Child Health Services (CHS) in Sweden are offered free of charge to all Swedish parents with children 0-5 years of age.  The regular service schedule includes home visits, health examinations, vaccinations and participation in parenting groups. The CHS should pay extra attention to disadvantaged families. The aim of this thesis was to investigate to what extent the CHS reaches groups of families with special needs, e.g. immigrant families, low income families, young and single mothers, with universal or selective measures, as well as to investigate the variation of two determinants of child health, second hand smoke and breastfeeding, in these groups of families. The thesis also aimed at investigating validity of data in the county CHS quality database (Basta). The thesis is based on data from Basta together with several national registers. The CHS equally reached all families with infants with the universal program except for participation in parenting group. Foreign born, young, single and low-income mothers had lower participation rates. Smoking rates were lower in foreign-born than in Swedish-born mothers and higher for foreign-born than in Swedish-born fathers. Smoking was more common among single and low income parents and young mothers. Young and single mothers had lower breastfeeding rates at 6 months. At 12 months the breastfeeding rates were higher among foreign-born mothers. The validity test of data in the Basta database showed sensitivity values for immunizations, breastfeeding and smoking at 90-100 % and for any home visit, participation in parenting group at any time, a minimum number of 6 visits at the Child Health Centre (CHC) and a minimum number of 11 visits at the CHC at 88 - 96 %. The sensitivity value for the exact match of number of CHC visits (+/- 3 visits) was 88 %. Conclusions: The universal programme was equally distributed in different immigrant and socio-demographic populations. However, the results did not indicate equality according to the assumption that some families need more input than others in order to achieve equity of outcome. Individual data routinely collected from CHS records to a quality database provides data of good quality that can be used for both quality surveillance and research.

According to previous research, internalizing and externalizing problems tend to be comorbid or co-occur at different ages in development (Angold, Costello, & Erkanli, 1999). The question that this dissertation addresses is how and why internalizing and externalizing problems, two disorders that represent separate forms of psychopathology, co-occur in children. This is an important question for the developmental psychopathology perspective because an appreciation of the concept of co-occurrence is essential for explaining the development and taxonomy of internalizing and externalizing psychopathology, and for understanding the etiology and course of these symptoms (Achenbach, 1990). Attempts to explain co-occurrence have proposed that co-occurring psychopathology might represent distinct, meaningful syndromes (Angold & Costello, 1992; O’Connor et al., 1998), and in support of this idea, evidence of the existence of pure and co-occurring internalizing and externalizing problems has been found (Keiley et al., 2003). However, no previous study has identified heterogeneous developmental patterns of pure or combined internalizing and externalizing problems within a dynamic framework by taking trajectories of change into account. This dissertation uses data from the NICHD study of Early Child Care to explore the co-occurrence between internalizing and externalizing problems from age 2 to 12 with the use of Latent Class Growth Analysis. The sample included 1232 children (52% male). Different groups of children exhibiting low/normative, pure internalizing, pure externalizing, and co-occurring internalizing and externalizing problems across the 10 year period were identified. The higher risk groups deviated from the low/normative group in terms of antecedents, SES risk, medical risk, difficult temperament, and home environment. Moreover, children who exhibited pure moderate externalizing problems, and children who exhibited chronic externalizing problems, with and without co-occurring internalizing problems, engaged in more risky behaviors and were more likely to have friends who also engaged in risky behaviors. Furthermore, the pure chronic externalizing group and the groups scoring high on internalizing problems, with and without co-occurring externalizing problems, were more asocial with peers. Finally, children exhibiting chronic co-occurring externalizing and internalizing problems were more excluded by peers in comparison to the rest of the sample’s population.

本研究旨在探討國小學生家庭社經地位與自我概念對學業成就之影響。研究採用問卷調查法，以新北市國小學生為樣本母群體，採分層隨機叢集抽樣，抽出20所國小共計740位受試者，回收有效問卷659份，所得資料分別以描述性統計、獨立樣本t檢定、單因子變異數分析、及多元逐步迴歸分析等統計方法進行資料的分析與處理，以了解國小學生家庭社經地位、自我概念與學業成就之現況、差異情形及國小學生家庭社經地位與自我概念對學業成就的預測力。 研究結論如下： 一、國小學生自我概念現況屬中上程度，以「心理自我概念」最高。 二、國小學生學業成就現況屬中上程度，以「國語科學業成就」最高。 三、就讀年級在整體自我概念上有顯著差異，五年級高於六年級。 四、性別在英語科學業成就上有顯著差異，女性學生高於男性學生；就讀年級在國 語科及社會科學業成就上有顯著差異，六年級學生高於五年級學生。 五、家庭社經地位在國小學生自我概念上有顯著差異，高社經地位或中社經地位高於低社經地位。 六、家庭社經地位在國小學生學業成就上有顯著差異，高社經地位及中社經地位高於低社經地位。 七、家庭社經地位與自我概念對學業成就具顯著正相關及預測效果。 最後依據研究結果與結論，提出具體建議，以作為教育行政機關、教育人員以及未來研究的參考。 / The purpose of this study is to investigate the effect of socio-economic status and self-concept on academic achievement of elementary school students. A survey research was conducted using a sample of the fifth and sixth grade students of elementary schools in New Taipei City. 740 students from 20 schools were selected by stratified random sampling and cluster sampling. 659 valid sample data were collected, analyzed and processed with the methods of descriptive statistics, independent samples t-test, one-way ANOVA, and multiple stepwise regression analyses.The major findings of this study are as follows: 1.Elementary school studen’s self-concept is above average, “psychological self-concept” ranks the highest position. 2.Elementary school student’s academic achievement is above average, “Chinese academic achievement” ranks the highest position. 3.Grade show significant differences in self-concept, students who are in the fifth grade show higher performance than those in the sixth grade. 4.Gender show significant differences in English academic achievement, female students show higher performance than male students. Grade show significant differences in Chinese academic achievement and Society academic achievement, students who are in the sixth grade show higher performance than those in the fifth grade. 5.Socio-economic status show significant differences in self-concept, students who have high socio-economic status or intermediate socio-economic status show higher performance than those of low socio-economic status. 6.Socio-economic status show significant differences in academic achievement, students who have high socio-economic status and intermediate socio-economic status show higher performance than those of low socio-economic status. 7.Socio-economic status and self-concept are positively related to academic achievement. In addition, socio-economic status and self-concept have positive direct effect on academic achievement. Based on the findings and the conclusions, further suggestions for educational administration authorities, pedagogical individuals and future related study are proposed.

This dissertation examines the influence of student, teacher, and school variables on English and math teachers' expectations for their students. Findings from multilevel-model analyses of data from the Education Longitudinal Study (ELS: 2002) show that student achievement and stigmatized status are the strongest predictors of teacher expectations. In this study, students could be stigmatized on any of three factors (ethnicity, SES, and native language). Consistent with previous research, teachers' expectations were predicted by student achievement (test scores in reading and math). Teachers' expectations for future student academic attainment were higher for students with higher achievement than for lower-achieving students. This lends support to the argument that teachers are generally accurate in forming expectations. However, also consistent with prior research, student stigmatized status predicted expectations, with stigmatized students receiving lower expectations than non-stigmatized students. Multiple stigmatizations were powerful--students stigmatized on all three factors, in particular, received the lowest expectations. Further analyses indicated that student achievement interacts with student stigmatization for English teachers. At low levels of achievement, teachers held equally low expectations for stigmatized (on three factors) and non-stigmatized students. But, for high levels of achievement, teachers had lower expectations for stigmatized students with equally high achievement. Specifically, stigmatized students (on three factors) received expectations that were a half of a standard deviation lower than non-stigmatized students. Teacher ethnicity also appeared to influence teacher expectations via an interaction between teacher ethnicity and student stigmatization (on three factors). For English teachers, expectations were equally high for (a) ethnically stigmatized teachers rating stigmatized students, (b) stigmatized teachers rating non-stigmatized students, and (c) non-stigmatized teachers rating non-stigmatized students. The lowest expectations came from non-stigmatized teachers (White and Asian) rating stigmatized students. These findings (which control for student achievement) suggest bias in expectations that non-stigmatized teachers have for stigmatized students. School level variables in this study (e.g., percent of students receiving free/reduced lunch, percent of students who fail the competency test on first attempt), did not have a large effect on teacher expectations. Implications are discussed regarding multiply stigmatized students, self-fulfilling prophecy, equal access to educational opportunities, and recruitment of ethnic minority teachers. / text

published_or_final_version / Education / Master / Master of Education

This study had the dual purpose of determining the anthropometric and motor development status of street children as well as to establish the effect of an intervention programme on their motor development. The first aim of the study was to determine the anthropometric and motor development status of street children. The children were selected from a sample of street children living in a state-run shelter. Twenty eight children (20 boys and 8 girls) between the ages of 7 and 14 were measured to determine their anthropometric and motor development status. The anthropometric measures included stature, mass, body-mass index (BMI), and two skin folds (subscapular and triceps). The measurements were performed according to the protocol of the International Society for the Advancement of Kinanthropometry (ISAK). The results of the anthropometric measurements showed that the street children are shorter, lighter and have a lower BMI and smaller skin folds than the norm for children of the same age. The sample exhibited a prevalence of malnutrition. The same subjects who were tested to determine the anthropometric composition (except for four children, who had since left the shelter) were used to determine the motor development status. The gross motor, fine motor and neuromotor functions were tested to determine the motor development status. This was determined by means of the Bruininks-Oseretsky Test II of Motor Proficiency (BOTMP), the Sensory Input Screening Instrument and a section of the Quick Neurological Screening Test II. The results showed that the motor (gross motor, fine motor and neuromotor) development of the street children is below the standard norms. The second aim of the study was to determine the effect of an intervention programme on the motor development of street children. The same subjects who were tested to determine the motor development status (except for four children, who had since left the shelter) were used to determine the effect of a motor intervention programme. Seventeen boys and 7 girls between the ages of 7 and 14 years were randomly selected and divided into an experimental (n=13) and a control group (n= 11). A 10-week motor intervention programme that consisted of bi-weekly sessions of 45 minutes was implemented. The affectivity of this was evaluated by a post-test. The programme consisted of perceptual motor, sensory integration and task specific activities using the integrated method. The main components, which were addressed in the lessons, were bilateral integration, response speed, hand skills, muscle tone, motor planning, equilibrium, vestibular function and vision strengthening activities. The program was presented by a qualified kinderkineticist. The Bruininks-Oseretsky Test of Motor Proficiency (BOTMP), the Sensory Input Screening Instrument and a section of the Quick Neurological Screening Test I1 were applied to determine the effect of the intervention programme. Covariance of analysis, correcting for pre-testing differences between the groups, indicated improvement of the Bruininks-Oseretsky-Test Total as well as in fine motor skills and upper limb speed in the experimental group. Vestibular and vision functions also increased significantly in this group, which might have contributed to the improvement in fine motor development. All these improvements showed a high practical significance (ES>0.8). Based on the results of this study, it is recommended that the physical growth and motor development deficits as well as the positive effects of the intervention program, as identified in this study be brought under the attention of relevant persons in state organizations and private institutions, which are involved with street children. / Thesis (M.A. (Human Movement Science))--North-West University, Potchefstroom Campus, 2005.

Atherosclerotic cardiovascular diseases (CVD), particularly coronary heart disease (CHD) and cerebrovascular disease, are today major causes of death in the industrialised parts of the world. There are evidence to suggest that the atherosclerotic process starts in childhood, implying that preventive measures should be implemented already in children and adolescents. The aim of this study was to examine CVD risk indicators and their determinants in healthy Swedish adolescents. The study population comprised 14- and 17-year-old boys and girls (n=1032), in the dty and surroundings of Umeå in northern Sweden. Biochemical, anthropometric, and physiological parameters associated to CVD (s- lipoproteins and s-apolipoproteins, s-insulin, s-ferritin, anthropometric measurements, blood pressure, and physical fitness) were evaluated in relation to family history of CVD, weight and length at birth, infant feeding regimen, physical growth during infancy and childhood, current diet, physical activity, smoking, and educational level and occupation of the parents. The main findings of the study were that, on average, total serum cholesterol (TC) values in boys and girls were at the same level as reported from other European countries. A family history of CVD, short duration of breast feeding, low attained height during infancy and childhood, high body mass index (BMI), and low physical fitness were all associated with an unfavourable serum lipid profile. The findings also showed that features typical of the insulin resistance syndrome are present already in adolescents. In boys, iron stores, estimated by serum ferritin, were related to BMI and physical fitness, in a similar way as well established CVD risk indicators. Compared to previous dietary studies in Sweden, mean relative (energy %) fat intake had decreased substantially although the mean relative intake of saturated fat was still rather high. For both boys and girls, reported relative energy intake (energy intake/estimated energy expenditure) decreased with increasing level of BMI. Furthermore, daily smoking was more common among adolescents from families with low socio-economic status (SES) but was most strongly associated to smoking in peers. Tobacco use was considerably higher among adolescents attending vocational programs at secondary high school as compared to theoretical programs. Daily smokers had a more unfavourable serum lipid profile compared to non-smokers. Low socio-economic status of the parents was related to higher BMI and low educational level to higher dietary fat intake in both boys and girls. In conclusion, the findings of the study show that parameters linked to adult CVD when examined in adolescents, are related to family history, infant nutrition, previous physical growth, current body composition, physical fitness, physical activity, smoking, and social status and educational level of the parents. / digitalisering@umu

This study had the dual purpose of determining the anthropometric and motor development status of street children as well as to establish the effect of an intervention programme on their motor development. The first aim of the study was to determine the anthropometric and motor development status of street children. The children were selected from a sample of street children living in a state-run shelter. Twenty eight children (20 boys and 8 girls) between the ages of 7 and 14 were measured to determine their anthropometric and motor development status. The anthropometric measures included stature, mass, body-mass index (BMI), and two skin folds (subscapular and triceps). The measurements were performed according to the protocol of the International Society for the Advancement of Kinanthropometry (ISAK). The results of the anthropometric measurements showed that the street children are shorter, lighter and have a lower BMI and smaller skin folds than the norm for children of the same age. The sample exhibited a prevalence of malnutrition. The same subjects who were tested to determine the anthropometric composition (except for four children, who had since left the shelter) were used to determine the motor development status. The gross motor, fine motor and neuromotor functions were tested to determine the motor development status. This was determined by means of the Bruininks-Oseretsky Test II of Motor Proficiency (BOTMP), the Sensory Input Screening Instrument and a section of the Quick Neurological Screening Test II. The results showed that the motor (gross motor, fine motor and neuromotor) development of the street children is below the standard norms. The second aim of the study was to determine the effect of an intervention programme on the motor development of street children. The same subjects who were tested to determine the motor development status (except for four children, who had since left the shelter) were used to determine the effect of a motor intervention programme. Seventeen boys and 7 girls between the ages of 7 and 14 years were randomly selected and divided into an experimental (n=13) and a control group (n= 11). A 10-week motor intervention programme that consisted of bi-weekly sessions of 45 minutes was implemented. The affectivity of this was evaluated by a post-test. The programme consisted of perceptual motor, sensory integration and task specific activities using the integrated method. The main components, which were addressed in the lessons, were bilateral integration, response speed, hand skills, muscle tone, motor planning, equilibrium, vestibular function and vision strengthening activities. The program was presented by a qualified kinderkineticist. The Bruininks-Oseretsky Test of Motor Proficiency (BOTMP), the Sensory Input Screening Instrument and a section of the Quick Neurological Screening Test I1 were applied to determine the effect of the intervention programme. Covariance of analysis, correcting for pre-testing differences between the groups, indicated improvement of the Bruininks-Oseretsky-Test Total as well as in fine motor skills and upper limb speed in the experimental group. Vestibular and vision functions also increased significantly in this group, which might have contributed to the improvement in fine motor development. All these improvements showed a high practical significance (ES>0.8). Based on the results of this study, it is recommended that the physical growth and motor development deficits as well as the positive effects of the intervention program, as identified in this study be brought under the attention of relevant persons in state organizations and private institutions, which are involved with street children. / Thesis (M.A. (Human Movement Science))--North-West University, Potchefstroom Campus, 2005.

Thesis (M.Ed. (Education Management)--North-West University, Potchefstroom Campus, 2008.

Background: The global burden of cardiovascular diseases (CVDs) is escalating as part of the rapid health transition that developing countries are experiencing. This increase is associated with shifts in demographics and economics, two of the major factors that affect diet and activity. The term social drift phenomenon (SDP) is used to describe the observations that: in the early stages of the epidemiological and nutrition transitions, it is usually the more affluent, higher socio–economic groups that are affected; in the later stages, it is the poor, lower socio–economic groups that display the consequences of these transitions. Therefore, in developing countries at the beginning of the transition, affluent people have higher prevalence of obesity and increased CVD risk. In developed countries, at much later stages of the transition, obesity and increased CVD risk is more prevalent in the lower socio–economic groups. In South Africa, the Transition and Health during Urbanisation of South Africans (THUSA) study which was done in 1996/1998 indicated that at that time, most of the risk factors for CVD were observed in the more urbanised (richer) subjects. It is not known if this pattern changed in any way due to the present rapid urbanisation of South African blacks. Therefore, in this study we explored the associations between socio–economic status (SES) (measured by level of urbanisation, education and employment) and CVD risk factors in an African population undergoing transition in the North–West Province of South Africa, that were prevalent in 2005 when the baseline data for in the Prospective Urban and Rural Epidemiology (PURE) study were collected. Objectives: The main objective of this dissertation was to examine the SDP in an African population in a nutrition and health transition, by: (i) Reviewing the literature on associations between socio–economic variables and biological health outcomes focusing on CVD risk factors in developed and developing countries; (ii) Analysing the baseline data from the 2005 PURE study to examine the relationships between components of SES, namely level of iii urbanisation, education and occupation, and nutrition–related CVD risk factors in men and women participating in the PURE study; and (iii) Comparing results on these associations between CVD risk factors and SES from the PURE study with those found in the THUSA study, which was conducted almost 10 years earlier, to examine if social drift in these associations has taken place. Study design: The dissertation is based on a comparison of the CVD risk factors and socio–economic status of the THUSA and PURE studies. Secondary analysis of the baseline cross–sectional epidemiological data from the PURE study was executed. The South African PURE study is part of a 12–year Prospective Urban and Rural Epidemiology study which investigates the health transition in urban and rural subjects in 22 different countries. The main selection criterion was that there should be migration stability within the chosen rural and urban communities. The rural community (A) was identified 450 km west of Potchefstroom on the highway to Botswana. A deep rural community (B), 35 km east from A and only accessible by gravel road, was also included. Both communities are still under tribal law. The urban communities (C and D) were chosen near the University in Potchefstroom. Community C was selected from Ikageng, the established part of the township next to Potchefstroom, and D from the informal settlements surrounding community C. The baseline data for PURE were collected from October to December 2005. A total of 2010 apparently healthy African volunteers (35 years and older), with no reported chronic diseases of lifestyle, tuberculosis (TB) or known human immunodeficiency virus (HIV) were recruited from a sample of 6000 randomly selected households. Methods: A variety of quantitative and qualitative research techniques was used by multidisciplinary teams to collect, measure and interpret data generated from biological samples and validated questionnaires. For this study, the statistical package for social sciences (SPSS) package (version 17.0, SPSS Inc) was used to analyze the data. Means and 95% confidence intervals (CI) of CVD risk and dietary factors were calculated. Participants of both genders were divided into different groups (according to urbanisation, education and employment levels) and compared. Estimated significant differences between rural and urban participants were determined with analysis of variance using the general linear model (GLM), multivariate procedure. Univariate analysis was used to explore further the influence of education on CVD risk factors and dietary intakes. Employment was used as a proxy for income, and pairwise comparisons using GLM, multivariate procedure were done for comparing the three groups (Not answered, employed and not employed). Tests were considered significant at P<0.05. Results: Comparison of urban with rural subjects participating in the PURE study showed that urban men had significantly higher systolic and diastolic blood pressures and lower fibrinogen levels than rural men. In women, systolic and diastolic blood pressure, fasting blood glucose and serum triglycerides were significantly higher in urban subjects whereas fibrinogen levels were significantly lower among urban subjects. After examining the relationship between the level of education and CVD risk factors, we observed that men with higher education levels had significantly higher BMI. In women, serum triglycerides and blood pressure were lower and BMI was significantly higher in the educated subjects. Because it was difficult to distinguish between reported household and individual income levels, we compared CVD risk factors of employed and unemployed subjects. Employed men had significantly higher BMI whereas the unemployed men had significantly higher fasting glucose and fibrinogen levels. Although mean blood pressure of employed men was higher than that of unemployed men, the difference did not reach significance. In women, the only significant difference seen was that employed women had lower high density lipoprotein (HDL) cholesterol, fasting glucose, triglycerides and fibrinogen levels, but they had a significantly higher BMI. Employed women had significantly higher BMI than unemployed women (27.9 [26.3–29.4] versus 26.5 [26.0–27.0] kg/m2). It seems that most of the nutrition related CVD risk factors were still higher in the higher socio–economic group, a situation similar to that reported in the THUSA study. v Conclusion: The results of this study showed little evidence of a major social drift in CVD risk factors from subjects participating in the 1996/1998 THUSA study to those in the 2005 PURE study. Most cardiovascular disease risk factors are still higher in the higher SES groups. However, there were some indications (increased fibrinogen in both men and women living in rural areas; higher triglyceride and fasting glucose levels in unemployed women; no significant differences in blood pressure and total cholesterol across different SES groups which existed in the THUSA study) that a social drift in CVD risk factors in our African population is on the way. This means that promotion of healthy, prudent diets and lifestyles should be targeted to Africans from all socio–economic levels for the prevention of CVD. / Thesis (M.Sc (Dietetics))--North-West University, Potchefstroom Campus, 2011.