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  • 1.
    Amoudruz, Petra
    et al.
    Stockholm University, Faculty of Science, The Wenner-Gren Institute .
    Holmlund, Ulrika
    Stockholm University, Faculty of Science, The Wenner-Gren Institute .
    Schollin, Jens
    Sverremark-Ekström, Eva
    Stockholm University, Faculty of Science, The Wenner-Gren Institute .
    Montgomery, Scott M
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Maternal country of birth and previous pregnancies are associated with breast milk characteristics2009In: Pediatric Allergy and Immunology, ISSN 0905-6157, E-ISSN 1399-3038, Vol. 20, no 1, p. 19-29Article in journal (Refereed)
    Abstract [en]

    Populations in high infectious exposure countries are at low risk of some immune-mediated diseases such as Crohn’s disease and allergy. This low risk is maintained upon immigration to an industrialized country, but the offspring of such immigrants have a higher immune-mediated disease risk than the indigenous population. We hypothesize that early life exposures in a developing country shape the maternal immune system, which could have implications for the offspring born in a developed country with a low infectious load. The aim of this study was to investigate if exposures in childhood (indicated by country of origin) and subsequent exposures influence immunologic characteristics relevant to stimulation of offspring. Breast milk components among 64 mothers resident in Sweden, 32 of whom immigrated from a developing country, were examined using the ELISA and Cytometric Bead Array methods. Immigrants from a developing country had statistically significantly higher levels of breast milk interleukin-6 (IL-6), IL-8 and transforming growth factor-β1. A larger number of previous pregnancies were associated with down-regulation of several substances, statistically significant for soluble CD14 and IL-8. The results suggest that maternal country of birth may influence adult immune characteristics, potentially relevant to disease risk in offspring. Such a mechanism may explain the higher immune-mediated disease risk among children of migrants from a developing to developed country. Older siblings may influence disease risk through the action of previous pregnancies on maternal immune characteristics.

  • 2.
    Arat, Arzu
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institute, Sweden.
    Östberg, Viveca
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Burström, Bo
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institute, Sweden.
    ADHD medication in offspring of immigrants - does the income level of the country of parental origin matter?2018In: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 18, no 1, article id 3Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Child psychiatric treatment facilities vary greatly worldwide and are virtually non-existent in many low-income countries. One of the most common psychiatric disorders in childhood is ADHD, with an estimated prevalence of 3-5% in Sweden. Previous studies have shown a similar prevalence of ADHD in minority and majority children in Sweden and the UK. However, clinical studies demonstrated that children from immigrant families living in Sweden received less psychiatric care than those of native-born parents. We tested the hypothesis that the consumption of child psychiatric care in immigrant families would be determined by the availability of such treatment in the parents' country of origin. Patterns of medication for attention-deficit hyperactivity disorder (ADHD) were studied as a proxy for child psychiatric care.

    METHODS: This was a register study of dispensed stimulant medication during 2013-2014 in Swedish national birth cohorts from 1995-2009. The study population, consisting of nearly 1.4 million children, was divided by national income of the parental country of origin and whether the parents were native Swedes, European immigrants, non-European immigrants or a mixture. Logistic regression was used to calculate the odds ratios of having been dispensed at least one ADHD drug during 2013, with adjustments for gender, family status indicating whether the child is living with both parents, household income and area of residence.

    RESULTS: Having parents born in low-income (OR [95% confidence interval] 0.27 [0.24-0.29]) or middle-income (European: OR 0.23 [0.20-0.26], non-European: OR 0.39 [0.34-0.41]) countries was associated with lower ADHD treatment levels than having parents born in high-income countries (European: OR 0.60 [0.54-0.66], non-European: OR 0.68 [0.59-0.79]), when compared to children of parents born in Sweden. In families with a background in low or middle income countries, there was no significant association between household income and ADHD medication, while in children with Swedish and mixed backgrounds high level of disposable income was associated with lower levels of ADHD medication.

    CONCLUSION: The use of child psychiatric care by immigrant families in Sweden was largely associated with the income level of the country of origin.

  • 3. Asmat, Tauseef M.
    et al.
    Tenenbaum, Tobias
    Jonsson, Ann-Beth
    Stockholm University, Faculty of Science, Department of Molecular Biosciences, The Wenner-Gren Institute.
    Schwerk, Christian
    Schroten, Horst
    Impact of Calcium Signaling during Infection of Neisseria meningitidis to Human Brain Microvascular Endothelial Cells2014In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 9, no 12, p. e114474-Article in journal (Refereed)
    Abstract [en]

    The pili and outer membrane proteins of Neisseria meningitidis (meningococci) facilitate bacterial adhesion and invasion into host cells. In this context expression of meningococcal PilC1 protein has been reported to play a crucial role. Intracellular calcium mobilization has been implicated as an important signaling event during internalization of several bacterial pathogens. Here we employed time lapse calcium-imaging and demonstrated that PilC1 of meningococci triggered a significant increase in cytoplasmic calcium in human brain microvascular endothelial cells, whereas PilC1-deficient meningococci could not initiate this signaling process. The increase in cytosolic calcium in response to PilC1-expressing meningococci was due to efflux of calcium from host intracellular stores as demonstrated by using 2-APB, which inhibits the release of calcium from the endoplasmic reticulum. Moreover, pre-treatment of host cells with U73122 (phospholipase C inhibitor) abolished the cytosolic calcium increase caused by PilC1-expressing meningococci demonstrating that active phospholipase C (PLC) is required to induce calcium transients in host cells. Furthermore, the role of cytosolic calcium on meningococcal adherence and internalization was documented by gentamicin protection assay and double immunofluorescence (DIF) staining. Results indicated that chelation of intracellular calcium by using BAPTA-AM significantly impaired PilC1-mediated meningococcal adherence to and invasion into host endothelial cells. However, buffering of extracellular calcium by BAPTA or EGTA demonstrated no significant effect on meningococcal adherence to and invasion into host cells. Taken together, these results indicate that meningococci induce calcium release from intracellular stores of host endothelial cells via PilC1 and cytoplasmic calcium concentrations play a critical role during PilC1 mediated meningococcal adherence to and subsequent invasion into host endothelial cells.

  • 4.
    Azad, Azade
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Leander, Lina
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Children's Reporting About Sexual Versus Physical Abuse: Patterns of Reporting, Avoidance and Denial2015In: Psychiatry, Psychology and Law, ISSN 1321-8719, E-ISSN 1934-1687, Vol. 22, no 6, p. 890-902Article in journal (Refereed)
    Abstract [en]

    This study analysed the reporting patterns of 22 sexually abused children and 23 physically abused children (all cases had been verified). Police interviews with the children were analysed in relation to the amount and type of information reported, as well as the frequency of denial and avoidance of critical information. Physically and sexually abused children reported more neutral information from the abusive acts per se than information regarding sexual or physically violent acts. The children were also high in avoidance and denial regarding information about the abuse. The physically abused children reported more severe information about physically abusive acts compared with the amount of information the sexually abused children reported about severe sexual acts. An explanation for this may have been the shameful and taboo nature of sexual abuse. It is important to undertake further investigation of how the nature and type of abuse, to which child witnesses have been exposed, may affect the reporting pattern. Such information may broaden our knowledge about how to conduct and evaluate child interviews.

  • 5.
    Baraldi, Erika
    Stockholm University, Faculty of Social Sciences, Department of Special Education.
    Den för tidigt födda eleven i förskola och skola - inskolning och anpassning2019Conference paper (Other academic)
  • 6.
    Baraldi, Erika
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Special Education.
    Westling Allodi, Mara
    Stockholm University, Faculty of Social Sciences, Department of Special Education.
    Löwing, Kristina
    Smedler, Ann-Charlotte
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Westrup, Björn
    Ådén, Ulrika
    Clinical Protocol & Research Process of Stockholm Preterm Interaction-Based Intervention, SPIBI2019In: Pediatric Research, ISSN 0031-3998, E-ISSN 1530-0447, Vol. 86, no Suppl., p. 54-55Article in journal (Refereed)
    Abstract [en]

    Background

    Extremely preterm (EPT) born children are at increased risk of cognitive and neurodevelopmental impairment, neuropsychiatric disorders and academic difficulties. Parents of EPT born children are extra vulnerable for anxiety, posttraumatic stress disorder and depression and the parent-child interaction is negatively affected by prematurity. There is some evidence that early interventions have beneficial effects on neurocognitive and motor outcomes (Spittle A et al 2015). Based on a previous intervention (Verkerk G et al 2012) and adjusted to the Swedish context with 480 days paid parental leave, we created a post–discharge intervention, SPIBI, for families of EPT born children.

    Method

    The aim of (SPIBI) is to improve the quality of the parent-child interaction, child development and parental mental health in families with EPT born children. . SPIBI is a randomized controlled beginning at discharge and lasting until the child is 12 months corrected age. The trial design is a two arm randomized trial with four recruiting sites in Stockholm. Intervention group (target, n=65) receives 10 visits and two telephone calls from a trained interventionist and the control group (target n=65) receives treatment as usual plus an extended follow-up program. The SPIBI-team has recruited and trained 6 multi-professional and NICU-experienced interventionists. The training takes one year (0.2 of full time) and the content was both theoretical and practical, including pilot-cases. 

    Result

    SPIBI is an ongoing research project, beginning the 1st of September 2018 and planning to end recruitment the 31st of August 2020 and finishing the home-visits in August 2021. By the end of April 2019, 33 eligible infants had been identified within the four neonatal units in Stockholm; of which 26 children approved and 7 children declined participation. At this stage, three children have dropped out of the study, because of severe social challenges and child death. Identified challenges have been social and medical vulnerability of the EPT-families, finding the optimal multi-professional balance of motoric, psychological, pedagogical and medical kernels of the intervention, ethical considerations when to ask families for participation, lack of long-term discharge-planning of the neonatal units and large geographical spread of NICUs as well as families.

    Conclusion

    In conclusion, the protocol seem to be feasible and appreciated by parents in the target group. With regard to the small recruitment base, trials of this kind needs a long inclusion time. Since EPT-children and their parents displays a wide scope of difficulties and challenges, multi-professional cooperation is preferable, placing high demands of sensitivity, professional respect and time for long collaborative processes.

  • 7.
    Berg, Lisa
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Saarela, Jan
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Parental Death During Childhood and Subsequent School Performance2014In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 133, no 4, p. 682-689Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Parental death during childhood has been linked to increased mortality and mental health problems in adulthood. School failure may be an important mediator in this trajectory. We investigated the association between parental death before age 15 years and school performance at age 15 to 16 years, taking into account potentially contributing factors such as family socioeconomic position (SEP) and parental substance abuse, mental health problems, and criminality.

    METHODS: This was a register-based national cohort study of 772117 subjects born in Sweden between 1973 and 1981. Linear and logistic regression models were used to analyze school performance as mean grades (scale: 1-5; SD: 0.70) and school failure (finished school with incomplete grades). Results are presented as -coefficients and odds ratios (ORs) with 95% confidence intervals (CIs).

    RESULTS: Parental death was associated with lower grades (ORs: -0.21 [95% CI: -0.23 to -0.20] and -0.17 [95% CI: -0.19 to -0.15]) for paternal and maternal deaths, respectively. Adjustment for SEP and parental psychosocial factors weakened the associations, but the results remained statistically significant. Unadjusted ORs of school failure were 2.04 (95% CI: 1.92 to 2.17) and 1.51 (95% CI: 1.35 to 1.69) for paternal and maternal deaths. In fully adjusted models, ORs were 1.40 (95% CI: 1.31 to 1.49) and 1.18 (95% CI: 1.05 to 1.32). The higher crude impact of death due to external causes (ie, accident, violence, suicide) (OR: -0.27 [90% CI: -0.28 to -0.26]), compared with natural deaths (OR: -0.16 [95% CI: -0.17 to -0.15]), was not seen after adjustment for SEP and psychosocial situation of the family.

    CONCLUSIONS: Parental death during childhood was associated with lower grades and school failure. Much of the effect, especially for deaths by external causes, was associated with socially adverse childhood exposures.

  • 8. Björkenstam, C.
    et al.
    Bjorkenstam, E.
    Ljung, R.
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Tuvblad, C.
    Suicidal behavior among delinquent former child welfare clients2013In: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 22, no 6, p. 349-355Article in journal (Refereed)
    Abstract [en]

    Child welfare clients represent a high-risk group for delinquency and adult criminality, but also for future suicidal behavior. We examine associations between delinquency and suicidal behavior in a national child welfare population. This register-based cohort study is based on data for all Swedish former child welfare clients born between 1972 and 1981 that experienced interventions before their adolescent years. We followed 27,228 individuals from age 20 years until 31 December 2006. Juvenile delinquency was defined as being convicted of at least one crime between age 15 and 19. The risk of suicidal behavior was calculated as incidence rate ratios (IRRs). Fifteen percent of the women and 40 % of the men had at least one conviction between the age 15 and 19. The adjusted risk of suicidal behavior among women with five or more convictions was 3.5 (95 % CI 2.0-6.2); corresponding IRR for men was 3.9 (95 % CI 3.1-4.9). Child welfare experience-specifically of out-of-home care-in combination with delinquency is a potent risk factor for suicidal behavior among young adults. However, we cannot exclude that some of this association is an epiphenomenon of uncontrolled confounders, such as impulsivity or severity of psychiatric disease. Despite this caveat, results should be disseminated to practitioners in the health and correction services.

  • 9. Björkenstam, Emma
    et al.
    Cheng, Siwei
    Burström, Bo
    Pebley, Anne R.
    Björkenstam, Charlotte
    Stockholm University, Faculty of Social Sciences, Department of Sociology. University of California, USA; Karolinska Institutet, Sweden.
    Kosidou, Kyriaki
    Association between income trajectories in childhood and psychiatric disorder: a Swedish population-based study2017In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 71, no 7, p. 648-654Article in journal (Refereed)
    Abstract [en]

    Background Childhood family income variation is an understudied aspect of households' economic context that may have distinct consequences for children. We identified trajectories of childhood family income over a 12-year period, and examined associations between these trajectories and later psychiatric disorders, among individuals born in Sweden between 1987 and 1991 (n=534 294).

    Methods We used annual income data between the ages of 3-14 years and identified 5 trajectories (2 high-income upward, 1 downward and 2 low-income upward trajectories). Psychiatric disorders in the follow-up period after age 15 were defined from International Classification of Disease (ICD)-codes in a nationwide patient register. Multiadjusted risks for all psychiatric disorders, as well as for specific psychiatric diagnoses, were calculated as HRs with 95% CIs.

    Results Of the 5 identified income trajectories, the constant low and the downward trajectories were particularly associated with later psychiatric disorder. Children with these trajectories had increased risks for psychiatric disorder, including mood, anxiety, psychotic disorders and attention deficit/hyperactivity disorder. The association remained, even after adjusting for important variables including parental psychiatric disorder. In contrast, the relationship was reversed for eating disorders, for which children in higher income trajectories had elevated risks.

    Conclusions Findings show that children growing up in a household characterised by low or decreasing family income have an increased risk for psychiatric disorder. Continued work is needed to reduce socioeconomic inequalities in psychiatric disorders. Policies and interventions for psychiatric disorders should consider the socioeconomic background of the family as an important risk or protective factor.

  • 10. Blix, Eva
    et al.
    Perski, Aleksander
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Berglund, Hans
    Savic, Ivanka
    Long-Term Occupational Stress Is Associated with Regional Reductions in Brain Tissue Volumes2013In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, no 6, article id e64065Article in journal (Refereed)
    Abstract [en]

    There are increasing reports of cognitive and psychological declines related to occupational stress in subjects without psychiatric premorbidity or major life trauma. The underlying neurobiology is unknown, and many question the notion that the described disabilities represent a medical condition. Using PET we recently found that persons suffering from chronic occupational stress had limbic reductions in the 5-HT1A receptor binding potential. Here we examine whether chronic work-related stress is also associated with changes in brain structure. We performed MRI-based voxel-based morphometry and structural volumetry in stressed subjects and unstressed controls focusing on gray (GM) and white matter (WM) volumes, and the volumes of hippocampus, caudate, and putamen - structures known to be susceptible to neurotoxic changes. Stressed subjects exhibited significant reductions in the GM volumes of the anterior cingulate cortex and the dorsolateral prefrontal cortex. Furthermore, their caudate and putamen volumes were reduced, and the volumes correlated inversely to the degree of perceived stress. Our results add to previous data on chronic psychosocial stress, and indicate a morphological involvement of the frontostriatal circuits. The present findings of morphological changes in these regions confirm our previous conclusion that symptoms from occupational stress merit careful investigations and targeted treatment.

  • 11. Boman, Krister K.
    et al.
    Kjällander, Ylva
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Karolinska Institutet, Sweden.
    Eksborg, Staffan
    Becker, Jeremy
    Impact of Prior Traumatic Life Events on Parental Early Stage Reactions following a Child's Cancer2013In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, no 3, article id e57556Article in journal (Refereed)
    Abstract [en]

    Background: In pediatric oncology, effective clinic-based management of acute and long-term distress in families calls for investigation of determinants of parents' psychological response to the child's cancer. We examined the relationship between parents' prior exposure to traumatic life events (TLE) and the occurrence of posttraumatic stress symptoms (PTSS) following their child's cancer diagnosis. Factors mediating the TLE-PTSS relationship were analyzed. Methodology: The study comprised 169 parents (97 mothers, 72 fathers) of 103 cancer diagnosed children (median age: 5,9 years; range 0.1-19.7 years). Thirty five parents were of immigrant origin (20.7%). Prior TLE were collated using a standardized questionnaire, PTSS was assessed using the Impact of Events-Revised (IES-R) questionnaire covering intrusion, avoidance and hyperarousal symptoms. The predictive significance of prior TLE on PTSS was tested in adjusted regression models. Results: Mothers demonstrated more severe PTSS across all symptom dimensions. TLE were associated with significantly increased hyperarousal symptoms. Parents' gender, age and immigrant status did not significantly influence the TLE-PTSS relationship. Conclusions: Prior traumatic life-events aggravate posttraumatic hyperarousal symptoms. In clinic-based psychological care of parents of high-risk pediatric patients, attention needs to be paid to life history, and to heightened vulnerability to PTSS associated with female gender.

  • 12. Bystrova, Ksenia
    et al.
    Matthiesen, Ann-Sofi
    Stockholm University, Faculty of Science, Department of Mathematics.
    Vorontsov, Igor
    Widstrom, Ann-Marie
    Ransjo-Arvidson, Anna-Berit
    Uvnas-Moberg, Kerstin
    Maternal axillar and breast temperature after giving birth: Effects of delivery ward practices and relation to infant temperature2007In: Birth, ISSN 0730-7659, E-ISSN 1523-536X, Vol. 34, no 4, p. 291-300Article in journal (Refereed)
    Abstract [en]

    Background: Little is known about the development and control of skin temperature in human mothers after birth. The purpose of this study was to explore the effects of delivery ward practices and early suckling on maternal axillar and breast temperatures during the first 2 hours postpartum and to relate them to the infant's foot and axillar temperatures. Methods: Three groups of 176 mother-infant pairs were randomized as follows-group I: infants lying prone in skin-to-skin contact on their mother's chest, named the ""skin-to-skin group"" (n = 44), group II: infants who were dressed and lying prone on their mother's chest, named the ""mother's arms group"" (n = 44), and group III: infants who were dressed and kept in the nursery, named the ""nursery group"" (n = 88). Maternal axillar and breast temperatures and infants' axillar and foot temperatures were measured at 15-minute intervals from 30 to 120 minutes after birth. Episodes of early suckling were noted. Results: The axillar and breast temperatures rose significantly in all mothers. The rise of temperature over time was significantly higher in multiparas than in primiparas but was influenced only slightly by group assignment. The variation in breast temperature was highest in mothers in the skin-to-skin group and lowest in mothers in the nursery group. In the mother's arms group, variation in breast temperature was larger in those mothers exposed to early suckling than in those not exposed. A positive relationship was found between the maternal axillar temperature and the infant foot and axillar temperature 90 minutes after the start of the experiment (120 min after birth) in the skin-to-skin and mother's arms groups. The rise in temperature in the infant's foot was nearly twice that in the axilla. No such relationship was established in the nursery group. In addition, foot temperature in infants from the skin-to-skin group was nearly 2 degrees C higher than that in infants from the mother's arms group. Conclusions: Maternal temperature rose after birth, and the rise was higher in multiparas than in primiparas. Skin-to-skin contact and early suckling increased temperature variation. Maternal temperature was related to infant foot and axillar temperatures.

  • 13.
    Carvalho-Queiroz, Claudia
    et al.
    Stockholm University, Faculty of Science, Department of Molecular Biosciences, The Wenner-Gren Institute.
    Johansson, Maria A.
    Stockholm University, Faculty of Science, Department of Molecular Biosciences, The Wenner-Gren Institute.
    Persson, Jan-Olov
    Stockholm University, Faculty of Science, Department of Mathematics.
    Jörtsö, Evelina
    Kjerstadius, Torbjörn
    Nilsson, Caroline
    Saghafian-Hedengren, Shanie
    Sverremark-Ekström, Eva
    Stockholm University, Faculty of Science, Department of Molecular Biosciences, The Wenner-Gren Institute.
    Associations between EBV and CMV Seropositivity, Early Exposures, and Gut Microbiota in a Prospective Birth Cohort: A 10-Year Follow-up2016In: Frontiers in Pediatrics, ISSN 2296-2360, Vol. 4, article id 93Article in journal (Refereed)
    Abstract [en]

    Early-life infections with persistent Epstein-Barr virus (EBV) and cytomegalovirus (CMV) are delayed in affluent countries, probably due to alterations in early environmental exposures, such as maternal age, siblings, and day-care attendance. We have previously reported that the timing of EBV and CMV contraction is related both to allergic sensitization and changes in functional competence of immune cells, while the presence/absence of lactobacilli [Lactobacillus (L.) casei, L. paracasei, and L. rhamnosus] or Staphylococcus (S.) aureus in feces is related to the risk for allergy. Here, we used the same prospective longitudinal birth cohort of children to investigate early-life environmental exposures and their influence on EBV and CMV contraction over time. Since gut microbes also belong to this category of early exposures, we investigated their association with herpesvirus contraction. Our results show that these two viruses are acquired with different kinetics and that EBV and CMV seroprevalence at 10 years of age was 47 and 57%, respectively. We also observed that a delayed EBV or CMV infection was associated with older maternal age [time ratio (TR) 1.14, 95% confidence interval (CI) 1.07-1.21, P-adj < 0.001 and TR 1.09, CI 1.03-1.16, P-adj = 0.008, respectively]. Further, we present the novel finding that S. aureus colonization reduced the time to CMV acquisition (TR 0.21, CI 0.06-0.78, = 0.02). Together, these findings suggest that there is a relationship between timing of herpesvirus acquisition and early-life immune modulating exposures, which interestingly also includes the early infant gut microbiota.

  • 14. Cernvall, Martin
    et al.
    Hovén, Emma
    Ljungman, Lisa
    Ljungman, Gustaf
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    von Essen, Louise
    Posttraumatic Stress and Attentional Bias towards Cancer-Related Stimuli in Parents of Children Recently Diagnosed with Cancer2016In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 4, article id e0152778Article in journal (Refereed)
    Abstract [en]

    Objectives To investigate whether posttraumatic stress symptoms (PTSS) are related to attentional bias towards cancer-related stimuli among parents of children recently diagnosed with cancer. Methods Sixty-two parents completed questionnaires measuring PTSS, depression, and anxiety and the emotional Stroop task via the Internet. The emotional Stroop task included cancer-related words, cardiovascular disease-related words, and neutral words. Results Participants were split in two groups based on the median of PTSS: High-PTSS and Low-PTSS. There was a significant interaction between word-type and group and a planned contrast test of this interaction indicated that the High-PTSS group had longer response latencies on cancer-related words compared to the other word-type and group combinations. Conclusions Findings suggest that PTSS are related to attentional bias towards cancer-related stimuli among parents of children recently diagnosed with cancer. Implications of this finding for the understanding of PTSS in this population, future research, and clinical practice are discussed.

  • 15. Eide, Ketil
    et al.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Inst, Dept Med, Stockholm, Sweden .
    Unaccompanied refugee children - vulnerability and agency2013In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 102, no 7, p. 666-668Article in journal (Refereed)
    Abstract [en]

    The numbers of refugee adolescents that arrive in Europe without their families has increased in recent years, particularly in Sweden. Research has demonstrated that these children have high rates of mental health problems, particularly depression and post-traumatic stress disorder, during the first years after resettlement. Despite this, there are also indications that many of these unaccompanied children are resourceful and arrive with a clear vision of a positive future in the new country. Follow-up studies in the United States and Norway have indicated fairly good social outcomes in the long term. Conclusion The education and care that unaccompanied minors receive during the first years after resettlement, together with their own drive to create a positive future, are key factors in their mental health and long-term adjustment.

  • 16. Engman, Mona-Lisa
    et al.
    Sundin, Mikael
    Miniscalco, Carmela
    Westerlund, Joakim
    Stockholm University, Faculty of Social Sciences, Department of Psychology. University of Gothenburg, Sweden.
    Lewensohn-Fuchs, Ilona
    Gillberg, Christopher
    Fernell, Elisabeth
    Prenatal acquired cytomegalovirus infection should be considered in children with autism2015In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 104, no 8, p. 792-795Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of the study was to evaluate the prevalence of congenital cytomegalovirus infection (CMV) in a representative sample of children with autism spectrum disorder. Methods: In a representative group of 115 preschool children with autism spectrum disorder, of whom 33 also had intellectual disability, the dried blood spots from the newborn metabolic screening were analysed for CMV DNA using TaqMan polymerase chain reaction. Results: One of the 33 children with autism spectrum disorder and intellectual disability - 3% of that group - had congenital CMV infection. The corresponding prevalence in newborn infants in Sweden is 0.2%. None of the 82 children without intellectual disability had congenital CMV. Conclusion: The finding lends some further support for congenital CMV being one of the many aetiologies underlying autism spectrum disorder with intellectual disability. The rate of 3% of congenital CMV in children with autism spectrum disorder with intellectual disability has implications for the medical work-up. The finding of congenital CMV also indicates the need for repeated hearing assessments in the child. There is a need for similar studies with much larger samples.

  • 17. Engström, Elisabet
    et al.
    Kallioinen, Petter
    Stockholm University, Faculty of Humanities, Department of Linguistics.
    von Mentzer, Cecilia Nakeva
    Lindgren, Magnus
    Ors, Marianne
    Sahlén, Birgitta
    Lyxell, Björn
    Uhlén, Inger
    Computer-assisted reading intervention for children with sensorineural hearing loss using hearing aids: Effects on auditory event-related potentials for and mismatch negativity2019In: International Journal of Pediatric Otorhinolaryngology, ISSN 0165-5876, E-ISSN 1872-8464, Vol. 117, p. 17-25Article in journal (Refereed)
    Abstract [en]

    Objectives: The primary aim was to investigate whether computer-assisted reading intervention somehow can affect event-related potentials (ERP) and mismatch negativity (MMN) in hearing impaired (HI) children with hearing aids (HAs) and normal hearing (NH) children.

    Methods: The study included 15 HI children with sensorineural hearing loss (SNHL) using bilateral HAs and 14 NH children as a reference group; all children between the ages of 5 and 8. A multi-feature MMN-paradigm, Optimum-1, with a standard stimulus alternating with 5 different deviants was used. ERPs were recorded pre and post intervention, i.e. one month of repeatedly computer-assisted training (GraphoGame). MMN was calculated from the average ERP of each deviant minus standard. Data were based on samples within a specific time interval, 80-224 ms, and repeated measures ANOVA was used to analyze possible interactions.

    Results: There was a significant difference between groups before training, though, the mean obligatory responses or MMN was not statistically significantly different before versus after training, neither among the NH nor the HI children. Further, the HI children did generally achieve lower levels in GraphoGame compared to the NH children. Altogether, our findings indicate differences between the groups and that training may affect the neurophysiological processing in the brain, gaining the HI children. Both MMN and positive mismatch response (pMMR) were seen among both the HA and NH children, irrespective to deviant type. Individually, changes of the MMN and pMMR after training seem unpredictable.

    Conclusion: There are statistically significant differences in both the obligatory responses in ERP and the MMNs between the NH and HI groups before the computer-assisted training. Though, these differences disappear after the intervention. This suggests possible training effects regarding the central auditory processing among the HI children.

  • 18. Eriksson, Mats Anders
    et al.
    Lieden, Agne
    Westerlund, Joakim
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Bremer, Anna
    Wincent, Josephine
    Sahlin, Ellika
    Gillberg, Christopher
    Fernell, Elisabeth
    Anderlid, Britt-Marie
    Rare copy number variants are common in young children with autism spectrum disorder2015In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 104, no 6, p. 610-618Article in journal (Refereed)
    Abstract [en]

    AimSeveral studies have suggested that rare copy number variants (CNVs) are an important genetic contributor to autism spectrum disorders. The aims of the study were to use chromosomal microarray to investigate the presence of rare copy number variants in a population-based cohort of well-characterised young children with autism spectrum disorders and to relate the genetic results to neurodevelopmental profiles and medical conditions. MethodsWe performed chromosomal microarray on samples from 162 children who had been referred to the Stockholm Autism Centre for Young Children in Sweden after being diagnosed with autism spectrum disorder between 20 and 54months of age. ResultsPathogenic aberrations were detected in 8.6% of the children and variants of uncertain significance were present in another 8.6%. CNVs were more frequent in children with congenital malformations or dysmorphic features as well as in the subgroup with intellectual disability. ConclusionOur results support the use of chromosomal microarray methods for the first tier genetic analysis of autism spectrum disorder. However, it is likely in the near future that chromosomal microarray methods will probably be replaced by whole-exome and whole-genome sequencing technologies in clinical genetic testing.

  • 19.
    Forinder, Ulla
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Social Work. Nordic School of Public Health NHV, Sweden.
    Lindahl Norberg, Annika
    Posttraumatic growth and support among parents whose children have survived stem cell transplantation2014In: Journal of Child Health Care, ISSN 1367-4935, E-ISSN 1741-2889, Vol. 18, no 4, p. 326-335Article in journal (Refereed)
    Abstract [en]

    In the current study, we investigated the occurrence of posttraumatic growth (PTG) among parents whose children had had stem cell transplantation (SCT) and survived. Although SCT is well established, it remains stressful and dangerous, and SCT is only performed if there is no other choice of treatment to be considered. A questionnaire batteries including the Post-Traumatic Stress Disorder (PTSD) Check ListCivilian version and the Post-Traumatic Growth Inventory were sent out to a cross-sectional national sample of parents of children who had had SCT six months or more before the study. The response rate was 66% (n = 281). The data were analyzed in relation to parents' appraisal of the event, gender, and perceived social support. The results confirm that SCT in childhood is an event of extreme adversity for the parents. Indications of PTSD were found among an important minority of the parents. Nevertheless, a large proportion of the parents had experienced growth as a consequence of the child's illness. Appreciation of life and personal strength were the domains with the highest scores. Moreover, a higher level of PTG was correlated with a higher level of posttraumatic stress and with an experience of the trauma as more severe. In summary, the study indicates that PTG is a relevant concept for this group of parents.

  • 20. Goisis, Alice
    et al.
    Remes, Hanna
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Max Planck Institute for Demographic Research, Germany; University of Helsinki, Finland.
    Klemetti, Reija
    Myrskylä, Mikko
    Medically assisted reproduction and birth outcomes: a within-family analysis using Finnish population registers2019In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 393, no 10177, p. 1225-1232Article in journal (Refereed)
    Abstract [en]

    Background Children born after medically assisted reproduction are at higher risk of adverse birth outcomes than are children conceived naturally. We aimed to establish the extent to which this excess risk should be attributed to harmful effects of treatment or to pre-existing parental characteristics that confound the association. Methods We used data from Finnish administrative registers covering a 20% random sample of households with at least one child aged 0-14 years at the end of 2000 (n=65 723). We analysed birthweight, gestational age, risk of low birthweight, and risk of preterm birth among children conceived both by medically assisted reproduction and naturally. First, we estimated differences in birth outcomes by mode of conception in the general population, using standard multivariate methods that controlled for observed factors (eg, multiple birth, birth order, and parental sociodemographic characteristics). Second, we used a sibling-comparison approach that has not been used before in medically assisted reproduction research. We compared children conceived by medically assisted reproduction with siblings conceived naturally and, thus, controlled for all observed and unobserved factors shared by siblings. Findings Between 1995 and 2000, 2776 (4%) children in our sample were conceived by medically assisted reproduction; 1245 children were included in the sibling comparison. Children conceived by medically assisted reproduction had worse outcomes than did those conceived naturally, for all outcomes, even after adjustments for observed child and parental characteristics-eg, difference in birthweight of -60 g (95% CI -86 to -34) and 2.15 percentage point (95% CI 1.07 to 3.24) increased risk of preterm delivery. In the sibling comparison, the gap in birth outcomes was attenuated, such that the relation between medically assisted reproduction and adverse birth outcomes was statistically and substantively weak for all outcomes-eg, difference in birthweight of -31 g (95% CI -85 to 22) and 1.56 percentage point (95% CI -1.26 to 4.38) increased risk of preterm delivery. Interpretation Children conceived by medically assisted reproduction face an elevated risk of adverse birth outcomes. However, our results indicate that this increased risk is largely attributable to factors other than the medically assisted reproduction treatment itself.

  • 21. Granhagen Jungner, Johanna
    et al.
    Tiselius, Elisabet
    Stockholm University, Faculty of Humanities, Department of Swedish Language and Multilingualism, Institute for Interpreting and Translation Studies. Karolinska Institutet, Sweden.
    Blomgren, Klas
    Lützén, Kim
    Pergert, Pernilla
    The interpreter's voice: Carrying the bilingual conversation in interpreter-mediated consultations in pediatric oncology care2019In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 102, no 4, p. 656-662Article in journal (Refereed)
    Abstract [en]

    Objectives: The objective of this study was to explore interpreters' perceived strategies in the interaction in interpreter-mediated consultations between healthcare personnel and patients/families with limited Swedish proficiency in pediatric oncology care. Methods: This study had an inductive approach using an exploratory qualitative design. A total of eleven semi-structured interviews were performed with interpreters who had experience interpreting in pediatric oncology care. Results: The interpreters' perceived strategies were divided into four generic categories; strategies for maintaining a professional role, strategies for facilitating communication, strategies for promoting collaboration, and strategies for improving the framework of interpreting provision. These four generic categories were then merged into the single main category of carrying the bilingual conversation. Conclusions: The interpreters stretch their discretionary power in order to carry the bilingual conversation by using strategies clearly outside of their assignment. Practical implications: The study contributes to the understanding of the interpreter-mediated consultation in pediatric oncology care, and this can be used to improve the care of patients and families in pediatric oncology care with limited knowledge of a country's majority language.

  • 22. Granhagen Jungner, Johanna
    et al.
    Tiselius, Elisabet
    Stockholm University, Faculty of Humanities, Department of Swedish Language and Multilingualism, Institute for Interpreting and Translation Studies. Karolinska Institutet, Sweden.
    Wenemark, Marika
    Blomgren, Klas
    Lützén, Kim
    Pergert, Pernilla
    Development and evaluation of the Communication over Language Barriers questionnaire (CoLB-q) in paediatric healthcare2018In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 101, no 9, p. 1661-1668Article in journal (Refereed)
    Abstract [en]

    Objective: To develop a valid and reliable questionnaire addressing the experiences of healthcare personnel of communicating over language barriers and using interpreters in paediatric healthcare. Methods: A multiple- methods approach to develop and evaluate the questionnaire, including focus groups, cognitive interviews, a pilot test and test-retest. The methods were chosen in accordance with questionnaire development methodology to ensure validity and reliability. Results: The development procedure showed that the issues identified were highly relevant to paediatric healthcare personnel and resulted in a valid and reliable Communication over Language Barriers questionnaire (CoLB-q) with 27 questions. Conclusion: The CoLB-q is perceived as relevant, important and easy to respond to by respondents and has satisfactory validity and reliability.& nbsp; Practice implications: The CoLB-q can be used to map how healthcare personnel overcome language barriers through communication tools and to identify problems encountered in paediatric healthcare. Furthermore, the transparently described process could be used as a guide for developing similar questionnaires.

  • 23. Grüne, Bettina
    et al.
    Piontek, Daniela
    Pogarell, Oliver
    Grübl, Armin
    Groß, Cornelius
    Reis, Olaf
    Zimmermann, Ulrich S.
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany.
    Acute alcohol intoxication among adolescents - the role of the context of drinking2017In: European Journal of Pediatrics, ISSN 0340-6199, E-ISSN 1432-1076, Vol. 176, no 1, p. 31-39Article in journal (Refereed)
    Abstract [en]

    This study aims (1) to describe the context of drinking among adolescents with acute alcohol intoxication (AAI) by gender, (2) to explore temporal changes in the context of drinking and (3) to analyse the association between the context of drinking and blood alcohol concentration (BAC). A retrospective chart review of 12- to 17-year-old inpatients with AAI (n = 1441) of the years 2000 to 2006 has been conducted in five participating hospitals in Germany. Gender differences in the context of drinking were tested with t test and chi2 test. Differences over time were analysed using logistic regressions. Multivariate linear regression was used to predict BAC. Girls and boys differed in admission time, drinking situation, drinking occasion and admission context. No temporal changes in drinking situation and in admission to hospital from public locations or places were found. Higher BAC coincided with male gender and age. Moreover, BAC was higher among patients admitted to hospital from public places and lower among patients who drank for coping.

    Conclusion: The results suggest gender differences in the context of drinking. The context of drinking needs to be considered in the development and implementation of target group-specific prevention and intervention measures.

  • 24. Hee, Siew Wan
    et al.
    Willis, Adrian
    Smith, Catrin Tudur
    Day, Simon
    Miller, Frank
    Stockholm University, Faculty of Social Sciences, Department of Statistics.
    Madan, Jason
    Posch, Martin
    Zohar, Sarah
    Stallard, Nigel
    Does the low prevalence affect the sample size of interventional clinical trials of rare diseases? An analysis of data from the aggregate analysis of clinicaltrials.gov2017In: Orphanet Journal of Rare Diseases, ISSN 1750-1172, E-ISSN 1750-1172, Vol. 12, article id 44Article in journal (Refereed)
    Abstract [en]

    Background: Clinical trials are typically designed using the classical frequentist framework to constrain type I and II error rates. Sample sizes required in such designs typically range from hundreds to thousands of patients which can be challenging for rare diseases. It has been shown that rare disease trials have smaller sample sizes than non-rare disease trials. Indeed some orphan drugs were approved by the European Medicines Agency based on studies with as few as 12 patients. However, some studies supporting marketing authorisation included several hundred patients. In this work, we explore the relationship between disease prevalence and other factors and the size of interventional phase 2 and 3 rare disease trials conducted in the US and/or EU. We downloaded all clinical trials from Aggregate Analysis of ClinialTrials.gov (AACT) and identified rare disease trials by cross-referencing MeSH terms in AACT with the list from Orphadata. We examined the effects of prevalence and phase of study in a multiple linear regression model adjusting for other statistically significant trial characteristics. Results: Of 186941 ClinicalTrials.gov trials only 1567 (0.8%) studied a single rare condition with prevalence information from Orphadata. There were 19 (1.2%) trials studying disease with prevalence <1/1,000,000, 126 (8.0%) trials with 1-9/1,000,000, 791 (50.5%) trials with 1-9/100,000 and 631 (40.3%) trials with 1-5/10,000. Of the 1567 trials, 1160 (74%) were phase 2 trials. The fitted mean sample size for the rarest disease ( prevalence <1/1,000,000) in phase 2 trials was the lowest ( mean, 15.7; 95% CI, 8.7-28.1) but were similar across all the other prevalence classes; mean, 26.2 ( 16.1-42.6), 33. 8 (22.1-51.7) and 35.6 (23.3-54.3) for prevalence 1-9/1,000,000, 1-9/100,000 and 1-5/10,000, respectively. Fitted mean size of phase 3 trials of rarer diseases, <1/1,000,000 (19.2, 6.9-53.2) and 1-9/1,000,000 (33.1, 18.6-58.9), were similar to those in phase 2 but were statistically significant lower than the slightly less rare diseases, 1-9/100,000 (75.3, 48.2-117.6) and 1-5/10,000 (77.7, 49.6-121.8), trials. Conclusions: We found that prevalence was associated with the size of phase 3 trials with trials of rarer diseases noticeably smaller than the less rare diseases trials where phase 3 rarer disease ( prevalence <1/100,000) trials were more similar in size to those for phase 2 but were larger than those for phase 2 in the less rare disease ( prevalence >= 1/100,000) trials.

  • 25.
    Hjern, Anders
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Ascher, Henry
    För nyanlända barn2012In: Barnmedicin / [ed] Katarina Hanséus, Hugo Lagercrantz, Tor Lindberg, Lund, 2012, 4, p. 121-130Chapter in book (Other academic)
  • 26.
    Hjern, Anders
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). institutionen för medicin, Karolinska institutet, Stockholm, Sweden.
    Ascher, Henry
    Svårt att säkert fastställa ålder hos asylsökande barn - Medicinska metoder håller inte måttet - psykosocialbedömning bör prövas2015In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, no 112, article id DRFZArticle in journal (Refereed)
    Abstract [en]

    Many unaccompanied asylum seeking young people in Europe lack documents proving their age. X rays of the wrist and wisdom teeth are often used by European migration authorities to assess age in this situation. The large inter-individual differences in physical maturation during adolescence create such large margins of error for these methods that their informative value is very limited. The Swedish National Board of Health and Welfare should reconsider its previous position on these methods and examine the possibility to include psychosocial methods in these age assessment procedures. 

  • 27.
    Hjern, Anders
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Brendler-Lindqvist, Maria
    Norredam, Marie
    Age assessment of young asylum seekers2012In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 101, no 1, p. 4-7Article in journal (Refereed)
    Abstract [en]

    During 2009, 15 100 unaccompanied children sought asylum in Europe. Many of them came from ‘failed states’ like Somalia and Afghanistan where official documents with exact birth dates are rarely issued. This has led to requests to health care professionals in many countries to assist migration authorities in determining whether a young asylum seeker is a child or an adult. Many different methods are currently employed in Europe for this purpose by dentists, paediatricians, radiographers and social workers, but no currently available method has been demonstrated to have the accuracy needed to be of real use in this decision. Unclear guidelines and arbitrary practices may lead to alarming shortcomings in the protection of this high-risk group of children and adolescents in Europe. Medical participation, as well as non-participation, in these dubious decisions raises a number of ethical questions.

    Conclusion: To improve care for young asylum seekers with undetermined age, we suggest better legal procedures for the determination of age and a more flexible approach to chronological age.

  • 28.
    Hjern, Anders
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). National Board of Health and Welfare, Sweden.
    Ekeus, Cecilia
    Rasmussen, Finn
    Lindblad, Frank
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Uppsala University, Sweden.
    Educational achievement and vocational career in twins - a Swedish national cohort study2012In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 101, no 6, p. 591-596Article in journal (Refereed)
    Abstract [en]

    Aim: To investigate how being born and raised as a twin is associated with IQ, educational achievement and vocational career. Methods: Register study in a national birth cohort, complemented with a siblings study. The study population included 13 368 individuals born and raised as twins and 837 752 singletons, including 3019 siblings of twins, in the Swedish birth cohorts of 19731981. Our outcome measures were mean grade points on a five point scale from ninth grade of primary school at 1516 years, IQ tests on a nine grade point scale from male conscripts at 1819 years, highest completed education, disability benefits, work income and employment at 2735 years of age. Results: Twins had slightly better mean grade point averages in ninth grade; +0.08 (95% CI 0.040.11) and more often had completed a university education in young adulthood; OR 1.16 (1.021.21) compared with singleton siblings, despite male twins having a slightly lower IQ at military conscription compared with male singletons. Employment rates, mean income and disability benefits were similar in twins and singletons. Conclusions: Twins have slightly better educational careers and similar vocational careers compared with those born as singletons.

  • 29. Holmström, Linda
    et al.
    Eliasson, Ann-Christin
    Almeida, Rita
    Stockholm University, Faculty of Humanities, Department of Linguistics. Karolinska Institutet, Sweden.
    Furmark, Catarina
    Weiland, Ann-Louise
    Tedroff, Kristina
    Löwing, Kristina
    Efficacy of the Small Step Program in a Randomized Controlled Trial for Infants under 12 Months Old at Risk of Cerebral Palsy (CP) and Other Neurological Disorders2019In: Journal of Clinical Medicine, ISSN 2077-0383, Vol. 8, no 7, article id 1016Article in journal (Refereed)
    Abstract [en]

    The objective was to evaluate the effects of the Small Step Program on general development in children at risk of cerebral palsy (CP) or other neurodevelopmental disorders. A randomized controlled trial compared Small Step with Standard Care in infants recruited at 4-9 months of corrected age (CA). The 35-week intervention targeted mobility, hand use, and communication during distinct periods. The Peabody Developmental Motor Scales(2ed) (PDMS-2) was the primary outcome measure. For statistical analysis, a general linear model used PDMS-2 as the main outcome variable, together with a set of independent variables. Thirty-nine infants were randomized to Small Step (n = 19, age 6.3 months CA (1.62 SD)) or Standard Care (n = 20, age 6.7 months CA (1.96 SD)). Administering PDMS-2 at end of treatment identified no group effect, but an interaction between group and PDMS-2 at baseline was found (p < 0.02). Development was associated with baseline assessments in the Standard Care group, while infants in the Small Step group developed independent of the baseline level, implying that Small Step helped the most affected children to catch up by the end of treatment. This result was sustained at 2 years of age for PDMS-2 and the PEDI mobility scale.

  • 30. Höglund Carlsson, Lotta
    et al.
    Westerlund, Joakim
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Cognitive psychology. Gothenburg University, Sweden.
    Barnevik Olsson, Martina
    Eriksson, Mats A.
    Hedvall, Åsa
    Gillberg, Christopher
    Fernell, Elisabeth
    Autism spectrum disorders before diagnosis: results from routine developmental surveillance at 18 months2016In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 105, no 7, p. 823-828Article in journal (Refereed)
    Abstract [en]

    Aim: This study investigated the results from the national, routine 18-month developmental surveillance at Child Healthcare Centres (CHCs) on children later diagnosed with autism spectrum disorder (ASD). Methods: Child Healthcare Centre records of 175 children, diagnosed with ASD before 4.5 years in Stockholm County, Sweden, were reviewed regarding the results of the eight-item neurodevelopmental surveillance. Results were contrasted with normative data from the general child population in Stockholm County. Results: More than one-third of the total ASD group, including half of the group with ASD and intellectual disability (ID), did not pass the required number of items, compared to one in 50 in the general child population. Of those with ASD and ID who had passed, more than one-third experienced developmental regression after 18 months of age. If the CHC surveillance had considered reported regulatory problems - crying, feeding and sleeping - then another 10% of the children with ASD and ID could have been identified during this surveillance. Conclusion: The existing CHC surveillance traced half of the group of children who were later diagnosed with ASD combined with intellectual disability. Adding an item on regulatory problems to the 18-month surveillance would have increased this number by another 10%.

  • 31. Isaksson, J.
    et al.
    Nilsson, K. W.
    Lindblad, Frank
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Uppsala University, Sweden.
    The Pressure-Activation-Stress scale in relation to ADHD and cortisol2015In: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 24, no 2, p. 153-161Article in journal (Refereed)
    Abstract [en]

    The Pressure-Activation-Stress (PAS) scale is a self-report questionnaire for children concerning perceived stress. To explore behavioral and physiological correlates, we investigated if scores discriminate between a group prone to perceive high levels of stress [children with attention-deficit/hyperactivity disorder (ADHD)] and a healthy school sample, and if they are associated with diurnal cortisol levels. The PAS scale was filled in at home by children (11-17 years) with clinically confirmed ADHD (n = 102) and non-affected comparisons (n = 146). Saliva samples were collected four times during a regular school day for radioimmunoassay analysis of cortisol. Subtypes and severity of ADHD symptoms were determined using parental rating scales. Children with ADHD scored higher on the PAS scale than a school sample. The PAS scores were similar over ages in the ADHD group while they increased with age in the healthy group. Female sex was associated with higher stress in both groups but no gender interaction was found. No association was found between PAS scores and cortisol levels in neither group. Children in the ADHD group had a lower ratio of cortisol levels/perceived stress on all sampling occasions, built up both by the higher PAS scores and the lower cortisol levels in children with ADHD. The higher PAS scores in children with ADHD support the validity of the scale. The lack of association between PAS scores and diurnal cortisol levels is intriguing and illustrates the complexity of the stress concept. Stress-related fragility seems to accompany ADHD during childhood.

  • 32. Kanstrup, Marie
    et al.
    Wicksell, Rikard K.
    Kemani, Mike
    Lipsker, Camilla Wiwe
    Lekander, Mats
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Holmström, Linda
    A Clinical Pilot Study of Individual and Group Treatment for Adolescents with Chronic Pain and Their Parents: Effects of Acceptance and Commitment Therapy on Functioning2016In: Children, ISSN 2227-9067, Vol. 3, no 4, article id 30Article in journal (Refereed)
    Abstract [en]

    Pediatric chronic pain is common and can result in substantial long-term disability. Previous studies on acceptance and commitment therapy (ACT) have shown promising results in improving functioning in affected children, but more research is still urgently needed. In the current clinical pilot study, we evaluated an ACT-based interdisciplinary outpatient intervention (14 sessions), including a parent support program (four sessions). Adolescents were referred to the clinic if they experienced disabling chronic pain. They were then randomized, along with their parents, to receive group (n = 12) or individual (n = 18) treatment. Adolescent pain interference, pain reactivity, depression, functional disability, pain intensity and psychological flexibility, along with parent anxiety, depression, pain reactivity and psychological flexibility were assessed using self-reported questionnaires. There were no significant differences in outcomes between individual and group treatment. Analyses illustrated significant (p < 0.01) improvements (medium to large effects) in pain interference, depression, pain reactivity and psychological flexibility post-treatment. Additionally, analyses showed significant (p < 0.01) improvements (large effects) in parent pain reactivity and psychological flexibility post-treatment. On all significant outcomes, clinically-significant changes were observed for 21%-63% of the adolescents across the different outcome measures and in 54%-76% of the parents. These results support previous findings and thus warrant the need for larger, randomized clinical trials evaluating the relative utility of individual and group treatment and the effects of parental interventions.

  • 33. Kark, M.
    et al.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Rasmussen, F.
    Poor school performance is associated with a larger gain in body mass index during puberty2013In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 103, no 2, p. 207-213Article in journal (Refereed)
    Abstract [en]

    Aim: Social inequalities in type 2 diabetes and coronary heart disease may be established in formative school years. We investigated whether school performance is associated with adiposity and increase in body mass index (BMI) between 10 and 15 years of age.

    Methods: A community sample of 2633 school children had height and weight measured in school at the ages of 10 and 15. Percentages of body fat and waist circumference were measured at the age of 15. Mean grades in several school subjects at the age of 15 (ninth school year) were divided into quartiles. A linear regression analysis with BMI as the main outcome took into account parental education and ethnicity, obtained from registers, and children’s living habits, collected by questionnaires.

    Results: In adjusted models, longitudinal changes in BMI between the ages of 10 and 15 were larger in the lowest quartiles of school grades compared with the highest: for girls, they were b=0.45 (p=0.007) and for boys they wereb=0.45 (p= 0.016). Crosssectional regression analyses, with percentage of body fat and waist circumference as outcomes, showed similar results.

    Conclusion: Our results suggest that school performance is one pathway to social inequalities in obesity in school children.

  • 34.
    Khanolkar, Amal
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Sovio, Ulla
    Bartlett, Jonathan W.
    Wallby, Thomas
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Socioeconomic and early-life factors and risk of being overweight or obese in children of Swedish- and foreign-born parents2013In: Pediatric Research, ISSN 0031-3998, E-ISSN 1530-0447, Vol. 74, no 3, p. 356-363Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Ethnic minorities/immigrants have differential health as compared with natives. The epidemic in child overweight/obesity (OW/OB) in Sweden is leveling oft but lower socioeconomic groups and immigrants/ethnic minorities may not have benefited equally from this trend. We investigated whether nonethnic Swedish children are at increased risk for being OW/OB and whether these associations are mediated by parental socioeconomic position (SEP) and/or early-life factors such as birth weight, maternal smoking, BMI, and breastfeeding. METHODS: Data on 10,628 singleton children (51% boys, mean age: 4.8 y, born during the period 2000-2004) residing in Uppsala were analyzed. OW/OB was computed using the International Obesity Task Force's sex- and age-specific cutoffs. The mother's nativity was used as proxy for ethnicity. Logistic regression was used to analyze ethnicity-OW/OB associations. RESULTS: Children of North African, Iranian, South American, and Turkish ethnicity had increased odds for being overweight/obese as compared with children of Swedish ethnicity (adjusted odds ratio (OR): 2.60 (95% confidence interval (CI): 1.57-4.27), 1.67 (1.03-2.72), 3.00 (1.86-4.80), and 2.90 (1.73-4.88), respectively). Finnish children had decreased odds for being overweight/obese (adjusted OR: 0.53 (0.32-0.90)). CONCLUSION: Ethnic differences in a child's risk for OW/OB exist in Sweden that cannot be explained by SEP or maternal or birth factors. As OW/OB often tracks into adulthood, more effective public health policies that intervene at an early age are needed.

  • 35. Kling, Stefan
    et al.
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Somatic assessments of 120 Swedish children taken into care reveal large unmet health and dental care needs2016In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 105, no 4, p. 416-420Article in journal (Refereed)
    Abstract [en]

    AimFor decades, non-Nordic countries have consistently reported high rates of somatic health problems among children placed in care by the authorities. This study examined the unmet health and dental care needs of Swedish children in foster and residential care. MethodsThe health of 120 consecutive children aged 0-17 years, who had recently been placed in foster or residential care in one Swedish region, was assessed by an experienced paediatrician using patient records, their medical history and a physical examination. ResultsFollowing the assessments, 51% of the subjects received at least one referral to a specialist or to primary care, either for a previously undetected medical condition or for a follow-up of a previously detected condition noted in their patient records. The study showed that 40% of the girls and 33% of boys were overweight and completed vaccination rates were only 86% for children up to the age of six and 68% for 7- to 17-year-olds. Half of the 7- to 17-year-olds had untreated dental decay. ConclusionOur study revealed a large unmet need for health and dental care interventions among children placed in foster care and residential care and a systematic strategy is required to address those needs.

  • 36.
    Lacerda, Francisco
    Stockholm University, Faculty of Humanities, Department of Linguistics, Phonetics.
    Barns talspråkutveckling - en komplex och mångfacetterad process2012In: Barnläkaren, ISSN 1651-0534, no 3, p. 11-12Article in journal (Other academic)
    Abstract [sv]

    Under småbarnsåren utvecklas den språkliga kommunikationsförmågan snabbt, och miljön har stor betydelse för språkutvecklingen. Det är dock först vid 2-årsåldern som barnet visar tecken på att ha uppfattat språkets grundläggande kombinatoriska principer.

  • 37. Laestadius, Åsa
    et al.
    Ingelman-Sundberg, Hanna M.
    Hed Myrberg, Ida
    Verme, Anna
    Sundberg, Erik
    Schweiger, Brunhilde
    Saghafian-Hedengren, Shanie
    Stockholm University, Faculty of Science, Department of Molecular Biosciences, The Wenner-Gren Institute. Karolinska Institutet, Sweden.
    Nilsson, Anna
    Altered proportions of circulating CXCR5+helper T cells do not dampen influenza vaccine responses in children with rheumatic disease2019In: Vaccine, ISSN 0264-410X, E-ISSN 1873-2518, Vol. 37, no 28, p. 3685-3693Article in journal (Refereed)
    Abstract [en]

    Biological therapy options for the treatment of rheumatic disease target molecules that can affect the cross-talk between innate and adaptive immune responses upon vaccination. Influenza vaccination in children with rheumatic disease has been recommended, but there are only sparse data on the quality of vaccine responses from pediatric patients treated with biological therapy. We conducted an influenza vaccine study over 3 consecutive seasons where the antibody response to TIV was evaluated in children with PRD (n = 78), including both non-treated (n = 17) and treated (with methotrexate, TNF-inhibitors with or without methotrexate, or IL-inhibitors, n = 61) children as well as healthy age-matched controls (n = 24). Peripheral B cells, T and NK cell populations, as well as CXCR5+ (follicular) helper T cells (T-FH) and chemokines involved in antibody responses were assessed prior to immunization in the same cohort. Data on disease duration, therapy and data on previous influenza vaccinations were retrieved. The proportion of circulating T-FH cells were significantly lower in non-treated children with PRD compared to treated patients and healthy controls. The significantly lower proportion of T-FH cells was mirrored by a marked significant increase in CXCL13 serum level, the ligand for CXCR5, with higher levels in non-treated children with PRD compared to treated patients and healthy controls. However, the proportion of T-FH cells or CXCL13 level at the time of vaccination was not a predictor of the antibody response to TIV in this cohort of children. Children with PRD had an overall similar response to TIV as healthy children. Although not significant, children treated with TNF-inhibitors differed as a few children remained seronegative towards H3N2- and influenza B viruses after immunization. Our data show that children with PRD respond to TIV as healthy children. Furthermore, plasma CXCL13 levels did not correlate to the proportion of T-FH cells in blood prior to immunisation, or to antibody responses following immunization.

  • 38. Lindahl Norberg, Annika
    et al.
    Mellgren, Karin
    Winiarski, Jacek
    Forinder, Ulla
    Stockholm University, Faculty of Social Sciences, Department of Social Work. Nordic School of Public Health, Gothenburg, Sweden.
    Relationship between problems related to child late effects and parent burnout after pediatric hematopoietic stem cell transplantation2014In: Pediatric Transplantation, ISSN 1397-3142, E-ISSN 1399-3046, Vol. 18, no 3, p. 302-309Article in journal (Refereed)
    Abstract [en]

    A few studies have indicated that parents' reactions to a child's serious disease may entail long-term stress for the parents. However, further knowledge of its consequences is valuable. The aim of the study was to investigate the occurrence of burnout in a Swedish national sample of parents of children who had undergone HSCT and survived. Burnout (Shirom-Melamed Burnout Questionnaire) and estimations of the child's health status (Lansky/Karnofsky estimations and study-specific questions) were self-reported by 159 mothers and 123 fathers. In addition, physicians made estimations of the child's health status (Lansky/Karnofsky estimations). Nonparametric tests revealed that burnout symptoms occurred more often among fathers of children who had undergone transplantation within the last five yr compared to fathers of children with no history of serious disease (34.4% vs. 19.9%). Burnout among mothers and fathers was associated with the child's number and severity of health impairments up to five yr after the child underwent HSCT (Spearman's rho for mothers 0.26-0.36 and for fathers 0.36-0.61). In conclusion, chronic stress in parents after a child's HSCT seems to abate eventually. However, parents should be monitored and offered adequate support when needed. Moreover, the situation of fathers in the often mother-dominated pediatric setting should receive more attention in research as well as in the clinic.

  • 39. Lofkvist, Ulrika
    et al.
    Almkvist, Ove
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Lyxell, Bjoern
    Tallberg, Ing-Mari
    Lexical and semantic ability in groups of children with cochlear implants, language impairment and autism spectrum disorder2014In: International Journal of Pediatric Otorhinolaryngology, ISSN 0165-5876, E-ISSN 1872-8464, Vol. 78, no 2, p. 253-263Article in journal (Refereed)
    Abstract [en]

    Objective: Lexical-semantic ability was investigated among children aged 6-9 years with cochlear implants (CI) and compared to clinical groups of children with language impairment (LI) and autism spectrum disorder (ASD) as well as to age-matched children with normal hearing (NH). In addition, the influence of age at implantation on lexical-semantic ability was investigated among children with Cl. Methods: 97 children divided into four groups participated, CI (n = 34), LI (n = 12), ASD (n = 12), and NH (n = 39). A battery of tests, including picture naming, receptive vocabulary and knowledge of semantic features, was used for assessment. A semantic response analysis of the erroneous responses on the picture-naming test was also performed. Results: The group of children with Cl exhibited a naming ability comparable to that of the age-matched children with NH, and they also possessed a relevant semantic knowledge of certain words that they were unable to name correctly. Children with CI had a significantly better understanding of words compared to the children with LI and ASD, but a worse understanding than those with NH. The significant differences between groups remained after controlling for age and non-verbal cognitive ability. Conclusions: The children with Cl demonstrated lexical-semantic abilities comparable to age-matched children with NH, while children with LI and ASD had a more atypical lexical-semantic profile and poorer sizes of expressive and receptive vocabularies. Dissimilar causes of neurodevelopmental processes seemingly affected lexical-semantic abilities in different ways in the clinical groups.

  • 40.
    Lundequist, Aiko
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Karolinska Institutet, Sweden.
    Bohm, Birgitta
    Lagercrantz, Hugo
    Forssberg, Hans
    Smedler, Ann-Charlotte
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Cognitive outcome varies in adolescents born preterm, depending on gestational age, intrauterine growth and neonatal complications2015In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 104, no 3, p. 292-299Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this study was to investigate long-term cognitive outcome in a cohort of 18-year-olds born preterm and previously assessed at the age of 5.5.

    Methods: We tested 134 adolescents born preterm with a very low birthweight of <1500g and 94 term-born controls with a comprehensive cognitive battery at 18years of age. The cohort was subdivided into 73 extremely preterm, 42 very preterm and 19 moderately preterm infants with gestational ages of 23-27, 28-31 and 32-36weeks, respectively. The moderately preterm group was dominated by adolescents born small for gestational age.

    Results:Very preterm adolescents performed on a par with term-born controls. In contrast, extremely preterm adolescents displayed inferior results on all cognitive tests, more so if they had suffered neonatal complications. Moderately preterm adolescents scored lower than very preterm and full-term born adolescents, particularly on complex cognitive tasks.

    Conclusion: Adolescents born at 28weeks of gestation or later, with appropriate birthweight and no perinatal complications, functioned like term-born peers at 18years of age. Extremely preterm birth per se posed a risk for long-term cognitive deficits, particularly executive deficits. Adolescents born moderately preterm but small for gestational age were at risk of general cognitive deficits.

  • 41. Löf, Catharina M.
    et al.
    Winiarski, Jacek
    Ljungman, Per
    Forinder, Ulla
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    The socioeconomic and psychosocial circumstances of adult long-term survivors of hematopoietic stem cell transplantation in childhood2011In: Pediatric Transplantation, ISSN 1397-3142, E-ISSN 1399-3046, Vol. 15, no 7, p. 691-698Article in journal (Refereed)
    Abstract [en]

    Socioeconomic factors such as education, employment, financial circumstances, marital status, and psychological well-being were investigated in 51 Swedish adults (age 19-42) surviving for at least five yr following pediatric allogeneic SCT (age at SCT 1-16 yr) using items derived from a Living Condition Survey (ULF). Psychological well-being and cognitive faculties were measured by HAD and SWED-QUAL. Socioeconomic data and marital status were compared with a norm group matched for gender and age, derived from the Swedish national population registry. Most subjects function well and lead normal lives, and they are nevertheless more likely than the norm to encounter problems with establishing themselves on the labor market. The SCT group demonstrated a lower level of employment, and the likelihood of having a disability pension was higher than in the normal population. Younger subjects and women encountered most financial difficulties and a higher risk of poverty. Cognitive difficulties intercorrelated both with inferior financial circumstances and with higher levels of anxiety and depression. These results indicate the importance of recognizing and attempting to tackle the possible cumulative disadvantage of problems that affect the adult following SCT in childhood.

  • 42.
    Lönnerblad, Malin
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Special Education. Karolinska Institutet, Sweden.
    Lovio, Riikka
    Berglund, Eva
    Stockholm University, Faculty of Social Sciences, Department of Special Education.
    van't Hooft, Ingrid
    Affected Aspects Regarding Literacy and Numeracy in Children Treated for Brain Tumors2017In: Journal of Pediatric Oncology Nursing, ISSN 1043-4542, E-ISSN 1532-8457, Vol. 34, no 6, p. 397-405Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to investigate the test results of reading speed, reading comprehension, word comprehension, spelling, basic arithmetic skills, and number sense (intuitive understanding of numbers) by children treated for brain tumors. This is a retrospective study based on medical records, including standardized academic tests. In the years of 2010 to 2014, all children in the area of Stockholm between 7 and 18 years (IQ <70) who had no major linguistic or motor difficulties after they had undergone treatment for brain tumors were offered a special education assessment one year after treatment, at school start, or the year before a transition from one stage to another. Our results indicate that children treated for a brain tumor are at risk of having difficulties in spelling, reading speed, and arithmetic and that the test performance may decline over years in arithmetic and spelling. Children diagnosed at age 0 to 6 years may need extra tutoring at school start, especially in basic arithmetic skills. In both reading and mathematics, many children perform better on tests focused on understanding than on tests focused on speed. Continuous special needs assessments including different aspects of literacy and numeracy, are important for understanding each child's specific needs.

  • 43.
    Marklund, Ulrika
    et al.
    Stockholm University, Faculty of Humanities, Department of Linguistics. Danderyds Hospital, Sweden.
    Lacerda, Francisco
    Stockholm University, Faculty of Humanities, Department of Linguistics.
    Persson, Anna
    Lohmander, Anette
    The development of a vocabulary for PEEPS – SEprofiles of early expressive phonological skills for Swedish2018In: Clinical Linguistics & Phonetics, ISSN 0269-9206, E-ISSN 1464-5076, Vol. 32, no 9, p. 844-859Article, review/survey (Refereed)
    Abstract [en]

    This paper describes the development of a vocabulary for Profiles of Early Expressive Phonological Skills for Swedish (PEEPS-SE), a tool for assessment of expressive phonology in Swedish-learning children in the age range of 18-36months. PEEPS-SE is the Swedish version of the original PEEPS, Profiles of Early Expressive Phonological Skills, which uses two age-adequate word listsa basic word list (BWL) for the assessment of 18-24-month-old children, to which an expanded word list (EWL) is added for assessment of 24-36-month-old children, or children with more than 250 words in their expressive vocabulary.The selection of words in PEEPS-SE is based on two types of criteria: age of acquisition and phonological complexity. The words also need to be easy to elicit in a natural way in test situations. Vocabulary data previously collected with the Swedish Early Communicative Development Inventory are used for selection of age-adequate words, where the BWL contains words acquired earlier compared to the additional words in the EWL. The latter also contains words that are more phonologically complex compared to those in the BWL. Word complexity was determined by the Swedish version of word complexity measure. PEEPS-SE has made an attempt to match the original version of PEEPS in terms of both assessment method and word selection.

  • 44. Mikkonen, Janne
    et al.
    Moustgaard, Heta
    Remes, Hanna
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). University of Helsinki, Finland; Max Planck Institute for Demographic Research, Germany; Karolinska Institutet, Sweden.
    The Population Impact of Childhood Health Conditions on Dropout from Upper-Secondary Education2018In: Journal of Pediatric Surgery Case Reports, ISSN 0022-3476, E-ISSN 2213-5766, Vol. 196, p. 283-290.e4Article in journal (Refereed)
    Abstract [en]

    Objectives To quantify how large a part of educational dropout is due to adverse childhood health conditions and to estimate the risk of dropout across various physical and mental health conditions. Study design A registry-based cohort study was conducted on a 20% random sample of Finns born in 1988-1995 (n = 101 284) followed for school dropout at ages 17 and 21. Four broad groups of health conditions (any, somatic, mental, and injury) and 25 specific health conditions were assessed from inpatient and outpatient care records at ages 10-16 years. We estimated the immediate and more persistent risks of dropout due to health conditions and calculated population-attributable fractions to quantify the population impact of childhood health on educational dropout, while accounting for a wide array of sociodemographic confounders and comorbidity. Results Children with any health condition requiring inpatient or outpatient care at ages 10-16 years were more likely to be dropouts at ages 17 years (risk ratio 1.71, 95% CI 1.61-1.81) and 21 years (1.46, 1.37-1.54) following adjustment for individual and family sociodemographic factors. A total of 30% of school dropout was attributable to health conditions at age 17 years and 21% at age 21 years. Mental disorders alone had an attributable fraction of 11% at age 21 years, compared with 5% for both somatic conditions and injuries. Adjusting for the presence of mental disorders reduced the effects of somatic conditions. Conclusions More than one fifth of educational dropout is attributable to childhood health conditions. Early-onset mental disorders emerge as key targets in reducing dropout.

  • 45.
    Nakeva von Mentzer, Cecilia
    et al.
    Karolinska Institutet.
    Lyxell, Björn
    Linköping University.
    Sahlén, Birgitta
    Lund University.
    Wass, Malin
    Lindgren, Magnus
    Ors, Marianne
    Kallioinen, Petter
    Stockholm University, Faculty of Humanities, Department of Linguistics, Phonetics.
    Uhlén, Inger
    Karolinska Institutet.
    Computer-assisted training of phoneme-grapheme correspondence for children who are deaf and hard of hearing: Effects on phonological processing skills2013In: International Journal of Pediatric Otorhinolaryngology, ISSN 0165-5876, E-ISSN 1872-8464, Vol. 77, no 12, p. 2049-2057Article in journal (Refereed)
    Abstract [en]

    Objective: Examine deaf and hard of hearing (DHH) children's phonological processing skills in relation to a reference group of children with normal hearing (NH) at two baselines pre intervention. Study the effects of computer-assisted phoneme grapheme correspondence training in the children. Specifically analyze possible effects on DHH children's phonological processing skills. Methods: The study included 48 children who participated in a computer-assisted intervention study, which focuses on phoneme grapheme correspondence. Children were 5, 6, and 7 years of age. There were 32 DHH children using cochlear implants (CI) or hearing aids (HA), or both in combination, and 16 children with NH. The study had a quasi-experimental design with three test occasions separated in time by four weeks; baseline 1 and 2 pre intervention, and 3 post intervention. Children performed tasks measuring lexical access, phonological processing, and letter knowledge. All children were asked to practice ten minutes per day at home supported by their parents. Results: NH children outperformed DHH children on the majority of tasks. All children improved their accuracy in phoneme grapheme correspondence and output phonology as a function of the computer-assisted intervention. For the whole group of children, and specifically for children with CI, a lower initial phonological composite score was associated with a larger phonological change between baseline 2 and post intervention. Finally, 18 DHH children, whereof 11 children with CI, showed specific intervention effects on their phonological processing skills, and strong effect sizes for their improved accuracy of phoneme grapheme correspondence. Conclusion: For some DHH children phonological processing skills are boosted relatively more by phoneme grapheme correspondence training. This reflects the reciprocal relationship between phonological change and exposure to and manipulations of letters.

  • 46. Nilsson, Gill
    et al.
    Westerlund, Joakim
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Sahlgrenska University Hospital, Sweden; University of Gothenburg, Sweden.
    Fernell, Elisabeth
    Billstedt, Eva
    Miniscalco, Carmela
    Arvidsson, Thomas
    Olsson, Ingrid
    Gillberg, Christopher
    Neurodevelopmental problems should be considered in children with febrile seizures2019In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 108, no 8, p. 1507-1514Article in journal (Refereed)
    Abstract [en]

    Aim: Clinical developmental phenotyping of four- to five-year-old children with febrile seizures (FSs).

    Methods: Children with FS (n = 157, corresponding to 3.7% of the targeted general population of four-five-year-olds) had been identified at child healthcare centres in Gothenburg. Parents of 73 children (41 boys, 32 girls) accepted participation in the present study. The assessments included a neuropaediatric assessment, Movement ABC, Wechsler Preschool and Primary Scale of Intelligence-III and parent questionnaires (Five-to-Fifteen (FTF) and Strengths and Difficulties Questionnaire (SDQ)). Hospital records were reviewed, when applicable.

    Results: One-third of the children had at least one DSM-5 neurodevelopmental disorder diagnosis or marked developmental problems within areas of attention, activity regulation, behaviour, speech and language, general cognition or motor functioning. No differences were found between children with single vs recurrent or simple vs complex FS.

    Conclusion: Febrile seizure are relatively often associated with Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations (ESSENCEs). We found no indications that ESSENCE might be caused by FS per se. However, the results suggest that child healthcare professionals should consider the possibility of ESSENCE in children with a history of FS.

  • 47. Norberg, Hanna
    et al.
    Stålnacke, Jannica
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Heijtz, Rochellys Diaz
    Smedler, Ann-Charlotte
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Nyman, Margareta
    Forssberg, Hans
    Norman, Mikael
    Antenatal corticosteroids for preterm birth: dose-dependent reduction in birthweight, length and head circumference2011In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 100, no 3, p. 364-369Article in journal (Refereed)
    Abstract [en]

    Aim: This study was undertaken to evaluate the effects of repeated courses of antenatal corticosteroids (ACS) on foetal growth. Methods: We studied 94 infants exposed to 2-9 courses of ACS. Mean gestational age (GA) at first exposure was 29 and at birth 34 weeks. Exposure data were retrieved from case record files. Information on potential confounders was collected from the Swedish Medical Birth Registry. Standard deviation scores (SDS) for birthweight (BW), birthlength (BL) and head circumference (HC) were calculated and considered as outcomes. Results: GA at start of ACS did not affect outcome. BW-SDS, BL-SDS and HC-SDS were -0.21, -0.19 and +0.25 in infants exposed to two courses, compared to -1.01, -1.04 and -0.23 in infants exposed to >= 4 courses of ACS (p = 0.04-0.07). In multiple regression analyses, >= 4 courses were associated with lower BW-SDS, BL-SDS and HC-SDS (p = 0.007-0.04) compared to SDS after 2-3 courses. The effects from >= 4 courses on BW and BL were comparable to reduction in birth size seen in twins and on HC to that observed after maternal smoking. Conclusions: Multiple courses of ACS are associated with a dose-dependent decline in foetal growth, which may affect later development and health.

  • 48. Norberg, Hanna
    et al.
    Stålnacke, Johanna
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Karolinska Institute.
    Nordenström, Anna
    Norman, Mikael
    Repeat Antenatal Steroid Exposure and Later Blood Pressure, Arterial Stiffness, and Metabolic Profile2013In: Journal of Pediatrics, ISSN 0022-3476, E-ISSN 1097-6833, Vol. 163, no 3, p. 711-716Article in journal (Refereed)
    Abstract [en]

    Objective To determine the relationship between repeat courses of antenatal corticosteroids (ACS) and risk factors for cardiovascular disease in adolescents and young adults. Study design We assessed body mass index, blood pressure, arterial stiffness, blood lipids, and insulin resistance (IR) in a Swedish population-based cohort (n = 100) at a median age of 18 (range 14-26) years. Fifty-eight subjects (36 males) had been exposed to 2-9 weekly courses of antenatal betamethasone and 42 (23 males) were unexposed subjects matched for age, sex, and gestational age (GA). Results There were no significant differences between the groups regarding body mass index, systolic or diastolic blood pressures, arterial stiffness measured by augmentation index, blood lipids, IR, or morning cortisol levels either in simple regression or in multivariable models. However, more subjects with elevated augmentation index had been exposed to repeat courses of ACS (n = 7) compared with unexposed subjects (n = 1, P = .06), and glucose, insulin, and IR correlated inversely to GA at start of ACS (P < .01). Conclusions Repeat courses of ACS did not correlate to adverse cardiovascular risk profile in adolescence and young adulthood, but long-standing effects on the arterial tree and glucose metabolism, the latter dependent on GA at ACS exposure, cannot be excluded. These observations have clinical implications for the ongoing discussion on short-term benefits and long-term safety of repeat ACS treatment.

  • 49. Olsson, Martina Barnevik
    et al.
    Carlsson, Lotta Höglund
    Westerlund, Joakim
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Gillberg, Christopher
    Fernell, Elisabeth
    Autism before diagnosis: crying, feeding and sleeping problems in the first two years of life2013In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 102, no 6, p. 635-639Article in journal (Refereed)
    Abstract [en]

    Aim To chart early registered regulatory problems (RP) in a representative group of young children with and without autism spectrum disorder (ASD). Methods The target group comprised 208 preschool children with ASD, whose records from the Child Health Centres (CHC) were reviewed regarding numbers of consultations for excessive crying, feeding and sleeping problems. The records from an age- and gender-matched comparison group were obtained from the same CHCs as those of the index children Results Significant differences between the ASD and comparison groups were found for each domain studied and when domains were collapsed. Two or more consultations had occurred in 44% of the children in the ASD group and in 16% of the comparison group (p<0.001). No correlations were found with regard to gender, later severity of autism, cognitive level or degree of hyperactivity. Conclusion Regulatory problems (RP) were much more common in children who later received a diagnosis of ASD. Children with many RP in infancy require attention from CHC and paediatric services and need to be followed with regard to development and family support.

  • 50. Olén, Ola
    et al.
    Bihagen, Erik
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Rasmussen, Finn
    Ludvigsson, Jonas F.
    Socioeconomic position and education in patients with coeliac disease2012In: Digestive and Liver Disease, ISSN 1590-8658, E-ISSN 1878-3562, Vol. 44, no 6, p. 471-476Article in journal (Refereed)
    Abstract [en]

    Background and aim: Socioeconomic position and education are strongly associated with several chronic diseases, but their relation to coeliac disease is unclear. We examined educational level and socioeconomic position in patients with coeliac disease. Methods: We identified 29,096 patients with coeliac disease through biopsy reports (defined as Marsh 3: villous atrophy) from all Swedish pathology departments (n=28). Age- and sex-matched controls were randomly sampled from the Swedish Total Population Register (n=145,090). Data on level of education and socioeconomic position were obtained from the Swedish Education Register and the Occupational Register. We calculated odds ratios for the risk of having coeliac disease based on socioeconomic position according to the European Socioeconomic Classification (9 levels) and education. Results: Compared to individuals with high socioeconomic position (level 1 of 9) coeliac disease was less common in the lowest socioeconomic stratum (routine occupations = level 9 of 9: adjusted odds ratio = 0.89; 95% confidence interval = 0.84-0.94) but not less common in individuals with moderately low socioeconomic position: (level 7/9: adjusted odds ratio = 0.96; 95% confidence interval = 0.91-1.02; and level 8/9: adjusted odds ratio = 0.99; 95% confidence interval = 0.93-1.05). Coeliac disease was not associated with educational level. Conclusions: In conclusion, diagnosed coeliac disease was slightly less common in individuals with low socioeconomic position but not associated with educational level. Coeliac disease may be unrecognised in individuals of low socioeconomic position.

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