Illness and use of medicines in relation to caries development and to immigrant status in infants and toddlers living in Sweden.

In Sweden about 28 per cent of 3-year-old children have developed carious lesions. It has been shown that children below the age of 3 have the highest hospital emergency department visiting rate and receive prescriptions for medicines more often than older preschool children. Furthermore, studies have shown that immigrants more often use hospital emergency departments than Swedes. The purpose of this study was to describe illness and use of medicines in infants and toddlers with special reference to caries prevalence at 2 and 3 years of age and to immigrant status. The study was designed as a prospective study, starting with 671 children aged 1 year. The parents were interviewed about the child's medical history. The results indicate that illness during the first year of life can influence caries prevalence in 2 and 3-year-olds. However, this study could not show any difference in caries prevalence between children who had used medicines at an early age and those who had not. Furthermore, during the first year of life the immigrants had visited a physician more often, been admitted to hospital more and consumed more medicines that non-immigrants.

Pertussis in Sweden after the cessation of general immunization in 1979.

Immunization against pertussis was introduced in Sweden in the 1950s and discontinued in 1979. This was followed by a low endemic level of pertussis for 3 years. Thereafter the incidence gradually increased and there were two outbreaks in 1983 and in 1985. In the period 1980 to 1985 pertussis was confirmed by culture or serology in 36,729 patients of which 11% were younger than 12 months of age and 69% were ages 1 to 6 years. An estimate of the total frequency of pertussis in preschool children was made from reports from a sample of the child health centers. The annual incidence rate per 100,000 population ages 0 to 6 years increased from the 700 cases in 1981 to 3200 in 1985. The ratio of total cases to those reported from the laboratories was 3:1 in 1981 and 2:1 in 1985. The cumulative incidence rate by the average age of 4 years was estimated at 16% of the unimmunized cohort born in 1980 compared with 5% of the immunized cohort born in 1978. The seriousness of pertussis was evaluated by studying the 2282 pertussis patients hospitalized from 1981 to the end of 1983. Forty-eight percent were infants younger than 12 months of age. Neurologic complications were noted in 4% and pneumonia in 14% of the hospitalized patients. Eleven children received assisted ventilation. Fatal outcomes were reported in 3 children (0.1%), 2 of whom had severe congenital disabilities.

Patients at a paediatric out-patient clinic. A study with particular reference to psychological and social background factors. I. The problem, material, methods and actual visit.

A large proportion of the children who attend paediatric clinics present with indefinite somatic symptoms or complaints which are clearly or possibly of a psychological nature. At the same time it is known that patients with serious psychological problems tend to seek help far too late. This study is an attempt to find out whether the patients who are liable to become problem cases in the long term can be identified by the paediatrician at an early stage and, if so, in what ways these patients differ from others in a paediatric clientele. All the patients who attended the Paediatric Out-Patient Clinic at Umeå Hospital during the course of one year were assessed by the physicians there. It was judged that psychological factors of importance were involved in 5.2%, that the importance was doubtful in 8.3% and that no psychological factors were involved in 86.5%. The proportion of cases involving psychological factors of importance increased with age and amounted to 17% amoung the 10 to 15-year-olds.

Patients at a paediatric out-patient clinic. A study with particular reference to psychological and social background factors. II. Earlier contacts with the health service, social background, parents' morbidity, general discussion and recommendations.

Psychological factors were considered by the examining physicians to play an important part in 5.2% of approximately 4 000 initial visits to a paediatric clinic. These cases are compared with a matched control group representing the cases where the physicians judged that psychological factors were not involved. As compared with the controls, then a considerably larger proportion of the patients with symptoms associated with psychological factors had a previous history of contacts with child psychiatrists or attendence at the paediatric clinic for problems of a psychological nature. Their parents, the mothers in particular, had a higher frequency of registered sickness for mental-nervous disorders and their families had more frequently been the subject of special social inquiries or assistance. To a large extent the examining paediatrician was unaware of these background conditions. With a better case history and proper follow-up one could probably reduce the number of X-ray examinations, consultations and laboratory tests. Further training and better contacts would be facilitated if members of a children's psychiatric team were stationed within the paediatric clinic.