Ragnhild Kornfält

Long-term Effects of Physical Exercise on Working Capacity and Pulmonary Function in Cystic Fibrosis

ABSTRACT. Seven patients with cystic fibrosis aged 6 to 20 were enrolled for 30 months in a daily exercise program. After 12 months conventional chest physiotherapy was withdrawn. Patients with low initial Shwachman scores improved as regards maximal working capacity. Spirometric data and volume of trapped gas indicated opening of closed airways. We suggest that physical exercise in general should be the basis of pulmonary therapy in cystic fibrosis. Other forms of physiotherapy are advisable when hard physical exercise is not feasible.

Physical health of ten-year-old children. An epidemiological study of school children and a follow-up of previous health care.

ABSTRACT. At 10 years of age, all 223 children in a school district underwent a physical examination and a screening for vision and hearing defects within the school health services. The purpose of the study was to detect health problems of importance for the day‐to‐day functioning of the child. In 26.1% significant deviations were found. Physical disorders comprised 11.7%, visual defects 11.7% and auditory impairment 2.7%. The vast majority of significant health problems were previously known and in only 4.4% of the 223 children newly detected, 0.9% by the physical examination, 2.7% by the vision screening and 0.9% by the auditory screening. The most frequent health problem of all was allergy in 13.5%, in 5.4% regarded as functionally important. Minor orthopaedic deviations and motor disturbances were common but not often considered to affect the functioning of the child significantly. As a whole, the childrens health was very good and the outcome of the physical examination at this age was not impressive. It is evident that the physicians role in the school health system needs to be reconsidered.

Gender affects self‐evaluation in children with cystic fibrosis and their healthy siblings

Aim: To determine whether self‐esteem among children with cystic fibrosis (CF) and their healthy siblings differs from that of a healthy reference group and whether there are differences within and between sibling pairs. Methods: All Swedish CF children 6–14 y old with a healthy sibling in the same age range (n=65) were invited to participate, 55 sibling pairs and their parents taking part in the study. Five aspects of the childrens self‐concept—physical characteristics, skills and talents, mental well‐being, relations to parents and family, and relations to others—were assessed by the “I think I am” self‐evaluation questionnaire. Severity of illness was assessed by means of the Shwachman Clinical Evaluation System. Results: Whereas self‐evaluation did not differ between groups at a general level, healthy girls as well as those with CF scored lower than girls in the reference group on the “mental well‐being” and “relations to parents and family” subscales. Comparison of gender combinations (sick girl/healthy boy, sick girl/healthy girl, sick boy/healthy boy, sick boy/healthy girl) suggested that girls pay a cost of a lesser sense of psychological well‐being and feelings of inadequacy in relation to their parents and family. The Shwachman score of the sick child was not related to the level of self‐esteem.

Utilization of primary care versus specialized care in children with and without chronic illness. A population-based study

ABSTRACT. Childrens utilization of curative care was studied to analyse the division of responsibilities between undifferentiated primary care and specialized care. All chronically ill (n= 510), a control group (n= 287) and the total population 0–15 years of age (n= 6080) in a primary care district were studied using register data. Chronically ill children comprised 8.4% of the total child population and were registered for 1/10 of the primary health care visits, 1/3 of the specialized visits, 1/3 of the hospitalizations and 112 of the in‐patient days of all children. The yearly ambulatory visits were 3.7/child in the chronically ill and 1.5/child in the control group, of which 1/3 and 2/3, respectively, were to primary care. Utilization of specialized care increased with disability. Chronically ill children visited primary care mainly for acute respiratory infections but seldom for allergic or other chronic conditions.

Total Consumption of Health Services by Schoolchildren in a Primary Health Care District in Southern Sweden: A Contemporary Registration of Consumption at the School Health Clinic, the Community Care Centre and the Hospital

During one year all consumption of health services by 1147 schóolchildren aged 7–16 years was recorded. The average frequency of visits per child and year was 5.3 to the School Health Clinic, 1.1 to the Community Care Centre and 0.9 to the ambulatories at the hospital. The rate of hospitalization was 0.05. The consultations at the School Health Clinic show a peak in frequency at 13 years of age and girls predominated. In 40% of the visits to the school nurse no somatic disease corresponding to the complaint could be found and the nurse was clearly being used as a resort by the children in any sort of trouble. Injuries and accidents were the predominant diagnoses in both in-and outpatient care. The high consumption of and need for health services of schoolchildren must be taken into consideration in the overall planning. The School Health Clinic plays an important role for the children and its contributions are underestimated. Apart from health surveillance, it provides medical care for many children, but above all support. The key person is the school nurse and she is best placed in the school even if school health services are in future to be integrated in the Health Services of the County Council at the Community Care Centre (15).