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  • 1.
    Bröms, Kristina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
    Norbäck, Dan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Eriksson, Margaretha
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Sundelin, Claes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Svärdsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Prevalence and co-occurrence of parentally reported possible asthma and allergic manifestations in pre-school children2013In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 13, p. 764-Article in journal (Refereed)
    Abstract [en]

    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.

  • 2.
    Bröms, Kristina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Norbäck, Dan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Sundelin, Claes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Eriksson, Margaretha
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Svärdsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    A nationwide study of asthma incidence rate and its determinants in Swedish pre-school children2012In: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 27, no 9, p. 695-703Article in journal (Refereed)
    Abstract [en]

    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.

  • 3.
    Bröms, Kristina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Svärdsudd, Kurt F
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Sundelin, Claes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Norbäck, Dan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    A nationwide study of indoor and outdoor environments in allergen avoidance and conventional daycare centers in Sweden2006In: Indoor Air, ISSN 0905-6947, E-ISSN 1600-0668, Vol. 16, no 3, p. 227-35Article in journal (Refereed)
    Abstract [en]

    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.

  • 4.
    Frid, Christina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Annerén, Göran
    Rasmussen, Finn
    Sundelin, Claes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Drott, Peder
    Utilization of medical care among children with Down's syndrome2002In: Journal of Intellectual Disability Research, ISSN 0964-2633, E-ISSN 1365-2788, Vol. 46, no 4, p. 310-317Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    The present authors have previously found an increased mortality rate in children with Down's syndrome (DS) and a congenital heart defect (CHD). The aim of the present study was to investigate the utilization of medical care in relation to congenital malformations in DS.

    METHOD:

    Retrospectively, 211 children with DS born between 1973 and 1980 in the northern part of Sweden were followed up for at least 17 years (1973-1997). The duration of neonatal care was compared with that of children with DS born between 1995 and 1998 in the same region.

    RESULTS:

    Neonatal care was reduced over time. Almost 50% of the children had CHD, and before 10 years of age, these subjects were admitted for inpatient care twice as often as children with DS who did not have malformations, and had more than 12 times as many inpatient days per month. The existence of a gastrointestinal or other malformation increased inpatient days per month four and two times, respectively, compared to healthy children with DS. During the first 10 years of life, children with DS and a CHD accounted for 71% of all inpatient days caused by infections. No gender differences were observed.

    CONCLUSIONS:

    At a group level, the presence of a CHD was the most important congenital abnormality in determining utilization of medical care and the burden of infections in the population of children with DS.

  • 5.
    Holmberg, Kirsten
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Sundelin, Claes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Hjern, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    RE: Routine developmental screening at 5.5 and 7 years of age is not an efficient predictor of attention-deficit/hyperactivity disorder: a critical comment: author's reply2010In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 99, no 9, p. 1280-1280Article in journal (Refereed)
  • 6.
    Holmberg, Kirsten
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Sundelin, Claes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Hjern, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Routine developmental screening at 5.5 and 7 years of age is not an efficient predictor of attention-deficit / hyperactivity disorder at age 102010In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 99, no 1, p. 112-120Article in journal (Refereed)
    Abstract [en]

    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.

  • 7.
    Holmberg, Kirsten
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Sundelin, Claes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Hjern, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Screening for attention-deficit/hyperactivity disorder (ADHD): can high-risk children be identified in first grade?2013In: Child Care Health and Development, ISSN 0305-1862, E-ISSN 1365-2214, Vol. 39, no 2, p. 268-276Article in journal (Refereed)
    Abstract [en]

    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.

  • 8.
    Holmbäck, Ulf
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Fridman, Jennifer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Gustafsson, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Proos, Lemm
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Sundelin, Claes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Forslund, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Overweight more prevalent among children than among adolescents2007In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 96, no 4, p. 577-581Article in journal (Refereed)
    Abstract [en]

    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.

  • 9.
    Kristjansdottir, Jona
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Olsson, Gunilla I.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Sundelin, Claes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Naessén, Tord
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Self-reported health in adolescent girls varies according to the season and its relation to medication and hormonal contraception: A descriptive study2013In: European journal of contraception & reproductive health care, ISSN 1362-5187, E-ISSN 1473-0782, Vol. 18, no 5, p. 343-354Article in journal (Refereed)
    Abstract [en]

    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.

  • 10.
    Kristjánsdóttir, Jóna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Olsson, Gunilla I.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Sundelin, Claes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Naessen, Tord
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Could SF-36 be used as a screening instrument for depression in a Swedish youth population?2011In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 25, no 2, p. 262-268Article in journal (Refereed)
    Abstract [en]

     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.

  • 11.
    Kristjánsdóttir, Jóna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Gynecological endocrinology.
    Sundelin, Claes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Paediatric Inflammation Research.
    Naessén, Tord
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Gynecological endocrinology.
    Health-related quality of life in young women starting hormonal contraception: a pilot study2018In: European journal of contraception & reproductive health care, ISSN 1362-5187, E-ISSN 1473-0782, Vol. 23, no 3, p. 171-178Article in journal (Refereed)
    Abstract [en]

    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.

  • 12.
    Lagerberg, Dagmar
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Magnusson, Margaretha
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Sundelin, Claes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Child health and maternal stress: does neighbourhood status matter?2011In: International Journal of Adolescent Medicine and Health, ISSN 0334-0139, E-ISSN 2191-0278, Vol. 23, no 1, p. 19-25Article in journal (Refereed)
    Abstract [en]

    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.

  • 13.
    Lagerberg, Dagmar
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Magnusson, Margaretha
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Sundelin, Claes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Child health services in transition: II. Mothers´ perceptions of 18-month-old children in the light of socio-economic status and some subjective factors2005In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 94, no 3, p. 337-344Article in journal (Refereed)
    Abstract [en]

    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.

  • 14.
    Lagerberg, Dagmar
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Magnusson, Margaretha
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Sundelin, Claes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Drawing the line in the Edinburgh Postnatal Depression Scale (EPDS): a vital decision2011In: International Journal of Adolescent Medicine and Health, ISSN 0334-0139, E-ISSN 2191-0278, Vol. 23, no 1, p. 27-32Article in journal (Refereed)
    Abstract [en]

    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.

  • 15.
    Lagerberg, Dagmar
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Magnusson, Margaretha
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Sundelin, Claes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Efternamn som markör för etnicitet: Studie inom barnhälsovården visar att invandrarfamiljer och svenska familjer tycks vara isolerade på olika sätt2005In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 102, no 30, p. 2145-2148Article in journal (Refereed)
    Abstract [en]

    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.

  • 16.
    Magnusson, M
    et al.
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Persson, K
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Sundelin, C
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    The effectiveness of routine health examinations at 2, 6, 9 and 12 months of age: experiences based on data from a Swedish county2001In: Child Care Health Dev, Vol. 27, p. 117-Article in journal (Refereed)
  • 17.
    Magnusson, M
    et al.
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Sundelin, C
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Barn och ungdomar i Uppsala Län: Ett folkhälsoperspektiv 1976-1996, Barnhälsovården i fokus2001Report (Other scientific)
  • 18.
    Magnusson, M
    et al.
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Sundelin, C
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Westerlund, M
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Identification of health problems at 18 months of age--a task for physicians or child health nurses?2006In: Child Care Health Dev, ISSN 0305-1862, Vol. 32, no 1, p. 47-54Article in journal (Refereed)
  • 19.
    Magnusson, Margaretha
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Lagerberg, Dagmar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Sundelin, Claes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    How can we identify vulnerable mothers who do not reach the cut off 12 points in EPDS?2011In: Journal of Child Health Care, ISSN 1367-4935, E-ISSN 1741-2889, Vol. 15, no 1, p. 39-49Article in journal (Refereed)
    Abstract [en]

    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.

  • 20.
    Magnusson, Margaretha
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Lagerberg, Dagmar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Sundelin, Claes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Organizational differences in early child health care: mothers' and nurses' experiences of the services2012In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 26, no 1, p. 161-168Article in journal (Refereed)
    Abstract [en]

    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.

  • 21.
    Pless, M
    et al.
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Carlsson, M
    Department of Public Health and Caring Sciences.
    Sundelin, C
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Persson, K
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Preschool children with developmental coordination disorder: a short-termfollow-up of motor status at seven to eight years of age.2002In: Acta Paediatr, Vol. 91, p. 521-Article in journal (Refereed)
  • 22.
    Pless, M
    et al.
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Carlsson, M
    Department of Public Health and Caring Sciences.
    Sundelin, C
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Persson, K
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Pre-school children with developmental co-ordination disorder:self-perceived competence and group motor skill intervention.2001In: Acta Paediatr, Vol. 90, p. 532-Article in journal (Refereed)
  • 23.
    Pless, M
    et al.
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Persson, K
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Sundelin, C
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Carlsson, M
    Department of Public Health and Caring Sciences.
    Children with developmental co-ordination disorder: A qualitative study of parents´ despcriptions2001In: Advances in Physiotherapy, Vol. 3, p. 128-Article in journal (Refereed)
  • 24.
    Sundelin, Claes
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Lagerberg, Dagmar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    ADHD/DAMP: några reflektioner när stridsdammet börjar lägga sig2001In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 98, no 16, p. 1958-1959, 1961Article in journal (Refereed)
  • 25.
    Sundelin, Claes
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Lagerberg, Dagmar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Measurement and Monitoring2002In: Conference Report, Measurement and Monitoring: Measurement and Monitoring of Mental Health in Children and Adolescents / [ed] Carin Bokedal, 2002Conference paper (Other (popular science, discussion, etc.))
  • 26.
    Sundelin, Claes
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Lagerberg, Dagmar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Ragnar Berfenstam: socialpediatriska pionjärinsatser och forskningens senare utveckling2010In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 87, no 5-6, p. 343-355Article in journal (Other academic)
  • 27.
    Sundelin, Claes
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Magnusson, Margaretha
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Lagerberg, Dagmar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Child health services in transition: I. Theories, methods and launching2005In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 94, no 3, p. 329-336Article in journal (Refereed)
    Abstract [en]

    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.

  • 28.
    Wallby, Thomas
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Lagerberg, Dagmar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Magnusson, Margaretha
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Sundelin, Claes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Basta: Validitet i ett regionalt barnhälsovårdsregister2011Report (Other academic)
    Abstract [en]

    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.

  • 29.
    Westerlund, Monica
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Bergkvist, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Lagerberg, Dagmar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Sundelin, Claes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Comorbidity in children with severe developmental language disability2002In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 91, no 5, p. 529-534Article in journal (Refereed)
    Abstract [en]

    In a cohort of 2359 children, screened for severe developmental language disability (DLD) at 3 y of age, 45 children were identified as true positives. The development, concerning DLD and comorbidity of 41 of these children still living in the municipality of Uppsala was followed up to school start. Criteria for comorbidity were: (a) suspected or diagnosed neuropsychiatric/neurodevelopmental disability according to information from the Child Habilitation Centre and the Child Psychiatric Centre or (b) low performance IQ, signs of activity/distractibility problems according to a psychologist's examination. By school start, 61% of the children with severe DLD were identified with comorbidity. Conclusion: Severe DLD is often combined with other disabilities within the neuropsychiatric/neurodevelopmental spectra. The comorbidity might not be obvious at 3 y of age--the age at which severe DLD is effectively identified by the 3-y screening programme. This in turn stresses the necessity of multidisciplinary teamwork both at the referral level and during the therapy work.

1 - 29 of 29
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