HEALTH SCREENING OF FOUR-YEAR-OLDS IN A SWEDISH COUNTY

ABSTRACT: Sundelin, C. and Vuille, J.-C. (Department of Paediatrics, University Hospital, Uppsala, Sweden and the Institute of Social and Preventive Medicine, University of Berne, Berne, Switzerland). Health screening of four-year-olds in a Swedish county I. Organization, methods and participation. Acta Paediatr Scand, 64: 795, 1975–Since January 1969, a systematic health screening has been offered to 4-year-olds resident in the county of Uppsala, Sweden, at the ordinary Child Health Centres by the regular staff. This report describes some organizational and methodological aspects and presents participation rates and reasons for non-participation. From the overall experience it is concluded that the program is feasible with respect to systematic examinations and data collection, acceptance by the public and the staff, and with respect to the strain on existing resources. The reasons for and the importance of program changes are discussed, and the main advantages and drawbacks of the decentralized approach are mentioned. Finally, a theoretical framework for a quantitative evaluation of effectiveness is presented.     

GENERAL HEALTH SCREENING OF FOUR-YEAR-OLDS IN A SWEDISH COUNTY

ABSTRACT. Since 1969, 4-year-olds in the County of Uppsala have been offered extensive health screening at the Child Health Centres. In 1969 and 1970 a total of 3810 children underwent the screening procedure. The psychological screening instrument consisted of a questionnaire (to be answered by the parents), an interview of the parents, a psychomotor examination and an observation of the child's behaviour. 156 (4.1 96) 4-year-olds were referred to a specialist team for investigation and decision concerning treatment. In the present study the effectiveness of the psychological screening instrument was assessed by its sensitivity, specificity and predictive value. The sensitivity was found to amount to a maximum of 0.73. The specificity was estimated to be 0.98-0.99, and the positive predictive value to 0.67. The authors consider the effectiveness to be sufficiently high to motivate continuation of the screening procedure for detection of psychological problems in pre-school age. Efforts should be made, however, to further improve the effectiveness.     

Prevalence of hay fever and allergic sensitization in farmer's children and their peers living in the same rural community

INTRODUCTION: Lower prevalence rates of allergic diseases in rural as compared with urban populations have been interpreted as indicating an effect of air pollution. However, little is known about other factors of the rural environment which may determine the development of atopic sensitization and related diseases. OBJECTIVE: The authors tested the hypothesis that children growing up on a farm were less likely to be sensitized to common aerollergens and to suffer from allergic diseases than children living in the same villages but in nonfarming families. MATERIALS AND METHODS: Three age groups of schoolchildren (6-7 years, 9-11 years, 13-15 years) living in three rural communities were included in the analyses. An exhaustive questionnaire was filled in by 1620 (86.0%) parents. A blood sample was provided by 404 (69.3%) of the 13-15 year olds to determine specific IgE antibodies against six common aeroallergens. RESULTS: Farming as parental occupation was reported for 307 children (19.0%). After adjustment for potential covariates such as family history of asthma and allergies, parental education, number of siblings, maternal smoking, pet ownership, indoor humidity and heating fuels, farming as parental occupation was significantly associated with lower rates of sneezing attacks during pollen season (adjusted OR 0.34, 95% CI 0.12-0.89) and atopic sensitization (adjusted OR 0.31, 95% CI 0.13-0.73) whereas the association with wheeze (adjusted OR 0.77 95% CI 0.38-1.58) and itchy skin rash (adjusted OR 0.86, 95% CI 0.49-1.50) was not statistically significant. The risk of atopic sensitization was lower in children from full-time farmers (adjusted OR 0.24, 95% CI 0.09-0.66) than from part-time farmers (adjusted OR 0.54, 95% CI 0.15-1.96). CONCLUSION: Factors directly or indirectly related to farming as parental occupation decrease the risk of children becoming atopic and developing symptoms of allergic rhinitis.     

Further Evidence of an Association between Psychosocial Problems and Increase in Relative Weight between 7 and 10 Years of Age

ABSTRACT. A sample of 5399 Swedish schoolchildren was subdivided into five groups according to the change in relative weight between the ages of 7 and 10 years and the relative weight attained at 10 years. Information on indicators of psychosocial problems was obtained by teacher interviews. There was a significant variation between groups with regard to the prevalence of behavioral and learning problems, and in girls also concerning social problems. The highest prevalence of problems was consistently found in the group with a rapid gain in relative weight. The association was stronger for serious than for mild problems. A causal mechanism is assumed to be the most probable explanation. The implications with respect to research and clinical practice are discussed.     

Rapidly Developing Overweight in School Children as an Indicator of Psychosocial Stress

ABSTRACT. From a cohort of 971 Swedish children followed up from birth through 15 years of age, all the children who had shown an increment in relative weight of more than 15 % (measured weight in % of standard weight for height) between the ages of 7 and 10 years (group A, n = 25), 10 and 13 years (group B, n = 23), and 7 and 13 years (group C, n = 22) were selected for the present study. For each case a control matched for sex and relative weight at 7 (groups A and C ) or 10 years (group B ) was selected. The degree of psychosocial stress was estimated by two raters on the basis of all the accumulated data in the school health records and of the personal knowledge of the school nurses. There was good agreement between the raters. A significant difference in the degree of psychosocial stress was found between cases and controls. An analysis of specific items revealed differences with respect not only to soft data, but also to objective facts (continuation of school after completion of the nine years of compulsory school). It is concluded that a rapid weight gain during school years may be an indicator of psychosocial problems.     

GENERAL HEALTH SCREENING OF FOUR-YEAR-OLDS IN A SWEDISH COUNTY IV. An Analysis of the Effectiveness of the Psychological Examination Program

Abstract. Since 1969, 4-year-olds in the County of Uppsala have been offered extensive health screening at the Child Health Centres. In 1969 and 1970 a total of 3810 children underwent the screening procedure. The psychological screening instrument consisted of a questionnaire (to be answered by the parents), an interview of the parents, a psychomotor examination and an observation of the child's behaviour. 156 (4.1%) 4-year-olds were referred to a specialist team for investigation and decision concerning treatment. In the present study the effectiveness of the psychological screening instrument was assessed by its sensitivity, specificity and predictive value. The sensitivity was found to amount to a maximum of 0.73. The specificity was estimated to be 0.98–0.99, and the positive predictive value to 0.67. The authors consider the effectiveness to be sufficiently high to motivate continuation of the screening procedure for detection of psychological problems in pre-school age. Efforts should be made, however, to further improve the effectiveness.     

GENERAL HEALTH SCREENING OF FOUR-YEAR-OLDS IN A SWEDISH COUNTY: A Strategy for Improving the Effectiveness and the Costefficiency of the Psychological Screening Program

Abstract. Data presented in a previous paper pointed to the necessity for improving the overall sensitivity of the psychological screening program. The present report indicates possibilities for such an improvement without changing the screening methods. A comparison of the primary data of the true positives, the false positives and all the negatives (non-referred) revealed the necessity of more stringent referral criteria. It is predicted that the systematic application of these criteria would result in an increase in the rate of true positives form 2.8 to 4.8% of the screened population. In addition a strategy aiming at a reduction of the costs without deteriorating the effectiveness and based on a differential application of the various elements of the screening program is presented.     

HEALTH SCREENING OF FOUR-YEAR-OLDS IN A SWEDISH COUNTY

ABSTRACT. The data gathered in connection with a routine health screening program for 4-year-olds were used in order to test a number of hypotheses concerning factors which might have influenced the effectiveness of the program, as well as concerning the quality of preventive care delivered to the children before the age of 4 years. It was found that preventive care of relatively high quality delivered to children 0–3 years of age had not reduced the prevalence of previously undetected health problems at 4 years of age. Furthermore, the analysis demonstrated substantial differences between physicians in the rates of correct and unnecessary referrals. Only a small part of these differences could be attributed to professional status or specific experience with the program. They consisted essentially in varying thresholds for what was perceived as a health problem needing treatment, and were considered as a matter of personal temperament. True differences of quality did occur but were less prominent. The implications of these findings with regard to the continuation of the program are discussed.