Child health care uptake among low-income and immigrant families in a Swedish county

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.     

The Ecological Context of Child Health in Saudi Arabia

ABSTRACT. The general background to child health in Saudi Arabia is reviewed. Information is provided on the social and demographic characteristics of the population, on common health indicators, on the health care system and its utilization, and on the general pattern of childhood morbidity and mortality. The unprecendented socioeconomic development has transformed the health care system. In 15 years the number of nurses have increased from 3261 to 29896, physicians from 1172 to 14335, primary health care centers from 591 to 1821, and hospital beds from 9036 to 30707. In spite of this progress, the disease pattern seems to resemble that of some developing countries with more limited resources. Parasitic diseases are still widespread, and sample surveys have indicated suboptimal nutrition of rural preschool children. Recent estimates on the infant mortality rate have ranged from 65 to 120 per 1000 live births. The preferred marriage partner is a close relative, and genetic diseases, such as hemoglobin disorders, are common in certain areas. Thus, the prevalence of alpha thalassemia is reported at 50 percent, and the sickle cell trait at 4.4–20 percent in sample surveys from the Eastern Province. The modest educational attainment of the mother, the heavy reliance on foreign manpower in all sectors, including the health sector, and the further development of the primary health care system are key issues today. It is emphasized that demographic and epidemiological information from Saudi Arabia is scarce and frequently uncertain, and that further studies are needed to identify the health needs of Saudi children.     

青少年心理病理症状及应对方式与童年期反复躯体和情感虐待经历的相关性研究

目的分析青少年心理问题、应对方式与童年期反复严重躯体虐待、中度躯体虐待及情感虐待经历的关联强度。方法5141名中学生以自愿、无记名方式填写调查表的形式调查童年期经历父母或其他监护人的严重和中度躯体虐待及情感虐待情况。以在小学年龄阶段,3类共24项虐待行为中至少1项平均1年发生3次以上,界定为有该项童年期反复虐待经历。用症状自评量表（SCLOO）评定总心理问题、心理病理症状阳性项目数和9种心理病理症状,运用特质性应对方式问卷评定青少年积极和消极应对方式。结果青少年总心理问题检出率为9．1％,其中躯体化、强迫、人际关系敏感、抑郁、焦虑、敌对、恐惧、偏执、精神病性症状检出率分别为1．3％、3．6％、3．6％、2．8％、2．2％、4．0％、2．1％、2．8％、1．6％。总心理问题检出率、9种心理病理症状检出率和阳性项目数与3类童年期反复虐待经历的数量呈剂量-反应趋势。有童年期反复虐待经历的青少年,消极应对评分高于无童年期反复虐待经历者,且消极评分越高,其总心理问题检出率和阳性项目数增加。以青少年和父母的人口统计学变量为协变量,多项式Logistic回归分析表明,积极应对评分不影响3类童年期反复虐待经历与总心理问题的比值比（OR）,但消极应对降低童年期反复虐待经历与总心理问题及9种心理病理症状的OR值。结论不同种类和数量的童年期反复躯体虐待、情感虐待经历对青少年心理健康产生负面影响,消极应对方式可能参与调节了童年期虐待经历与青少年心理问题的联系。     

The impact of poverty on the current and future health status of children

Child poverty in Canada is a significant public health concern. Because child development during the early years lays the foundation for later health and development, children must be given the best possible start in life. Family income is a key determinant of healthy child development. Children in families with greater material resources enjoy more secure living conditions and greater access to a range of opportunities that are often unavailable to children from low-income families. On average, children living in low-income families or neighbourhoods have poorer health outcomes. Furthermore, poverty affects children’s health not only when they are young, but also later in their lives as adults. The health sector should provide services to mitigate the health effects of poverty, and articulate the health-related significance of child poverty, in collaboration with other sectors to advance healthy public policy.     

Canada’s history of failing to provide medical care for Indigenous children

In December 2007, the House of Commons unanimously supported Jordan’s Principle, a commitment that all First Nations children would receive the health care products, social services, and supports, and education they need, in memory of Jordan River Anderson. However, the process of applying for Jordan’s Principle was convoluted and not transparent, leaving several cases not being responded to. The Canadian Human Rights Tribunal found the definition and implementation of Jordan’s Principle to be racist and discriminatory in 2016, ordering the Canadian government to make immediate changes. Failing to make changes to Jordan’s Principle, the Canadian government was found to be noncompliant with the Canadian Human Rights Tribunal orders in 2018. This article provides one case example of Jordan’s Principle that was not responded to, details on the current status of Jordan’s Principle, and information on the recent implementation of the Act respecting First Nations, Inuit and Métis children, youth and families.     

Psychosocial aspects of child and adolescent obesity

In addition to counselling families about regular physical activity and healthy nutrition, clinicians need to identify and help them to address the psychosocial factors that may be contributing to their child’s or adolescent’s obesity. Affected individuals may suffer from depression, low self-esteem, bullying, and weight bias, experiences that can make achieving desired health outcomes more difficult. Clinicians should try to identify these underlying stressors and ensure that appropriate counselling is implemented.     

CHILD HEALTH IN EUROPE: A Review of WHO Activities

Abstract. Petersson, P. O. and Ichimura, K. (Administration, University Hospital, Uppsala, Sweden). Child health in Europe—A review of WHO activities. Review of the activities in maternal and child health arranged in recent years by the European Office of the World Health Organization.     

CHILD-ENVIRONMENT SUPERVISORS—A NEW STRATEGY FOR PREVENTION OF CHILDHOOD ACCIDENTS

Abstract. Gustafsson, L. H. et al. (Department of Paediatrics, University Hospital, Uppsala, Sweden). Child-environment supervisors—a new strategy for prevention of childhood accidents. This paper is a provisional report from an ongoing field experiment in Uppsala, Sweden, with the aim to reduce the number of serious childhood accidents. Groups of parents have been systematically trained to function as child-environment supervisors. The experiences have been very positive so far. The child-environment supervisors have proved to possess good knowledge about how to prevent accidents. A large number of hazards have been detected and successfully eliminated. The groups are now taking an active part in the planning of new housing estates. The findings also indicate that the Child Health Organization should be able to play a more active role in the work of environmental improvement for the safety of children. A suggestion for a collective strategy for such activity has been worked out.     

儿童期躯体情感虐待经历对大学生心理健康的影响

目的：探讨儿童期躯体情感虐待经历对大学生心理健康的影响。方法：对西安1 200名大学生就儿童期躯体情感虐待经历进行儿童虐待史问卷（Bernstein）（修订后）及症状自评量表 (Symptom Check List-90,SCL-90)进行不记名调查。结果：668名学生（55.7%）16岁前曾经历过羞辱、体罚、挨打或限制活动等躯体情感虐待,其中21.0%有过挨打 (包括用器械打)的经历。儿童期有严重躯体情感虐待经历的学生,其躯体症状、强迫症状、人际关系敏感、抑郁、焦虑、敌对、恐怖、偏执等症状因子分≥ 1的检出率明显高于无躯体情感虐待经历的学生。结论：中国儿童期羞辱、体罚等躯体情感虐待问题仍较常见,而且儿童期严重躯体情感虐待经历直接会影响到大学生心理健康,应该重视儿童虐待的干预及研究。［中国当代儿科杂志,2009,11（8）：675-678］     

Pre-school children with developmental co-ordination disorder: self-perceived competence and group motor skill intervention

OBJECTIVE: To investigate self-perceived competence in 5- to 6-y-old children with developmental co-ordination disorder. SUBJECTS AND METHODS: Scores in two scales of self-perceived competence were compared between a study group of children with developmental co-ordination disorder (n = 37) and a reference group (n = 60). In addition, effects of group motor skill intervention were evaluated by comparing scores in study group children randomly allocated to an intervention (n = 17) and a control subgroup (n = 20). The intervention subgroup received intervention once weekly for 10 wk. CONCLUSIONS: Pre-school children with developmental co-ordination disorder are similar to peers of the same age regarding self-perception of their own competence in areas concerning school, peer relations and motor skills. The change in score in the perceived motor competence scale was significantly greater in the intervention than in the control subgroup, suggesting that the intervention increased individual awareness of motor competence.     

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.     

The enigma of the welfare state: excellent child health prerequisites – poor subjective health

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.