Insufficient Sleep Is Associated with Obesity and Excessive Screen Time Amongst Ten-Year-Old Children in Sweden.

PURPOSE: This study investigated sleep, television, computer habits, and obesity in school-age children. DESIGN AND METHODS: This was a cross-sectional self-report survey of 1260 children in grade 4 (mean age, 10.1) living in southern Sweden (49.1% boys). The heights and weights of 1097 (87.1%) of the children were recorded. Descriptive statistics, bivariate analyses, and multiple logistic regression were employed. RESULTS: The median length of self-reported sleep on weeknights was 9.5h. Approximately 40% of the children reported receiving <9h of sleep. The median bedtime was 9PM (21:00). On weekends, the median bedtime was 1 h later, and they delayed getting up by 1.5h. The median time spent watching TV and using a computer was 1 h each. The prevalence of being overweight (including obesity) was 18%. Insufficient sleep (<9h) was associated with being overweight, watching TV, or using a computer for two or more hours each day, difficulty falling asleep, and being tired at school. CONCLUSIONS: School-age children who receive less sleep are more likely to be overweight and report excessive television and computer use. A strong and urgent need exists to highlight the importance of healthy sleep and media habits. It is challenging for pediatric nurses and school nurses to teach children and their families about healthy sleep and media habits.

Overweight and television and computer habits in Swedish school-age children and adolescents: a cross-sectional study.

The aim of this cross-sectional study was to investigate the prevalence of overweight and obesity in children and adolescents (6-16 years), and relationships between being overweight and sleep, experiencing of fatigue, enjoyment of school, and time spent in watching television and in sitting at the computer. Trained school nurses measured the weight and height of 2891 children aged 6, 7, 10, 14, and 16, and distributed a questionnaire to them regarding television and computer habits, sleep, and enjoyment of school. Overweight, obesity included, was present in 16.1% of the study population. Relationships between lifestyle factors and overweight were studied using multivariate logistic regression analysis. Having a bedroom television and spending more than 2 h a day watching television were found to be associated with overweight (OR 1.26 and 1.55 respectively). No association was found between overweight and time spent at the computer, short sleep duration, enjoyment of school, tiredness at school, or difficulties in sleeping and waking up. It is recommended that the school health service discuss with pupils their media habits so as to promote their maintaining a healthy lifestyle.

Consultation training of nurses for cardiovascular prevention - a randomized study of 2 years duration.

The aim of this study was to increase patients' adherence to the treatment of hypertension through the consultation training of nurses. Thirty-three nurses were included in the study. In the intervention group (IG), 19 nurses took part in a 3-day residential training course on the Stages of Change model, Motivational Interviewing and guidelines for cardiovascular prevention, and recruited 153 patients. Sixteen nurses in the control group (CG) recruited 59 patients. A decrease in systolic and diastolic blood pressure and total cholesterol was noticed in both groups over the 2 years. Heart rate (p = 0.027), body mass index (p = 0.019), weight (p = 0.0001), waist (p = 0.041), low-density lipoprotein-cholesterol (p = 0.0001), the waist-hip ratio (p = 0.024), and perceived stress (p = 0.001) decreased to any great extent only in the IG. After 2 years, 52.6% of the patients in the IG (p = 0.13) reached the target of ≤ 140/90 mmHg in blood pressure compared with 39.2% in the CG. For self-reported physical activity, there was a significant (p = 0.021) difference between the groups. The beneficial effects of the consultation training on patients' weight parameters, physical activity, perceived stress and the proportion of patients who achieved blood pressure control emphasize consultation training and the use of behavioural models in motivating patients to adhere to treatment.

Development and psychometric evaluation of a new instrument for measuring sleep length and television and computer habits of Swedish school-age children.

The aim was to develop a new instrument for measuring length of sleep as well as television and computer habits in school-age children. A questionnaire was constructed for use when children visit the school health care unit. Three aspects of the validity of the questionnaire were examined: its face validity, content validity, and construct validity. Test-retest reliability was assessed by giving the questionnaire twice, 2 weeks apart, to the respondents. The questionnaire was assessed as being reasonably valid, the test-retest results (n = 138) showing 90.4% of the estimates regarding bedtime on weeknights on the two survey occasions to lie within ± 30 min of each other, the test-retest agreement also being rather close (κ > .600) regarding both sleep and media habits. The instrument can be a valuable tool in a clinical setting, both for measuring sleep habits in a class and for discussing sleep with individual school children and their families.

Sleep and television and computer habits of Swedish school-age children.

The aim of this study was to investigate sleep, television and computer habits and enjoyment and feelings of tiredness in school of school-age children and adolescents in Sweden. An instrument found to be valid and reliable here was distributed to 3,011 children aged 6, 7, 10, 14, and 16 years. Those sleeping less than the median length of time reported a significantly lower degree of enjoyment of school. Short sleep was found to be associated with having a bedroom TV, spending more than 2 hr a day at the TV or the computer, being tired in school, and having difficulties both in waking up and in sleeping. Discussing sleep and media habits with schoolchildren and their parents regarding matters of optimal sleep and of how media habits affect sleep and learning is seen to be an important task of the school health service.

Factors related to outcome of neuroischemic/ischemic foot ulcer in diabetic patients.

OBJECTIVES: Peripheral vascular disease (PVD) is an important limiting factor for healing in neuroischemic or ischemic diabetic foot ulcer. The purpose of this study was to identify factors related to healing in patients with diabetes with foot ulcers and severe PVD. METHODS: Patients with diabetes with a foot ulcer, consecutively presenting at a multidisciplinary foot center with a systolic toe pressure <45 mm Hg or an ankle pressure <80 mm Hg were prospectively included, followed according to a preset program, and with the exception of specified exclusions, subjected to angiography offered vascular intervention when applicable. All patients had continuous follow-up until healing or death irrespective of the type of vascular intervention. RESULTS: One thousand one hundred fifty-one patients were included. Eighty-two percent had a toe pressure <45 mm Hg and 49% had an ankle pressure <80 mm Hg. Eight hundred one patients (70%) underwent an angiography. Out of these, 63% had vascular intervention, either percutaneous transluminal angioplasty (PTA; 39%) or reconstructive surgery (24%). Nine percent of the patients had one or more complications after angiography. PTA was multisegmental in 46% and to the crural arteries in 46%. Reconstructive surgery was distal in 51%. Age (P < .001), renal function impairment (P = .005), congestive heart failure (P = .01), number and type of ulcer (P < .001), and severity of PVD (P = .003) affected the outcome of ulcers. PTA and reconstructive vascular surgery increased the probability of healing without amputation (odds ratio [OR], 1.77 and 2.05, respectively). CONCLUSION: Probability of ulcer healing is strongly related to comorbidity, extent of tissue involvement, and severity of PVD in patients with diabetes with severe PVD.

Predicting mortality of residents at admission to nursing home: a longitudinal cohort study.

BACKGROUND: An increasing numbers of deaths occur in nursing homes. Knowledge of the course of development over the years in death rates and predictors of mortality is important for officials responsible for organizing care to be able to ensure that staff is knowledgeable in the areas of care needed. The aim of this study was to investigate the time from residents' admission to Icelandic nursing homes to death and the predictive power of demographic variables, health status (health stability, pain, depression and cognitive performance) and functional profile (ADL and social engagement) for 3-year mortality in yearly cohorts from 1996-2006. METHODS: The samples consisted of residents (N = 2206) admitted to nursing homes in Iceland in 1996-2006, who were assessed once at baseline with a Minimum Data Set (MDS) within 90 days of their admittance to the nursing home. The follow-up time for survival of each cohort was 36 months from admission. Based on Kaplan-Meier analysis (log rank test) and non-parametric correlation analyses (Spearman's rho), variables associated with survival time with a p-value < 0.05 were entered into a multivariate Cox regression model. RESULTS: The median survival time was 31 months, and no significant difference was detected in the mortality rate between cohorts. Age, gender (HR 1.52), place admitted from (HR 1.27), ADL functioning (HR 1.33-1.80), health stability (HR 1.61-16.12) and ability to engage in social activities (HR 1.51-1.65) were significant predictors of mortality. A total of 28.8% of residents died within a year, 43.4% within two years and 53.1% of the residents died within 3 years. CONCLUSION: It is noteworthy that despite financial constraints, the mortality rate did not change over the study period. Health stability was a strong predictor of mortality, in addition to ADL performance. Considering these variables is thus valuable when deciding on the type of service an elderly person needs. The mortality rate showed that more than 50% died within 3 years, and almost a third of the residents may have needed palliative care within a year of admission. Considering the short survival time from admission, it seems relevant that staff is trained in providing palliative care as much as restorative care.

Driving to learn in a powered wheelchair: the process of learning joystick use in people with profound cognitive disabilities.

The Driving to Learn project explored ways to help people with profound cognitive disabilities practice operating a joystick-operated powered wheelchair. The project used a grounded theory approach with constant comparative analysis and was carried out over 12 yr. The participants were 45 children and adults with profound cognitive disabilities. Reference groups included 17 typically developing infants and 64 participants with lesser degrees of cognitive disability. The data sources included video recordings, field notes, open interviews, and a rich mixture of literature. The findings that emerged yielded strategies for facilitating achievements, an 8-phase learning process, an assessment tool, and a grounded theory of deplateauing explaining the properties necessary for participants to exceed expected limitations and plateaus. Eight participants with profound cognitive disabilities reached goal-directed driving or higher. Participants were empowered by attaining increased control over tool use, improving their autonomy and quality of life.

Driving to Learn in a powered wheelchair: inter-rater reliability of a tool for assessment of joystick-use.

BACKGROUND/AIM: People with profound cognitive disabilities are not expected to learn powered mobility use. The Driving to Learn project focussed on what this population could achieve from practising in a joystick-operated powered wheelchair. By means of using grounded theory methodology an eight-phase process 'growing consciousness of joystick-use' was identified. In addition, a tool for assessment of actual phase of joystick-use and facilitating strategies for each phase emerged. The aim of the present study was to evaluate inter-rater reliability of the assessment tool. METHODS: The first author (LN) selected 24 video-sequences within the video data collected in the project. Each of the eight phases in the identified process were represented by three video-clips. The video-clips ranged in length between two to five minutes. LN's ratings served as criterion rating against which three independent raters' judgements were compared. The three raters were all occupational therapists, and two were experienced with the Driving to Learn method, powered wheelchair provision and the target population; and one was inexperienced. RESULTS: When comparing the three raters' assessments with that of LN (N = 72), the calculation gave a weighted kappa value of 0.85. All raters judged the tool as having a high degree of usability for assessing phases of joystick-use. Minimal differences were found between the experienced and inexperienced raters. CONCLUSION AND SIGNIFICANCE OF THE STUDY: The inter-rater reliability of the assessment tool was very good. The findings indicate that the tool is reliable and has clinical usability in occupational therapy practice.

Symptoms, care needs and diagnosis in palliative cancer patients in acute care hospitals: a 5-year follow-up survey.

INTRODUCTION: Palliative cancer care in acute hospitals is scarcely studied. We therefore described and compared symptoms, care needs and types of cancer sites in 2002 compared to 2007 and analysed the relationships between these factors. METHODS: The study was population-based with a cross-sectional design and was carried out in medical, surgical and oncology wards in two acute care hospitals with no advanced palliative home care service. In 2002, 82 one-day-inventories were done (1 352 patients) compared to 142 one-day-inventories in 2007 (2 972 patients). Symptoms, care needs and cancer site were registered according to a questionnaire. Multiple logistic regression models were used to analyse associations between symptoms, care needs and cancer site. RESULTS: The proportion of palliative cancer patients had decreased during a five year period (14% vs. 11%, p<0.01). The patients were older in 2007 (74 vs. 70 years, p<0.001) and had more symptoms and care needs per patient (2.6 vs. 1.6, p<0.001). The most common symptoms were pain and deterioration and the most common cancer sites were prostate and colorectal cancer in both samples. Associations between symptoms, care needs and cancer site were mostly weak. Deterioration was associated with colorectal cancer, whereas pain was not associated with any specific cancer site. In haematological malignancies there was a high occurrence of infections and a high need of blood transfusions and infusions. Stomach/oesophagus cancers were significantly associated with nausea, nutritional problems and need of infusions while unknown primary malignancies were associated with abdominal surgery and infusions. DISCUSSION: Although we do not know all the causes for hospitalization, this study indicates that more focus should be on the symptoms instead of the specific cancer diagnosis. The findings also indicate that many palliative cancer patients' problems would be suitable for advanced palliative home care instead of acute hospital care.

Interpretation of response categories in patient-reported rating scales: a controlled study among people with Parkinson's disease.

BACKGROUND: Unambiguous interpretation of ordered rating scale response categories requires distinct meanings of category labels. Also, summation of item responses into total scores assumes equal intervals between categories. While studies have identified problems with rating scale response category functioning there is a paucity of empirical studies regarding how respondents interpret response categories. We investigated the interpretation of commonly used rating scale response categories and attempted to identify distinct and roughly equally spaced response categories for patient-reported rating scales in Parkinson's disease (PD) and age-matched control subjects. METHODS: Twenty-one rating scale response categories representing frequency, intensity and level of agreement were presented in random order to 51 people with PD (36 men; mean age, 66 years) and 36 age-matched controls (14 men; mean age, 66). Respondents indicated their interpretation of each category on 100-mm visual analog scales (VAS) anchored by Never--Always, Not at all--Extremely, and Totally disagree--Completely agree. VAS values were compared between groups, and response categories with mean values and non-overlapping 95% CIs corresponding to equally spaced locations on the VAS line were sought to identify the best options for three-, four-, five-, and six-category scales. RESULTS: VAS values did not differ between the PD and control samples (P = 0.286) or according to educational level (P = 0.220), age (P = 0.220), self-reported physical functioning (P = 0.501) and mental health (P = 0.238), or (for the PD sample) PD duration (P = 0.213) or presence of dyskinesias (P = 0.212). Attempts to identify roughly equally spaced response categories for three-, four-, five-, and six-category scales were unsuccessful, as the 95% CIs of one or several of the identified response categories failed to include the criterion values for equal distances. CONCLUSIONS: This study offers an evidence base for selecting more interpretable patient-reported rating scale response categories. However, problems associated with raw rating scale data, primarily related to their ordinal structure also became apparent. This argues for the application of methodologies such as Rasch measurement. Rating scale response categories need to be treated with rigour in the construction and analysis of rating scales.

Whose quality of life? Ethical implications in patient-reported health outcome measurement.

OBJECTIVES: Patient-reported health status questionnaires intend to assess illness and therapy from the patients' perspective. To provide fair and valid assessments, they should be equally relevant to major subsets of respondents. Furthermore, disease-specific measures are assumed to be perceived as more relevant than generic ones. This study assessed these assumptions among people with Parkinson's disease. METHODS: Cross-sectional data from 202 people with Parkinson's disease (54% men; mean age, 70) were analyzed regarding patient-rated relevance and predictors of patient-rated poor relevance of two generic [the 36-item Short Form Health Survey (SF-36) and Nottingham Health Profile (NHP)] and one disease-specific [Parkinson's Disease Questionnaire (PDQ-39)] health status questionnaire. RESULTS: There were no differences in relevance ratings across the questionnaires. Poorer overall quality of life [odds ratio (OR), 2.459] and mental health (OR, 1.023) were associated with poorer patient-rated relevance of the SF-36, and higher age was associated with poorer patient-rated relevance of the PDQ-39 (OR, 1.040). No significant predictors were found for the NHP. CONCLUSIONS: The PDQ-39 failed to meet the assumption that disease-specific scales are more relevant than generic ones. Nevertheless, the most important implication of this study is an ethical one. Because the relevance of the SF-36 and PDQ-39 is perceived as poorer by those who fare least well and by older people, these scales may not reflect the perspectives of these groups. This challenges bioethical principles and threatens scientific validity. Perceived relevance of patient-centered outcomes needs to be considered, or the voice of vulnerable groups may be silenced, fair inferences prohibited, and opportunities for improved care lost.

Parents' worried state of mind when fetal ultrasound shows an unexpected finding: a comparative study.

OBJECTIVE: Most parents yearn for a second-trimester ultrasound examination and feel excitement about it, but some also worry about what the examination will show. According to prior research, using only generic instruments or specific questionnaires, anxiety decreases when the ultrasound findings are normal. The aim of this study was to compare parents' worry (Parents' Expectations, Experiences, and Reactions to Ultrasound [PEER-U] State of Mind Index) and sense of coherence before and after a routine second-trimester ultrasound examination when it showed normal or abnormal findings. METHODS: A 1-year cohort study was performed at a Swedish university hospital. A total of 2049 parents who had their second-trimester ultrasound examinations there filled in a questionnaire consisting of 2 parts before and after the examinations. RESULTS: Parents with normal ultrasound findings were less worried than parents with abnormal findings. The group with normal findings also showed less worry after the examination than before. A sex analysis showed similar patterns. CONCLUSIONS: Parents with abnormal ultrasound findings are more worried and anxious. The new instrument, the PEER-U State of Mind Index, not only measures parents' worry but can also expose what influences their ultrasound examination experience.

Obstetric risk indicators for labour dystocia in nulliparous women: a multi-centre cohort study.

BACKGROUND: In nulliparous women dystocia is the most common obstetric problem and its etiology is largely unknown. The frequency of augmentation and cesarean delivery related to dystocia is high although it is not clear if a slow progress justifies the interventions. Studies of risk factors for dystocia often do not provide diagnostic criteria for the diagnosis. The aim of the present study was to identify obstetric and clinical risk indicators of dystocia defined by strict and explicit criteria. METHODS: A multi-centre population based cohort study with prospectively collected data from 2810 nulliparous women in term spontaneous labour with a singleton infant in cephalic presentation. Data were collected by self-administered questionnaires and clinical data-records. Logistic regression analyses were used to estimate adjusted Odds Ratios (OR) and 95% confidence intervals (CI) are given. RESULTS: The following characteristics, present at admission to hospital, were associated with dystocia during labour (OR, 95% CI): dilatation of cervix < 4 cm (1.63, 1.38-1.92), tense cervix (1.31, 1.04-1.65), thick lower segment (1.32, 1.09-1.61), fetal head above the inter-spinal diameter (2.29, 1.80-2.92) and poor fetal head-to-cervix contact (1.83, 1.31-2.56). The use of epidural analgesia (5.65, 4.33-7.38) was also associated with dystocia. CONCLUSION: Vaginal examinations at admission provide useful information on risk indicators for dystocia. The strongest risk indicator was use of epidural analgesia and if part of that is causal, it is of concern.

Measuring care of the elderly: psychometric testing and modification of the Time in Care instrument for measurement of care needs in nursing homes.

BACKGROUND: Aging entails not only a decrease in the ability to be active, but also a trend toward increased dependence to sustain basic life functions. An important aspect for appropriately elucidating the individual's care needs is the ability to measure them both simply and reliably. Since 2006 a new version of the Time in Care needs (TIC-n) instrument (19-item version) has been explored and used in one additional municipality with the same structure as the one described in an earlier study. METHODS: The TIC-n assessment was conducted on a total of 1282 care recipients. Factor analysis (principal component) was applied to explore the construct validity of the TIC-n. Cronbach's alpha was calculated to test reliability and for each of the items remaining in the instrument after factor analysis, an inter-rater comparison was carried out on all recipients in both municipalities. Independently of each other, a weighted Kappa (Kw) was calculated. Results. The mean of each weighted Kappa (Kw) for the dimensions in the two municipalities was 0.75 and 0.76, respectively. Factor analysis showed that all 19 items had a factor loading of >or=0.40. Three factors (General Care, Medical Care and Cognitive Care) were created. CONCLUSION: The TIC-n instrument has now been tested for validity and reliability in two municipalities with satisfactory results. However, TIC-n can not yet be used as a golden standard, but it can be recommended for use of measurement of individual care needs in municipal elderly care.

Specific nasal symptoms and symptom-provoking factors may predict increased risk of developing COPD.

In a 1992 questionnaire study, we found that certain nasal symptoms and symptom-provoking factors were associated with prevalence of self-reported chronic bronchitis/emphysema (CBE). In this follow-up study, we examined whether any nasal features could predict an increased incidence of self-reported physician's diagnosis of CBE/chronic obstructive pulmonary disease (COPD). In 2000, a survey was performed similar to the one in 1992. Of a paired follow-up group of 4933 participants aged 28-67 years, 4280 (86.8%) returned the questionnaire. Odds ratios (ORs) for cumulative incidence (between 1992 and 2000) of self-reported physician-diagnosed CBE/COPD and asthma, respectively, were calculated by logistic regression with adjustment for age, gender and smoking habits. Reports of thick, yellow nasal discharge and nasal blockage in 1992 predicted incidence of CBE/COPD: OR 2.3 (1.2-4.2) and 1.8 (1.1-2.8) respectively. Moreover, nasal symptoms provoked by exposure to damp/cold air and tobacco smoke predicted CBE/COPD: OR 3.4 (1.9-6.0) and 2.5 (1.4-4.2). Nasal itching and nasal symptoms provoked by exposure to grass pollen and furred animals predicted incidence of asthma. These results suggest that certain nasal symptoms and nasal symptom-provoking exposures, different from those commonly associated with asthma, may predict increased risk of developing CBE/COPD. This supports the possibility of nasal co-morbidity in COPD.

Collaboration between relatives of elderly patients and nurses and its relation to satisfaction with the hospital care trajectory.

BACKGROUND: Relatives are often involved in the care of frail elderly patients prior to admission and are thus important collaborative partners for nurses. They hold valuable knowledge, which may improve care planning for the benefit of the patient and the hospital care trajectory. Satisfaction among relatives may be an indicator of this. AIM: To investigate collaboration between relatives and nurses among those relatives reporting high versus low satisfaction with the hospital care trajectory. Further, the aim was to investigate the relationship between satisfaction with the hospital care trajectory and (i) participants' characteristics and (ii) the dimensions of collaboration. SAMPLE: Relatives of elderly patients (n = 156) in acute hospital wards. Women constituted 74.8%, adult children 63.9% and spouses 20% of the participants. Mean age was 60.78 (SD 11.99). DESIGN: Cross-sectional, comparative, analytical. METHOD: A self-report, structured questionnaire covering attributes, prerequisites, outcome and barriers/promoters for collaboration. Respondents reporting high versus low satisfaction were compared with regards to characteristics and mean scores in dimensions of collaboration. Multivariate logistic regression analyses examined predictors for satisfaction with the hospital care trajectory. FINDINGS: Low satisfaction was significantly related to low level of collaboration. Other predictors for low satisfaction were: feelings of guilt and powerlessness, having provided help for less than a year and not providing psychosocial help. CONCLUSION: Satisfaction with care as a hypothesized outcome of collaboration was supported in this study. Hitherto, research has mainly focussed on relatives as potential clients; this study has focussed on relatives as competent collaborative partners in care. A new role for relatives as partners in decision-making rather than passive recipients of information is indicated for the benefit of care quality. Further, increased collaboration between relatives and nurses, assigning relatives' influence, may reduce their powerlessness and guilt and thereby indirectly increase their satisfaction.

Relatives' view on collaboration with nurses in acute wards: development and testing of a new measure.

BACKGROUND: Collaboration between relatives and nurses in acute care settings is sparsely investigated, and that mostly from nurses' point of view. Feasible and valid instruments are needed for assessing collaboration, its prerequisites and outcome. OBJECTIVES: To develop and test an instrument to assess, from the relatives' perspective, collaboration between relatives of frail elderly patients and nurses in acute hospital wards, as well as prerequisites for, and outcome of, collaboration. DESIGN: Instrument development and psychometric testing. SETTING: Acute medical and geriatric wards. PARTICIPANTS: One hundred fifty-six relatives. Women constituted 74.8%, offspring 63.9% and spouses 20%, respectively. METHODS: A model for collaboration was developed and underpinned the development and construction of the instrument. Face and content validity was examined by relatives and an expert panel, before testing it among 156 relatives. Construct validity was assessed by principal component analysis and test for correlation between factors. Predictive validity was assessed by comparing factor scores with scores in outcome measures. Internal consistency was assessed by Cronbach's alpha for factors, item-to-total correlation and item-to-item correlation. Systematic internal dropout was investigated. RESULTS: A five-factor solution labelled "influence on decisions", "quality of contact with nurses", "trust and its prerequisites", "achieved information level" and "influence on discharge" showed Cronbach's alpha values between .83 and .94. Correlation between factors showed coefficients between .16 and .60. Item-to-total correlation values ranged between .34 and .83 and mean inter-item-correlation coefficients between .40 and .56. Predictive validity was indicated. Systematic internal dropout was related to higher age and lower educational level. CONCLUSION: The instrument was mainly valid and reliable. The instrument is, to our knowledge, the first of its kind and should be tested on larger samples in various cultural contexts. The feasibility of the instrument may benefit from a reduction of number of items.

Predicting developmental deficiencies at the age of four based on data from the first seven months of life.

The study examines very young children with the aim of identifying precursors of developmental problems during the first 7 months of age. Information from screening and observations in the birth clinic, in the first level of health care, and from parents was collected on five different occasions. The information that was included concerning the child and family was defined as either optimal or nonoptimal. At the age of 4 years, a clinical group was identified (11.1% of the total population). Logistic regression analyses were performed to detect risk factors. Twenty-one precursors were used to create a screening questionnaire that provided useful information (sensitivity = 56.1%, specificity = 98.8%) for predicting developmental problems of the children. The contribution of sociodemographic data was significant; medical information was less significant. The highest prediction rate surprisingly was found in the moderate clinical subgroup (62.1%), compared to the group with more severe problems that had a slightly lower rate (46.7%). The conclusion of the study is that it is possible to detect infants in need of early intervention using a continuous process of observation and screening.

Blood pressure in middle-aged women: are androgens involved? A population-based study of Swedish women: the Women's Health in the Lund Area study.

OBJECTIVE: To assess the prevalence of hypertension and use of antihypertensive drug therapy in relation to menopausal status and to delineate perceived associations between androgens and blood pressure in perimenopausal women. METHODS: A population-based sample of women aged 50-59 (n = 6893). Women were divided into three groups according to their hormonal status: premenopausal, postmenopausal without hormone therapy, and postmenopausal with hormone therapy. RESULT: In the premenopausal, postmenopausal without hormone therapy, and postmenopausal with hormone therapy groups, the prevalence of high blood pressure (>/= 140 mmHg systolic or >/= 90 mmHg diastolic) was 43.9, 49.9 and 45.8%, respectively. In women with normal blood pressure, adjusting for age, body mass index and smoking, there were negative associations between serum testosterone and systolic blood pressure in the total sample (P < 0.01) and the postmenopausal without hormone therapy group (P < 0.05). In women using antihypertensive drug therapy with a blood pressure of at least 140/90 mmHg, positive associations were found between serum testosterone and systolic blood pressure in the total series (P < 0.05) and in the postmenopausal without hormone therapy group (P < 0.05). CONCLUSION: Abnormal blood pressure is common in middle-aged women regardless of hormonal status. Our findings suggest that testosterone could have a dual influence on blood pressure in perimenopausal women.