Health-related quality of life in young women starting hormonal contraception: a pilot study.

OBJECTIVES: Our purpose was to study whether there is a difference in self-rated health-related quality of life (HRQOL) and changes in HRQOL perception after 3 months of hormonal contraceptive use in adolescents. Seasonal variations in symptoms of depression were also studied. METHODS: A test group (T1) (n = 193) and a selected control group (n = 238) of women aged 14-20 years who were visiting a young person's clinic completed the 36-item short-form health survey (SF-36) and answered additional questions on menstrual history and pattern, need for menstrual pain relief medication, and other regular medication. The test group was reassessed after 3 months of hormonal contraception (T2). Seasonal variations in reported SF-36 scores were studied for the whole group. RESULTS: The selected control group and test group at T1 were similar with regard to age at menarche and menstrual pattern. The duration of bleeding and use of painkillers were significantly reduced and the impact on everyday life was significantly improved after 3 months of hormonal contraception (p = .000, two-tailed). No changes in HRQOL or symptoms of possible depression were found after 3 months of hormonal contraception. The highest prevalence odds ratio for possible depression (SF-36 mental health scale score ≤48), adjusted for group, season and age, for spring vs winter, was 2.15 (95% confidence interval 0.95, 4.85). CONCLUSIONS: After 3 months of hormonal contraception both the number of days of menstrual bleeding and the use of medication to relieve menstrual pain were reduced, but there were no significant changes in self-rated HRQOL perception. Seasonal effects on HRQOL were reported.

Prevalence and co-occurrence of parentally reported possible asthma and allergic manifestations in pre-school children.

BACKGROUND: The aim of this study was to make an in-depth analysis of the prevalence and co-occurrence in pre-school children of possible asthma and atopic manifestations. METHODS: In Sweden 74%-84% of preschool children, depending on age, attend municipality organised day-care centres. Parents of 5,886 children 1-6 years of age, sampled from day-care centres in 62 municipalities all over Sweden, responded to a postal questionnaire regarding symptoms indicating prevalent possible asthma, allergic rhinitis, eczema, and food, furred pet and pollen allergy and other data in their children. Possible asthma was defined as any of the four criteria wheezing four times or more during the last year, physician diagnosis and current wheezing, ever had asthma and current wheezing, and current use of inhalation steroids, all based on questionnaire responses. RESULTS: The overall prevalence of possible asthma was 8.9%, of eczema 21.7%, of rhinitis 8.1%, and of food allergy 6.6%. There was a highly significant co-occurrence between possible asthma and all atopic manifestations, 35.7% having any of the manifestations. Presence of pet allergy was the manifestation showing the closest co-occurrence with presence of possible asthma, presence of pollen allergy with presence of rhinitis, and presence of food allergy with presence of eczema. Assessed from plots of age-specific prevalence of possible asthma, rhinitis, eczema and food allergy, the prevalence of all manifestations increased from one to three years of age and then decreased, except for rhinitis where the prevalence increased until six years of age, indicating no specific ordered sequence. CONCLUSIONS: Parentally reported possible asthma, eczema and food allergy had a curvilinear prevalence course across age with a maximum at age 3, while rhinitis prevalence increased consistently with age. Co-occurrence between possible asthma and atopic manifestations was common, and some combinations were more common than others, but there was no evidence of a specific ordered onset sequence.

Self-reported health in adolescent girls varies according to the season and its relation to medication and hormonal contraception--a descriptive study.

OBJECTIVES: To study seasonal variations in self-rated health and depressive symptoms in adolescent girls and possible differences in reported health with regard to use of medications. METHOD: The SF-36 questionnaire was completed by 1250 girls with a mean age of 17 years, who visited a health centre in the course of one year. From January to July inclusive, depressive symptoms in 453 of the participants were also assessed using MADRS-S. Age and regular medication data were recorded. RESULTS: Significantly better mental health and less depressive symptoms were reported during the summer, than in winter months. Seasonality was more related to the SF-36 mental, than physical health subscales. Respondents treated with hormonal contraceptives (HCs) only and those not taking any medication scored better on several SF-36 subscales, than girls on antidepressives and other medications. Respondents taking HCs tended to report better physical health and less depressive symptoms on MADRS-S than those taking no medication. CONCLUSIONS: Adolescent girls showed seasonal variations in self-reported health and depressive symptoms, with more symptoms during winter months. HC users tended to report better physical health and less depressive symptoms than those on no medication. The high prevalence of suspected depression during the winter months deserves attention.

A nationwide study of asthma incidence rate and its determinants in Swedish pre-school children.

While many studies on asthma prevalence have been published, the number of studies on asthma incidence in pre-school children is limited. In this project, a nationwide sample of pre-school children was followed with the aim of estimating cumulative 5-year asthma incidence and its determinants. Parents of 5,886 children 1-6 years of age, sampled from day-care centres in 62 municipalities all over Sweden, responded in 2002 to a baseline postal questionnaire with questions regarding symptoms indicating possible asthma or atopic conditions, and a number of other variables. In 2007, parents of 4,255 children responded to an almost identical follow-up questionnaire. Of these, the 3,715 children who were free from asthma at baseline constitute the study population for this report. A large number of potential baseline determinants for cumulative 5-year asthma incidence were identified. Of these, food allergy, rhinitis, incomplete asthma diagnosis criteria (wheezing last 12 months, and ever had asthma but no current symptoms), parental rhinitis, parental asthma, age, and eczema, in ranking order of importance, remained significant in multivariate logistic regression analysis. The asthma incidence rate was highly dependent on presence or absence of these variables, the average annual rate ranging from 2/1,000/year in 6-year-olds with no determinants to 154/1,000/year in 1-year-olds with all determinants, corresponding to 11/1,000/year based on the whole study population.

Organizational differences in early child health care -- mothers' and nurses' experiences of the services.

AIM: The aim of this study was to evaluate parents' and nurses' perceptions of the child health services (CHS) in relation to whether the nurse worked exclusively with children (focused-child health centre, CHC) vs. with people of all ages (mixed-CHC). METHOD: Information about parents' perceptions about the CHS was acquired by a questionnaire intended for the mothers of 18-month-old children. One thousand thirty-nine answered in the baseline 2002-2003 and 996 in the follow-up 2004-2005. The nurses answered a special questionnaire aimed to obtain knowledge about their satisfaction with their work. Eighteen CHCs were chosen from the county of Uppsala and eighteen from other Swedish counties. The CHCs were chosen from areas with poor psycho-social status. The data were collected by questionnaires to mothers and nurses, and the analysis used the chi-square test, t-test and logistic regression. The study was approved by the Research Ethics Committees of the universities involved. RESULTS: Mothers were more satisfied, and the nurses found their work tasks easier, at CHCs where the child health nurse worked exclusively with children, compared with mothers and nurses belonging to CHCs where the nurses provided care to people of all ages. CONCLUSION: The findings indicated that nurses working exclusively with children, being able to concentrate their time and knowledge on a specialized field, develop a more solid child health competence. There are strong reasons to consider introducing 'exclusive' CHCs in psycho-socially vulnerable areas, which would probably make the services more effective. However, intensified education may modify the drawbacks of mixed-CHCs.

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

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 cutoff 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?

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 children's 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.

How can we identify vulnerable mothers who do not reach the cut off 12 points in EPDS?

The aim was to investigate the correspondence between 352 mother's self-reports about postpartum distress in a questionnaire including an item about distress 18 months after birth and their earlier scores within, on average, 2.5 months of childbirth from a screening with the Edinburgh Postnatal Depression Scale (EPDS). Mothers who did not reach the EPDS score of 12 points, but reported that they had been sad/depressed after childbirth, were similar in socio-demographic variables to mothers with no outcomes in sadness/depression issues. In items related to negative parenting and perceptions of the child, they presented the same picture as those with high EPDS scores who also reported having been depressed. These results suggest that EPDS does not identify all vulnerable mothers. Complementary methods for detecting mothers at risk of stress and depression need to be developed.

Could SF-36 be used as a screening instrument for depression in a Swedish youth population?

OBJECTIVE: Depression among youth is a condition associated with serious long-term morbidity and suicide. The aim of this study was to investigate whether a HRQoL instrument, the short form 36 version 1.0 (SF-36), could be used to screen for depression in a clinical Youth Centre (YC). A second purpose was to describe self-reported health and depression. SETTING: A clinical YC at a University hospital. DESIGN: A sample of 660 youths, 14-20 years old was assessed with SF-36 and Montgomery Åsberg Depression Rating Scale, self-screening version (MADRS-S). Answers to all the questions in both instruments were given by 79% (519/660; 453 women and 66 men). Mean age in the sample was 17.5±1.6 years. RESULTS: Strong correlations were found between all the SF-36 subscales and the depression ratio scale MADRS-S. Receiver operating characteristic (ROC) curve analysis confirmed that the SF-36 subscales mental health (MH) and vitality (VT) could correctly predict depression on the individual level with Area Under the ROC Curve values 0.87 and 0.84 in ROC curves. Individuals scoring 48 or lower on MH and 40 or lower on VT should be followed up with a clinical interview concerning possible depressive disorder. Mild to moderate depression was common (35.5%), especially among women (37.5%). Men scored higher than women on all SF-36 subscales except for physical functioning. CONCLUSIONS: The SF-36 can be used to screen for suspect depression in a youth population followed by interview. This gives an opportunity to detect and treat emerging depressive symptoms early.

Routine developmental screening at 5.5 and 7 years of age is not an efficient predictor of attention-deficit / hyperactivity disorder at age 10.

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.

Effect of degree of urbanisation on age and sex-specific asthma prevalence in Swedish preschool children.

BACKGROUND: There are few studies on age and sex-specific asthma prevalence in the age range 1-6 years. The purpose of this report was to estimate age and sex specific asthma prevalence in preschool children and to analyse the influence of possible demographic and geographic determinants. METHODS: All 70 allergen avoidance day-care centres and 140 matched ordinary day-care centres across Sweden were sampled. The parents of all 8,757 children attending these day-care centres received the International Study of Asthma and Allergies in Childhood (ISAAC) written questionnaire, supplemented with questions on medical treatment, physician assessed asthma diagnosis, and other asthma related questions. The response rate was 68%. RESULTS: The age specific asthma prevalence, adjusted for the underlying municipality population size, was among boys 9.7% at age 1, 11.1% at age 2, 11.4 at age 3, 10.5 at age 4, 8.7 at age 5, and 6.4 at age 6. The corresponding proportions among girls were 8.9%, 9.9%, 9.8%, 8.8%, 7.0%, and 5.0%, on average 9.6% for boys and 8.2% for girls, altogether 8.9%. In addition to age and sex the prevalence increased by municipality population density, a proxy for degree of urbanisation. Moreover, there was a remaining weak geographical gradient with increasing prevalence towards the north and the west. CONCLUSION: The age-specific asthma prevalence was curvilinear with a peak around age 3 and somewhat higher for boys than for girls. The asthma prevalence increased in a slowly accelerating pace by municipality population density as a proxy for degree of urbanisation.

Health-related self-assessed quality of life in young people at a Youth Centre in Sweden.

OBJECTIVE: To study the self-reported health of young people visiting a Youth Centre (YC) at a University hospital, describe possible gender differences and to compare the results with those in previous Swedish reports on similar age groups using the same instrument. DESIGN: All young people who visited a YC at a particular, randomly chosen time, were verbally asked to fill out a questionnaire, Short Form 36. The interviews were conducted during a 12-month period to lessen the impact of seasonal variations. SETTING: A YC at the department for obstetrics and gynaecology, Uppsala University hospital. PARTICIPANTS: A total of 1495 young people aged 14-25 years who visited the YC. RESULTS: The study population (n = 1495). Response rate was 96%. This population reported lower overall scores compared with the normative Swedish population from 1992. Further, females scored significantly lower than males on all subscales (p < 0.001), except for 'Physical Functioning'. The lowest scores were reported for the subscales Vitality, Role Emotional and Mental Health. CONCLUSION: This study describes physical functioning and mental health among young people visiting a YC. The results indicate a worsening of the perceived physical and MH in young individuals, especially in young women. Further studies are needed to monitor changes in MH and quality of life over time in this group and assess the effects of interventions. This study enhances the importance of a holistic approach towards health and health promotion comprising both physical and mental health issues.

Overweight more prevalent among children than among adolescents.

AIMS: To study if there is a change in paediatric overweight/obesity prevalence from 1982 to 2002 in a population with a high proportion of post-graduate education. DESIGN: Two samples of children in Uppsala County, Sweden, were compared: children who were 4, 10 and 16 year old in 1982; or 4, 10 and 16 year old in 2002. Mean BMI (in the lowest 10%, middle 50% and highest 10%) and ISO-BMI ('age adjusted BMI') cut-off values were calculated in each age and gender group. RESULTS: Using the mean BMI or ISO-BMI cut-off values, the BMI-distribution shifted from 1982 to 2002. More 4- and 10-year-old girls and boys were overweight/obese, although this shift was larger in girls. No shift was seen in the 16-year-olds, only the middle 50% group in the 16-year-old girls had a slight increase of their mean BMI. In the 2002 4-year-old, and both 10-year-old samples, a higher proportion of the girls were overweight/obese compared to the boys, but no difference was seen in the 16-year-old sample. CONCLUSION: Young children, especially girls, have become much more overweight/obese during the past 20 years, despite a high proportion of post-graduate education in the population. The lack of major change in 16-year-olds may suggest a rather recent change in the children's environment/lifestyle.

[Surname as a marker of ethnicity. A study from child health services shows that immigrant respective Swedish families seem to be isolated in different ways]. / Efternamn som markör för etnicitet. Studie inom barnhälsovården visar att invandrarfamiljer och svenska familjer tycks vara isolerade på olika sätt.

A practical method was tested for identifying ethnicity through family names in the absence of precise demographic information. In a questionnaire study of children covered by the Swedish child health services in some different counties, all potential participants (the children's mothers) were classified as "Swedish" or "non-Swedish" using family names. Inter-rater reliability was assessed by comparing the scores of two independent raters (Cohen's kappa: 0.89). Cases in which the raters did not agree were settled through discussion. The method's validity was roughly measured by comparing assigned classifications against ethnicity information provided by the 63.8 percent of the mothers who returned the questionnaire (1039 of 1628). Assigned and self-reported classifications were the same in 86.5 percent of the cases. Information from child health services about mothers who had agreed to participate in the study revealed health-related differences between those who returned the questionnaires and those who did not. The family name classification method indicated an ethnic selectivity in drop-out rates, which was helpful in interpreting these health differences.