| 1. |
- Nayeb, Laleh
(författare)
-
Lika men ändå olika : Språkscreening av enspråkiga och flerspråkiga barn vid 2,5-3 år på BVC
- 2022
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Children who do not develop their language as expected are at risk of difficulties in school and with peer relations. The Swedish Child Health Services (CHS) offer preventive health surveillance, including language screening, at 2.5-3 years. However, the screening has only been validated for monolingual children. The aims of the thesis were to explore CHS nurses’ experiences of language screening of bilingual children, to evaluate the 3-year screening for language disorder for use at 2.5 years, and to assess the stability of the children’s diagnoses and the classification accuracy of the screening after 6 months. In Study I, 863 nurses answered a web-based survey. Half of the nurses simplified the screening processes for bilingual children, and 74% postponed referrals to speech and language services. About 80% believed that language development was slower in bilingual children which was the strongest predictor of simplified screening practices. In Studies II and III, 105 monolingual and 111 bilingual children were screened and clinically assessed at age 2.5. The screening classification accuracy for monolinguals vs bilinguals screened in both their languages was: sensitivity 91% vs 88%, specificity 91% vs 82%, PPV 56% vs 67%, and NPV 99% vs 94%, respectively. Study IV reassessed 141 children (48 mono- and 93 bilinguals) at age 3, i.e. all children with a positive outcome at age 2.5 from studies II and III, and matched children from the same studies with negative outcomes. The number of new cases with language disorder (n=4) was about the same as the number who had recovered (n=5) at age 3. These few changes were statistically significant, but not considered to be of clinical relevance since the classification accuracy of the screening was still within 95 CI after 6 months. The screening classification accuracy for monolinguals vs bilinguals was: sensitivity 71% vs 81%, specificity 93% vs 82%, PPV 39% vs 67%, and NPV 98% vs 90%. In conclusion, the modified language screening can be recommended for use at age 2.5. Bilingual children who don’t pass the screening in Swedish, should be screened in their mother tongue using a standard procedure. The wait-and-see strategy reported by the nurses in Study I was not supported as screening results remained stable between 2.5 and 3 years. There is a need to implement new evidence-based routines in child health services to equitably screen both monolingual and bilingual children for language disorder.
|
|
| 2. |
- Mangrio, Elisabeth
(författare)
-
Epidemiological studies of sociodemographic factors, early life factors, health, and medical care consumption among small children
- 2011
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- By international standards, children in Sweden experience good health. Sweden has low infant mortality rates, low accident mortality rates, a high number of breastfed children and a high proportion of vaccinated children. However, during the past twenty years the prevalence of overweight children has doubled in Sweden, while that of obese children has increased 4-5 times. Furthermore, there has been an increase in self-reported problems such as anxiety and sleeping disturbances among adolescents. Asthma and other types of allergic diseases are the most common chronic diseases during childhood, while infectious diseases are the most common causes of short-term morbidity. It is well-known that the social position of the family, living conditions, and parental health-related behaviors are closely connected with health in childhood. The socioeconomic position (SEP) of the family affects the child’s health from the very beginning of life through the mother’s health-related behaviors during pregnancy. Even though the prevailing etiological model for adult chronic disease emphasizes adult risk factors, the importance of earlier life circumstances has recently attracted considerable attention. A life course perspective seems to increase our understanding of health in childhood as well as later on, in adulthood. In this thesis, the associations between sociodemographic factors and early life factors (e.g., maternal smoking during pregnancy, exposure to secondhand tobacco smoke, breastfeeding, and high birth weight) on the one hand and health and medical care consumption on the other hand, were investigated among small children in Malmö. The studies in the thesis were population-based and cross-sectional, and the study populations comprised children who visited the Child health care (CHC) centers for their 8-month or 4-year check-up during 2003-2008 and whose parents answered a self-administered questionnaire. The self-administered questionnaire was handed out to the parents of 8-month-old and 4-year-old children in conjunction with their check-up at the CHC centers aiming to reach all children in Malmö in these two age groups. The questionnaire was distributed by the pediatric nurses at the centers. The results showed that antibiotic consumption at an early age was influenced by several factors including parental sociodemographic factors, lifestyle factors, psychosocial support, as well as child-related factors. The results further showed associations between exposure to unfavorable early life factors and the development of childhood allergy and overweight or obesity. Such effects were enhanced when there were presence of parental allergy or parental overweight, respectively. Children with less educated mothers were exposed to more health risks, fewer health promoting factors, worse social support and had a higher medical care consumption than children with mothers with higher levels of education.In conclusion, the results show that children’s health seems to be highly influenced by the characteristics of the families into which they are born. The results also put focus on the importance of early targeted interventions.
|
|
