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Aim To study the association of parental country of origin - expressed as low-, medium-, and high Human Development Index (HDI) countries - with caries experience in children of immigrant families in Stockholm. Methods This registry-based cohort study included all children born in 2000-2003 who resided in Stockholm County, Sweden, at age 3 years (n=83,147) with follow-up at 7 years of age. A logistic regression was performed for the multivariate analysis with adjustments for sociodemographic factors. Results After adjustments, logistic regression analyses revealed that, compared with Swedish children of the same age, the risk of caries was highest when the immigrant parents originated in a medium (OR 4.22 (95% CI 3.99:4.47)) or low (OR 2.80 (95% CI 2.56:3.06)) income country background at age 7 years, but was increased also for high income country background, OR 1.77 (95% CI 1.52-2.05). Furthermore, the risk of presenting with caries experience at age 7 years increased for all children in the 1st (lowest) household income quintile in the host country Sweden. Conclusion This study shows that the developmental level of the parental country of birth as well as the family socioeconomic position in Sweden influence the risk for caries development in their children.

International research has consistently reported that youth in secure residential care have high rates of somatic/dental health problems. Here, we report results from the first such study in a Nordic country. An experienced paediatrician performed systematic somatic and rudimentary dental health assessments of 91 youths, age 13–17, recently admitted to four secure residential units in Sweden. Girls were oversampled. Participants were tested for sexually transmitted diseases (STD). We found large unmet needs of health/dental care, similar to reports from other countries: 75% of the girls and 53% of the boys had at least one previously known health problem that was poorly followed up or was unknown before the assessment. Over 40% of the girls had severe dental decay. Only two cases of STD were identified (Chlamydia). Some 91% of the girls and 64% of the boys were referred to a health or a dental care clinic. (Less)

This study examined health-related quality of life of youth in secure residential care employing a gender perspective. The KIDSCREEN-52 questionnaire was administered to 91 youths (46 boys and 45 girls) aged 13–17, admitted to four secure residential units in southern Sweden, in connection with a medical examination. Results were compared with a national Swedish survey from 2009 of 86,000 youths aged 15–16 years old. In age-adjusted analyses, youth in secure residential care units reported lower levels of wellbeing for all but one KIDSCREEN measure, compared with the national survey, with moderate to large differences in effect size. In the residential care sample, female gender was associated will lower psychological wellbeing, poorer parental relations and less school satisfaction, while male gender was associated with lower self-perception and peer relations. (Less)

We used Swedish national registers to analyse dental health care among young adults with childhood experience of out-of-home care (OHC), in Cox regression analyses. All 1.7 million Swedish resident ...

AIM We investigated socio-economic and geographical determinants of hospital care for viral gastroenteritis in young children. METHOD This is a register-based study in a national birth cohort of 752 078 children 0-5 years of age in Sweden during 2006-2012. Hazard ratios (HR) of time to first admission and first episode of outpatient emergency department (ED) care with a diagnosis of viral gastroenteritis were estimated with Cox regression. RESULTS The adjusted HRs for hospital admission with a diagnosis of viral gastroenteritis were increased when the mother was below 25 years at the birth of the child, 1.30 (95% CI: 1.24-1.35), had a short (

Background To investigate the association between maternal country of birth and father's origin and unplanned and planned caesarean birth in Sweden. Methods Population-based register study including all singleton births in Sweden between 1999 and 2012 (n = 1 311 885). Multinomial regression was conducted to estimate odds ratios (OR) for unplanned and planned caesarean with 95% confidence intervals for migrant compared with Swedish-born women. Analyses were stratified by parity. Results Women from Ethiopia, India, South Korea, Chile, Thailand, Iran, and Finland had statistically significantly higher odds of experiencing unplanned (primiparous OR 1.10–2.19; multiparous OR 1.13–2.02) and planned caesarean (primiparous OR 1.18–2.25; multiparous OR 1.13–2.46). Only women from Syria, the former Yugoslavia and Germany had consistently lower risk than Swedish-born mothers (unplanned: primiparous OR 0.76–0.86; multiparous OR 0.74–0.86. Planned; primiparous OR 0.75–0.82; multiparous OR 0.60–0.94). Women from Iraq and Turkey had higher odds of an unplanned caesarean but lower odds of a planned one (among multiparous). In most cases, these results remained after adjustment for available social characteristics, maternal health factors, and pregnancy complications. Both parents being foreign-born increased the odds of unplanned and planned caesarean in primiparous and multiparous women. Conclusions Unplanned and planned caesarean birth varied by women's country of birth, with both higher and lower rates compared with Swedish-born women, and the father's origin was also of importance. These variations were not explained by a wide range of social, health, or pregnancy factors.

Background Many births in industrialised countries are to immigrant parents, or to one immigrant and one domestically born parent. Their newborn outcomes have not been well studied. Methods We conducted a study of 1 690 423 singleton infants born in Sweden between 1987 and 2008, including those of immigrants from East Asia, South Asia, Sub-Saharan Africa, and East Africa. Preterm delivery and small for gestational age (SGA) were assessed among infants of (i) immigrant parents from the same world region, (ii) an immigrant mother and a Swedish-born father, and (iii) a Swedish-born mother and an immigrant father; each compared to (iv) two Swedish-born parents. Log binomial regression analysis generated adjusted risk ratios (ARRs) and 95% confidence intervals (CIs) for preterm delivery and SGA. Results Compared with infants of two Swedish-born parents, infants born to immigrant mothers from East Asia, South Asia, and Sub-Saharan African were at higher risk of preterm delivery (ARR ranging from 1.2 to 1.9), irrespective of whether the father was from the same world region or Swedish-born, with the only exception of East African women, who had lower risk. Infants born to two foreign-born parents had the highest risks of SGA, particularly South Asians (ARR 4.69; 95% CI 4.29, 5.12). Mixed couples exhibited intermediate risks of SGA. Conclusions Adverse birth outcomes differ according to a couple's ethnic composition. Having a Swedish-born partner is associated with lower risk of SGA among immigrant mothers and fathers, and with lower risk of preterm delivery among immigrant fathers but not mothers.

This study compared the psychological symptoms of 129 children in joint physical custody with children in single care and nuclear families, using a nationally representative 2011 survey of 1,297 Swedish children aged between four and 18 years. The outcome measure was the Strengths and Difficulties Questionnaire (SDQ) and its association with three dimensions of parental life satisfaction was investigated. Linear regression analyses showed higher SDQ-scores for children in joint physical custody (B = 1.4, p

Main: outcome measures Pre-eclampsia, eclampsia and pre-eclampsia with prolonged hospitalisation (cases per 1000 deliveries)., 0, SCOPUS: ar.j, FLWIN, info:eu-repo/semantics/published

Aim Social inequalities in type 2 diabetes and coronary heart disease may be established in formative school years. We investigated whether school performance is associated with adiposity and increase in body mass index (BMI) between 10 and 15 years of age. Methods A community sample of 2633 school children had height and weight measured in school at the ages of 10 and 15. Percentages of body fat and waist circumference were measured at the age of 15. Mean grades in several school subjects at the age of 15 (ninth school year) were divided into quartiles. A linear regression analysis with BMI as the main outcome took into account parental education and ethnicity, obtained from registers, and children's living habits, collected by questionnaires. Results In adjusted models, longitudinal changes in BMI between the ages of 10 and 15 were larger in the lowest quartiles of school grades compared with the highest: for girls, they were β = 0.45 (p = 0.007) and for boys they were β = 0.45 (p = 0.016). Cross-sectional regression analyses, with percentage of body fat and waist circumference as outcomes, showed similar results. Conclusion Our results suggest that school performance is one pathway to social inequalities in obesity in school children.

Aim To investigate whether socio-economic status (SES) in childhood and school failure at 15 years of age predict illicit drug abuse in youth and young adulthood. Design setting and participantsReg ...

Aim Recent studies have demonstrated the beneficial long-term effects of an indicated parent support programme for acting out behaviour in pre-school children with attention-deficit/hyperactivity d ...

Aim: To investigate how being born and raised as a twin is associated with IQ, educational achievement and vocational career. Methods: Register study in a national birth cohort, complemented with a ...

UNLABELLED During 2009, 15,100 unaccompanied children sought asylum in Europe. Many of them came from 'failed states' like Somalia and Afghanistan where official documents with exact birth dates are rarely issued. This has led to requests to health care professionals in many countries to assist migration authorities in determining whether a young asylum seeker is a child or an adult. Many different methods are currently employed in Europe for this purpose by dentists, paediatricians, radiographers and social workers, but no currently available method has been demonstrated to have the accuracy needed to be of real use in this decision. Unclear guidelines and arbitrary practices may lead to alarming shortcomings in the protection of this high-risk group of children and adolescents in Europe. Medical participation, as well as non-participation, in these dubious decisions raises a number of ethical questions. CONCLUSION To improve care for young asylum seekers with undetermined age, we suggest better legal procedures for the determination of age and a more flexible approach to chronological age.

Aim: To investigate whether the age of first exposure to a high-incidence country like Sweden determines the risk of T1DM in children with an origin in a low incidence region of the world.Methods: ...

Aim: To study socio-demographic patterns of obesity in Chinese children and adolescents. Methods: Data came from the 2005 cycle of the Chinese National Survey on Student's Constitution and Health ...

Child Health Services (CHS) in Sweden are offered free of charge to all Swedish parents with children 0-5 years of age. The regular service schedule includes home visits, health examinations, vaccinations and participation in parenting groups. The CHS should pay extra attention to disadvantaged families. The aim of this thesis was to investigate to what extent the CHS reaches groups of families with special needs, e.g. immigrant families, low income families, young and single mothers, with universal or selective measures, as well as to investigate the variation of two determinants of child health, second hand smoke and breastfeeding, in these groups of families. The thesis also aimed at investigating validity of data in the county CHS quality database (Basta). The thesis is based on data from Basta together with several national registers. The CHS equally reached all families with infants with the universal program except for participation in parenting group. Foreign born, young, single and low-income mothers had lower participation rates. Smoking rates were lower in foreign-born than in Swedish-born mothers and higher for foreign-born than in Swedish-born fathers. Smoking was more common among single and low income parents and young mothers. Young and single mothers had lower breastfeeding rates at 6 months. At 12 months the breastfeeding rates were higher among foreign-born mothers. The validity test of data in the Basta database showed sensitivity values for immunizations, breastfeeding and smoking at 90-100 % and for any home visit, participation in parenting group at any time, a minimum number of 6 visits at the Child Health Centre (CHC) and a minimum number of 11 visits at the CHC at 88 - 96 %. The sensitivity value for the exact match of number of CHC visits (+/- 3 visits) was 88 %. Conclusions: The universal programme was equally distributed in different immigrant and socio-demographic populations. However, the results did not indicate equality according to the assumption that some families need more input than others in order to achieve equity of outcome. Individual data routinely collected from CHS records to a quality database provides data of good quality that can be used for both quality surveillance and research.

Background Studies of asthma in migrant populations illustrate the effects of environmental changes. Objective In this register study we investigated the importance of exposure to a western lifestyle in different phases of development in Swedish residents with an origin in regions in the world where asthma usually is less prevalent. Methods The study population comprised 24 252 international adoptees, 47 986 foreign-born and 40 971 Swedish-born with foreign-born parents and 1 770 092 Swedish-born residents with Swedish-born parents (age 6-25 years). Purchased prescribed inhaled corticosteroids (ICS) during 2006 were used as an indicator of asthma. Results International adoptees and children born in Sweden by foreign-born parents had three-to fourfold higher rates of asthma medication compared with foreign-born children. The odds ratios (ORs) of asthma medication declined persistently with age at immigration. For adoptees the ORs compared with infant adoptees were 0.78 [95% confidence interval (CI) 0.71-0.85] for those adopted at 1-2 years, 0.51 (0.42-0.61) at 3-4 years and 0.35 (0.27-0.44) after 5 or more years of age. Corresponding ORs for foreign-born children with foreign-born parents immigrating at 0-4 years, at 5-9 years, at 10-14 years and at 15 years or more were 0.73 (0.63-0.86), 0.56 (CI 0.46-0.68) and 0.35 (CI 0.28-0.43), respectively. The ORs were only marginally affected by adjustment for region of birth and socio-economic indicators. Conclusions and Clinical Relevance Age at immigration is a more important determinant of purchased ICS than population of origin. This indicates the importance of environmental factors for asthma in schoolchildren and young adults.

Studies of different national populations were indispensable for estimating the impact of illness-related disability on social outcomes in adult childhood cancer survivors. The effects of childhood cancer on educational attainment, employment, and income in adulthood in a Swedish setting were studied.The study population was a national cohort of 1.46 million Swedish residents, including 1716 survivors of childhood cancer diagnosed before their 16th birthday, followed up in 2002 in registries at25 years of age. Main outcomes were educational attainment, employment, and net income. Markers of persistent disability were considered, and outcomes were analyzed with multivariate linear and logistic regression models adjusted for age, sex, and socioeconomic indicators of the childhood households.Non-central nervous system (CNS) cancer survivors had similar education, employment, and income as the general population in adjusted models, whereas survivors of CNS tumors more often had no more than basic (or =9 years) education (relative risk [RR], 1.80 [95% confidence interval (95% CI), 1.45-2.23]), less often attained education beyond secondary school (RR, 0.69 [95% CI, 0.58-0.81]), and less often were employed (RR, 0.85 [95% CI, 0.77-0.94]). Predicted net income from work was lower in CNS tumor survivors (P.001) than in the general population, even after the exclusion of individuals who received economic disability compensation.CNS tumor survivors had poorer social outcomes compared with the general population, whereas outcomes for survivors of other childhood cancers were similar to the general population. Established late effects highlighted the importance of improved, safer pediatric CNS tumor treatment protocols and surveillance that identified individual needs for preventive and remedial measures.

To investigate differences in the use of epidural analgesia (EDA) during labor between native Swedish and immigrant women and whether such possible differences could be explained by other maternal factors or birthweight.Population-based register study.Nationwide study in Sweden.A total of 455,274 primiparous women, who gave birth to a singleton infant at 37-41 completed gestational weeks during 1992-2005. Of the 72,086 (16%) immigrants, data on 31,148 women from the eight most common countries of origin were analyzed to test our hypotheses.Register study with perinatal data from the Medical Birth Register and socio-demographic variables from national income and population registers.Use of EDA during vaginal delivery.Compared with native Swedish women, EDA was more often used by women from Chile, odds ratio (OR) 1.39 (95% confidence interval (CI) 1.23-1.57); Iran, OR 1.38 (1.26-1.53); Poland, OR 1.22 (1.08-1.37) and Finland, OR 1.10 (1.03-1.17) after adjustments for perinatal and socio-demographic confounders, while EDA was less often used among women from Somalia, OR 0.57 (0.46-0.70); Iraq, OR 0.71 (0.64-0.78); Turkey, OR 0.77(0.69-0.86) and Yugoslavia, OR 0.85 (0.79-0.91). Having a native Swedish partner increased the use of EDA in immigrant women.EDA use during labor varies more by maternal country of origin than by socio-economic factors. This suggests that expectations of care from the country of origin continue to influence the use of EDA after immigration to Sweden.

Aims: To test the hypothesis that psychosocial adversity in the family predicts medicated ADHD in school children. Method: ADHD-medication during 2006 was identified in the Swedish Prescribed Drug ...

Aim: To investigate whether severe loss of activities of daily living (ADL) in asylum-seeking children is associated with physical disease or toxic influences and to describe the clinical course during the recovery process. Methods: A total of 29 asylum-seeking children with severe loss of ADL were regularly assessed by physical examinations, laboratory tests and a structured evaluation of their ADL status during rehabilitation. Results: A total of 12 children had previously recorded suicide attempts and 21 were recorded to have experienced traumatic events in their country of origin. The mean time from turning point to recovery was 6 months. Of the study participants, 22 needed enteral feeding and 18 gained weight during recovery. All children had a pulse rate and systolic blood pressure within the normal range. No sign of intoxication or physical disease was identified in laboratory tests or clinical examinations, with the exception of one case of epilepsy. Conclusion: Physical disease, pharmacological sedation or anorexia nervosa was not considered to be a probable cause of the loss of ADL in these children. The high rate of psychosocial risk factors and the stressful event of being in an asylum-seeking process call for further investigation of psychosomatic mechanisms.

Objective. To investigate the relation between use of epidural analgesia (EDA) and maternal and fetal characteristics. Design. Population-based register study. Setting. Nationwide study in Sweden. Population. All 106,775 primiparous women who in 2002–2005 delivered a singleton infant vaginally at term. Methods. Register study with data from the Medical Birth Registry and the Swedish Register of Education. Main outcome measure. Use of EDA during vaginal delivery. Results. A total of 47,810 women (45%) received EDA during labor. EDA was used more often in women who were either young or short, had a high body mass index or a short education, or gave birth to an infant with high birthweight. After adjustment, the positive correlation with birthweight persisted. The use of EDA was twice as high in women with infant birthweight >4,500 g, 60% higher in those with infants weighing between 4,000 and 4,500 g and 25% lower when infants weighed

The association of attention-deficit-hyperactivity disorder (ADHD) with bullying in the peer group in school was studied in an entire population of 577 fourth graders (10-year-olds) in one municipality in Stockholm, Sweden. The schoolchildren were screened for ADHD in a two-step procedure that included Conners'ratings of behavioural problems: teacher and parent interviews in a first step; and a clinical assessment in the second. Information about bullying was collected from the children themselves in a classroom questionnaire. Five-hundred and sixteen children (89.4%; 252 females, 264 males), for whom there was information from all data sources, were included in the study population. Conners'ratings that were collected from parents early in first grade were available for 382 of these children. Hypotheses were tested by multivariate analyses with adjustment for sex and parental education. Pervasive ADHD was diagnosed in 9.5% (95% confidence interval [CI] 5.6-12.8) of the males and 1.6% (CI 0.1-3.1) of the females. ADHD was associated with bullying other students (adjusted odds ratios (OR) 3.8 [CI 2.0-7.2]) as well as being bullied (often, OR 10.8 [CI 4.0-29.0]; sometimes, OR 2.9 [CI 1.5-5.7]). Bullying other students in fourth grade was associated with high scores in parental reports of behavioural problems at entry into first grade, suggesting a causal link to the ADHD syndrome. Being bullied, on the other hand, was not linked to behavioural problems at school entry. This study demonstrates a connection between ADHD and bullying in the peer group at school. Evaluation and treatment strategies for ADHD need to include assessment and effective interventions for bullying. Evaluation of ADHD should be considered in children involved in bullying.

Background: The proportion of Scandinavian school children reporting psychosomatic pain and psychological complaints have increased in recent decades. In this study we investigated these symptoms in relation to potential stressors in the school environment. Methods: A cross-sectional study was conducted based on child interviews linked to nationally representative household surveys in Sweden during 2002–2003 covering a sample of 2588 children aged 10–18 years. The main outcome variable of psychosomatic pain signified suffering from headache as well as recurrent abdominal pain on a weekly basis. Results: School stressors, such as harassment by peers, schoolwork pressure and being treated poorly by teachers, were associated with psychosomatic pain as well as psychological complaints such as sadness, irritability, feeling unsafe and nervous. Harassment was identified as a particularly important determinant with adjusted odds ratios (ORs) ranging from 3.1 to 8.6 for psychosomatic pain. All psychological complaints were associated with psychosomatic pain with adjusted ORs ranging from 2.2 to 3.7, and mediated most of the association of harassment to psychosomatic pain. Conclusions: School stressors are strongly associated with psychosomatic pain and psychological complaints in school children. Psychological complaints seem to function as mediators in the association of school stressors to psychosomatic pain symptoms to a great extent.

Aim: To investigate the association between low Apgar score and the development of cholestasis. Methods: Seventy-seven cholestatic infants, all referred to our tertiary centre and born between 1987 and 1996 were studied. Twenty-eight patients had biliary atresia (BA), 36 had various intra-hepatic disorders and for 13 patients the aetiology of the cholestasis was unknown. Data on gestational age, mode of delivery, Apgar score and birthweight for the cholestatic infants and 1 118 270 control subjects born during the same time period were obtained from the Swedish Medical Birth Registry. If the Apgar score of the cholestatic patient was

The number of children admitted to hospitals because of asthma has been reported to decrease in Sweden in recent decades despite an increasing prevalence of childhood asthma. This decrease has been explained by improved maintenance therapy of children with severe asthma. In this study we used data on hospital admissions for asthma from the Swedish National Patient Discharge Registers in Stockholm, Malmo and Gothenburg 1990-1994 to identify social and ethnic characteristics of children 2-18-y-old in need of improvement in disease management. Children in families on social welfare (adjusted odds ratios (OR): 1.3 and 1.5) and children in single-parent households (adjusted OR: 1.3 and 1.4) were more often admitted to hospital because of asthma at least once during a calendar year in the 2-6- and 7-18-y-old groups. Children in families on social welfare had a particularly high risk of being admitted more than once during a calendar year (adjusted OR: 1.6 in the younger age group and 2.9 in the older group). Exposure to smoking during pregnancy was more common in socially disadvantaged families and increased the risk of hospital admission in children below 3 y of age. Children born outside Western Europe, the USA and Australia were less commonly admitted to hospital because of asthma than other children in the population (adjusted OR: 0.1-0.5). Swedish-born children with mothers who were born in Eastern and Southern Europe were also at lower risk for admission to hospital with a diagnosis of asthma (adjusted OR: 0.2-0.6). This probably indicates a lower prevalence of asthma in these ethnic groups. Further studies are needed to identify factors that can explain these ethnic differences in childhood asthma.

Background: The proportion of Swedish schoolchildren that reports psychosomatic complaints has increased during recent decades, parallel to major structural changes in Swedish society. Aim: To investigate the association of psychosomatic complaints in relation to household socio-economic conditions. Methods: Cross-sectional study based on data from child supplements linked to nationally representative household surveys in Sweden during 2000–2003, covering a sample of 5390 children aged 10–18 y. Symptom variables were based on child interviews, while data from parental interviews were used to create socio-economic variables. Results: Girls more often reported headache and recurrent abdominal pain (RAP) than boys, and these differences became more pronounced with age. Economic stress in the household was associated with headache (OR 1.21, p

Background: Few large sample studies have examined psychiatric morbidity among former child welfare/protection clients. In this study, risks for suicide attempts and severe psychiatric morbidity in younger years were assessed for former child welfare clients in ten national birth cohorts, comparing them with general population peers and inter-country adoptees. Methods: We used national register data for almost one million people: 22,305 former child welfare clients who had experienced interventions before their teens, 955,326 general population cohort peers and 12,240 inter-country adoptees. Multivariate Cox regression models were used to estimate risks of hospitalisation for suicide attempts and psychiatric disorders from age 13 to age 18–27. Results: Former child welfare clients were in year of birth and sex standardised risk ratios (RRs) four to five times more likely than peers in the general population to have been hospitalised for suicide attempts. They were five to eight times more likely to have been hospitalised for serious psychiatric disorders in their teens, four to six times in young adulthood. High excess risks were also found for psychoses and depression. Individuals who had been in long-term foster care tended to have the most dismal outcome. Adjusting for birth parents’ hospitalisations with a psychiatric diagnosis or for substance abuse, and for birth-home-related socio-economic factors, reduced excess risks to around twofold. Conclusions: Irrespective of issues of causality, findings suggest that former child welfare/protection clients should be considered a high-risk group for suicide attempts and severe psychiatric morbidity. Results have substantial practice implications for mental health and social agencies serving this group in adolescence and/or young adulthood.

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common behavioural disturbances in school children. The aims of this thesis were to explore the association of ADHD with recurrent health complaints and bullying behaviour in children in grade four, and to evaluate whether it is possible to predict ADHD in grade four by screening before or at school entry. Cohort study in a population of 577 fourth graders (10-year-olds) in Sigtuna, a municipality in Stockholm County. All children were screened for attention and behaviour problems by parents and teachers in fourth grade. In a second step children with high scores underwent further clinical and cognitive assessments. Information about health complaints and bullying was collected from the children themselves in a classroom questionnaire. Hypotheses were tested in multivariate analyses with adjustment for sex and parental education. Screening with developmental indicators and Conners scale from routine child health services was performed. Sensitivity, specificity and positive predictive value for being diagnosed with ADHD in fourth grade was calculated. Recurrent abdominal pain, sleeping problems, and tiredness were associated with ADHD (adjusted relative risks: 2.2 [1.4-3.4], 1.7 [1.1-2.7], and 2.7 [1.7-4.1] respectively). ADHD was associated with bullying others students (adjusted odds ratios; 3.8 [95% C.I.: 2.0-7.2]) as well as being bullied (often 10.8 [4.0-29.0] and sometimes 2.9 [1.5-5.7]). The predictive value of developmental deviations for ADHD was no more than 20% and 50% when combining a Conner score of at least 10 from both parents and teachers. This thesis demonstrates a connection between ADHD in one as well as two settings (home and school), health complaints, and bullying in school children. Treatment strategies for ADHD need to include an effective evaluation and treatment of health complaints and effective interventions for bullying. Evaluation of ADHD should be considered in children with recurrent health complaints and in children involved in bullying. Screening does not identify children who are diagnosed with ADHD in grade four with a high degree of selectivity. It may be more important for schools to have an effective strategy for identifying and dealing with children who develop ADHD when these problems evolve, rather than before school entry.

Objective: The current study investigates the background and outcome of anorexia nervosa (AN) in young men. Method: All (N = 61) men, born in 1968–1977 with hospital care in Sweden between 1987 and 1992 due to AN, were compared with the general population. Information about socioeconomic background, health-related outcome (hospital care for AN, other psychiatric diagnoses, abuse of alcohol/drugs and/or suicide attempt), and social outcome (major income from sick leave/sick pension or ≥ 6 months social welfare, living with birth parents, and living with child and partner; education level) was taken from national registers. Results: On a group level, the findings suggest some differences between male patients with AN and the male population without AN concerning social background, capacity to support oneself, and living with partner and child. Mental ill-health outcome was almost the same for men with AN as for the general population. Conclusion: Male gender in AN — on a group level — suggests a good psychiatric prognosis. © 2006 by Wiley Periodicals, Inc. Int J Eat Disord 2006; 39:662–666

The general aims of this dissertation are to analyse how family situation, and especially lone parenting, influence health and life chances in Sweden and the extent to which possible relations are influenced by socioeconomic circumstances and health selection. In two population-based cohort studies we analysed overall and cause-specific mortality (1991-95), and also severe morbidity (1991-94) from different causes among lone mothers in comparison with mothers with partners. Information on the mothers was obtained from the Swedish Population and Housing censuses of 1985 and 1990. The outcomes considered were death or utilisation of (overnight) hospital care, with data taken from population-based national health registers. In the analyses we adjusted for socioeconomic and demographic circumstances, such as socioeconomic status, country of birth, receipt of social-welfare benefit, and housing situation. To take health-selection effects into account, we adjusted for previous inpatient history (1987-90). Our findings suggest that lone motherhood entails health disadvantages with regard to mortality, severe morbidity and injury. Socioeconomic circumstances were found to play a major role in accounting for increased risks, but the risks are partly independent of both socioeconomic conditions and health selection into lone motherhood. In two further studies we analysed mortality (1991-98), severe morbidity and injury (1991-99), and also educational achievement (in 1998 at ages 24-25 of offspring), of children who had lived in lone-parent families in comparison with children in two-parent families. We mainly used data from the Swedish censuses and national health-data registers. Living in a lone parent family was found to be associated with increased risks of a variety of unfavourable outcomes: psychiatric disease, suicide/suicide attempt, injury, addiction, and low educational attainment. Relatively poor educational performance and also health disadvantages are explicable to a large extent by socioeconomic conditions, especially a lack of economic resources (as measured here by receipt of social-welfare benefit and having rented accommodation). Educational achievement among children varies with cause of lone parenthood, with the best prospects found among the children of widows/widowers. In a fifth study we analysed mortality from different causes (1991-2000) among lone fathers (fathers with and without custody of their children) and childless men (with and without partners) in comparison with cohabiting fathers with children in the household. For this purpose we linked information from the Swedish censuses of 1985 and 1990 to Sweden’s Multi-Generation Register (which contains information about all known biological relations between children and parents). Lone non-custodial fathers and lone childless men suffer from the most pronounced elevated risks, especially of death from injury or addiction, but also from all-cause mortality and death from ischaemic heart disease. Being a lone custodial father also seems to entail an increased mortality risk, although generally to a much lesser degree, and not for all outcomes studied. The elevated risks for all subgroups fell when variables assumed to control health selection and socioeconomic circumstances were introduced into the initial regression model employed. However, even following adjustments, significantly increased risks, albeit greatly attenuated, remained in all the subgroups investigated. Key Words: Single parent, single mother, single father, children, risk factor, socio-economic status, mortality, morbidity, injury, psychiatric disease, education, epidemiology, longitudinal

Alcohol-related disorders in first- and second-generation immigrants inSweden: a national cohort study.

Background Earlier studies have given conflicting results regarding the effect of exposure to tobacco smoke on atopic sensibilization. Methods A cross-sectional study of present and former smoking habits in relation to atopic disorders from data on 6909 young and middle-aged adults (16–49 years) and their 4472 children (3–15 years) from the Swedish Survey of Living Conditions in 1996–97. Results The prevalence of allergic asthma and allergic rhino-conjunctivitis decreased, in a dose–response manner (P = 0.03 and P = 0.004, respectively), with increasing exposure to tobacco smoke in the adult study population. This pattern was little changed when potential confounders (sex, age, education, domicile, country of birth) were entered into a multivariate analysis: the adjusted odds ratio (OR) for allergic rhino-conjunctivitis was 0.5 (0.4–0.7) for those who smoked at least 20 cigarettes a day and OR 0.7 (0.6–0.9) for those smoking 10–19 cigarettes, compared with those who reported that they never had smoked Former smokers had a tendency for a slightly lower risk: OR 0.9 (0.8–1.0). In a multivariate analysis, children of mothers who smoked at least 15 cigarettes a day tended to have lower odds for suffering from allergic rhino-conjunctivitis, allergic asthma, atopic eczema and food allergy, compared to children of mothers who had never smoked (ORs 0.6–0.7). Children of fathers who had smoked at least 15 cigarettes a day had a similar tendency (ORs 0.7–0.9). Conclusions This study demonstrates an association between current exposure to tobacco smoke and a low risk for atopic disorders in smokers themselves and a similar tendency in their children. There is a need for further studies with a prospective design to certify the causal direction of this association. Smoking habits and atopic disorder in parents should not be considered independent variables in epidemiological studies of the connection between exposure to tobacco smoke and atopy in children.

–Objective: To describe oral health and use of dental care in relation to socio-economic determinants over time in Sweden. Methods: Cross-sectional study based on interview data on two randomly sampled sequential populations consisting of 7610 Swedish adult (25–64 years) residents and 4315 children (3–15 years) in their households from the Survey of Living Conditions 1996–97, and 7649 adult Swedish residents (25–64 years) from the survey of 1988–89. Results: Low educational level, having no cash margin and being born outside of Sweden was associated with higher odds of problems with chewing, wearing a prosthesis and not having been treated by a dentist during the 24 months preceding the interview, in a logistic regression analysis of data from the 1996–97 survey in the adult study population (adjusted odds ratios 1.6–2.9). The same socio-economic determinants were associated with caries in children (adjusted odds ratios 1.2–1.5). The socio-economic differences in dental treatment and problems with chewing were greater in the age group 45–64 years compared to 25–44-year-olds. The prevalence of problems with chewing increased from 7.1% (95% CI 6.5–8.1) in the 1988–89 survey to 9.1% (8.4–9.8) in the 1996–97 survey. A similar increase, from 2.4% (2.2–2.6) to 4.4% (3.9–4.9) was observed for individuals not having been in dental treatment during the last 24 months. The socio-economic distribution of oral health and use of dental care in the adult population was similar in the two surveys. Conclusion: This study demonstrates that socio-economic differences in oral health and use of dental care are most marked in older (45–64 years) adults in Sweden, but are significant in young adults and, in terms of oral health, in children as well. A steep increase in user charges during the 1990s has been paralleled by a moderate increase in problems with chewing and the proportion of the population that has no regular dental care, which suggests a link that needs to be evaluated in further studies.

Summary Background The International Study of Asthma and Allergies in Childhood (ISAAC) has demonstrated large differences in the prevalence of atopic disorders in children between different regions in the world. Populations with a higher standard of living and a more westernized lifestyle tend to have higher rates of atopy and asthma. Many hypotheses regarding environmental causes of atopic disorder focus on the early childhood environment. Objective To study the influence of ethnicity and country of birth for the prevalence of atopic disorders. Methods The prevalence of atopic disorders in Swedish residents born in Turkey and Chile, who settled in Sweden as adults in the 1980s, was compared with their own Swedish-born children and a sample of Swedish-born parents and their children in interview data from the Survey of Living Conditions in 1996. The study group included 1734 adults 27‐60 years of age and their 2964 children aged 3‐15. Results The Chilean-born parents and their children had the highest risk for allergic asthma; adjusted odds ratios (ORs) 2.2 (1.2‐4.0) and 2.7 (1.6‐4.5), respectively, and allergic rhino-conjunctivitis; OR 1.6 (1.1‐3) and 1.6 (1.1‐2.5) in both groups, when compared with the Swedish-born parents and their children. The Turkish-born parents and their children had the lowest risk for allergic rhino-conjunctivitis; both groups had OR 0.6 (0.4‐0.9) and the children in this group also had the lowest risk for eczema; OR; 0.4 (0.3‐0.7). The risk for all atopic disorders was lower in the Turkish group compared with the Chileans. Conclusion This study demonstrates that ethnicity is an important determinant of atopic disorder independent of the external childhood environment. The value of international comparisons of environment and risk for atopic disorders can be questioned until more is known about factors related to ethnicity, such as genetic susceptibility and diet, for the development of atopy.

Family size and smoking during pregnancy were studied as mediating factors for social and ethnic variation of lower respiratory tract infection (LRI) in hospital discharge data. The study population consisted of all children aged 0-4 years in the three largest metropolitan areas of Sweden during 1990-94. Maternal smoking during pregnancy increased the risk of children being admitted to hospital for LRI during their first 3 years of life, with an adjusted odds ratio (OR) of 1.3 for the age-group 0-1 years. The risk attributed to smoking during pregnancy was the same in children of mothers in ethnic groups in which smoking during pregnancy was related to social adversity as in those in which it was not. Having at least one sibling increased the risk of being admitted to hospital for LRI in the age group 0-1 years (adjusted OR 2.2). This risk was lower in children in families in which the mother was born in southern Europe, Africa, Asia or Latin America, suggesting a contextual relation to ethnicity for this risk factor. It is concluded that family size and smoking during pregnancy are important mediators of the risk for LRI related to social adversity and ethnicity in Swedish children below 2 years of age.

Purpose: To classify a cohort of 62 patients with vernal keratoconjunctivitis (VKC) in immunologic, functional, and epidemiological terms. Methods: A retrospective chart review was conducted to establish the patients’ ethnic origin and to ascertain the results of standard in vitro and in vivo testing for atopic allergy. The latter data were compared with tear Phadiatop A ,a n allergy screening test, in 31 subjects. Further subgroup analyses included methacholine bronchial provocations, serum screening for chlamydial antibodies and epidemiological calculations of the observed prevalence of VKC in the Stockholm area in 1994. Results: Thirty-seven subjects (59.7%) were sensitised to common allergens. No additional allergic subjects were diagnosed with the tear Phadiatop A test. The serology for ocular chlamydial disease was negative. Only 6 out of 17 subjects displayed bronchial reactivity to methacholine of whom 4 had a history of asthma. VKC was clearly more common in individuals with an Asian and African origin. Conclusions: Sensitivity to allergens is a strong determinant for the disease but in a large proportion of the subjects this immunologic abnormality is absent. The varying prevalence of the condition in different ethnic groups indicates a genetic predisposing factor.

We have studied asthma and allergic rhinitis prevalence in Swedish conscripts born 1973-1977 according to the military service conscription register in relation to the socio-economic status and country of birth of the conscripts and their parents, and age when granted residency in Sweden. There was an increase in prevalence of asthma and allergic rhinitis over time in all groups irrespective of country of birth or ethnic origin. Conscripts who themselves were born in Africa, Asia, Latin America and the Mediterranean had a significantly lower risk for asthma and allergic rhinitis than Swedish-born conscripts. The risk of atopic disorder among the foreign-born conscripts increased with time of residency in Sweden. Conscripts with mothers from Latin America, Asia and Africa were identified as having the highest risk for atopic disorder among Swedish-born conscripts with high socio-economic status; the adjusted risk ratio (RR) for asthma was 2.6 (95% CI 1.7-4.0) and that for allergic rhinitis was 2.0 (1.5-2.6). The conscripts with mothers from the Mediterranean had the lowest risk for atopic disorders of the Swedish-born conscripts with low socio-economic status; the RR for asthma was 0.43 (0.34-0.56) and that for allergic rhinitis was 0.84 (0.76-0.93). This study demonstrates that factors related to migration and ethnicity are important determinants of atopic disorder among Swedish conscripts.

Epidemiological and laboratory studies have implied that the environment during early childhood is important for the risk of developing atopic disorders. In this study we analyzed the prevalence of asthma, hayfever and eczema among 1901 internationally adopted young men at the military-induction medical examination in relation to indicators of their early childhood environment. The adopted young men who came to Sweden before 2 years of age suffered from asthma, hayfever and eczema significantly more often than those who came to Sweden between 2 and 6 years of age; the risk ratios (RR) were 1.6, 2.5 and 2.1, respectively. The young men who were born in the Far East were identified as being particularly susceptible to the development of hayfever and eczema, with RRs of 1.3 and 1.7. This study demonstrates that the environment during the first 6 years of life has a profound influence on the risk of suffering from atopic disorders as young adults.

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 ...

Several recent studies have found that the majority of children in Sweden are happy, healthy and faring well� This comes across most clearly when children are given the opportunity to speak for themselves� The report by the Children’s Ombudsman ‘How much fun is that, on a scale of 1 to 10’ (Barnombudsmannen, 2005) found that the 1,900 children who took part in the study were, by and large, very satisfied with their lives� They were satisfied with their families, friends, homes and schools, and believed strongly in the future� The study found that differences between groups were relatively small, although children with disabilities were less satisfied than others, as were teenagers in the last two years of compulsory education1 (grades 7–9) and children living with a single parent� Health was crucial to children’s sense of wellbeing, particularly among girls� Although children living in residential areas with a high concentration of immigrants were more satisfied with their schools than pupils in other schools, concerns about violence and accidents were common in such areas� Older children were more concerned than younger children, girls more than boys; most worried were children from non-Swedish backgrounds and children living in areas with predominantly immigrant population�

RE: Routine developmental screening at 5.5 and 7 years of age is not an efficient predictor of attention-deficit/hyperactivity disorder : a critical comment: author's reply