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  • 1. Aronsson, B.
    et al.
    Wiberg, C.
    Sandstedt, P.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
     Asylum-seeking children with severe loss of activities of daily living: clinical signs and course during rehabilitation2009In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 98, no 12, p. 1977-1981Article in journal (Refereed)
  • 2.
    Bergström, Malin
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Fransson, Emma
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Fabian, Helena
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Sarkadi, Anna
    Salari, Raziye
    Preschool children living in joint physical custody arrangements show less psychological symptoms than those living mostly or only with one parent2018In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 107, no 2, p. 294-300Article in journal (Refereed)
    Abstract [en]

    Aim

    Joint physical custody (JPC), where children spend about equal time in both parent's homes after parental separation, is increasing. The suitability of this practice for preschool children, with a need for predictability and continuity, has been questioned.

    Methods

    In this cross-sectional study, we used data on 3656 Swedish children aged three to five years living in intact families, JPC, mostly with one parent or single care. Linear regression analyses were conducted with the Strengths and Difficulties Questionnaire, completed by parents and preschool teachers, as the outcome measure.

    Results

    Children in JPC showed less psychological problems than those living mostly (adjusted B 1.81; 95% CI [0.66 to 2.95]) or only with one parent (adjusted B 1.94; 95% CI [0.75 to 3.13]), in parental reports. In preschool teacher reports, the adjusted Betas were 1.27, 95% CI [0.14 to 2.40] and 1.41, 95% CI [0.24 to 2.58], respectively. In parental reports, children in JPC and those in intact families had similar outcomes, while teachers reported lower unadjusted symptom scores for children in intact families.

    Conclusion

    Joint physical custody arrangements were not associated with more psychological symptoms in children aged 3–5, but longitudinal studies are needed to account for potential preseparation differences.

  • 3.
    Brolin Låftman, Sara
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Fransson, Emma
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Modin, Bitte
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Östberg, Viveca
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    National data study showed that adolescents living in poorer households and with one parent were more likely to be bullied2017In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 106, no 12, p. 2048-2054Article in journal (Refereed)
    Abstract [en]

    Aim

    The aim of this study was to assess whether sociodemographic household characteristics were associated with which Swedish adolescents were more likely to be bullied.

    Methods

    The data were derived from the Swedish Living Conditions Survey and its child supplements from the survey years 2008-2011. The analyses included information on 3,951 adolescents aged 10-18 years. Exposure to bullying was reported by adolescents and information on sociodemographic household characteristics was reported by parents and obtained from official registers. Binary logistic regression was used to analyse the data.

    Results

    Adolescents were more likely to be bullied if they lived in households with no cash margin, defined as the ability to pay an unexpected bill of 8,000 Swedish Kronor or about 800 Euros, and if they lived with just one custodial parent. In the unadjusted analyses, elevated risks were identified if adolescents lived in working class households and had unemployed and foreign-born parents. However, these associations were at least partly accounted for by other sociodemographic household characteristics, in particular the lack of a cash margin.

    Conclusion

    This study showed that Swedish adolescents living in households with more limited financial resources had an increased risk of being bullied, supporting results from previous international research.

  • 4. Chen, Tian-Jiao
    et al.
    Modin, Bitte
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Ji, Cheng-Ye
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Regional, socioeconomic and urban-rural disparities in child and adolescent obesity in China: a multilevel analysis2011In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 100, no 12, p. 1583-1589Article in journal (Refereed)
    Abstract [en]

    Aim:  To study socio-demographic patterns of obesity in Chinese children and adolescents. Methods:  Data came from the 2005 cycle of the Chinese National Survey on Student's Constitution and Health. In all, 231 326 subjects aged 7-18 years, distributed across 622 schools and 30 provinces, were analysed. Multilevel modelling was used to estimate variations at individual, school area and province levels. Results:  The prevalence of obesity varied enormously across different areas. Young people living in high socioeconomic and urban areas had higher body mass index (BMI) and higher odds of overweight and obesity than those living in lower socioeconomic and rural areas. Subjects living in provinces with a higher standard of living, as indicated by less perinatal mortality, lower Engel coefficient, and higher personal expenditure on health had higher BMI and higher odds of overweight and obesity than those living in less affluent provinces. An interaction between gender and urbanicity revealed that boys in urban areas were especially prone to obesity. Conclusion:  In contrast to most present-day high income countries, obesity among young people in China is associated with affluence and urban residence. Intervention and strategy for obesity prevention should be targeting high socioeconomic families in urban areas, perhaps with particular focus on boys.

  • 5. Dahl, Sara
    et al.
    Wickström, Ronny
    Ek, Ulla
    Stockholm University, Faculty of Social Sciences, Department of Special Education.
    Fahnehjelm, Kristina Tear
    Children with optic nerve hypoplasia face a high risk of neurodevelopmental disorders2018In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 107, no 3, p. 484-489Article in journal (Refereed)
    Abstract [en]

    Aim: Optic nerve hypoplasia (ONH) is a congenital ocular malformation that has been associated with neurodevelopmental disorders, but the prevalence in unilateral disease and less severe visual impairment is unknown. We studied intellectual disability and autism spectrum disorders (ASDs) in patients with ONH.

    Methods: This was a population-based cross-sectional cohort study of 65 patients (33 female) with ONH below 20 years of age, living in Stockholm in December 2009, with data analysed in January 2016. Of these 35 were bilateral and 30 were unilateral. Neurodevelopmental disorders were diagnosed or confirmed by neurological assessments, the Five to Fifteen parent questionnaire and reviewing previous neuropsychological investigations or conducting neuropsychological tests.

    Results: Bilateral ONH patients had lower mean full scale intelligence quotient scores than unilateral patients (84.4 and 99.4, respectively, p = 0.049). We assessed intellectual disability in 55 eligible patients, and it was more common in patients with bilateral ONH (18 of 32, 56%) than unilateral ONH (two of 23, 9%, p < 0.001). ASDs were diagnosed in seven of 42 (17%) patients.

    Conclusion: Children with bilateral ONH had a high risk of neurodevelopmental disorders, especially intellectual disability. The risk was lower in unilateral ONH, but the levels of neurodevelopmental disorders warrant screening of both groups.

  • 6. 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.

  • 7.
    Ek, Ulla
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Special Education.
    Westerlund, Joakim
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Holmberg, K.
    Fernell, E.
    Academic performance of adolescents with ADHD and other behavioural and learning problems: a population-based longitudinal study2011In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 100, no 3, p. 402-406Article in journal (Refereed)
    Abstract [en]

    Aim: To study academic performance (final grades at the age of 16 years) in individuals with i) attention-deficit/hyperactivity disorder (ADHD) and ii) other learning and/or behavioural problems. Methods: Of a total population of 591 children, originally assessed at the age of 10-11 years, it was possible to obtain final grades for 536 16-year-olds (in grade 9). Those fulfilling the criteria for ADHD/sub-threshold ADHD (n=39) and those with 'Behaviour and Learning Problems' (BLP group), (n=80) and a comparison group (n=417) were contrasted. Results: The ADHD and BLP groups had a significantly lower total mean grade at the age of 16 years than the comparison group. In addition, the ADHD and BLP groups also qualified for further studies in the upper secondary school to a significantly lesser extent than the controls (72%, 68% and 92%, respectively). All IQ measures (at the age of 10-11 years) were positively correlated with the overall grade after grade 9, with especially strong correlations for verbal capacity. Conclusion: ADHD and similar problems entail a risk of underachievement at school. The results indicate that pupils with ADHD underachieve in the school situation in relation to their optimal cognitive capacity. The contextual situation and the particular requirements should be considered in order for adequate educational measures to be undertaken.

  • 8. 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.

  • 9. 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.

  • 10. Fernell, Elisabeth
    et al.
    Ek, Ulla
    Stockholm University, Faculty of Social Sciences, Department of Special Education.
    Borderline intellectual functioning in children and adolescents - insufficiently recognized difficulties2010In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 99, no 5, p. 748-753Article in journal (Refereed)
    Abstract [en]

    Aim: To draw attention to groups of children and adolescents with borderline intellectual functioning, especially with respect to their school-situation. Methods: In one study, population-based, children with borderline intellectual functioning at age 10 years were followed until they finished compulsory school when their final certificates could be analysed. In a second study parents of 20 individuals in the upper secondary school for pupils with mild mental retardation were interviewed according to the Vineland adaptive scales and school health records were reviewed. In a third study pupils attending an individual programme in upper secondary school were assessed and we report one representative case. Results: (1) Pupils with borderline intellectual functioning, assessed in grade 4, received significantly lower grades when finishing the compulsory school. (2) In the group of pupils in the upper secondary school for the mildly mentally retarded, compiled data indicated that a considerable number did not fulfil the combined IQ and adaptive criteria for mild mental retardation. (3) The subtle nature of borderline intellectual functioning may delay appropriate measures at school, which our case illustrates. Conclusion: Borderline intellectual functioning seldom attracts attention. Our studies indicate that school and also society at large must be prepared to adapt educational and working conditions for the large minority of individuals with borderline intellectual functioning.

  • 11. Hedvall, Åsa
    et al.
    Westerlund, Joakim
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Fernell, Elisabeth
    Holm, Anette
    Gillberg, Christopher
    Billstedt, Eva
    Autism and developmental profiles in preschoolers: stability and change over time2014In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 103, no 2, p. 174-181Article in journal (Refereed)
    Abstract [en]

    AimIncreasing numbers of young children are now being diagnosed with autism spectrum disorder (ASD). This study aimed to analyse developmental trajectories in a representative group of preschool children with ASD. MethodIn a naturalistic study, 208 preschool children with different subtypes of ASD were followed over a 2-year period. Their trajectories, as regards persistence of ASD diagnoses, developmental/intellectual levels, adaptive functioning and expressive speech, were monitored. ResultsDevelopmental profiles showed considerable change over time, especially in children with atypical autism and in those with developmental delay/borderline intellectual functioning at their first assessment. Approximately 50% of the children were found to have intellectual disability (ID) at follow-up and, of these, the majority had severe ID. This was in contrast to the first assessment by the referral team when ID had rarely been mentioned or discussed. ConclusionChanges in developmental profiles during preschool years are common in children with ASD. This implies that reassessments, covering different developmental areas, are needed. Such follow-up assessments prior to the start of school will yield a more valid estimation of the child's general cognitive level and a more accurate ASD diagnosis and thus form a better basis for realistic educational planning and intervention.

  • 12. Hirvikoski, Tatja
    et al.
    Lindholm, Torun
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Lajic, Svetlana
    Nordenström, Anna
    Gender role behaviour in prenatally dexamethasone-treated children at risk for congenital adrenal hyperplasia - a pilot study2011In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 100, no 9, p. e112-E119Article in journal (Refereed)
    Abstract [en]

    Aim: To investigate the effects of prenatal dexamethasone (DEX) exposure on gender role behaviour. Methods: The participants were 25 of the 40 children (62%, mean age 11 years) at risk for CAH treated with DEX prenatally during the years 1985-1995 in Sweden. The control group consisted of 35 sex- and age-matched healthy children. A new inventory, the Karolinska Inventory of Gender Role Behaviour (KI-GRB), was developed to assess directly school-age children's behaviour, and was evaluated using a separate sample of 160 school-age children. Results: DEX-treated CAH-unaffected boys showed more neutral behaviours than the controls (p = 0.04), while the DEX-treated CAH-unaffected girls did not differ from the controls after adjusting for the site of residence. There was a larger variation in the behaviour of the DEX-treated boys (p < 0.05) and a tendency for less-masculine behaviours in the DEX-treated CAH-unaffected children (p = 0.13). There were no between-group differences in the feminine behaviours. Recalculation of the analyses including the CAH-affected children showed analogous results. Conclusions: This pilot study indicates that the gender role behaviour may be affected in boys as an effect of DEX exposure in early pregnancy. Larger retrospective studies are needed for more conclusive results.

  • 13.
    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.

  • 14. Hjern, Anders
    et al.
    Ekeus, Cecilia
    Rasmussen, Finn
    Lindblad, Frank
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    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.

  • 15.
    Hjern, Anders
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Weitoft, G.R.
    Lindblad, Frank
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Social adversity predicts ADHD-medication in school children – a national cohort study2010In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 99, no 6, p. 920-924Article in journal (Refereed)
    Abstract [en]

    Aims: To test the hypothesis that psychosocial adversity in the family predicts medicated ADHD in school children.

    Method: ADHD-medication during 2006 was identified in the Swedish Prescribed Drug Register in national birth cohorts of 1.1 million 6–19 year olds. Logistic regression models adjusted for parental psychiatric disorders were used to test our hypothesis.

    Results: There was a clear gradient for ADHD medication with level of maternal education, with an adjusted odds ratio of 2.20 (2.04–2.38) for the lowest compared with the highest level. Lone parenthood and reception of social welfare also implied higher risks of ADHD-medication with adjusted ORs of 1.45 (1.38–1.52) and 2.06 (1.92–2.21) respectively. Low maternal education predicted 33% of cases with medicated ADHD and single parenthood 14%.

    Conclusions: Social adversity in the family predicts a considerable proportion of ADHD-medication in school children in Sweden.

  • 16. Holmberg, K.
    et al.
    Sundelin, C.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Routine developmental screening at 5.5 and 7 years of age is not an efficient predictor of attention-deficit / hyperactivity disorder at age 102010In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 99, no 1, p. 112-20Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this study was to assess the efficiency of developmental screening for deficits in attention, motor control and perception or attention-deficit/hyperactivity disorder (DAMP/ADHD) at 5.5 and 7 years of age for diagnosing ADHD in grade 4.

    Method: The study population consisted of 442 children from a cohort study of ADHD in 10-year olds in one municipality in Stockholm County. Sensitivity, specificity and positive predictive value of a developmental screening at 5.5 and at 7 years of age for being diagnosed with ADHD at 10 years of age was calculated.

    Results: The sensitivity was 44%, the specificity 85% and the positive predictive value for having a diagnosis of pervasive ADHD in 4th grade was 15%, when at least two deviations in nine items was used as the cut-off point in 5.5-year screening at Child Health Centres (CHCs). With a cut-off score of at least two deviations in four items rated by parents or and teachers in 1st grade, these estimates were 58%, 81% and 15% respectively.

    Conclusion: This study demonstrates that developmental screening for DAMP/ADHD at 5.5 and 7 years of age does not identify children who are diagnosed with ADHD in grade 4 with a high degree of selectivity.

  • 17. 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%.

  • 18.
    Ivarsson, Malena
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Anderson, Martin
    Karolinska Institutet.
    Åkerstedt, Torbjörn
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Lindblad, Frank
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Playing a violent television game affects heart rate variability2009In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 98, no 1, p. 166-172Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate how playing a violent/nonviolent television game during the evening affects sympathetic and parasympathetic reactions during and after playing as well as sleep quality during the night after playing.

    Subjects and Methods: In total, 19 boys, 12–15 years of age, played television games on two occasions in their homes and participated once without gaming. Heart rate, heart rate variability (HRV) and physical activity were measured during gaming/participating and the night to follow using a portable combined heart rate and movement sensor. A sleep diary and questionnaires about gaming experiences and session-specific experiences were filled in.

    Criteria for Selection of Games: Violent game involves/rewards direct physical violence (no handguns) against another person, and nonviolent game involves/rewards no violence; same game design ('third-person game'); conducted in the same manner; no differences concerning motor activity; similar sound and light effects; no sexual content, violence against women or racial overtones.

    Results: During violent (vs. nonviolent) gaming, there was significantly higher activity of the very low frequency component of the HRV and total power. During the night after playing, very low frequency, low frequency and high frequency components were significantly higher during the violent (vs. nonviolent) condition, just as total power. There were no significant differences between the three conditions (violent/nonviolent/no gaming) with respect to an index reflecting subjectively perceived sleep difficulties. Nor was there any difference between violent and nonviolent condition for any single sleep item.

    Conclusion: Violent gaming induces different autonomic responses in boys compared to nonviolent gaming – during playing and during the following night – suggesting different emotional responses. Subjectively perceived sleep quality is not influenced after a single gaming experience. Future studies should address the development of the autonomic balance after gaming over longer time than a night, physiological adaptation to frequent gaming and potential gender differences.

  • 19.
    Ivarsson, Malena
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Anderson, Martin
    Karolinska Institutet.
    Åkerstedt, Torbjörn
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Lindblad, Frank
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Playing a violent television game does not affect saliva cortisol2009In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 98, no 6, p. 1052-1053Article in journal (Refereed)
  • 20. Kark, M.
    et al.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    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.

  • 21. 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.

  • 22. Köhler, M
    et al.
    Emmelin, M
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Rosvall, M
    Children in family foster care have greater health risks and less involvement in child health services2015In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 104, no 5, p. 508-513Article in journal (Refereed)
    Abstract [en]

    Aim

    This study investigated the impact of being in family foster care on selected health determinants and participation in Child Health Services (CHS).

    Methods

    Two groups of 100 children, born between 1992 and 2008, were studied using data from Swedish Child Health Services for the preschool period up to the age of six. The first group had been in family foster care, and the controls, matched for age, sex and geographic location, had not. Descriptive statistics were used to describe differences in health determinants and participation in Child Health Services between the two groups.

    Results

    The foster care group had higher health risks, with lower rates of breastfeeding and higher levels of parental smoking. They were less likely to have received immunisations and attended key nurse or physician visits and speech and vision screening. Missing data for the phenylketonuria test were more common in children in family foster care.

    Conclusion

    Children in family foster care were exposed to more health risks than the control children and had lower participation in the universal child health programme during the preschool period. These results call for secure access to high-quality preventive health care for this particularly vulnerable group of children.

  • 23. Lindgren, C
    et al.
    Lindblad, Frank
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    The enigma of the welfare state: excellent child health prerequisites--poor subjective health2010In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 99, no 6, p. 803-7Article in journal (Refereed)
    Abstract [en]

    The rate of subjective health complaints among Swedish children is increasing by age and over time, and more so than among children in other Scandinavian countries. In contrast, the somatic health and prerequisites for wellbeing are excellent. This paradoxical situation, The Enigma of the Welfare State, is the focus of this viewpoint. We argue that one important background factor may be late adverse effects of the welfare society itself and some of its inherent values. We have identified several possible pathways. We have given them names of diseases--on the society level--like health obsession, stress panic, welfare apathy and hyper-individualism. Together with other factors such as a dysfunctional school and an unsatisfactory labour market for youth, these diseases are involved in an interplay that is constantly inducing anxiety and low self-esteem. CONCLUSION: The gradually deteriorating self-reported health among Swedish youth may, to some degree, be explained as a late adverse effect of the welfare society itself and its inherent values.

  • 24. Lindström, K.
    et al.
    Lindblad, F.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Preterm birth and ADHD in school children : a Swedish national cohort study2010In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 99, no Suppl46, p. 66-Article in journal (Refereed)
  • 25.
    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.

  • 26. 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.

  • 27. 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.

  • 28. Otterman, Gabriel
    et al.
    Lainpelto, Katrin
    Stockholm University, Faculty of Law, Department of Law, Stockholm Centre for the Rights of the Child.
    Lindblad, Frank
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Factors influencing the prosecution of child physical abuse cases in a Swedish metropolitan area2013In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 102, no 12, p. 1199-1203Article in journal (Refereed)
    Abstract [en]

    AIM: To examine whether case characteristics of alleged child physical abuse, such as severity, influence criminal investigation procedures and judicial outcomes.

    METHOD: We identified all police-reported cases of nonfatal child physical abuse during 2006 in a Swedish metropolitan area (n = 158). Case characteristics were abstracted from police records.

    RESULTS: Over half (56%) of the victims were boys, and the median age group was 9-12 years. The severity of the alleged violence was low in 8% of cases, moderate in 51% and high in 41%. Suspects were interviewed in 53% of cases, with fathers more likely to be interviewed than mothers. Children were forensically interviewed in 52% of cases, with 9% physically examined by a clinician and 2.5% by a forensic specialist. Seven per cent of the cases were prosecuted and 1.3% resulted in summary punishment. We found no association between severity of alleged abuse and whether the suspect was interviewed, the child was forensically interviewed or physically examined or whether the perpetrator was prosecuted.

    CONCLUSIONS: Despite the high severity of alleged violence, physical examination rates were low, suggesting a need for criminal investigative procedures on child physical abuse to be reviewed in Sweden.

  • 29. Rindsjö, Erika
    et al.
    Barber, Matthew
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Lindblad, Frank
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Alm, Johan
    Scheynius, Annika
    Joerink, Maaike
    Increased mRNA expression of glucocorticoid receptor-P in placenta is associated with a decreased risk of allergen sensitisation in the child2015In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 104, no 6, p. 638-640Article in journal (Refereed)
  • 30. Schollin Ask, Lina
    et al.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden; Sachs′ Children and Youth Hospital, Sweden.
    Lindstrand, Ann
    Olen, Ola
    Sjögren, Eva
    Blennow, Margareta
    Örtqvist, Ake
    Receiving early information and trusting Swedish child health centre nurses increased parents' willingness to vaccinate against rotavirus infections2017In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 106, no 8, p. 1309-1316Article in journal (Refereed)
    Abstract [en]

    Aim: Rotavirus vaccines are effective against severe infections, but have a modest impact on mortality in high-income countries. Parental knowledge and attitudes towards vaccines are crucial for high vaccination coverage. This study aimed to identify why parents refused to let their infant have the vaccination or were unsure. Methods: This cross-sectional study was based on 1,063 questionnaires completed by the parents of newborn children in 2014. Stepwise logistic regression was used to identify the main predictors. Results: Most (81%) parents intended to vaccinate their child against the rotavirus, while 19% were unwilling or uncertain. Parents with less education and children up to five weeks of age were more likely to be unwilling or uncertain about vaccinating their child. Factors associated with a refusal or uncertainty about vaccinating were not having enough information about the vaccine, no intention of accepting other vaccines, paying little heed to the child health nurses' recommendations, thinking that the rotavirus was not a serious illness and not believing that the vaccine provided protection against serious forms of gastroenteritis. Conclusion: Early information, extra information for parents with less education and close positive relationships between parents and child health nurses were important factors in high rotavirus vaccination rates.

  • 31. Swartz, Jackie
    et al.
    Alm, Johan
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Lindblad, Frank
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Uppsala University.
    Parental Sense of Coherence in the first 2 years of life is not related to parental and child diurnal cortisol rhythm or proxies of anthroposophic lifestyle2013In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 102, no 9, p. 920-924Article in journal (Refereed)
    Abstract [en]

    Aim: Sense of Coherence (SOC) is hypothesized to have direct physiological consequences on endocrine and immunological processes. In this study, we compare parental SOC scores from pregnancy in groups of infants and parents representing different lifestyles (anthroposophic, partly anthroposophic and nonanthroposophic). We also analyse whether these could predict cortisol levels of the parents and their infants at 6-24 months postpartum. Methods: Parental SOC-13 was collected during the third trimester of pregnancy from a birth cohort of families with different lifestyles. Salivary samples were collected from the whole family when the child was 6 months (n = 210), 12 (n = 178) and 24 months of age (n = 149), and cortisol levels were analysed with radioimmunoassay technique. Results: Sense of Coherence scores did not differ between the three lifestyle groups, and there were no correlations between SOC scores and salivary cortisol concentrations in separate analyses of mothers, fathers and children at any sampling age or at any sampling time during the day (morning, afternoon, bedtime). Conclusion: Sense of Coherence scores did not vary in parents with different lifestyles and were not associated with salivary cortisol levels in parents or in children.

  • 32. Swartz, Jackie
    et al.
    Stenius, Fredrik
    Alm, Johan
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Lindblad, Frank
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Uppsala University, Sweden.
    Lifestyle and salivary cortisol at the age of 12 and 24 months2012In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 101, no 9, p. 979-984Article in journal (Refereed)
    Abstract [en]

    Aim: To analyse salivary cortisol levels in 12- and 24-month-olds from families with an anthroposophic lifestyle and comparisons (partly anthroposophic and non-anthroposophic). Methods: Salivary samples were collected at child ages of 12 (n = 178) and 24 (n = 149) months. Cortisol was analysed with radioimmunoassay technique. Results: Evening cortisol levels in children from anthroposophic families were lower than in comparisons at 12 months of age (geometric means: anthroposophic 1.7, partly anthroposophic 1.9, non-anthroposophic 3.6 nmol/L; p = 0.024) and at 24 months of age (1.1, 1.8 and 2.9 nmol/L, respectively; p = 0.002). At 24 months of age, similar differences were noted also for the afternoon levels (2.3, 3.3 and 3.9 nmol/L, respectively; p = 0.043). At age 12 months, the differences in the evening cortisol were statistically explained by a meat-free diet and at age 24 months by the anthroposophic lifestyle as such. The circadian variations were parallel in the three groups at age 12 and 24 months. No cortisol differences were observed between parents representing different lifestyles. Conclusions: An anthroposophic lifestyle is associated with low cortisol levels in the evening at age 12 and 24 months, at age 24 months also in the afternoon.

  • 33. Söderström, Ulf
    et al.
    Aman, Jan
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Being born in Sweden increases the risk for type 1 diabetes: a study of migration of children to Sweden as a natural experiment.2012In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 101, no 1, p. 73-77Article in journal (Refereed)
    Abstract [en]

    Aim:  To investigate whether the age of first exposure to a high-incidence country like Sweden determines the risk of T1DM in children with an origin in a low incidence region of the world. Methods:  Register study in a Swedish study population in the age 6-25 years in three categories of residents with an origin in low incidence regions of T1DM (Eastern Europe, East Asia, South Asia and Latin America); 24 252 international adoptees; 47 986 immigrants and 40 971 Swedish-born with two foreign-born parents and a comparison group of 1 770 092 children with Swedish-born parents. Retrieval of a prescription of insulin during 2006 was used as an indicator of T1DM and analysed with logistic regression. Results:  The odds ratios (OR) for T1DM were lower than the Swedish majority population for residents with an origin in the four low incidence regions. Being Swedish-born implied a higher risk for T1DM in the four low incidence study groups compared with the internationally adopted with an OR of 1.68 (CI 1.03-2.73). Conclusions:  Being born in Sweden increases the risk for T1DM in children with an origin in low incidence countries. This may imply that exposures in utero or very early infancy are important risk factors for T1DM.

  • 34.
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Growing evidence supports the positive impact of music on child health2016In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 105, no 10, p. 1119-1120Article in journal (Other academic)
  • 35.
    Theorell, Töres
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Lennartsson, A. -K
    Madison, G.
    Mosing, M. A.
    Ullén, F.
    Predictors of continued playing or singing - from childhood and adolescence to adult years2015In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 104, no 3, p. 274-284Article in journal (Refereed)
    Abstract [en]

    Aim: Many individuals play an instrument or sing during childhood, but they often stop later in life. This study surveyed adults representative of the Swedish population about musical activities during childhood.

    Methods: We asked 3820 adults (65% women) aged from 27 to 54 from the Swedish Twin Registry, who took extra music lessons to those provided at school, to fill in a web-based questionnaire. Factors analysed were the age they started studying music, the instrument they played, kind of teaching, institution and educational content, number of lessons and perceived characteristics of the lessons, the music environment during their childhood years and their preferred music genre. All variables were dichotomised.

    Results: Factors strongly associated with continued playing or singing were male sex, young starting age, cultural family background, self-selected instrument, attending music classes and more than once a week, church-related or private education, pop, rock or classical music, playing by ear and improvisation.

    Conclusion: Several significant predictors determined whether a child continued to sing or play an instrument as an adult and many could be externally influenced, such as starting at a young age, taking music classes more than once a week, improvisation and the type of music they played.

  • 36. Wallby, T.
    et al.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Child health care uptake among low-income and immigrant families in a Swedish county2011In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 100, no 11, p. 1495-1503Article in journal (Refereed)
    Abstract [en]

    Aim:  To study the uptake of child health care among low-income and immigrant families in the county of Uppsala, Sweden, to investigate whether these families received extra attention as proposed in the Swedish Child Health Services (CHS) state-of-the-art consensus document from the year 2000.

    Methods:  Data were collected for 25 024 infants born 1998–2006 from the database of statistics of the Child Health Care Unit in Uppsala and socio-demographic indicators from Swedish national registers. Disposable income was divided into quartiles. Country of birth of the mother was categorized into four regions with two subgroups each, mothers with or without a Swedish-born partner. Analysis was conducted by Cox regression and linear regression models.

    Results:  Small differences between Swedish vs. immigrant and high vs. low-income families were detected. Low-income mothers (RR 0.78) as well as mothers born in all country of birth regions with an immigrant partner (RR 0.28–0.95) had lower rates of participation in parental groups.

    Conclusion:  The CHS provided basic child health care to almost all infants including children in immigrant and low-income Swedish families. However, the results did not indicate that disadvantaged families received the extra attention proposed in the consensus document.

  • 37. Wallby, T.
    et al.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Region of birth, income and breastfeeding in a Swedish county2009In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 98, no 11, p. 1799-804Article in journal (Refereed)
    Abstract [en]

    Aim:  To study the relationship between maternal region of birth, disposable income and breastfeeding initiation and duration.

    Methods:  The study population consisted of 12 197 term born, singleton infants, born 1997–2001 in the county of Uppsala. Data on breastfeeding at 1 week, 6 months and 12 months were collected from the register of statistics of the Child Health Care Unit in Uppsala and socioeconomic indicators from Swedish national registers. Multivariate analysis was conducted using Cox regression.

    Results:  No influence of disposable income or region of birth on breastfeeding initiation was observed. Breastfeeding rates at 6 months were lower for mothers with disposable incomes in quartile 1–3 compared with mothers with the highest incomes in quartile 4 (hazard ratios (HRs) 0.88–0.90, adjusted HRs 0.92). The breastfeeding rates at 12 months were higher for mothers born in all regions compared with mothers born in Sweden (HRs 1.25–2.45, adjusted HRs 1.20–2.14).

    Conclusions:  The findings in the present study show that disposable income is a strong predictor for breastfeeding at 6 months in the Swedish context. Region of birth of the mother predicted long term breastfeeding, ≥12 months. This calls for professionals in the maternity and child health care to pay extra attention to breastfeeding in low-income mothers in all ethnic groups.

  • 38.
    Wells, Michael B.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Literature review shows that fathers are still not receiving the support they want and need from Swedish child health professionals2016In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 105, no 9, p. 1014-1023Article, review/survey (Refereed)
    Abstract [en]

    Sweden has a reputation for gender equality, and its child health services seek to support both parents. However, this meta-ethnographic analysis of 62 studies from 2000 to 2015 covering prenatal clinics, labour and birth wards, postnatal wards and child health centres found programmes had not been designed around paternal needs. Therefore, despite the policy change nearly 50 years ago to include both parents, fathers were still not fully accepted and supported. ConclusionTo provide fathers in Sweden with greater support throughout the child health field, organisational changes should be considered, as this could provide further beneficial outcomes for children, families and society.

  • 39. Wells, Michael B.
    et al.
    Massoudi, Pamela
    Bergström, Malin
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Swedish child health nurses treat fathers more equally in 2014 than 2004, but mothers remain their primary focus2017In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 106, no 8, p. 1302-1308Article in journal (Refereed)
    Abstract [en]

    Aim: This study focused on Swedish child health nurses' attitudes and the support they provided to fathers and mothers, highlighting changes from 2004 to 2014. Method: In 2014, 363 child health nurses in Stockholm County completed a 23-item questionnaire, similar to the questionnaire by Massoudi et al. in 2004, on their attitudes and the support they gave to fathers and mothers. Analyses were completed using chi-square tests of nurses' attitudes and support to fathers and mothers, and the results from the 2004 and 2014 studies were compared. Results: In 2014, the vast majority of nurses fully agreed that it was important to have close contact with both parents, but more than two-thirds did not feel they had the same competencies for mothers and fathers and three quarters found it complicated to support both parents. The majority viewed fathers more equally in 2014 than in 2004 and although they did provide more support to both parents, mothers in 2014 still received more support than fathers. Conclusion: While Swedish child health nurses viewed fathers as more equal to mothers in 2014 than 2004, mothers still received the majority of the parenting support.

  • 40.
    Westerlund, Joakim
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Ek, Ulla
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Holmberg, Kirsten
    Uppsala Universitet.
    Näswall, Katharina
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Fernell, Elisabeth
    Karolinska Sjukhuset.
    The Conners' 10-item scale: findings in a total population of Swedish 10–11-year-old children2009In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 98, no 5, p. 828-833Article in journal (Refereed)
    Abstract [en]

    Aim: To present normative data for the Swedish version of the Conners' 10-item scale, to validate the scale by comparing children with and without attention deficit/hyperactivity disorder (ADHD), to explore the factor structure of this scale and to investigate behavioural characteristics and gender differences among 10- to 11-year-old children, as rated by parents and teachers respectively.

    Methods: Parents and teachers rated 509 10- to 11-year-old children (261 boys and 248 girls) from a population-based cohort in a Swedish municipality.

    Results: The Conners' 10-item scale discriminated very well between children with and without ADHD. Confirmatory factor analyses confirmed a two-dimensional structure of the scale with items measuring restless/impulsive behaviour in one factor and items measuring emotional lability in another. An ANOVA revealed that parents and teachers reported different behavioural characteristics in boys as compared to girls.

    Conclusion: The Conners' 10-item scale is a valid screening instrument for identification of ADHD. The two subscales can be used separately, in addition to the total score, to get a more detailed picture of the child's behaviour. Parents and teachers pay attention to different aspects of problem behaviour in boys and girls. The less disruptive behaviour of girls needs to be highlighted.

  • 41.
    Yu, Bing
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Garcy, Anthony M.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    A longitudinal study of cognitive and educational outcomes of those born small for gestational age2018In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 107, no 1, p. 86-94Article in journal (Refereed)
    Abstract [en]

    Aim

    This study examined the long-term cognitive and educational outcomes of being born small for gestational age (SGA) and assessed whether the family's attitude towards education modified the effect of being born SGA on educational attainment.

    Methods

    We used anonymised data on 9598 individuals from the Stockholm Birth Cohort. This study focused on babies born in 1953 in the Stockholm metropolitan area, who were followed up for 50 years, and included educational data at the age of 13 and 48. Ordinary least squares regression analyses, modification analyses and logistic regression analyses were conducted.

    Results

    The findings suggested that individuals who were born SGA (n = 798) had lower mean verbal, spatial and numerical test scores than those born appropriate for gestational age (AGA) (n = 7364) and large for gestational age (n = 1436). The SGA/AGA differences were small, but statistically significant, and the effects of being born SGA on the test scores was modified by the family's attitude towards education. The findings also suggested that attaining higher education was largely, but not entirely, explained by the family's attitude towards education.

    Conclusion

    The detrimental effects of being born SGA were limited on cognitive and educational outcomes, but may have been reduced by positive family attitudes.

1 - 41 of 41
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