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  • 1.
    Berglund, Staffan K.
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Chmielewska, Anna
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Starnberg, Josefine
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Westrup, Björn
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Norman, Mikael
    Domellöf, Magnus
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Effects of iron supplementation of low-birth-weight infants on cognition and behavior at 7 years: a randomized controlled trial2018In: Pediatric Research, ISSN 0031-3998, E-ISSN 1530-0447, Vol. 83, p. 111-118Article in journal (Refereed)
    Abstract [en]

    Background Low-birth-weight infants (LBW) are at an increased risk of iron deficiency that has been associated with impaired neurodevelopment. We hypothesized that iron supplementation of LBW infants improves cognitive scores and reduces behavioral problems until school age.

    Methods We randomized 285 marginally LBW (2,000-2,500 g) infants to receive 0, 1, or 2 mg/kg/day of iron supplements from 6 weeks to 6 months of age. At 7 years of age, 205 participants were assessed regarding cognition using Wechsler Intelligence Scale for Children (WISC-IV) and behavior using the parental questionnaires Child Behavior Checklist (CBCL) and Five to Fifteen (FTF).

    Results There were no significant differences between the intervention groups in WISC-IV or FTF. However, the CBCL scores for externalizing problems were significantly different, in favor of supplemented children (P=0.045). When combining the supplemented groups, they had significantly lower scores for externalizing behavior compared with placebo (median (interquartile range): 44 [34;51] vs. 48.5 [41;56] P=0.013), and their risk ratio (95% confidence interval) for a total behavioral score above the cutoff for clinical problems was 0.31 (0.09-1.0), P=0.054.

    Conclusion Lower scores of externalizing behavior in supplemented children support our previous findings at 3 years, and suggest that iron supplementation may have long-lasting effects on behavioral functions.

  • 2.
    Berglund, Staffan
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Westrup, Björn
    Division of Neonatology, Department of Women and Child Health, Karolinska Institute, Stockholm, Sweden.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Hernell, Olle
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Domellöf, Magnus
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Effects of iron supplementation of LBW infants on cognition and behavior at 3 years2013In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 131, p. 47-55Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Low birth weight (LBW) infants are at increased risk of cognitive and behavioral problems and at risk for iron deficiency, which is associated with impaired neurodevelopment. We hypothesized that iron supplementation of LBW infants would improve cognitive scores and reduce behavioral problems. METHODS: In a randomized controlled trial, 285 marginally LBW (2000-2500 g) infants received 0, 1, or 2 mg/kg/day of iron supplements from 6 weeks to 6 months of age. At 3.5 years of age, these infants and 95 normal birth weight controls were assessed with a psychometric test (Wechsler Preschool and Primary Scale of Intelligence) and a questionnaire of behavioral problems (Child Behavior Checklist; CBCL). RESULTS: There were no significant differences in IQ between the LBW groups or LBW infants versus controls. Mean (SD) full-scale IQ was 105.2 (14.5), 104.2 (14.7), and 104.5 (12.7) in the placebo, 1 mg, and 2 mg groups, respectively (P = .924). However, for behavioral problems, there was a significant effect of intervention. The prevalence of children with CBCL scores above the US subclinical cutoff was 12.7%, 2.9%, and 2.7% in the placebo, 1-mg, and 2-mg groups, respectively (P = .027), compared with 3.2% in controls. Relative risk (95% confidence interval) for CBCL score above cutoff in placebo-treated children versus supplemented was 4.5 (1.4-14.2). CONCLUSIONS: Early iron supplementation of marginally LBW infants does not affect cognitive functions at 3.5 years of age but significantly reduces the prevalence of behavioral problems. The study suggests a causal relation between infant iron deficiency and later behavioral problems.

  • 3.
    Birkeland, Anna-Lena
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Dahlgren, Lars
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Rydberg, Annika
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Breaking bad news: an interview study of paediatric cardiologists2011In: Cardiology in the Young, ISSN 1047-9511, E-ISSN 1467-1107, Vol. 21, no 3, p. 286-291Article in journal (Refereed)
    Abstract [en]

    Technical developments in paediatric cardiology over the last few decades have increased expectations on professionals, demanding of them more emotional competence and communicative ability. The aim of this study was to examine the approach of paediatric cardiologists in informing and communicating with the family of the patient.

    Method: A qualitative interview method was first tested in a pilot study with two paediatric cardiologists. There were nine subsequent semi-structured interviews that were carried out with paediatric cardiologists. A researcher performed all the interviews, which were taped, transcribed, decoded, and analysed.

    Results: Among paediatric cardiologists, how to break bad news to the family is an important concern, evident in findings regarding the significance of trust and confidence, the use of different emotional positions, and a common ambition to achieve skills to handle the situation. There is a need for reflection, education, and sharing of experiences. The cardiologists desire further development of teamwork and of skills in medical students and residents for delivering bad news.

    Conclusions: Doctors are expected to cope with the complexities of diagnoses and decisions, while simultaneously being sensitive to the feelings of the parents, aware of their own emotions, and able to keep it all under control in the context of breaking the bad news to the parents and keeping them informed. These conflicting demands create a need to expand the professional role of the doctor by including more training in emotional competence and communicative ability, beginning in medical school and continuing through consultancy.

  • 4.
    Birkeland, Anna-Lena
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Hagglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Dahlgren, Lars
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Rydberg, Annika
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Interprofessional teamwork in Swedish pediatric cardiology: a national exploratory study2013In: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567, Vol. 27, no 4, p. 320-325Article in journal (Refereed)
    Abstract [en]

    This paper aims to describe the nature of pediatric cardiology teams (PCTs) based in Sweden through the use of a mixed methods approach. Questionnaires examining issues about the organization/ways of working, functions/tasks and attitudes were answered by 30 PCTs. Focus group interviews were conducted with six PCTs, selected purposefully by size and location, and information on experiences and attitudes on interprofessional teamwork was explored in depth. Results from the quantitative indicated that in 17 of the teams, where the nurse acted as the central coordinator, there was a positive attitude to the value of teamwork. In the interviews, different problems and needs of improvements were mentioned regarding structure, leadership, presence of physicians in the team as well as the team's mandate. All of the participants, however, agreed that interprofessional teams were required to manage the complexity of the children's care. In conclusion, this study suggests that PCTs need further support to develop structure, leadership and coordination of resources to function in a more effective manner. National plans or recommendations that mandate the organization and working methods of PCTs would be helpful for the ongoing development of PCTs in Sweden.

  • 5.
    Birkeland, Anna-Lena
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Hällgren Graneheim, Ulla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Rydberg, Annika
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Dahlgren, Lars
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Facing bad news: a case study focusing on families having a child with congenital heart diseaseManuscript (preprint) (Other academic)
  • 6.
    Birkeland, Anna-Lena
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Rydberg, Annika
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Dahlgren, Lars
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Teamwork in Swedish paediatric cardiology: a national exploratory study examining function and dynamicsManuscript (preprint) (Other academic)
  • 7.
    Birkeland, Anna-Lena
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Rydberg, Annika
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    The complexity of the psychosocial situation in children and adolescents with heart disease2005In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 94, no 10, p. 1495-1501Article in journal (Refereed)
    Abstract [en]

    Aim: To describe the psychosocial situation of children/adolescents with heart disease and their families, an inventory method was worked out.

    Methods: Ninety-seven children/adolescents with congenital heart disease (CHD) were graded into three categories with respect to complexity of CHD. Group I included 42 patients with malformations requiring standardized operations. Group II included 20 patients with more complicated malformations, and group III included 35 patients with very complex malformations. The patients were compared with controls without heart disease, matched for age and gender. The psychosocial impact of CHD was measured by the inventory.

    Results: The most frequent problems in the patient group were healthcare and treatment-related needs (71/97) in the external sphere, family symptoms (68/97) in the interpersonal sphere, and somatic symptoms (19/97) in the personal sphere. Corresponding numbers in the controls were treatment-related needs (15/97), family (9/97) and somatic symptoms (25/97). Fifty per cent of the symptoms in the patient groups were mild, 30% moderate and 20% severe. The most severe symptoms were found in the interpersonal sphere, where family symptoms constituted the most severe variable. The frequency of severe problems in the personal sphere was 11% in the patients and 1% in the controls. This inventory method differentiates the grades of medical complexity both regarding number and severity of psychosocial symptoms. It indicates severe personal problems in the most complex group and shows that they have severe personal problems independent of family problems.

    Conclusion: This study elucidates the psychosocial complexity in children/adolescents with CHD, which has clinical implications in developing a psychosocial care programme.

  • 8.
    Blomqvist, Ida
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Henje Blom, Eva
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Hammarström, Anne
    Increase of internalized mental health symptoms among adolescents during the last three decades2019In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 29, no 5, p. 925-931Article in journal (Refereed)
    Abstract [en]

    Background: Previous studies suggest an overall increase of adolescent mental health symptoms globally since the 1980s until today, especially an increase of internalizing symptoms in girls. Due to methodological limitations of these studies, further studies are warranted to obtain a more solid knowledgebase.

    Methods: This study was cross-sectional and compared two separate but geographically identical groups of adolescents in a middle-sized industrial municipality in Northern Sweden at two time-points [(i) 1981, n = 1083, (505 girls, 577 boys), response rate 99.7%; (ii) 2014, n = 682, (338 girls, 344 boys), response rate 98.3%]. All students in their last year of compulsory school were included. The same self-report questionnaire, consisting of four sub-scales (functional somatic-, anxiety-, depressive symptoms and conduct problems), was used at both occasions. Data were analyzed with descriptive statistics, two-way ANOVA and general linear model.

    Results: Symptoms of anxiety and depression and functional somatic symptoms, increased among both boys and girls from 1981 until 2014 (P < 0.001 for all subscales), and the increase of these symptoms was higher in girls. Conduct problems were significantly higher in boys in 1981 and decreased over time so that in 2014 there was no longer a significant difference between boys and girls regarding conduct problems (P = 0.286).

    Conclusion: In this population-based study spanning over 30 years, both girls and boys showed increasing internalizing problems, while conduct problems decreased. To halt this trend, we need a deeper understanding of the impact of the major societal changes that have occurred during the last three decades.

  • 9.
    Carballeira Suarez, Nivia
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Nilsson, Karin
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Mitt barn svälter sig – hjälp!: Fallstudie med fokus på familjeterapi som behandling av ätstörning2012In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 109, no 42, p. 1889-1891Article in journal (Other academic)
    Abstract [sv]

    Maudsley-modellen är en familjebaserad behandlingsmetod vid ätstörning.

    Behandlingen lägger tonvikt på ätande och viktuppgång med stöd av föräldrarna, förhandling om nya relationsmönster och hantering av vanliga tonårsfrågor för återgång till ett åldersadekvat liv.

    Denna studie summerar elva samtal med en familj, där samtalen enligt mätningar och observationer under behandlingsförloppet gav god effekt på såväl ätstörningsproblematiken som familjens kommunikation.

  • 10. Chaplin, John Eric
    et al.
    Kriström, Berit
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Jonsson, Björn
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Tuvemo, Torsten
    Aronson, A Stefan
    Dahlgren, Jovanna
    Albertsson-Wikland, Kerstin
    Improvements in behaviour and self-esteem following growth hormone treatment in short prepubertal children2011In: Hormone research in paediatrics, ISSN 1663-2826, Vol. 75, no 4, p. 291-303Article in journal (Refereed)
    Abstract [en]

    Background/Aims: To evaluate effects of growth hormone (GH) treatment on behaviour and psychosocial characteristics in short-stature children.

    Methods: 99 referred prepubertal non-familiar short-stature children (32 GH deficiency; 67 idiopathic short stature) aged 3-11 years, randomized to fixed or individual GH doses and their parents completed questionnaires (Child Behaviour Checklist, Birleson Depression Self-Report Scale, Abbreviated Parent-Teacher Questionnaire, I Think I Am, Well-Being Visual-Analogue Scales for Short-Stature Children) at baseline (BL) and after 3, 12, and 24 months.

    Results: At BL, children showed higher levels of internalizing behaviour (p < 0.001), lower levels of externalizing behaviour (p < 0.006) and self-esteem (p < 0.001) compared to reference values. During GH treatment, behavioural measures (p < 0.001) and depression (p < 0.01) changed towards the mean of the population within the first 3 months and remained improved to 24 months. Self-esteem improved at all time points (p < 0.001), and in all subgroups, as did well-being dimensions stability and mood (p < 0.05). Multiple regression analysis showed that greater improvements were related to lower BL value, height gain, higher maximal GH value, being older, and being male.

    Conclusion: On GH treatment, prepubertal short children significantly improved on behavioural, depression, and psychosocial evaluations over a 2-year period of GH treatment. Most change occurred within the first 3 months, which highlights this short period as important not only for growth and metabolic changes but also for behaviour and psychosocial improvements following GH treatment.

  • 11.
    Chotai, Jayanti
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Jonasson, Mattias
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Adolfsson, Rolf
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Adolescent attachment styles and their relation to the temperament and character traits of personality in a general population.2005In: Eur Psychiatry, ISSN 0924-9338, Vol. 20, no 3, p. 251-9Article in journal (Refereed)
  • 12.
    Chotai, Jayanti
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Jonasson, Mattias
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Adolfsson, Rolf
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    The Temperament Scale of Novelty Seeking in adolescents shows an association with season of birth opposite to that in adults.2002In: Psychiatry Research, ISSN 0165-1781, E-ISSN 1872-7123, Vol. 111, no 1, p. 45-54Article in journal (Refereed)
    Abstract [en]

    We investigated the relationship between season of birth and the Junior Temperament and Character Inventory of Personality (Junior TCI, JTCI) in adolescents. The Temperament Scale of Novelty Seeking (NS) is significantly higher for females born during October-January as compared to females born otherwise. This association is opposite to that obtained earlier for adults. For both genders pooled, NS is significantly higher for those born during October-March compared to April-September. This association is also found when examining the data for those of age up to 18 years in a third independent study on the age range 11-81 years with the adult TCI. There is a greater tendency for exploration and risk-taking behavior as the child individuates from the family. Our study suggests that the effects of such environmental and developmental changes on personality are different in those born during October-March as compared to those born during April-September. The former show a higher rise in NS during adolescence and a steeper fall in NS during the years of adulthood, compared to the latter. Dopamine turnover is likely associated with NS, and the mutually inhibitory systems of dopamine and melatonin are the paracrine signals of day and night, respectively. Thus, the maternal entrainment of these systems during the prenatal period, or the postnatal environmental influence on these systems, may be different for those born during the short photoperiod of October-March as compared to those born during the long photoperiod part of the year.

  • 13.
    Desta, Menelik
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Kebede, Derege
    Alem, Atalay
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Psychiatric disorders in urban children in Ethiopia: a population based cross sectional surveyIn: Social psychiatry and psychiatric epidemiologyArticle in journal (Refereed)
  • 14.
    Desta, Menelik
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Kebede, Derege
    Alem, Atalay
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Socio-demographic and psychopathologic correlates of enuresis in urban Ethiopian children.2007In: Acta Paediatr, ISSN 0803-5253, Vol. 96, no 4, p. 556-560Article in journal (Refereed)
  • 15.
    Desta, Menelik
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Kebede, Derege
    Alem, Atalay
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Stenlund, Hans
    Demographic and social factors associated with disruptive behaviour disorders and anxiety disorders in children in an urban community in EthiopiaIn: Nordic journal of psychiatryArticle in journal (Refereed)
  • 16.
    Desta, Menelik
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Kebede, Derege
    Alem, Atalay
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Stenlund, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    The Reporting Questionnaire for Children (RQC) as a valid and simple child mental health screening instrument in EthiopiaManuscript (preprint) (Other academic)
  • 17.
    Farooqi, Aijaz
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Adamsson, M
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Serenius, F.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Executive Functioning and Learning Skills of Adolescent Children Born at Fewer than 26 Weeks of Gestation2016In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 3, article id e0151819Article in journal (Refereed)
    Abstract [en]

    Aims To assess the cognitive and behavioral aspects of executive functioning (EF) and learning skills in extremely preterm (EPT) children compared with term control children aged 10 to 15 years. Methods A total of 132 of 134 (98% of all eligible survivors) EPT children born at the 2 Swedish regional tertiary care centers from 1992 to 1998 (mean age = 12 years, mean birth weight = 718 g, and mean gestational age = 24.4 weeks) and 103 matched term controls were assessed. General intelligence was assessed using the Wechsler Intelligence Scale for Children (WISC-III-R), and cognitive aspects of EF were analyzed using EF-sensitive sub-scales of the WISC-III-R and Tower test of the Delis-Kaplan Executive Function Scale (D-KEFS). Behaviors related to EF and learning skills were assessed using the Five to Fifteen questionnaire, which is a validated parent and teacher instrument. Academic performance in school was assessed by teachers' responses on Achenbach's Teachers Report Form. Analyses performed included multivariate analyses of covariance (ANCOVA and MANCOVA) and logistic regression analyses. Results The EPT children displayed significant deficits in cognitive aspects of EF compared with the controls, exhibiting decreases on the order of 0.9 SD to 1.2 SD for tasks of verbal conceptual reasoning, verbal and non-verbal working memory, processing speed and planning ability (P < 0.001 for all). After excluding the children with major neurosensory impairment (NSI) or a Full Scale intelligence quotient (FSIQ) of < 70, significant differences were observed on all tests. Compared with controls, parents and teachers of EPT children reported significantly more EF-related behavioral problems. MANCOVA of teacher-reported learning skills in children with FSIQ > 70 and without major NSI revealed no interactions, but significant main effects were observed for the behavioral composite executive function score, group status (EPT vs control) and FSIQ, for which all effect sizes were medium to large. The corresponding findings of MANCOVA of the parent-reported learning skills were very similar. According to the teachers' ratings, the EPT children were less well adjusted to the school environment. Conclusion EPT children born in the 1990s who received active perinatal care are at an increased risk of executive dysfunction, even after excluding children with significant neurodevelopmental disabilities. Even mild to moderate executive dysfunctions has a significant impact on learning skills. These findings suggest the need for timely interventions that address specific cognitive vulnerabilities and executive dysfunctions.

  • 18.
    Farooqi, Aijaz
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Sedin, G
    Gothefors, L
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Serenius, F
    Executive functions, language and learning skills in children born at 23-25 weeks' gestation in the 1990s: a Swedish national prospective follow-up studyArticle in journal (Refereed)
  • 19.
    Farooqi, Aijaz
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Sedin, Gunnar
    Gothefors, Leif
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Serenius, Fredrik
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Chronic conditions, functional limitations, and special health care needs in 10- to 12-year-old children born at 23 to 25 weeks' gestation in the 1990s: a Swedish national prospective follow-up study.2006In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 118, no 5, p. e1466-e1477Article in journal (Refereed)
  • 20.
    Farooqi, Aijaz
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics. Pediatrik.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry. Barn- och ungdomspsykiatri.
    Sedin, Gunnar
    Gothefors, Leif
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics. Pediatrik.
    Serenius, Fredrik
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics. Pediatrik.
    Growth in 10- to 12-year-old children born at 23 to 25 weeks' gestation in the 1990s: a Swedish national prospective follow-up study.2006In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Pediatrics, ISSN 1098-4275, Vol. 118, no 5, p. e1452-e1465Article in journal (Refereed)
  • 21.
    Farooqi, Aijaz
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Sedin, Gunnar
    Gothefors, Leif
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Serenius, Fredrik
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Mental health and social competencies of 10- to 12-year-old children born at 23 to 25 weeks of gestation in the 1990s: a Swedish national prospective follow-up study.2007In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 120, no 1, p. 118-133Article in journal (Refereed)
    Abstract [en]

    Abstract

    OBJECTIVE: We investigated a national cohort of extremely immature children with respect to behavioral and emotional problems and social competencies, from the perspectives of parents, teachers, and children themselves.

    METHODS: We examined 11-year-old children who were born before 26 completed weeks of gestation in Sweden between 1990 and 1992. All had been evaluated at a corrected age of 36 months. At 11 years of age, 86 of 89 survivors were studied and compared with an equal number of control subjects, matched with respect to age and gender. Behavioral and emotional problems, social competencies, and adaptive functioning at school were evaluated with standardized, well-validated instruments, including parent and teacher report questionnaires and a child self-report, administered by mail.

    RESULTS: Compared with control subjects, parents of extremely immature children reported significantly more problems with internalizing behaviors (anxiety/depression, withdrawn, and somatic problems) and attention, thought, and social problems. Teachers reported a similar pattern. Reports from children showed a trend toward increased depression symptoms compared with control subjects. Multivariate analysis of covariance of parent-reported behavioral problems revealed no interactions, but significant main effects emerged for group status (extremely immature versus control), family function, social risk, and presence of a chronic medical condition, with all effect sizes being medium and accounting for 8% to 12% of the variance. Multivariate analysis of covariance of teacher-reported behavioral problems showed significant effects for group status and gender but not for the covariates mentioned above. According to the teachers' ratings, extremely immature children were less well adjusted to the school environment than were control subjects. However, a majority of extremely immature children (85%) were functioning in mainstream schools without major adjustment problems.

    CONCLUSIONS: Despite favorable outcomes for many children born at the limit of viability, these children are at risk for mental health problems, with poorer school results.

  • 22.
    Farooqi, Aijaz
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Sedin, Gunnar
    Serenius, Fredrik
    Impact at age 11 years of major neonatal morbidities in children born extremely preterm2011In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 127, no 5, p. e1247-e1257Article in journal (Refereed)
    Abstract [en]

    Background: Uncertainty continues regarding the extent to which neonatal morbidities predict poor long-term outcome and functional abilities in extremely preterm infants.

    Objective: The goal of this study was to determine the impact of bronchopulmonary dysplasia (BPD), ultrasonographic signs of brain injury, and severe retinopathy of prematurity (ROP) on 11-year outcomes in infants born at <26 weeks' gestation.

    Methods: A total of 247 infants were born alive before 26 completed weeks of gestation from 1990 through 1992 in all of Sweden, and 98 (40%) survived to a postmenstrual age of 36 weeks. Main outcome measures were (1) poor outcome, defined as combined end point of death after 36 weeks' postmenstrual age or survival with at least 1 major disability at 11 years, and (2) consequences of chronic conditions in the survivors according to a validated instrument administered to parents.

    Results: Brain injury and severe ROP but not BPD correlated independently with poor outcome at 11 years of age. Among children who were free from BPD, brain injury, and severe ROP, 10% had a poor outcome. Corresponding rates with any 1, any 2, and all 3 neonatal morbidities were 19%, 58%, and 80%, respectively. Multivariate analysis revealed that brain injury and severe ROP were associated with high rates of consequences of chronic conditions.

    Conclusions: In infants born extremely preterm who survive to a postmenstrual age of 36 weeks, severe ROP and brain injury separately predict the risk of death or major disability at 11 years of age. Thus, continued research to determine how to prevent these complications of prematurity is critical.

  • 23.
    Farooqi, Aijaz
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Serenius, Fredrik
    Uppsala Univ, Sect Pediat, Dept Womens & Childrens Hlth, Uppsala, Sweden.
    Behaviours related to executive functions and learning skills at 11years of age after extremely preterm birth: a Swedish national prospective follow-up study2013In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 102, no 6, p. 625-634Article in journal (Refereed)
    Abstract [en]

    Aim We investigated a national cohort of children born extremely immature (<26weeks gestation, EI) regarding the nature, frequency and severity of the behavioural problems related to the executive functions (EF) and concerning learning skills, from the perspectives of parents and teachers. Methods At 11years of age 86 of 89 survivors of this cohort were studied and compared with an equal number of controls. Behaviours related to EF, and learning skills were assessed by a validated instrument, namely the Five to Fifteen questionnaire sent by mail to parents and teachers. Results Compared with controls, parents of EI children reported significantly more problems in behaviours related to EF in all areas assessed (Attention, Hyperactivity/Impulsivity, Hypoactivity, Planning/Organizing, and Working Memory). Teachers ratings showed a similar pattern. EI children also displayed deficient skills in the 4 standard measures of learning skills. Multivariate analysis revealed that prematurity, gender and behavioural composite score was associated with learning skills. Only a relatively small proportion of EI children (1030%) exhibited clinically significant impairments. Conclusion Despite a favourable outcome in many school-age children born at the threshold of viability, these are at increased risk of developing behavioural problems related to EF.

  • 24.
    Fekadu, Daniel
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Alem, Atalay
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Child abuse in child labor in urban district, EthiopiaManuscript (preprint) (Other academic)
  • 25.
    Fekadu, Daniel
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Alem, Atalay
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    The prevalence of mental health problems in Ethiopian child laborers.2006In: Journal of child psychology and psychiatry, ISSN 0021-9630, Vol. 47, no 9, p. 954-959Article in journal (Refereed)
  • 26.
    Fekadu, Daniel
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Alem, Atalay
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Review of child labor with emphasis on mental healthManuscript (Other academic)
  • 27.
    Fransson, Per
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Sundbom, Elisabet
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    A comparative study of adolescents in psychiatric care assessed by means of the Defense Mechanism Test and the DSM-IV classification system1998In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 52, no 6, p. 527-536Article in journal (Refereed)
    Abstract [en]

    Twenty-seven adolescents in psychiatric care, assessed by means of DSM-IV, and 33 healthy controls were tested using the projective percept-genetic Defense Mechanism Test (DMT). Three diagnostic subgroups were created: psychotic (Axis 1), borderline personality disorder (Axis 2), and a non-patient group. The test protocols were scored with regard to 130 DMT variables and analyzed by means of partial least squares (PLS) discriminant analysis and by means of a pattern analysis of the DMT variables. The results showed that it was possible to distinguish significantly among the three groups. Specific perceptual distortions were identified among the three groups. It was concluded that DMT is a promising instrument in the assessment of adolescents in psychiatric care.

  • 28.
    Goldin, Stephen
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Levin, Lilian
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Persson, Lars Åke
    International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Sweden.
    Mental health of Bosnian refugee children: a comparison of clinician appraisal with parent, child and teacher reports2008In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 62, no 3, p. 204-216Article in journal (Refereed)
    Abstract [en]

    This study compares clinician appraisal of Bosnian refugee children with independent parent, child and teacher reports. From whom and by what means can children “at risk” be reasonably identified? Forty-eight Bosnian refugee children (aged 7–20), resettled in Sweden 1994–95, were assessed clinically by means of a semi-structured interview. Thereafter, standardized mental health questionnaires were administered to parents (Achenbach's Child Behavior Checklist), children (Achenbach's Youth Self-Report and Macksoud's Posttraumatic Stress Reaction Checklist) and teachers (clinician designed School Competence Scale and Achenbach's Teacher's Report Form). On clinician interview, nearly half of the children (48%) were identified with one or more mental health problem “demanding further attention”. Depressiveness was the single most prevalent symptom (31%); followed by post-traumatic stress (23%), and anxiety-regressiveness (15%). At the same time, 75% of the children were rated by teachers as “quite competent” in school. Parent, child and clinician appraisals of primary school children showed broad similarities. Teachers reported a similar prevalence of child distress, but identified different symptoms and different children demanding attention. Evaluation of teenage youths showed greater disparity: teenagers labeled their own symptoms more often as post-traumatic stress reactions and teachers identified few youths in need of attention. Inter-relatedness among parent, child and clinician appraisals supports the robustness of our semi-structured interview. At the same time, apartness of teacher report underscores the need to incorporate an outside-world vantage point in the process of risk assessment. Also, a more concrete presentation of post-traumatic stress reactions and a higher “further attention” threshold for inward emotional problems seem called for.

  • 29.
    Goldin, Stephen
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Persson, Lars Åke
    Risk and protective factors for mental health in Bosnian refugee childrenManuscript (Other academic)
  • 30.
    Goldin, Stephen
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Levin, Lilian
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Persson, Lars Åke
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Child war trauma: a comparison of clinician, parent and child assessments2003In: Nordic journal of psychiatry, ISSN 0803-9488, Vol. 57, no 3, p. 173-183Article in journal (Refereed)
  • 31.
    Goldin, Stephen
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Levin, Lilian
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Persson, Lars Åke
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Stories of pre-war, war and exile: Bosnian refugee children in Sweden2001In: Medicine, conflict and survival, ISSN 1362-3699, Vol. 17, no 1, p. 25-47Article in journal (Refereed)
  • 32. Hammarström, A.
    et al.
    Korhonen, J.
    Blomqvist, I.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Increase of internalised mental health symptoms over the last 33 years among adolescents2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no suppl_3, p. 271-272Article in journal (Other academic)
    Abstract [en]

    Background: Mental health among young people is of increasing public health importance. Several studies comparing the 1990ies with today suggest an increase of internalised mental health problems among adolescent girls. The development among adolescent boys is less clear. The aim of this study was to analyse the development of mental health among adolescence from the early 1980ies until today with regard to internalised and externalised symptoms among both boys and girls.

    Methods: Two cohorts were compared consisting of all pupils in the last year of compulsory school in Luleå (Sweden) in 1981 (n = 1083, response rate 99.7%) and in 2014 (n = 682, response rate 98.3%). The same questionnaire was used with validated questions about symptoms of mental health. Confirmatory factor analysis were performed in order to validate the proposed a priori factor structure of the mental health measures; anxiety symptoms, depression symptoms, functional somatic symptoms and externalised symptoms.

    Results: Symptoms of anxiety, depression and functional somatic symptoms increased among both boys and girls from 1981 until 2014 (p < 0.001 for all symptoms and for both boys and girls). Externalised symptoms decreased, especially among boys (p < 0.001 for both boys and girls). These changes between the cohorts were confirmed using multivariate regression techniques (controlling for parental socioeconomic status and parental country of origin) for each measure of mental health. among boys and girls.

    Conclusions: Symptoms of internalised mental health have increased among 16-year old boys and girls over the last 33 years while externalised symptoms have decreased, especially among boys. Public health actions need to be initiated in order to stop the increase and prevent internalised mental health problems among teenagers.

    Key messages:

    • A longer period than 20 years is needed in order to detect an increase in internalised mental health symptoms among adolescent boys.
    • Adolescent girls have the highest level and the highest increase in these symptoms during a period of 33 years, while externalised mental health symptoms have decreased mostly among adolescent boys.
  • 33.
    Hammarström, Anne
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Socialmedicin.
    Westerlund, Hugo
    Kirves, Kaisa
    Nygren, Karina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Socialmedicin.
    Virtanen, Pekka
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Socialmedicin. School of Health Sciences, University of Tampere, Tampere, Finland.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Addressing challenges of validity and internal consistency of mental health measures in a 27- year longitudinal cohort study–the Northern Swedish Cohort study2016In: BMC Medical Research Methodology, ISSN 1471-2288, E-ISSN 1471-2288, Vol. 16, article id 4Article in journal (Refereed)
    Abstract [en]

    Background:There are inherent methodological challenges in the measurement of mental health problems in longitudinal research. There is constant development in definitions, taxonomies and demands concerning the properties of mental health measurements. The aim of this paper was to construct composite measures of mental health problems (according to today’s standard) from single questionnaire items devised in the early 1980s, and to evaluate their internal consistency and factorial invariance across the life course using the Northern Swedish Cohort.Methods:All pupils in the last year of compulsory school in Luleå in 1981 (n= 1083) form a prospective cohort study where the participants have been followed with questionnaires from the age of 16 (in 1981) until the age of43 (in 2008). We created and tested the following composite measures from self-reports at each follow-up:depressive symptoms, anxiety symptoms, functional somatic symptoms, modified GHQ and positive health. Validity and internal consistency were tested by confirmatory factor analysis, including tests of factorial invariance over time.Results:As an overall assessment, the results showed that the composite measures (based on more than 30-year-old single item questions) are likely to have acceptable factorial invariance as well as internal consistency over time.Conclusions:Testing the properties of the mental health measures used in older studies according to the standards of today is of great importance in longitudinal research. Our study demonstrates that composite measures of mental health problems can be constructed from single items which are more than 30 years old and that these measures seem to have the same factorial structure and internal consistency across a significant part of the life course. Thus, it can be possible to overcome some specific inherent methodological challenges in using historical data in longitudinal research.

  • 34.
    Holsti, Antti
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Adamsson, M.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Serenius, F.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Farooqi, Aijaz
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Two-thirds of adolescents who received active perinatal care after extremely preterm birth had mild or no disabilities2016In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 105, no 11, p. 1288-1297Article in journal (Refereed)
    Abstract [en]

    Aim: Active perinatal care (APC) increases the survival of extremely preterm (EPT) infants, but may increase the rate of disabilities. We examined neurodevelopmental outcomes in adolescents aged 10-15 years who were born EPT and received APC in two Swedish tertiary care centres.

    Methods: Cognitive function was assessed using the Wechsler Intelligence Scale for Children, and neurosensory impairments were assessed by reviewing the case records and a standard parent health questionnaire. The outcomes were compared to term-born controls.

    Results: We assessed 132 EPT adolescents and 103 controls. The rates of cerebral palsy, moderate to severe visual impairment and moderate to severe hearing impairment were 9%, 4% and 6%, respectively, for the EPT children and zero for the controls. Serious cognitive impairment was present in 31% of the EPT adolescents and 5% of the controls. Combining impairments across domains showed that 34% of EPT adolescents had moderate and severe disabilities compared with 5% of the controls. Impairments were more common at 23-24 weeks of gestational age (43%) than at 25 weeks (28.4%).

    Conclusion: Two-thirds (66%) of adolescents born EPT who received APC had mild or no disabilities. Our results are relevant for healthcare providers and clinicians counselling families.

  • 35.
    Holsti, Antti
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Adamsson, Marie
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Farooqi, Aijaz
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Serenius, Fredrik
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics. Uppsala Univ, Dept Womens & Childrens Hlth, Uppsala, Sweden.
    Chronic Conditions and Health Care Needs of Adolescents Born at 23 to 25 Weeks' Gestation2017In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 139, no 2, article id e20162215Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: We examined chronic conditions, functional limitations, and special health care needs in extremely preterm children (EPT; 23-25 weeks' gestation) born between 1992 and 1998 at 2 Swedish tertiary care centers that offered regional and active perinatal care to all live-born EPT infants. METHODS: Of 134 surviving EPT children, 132 (98%) were assessed at 10 to 15 years of age alongside 103 term-born controls. Identification of children with functional limitations and special health care needs was based on a questionnaire administered to parents. Categorization of medical diagnoses and developmental disabilities was based on child examinations, medical record reviews, and parent questionnaires. RESULTS: In logistic regression analyses adjusting for social risk factors and sex, the EPT children had significantly more chronic conditions than the term-born controls, including functional limitations (64% vs 6%; odds ratio [OR], 15; 95% confidence interval [CI], 6.1-37.2; P < .001), compensatory dependency needs (60% vs 29%; OR, 3.8; 95% CI, 2.2-6.6; P < .001), and services above those routinely required by children (64% vs 25%; OR, 5.4; 95% CI, 3.0-9.6; P < .001). Specific diagnoses and disabilities for the EPT group versus controls included cerebral palsy (9.1% vs 0%; P < .001), asthma (21.2% vs 6.8%; P = 001), IQ < -2 SD (31.1% vs 4.9%; P < .001), poor motor skills without neurosensory impairment (21.9% vs 1.9%; P < .001), and psychiatric conditions (15.2% vs 1.9%; P < .001). CONCLUSIONS: Adolescents born EPT have considerable long-term health and educational needs. Few had severe impairments that curtailed major activities of daily life.

  • 36.
    Karling, Mats
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Behavioural changes after anaesthesia: association of socioeconomic factors and child behaviour checklist to the post hospital behaviour questionnaireManuscript (Other academic)
  • 37.
    Karling, Mats
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Child behaviour after anaesthesia: association of socioeconomic factors and child behaviour checklist to the Post-Hospital Behaviour Questionnaire2007In: Acta Paediatr, Vol. 96, no 3, p. 418-23Article in journal (Refereed)
    Abstract [en]

    AIM: In the process of validation of the Swedish translation of the Post-Hospital Behaviour Questionnaire (PHBQ) to assess its relation to the Child Behaviour Checklist (CBCL) and to describe its relation to sociodemographic factors. METHOD: Three hundred and forty children 2-13 years studied in connection with elective procedures which included anaesthesia. Parents completed the CBCL forms before and after hospitalization as well as the PHBQ 2 weeks after hospitalization. RESULTS: In multivariate analysis of PHBQ total score independent risk factors were: age <5 (OR 2.4; CI 1.4-4.0), living in a one parent family (OR 4.4; CI: 1.6-12.6) and not living in a rural area (OR 1.6; CI: 1.0-2.6). The correlation between the total scores for PHBQ and CBCL for children aged 2-4 was moderate: (r = 0.38; p < 0.005). For children aged 4-7 there were significant correlations between PHBQ sleep anxiety and CBCL Other problems (r = 0.4; p < 0.01), PHBQ eating disturbances and CBCL total score (r = 0.3; p < 0.01), though none of these significant correlations were observed for children above 7 years of age. CONCLUSION: There is an association between PHBQ and CBCL which is weaker for older children. The reason for this might be that PHBQ is more sensitive in the younger age group and to minor changes in behaviour. Children younger than 5 years of age or living in a one parent family or not living in rural areas appear to have higher incidence of problematic behaviour in a 2 week follow up after anaesthesia.

  • 38.
    Karling, Mats
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Stenlund, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Behavioural changes after anaesthesia: validity and liability of the Post Hospitalization Behavior Questionnaire in a Swedish paediatric population.2006In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 95, no 3, p. 340-346Article in journal (Refereed)
    Abstract [en]

    AIM: To study the validity and liability of a Swedish translation of the Post Hospitalization Behavior Questionnaire (PHBQ) in children in Sweden. METHODS: The PHBQ was translated using a back-translation method. The subjects were 340 children, ages 2-13 y, admitted for elective surgery or diagnostic procedure with anaesthesia. The results were analysed using exploratory factor analysis with principal component analysis with Oblimin rotation. The fit to data was examined using confirmative factor analysis with a good measure of fit for the model (p>0.09 for all factors). RESULTS: Five factors emerged as being most consistent: general anxiety-withdrawal, eating disturbances, separation anxiety, regression-aggression and sleep anxiety. A panel of child psychologists confirmed the face validity of factors. Internal consistency (Chronbach's alpha) was adequate (0.75-0.87) for subscales and excellent for total score (0.93). Children less than 5 y old had higher scores than older children (mean 0.046+/-0.018 vs -0.0089+/-0.014, p<0.001). There were no gender differences. CONCLUSION: The results support a conclusion that a five-factor model better fits data from Swedish children than the original six-factor model.

  • 39.
    Karling, Mats
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Stenlund, Hans
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Child behaviour after anaesthesia: associated risk factors2007In: Acta Paediatr, Vol. 96, no 5, p. 740-7Article in journal (Refereed)
    Abstract [en]

    AIM: To identify hospital care factors which are associated with problematic behaviours in children after hospitalization. METHOD: A cohort of 340 children ages 2-13 was studied in connection with elective procedures which included anaesthesia. Data collected: sociodemographic, type of procedure, anaesthesia induction technique and premedication. Staff and parents assessed child anxiety at induction of anaesthesia, pain, anxiety and nausea in recovery room and hospital ward. Parents assessed their child's pain and nausea and the behaviour measured with the Post Hospital Behavioural Questionnaire two weeks after hospitalization. RESULTS: One-third (34.4 %) of the children developed at least one problematic behaviour, measured by the PHBQ subscales. Multiple logistic regression identified the following risk factors: age <5, pain at home but not at hospital, nausea, child anxiety at anaesthesia induction, postoperative nausea, postoperative distress, previous hospitalizations, living in a one adult family and having some previous problematic behaviours. Moderate-to-severe pain at home, but not at hospital, was associated with the greatest risk (OR 6.39 CI: 3.53-11.6). Previous anaesthesia, midazolam use in premedication and living in rural areas seemed to be protective factors. CONCLUSION: Pain at home but not in hospital is a strong risk factor for the onset or worsening of problematic behaviour after childhood hospitalization, which included anaesthesia. Proactive interventions are suggested to prevent this by improving pain treatment at home.

  • 40.
    Karling, Mats
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Stenlund, Hans
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Child behaviour after anaesthesia: associated risk factorsManuscript (Other academic)
  • 41.
    Lekkou, Spyridoula
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Åström, Torsten
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Swedish and Greek adolescents´ perceptions of family functioning and mental healthArticle in journal (Refereed)
  • 42.
    Lekkou, Spyridoula
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Åström, Torsten
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Nygren, Lennart
    Attitudes about life issues in Greek and Swedish adolescents2006In: Social Work Journal of the Hellenic Association of Social Workers, no 83, p. 151-166Article in journal (Refereed)
  • 43.
    Lekkou, Spyridoula
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Åström, Torsten
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Nygren, Lennart
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Greek youths´ attitudes to social problems, fears, coping and future plans2006In: Review of Clinical Pharmacology and Pharmacokinetics, ISSN 1011-6583, Vol. 20, no 1, p. 22-30Article in journal (Refereed)
  • 44.
    Lekkou, Spyridoula
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Åström, Torsten
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Nygren, Lennart
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Personal attitudes about problems and fears in Greek and Swedish adolescents2006In: Social Work Journal of the Hellenic Association of Social Workers, Vol. 21, no 83, p. 151-166Article in journal (Refereed)
  • 45.
    Lernmark, B
    et al.
    Department of Woman and Child Health, Karolinska Institutet, Stockholm.
    Dahlquist, Gisela
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Fransson, P
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Ivarsson, S A
    Paediatric Clinic, Malmö University Hospital, University of Lund, Lund.
    Ludvigsson, J
    Department of Paediatrics, University of Linköping, Linköping.
    Sjöblad, S
    Department of Woman and Child Health, Karolinska Institutet, Stockholm.
    Thernlund, G
    Department of Child and Adolescent Psychiatry, University of Lund, Lund.
    Relations between age, metabolic control, disease adjustment and psychological aspects in insulin-dependent diabetes mellitus1996In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 85, no 7, p. 818-824Article in journal (Refereed)
    Abstract [en]

    The relations between age, metabolic control, disease adjustment, and psychological factors in boys and girls with recently diagnosed insulin-dependent diabetes mellitus (IDDM) were studied. Older girls had significant higher postremission glycosylated haemoglobin A (Hb AIc) levels (p = 0.008). Girls with more hospitalizations had a lower developmental level (p = 0.05), and had significantly more problems in the behavioural rating (p = 0.05). Boys with more hospitalizations had a more external locus of control (p = 0.01), more difficulties with disease adjustment, more emotional problems, and were also clinically assessed as having more behavioural problems. Boys showing more difficulties in psychological adjustment to the disease also had higher postremission Hb AIc levels (p = 0.02). Although Swedish children with IDDM of short disease duration do not differ from healthy children in important psychological aspects, older girls and a small group of problematic younger boys are at risk of developing metabolic imbalance after a short disease duration.

  • 46.
    Levidioti-Lekkou, Spyridoula
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Åström, Torsten
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Self-reported mental health and sense of coherence among Swedish and Greek adolescents2006In: Review of Clinical Pharmacology and Pharmacokinetics, ISSN 1011-6583, no 20, p. 1-14Article in journal (Refereed)
  • 47. Lundmark, Elisabet
    et al.
    Stenberg, Arne
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Nevéus, Tryggve
    Reboxetine in therapy-resistant enuresis: a randomized placebo-controlled study2016In: Journal of Pediatric Urology, ISSN 1477-5131, E-ISSN 1873-4898, Vol. 12, no 6, p. 397.e1-397.e5Article in journal (Refereed)
    Abstract [en]

    Introduction: A significant minority of children with enuresis do not respond to either desmopressin or the enuresis alarm. Anticholinergics have not proven as successful as expected. The fourth evidence-based treatment, the tricyclic antidepressant imipramine, is cardiotoxic when overdosed, which has led to diminished use. Aim: The aim was to determine whether there is a role for the noradrenergic antidepressant reboxetine, as monotherapy or combined with desmopressin, in the treatment of enuresis in children who have not responded to standard therapy, and whether there are side effects involved. We also sought prognostic factors in anamnestic data and in the voiding chart. Patients and methods: The study was a randomized placebo-controlled study with a double-blind cross-over design, in which all patients underwent treatment during three 4-week periods, one with reboxetine 4 mg and placebo, one with reboxetine 4 mg and desmopressin, and one with double placebo treatment. The proportion of wet nights out of 14 was compared before treatment and during the last 2 weeks of each treatment period. Results: Eighteen patients were included. The reduction of wet nights was much better with either reboxetine in monotherapy or in combination with desmopressin than during the placebo period (p = 0.002) (Figure). However, only one patient achieved complete dryness, this during monotherapy. There were three intermediate responders to monotherapy and five to combination treatment. With reboxetine in monotherapy, six children experienced negative side effects compared with three with combination therapy, and two with placebo. All of these side effects were mild and reversible. Only one patient chose to cease treatment because of side effects. No prognostic factors were found in either the case history or in voiding chart data. Discussion: The present study, the first placebo-controlled trial, confirms that reboxetine is an evidence-based alternative to cardiotoxic antidepressant treatment in therapy-resistant enuresis. The fact that few patients achieved complete dryness may be due to the low dosage used. In our clinical practice we increase the dose to 8 mg when dryness is not achieved with the lower dose. Our experience is that this leaves more children with full response, but the evidence of this has yet to be shown. Conclusion: Reboxetine seems to be an alternative in the treatment of enuretic children who have not responded to standard treatment.

  • 48.
    Löfgren, Hans O.
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Padyab, Mojgan
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Ghazinour, Mehdi
    Umeå University, Faculty of Social Sciences, Police Education Unit at Umeå University.
    Nilsson, Karin
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Petersen, Solveig
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Healthier Parents: Effects of Parent Training Programs on Mental Health2017In: International Journal of Social Work and Human Services Practice, ISSN 2332-6832, E-ISSN 2332-6840, Vol. 5, no 2, p. 70-79Article in journal (Refereed)
    Abstract [en]

    The study aims to investigate the effects of Parent Training Programs on the mental health of parents with children aged between 1 and 17 in a universal preventive setting. The intervention group included 279 parents who were assigned to five professionally administered interventions, which included 5–10 two-hour sessions; they were then compared to 702 parents in the comparison group without intervention. The improvement in general mental health was statistically significant in the intervention group compared to the comparison group. The findings suggest that evidence-based parent training programs enhance well-being in parents without indicated problems. However further exploration of preventive training programs for parents are needed.

  • 49.
    Löfgren, Hans O.
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Padyab, Mojgan
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Nyroos, Mikaela
    Umeå University, Faculty of Social Sciences, Department of Education.
    Ghazinour, Mehdi
    Umeå University, Faculty of Social Sciences, Police Education Unit at Umeå University.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    First-level trial of two school-based prevention programmes for depression, anxiety and social problems in adolescentsManuscript (preprint) (Other academic)
    Abstract [en]

    Recognizing the positive mental health benefits of school-based interventions, the present study examined the effect of the preventive programmes. A small feasibility try-out turned out to have conclusive results worth reporting. Choosing Healthy Actions and Thoughts (CHAT) was examined and compared to Life-Skills, commonly used primary preventive method in Swedish schools that has been evaluated in research studies and showing effects on social skills. The aim was to determine if CHAT can be included in the school curriculum and result in positive mental health gains. A community sample of 59 pupils in grade 7 completed a test battery including the Sense of Coherence, the Children’s Depression Inventory, and the Youth Self Report instruments. Post intervention measures were performed at two time points, i.e., right after the intervention sessions and after 12 months follow-up. The two programmes aimed at improving mental health in schoolchildren and both are administered by teachers. The main result was improvement in self-reported depression symptoms for the CHAT programme and less social problems for the Life-Skill programme. There is however a dimension, attention problems, where the programmes had no effect. The feasibility was considered satisfactory. Educational and healthcare implications are discussed.

  • 50.
    Löfgren, Hans O.
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Petersen, Solveig
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Nilsson, Karin
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Ghazinour, Mehdi
    Umeå University, Faculty of Social Sciences, Police Education Unit at Umeå University.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Effects of Parent Training Programmes on Parents' Sense of Competence in a General Population Sample2017In: Global Journal of Health Science, ISSN 1916-9736, E-ISSN 1916-9744, Vol. 9, no 7, p. 24-34Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: This longitudinal case-controlled study examined the effects of universal parent-focused interventions on parents’ perceived competence in terms of parental efficacy and satisfaction.

    METHOD: The study sample consisted of parents from northern Sweden in the general population who participated in parent training programmes from 2010 to 2013, and a matched-comparison group. All parents had children aged 0–17. Sense of competence was measured by the Parenting Sense of Competence Scale at pre- and post-intervention and six months after the intervention.

    RESULTS: The intervention group showed a statistically significant improvement in parental competence compared to the comparison group over time. The intervention itself had a significant effect on parental satisfaction, but the efficacy effect was not sustained when taking into account potential confounders.

    CONCLUSIONS: Earlier studies indicate that parent training programmes enhance perceived parental competence amongst referred parents. The present study shows that parent training programmes applied in the general population may also enhance perceived parental satisfaction, suggesting that parent training programmes can be an important preventive strategy to enhance parental feelings of satisfaction in the wider population. The results suggest that parents who participate in parent training programmes might have a need to increase parental competence, based on lower scores than the comparison group, both before and after the intervention.

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