Quantitative results obtained during the first 3 years of operation of a routine health screening program for 4-year-olds are presented. From these figures it is conccluded that the effectiveness in detecting previously unknown health problems needing treatment is high enough to justify the continuation of this systematic health screening by the ordinary child health staff. However, the total prevalence of newly detected anomalies was lower in our population than in similar studies where the screening was performed by a few teams of specially trained professionals. The consequences of this observation are briefly discussed.
Since January 1969, a systematic health screening has been offered to 4-year-olds resident in the county of Uppsala, Sweden, at the ordinary Child Health Centres by the regular staff. This report describes some organizational and methodological aspects and presents participation rates and reasons for non-participation. From the overall experience it is concluded that the program is feasible with respect to systematic examinations and data collection, acceptance by the public and the staff, and with respect to the strain on existing resources. The reasons for and the importance of program changes are discussed, and the main advantages and drawbacks of the decentralized approach are mentioned. Finally, a theoretical framework for a quantitative evaluation of effectiveness is presented.
The data gathered in connection with a routine health screening program for 4-year-olds were used in order to test a number of hypotheses concerning factors which might have influenced the effectiveness of the program, as well as concerning the quality of preventive care delivered to the children before the age of 4 years. It was found that preventive care of relatively high quality delivered to children 0-3 years of age had not reduced the prevalence of previously undetected health problems at 4 years of age. Furthermore, the analysis demonstrated substantial differences between physicians in the rates of correct and unnecessary referrals. Only a small part of these differences could be attributed to professional status or specific experience with the program. They consisted essentially in varying thresholds for what was perceived as a health problem needing treatment, and were considered as a matter of personal temperament. True differences of quality did occur but were less prominent. The implications of these findings with regard to the continuation of the program are discussed.
Data presented in a previous paper pointed to the necessity for improving the overall sensitivity of the psychological screening program. The present report indicates possibilities for such an improvement without changing the screening methods. A comparison of the primary data of the true positives, the false positives and all the negatives (non-referred) revealed the necessity of more stringent referral criteria. It is predicted that the systematic application these criteria would result in an increase in the rate of true positives form 2.8 to 4.8% of the screened population. In addition a strategy aiming at a reduction of the costs without deteriorating the effectiveness and based on a differential application of the various elements of the screening program is presented.
Since 1969, 4-year-olds in the County of Uppsala have been offered extensive health screening at the Child Health Centres. In 1969 and 1970 a total of 3810 children underwent the screening procedure. The psychological screening instrument consisted of a questionnaire (to be answered by the parents), an interview of the parents, a psychomotor examination and an observation of the child's behaviour. 156 (4.1%) 4-year-olds were referred to a specialist team for investigation and decision concerning treatment. In the present study the effectiveness of the psychological screening instrument was assessed by its sensitivity, specificity and predictive value. The sensitivity was found to amount to a maximum of 0.73. The specificity was estimated to be 0.98-0.99, and the positive predictive value to 0.67. The authors consider the effectiveness to be sufficiently high to motivate continuation of the screening procedure for detection of psychological problems in pre-school age. Efforts should be made, however, to further improve the effectiveness.