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1.
  • Bröms, Kristina, 1954- (författare)
  • A Nationwide Study of Asthma and Allergy in Swedish Preschool Children : with Special Reference to Environment, Daycare, Prevalence, Co-ocurrence and Incidence
  • 2010
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Aim: The aim of this project was to study the age and sex specific occurrence of atopic and non-atopic asthma and other atopic manifestations in a nationwide sample of Swedish pre-school children. Methods: All 70 allergen avoidance day-care centres (AADC) with 84 sections and 140 matched ordinary day-care centres with 440 sections in 62 municipalities across Sweden were sampled. In 2000 the staff at each section responded to a questionnaire on indoor and outdoor environment at the section. In 2002 parents of 5,886 children attending the AADCs and ODCs responded to a postal questionnaire regarding symptoms indicating prevalent asthma, allergic rhinitis, eczema, and food, furred pet and pollen allergy and other data in their children. In 2007, parents of 4255 children responded to an almost identical follow-up questionnaire. Results: The AADCs had far more strict rules than ODCs on furred pets and smoking at home and on perfume use, and the indoor environment was better, owing to better cleaning. The age specific asthma prevalence was curvilinear with a peak at age 3 of 11.4% among boys and 9.8% among girls. In addition the prevalence increased by municipality population density, a proxy for degree of urbanisation. There was a highly significant co-occurrence between all asthma-atopic manifestations, but there was no evidence of ordered sequence of manifestation onset. The asthma incidence was highly dependent on presence or absence of co-occurrence variables. Given the variable mix in the present study population, the annual asthma incidence ranged from 0.6% to 1.2%. Conclusions: AADCs had more strict rules and a better indoor environment than ODCs. The asthma prevalence was affected by age, sex and degree of urbanisation. There was close co-occurrence between all asthma and atopic manifestations but no evidence of ordered sequence of onsets. The annual asthma incidence was strongly dependent of co-occurrence conditions.
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  • Bröms, Kristina, et al. (författare)
  • A nationwide study of asthma incidence rate and its determinants in Swedish pre-school children
  • 2012
  • Ingår i: European Journal of Epidemiology. - : Springer Science and Business Media LLC. - 0393-2990 .- 1573-7284. ; 27:9, s. 695-703
  • Tidskriftsartikel (refereegranskat)abstract
    • While many studies on asthma prevalence have been published, the number of studies on asthma incidence in pre-school children is limited. In this project, a nationwide sample of pre-school children was followed with the aim of estimating cumulative 5-year asthma incidence and its determinants. Parents of 5,886 children 1-6 years of age, sampled from day-care centres in 62 municipalities all over Sweden, responded in 2002 to a baseline postal questionnaire with questions regarding symptoms indicating possible asthma or atopic conditions, and a number of other variables. In 2007, parents of 4,255 children responded to an almost identical follow-up questionnaire. Of these, the 3,715 children who were free from asthma at baseline constitute the study population for this report. A large number of potential baseline determinants for cumulative 5-year asthma incidence were identified. Of these, food allergy, rhinitis, incomplete asthma diagnosis criteria (wheezing last 12 months, and ever had asthma but no current symptoms), parental rhinitis, parental asthma, age, and eczema, in ranking order of importance, remained significant in multivariate logistic regression analysis. The asthma incidence rate was highly dependent on presence or absence of these variables, the average annual rate ranging from 2/1,000/year in 6-year-olds with no determinants to154/1,000/year in 1-year-olds with all determinants, corresponding to 11/1,000/year based on the whole study population.
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  • Bröms, Kristina, et al. (författare)
  • A nationwide study of indoor and outdoor environments in allergen avoidance and conventional daycare centers in Sweden
  • 2006
  • Ingår i: Indoor Air. - : Hindawi Limited. - 0905-6947 .- 1600-0668. ; 16:3, s. 227-35
  • Tidskriftsartikel (refereegranskat)abstract
    • Sweden has had specialized 'allergen avoidance daycare centers' (AADC) since 1979. The aim was to compare AADC with ordinary daycare centers (ODC). Through contacts with municipalities and hospitals, 72 AADC were identified. For each AADC, the two nearest ODCs served as controls. A questionnaire was sent to the local directors of the 216 daycare centers (531 sections), 83% responded. A total of 39% of the ODCs had ever had dampness/molds, 12% were near (<500 m) stables/farms, 23% were closer than 50 m to a heavy trafficked road, and 13% were exposed to wood smoke in winter. Only 11% of the AADCs had any child with furred pets at home, while 97% of the ODCs had children with furred pets. Bans on smoking at home and on perfumes were more common at the AADCs (P = 0.001). Fewer AADCs had PVC floors (OR = 0.53; P = 0.01), dampness/molds (OR = 0.55; P = 0.04), shelves (OR 3.03; P = 0.001), curtains (OR = 1.67; P = 0.047), and flowers (OR = 0.03; P < 0.001), while more had daily floor cleaning (OR = 19.9; P = 0.004), weekly wiping of furniture (OR = 11.0; P = 0.001), and washing of pillows/mattresses (OR = 2.74; P = 0.005) and curtains (OR = 9.07; P = 0.001). In conclusion, allergy avoidance daycare centers differ from other daycare centers, and may have better indoor environments. PRACTICAL IMPLICATIONS: There is a need to improve the indoor environments of daycare centers, including reduction of building dampness and molds. Allergen avoidance daycare centers (AADC) in Sweden differ from ordinary daycare centers in many respects, with fewer indoor and building factors related to dust, allergens and irritants. This shows that the indoor environments of daycare centers can be improved. Data suggest that AADC may have lower levels of pet allergens, and this is beneficial for children with pet allergy. The effects of these improvements on indoor exposures and health of the children need to be further evaluated.
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  • Bröms, Kristina, 1954-, et al. (författare)
  • Effect of degree of urbanisation on age and sex-specific asthmaprevalence in Swedish preschool children
  • 2009
  • Ingår i: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 9, s. 303-
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: There are few studies on age and sex-specific asthma   prevalence in the age range 1-6 years. The purpose of this report was   to estimate age and sex specific asthma prevalence in preschool   children and to analyse the influence of possible demographic and   geographic determinants.   Methods: All 70 allergen avoidance day-care centres and 140 matched   ordinary day-care centres across Sweden were sampled. The parents of   all 8,757 children attending these day-care centres received the   International Study of Asthma and Allergies in Childhood (ISAAC)   written questionnaire, supplemented with questions on medical   treatment, physician assessed asthma diagnosis, and other asthma   related questions. The response rate was 68%.   Results: The age specific asthma prevalence, adjusted for the   underlying municipality population size, was among boys 9.7% at age 1,   11.1% at age 2, 11.4 at age 3, 10.5 at age 4, 8.7 at age 5, and 6.4 at   age 6. The corresponding proportions among girls were 8.9%, 9.9%, 9.8%,   8.8%, 7.0%, and 5.0%, on average 9.6% for boys and 8.2% for girls,   altogether 8.9%. In addition to age and sex the prevalence increased by   municipality population density, a proxy for degree of urbanisation.   Moreover, there was a remaining weak geographical gradient with   increasing prevalence towards the north and the west.   Conclusion: The age-specific asthma prevalence was curvilinear with a   peak around age 3 and somewhat higher for boys than for girls. The   asthma prevalence increased in a slowly accelerating pace by   municipality population density as a proxy for degree of urbanisation.
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5.
  • Bröms, Kristina, 1954-, et al. (författare)
  • Prevalence and co-occurrence of asthma and allergic manifestations in preschool children
  • Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
    • Background: It has been claimed that preschool children may embark on ‘the atopic march’, which means that atopic manifestations show up one after another in a certain order. The aim of this study was to make an in-depth analysis of the co-occurrence of asthma and atopic manifestations. Methods: Parents of 5886 children 1-6 years of age, sampled from day-care centres in 62 municipalities all over Sweden, responded to a postal questionnaire regarding symptoms indicating prevalent asthma, allergic rhinitis, eczema, food allergy, furred pet and pollen allergy and other data in their children. Age specific prevalence of asthma, rhinitis, eczema, and food allergy was computed, adjusted for municipality population size. Results: The overall prevalence of asthma was 8.9%, of eczema 21.7%, of rhinitis 8.1%, and of food allergy 6.6%. There was a highly significant co-occurrence between all asthma-atopic manifestations. Presence of pet allergy was the manifestation showing the closest co-occurrence with presence of asthma, presence of pollen allergy with presence of rhinitis, and presence of food allergy with presence of eczema. Assessed from plots of age specific prevalence of asthma, rhinitis, eczema and food allergy the prevalence of all manifestations increased from one to three years of age and then decreased, except for rhinitis where the prevalence increased until six years of age. There was no evidence of a rank order of asthma and allergy manifestation onset. Conclusions: There was close co-occurrence between all asthma-atopic manifestations but no evidence of a rank order of onsets.
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6.
  • Bröms, Kristina, et al. (författare)
  • Prevalence and co-occurrence of parentally reported possible asthma and allergic manifestations in pre-school children
  • 2013
  • Ingår i: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 13, s. 764-
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The aim of this study was to make an in-depth analysis of the prevalence and co-occurrence in pre-school children of possible asthma and atopic manifestations. Methods: In Sweden 74%-84% of preschool children, depending on age, attend municipality organised day-care centres. Parents of 5,886 children 1-6 years of age, sampled from day-care centres in 62 municipalities all over Sweden, responded to a postal questionnaire regarding symptoms indicating prevalent possible asthma, allergic rhinitis, eczema, and food, furred pet and pollen allergy and other data in their children. Possible asthma was defined as any of the four criteria wheezing four times or more during the last year, physician diagnosis and current wheezing, ever had asthma and current wheezing, and current use of inhalation steroids, all based on questionnaire responses. Results: The overall prevalence of possible asthma was 8.9%, of eczema 21.7%, of rhinitis 8.1%, and of food allergy 6.6%. There was a highly significant co-occurrence between possible asthma and all atopic manifestations, 35.7% having any of the manifestations. Presence of pet allergy was the manifestation showing the closest co-occurrence with presence of possible asthma, presence of pollen allergy with presence of rhinitis, and presence of food allergy with presence of eczema. Assessed from plots of age-specific prevalence of possible asthma, rhinitis, eczema and food allergy, the prevalence of all manifestations increased from one to three years of age and then decreased, except for rhinitis where the prevalence increased until six years of age, indicating no specific ordered sequence. Conclusions: Parentally reported possible asthma, eczema and food allergy had a curvilinear prevalence course across age with a maximum at age 3, while rhinitis prevalence increased consistently with age. Co-occurrence between possible asthma and atopic manifestations was common, and some combinations were more common than others, but there was no evidence of a specific ordered onset sequence.
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11.
  • Frid, Christina, et al. (författare)
  • Maternal and neonatal factors and mortality in children with Down syndrome born in 1973-1980 and 1995-1998
  • 2004
  • Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 93:1, s. 106-112
  • Tidskriftsartikel (refereegranskat)abstract
    • AIMS:To investigate maternal and neonatal factors in Down syndrome (DS) at birth, the impact of a congenital heart defect (CHD) on these factors and changes over time.METHODS:Medical data of children with DS born in northern Sweden in the periods 1973-1980 (n = 219) and 1995-1998 (n = 88) obtained from the Swedish Medical Birth Register were compared. A comparison with the general population on a group level was also made.RESULTS:The main finding was a reduction in infant mortality in DS, from 14.2% to 2.3% in 1995-1998 (p < 0.001), but this was still significantly higher than in the general population. The rate of Caesarean sections increased over time (from 14.5% to 27.3%, p < 0.05) even after adjustment for increased maternal age. No change over time was detected in the following rates: premature birth (gestational age < or = 36) (25%); asphyxia (5-min Apgar score < or = 6) (8%); low birthweight (< 2500 g) (14%); or small for gestational age (SGA) (14%); all rates were significantly higher than those of the general population. A CHD did not seem to influence the rates of these factors in a logistic regression model.CONCLUSION:Infant mortality decreased substantially over time in the DS group, whereas there was no reduction in the rate of asphyxia, SGA, low birthweight or prematurity. The presence of a CHD did not influence any of the neonatal factors studied.
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14.
  • Holmberg, Kirsten, 1952-, et al. (författare)
  • Routine developmental screening at 5.5 and 7 years of age is not an efficient predictor of attention-deficit / hyperactivity disorder at age 10
  • 2010
  • Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 99:1, s. 112-120
  • Tidskriftsartikel (refereegranskat)abstract
    • AIM: The aim of this study was to assess the efficiency of developmental screening for deficits in attention, motor control and perception or attention-deficit/hyperactivity disorder (DAMP/ADHD) at 5.5 and 7 years of age for diagnosing ADHD in grade 4. METHOD: The study population consisted of 442 children from a cohort study of ADHD in 10-year olds in one municipality in Stockholm County. Sensitivity, specificity and positive predictive value of a developmental screening at 5.5 and at 7 years of age for being diagnosed with ADHD at 10 years of age was calculated. RESULTS: The sensitivity was 44%, the specificity 85% and the positive predictive value for having a diagnosis of pervasive ADHD in 4th grade was 15%, when at least two deviations in nine items was used as the cut-off point in 5.5-year screening at Child Health Centres (CHCs). With a cut-off score of at least two deviations in four items rated by parents or and teachers in 1st grade, these estimates were 58%, 81% and 15% respectively. CONCLUSION: This study demonstrates that developmental screening for DAMP/ADHD at 5.5 and 7 years of age does not identify children who are diagnosed with ADHD in grade 4 with a high degree of selectivity.
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15.
  • Holmberg, Kirsten, 1952-, et al. (författare)
  • Screening for attention-deficit/hyperactivity disorder (ADHD) : can high-risk children be identified in first grade?
  • 2013
  • Ingår i: Child Care Health and Development. - : Wiley. - 0305-1862 .- 1365-2214. ; 39:2, s. 268-276
  • Tidskriftsartikel (refereegranskat)abstract
    • Aim Recent studies have demonstrated the beneficial long-term effects of an indicated parent support programme for acting out behaviour in pre-school children with attention-deficit/hyperactivity disorder (ADHD) traits. In this study we wanted to assess different thresholds for screening with the Conners scale for hyperactive-inattentive behaviours in first grade for ADHD in grade four.Method The study population consisted of 422 first graders (6- to 7-year-olds) in one municipality in Stockholm County who were screened with Conners 10-item scale and followed up by ADHD assessment in grade four. Sensitivity, specificity, likelihood ratios, and positive predictive value (PPV) of the screening by parents and teachers in first grade for being diagnosed with ADHD in fourth grade were calculated.Results  The prevalence of pervasive and situational ADHD was 5.7% and 5.9% respectively. A score ≥10 on the Conners scale in first grade in teachers' reports identified 63% [95% confidence interval (CI): 43-79] of children diagnosed with pervasive ADHD in grade four (P < 0.001) with a PPV of 29% and a positive likelihood ratio (LR+) of 6.72. Parental reports of a score ≥10 yielded a lower sensitivity (29%; 95% CI: 15-49), PPV of 20% and LR+ of 4.24 for pervasive ADHD. The best predictor was a combination of parent and teacher scores ≥10 with a PPV of 50% and LR+ of 16.63. Associations with situational ADHD were weak with LR+ of 1.81 and 2.49, respectively, for teachers' and parental scores ≥10.Conclusions This study indicates a strong association between a teacher's report of a score ≥10 on the Conners scale in first grade and pervasive ADHD in grade four, while parental reports were less predictive.
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16.
  • Holmberg, Lars I, 1944- (författare)
  • Health, Risk-Taking Behavior and Sexuality in Swedish Adolescents
  • 2007
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • The overall aims of this research were to develop methods of identifying adolescents with unhealthy and/or risk-taking behavior with special reference to sexuality, and to evaluate support measures for young people in need of such interventions. A further aim was to assess strategies for preventing unhealthy and/or risk-taking behavior. Data were obtained by questionnaires (studies I, III, IV and V) and interviews (study II).The results showed that young men involved in unintended pregnancies would benefit from active participation in the decision making regarding continuation or termination of the pregnancy, and from support at Outpatient Clinics for Adolescents in Sweden, including information together with the partner (I).It was also concluded that consideration should be paid to questions and problems, e.g. feelings, apprehensions, moral issues and psychosocial factors, that require individual support from personnel with knowledge and resources to help young men in this difficult situation (II).Among the most important findings regarding young men who had been involved in an unplanned pregnancy were that in this group a high percentage had previously considered suicide and that anabolic steroids were frequently used, compared with young men without experience of pregnancy (III).The finding that unprotected intercourse occurred in a fairly high frequency among 13- to 18-year-olds, despite massive education and easy access to contraceptives, gives reason for further considerations regarding appropriate ways of providing information to young people (IV).Girls and boys in vocational programs in Swedish high schools exhibit more risk-taking behaviors than those in theoretical programs and these two groups differ in clustering and accumulation of these behaviors. This means that preventive interventional strategies need to be elaborated with regard to these differences, with the aim of improving health maintenance among adolescents (V).Child-and-youth centers with a developmental and research capacity need to be established with the broad purpose of drawing up health prevention programs for children and young people.
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  • Holmbäck, Ulf, et al. (författare)
  • Overweight more prevalent among children than among adolescents
  • 2007
  • Ingår i: Acta Paediatrica. - : John Wiley & Sons. - 0803-5253 .- 1651-2227. ; 96:4, s. 577-581
  • Tidskriftsartikel (refereegranskat)abstract
    • Aims To study if there is a change in paediatric overweight/obesity prevalence from 1982 to 2002 in a population with a high proportion of post-graduate education. Design Two samples of children in Uppsala County, Sweden, were compared: children who were 4, 10 and 16 year old in 1982; or 4, 10 and 16 year old in 2002. Mean BMI (in the lowest 10%, middle 50% and highest 10%) and ISO-BMI ('age adjusted BMI') cut-off values were calculated in each age and gender group. Results Using the mean BMI or ISO-BMI cut-off values, the BMI-distribution shifted from 1982 to 2002. More 4- and 10-year-old girls and boys were overweight/obese, although this shift was larger in girls. No shift was seen in the 16-year-olds, only the middle 50% group in the 16-year-old girls had a slight increase of their mean BMI. In the 2002 4-year-old, and both 10-year-old samples, a higher proportion of the girls were overweight/obese compared to the boys, but no difference was seen in the 16-year-old sample. Conclusion Young children, especially girls, have become much more overweight/obese during the past 20 years, despite a high proportion of post-graduate education in the population. The lack of major change in 16-year-olds may suggest a rather recent change in the children's environment/lifestyle.
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18.
  • Khalifa, Najah, 1960- (författare)
  • Tourette Syndrome and Tic Disorders in a Swedish School Population : Prevalence, Clinical Assessment, Background, Psychopathology, and Cognitive Function
  • 2006
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • A total population of 4,479 children (7-15 years of age) attended school in Ludvika & Smedjebacken in 2000. All the school children and their parents were asked to fill in a questionnaire concerning different tics A three-stage procedure was used: tic identification, interview, and clinical assessment.Tourette syndrome, according to DSM IV criteria was found in 25 (0.6%) of the children, another 34 (0.8%) suffered from chronic motor tics (CMT), 24 (0.4%) from chronic vocal tics (CVT) and 214 (4.8%) children had had transient tics (TT) during the last year. Altogether 297 (6.6%) children had or had had some tic disorder.Twenty-five controls without tics and 25 children with TT of the same age, sex and school as the TS children were randomly chosen. They were together with the 34 children with CMT and the 24 children with CVT examined with use of a broad battery of instruments.The mean age of the first symptoms of TS was significantly lower than the onset of chronic motor/vocal tics. A younger age of onset of TS indicated more severe tics. Eighty per cent had a first-degree relative with a psychiatric disorder such as tic disorder, obsessive-compulsive behaviour, attentiondeficit/hyperactivity disorder (ADHD), or depression. A non-significant increase with regard to reduced optimality score in the pre-, peri-, or neonatal periods was found in children with TS compared to controls. No differences were found concerning socio-economic status. Psychiatric comorbid disorders were found in 92% of the children with TS. ADHD was most common. Patterns of psychiatric comorbidity were similar in children with TS and CVT. Children with TS perform poorer than the population in general with respect to cognitive functioning and self-perception.The results are discussed as they relate to the need for case identification, diagnosis, intervention, and treatment.
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  • Kristjánsdóttir, Jóna, et al. (författare)
  • Could SF-36 be used as a screening instrument for depression in a Swedish youth population?
  • 2011
  • Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 25:2, s. 262-268
  • Tidskriftsartikel (refereegranskat)abstract
    •  Objective: Depression among youth is a condition associated with serious long-term morbidity and suicide. The aim of this study was to investigate whether a HRQoL instrument, the short form 36 version 1.0 (SF-36), could be used to screen for depression in a clinical Youth Centre (YC). A second purpose was to describe self-reported health and depression. Setting: A clinical YC at a University hospital. Design: A sample of 660 youths, 14-20 years old was assessed with SF-36 and Montgomery Asberg Depression Rating Scale, self-screening version (MADRS-S). Answers to all the questions in both instruments were given by 79% (519/660; 453 women and 66 men). Mean age in the sample was 17.5 +/- 1.6 years. Results: Strong correlations were found between all the SF-36 subscales and the depression ratio scale MADRS-S. Receiver operating characteristic (ROC) curve analysis confirmed that the SF-36 subscales mental health (MH) and vitality (VT) could correctly predict depression on the individual level with Area Under the ROC Curve values 0.87 and 0.84 in ROC curves. Individuals scoring 48 or lower on MH and 40 or lower on VT should be followed up with a clinical interview concerning possible depressive disorder. Mild to moderate depression was common (35.5%), especially among women (37.5%). Men scored higher than women on all SF-36 subscales except for physical functioning. Conclusions: The SF-36 can be used to screen for suspect depression in a youth population followed by interview. This gives an opportunity to detect and treat emerging depressive symptoms early.
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  • Kristjánsdóttir, Jóna, et al. (författare)
  • Health-related quality of life in young women starting hormonal contraception : a pilot study
  • 2018
  • Ingår i: European journal of contraception & reproductive health care. - : TAYLOR & FRANCIS LTD. - 1362-5187 .- 1473-0782. ; 23:3, s. 171-178
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: Our purpose was to study whether there is a difference in self-rated health-related quality of life (HRQOL) and changes in HRQOL perception after 3 months of hormonal contraceptive use in adolescents. Seasonal variations in symptoms of depression were also studied. Methods: A test group (T1) (n=193) and a selected control group (n=238) of women aged 14-20 years who were visiting a young person's clinic completed the 36-item short-form health survey (SF-36) and answered additional questions on menstrual history and pattern, need for menstrual pain relief medication, and other regular medication. The test group was reassessed after 3 months of hormonal contraception (T2). Seasonal variations in reported SF-36 scores were studied for the whole group. Results: The selected control group and test group at T1 were similar with regard to age at menarche and menstrual pattern. The duration of bleeding and use of painkillers were significantly reduced and the impact on everyday life was significantly improved after 3 months of hormonal contraception (p=.000, two-tailed). No changes in HRQOL or symptoms of possible depression were found after 3 months of hormonal contraception. The highest prevalence odds ratio for possible depression (SF-36 mental health scale score <= 48), adjusted for group, season and age, for spring vs winter, was 2.15 (95% confidence interval 0.95, 4.85). Conclusions: After 3 months of hormonal contraception both the number of days of menstrual bleeding and the use of medication to relieve menstrual pain were reduced, but there were no significant changes in self-rated HRQOL perception. Seasonal effects on HRQOL were reported.
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21.
  • Kristjánsdóttir, Jóna, et al. (författare)
  • Health-related self-assessed quality of life in young people at a Youth Centre in Sweden
  • 2009
  • Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 23:3, s. 465-472
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: To study the self-reported health of young people visiting a Youth Centre (YC) at a University hospital, describe possible gender differences and to compare the results with those in previous Swedish reports on similar age groups using the same instrument. Design: All young people who visited a YC at a particular, randomly chosen time, were verbally asked to fill out a questionnaire, Short Form 36. The interviews were conducted during a 12-month period to lessen the impact of seasonal variations. Setting: A YC at the department for obstetrics and gynaecology, Uppsala University hospital. Participants: A total of 1495 young people aged 14-25 years who visited the YC. Results: The study population (n = 1495). Response rate was 96%. This population reported lower overall scores compared with the normative Swedish population from 1992. Further, females scored significantly lower than males on all subscales (p < 0.001), except for 'Physical Functioning'. The lowest scores were reported for the subscales Vitality, Role Emotional and Mental Health. Conclusion: This study describes physical functioning and mental health among young people visiting a YC. The results indicate a worsening of the perceived physical and MH in young individuals, especially in young women. Further studies are needed to monitor changes in MH and quality of life over time in this group and assess the effects of interventions. This study enhances the importance of a holistic approach towards health and health promotion comprising both physical and mental health issues.
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  • Kristjansdottir, Jona, et al. (författare)
  • Self-reported health in adolescent girls varies according to the season and its relation to medication and hormonal contraception : A descriptive study
  • 2013
  • Ingår i: European journal of contraception & reproductive health care. - : Informa UK Limited. - 1362-5187 .- 1473-0782. ; 18:5, s. 343-354
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives To study seasonal variations in self-rated health and depressive symptoms in adolescent girls and possible differences in reported health with regard to use of medications. Method The SF-36 questionnaire was completed by 1250 girls with a mean age of 17 years, who visited a health centre in the course of one year. From January to July inclusive, depressive symptoms in 453 of the participants were also assessed using MADRS-S. Age and regular medication data were recorded. Results Significantly better mental health and less depressive symptoms were reported during the summer, than in winter months. Seasonality was more related to the SF-36 mental, than physical health subscales. Respondents treated with hormonal contraceptives (HCs) only and those not taking any medication scored better on several SF-36 subscales, than girls on antidepressives and other medications. Respondents taking HCs tended to report better physical health and less depressive symptoms on MADRS-S than those taking no medication. Conclusions Adolescent girls showed seasonal variations in self-reported health and depressive symptoms, with more symptoms during winter months. HC users tended to report better physical health and less depressive symptoms than those on no medication. The high prevalence of suspected depression during the winter months deserves attention.
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  • Lagerberg, Dagmar, 1941-, et al. (författare)
  • Child health and maternal stress : does neighbourhood status matter?
  • 2011
  • Ingår i: International Journal of Adolescent Medicine and Health. - : Walter de Gruyter GmbH. - 0334-0139 .- 2191-0278. ; 23:1, s. 19-25
  • Tidskriftsartikel (refereegranskat)abstract
    • The purpose of this cross-sectional questionnaire study was to explore neighbourhood-level differences in health behaviour, maternal stress and sense of coherence, birth weight, child health and behaviour, and children's television watching habits. In total, 2006 pairs of Swedish mothers and children, aged approximately 20 months, from the general population participated in the study. A total of 1923 lived in neighbourhoods of average socioeconomic status in six counties, and 83 in a high-status neighbourhood in one of the counties. Data were collected in 2002-2003 and 2004-2005 through the Child Health Services. Socio-demographic confounders were adjusted for in multiple logistic regressions (maternal age, country of birth, education, marital status and parity). Compared with their counterparts in average neighbourhoods, mothers in the high-status neighbourhood were less frequently smokers and had been breastfeeding their children more. They felt less stress from social isolation and had a higher sense of coherence. All these differences except lower social isolation were non-significant after adjusting for socio-demographic characteristics. Privileged mothers felt more restricted by their parenting tasks (unadjusted comparison), and more privileged children were frequent television watchers. Child birth weight, health and behaviour were no better in the privileged than in average neighbourhoods. This paper adds to previous knowledge by showing that status-based geographic differences in important parenting and health parameters can be non-significant in an equitable society such as Sweden, where all families with young children have access to free high-quality health services. Individual characteristics could provide better explanations than neighbourhood status.
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25.
  • Lagerberg, Dagmar, 1941-, et al. (författare)
  • Child health services in transition : II. Mothers´ perceptions of 18-month-old children in the light of socio-economic status and some subjective factors
  • 2005
  • Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 94:3, s. 337-344
  • Tidskriftsartikel (refereegranskat)abstract
    • AIMS: To analyse mothers' self-assessed quality of interaction with their children and their opinions about child difficulty with respect to socio-economic status and subjective factors: postnatal depression, social isolation, sense of coherence and locus of control. METHODS AND MATERIAL: A comprehensive questionnaire was completed by 1039 mothers of 18-mo-old children participating in the baseline measurements of a Swedish multicentre study developing and testing a new psychosocial model for the child health services. RESULTS: All subjective factors, including the number of factors, showed significant associations with perceived interaction and difficultness. Effect sizes of subjective factors ranged from about 0.3 to 1 SD for interaction, and from about 0.2 to 0.8 SD for difficultness. As for difficultness, effect sizes were larger for boys. There were no associations between high socio-economic status and high-quality interaction or low child difficultness: the few significant differences in fact favoured low-status children. CONCLUSION: The results provided some contradictory findings to the well-known association between high socio-economic status and favourable outcome. This result is of practical relevance for interventions: supportive programmes cannot be limited to areas and families of low socio-economic status. Positive effects may ensue if subjective factors like those studied here can be promoted among parents and children through the child health services.
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26.
  • Lagerberg, Dagmar, 1941-, et al. (författare)
  • Drawing the line in the Edinburgh Postnatal Depression Scale (EPDS) : a vital decision
  • 2011
  • Ingår i: International Journal of Adolescent Medicine and Health. - : Walter de Gruyter GmbH. - 0334-0139 .- 2191-0278. ; 23:1, s. 27-32
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: The Edinburgh Postnatal Depression Scale (EPDS) is widely used in early child health care. This study examined the appropriateness of the recommended EPDS cut-off score 11/12. METHODS: Two main analyses were performed: 1. Associations between EPDS scores and maternal health behaviour, stress, life events, perceived mother-child interaction quality and child behaviour. 2. Screening parameters of the EPDS, i.e., sensitivity, specificity and positive predictive value. EPDS scores were available for 438 mothers and maternal questionnaires for 361 mothers. RESULTS: Already in the EPDS score intervals 6-8 and 9-11, there were notable adversities, according to maternal questionnaires, in stress, perceived quality of mother-child interaction, perceived child difficultness and child problem behaviours. Using maternal questionnaire reports about sadness/distress postpartum as standard, the recommended EPDS cut-off score 11/12 resulted in a very low sensitivity (24%). The cutoff score 6/7 yielded a sensitivity of 61%, a specificity of 82% and a positive predictive value of 61%. CONCLUSIONS: In terms of both clinical relevance and screening qualities, an EPDS cut-off score lower than 11/12 seems recommendable.
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27.
  • Lagerberg, Dagmar, et al. (författare)
  • Efternamn som markör för etnicitet : Studie inom barnhälsovården visar att invandrarfamiljer och svenska familjer tycks vara isolerade på olika sätt
  • 2005
  • Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 102:30, s. 2145-2148
  • Tidskriftsartikel (refereegranskat)abstract
    • A practical method was tested for identifying ethnicity through family names in the absence of precise demographic information. In a questionnaire study of children covered by the Swedish child health services in some different counties, all potential participants (the children's mothers) were classified as "Swedish" or "non-Swedish" using family names. Inter-rater reliability was assessed by comparing the scores of two independent raters (Cohen's kappa: 0.89). Cases in which the raters did not agree were settled through discussion. The method's validity was roughly measured by comparing assigned classifications against ethnicity information provided by the 63.8 percent of the mothers who returned the questionnaire (1039 of 1628). Assigned and self-reported classifications were the same in 86.5 percent of the cases. Information from child health services about mothers who had agreed to participate in the study revealed health-related differences between those who returned the questionnaires and those who did not. The family name classification method indicated an ethnic selectivity in drop-out rates, which was helpful in interpreting these health differences.
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28.
  • Lagerberg, Dagmar, 1941-, et al. (författare)
  • Hörnfeldt bortser från viktiga perspektiv
  • 2009
  • Ingår i: Tvärsnitt. - Stockholm : Vetenskapsrådet. - 0348-7997. ; :1, s. 22-23
  • Tidskriftsartikel (populärvet., debatt m.m.)
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29.
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30.
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31.
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32.
  • Magnusson, Margaretha, 1950-, et al. (författare)
  • How can we identify vulnerable mothers who do not reach the cut off 12 points in EPDS?
  • 2011
  • Ingår i: Journal of Child Health Care. - : SAGE Publications. - 1367-4935 .- 1741-2889. ; 15:1, s. 39-49
  • Tidskriftsartikel (refereegranskat)abstract
    • The aim was to investigate the correspondence between 352 mother's self-reports about postpartum distress in a questionnaire including an item about distress 18 months after birth and their earlier scores within, on average, 2.5 months of childbirth from a screening with the Edinburgh Postnatal Depression Scale (EPDS). Mothers who did not reach the EPDS score of 12 points, but reported that they had been sad/depressed after childbirth, were similar in socio-demographic variables to mothers with no outcomes in sadness/depression issues. In items related to negative parenting and perceptions of the child, they presented the same picture as those with high EPDS scores who also reported having been depressed. These results suggest that EPDS does not identify all vulnerable mothers. Complementary methods for detecting mothers at risk of stress and depression need to be developed.
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33.
  • Magnusson, Margaretha, 1950-, et al. (författare)
  • Organizational differences in early child health care : mothers' and nurses' experiences of the services
  • 2012
  • Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 26:1, s. 161-168
  • Tidskriftsartikel (refereegranskat)abstract
    • Aim: The aim of this study was to evaluate parents' and nurses' perceptions of the child health services (CHS) in relation to whether the nurse worked exclusively with children (focused-child health centre, CHC) vs. with people of all ages (mixed-CHC).Method:  Information about parents' perceptions about the CHS was acquired by a questionnaire intended for the mothers of 18-month-old children. One thousand thirty-nine answered in the baseline 2002-2003 and 996 in the follow-up 2004-2005. The nurses answered a special questionnaire aimed to obtain knowledge about their satisfaction with their work. Eighteen CHCs were chosen from the county of Uppsala and eighteen from other Swedish counties. The CHCs were chosen from areas with poor psycho-social status. The data were collected by questionnaires to mothers and nurses, and the analysis used the chi-square test, t-test and logistic regression. The study was approved by the Research Ethics Committees of the universities involved.Results: Mothers were more satisfied, and the nurses found their work tasks easier, at CHCs where the child health nurse worked exclusively with children, compared with mothers and nurses belonging to CHCs where the nurses provided care to people of all ages.Conclusion: The findings indicated that nurses working exclusively with children, being able to concentrate their time and knowledge on a specialized field, develop a more solid child health competence. There are strong reasons to consider introducing 'exclusive' CHCs in psycho-socially vulnerable areas, which would probably make the services more effective. However, intensified education may modify the drawbacks of mixed-CHCs.
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34.
  • Normann, Erik, 1966- (författare)
  • Chlamydia pneumoniae in Children - Epidemiology and Clinical Implications
  • 2003
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Chlamydia pneumoniae is a human respiratory tract pathogen. Seroepidemiological studies indicate that C. pneumoniae infection is most common in school-aged children and infrequently detected in younger children.The aims of this study were to further elucidate the prevalence of C. pneumoniae in paediatric populations and to describe the clinical implications of these infections.The study population consisted of 367 children with respiratory tract diseases, 453 presumed healthy children at day-care, 69 children undergoing adenoidectomy and 1585 children from a population based cohort. Family members to infected day-care children were investigated. The laboratory methods used were polymerase chain reaction (PCR) on specimen from upper respiratory tract, serology by microimmunofluorescence (MIF), and immunohistochemistry (IHC) on adenoid tissue specimen. Personal data and medical history were obtained by the means of questionnaires and by the study of patient records.In children younger than five years, the prevalence of C. pneumoniae was 17% as detected by PCR. This prevalence started to increase with increasing age from two years of age. The corresponding increase in serology as detected by MIF started at the age of four years. The prevalence at day-care centres varied from 4 to 39%. Both PCR and MIF underestimated the prevalence of C. pneumoniae detected by IHC. Families to infected children were investigated: mothers were more often infected than fathers were.Most C. pneumoniae infections in small children were confined to the upper respiratory tract. These infections were usually mild or asymptomatic. Symptomatic disease may be of prolonged nature. No subsequent illness after C. pneumoniae infection was detected at follow-up after four years. In general, no association between C. pneumoniae and asthma was found, but C. pneumoniae may be of importance for asthma in some susceptible individuals. Previous C. pneumoniae infection reduced the risk for later atopy.In conclusion, C. pneumoniae is a common finding in small children and most often causes relatively mild disease. If the acquisition of this infection early in life will have any implications for future health remains to be investigated.
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35.
  • Olsson, Erik, 1967-, et al. (författare)
  • The e-mental health treatment in Stockholm myocardial infarction with non-obstructive coronaries or Takotsubo syndrome study (E-SMINC) : a study protocol for a randomised controlled trial
  • 2022
  • Ingår i: Trials. - : Springer Science and Business Media LLC. - 1745-6215. ; 23:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: In the aftermath of a myocardial infarction with non-obstructive coronary arteries (MINOCA) or Takotsubo syndrome (TS), patients commonly express high levels of stress and anxiety. Current treatment alternatives rarely address these issues. Methods: The study is a randomised controlled trial, where 90 patients with a discharge diagnosis of MINOCA or TS who also report symptoms of stress or anxiety will be randomised 2–6 weeks after their cardiac event. The treatment consists of 10 weeks of Internet-based cognitive behaviour therapy (CBT) and starts immediately after randomisation for the treatment group. The control group receives usual care. Main outcomes are symptoms of anxiety measured with the Hospital Anxiety and Depression scale, anxiety subscale, and perceived stress measured with the Perceived Stress Scale, 14-item version, 10 weeks after randomisation. Secondary measures include cardiac specific anxiety, symptoms of post-traumatic stress, quality of life, cortisol measured in hair and physiological stress responses (heart rate variability, blood pressure and saliva cortisol) during a stress procedure. Ten weeks after randomisation, the control group will also receive treatment. Long-term follow-up in the self-report measures mentioned above will be conducted 20 and 50 weeks after randomisation where the total group’s development over time is followed, and the groups receiving intervention early versus late compared. Discussion: At present, there are no randomised studies evaluating psychological treatment for patients with MINOCA or TS. There is an urgent need for treatment alternatives aiming at relieving stress and anxiety considering the high mental stress and anxiety levels observed in MINOCA and TS, leading to decreased quality of life. CBT aiming at reducing mental stress has been shown to be effective regarding prognosis in patients with coronary artery disease. The current protocol describes a randomised open-label controlled trial evaluating an Internet-based CBT program for reduction of stress and anxiety in patients with increased mental stress and/or anxiety with a discharge diagnosis of either MINOCA or TS. Trial registration: ClinicalTrials.govNCT04178434. Registered on 26 November 2019. 
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36.
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37.
  • Pless, Mia, et al. (författare)
  • Effects of group motor skill intervention on five- to six-year-old children with developmental coordination disorder.
  • 2000
  • Ingår i: Pediatric Physical Therapy. - 0898-5669 .- 1538-005X. ; 12:4, s. 183-189
  • Tidskriftsartikel (refereegranskat)abstract
    • The purpose of this study was to determine whether group motor skill intervention is an effective form of treatment when added to consultative services in 5- to 6-year-old children with developmental coordination disorder (DCD). An experimental group of DCD children (n = 17) was compared with a DCD control group without intervention (n = 20). The intervention was conducted once a week for 10 weeks. No significant differences between the groups in either Movement ABC motor test or the Movement ABC checklist were found before or after this intervention. When subgroups with different categories of motor difficulties were compared, significantly more children with borderline motor difficulties in the experimental group than in the control group had changed (improved) their category after intervention. It is concluded that children with definite motor difficulties do not benefit from this type of intervention. Future research should include comparison of well-defined subgroups of children with DCD.
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38.
  • Rondung, Elisabet, 1980-, et al. (författare)
  • Reducing stress and anxiety in patients with myocardial infarction with non-obstructive coronary arteries or Takotsubo syndrome : A non-randomized feasibility study
  • 2022
  • Ingår i: Internet Interventions. - : Elsevier. - 2214-7829. ; 29
  • Tidskriftsartikel (refereegranskat)abstract
    • Background and aim: In the aftermath of a myocardial infarction with non-obstructive coronary arteries (MINOCA) or Takotsubo syndrome (TS), patients commonly express high levels of stress and anxiety. Current treatment alternatives rarely address these issues. The planned E-health Treatment of Stress and Anxiety in Stockholm Myocardial Infarction With Non-obstructive Coronaries Study (e-SMINC) aims to evaluate the effects of an internet-based intervention, building on cognitive behavioral therapy (CBT) by comparison with treatment as usual using an RCT approach. This was a small-scale single arm study designed to test the feasibility of the RCT, addressing uncertainties regarding recruitment, data collection, and intervention delivery.Methods: Participant recruitment and screening took place before discharge from the coronary care unit at a large Swedish hospital. Eligible patients were invited to a nine-step psychologist guided, internet-based CBT intervention. The sample size was set in advance to 10 participants completing the intervention. The recruitment and flow of participants were documented and evaluated in relation to seven pre-defined progression criteria. Self-reports of anxiety (HADS-A), stress (PSS-14), cardiac anxiety (CAQ), posttraumatic stress (IES-6) and quality of life (Rand-36), collected at screening, pre-intervention and post-intervention, were analysed descriptively and by effect sizes (Cohen's d). Individual interviews targeting participant experiences were conducted.Results: Six out of seven progression criteria yielded no concerns. Out of 49 patients with a working diagnosis of MINOCA or TS, 31 were eligible for screening, 26 consented to participate, and 14 were eligible with regard to symptoms of stress and/or anxiety. Eleven completed the pre-assessment and were given access the intervention, and 9 completed the intervention. Only the number of patients screened prior to eligibility assessment was slightly lower than expected, indicating possible concerns. Self-reports of anxiety, stress, cardiac anxiety, posttraumatic stress, and quality of life all indicated symptom reduction from pre- to post-intervention, generally showing large effect sizes (d = 0.6–2.6). The general consensus among participants was that the programme was helpful and relevant, and that the personal contact with the psychologist was highly valued. Setting aside time to complete assignments was found critical.Conclusion: Conducting a full scale RCT was found feasible. Inclusion of more study sites and minor amendments to the protocol and intervention were decided to improve feasibility further.
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39.
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40.
  • Smedby, Björn, et al. (författare)
  • Admission Rate and Length of Stay for Nonspecific Enteritis in Pediatric Departments in Sweden
  • 1972
  • Ingår i: International Journal of Health Services. - 0020-7314 .- 1541-4469. ; 2:4, s. 537-550
  • Tidskriftsartikel (refereegranskat)abstract
    • In a study of variations in use of inpatient care for nonspecific enteritis in six pediatric departments in the Uppsala region of Sweden considerable differences in both admission rate and length of stay were revealed. The department with the highest use of hospital days for enteritis devoted nine times as many days per unit of population than did the department with the lowest use. It was concluded that differences in admission rate were only partly explained by differences in incidence of disease in the various catchment areas. A high admission rate was linked with relatively liberal indications for admission. This did not result in shorter mean stay, however. Differences in disease characteristics, and geographic, social, departmental, and other factors were investigated in determining causes for variation in length of stay, and the simultaneous effect of these variables on length of stay was studied by multiple regression analysis. A significant proportion of the individual variation in length of stay proved to depend on admitting department policy. In fact, local policy differences seemed to have had a greater effect on length of stay than did combined demographic, geographic, social, and disease characteristics.
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41.
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42.
  • Sundelin, Claes, 1939-, et al. (författare)
  • Child health services in transition : I. Theories, methods and launching
  • 2005
  • Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 94:3, s. 329-336
  • Tidskriftsartikel (refereegranskat)abstract
    • AIM: To describe an evidence-based model for preventive child health care and present some findings from baseline measurements. METHODS: The model includes: parent education; methods for interaction and language training; follow-up of low birthweight children; identification and treatment of postnatal depression, interaction difficulties, motor problems, parenthood stress, and psychosocial problems. After baseline measurements at 18 mo (cohort I), the intervention was tested on children from 0 to 18 mo at 18 child health centres in Uppsala County (cohort II). Eighteen centres in other counties served as controls. Two centres from a privileged area were included in the baseline measurements as a "contrasting" sample. Data are derived from health records and questionnaires to nurses and mothers. RESULTS: Baseline experiment (n = 457) and control mothers (n = 510) were largely comparable in a number of respects. Experiment parents were of higher educational and occupational status, and were more frequently of non-Nordic ethnicity. Mothers in the privileged area (n = 72) differed from other mothers in several respects. Experiment nurses devoted considerably fewer hours per week to child health services and to child patients than did control nurses. CONCLUSIONS: Despite certain differences, experiment and control samples appeared comparable enough to permit, in a second step, conclusions about the effectiveness of the intervention.
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43.
  • Sundelin, Claes, 1939-, et al. (författare)
  • Measurement and Monitoring
  • 2002
  • Ingår i: Conference Report, Measurement and Monitoring. - 917257156X
  • Konferensbidrag (populärvet., debatt m.m.)
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44.
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45.
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46.
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47.
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48.
  • Sundelin, Claes, 1939-, et al. (författare)
  • Svar : Läs vad som står!
  • 2000
  • Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 97:32, s. 3504-3505
  • Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
  •  
49.
  • Wallby, Thomas, 1956-, et al. (författare)
  • Basta : Validitet i ett regionalt barnhälsovårdsregister
  • 2011
  • Rapport (övrigt vetenskapligt/konstnärligt)abstract
    • Aim: To validate a local Child Health Care Quality database (Basta) in the county of Uppsala, Sweden in terms of completeness and agreement with the Child Health Care record (CHCR). Material and methods: The target population for the study consisted of 2-year old children born during 2005 to 2008 and registered as residents in the county of Uppsala Sweden (n= 15 769), each child enrolled at one specific Child Health Centre (CHC, n= 41) in the county. The study population was determined by means of a two step cluster selection design. In step one 11 CHC: s was randomly selected. In step 2 five percent of the children at each of the 11 randomized CHC was randomly selected, the selection procedure ending up in a study population comprising 198 children. The CHCR for all 198 children was retrieved and information regarding visits at the CHC, home visits, participation in parenting group, parental smoking habits, breastfeeding and vaccination status was entered into the study database together with the corresponding data from the Basta database. The data on each pair of connected variables was compared and the results regarding the number of visits at CHC, the number of home visits, any home visit, a minimum number of 6 visits at CHC,  a minimum number of 11 visits at CHC and participation in parenting group at any time were expressed as the percentage of correspondence. For results regarding if the child had received each dose of the recommended vaccines, breastfeeding status at given time points and paternal smoking at given time points the sensitivity, specificity and positive and negative predictive value between the CHCR and the corresponding Basta data was calculated. Results: The sensitivity value for given doses of vaccines against diphtheria, tetanus, whooping cough, polio myelitis and hemophilus influenza was > 95 % and for breastfeeding at 1 week, 2, 4 and 6 months of child age 94-95 %. The sensitivity value for maternal smoking was 100 % and for paternal smoking>90 %. For any home visit, participation in parenting group at any time, a minimum number of 6 visits at CHC and a minimum number of 11 visits at CHC the calculated sensitivity value were between 88 to 96 %. The sensitivity value for the exact match of number of visits at CHC was low. Increasing the tolerance to +/- 3 visits the sensitivity value was 88 %. Conclusions: The results showed a satisfactory level of completeness in the Basta database and sufficient agreement with data in the CHCR. The data in Basta could be considered valid enough to be used for both the guarantee of quality and research purposes. However, some concerns could be made about using data on breastfeeding at 10 and 12 months and smoking status at 9 months where the attrition was higher and the exact number of visits at CHC where the exact match was low.
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50.
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