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I stora delar av den offentliga sektorn försvåras prioritering av insatser eftersom forskning om insatsernas kostnadseffektivitet saknas. Ändå måste prioriteringsbesluten fattas. Hur kan beslutsunderlagen i denna situation bli bättre? I artikeln presenteras ett verktyg för att göra en rimlighetsbedömning avseende kostnadseffektiviteten av sådana insatser för barn och unga — Kalkylverktyg för insatser mot social utsatthet (KAMSO). Metoden och ett beräkningsexempel presenteras. Både den samhällsekonomiska kostnadseffektiviteten med vunna goda år som utfallsmått och de finansiella fördelningseffekterna beskrivs. Artikeln avslutas med en diskussion om utvecklingsmöjligheter för KAMSO.

Aim: To study the development of overweight, obesity and underweight among 4-year-olds from 2007 to 2022, covering the COVID-19 pandemic period.

Methods: This repeated cross-sectional analysis was conducted in Västerbotten County, northern Sweden. It used data on weight, height, age and sex, which were collected when children attended their 4-year check-ups at any of the 38 Child Health Centres.

Results: The data comprised 42 614 4-year-old children (52% boys). From 2007 to 2022, the prevalence of overweight decreased from 13.4% to 9.5% in the boys and from 14.9% to 12.0% in the girls. The prevalence of obesity decreased from 3.7% to 1.8% in the boys and from 2.4% to 2.0% in the girls. During the first year of the COVID-19 pandemic, overweight and obesity temporarily increased for both the boys and girls, but the levels had returned to pre-pandemic levels by 2022. The prevalence of underweight increased among both boys and girls.

Conclusion: Our study documents a decline in the prevalence of overweight and obesity among Swedish 4-year-olds over more than a decade, except for a surge during the early COVID-19 pandemic. Additionally, we observed an unexpected increase in the prevalence of underweight during the same period.

BACKGROUND: Social-emotional ability is important for overall health and wellbeing in early childhood. Recognizing preschool children in need of extra support, especially those living in unfavourable conditions, can have immediate positive effects on their health and benefit their wellbeing in the long-term.

OBJECTIVES: The aim of this study is to investigate whether there are social inequalities in preschool children's social-emotional problems, and whether inequalities differ between boys and girls.

METHOD: This study utilized repeated measures from cross-sectional population-based surveys of three-year old children (2014-2018). The final study population comprised of 9,099 children which was 61% of all the eligible children in Västerbotten County during the study period. The Ages and Stages Questionnaires: Social-Emotional (ASQ:SE) 36-month interval was used to measure children's social-emotional ability. Social inequalities were studied with respect to parents' income, education, and place of birth, for which data was obtained from Statistics Sweden. Multiple logistic and ordered regressions were used.

RESULTS: Among 3-year-olds, social-emotional problems were more common in the most vulnerable social groups, i.e. parents in the lowest income quintile (OR: 1.45, p < 0.001), parents with education not more than high school (OR: 1.51, p < 0.001), and both parents born outside Sweden (OR: 2.54, p < 0.001). Notably, there was a larger difference in social-emotional problems between the lowest and highest social categories for girls compared to boys. Higher odds of social-emotional problems were associated with boys not living with both parents and girls living in the areas of Skellefteå and Umeå, i.e. more populated geographical areas.

CONCLUSION: Already at 3-years of age social-emotional problems were more common in children with parents in the most vulnerable social groups. This does not fulfil the ambition of an equitable start in life for every child and might contribute to reproduction of social inequalities across generations.

With regard to fully harvesting the potential of big data, public health lags behind other fields. To determine this potential, we applied big data (air passenger volume from international areas with active chikungunya transmission, Twitter data, and vectorial capacity estimates of Aedes albopictus mosquitoes) to the 2017 chikungunya outbreaks in Europe to assess the risks for virus transmission, virus importation, and short-range dispersion from the outbreak foci. We found that indicators based on voluminous and velocious data can help identify virus dispersion from outbreak foci and that vector abundance and vectorial capacity estimates can provide information on local climate suitability for mosquitoborne outbreaks. In contrast, more established indicators based on Wikipedia and Google Trends search strings were less timely. We found that a combination of novel and disparate datasets can be used in real time to prevent and control emerging and reemerging infectious diseases.

BACKGROUND: Some Vibrio spp. are pathogenic and ubiquitous in marine waters with low to moderate salinity and thrive with elevated sea surface temperature (SST). OBJECTIVES: Our objective was to monitor and project the suitability of marine conditions for Vibrio infections under climate change scenarios. METHODS: The European Centre for Disease Prevention and Control (ECDC) developed a platform (the ECDC Vibrio Map Viewer) to monitor the environmental suitability of coastal waters for Vibrio spp. using remotely sensed SST and salinity. A case-crossover study of Swedish cases was conducted to ascertain the relationship between SST and Vibrio infection through a conditional logistic regression. Climate change projections for Vibrio infections were developed for Representative Concentration Pathway (RCP) 4.5 and RCP 8.5. RESULTS: The ECDC Vibrio Map Viewer detected environmentally suitable areas for Vibrio spp. in the Baltic Sea in July 2014 that were accompanied by a spike in cases and one death in Sweden. The estimated exposure response relationship for Vibrio infections at a threshold of 16 degrees C revealed a relative risk (RR) = 1.14 (95% CI: 1.02, 1.27; p=0.024) for a lag of 2 wk; the estimated risk increased successively beyond this SST threshold. Climate change projections for SST under the RCP 4.5 and RCP 8.5 scenarios indicate a marked upward trend during the summer months and an increase in the relative risk of these infections in the coming decades. CONCLUSIONS: This platform can serve as an early warning system as the risk of further Vibrio infections increases in the 21st ritui due to climate change.

Purpose: To investigate the relationship between outdoor temperature in Sweden and the reporting of drug-induced hyponatremia to the Medical Products Agency (MPA). Methods: All individual adverse drug reactions (ADR) reported to MPA from 1 January 2010 to 31 October 2013 of suspected drug-induced hyponatremia and random controls were identified. Reports where the ADR had been assessed as having at least a possible relation to the suspected drug were included. Information on administered drugs, onset date, causality assessment, sodium levels, and the geographical origin of the reports was extracted. A case-crossover design was used to ascertain the association between heat exposure and drug-induced hyponatremia at the individual level, while linear regression was used to study its relationship to sodium concentration in blood. Temperature exposure data were obtained from the nearest observation station to the reported cases. Results: During the study period, 280 reports of hyponatremia were identified. More cases of drug-induced hyponatremia were reported in the warmer season, with a peak in June, while other ADRs showed an opposite annual pattern. The distributed lag non-linear model indicated an increasing odds ratio (OR) with increasing temperature in the warm season with a highest odds ratio, with delays of 1-5 days after heat exposure. A cumulative OR for a lag time of 1 to 3 days was estimated at 2.21 at an average daily temperature of 20 degrees C. The change in sodium per 1 degrees C increase in temperature was estimated to be -0.37 mmol/L (95% CI: -0.02, -0.72). Conclusions: Warm weather appears to increase the risk of drug-induced hyponatremia.

INTRODUCTION: Dengue has emerged as a significant public health problem in Sri Lanka. Historically surveillance was passive, with mandatory dengue notifications based on clinical diagnosis with only limited laboratory confirmation. To obtain more accurate data on the disease burden of dengue, we set up a laboratory-based enhanced sentinel surveillance system in Colombo District. Here we describe the study design and report our findings of enhanced surveillance in the years 2012-2014.

METHODS: Three outpatient clinics and three government hospitals in Colombo District that covered most of the Colombo metropolitan area were selected for the sentinel surveillance system. Up to 60 patients per week presenting with an undifferentiated fever were enrolled. Acute blood samples from each patient were tested by dengue specific PCR, NS1 ELISA and IgM ELISA. A sub-set of samples was sent to Duke-NUS Singapore for quality assurance, virus isolation and serotyping. Trained medical research assistants used a standardized case report form to record clinical and epidemiological data. Clinical diagnoses by the clinicians-in-charge were recorded for hospitalized cases.

RESULTS: Of 3,127 febrile cases, 43.6% were PCR and/or NS1 positive for dengue. A high proportion of lab confirmed dengue was observed from inpatients (IPD) (53.9%) compared to outpatient (clinics in hospitals and general practice) (7.6%). Dengue hemorrhagic fever (DHF) was diagnosed in 11% of patients at the time of first contact, and the median day of illness at time of presentation to the sentinel sites was 4. Dengue serotype 1 was responsible for 85% of the cases and serotype 4 for 15%. The sensitivity and specificity of the clinicians' presumptive diagnosis of dengue was 84% and 34%, respectively.

CONCLUSION: DENV-1, and to a lesser degree DENV-4, infection were responsible for a high proportion of febrile illnesses in Colombo in the years 2012 to 2014. Clinicians' diagnoses were associated with high sensitivity, but laboratory confirmation is required to enhance specificity.

Background: There is an urgent need to enhance our armamentarium to prevent dengue infections in children. Since dengue vectors (Aedes mosquitoes) are active mainly during the day, a potential target for control should be schools where children spend a considerable amount of their day. School uniforms are the cultural norm in most developing countries, worn throughout the day. We hypothesized that insecticide-treated school uniforms will  reduce the incidence of dengue infection in school-aged children. Our objective was to determine the impact of impregnated school uniforms on dengue incidence.

Methods: A randomised controlled trial was conducted in 10 schools in eastern Thailand in 2012. Pre-fabricated school uniforms were commercially treated to ensure consistent high quality of insecticide impregnation with permethrin. The 1-h-knock-down effect and 24 h mortality of Aedes mosquitoes by the impregnated cloth was tested at baseline and then once per month using WHOPES cone test. Blood samples were taken at baseline and at the end of the school-term for the hemagglutination-inhibition assay to identify serologically confirmed dengue infections during the study period. Students were randomized into intervention schools (all students wearing impregnated uniforms) versus control schools (uniforms had the same appearance and odor, but were not impregnated).

Results: A total of 1808 students in 10 schools were enrolled, mean age 10.07 years. Of these, 1651 had paired blood samples taken, which showed an incidence of new dengue infection of 3.3 % over the school term (5  months). There was no difference in the incidence of dengue infections in intervention versus control schools. Both the knock-down and mortality at baseline were close to 100%, but rapidly waned after only 8 washes to 20% e.g. after only 1 month of wearing the uniform.

Conclusion: Although the results of mosquitoes’ knock-down and mortality of impregnated schools looked very promising, we did not see a protective effect of impregnated uniforms on reducing dengue infections in this school-based trial. The most likely reason for the apparent failure was the rapid waning efficacy of impregnation after washing. New technologies need to be developed to overcome rapid waning efficacy of impregnated clothing.

Disclosure: This research was funded by the European Commission 7th Framework and was conducted by ‘DengueTools’ partners.