Illness and exposure to negative life experiences in adolescence: two sides of the same coin? A study of 15-year-olds in Oslo, Norway.

AIM: To investigate associations between negative life experiences and common illnesses among adolescents. METHODS: Cross-sectional questionnaire study carried out at all lower secondary schools (10 grade) in Oslo. Norway, during 2000 and 2001 (n = 8316 pupils). Different negative life experiences and illnesses were addressed. RESULTS: The participation rate was 88%. Among reported negative life experiences last year were a pressure felt to succeed (62%), death of a close person (26%), exposure to physical violence (22%), bullying at school (15%) and sexual violation (4%). A large number of the pupils had some chronic illness: hay fever (38%), eczema (29%) and asthma (13%). Reported illnesses the previous 12 month were: headache (56%), painful neck or shoulders (35%), sore throat at least three times (15%), lower respiratory tract infection (9%) and mental problems for which help was sought (7%). During the week prior to the survey, 26% of all girls had symptoms of a depressive disorder, while this applied to 10% of all boys. Fifty-three percent of the boys (29% of the girls) who had depressive symptoms had been exposed to physical violence. Sexually violated boys had a high probability for seeking help for mental problems (OR = 4.9) and for frequent episodes of sore throat (OR = 2.5). Corresponding odds ratios for girls were 1.7 and 2.5, respectively. CONCLUSION: Common illnesses in adolescence are significantly associated with negative life experiences. In clinical encounters with adolescents not only should the presenting complaints be addressed, but also other common illnesses and relevant background factors such as negative life events.

Family history of essential hypertension versus obesity as risk factors for hypertension in adolescents.

Family history of hypertension and obesity are both risk factors for hypertension. Hypertension and obesity share several physiopathologic abnormalities and are frequently associated. However, not all obese people are hypertensive. Renal handling of sodium has been proposed as a physiopathogenic mechanism of essential hypertension and obesity. This study was conducted in obese adolescents to evaluate the role of a family history of hypertension versus obesity in the renal handling of sodium. Fractional excretion of lithium (FELi) and uric acid (FEUA) were measured in 46 obese adolescent offspring of hypertensive parents (OH: body mass index [BMI], 29.5 +/- 0.6 kg/m2, age 14.2 +/- 0.3 years, 22 males); eight obese offspring of normotensive parents (ON: BMI, 30.7 +/- 1.7 kg/m2, 14.8 +/- 0.8 years, four males), and in 34 lean adolescent offspring of hypertensive parents (LH: BMI, 20.5 +/- 0.5 kg/m2, 14.3 +/- 0.3 years, 24 males). FELi in OH was 16.5% +/- 1.3%, in ON it was 22.4% +/- 2.3%, and in LH it was 14.4% +/- 1.2% (P < .05). FEUA in OH was 8.5% +/- 0.8%, in ON it was 14.8% +/- 3.6%, and in LH it was 7.9% +/- 0.8% (P < .01). Plasma renin activity (PRA) and aldosterone (PA) were measured in OH and LH; PRA was 5.3 +/- 0.4 and 4.5 +/- 0.4 ng/mL/h, respectively (P = NS), and PA was 366 +/- 36 and 242 +/- 32 pg/mL, respectively (P < .05). In summary, adolescents with a family history of hypertension, regardless of their body mass, have a diminished FELi and FEUA. Obese adolescents also have higher plasma levels of aldosterone than lean ones. In conclusion, the family history of hypertension would be related to the increased renal proximal sodium reabsorption whereas obesity would be related to increased distal sodium reabsorption mechanisms, such as aldosterone. Both mechanisms could explain the higher prevalence of hypertension in obese offspring of hypertensive parents.

[Forensic psychiatric examinations of the mentally retarded]. / Rettspsykiatriske undersøkelser av psykisk utviklingshemmede.

3,343 forensic psychiatric examinations were recorded in Norway from 1980 to 1996. 294 patients were diagnosed as mentally retarded. The annual number of mentally retarded persons increased during the observation period, but the relative percentage remained stable. The majority of the retarded persons being discussed had been charged with sexual felony, and some with arson. About half had previous convictions. Few had problems with alcohol or other intoxicants. Every fourth retarded person examined was considered not only to be mentally retarded, but also to suffer from other psychiatric disorders. We discuss to what extent deinstitutionalization of retarded persons and the accompanying social isolation they experience could contribute to the increase in maladaption and criminal behaviour. It is stressed that many of the sexual felonies may be explained by the fact that the mentally retarded are mentally immature.

[Convicted sexual offenders. The risk of recidivism?]. / Straffedømte sedelighetsovergripere. Hvor stor er tilbakefallsrisikoen?

332 persons, who in 1987 received sanctions for sexual offences, were observed in freedom for five years, or until recidivism at an earlier stage. 82 (24.7%) committed new crimes during the observation period. Sexual offences comprised about 1/3 (8.4%) of the crimes committed. Rapists had the highest degree of recidivism. There was no significant difference between the various subgroups of sexual offenders (sexual offences against minors, rapists and other offenders) with regard to the frequency of recidivism into sexual offences. Registered sanctions for sexual offences before 1987, and sexual abuse and obscene conduct toward minors registered i 1987, were found to be significantly correlated to sexual recidivism after 1987. Problems regarding the evaluation of the effects of treatment to forestall recidivism into sexual crimes are discussed.

[Is the governmental vocational rehabilitation program too ambitious?]. / Er regjeringens arbeidslinje for ambisiøs?

The Norwegian government has stressed the importance of supporting vocational training for clients with health problems in order to secure their active participation in the labour force. On average, 35,000-40,000 people were referred from the National Insurance Scheme to the Directorate of Labour to take part in vocational rehabilitation projects in 1995. The majority of the vocationally handicapped are young. Three out of four have a poor educational background, and close to 70% have health problems, mainly in the form of chronic musculoskeletal pain or psychiatric illness, usually depression and anxiety-states. So far, the success of the rehabilitation seems to be rather limited, since approximately 40% of the clients were referred back to the Insurance Scheme. They were considered unfit for training because of impaired health. Another 40% of the cases were considered fully or partly successful. Clients with psychiatric illness seem to be particularly difficult to rehabilitate to vocational activity.

[Are life experiences of children significant for the development of somatic disease? A literature review]. / Er barns livserfaringer av betydning for somatisk sykdomsutvikling? En litteraturoversikt.

This review presents the relationship between serious life events, chronic family difficulties and illness, and focuses on how healthy children cope. Hospitalised children had experienced about twice as many serious life events as children in healthy environments. Known diseases related to stress are eczema, upper respiratory tract infections, asthma, ulcerative colitis, heart disease in adults, juvenile rheumatoid arthritis, fibromyalgia and juvenile diabetes. Research on healthy children at risk (resiliences) has revealed a number of social and interpersonal protective factors. A modified biopsychosocial model, for the purpose of understanding the health status and care of children at high risk, is presented. More research is needed to understand these multietiological diseases in order to develop strategies for the promotion of good health.

[Forensic psychiatry in Norway. A review of the period 1980-93]. / Rettspsykiatrisk virksomhet i Norge. Oversikt for perioden 1980-93.

2,533 persons charged for serious criminal offences during the years 1980-93 were submitted for forensic psychiatric examination. The purpose of the examinations was to decide whether the person, because of his or her mental state at the time of the offence, was liable or not to prosecution. The three most common criminal offences were murder, arson resulting in potential murder and serious cases of sexual offence like paedophilia. There was a sharp increase in the number of forensically examined persons from 1980 to 1993. This reflects the increasing crime rates in Norway, particularly as regards sexual delinquency and violence. A majority of the clients had severe chronic drinking and/or drug problems. 27% of the females and 19% of the males were psychotic, mainly schizophrenic, at the time of the offence. 50-60% had serious personality disorders, mainly of antisocial and immature nature. All forensic reports are monitored by the Forensic Psychiatric Commission in order to secure the quality of forensic assessments. 85% of the reports were accepted. In a few cases the psychiatrists were asked to reconsider either parts of or the entire conclusion.

[Sick women and men with disability pensions. Some reflections]. / Syke kvinner og uførepensjonerte menn. Noen refleksjoner.

According to population studies, chronic disease leading to a disability pension is common in the Norwegian population, and has increased during the last 15 years. This trend is partly a consequence of the vast increase in the female work force during the last 20 years. Simultaneously, there has been a strong increase in health facilities and improvement in medical technology. Thus the increase in both morbidity and utilisation of the pension scheme seems paradoxical. Disability pensions function to secure people's purchasing power. The social benefit system in modern welfare states conforms with Keynesian economic principles, implying a redistribution of money from the well off on regular pay roll to members of the work force who are less adaptable due to disease and infirmity. However, there seems to be a substantial potential for further growth in the number of disabled persons receiving a pension, particularly among women. In many cases a pension serves as an alternative to unemployment benefit. From a welfare-state viewpoint such a development is politically and socially more acceptable.

Calcium-ATPase and insulin in adolescent offspring of essential hypertensive parents.

A number of abnormalities in calcium homeostasis have been reported in patients with essential hypertension. IN turn, insulin has been shown to influence the activity of the Ca(2+)-ATPase. We have previously shown that normotensive offspring of essential hypertensive individuals have an exaggerated insulin response to a glucose overload. Therefore, the aim of the present study was to evaluate basal and calmodulin-activated Ca(2+)-ATPase in red blood cells and its relationship to the insulin response during an intravenous glucose tolerance test in 27 normotensive adolescents with a family history of essential hypertension (F+) (mean age, 13.9 +/- 0.5 years) and in 10 control subjects matched for age and body mass index with no family history of hypertension (F-). The results (mean +/- SD) were as follows (mumol Pi/[mg protein/h]10(-1)): basal Ca(2+)-ATPase, 4.5 +/- 1.2 in F+ and 5.1 +/- 1.6 in F- (P = NS); calmodulin-activated Ca(2+)-ATPase, 13.6 +/- 3.9 in F+ and 16.2 +/- 1.7 in F- (P < .04). The insulin area under the curve after the glucose load was 3413 +/- 1674 microU/mL per hour in F+ and 2752 +/- 928 in F- (P = NS). Calmodulin-activated Ca(2+)-ATPase showed a negative correlation with the insulin area under the curve (r = -.59, P < .005) and cholesterol levels (r = -.38, P < .03). Urinary calcium excretion was 1.82 +/- 0.9 mmol/d in F+ and 2.47 +/- 0.9 mmol/d in F- (P = NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Insulin effect on renal sodium reabsorption in adolescent offspring of essential hypertensive parents.

We previously showed that children and adolescent offspring of patients with essential hypertension have an increased proximal renal sodium reabsorption as measured by lithium fractional excretion. Insulin has been shown to have antinatriuretic properties and to be increased (hyperinsulinemia) in essential hypertension. The aim of this study was to evaluate the role of insulin on the increased proximal renal sodium reabsorption previously reported. Lithium and sodium fractional excretions were measured 3 hours before and 3 hours after an intravenous glucose tolerance test in 20 normotensive adolescents with a family history of essential hypertension (F+, 14.8 +/- 0.5 years) and 10 normotensive control subjects without a family history of hypertension (F-, 15.2 +/- 0.9 years). Results are mean +/- SEM. Lithium fractional excretion before glucose loading was 16.1 +/- 1.8% in F+ versus 23.5 +/- 2.0% in F- (P < .02) and after glucose loading was 14.7 +/- 1.3% in F+ versus 20.9 +/- 1.7% in F- (P = NS). Lithium fractional excretion did not change after intravenous glucose loading in either group. The insulin area under the curve was 2815 +/- 499 in F+ versus 2290 +/- 418 microU/mL per hour in F- (P = NS). There was no correlation between lithium fractional excretion and insulin area under the curve. Fractional excretion of sodium before glucose loading was 0.99 +/- 0.1% in F+ versus 0.99 +/- 0.1% in F- (P = NS) and after glucose loading was 0.77 +/- 0.1 in F+ versus 0.85 + 0.1% in F- (P < .01 versus values before loading in both groups).(ABSTRACT TRUNCATED AT 250 WORDS)

[Rehabilitation status at a regional social insurance office. Experiences with 103 clients at the Grünerløkka-Sofienberg office]. / Attføringsstatus ved et trygdekontor. Erfaringer fra 103 klientsaker ved Grünerløkka-Sofienberg trygdekontor.

103 patients, mostly females, on rehabilitation measures mainly because of psychiatric conditions and chronic musculo-skeletal pain syndromes, were investigated with regard to outcome. In general, the patients had a low level of education, only 10% had vocational training, and most were unskilled labourers. Prior to the rehabilitation period they had been certified sick on several occasions. On average, the patients were followed up for three years. 84% were still on medical rehabilitation, i.e. they were under more or less systematic medical treatment, and were receiving benefits. 8% had been granted a disability pension, and only 4% had managed to become independent of the social insurance system. Until the recent years the rehabilitation system has functioned inefficiently as regards bringing people back to work. The patients remain inactive for long periods, owing to lack of planning and systematic implementation of rehabilitation measures, medical as well as vocational. In addition the vocational quality requirements of the labour market make it hard for people even with mainly minor health problems to obtain employment.

Hyperinsulinemia in normotensive offspring of hypertensive parents.

Hyperinsulinemia and insulin resistance have been extensively reported in adult patients with essential hypertension. The aim of this study was to examine serum glucose and insulin levels both in the fasting state and after 0.25 g/kg IV glucose and to relate those findings to the status of intracellular Na+ and red blood cell Na(+)-Li+ countertransport in a population of 21 normolipemic normotensive offspring of hypertensive parents (N-EH) and 13 control children without a history of parental essential hypertension or diabetes mellitus matched for age, body mass index, and pubertal stage. Offspring of hypertensive parents presented significantly higher serum insulin levels both after an overnight fast (17.4 +/- 1.6 versus 11.6 +/- 1.6 microU/mL in control [mean +/- SEM], P < .01) and after intravenous glucose than control subjects (insulin area under the curve, 3015 +/- 310 and 2057 +/- 234 microU/mL per hour, respectively, P < .01). No relation could be established between the high red blood cell Na(+)-Li+ countertransport (343 +/- 22 versus 215 +/- 15 mumol/L per hour, N-EH versus control; P < .002) or high intracellular Na+ (9.8 +/- 0.28 versus 8.7 +/- 0.36 mEq/L, N-EH versus control) and hyperinsulinemia found in children of hypertensive parents. We conclude that the time precedence of hyperinsulinemia (and possibly insulin resistance) over the appearance of clinical hypertension in a high-risk population further supports the contention that an abnormal insulin action may play a pathogenetic role in essential hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)

[Mental retardation and sexual abuse. 65 mentally retarded men submitted to forensic psychiatric examination because of sex offences]. / Psykisk utviklingshemning og seksuelle overgrep. 65 rettspsykiatrisk undersøkte psykisk utviklingshemmede menn siktet for seksualforbrytelser.

65 mentally impaired men charged with different sexual crimes were submitted to judicial psychiatric examination. 37% of these men had previously stayed in institutions for the mentally impaired, two thirds had worked for a period. Half of the charged men were functionally retarded and the rest were assessed as functioning at an even lower level. Approximately every third man suffered from serious behavioural symptoms and personality disturbances. Most of the abuse was towards acquaintances or persons in the local environment. Almost half of the men used violence in connection with the abuse. Two thirds of the victims were under the age of 16 years. About half of the men were charged with sexual abuse of minors, and a few with rape. The majority were charged, and almost half were placed under preventive detention.

Pre- and post-treatment sexual life in testicular cancer patients: a descriptive investigation.

Aspects of sexuality were assessed by questionnaires in 76 testicular cancer patients after orchiectomy before further treatment and, respectively, 6, 12 and 36 months after therapy. Before treatment 11% of the patients reported dissatisfaction with sexual life. About 20% of the patients sometimes experienced reduced libido and erectile difficulties. Six months after therapy significantly more patients (27%) recorded an unsatisfactory sexual life as compared to the pretreatment situation. At the 36 months' evaluation 22 of 76 evaluable patients (18%) still stated that their sexual life was inferior to the pretreatment experience. Libido and erectile function decreased transiently during the first year after treatment in most patients. Twelve patients reported permanent 'dry ejaculation' after bilateral retroperitoneal lymph node dissection. Other sexual disturbances could not be related to specified treatment modalities. Increased age at the time of diagnosis and psychological distress tended to correlate with the incidence of sexual problems. For about 60% of the patients the discussion of expected and experienced sexual life problems was an important issue to be discussed before their treatment for testicular cancer and during follow-up. The high frequency of any kind of long-lasting sexual problems (30%), though often of minor degree, warrants an adequate counselling of these patients before and after treatment.

[Sexual child abuse. 221 persons charged with sexual abuse of children examined by forensic psychiatrists]. / Seksuelle overgrep mot barn. 221 rettspsykiatrisk undersøkte personer siktet for utuktig omgang med barn.

The number of police reports of sexual abuse of children below the age of 14 increased fourfold from 1980 to 1991. Half of the charges were dismissed by the police. 20% of the charged, predominantly males, were examined by forensic psychiatrists. Mean age of the examined was 32 years, and close to 50% were unmarried. 40% had alcohol and/or drug addiction problems. One third had been sentenced by a court before, and 20% had experienced previous court reactions for sexual abuse or deviant behaviour. 7% were diagnosed as psychotic and 80% were considered to have personality disorders. In 10% of the cases no psychiatric diagnosis was made. Dynamic factors behind the abuse are discussed. Most of the abusers are psychosexually immature as part of a more comprehensive personality disturbance.

[Sexual relations in therapeutic situations]. / Seksuelle forhold i behandlingssituasjonen.

Patients who feel sexually violated by their therapists may complain to the health authorities. During recent years there has been an increasing number of such complaints. 15 cases were under investigation at the Directorate of Health in July 1992. Most of the doctors and psychologists involved had long therapeutic experience. The sexual contacts were of highly divergent types. In the majority of cases the therapists lacked the capacity to draw clear borderlines between professional and private life. Some of the therapists had a tendency to belittle the contacts. Sexual contact between patient and therapist has a detrimental effect upon the relationship and the mental functioning of the patients. Therapists acquainted with colleagues' sexual violations should react swiftly. Too lenient and permissive ethical and social attitudes towards sexual relationships between therapist and patient may be conducive to further abuse. It is important to incorporate the study and discussion of these problems into both the basic and postgraduate education of therapists. Therapists who have violated the norms for decent behaviour need professional support.