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Biomedical subjects

M Westerlund

Publications and source records attributed to M Westerlund.

At least 19 recordsLinked to original sources
PubMed2006

Identification of health problems at 18 months of age--a task for physicians or child health nurses?

BACKGROUND: Several studies have questioned the rationality of repeated routine health examinations by physicians during the first years of life. The aim of the present study was to evaluate the population-based 18-month health examination and compare the yield of new health problems identified by physicians in 1994 with the yield identified by child health centre (CHC) nurses in 2000. METHODS: Two populations of children were invited to their 18-month health examination during one year, the first in 1994 and the second in 2000. In 1994 the population consisted of 4075 and in 2000 of 2968 children who were registered in Uppsala county, Sweden, for census purposes in December 31 each year. Data from a county health register as well as child health records and information regarding referrals were analysed to categorize the health problems by type, severity and action taken. RESULTS: On the whole few new verified health problems were detected by the health examinations at the 18 month health examinations: 2.3% in 1994 and 1.7% in 2000. In 1994, when the physicians carried out the examinations, the most common health problems were somatic problems, particularly moderate transient infections. In 2000, when the nurses carried out the examinations, the dominant problems were speech problems. Peculiarly enough a couple of children with the same severe health problems, gluten allergy and problems in the autistic spectrum, were identified both in 1994 and in 2000. In addition the nurses in 2000 identified seven children with severe speech problems. No additional severe health problems were identified by the physicians in 1994. CONCLUSIONS: According to the present study, there is no evidence that health examinations carried out by nurses are of lower quality in detecting health problems than those carried out by physicians. The organization and content of the health surveillance programme ought to be reconsidered with respect to available resources and importance of the close relationship established between nurse and family already in the newborn period.

Clinical Competence↗
PubMed2004

A short-term follow-up of children with poor word production at the age of 18 months.

AIM: (a) To study the stability of poor language development assessed by a new screening instrument based on parents' recognition of words their 18-mo-old children use; (b) to evaluate the predictability of the less-than-eight-words cut-off used by Child Health Centres (CHCs) in Sweden at the present 18-mo check-up--an assessment based on parents' recall of their children's vocabulary. METHODS: All failures of the less-than-eight-words criterion, corresponding to about 10% of 1000 children from a community-based study, were followed up within half a year after the first assessment. The follow-up instrument was an extensive, internationally well-known and structured parent questionnaire, standardized for Swedish children. RESULTS: Almost half of the followed-ups performed below the 10th percentile and more than two-thirds were found below the 20th percentile. Thus, after a few months about one-third of the children had caught up to a fairly normal level of performance. Two of the children who had recovered performed above median. More relaxed cut-off criteria were applied ad hoc, reducing the proportion of children with a fast recovery. CONCLUSION: Age of language assessment and/or the level of cut-off criterion presently used at Swedish CHCs should be reconsidered.

Female↗
PubMed2002

Comorbidity in children with severe developmental language disability.

UNLABELLED: In a cohort of 2359 children, screened for severe developmental language disability (DLD) at 3 y of age, 45 children were identified as true positives. The development, concerning DLD and comorbidity of 41 of these children still living in the municipality of Uppsala was followed up to school start. Criteria for comorbidity were: (a) suspected or diagnosed neuropsychiatric/neurodevelopmental disability according to information from the Child Habilitation Centre and the Child Psychiatric Centre or (b) low performance IQ, signs of activity/distractibility problems according to a psychologist's examination. By school start, 61% of the children with severe DLD were identified with comorbidity. CONCLUSION: Severe DLD is often combined with other disabilities within the neuropsychiatric/neurodevelopmental spectra. The comorbidity might not be obvious at 3 y of age--the age at which severe DLD is effectively identified by the 3-y screening programme. This in turn stresses the necessity of multidisciplinary teamwork both at the referral level and during the therapy work.

Age Factors↗
PubMed2001

Relationship between a global rating of speech ability at the age of 3 yrs and a phonological screening 1 yr later: a prospective field study.

OBJECTIVE: This study, which was carried out under routine conditions, evaluates the predictability of a global rating of children's speaking manner made by Child Health Centre nurses. The global rating was added to a formalized screening of 3-yr olds, which intended to identify severely language disabled children. This screening procedure is used in several Swedish counties and the participation rate is nearly 100%. The main questions of the study are: (i) can a global rating of speech ability in children, who have passed the 3-yr screening, predict the outcome of a new population screening 1 yr later? and if so (ii) what is the most efficient cut-off point? METHODS: The global ratings of the 3-yr olds were made using a 100 mm visual analogue scale (VAS). At the age of 4 yrs, 2065 globally rated children with no objections from the 3-yr screening participated in a second, well-established assessment. The purpose of this second screening was to identify not only severe but also moderate disability. RESULTS: The mean VAS value of the global ratings was 62 mm. One-third of the ratings fell on the lower half of the scale. With a cut-off level set at < or =50 mm on the VAS two newly-identified, severely disabled children and 74% of the moderately disabled 4-yr olds were identified. CONCLUSION: The results suggest that the global rating in connection to the 3-yr screening would serve as a useful tool for selective screening of 4-yr olds, and thus, reduce the work load.

Age Factors↗
PubMed2000

Screening for developmental language disability in 3-year-old children. Experiences from a field study in a Swedish municipality.

This study evaluates a screening instrument for identification of severe developmental language disability (DLD) in 3-year-old children, which is used as a routine assessment at several child health centres (CHCs) in Sweden. The results are reported in terms of clinical outcome (false- and true-positive rates), kind and extent of DLD, signs of comorbidity and relation between nurses' and parents' observations. More than 60 CHC nurses, all with experience of the screening instrument, assessed in all 2359 3-year-old children (98% of the whole population) by direct observation of their language comprehension, language production and level of co-operation. In addition to the screening parents answered a questionnaire. Children who failed the screening had their hearing assessed and were clinically examined by trained speech and language therapists. Forty-four (34 boys and ten girls) of the 65 referred children were clinically examined. Apart from two false-positive cases most of them were diagnosed as generally and severely language disabled. According to the nurses' observations attention deficit was common among the referred boys, which was later confirmed by the speech therapist in two-thirds of them. Agreement between nurses and parents was poor and only half of the parents were concerned about their child's language development. In the light of this result, continued application of the screening and the use of parent questionnaires is discussed.

Child, Preschool↗
PubMed2000

Can severe language disability be identified in three-year-olds? Evaluation of a routine screening procedure.

This study evaluates the predictability of a new language screening procedure in 3-y-olds. It is used in several Child Health Centres (CHC) in Sweden and has the character of a field study involving more than 60 CHC nurses. The main questions concern the (i) development in 3-y-olds assessed as severely language delayed and (ii) whether there are any earlier unknown severely disabled children identified at 4 y of age. Ninety-six percent of the original study population participated in the follow-up. The calculations are based on results from 2237 children. A well-established screening routine, which has been shown capable of predicting the risk of not being able to follow expected schooling, and case records were used as an acceptable proxy outcome measure, pending a better gold standard. In the group of severely disabled 3-y-olds, sensitivity, specificity and positive predictive values were 86, 99 and 43%, respectively. Finally, three false-negatives were identified. In light of the present results, continued application of the 3-y screening is discussed.

Child, Preschool↗
PubMed1992

Health examination of preschool children in relation to school adjustment in grade I.

The results of a collaborative study on health examination in preschool children, using data from child health care, preschool establishments and a teacher evaluation carried out six months after the start of school were compared. The analysis showed that many children with difficulties in motor function, behaviour and/or learning in grade 1 had been identified at the health examination. The results emphasize the value of collaboration between preschool establishments, child health care centres and schools for identification of children at risk of developing early adjustment problems.

Adaptation, Physiological↗
PubMed1991

Teacher rated problems and school ability tests in relation to preschool problems and parents' health information at school start. A study of first-graders.

The reliability of assessments at four and six years of age in identifying teacher rated problems in behaviour, concentration, motor skill and school achievement was investigated in a study of first-graders. Relationships between preschool data and school ability tests, and between parents' information at school start and teacher ratings were also studied. Problems noted in preschool and school were often present in more than one area. Multiple problems at four and six years were strong predictors of later school problems, but preschool assessments of separate areas could not in general predict problems in corresponding areas in school. However, cross situational concentration deficits at the age of six did reliably identify concentration problems in the first grade, at the age of seven.

Aptitude↗
PubMed1984

Lateral ligament injury of the ankle in children. Follow-up results of primary surgical treatment.

Among 40 acutely injured ankles in children, surgery revealed a cartilaginous and/or bony fragment in 19, and an isolated rupture of the anterior talo-fibular ligament without any lesion of the bone or cartilage in another 17. In four ankles there was no ligament lesion. The lesions were surgically repaired. All ankles healed well and were painless and functionally stable at follow-up. In four ankles radiographs showed a small subfibular fragment, in which bony fusion had failed, but even these ankles were stable. Two other ankles gave a slightly positive sign in the clinical anterior drawer test as compared with the contralateral uninjured ankle, but there were no signs of functional instability nor were there any subjective complaints. Our results suggest that severe ankle sprains in children may cause isolated ruptures of the anterior talofibular ligament and frequently osteochondral lesions. We therefore advocate primary suture of ruptured lateral ligaments of the ankle in children.

Adolescent↗
PubMed1983

Sprained ankle in children. A clinical follow-up study of 90 children treated conservatively and by surgery.

The study concerns 90 ankle injuries with lateral sprains, in children aged 5 to 14 years. 50 ankles treated non-operatively during 1978 were examined clinically and radiologically 14 to 24 months (mean 18 months) after the injury. Those patients who still had complaints were examined by questionnaire in October 1982, about four years after the injury. 21 patients (42%) had symptoms of disability at the first follow-up examination, and in 4 of these 21 ankles had to be operated on later because of functional instability and pain. Five others which had been treated conservatively, continued to have symptoms of functional instability four years after the injury, whereas the other 12 had healed and were symptomless. In 40 acutely injured ankles, surgery revealed an avulsion fragment in 19, and an isolated rupture of the anterior talo-fibular ligament without any lesion of the bone or cartilage in another 17. Ankles treated operatively healed well and the patients were symptom free at follow-up 6 to 21 months (mean 9 months) postoperatively. Our results suggest that lesions of the anterior talo-fibular ligament are surprisingly common in children. Primary repair of the ligament will ensure a symptomless and stable ankle joint.

Adolescent↗