Growing up in Uppsala: the "new morbidity" in the adolescent period. A longitudinal epidemiological study based on school data and some external sources.

The study comprised all 1805 children, most born in 1967, who were in grade 9 of the compulsory school in Uppsala in the spring of 1983 (cross-sectional population) and all 1723 children born in 1967 and resident in Uppsala at ages 10 and 15 years (longitudinal population). The aims were (1) to describe and analyse a normal population of 9th graders in social, medical, educational and psychological respects, (2) to assess relationships between risk level at 10 years, school-identified difficulties at 15 years and psychosocial problems up to age 18, (3) to assess relationships between intervention in school at 15 years and psychosocial problems up to 18 years. Ten-year data had been collected through teacher interviews and analysis of school health records in grade 3. Fifteen-year data were collected through interviews with school health staff and analysis of school health records in grade 9. School marks were gathered at the end of grade 9. Psychosocial problems up to 18 years were assessed on the basis of all registered contacts with official institutions outside school (authorities for care of the handicapped, Department of Child Psychiatry, social agencies, legal authorities). CROSS-SECTIONAL POPULATION. Children older than the grade norm and children of lower social class manifested a more problematic school adjustment and had lower mean marks than younger children and those of higher social classes. Twenty-five per cent of the population had entries in official registers up to age 18, indicating psychosocial problems. Social conditions were related both to the learning process and to psychological health. Educational and psychological problems were mutually correlated. Social problems increased the risk of a number of medical conditions. There were certain relationships between medical and educational problems as well as between medical and psychological problems. LONGITUDINAL POPULATION. Both 10- and 15-year data, particularly the latter, contributed independently to the prediction of psychosocial problems up to age 18. There was a considerably increased risk of psychosocial problems if there had been numerous school difficulties at age 15. Children who had been offered intervention in school at 15 years did not escape psychosocial problems up to 18 years more frequently than children without interventions. In fact, the contrary was the case: with more interventions, the frequencies of psychosocial problems up to age 18 increased.

Growing up in Uppsala. The role of public services in identification and treatment of health and adjustment problems. Part I. Definition and classification of dependent variables.

A comprehensive prospective longitudinal study of health, development and social adjustment from the age of four to 18 years has been carried out in Uppsala, Sweden. This report presents the accumulated psychosocial burden up to 18 years of age for all 1715 children born in 1965 and resident in Uppsala from age 10 to 18 years. The psychosocial burden up to 18 years of age was assessed through analysis of records and register information from school health services, authorities for care of the handicapped, the Department of Child Psychiatry, social agencies and legal authorities. The analysis showed that 11.8% of the adolescents had a severe psychosocial burden up to the age of 18 years which could hamper their future life as adults. It was possible to categorize the whole birth cohort into one subgroup without manifest psychosocial problems and five different subgroups with serious problems: the six groups (severe mental or physical handicap, antisocial behaviour, psychiatric problems, social support, multiple problems, "normal") had specific profiles concerning sex distribution, symptoms, social background, utilization of care services and delinquency.

Growing up in Uppsala. Part II. Could adolescents with severe psychosocial problems have been identified by symptoms observed in school at age 10 years?

The study comprised all 1715 children born in 1965 and resident in Uppsala at age 10 and 18 years. Data were collected through teacher interviews and analysis of school health records in grade 3 at the age of 10 years. The psychosocial burden up to the age of 18 years was assessed on the basis of all registered contacts with official institutions outside school (authorities for care of the handicapped, Department of Child Psychiatry, social agencies, legal authorities). Approximately 12% of the adolescents were clearly in a situation of manifest psychosocial risk on the threshold of adult life. These adolescents were assigned to five mutually exclusive problem groups comprising different sex distribution, symptoms and utilization of institutional care. The analysis of the relationship between data from grade 3 and the psychosocial burden up to 18 years of age showed that the information available to the school did not permit reasonably secure predictions of the child's psychosocial situation at the end of adolescence. Observations in school of pre-adolescent children cannot be used as a basis for risk-group strategies aiming at concentrating early treatment measures and resources to a restricted number of children at risk. However, the prognosis is apparently serious for a limited number of 10-year-olds with serious problems in school.

Rapidly developing overweight in school children as an indicator of psychosocial stress.

From a cohort of 971 Swedish children followed up from birth through 15 years of age, all the children who had shown an increment in relative weight of more than 15% (measured weight in % of standard weight for height) between the ages of 7 and 10 years (group A, n = 25), 10 and 13 years (group B, n = 23), and 7 and 13 years (group C, n = 22) were selected for the present study. For each case a control matched for sex and relative weight at 7 (groups A and C) or 10 years (group B) was selected. The degree of psychosocial stress was estimated by two raters on the basis of all the accumulated data in the school health records and of the personal knowledge of the school nurses. There was good agreement between the raters. A significant difference in the degree of psychosocial stress was found between cases and controls. An analysis of specific items revealed differences with respect not only to soft data, but also to objective facts (continuation of school after completion of the nine years of compulsory school). It is concluded that a rapid weight gain during school years may be an indicator of psychosocial problems.

Further evidence of an association between psychosocial problems and increase in relative weight between 7 and 10 years of age.

A sample of 5,399 Swedish schoolchildren was subdivided into five groups according to the change in relative weight between the ages of 7 and 10 years and the relative weight attained at 10 years. Information on indicators of psychosocial problems was obtained by teacher interviews. There was a significant variation between groups with regard to the prevalence of behavioral and learning problems, and in girls also concerning social problems. The highest prevalence of problems was consistently found in the group with a rapid gain in relative weight. The association was stronger for serious than for mild problems. A causal mechanism is assumed to be the most probable explanation. The implications with respect to research and clinical practice are discussed.

Long-term follow-up of children breast-fed by mothers using oral contraceptives.

In a long-term follow-up study 48 breast-fed children, whose mothers had used oral contraceptives containing 50 micrograms of ethinylestradiol while lactating, were compared to a matched control group whose mothers had not used any hormonal contraceptives during lactation. In spite of a very large number of data collected from several different sources of information, no effect could be demonstrated of the ingested steroid, neither upon the panorama of diseases nor upon intellectual or psychological behaviour of the infants and children up to 8 years of age. The mothers who used oral contraceptives lactated a significantly shorter period of time than the controls, but no differences were found in weight gain and height increase in the children between cases and controls.

PIP: When lactating women use hormonal contraceptives, small amounts of the steroids are transferred to the breast milk; these steroids can also be detected in infants' plasma after breastfeeding. In a long-term follow-up study 48 breast-fed children, whose mothers had used oral contraceptives (OCs) containing .50 microgram of ethinylestradiol while lactating, were compared to a matched control group whose mothers had not used hormonal contraceptives during lactation. The only significant difference between cases and controls was a shorter lactating period for the women who had used OCs. However, the study demonstrated no effect of the steroid ingested during the suckling period, neither upon the panorama of diseases nor upon intellectual or psychological behavior of the infants and children up to 8 years of age. The study looked at the 1st, 2nd, and 3rd consecutive illnesses of the children who became diseased as well as the age at debut and degree of difficulty; no significant differences were found between cases and controls. Nor were there any differences between the 2 groups according to a special control of 4-year old children or at school start. Also, no differences were found in weight gain and height increase between cases and controls. Admittedly, the present study includes a limited number of cases and controls. However, for each child a very large number of data was collected from several different sources of information and sets of data are complete for all cases and controls. The time period of observation in this prospective study is now 8 years; the study will be continued beyond puberty.

Plasma androgenic activity in women with acne vulgaris and in healthy girls before, during and after puberty.

The possible relationship between plasma androgenic activity and acne vulgaris was investigated. Plasma testosterone and sex hormone binding globulin (SHBG) levels were determined in healthy girls during different stages of puberty, in healthy adult women and in women with acne vulgaris. Testosterone increase during puberty, whereas SHBG decreased during the early stages before it increased and stabilized plasma concentrations of testosterone and SHBG. Women with severe acne vulgaris had testosterone levels in the same range but the SHBG levels were significantly lower than those of healthy women and women with mild acne. These results show a high androgenic activity in the intermediate stages of puberty, when acne vulgaris is a common complaint and an increased androgenic activity in adult women with severe acne vulgaris.

Obesity in 10-year-olds: an epidemiologic study.

With a multifactorial pathogenetic model (heredity versus environment, central nervous control, energy balance, morphology of the fat tissue), an attempt was made by this study to assess the relative importance of the various factors to the origin of overweight and obesity in school children. From an original sample of 972 children followed longitudinally from the ages of 7 to 16 years, and with retrospective weight data from the first year of life, 550 were selected for this study at age 10. Information concerning the children's habits (physical activity and appetite), social conditions, and parental heights and weights were obtained from the parents by questionnaire (response rate 94%). The major results of a multiple regression analysis were: (1) clear-cut sex differences; heredity and physical inactivity having the greatest explanatory power for both overweight and obesity at 10 years in girls, whereas appetite and environmental conditions were more prominent predictors in boys; (2) an analysis of the main predictors of the variable "change in relative weight between 7 and 10 years"--a variable with possible implications for preventive school programs--indicated that markedly inactive only children from lower class families are particularly at risk of developing obesity during the first years at school; and (3) in the absence of all the risk factors considered in this study, obesity does not occur; at the other extreme, even a high risk score still implies a 50% chance of escaping the fate of obesity.

Penicillinase production in community strains of staphylococcus aureus.

A survey of penicillinase production in 406 strains of Staphylococcus aureus isolated from wounds in the County of Uppsala in 1975 showed that 76% of strains from inpatients produced penicillinase compared to 69% of the outpatient strains. The frequency of penicillinase production in Staph. aureus strains from surgical staff was 59%. 51% of strains from school children and 38% of strains from healthy adults produced penicillinase. The conclusions are that ordinary penicillinase-sensitive penicillin should not be used for treating infections in outpatients unless the isolated aureus strain has been shown to be penicillinase-negative.

Relationship of weight gain in infancy to subcutaneous fat and relative weight at 10 1/2 years of age.

In a representative sample of 895 schoolchildren, aged between 9 years 10 months and 11 years 2 months, the risk of being overweight or obese was compared between those who had gained weight rapidly during infancy and those whose weight gain had been normal. A substantially increased risk ratio was found only in boys for whom a correlation analysis showed that the total weight gain during the first year of life was associated with the total body mass in relation to height, more or less independently of the degree of fatness at 10 1/2 years of age. In girls, a direct but very weak association was found between weight gain in infancy and the degree of fatness at 10 1/2 years. The implications of these findings with respect to aetiology and the possibilities of prevention are briefly discussed.

Weight gain in infancy and physical development between 7 and 10 1/2 years of age.

Heights and weights were measured in 963 10-year-old children, whose weight data from the first year of life were available. Rapid weight gain in infancy was arbitrarily defined on the basis of sex-specific percentiles of weight gain at four-month intervals and from birth to 12 months. In girls, no significant association between rapid weight gain in infancy and overweight at 10 1/2 years was found. In boys, the association was significant for severe overweight (greater than 120% of standard weight for height). An estimation of the possible benefit of an intervention programme (food restriction in all male infants with rapid weight gain) showed, however, that at the very best 12% of the boys treated in this way could be expected to gain some benefit. The result of a correlation analysis between weight gain in infancy and change in height and relative weight between 7 and 10 1/2 years suggested that the factors which determined weight gain in infancy were no longer operative at ages between 7 and 10 1/2 years.

Zinc and vitamin A: serum concentrations of zinc and retinol-binding protein (RBP) in healthy adolescents.

The concentrations of serum zinc and retinol-binding protein (RBP) have been studied with special reference to pubertal development in 132 healthy adolescents and young adults (11-26 years of age). The RBP level remained low during the first three of the five stages of puberty (mean, about 30 mg/l). When puberty degree 4 had been reached, the mean RBP level increased to nearly adult values (about 40 mg/l), the boys having somewhat higher levels than the girls. Use of oral contraceptives significantly increased the RBP level. The mean zinc values were rather constant throughout puberty, but boys 13-14 years of age had significantly depressed values. There was a statistically significant correlation between the serum levels of zinc and RBP.