Socialpediatrik och barnhälsovård som yrke - Några reflexioner om betydelsen av vägvisare och personliga möten

I denna artikel beskriver Claes Sundelin några personliga möten som varit betydelsefulla för hans forskning och yrkesverksamhet.

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

Basta : Validitet i ett regionalt barnhälsovårdsregister

Aim: To validate a local Child Health Care Quality database (Basta) in the county of Uppsala, Sweden in terms of completeness and agreement with the Child Health Care record (CHCR). Material and methods: The target population for the study consisted of 2-year old children born during 2005 to 2008 and registered as residents in the county of Uppsala Sweden (n= 15 769), each child enrolled at one specific Child Health Centre (CHC, n= 41) in the county. The study population was determined by means of a two step cluster selection design. In step one 11 CHC: s was randomly selected. In step 2 five percent of the children at each of the 11 randomized CHC was randomly selected, the selection procedure ending up in a study population comprising 198 children. The CHCR for all 198 children was retrieved and information regarding visits at the CHC, home visits, participation in parenting group, parental smoking habits, breastfeeding and vaccination status was entered into the study database together with the corresponding data from the Basta database. The data on each pair of connected variables was compared and the results regarding the number of visits at CHC, the number of home visits, any home visit, a minimum number of 6 visits at CHC,  a minimum number of 11 visits at CHC and participation in parenting group at any time were expressed as the percentage of correspondence. For results regarding if the child had received each dose of the recommended vaccines, breastfeeding status at given time points and paternal smoking at given time points the sensitivity, specificity and positive and negative predictive value between the CHCR and the corresponding Basta data was calculated. Results: The sensitivity value for given doses of vaccines against diphtheria, tetanus, whooping cough, polio myelitis and hemophilus influenza was > 95 % and for breastfeeding at 1 week, 2, 4 and 6 months of child age 94-95 %. The sensitivity value for maternal smoking was 100 % and for paternal smoking>90 %. For any home visit, participation in parenting group at any time, a minimum number of 6 visits at CHC and a minimum number of 11 visits at CHC the calculated sensitivity value were between 88 to 96 %. The sensitivity value for the exact match of number of visits at CHC was low. Increasing the tolerance to +/- 3 visits the sensitivity value was 88 %. Conclusions: The results showed a satisfactory level of completeness in the Basta database and sufficient agreement with data in the CHCR. The data in Basta could be considered valid enough to be used for both the guarantee of quality and research purposes. However, some concerns could be made about using data on breastfeeding at 10 and 12 months and smoking status at 9 months where the attrition was higher and the exact number of visits at CHC where the exact match was low

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

Molecular cloning of the murine substance K and substance P receptor genes

The peptides substance K and substance P evoke a variety of biological responses via distinct, guanosine‐nucleotide‐binding‐regulatory‐protein‐coupled receptors. We have screened a murine genomic cosmid library using oligonucleotide probes and have isolated, cloned and characterized the substance K receptor and the substance P receptor genes. The coding portion of the substance K receptor gene consists of five exons distributed over 13 kbp. The substance P receptor gene is considerably larger than that of substance K (more than 30 kbp), however, the bundaries of the four exons that have been characterized in the substance P receptor gene correspond exactly to the homologous exons in the substance K receptor gene. To verify the identity of the isolated genes, we have cloned the corresponding cDNA by means of the polymerase chain reaction and we have expressed these cDNA species in Xenopus laevis oocytes. The ligand binding characteristics determined in this system pharmacologically confirm the identity of the two receptors. The deduced amino acid sequence of the mouse substance K receptor is 94% identical to the rat sequence and 85% identical to the bovine and human sequences. The mouse substance P receptor amino acid sequence is 99% identical to the rat sequence. The cloning of the murine substance K and substance P receptor genes should contribute substantially to the generation of in vivo models for the detailed analysis of the functional significance of these receptors

Reducing stress and anxiety in patients with myocardial infarction with non-obstructive coronary arteries or Takotsubo syndrome: A non-randomized feasibility study

Background and aim: In the aftermath of a myocardial infarction with non-obstructive coronary arteries (MINOCA) or Takotsubo syndrome (TS), patients commonly express high levels of stress and anxiety. Current treatment alternatives rarely address these issues. The planned E-health Treatment of Stress and Anxiety in Stockholm Myocardial Infarction With Non-obstructive Coronaries Study (e-SMINC) aims to evaluate the effects of an internet-based intervention, building on cognitive behavioral therapy (CBT) by comparison with treatment as usual using an RCT approach. This was a small-scale single arm study designed to test the feasibility of the RCT, addressing uncertainties regarding recruitment, data collection, and intervention delivery. Methods: Participant recruitment and screening took place before discharge from the coronary care unit at a large Swedish hospital. Eligible patients were invited to a nine-step psychologist guided, internet-based CBT intervention. The sample size was set in advance to 10 participants completing the intervention. The recruitment and flow of participants were documented and evaluated in relation to seven pre-defined progression criteria. Self-reports of anxiety (HADS-A), stress (PSS-14), cardiac anxiety (CAQ), posttraumatic stress (IES-6) and quality of life (Rand-36), collected at screening, pre-intervention and post-intervention, were analysed descriptively and by effect sizes (Cohen's d). Individual interviews targeting participant experiences were conducted. Results: Six out of seven progression criteria yielded no concerns. Out of 49 patients with a working diagnosis of MINOCA or TS, 31 were eligible for screening, 26 consented to participate, and 14 were eligible with regard to symptoms of stress and/or anxiety. Eleven completed the pre-assessment and were given access the intervention, and 9 completed the intervention. Only the number of patients screened prior to eligibility assessment was slightly lower than expected, indicating possible concerns. Self-reports of anxiety, stress, cardiac anxiety, posttraumatic stress, and quality of life all indicated symptom reduction from pre- to post-intervention, generally showing large effect sizes (d = 0.6–2.6). The general consensus among participants was that the programme was helpful and relevant, and that the personal contact with the psychologist was highly valued. Setting aside time to complete assignments was found critical. Conclusion: Conducting a full scale RCT was found feasible. Inclusion of more study sites and minor amendments to the protocol and intervention were decided to improve feasibility further