Evaluation of a universal early intervention for parents and children from birth to age five

Abstract Background This study aimed to investigate the health and economic outcomes of a universal early intervention for parents and children, the Salut Programme, from birth to when the child completed five years of age. Methods This study adopted a retrospective observational design using routinely collected register data with respect to both exposures and outcomes from a county in northern Sweden. Areas that received care-as-usual (non-Salut area) were compared to areas where the Programme was implemented after 2006 (Salut area) in terms of: i) health outcomes, healthcare resource use and related costs around pregnancy, delivery and birth, and ii) healthcare resource use and related costs, as well as costs related to care of sick child. Costs were estimated for inpatient care and specialised outpatient care for mothers and children. Two analyses were conducted: a matched difference-in difference analysis using the total sample and an analysis including a longitudinal subsample. Results The longitudinal analysis on mothers who had given birth in both the pre- and post-measure periods showed that those that had been exposed to the Salut Programme, had on average 6% (95% CI 3-9%) more full-term pregnancies and 2% (95% CI 0.03-3%) more babies born within normal weight range, compared to mothers who had only care-as-usual. Savings were incurred in terms of outpatient care related costs for children of mothers in the Salut area ($826). The difference-in-difference analysis using the total sample did not result in any significant differences in health outcomes or cumulative resource use over time. Conclusions The Salut Programme achieved health gains at a reasonable cost for children and parents, and may lead to lower usage of outpatient care. Other indicators point towards positive effects but the small sample size may have led to underestimation of true differences. The current findings support the continuous investment in this early childhood programme. Key messages • The Salut Programme improves the health of children and parents at a low cost. • The Salut Programme as a health promotion early intervention is value for money and should be included in the local policy investment agenda.


Background and aims:
The PM air pollution is a serious concern in northern Moravia in the Czech Republic.The aim is to evaluate the risk of acute hospital admissions for cardiovascular and respiratory causes with the use of the Geographic information system (GIS).

Methods:
The data on acute hospital admissions for cardiovascular (I00-99 according to ICD-10) and respiratory (J00-99) causes was assigned based on the information on residence to 77 geographical units (601,299 inhabitants).The annual concentrations of PM2.5 in the period 2013-2019 were assigned to this units according to the respective concentration iso-shapes (step 2 mg.m-3, concentrations 29 to 38 mg.m-3).The Incidence Rate Ratio (IRR) and 95% confidence interval (CI) was calculated for each concentration category.The incidence in the first category with the lowest PM2.5 concentrations (29 mg.m-3) was chosen the reference category.The statistical analyses were performed using the SW STATA v.15.Results: About a half of population (56%) in the year 2013 belonged into the PM2.5 category 34-35 mg.m-3, 26 thousand of inhabitants (4%) live in the PM2.5 concentrations 38 mg.m-3.During the analysed period the average concentration values decreased from 30.8 to 21.4 mg.m-3.A statistically significant risk of the acute hospitalization for cardiovascular causes was identified in the categories 36 mg.m-3, in the highest interval of PM2.5 the IRR values were 2-3-fold higher comparing with the reference category.As for respiratory causes, the trend is similar, but the statistically significant risk was found already from the interval 34-35 mg.m-3.

Conclusions:
With increasing concentrations, the risk of both acute cardiovascular, and respiratory hospitalizations increased.
This presentation was supported by the project TH03030195 of the Technology Agency of the Czech Republic and the project Healthy Aging in the Industrial Environment CZ.02.1.01/0.0/0.0/16_019/0000798 (HAIE).

Key messages:
A statistically significant increase of the IRR for acute cardiovascular and respiratory hospitalizations was found at PM2.5 concentrations 34 mg.m-3 compared to the reference category 29 mg.m-3.Average annual PM2.5 concentration decreased from 30.8 to 21.4 mg.m-3 during the followed period and also the risk of acute hospitalization from cardiovascular and respiratory causes decreased.

Abstract citation ID: ckac131.246
The computer-assisted interview In My Shoes -a successful method to capture children's perspectives Karin Fa ¨ngstro ¨m CHAP, Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden Contact: karin.fangstrom@pubcare.uu.se

Background:
Child mental health problems are considered the second highest cause of burden of disease in Europe and the Americas.
Children's own opinions and experiences are pivotal in addressing these problems.However, including young children as active informants in health research and practice not only requires a well-trained and highly qualified workforce, but also valid methods that enhance and support children's selfexpression.The aim was to investigate preschool aged children's experiences in two health and welfare contexts using the interactive computer-assisted interview In My Shoes (IMS).

Methods:
Interviews were conducted using IMS in three studies encompassing 43 children aged 3-6 years old.The setting for the first and second study was Child Health Centres and the third setting was families entering the Triple P group parenting programme.Qualitative content analysis was performed.

Results:
The IMS interview aided preschool aged children to report on the factual, emotional and physical aspects of their experiences within a health care context.In addition, IMS helped young children verbalise unique information on negative interplay within their families, especially experiences of negative parenting including verbal and physical child abuse.The successes with IMS are likely related to the structured and systematic approach, that it is pictorial-based and emotion-focused, as well as the interactive, collaborative and triadic conversation between the child, the interviewer and the computer.

Conclusions:
The interactive computer-assisted interview IMS, is a suitable and valid method for aiding young children to provide unique and extensive information about different aspects of their experiences and lives.We urge professionals and researchers to systematically include the young children's own perspectives to better tailor and evaluate interventions on all levels to improve Background: Each year, numerous initiatives are carried out to improve the outcomes for youth living in vulnerable areas.However, the impact of these initiatives is rarely measured, partly because there is no reliable, valid, relevant and easy-to-use tool available to measure the impact of social investments from the youth perspective.Mina Svar is an app co-created with youth that aims to address this gap.

Methods and results:
Save the Children led the collaboration in defining a measurement framework.Experts from Save the Children, researchers from Linko ¨ping University, and representatives from Accenture, Skandia and Apoteket as well as youth themselves were involved in an iterative process.Five interconnected areas were identified as central: democracy and influence, education, work, housing and neighbourhood, and health.The first version of Mina Svar included 34 items.
Researchers from Uppsala University were involved to help with testing the psychometric properties of Mina Svar in a sample of 237 youths.We examined the tool's internal consistency, content validity and structure validity.Analyses showed that all the subscales except democracy and influence had good internal consistency (0.70 and higher).However, inspection of individual items revealed that several items lacked clarity and many items did not comprehensively reflect the related constructs as intended.Confirmatory factor analysis suggested a poor fit for the proposed model (CFI = 0.52 TLI = 0.56, and RMSEA = 0.103).Currently, we are going through a second iterative process to increase the reliability and validity of Mina Svar.The work involves refining the framework, rewriting ambiguous items, generating new items, and re-examining the psychometric properties of the revised version.

Conclusions:
Mina Svar is a promising short multidimensional survey tool which offers a potential solution to tackle the problem with measuring the impact of social investments from the youth perspective.

Introduction:
Air pollution has been recognized as one of the major risk factors for the global burden of disease.In modern society, most exposure occurs indoors, and air quality may be improved with air purifiers utilizing various cleaning techniques.This analysis aims to evaluate whether recommended room surface in which to use these devices as declared by producers is actually in line with their real effective area of activity.

Methods:
A review of devices for the purification of the air was carried out between January-April 2022.Four different types of air purifiers were considered based on the adopted technologies: I) HEPA filters and UV lamps; II) only with HEPA filters; III) only UV lamps and IV) those using other technologies.For each group, based on the CADR (Clean Air Delivery Rate) provided by the producers, the optimal real surface area of the room to use the device was calculated, referring to the standard EN779:2012.This value was compared with the recommended area of the room declared by the producers.Descriptive