5.1-10.0). Collaboration with antenatal care had decreased since 1997. Nearly all the nurses mentioned difficulties in reaching fathers (70%), groups such as immigrant families (87%) and socially vulnerable families (94%) with the tobacco preventive programme. No nurses reported having special strategies to reach these groups. CONCLUSIONS: Improvement of methods for tobacco prevention at child healthcare centres is called for, especially for vulnerable groups in society. However, the positive attitude among nurses found in this study forms a promising basis for successful interventions. RELEVANCE TO CLINICAL PRACTICE: This study shows that launching national programmes for tobacco prevention is not sufficient to achieve sustainable work. Nurses working in child healthcare centres have an overall positive attitude to tobacco prevention but need continuous education and training in communication skills especially to reach social vulnerable groups. Regular feedback from systematic follow-ups might increase motivation for this work.

Polybrominated diphenyl ether congener patterns, hexabromocyclododecane, and brominated biphenyl 153 in eggs of peregrine falcons (Falco peregrinus) breeding in Sweden.

Previous analyses of 52 peregrine falcon (Falco peregrinus) eggs collected from two wild and one captive population in Sweden 1987 through 1999 were complemented by including additional polybrominated diphenyl ether (PBDE) congeners (BDE-35, -183, -184, -185, -196, -197, -203, and -207). In addition, 31 eggs not previously analyzed for hexabromocyclododecane (HBCD) and BDE-209 were analyzed for these. Geometric mean concentrations of BPBDEs, HBCD, and the hexabrominated biphenyl (BB-153) were 3,100, 140, and 81 ng/g of lipid weight for the southern population; 2,500, 110, and 84 ng/g of lipid weight for the northern population; and 47, not detected, and 8 ng/g of lipid weight for the captive population. The BDE congener pattern was dominated by BDE-153, -99, and -100. The results were used to investigate whether a difference in PBDE congener pattern could be distinguished between the two wild populations of peregrine falcons due to different diets, as the southern population preys mainly on birds belonging to the terrestrial food chain while the northern population preys more on aquatic birds. A multivariate t-test showed a subtle but significant (p < 0.001) difference in PBDE congener pattern between the two populations. However, our hypothesis that higher-brominated congeners of PBDEs would be present to a greater extent in the terrestrial food chain was not supported by principal component analysis. The average brood size for individual females from the southern population decreased with increasing concentrations of IPBDE in the eggs (log-linear regression p < 0.01).