Always stay cheerful - health information in the 1920s. / Vær alltid i godt humør ­ helseopplysning i 1920-årene.

BACKGROUND: The interwar period was a time of comprehensive preventive health programmes in Norway. Physical exercise, nutritious diets, strict sleep regimens and better hygiene were at the centre of these efforts. A massive mobilisation of volunteers and professionals took place. The publication of House Maxims for Mothers and Children was part of this large-scale mobilisation, and consisted of ten posters with pithy health advice for hanging on the wall. Mothers were an important target group for health promotion. MATERIAL AND METHOD: The posters have previously received little attention in medical literature, but they can elucidate some features of life and the health propaganda of their time. We have used databases that provide access to newspapers, books and medical literature: Retriever, bokhylla.no, Oria, PubMed and Web of Science. RESULTS: It is hard to quantify the effect of this popular movement when compared to political measures to improve living conditions. In any case, mortality rates fell, life expectancy increased and the dreaded communicable diseases were largely defeated. Special efforts were targeted at children, also with good results. Infant mortality fell and schoolchildren became healthier, stronger, taller and cleaner. INTERPRETATION: The line between social hygiene and general disciplining is blurred, for example the boundary between a healthy diet and bourgeois norms. The education of mothers and children also included a normative aspect that concerned good manners and control.

Re-examining the link between prenatal maternal anxiety and child emotional difficulties, using a sibling design.

Background: Prenatal exposure to maternal anxiety has been associated with child emotional difficulties in a number of epidemiological studies. One key concern, however, is that this link is vulnerable to confounding by pleiotropic genes or environmental family factors. Methods: Data on 82 383 mothers and children from the population-based Mother and Child Cohort Study and data on 21 980 siblings were used in this study. Mothers filled out questionnaires for each unique pregnancy, for infant difficulties at 6 months and for emotional difficulties at 36 months. The link between prenatal maternal anxiety and child difficulties were examined using logistic regression analyses and multiple linear regression analyses for the full study sample and the sibling sample. Results: In the conventional full-cohort analyses, prenatal exposure to maternal anxiety was associated with child difficulties at both 6 months [odds ratio (OR) = 2.1 (1.94-2.27)] and 36 months [OR = 2.72 (2.47-2.99)]. The findings were essentially the same whether we examined difficulties at 6 months or at 36 months. However, these associations were no longer present once we controlled for potential social and genetic confounders in the sibling comparison analyses, either at 6 months [OR = 1.32 (0.91-1.90)] or at 36 months [OR = 1.28 (0.63-2.60)]. Findings from multiple regression analyses with continuous measures were essentially the same. Conclusions: Our finding lends little support for there being an independent prenatal effect on child emotional difficulties; rather, our findings suggest that the link between prenatal maternal anxiety and child difficulties could be confounded by pleiotropic genes or environmental family factors.

[Overweight children--how important is the urban/rural factor?]. / Overvekt hos barn--hvilken betydning har bosted?

BACKGROUND: Targeted measures to prevent overweight children are dependent on a knowledge of which environmental factors play a part. We wanted to investigate whether overweight in Norwegian eight-year-olds is related to whether they live in urban or rural areas. MATERIAL AND METHOD: In the cross-sectional study "Children's growth in Norway 2008", the weight, height and waist of 3473 eight-year-olds were measured. We examined relationships between overweight and waist measurement and centrality, population density and number of inhabitants in the municipalities where the children lived by means of regression analyses. RESULT: In adjusted analyses, the odds on children in central municipalities being overweight was 34 lower than for children in less central municipalities (OR = 0.66; 95 % CI: 0.46-0.94), and children in municipalities with a high population density had on average 0.66 cm smaller waists than children in municipalities with a low population density (95 % CI: 0.02-1.31). The relationships between overweight and the explanatory variables population density and number of inhabitants, and between waist measurement and the explanatory variables centrality and population density showed the same tendency, but were not statistically significant in the adjusted analyses. INTERPRETATION: The results indicate that there is a higher percentage of overweight children in rural areas than in urban areas. Education and income level in the municipalities appeared to explain some of the effect of the urbanity variables on overweight and waist measurement.

Childhood abuse and later worries about the baby's health in pregnancy.

OBJECTIVE: to explore the associations between sexual and/or physical abuse in childhood and worries about the baby's health in pregnancy. DESIGN: cross-sectional questionnaire study. Setting. Norwegian prospective pregnancy cohort. SAMPLE: an original sample of 58,139 pregnancies (1999-2006) covering about 43% of the pregnant population. METHODS: two self-reported questionnaires in the 17th and 30th week of gestation were merged with data from the Medical Birth Registry of Norway. Associations between physical and/or sexual childhood abuse and worries about the baby's health were assessed with multiple logistic regression analyses. MAIN OUTCOME MEASURES: strong worries about the baby's health in the 30th week of gestation among women with experience of childhood abuse. RESULTS: women who reported being exposed to physical or sexual childhood abuse or a combination of the two were at increased risk of strong worries about the baby's health compared to women who had not been similarly exposed (adjusted odds ratio (OR) = 1.62, 95% confidence interval (CI) 1.26-2.08; adjusted OR = 1.30, 95% CI 1.03-1.64; adjusted OR = 2.10, 95% CI 1.68-2.62, respectively). Marital status, adult abuse, pelvic pain, quality of antenatal care, self-efficacy and previous birth experiences were also associated with concern about the baby's health. CONCLUSIONS: there were significant associations between physical and/or sexual childhood abuse and strong concern about the baby's health. Worries about the baby's health are complex and associated with many elements of risk.

Postpartum depression among Pakistani women in Norway: prevalence and risk factors.

OBJECTIVE: To assess the prevalence of and risk factors for postpartum depression among Pakistani women in Norway. METHODS: A total of 207 pregnant Pakistani women living in Norway participated in a questionnaire study. The author interviewed the women face to face during pregnancy and 6 to 12 weeks after delivery. The Edinburgh postnatal depression scale was used to identify the risk cases. RESULTS: Only 7.6% of the immigrant Pakistani women were depressed postpartum. High scores on the life event scale, a history of prior depression, single marital status, a poor relationship to one's partner and an age of 30 years or more were found to be significant risk factors for postpartum depression. CONCLUSIONS: The prevalence of postpartum depression among immigrant Pakistani women seems to be low compared with the prevalence reported in immigrant populations elsewhere, it was however only slightly lower than the study of ethnic Norwegians (8.9%). The risk factors were similar to results from international reports; moreover, there were few cultural differences in risk factors between ethnic Norwegian and Pakistani immigrants.

Overweight and obesity among adolescents in Norway: cultural and socio-economic differences.

BACKGROUND: The aim of this study was to investigate overweight and obesity among a representative population of 15,966 Norwegian 15-16 year olds and the associations with different socio-economic and cultural risk factors. METHODS: Self-reported data were obtained from school-based surveys in six counties during 2000-04. Overweight and obesity were calculated using Cole's index. RESULTS: The prevalence of overweight and obesity were 11.8% and 2.4%, respectively, higher among boys. Logistic regression analyses revealed that adolescents in Nordland, Troms and Finnmark (the northernmost counties) were 70-90% more likely to be overweight and obese compared with adolescents in Oslo (the capital and southernmost county) (OR for overweight in Finnmark = 1.7, CI = 1.3, 2.3). Lower educational plans and poor family economy were both significantly associated with overweight and obesity. So was physical inactivity (OR = 1.2, CI = 1.1, 1.3 and OR = 1.6, CI = 1.2, 2.1, respectively). Eating breakfast was positively associated with not being overweight/obese. CONCLUSION: Overweight and obesity is associated with socio-economic factors and with factors related to food habits and nutrition, suggesting important areas for prevention.

[Sense of coherence for parents of disabled children]. / Mestring hos foreldre til barn med funksjonshemninger.

BACKGROUND: The link between chronic illness in children and their parents' sense of coherence has not previously been studied in Norway. MATERIAL AND METHOD: The study population was composed of two different samples. The first sample was randomised and taken from children in Norway aged 2 to 17 years in 1996. The other sample was not randomised and was taken from children aged 4 to 16 years staying at Frambu (national centre of expertise and information for rare disabilities) in the period from ultimo 1995 to primo 1997. Parents answered a questionnaire for both samples. RESULTS: The results showed a link between chronic illness and disabilities in children and their parents' poor sense of coherence. High odds for a poor sense of coherence were most common among parents of mentally disabled children (OR = 2.05, KI = 1.14-3.69). Parents of children with chronic illness and disabilities scored higher for the dimensions meaningfulness and comprehension, compared with parents who had children without such problems. CONCLUSIONS: Our findings indicate that parents of mentally disabled children are more vulnerable than parents of children without a chronic disease or functional impairment, and also more vulnerable than parents of children with other chronic disease/functional impairments.

The biobank of the Norwegian Mother and Child Cohort Study: a resource for the next 100 years.

INTRODUCTION: Long-term storage of biological materials is a critical component of any epidemiological study. In designing specimen repositories, efforts need to balance future needs for samples with logistical constraints necessary to process and store samples in a timely fashion. OBJECTIVES: In the Norwegian Mother and Child Cohort Study (MoBa), the Biobank was charged with long-term storage of more than 380,000 biological samples from pregnant women, their partners and their children for up to 100 years. METHODS: Biological specimens include whole blood, plasma, DNA and urine; samples are collected at 50 hospitals in Norway. All samples are sent via ordinary mail to the Biobank in Oslo where the samples are registered, aliquoted and DNA extracted. DNA is stored at -20 degrees C while whole blood, urine and plasma are stored at -80 degrees C. RESULTS: As of July 2006, over 227,000 sample sets have been collected, processed and stored at the Biobank. Currently 250-300 sets are received daily. An important part of the Biobank is the quality control program. CONCLUSION: With the unique combination of biological specimens and questionnaire data, the MoBa Study will constitute a resource for many future investigations of the separate and combined effects of genetic, environmental factors on pregnancy outcome and on human morbidity, mortality and health in general.

[Revisiting the Forsdahl-Barker hypothesis]. / Gjensyn med Forsdahl-Barker-hypotesen.

The hypothesis about the influence of the environment in early life for later health and development has been the basis for several hundred studies over the last two decades. Despite some diverging results in different studies and methodological shortcomings, including selection and confounding from socio-economic and other factors, there seems to be substantial evidence to the effect that the environment in early life is essential for later health and development. The association of low birthweight and risk of cardiovascular disease later in life is the most consistent finding, though the causal pathways for this connection have not been traced. Permanent damage caused by inadequate nutrition in critical periods of early life expressed as chronic disease later in life is a favoured hypothesis. To further elucidate potential mechanisms, there is a need for refining the measurement parameters for early experience. Placenta function, quality of nutrition, infections, hormonal and genetic factors may also play a role. The course-of-life approach claims that early life is an important period in human life, but not the only one. Continuous life events and socio-economic circumstances may modify early life experiences. Such an approach may be useful in order to see early life events in the right perspective.

[Occasional smoking--an increasing problem]. / Av-og-til-røyking--et økende problem.

Little attention is given to occasional smoking compared with daily smoking. However, there are indications that there is a continuous increase in occasional smoking throughout the western world. In Norway, 33% of smokers do not smoke daily. Little is known about these smokers' background, how often they smoke, and how many cigarettes they consume when they do smoke. Studies indicate that occasional smokers seem to differ from regular smokers in their socio-demographic characteristics. In this article we show that a proportion of the occasional smokers smoke more than previously assumed. Therefore this smoking pattern may have greater implications for health than previously assumed and can no longer be ignored.

[Postnatal care in a cross-cultural and historical perspective]. / Barselomsorg i et tverrkulturelt og historisk perspektiv.

BACKGROUND: In most societies, birth and the immediate postpartum period are considered a time of vulnerability for mother and child. Rituals for major changes in the life cycle are common in most societies. The aim of this study was to present some examples of postpartum customs in a cross-cultural and historical perspective. We also present research on associations between postnatal care and mental health. MATERIAL AND METHODS: A systematic search was performed in Medline and the Science Citation Index Expanded (ISI) from 1966 until March 2003. Reference lists in books about pregnancy and birth from the library of the University of Oslo were used to get additional information. RESULTS: The postnatal period is defined as approximately 40 days in most cultures; most societies have special postnatal customs that include special diet, isolation, rest and help in the household. The resemblance between different cultures is striking. Many postnatal customs from rural societies that were common before 1950 have disappeared. The focus on rest and help in the household for the mother after delivery has been reduced. INTERPRETATION: We need more knowledge about the impact of different kinds of postnatal care on the mother's wellbeing.

Recurrent pain in children, socio-economic factors and accumulation in families.

The aim of this study was to estimate the prevalence of parent-reported pain among children in the Nordic countries in 1996, and to describe the association between recurrent pain in children and parental socio-economic factors. We also wanted to estimate the association between parental pain and childhood pain and co-occurrence of different pain patterns in the same child. Data were obtained from a cross-sectional survey on children's health and well-being in the Nordic countries in 1996. About 10,000 children aged 2-17 years of age were selected from population registries. Mean response rate was 68%. We selected the cases > or = 7 years where the respondent was the child's biological mother or father, yielding a total of 6230 subjects. The adjusted analyses were performed using logistic regression in SPSS. The total prevalence of headache, abdominal pain and back pain among children 7-17 years of age was 14.9, 8.3 and 4.7%, respectively. The most common pain combination was headache and abdominal pain. Pain was most frequent among girls. The prevalence was slightly higher in low educated or low-income families compared to those of high status. Children living in low educated, low-income, worker families had approximately a 1.4-fold odds of having pain. There was a strong association between the different pain conditions, and between pain and other forms of distress in the same child. A site-specific association between parental and child pain was also shown, but we assume that this might have been mediated through subjective (information) bias.

Is parental sense of coherence associated with child health?

Antonowsky's concept of sense of coherence (SOC) has, during recent years, gained increased attention as a salutogenic model on the relationship between health and disease. However, only sparse information connecting child chronic health conditions to parental SOC is yet available. This article presents results from a cross-sectional study of about 10,000 children aged 2-17 years in the five Nordic countries in 1996. Factors associated with parental SOC were analysed, with focus on child chronic health conditions. Sense of coherence was measured according to a short and condensed three-item instrument based on Antonovsky's original 29-item instrument. Overall, about 23% of parents in Nordic countries had a poor sense of coherence, the lowest proportion found among Icelandic parents. Compared to the higher social classes, poor SOC was more common in the lower social classes. The association of child chronic health conditions with parental poor SOC was found to be disability specific. Parents of children with diabetes, epilepsy or psychiatric/nervous problems had approximately 2-5 higher odds of having poor SOC compared to parents of children without a specific diagnosis. The overall effect of having a child with chronic health conditions was, however, low, lower than the effect of the parents' own health complaints.

Health service utilization in the Nordic countries in 1996: Influence of socio-economic factors among children with and without chronic health conditions.

BACKGROUND: Previous studies have shown social, economic and psychological factors that influence consulting behaviour, but the health service use of children is seldom studied. METHOD: Data from a cross-sectional study conducted in 1996 including approximately 10,000 children aged 2-17 years in the Nordic countries were analysed according to health service use, measured as consulting a general practitioner (GP) or a specialist during the last three months prior to the survey. RESULTS: Approximately one-fifth of the children in the survey had visited a GP and about one-seventh had visited a specialist. Highest consulting behaviour was found among children with chronic health conditions. Visiting a GP or a specialist varied across the Nordic countries, the pattern depending on disease status. Specialist utilization was higher in towns than in rural areas. Social inequality in the use of specialist, but not GP health services, was present, mainly among children with chronic health conditions. And further, compared to white-collar parents, a higher proportion of working class parents judged specialist health services as important when consulting a doctor because of the child's health problem. CONCLUSION: In all the Nordic countries GP use did not depend on social class, and utilization of specialist health services was mainly unrelated to social class among children without chronic health conditions. Specialist use was associated with high socio-economic status among children with chronic health conditions, despite the observation that a higher proportion of parents in the lower social classes judged specialist health services as important when consulting a doctor.

[Recurrent pain in children and parents--no factual evidence of familial pain clustering]. / Gjentatte smerter hos barn og foreldre--få holdepunkter for familiaer smerteopphopning.

Recurrent pain in children is a universal phenomenon, which occurs in about 50 percent of all children. The most prevalent pain areas are the stomach, head, back and neck/shoulders. A somatic cause of the symptoms is seldom found, but the pain is often related to other discomforts, problems or lack of family functioning. There has been a common belief that "pain runs in families". In our investigation of 358 mother-father-child trios, where the members reported on their own symptoms, we found little support for this hypothesis. There is a need for further research on these problems, where the study design and measure instruments should be carefully validated.