Filmpjes voor het afnemen van de Van Wiechenkenmerken door ouders: determinanten van gebruik

Inleiding: Korte filmpjes van de Van Wiechenkenmerken zijn ontwikkeld, zodat ouders deze kenmerken met hun kind kunnen uitvoeren. Door ouders meer te betrekken bij de ontwikkeling van hun kind en het ontwikkelingsonderzoek door de jeugdgezondheidszorg (JGZ) komen ze beter voorbereid op het consult en zijn ze tijdens het consult meer gelijkwaardige gesprekspartners. Het doel van dit onderzoek is om determinanten van huidig en toekomstig gebruik van de filmpjes (wel/niet aanbieden en ervaringen) door JGZ-professionals en gebruik (ervaringen) door ouders te onderzoeken om daarmee implementatie van de filmpjes binnen de JGZ te ondersteunen.

Methode: Er is kwalitatief onderzoek met semigestructureerde interviews uitgevoerd om de belemmerende en bevorderende determinanten van het gebruik van de filmpjes zoals ervaren door JGZ-professionals (n = 14) en ouders (n = 10) in kaart te brengen. Met data (n = 4.370 ouders) uit een online tool waarin de filmpjes en vragenlijsten werden getoond, is kwantitatief onderzoek uitgevoerd, waarbij de ervaringen van de ouders met de filmpjes en de uitkomsten op de leeftijdsspecifieke kenmerken van hun kind zijn afgenomen.

Resultaten: Het kwalitatieve onderzoek liet zien dat het gebruik van de filmpjes door de meeste JGZ-professionals en ouders als positief werd ervaren. Aandachtspunten waren onder andere het beperkte bereik en gebruik van de filmpjes bij specifieke groepen (bijvoorbeeld anderstaligen), gebrek aan tijd bij sommige ouders en JGZ-professionals, ouders misten feedback direct na afname van de Van Wiechenkenmerken en uitkomsten op kenmerken kwamen niet altijd overeen tussen ouders en JGZ-professionals. Het kwantitatieve onderzoek liet zien dat ouders de filmpjes gemiddeld een 8,2 als rapportcijfer gaven en dat ongeveer de helft van de ouders zich (meer) betrokken voelde bij de ontwikkeling van hun kind en (beter) waren voorbereid op de afspraak bij de JGZ. De kenmerken werden door 96–100% van de ouders begrepen. Bij enkele kenmerken moest er gebruik worden gemaakt van materiaal dat niet aanwezig was in elk huishouden, zoals een stoof of een driewieler.

Conclusie: JGZ-professionals en ouders waren positief over het gebruik van de filmpjes. Op basis van de determinanten uit dit onderzoek is een implementatieplan ontwikkeld om JGZ-organisaties te ondersteunen als zij het gebruik van de filmpjes willen implementeren.

Spectacle wear and refractive errors in Dutch children

Background

Myopia is a refractive error that is increasing dramatically all over the world. Early onset is associated with a significant visual burden later in life, but little is known about refractive errors in preschool children. The aim of this study was to assess prevalence of spectacle wear, visual acuity and refractive errors in young Dutch children and to make global comparisons.

Methods

We analyzed data of three prospective population-based studies: 99,660 3- to 5-year-olds undergoing vision screening at preventive child healthcare organizations, 6,934 6-year-olds from the Generation R study, and 2,974 7-year-olds from the RAMSES study. Visual acuity was measured with Landolt-C or LEA charts, spectacle wear was assessed, and refractive errors at age 6 and 7 were measured with cycloplegic refraction. Spectacle wear was compared with international studies.

Results

The prevalence of spectacle wear was 1.5%, 2.3%, 6.6%, 8.2% and 11.8% at 36, 45, 60, 72 and 84 months, respectively, with no major sex differences. Among children with spectacle wear at 72 months (N = 583) and 84 months (N = 351) 29.8% and 34.6% had myopia respectively, of which 21.1% and 21.6% combined with astigmatism, 19.6% and 6.8% had hyperopia, 37.2% and 11.1% hyperopia and astigmatism, and 12.5% and 33.3% astigmatism only. The prevalence of spectacle wear globally varied between 1.5% to 21%.

Conclusions

Spectacle wear in these European children started early in preschool and increased to substantial figures at school age. Among children with spectacle wear, >30% were already myopic, illustrating the urgency to implement myopia prevention strategies in child health centers.

Key messages

Early onset myopia is a public health issue. Of the 6- to 7-year-olds with spectacles 30-34% were already myopic. Monitoring of refractive errors and preventive lifestyle interventions are warranted.

Effectiveness of the Children of Divorce Intervention Program in the Netherlands

Background

Many children experience parental separation and divorce. This experience is likely to negatively affect their wellbeing, conduct, psychological adjustment and social relations. Prevention of these problems thus has major priority but effective intervention programmes are still rare. This study therefore aimed to assess the effects of a 12-session preventive group intervention “Dappere Dinos™” for 6 to 8 year old children.

Methods

We performed a quasi-experimental study (registered as NTR 6788) on 105 children participating in the intervention group, 37 children with separated parents not participating (’divorce controls’) and 138 children from intact families (’intact controls’). Outcomes regarded children’s positive functioning (Parent Evaluation Form; Pedro-Carroll & Cowen, 1989), emotional and behavioral problems (Strengths and Difficulties Questionnaire; Goodman, 1997), and wellbeing (Cantril ladder, Cantril, 1965).

Results

Analyses showed that children’s positive functioning after participating in Dappere Dino’s increased according to mothers (MΔpre-post(SD) = 0.26 (0.32); p < .001). Also, children’s overall emotional and behavioral problems decreased after participation (MΔpre-post_mother(SD) = -2.02 (4.55); p < .01; MΔpre-post_trainer(SD) = -1.07 (4.34); p < .05; MΔpre-post_teacher(SD) = -1.64 (3.54); p < .01). Children’s wellbeing increased after participation (MΔpre-post_mother(SD) = 0.77 (1.02); p < .001; MΔpre-post_trainer(SD) = 0.69 (0.94); p < .001), or stayed the same (MΔpre-post_teacher(SD) = 0.19 (1.03); p = n.s.). No such changes were found in the two comparison groups.

Conclusions

After parental divorce, a 12-session preventive group intervention Dappere Dino’s™ for 6- to 8-year-olds can be efficacious in promoting children’s emotional well-being and positive functioning, and reducing their emotional and behavioral problems.

Key messages

Given the high prevalence of divorce and the potential risk for child well-being and functioning, prevention of problems for these children and helping them adapt to the divorce are major priorities. After parental divorce, preventive group support can be efficacious in promoting children’s emotional well-being and positive functioning, and reducing their emotional and behavioral problems.

Specific language impairment is associated with maternal and family factors

BACKGROUND

This study aimed to identify risk factors associated with specific language impairment (SLI).

METHODS

In a nested case-control design, 253 children attending special needs schools for severe speech and language difficulties in the Netherlands were matched for sex and date of birth with 253 children attending mainstream education. Data on perinatal, maternal and family issues were retrieved from well-child care files registered shortly after birth.

RESULTS

Children with SLI had younger mothers than children in the control group (mean 30 years 9 months vs. mean 31 years 9 months) (P = 0.02). Children with SLI were less frequently breastfed directly after birth (55% vs. 71%) (P = 0.0007) and were less frequently firstborns (33.3% vs. 46.2%) (P = 0.002). No statistically significant differences were found for any of the other risk factors.

CONCLUSIONS

A relationship was found between SLI and maternal age, being breastfed and place in the birth order. Perinatal risk factors do not seem to be strongly associated with SLI.

Trends in oral health in young people in the Netherlands over the past 20 years: a study in a changing context

OBJECTIVES

From 1 January 2006, the distinction between the health insurance fund and private insurance was abolished and a basic insurance package was agreed for everyone in the Netherlands. Dental treatment for young people below the age of 18 is reimbursed under the terms of this basic package. Dental treatment for adults is not covered in this basic insurance package. Basic principles for nonreimbursing dental care for adults were that any health and financial risks for individual citizens in the future should be acceptable for them with the corollary that the oral health of young adults when they make the switch - from collectively financed care to care to be paid for individually - should be at such a level that the needed oral health care is affordable. To meet this requirement, it is important to have knowledge of the prevalence of oral diseases and trends in oral health in young people from a public health perspective. The aim of this article is to describe trends in caries experience in young people in the Netherlands from 1990 to 2009, taking into account the challenge in methodology concerning this changing social context.

METHODS

To describe caries experience in young people, a repeated cross-sectional study design was used. The study consisted of a clinical oral examination and a questionnaire survey. Data were sampled from 8, 14 and 20-year-olds in 1990 and 1996, and 9, 15 and 21-year-olds in 2003 and 2009, living in Alphen a/d Rijn, Gouda, Breda and 's-Hertogenbosch. The DMF index was used for describing caries experience. The trends were studied separately in high and low socioeconomic status (SES) groups. SES was operationalized as the dichotomous variable of educational level of the mother or the adolescent. Multiple imputation was applied to predict the DMFS for missing ages for certain years, which made it possible to test the trends. Linear and logistic regression analyses were used to study the trends through the years.

RESULTS

This study showed, according to different age- and SES groups, either declines or no statistically significant changes in caries experience over the last two decades.

CONCLUSIONS

No deterioration was shown. However, there is still room for further improvement in oral health in children. Dental professionals and politicians should develop a vision on to what extent caries experience is acceptable in a public health perspective in young people.

Ten-year quality assurance of the nationwide hearing screening programme in Dutch neonatal intensive care units

AIM

To evaluate 10-year quality assurance of newborn hearing screening (NHS) in Dutch neonatal intensive care units (NICU).

METHODS

Results of the two-stage automated auditory brainstem response (AABR) screening and diagnostic examination in NICU graduates were centrally registered between October 1998 and December 2008. This registration facilitates screening, tracking and follow-up after abnormal screening results. Outcome measures are referral rates, prevalence rate of hearing loss and (trends of) coverage rates and timeliness of follow-up.

RESULTS

Thirty-two thousand one hundred and two infants have been screened. Referral rates were 9.2% at the first and 26.3% at the second stage. Hearing loss was diagnosed in 728 infants (2.2%). Coverage rates were 98.7% at the first, 92.1% at the second stage, 92.3% for the diagnostic examination and 97.9% for the complete programme. After correction for gestational age, 95.8% of the infants had their first AABR<1 month, 81.8% of the referred infants had their second AABR<6 weeks and 67.1% were diagnosed<3 months. There was a positive trend in referred infants that had their second AABR<6 weeks (p=0.004) as well as in infants diagnosed<3 months (p<0.001).

CONCLUSION

The NHS in Dutch NICUs is effective. Timely identification of hearing loss is improving over time.

Risk indicators for hearing loss in infants treated in different neonatal intensive care units

AIM

To assess which infants' characteristics and specialized procedures are risk indicators for unilateral or bilateral hearing loss (HL) and to evaluate whether these risk indicators are associated with variation in prevalence of HL between Neonatal Intensive Care Units (NICUs).

METHODS

For 2002-2005, data from the NICU hearing screening database in the Netherlands were matched with the national neonatology database in which all NICU infants with their patient characteristics and specialized procedures are registered. Multivariate logistic regression analyses were performed to assess risk indicators for HL and to explain differences in prevalence rates between NICUs.

RESULTS

A total of 10 830 infants were available for analyses. The prevalence of HL was 1.8% and ranged from 0.7 to 3.7% between NICUs. Infants' characteristics that significantly increased the risk of HL were the presence of craniofacial anomalies, chomosomal/syndromal anomalies, central nervous system conditions, circulatory system conditions and intra-uterine infections. The specialized procedures involving > or =12 days of intensive care and high frequency oxygenation ventilation were independent risk indicators for HL. Approximately 20% of the variance can be explained by the studied risk indicators. Differences in prevalence rates between NICUs were slightly reduced after adjustment for these risk indicators. NICUs with the highest prevalence rates of HL were situated in the largest cities in the Netherlands with a mixed population because of immigration. Therefore, ethnicity may be a risk indicator.

CONCLUSIONS

Several independent risk indicators for HL were found, but they could not explain all differences in prevalence rates of HL between NICUs.

Trends in overweight and obesity prevalence in Dutch, Turkish, Moroccan and Surinamese South Asian children in the Netherlands

OBJECTIVE

To determine trends in the prevalence of overweight and obesity in children in The Hague (the Netherlands) from 1999 through 2007.

DESIGN

Population-based study of a series of cross-sectional assessments of height and weight from electronic health records.

SETTING

Child Health Care (Municipal Health Service), The Hague.

PARTICIPANTS

50,961 children aged 3-16 years, with Dutch (59%), Turkish (17%), Moroccan (13%) or Surinamese South Asian (11%) ethnicity, representative of the four major ethnic groups in The Hague, with 85,234 weight and height measurements recorded in 1999-2007.

MAIN OUTCOME MEASURES

(Trends in) the prevalence of overweight (excluding obesity) and obesity as defined by the International Obesity Taskforce cut-off points, using logistic regression with year as independent variable.

RESULTS

From 1999 through 2007 there was a decrease in the prevalence of overweight in Dutch girls from 12.6% to 10.9% (OR 0.96; 95% CI 0.95 to 0.98) and an increase in Turkish boys from 14.6% to 21.4% (OR 1.08; 95% CI 1.04 to 1.11). Obesity prevalence rose significantly in Turkish boys from 7.9% to 13.1% (OR 1.04; 95% CI 1.01 to 1.06) and in Turkish girls from 8.0% to 10.7% (OR 1.04; 95% CI 1.01 to 1.08). Dutch boys, and Moroccan and Surinamese South Asian boys and girls showed no significant trends.

CONCLUSIONS

The declining prevalence of overweight in Dutch girls may indicate reversal of previous trends in the Netherlands. However, in Turkish children overweight prevalence and obesity is high and increasing. Further public health action is necessary, especially for Turkish children.

Developing evidence-based guidelines for referral for short stature

OBJECTIVE

To establish evidence-based guidelines for growth monitoring on a population basis.

STUDY DESIGN

Several auxological referral criteria were formulated and applied to longitudinal growth data from four different patient groups, as well as three samples from the general population.

RESULTS

Almost 30% of pathology can be detected by height standard deviation score (HSDS) below -3 or at least two observations of HSDS below -2.5 at a low false-positive rate (<1%) in 0-3-year-old infants. For 3-10-year olds, a rule concerning distance to target height of >2 SD in combination with HSDS <-2.0 has the best predictive value. In combination with a rule on severe short stature (<-2.5 SDS) and a minor contribution from a rule on "height deflection", 85.7% of children with Turner syndrome and 76.5% of children who are short because of various disorders are detected at a false-positive rate of 1.5-2%.

CONCLUSIONS

The proposed guidelines for growth monitoring show high sensitivity at an acceptably low false-positive rate in 3-10-year-old children. Distance to target height is the most important criterion. Below the age of 3 years, the sensitivity is considerably lower. The resulting algorithm appears to be suitable for industrialised countries, but requires further testing in other populations.

[Weight loss, serum sodium concentration and residual symptoms in patients with hypernatremic dehydration caused by insufficient breastfeeding]

OBJECTIVE

To determine the relationship between serum sodium concentration and weight loss as well as residual symptoms in newborns with hypernatremic dehydration caused by insufficient breastfeeding; and to determine the sensitivity of the following rule of thumb 'if weight loss is less than 10%, the baby does not have hypernatremic dehydration caused by insufficient breastfeeding'.

DESIGN

Systematic literature search.

METHOD

Medline was searched using the terms 'dehydration AND breastfeeding' for case reports on patients with 'hypernatremic dehydration caused by insufficient breastfeeding'. Reference lists from the articles retrieved were also searched. Articles published in 1970-2004 in Dutch, English, French, and German were included. All cases that the author diagnosed as 'hypernatremic dehydration caused by insufficient breastfeeding' were included.

RESULTS

A total of 47 articles were found, containing 128 relevant cases. Of these, 9 had less than 10% weight loss. Therefore, the sensitivity of the 10% rule was 93%. We found a linear relationship between the degree of weight loss and serum sodium concentration (Pearson's correlation coefficient = 0.71; p < 0.001). For every 10% increase in weight loss, the serum sodium concentration increased by 16 mmol/l (95% CI: 13-19). As the serum sodium concentration increased, the prevalence of residual symptoms increased. No residual symptoms were reported in patients with less than 10% weight loss.

CONCLUSION

A relatively strong linear relationship was found between weight loss and serum sodium concentration. If the weight loss was more than 10%, the serum sodium concentration was beyond the range of normal values. The rule of thumb had a high sensitivity; however, the specificity should be determined before the rule of thumb is implemented.

Individual growth curve models for assessing evidence-based referral criteria in growth monitoring

The goal of this study is to assess whether a growth curve model approach will lead to a more precise detection of Turner sydnrome (TS) than conventional referral criteria for growth monitoring. The Jenss-Bayley growth curve model was used to describe the process of growth over time. A new screening rule is defined on the parameters of this growth curve model, parental height and gestational age. The rule is applied to longitudinal growth data of a group of children with TS (n=777) and a reference (n=487) group. The outcome measures are sensitivity, specificity and median referral age. Growth curve parameters for TS children were different from reference children and can therefore be used for screening. The Jenss-Bayley growth model, which uses all longitudinal measurements from birth to a maximum age of 5 years with at least one measurement after the age of 2, together with parental height and gestational age can achieve a sensitivity of 85.2 per cent with a specificity of 99.5 per cent and a median referral age of 4.2 (the last measurement between the age of 2 and 5 of each child is considered to be the moment of referral). Sensitivity increases by 2 percentage points when decreasing the specificity to 99 per cent. The Jenss-Bayley growth model from birth to a maximum age of 8 years with at least one measurement after the age of 2, together with parental height results in a sensitivity of 89.0 per cent with a specificity of 99.5 per cent and a median referral age of 6.1. For a specificity of 98 per cent, we obtain a sensitivity of 92.3 per cent. In comparison to conventional rules applied to the same data, sensitivity is about 11-30 percentage points higher at the same level of specificity for the Jenss-Bayley growth rule. We conclude that from the age of 4, growth curve models can improve the screening on TS to conventional screening rules.

Towards evidence based referral criteria for growth monitoring

AIMS

To evaluate the performance of growth monitoring in detecting diseases. Turner's syndrome (TS) is taken as the target disease.

METHODS

Case-control simulation study. Three archetypal screening rules are applied to longitudinal growth data comparing a group with TS versus a reference group from birth to the age of 10 years. Main outcome measures were sensitivity, specificity, and median referral age.

RESULTS

Clear differences in performance of the rules were found. The best rule takes parental height into account. Combining rules could improve diagnostic accuracy.

CONCLUSION

Growth monitoring is useful to screen for TS. A combined rule that takes absolute height SDS, parental height, and deflection in height velocity into account is the best way to do this. Similar research is needed for other diseases, populations, and ages, and the results should be synthesised into evidence based referral criteria.