Margaretha Magnusson

Rationality of routine health examinations by physicians of 18‐month‐old children: experiences based on data from a Swedish county

Abstract The aim of the present study was to evaluate the rationality of health check‐ups by a physician of 18‐month‐old children. The study population consisted of all 4075 children in Uppsala county who were 18 months old in 1994 and should have had a routine health examination at that point. Information about the 18‐month health examination came from primary data in a longitudinal child health register regarding all children of preschool age. The children in the study population were classified into two main categories, namely children with no newly detected health problem (92.6%) and children in whom a new health problem was detected (3.3%). Data from the register and other sources were analysed to categorize the health problems by severity and type and to determine who (parents, nurse or physician) had identified each. Among the 4075 children in the study population, 135 children were identified as having a newly detected health problem. One‐third of them were actually healthy (false positive). Among the 92 verified new health problems (2.3%), 48 were minor, 42 were moderate and 2 were severe. More than half of the moderate health problems were transient infections. The main conclusion of the study is that, undercurrent conditions in Sweden, it would be reasonable to replace the 18‐month examination by a physician with an examination by a nurse, this examination being particularly orientated towards developmental and psychosocial problems.

Child health services in transition: I. Theories, methods and launching

Aim: To describe an evidence‐based model for preventive child health care and present some findings from baseline measurements. Methods: The model includes: parent education; methods for interaction and language training; follow‐up of low birthweight children; identification and treatment of postnatal depression, interaction difficulties, motor problems, parenthood stress, and psychosocial problems. After baseline measurements at 18 mo (cohort I), the intervention was tested on children from 0 to 18 mo at 18 child health centres in Uppsala County (cohort II). Eighteen centres in other counties served as controls. Two centres from a privileged area were included in the baseline measurements as a “contrasting” sample. Data are derived from health records and questionnaires to nurses and mothers. Results: Baseline experiment (n= 457) and control mothers (n= 510) were largely comparable in a number of respects. Experiment parents were of higher educational and occupational status, and were more frequently of non‐Nordic ethnicity. Mothers in the privileged area (n= 72) differed from other mothers in several respects. Experiment nurses devoted considerably fewer hours per week to child health services and to child patients than did control nurses.

Drawing the line in the Edinburgh Postnatal Depression Scale (EPDS): a vital decision.

Abstract Background: The Edinburgh Postnatal Depression Scale (EPDS) is widely used in early child health care. This study examined the appropriateness of the recommended EPDS cut-off score 11/12. Methods: Two main analyses were performed: 1. Associations between EPDS scores and maternal health behaviour, stress, life events, perceived mother-child interaction quality and child behaviour. 2. Screening parameters of the EPDS, i.e., sensitivity, specificity and positive predictive value. EPDS scores were available for 438 mothers and maternal questionnaires for 361 mothers. Results: Already in the EPDS score intervals 6–8 and 9–11, there were notable adversities, according to maternal questionnaires, in stress, perceived quality of mother-child interaction, perceived child difficultness and child problem behaviours. Using maternal questionnaire reports about sadness/distress postpartum as standard, the recommended EPDS cut-off score 11/12 resulted in a very low sensitivity (24%). The cut-off score 6/7 yielded a sensitivity of 61%, a specificity of 82% and a positive predictive value of 61%. Conclusions: In terms of both clinical relevance and screening qualities, an EPDS cut-off score lower than 11/12 seems recommendable.

Child health and maternal stress: does neighbourhood status matter?

Abstract The purpose of this cross-sectional questionnaire study was to explore neighbourhood-level differences in health behaviour, maternal stress and sense of coherence, birth weight, child health and behaviour, and childrens television watching habits. In total, 2006 pairs of Swedish mothers and children, aged approximately 20 months, from the general population participated in the study. A total of 1923 lived in neighbourhoods of average socioeconomic status in six counties, and 83 in a high-status neighbourhood in one of the counties. Data were collected in 2002–2003 and 2004–2005 through the Child Health Services. Socio-demographic confounders were adjusted for in multiple logistic regressions (maternal age, country of birth, education, marital status and parity). Compared with their counterparts in average neighbourhoods, mothers in the high-status neighbourhood were less frequently smokers and had been breastfeeding their children more. They felt less stress from social isolation and had a higher sense of coherence. All these differences except lower social isolation were non-significant after adjusting for socio-demographic characteristics. Privileged mothers felt more restricted by their parenting tasks (unadjusted comparison), and more privileged children were frequent television watchers. Child birth weight, health and behaviour were no better in the privileged than in average neighbourhoods. This paper adds to previous knowledge by showing that status-based geographic differences in important parenting and health parameters can be non-significant in an equitable society such as Sweden, where all families with young children have access to free high-quality health services. Individual characteristics could provide better explanations than neighbourhood status.

Motivational Interviewing to Prevent Childhood Obesity : A Cluster RCT

OBJECTIVE: The objective was to evaluate a manualized theory-driven primary preventive intervention aimed at early childhood obesity. The intervention was embedded in Swedish child health services, starting when eligible children were 9 to 10 months of age and continuing until the children reached age 4. METHODS: Child health care centers in 8 Swedish counties were randomized into intervention and control units and included 1355 families with 1369 infants. Over ∼39 months, families in the intervention group participated in 1 group session and 8 individual sessions with a nurse trained in motivational interviewing, focusing on healthy food habits and physical activity. Families in the control group received care as usual. Primary outcomes were children’s BMI, overweight prevalence, and waist circumference at age 4. Secondary outcomes were children’s and mothers’ food and physical activity habits and mothers’ anthropometrics. Effects were assessed in linear and log-binominal regression models using generalized estimating equations. RESULTS: There were no statistically significant differences in children’s BMI (β = –0.11, 95% confidence interval [CI]: –0.31 to 0.08), waist circumference (β = –0.48, 95% CI: –0.99 to 0.04), and prevalence of overweight (relative risk = 0.95, 95% CI: 0.69 to 1.32). No significant intervention effects were observed in mothers’ anthropometric data or regarding mothers’ and children’s physical activity habits. There was a small intervention effect in terms of healthier food habits among children and mothers. CONCLUSIONS: There were no significant group differences in children’s and mothers’ anthropometric data and physical activity habits. There was, however, some evidence suggesting healthier food habits, but this should be interpreted with caution.

Utilization of child health services, stress, social support and child characteristics in primiparous and multiparous mothers of 18-month-old children

Aim: Traditionally, the child health services have laid emphasis on first-time mothers. Some researchers have argued that the needs of multiparous mothers must be considered equally important. The aim of this paper was to analyse parity-related characteristics in pairs of mothers and 18-month-old children. Methods: The study was population-based and cross-sectional. 586 primiparous mothers and 821 mothers with at least one previous child completed a questionnaire. Additional information was extracted from the child health records by the nurses. Data were collected in 2002–2003 and 2004–2005. Results: Compared to multiparous mothers, primiparous mothers had a higher utilization of child health services. Multiparous mothers scored higher on parental incompetence stress and felt that their work load was more demanding. Multiparous mothers reported less social support, particularly in practical respects such as baby-sitting. They considered their interaction with the child as less satisfactory than did primiparous mothers; their children participated less in shared reading and had a more restricted vocabulary. Fewer multiparous mothers assessed their own and their child’s total situation as very good. Conclusions: The child health services should develop competence and methods to support multiparous mothers and alleviate their workload when caring for several children.

Vaccination of children – summary and conclusions from a systematic review.

Vaccination of children – summary and conclusions from a systematic review The full review can be found in Acta Pædiatrica 2010; 99: s461 Sven-Arne Silfverdal, Lennart Nilsson, Margareta Blennow, Rose-Marie Carlsson, Lars Å Hanson, Anders Lindberg, Lars Lindquist, Margaretha Magnusson, Anders Norlund, Olof Nyrén, Per Olcén, Patrick Olin, Juliette Säwe, Ann Söderström, Birger Trollfors, Åke Örtqvist (ake.ortqvist@sll.se)1.Department of Pediatrics, Bnai Zion Medical Center, The B. and R. Rappaport Faculty of Medicine, Technion, Haifa, Israel 2.Pediatric Infectious Disease Unit, Meyer Children’s Hospital, Rambam Medical Center, The B. and R. Rappaport Faculty of Medicine, Technion, Haifa, Israel 3.Pediatric Intensive Care Unit, Meyer Children’s Hospital, Rambam Medical Center, The B. and R. Rappaport Faculty of Medicine, Technion, Haifa, Israel 4.Metabolic Unit, Meyer Children’s Hospital, Rambam Medical Center, The B. and R. Rappaport Faculty of Medicine, Technion, Haifa, Israel

Relationship Between Breastfeeding and Early Childhood Obesity: Results of a Prospective Longitudinal Study from Birth to 4 Years

AIM To study a potential link between breastfeeding in infancy and obesity at age 4. MATERIALS AND METHODS A total of 30,508 infants born during 2002-2007 from the databases of the Preventive Child Health Services in two Swedish counties and from national registers were studied. The outcome variable was obesity at age 4. Analyses were conducted by logistic regression models using the methodology of generalized estimating equations. Analyses were adjusted for child sex and maternal anthropometric and sociodemographic variables. RESULTS In unadjusted analyses, any breastfeeding up to 9 months was linked to successively decreasing odds ratios (ORs) for obesity at age 4 (ORs 0.78-0.33), however, not significantly for 1 week and 2 months of breastfeeding. In adjusted analyses, the same pattern remained statistically significant for breastfeeding for 4 (OR 0.51), 6 (OR 0.55), and 9 (OR 0.47) months. Child sex, maternal education, maternal body mass index, and maternal smoking additionally influenced child obesity. CONCLUSION Breastfeeding duration for at least 4 months may contribute independently to a reduced risk for childhood obesity at 4 years.

'Now I use words like asymmetry and unstable': nurses' experiences in using a standardized assessment for motor performance within routine child health care.

RATIONALE, AIMS AND OBJECTIVES There is an increasing recognition that early intervention is important for children with motor disorders. The use of standardized assessment methods within the Swedish Child Health Services (CHS) may improve early identification of these children and thereby their development and quality of care. Given the key role of nurses within the CHS, we explored their experiences of using a structured assessment of motor performance (SOMP-I) in a clinical setting, and investigated possible barriers and facilitators for implementation of the method within the CHS. METHODS The study was conducted in 2013 in Uppsala County, Sweden. Ten child health nurses participated in two focus group interviews, which were analysed using systematic text condensation. RESULTS The analysis yielded three themes: (1) increased knowledge and professional pride - nurses described their desire to provide high-quality care for which SOMP-I was a useful tool; (2) improved parent-provider relationship - nurses felt that using SOMP-I involved both the parents and their infant to a greater extent than routine care; and (3) conditions for further implementation - nurses described that the time and effort needed to master new skills must be considered and practical barriers, such as lack of examination space, resource constraints and difficulties in documenting the assessment must be addressed before implementing the SOMP-I method in routine care. CONCLUSION Child health nurses felt that the SOMP-I method fitted well with their professional role and increased the quality of care provided. However, significant barriers to implementing SOMP-I into routine child health care were described.

Vaccination of children – summary and conclusions from a systematic reviewThe full review can be found in Acta Pædiatrica 2010; 99: s461

Vaccination of children - summary and conclusions from a systematic reviewThe full review can be found in Acta Paediatrica 2010; 99: s461