Early Detection and Referral of Young Children with Psychosocial Problems in the Preventive Child Health Care

__Abstract__ The detection and treatment of psychosocial problems at an early age is increasingly recognized as being of the utmost importance [1], more so since we know that these problems can influence the daily lives of children negatively [2] and tend to become persistent if left untreated [3-4]. That is why the development of empirically informed public health policies in order to respond adequately to such problems in young children has become a health priority globally [5-6]. One way of treating psychosocial problems in young children is by offering specialist mental health care. However, before entering treatment children first need to be identified as having psychosocial problems and consequently need to be referred to proper care. In the Netherlands, early detection of psychosocial problems is a task of the preventive care system [7]. For this task the parent reported Strength and Difficulties Questionnaire (SDQ) is recommended by the Health care Inspectorate of the Dutch government [8]. The SDQ is widely used and it was validated in many countries with satisfying results. However, the SDQ has not yet been validated for children in the younger age groups, nor in children of different ethnic backgrounds. Furthermore, little is known about the process of identification of psychosocial problems and referral for these problems in young children by the preventive child health care professional (CHP) who are making use of early detection instruments. Therefore, the main aim of this thesis is to explore the role of the SDQ in identifying psychosocial problems in young children by the preventive youth health care professional as well as the role of the SDQ in referral for these problems. Initially, the reliability and validity of the parent and teacher reported SDQ was determined in 5 to 6 year old children as well as in subgroups with the same background characteristics. In the next paragraphs a theoretical model for help-seeking behaviour will be presented. Psychosocial problems, the Dutch preventive child health care, different ways of identification of psychosocial problems and the SDQ will be explained in more detail. Finally, the research questions and the outline of this thesis will be presented

Risky music listening, permanent tinnitus and depression, anxiety, thoughts about suicide and adverse general health

Objective: To estimate the extent to which exposure to music through earphones or headphones with MP3 players or at discotheques and pop/rock concerts exceeded current occupational safety standards for noise exposure, to examine the extent to which temporary and permanent hearing-related symptoms were reported, and to examine whether the experience of permanent symptoms was associated with adverse perceived general and mental health, symptoms of depression, and thoughts about suicide. Methods: A total of 943 students in Dutch inner-city senior-secondary vocational schools completed questionnaires about their sociodemographics, music listening behaviors and health. Multiple logistic regression analyses were used to examine associations. Results: About 60% exceeded safety standards for occupational noise exposure; about one third as a result of listening to MP3 players. About 10% of the participants experienced permanent hearing-related symptoms. Temporary hearing symptoms that occurred after using an MP3 player or going to a discotheque or pop/rock concert were associated with exposure to high-volume music. However, compared to participants not experiencing permanent hearing-related symptoms, those experiencing permanent symptoms were less often exposed to high volume music. Furthermore, they reported at least two times more often symptoms of depression, thoughts about suicide and adverse self-assessed general and mental health. Conclusions: Risky music-listening behaviors continue up to at least the age of 25 years. Permanent hearing-related symptoms are associated with people's health and wellbeing. Participants experiencing such symptoms appeared to have changed their behavior to be less risky. In order to induce behavior change before permanent and irreversible hearingrelated symptoms occur, preventive measurements concerning hearing health are needed

The Strengths and Difficulties Questionnaire Parent Form:Dutch norms and validity

OBJECTIVE: This study provides Dutch national norms for the parent-reported Strengths and Difficulties Questionnaire (SDQ) for children aged 3-14 years, and assesses the test performance of the SDQ Total Difficulties Scale (TDS) and impairment Scale. We further compared Dutch SDQ norms with those of the United Kingdom (UK), to determine potential variation in country-specific norms. STUDY DESIGN: We analyzed data of 3384 children aged 3 to 14 years. The data were obtained in schools, and in the context of Preventive Child Healthcare. Parents completed the SDQ parent form and the Child Behavior Checklist (CBCL). We determined clinical (10% elevated scores) and borderline (20% elevated scores) SDQ TDS norms. We assessed the test performance (validity) of the SDQ TDS and Impairment Score using the CBCL as criterion. RESULTS: The clinical SDQ TDS norms varied between > 10 and > 14 depending on the age group. The SDQ TDS discriminated between children with and without problems, as measured by the CBCL, for all age groups (AUCs varied from 0.92 to 0.96). The SDQ Impairment Score had added value (beyond the SDQ TDS) only for the age group 12-14 years. For the Netherlands we found lower clinical SDQ TDS norms than those previously reported for the UK (i.e. > 16). CONCLUSION: The clinical SDQ TDS norms varied between > 10 and > 14 depending on the age groups. We found good test performance at these proposed norms. Dutch norms differed somewhat from UK norms. In the Netherlands, the SDQ performed better with Dutch-specific norms than with UK-specific norms

Prevalence of bullying and victimization among children in early elementary school:Do family and school neighbourhood socioeconomic status matter?

BACKGROUND: Bullying and victimization are widespread phenomena in childhood and can have a serious impact on well-being. Children from families with a low socioeconomic background have an increased risk of this behaviour, but it is unknown whether socioeconomic status (SES) of school neighbourhoods is also related to bullying behaviour. Furthermore, as previous bullying research mainly focused on older children and adolescents, it remains unclear to what extent bullying and victimization affects the lives of younger children. The aim of this study is to examine the prevalence and socioeconomic disparities in bullying behaviour among young elementary school children. METHODS: The study was part of a population-based survey in the Netherlands. Teacher reports of bullying behaviour and indicators of SES of families and schools were available for 6379 children aged 5–6 years. RESULTS: One-third of the children were involved in bullying, most of them as bullies (17%) or bully-victims (13%), and less as pure victims (4%). All indicators of low family SES and poor school neighbourhood SES were associated with an increased risk of being a bully or bully-victim. Parental educational level was the only indicator of SES related with victimization. The influence of school neighbourhood SES on bullying attenuated to statistical non-significance once adjusted for family SES. CONCLUSIONS: Bullying and victimization are already common problems in early elementary school. Children from socioeconomically disadvantaged families, rather than children visiting schools in disadvantaged neighbourhoods, have a particularly high risk of involvement in bullying. These findings suggest the need of timely bullying preventions and interventions that should have a special focus on children of families with a low socioeconomic background. Future studies are necessary to evaluate the effectiveness of such programs

Gene therapy for insulin dependent diabetes mellitus using IL-12p40- producing islet grafts

本研究では, インスリン依存型糖尿病 (IDDM) のモデル動物である NOD (nonobese diabetic) マウスに, 抑制性サイトカイン遺伝子をアデノウイルスベクターを用いて導入した膵ラ島移植を行ない自己免疫機序による拒絶反応の阻止を試みた。糖尿病発症NODマウスに, IL-12p40およびIL-10遺伝子をアデノウイルスベクターを用いて導入したNODマウス膵ラ島を移植した。IL-12p40産生膵ラ島移植では4週間以上の移植片の生着を認めたが, IL-10産生膵ラ島移植では移植片の長期の生着は得られなかった。組織学的検討では, IL-12p40産生膵ラ島移植では移植7日および60日後で正常膵ラ島構造を維持し軽度の単核球浸潤のみ認めたが, IL-10産生膵ラ島移植では移植7日後ですでに著明な単核球浸潤を伴い膵ラ島構造も破壊されていた。また, RT-PCR法での移植片局所のサイトカインの解析より, 移植片の長期生着のメカニズムとして, IL-12p40産生膵ラ島移植ではIFN-γ産生細胞の減少とTGF-β産生細胞の誘導により免疫寛容が成立した可能性が示唆された。以上より, IL-12p40産生膵ラ島移植では移植片の長期生着が可能であり, 今後のIDDM発症後の治療法として膵ラ島移植を用いた遺伝子療法の確立への第一歩と考えられた。 / Insulin dependent diabetes mellitus (IDDM) is considered to be a T cell-mediated autoimmune disease. It has been demonstrated that T helper (Th) 1 cells would play an important role in destruction of pancreatic β cells. It has recently been reported that systemic administration of IL-12 accelerates diabetes onset and that IL-12p40, an antagonist of IL-12, prevents diabetes development. From these results, we considered to establish gene therapy for IDDM with the islet grafts producing immunosuppressive cytokine such as IL-12p40. The syngeneic islet transplantation into diabetic nonobese diabetic (NOD) mice was performed using the recombinant adenoviral vector with inserted mlL-12p40 (Ad. IL-12p40) or mlL-10 (Ad. IL-10). Ad. IL-12p40-transfected islet grafts could significantly prevent autoimmune diabetes recurrence for over 4wk after transplantation (Tx). In contrast, Ad.IL-10 could not prolong syngeneic islet graft survival. Histological study revealed that IL-12p40-producing islet grafts remained normal in configulation with a small amount of lymphoid infiltration on day 60 after Tx, in contrast to IL-10-producing islet grafts with massive infiltration on day 7 after Tx. Reverse transcription (RT)-PCR analysis demonstrated that IL-12p40 gene transfer into islet grafts led to the significant decrease of IFN- 7 and the augmentation of TGF-β. These results suggest that IL-12 plays a key role in the autoimmune diabetes and that locally-produced IL-12p40 protects syngeneic islet grafts from recurrent autoimmune destruction of β cells by reducing IFN- γ and increasing TGF-β. This novel gene therapy would be clinically applicable to human IDDM

Television viewing through ages 2-5 years and bullying involvement in early elementary school

BACKGROUND: High television exposure time at young age has been described as a potential risk factor for developing behavioral problems. However, less is known about the effects of preschool television on subsequent bullying involvement. We examined the association between television viewing time through ages 2-5 and bullying involvement in the first grades of elementary school. We hypothesized that high television exposure increases the risk of bullying involvement. METHOD: TV viewing time was assessed repeatedly in early childhood using parental report. To combine these repeated assessments we used latent class analysis. Four exposure classes were identified and labeled “low”, “mid-low”, “mid-high” and “high”. Bullying involvement was assessed by teacher questionnaire (n = 3423, mean age 6.8 years). Additionally, peer/self-report of bullying involvement was obtained using a peer nomination procedure (n = 1176, mean age 7.6 years). We examined child risk of being a bully, victim or a bully-victim (compared to being uninvolved in bullying). RESULTS: High television exposure class was associated with elevated risks of bullying and victimization. Also, in both teacher- and child-reported data, children in the high television exposure class were more likely to be a bully-victim (OR = 2.11, 95% CI: 1.42-3.13 and OR = 3.68, 95% CI: 1.75-7.74 respectively). However, all univariate effect estimates attenuated and were no longer statistically significant once adjusted for maternal and child covariates. CONCLUSIONS: The association between television viewing time through ages 2-5 and bullying involvement in early elementary school is confounded by maternal and child socio-demographic characteristics

Prevalence of bullying and victimization among children in early elementary school: Do family and school neighbourhood socioeconomic status matter?

Background: Bullying and victimization are widespread phenomena in childhood and can have a serious impact on well-being. Children from families with a low socioeconomic background have an increased risk of this behaviour, but it is unknown whether socioeconomic status (SES) of school neighbourhoods is also related to bullying behaviour. Furthermore, as previous bullying research mainly focused on older children and adolescents, it remains unclear to what extent bullying and victimization affects the lives of younger children. The aim of this study is to examine the prevalence and socioeconomic disparities in bullying behaviour among young elementary school children. Methods. The study was part of a population-based survey in the Netherlands. Teacher reports of bullying behaviour and indicators of SES of families and schools were available for 6379 children aged 5-6 years. Results: One-third of the children were involved in bullying, most of them as bullies (17%) or bully-victims (13%), and less as pure victims (4%). All indicators of low family SES and poor school neighbourhood SES were associated with an increased risk of being a bully or bully-victim. Parental educational level was the only indicator of SES related with victimization. The influence of school neighbourhood SES on bullying attenuated to statistical non-significance once adjusted for family SES. Conclusions: Bullying and victimization are already common problems in early elementary school. Children from socioeconomically disadvantaged families, rather than children visiting schools in disadvantaged neighbourhoods, have a particularly high risk of involvement in bullying. These findings suggest the need of timely bullying preventions and interventions that should have a special focus on children of families with a low socioeconomic background. Future studies are necessary to evaluate the effectiveness of such programs

The longitudinal association between potential stressful life events and the risk of psychosocial problems in 3-year-old children

BackgroundExperiencing certain potentially stressful life events can impact psychosocial well-being among school-aged children and adolescents. This study aims to evaluate the association between life events occurring before age 2 and risk of psychosocial problems at 3 years of age.MethodsAll parents invited for the regular well-child visit when their child was 2 years of age by the preventive Youth Health Care in the Rotterdam-Rijnmond area, the Netherlands, were invited to participate in this study. In total 2,305 parents completed the baseline questionnaire at child age 2-years; 1,540 parents completed the questionnaire at child age 3-years. The baseline questionnaire included a life events assessment (12 items), and tension caused by the event (range 0–3). At child age 3-years the questionnaire included the Strengths and Difficulties Questionnaire (SDQ) to assess risk of psychosocial problems. Logistic regression models were applied.ResultsIn the current study 48.5% of families experienced ≥1 life event before child age 2 years. Divorce and problems in the relationship between the parents received the highest perceived severity score [respectively 2.1 (SD = 0.8) and 2.0 (SD = 0.7)]. Children experiencing ≥1 event before the age of 2 years were at higher risk of psychosocial problems at 3 years of age, compared to children that had experienced no life event (1–2 events OR = 1.50, 95%CI: 1.09; 2.06, and >2 events OR = 2.55, 95%CI 1.64; 4.00, respectively). When life events caused high perceived levels of tension, there was also an association with an increased risk of psychosocial problems at age 3-years (OR = 2.03, 95%CI 1.43; 2.88).ConclusionsApproximately half of children in our study experienced a potential stressful life event before the age of 2 years. Results suggest an association between experiencing a life event and risk of psychosocial problems at child age 3-years. These findings emphasize the need for child health care professionals to pay attention to life events taking place in the life of young children in order to provide appropriate support

Bullying and Victimization Among Young Elementary School Children: The Role of Child Ethnicity and Ethnic School Composition

School-aged children with an ethnic minority background are relatively often involved in bullying and victimization, but the role of ethnic composition of schools in this context remains unclear. This study examined the relation between ethnic minority background, ethnic school composition, and bullying behaviour around primary school entry in the Netherlands. The study was based on a 2008/2009 school survey in Rotterdam, a Dutch city where about 50 % of children have a non-Dutch background. For 8523 children, teacher reports of bullying behaviour at age 5–6 years were available. Children with a non-Dutch background had higher odds of being a victim (adjusted OR 1.41, 95 % CI 1.11, 1.80), bully (OR 1.38, 95 % CI 1.20, 1.58) or bully-victim (OR 1.38, 95 % CI 1.19, 1.62) than children of Dutch national origin. Ethnic diversity in schools increased children’s risk of bullying behaviour (e.g. ORvictim per 0.1 increase in 0–1 diversity range = 1.06, 95 % CI 1.00, 1.13), with children of both Dutch and non-Dutch national origin relatively more often involved in bullying in ethnically diverse schools. The proportion of same-ethnic peers in school reduced the risk of bullying among children of Dutch national origin (e.g. ORvictim per 10 % more same-ethnic children = 0.90, 95 % CI 0.83, 0.98), but not among non-Dutch children. In conclusion, ethnic minority background and ethnic diversity within schools are risk factors for bullying among 5–6 year olds. Plausibly, reductions in absolute numbers of bullying events may be obtained with tailor-made interventions in ethnically diverse schools. Such interventions should preferably be offered early in the school curriculum